Pain Medicine最新文献

{"title":"Association of Opioid Tapering with Pain-Related Emergency Department Visits, Hospitalizations, and Primary Care Visits: A Retrospective Cohort Study.","authors":"Elizabeth Magnan, Daniel J Tancredi, Guibo Xing, Alicia Agnoli, I E Tseregounis, Joshua J Fenton","doi":"10.1093/pm/pnae121","DOIUrl":"https://doi.org/10.1093/pm/pnae121","url":null,"abstract":"<p><strong>Objective: </strong>Tapering of chronic opioids has increased, with subsequent reports of exacerbated pain among patients who tapered. We aimed to evaluate the association between opioid dose tapering and subsequent pain-related healthcare utilization (ED visits, hospitalizations and primary care visits).</p><p><strong>Design, setting and subjects: </strong>We conducted a retrospective cohort study from 2015-2019 using data from the Optum Labs Data Warehouse that contains de-identified retrospective administrative claims data for commercial and Medicare Advantage enrollees in the US. Adults aged ≥18 years who were prescribed stable doses of opioids, ≥50 morphine milligram equivalents (MME)/day, during a 12-month baseline period.</p><p><strong>Methods: </strong>Tapering was defined as ≥ 15% relative reduction in mean daily opioid dose during one of 6 overlapping 60-day periods. Tapered patient-periods were subclassified as tapered-and-continued (MME > 0) vs. tapered-and-discontinued (MME = 0). We modeled monthly counts of visits for pain diagnoses up to 12 months after cohort entry using negative binomial regression as a function of tapering, baseline utilization, and patient level-covariates.</p><p><strong>Results: </strong>Among 47,033 patients, 13,793 patients tapered. Compared to no taper, any taper was associated with more ED visits for pain (adjusted incidence rate ratio [aIRR] 1.21, 95% CI: 1.11-1.30), tapered then continued status was associated with more ED visits (aIRR 1.23, CI: 1.14-1.32) and hospitalizations (aIRR 1.14, CI: 1.03-1.27) for pain, and tapered-and-discontinued was associated with fewer primary care visits for pain (aIRR 0.68, CI: 0.61-0.76).</p><p><strong>Conclusions: </strong>These associations suggest that opioid tapering may lead to increased emergency and hospital utilization for acute pain and possibly a decreased perceived need for primary care for those whose opioids were discontinued.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710619","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 factors associated with persistent opioid use after total joint arthroplasty: A retrospective review.","authors":"Aurora Quaye, John DiPalazzo, Kristin Kostka, Janelle M Richard, Blaire Beers-Mulroy, Meredith Peck, Robert Krulee, Yi Zhang","doi":"10.1093/pm/pnae120","DOIUrl":"10.1093/pm/pnae120","url":null,"abstract":"<p><strong>Objective: </strong>To identify predictors of persistent opioid use in opioid-naïve individuals undergoing total joint arthroplasty.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Maine Health System.</p><p><strong>Subjects: </strong>Opioid-naïve patients who underwent at least one total joint arthroplasty (knee, hip, or shoulder) between 2015 and 2020.</p><p><strong>Methods: </strong>Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was used to create a predictive model for persistent opioid use after surgery from a US Electronic Health Record dataset in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) format. 75% of the data was used to build the LASSO model using 10-fold cross-validation and 25% of the data was used to determine the optimal probability threshold for predicting the binary outcome.</p><p><strong>Results: </strong>Out of 6432 patients, 12.3% (792) were identified as having persistent opioid use across combined total joint arthroplasties defined as at least one opioid prescription between 90 days and one year after surgery. Patients with persistent opioid use were more likely to be current smokers (OR 1.65), use antidepressants (OR 1.76), or have a diagnosis of post-traumatic stress disorder (OR 2.07), or a substance related disorder (OR 1.69). Other factors associated with persistent opioid use included back pain (OR 1.43), dementia (OR 1.65), and BMI over 40 (OR 2.50). The probability of persistent opioid use was not associated with age, sex, or ethnicity.</p><p><strong>Conclusions: </strong>This predictive model for persistent opioid use after total joint arthroplasty shows promise as an evidence-based, validated, and standardized tool for identifying high-risk patients before surgery in order to target strategies and interventions to reduce the reliance on opioids for post-operative pain control.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682448","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":"Proinflammatory Diet is Associated with Higher Pain, Disease Severity and Biochemical Parameters Associated with Inflammation in Fibromyalgia.","authors":"Nursena Ersoy Söke, Hansa İnceöz, İlker Solmaz, Hülya Yardımcı","doi":"10.1093/pm/pnae118","DOIUrl":"https://doi.org/10.1093/pm/pnae118","url":null,"abstract":"<p><strong>Objective: </strong>Fibromyalgia, which is becoming increasingly common today, affects the quality of life of those affected. The aim of this study was to investigate the relationship between diet and pain, disease severity and biochemical parameters in fibromyalgia.</p><p><strong>Design: </strong>Cross-sectional design using validated questionnaires.</p><p><strong>Setting: </strong>Fibroyalgia patients with Traditional and Complementary Medicine clinics.</p><p><strong>Subject: </strong>84 patients with Fibromyalgia (FM), which was diagnosed by a rheumatologist.</p><p><strong>Methods: </strong>The cross-sectional study was conducted with 84 fibromyalgia patients in Turkey. The Dietary Inflammatory Index (DII) was calculated by a 24-hour diet recall. Self-reported pain levels and disease severity were evaluated by the Visual Analog Scale (VAS) and a Revised Fibromyalgia Impact Questionnaire (FIQR), respectively. Antropometric measures and biochemical parameters associated with inflammation were also evaluated.</p><p><strong>Results: </strong>Linear regression analysis revealed that the VAS pain score [β (%95CI)=1,72 (0,90-2,55), p < 0,001], FIQ-R [β (%95CI)=5,62 (0,14-11,09), p < 0,001] and uric acid/creatinine ratio [β (%95CI)=0,21 (-0,10-0,52), p < 0,001] were positively associated with the DII after adjustments for BMI, body fat, fat free mass, cholesterol, fiber, caroten, iron, magnesium, vitamine C reported by the patients with FM.</p><p><strong>Conclusions: </strong>A pro-inflammatory diet was associated with higher pain, disease severity and uric acid/creatinine ratio in patients with FM.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681039","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 High-Dose Long-Term opioid therapy patients 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":"https://doi.org/10.1093/pm/pnae119","url":null,"abstract":"<p><strong>Objective: </strong>Rapid opioid reduction or discontinuation among high-dose long-term opioid therapy patients (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 healthcare access with rapid opioid reduction or discontinuation among HD-LTOT patients, 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 18-64 years old HD-LTOT patients (≥ 90 morphine milligram equivalents for 81/90 consecutive days), with one-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 healthcare access (measured as geographic distance to healthcare facilities) and residential segregation (operationalized using the Index of Concentration at the Extremes). We conducted bivariate linear regression to estimate one-year risk differences (RDs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Of 13,375 HD-LTOT patients, 48.6% experienced rapid opioid reduction or discontinuation during one-year follow-up. Female patients and those diagnosed with PTSD who live in areas of least racial and economic privilege have higher risks of rapid opioid reduction or discontinuation compared to those living in areas with the most racial and economic privilege.</p><p><strong>Conclusion: </strong>Healthcare providers need to address potential biases towards patients living in underserved and marginalized communities and 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":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RE: Exploring new educational approaches in neuropathic pain: Assessing accuracy and consistency of AI responses from GPT-3.5 and GPT-4.","authors":"Alejandro García-Rudolph, David Sanchez-Pinsach, Eloy Opisso, Maria Dolors Soler","doi":"10.1093/pm/pnae116","DOIUrl":"https://doi.org/10.1093/pm/pnae116","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625669","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":"RE: Exploring new educational approaches in neuropathic pain: Assessing accuracy and consistency of AI responses from GPT-3.5 and GPT-4.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1093/pm/pnae115","DOIUrl":"https://doi.org/10.1093/pm/pnae115","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625667","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 Q2-Approach for Percutaneous Peripheral Neuromodulation Stimulator Implant Targeting C2 Dorsal Root Ganglion at C2 Lamina for Treating Intractable Headache: A Technical Note.","authors":"QiLiang Chen, Xiang Qian","doi":"10.1093/pm/pnae113","DOIUrl":"https://doi.org/10.1093/pm/pnae113","url":null,"abstract":"<p><strong>Objectives: </strong>Despite significant medical treatment advancements, interventional treatments for intractable headache disorders are limited. This study's objective is to detail a novel percutaneous approach (\"Q2-approach\") and its technical considerations for implanting peripheral neuromodulation stimulators (PNS) to the C2 dorsal root ganglion (C2-DRG) at C2 lamina, a previously unattempted target, as a treatment for intractable headache.</p><p><strong>Design and methods: </strong>In an outpatient setting, PNS electrodes could be percutaneously implanted at C2-DRG in patients under moderate sedation using combined ultrasound and fluoroscopic guidance. The final electrode position was determined by intraoperative patient feedback to ensure optimal stimulation. Four patients were included to demonstrate technical parameters and feasibility. Follow-ups were conducted on postoperative days 10, 30, 60, and 100-120.</p><p><strong>Results: </strong>The Q2-approach allows safe C2-DRG PNS implants in an outpatient setting. Average operative duration was <60 minutes. All four patients achieved >50% pain relief during the 60-day implant period and 3/4 demonstrated sustained benefit beyond the implant period. No complications (e.g., lead migration or infection) were observed.</p><p><strong>Conclusions: </strong>The current technical note demonstrated the feasibility of a novel, safe, minimally invasive approach to access C2-DRG at the C2 lamina for the treatment of intractable headaches. The utilization of PNS on C2-DRG fills an important gap in headache management as it provides an alternative neuromodulation treatment modality to the existing destruction/denervation-based techniques.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625674","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 Intersectionality of Chronic Pain Stigma and Racial Discrimination in Black and White Adults with Chronic Low Back Pain.","authors":"Jenna M Wilson, Staja Q Booker, Burel R Goodin, Pavithra A Thomas, Robert E Sorge, Tammie L Quinn, Matthew C Morris, Edwin N Aroke, Samantha M Meints","doi":"10.1093/pm/pnae114","DOIUrl":"https://doi.org/10.1093/pm/pnae114","url":null,"abstract":"<p><strong>Objective: </strong>We examined the intersection between chronic pain stigma and racial discrimination, separately among Black and White U.S. adults with chronic low back pain.</p><p><strong>Methods: </strong>Participants completed measures of chronic pain stigma, lifetime experiences of racial discrimination, pain severity and interference. A composite variable representing the intersectionality of stigma and discrimination was created, and Black and White participants were separately categorized into 4 groups. Black participants were categorized as: 1) high discrimination/high stigma, 2) high discrimination/low stigma, 3) low discrimination/high stigma, and 4) low discrimination/low stigma. White participants were categorized as: 1) any discrimination/high stigma, 2) any discrimination/low stigma, 3) no discrimination/high stigma, and 4) no discrimination/low stigma.</p><p><strong>Results: </strong>Black participants reported more frequent experiences of racial discrimination than White participants (p<.05), but there was not a racial difference in chronic pain stigma (p>.05). Among Black participants, those in the high discrimination/high stigma and low discrimination/high stigma groups reported greater pain severity and interference than those in the high discrimination/low stigma and low discrimination/low stigma groups (p<.05). Among White participants, those in the any discrimination/high stigma group reported greater pain severity and interference than those in the no discrimination/low stigma group (p<.05), but there were no differences in pain severity or interference between the any discrimination/no stigma and no discrimination/high stigma groups (p>.05).</p><p><strong>Conclusion: </strong>Our findings suggest that the relationship of intersectional chronic pain stigma and racial discrimination with pain is nuanced and differs across racial groups.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625672","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":"Evaluation of a novel nerve ablation technique to relieve lower back pain: A cadaveric feasibility pilot study.","authors":"Charlotte Jones-Whitehead, John Tran, Timothy D Wilson, Eldon Loh","doi":"10.1093/pm/pnae112","DOIUrl":"https://doi.org/10.1093/pm/pnae112","url":null,"abstract":"<p><strong>Introduction: </strong>Radiofrequency ablation is a treatment for facetogenic low back pain that targets medial branches of lumbar dorsal rami to denervate facet joints. Clinical outcomes vary; optimizing cannula placement to better capture the medial branch may improve clinical outcomes. A novel parasagittal technique was proposed from an anatomical model; this technique was proposed to optimize capture of the medial branch. The anatomical feasibility of the novel technique has not been evaluated.</p><p><strong>Objective: </strong>To simulate and evaluate the proposed parasagittal technique in its ability to achieve proper cannula placement, and proximity of uninsulated cannula tips to the medial branches of the dorsal rami in cadaveric specimens.</p><p><strong>Materials and methods: </strong>Under fluoroscopic guidance, 14 cannulae were placed using the parasagittal technique targeting the lumbar medial branches of two cadavers. Meticulous dissection was undertaken to assess cannula alignment and measure proximities to target nerves using a digital caliper.</p><p><strong>Results: </strong>The novel parasagittal technique was successfully performed in a cadaveric model in 12/14 attempts. The technique achieved close proximity of cannula tips to medial branches (0.8 ± 1.1 mm). In two instances cannulae were placed unsuccessfully, where one cannula was too far anterior, the other too far retracted.</p><p><strong>Conclusion: </strong>In this cadaveric simulation study, the feasibility of performing the parasagittal technique for lumbar radiofrequency ablation was evaluated. This study suggests the parasagittal technique is a feasible option for lumbar medial branch radiofrequency ablation.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590714","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":"Single Arm Feasibility Trial of a Mobile Application for Adolescent Migraine Management.","authors":"Amy E Noser, Abigail S Robbertz, James Peugh, Marielle Kabbouche, Joanne Kacperski, Scott W Powers, Andrew D Hershey, Kevin A Hommel","doi":"10.1093/pm/pnae111","DOIUrl":"https://doi.org/10.1093/pm/pnae111","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581895","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}