Pain Medicine最新文献

{"title":"Clinical and Mental Health Characteristics Among Patients Receiving Medications for OUD Treatment vs High-Dose Opioids When Referred for Pain Management.","authors":"Jie Yang, Melita Giummarra, Louisa Picco, Carolyn Arnold, Suzanne Nielsen","doi":"10.1093/pm/pnaf011","DOIUrl":"https://doi.org/10.1093/pm/pnaf011","url":null,"abstract":"<p><strong>Objective: </strong>To examine the demographic and clinical characteristics of patients attending pain management services who were receiving opioid agonist treatment (ie, methadone or buprenorphine for the treatment of opioid use disorder) in comparison to those taking prescription opioid analgesics in oral morphine equivalent daily doses at low (<40 mg) and high doses (>100 mg) using a national database from the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>Australian pain services.</p><p><strong>Subjects: </strong>Adult patients referred to Australian pain service clinics between 2016 and 2021.</p><p><strong>Methods: </strong>Multinomial and bivariate logistic regression models were conducted to compare the demographic and clinical characteristics of patients on opioid agonist treatment and those taking other prescription opioid analgesics.</p><p><strong>Results: </strong>Among 42,182 participants, most were female (56.8%), with a mean age of 51.7 years. People on opioid agonist treatment (n = 1,016) and high-dose opioids (n = 7,122) were similar in that they both had more severe mental health symptoms and longer pain duration, compared with the low-dose group (n = 20,517). Compared to the high-dose group, people on opioid agonist treatment had reduced odds of reporting more severe pain intensity, but increased odds of having multimorbidity, more severe anxiety and pain catastrophising thoughts.</p><p><strong>Conclusions: </strong>These findings highlight the need for mental health treatment and the necessity of tailored multidisciplinary pain management for people in opioid agonist treatment.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Occupational Radiation Measurements in Interventional Pain Medicine Physicians Wearing Chest versus Hand Dosimeters: A Quality Improvement Study.","authors":"Eric Fellin, Rebecca Rdesinski, Sandy Christiansen","doi":"10.1093/pm/pnaf010","DOIUrl":"https://doi.org/10.1093/pm/pnaf010","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Clinical, Psychophysical or Psychological Variables Helpful for Discriminating Patients with tension type headache? A diagnostic accuracy study.","authors":"Margarita Cigarán-Mendez, Juan C Pacho-Hernández, Angela Tejera-Alonso, Francisco G Palacios-Fernández, Juan Antonio Valera-Calero, Cristina Gómez, César Fernández-de-Las-Peñas","doi":"10.1093/pm/pnaf009","DOIUrl":"https://doi.org/10.1093/pm/pnaf009","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of this study were: 1, to determine the ability of pain thresholds to differentiate between subjects with and without tension-type headache (TTH); and 2, to determine the capability of clinical, psychological and psychophysical variables to differentiate between individuals with frequent episodic (FETTH) or chronic (CTTH) tension-type headache.</p><p><strong>Methods: </strong>A diagnostic accuracy study was conducted. Pressure pain threshold (PPTs) over the temporalis muscle, cervical spine, second metacarpal, and tibialis anterior muscle and dynamic pain thresholds (DPT) were bilaterally assessed in 100 individuals with TTH and 50 comparable non-headache subjects. Clinical headache parameters (headache diary), headache-associated burden (HDI), anxiety and depressive levels (HADS), sleep quality (PSQI), and state (STAI-S) - trait (STAI-T) anxiety levels were also evaluated. The area under the receiver operating characteristic (ROC) curve, optimal cut-off point, sensitivity, specificity, and positive and negative likelihood ratios (LR) for each variable were calculated.</p><p><strong>Results: </strong>Individuals with TTH exhibited lower PPTs and DPT than those without TTH. No significant differences in PPTs and DPT were found between FETTH and CTTH individuals. Overall, no clinical, psychological or psychophysical variable exhibited an acceptable ROC value (≥0.7) for identifying between TTH patients and non-headache controls or between subjects with FETTH and CTTH.</p><p><strong>Conclusion: </strong>Although individuals with TTH exhibit widespread pressure pain hyperalgesia, neither clinical nor psychological nor psychophysical variable had proper diagnostic accuracy to discriminate between individuals with/without TTH or between those with FETTH and CTTH. Further studies should clarify the clinical relevance of these findings.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned from the INTEGRATE-Pain Delphi Process to Develop Core Outcome Sets (COS) across the Pain Continuum.","authors":"Giulia Bova, Janelle Letzen, Adam Anicich, Judy Birch, Anthony Domenichiello, Ulrike Kaiser, Kate Nicholson, Daniela C Rosenberger, Laura Wandner, Esther Pogatzki-Zahn","doi":"10.1093/pm/pnaf008","DOIUrl":"https://doi.org/10.1093/pm/pnaf008","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and meta-analysis of conventional medical management in a patient population with refractory chronic pain suitable to receive a spinal cord stimulation system.","authors":"Marc Russo, Sarah Nevitt, Danielle Santarelli, Sam Eldabe, Rui V Duarte","doi":"10.1093/pm/pnaf004","DOIUrl":"https://doi.org/10.1093/pm/pnaf004","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this review was to systematically identify all evidence that used conventional medical management (CMM) as a comparator in randomised controlled trials (RCTs) of spinal cord stimulation (SCS) therapy, and to conduct a meta-analysis to investigate if continued CMM provides statistical or clinically meaningful pain relief and whether CMM effects have improved over the last few decades.</p><p><strong>Methods: </strong>Databases were searched from inception to June 2024 for RCTs that compared SCS to CMM. The primary outcome of the review was absolute change in pain intensity from baseline to the last available follow-up in the CMM group, measured using a visual analogue scale or numerical rating scale. The measure of treatment effect for absolute change and percentage change in pain intensity from baseline was mean difference (MD) and 95% confidence interval (CI). Risk of bias (RoB) was assessed by using the revised Cochrane RoB tool. The protocol for this review is registered on PROSPERO (CRD42023449215).</p><p><strong>Results: </strong>Meta-analysis of absolute change in pain intensity from baseline to last follow-up shows that CMM is not associated with any significant reductions in pain intensity (MD -0.11; 95% CI: -0.32 to 0.11; moderate certainty). Similar results were observed for percent change in pain intensity from baseline to last follow-up (MD -3.22%; 95% CI: -12.59% to 6.14%; moderate certainty). No significant differences were observed when considering decade of publication of the RCT for absolute (p = 0.065; moderate certainty) or percent change in pain intensity (p = 0.524; moderate certainty). Meta-analysis for 6-month follow-up and sensitivity analysis shows similar numerical results.</p><p><strong>Conclusion: </strong>Our findings show that continued CMM for a population eligible for SCS does not provide meaningful pain relief and has not considerably changed over the last few decades. The use of CMM as the control to evaluate relative SCS treatment effects should be reassessed.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating language processing artificial intelligence answers to patient-generated queries on chronic pelvic pain.","authors":"Carlos Agustín Zapata-Caballero, Nelly Alejandra Galindo-Rodriguez, Rebeca Rodriguez-Lane, Jonathan Fidel Cueto-Cámara, Viridiana Gorbea-Chávez, Verónica Granados-Martínez","doi":"10.1093/pm/pnae104","DOIUrl":"10.1093/pm/pnae104","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"114-116"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociogeographic determinants of rapid opioid reduction or discontinuation among patients on high-dose long-term opioid therapy in North Carolina, 2006-2018.","authors":"Ishrat Z Alam, Bethany L DiPrete, Brian W Pence, Arrianna Marie Planey, Stephen W Marshall, Naoko Fulcher, Shabbar I Ranapurwala","doi":"10.1093/pm/pnae119","DOIUrl":"10.1093/pm/pnae119","url":null,"abstract":"<p><strong>Objective: </strong>Rapid opioid reduction or discontinuation among patients on high-dose long-term opioid therapy (HD-LTOT) is associated with increased risk of heroin use, overdose, opioid use disorder, and mental health crises. We examined the association of residential segregation and health care access with rapid opioid reduction or discontinuation among patients on HD-LTOT and examined effect measure modification of individual-level characteristics.</p><p><strong>Methods: </strong>Using 2006-2018 North Carolina private insurance claims data, we conducted a retrospective cohort study of patients who were 18-64 years of age and on HD-LTOT (≥90 morphine milligram equivalents for 81 of 90 consecutive days), with 1-year follow-up. The outcome was rapid opioid reduction or discontinuation (versus maintenance, increase, or gradual reduction/discontinuation). Individual-level characteristics included age, sex, and clinical diagnoses (post-traumatic stress disorder [PTSD], depression, anxiety, and substance use disorder). Neighborhood-level characteristics included health care access (measured as geographic distance to health care facilities) and residential segregation (operationalized with the Index of Concentration at the Extremes). We conducted bivariate linear regression to estimate 1-year risk differences and 95% confidence intervals.</p><p><strong>Results: </strong>Of 13 375 patients on HD-LTOT, 48.6% experienced rapid opioid reduction or discontinuation during 1-year follow-up. Female patients and those diagnosed with PTSD who lived in areas of least racial and economic privilege had higher risks of rapid opioid reduction or discontinuation than did those living in areas with the most racial and economic privilege.</p><p><strong>Conclusion: </strong>Health care providers need to address potential biases toward patients living in underserved and marginalized communities, as well as intersectionality with mental health stigma, by prioritizing training and education in delivering unbiased care during opioid tapering.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"63-69"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined transcranial direct current stimulation and pain neuroscience education for chronic low back pain: a randomized controlled trial.","authors":"Cory Alcon, Christopher Zoch, Riley Luetkenhaus, Emily Lyman, Kelli Brizzolara, Hui-Ting Goh, Sharon Wang-Price","doi":"10.1093/pm/pnae101","DOIUrl":"10.1093/pm/pnae101","url":null,"abstract":"<p><strong>Objective: </strong>Priming the neural circuity likely targeted by pain neuroscience education (PNE), using transcranial direct current stimulation (tDCS) may enhance the efficacy of PNE. The aim of this study was to compare the effects of active tDCS + PNE to sham tDCS + PNE on measures of pain, pain behaviors, and cognitive function in participants with chronic low back pain (CLBP) and high pain catastrophizing.</p><p><strong>Methods: </strong>20 participants were recruited and randomly allocated into the active tDCS + PNE (n = 10) or sham tDCS + PNE (n = 10) groups. All participants received five sessions of their assigned interventions over a 2-week period. The active tDCS + PNE group received 20 min of 2 mA, anodal current applied to the left dorsolateral prefrontal cortex.</p><p><strong>Results: </strong>Within groups, both interventions demonstrated significant improvement in NPRS, PCS, and TSK. The active tDCS + PNE group also demonstrated significant improvement in the SCWT, CTMT2-Inhibitory, and CTMT2-Set Shifting. Between groups, the active tDCS + PNE group showed significantly greater improvement on the PCS, SCWT, and CTMT2-Inhibitory.</p><p><strong>Conclusions: </strong>The results of this pilot study suggest that active tDCS + PNE appeared to provide greater improvement than sham tDCS + PNE on levels of pain catastrophizing and attentional interference in participants with CLBP and high pain catastrophizing, consistent with both interventions targeting brain regions involved in those processes. Considering the differences between groups, tDCS appears to provide a priming effect on PNE.</p><p><strong>Perspective: </strong>This article presents evidence of a priming effect of transcranial direct current stimulation on pain neuroscience education in participants with chronic low back pain and high pain catastrophizing. The findings support that the combination of interventions improves pain behavior and cognitive function greater than pain neuroscience education alone.</p><p><strong>Clinical trial registry: </strong>NCT05571215, The Effect of Combining Pain Neuroscience Education and Transcranial Direct Current Stimulation on Pain Catastrophizing, Kinesiophobia, and Pain in Patients With Chronic Low Back Pain, https://classic.clinicaltrials.gov/ct2/show/NCT05571215.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"90-97"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subdural hematoma after spinal anesthesia.","authors":"Michael Beeler, Paul Porensky, Rintaro Kinjo, Scott Hughey","doi":"10.1093/pm/pnae108","DOIUrl":"10.1093/pm/pnae108","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"112-113"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive brain stimulation beyond the motor cortex: a systematic review and meta-analysis exploring effects on quantitative sensory testing in clinical pain.","authors":"Andrew Flood, Rocco Cavaleri, We-Ju Chang, Jason Kutch, Constantino Toufexis, Simon J Summers","doi":"10.1093/pm/pnae103","DOIUrl":"10.1093/pm/pnae103","url":null,"abstract":"<p><strong>Background: </strong>Noninvasive brain stimulation (NIBS) has been investigated increasingly as a means of treating pain. The effectiveness of NIBS in the treatment of pain has traditionally focused on protocols targeting the primary motor cortex (M1). However, over time, the effectiveness of M1 NIBS has been attributed to effects on interconnected cortical and subcortical sites rather than on M1 itself. Although previous reviews have demonstrated the effectiveness of non-M1 NIBS in improving subjective reports of pain intensity, the neurophysiological mechanisms underlying these effects remain incompletely understood. As chronic pain is associated with pain hypersensitivity and impaired endogenous descending pain modulation, it is plausible that non-M1 NIBS promotes analgesic effects by influencing these processes.</p><p><strong>Objective: </strong>The aim of this systematic review and meta-analysis was therefore to evaluate the effect of NIBS over non-M1 sites on quantitative sensory testing measures in clinical pain populations.</p><p><strong>Methods: </strong>A systematic search of electronic databases was conducted from inception to January 2024. Included articles (13 trials, n = 565 participants) were appraised with the Physiotherapy Evidence Database (PEDro) scale and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a random-effects model was used to meta-analyze outcomes where possible.</p><p><strong>Results: </strong>A small number of studies found that NIBS applied to the dorsolateral prefrontal cortex might improve pain modulation in patients with fibromyalgia and that stimulation of the posterior superior insula and prefrontal cortex could improve pain sensitivity in chronic neuropathic and osteoarthritic pain, respectively. However, findings varied among studies, and there remains a paucity of primary research.</p><p><strong>Conclusion: </strong>This review indicates that current literature does not provide clear evidence that NIBS over non-M1 sites influences pain processing.</p><p><strong>Study registration: </strong>PROSPERO (CRD42020201076).</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"98-111"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}