Pain Medicine最新文献

{"title":"Shrinking pipelines and shifting priorities: an analysis of the 2019-2025 pain medicine fellowship match.","authors":"Thelma B Wright, Seung J Lee, Trent Emerick, Alexander Bautista, Kristen Noon, Nu Cindy Chai, Scott Pritzlaff, Lynn Kohan, Meredith Barad","doi":"10.1093/pm/pnag070","DOIUrl":"10.1093/pm/pnag070","url":null,"abstract":"<p><strong>Background: </strong>Pain medicine fellowship training has evolved significantly since the Accreditation Council for Graduate Medical Education accreditation in 1993. Recent years have seen substantial changes in applicant demographics and match outcomes, particularly a dramatic decline in the number of anesthesiology applicants.</p><p><strong>Objective: </strong>To analyze trends in the Pain Medicine Fellowship Match from 2019 to 2025, examining applicant demographics, match outcomes, and implications for workforce development and training standardization.</p><p><strong>Methods: </strong>Retrospective analysis of National Resident Matching Program and Electronic Residency Application Service data from 2019 to 2025 pain medicine fellowship cycles, including applicant specialty backgrounds, positions offered, fill rates, and program-level outcomes.</p><p><strong>Results: </strong>Total applicants declined from 520 (2019) to 442 (2025), with anesthesiology applicants decreasing by 70%, from 351 to 106, over this period. During that time, physical medicine and rehabilitation applicants increased from 101 in 2019 to 170 in 2025, representing a 68% increase and making it the largest single specialty group in 2025. Emergency medicine applicants increased from 10 to 61 while neurology and psychiatry applicants remained stable. From 2024 to 2025, total positions stabilized (389 to 390) with a trend toward improvement in the fill rate (82.3% to 85.4%). The applicant pool shifted from anesthesiology-dominant to multidisciplinary, with significant regional disparities in program fill rates.</p><p><strong>Conclusions: </strong>The pain medicine fellowship match reflects a fundamental transformation in specialty composition, driven by anesthesiology workforce dynamics and reimbursement concerns. This evolution presents both challenges in training standardization and opportunities for enhanced multidisciplinary care. Strategic interventions, including early specialty exposure, enhanced mentorship, and curriculum adaptation, are essential to sustain workforce capacity and address access disparities.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1100-1107"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176463","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":"Cumulative exposure and cardiovascular risk: predictors of serious adverse outcomes following long-term intravenous lidocaine therapy for chronic pain.","authors":"Natalie Shalit, Roy Shalit, Michelle Levitan, Hadas Afgin, Ofir Morag, Itay Goor-Aryeh","doi":"10.1093/pm/pnag066","DOIUrl":"10.1093/pm/pnag066","url":null,"abstract":"<p><strong>Background: </strong>Intravenous (IV) lidocaine has emerged as a non-opioid alternative for chronic pain management. However, the safety profile of repeated, long-term administration, particularly regarding cumulative exposure and cardiovascular comorbidities, remains poorly defined.</p><p><strong>Objective: </strong>To identify risk factors for serious adverse outcomes (SAOs) following IV lidocaine infusion in chronic pain patients.</p><p><strong>Methods: </strong>A retrospective cohort study examined 1093 patients treated with IV lidocaine at a hospital-based pain clinic in Israel (2014-2022), totaling 15 820 infusions. SAOs were defined as emergency department visits within 14 days of infusion. Multivariable logistic regression and Generalized Estimating Equations (GEE) were used to assess predictors, including cardiovascular disease, cerebrovascular accident (CVA) history, diabetes mellitus, and cumulative infusion count, to distinguish between true dose-frequency effects and artifacts of cumulative exposure time. A secondary analysis retained only events plausibly attributable to lidocaine based on its pharmacological profile.</p><p><strong>Results: </strong>Fifty-five patients (5.0%) experienced SAOs. Cumulative exposure exceeding 50 infusions was the strongest predictor of adverse outcomes (OR = 12.58, P < .001). A GEE model accounting for repeated measures revealed that the risk per individual infusion remained stable and did not increase with the infusion sequence number (OR = 1.00, P = .854). CVA history was initially significant but lost significance in the secondary analysis when restricted to plausibly lidocaine-related events (n = 30), suggesting the association reflected disease progression rather than treatment effect. Conversely, pre-existing cardiovascular disease emerged as a significant predictor only in the refined analysis (OR = 3.88, P = .008), consistent with lidocaine's known cardiac electrophysiological effects.</p><p><strong>Conclusions: </strong>IV lidocaine demonstrates a favorable safety profile with low SAO incidence. While the statistical probability of an event increases with total exposure time, the per-infusion risk remains stable across the treatment course suggesting an absence of cumulative physiological toxicity. Pre-existing cardiovascular disease, specifically ischemic heart disease and arrhythmias, remains a primary risk factor. These findings support the use of enhanced cardiac monitoring for patients with these specific cardiovascular comorbidities and periodic risk-benefit reassessments for high-utilization patients.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1123-1128"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988606","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":"Preoperative guidance and an adolescent's surgical recovery experience: a qualitative study.","authors":"Tori N Sutherland, Scott E Hadland, Jennifer A Rabbitts, Jiwon Moon, Joana Fardad, Katherine Kellom, Justin T Clapp","doi":"10.1093/pm/pnag068","DOIUrl":"10.1093/pm/pnag068","url":null,"abstract":"<p><strong>Background: </strong>Adolescents are at increased risk of persistent postsurgical opioid use. Qualitative data may provide insight on protective experiences and guidance.</p><p><strong>Study design: </strong>Adolescents aged 11-21 years who were enrolled in a larger longitudinal survey study participated in semi-structured interviews one and 3 months after surgery between September 2022 and March 2023. Experiences were examined among adolescents who used opioids in postoperative weeks 3 and 4, after severe pain resolved.</p><p><strong>Results: </strong>Fifty interviews with 46 adolescents undergoing common procedures associated with severe pain and/or persistent opioid use (POU) revealed that preoperative clinic conversations set an important framework for recovery. Positive experiences included normalizing anxiety, awareness of physical changes signifying recovery, including resolution of severe pain and subsequent opioid cessation, and effective non-opioid and non-pharmacologic pain treatment options, including ice and stretching. Patients with prolonged opioid use, whose caregivers often directed pain management, described more profound fears, struggles with seeking out information, difficulties actively engaging in recovery, and the use of opioids and sleep to avert pain.</p><p><strong>Conclusion: </strong>The preoperative visit and recovery framework provided by the surgical team played an important role in guiding the recovery experience. Factors that may offer protection against prolonged opioid use include realistic descriptions of the recovery process with common milestones, encouraging preparation and engagement in the work of recovery, and educating on the role of opioid, non-opioid, and non-pharmacologic pain management options, including when to stop using opioids.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1091-1099"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056017","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":"Patient-reported versus pharmacy-verified naloxone co-prescription fill rates in a chronic pain clinic: a cross-sectional discordance analysis.","authors":"Gustaf Van Acker, Nafis Eghrari, Woo Jun Shim, Chong Kim","doi":"10.1093/pm/pnag080","DOIUrl":"10.1093/pm/pnag080","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1158-1160"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685567","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":"2026 PainConnect award-winning scientific poster abstracts-Salt Lake City, Utah.","authors":"","doi":"10.1093/pm/pnag115","DOIUrl":"https://doi.org/10.1093/pm/pnag115","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":"27 10","pages":"1162"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113249","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":"Painfully different numbers: spinal patients' self-reported pain ratings in clinical versus research assessments.","authors":"Meredith Stensland, Elizabeth Sanford, Timothy Houle, Myla Hummel, Maxim Eckmann, Mathew McClure, Zachary L McCormick, Shikara Train, Donald McGeary","doi":"10.1093/pm/pnag074","DOIUrl":"10.1093/pm/pnag074","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1154-1157"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284159","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":"Co-occurring chronic overlapping pain conditions and pain management engagement in veterans diagnosed with fibromyalgia: a comparison of women and men.","authors":"Jenna L Adamowicz, Brian C Lund, Lauren Garvin, Mary A Driscoll, Katherine Hadlandsmyth","doi":"10.1093/pm/pnag069","DOIUrl":"10.1093/pm/pnag069","url":null,"abstract":"<p><strong>Objective: </strong>To examine the prevalence of co-occurring chronic overlapping pain conditions (COPCs) and utilization of recommended treatments for the management of fibromyalgia among veterans served by the US Department of Veterans Affairs (VA) healthcare system.</p><p><strong>Methods: </strong>Data from the Veterans Health Administration Corporate Data Warehouse were derived from a cohort diagnosed with fibromyalgia. Sociodemographic and clinical characteristics and the presence of 9 COPCs were examined. Commonly recommended treatments for the management of fibromyalgia were assessed across 2 domains: nonpharmacological and pharmacological. Multimodal treatment engagement was also examined. A series of logistic regressions was used to assess the impact of sex on treatment engagement, in both unadjusted models and models adjusted for sociodemographic and clinical characteristics.</p><p><strong>Results: </strong>The 30 462 veterans were majority female (58.9%), White (68.3%) and 45 to 64 years old (55.0%). Women were more likely than men to be diagnosed with a co-occurring COPC (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.11-1.23). Women were more likely to engage in physical therapy, psychotherapy, or any complementary approaches (aOR range: 1.28-1.52). Women were also more likely than men to be prescribed cyclobenzaprine (aOR: 1.36, 95% CI: 1.28-1.45) and less likely than men to be prescribed pregabalin (aOR: 0.80, 95% CI: 0.75-0.85). Although women were more likely to engage in multimodal treatment (aOR: 1.29, 95% CI: 1.19-1.40), overall rates for both women and men were between 9% and 12%.</p><p><strong>Conclusions: </strong>Although women veterans with fibromyalgia were more likely than men to receive nonpharmacological treatments, overall receipt rates for these approaches were low in both women and men. Future work in this area is needed to examine potential barriers to access and engagement.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1129-1138"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176468","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 big picture: extent of ablation-induced multifidus denervation visualized on MRI.","authors":"Gary Allen, Kevin Gilbert, Julia Evans, W Evan Rivers","doi":"10.1093/pm/pnag065","DOIUrl":"10.1093/pm/pnag065","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1149-1150"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148016775","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":"Association between opioid use and sensory perception in patients with cancer pain: a neurometric study.","authors":"Akifumi Kanai, Masatomo Ara, Yuichiro Takahashi","doi":"10.1093/pm/pnag071","DOIUrl":"10.1093/pm/pnag071","url":null,"abstract":"<p><strong>Background: </strong>Opioids are a cornerstone of cancer pain management; however, their effects on sensory and pain thresholds in routine clinical settings remain incompletely understood.</p><p><strong>Objective: </strong>To investigate the association between opioid use and neurometric sensory and pain thresholds in patients with cancer-related pain.</p><p><strong>Methods: </strong>This cross-sectional observational study assessed quantitative sensory function using the Neurometer. Current perception thresholds (CPT) and pain thresholds (PT) for Aβ, Aδ, and c fibers were evaluated in 208 adult patients with cancer pain in a hospital-based palliative care setting. Patients were classified according to opioid use, and age-adjusted analyses were performed.</p><p><strong>Results: </strong>Pain thresholds did not differ between the opioid and non-opioid groups in either unadjusted or age-adjusted analyses across all fiber types. After adjustment for age, a significant between-group difference was observed for Aβ CPT, whereas CPT for Aδ and c fibers did not differ between groups.</p><p><strong>Conclusions: </strong>In patients with cancer-related pain, routine opioid use was not associated with clinically meaningful alterations in pain thresholds in this cohort; however, these findings should be interpreted cautiously given the cross-sectional design and potential residual confounding.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1139-1148"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239889","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 importance of accurately characterizing closed-loop spinal cord stimulation systems: Considerations arising from \"Closed-Loop SCS and sensing: now and in the future\".","authors":"Jason E Pope, Johnathan Goree","doi":"10.1093/pm/pnag118","DOIUrl":"https://doi.org/10.1093/pm/pnag118","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081558","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}