Pain Practice最新文献

{"title":"Effects of an extended MRI approval of an implantable spinal cord stimulation device on compliance with manufacturer's recommendations.","authors":"Marco Reining, Dirk Winkler, Klaus Kirchhof, Joachim Boettcher, Michael Kretzschmar","doi":"10.1111/papr.70022","DOIUrl":"10.1111/papr.70022","url":null,"abstract":"<p><strong>Objective: </strong>The current approval for all available spinal cord stimulation (SCS) devices set several limitations for magnetic resonance imaging (MRI). As a result, most of the necessary examinations are not possible within the scope of the restrictive approvals and, if legally permitted, must be carried out off-label. This retrospective subgroup analysis investigates if the currently extended MRI approval of one specific device allows more MRI scans to be conducted within the manufacturer's recommendations.</p><p><strong>Materials and methods: </strong>Technical MRI data (saved in the DICOM headers) and medical treatment data for all MRI examinations on patients with Proclaim® implantable pulse generators (IPG; Proclaim® spinal cord stimulation systems, Abbott Laboratories, Plano, TX, USA) were examined. Due to a major change in our standard operating procedures for MRI scans in 2019, the two time periods (before and after 2019) were separately analyzed.</p><p><strong>Results: </strong>We identified 62 MRI scans with the IPG. The entire implanted system was approved for MRI examinations in just over 50% of the cases, regardless of old and new approval. Options for lead placement were expanded in the new approval; however, this did not significantly improve the number of MR conditional devices. By contrast, for a higher specific absorption rate, significantly more scans within the recommendations are possible in Period 2 (p = 0.011). However, the number of possible scans did not reach statistical significance in Period 1 (p = 0.078). No device-related adverse events were noted.</p><p><strong>Conclusion: </strong>The new MRI approval is suitable for performing more scans within the manufacturer's specifications. Cervical leads remain problematic because longer leads are required, and the lower impedances inhibit the MRI mode.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 4","pages":"e70022"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753882","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":"On the cervical epidural needle tip position and contrast spread: Is the anteroposterior view superior to the lateral view for determining target access and as a marker for efficacy?","authors":"Jatinder S Gill, Thomas Simopoulos","doi":"10.1111/papr.70027","DOIUrl":"https://doi.org/10.1111/papr.70027","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 4","pages":"e70027"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764607","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":"16. Pain in chronic pancreatitis.","authors":"Laura van Zeggeren, Raha Boelens Nabbi, Jan Willem Kallewaard, Monique Steegers, Steven P Cohen, Leonardo Kapural, Hjalmar van Santvoort, André Wolff","doi":"10.1111/papr.70030","DOIUrl":"10.1111/papr.70030","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pancreatitis is defined as a disease of the pancreas in which recurrent inflammatory episodes result in replacement of the pancreatic parenchyma by fibrous connective tissue in individuals with genetic, environmental, and other risk factors. Pain is one of the most important symptoms of chronic pancreatitis and, in many cases, has chronic visceral nociceptive, nociplastic, and even neuropathic components, with evidence of both central and peripheral sensitization, neuroplasticity, and neurogenic inflammation.</p><p><strong>Methods: </strong>The literature on the diagnosis and treatment of pain in chronic pancreatitis was reviewed and summarized.</p><p><strong>Results: </strong>Treatment of abdominal pain in chronic pancreatitis is guided by pancreatic morphology on imaging, although the correlation between pain symptoms and pathoanatomical changes is not always straightforward. Patients with pancreatic duct obstruction are initially offered endoscopic or surgical therapies, while non-obstructive disease is mostly managed medically. Lifestyle changes and psychological support are of particular importance for all chronic pancreatitis patients. Analgesic options range from non-opioid medications to opioids and adjuvant agents. Interventional pain management may consist of radiofrequency treatment of the splanchnic nerves and spinal cord stimulation. To date, there are no randomized trials supporting their efficacy in the treatment of chronic pancreatitis pain, and the recommendation to consider these treatment options is justified by evidence from observational studies. Possible opioid-sparing effects of interventional pain treatments are important to consider because opioid use and dependency are common in chronic pancreatitis patients and associated with worse outcomes. Celiac plexus block is not generally recommended for chronic pancreatitis due to the limited quality of evidence, overall short duration of effect, and invasiveness of the procedure. Central sensitization can impact the effectiveness of invasive treatments.</p><p><strong>Conclusions: </strong>Managing pain in chronic pancreatitis is a complex task that requires a multidimensional and individualized approach. Due to the lack of randomized trials, treatment decisions are often guided by expert opinion. Integrating pharmacological and non-pharmacological interventions and collaborating with a multidisciplinary team are key components of effective chronic pancreatitis pain management.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 4","pages":"e70030"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796060","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":"Retrograde cervical insertion of spinal cord stimulator in persistent spinal pain syndrome type 2 in patient with fusion from sacrum to T10.","authors":"Christopher L Robinson, Corey Hunter, Vwaire Orhurhu, Alan D Kaye, Mark Jones","doi":"10.1111/papr.70014","DOIUrl":"10.1111/papr.70014","url":null,"abstract":"<p><strong>Introduction: </strong>Placement of a spinal cord stimulator (SCS) is a neuromodulatory technique with several indications, including persistent spinal pain syndrome type 2 (PSPS2), painful diabetic neuropathy, non-surgical chronic low back pain, and complex regional pain syndrome. SCS is conventionally placed in a caudal to cranial fashion (anterograde), yet there are cases such that spinal fusion hardware and adhesions prevent this insertion technique.</p><p><strong>Case presentation: </strong>Our patient is a 57-year-old man with PSPS2 who had extensive spinal fusion and epidural scarring extending from the sacrum to T10. The patient trialed and failed conservative medical management for his PSPS2 pain, with limited options available for pain relief. The decision was made to place the SCS leads in a retrograde manner at C7-T1, which were then threaded to the T10 level, offering the patient complete relief of back pain and >80% of bilateral lower extremity radicular symptoms.</p><p><strong>Conclusion: </strong>Here, we present another case in the literature of a permanently placed SCS performed in the retrograde fashion by an interventional chronic pain physician. Though the technique was off label, the retrograde approach offered the patient significant relief when all other treatment modalities failed. Despite the effective use of the retrograde approach, more studies are needed, including guidelines as to when to offer the retrograde approach for patients with inaccessible anatomy for a typical anterograde technique.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 3","pages":"e70014"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531770","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":"Feasibility of collecting objective data and exploring patient's experiences on physical activity in persistent spinal pain syndrome type 2 patients receiving spinal cord stimulation: A mixed feasibility study.","authors":"Tanja Hamm-Faber, Inge Arnts, Dylan J H A Henssen, Eric-Jan J A A van Gorp, Frank G A M van Haren, Robert van Dongen, Yvonne Engels, Kris C P Vissers","doi":"10.1111/papr.70013","DOIUrl":"10.1111/papr.70013","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients with chronic pain due to persistent spinal pain syndrome Type 2 (PSPS Type 2) experience daily limitations in their physical activities. Physical, emotional, and social well-being changes are usually measured with standardized, validated self-reporting questionnaires. These reported data are subjective and are answered at a particular moment, which may not accurately reflect the patient's overall condition. Moreover, questionnaires could be misinterpreted, leading to potential inaccuracies in the reported data. This highlights the need for objective measurement tools that report longitudinal real-life data, which could be helpful in evaluating physical activity in spinal cord stimulation (SCS). However, objective measurement tools in SCS therapy are scarce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to investigate the feasibility of collecting objective data from an activity tracker and a neurostimulator device to evaluate physical activity. As this is a feasibility study, we also aimed to evaluate the experiences of participating patients and healthcare professionals to explore the viability and practicality of future studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a mixed-methods feasibility study with quantitative and qualitative data collection. Alongside the standardized questionnaires, we collected objective data on different bodily functions as measured by the activity tracker and on different body positions as measured with the neurostimulator device, starting 1 month before the trial spinal cord stimulation and with a follow-up of 3 months. Additionally, we performed face-to-face, in-depth interviews exploring patients' experiences of physical activity using the six dimensions of the diagram of positive health as a topic list. At the end of the study, patients and participating healthcare professionals were asked to evaluate their experiences on a five-point Likert scale expressing satisfaction. The study was performed in two Dutch hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 20 patients with PSPS Type 2, of whom 17 (85%) completed the three-month follow-up with a nearly complete personalized real-time data set. Most of the missing data was due to the wear of the watch. One patient developed an allergic reaction to the watch strap. According to the interviews, patients mentioned feeling motivated to be physically active by wearing an activity tracker. The evaluation form showed that 84% of the patients and 75% of the healthcare professionals were very satisfied and would participate in a study with a similar design. The activity tracker remotely collected objective data on physical activity at baseline, trial, and three-month follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Collecting objective data on physical activities and health status of PSPS Type 2 patients receiving SCS appeared feasible with a neuromodulation device and an activity tracker if the watch was correctly worn on th","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 3","pages":"e70013"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441675","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":"A prospective study of the association between pain and catastrophizing after selective nerve root blockade.","authors":"Pedram Tabatabaei Shafiei, Josefin Åkerstedt, Amar Awad, Rickard L Sjöberg, Johan Wänman","doi":"10.1111/papr.70017","DOIUrl":"10.1111/papr.70017","url":null,"abstract":"<p><strong>Introduction: </strong>Pain, comprising sensory and emotional elements, is influenced by pain catastrophizing, which magnifies pain and promotes helplessness and rumination. This study explores the relationship between pain catastrophizing and outcomes following selective nerve root blockade (SNRB) in patients with lumbar radicular pain (LRP).</p><p><strong>Methods: </strong>A prospective cohort study of 103 LRP patients, confirmed by MRI, was conducted. All participants underwent SNRB at Umeå University Hospital. Outcomes were measured using PROMIS-29 and the Pain Catastrophizing Scale (PCS) at baseline and several intervals up to 84 days post-intervention. Patients were categorized into responder (≥30% pain reduction) and non-responder groups and stratified into three groups based on baseline PCS scores. Changes in outcomes from baseline to 14 days post-SNRB were analyzed in relation to PCS groups. PCS changes over time were evaluated between responders and non-responders. Statistical analyses assessed PCS and outcome changes.</p><p><strong>Results: </strong>Baseline pain catastrophizing was not a significant predictor of pain response to SNRB. However, responders demonstrated significant reductions in pain catastrophizing following the intervention, suggesting that SNRB may influence cognitive coping mechanisms related to pain.</p><p><strong>Conclusion: </strong>SNRB reduces pain catastrophizing in LRP patients, although baseline catastrophizing does not predict pain outcomes. Addressing catastrophizing remains important but may serve better as an outcome measure rather than a predictor of treatment response.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 3","pages":"e70017"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542927","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":"Superficial cervical plexus hydrodissection for submandibular pain.","authors":"Jasmine Kaur, Sujeet Gautam","doi":"10.1111/papr.70021","DOIUrl":"https://doi.org/10.1111/papr.70021","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 3","pages":"e70021"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531774","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":"What is cancer pain? Investigating attitudes of patients, carers, and health professionals: A cross-sectional survey.","authors":"E Henriksen, J Young, C Power, C Chan","doi":"10.1111/papr.70018","DOIUrl":"10.1111/papr.70018","url":null,"abstract":"<p><strong>Background: </strong>Cancer pain is a prevalent and debilitating symptom that impacts quality of life. Pain management remains challenging; however, due to various barriers, including stigma associated with opioid use, ambiguous roles of clinicians, and diverse attitudes toward pain management among healthcare professionals, patients, and carers.</p><p><strong>Objective: </strong>To explore the attitudes surrounding cancer pain among patients, carers, and health professionals at a tertiary cancer hospital.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted at the Peter MacCallum Cancer Centre. The survey included demographic measures and statements assessing attitudes toward cancer pain management. Data was analyzed using descriptive statistics in IBM SPSS 29. Ethics approval was granted by the Peter MacCallum HREC.</p><p><strong>Results: </strong>308 participants (153 patients and carers, 155 health professionals) completed the survey. The results revealed significant variability in attitudes surrounding cancer pain and its management. Discrepancies in understanding between health professionals and patients/carers were observed. Differing views on the goals of pain management were revealed, with 51.6% of patients/carers expecting pain elimination compared to 20.6% of health professionals. The roles of clinicians in pain management were also perceived differently, highlighting a lack of clarity in responsibilities. Both groups emphasized the need for increased education on cancer pain and its management.</p><p><strong>Conclusions: </strong>The study revealed substantial variability in attitudes toward cancer pain management among patients, carers, and health professionals. Discrepancies emerged in understanding, with many patients and carers uncertain about the nature of cancer pain, contrasting with health professionals' recognition of its complexity. The terminology distinguishing \"cancer pain\" from \"non-cancer pain\" may contribute to this confusion, suggesting a need to reconsider these semantics. Divergent views on clinician roles and opioid use underscored uncertainties, especially regarding specialist access and prescribing practices. Both groups emphasized the need for education to bridge these gaps, with clearer communication and revised guidelines potentially improving patient outcomes.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 3","pages":"e70018"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567917","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":"Short-term clinical outcomes and safety of the SpineJack implant system for the treatment of pathological vertebral compression fractures in cancer patients: A retrospective analysis.","authors":"Jason Parmar, Aila Malik, Gelilla Zemmedhun, Saba Javed","doi":"10.1111/papr.70020","DOIUrl":"10.1111/papr.70020","url":null,"abstract":"<p><strong>Background: </strong>The SpineJack implant system is an FDA-approved treatment modality for vertebral compression fractures (VCFs) with reported clinical efficacy comparable to the gold-standard balloon kyphoplasty. Specifically, there is insufficient literature regarding the treatment and safety outcomes of the SpineJack when analyzing a specific subset of patients such as the cancer population.</p><p><strong>Methods: </strong>This is an institutional-level retrospective study at a cancer center on the SpineJack implant consisting of 67 cancer patients (mean age 64 ± 13 years) undergoing a total of 94 SpineJack implantations inserted at 15 thoracolumbar vertebral levels for the treatment of pathologic vertebral compression fractures. The primary outcome of the study was the change in pain score based on the Numeric Rating Scale (NRS) and the secondary outcome was the change in opioid requirement based on morphine milligram equivalents (MME). The average follow-up period was 2 weeks.</p><p><strong>Results: </strong>Post-procedure, a statistically significant decrease in pain severity was observed, with the mean pain score improving from 7.72 ± 2.29 points to 3.45 ± 2.55 points (p-value < 0.0001). Additionally, a reduction in opioid requirement was noted, with a decrease in MME from 66.42 ± 92.66 mg preoperatively to 43.1 ± 60.78 mg (p-value < 0.0001) postoperatively. There was a 1.5% (N = 1) incidence of adjacent level fracture (ALF) reported over an average of 2-week follow-up. The most common intraoperative complication reported was cement extravasation.</p><p><strong>Conclusion: </strong>Overall, treatment of cancer patients with pathologic fractures using the SpineJack procedure resulted in remarkably decreased pain scores, overall decreased MME requirements, a significantly low incidence of ALF (s), and minor intraoperative complications without long-term consequences. The SpineJack procedure is a clinically effective, low-risk treatment option for cancer patients with symptomatic, pathologic VCFs.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 3","pages":"e70020"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573612","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":"Response to: Do not forget botulinum toxin. Letter to the editor: 8. Herpes zoster and post herpetic neuralgia.","authors":"Elisabeth J M Adriaansen, Albert J M van Wijck, Steven P Cohen, Frank J P M Huygen, Mienke Rijsdijk","doi":"10.1111/papr.70019","DOIUrl":"https://doi.org/10.1111/papr.70019","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 3","pages":"e70019"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557668","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}