Pain Medicine最新文献

{"title":"The Role of Multimodal Pain Management in Complex Pelvic Pain with Muscular Dystrophy: A Problem-Based Learning Discussion.","authors":"Steven Abriola, Robert W Hurley, Eva Reina, Janelle K Moulder, Heather Columbano, Jessica Meister Berger","doi":"10.1093/pm/pnaf114","DOIUrl":"https://doi.org/10.1093/pm/pnaf114","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963804","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 Genicular Nerve Radiofrequency Ablation in Osteoarthritis and Post-surgical Knee Pain: Systematic Review.","authors":"Napatpaphan Kanjanapanang, Roy Madrid, Peter Lin, Mark Shilling, Amanda Cooper, Hasan Sen, Sherwin Thiyagarajan, Kai-Hua Chang, Henry Luo, Aaron Conger, Zachary L McCormick, Reza Ehsanian","doi":"10.1093/pm/pnaf115","DOIUrl":"https://doi.org/10.1093/pm/pnaf115","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of genicular nerve radiofrequency ablation (GnRFA) for chronic knee pain due to osteoarthritis or persistent post-surgical knee pain (PPSP).</p><p><strong>Methods: </strong>Population: Adults ≥ 18 years with chronic knee pain due to osteoarthritis (OA) or PPSP. Intervention: GnRFA. Comparison: Sham, placebo, active treatments, or no comparator. Outcomes: Proportion of individuals with pain score reductions of ≥ 50% or ≥ 2 points or ≥ 30% improvement in functional measures at 1, 3, 6, 12, 18, and 24 months. Search Strategy and Risk of Bias Assessment: Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched through April 2024 (PROSPERO ID CRD42024552068). Cochrane Risk of Bias 2, Risk of Bias In Non-Randomized Studies-of Interventions and National Heart, Lung, and Blood Institute quality assessment tools were used accordingly.</p><p><strong>Results: </strong>The search identified 1,849 records, with 226 full-texts reviewed and 28 studies included (11 randomized controlled trials and 17 observational studies, totaling 2,218 participants). Pooled success rates for ≥50% pain reduction in both OA and PPSP were 51% (95% CI : 49-54%) at 6 months, 43% (95% CI : 40-47%) at 12 months, and 58% (95% CI : 48-67%) at 24 months. Large lesions showed higher pooled success rates compared to small lesions at 12 months (55% (95%CI : 51-59%) vs. 34% (95%CI : 26-43%)).</p><p><strong>Conclusions: </strong>GnRFA is effective in reducing knee pain in the majority of patients with osteoarthritis when large lesion techniques are used with moderate-certainty evidence, according to GRADE. Alternatively, there is low quality evidence that GnRFA results in treatment benefit for individuals with PPSP. These conclusions, however, are limited by small subgroup sample sizes and the lack of a meta-analysis.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964094","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":"Evidence-Based Framework for Identifying Opioid Use Disorder in Administrative Data: A Systematic Review and Methodological Development Study.","authors":"Robert W Hurley, Khadijah T Bland, Mira D Chaskes, Daniel Guth, Elaine L Hill, Meredith C B Adams","doi":"10.1093/pm/pnaf116","DOIUrl":"https://doi.org/10.1093/pm/pnaf116","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate existing approaches for identifying opioid use disorder (OUD) in administrative datasets and develop evidence-based recommendations for standardized identification methods.</p><p><strong>Design: </strong>Systematic review following PRISMA-Scoping Review guidelines with comprehensive literature search and evidence synthesis for framework development.</p><p><strong>Setting: </strong>Administrative datasets including commercial claims, Medicaid, Medicare, and electronic health records.</p><p><strong>Subjects: </strong>169 studies using administrative codes to identify OUD, primarily from U.S. healthcare systems (94.7%).</p><p><strong>Methods: </strong>Systematic search of EMBASE, MEDLINE, Google Scholar, and PubMed through February 2024. Three independent reviewers screened articles and extracted data using standardized tools. Study quality was assessed using modified Newcastle-Ottawa Scale. Framework development employed systematic integration of evidence-based components from high-quality studies.</p><p><strong>Results: </strong>Our analysis of 169 studies revealed four distinct identification approaches: Direct diagnosis codes (36.7%), composite definitions (48.0%), overdose codes (10.1%), and medication-assisted treatment codes (1.2%). Commercial claims data predominated (60.4%), followed by Medicaid claims (10.1%) and electronic health records (7.7%). Multi-modal strategies incorporating both diagnostic and treatment codes showing superior theoretical foundation compared to single-method approaches. Substantial variation existed in reference periods, code requirements, and treatment verification approaches.</p><p><strong>Conclusions: </strong>An evidence-based framework incorporating diagnosis codes, specific temporal requirements, validated indirect indicators, and treatment evidence provides theoretical foundation for standardized OUD identification protocols. The framework addresses known sources of misclassification while maintaining diagnostic specificity through clinical diagnostic alignment and systematic validation research programs.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964092","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 Relationship of Age of First Sexual Activity to Pain and Psychological Symptoms Among Women with Urogenital Pain.","authors":"Britney Abro, Marjorie Heule, Laura Krasean, Janice Tomakowsky, Bernadette Zwaans, Mark A Lumley","doi":"10.1093/pm/pnaf117","DOIUrl":"https://doi.org/10.1093/pm/pnaf117","url":null,"abstract":"<p><strong>Objective: </strong>Age of first sexual activity (AFSA) may be a developmental marker linked to later clinical status (e.g., pain, depression). However, correlates of AFSA have not been examined in chronic pain populations and are unknown in women with urogenital pain.</p><p><strong>Methods: </strong>A series of 309 women (age M = 48.4 years) presenting to a tertiary women's urology center with urogenital pain completed a comprehensive intake survey, which included their AFSA and measures of pain severity and interference, depression, anxiety, adverse childhood experiences, and childhood abuse.</p><p><strong>Results: </strong>The mean AFSA was 18 years (median = 17). AFSA was significantly, inversely related to pain intensity (r = -0.16), pain interference (r = -0.20), and depression (r = -0.11). Curvilinear (quadratic) associations were also identified; scatter plots and age-group comparisons showed that these inverse relationships flattened or slightly reversed for AFSA after the college years. Analyses also found that childhood adversities and childhood abuse predicted an earlier AFSA.</p><p><strong>Conclusions: </strong>Among women with urogenital pain, an earlier AFSA is associated with worse pain and distress, at least through the college years. Earlier sexual activity may directly increase risk for later pain and distress or serve as a marker of other risk factors-such as childhood adversity or abuse. A relatively late AFSA is not protective in this sample, perhaps due to psychological or interpersonal factors associated with a later first sexual experience. Clinical inquiry into AFSA may provide insight into risk factors for urogenital pain and distress.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963587","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":"Medical Cannabis Authorization and Opioid Milligram Equivalents Over Time In Patients with Chronic Pain: A Retrospective Analysis.","authors":"Michelle Sexton, Nicholas C Glodosky, Michael Cleveland, Carrie Cuttler, Euyhyun Lee, Greg Polston, Timothy Furnish, Imanuel Lerman, Nathaniel M Schuster, Mark S Wallace","doi":"10.1093/pm/pnaf113","DOIUrl":"https://doi.org/10.1093/pm/pnaf113","url":null,"abstract":"<p><strong>Objective: </strong>Strategies are needed for patients with chronic pain who are using opioids to safely and effectively wean opioids without worsening of pain. The objective was to measure associations between medical cannabis authorization and opioid milligram equivalents in patients with chronic non-cancer pain.</p><p><strong>Design: </strong>A longitudinal, retrospective cohort analysis from July 2016-August 2019.</p><p><strong>Setting: </strong>Electronic health record data were analyzed.</p><p><strong>Subjects: </strong>Adult patients (≥ 18 years) seen in a university-based pain clinic.</p><p><strong>Methods: </strong>Longitudinal multilevel modeling with maximum likelihood estimation.</p><p><strong>Results: </strong>Average overall opioid milligram equivalent at the final time point was 33.4 mg/day (SE = 1.18) with increase over time, of 0.45 mg/day per quarter (not statistically significant). Average OME in those without medical cannabis authorization was 32.60 mg/day (SE = 1.11); vs. 38.51 mg/day (SE = 4.81) in those with medical cannabis authorization, not significantly different. Medical cannabis consultation predicted a non-significant decrease of 14.25 mg/day opioid milligram equivalent. Long term opioid use was a significant predictor with a mean opioid milligram equivalent of 85.34 mg/day, 63 mg/day higher than the rest of the cohort at the final quarter (t = 5.77, SE = 10.93, p < 0.0001).</p><p><strong>Conclusions: </strong>In this longitudinal study of electronic health record data, medical cannabis authorization was not associated with a statistically significant decrease in opioid milligram equivalent over time. However, patients with long-term opioid use diagnostic code demonstrated a significantly higher endpoint opioid milligram equivalent. Future prospective research is needed to establish whether there are opioid-sparing effects of cannabis in humans.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964068","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":"Reply to Wang et al.'s Reply to \"Notable Concerns in Methodology and Conclusions of the Wang et al. Meta-Analysis in BMJ by the American Academy of Pain Medicine\" by Schuster et al.","authors":"Nathaniel M Schuster, Mustafa Broachwala, Farshad M Ahadian, Charles E Argoff, Steven P Cohen, Shravani Durbhakula, Amitabh Gulati, Robert W Hurley, Lynn Kohan, Zachary L McCormick, Sayed E Wahezi, Antje M Barreveld","doi":"10.1093/pm/pnaf108","DOIUrl":"https://doi.org/10.1093/pm/pnaf108","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964065","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":"Difficult Encounters, Systemic Bias and the Heisenberg Uncertainty Principle: Unraveling the Relationship Between the Pleasantness of New Patient Evaluations and Chronic Pain Outcomes.","authors":"Steven P Cohen, Winnie L Liu","doi":"10.1093/pm/pnaf112","DOIUrl":"https://doi.org/10.1093/pm/pnaf112","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964050","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":"Reply to \"Notable Concerns in Methodology and Conclusions of the Wang et al. Meta-Analysis in BMJ by the American Academy of Pain Medicine\" by Schuster et al.","authors":"Xiaoqin Wang, Liang Yao, Stéphane Genevay, Gordon H Guyatt, Thomas Agoritsas, Jason W Busse","doi":"10.1093/pm/pnaf106","DOIUrl":"https://doi.org/10.1093/pm/pnaf106","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964088","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":"Cannabis and Cannabidiol for Post-Operative Pain Management in Orthopedic Surgery: A Scoping Review.","authors":"Kevin Tran, Kari Odland, David W Polly","doi":"10.1093/pm/pnaf110","DOIUrl":"10.1093/pm/pnaf110","url":null,"abstract":"<p><strong>Objective: </strong>The use of cannabis and cannabidiol (CBD) as alternatives to opioids for managing post-operative pain has gained increasing interest, especially in orthopedic surgical contexts where opioid dependence remains a pressing concern. This scoping review evaluates experimental studies from 2014 to 2025 that investigated the efficacy and safety of cannabis or CBD products in managing post-operative orthopedic pain.</p><p><strong>Design: </strong>Scoping Review.</p><p><strong>Methods: </strong>A total of 14experimental studies met the inclusion criteria and were categorized by cannabinoid composition (CBD-only, THC-only, or CBD/THC combination).</p><p><strong>Results: </strong>While CBD-only interventions showed mixed results, THC/CBD combinations demonstrated modest potential for opioid-sparing effects, with neutral safety profiles. One THC-only study reported increased opioid use and length of stay, though confounding variables were present.</p><p><strong>Conclusions: </strong>Overall, the heterogeneity in study design, cannabinoid formulation, dosing, and patient factors limits significant conclusions. There is a critical need for standardized, prospective clinical trials to better evaluate the potential of cannabinoids in post-operative orthopedic surgery.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883399","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 Nerve to Vastus Medialis as a Target for Treating Chronic Medial Knee Joint Pain: An Ultrasound-Based Anatomical Localization Study in Healthy Subjects.","authors":"Jorge Orduña-Valls, Nuno Ferreira-Silva, Carlos Acevedo, Tomas Cuñat, Ricardo Araujo-Cernuda, Ricardo Vallejo, Tomás Ribeiro- Da-Silva, Isaac Peña, Guilherme Ferreira- Dos-Santos","doi":"10.1093/pm/pnaf111","DOIUrl":"10.1093/pm/pnaf111","url":null,"abstract":"<p><strong>Background: </strong>Chronic knee joint pain, resulting from osteoarthritis, post-surgical sequelae, or traumatic injuries, represents a debilitating clinical condition. Interventional approaches to manage chronic knee joint pain have been employed for decades, yielding variable outcomes in terms of pain relief, sustainability of analgesic effects, and functional restoration. The term \"genicular nerves\" is commonly used to refer to the primary sensory innervation of the knee joint capsule. However, recent studies have increasingly recognized the significance of additional neural structures, such as the nerve to vastus medialis.</p><p><strong>Methods: </strong>This descriptive, prospective anatomical study involved twenty healthy volunteers. The nerve to vastus medialis was assessed using ultrasound. The following was documented: (a) confirmation of the presence of the nerve to vastus medialis; (b) number of branches/distribution patterns; (c) distance from the division of the NVM into its distal branches to the medial femoral epicondyle; (d) positional relationship of the branches in the distal region of the knee.</p><p><strong>Results: </strong>The presence of the nerve to vastus medialis was confirmed in all participants. The nerve exhibited considerable variability in terms of the number of branches (2 to 5). Two distinct types of branches were identified: (a) trans/intramuscular branches, which were present in varying numbers (0 to 3) in the proximal thigh likely providing motor innervation to the muscle; (b) extramuscular branches, (typically 2 or 3), located in the distal thigh, presumed to have a sensory function. The distance from the division of the NVM into its distal branches to the medial femoral epicondyle was 13.07 ± 3.40 cm. The depths of the distal branches ranged from 1.0 to 4.4cm.</p><p><strong>Conclusion: </strong>The findings from this study offer a standardized approach to the identification and mapping of the nerve to vastus medialis distal branches, essential for interventional treatments.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883400","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}