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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
The mechanism and potential therapeutic target of piezo channels in pain. 压电通道在疼痛中的作用机制和潜在治疗目标。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1452389
Yi Xu, Yuheng Wang, Shuchong Mei, Jialing Hu, Lidong Wu, Luyang Xu, Lijie Bao, Xiaowei Fang

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.

疼痛是许多临床疾病的常见症状,它对患者的身心健康造成不利影响,降低患者的生活质量,给患者和社会带来沉重负担。疼痛治疗是当今最棘手的问题之一。为提高疼痛的诊断和治疗率,探索疼痛发病机制的潜在因素迫在眉睫。Piezo1/2是一种新发现的机械敏感性离子通道,在机械刺激下开放,在调节疼痛相关疾病中起着关键作用。抑制或下调 Piezo1/2 可减轻疾病引起的疼痛。因此,在本研究中,我们全面讨论了该基因的生物学特性,重点研究了其在疼痛相关疾病中的潜在相关性,并探讨了使用该基因药物治疗疼痛的药理作用。
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引用次数: 0
Understanding the importance of therapeutic alliance during physiotherapy treatment for musculoskeletal pain in children: a scoping review. 了解儿童肌肉骨骼疼痛物理治疗过程中治疗联盟的重要性:范围界定综述。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-25 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1452771
Rhiannon Joslin, Eve Allen, Bernie Carter

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.

简介影响儿童的肌肉骨骼疼痛很常见。康复和治疗效果会受到多种个人和环境因素的影响。需要对儿童疼痛的物理治疗进行更严格的评估,确定特定技术的作用,并探讨治疗联盟的影响。本研究综述旨在研究:(1)儿童、家长和物理治疗师对肌肉骨骼疼痛治疗过程中治疗联盟的重要性有何看法?(2) 从儿童、家长和物理治疗师的角度看,儿童肌肉骨骼疼痛治疗过程中治疗联盟的主要特征是什么?范围界定综述以 Arksey 和 O'Malley 的框架为基础,以 PRISMA-ScR 为指导进行报告。检索策略基于三个概念块:(1) 研究人群:儿童(结果:在对最初的 236 篇文章进行重复删除和资格评估后,共收录了 9 篇文章;其中只有一篇文章专门探讨了治疗联盟问题,这也是唯一一篇直接提及治疗联盟的文章。所有九篇文章都介绍了儿童的经历。其中有一个总主题 "通过治疗联盟找到我内心的复原力 "和三个主要主题:"讨论:儿童、家长和物理治疗师都认为治疗联盟非常重要,它影响着儿童和家长对物理治疗的看法以及整体治疗效果。物理治疗师可以通过提供学科专业知识,与儿童建立联系和合作,成为他们值得信赖的向导,并通过帮助他们了解自己的身体、疼痛和康复时间表,共同绘制康复路线图,从而培养儿童在经历肌肉骨骼疼痛时的恢复能力。
{"title":"Understanding the importance of therapeutic alliance during physiotherapy treatment for musculoskeletal pain in children: a scoping review.","authors":"Rhiannon Joslin, Eve Allen, Bernie Carter","doi":"10.3389/fpain.2024.1452771","DOIUrl":"10.3389/fpain.2024.1452771","url":null,"abstract":"<p><strong>Introduction: </strong>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?</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"5 ","pages":"1452771"},"PeriodicalIF":2.5,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395686","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
Causality of genetically determined serum metabolites on lower back pain or/and sciatica: a comprehensive Mendelian randomized study. 由基因决定的血清代谢物对下背痛或/和坐骨神经痛的因果关系:孟德尔随机综合研究。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-25 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1370704
Yi-Ming Ren, Wei-Yu Hou, Bao-You Fan, Yuan-Hui Duan, Yun-Bo Sun, Tao Yang, Han-Ji Zhang, Tian-Wei Sun, Meng-Qiang Tian

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 PIVW < 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.

背景:临床上迫切需要确认反映下背痛或/和坐骨神经痛发病机制的生物标志物和靶向药物。本研究旨在进行双向孟德尔随机分析(MR),探讨 486 种血清代谢物与下背痛或/和坐骨神经痛之间的因果关系:所有数据均来自两个欧洲血统的公共共享数据库,下背痛或/和坐骨神经痛的单核苷酸多态性(SNPs)作为工具变量。使用传统的逆方差加权法(IVW)、加权中值法、MR-Egger 法和其他方法估计因果关系。还通过 MR-Egger 截距检验、Cochran's Q 检验、MR-PRESSO 检验和遗漏敏感性分析验证了水平多向性和异质性。我们采用了反向磁共振分析来评估代谢物对下背痛或/和坐骨神经痛的直接影响。此外,我们还进行了共定位分析,以深入反映因果关系。结果表明:使用基因变异作为 PIVW 的探针后,28 个代谢物(18 个已知代谢物、1 个已识别代谢物和 9 个未知代谢物)与坐骨神经痛或/和下背痛的风险相关:我们的分析为血液代谢物与坐骨神经痛或/和下背痛之间的因果关系提供了有力的证据。然而,其潜在机制仍有待进一步研究。
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引用次数: 0
A novel opioid/pramipexole combination treatment for the management of acute pain: a pilot study. 治疗急性疼痛的新型阿片类药物/普拉克索联合疗法:一项试点研究。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-24 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1422298
Cara Girardi, Joseph Duronio, Ryan Patton, Kevin O'Brien, Stefan Clemens, Kori L Brewer

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).

目的:尽管阿片类药物具有危险的副作用,但它仍然是治疗中度至重度疼痛的标准药物,几乎没有替代药物。我们需要一种既能保持阿片类药物镇痛效果,又能将相关风险降至最低的策略。临床前研究表明,使用多巴胺 3 受体(D3R)激动剂作为吗啡的辅助药物,可提供比单独使用吗啡更优越的疼痛刺激镇痛效果。我们的目的是测试 D3R 受体激动剂的辅助治疗能否在保持有效镇痛的同时减少阿片类药物的使用:本研究为双盲、安慰剂对照随机试验。研究对象包括急诊科的急性肾绞痛患者,患者被随机分配到 "对照组 "或 "研究组"。对照组接受标准治疗(吗啡,0.1 毫克/千克;静脉注射)和口服安慰剂。实验组接受半剂量吗啡和口服普拉克索丸(0.25 毫克)。在基线和随后每隔 15 分钟对参加者进行疼痛测量,包括疼痛数字量表和视觉模拟量表:共有 19 名患者完成了研究,其中实验组 10 人,对照组 9 人。在研究期间,80% 的实验组患者实现了有效镇痛(比基线下降 50%),而对照组仅为 33.3%:我们的试点临床试验证明,D3R招募可作为低剂量吗啡的有效辅助药物,用于控制肾绞痛以及其他潜在的急性疼痛:临床试验注册:ClinicalTrials.gov,标识符(NCT04160520)。
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引用次数: 0
Validation of a novel medical device (Chloe SED®) for the administration of analgesia during manual vacuum aspiration: a randomized controlled non-inferiority pilot study. 验证新型医疗设备(Chloe SED®)在手动真空吸引过程中的镇痛效果:随机对照非劣效试验研究。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-18 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1326772
Aparna Ramanathan, Karlheinz Tondo Samenjo, Robert C Bailey, Javan Imbamba, Stella Odenyo, Erin Koksal, Jan Carel Diehl, Jackton Omoto, Stephen Gwer

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.

导言:全世界每年有数百万妇女在没有止痛药的情况下接受人工真空吸引术(MVA),这侵犯了她们的基本人格尊严。我们设计了一种新型设备(Chloe SED®),用于在宫颈旁阻滞术(MVA)过程中实施宫颈旁阻滞(PCB):我们在肯尼亚基苏木的两家医院进行了一项单盲、随机对照非劣效性试验,共纳入 61 名患者,以验证 Chloe SED® 在 MVA 期间实施 PCB 的有效性。使用 Chloe SED® 施用多氯联苯与使用标准脊柱针施用多氯联苯进行了比较。需要进行 MVA 的患者被随机分成六组,每组六人,每个医疗服务提供者完成六次多氯联苯注射,其中三次使用 Chloe SED®,另外三次使用标准脊柱针。该试验已在肯尼亚药剂和毒药委员会注册,编号为 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)。试验完成了意向治疗分析。主要结果是排空子宫时疼痛评分的非劣效性,非劣效性差值为 11 分数字评分表中的 2 分。次要结果包括其他四个时间点的疼痛评分和患者满意度:Chloe SED® 的主要结果显示,排空过程中的平均疼痛评分为 3.8[90%置信区间 (CI):3.1-4.6],而脊柱针的评分为 4.1(90% CI:3.5-4.7),两者无劣效。所有时间点的疼痛评分均无劣势。大多数患者表示希望继续使用该装置为颅内压增高症患者注射多氯联苯。未发现任何不良反应:总之,Chloe SED® 似乎并不比脊髓针差,是在 MVA 期间使用多氯联苯的理想选择。
{"title":"Validation of a novel medical device (Chloe SED®) for the administration of analgesia during manual vacuum aspiration: a randomized controlled non-inferiority pilot study.","authors":"Aparna Ramanathan, Karlheinz Tondo Samenjo, Robert C Bailey, Javan Imbamba, Stella Odenyo, Erin Koksal, Jan Carel Diehl, Jackton Omoto, Stephen Gwer","doi":"10.3389/fpain.2024.1326772","DOIUrl":"https://doi.org/10.3389/fpain.2024.1326772","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>In summary, the Chloe SED® appears non-inferior to the spinal needle and desirable for the administration of PCB during MVA.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"5 ","pages":"1326772"},"PeriodicalIF":2.5,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11476421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482348","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
Editorial: Musculoskeletal pain phenotypes and personalised pain medicine. 社论:肌肉骨骼疼痛表型与个性化疼痛医学。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-06 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1481839
Maja R Radojčić, Lingxiao Chen
{"title":"Editorial: Musculoskeletal pain phenotypes and personalised pain medicine.","authors":"Maja R Radojčić, Lingxiao Chen","doi":"10.3389/fpain.2024.1481839","DOIUrl":"10.3389/fpain.2024.1481839","url":null,"abstract":"","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"5 ","pages":"1481839"},"PeriodicalIF":2.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302532","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
Commentary: Intraganglionic reactive oxygen species mediate inflammatory pain and hyperalgesia through TRPA1 in the rat. 评论:神经节内活性氧通过 TRPA1 在大鼠体内介导炎性疼痛和痛觉减退。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.3389/fpain.2024.1456548
Felix Yang, Arkadeep Ghosh, Shreya Katwala, Xiang-Ping Chu
{"title":"Commentary: Intraganglionic reactive oxygen species mediate inflammatory pain and hyperalgesia through TRPA1 in the rat.","authors":"Felix Yang, Arkadeep Ghosh, Shreya Katwala, Xiang-Ping Chu","doi":"10.3389/fpain.2024.1456548","DOIUrl":"https://doi.org/10.3389/fpain.2024.1456548","url":null,"abstract":"","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"5 ","pages":"1456548"},"PeriodicalIF":2.5,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302529","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
期刊
Frontiers in pain research (Lausanne, Switzerland)
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