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

Introduction: Intravenous non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in healthcare settings, but their comparative safety and resource utilization impacts remain understudied. This study aimed to compare adverse drug reactions (ADRs) and healthcare resource utilization (HCRU) between patients receiving IV-ibuprofen versus IV/IM ketorolac.

Methods: A retrospective, longitudinal analysis was conducted using an all-payer database, examining records from January 1, 2014, to June 3, 2023. The study included both adult (≥18 years) and pediatric (<18 years) populations who received one or more doses of either medication. Propensity score matching was applied to both populations, and HCRU was tracked for 29 days post-final dose. The adult cohort included 31,046 IV-ibuprofen and 124,184 ketorolac records, while the pediatric cohort had 5,579 patients per treatment arm.

Results: Both adult and pediatric patients receiving IV-ibuprofen demonstrated lower ADR incidence and reduced HCRU compared to those receiving ketorolac.

Discussion: The findings suggest IV-ibuprofen may be a safer alternative to ketorolac, potentially improving patient care outcomes while reducing healthcare system burden. These results have implications for clinical practice and healthcare resource management.

Introduction: Neuropathic pain is a prevalent and burdensome condition, and both pregabalin and gabapentin are widely used for its treatment. However, there is a lack of clarity regarding their comparative efficacy and safety. This meta-analysis aims to evaluate and compare the effectiveness and safety of pregabalin vs. gabapentin in managing neuropathic pain.

Methods: This study followed PRISMA guidelines and employed the PICOS search strategy. Comparative studies (clinical trials and cohort studies) were included, with patients with neuropathic pain treated either with pregabalin or gabapentin. Primary outcomes assessed were efficacy and safety. Data were extracted from PubMed, Embase, Scopus, and the Cochrane Collaboration Library databases. The risk of bias was evaluated using the Cochrane Review Manager tool. Statistical analysis was performed using Review Manager 5.4.1 software, calculating effect sizes and conducting sensitivity analysis based on medication dosage.

Results: A total of 14 studies with 3,346 patients were analyzed. Pregabalin showed superior results compared to gabapentin in the Visual Analog Scale (VAS) at various time intervals up to 12-14 weeks (SMD -0.47, 95% CI -0.74 to -0.19). The pregabalin group also had significant improvements in SF-12/SF-36/EQ-5D scores (SMD 0.39, 95% CI 0.11-0.68) and experienced more days with no/mild pain (MD 9.00, 95% CI 8.93-9.07) and fewer days with severe pain (MD -3.00, 95% CI -4.96 to -1.04). Pregabalin resulted in lower opioid consumption (OR 0.50, 95% CI 0.33-0.76). Gabapentin had a higher incidence of nausea and vomiting. Sensitivity analysis supported the efficacy of pregabalin.

Conclusion: In conclusion, pregabalin demonstrated superior and faster efficacy in alleviating neuropathic pain than gabapentin did. Additionally, it improved patient-reported outcomes, resulted in lower opioid consumption, and led to fewer adverse events.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=565208, PROSPERO (CRD42024565208).

Chronic pain is highly prevalent among older adults, is associated with cognitive deficits, and is commonly treated in primary care. We sought to document the extent of impairment across specific neurocognitive domains and its correlates among older adults with chronic pain in primary care. We analyzed baseline data from the Problem Adaptation Therapy for Pain trial, which examined a psychosocial intervention to improve emotion regulation in 100 adults ≥ 60 years with comorbid chronic pain and negative emotions, who did not have evidence of moderate-to-severe cognitive impairment. Questionnaires on comorbidities, depressive symptoms, pain intensity, and pain-related disability were administered along with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Montreal Cognitive Assessment (MoCA). Multiple regression assessed the relationship between demographic and clinical characteristics with specific neurocognitive domains. Over half of participants (56%) had mild-to-moderate cognitive impairment (<26 on the MoCA). Across domains, participants scored the lowest in visuospatial/constructional (M = 86.2; SD = 15.7), and 15%-23% scored at least one standard deviation below the mean for immediate and delayed memory, visuospatial/constructional, and attention. In adjusted models, greater medical comorbidities were associated with poorer performance on the total RBANS, immediate memory, and attention. Cognitive deficits in older adults with chronic pain in primary care are substantial, with varying levels of deficits by neurocognitive domain. Future research should examine synergistic effects of chronic pain and comorbidities on cognition, and the impact of cognitive deficits on older adults' ability to engage in pain interventions and self-management behaviors.

The sensory/discriminative domain of pain is often given more consideration than the cognitive and affective influences that ultimately make pain what it is: a highly subjective experience that is based on an individual's life history and experiences. While many investigations of the underlying mechanisms of pain have focused on solely noxious stimuli, few have compared somatosensory stimuli that cross the boundary from innocuous to noxious. Of those that have, there is little consensus on the similarities and differences in neural signaling across these sensory domains. The purpose of this study was to apply our established network connectivity analyses toward the goal of understanding the neural mechanisms behind sensory, cognitive, and affective responses to noxious and innocuous stimuli. Functional MRI data were collected from 19 healthy women and men that experienced warm and hot thermal stimuli across multiple trials. This is a within-subjects cross-sectional experimental study with repeated measures. Ratings of stimulus intensity and unpleasantness that were collected during each run confirmed significant perceptual differences between the two types of stimuli. Despite this finding, no group differences in network connectivity were found across conditions. When individual differences related to pain ratings were investigated, subtle differences were found in connectivity that could be attributed to sensory and association regions in the innocuous condition, and cognitive, affective, and autonomic regions in the pain condition. These results were reflected in the time-course data for each condition. Overall, signaling mechanisms for innocuous and noxious somatosensation are intricately linked, but pain-specific perception appears to be driven by our psychological and autonomic states.

The neuraxial delivery of drugs for the management of pain and other spinal pathologies is widely employed and is the subject of a large volume of ongoing research with several thousand papers appearing in the past 5 years alone on neuraxial delivery. Several learned texts have been recently published. A number of considerations have contributed to this widespread interest in the development of the use of neuraxial therapeutics to manage pain. In the following section, major topics relevant to spinal encoding and in the use of neuraxial therapeutics are considered by the Frontiers in Pain Research editors of the research topic: "Neuraxial Therapeutics in Pain Management: Now and Future". This paper seeks to serve as a perspective to encourage the submission of manuscripts reflecting research in this exciting area.

Herpes zoster-associated pain is a difficult-to-treat pathologic pain that seriously affects patients' quality of life. In recent years, emerging therapeutic techniques such as autologous platelet-rich plasma, sympathetic nerve block and pulsed radiofrequency have been gradually applied in the field of pain with the advantages of less trauma, quicker recovery and significant efficacy. These therapeutic options have become a new hope for the treatment of herpes zoster-associated pain. This article reviews the studies on herpes zoster-associated pain in non-oral drug therapy, summarizes the efficacy, safety, and possible mechanisms, and provides a reference basis for clinical treatment.

Paclitaxel is a widely used chemotherapeutic agent for treating various solid tumors. However, resulting neuropathic pain, often a lifelong side effect of paclitaxel, can limit dosing and compromise optimal treatment. The choroid plexus, located in the brain ventricles, spreads peripheral inflammatory reactions into the brain. Our study is the first to analyze the effects of paclitaxel on inflammatory alterations in the choroid plexus. We hypothesized that the choroid plexus could respond directly to paclitaxel and simultaneously be indirectly altered via circulating damage-associated molecular patterns (DAMPs) produced by paclitaxel application. Using immunohistochemical and Western blot analysis, we examined the levels of toll-like receptor 9 (TLR9) and formyl peptide receptor 2 (FPR2), along with the pro-inflammatory cytokines interleukin 6 (IL6) and tumor necrosis factor α (TNFα) in choroid plexus epithelial cells of male Wistar rats following paclitaxel treatment. Moreover, we utilized an in vitro model of choroid plexus epithelial cells, the Z310 cells, to investigate the changes in these cells in response to paclitaxel and DAMPs (CpG ODN). Our results demonstrate that paclitaxel increases TLR9 and FPR2 levels in the choroid plexus while inducing IL6 and TNFα upregulation in both acute and chronic manners. In vitro experiments further revealed that paclitaxel directly interacts with epithelial cells of the choroid plexus, leading to increased levels of TLR9, FPR2, IL6, and TNFα. Additionally, treatment of cells with CpG ODN, an agonist of TLR9, elicited upregulation of IL6 and TNFα. Our findings determined that paclitaxel influences the choroid plexus through both direct and indirect mechanisms, resulting in inflammatory profile alterations. Given the pivotal role of the choroid plexus in brain homeostasis, a compromised choroid plexus following chemotherapy may facilitate the spread of peripheral inflammation into the brain, consequently exacerbating the development of neuropathic pain.

In clinical terms, chronic pain is the most prevalent sequela resulting from COVID-19, which is induced by the novel coronavirus (SARS-CoV-2), while type 2 diabetes mellitus (T2D) is the most common comorbidity. This triangular relationship can be attributed to the dysfunction of the insulin receptor signaling system (IRSS) in both central and peripheral systems. Patients with T2D are essentially more susceptible to SARS-CoV-2 infection due to the widespread expression of angiotensin converting enzyme 2 (ACE2) in their pancreatic beta cells, which serves as the cellular port for the SARS-CoV-2 to infect and enter the cell. This infection can exacerbate chronic pain and insulin resistance for various reasons. Peripherally, once infected, the virus can cause damage to peripheral nerves and pancreatic β-cells, further exacerbating pain and glucose metabolism conditions. Additionally, in the central nervous system, dysfunctional IRSS is closely linked to chronic pain. Over the past few years of the COVID-19 pandemic, an increasing body of evidence suggests that insulin and other medications currently used in clinical practice for hyperglycemia control may not be safe for treating these patients. Therefore, we need a proper approach for the treatment of chronic pain in long COVID patients, especially patients with T2D. This review presents evidence that transcutaneous auricular vagal nerve stimulation (taVNS) may provide a viable treatment option for chronic pain and metabolic dysfunction by improving the function of IRSS in both the central nervous system and peripheral tissues.