Pain physician最新文献

{"title":"Prophylactic Perioperative Fluid Infusion Strategy During Splanchnic Nerve Neurolysis to Prevent Systemic Hypotension: A Case Series of 70 Patients With Cancer.","authors":"Tetsumi Sato, Yuichiro Nishibori, Motoki Sekikawa, Ryoken Nara, Tetsu Sato, Yoshiko Kamo, Rei Tanaka","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>When performing splanchnic nerve neurolysis (SNN), systemic hypotension may occur due to upper abdominal sympathetic blockade; therefore, appropriate periprocedural fluid resuscitation is crucial.</p><p><strong>Objectives: </strong>The aims of this retrospective observational study were: 1) to validate the efficacy and safety of our prophylactic periprocedural fluid resuscitation in order to prevent systemic hypotension post-SNN, and 2) to explore the indicators that predict the need for additional fluid administration post-SNN.</p><p><strong>Study design: </strong>This was a retrospective observational study using medical records from electronic medical charts.</p><p><strong>Setting: </strong>All patients who received SNN in the Division of Palliative Medicine of Shizuoka Cancer Center from April 2016 through November 2022 in order to relieve pain caused by upper abdominal cancer and/or abdominal paraaortic lymph node swelling, had their electronic medical charts reviewed. Pancreatic cancer (n = 41) was the primary pain origin.</p><p><strong>Methods: </strong>SNN was performed with the patient prone. Under fluoroscopic guidance a transdiscal approach using a 22G nerve block needle was utilized. The patients maintained their prone position for an hour postprocedure and rested in bed until the following morning. Urine output and blood pressure were measured every postprocedure 4 hours. One thousand mL of dextran 40 solution and 1,000 mL of lactated Ringer's solution were administered as basic fluids during the perioperative 24 hours; additional lactated Ringer's solution was adminstered when oliguria and/or hypotension was observed post block. We recorded patient background data, including the primary malignancy site, clinical classification of pain mechanism, performance status (Eastern Cooperative Oncology Group), presence of diabetes mellitus, hypertension, serum albumin level, hemoglobin level, hematocrit level, C-reactive protein level, estimated glomerular filtration rate, glomerular filtration ratio, presence of celiac plexus invasion and/or peritoneal dissemination,  neurolytic agent dose, postblock pyrexia, and survival time post-SNN.</p><p><strong>Results: </strong>Seventy cases (68 patients, 62.5 ± 12.0 years, 32 men and 36 women, duplicated in 2) were analyzed. The volume of anhydrous ethanol administered as the neurolytic agent was 16.8 ± 2.6 mL. Fourteen patients (21%) received 250 - 1,250 mL of lactated Ringer's solution as additional postprocedure fluid due to oliguria. No systemic hypotension was observed at pre- or  postprocedure. No clinical signs of excessive fluid, such as pleural effusion, ascites, edema, and/or dyspnea, was observed. The only indicator to predict the need for additional fluid administration was the dose of neurolytic agent (anhydrous ethanol).</p><p><strong>Limitations: </strong>The limitations of this study include, firstly, its single-center retrospective observational desig","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"51-57"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190160","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 \"Research Status of Different Adjuvants on Nerve Block's Effect\".","authors":"Dingping Zhou, Nijuan Li, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E105-E106"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190118","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":"Clinical Trial of Ozonated Water Enema for the Treatment of Fibromyalgia: A Randomized, Double-Blind Trial.","authors":"Qianhao Hou, Jinyuan Zhang, Zehua Su, Xiaomei Wang, Hongwei Fang, Shuwen Qian, Haobing Shi, Qing Wang, Yuling Li, Jiaqi Lin, Xiangrui Wang, Zetian Wang, Lijun Liao","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The pathogenesis of fibromyalgia (FM) is currently unknown. Many patients with this condition are not effectively treated, and disorders of the intestinal dysbiosis have been identified in patients with FM. This trial aimed to investigate whether ozonated water enema could alleviate the symptoms of FM by improving intestinal dysbiosis in these patients.</p><p><strong>Objective: </strong>This trial aims to evaluate the therapeutic advantages of ozonated water enema therapy for patients suffering from FM.</p><p><strong>Study design: </strong>A single-center, double-blind, randomized controlled trial.</p><p><strong>Setting: </strong>Department of Pain Management, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.</p><p><strong>Methods: </strong>This is a randomized, double-blind trial conducted on FM patients (n = 66). The selected patients were randomly categorized into the O3 and control groups. The patients in the O3 and control groups received an ozonated and deionized water enema, respectively, at the same dose and frequency. After the treatment, the scores on the numerical rating scale (NRS), widespread pain index (WPI), Hamilton anxiety scale (HAMA), and the Pittsburgh sleep quality index (PSQI) were compared between the 2 groups, as were the doses of duloxetine, to evaluate the treatment effect. Furthermore, the effectiveness of the treatment was assessed by comparing fecal samples from the O3 group collected before and after treatment with 25 healthy individuals from the physical examination department of Shanghai East Hospital.</p><p><strong>Results: </strong>The patients in the O3 group indicated significant relief in pain and reduced NRS, HAMA, PSQI, and WPI scores at each follow-up time point (P < 0.001) when compared to the control group. In addition, the patients in the O3 group used lower doses of duloxetine than did those the control group (P < 0.001). Moreover, FM patients treated with ozonated water indicated improvements to their gut microbiome.</p><p><strong>Limitations: </strong>The trial's findings might be affected by confounding factors, including medicines, diet, and environmental circumstances. Also, this trial was limited by its sample size, and the symptom severity scores (SSS) of the patients at 3 months after treatment at the given follow-up period were not assessed.</p><p><strong>Conclusion: </strong>This trial confirmed that the symptoms of pain, anxiety, and sleep disorders in FM patients were effectively relieved after treatment with an ozonated water enema. Furthermore, the ozonated water enema was associated with a significant reduction in duloxetine dosage and improved gut microbiome disorder, suggesting that the enema could target disorders related to the gut microbiome and therefore serve as a therapeutic intervention for FM.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E13-E22"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189992","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":"Adjuvants to Conventional Management of Postdural Puncture Headache Following Obstetric Surgery Under Spinal Anesthesia: Mirtazapine vs. Sumatriptan.","authors":"Tarek Mohamed Ashoor, Ahmed Maher Abd ElKader, Raouf Ramzy Gadalla, Ibrahim Mamdouh Esmat, Ahmad Mahmoud Hasseb","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postdural puncture headache (PDPH) is a debilitating, life-altering complication of the administration of obstetric spinal anesthesia (SA). The lack of evidence-based treatment for PDPH necessitates the implementation of new treatment modalities. Mirtazapine is a noradrenergic and specific serotonergic antidepressant that has been used as a prophylactic treatment for chronic tension-type headaches. Few previous studies have assessed the efficacy of sumatriptan in the treatment of PDPH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The purpose of this study was to assess the hypothesis that an adjunctive therapy that involved adding mirtazapine or sumatriptan to conventional management (CM) would be more effective in reducing the incidence of refractory PDPH after obstetric surgery under SA than would CM alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A prospective randomized study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was carried out at Ain-Shams University Maternity Hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two hundred and ten American Society of Anesthesiologists (ASA) physical status II  women who complained of PDPH after obstetric SA were randomly allocated to one of 3 groups. Each group consisted of 70 women. The intervention treatment for every group was continued for 3 days, as was the CM of PDPH. Every day at 8 p.m., patients in the mirtazapine group (the M-group) took 30 mg mirtazapine tablet, patients in the sumatriptan group (the S-group) took 50 mg sumatriptan tablet, and patients in the control group (the C-group) took placebo tablets. The primary outcome was the incidence of refractory headache 72 hours after the ingestion of the first dose of the intervention drugs. The incidences of side effects of the study drugs, the hospital length of stay (LOS), and the patient satisfaction score were secondary outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients in the C-group had higher means of headache intensity, lower rates of complete response to medical treatment, more increased incidences of refractory PDPH 72 hours after intervention, and a greater need for epidural blood patches than did patients in either of the intervention groups (P &lt; 0.001), with comparable efficacy between the M- and S-groups (P &gt; 0.05). Incidences of nausea, vomiting, and the need for antiemetics were least frequent in the M-group (P &lt; 0.001). More patients in the C-group had a high prevalence of photophobia and neck stiffness than did patients in the other 2 groups (P &lt; 0.001). Meanwhile, patients in the M- and S-groups had lower hospital LOS and higher patient satisfaction scores (P &lt; 0.001), with no significant differences between the intervention groups (P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This was a single-center study. This study did not determine the optimal dose of mirtazapine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Adding either mirtazapine or sumatriptan to the CM of PDPH following obstetric SA was associated with lower me","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"39-49"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190025","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 \"Efficacy Analysis of Temporary Spinal Cord Stimulation in the Treatment of Refractory Postherpetic Neuralgia\".","authors":"Hui Li, XiaoDong Liu, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E97-E98"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190111","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":"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":"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":"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}