Frontiers in pain research (Lausanne, Switzerland)最新文献

Background: The perception of pain is difficult to assess due to the complex combination of various components related to nociception, experience, and cognition. There are currently no biomarkers to assess the affective component of pain in healthy volunteers. Using Virtual Reality (VR), it may be possible to assess changes in pain perception when adding an affective component to painful stimulation.

Methods: In this two-visit feasibility study, we assess the effect of a simulated wound in VR on the electrical pain detection (PDT) and tolerance (PTT) threshold in 24 healthy male study participants. The VR simulation presented a copy of the research room from first person view. Prior to each VR assessment, study participants were primed by interacting with the VR environment. Two conditions were assessed: (1) VR-Wound: a burn-wound, smoke, and electrical sparks become visible and audible with increasing stimulus intensity, and (2) VR-neutral: no additional aspects. The PDT and PTT to electrical stimuli were recorded during both VR conditions and outside of VR. VAS-Questionnaires were used to assess unpleasantness and fear.

Results: The PDT decreased when a virtual wound is presented compared to a neutral condition. Study participants experienced the electrical stimulation as more painful and more intense during the wound simulation than during the neutral condition. The effect was more pronounced during the second visit.

Conclusion: VR enhanced the perception of pain, thereby providing new insights into the affective component of pain. Further testing of this methodology is warranted by performing a clinical study that evaluates drug effects on the affective component of pain.

Introduction: Excessive polypharmacy, which can be defined as the concurrent use of ≥10 medications, is prevalent among individuals with chronic pain. However, it remains unclear how it may vary between individuals or over time.

Objectives: This study aimed to describe and identify factors associated with trajectories of excessive polypharmacy.

Methods: A retrospective longitudinal study was conducted using the TorSaDE Cohort, which links Canadian Community Health Surveys (2007-2016) and Quebec health administrative databases. Among 9,156 adults living with chronic pain and covered by public prescribed drug insurance, the presence of excessive polypharmacy (yes/no) was assessed monthly for one-year post-survey completion (12 time points). Group-based trajectory modelling was applied to identify groups with similar patterns over time (trajectories). Multivariable multinomial regression was used to identify factors associated with trajectory membership.

Results: Four trajectories were obtained: (1) "No excessive polypharmacy" (74.8%); (2) "Sometimes in excessive polypharmacy" (8.6%); (3) "Often in excessive polypharmacy" (6.1%); 4) "Always in excessive polypharmacy" (10.5%). Factors associated with the "always in excessive polypharmacy" trajectory membership were: being older, being born in Canada, having a lower income, having a higher comorbidity index score, more severe pain intensity, and more daily activities prevented by pain, reporting arthritis or back pain and poorer perceived general health, and having a family physician. Using opioids or benzodiazepines, having a lower alcohol consumption, doing less physical activity, a higher number of prescribers and visits to a family physician also predicted being always in excessive polypharmacy.

Discussion: This study identifies distinct trajectories of excessive polypharmacy in adults with chronic pain, emphasizing key sociodemographic and clinical factors and the need for tailored interventions for effective medication management.

Objectives: This research aims to better delineate how intrathecal drug delivery systems (IDDS) are incorporated into the oncology care continuum and highlight the need for further awareness of interventional options for pain management of cancer patients in the United Kingdom. The study focuses on exploring the knowledge, perspectives, and experiences of healthcare professionals regarding IDDS as a treatment option for managing chronic refractory pain in cancer patients.

Methodology: A thematic coding using inductive analysis was employed to achieve the research objectives. Semi-structured interviews were conducted with 18 healthcare professionals in various specialties, including oncology, neurosurgery, pain management, and palliative care. The interviews were transcribed, and a two-phased qualitative inductive coding approach was used to analyze the data.

Results: The findings of the study revealed four major themes: Education, Barriers & Benefits, Technical & Administrative, and Patient-Centered Care. The theme of Education highlighted the need for increased knowledge and awareness of IDDS among healthcare professionals. Barriers & Benefits encompassed concerns about infection risk, suitability for patients with a short life expectancy, and the challenges and advantages of IDDS use. The Technical & Administrative theme addressed cost considerations, device management, and the need for improved guidelines. Patient-Centered Care emphasized the importance of involving patients in decision-making and considering their physical and emotional well-being throughout the treatment pathway.

Conclusions: This research identifies several areas of unmet need in the management of refractory pain in cancer patients, including the development of more inclusive guidelines, greater awareness among clinicians and patients, and the role of medical technology companies in supporting effective pain management. The findings underscore the impact of IDDS on improving pain control and highlight the potential importance of early intervention and comprehensive pain management in influencing the trajectory of oncological diseases.

Phantom limb pain (PLP) is defined as the perception of pain in a limb that has been amputated. In the United States, approximately 30,000-40,000 amputations are performed annually with an estimated 2.3 million people living with amputations. The prevalence of PLP among amputees is approximately 64%. Over the years, various theories regarding the etiology of PLP have been proposed, with some gaining more prominence than others. Yet, there is a lack of consensus on PLP mechanisms as the current literature exploring the pathophysiology of PLP is multifactorial, involving complex interactions between the central and peripheral nervous systems, psychosocial factors, and genetic influences. This review seeks to enhance the understanding of PLP by exploring its multifaceted pathophysiology, including genetic predispositions. We highlight historical aspects of pain theories and PLP, examining how these theories have expanded to include psychosocial dimensions associated with chronic pain in amputees. Additionally, we present significant findings from both human and animal studies focused on neuroaxial systems and recent advances in molecular research to further elucidate the complex and multifactorial nature of PLP. Ultimately, we hope that the integration of current theoretical frameworks and findings will lay a more robust foundation for future research on PLP.

Introduction: An obstacle to analysis of the long-term effectiveness of intrathecal (IT) opioids is absence of historical patient baseline data. The electronic Persistent Pain Outcomes Collaboration (ePPOC) is an initiative of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists. Recently published ePPOC data has provided justifiable surrogate baseline data allowing opportunities for pain outcomes research into select patient treatment groups. Our aim was to compare long-term outcomes of IT opioid therapy with a surrogate baseline utilizing a large ePPOC data set for patients at the time of initial presentation to 36 pain clinics in Australia and New Zealand.

Methods: Study participants were 49 consenting patients receiving IT opioids as part of a long-term pain management regime for treating chronic non-cancer pain. Their data were compared with the large ePPOC data set (n = 13,343). The questionnaires comprised a demographic questionnaire, the Brief Pain Inventory, the Depression, Anxiety and Stress Scale, the Pain Catastrophizing Questionnaire, and the Pain Self-Efficacy Questionnaire.

Results: Compared with the ePOCC group, participants who received IT opioids long-term for the relief of chronic non-cancer pain reported significantly lower (p ≤ 0.001) pain severity (4.3 vs. 6.4), and pain interference scores (5.5 vs. 7), significantly lower depression (20.2 vs. 13.7), anxiety (9.6 vs. 14.1), stress (15.5 vs. 21), rumination (6.9 vs. 10), magnification (3.8 vs. 5.9), helplessness (9.7 vs. 14.1), general catastrophizing (20.4 vs. 29.8), and higher self-efficacy (29.5 vs. 20.7).

Discussion: The observed improvements in all measured pain variables have occurred in the context of comprehensive pain management, and therefore, may be attributable to pain reduction and not directly to IT opioid use or the device itself. Favourable pain management outcomes, in a select patient treatment group utilizing long-term IT opioid therapy, were demonstrated using the large-data ePPOC initiative, highlighting the research opportunities it provides.

Introduction: The aim of this study was to determine if specific anatomical changes were present in patients with recurrent headaches including patients with chronic migraines, chronic tension-type headaches, and daily persistent headaches. A retrospective study of 200 patients was performed to evaluate the potential of measuring the amount of nasal blood pool activity (nasal congestion) as a predictive marker for recurrent headaches.

Methods: A cohort analysis was performed involving patients who had been referred to the Nuclear Medicine Clinic over a 3-year period for whole-body blood pool scans. The scans were evaluated by region of interest (ROI) analysis of nasal and heart max pixel count ratios (NHMRs) to determine an association between nasal blood pooling activity and recurrent headaches at the time of the initial scan and in follow-up evaluations over a period of 3-6 years.

Results: Significantly greater NHMRs were observed in 122 patients with chronic headaches at the time of referral for their initial whole-body blood pool scan when compared with those patients without recurrent headaches (p = 0.004; OR 10.5; 95% CI 2.22-56.7). An additional 15 patients, for a total of 137, developed recurrent headaches following their initial scan and before their follow-up evaluation. NHMRs were also significantly increased in the additional patients when compared to those without recurrent headaches (p = 0.004; OR 12.3; 95% CI 2.34-75.5).

Conclusion: Patients with recurrent headaches have significantly increased nasal activity as observed on ^99mTc-MDP whole-body blood pool scans, supporting the hypothesis that nasal lymphatic dysfunction plays a role in the etiology of recurrent headaches. This research highlights a novel diagnostic use of the whole-body blood pool scan for the assessment of nasal turbinate vasodilation as well as a possible new target for the treatment of recurrent headaches.

Building flexibility into the research design of a study allows for responsiveness to the embodied and fluctuating nature of participants' chronic illnesses, which may be shaped, for instance, by flare-ups and periods of remission of acute pain. Whilst the methodology literature has, to some extent, considered how to accommodate the pain of research participants when designing a study, consideration of how methodological choices are responsive to the researcher's pain needs has not to date been foregrounded. From the perspective of a researcher with Ankylosing Spondylitis (AS), a form of inflammatory arthritis characterized by chronic pain, and Crohn's disease, a type of inflammatory bowel disease, characterized by stomach and joint pain, this paper provides insight into pain and researcher-participant relationships, from the perspective of a researcher in pain, designing a study to accommodate her own pain needs, as well as anticipating the needs of prospective participants in pain. This paper proposes the use of flexible, remote, and asynchronous research methods as ways to make studies inclusive for researchers living with pain, whilst fostering the most fruitful research relationships with participants who also live with pain, thereby moving towards a position of shared vulnerability. It also highlights the relative absence of the researcher's needs and possible vulnerability in ethics forms and considered by research ethics committees, in comparison to the needs and vulnerability of participants.