Pain Medicine最新文献

{"title":"Systematic review and meta-analysis of conventional medical management in a patient population with refractory chronic pain suitable to receive a spinal cord stimulation system.","authors":"Marc Russo, Sarah Nevitt, Danielle Santarelli, Sam Eldabe, Rui V Duarte","doi":"10.1093/pm/pnaf004","DOIUrl":"https://doi.org/10.1093/pm/pnaf004","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this review was to systematically identify all evidence that used conventional medical management (CMM) as a comparator in randomised controlled trials (RCTs) of spinal cord stimulation (SCS) therapy, and to conduct a meta-analysis to investigate if continued CMM provides statistical or clinically meaningful pain relief and whether CMM effects have improved over the last few decades.</p><p><strong>Methods: </strong>Databases were searched from inception to June 2024 for RCTs that compared SCS to CMM. The primary outcome of the review was absolute change in pain intensity from baseline to the last available follow-up in the CMM group, measured using a visual analogue scale or numerical rating scale. The measure of treatment effect for absolute change and percentage change in pain intensity from baseline was mean difference (MD) and 95% confidence interval (CI). Risk of bias (RoB) was assessed by using the revised Cochrane RoB tool. The protocol for this review is registered on PROSPERO (CRD42023449215).</p><p><strong>Results: </strong>Meta-analysis of absolute change in pain intensity from baseline to last follow-up shows that CMM is not associated with any significant reductions in pain intensity (MD -0.11; 95% CI: -0.32 to 0.11; moderate certainty). Similar results were observed for percent change in pain intensity from baseline to last follow-up (MD -3.22%; 95% CI: -12.59% to 6.14%; moderate certainty). No significant differences were observed when considering decade of publication of the RCT for absolute (p = 0.065; moderate certainty) or percent change in pain intensity (p = 0.524; moderate certainty). Meta-analysis for 6-month follow-up and sensitivity analysis shows similar numerical results.</p><p><strong>Conclusion: </strong>Our findings show that continued CMM for a population eligible for SCS does not provide meaningful pain relief and has not considerably changed over the last few decades. The use of CMM as the control to evaluate relative SCS treatment effects should be reassessed.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080653","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":"Evaluating language processing artificial intelligence answers to patient-generated queries on chronic pelvic pain.","authors":"Carlos Agustín Zapata-Caballero, Nelly Alejandra Galindo-Rodriguez, Rebeca Rodriguez-Lane, Jonathan Fidel Cueto-Cámara, Viridiana Gorbea-Chávez, Verónica Granados-Martínez","doi":"10.1093/pm/pnae104","DOIUrl":"10.1093/pm/pnae104","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"114-116"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471854","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 patients on high-dose long-term opioid therapy 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":"10.1093/pm/pnae119","url":null,"abstract":"<p><strong>Objective: </strong>Rapid opioid reduction or discontinuation among patients on high-dose long-term opioid therapy (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 health care access with rapid opioid reduction or discontinuation among patients on HD-LTOT 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 patients who were 18-64 years of age and on HD-LTOT (≥90 morphine milligram equivalents for 81 of 90 consecutive days), with 1-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 health care access (measured as geographic distance to health care facilities) and residential segregation (operationalized with the Index of Concentration at the Extremes). We conducted bivariate linear regression to estimate 1-year risk differences and 95% confidence intervals.</p><p><strong>Results: </strong>Of 13 375 patients on HD-LTOT, 48.6% experienced rapid opioid reduction or discontinuation during 1-year follow-up. Female patients and those diagnosed with PTSD who lived in areas of least racial and economic privilege had higher risks of rapid opioid reduction or discontinuation than did those living in areas with the most racial and economic privilege.</p><p><strong>Conclusion: </strong>Health care providers need to address potential biases toward patients living in underserved and marginalized communities, as well as 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":"63-69"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789783/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined transcranial direct current stimulation and pain neuroscience education for chronic low back pain: a randomized controlled trial.","authors":"Cory Alcon, Christopher Zoch, Riley Luetkenhaus, Emily Lyman, Kelli Brizzolara, Hui-Ting Goh, Sharon Wang-Price","doi":"10.1093/pm/pnae101","DOIUrl":"10.1093/pm/pnae101","url":null,"abstract":"<p><strong>Objective: </strong>Priming the neural circuity likely targeted by pain neuroscience education (PNE), using transcranial direct current stimulation (tDCS) may enhance the efficacy of PNE. The aim of this study was to compare the effects of active tDCS + PNE to sham tDCS + PNE on measures of pain, pain behaviors, and cognitive function in participants with chronic low back pain (CLBP) and high pain catastrophizing.</p><p><strong>Methods: </strong>20 participants were recruited and randomly allocated into the active tDCS + PNE (n = 10) or sham tDCS + PNE (n = 10) groups. All participants received five sessions of their assigned interventions over a 2-week period. The active tDCS + PNE group received 20 min of 2 mA, anodal current applied to the left dorsolateral prefrontal cortex.</p><p><strong>Results: </strong>Within groups, both interventions demonstrated significant improvement in NPRS, PCS, and TSK. The active tDCS + PNE group also demonstrated significant improvement in the SCWT, CTMT2-Inhibitory, and CTMT2-Set Shifting. Between groups, the active tDCS + PNE group showed significantly greater improvement on the PCS, SCWT, and CTMT2-Inhibitory.</p><p><strong>Conclusions: </strong>The results of this pilot study suggest that active tDCS + PNE appeared to provide greater improvement than sham tDCS + PNE on levels of pain catastrophizing and attentional interference in participants with CLBP and high pain catastrophizing, consistent with both interventions targeting brain regions involved in those processes. Considering the differences between groups, tDCS appears to provide a priming effect on PNE.</p><p><strong>Perspective: </strong>This article presents evidence of a priming effect of transcranial direct current stimulation on pain neuroscience education in participants with chronic low back pain and high pain catastrophizing. The findings support that the combination of interventions improves pain behavior and cognitive function greater than pain neuroscience education alone.</p><p><strong>Clinical trial registry: </strong>NCT05571215, The Effect of Combining Pain Neuroscience Education and Transcranial Direct Current Stimulation on Pain Catastrophizing, Kinesiophobia, and Pain in Patients With Chronic Low Back Pain, https://classic.clinicaltrials.gov/ct2/show/NCT05571215.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"90-97"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471851","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":"Noninvasive brain stimulation beyond the motor cortex: a systematic review and meta-analysis exploring effects on quantitative sensory testing in clinical pain.","authors":"Andrew Flood, Rocco Cavaleri, We-Ju Chang, Jason Kutch, Constantino Toufexis, Simon J Summers","doi":"10.1093/pm/pnae103","DOIUrl":"10.1093/pm/pnae103","url":null,"abstract":"<p><strong>Background: </strong>Noninvasive brain stimulation (NIBS) has been investigated increasingly as a means of treating pain. The effectiveness of NIBS in the treatment of pain has traditionally focused on protocols targeting the primary motor cortex (M1). However, over time, the effectiveness of M1 NIBS has been attributed to effects on interconnected cortical and subcortical sites rather than on M1 itself. Although previous reviews have demonstrated the effectiveness of non-M1 NIBS in improving subjective reports of pain intensity, the neurophysiological mechanisms underlying these effects remain incompletely understood. As chronic pain is associated with pain hypersensitivity and impaired endogenous descending pain modulation, it is plausible that non-M1 NIBS promotes analgesic effects by influencing these processes.</p><p><strong>Objective: </strong>The aim of this systematic review and meta-analysis was therefore to evaluate the effect of NIBS over non-M1 sites on quantitative sensory testing measures in clinical pain populations.</p><p><strong>Methods: </strong>A systematic search of electronic databases was conducted from inception to January 2024. Included articles (13 trials, n = 565 participants) were appraised with the Physiotherapy Evidence Database (PEDro) scale and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a random-effects model was used to meta-analyze outcomes where possible.</p><p><strong>Results: </strong>A small number of studies found that NIBS applied to the dorsolateral prefrontal cortex might improve pain modulation in patients with fibromyalgia and that stimulation of the posterior superior insula and prefrontal cortex could improve pain sensitivity in chronic neuropathic and osteoarthritic pain, respectively. However, findings varied among studies, and there remains a paucity of primary research.</p><p><strong>Conclusion: </strong>This review indicates that current literature does not provide clear evidence that NIBS over non-M1 sites influences pain processing.</p><p><strong>Study registration: </strong>PROSPERO (CRD42020201076).</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"98-111"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471855","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":"Subdural hematoma after spinal anesthesia.","authors":"Michael Beeler, Paul Porensky, Rintaro Kinjo, Scott Hughey","doi":"10.1093/pm/pnae108","DOIUrl":"10.1093/pm/pnae108","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"112-113"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505298","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 Common Data Model 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 1 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 body mass index 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 postoperative pain control.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"53-62"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789782/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of vaginal estrogen for provoked vestibulodynia in breast cancer survivors: a delicate balance of risk and relief.","authors":"Carlos Agustín Zapata-Caballero, Cintia Indira Velasquez Chavarría, Claudia Melina Robellada-Zárate, Rebeca Rodriguez-Lane, Jaime Ignacio Cevallos-Bustillos, Viridiana Gorbea-Chávez, Verónica Granados-Martínez","doi":"10.1093/pm/pnae099","DOIUrl":"10.1093/pm/pnae099","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"117-119"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392317","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":"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 could improve clinical outcomes. A novel parasagittal technique was proposed from an anatomic model; this technique was proposed to optimize capture of the medial branch. The anatomic 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>Methods: </strong>Under fluoroscopic guidance, the parasagittal technique was used to place 14 cannulae targeting the lumbar medial branches of 2 cadavers. Meticulous dissection was undertaken to assess cannula alignment and measure proximities to target nerves with a digital caliper.</p><p><strong>Results: </strong>The novel parasagittal technique was successfully performed in a cadaveric model in 12 of 14 attempts. The technique achieved close proximity of cannula tips to medial branches (0.8 ± 1.1 mm). In 2 instances, cannulae were placed unsuccessfully; in one instance, the cannula was too far anterior, and in the other, it was 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 that the parasagittal technique is a feasible option for lumbar medial branch radiofrequency ablation.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"70-75"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789780/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemical neurolysis of genicular nerves for chronic non-cancer knee pain: a scoping review.","authors":"Matthew Rong Jie Tay, Nimish Mittal, Samantha Yao, Jordan Farag","doi":"10.1093/pm/pnae109","DOIUrl":"10.1093/pm/pnae109","url":null,"abstract":"<p><strong>Objective: </strong>Chemical neurolysis of the genicular nerves is a treatment option for intractable non-cancer knee pain. This scoping review synthesizes the available literature on the effectiveness, adverse events, and procedural techniques of chemical neurolysis of genicular nerves for the management of knee pain.</p><p><strong>Design: </strong>Scoping review.</p><p><strong>Setting: </strong>All clinical and research settings.</p><p><strong>Subjects: </strong>Adult participants with chronic non-cancer knee pain undergoing chemical neurolysis of genicular nerves.</p><p><strong>Methods: </strong>A literature search in MEDLINE, EMBASE, and Cochrane Library was conducted up to September 4, 2023. Articles were searched via terms and keywords relating to \"knee,\" \"pain,\" \"knee osteoarthritis,\" \"ablation,\" \"alcohol,\" \"phenol,\" and \"chemical neurolysis.\" Included articles were full-text primary studies and in English. Data were extracted by 2 independent reviewers using an electronic database.</p><p><strong>Results: </strong>Eight studies were included in this review (including 1 randomized controlled trial), comprising 192 patients. Of the 8 studies, 4 used phenol, 3 used alcohol, and 1 used either alcohol or phenol for chemical neurolysis. Fluoroscopy, ultrasound guidance, or both were used for nerve target identification. All studies demonstrated that chemical neurolysis resulted in improved pain or functional outcomes, with no serious adverse events reported.</p><p><strong>Conclusions: </strong>Chemical neurolysis of the genicular nerves is a promising treatment strategy for chronic knee pain. Interpretation of the available studies is limited by study heterogeneity and small sample sizes. High-quality randomized controlled trials are required to clarify the selection of appropriate nerve targets and choice of image guidance and to compare with other ablative modalities.</p><p><strong>Study registration: </strong>Open Science Framework (https://osf.io/jg8wh).</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"76-89"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546678","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}