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

Pain is a common symptom of many clinical diseases; it adversely affects patients' physical and mental health, reduces their quality of life, and heavily burdens patients and society. Pain treatment is one of the most difficult problems today. There is an urgent need to explore the potential factors involved in the pathogenesis of pain to improve its diagnosis and treatment rate. Piezo1/2, a newly identified mechanosensitive ion channel opens in response to mechanical stimuli and plays a critical role in regulating pain-related diseases. Inhibition or downregulation of Piezo1/2 alleviates disease-induced pain. Therefore, in this study, we comprehensively discussed the biology of this gene, focusing on its potential relevance in pain-related diseases, and explored the pharmacological effects of drugs using this gene for the treatment of pain.

Introduction: Musculoskeletal pain affecting children is common. Rehabilitation and treatment effectiveness can be influenced by multiple individual and contextual factors. The need for more rigorous evaluation of physiotherapy treatment for children's pain, identification of the role of specific techniques, and exploration of the influence of the therapeutic alliance is needed. This scoping review of research aimed to examine: (1) What are the perceptions of children, parents, and physiotherapists about the importance of therapeutic alliance during musculoskeletal pain treatment? (2) What are the key characteristics of therapeutic alliance during a child's musculoskeletal pain treatment from the perspectives of children, parents, and physiotherapists? and (3) What are the perceived impacts of therapeutic alliance (positive and negative) during a child's physiotherapy treatment for musculoskeletal pain?

Methods: The scoping review, based on Arksey and O'Malley's framework and reporting was guided by PRISMA-ScR. The search strategy was based on three concept blocks: (1) Study population: Children (<18 years); (2) Medical condition: Any musculoskeletal pain (acute, chronic primary, chronic secondary); (3) Intervention: Qualitative exploration of experience of physiotherapy treatment delivered by a physiotherapist from the perspective of a child, parent, or physiotherapist. The search (no date limit) was conducted in February 2024 across Medline, AMED and CINAHL.

Results: Following duplicate removal and assessment of eligibility of the initial 236 articles, nine articles were included; of these, only one specifically aimed to explore therapeutic alliance and it was the only paper to directly mention therapeutic alliance. All nine articles presented the child's experience. One overarching theme "Finding resilience within me through therapeutic alliance" and three main themes: "A trusted guide through the ups and the downs of rehabilitation"; "Having a route map"; and "Take me seriously but make it fun" were identified.

Discussion: Therapeutic alliance was considered important by children, parents and physiotherapist and it influenced child and parent perceptions of physiotherapy and overall treatment outcomes. Physiotherapists can foster the children's resilience when experiencing musculoskeletal pain by providing disciplinary expertise, connecting and collaborating with the child by becoming their trusted guide, and co-creating a route map for rehabilitation by helping them to learn about their body, pain and recovery timeline.

Background: There is an urgent need to confirm biomarkers reflecting the pathogenesis and targeted drugs of lower back pain or/and sciatica in clinical practice. This study aimed to conduct a two sample bidirectional Mendelian randomization (MR) analysis to explore the causal link between 486 serum metabolites and lower back pain or/and sciatica.

Methods: All data come from two public shared databases of European ancestry and single nucleotide polymorphisms (SNPs) for lower back pain or/and sciatica acted as instrumental variables. The traditional inverse variance weighting (IVW) method, weighted-median method, MR-Egger methodand other methods were used to estimate causality. The horizontal pleiotropy, heterogeneities were also verified through the MR-Egger intercept test, Cochran's Q test, MR-PRESSO test and the leave-one-out sensitivity analysis. Reverse MR analysis was employed to evaluate the direct impact of metabolites on lower back pain or/and sciatica. Additionally, we conducted the colocalization analysis to reflect the causality deeply. Furthermore, metabolic pathway analysis was performed.

Results: 28 metabolites (18 known metabolites, 1 identified metabolites and 9 unknown metabolites) relevant to the risk of sciatica or/and lower back pain after using genetic variants as probes at P_IVW < 0.05 were identifed. Among them, 8 serum metabolites decreased risk of sciatica or/and lower back pain significantly (P < 0.05), and 14 serum metabolites increased risk of sciatica or/and lower back pain significantly (P < 0.05). No reverse causal association was found between 28 metabolites and sciatica or/and lower back pain. Colocalization analysis results showed that the associations between sciatica or/and lower back pain and the 28 identified metabolites were not due to shared causal variant sites. Moreover, pathway enrichment analysis identifed 11 signifcant metabolic pathways, which are mainly involved in the pathological mechanism of sciatica or/and lower back pain (P < 0.05). There was no horizontal pleiotropy or heterogeneity in the other analyses.

Conclusion: Our analyses provided robust evidence of causal associations between blood metabolites on sciatica or/and lower back pain. However, the underlying mechanisms remain to be further investigated.

Purpose: Despite their dangerous side effects, opioid drugs remain a standard of care for moderate to severe pain with few alternatives. Strategies to maintain the analgesic effects of opioids while minimizing the associated risks are needed. Pre-clinical studies have shown using a dopamine 3 receptor (D3R) agonist as an adjuvant to morphine provides superior analgesia against painful stimuli compared to morphine alone. Our objective was to test if adjunct treatment with a D3R agonist can lead to a reduction in opioid use while maintaining effective analgesia.

Patients and methods: This study was set up as a double-blinded, placebo-controlled randomized trial. Enrollment included acute renal colic patients presenting to the emergency department, from which patients were randomized to either the "control" or "study arm". The control group received standard treatment of care (morphine, 0.1 mg/kg; i.v.) and an oral placebo pill. The experimental group received half-dosed morphine and oral pramipexole pill (0.25 mg). Pain measurements including a numerical pain scale and visual analog scale were collected from enrollees at baseline and every subsequent 15 min.

Results: A total of 19 patients completed the study, 10 in the experimental arm and 9 in the control arm. During the study period, effective analgesia (50% decrease from baseline) was achieved in 80% of patients in the experimental arm vs. 33.3% in the control arm.

Conclusion: Our pilot clinical trial demonstrated that D3R recruitment can serve as an effective adjuvant to low-dose morphine for control of renal colic pain and potentially other acute pain conditions.

Clinical trial registration: ClinicalTrials.gov, identifier, (NCT04160520).

Introduction: Millions of women worldwide annually undergo manual vacuum aspiration (MVA) with no pain medication, which is a violation of their basic human dignity. We designed a novel device (Chloe SED®) to administer paracervical block (PCB) during MVA in countries where pain medication is not typically given due to the high cost of the necessary tools.

Methods: We conducted a single-blinded, randomized controlled non-inferiority trial including 61 patients at two hospitals in Kisumu, Kenya, to validate Chloe SED® for administration of PCB during MVA. PCB administered with Chloe SED® was compared to PCB administered with a standard spinal needle. Patients requiring MVA were block randomized in blocks of six, each provider completing six PCBs-three with the Chloe SED® and three with the standard spinal needle. The trial was registered with the Kenya Pharmacy and Poisons Board, ECCT/19/03/01 (https://ctr.pharmacyboardkenya.org/applications/index/protocol_no:RUNDVC8xOS8wMy8wMQ__/filter:/investigator:/sites:/pages:5/start_date:/end_date:/disease_condition:/users:/ercs:/stages). An intention-to-treat analysis was completed. The primary outcome was the non-inferiority of the pain score during uterine evacuation with a non-inferiority margin of 2 points on an 11-point numerical rating scale. Secondary outcomes included the non-inferiority of the pain score at four other time points and patient satisfaction.

Results: Chloe SED® showed non-inferiority of the primary outcome with a mean pain score during evacuation of 3.8 [90% confidence interval (CI): 3.1-4.6] compared with the spinal needle at 4.1 (90% CI: 3.5-4.7). Non-inferiority of the pain score was shown at all time points. Most patients expressed a desire for the continued use of the device to administer PCB for MVA. No adverse events were noted.

Conclusion: In summary, the Chloe SED® appears non-inferior to the spinal needle and desirable for the administration of PCB during MVA.

Background: Mind-body treatments can improve coping mechanisms to deal with pain, improve the quality of life of patients with fibromyalgia syndrome (FMS), and reduce perceived pain in some cases. However, responses to these treatments are highly variable, the mechanisms underpinning them remain unclear, and reliable predictors of treatment response are lacking. We employed resting-state blood oxygen level-dependent (rsBOLD) functional magnetic resonance imaging (fMRI) to examine changes in brain functional connectivity (FC) following mind-body treatment that may relate to and predict pain relief.

Methods: We recruited patients with FMS who underwent either mindfulness-based stress reduction (MBSR; n = 18) or a psychoeducational program (FibroQoL; n = 22) and a treatment-as-usual FMS group (TAU; n = 18). We collected rsBOLD data, alongside subjective pain, anxiety, depression, and catastrophizing measures prior to and following treatments. We examined behavioral changes and FC changes in the salience network (SN) and sensorimotor network (SMN) and performed regression analyses to identify predictors for treatment response.

Results: The MBSR and FibroQoL groups experienced significant reductions in pain catastrophizing. After treatment, the FC of the sensorimotor cortex with the rest of the SMN became significantly reduced in the MBSR group compared to the TAU group. The FC between the SN and the SMN at baseline was negatively correlated with pain reductions following MBSR but positively correlated with pain reductions in the FibroQoL group. These results yielded large to very large effect sizes. Following MBSR, only for those patients with lower baseline SMN-SN FC, minutes of mindfulness practice were positively associated with clinical improvement (small to medium effect size).

Conclusions: Different mind-body treatments are underpinned by discrete brain networks. Measures of the functional interplay between SN and SMN have the potential as predictors of mind-body treatment response in patients with FMS.

Background: Limited knowledge exists on recognition and treatment of equine abdominal pain in low- and middle-income countries. This study aimed at finding indicators for recognizing abdominal pain, evaluating responses to clinical and behavioral changes, and assessing the impact of timely referral on colic outcomes in a suburban region of Senegal. The final goal was to identify factors that may be leveraged to improve the outcome of horses presented for abdominal pain in Senegal.

Study design: Retrospective, observational cohort study.

Methods: Data from 26 foals and 40 adult horses referred for acute abdomen between 2013 and 2014 and the first semester of 2023 were reviewed. Signs of abdominal pain were grouped into behavioral, posture modification and animal interactions with the environment. Time to referral was defined as the time between the recognition of abdominal pain and referral. The association of time to referral and the outcome was calculated for each subpopulation and compared using logistic regression analysis as appropriate.

Results: A significant proportion of owners (47%) and veterinarians (77.8%) relied on behavioral changes to detect abdominal pain in foals. Most owners referred foals within 24 h, while veterinarians referred within 12 h. Mortality in foals exceeded 50% when referral was delayed by 12 h or more. In adult horses, groomers often were the first noticing behavioral changes (79%), and they referred the horse within three hours, whereas owners typically delayed referral for 24 h or longer, leading to increased hospitalization expenses.

Limitations: The study considered a limited cohort in an suburban area of Senegal. Sourcing complete data was challenging. Additionally, accurately assessing owner experience was difficult due to the participant group's heterogeneity. Absence of a reliable system to measure daily horse-owner interaction time and logistical challenges in the abdominal pain symptom alert chain were also limiting factors.

Conclusions: Early detection is critical for positive colic outcomes in both foals and adult horses. Therefore, raising awareness and providing training to horse owners for prompt recognition of symptoms and referral is essential. This proactive approach aims to improve overall outcomes and reduce the financial burden of equine hospitalization in Senegal.

Purpose: Cancer patients often experience pain, which can greatly reduce their quality of life. It affects their emotions, cognitive function, and daily interactions. Healthcare providers need to understand the obstacles to pain management to create helpful programs for patients and families. This study focuses on Iranian nurses' views on pain management barriers in cancer patients.

Methods: The study utilized a qualitative content analysis method with a purposive sampling approach, involving 27 nurses. Participants were selected to ensure a wide range of perspectives and experiences by considering factors such as gender, age, work experience, education levels, and positions until data saturation was achieved. Inclusion criteria specified a minimum of six months of oncology ward experience and a bachelor's degree or higher in nursing. Nurses with less than six months of oncology experience or lacking a nursing degree were excluded. Data collection was conducted through semi-structured interviews and analyzed using Lundman and Granheim's qualitative content analysis method.

Results: One main theme, four main categories, and nine subcategories in the study reflected the nurses' experiences and viewpoints about barriers to pain management. These categories included the marginalization of complementary medicine, medical malpractice, inadequate organizational infrastructure, and personal barriers.

Conclusion: The study demonstrated that the barriers to pain management in cancer patients were complex. To improve patients' comfort and quality of life, it is important to identify and address issues from different angles. It is crucial to train patients and healthcare providers in pain management and to address weaknesses in the healthcare system.