Pain physician最新文献

{"title":"Mode of Action of Amitriptyline Against Neuropathic Pain via Specific NF-kB Pathway Suppression.","authors":"YouMi Hwang, So Young Kwon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Neuropathic pain occurs for various reasons involving adenosine receptors. One of several drugs used to control neuropathic pain is amitriptyline, a tricyclic antidepressant. Amitriptyline has an antinociceptive effect on the A3 adenosine receptor (A3AR). However, the exact mechanisms underlying A3AR activation remain unclear.</p><p><strong>Objectives: </strong>By investigating the effects of amitriptyline on neuropathic pain mitigation and its impact on inflammatory pathways via A3AR activation, we aimed to provide novel insights into the potential mechanisms of action of amitriptyline in neuropathic pain management. These insights could potentially revolutionize the way we understand and treat neuropathic pain.</p><p><strong>Study design: </strong>We used Sprague-Dawley rats for the neuropathic pain models. The rats were sorted into the sham (control), neuropathic pain (NP+NS), and neuropathic pain and amitriptyline (NP+AMI) groups. Each group consisted of 8 rats. This design allowed us to compare the effects of amitriptyline on neuropathic pain in a control group and a group that experienced neuropathic pain without amitriptyline treatment.</p><p><strong>Setting: </strong>St. Vincent's hospital, research institute of medical science.</p><p><strong>Methods: </strong>Normal saline and amitriptyline were injected intraperitoneally into rats using a subcutaneously implanted osmotic pump. A week after the procedure, nuclear factor kappa B (NF-kB) and a related proinflammatory cytokine (TNF-a) were quantified using immunoblotting or reverse-transcription PCR.</p><p><strong>Results: </strong>Our results brought positive news. The NF-kB concentrations of the groups were not different from one another, indicating a stable baseline. The control and NP+NS groups showed relatively increased activation of the mu-opioid receptor (MOR) and proinflammatory cytokines, including TNF-a, but demonstrated no intergroup difference. However, the MOR and TNF-a concentrations were markedly lower in the NP+AMI group than in the control or NP+NS groups (P = 0.02, 0.002, respectively). This difference suggests a potential for amitriptyline to reduce inflammation. The paw withdrawal threshold test revealed a recovery response to mechanical allodynia for the NP+AMI group (P < 0.05), indicating a positive impact on neuropathic pain.</p><p><strong>Limitations: </strong>The experiment involved only a few mice, so the results may not be generalizable.</p><p><strong>Conclusions: </strong>The release of proinflammatory cytokines via NF-kB expression and subsequent inflammatory responses is significantly associated with the development of neuropathic pain. Our study reveals that AMI effectively suppresses NF-kB-related proinflammatory cytokines, offering a promising avenue for treating pain related to peripheral nerve injuries. These findings provide valuable insights into neuropathic pain management.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E73-E79"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Chronic Opioids for Pain to Microgram Buprenorphine: Key Factors in an Increasingly Recommended Transition.","authors":"Thomas R Hickey, James M Hitt","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Guidelines on the use of opioids in chronic pain management increasingly recommend consideration of buprenorphine for patients on long-term full agonist opioid therapy. Published strategies for patients' transitions to buprenorphine vary widely in terms of study design, dose, formulation, and timing of buprenorphine initiation. A further limitation in informing an ideal transition strategy is the paucity of data describing factors that influence the likelihood of a successful transition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We sought to describe factors that influenced the likelihood of a successful transition to buprenorphine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This research used data from the national Corporate Data Warehouse of the Veterans Health Administration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We reviewed the Veterans Affairs Corporate Data Warehouse for information concerning patients who had outpatient opioid prescriptions and had received microgram-strength buprenorphine. With this information in mind, we examined the factors associated with a successful transition to buprenorphine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified significant reductions in the number of patients prescribed full agonist opioids and in the total dose of opioids prescribed after buprenorphine exposure, with the largest effect observed in patients who continued using buprenorphine. While the potency and dose of baseline opioids were not predictive of the continued use of buprenorphine, higher opioid doses were associated with a decreased likelihood of continuation. Although factors correlating with patient support were associated with buprenorphine continuation, factors correlating with reduced support were associated with lower odds of continued buprenorphine use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Limitations inherent to large-scale observational studies are present, including imperfect data quality/ integrity, incomplete data, and the use of stop codes and CPT codes to determine the nature of a clinical encounter. The dataset is limited to the information collected, which excludes other factors likely associated with the outcomes. We used the continuous prescription of buprenorphine as a surrogate marker of a successful transition. Given the retrospective nature of the study, we are unable to determine if buprenorphine exposure is causally related to reduced opioid use. The population served by the Veterans Health Administration is not representative of other populations, and the results of this study may not generalize to other patient populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings support the recommendation to trial buprenorphine in patients receiving chronic opioid therapy. This study's results also suggest that patient factors and shared decision-making are more important predictors of success than are the pharmacologic properties, potency, or dose o","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"59-67"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Comparison of the Efficacy of Ultrasound-Guided Suprascapular Nerve Blocks and Intraarticular Corticosteroid Injections for Frozen Shoulder: A Randomized Controlled Trial\".","authors":"Alper Mengi","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E99"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"A Novel Sequential Percutaneous Radiofrequency Treatment Strategy for Drug-refractory Trigeminal Neuralgia: A Propensity Score-matched Study\".","authors":"Zihao Zhanga, Yiming Lib","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E102-E103"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Comparison of the Efficacy of Ultrasound-Guided Suprascapular Nerve Blocks and Intraarticular Corticosteroid Injections for Frozen Shoulder: A Randomized Controlled-Trial\".","authors":"Qiang Wang, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E100-E101"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Cord Stimulation Using High Frequency Electromagnetic Coupling (HF-EMC) Technology to Power an Implanted Neurostimulator With a Separate Receiver for Treating Chronic Back and Leg Pain: A Retrospective Study.","authors":"Raul Rodas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back and lower limb pain occurs in 13% of Americans, and is the leading cause of disability. Patients with this condition have a reduced quality of life, have mental health disorders, and cognitive disfunction. While back pain alone is difficult to manage, back pain with associated leg pain results in further reduced outcomes. Spinal cord stimulation (SCS) is a minimally invasive therapy that has been used for a variety of chronic pain disorders when conservative management strategies have failed. The therapy is appealing because of its ability to provide long-term relief at a reduced cost and it has low rates of serious adverse events.</p><p><strong>Objective: </strong>The objective of this retrospective study was to examine the safety and efficacy of the Freedom® Spinal Cord Stimulator System for treating patients who have chronic bilateral back and leg pain.</p><p><strong>Study design: </strong>This retrospective study included 32 patients who received a permanent Freedom® SCS System to treat their chronic bilateral back and leg pain due to nerve compression due to complex regional pain syndrome (CRPS) Type I and/or II. A retrospective chart review was conducted to assess baseline and follow-up Verbal Rating Scale (VRS) pain scores as well as  complications.</p><p><strong>Setting: </strong>This study was conducted at a single center in the United States.</p><p><strong>Methods: </strong>The data were retrospectively collected from patients' medical records. Pain was assessed using the 11-point VRS scores; these scores were collected at baseline, post-trial, 6 months post-implantation, and 12 months post-implantation. Adverse events were reported descriptively and classified as serious or nonserious and either related or nonrelated to the implantation.</p><p><strong>Results: </strong>The post-trial VRS scores for the 32 patients  were reduced by 73% (P < 0.001). At 6 months post-implantation, the VRS scores were reduced by 71% (P < 0.001) for 30 patients and at 12 months by 74% (P < 0.001) for 19 patients. No adverse events were reported.</p><p><strong>Limitations: </strong>Our study's retrospective design limited us to the data available in the patients' charts.</p><p><strong>Conclusion: </strong>The Freedom SCS System is an effective and safe therapy for treating patients with chronic back and leg pain that is resistant to conservative therapy due to nerve compression and CRPS Type I and/or II. These types of patients often report aggravation of symptoms with surgery. Minimal invasive surgery should decrease the chance of extra symptoms.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E43-E47"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Effectiveness and Safety of Hydromorphone Compared to Morphine for Postoperative Analgesia: A Systematic Review and Meta-analysis\".","authors":"Jinxiang Peng, Haozhu Chen, Feng Wu","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E111-E112"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Long-term Follow-up of the Effectiveness and Safety of High-voltage Pulsed Radiofrequency Treatment for Infraorbital Neuralgia: A Retrospective Study\".","authors":"Hanwen Tang, Yijun Xiao, Lu Chen","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E114"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluoroscopy-guided Intradiscal Radiopaque Gelified Ethanol Injection Using an Anteroposterior View Compared to an Oblique View: A Randomized Controlled Trial.","authors":"Masoud Hashemi, Sina Hassannasab, Payman Dadkhah, Mohammad E Majd, Sogol Asgari","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>This study introduces a new fluoroscopy-guided intradiscal radiopaque gelified ethanol injection technique using the antero-posterior view and compare it to conventional oblique view. Intradiscal procedures, are minimally invasive techniques that aim to reduce pain associated with lumbar disc herniation by modifying the disc material and decreasing pressure on surrounding nerves.</p><p><strong>Objectives: </strong>This study introduces a new fluoroscopy-guided intradiscal radiopaque gelified ethanol injection technique using an anteroposterior view compared to the conventional oblique view.</p><p><strong>Study design: </strong>This is a double blind, randomized trial.</p><p><strong>Setting: </strong>A tertiary care center.</p><p><strong>Methods: </strong>Patients with radicular leg pain were randomly assigned to receive a radiopaque gelified ethanol injection via an anteroposterior view or oblique view.. The primary outcomes were procedure time, complication rates, and radiation exposure.</p><p><strong>Results: </strong>A total of 70 patients were randomized to each group (35 for each group). There were no serious complications in either group. Radiation exposure was significantly lower in the anteroposterior view group (36.92 vs 50.46 µGray/m2 [µGy/m2; P = 0.007). The procedure time was also significantly lower in the anteroposterior  group (171 vs 287 seconds; P = 0.001).</p><p><strong>Limitations: </strong>Limitations of our trial include the relatively small sample size, the single-center nature of the study, and the short follow-up period. We were also limited in only including patients with moderate body habitus, and patients with only L3 or L4 disc herniation, which might restrict the generalizability of the findings.</p><p><strong>Conclusion: </strong>An anteroposterior view radiopaque gelified ethanol injection is a promising alternative to the conventional oblique view technique for radicular leg pain management. This novel approach offers a safer and more efficient treatment option, reducing radiation exposure and procedure time without compromising clinical outcomes. Its potential to minimize patient discomfort and enhance overall management of radicular leg pain warrants further investigation and widespread adoption.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"25-30"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Response to Comment on \"Effectiveness and Safety of Hydromorphone Compared to Morphine for Postoperative Analgesia: A Systematic Review and Meta-analysis\".","authors":"Yihang Li, Shuang Liang, Wangyuan Zou","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E113"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}