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Rescue analgesia with a transversus abdominis plane block alleviates moderate-to-severe pain and improves oxygenation after abdominal surgery: a randomized controlled trial. 腹横肌平面阻滞镇痛可减轻腹部手术后的中度至重度疼痛并改善氧合:随机对照试验。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1454665
Jingxian He, Shuai Qin, Yuwen Wang, Qiuping Ye, Penglei Wang, Ye Zhang, Yun Wu

Background: Abdominal surgery is a common surgical procedure that is frequently associated with substantial postoperative pain. However, rescue analgesia using opioids is associated with several adverse effects. The transversus abdominis plane block (TAPB) has been demonstrated to be effective as part of multimodal analgesia. This study aims to evaluate the effects of rescue analgesia using the TAPB following abdominal surgery.

Methods: Ninety patients undergoing abdominal surgery and reporting a numeric rating scale (NRS) score of cough pain ≥4 on the first postoperative day were randomized to receive either sufentanil or TAPB for rescue analgesia. Pain scores and arterial oxygen pressure (PaO2) were evaluated before and after the administration of rescue analgesia. Sleep quality and gastrointestinal function were assessed postoperatively. The primary outcome was the degree of pain relief on coughing 30 min after the administration of rescue analgesia.

Results: Patients of both groups reported a significantly reduced NRS score on coughing 30 min after receiving rescue analgesia (P paired < 0.001 for both groups). Notably, the degree of pain relief was significantly higher in the TAPB group than in the sufentanil group [median (interquartile range), -3 (-4 to -2) vs. -2 (-2 to -1), median difference = -1; 95% confidence interval, -2 to -1; P < 0.001]. Moreover, patients in the TAPB group experienced less pain than those in the sufentanil group during the following 24 h. When evaluated, PaO2 increased significantly after rescue analgesia was administered in the TAPB group (P paired < 0.001); however, there were no significant intragroup differences in the sufentanil group (P paired = 0.129). Patients receiving the TAPB experienced better quality of sleep than those receiving sufentanil (P = 0.008), while no statistical differences in gastrointestinal function were observed between the two groups.

Conclusion: Rescue analgesia with the TAPB on the first postoperative day alleviated pain, enhanced oxygenation, and improved sleep quality in patients undergoing abdominal surgery; however, its effect on gastrointestinal function requires further research.

Clinical trial registration: This study was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=170983, ChiCTR2200060285) on 26 May 2022: Patients were recruited during the period between 30 May 2022 and 14 February 2023, and a follow-up of the last enrolled patient was completed on 16 March 2023.

背景:腹部手术是一种常见的外科手术,经常伴有剧烈的术后疼痛。然而,使用阿片类药物进行抢救性镇痛会产生一些不良反应。作为多模式镇痛的一部分,腹横肌平面阻滞(TAPB)已被证明是有效的。本研究旨在评估腹部手术后使用腹横肌平面阻滞进行抢救性镇痛的效果:方法:90 名接受腹部手术且术后第一天咳嗽疼痛评分≥4 分的患者随机接受舒芬太尼或 TAPB 进行镇痛。在使用镇痛抢救前后对疼痛评分和动脉氧压(PaO2)进行了评估。术后对睡眠质量和胃肠功能进行了评估。主要结果是使用镇痛剂 30 分钟后咳嗽时疼痛的缓解程度:结果:两组患者在接受镇痛抢救 30 分钟后咳嗽的 NRS 评分均明显降低(TAPB 组患者在镇痛抢救后咳嗽的 NRS 评分明显升高(P 2 = 0.129))。与接受舒芬太尼镇痛的患者相比,接受TAPB镇痛的患者的睡眠质量更好(P = 0.008),而两组患者的胃肠功能没有统计学差异:结论:术后第一天使用 TAPB 进行镇痛可减轻腹部手术患者的疼痛,增强氧合,改善睡眠质量;但其对胃肠功能的影响还需进一步研究:本研究于 2022 年 5 月 26 日在中国临床试验注册中心(https://www.chictr.org.cn/showproj.html?proj=170983,ChiCTR2200060285)注册:患者招募时间为 2022 年 5 月 30 日至 2023 年 2 月 14 日,最后一名入组患者的随访于 2023 年 3 月 16 日完成。
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引用次数: 0
Pediatric pain physician workforce: an assessment of supply and demand. 儿科疼痛医生队伍:供需评估。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-15 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1390736
Christopher B Theriault, Tracy Burns, Kenneth Goldschneider, Anjali Koka, Deirdre Logan, Steven J Weisman, Robert T Wilder, R Blake Windsor, William T Zempsky

Introduction: Many youth with pain lack access to pediatric pain expertise. There is a critical shortage of pediatric pain physicians, due partly to a paucity of training programs in Pediatric Pain Medicine. Pain fellowships are Anesthesiology-based and there is no pathway to fellowship training or Pain Medicine board certification for pediatricians. This workforce assessment sought to examine the current state of Pediatric Pain Medicine in the United States and future interest in pursuing Pain Medicine among pediatricians.

Methods: A multidisciplinary working group of Pain Medicine clinicians designed three surveys to examine pediatric comprehensive pain programs in the US, practice patterns of pediatricians and their motivations and opinions regarding Pain Medicine board certification, and current residents' exposure to and interest in Pediatric Pain Medicine.

Results: Wait times for initial evaluations are two months or longer for two-thirds of responding centers, and barriers to increase staff size and resources were reported, including an inadequate number of trained or available physicians. Pediatricians expressed interest in earning board certification in Pain Medicine, given the opportunity. Additionally, there is interest among pediatric residents in pursuing Pediatric Pain Medicine, and qualitative data highlight information residents perceived needing in order to pursue a career in the field.

Discussion: Results demonstrate the need for increased training opportunities in pediatric pain medicine. A formal pathway to Pain Medicine for Pediatricians should be developed to increase the potential workforce and to address the lack of trained pediatric pain specialists, thereby improving access to care for youth with pain.

导言:许多患有疼痛的青少年无法获得儿科疼痛方面的专业知识。儿科疼痛医生严重短缺,部分原因是儿科疼痛医学培训项目太少。疼痛研究金以麻醉学为基础,儿科医生没有获得研究金培训或疼痛医学委员会认证的途径。这项人才队伍评估旨在研究美国儿科疼痛医学的现状以及儿科医生未来对疼痛医学的兴趣:一个由疼痛医学临床医生组成的多学科工作组设计了三项调查,以研究美国的儿科综合疼痛项目、儿科医生的执业模式及其对疼痛医学委员会认证的动机和意见,以及目前住院医师对儿科疼痛医学的接触和兴趣:结果:在三分之二的受访中心中,初步评估的等待时间为两个月或更长,并且报告了增加人员规模和资源的障碍,包括训练有素或可用的医生数量不足。儿科医生表示,如果有机会,他们有兴趣获得疼痛医学委员会的认证。此外,儿科住院医师也有兴趣学习儿科疼痛医学,定性数据强调了住院医师认为从事该领域工作所需的信息:讨论:研究结果表明,有必要增加儿科疼痛医学的培训机会。应为儿科医生开发一条通往疼痛医学的正规途径,以增加潜在的劳动力,解决缺乏训练有素的儿科疼痛专家的问题,从而改善患有疼痛的青少年获得护理的机会。
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引用次数: 0
Evaluating pain in non-verbal critical care patients: a narrative review of the critical care pain observation tool and Its clinical applications. 评估非语言危重症患者的疼痛:危重症疼痛观察工具及其临床应用的叙述性回顾。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-15 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1481085
Abebe Dilie Afenigus

Background: Assessing pain in critically ill patients who cannot communicate verbally poses significant challenges. Traditional self-report measures are ineffective for these patients, making the need for reliable observational tools crucial.

Objective: To evaluate the effectiveness, reliability, and clinical applicability of the Critical Care Pain Observation Tool (CPOT) in various intensive care unit (ICU) settings and to explore potential innovations for improving its use and integration into clinical practice.

Methods: A narrative review evaluated the Critical Care Pain Observation Tool (CPOT) for non-communicative ICU patients, comparing it to the Behavioral Pain Scale (BPS) and the FLACC scale. The review assessed CPOT's effectiveness across different ICU settings, identified limitations and challenges, and explored potential enhancements such as electronic scoring, additional physiological indicators, and improved training protocols.

Results: The CPOT has been validated as an effective pain assessment tool for non-verbal ICU patients. It evaluates pain through facial expressions, body movements, muscle tension, and ventilator compliance. The CPOT shows superior sensitivity at 76.5% compared to 62.7% for the BPS and offers a more comprehensive assessment of pain indicators like muscle tension and ventilator compliance than the FLACC scale. Despite its strengths, the CPOT has limitations, including inter-rater variability and challenges in certain patient populations. Barriers to implementation include resource constraints and the need for extensive training.

Conclusion: The Critical Care Pain Observation Tool (CPOT) is a highly effective instrument for assessing pain in non-verbal ICU patients, demonstrating superior accuracy and reliability compared to other tools like the Behavioral Pain Scale (BPS) and FLACC scale. Its detailed approach, covering facial expressions, body movements, muscle tension, and ventilator compliance, offers a detailed measure of pain. However, challenges such as inter-rater variability and limitations in specific patient populations highlight the need for ongoing refinement and research.

背景:对无法进行语言交流的重症患者进行疼痛评估是一项重大挑战。传统的自我报告方法对这些病人无效,因此需要可靠的观察工具:评估重症监护疼痛观察工具(CPOT)在各种重症监护病房(ICU)环境中的有效性、可靠性和临床适用性,并探索改进其使用和融入临床实践的潜在创新方法:一项叙述性综述评估了重症监护疼痛观察工具(CPOT)在非交流性 ICU 患者中的应用,并将其与行为疼痛量表(BPS)和 FLACC 量表进行了比较。该研究评估了 CPOT 在不同 ICU 环境中的有效性,确定了其局限性和面临的挑战,并探讨了潜在的改进措施,如电子评分、附加生理指标和改进培训方案等:结果:CPOT 已被证实是 ICU 非语言病人的有效疼痛评估工具。它通过面部表情、肢体动作、肌肉紧张度和呼吸机顺应性来评估疼痛。CPOT 的灵敏度高达 76.5%,高于 BPS 的 62.7%,与 FLACC 量表相比,CPOT 能更全面地评估肌肉紧张度和呼吸机顺应性等疼痛指标。尽管 CPOT 有其优势,但也有其局限性,包括评分者之间的差异和在某些患者群体中的挑战。实施的障碍包括资源限制和需要大量培训:危重症疼痛观察工具(CPOT)是一种评估ICU非语言患者疼痛的高效工具,与行为疼痛量表(BPS)和FLACC量表等其他工具相比,其准确性和可靠性更胜一筹。该方法涵盖面部表情、肢体动作、肌肉紧张度和呼吸机顺应性等细节,可对疼痛进行详细测量。然而,评分者之间的差异和在特定患者群体中的局限性等挑战凸显了不断改进和研究的必要性。
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引用次数: 0
Enhancing analgesia in acute renal colic pain: a randomized controlled trial of gabapentin adjunct to ketorolac-based regimen. 增强急性肾绞痛的镇痛效果:加巴喷丁辅助酮咯酸疗法的随机对照试验。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-14 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1427711
Parisa Kianpour, Parmis Valavioun, Pooya Payandemehr, Arash Safaei, Yasaman Borhani, Hooshyar Honarmand, Mojtaba Mojtahedzadeh, Kamal Basiri, Elahe Karimpour-Razkenari, Farhad Najmeddin

Background: Renal colic is characterized by severe pain that is highly disabling. Gabapentin, an antiepileptic medication, is often recommended as a first-line therapy for neuropathic pain. However, its effectiveness in managing somatic pain, which is defined as the result of activity by pain receptors in the deep tissues, such as renal colic pain, is not as well-established.

Method: A phase 3 randomized clinical trial was conducted to evaluate the adjuvant analgesic effects of gabapentin on acute renal colic pain. Eligible patients participated in the study via random allocation to the control or gabapentin groups using the block randomization method. All patients received a shared regimen of ketorolac and rescue morphine as the conventional analgesic treatment for renal colic pain. Gabapentin was added as an adjuvant analgesic for the gabapentin group.

Result: A total of 63 individuals with an average age of 41.35 ± 13.08, were enrolled and completed the study. At the time of admission, there were no significant differences between the baseline characteristics of two groups, with exception of weight. The gabapentin group showed a significantly higher percentage of patients with pain severity of less than 5 after 60 and 90 min, as well as a significantly lower percentage of morphine rescue requirement and total morphine intake (mg) and mg/kg.

Conclusion: In cases of acute renal colic, gabapentin significantly decreases both the amount of morphine required and the degree of pain, indicating that it may be a useful adjutant to standard analgesic regimens. Treatment regimens that include gabapentin may help individuals manage their pain and become less reliant on opioids.

Clinical trial registration: https://irct.behdasht.gov.ir/trial/56066, identifier: IRCT20200322046833N2.

背景:肾绞痛的特点是剧烈疼痛,极易致残。加巴喷丁是一种抗癫痫药物,通常被推荐作为治疗神经病理性疼痛的一线疗法。然而,加巴喷丁在治疗躯体疼痛(指深层组织中疼痛受体活动引起的疼痛,如肾绞痛)方面的疗效尚未得到充分证实:我们开展了一项三期随机临床试验,以评估加巴喷丁对急性肾绞痛的辅助镇痛效果。符合条件的患者通过整群随机法随机分配到对照组或加巴喷丁组参与研究。所有患者都接受了酮咯酸和吗啡作为肾绞痛常规镇痛治疗的共同方案。加巴喷丁组加入加巴喷丁作为辅助镇痛剂:共有 63 人参与并完成了研究,平均年龄(41.35±13.08)岁。入院时,除体重外,两组患者的基线特征无明显差异。加巴喷丁组患者在 60 分钟和 90 分钟后疼痛严重程度低于 5 级的比例明显更高,需要吗啡抢救的比例和吗啡总摄入量(毫克)和毫克/千克也明显更低:结论:在急性肾绞痛病例中,加巴喷丁能显著减少吗啡用量和疼痛程度,表明它可以作为标准镇痛方案的辅助药物。包含加巴喷丁的治疗方案可帮助患者控制疼痛,减少对阿片类药物的依赖。临床试验注册:https://irct.behdasht.gov.ir/trial/56066,标识符:irct202003220468:IRCT20200322046833N2.
{"title":"Enhancing analgesia in acute renal colic pain: a randomized controlled trial of gabapentin adjunct to ketorolac-based regimen.","authors":"Parisa Kianpour, Parmis Valavioun, Pooya Payandemehr, Arash Safaei, Yasaman Borhani, Hooshyar Honarmand, Mojtaba Mojtahedzadeh, Kamal Basiri, Elahe Karimpour-Razkenari, Farhad Najmeddin","doi":"10.3389/fpain.2024.1427711","DOIUrl":"10.3389/fpain.2024.1427711","url":null,"abstract":"<p><strong>Background: </strong>Renal colic is characterized by severe pain that is highly disabling. Gabapentin, an antiepileptic medication, is often recommended as a first-line therapy for neuropathic pain. However, its effectiveness in managing somatic pain, which is defined as the result of activity by pain receptors in the deep tissues, such as renal colic pain, is not as well-established.</p><p><strong>Method: </strong>A phase 3 randomized clinical trial was conducted to evaluate the adjuvant analgesic effects of gabapentin on acute renal colic pain. Eligible patients participated in the study via random allocation to the control or gabapentin groups using the block randomization method. All patients received a shared regimen of ketorolac and rescue morphine as the conventional analgesic treatment for renal colic pain. Gabapentin was added as an adjuvant analgesic for the gabapentin group.</p><p><strong>Result: </strong>A total of 63 individuals with an average age of 41.35 ± 13.08, were enrolled and completed the study. At the time of admission, there were no significant differences between the baseline characteristics of two groups, with exception of weight. The gabapentin group showed a significantly higher percentage of patients with pain severity of less than 5 after 60 and 90 min, as well as a significantly lower percentage of morphine rescue requirement and total morphine intake (mg) and mg/kg.</p><p><strong>Conclusion: </strong>In cases of acute renal colic, gabapentin significantly decreases both the amount of morphine required and the degree of pain, indicating that it may be a useful adjutant to standard analgesic regimens. Treatment regimens that include gabapentin may help individuals manage their pain and become less reliant on opioids.</p><p><strong>Clinical trial registration: </strong>https://irct.behdasht.gov.ir/trial/56066, identifier: IRCT20200322046833N2.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Non-opioid psychiatric medications for chronic pain: systematic review and meta-analysis. 治疗慢性疼痛的非阿片类精神药物:系统回顾和荟萃分析。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-10 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1398442
Shahana Ayub, Anil Krishna Bachu, Lakshit Jain, Shanli Parnia, Siddhi Bhivandkar, Rizwan Ahmed, Jasleen Kaur, Surya Karlapati, Sakshi Prasad, Hansini Kochhar, Oghenetega Esther Ayisire, Saloni Mitra, Bikona Ghosh, Sushma Srinivas, Sahar Ashraf, Bhavani Nagendra Papudesi, Palash Kumar Malo, Shoib Sheikh, Michael Hsu, Domenico De Berardis, Saeed Ahmed
<p><strong>Background: </strong>The escalating number of deaths related to opioid usage has intensified the pursuit of non-opioid alternatives for managing chronic pain. It's often observed that psychiatric comorbidities coexist in patients suffering from chronic pain. There are a variety of psychotropic medications that have demonstrated effectiveness in treating both psychiatric symptoms and pain. This systematic review and meta-analysis aim to assess the effectiveness of various psychiatric drugs in managing specific types of chronic pain, including fibromyalgia, neuropathic pain, and chronic low back pain.</p><p><strong>Methods: </strong>A comprehensive search of five major databases was conducted through February 2023 to identify randomized controlled trials (RCTs) that met our inclusion criteria, focusing on outpatients Over 18 years of age with chronic pain. The study assessed the effectiveness of duloxetine, mirogabalin, pregabalin, gabapentin, and tricyclic antidepressants (TCAs), including serotonin-norepinephrine reuptake inhibitors (SNRIs), across various chronic pain conditions such as fibromyalgia, neuropathic pain, and chronic low back pain. The primary outcome measures included pain reduction, improvement in function, and quality of life. Of the 29 RCTs in the systematic review, 20 studies qualified for the meta-analysis. The analysis was stratified by pain type and treatment duration (short-term ≤14 weeks vs. long-term >14 weeks), using Hedge's g standardized mean differences and a random-effects model, along with sensitivity and subgroup analyses.</p><p><strong>Results: </strong>The overall short-term intervention effect across all studies was significant (SMD -1.45, 95% CI -2.15 to -0.75, <i>p</i> < 0.001), with considerable heterogeneity (I<sup>2</sup> = 99%). For fibromyalgia, both duloxetine and mirogabalin demonstrated substantial efficacy with SMDs of -2.42 (95% CI -3.67 to -1.18, <i>p</i> < 0.0001) and -2.10 (95% CI -3.28 to -0.92, <i>p</i> = 0.0005), respectively. Conversely, treatments for neuropathic pain and chronic low back pain, including those with amitriptyline and desipramine, did not show significant benefits. The effectiveness of gabapentin could not be conclusively determined due to limited representation in the data. Additionally, no consistent long-term benefits were observed for any of the medications.</p><p><strong>Conclusions: </strong>While the results of this study underscore the importance of exploring non-opioid alternatives for chronic pain management, particularly in light of the opioid crisis, it is crucial to interpret the findings carefully. Our analysis suggests that certain psychiatric medications, such Duloxetine and mirogabalin demonstrated significant short-term efficacy in fibromyalgia patients. However, their effectiveness in treating neuropathic pain and chronic low back pain was not statistically significant. Additionally, the effectiveness of gabapentin and other medications, such as pr
背景:与阿片类药物使用相关的死亡人数不断攀升,加剧了人们对非阿片类药物替代品治疗慢性疼痛的追求。人们经常发现,慢性疼痛患者同时患有精神疾病。有多种精神药物在治疗精神症状和疼痛方面具有疗效。本系统综述和荟萃分析旨在评估各种精神科药物在治疗特定类型慢性疼痛(包括纤维肌痛、神经性疼痛和慢性腰背痛)方面的有效性:我们在 2023 年 2 月之前对五个主要数据库进行了全面检索,以确定符合我们纳入标准的随机对照试验 (RCT),重点是 18 岁以上的门诊慢性疼痛患者。研究评估了度洛西汀、米罗格巴林、普瑞巴林、加巴喷丁和三环类抗抑郁药(TCAs)(包括血清素-去甲肾上腺素再摄取抑制剂(SNRIs))在纤维肌痛、神经性疼痛和慢性腰背痛等各种慢性疼痛病症中的疗效。主要研究结果包括疼痛减轻、功能改善和生活质量。在系统综述的 29 项研究中,有 20 项研究符合荟萃分析的要求。分析按照疼痛类型和治疗时间(短期≤14周与长期>14周)进行分层,采用Hedge's g标准化均值差异和随机效应模型,并进行了敏感性分析和亚组分析:结果:所有研究的总体短期干预效果显著(SMD -1.45,95% CI -2.15 至 -0.75,P 2 = 99%)。对于纤维肌痛,度洛西汀和米罗格巴林都显示出显著疗效,SMD分别为-2.42(95% CI -3.67至-1.18,P = 0.0005)。相反,对神经性疼痛和慢性腰背痛的治疗,包括阿米替林和地西泮,并没有显示出显著的疗效。由于数据代表性有限,无法最终确定加巴喷丁的有效性。此外,没有观察到任何一种药物具有持续的长期疗效:虽然本研究的结果强调了探索非阿片类药物替代品治疗慢性疼痛的重要性,尤其是在阿片类药物危机的背景下,但仔细解读研究结果至关重要。我们的分析表明,某些精神科药物,如度洛西汀和米罗格巴林,对纤维肌痛患者有显著的短期疗效。然而,它们在治疗神经性疼痛和慢性腰背痛方面的疗效在统计学上并不显著。此外,由于数据有限和研究的高度异质性,加巴喷丁和其他药物(如普瑞巴林)对神经病理性疼痛的疗效也无法最终确定。所研究的药物均未观察到持续的长期疗效,这使人们对这些药物在慢性疼痛治疗中的持续疗效产生了疑问。这些发现凸显了进一步研究的必要性,以便更好地了解精神科药物在治疗特定慢性疼痛病症中的作用,而不是过早地断定这些药物无效或不适合用于这些目的。
{"title":"Non-opioid psychiatric medications for chronic pain: systematic review and meta-analysis.","authors":"Shahana Ayub, Anil Krishna Bachu, Lakshit Jain, Shanli Parnia, Siddhi Bhivandkar, Rizwan Ahmed, Jasleen Kaur, Surya Karlapati, Sakshi Prasad, Hansini Kochhar, Oghenetega Esther Ayisire, Saloni Mitra, Bikona Ghosh, Sushma Srinivas, Sahar Ashraf, Bhavani Nagendra Papudesi, Palash Kumar Malo, Shoib Sheikh, Michael Hsu, Domenico De Berardis, Saeed Ahmed","doi":"10.3389/fpain.2024.1398442","DOIUrl":"https://doi.org/10.3389/fpain.2024.1398442","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The escalating number of deaths related to opioid usage has intensified the pursuit of non-opioid alternatives for managing chronic pain. It's often observed that psychiatric comorbidities coexist in patients suffering from chronic pain. There are a variety of psychotropic medications that have demonstrated effectiveness in treating both psychiatric symptoms and pain. This systematic review and meta-analysis aim to assess the effectiveness of various psychiatric drugs in managing specific types of chronic pain, including fibromyalgia, neuropathic pain, and chronic low back pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search of five major databases was conducted through February 2023 to identify randomized controlled trials (RCTs) that met our inclusion criteria, focusing on outpatients Over 18 years of age with chronic pain. The study assessed the effectiveness of duloxetine, mirogabalin, pregabalin, gabapentin, and tricyclic antidepressants (TCAs), including serotonin-norepinephrine reuptake inhibitors (SNRIs), across various chronic pain conditions such as fibromyalgia, neuropathic pain, and chronic low back pain. The primary outcome measures included pain reduction, improvement in function, and quality of life. Of the 29 RCTs in the systematic review, 20 studies qualified for the meta-analysis. The analysis was stratified by pain type and treatment duration (short-term ≤14 weeks vs. long-term &gt;14 weeks), using Hedge's g standardized mean differences and a random-effects model, along with sensitivity and subgroup analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall short-term intervention effect across all studies was significant (SMD -1.45, 95% CI -2.15 to -0.75, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with considerable heterogeneity (I&lt;sup&gt;2&lt;/sup&gt; = 99%). For fibromyalgia, both duloxetine and mirogabalin demonstrated substantial efficacy with SMDs of -2.42 (95% CI -3.67 to -1.18, &lt;i&gt;p&lt;/i&gt; &lt; 0.0001) and -2.10 (95% CI -3.28 to -0.92, &lt;i&gt;p&lt;/i&gt; = 0.0005), respectively. Conversely, treatments for neuropathic pain and chronic low back pain, including those with amitriptyline and desipramine, did not show significant benefits. The effectiveness of gabapentin could not be conclusively determined due to limited representation in the data. Additionally, no consistent long-term benefits were observed for any of the medications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;While the results of this study underscore the importance of exploring non-opioid alternatives for chronic pain management, particularly in light of the opioid crisis, it is crucial to interpret the findings carefully. Our analysis suggests that certain psychiatric medications, such Duloxetine and mirogabalin demonstrated significant short-term efficacy in fibromyalgia patients. However, their effectiveness in treating neuropathic pain and chronic low back pain was not statistically significant. Additionally, the effectiveness of gabapentin and other medications, such as pr","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Case Report: Reduction in post-amputation phantom limb pain intensity accompanying the onset of phantom limb telescoping. 病例报告:伴随幻肢伸缩的截肢后幻肢疼痛强度降低。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-09 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1409352
Andrea Aternali, Heather Lumsden-Ruegg, Lora Appel, Sander L Hitzig, Amanda L Mayo, Joel Katz

Introduction: Individuals with limb loss frequently report post-amputation phenomena, including nonpainful phantom sensations, phantom limb pain (PLP), and residual limb pain (RLP). Although post-amputation pain is common, not all patients benefit from widely accepted treatments. A greater understanding of phantom limb "telescoping", the experience of one's phantom hand or foot gradually approaching the residual limb, may assist in developing more effective interventions for reducing post-amputation pain. This case report explores the relationships between PLP, RLP, telescoping, and psychosocial experience in one person with a lower limb amputation. The aim of this case is to illustrate one possible relationship between telescoping and PLP as the mechanisms linking the two remain equivocal.

Methods: The participant is a 35-year-old male who underwent a transfemoral amputation due to a traumatic injury to his right leg approximately 4 years prior. He responded to questionnaires evaluating demographic and health-related information (e.g., age, sex, marital status, reason for amputation), pain and psychological variables via the Brief Pain Inventory (BPI-SF), ID Pain Questionnaire (IDPQ), Pain Catastrophizing Scale (PSC-4), Patient Health Questionnaire-4 (PHQ-4), Life Orientation Test-Revised (LOT-R), Connor-Davidson Resilience Scale (CD-RISC2), and Chronic Pain Acceptance Questionnaire (CPAQ-8) and telescoping, measured by a newly developed app. The participant completed a semi-structured interview that was designed to ascertain patterns in the overlapping experience of phantom limb telescoping and post-amputation pain.

Results: The participant rated his average PLP as 10 on a Numeric Rating Scale (NRS) from 0 ("no pain") to 10 ("worst pain imaginable") shortly after amputation. Approximately 12 months later, the participant noticed a shortening of his phantom limb, with a concurrent decrease in PLP. At present, his average NRS pain intensity is a 5/10. The participant described how the daily, debilitating PLP intensity diminished to weekly, manageable pain over time. Most notably, his responses on questionnaires were consistent with neuropathic PLP, mild to moderate levels of pain interference, a high level of catastrophic thinking about pain, low optimism, and mild symptoms of anxiety and depression.

Discussion: In this report, telescoping appeared to be preceded by an initial reduction in PLP intensity but these findings are based on a single case report and must be replicated with a large sample size before we have a clearer idea of the relationship between telescoping and PLP. This study provides insight into factors that may maintain PLP, generating targets for further investigation.

导言:肢体缺失患者经常会报告截肢后现象,包括非疼痛性幻觉、幻肢痛(PLP)和残肢痛(RLP)。虽然截肢后疼痛很常见,但并非所有患者都能从广泛接受的治疗方法中获益。进一步了解幻肢 "伸缩"(幻觉中的手或脚逐渐接近残肢的体验)可能有助于制定更有效的干预措施,减轻截肢后疼痛。本病例报告探讨了一名下肢截肢患者的幻肢疼痛(PLP)、幻痛(RLP)、伸缩和社会心理体验之间的关系。本病例旨在说明伸缩和PLP之间的一种可能关系,因为两者之间的联系机制仍不明确:被试是一名 35 岁的男性,大约 4 年前因右腿外伤接受了经股截肢手术。他回答了评估人口统计学和健康相关信息的调查问卷(如年龄、性别、婚姻状况、健康状况等)、通过简明疼痛量表 (BPI-SF)、ID 疼痛问卷 (IDPQ)、疼痛灾难化量表 (PSC-4)、患者健康问卷-4 (PHQ-4)、生活取向测试修订版 (LOT-R)、康纳-戴维森复原力量表 (CD-RISC2) 和慢性疼痛接受度问卷 (CPAQ-8),他回答了评估人口统计学和健康相关信息(如年龄、性别、婚姻状况、截肢原因)、疼痛和心理变量的问卷,并通过新开发的应用程序测量了伸缩性。受试者完成了一项半结构化访谈,旨在确定幻肢伸缩和截肢后疼痛重叠体验的模式:结果:在截肢后不久,受试者按照从 0("无痛")到 10("能想象到的最剧烈疼痛")的数字评定量表(NRS)将其幻肢伸缩平均评定为 10。大约 12 个月后,该受试者发现他的幻肢缩短了,PLP 也同时下降。目前,他的平均 NRS 疼痛强度为 5/10。据该患者描述,随着时间的推移,他每天都会感到的令人衰弱的幻肢疼痛强度逐渐减弱为每周都会感到的可控疼痛。最值得注意的是,他在调查问卷上的回答与神经病理性 PLP、轻度至中度疼痛干扰、对疼痛的灾难性思考程度高、乐观程度低以及轻度焦虑和抑郁症状一致:讨论:在本报告中,伸缩似乎先于PLP强度的最初降低,但这些发现是基于单个病例报告,我们必须在更清楚地了解伸缩与PLP之间的关系之前,用大量样本进行重复。本研究深入探讨了可能维持PLP的因素,为进一步研究提供了目标。
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引用次数: 0
Pharmacology of spinal interventions: review of agents used in spine pain procedures. 脊柱介入的药理学:脊柱疼痛手术所用药物综述。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-09 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1408905
Ericson John V Torralba, Robert F Short, Jeffrey B Travers, John M Mathis

Spine procedures are commonly performed to diagnose and treat various spinal conditions, ranging from degenerative disc disease to vertebral fractures. These procedures often involve the use of pharmaceutical agents to enhance the efficacy of the intervention and improve patient outcomes. This review provides an overview of the pharmaceuticals commonly utilized in spine procedures, including corticosteroids, anesthetics, antibiotics, radiographic contrast, neurolytic agents, and materials used in kyphoplasty and vertebroplasty. This review summarizes the utilization of these pharmaceutical agents in spine procedures in an effort to optimize patient outcomes. Understanding the pharmacological properties and appropriate uses of these pharmaceuticals is essential for interventionalist and healthcare providers involved in the care of patients undergoing spinal interventions.

脊柱手术通常用于诊断和治疗各种脊柱疾病,包括椎间盘退行性病变和脊椎骨折。这些手术通常需要使用药物来提高干预效果并改善患者预后。本综述概述了脊柱手术中常用的药物,包括皮质类固醇、麻醉剂、抗生素、放射造影剂、神经溶解剂以及用于椎体成形术和椎体成形术的材料。本综述总结了这些药物在脊柱手术中的应用,旨在优化患者的治疗效果。了解这些药物的药理特性和适当用途对于介入医师和参与脊柱介入患者护理的医护人员来说至关重要。
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引用次数: 0
The perpetual evidence-practice gap: addressing ongoing barriers to chronic pain management in primary care in three steps. 证据与实践之间的永久鸿沟:分三步走解决基层医疗中慢性疼痛管理的持续障碍。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1376462
Laura Ellen Ashcraft, Megan E Hamm, Serwaa S Omowale, Valerie Hruschak, Elizabeth Miller, Shaun M Eack, Jessica S Merlin

Background: Most management of chronic pain, a serious illness affecting the physical and psychological wellbeing of millions, occurs in primary care settings. Primary care practitioners (PCPs) attempt to provide evidence-based practices to treat chronic pain. However, there continues to be a gap between the care people receive and the evidence. The objectives for this study were to (1) explore determinants of evidence-based chronic pain management and (2) develop a novel approach to using implementation science to address the evidence-practice gap.

Method: A convenience sample of twenty-one Pennsylvania PCPs participated in one-time semi-structured telephone interviews. Interviews were transcribed verbatim and both deductive and inductive approaches were used during analysis. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to inform our analysis and findings.

Results: We identified determinants of evidence-based chronic pain management across the CFIR domains of Intervention Characteristics, Characteristics of Individuals, and the Outer Setting and reported implementation strategies. Based on identified themes, we developed a three-step process to support the ongoing and pragmatic implementation of evidence-based chronic pain management in primary care settings.

Conclusions: Previous efforts exist to integrate implementation science into chronic pain management; yet a gap persists. Implementation approaches should prioritize the needs of people living with chronic pain and their families. Further, future approaches or strategies used should build on the current three-step model to include the fourth step of tailoring existing implementation strategies to the specific needs of chronic pain in the clinical context.

背景:慢性疼痛是一种影响数百万人身心健康的严重疾病,大多数慢性疼痛的治疗都是在初级保健机构进行的。初级保健医生(PCPs)试图提供以证据为基础的慢性疼痛治疗方法。然而,人们所接受的治疗与证据之间仍然存在差距。本研究的目标是:(1) 探讨循证慢性疼痛管理的决定因素;(2) 开发一种新方法,利用实施科学来解决证据与实践之间的差距:对宾夕法尼亚州 21 名初级保健医生进行了一次性半结构化电话访谈。访谈内容被逐字记录,分析过程中使用了演绎法和归纳法。我们使用了实施研究综合框架 (CFIR) 和实施变革专家建议 (ERIC) 来指导我们的分析和研究结果:结果:我们确定了基于证据的慢性疼痛管理在干预特征、个人特征和外部环境等 CFIR 领域的决定因素,并报告了实施策略。根据确定的主题,我们制定了一个三步流程,以支持在初级医疗机构中持续、务实地实施循证慢性疼痛管理:结论:在将实施科学纳入慢性疼痛管理方面,我们已经做出了努力,但差距依然存在。实施方法应优先考虑慢性疼痛患者及其家人的需求。此外,未来使用的方法或策略应以当前的三步模式为基础,包括第四步,即根据临床环境中慢性疼痛的具体需求调整现有的实施策略。
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引用次数: 0
Beyond pain privacy and pain meters: a new vision for pain biomarkers. 超越疼痛隐私和疼痛测量仪:疼痛生物标志物的新愿景。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1397645
Charles Djordjevic, Carl Y Saab

To an individual, pain is unambiguously real. To a caregiver, assessing pain in others is a challenging process shrouded in doubt. To explain this challenge, many assume that pain "belongs" exclusively to the bearer of that experience and accept the dogma that pain is private. However, privacy also entails that it is not possible to identify, share, or communicate that experience with others. Obviously, this is not true and the consequences of pain privacy would be devastating for healthcare. Pain is indeed unique and subjective, but not necessarily private. Pain is in fact readily communicable, though perhaps not as effectively and reliably as caregivers would like. On the other hand, healthcare systems mandate objective metrics in pain diagnosis. Smiley face caricatures are a staple of clinical practice and a universal standard for reporting pain levels. These conditions create a double paradox: Assess a private experience that is inaccessible, and use numerical scales to measure subjective attributes. Navigating this stressful environment, medical professionals experience intellectual dissonance, patients are frustrated, and value-based care is undermined. Offering a way out, first, we refute the privacy and objectification of pain citing philosophical, behavioral, and neuroscientific arguments. We discuss Wittgensteinian views against privacy, explore the clear evolutionary advantage of communicating pain to others, and identify neural circuits in the mammalian brain that contribute to empathy. Second, we highlight the subjectivity of pain, embracing the complexity and uniqueness of an individual's pain. We also provide compelling evidence for brain mechanisms that actively shape the pain experience according to predictive coding principles. Third, we offer a vision for the development of biomarker technologies that assess pain fairly without engendering bias against the patient's narrative. Our recommendations are based on the overwhelming appreciation that "medicine by emoji" is inadequate for capturing the multidimensional nature of pain. Our view is that the most promising candidates for pain biomarkers consist of self-reports as ground truth augmented by physiological signatures of biological relevance to pain. Integration of subjective and objective multimodal features will be key for the development of comprehensive pain assessment models.

对于一个人来说,疼痛无疑是真实存在的。而对于护理人员来说,评估他人的疼痛则是一个充满挑战和疑虑的过程。为了解释这一挑战,许多人假定疼痛只 "属于 "体验者,并接受疼痛是隐私的教条。然而,隐私也意味着不可能与他人识别、分享或交流这种体验。显然,事实并非如此,疼痛隐私权的后果将对医疗保健造成毁灭性打击。疼痛确实是独特的、主观的,但并不一定是隐私。事实上,疼痛是很容易传播的,尽管可能没有护理人员希望的那么有效和可靠。另一方面,医疗保健系统规定疼痛诊断必须采用客观指标。笑脸漫画是临床实践的主要内容,也是报告疼痛程度的通用标准。这些情况造成了双重悖论:既要评估无法触及的私人体验,又要使用数字量表来衡量主观属性。在这种充满压力的环境中,医疗专业人员会感到知识上的不协调,患者会感到沮丧,以价值为基础的医疗服务也会受到破坏。首先,我们引用哲学、行为学和神经科学的论据驳斥了疼痛的隐私化和客观化,为我们提供了一条出路。我们讨论了维特根斯坦反对隐私的观点,探讨了向他人传达疼痛的明显进化优势,并确定了哺乳动物大脑中有助于共情的神经回路。其次,我们强调疼痛的主观性,承认个体疼痛的复杂性和独特性。我们还提供了令人信服的证据,证明大脑机制能够根据预测编码原则积极塑造疼痛体验。第三,我们提出了开发生物标记技术的愿景,这些技术可以公平地评估疼痛,而不会对患者的叙述产生偏见。我们的建议基于对 "表情符号医学 "不足以捕捉疼痛的多维性这一压倒性认识。我们认为,最有希望成为疼痛生物标志物的候选者包括作为基本事实的自我报告,以及与疼痛生物学相关的生理特征。整合主观和客观的多模态特征将是开发综合疼痛评估模型的关键。
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引用次数: 0
Enhancing chronic low back pain management: an initial neuroimaging study of a mobile interoceptive attention training. 加强慢性腰背痛管理:移动互感注意力训练的初步神经影像学研究。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1408027
Irina A Strigo, Sergio Garcia Guerra, Salvatore Torrisi, Emily Murphy, Tiffany Toor, Veronica Goldman, Benedict J Alter, An Thanh Vu, Rich Hecht, Jeff Lotz, Alan N Simmons, Wolf E Mehling

Introduction: Chronic low back pain (cLBP) poses significant challenges, often addressed through avoidance or distraction. Emerging evidence suggests that mind-body interventions, like our novel Mind Your Pain (MyP) smartphone mobile application, may offer relief. We conducted a single-arm, mixed-methods neuroimaging study to assess the degree to which treatment response to our 8-week intervention, as measured by the reduction in the Pain, Enjoyment of Life and General Activity Scale (PEG), was associated with enhanced pain-related insula activation over time.

Methods: Twenty-nine individuals with cLBP completed patient-reported assessments, qualitative sensory testing (QST) measures, and neuroimaging pre- and post-MyP. Functional MRI data during experimental heat pain on the left forearm were collected and analyzed, comparing responders (≥50% reduction in PEG scores) and non-responders.

Results: MyP led to significant decreases in PEG scores overall. Furthermore, MyP responders exhibited increased pain-related activation in key brain regions, including the contralateral posterior insula, bilateral ventral anterior insula, ventral anterior cingulate, dorsolateral prefrontal cortex, and nucleus accumbens. Although baseline behavioral and sensory measures did not differ between the two responder groups, baseline neural differences related to the impact of the endogenous back pain were observed.

Discussion: MyP appears to modify pain response and underlying neural circuitry, suggesting neural changes in interoception may serve as biomarkers for mind-body interventions in cLBP. This study highlights the potential of MyP as a novel approach for cLBP management, warranting further investigation.

导言:慢性腰背痛(cLBP)给人们带来了巨大的挑战,通常通过逃避或分散注意力来解决。新出现的证据表明,心身干预(如我们的新型智能手机应用程序 "Mind Your Pain (MyP)")可以缓解疼痛。我们进行了一项单臂、混合方法的神经影像学研究,以评估对我们为期 8 周的干预的治疗反应(以疼痛、生活享受和一般活动量表(PEG)的减少来衡量)在多大程度上与疼痛相关的脑岛激活随着时间的推移而增强相关:方法:29 名 cLBP 患者在接受 MyP 前后完成了患者报告评估、定性感觉测试 (QST) 测量和神经影像学检查。收集并分析左前臂热痛实验期间的功能磁共振成像数据,比较有反应者(PEG评分降低≥50%)和无反应者:结果:MyP使PEG评分总体上明显下降。此外,MyP应答者的主要脑区与疼痛相关的激活增加,包括对侧后脑岛、双侧腹腔前脑岛、腹腔前扣带回、背外侧前额叶皮层和凹凸核。虽然两组反应者的基线行为和感觉测量没有差异,但观察到了与内源性背痛影响有关的基线神经差异:讨论:MyP 似乎能改变疼痛反应和潜在的神经回路,这表明互感的神经变化可作为对 cLBP 进行身心干预的生物标志物。这项研究强调了 MyP 作为一种新方法治疗 cLBP 的潜力,值得进一步研究。
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引用次数: 0
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Frontiers in pain research (Lausanne, Switzerland)
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