Pain Medicine最新文献

{"title":"Early Outcomes with a Flexible ECAP Based Closed Loop Using Multiplexed Spinal Cord Stimulation Waveforms-Single-arm Study with In-clinic Randomized Crossover Testing.","authors":"Vahid Mohabbati, Richard Sullivan, James Yu, Peter Georgius, Charles D Brooker, Malgorzata Siorek, Nancy L McClelland, Filippo Coletti, Xiaoxi Sun, Abi Franke, Marc A Russo","doi":"10.1093/pm/pnaf058","DOIUrl":"https://doi.org/10.1093/pm/pnaf058","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) systems that deliver fixed amplitudes expose target tissue to varying electrical fields due to the changing lead-to-cord distance accompanying postural shifts and other body movements. Inconsistent stimulation results in periods of overstimulation or under-stimulation perceived by patients as discomfort or potentially inadequate pain relief. CL-SCS may be applied to provide a comfortable level of perception down to imperceptible stimulation, commonly preferred in higher frequency and multiplexed programming. Here we report outcomes from a study evaluating a closed-loop (CL) SCS system that uses spinal evoked compound action potentials to adjust stimulation.</p><p><strong>Methods: </strong>This ongoing study combines the evaluation of pain-related outcomes (for ≤24 months) with in-clinic randomized, crossover testing of CL performance.</p><p><strong>Results: </strong>Sixty subjects have been implanted with the CL-SCS system and 54 subjects have completed the 3-month visit. Sixty percent preferred below-perception waveforms for therapy during at-home use. The study successfully met its primary endpoint with 89.3% of subjects in the Primary Analysis Set (n = 28) reporting reduction in overstimulation with CL-SCS relative to OL-SCS at 1-month (p < 0.001; binomial exact test); at 3-months, 86% of subjects with low-back/leg pain (n = 51) and all three with upper limb pain reported ≥50% reduction in pain, relative to baseline.</p><p><strong>Conclusions: </strong>The data presented here support the performance of a flexible CL-SCS system that can deliver a variety of waveforms, with amplitude programmed to patient comfort and automatically adjusted up to 50 times per second, to improve the consistency of therapy experience.</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":"144079215","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":"Geographic Disparities in Access to Chronic Pain Clinical Trials in the United States.","authors":"Ekambir Saran, Dany Alkurdi, Ezdean Alkurdi, Shiven Sharma, Karim Ladha","doi":"10.1093/pm/pnaf059","DOIUrl":"https://doi.org/10.1093/pm/pnaf059","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079220","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":"Improving Pain Medicine Education: Challenges Faced, and Opportunities Ahead, Towards the Establishment of a Pain Medicine Residency.","authors":"Sayed E Wahezi, Ugur Yener, Rollin M Gallagher","doi":"10.1093/pm/pnaf056","DOIUrl":"https://doi.org/10.1093/pm/pnaf056","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041552","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":"Identifying the Relative Contributions of Shoulder Dysfunction in Patients with Subacromial Pain Syndrome.","authors":"Chris J Pierson, Nitin B Jain, Karen Brewer-Mixon, Jijia Wang, Richard D Wilson","doi":"10.1093/pm/pnaf057","DOIUrl":"https://doi.org/10.1093/pm/pnaf057","url":null,"abstract":"<p><strong>Objective: </strong>To identify and quantify the factors associated with shoulder dysfunction in patients with subacromial pain syndrome (SAPS).</p><p><strong>Design: </strong>This was a cross-sectional study with data collected at a single time point.</p><p><strong>Setting: </strong>Two large, urban, academic medical centers in the United States.</p><p><strong>Subjects: </strong>Participants included those with chronic SAPS for three months or longer.</p><p><strong>Methods: </strong>Shoulder function was evaluated using both the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) and Shoulder Pain and Disability Index-Disability (SPADI-D). First, 12 demographic and clinical variables were independently assessed for an association with FIT-HaNSA and SPADI-D score. Next, two separate multivariable linear regression analyses, one for each outcome measure, were created to examine the association of each with all variables.</p><p><strong>Results: </strong>The 113 participants had a median age of 55 years, a median pain duration of 14 months, and a median composite SPADI score of 43.85%. In univariate analysis, four variables were associated with FIT-HaNSA and five were associated with SPADI-D. The FIT-HaNSA multivariable linear regression model (F = 4.01, p < 0.0001) had an overall R2 of 38.27% (n = 98). This identified the worst pain in the past week (F = 10.86, p = 0.0014), and deltoid pressure pain threshold (F = 14.94, p = 0.0002) with significant associations. The SPADI-D model (F = 4.20, p < 0.0001) had an overall R2 of 39.38% (n = 98). This identified the worst pain in the past week (F = 21.04, p > 0.001) and Pain Catastrophizing Scale score (F = 5.32, p = 0.235) with significant associations.</p><p><strong>Conclusions: </strong>Six variables were associated with shoulder function in univariate analyses and three associated in a multivariable analysis. Future research is necessary to determine if these variables are appropriate targets for clinical intervention to improve shoulder function, and to identify the other factors explaining the remaining outcome measure variability.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973075","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":"Cross-Cultural Validation of the Revised Graded Chronic Pain Scale in Brazilian Portuguese: Advancing Health and Disability Assessment Across Cultures.","authors":"Jaira Ehlers, Barbara Regina França, Graziele Borges Bueno, Jessica S Vebber, Rogério Boff Borges, Iraci L S Torres, Felipe Fregni, Wolnei Caumo","doi":"10.1093/pm/pnaf048","DOIUrl":"https://doi.org/10.1093/pm/pnaf048","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036894","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":"Effectiveness of motivational interviewing plus cognitive behavioral therapy versus shared decision making for voluntary opioid tapering in patients with chronic pain: The INSPIRE randomized pragmatic trial.","authors":"Lauren A McCormack, Mark J Edlund, Sonia M Thomas, Li-Tzy Wu, Paul R Chelminski, Kristin R Archer, Laura K Wagner, Shawn Hirsch, Jessica E Thompson, Rowena J Dolor, Timothy J Ives, Charlene M Dewey, Samantha Chang","doi":"10.1093/pm/pnaf049","DOIUrl":"https://doi.org/10.1093/pm/pnaf049","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness of motivational interviewing plus cognitive behavioral therapy versus shared decision making on change in daily dosage of prescribed opioids for individuals with chronic non-cancer pain.</p><p><strong>Design: </strong>Pragmatic randomized trial.</p><p><strong>Setting: </strong>Three health systems in the southeastern United States.</p><p><strong>Subjects: </strong>Adults (N = 525) prescribed opioid therapy for chronic non-cancer pain.</p><p><strong>Methods: </strong>Participants were randomized to Arm 1 (a motivational interviewing visit plus eight group sessions of cognitive behavioral therapy) or Arm 2 (shared decision making medical visits). The primary outcome was change in average daily opioid dosage from baseline to 12 months using prescribing data from health records. Secondary outcomes were self-reported pain interference and physical function.</p><p><strong>Results: </strong>Both arms experienced small decreases in dosage at 12 months from baseline: Arm 1 -12 milligram morphine equivalents (95% confidence interval: -19 to -4); Arm 2 -6 milligram morphine equivalents (95% confidence interval: -14 to 2). The mean difference between arms for change in dosage, at -6 milligram morphine equivalents (95% confidence interval: -17 to 5), was neither statistically significant nor clinically meaningful. Those in Arm 1 with a mental health diagnosis had a larger reduction in dosage (-22 milligram morphine equivalents, 95% confidence interval: -33 to -11) than those in Arm 1 without a mental health diagnosis and those in Arm 2 with a mental health diagnosis (interaction p = 0.10). No change from baseline occurred in pain interference or physical function for either arm.</p><p><strong>Conclusions: </strong>Additional strategies are needed to support individuals prescribed opioid therapy for chronic pain with pain management and dosage reduction.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019451","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 Mental Defeat in Individuals with Chronic Non-Cancer Pain on Long-term Opioid Therapy.","authors":"Yoonjae Lee, Nicholas A Giordano, Peggy A Compton, Nicole K Y Tang, Rosemary C Polomano, Martin D Cheatle","doi":"10.1093/pm/pnaf055","DOIUrl":"https://doi.org/10.1093/pm/pnaf055","url":null,"abstract":"<p><strong>Background: </strong>Individuals with chronic non-cancer pain (CNCP) often present with significant challenges that can impact physical, psychological, and social well-being. Mental defeat is a critical consequence of CNCP being a known predictor of suicidality. This study examines the relationships between specific psychological and coping factors and mental defeat among individuals with CNCP on long-term opioid therapy (LTOT).</p><p><strong>Design: </strong>A cross-sectional study of secondary data.</p><p><strong>Setting: </strong>Primary care, pain, and substance abuse clinics in Pennsylvania, Washington, and Utah.</p><p><strong>Subjects: </strong>744 adults with CNCP receiving LTOT (≥ 6 months).</p><p><strong>Methods: </strong>Anxiety and depression symptoms and pain coping strategies were examined with hierarchical multiple linear regression analysis to describe their relationship to mental defeat. In an exploratory analysis, we also stratified the sample by the presence of opioid use disorder (OUD) to determine if the associations were differently represented.</p><p><strong>Results: </strong>After controlling for covariates, anxiety (β = 7.07, P < 0.001) and depression symptoms (β = 14.17, P < 0.001) were statistically significant correlates of increased mental defeat. Diverting attention (β = 0.31, P < 0.05), coping self-statements (β= -0.30, P < 0.05), and catastrophizing (β = 1.47, P < 0.001) were significant correlates, explaining 51% of the variance in mental defeat (P < 0.001). Exploratory analysis revealed subgroup differences, such that while depression symptoms and catastrophizing were significant correlates of mental defeat in persons with and without OUD, anxiety and diverting attention were significant only in persons without OUD.</p><p><strong>Conclusions: </strong>These findings identify key psychological and coping correlates of mental defeat in persons with CNCP on LTOT, informing the development of interventions to mitigate it, and thereby reducing the risk of suicide in this vulnerable population.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018135","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":"Enhanced Pain Relief with Guanfacine as an Adjuvant for Trigeminal Nerve Blocks: Insights from a PheWAS-Guided Randomized Controlled Study.","authors":"Shelby E Meier, Michael B Orr, Matthew S Shotwell, Rebecca N Jerome, Jana K Shirey-Rice, Jill M Pulley, David A Edwards, Amanda D Toye, Puneet Mishra, Tigran Kesayan","doi":"10.1093/pm/pnaf054","DOIUrl":"https://doi.org/10.1093/pm/pnaf054","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal neuralgia and painful trigeminal neuropathy are severely painful conditions which are often difficult to treat with medications. A Phenome-Wide Association Study (PheWAS) analysis identified an association between single nucleotide variants in the alpha-2 adrenergic receptor (ADRA2) subtype B, a G protein-coupled receptor expressed on peripheral and central presynaptic terminals, and an increased risk for trigeminal nerve disorders. We hypothesized that adding the ADRA2 agonist guanfacine to routine care trigeminal nerve injections would provide enhanced pain relief in trigeminal neuralgia than routine care alone.</p><p><strong>Methods: </strong>PheWAS analysis identified the drug target/indication pair. The trial was a single-center, prospective, randomized, controlled, double-blinded, two-way crossover trial for patients with pain attributed to the trigeminal nerve. Injections of lidocaine alone or lidocaine + 250 µg guanfacine were delivered to the V2 and V3 branches of the trigeminal nerve by experienced clinicians. Patients reported pain using a Numeric Rating Scale (NRS) and quality of life measures (using the PROMIS Global Physical Health, Mental Health, and Pain Interference surveys).</p><p><strong>Results: </strong>NRS pain scores over the first 8 hours post-injection were significantly lower in the interventional group (guanfacine + lidocaine) compared to active control (p < 0.001), but not from day 1 through day 14. There was no significant difference between treatment groups in time to recovery of baseline pain intensity (primary outcome), PROMIS outcomes, or adverse events. No serious adverse events were reported.</p><p><strong>Conclusions: </strong>The addition of 250 µg guanfacine to lidocaine for a nerve block procedure enhanced analgesia compared to lidocaine alone within the first 8 hours post-injection.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008618","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":"Neuroscientific underpinnings of psychosocial factors in chronic pain.","authors":"Brian Key, Deborah J Brown","doi":"10.1093/pm/pnaf014","DOIUrl":"10.1093/pm/pnaf014","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"290-291"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693066","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":"Peripheral nerve stimulation for post-spinal fusion sacroiliac joint pain.","authors":"Changho Yi, Evgeny Bulat, Oranicha Jumreornvong, Sravya Madabhushi, Sudhir Diwan, Alan David Kaye, Reda Tolba, Erkan Kurt, Michael E Schatman, R Jason Yong, Christopher L Robinson, Jamal Hasoon","doi":"10.1093/pm/pnae125","DOIUrl":"10.1093/pm/pnae125","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"279-282"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818802","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}