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Combining onabotulinumtoxin A with a CGRP antagonist for chronic migraine prophylaxis: where do we stand? 联合肉毒杆菌毒素A与CGRP拮抗剂预防慢性偏头痛:进展如何?
Pub Date : 2023-10-27 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1292994
Lanfranco Pellesi
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引用次数: 0
US medical school curriculum on opioid use disorder-a topic review of current curricular research and evaluation of winning student-designed opioid curricula for the 2021 Coalition on Physician Education in Substance Use Disorders curricular competition. 美国医学院关于阿片类药物使用障碍的课程-对当前课程研究的主题回顾和2021年药物使用障碍医师教育联盟课程竞赛中获奖学生设计的阿片类药物课程的评估。
Pub Date : 2023-10-27 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1257141
Ling Cao, Jennifer Van Deusen

The opioid crisis in the US severely affected and continues to affect population's health. The opioid crisis was in part fueled by inadequate pain management, which is in part due to the inadequate education in both pain and opioid use disorder (OUD) for health care professionals. In 2021, the Coalition on Physician Education in Substance Use Disorders (COPE) organized a curricular competition soliciting US medical students-designed OUD-related curricula. Twelve winning curricula were identified. Here, we first conducted a topic review regarding current US medical school OUD curricula. Then we evaluated the COPE winning curricula and compared them to the curricula identified in the topic review. For the topic review, ten relevant databases were searched up to December 31, 2021 using a combination of pre-determined keywords. Total of 25 peer-reviewed articles were selected based on the pre-determined criteria, which included 5 articles describing opioid curricular development at the state level (AZ, CA, MA, PA, and RI), 17 research articles evaluating a curriculum developed in a single institution, 2 literature reviews, and 1 article detailing curricular development and validation processes in a single institution. Although vary in organizations and formats, state-level curricula were comprehensive and could be adopted by other states or institutions with necessary local issue-based modifications. Faculty development and critical resources were major challenges for curricular implementation. The 17 research articles exhibited good scientific quality (Medical Education Research Study Quality Instrument (MERSQI) score = 11.94 ± 2.33 (maximal score = 18)). All research articles reported to some extent, the success of respective curriculum, in improving students' knowledge in and/or attitude towards OUD, based on primarily pre- and post- comparisons. Compared to these published curricula, winning students-designed curricula had more specific focuses, diverse learning activities, and varieties in assessment methods. For all curricula, long-term evaluations were lacking. Except for the state level curricula, majority of the other curricula did not emphasize specifically on chronic pain education or the biopsychosocial approach. Interprofessional education approach was also lacking. Our topic review and curricular evaluation highlighted the needs for integrating OUD and chronic pain medical curricula, developing long-term assessment tools, and more OUD curriculum research overall.

美国的阿片类药物危机严重影响并继续影响着人们的健康。阿片类药物危机的部分原因是疼痛管理不足,而疼痛管理不足的部分原因是卫生保健专业人员在疼痛和阿片类药物使用障碍方面的教育不足。2021年,药物使用障碍医师教育联盟(COPE)组织了一场课程竞赛,征集美国医学生设计与药物使用障碍相关的课程。选出了12个获奖课程。在这里,我们首先对当前美国医学院OUD课程进行了主题回顾。然后,我们评估了COPE获奖课程,并将其与主题审查中确定的课程进行了比较。为了进行主题审查,使用预先确定的关键词组合搜索到2021年12月31日之前的10个相关数据库。根据预先确定的标准,共选择了25篇同行评议的文章,其中包括5篇描述州一级(AZ, CA, MA, PA和RI)阿片类药物课程开发的文章,17篇评估单个机构开发的课程的研究文章,2篇文献综述,1篇详细介绍单个机构课程开发和验证过程的文章。虽然组织和形式各不相同,但州一级的课程是全面的,可以由其他州或机构根据当地问题进行必要的修改后采用。教师发展和关键资源是课程实施的主要挑战。17篇研究论文的科学质量较好(医学教育研究质量仪器评分= 11.94±2.33(最高评分= 18))。所有研究文章都在一定程度上报告了各自课程在提高学生对OUD的知识和/或态度方面的成功,主要基于前后比较。与这些已出版的课程相比,获奖学生设计的课程重点更明确,学习活动更多样化,评估方法也更多样化。所有课程都缺乏长期评估。除了州一级的课程外,大多数其他课程都没有特别强调慢性疼痛教育或生物心理社会方法。跨专业教育方法也缺乏。我们的主题回顾和课程评估强调了整合OUD和慢性疼痛医学课程、开发长期评估工具以及更多OUD课程研究的必要性。
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引用次数: 0
Assessing changes in range of motion in adolescent patients undergoing myoActivation® for chronic pain related to myofascial dysfunction: a feasibility study. 评估青少年患者接受myoActivation®治疗与肌筋膜功能障碍相关的慢性疼痛时运动范围的变化:一项可行性研究
Pub Date : 2023-10-25 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1225088
Tim Bhatnagar, Farah T Azim, Mona Behrouzian, Karen Davies, Diane Wickenheiser, Gail Jahren, Nicholas West, Lise Leveille, Gillian R Lauder

Introduction: myoActivation® assessment utilizes systemized movement tests to assess for pain and limitations in motion secondary to myofascial dysfunction. myoActivation needling therapy resolves the myofascial components of pain and is associated with immediately observed changes in pain, flexibility, and range of motion. The principal aim of this feasibility study was to objectively characterize the kinematic metrics of upper and lower body motion before and after myoActivation movement tests and therapy.

Methods: Five consecutive eligible adolescent participants considered appropriate for myoActivation were consented to receive their myoActivation intervention in a motion laboratory. Clinical motion analysis was used to measure the changes in maximum range of motion (maxROM) and maximum angular speed to maximum ROM (speedROM) of movement tests predicted to change. Metrics were analyzed to assess changes over specified time intervals - i) baseline to after initial myoActivation session, and ii) baseline to after complete myoActivation course. Each participant served as their own control.

Results: We demonstrated objective evidence of improved maxROM and/or speedROM in 63% of the movement tests predicted to change after just one session of myoActivation and in 77% of movement tests predicted to change over the complete course of treatment. The myoActivation clinician observed positive change in 11/19 of movement tests across all patients, that were predicted to change after the initial myoActivation session; 81% of these positive changes were confirmed by the kinematic data.

Discussion: Clinical motion analysis provides objective support to clinicians evaluating, treating, and teaching myofascial release. A larger, prospective clinical trial is warranted to explore the impact of myoActivation on movement. Refinement of observation techniques and outcome measures established in this feasibility study will strengthen future clinical motion analysis of the myoActivation process.

myoActivation®评估采用系统化的运动测试来评估继发于肌筋膜功能障碍的疼痛和运动限制。肌激活针刺疗法可缓解疼痛的肌筋膜成分,并可立即观察到疼痛、柔韧性和活动范围的变化。这项可行性研究的主要目的是客观地描述肌激活运动测试和治疗前后上半身和下半身运动的运动学指标。方法:连续5名被认为适合进行肌激活的青少年参与者同意在运动实验室接受他们的肌激活干预。临床运动分析用于测量最大运动范围(maxROM)和最大角速度到最大运动范围(speedROM)的变化。分析指标以评估指定时间间隔内的变化- i)基线至初始肌激活会话后,ii)基线至完成肌激活课程后。每个参与者都作为自己的对照。结果:我们证明了客观证据,63%的运动测试预测在一次肌激活后会改变maxROM和/或speedROM, 77%的运动测试预测在整个治疗过程中会改变。肌激活临床医生在所有患者中观察到11/19的运动测试呈阳性变化,预计在初始肌激活后会发生变化;81%的这些积极变化被运动学数据证实。讨论:临床运动分析为临床医生评估、治疗和教授肌筋膜松解提供了客观的支持。一个更大的前瞻性临床试验是必要的,以探索肌激活对运动的影响。在这项可行性研究中建立的观察技术和结果测量的改进将加强未来对肌激活过程的临床运动分析。
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引用次数: 0
Dietary fatty acids improve perceived sleep quality, stress, and health in migraine: a secondary analysis of a randomized controlled trial. 膳食脂肪酸改善偏头痛患者的睡眠质量、压力和健康:一项随机对照试验的二次分析。
Pub Date : 2023-10-25 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1231054
Keturah R Faurot, Jinyoung Park, Vanessa Miller, Gilson Honvoh, Anthony Domeniciello, J Douglas Mann, Susan A Gaylord, Chanee E Lynch, Olafur Palsson, Christopher E Ramsden, Beth A MacIntosh, Mark Horowitz, Daisy Zamora

Background: Migraine is a prevalent disabling condition often associated with comorbid physical and psychological symptoms that contribute to impaired quality of life and disability. Studies suggest that increasing dietary omega-3 fatty acid is associated with headache reduction, but less is known about the effects on quality of life in migraine.

Methods: After a 4-week run-in, 182 adults with 5-20 migraine days per month were randomized to one of the 3 arms for sixteen weeks. Dietary arms included: H3L6 (a high omega-3, low omega-6 diet), H3 (a high omega-3, an average omega-6 diet), or a control diet (average intakes of omega-3 and omega-6 fatty acids). Prespecified secondary endpoints included daily diary measures (stress perception, sleep quality, and perceived health), Patient-Reported Outcome Measurement Information System Version 1.0 ([PROMIS©) measures and the Migraine Disability Assessment (MIDAS). Analyses used linear mixed effects models to control for repeated measures.

Results: The H3L6 diet was associated with significant improvements in stress perception [adjusted mean difference (aMD): -1.5 (95% confidence interval: -1.7 to -1.2)], sleep quality [aMD: 0.2 (95% CI:0.1-0.2)], and perceived health [aMD: 0.2 (0.2-0.3)] compared to the control. Similarly, the H3 diet was associated with significant improvements in stress perception [aMD: -0.8 (-1.1 to -0.5)], sleep quality [aMD: 0.2 (0.1, 0.3)], and perceived health [aMD: 0.3 (0.2, 0.3)] compared to the control. MIDAS scores improved substantially in the intervention groups compared with the control (H3L6 aMD: -11.8 [-25.1, 1.5] and H3 aMD: -10.7 [-24.0, 2.7]). Among the PROMIS-29 assessments, the biggest impact was on pain interference [H3L6 MD: -1.8 (-4.4, 0.7) and H3 aMD: -3.2 (-5.9, -0.5)] and pain intensity [H3L6 MD: -0.6 (-1.3, 0.1) and H3 aMD: -0.6 (-1.4, 0.1)].

Discussion: The diary measures, with their increased power, supported our hypothesis that symptoms associated with migraine attacks could be responsive to specific dietary fatty acid manipulations. Changes in the PROMIS© measures reflected improvements in non-headache pain as well as physical and psychological function, largely in the expected directions. These findings suggest that increasing omega-3 with or without decreasing omega-6 in the diet may represent a reasonable adjunctive approach to reducing symptoms associated with migraine attacks. Trial Registration: ClinicalTrials.gov NCT02012790.

背景:偏头痛是一种常见的致残疾病,通常伴有身体和心理上的合并症,导致生活质量受损和残疾。研究表明,增加饮食中的omega-3脂肪酸与减轻头痛有关,但对偏头痛患者生活质量的影响知之甚少。方法:经过4周的磨合,182名每月有5-20天偏头痛的成年人被随机分配到3组中的一组,为期16周。饮食组包括:H3L6(高omega-3,低omega-6饮食),H3(高omega-3,平均omega-6饮食),或对照饮食(平均摄入omega-3和omega-6脂肪酸)。预先指定的次要终点包括每日日记测量(压力感知、睡眠质量和感知健康)、患者报告的结果测量信息系统1.0版([PROMIS©)测量和偏头痛残疾评估(MIDAS)。分析使用线性混合效应模型来控制重复测量。结果:与对照组相比,H3L6饮食与压力感知[调整平均差(aMD): -1.5(95%可信区间:-1.7至-1.2)]、睡眠质量[aMD: 0.2 (95% CI:0.1-0.2)]和感知健康[aMD: 0.2(0.2-0.3)]的显著改善相关。同样,与对照组相比,H3饮食与压力感知[aMD: -0.8(-1.1至-0.5)]、睡眠质量[aMD: 0.2(0.1, 0.3)]和感知健康[aMD: 0.3(0.2, 0.3)]的显著改善有关。与对照组相比,干预组的MIDAS评分显著提高(H3L6 aMD: -11.8 [-25.1, 1.5], H3 aMD: -10.7[-24.0, 2.7])。在promisi -29评估中,影响最大的是疼痛干扰[H3L6 MD: -1.8(-4.4, 0.7)和H3 aMD: -3.2(-5.9, -0.5)]和疼痛强度[H3L6 MD: -0.6(-1.3, 0.1)和H3 aMD: -0.6(-1.4, 0.1)]。讨论:日记测量法的功效增强,支持了我们的假设,即偏头痛发作的相关症状可能对特定的膳食脂肪酸操作有反应。PROMIS©测量的变化反映了非头痛疼痛以及身体和心理功能的改善,主要是在预期的方向上。这些发现表明,在饮食中增加或不减少omega-6的同时增加omega-3可能是减轻偏头痛发作相关症状的一种合理的辅助方法。试验注册:ClinicalTrials.gov NCT02012790。
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引用次数: 0
Management of polyneuropathy using yoga and naturopathic medicine in India: recommendations for future research and clinical practice. 印度使用瑜伽和自然疗法治疗多发性神经病变:对未来研究和临床实践的建议。
Pub Date : 2023-10-25 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1264450
Pradeep M K Nair, Karishma Silwal, Jyoti Keswani, Sucheta Kriplani, Vakeel Khan, Ayush Maheshwari, Mili Arpan Shah, Naga Jyoti, Vinutha Rao, Cijith Sreedhar, Kinjal Dilipsinh Bhalavat, Renjish Mohanan, Jerin Subha M, Rakesh Gupta, Hemanshu Sharma, Gulab Rai Tewani
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引用次数: 0
Allogenic umbilical cord tissue for temporomandibular joint injuries. 同种异体脐带组织治疗颞下颌关节损伤。
Pub Date : 2023-10-24 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1281277
Adarsh Aratikatla, Samir Ghandour, Nicola Maffulli, Manu Gupta, Ashim Gupta

The temporomandibular joint (TMJ) is crucial for functions of daily living such as mastication and articulation. Common TMJ issues include osteoarthritis, internal derangement, and myofascial pain dysfunction. Conservative methods such as physical therapy and medications are used, with surgical options such as arthroscopy and replacement for severe cases. Emerging regenerative medicine explores non-surgical treatments using human stem cells from umbilical cord derivatives, showing potential for tissue regeneration in TMJ disorders. A systematic search was conducted across PubMed, Embase, Scopus, and Web of Science databases, adhering to PRISMA guidelines, aiming to identify relevant articles published in English until August 2023. The search used specific terms to target in vitro, preclinical, and clinical studies on umbilical cord (UC)-derived tissue and mesenchymal stem cells (MSCs) for treating TMJ disorders. The search was extended to three clinical trial registries for on-going investigations related to UC tissue and MSCs for TMJ disorder management. The studies included in this article report the safety and efficacy profiles of allogenically acquired, umbilical cord-derived tissues and associated mesenchymal stem cells for temporomandibular joint ailments, future adequately powered, randomized controlled trials are warranted to conclusively justify the clinical use of this biologic therapy.

颞下颌关节(TMJ)对日常生活功能(如咀嚼和关节)至关重要。常见的TMJ问题包括骨关节炎、内部紊乱和肌筋膜疼痛功能障碍。使用物理治疗和药物治疗等保守方法,并可选择关节镜检查和严重病例的替代手术。新兴的再生医学探索了使用脐带衍生物的人类干细胞进行非手术治疗,显示出TMJ疾病组织再生的潜力。根据PRISMA指南,在PubMed、Embase、Scopus和Web of Science数据库中进行了系统搜索,旨在识别2023年8月之前以英语发表的相关文章。这项研究使用了特定的术语来靶向脐带(UC)衍生组织和间充质干细胞(MSC)治疗TMJ疾病的体外、临床前和临床研究。搜索范围扩大到三个临床试验注册中心,以进行与UC组织和MSCs有关的TMJ疾病管理的持续研究。本文中的研究报告了同种异体获得的脐带来源组织和相关间充质干细胞治疗颞下颌关节疾病的安全性和有效性,未来有必要进行充分的随机对照试验,以最终证明这种生物疗法的临床应用是合理的。
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引用次数: 0
Multidimensional visualization and analysis of chronic pain variables of patients who attended a chronic pain program. 参加慢性疼痛项目的患者的慢性疼痛变量的多维可视化和分析。
Pub Date : 2023-10-24 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1125992
Yuelin Cindy Li, Eleni G Hapidou

Psychologically-based chronic pain variables measure multiple domains of the pain experience such as anxiety, depression, catastrophizing, acceptance and stages of change. These variables measure specific areas such as emotional and cognitive states towards chronic pain and its management, acceptance towards the chronic pain condition, and an individual's readiness to move towards self-management methods. Conceptually, these variables appear to be interrelated to each other, and also form groupings of similar underlying themes. Groupings that have been previously discussed for these variables include positive and negative affect, and improved and poor adjustment. Psychological experience of chronic pain as a whole is mostly understood through conceptually consolidating individual scores across different measures covering multiple domains. A map of these variables in relation to each other can offer an overview for further understanding and exploration. We hereby visualize highlights of relationships among 11 psychosocial chronic pain variables including measures examining physical and somatic aspects, using three-dimensional biplots. Variables roughly form two groupings, with one grouping consisting of items of negative affect, cognition, and physical state ratings, and the other grouping consisting of items of acceptance and the later three stages of change (contemplation, action, maintenance). Also, we follow up with canonical correlation as a complement to further identify key relationships between bimodal groupings. Key variables linking bimodal relationships consist of catastrophizing, depression and anxiety in one grouping and activity engagement in the other. Results are discussed in the context of existing literature.

基于心理学的慢性疼痛变量测量疼痛体验的多个领域,如焦虑、抑郁、灾难、接受和变化阶段。这些变量衡量特定领域,如对慢性疼痛及其管理的情绪和认知状态,对慢性疼痛状况的接受程度,以及个人走向自我管理方法的准备程度。从概念上讲,这些变量似乎是相互关联的,也形成了相似的基本主题的分组。之前讨论过的这些变量的分组包括积极和消极影响,以及改进和较差的调整。慢性疼痛的心理体验作为一个整体,主要是通过概念上整合涵盖多个领域的不同指标的个人得分来理解的。这些变量之间的关系图可以为进一步理解和探索提供概览。我们在此可视化11个心理社会慢性疼痛变量之间关系的亮点,包括使用三维双图检查身体和身体方面的测量。变量大致分为两组,一组由负面影响、认知和身体状态评分组成,另一组由接受和后三个变化阶段(沉思、行动、维持)组成。此外,我们将正则相关作为补充,以进一步确定双峰分组之间的关键关系。连接双峰关系的关键变量包括一组中的灾难性、抑郁和焦虑,另一组则包括活动参与。结果在现有文献的背景下进行了讨论。
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引用次数: 0
Editorial: Advancements in deep brain stimulation for chronic pain control. 社论:脑深部刺激治疗慢性疼痛的进展。
Pub Date : 2023-10-23 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1293919
Michael D Staudt, Nasser K Yaghi, David J Mazur-Hart, Prasad Shirvalkar
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引用次数: 0
Physicians' perception about predictors of opioid abuse in patients with chronic non-cancer pain: a Delphi study. 医生对慢性非癌性疼痛患者阿片类药物滥用预测因素的认知:德尔菲研究。
Pub Date : 2023-10-19 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1269018
Santiago Galán, Rocío de la Vega, Rosa Esteve, Alicia E López-Martínez, Mariano Fernández Baena, Carmen Ramírez-Maestre

Background: Opioids are being prescribed widely, and increasingly, for the treatment of chronic non-cancer pain (CNCP). However, several side effects are associated with mid- and long-term opioid use and, for certain patients, with the risk of problematic opioid use. The aim of this study is to know the perception of the physicians about which variables could be associated with increased risk of patients with CNCP developing a problem of abuse or misuse of the prescribed opioid medication.

Methods: Twenty-nine physicians with experience in CNCP pain management and opioids prescription participated in a two-round Delphi study focused on the risk factors for opioid misuse and abuse.

Results: The variables that reached consensus regarding their relationship with the increased risk of suffering a problem of opioid abuse or misuse were: (1) Experiencing pain on a daily basis, (2) previous use of high-dose opioids, (3) generalized anxiety, (4) hopelessness, (5) benzodiazepine intake, (6) use of opioids for reasons other than pain, (7) family problems, family instability or family breakdown, and (8) having access to several opioid prescribers. The only variable that reached consensus regarding it not being associated to a possible risk of abuse or misuse was having mild pain intensity (0-4 on a NRS-11).

Conclusions: This study provides useful information that could help make decisions about the use of opioids for CNCP treatment and prevent future difficulties. Prospective studies testing the relationship of the variables that reached consensus with the risk of opioid misuse and abuse are warranted.

Significance: This study shows the variables of CNCP that the professional must take into account in order to avoid possible problems when prescribing opioids.

背景:阿片类药物被广泛且越来越多地用于治疗慢性非癌性疼痛(CNCP)。然而,一些副作用与中长期阿片类药物使用有关,对某些患者来说,还与阿片类物质使用有问题的风险有关。本研究的目的是了解医生对哪些变量可能与CNCP患者出现滥用或滥用处方阿片类药物问题的风险增加有关的看法。方法:29名在CNCP疼痛管理和阿片类药物处方方面有经验的医生参与了一项两轮德尔菲研究,重点是阿片类物质滥用和滥用的风险因素。结果:就其与阿片类药物滥用或滥用问题风险增加的关系达成共识的变量是:(1)每天经历疼痛,(2)以前使用过高剂量阿片类,(3)普遍焦虑,(4)绝望,(5)苯二氮卓类药物摄入,(6)因疼痛以外的原因使用阿片类,家庭不稳定或家庭破裂,以及(8)接触到几位阿片类药物处方医生。唯一达成共识的与可能的滥用或误用风险无关的变量是轻度疼痛强度(NRS-11为0-4)。结论:这项研究提供了有用的信息,有助于决定使用阿片类药物治疗CNCP,并防止未来的困难。有必要进行前瞻性研究,测试达成共识的变量与阿片类药物滥用风险的关系。意义:本研究显示了专业人员在开具阿片类药物处方时必须考虑的CNCP变量,以避免可能出现的问题。
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引用次数: 0
Editorial: Computational methods for pain pharmacology. 社论:疼痛药理学的计算方法。
Pub Date : 2023-10-19 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1298882
Jakub Mlost, Mateusz Kucharczyk
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引用次数: 0
期刊
Frontiers in pain research (Lausanne, Switzerland)
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