Pain Medicine最新文献

{"title":"The Impact of Transcranial Magnetic Stimulation (TMS) on Depressive Symptomatology in Patients with Chronic Pain Disorders: A Systematic Review.","authors":"Maria Inês Salgado, Inês Pereira Baptista, Ana Rita Ferreira, Patrick Alexandre Alves","doi":"10.1093/pm/pnaf069","DOIUrl":"https://doi.org/10.1093/pm/pnaf069","url":null,"abstract":"<p><strong>Objective: </strong>Transcranial Magnetic Stimulation (TMS) is a recognized therapy for treatment-resistant depression and has been studied for its potential in managing chronic pain. Knowing the intrinsic relationship between pain and depressive symptomatology, this systematic review aims to assess the impact of TMS on depressive symptoms in patients with chronic pain.</p><p><strong>Materials and methods: </strong>Electronic databases were systematically searched until November 2023 for studies applying TMS in chronic pain patients, with an assessment of both pain and depressive symptomatology.</p><p><strong>Results: </strong>From the records screened, 36 studies met the inclusion criteria for qualitative synthesis, including a total of 1339 unique patients. The results showed heterogeneous protocols with widely different results in depressive symptomatology across the studies, precluding meta-analysis. TMS was considered a safe treatment option with minor side effects.</p><p><strong>Conclusions: </strong>The impact of TMS on depressive symptomatology among patients with chronic pain is a complex subject. Considering the diversity of the protocols and results encountered, future research should prioritize the establishment of standardized TMS protocols to clarify their efficacy in managing depressive symptoms among these patients. This systematic review highlights the need for further investigation of TMS as a dual therapeutic approach for chronic pain and depressive symptomatology, emphasizing the necessity of improving the protocols to enhance clinical outcomes.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160834","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":"Psychometric Properties of the Knee Osteoarthritis Pain Index.","authors":"Scott G Ravyts, Timothy R Fleagle, Elena Staguhn, Daniel Scharfstein, Rachel V Aaron, Steven Paul Cohen, Robert W Hurley, Srinivasa N Raja, Jennifer Haythornthwaite, Lauren Allen, Robert R Edwards, Lars Arendt-Nielsen, Claudia M Campbell, Renan Castillo","doi":"10.1093/pm/pnaf067","DOIUrl":"https://doi.org/10.1093/pm/pnaf067","url":null,"abstract":"<p><strong>Objectives: </strong>The current study sought to evaluate the psychometric properties of a newly developed Knee OsteoArthritis Pain Index (KOAPI), derived from the Brief Pain Inventory (BPI), among individuals with knee osteoarthritis (KOA).</p><p><strong>Methods: </strong>This study consisted of secondary data analysis of two clinical trials. In study 1, 241 individuals with KOA were evaluated before total knee arthroplasty and six months post-surgery. In study 2, 37 individuals with KOA participated in a randomized, double-blind, placebo controlled, two-way crossover study in which they received either a COX-2 inhibitor followed by a placebo or a placebo followed by a COX-2 inhibitor. The KOAPI was derived from the BPI and included three BPI pain severity items (worst, average, current) and the BPI pain interference item related to pain when walking.</p><p><strong>Results: </strong>The KOAPI showed excellent model fit (CFI = 0.99; TFI: 0.98-0.99; RMSEA: 0.08-0.001), good reliability (Cronbach's alpha: 0.84-0.87) and high convergent validity with the Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.66; 95% CI: 0.44, 0.81) and the Pain Catastrophizing Scale (r = 0.50; 95% CI: 0.39, 0.60).</p><p><strong>Conclusions: </strong>Overall, the psychometric properties of the KOAPI were comparable or better than those produced by the original BPI pain severity subscale. The KOAPI may be a helpful screening and outcome measure for individuals with KOA that more closely captures symptoms which drive patients to seek clinical care.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143152","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":"Correlates of Pain-Related Disability in Older Veterans with Chronic Low Back Pain.","authors":"Debra K Weiner, Angela Gentili, Edward Garay, Meika Fang, Lenore Joseph, Laura Lawson, Cathy C Lee, Michelle Rossi, Yanlin He, Subashan Perera","doi":"10.1093/pm/pnaf066","DOIUrl":"https://doi.org/10.1093/pm/pnaf066","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain (CLBP) is a potentially disabling condition that affects an estimated one-third of older adults. Treatments recommended by existing guidelines result in modest improvements. Identification of modifiable factors that contribute to CLBP-associated disability in older adults is needed to optimize outcomes.</p><p><strong>Methods: </strong>Baseline data were analyzed from 275 participants in the Aging Back Clinics trial designed to evaluate the efficacy of a personalized approach to treating CLBP in older Veterans. Participants had low back pain of moderate severity on half the days for 6 months or worse, a negative dementia screen, no red flags or history of lumbar surgery, and no communication impairment. Measures included demographics, the Oswestry Disability Index (ODI-main outcome), the NIH Minimal Data Set for CLBP research, PROMIS-29, medical comorbidity, pain medications, Medical Outcomes Study social support scale, Prescribed Opioids Difficulties Scale, and the Pain Self-Efficacy Questionnaire. No to minimal disability was defined as ODI ≤ 20, moderate as 20<ODI ≤ 40 and severe to crippling as ODI > 40 to which we fitted multinomial logistic regression model with a generalized logit link and forward selection.</p><p><strong>Results: </strong>Average age was 73.5, 93% were male, 67% white and 28% black. Approximately 24% reported no-mild, 50% moderate and 26% severe-crippling disability. Among the three modifiable risk factors identified, for each 5-point increase in self-efficacy, there was ∼ 50% lower risk of moderate (OR 0.54 [0.42-0.69]; p < 0.0001) and ∼60% lower risk of severe/crippling disability (OR 0.39 [0.29-0.52]; p < 0.0001). Difficulty falling asleep was associated with over doubling risk of moderate disability (OR 2.48 [1.06-5.81]; p = 0.0367) and nearly sixfold greater risk of severe/crippling disability (OR 5.77 [2.09-15.96]); p = 0.0007). Each one-point increase in pain severity was associated with a ∼1.5-fold increased risk of moderate and severe disability.</p><p><strong>Conclusions: </strong>Low self-efficacy, difficulty falling asleep and pain severity were identified as independent and potentially modifiable factors associated with CLBP-associated disability risk.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143250","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":"Ultrasound-Guided Biceps Femoris Short Head (BiFeS) Block: A Novel Regional Anesthesia Technique for the Posterolateral Knee.","authors":"Alper Kilicaslan, Serkan Tulgar, Ali Ahiskalioglu, İlker Onguc Aycan, Ahmet Fevzi Kekec, Ayse Gulbin Arici, Garip Kılıc, Muzaffer Sindel","doi":"10.1093/pm/pnaf068","DOIUrl":"https://doi.org/10.1093/pm/pnaf068","url":null,"abstract":"<p><strong>Objective: </strong>We introduce a novel intervention for posterolateral knee pain termed the Biceps Femoris Short Head (BiFeS) Block, which targets the articular branches innervating the posterolateral aspect of the joint. We describe a two-part proof-of-concept study to validate the BiFeS block: A cadaveric study evaluating injectate spread and a retrospective case series assessing analgesic efficacy.</p><p><strong>Methods: </strong>In the cadaveric study, 25 mL of dye solution was applied at the interface between the BiFeS and the lateral supracondylar line of the femur following bone contact. For the retrospective cases, we present five patients with posterolateral knee pain following total knee arthroplasty (TKA) who underwent a BiFeS block with 25 mL of 0.25% bupivacaine.</p><p><strong>Results: </strong>In all cadaveric specimens, a distinct dye spread was observed deep to the BiFeS, extending both medial and lateral to the lateral supracondylar line and along the facies poplitea. In all specimens, the superior lateral genicular nerve and the lateral branch of the nerve to the vastus intermedius were stained. The anterior branch of the common fibular nerve was stained in 2 out of 6 specimens where it could be identified. In the clinical cases, the median(IQR) NRS score decreased from 6.5(6-7) pre-block to 3(2-3) post-intervention.</p><p><strong>Conclusion: </strong>Our preliminary data demonstrate that the BiFeS block achieves complete blockage of the posterolateral knee capsule. This technique may serve as a complementary, motor-sparing regional anesthesia method, particularly for postoperative pain management following TKA. Advantages include a low risk of complications, avoidance of vascular and neural structures, feasibility in the supine position.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143281","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":"Quantifying the Impact of Concurrent Analgesic Use in Interventional Pain Trials: A Meta-Epidemiologic Study.","authors":"Balaji V Sridhar, Andrew Humbert, Adam Babitts, Carina A Staab, Clinton J Daniels, Malka Dhillon, Patrick J Heagerty, Joshua Z Goldenberg, Mark P Jensen, Pradeep Suri","doi":"10.1093/pm/pnaf071","DOIUrl":"https://doi.org/10.1093/pm/pnaf071","url":null,"abstract":"<p><strong>Objective: </strong>The modest effect sizes of most pain treatments make it essential that randomized controlled trials (RCTs) use methods that clearly define treatment effects of interest and consider the role of concurrent treatments. This study aims to determine how frequently concurrent analgesic use is reported in interventional pain RCTs and how accounting for analgesic use can affect estimates of pain intensity outcomes.</p><p><strong>Design: </strong>Meta-epidemiologic study.</p><p><strong>Methods: </strong>We conducted a study of concurrent analgesic use among RCTs from a recent systematic review of non-surgical interventional pain treatments (n = 37). We calculated the prevalence of methods used to report concurrent analgesic use. We performed meta-analyses to compare treatment effects on pain intensity with vs. without accounting for concurrent analgesic use via a novel quantitative composite outcome, the \"QPAC1.5.\"</p><p><strong>Results: </strong>About half of interventional pain RCTs reported concurrent analgesic use, but only one directly accounted for concurrent analgesic use in their pain intensity outcome. Analyses accounting for concurrent analgesics using the QPAC1.5 substantially increased the estimated treatment effect of interventions on pain intensity by an average of - 0.45 numeric rating scale points (95% CI - 0.76 to - 0.14; p < 0.001), as compared to analyses that did not adjust for analgesic use.</p><p><strong>Conclusion: </strong>Concurrent analgesic use is sometimes reported in interventional pain RCTs, but rarely accounted for when examining treatment effects on pain intensity. Accounting for concurrent analgesic use may mitigate the effects of that use and substantially impact estimated treatment effect sizes.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143279","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":"Radiological analysis of herniated disc size changes after Percutaneous Laser disc Decompression.","authors":"Roberto Gazzeri, Felice Occhigrossi, Marcelo Galarza, Marco Mercieri, Matteo Luigi Giuseppe Leoni","doi":"10.1093/pm/pnaf070","DOIUrl":"https://doi.org/10.1093/pm/pnaf070","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic lumbar disc herniation is a major cause of low back pain and sciatica in adults, significantly affecting quality of life and creating economic burdens. Minimally invasive percutaneous intradiscal techniques, such as percutaneous laser disc decompression (PLDD), have been developed as alternatives to open surgery; however, their efficacy remains debated.</p><p><strong>Objective: </strong>This study evaluated the effectiveness of PLDD in patients with lumbar disc protrusions and contained herniations by assessing quantitative changes in herniated disc area on axial and sagittal MR images.</p><p><strong>Methods: </strong>A total of 58 patients with lumbar radiculopathy due to disc herniation underwent MRI two months after PLDD to evaluate changes in disc area. Axial and sagittal MR images with the greatest protrusion and neural compromise were analyzed, and patient pain severity, clinical outcomes, and satisfaction were recorded.</p><p><strong>Results: </strong>Results showed a statistically significant reduction in both axial and sagittal disc areas post-PLDD. The initial mean axial disc area of 0.51 cm2 (0.44-0.58) decreased to 0.29 cm2 (0.25-0.37), reflecting a median reduction of 35.9% (p < 0.0001). Similarly, the sagittal disc area decreased from a mean of 0.37 cm2 (0.33-0.43) to 0.19 cm2 (0.13-0.25), with a median reduction of 49.3% (p < 0.0001). All patients showed reductions in disc area, with a median reduction ratio of 52.7% (IQR: 45.2-56.2).</p><p><strong>Conclusions: </strong>These findings suggest that PLDD is an effective option for reducing herniated disc size in carefully selected patients with contained disc herniations who have not responded to conservative treatment. Although not a substitute for open surgery, PLDD offers a statistically significant reduction in herniated disc size, making it a valuable therapeutic option for symptomatic contained lumbar disc herniation.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143280","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":"Diagnostic Precision in Lumbar Radiculopathy: Impact of Transitional Vertebrae on Treatment Level Selection and Outcomes.","authors":"Bart Liebrand, Selina van der Wal, Marjan Slob, Arthur Boon, Dylan Henssen, JanVan Zundert, Walter van der Weegen, Kris Vissers","doi":"10.1093/pm/pnaf061","DOIUrl":"https://doi.org/10.1093/pm/pnaf061","url":null,"abstract":"<p><strong>Background: </strong>In patients with lumbosacral transitional vertebrae, discrepancies indetermining the correct vertebral level of lumboradicular pain occur. This study evaluates the consequences of the real-world diagnostic process and subsequent treatment differences due to misidentified levels.</p><p><strong>Methods: </strong>This retrospective analysis used prospectively collected data on involved spinal levels (February 2016 - October 2022) reported in the referrals, MRI- and treatment reports. Variables analyzed included the number of referrals, consultations, invasive treatments, duration of treatment, radiographs, operations, and hospitalization. Independent clinical researchers conducted vertebral counting, transitional vertebra classification, and wrong level determination using standard methods.</p><p><strong>Results: </strong>Of a total of 4184 patientsassessed, 214included patients (5.1%) with lumbosacral transitional vertebrae were divided intothree groups: Correct level determination (72), wrong level determination (36) andambiguous level diagnosis(106).Theambiguous levelgroup had more consultations, interventional treatments, radiographic diagnostics, longer treatment duration and more referrals to other hospitals (p < 0.04) at the pain management department and significantly less consultations of other specialisms (p 0.01-0.02) compared to the other groups due to uncertain level diagnosis. Discrepancies between reported MRI- and treatment levels in the records increased the chance for wrong level treatment (p < 0.001).</p><p><strong>Conclusion: </strong>In patients with lumbosacral transitional vertebrae and lumboradicular pain, discrepancies between referral, MRI, and treatment levels are common, leading to uncertain diagnoses and treatment due to incorrect leveldetermination. Interdisciplinary consultation to reach consensus on the most appropriate spinal level for treatment and clear spine images may prevent such discrepancies. Amulticentre study with a larger patient sample is strongly recommended.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132560","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":"The complex pain management of older adults suffering from critical limb ischemia: A problem-based learning discussion.","authors":"Catherine Lequy, Elise Chartier, Claude-Charles Balick-Weber, Alex Chanteclair","doi":"10.1093/pm/pnaf064","DOIUrl":"https://doi.org/10.1093/pm/pnaf064","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128305","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":"Intraoperative CT-Guided Neuronavigation for Radiofrequency Rhizotomy in Trigeminal Neuralgia: Optimizing Cannulation Trajectories for Individual Anatomy.","authors":"Junhyung Kim, Jung Woo Yu, Jinu Rim, Won Seok Chang, Hyun Ho Jung","doi":"10.1093/pm/pnaf060","DOIUrl":"https://doi.org/10.1093/pm/pnaf060","url":null,"abstract":"<p><strong>Objectives: </strong>Fluoroscopy-guided radiofrequency rhizotomy for trigeminal neuralgia relies on biplanar fluoroscopic imaging and surface landmarks. However, anatomical variations and imaging limitations often necessitate multiple attempts, leading to patient discomfort and increased procedural risks. This study evaluated the procedural outcomes of radiofrequency rhizotomy using preplanned trajectories and intraoperative computed tomography with neuronavigation.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Single-center study conducted in a neurosurgical department.</p><p><strong>Subjects: </strong>Forty-six patients with trigeminal neuralgia who underwent radiofrequency rhizotomy between September 2019 and December 2024 were recruited in this study.</p><p><strong>Methods: </strong>Cannulation was performed using navigation-guided trajectories, with intraoperative computed tomography employed to adjust the trajectory if initial attempts failed. Success rates and the distances between the landmark-based and neuronavigation-guided entry points were measured.</p><p><strong>Results: </strong>Among the 46 procedures, the entry points were adjusted from the landmark-based entry points in 22 patients (47.8%) to achieve successful foramen ovale cannulation. Adjustments involved inferolateral displacement in 17 cases and inferomedial displacement in five cases. The mean lateral displacement was 3.75 ± 5.40 mm, and the mean inferior displacement was 14.65 ± 6.91 mm. Foramen ovale cannulation was successfully achieved in all the patients without complications.</p><p><strong>Conclusions: </strong>Intraoperative computed tomography and navigation-guided radiofrequency rhizotomy are safe and effective techniques for treating trigeminal neuralgia. The conventional entry point designated by surface landmarks was not optimal in 47.8% cases, who required an inferior shift to accommodate anatomical variations.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079224","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":"A Survey of Pain Fellowship Program Directors on Medical Simulation.","authors":"Novelpreet Boparai, Lynn Kohan, Gary Brenner, Taylor Purvis, David Brodnik, Jordan Newmark","doi":"10.1093/pm/pnaf063","DOIUrl":"https://doi.org/10.1093/pm/pnaf063","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079199","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}