Pain Practice最新文献

{"title":"Semi‐invasive therapies for pain in knee osteoarthritis: A systematic review and network meta‐analysis","authors":"Siew‐Li Goh, Melissa Wee Chong, Jerri Ling, Zulkarnain Jaafar, Zhuang‐Li Lim, May‐Yann Yau, Terence Ong, Jim Richards","doi":"10.1111/papr.13404","DOIUrl":"https://doi.org/10.1111/papr.13404","url":null,"abstract":"BackgroundThe increasing number of semi‐invasive pain therapies in knee osteoarthritis poses challenges in decision‐making. This review aimed to simultaneously compare established intra‐articular therapies with newer peri‐articular therapies and explore effect modifiers.MethodsRandomized controlled trials were searched from five electronic databases without date or language restrictions. Study selection and data extraction of reports, retrieved up to May 2024, were performed independently by paired assessors. The primary outcome was 6‐month pain score. Nine treatments were included. The effect size (ES) for each treatment, relative to placebo, was estimated using standardized means difference and expressed with 95% confidence intervals (CI). The rigor of results was evaluated with subgroup/sensitivity analyses.ResultsA total of 111 studies (14,695 participants) were included, with intra‐articular hyaluronic acid having the greatest number of participants. Neuroablation demonstrated the greatest ES (1.08, 95% CI: 0.07, 2.10). While platelet‐rich plasma (PRP) ranked second (ES: 0.75, 95% CI: 0.28, 1.22), it was the only intervention demonstrating statistically significant effect at 3, 6, and 12 months. However, this statistical significance was lost in some sensitivity analyses. Larger estimates for biologics and PRP compared with prolotherapy, steroid, and hyaluronic acid injections were consistently observed across different timepoints and in multiple sensitivity analyses. Generally, no statistically significant difference was found between the nine types of therapies.ConclusionAlthough there is robust evidence suggesting greater efficacy of PRP, potentially including biologics, over other interventions, future research is needed to identify the phenotype or patient subgroup that would benefit most from PRP.","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"55 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268624","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":"Elevated lead impedances in spinal cord stimulation systems","authors":"Alaa Abd‐Elsayed, Christopher Gilligan","doi":"10.1111/papr.13415","DOIUrl":"https://doi.org/10.1111/papr.13415","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"20 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268625","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":"Low‐energy differential target multiplexed SCS derivative reduces pain and improves quality of life through 12 months in patients with chronic back and/or leg pain","authors":"Jeffery Peacock, David Provenzano, Michael Fishman, Kasra Amirdelfan, Todd Bromberg, Todd Schmidt, Thomas White, Prabhdeep Grewal, Rafael Justiz, Aaron Calodney, Amr El‐Naggar, Binit Shah, Michael Esposito, Kliment Gatzinsky, Jan Willem Kallewaard, Lawrence Poree, Andrew Cleland, Calysta Rice, Erin Theis, Kate Noel, Maddie LaRue","doi":"10.1111/papr.13407","DOIUrl":"https://doi.org/10.1111/papr.13407","url":null,"abstract":"IntroductionEnergy‐reducing spinal cord stimulation (SCS) approaches have the potential to impact patient experience with rechargeable and non‐rechargeable SCS devices through reducing device recharge time or enhancing device longevity. This prospective, multi‐center study evaluated the safety, effectiveness, and actual energy usage of differential target multiplexed (DTM) endurance therapy, a reduced energy DTM SCS derivative.MethodsSubjects who reported an overall pain visual analog score (VAS) of ≥6/10 cm and an Oswestry Disability Index score of 21–80 out of 100 at baseline with moderate to severe chronic, intractable back and/or leg pain were eligible. Evaluation visits occurred at 1, 3, 6, and 12 months post‐device activation. The primary objective was to characterize change in overall pain intensity, as measured by VAS, from baseline to 3‐month visit.ResultsFifty‐seven subjects enrolled at 12 US sites from November 2020 through June 2021, 35 were implanted with a rechargeable SCS device, and 27 completed the 12‐month visit. Subjects experienced a 50.4% mean reduction in overall pain from baseline at the 3‐month follow‐up that was sustained through 12 months. Additional outcomes including changes in overall, back, and leg pain intensity, quality of life, disability, therapy satisfaction, safety, and current battery usage are shown through 12‐month follow‐up.ConclusionThe use of DTM endurance SCS therapy in this study resulted in reductions in pain relief through 12 months, demonstrating that energy‐reducing stimulation patterns can provide clinical benefit. Clinically effective, reduced energy SCS derivatives have the potential to impact patient experience through either reduced recharge requirements or increased device longevity.","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"390 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185066","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":"10. Complex regional pain syndrome","authors":"Daniël P. C. van der Spek, Maaike Dirckx, Thomas J. P. Mangnus, Steven P. Cohen, Frank J. P. M. Huygen","doi":"10.1111/papr.13413","DOIUrl":"https://doi.org/10.1111/papr.13413","url":null,"abstract":"IntroductionComplex regional pain syndrome (CRPS) is a clinical disorder that can develop following surgery or trauma. Based on the most prominent underlying pathophysiological mechanisms, CRPS can be classified into different subtypes, namely inflammatory, nociplastic/neuropathic, vasomotor, and motor. Depending on the subtype, personalized treatment can be applied. If conservative treatments are insufficient or ineffective, more invasive treatments may be recommended. This article provides an overview of the most recent insights into CRPS and discusses the most common invasive treatments.MethodsThe literature regarding interventional treatments for CRPS has been systematically reviewed and summarized.ResultsBisphosphonates are effective in treating the inflammatory subtype, while ketamine can provide pain relief for the nociplastic/neuropathic subtype. Sympathetic blocks are effective in addressing vasomotor disturbances. For patients with refractory symptoms, neurostimulation is a viable option due to its multimechanistic properties for all subtypes. End‐of‐line motor disturbances may benefit from intrathecal baclofen.ConclusionsCRPS is a debilitating condition with an unpredictable course. The effectiveness of treatment varies from patient to patient. When conservative approaches prove insufficient, gradual progression to invasive treatments based on the underlying subtype is recommended.","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"19 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185065","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":"Smaller thoracic canal diameters are associated with thoracic radiculopathy and abdominal pain after spinal cord stimulator paddle lead placement.","authors":"Brian T Ragel, Matthew McGehee, Nicolas Karvelas, Ahmed M Raslan","doi":"10.1111/papr.13414","DOIUrl":"https://doi.org/10.1111/papr.13414","url":null,"abstract":"<p><strong>Introduction: </strong>It is not uncommon for patients to experience postoperative neurologic deficit, thoracic radiculopathy, abdominal pain, or lower extremity paresthesia after the implantation of thoracic spinal cord stimulator (SCS) paddle leads. Smaller thoracic canal diameters have previously been associated with postoperative neurologic deficits.</p><p><strong>Objective: </strong>This imaging study examined whether postoperative SCS neurologic complaints other than neurologic deficit may be correlated with thoracic spinal canal diameter.</p><p><strong>Methods: </strong>Patients who underwent thoracic laminotomy for SCS paddle lead placement between January 2018 and March 2023 were identified. Preoperative thoracic canal diameter was measured on MRI or CT imaging in the sagittal plane from T5/6 to T11/12. The canal diameters of patients with and without new postoperative neurologic complaints were compared.</p><p><strong>Results: </strong>Two hundred forty-six patients underwent thoracic laminotomy for SCS paddle lead placement. Thoracic radiculopathy, abdominal pain, and lower extremity paresthesia occurred in 3.7% (9/246), 2.8% (7/246), and 2.0% (5/246) patients, respectively. The mean canal diameter for patients without neurologic complaint, thoracic radiculopathy, abdominal pain, and lower extremity paresthesia was 13.1 mm, 12.0 mm (p < 0.0001), 12.1 mm (p < 0.01), and 12.8 mm (p = 0.365), respectively.</p><p><strong>Conclusion: </strong>A smaller thoracic canal diameter is associated with postoperative thoracic radiculopathy and abdominal pain. We believe that surgical planning to create adequate space for SCS leads is critical in preventing postoperative neurologic complaints of deficit, thoracic radiculopathy, and abdominal pain.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140776","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":"Letter to the editor on \"The effect of ketamine on acute and chronic wound pain in patients undergoing breast surgery: A meta-analysis and systematic review\".","authors":"Umar Akram, Zain Ali Nadeem","doi":"10.1111/papr.13374","DOIUrl":"10.1111/papr.13374","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"965"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306436","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 current state of training in pain medicine fellowships: An Association of Pain Program Directors (APPD) survey of program directors.","authors":"Sayed Emal Wahezi, Trent D Emerick, Moorice Caparó, Heejung Choi, Yashar Eshraghi, Tahereh Naeimi, Lynn Kohan, Magdalena Anitescu, Thelma Wright, Rene Przkora, Kiran Patel, Tim J Lamer, Susan Moeschler, Ugur Yener, Jonathan Alerte, Radhika Grandhe, Alexander Bautista, Boris Spektor, Kristen Noon, Rajiv Reddy, Uzondu C Osuagwu, Anna Carpenter, Frederic J Gerges, Danielle B Horn, Casey A Murphy, Chong Kim, Scott G Pritzlaff, Cameron Marshall, Gwynne Kirchen, Christine Oryhan, Tejinder S Swaran Singh, Dawood Sayed, Timothy R Lubenow, Nalini Sehgal, Charles E Argoff, Amit Gulati, Miles R Day, Naum Shaparin, Nabil Sibai, Anterpreet Dua, Meredith Barad","doi":"10.1111/papr.13373","DOIUrl":"10.1111/papr.13373","url":null,"abstract":"<p><strong>Introduction: </strong>The Accreditation Council for Graduate Medical Education (ACGME) approved the first pain medicine fellowship programs over three decades ago, designed around a pharmacological philosophy. Following that, there has been a rise in the transition of pain medicine education toward a multidisciplinary interventional model based on a tremendous surge of contemporaneous literature in these areas. This trend has created variability in clinical experience and education amongst accredited pain medicine programs with minimal literature evaluating the differences and commonalities in education and experience of different pain medicine fellowships through Program Director (PD) experiences. This study aims to gather insight from pain medicine fellowship program directors across the country to assess clinical and interventional training, providing valuable perspectives on the future of pain medicine education.</p><p><strong>Methods: </strong>This study involved 56 PDs of ACGME-accredited pain fellowship programs in the United States. The recruitment process included three phases: advanced notification, invitation, and follow-up to maximize response rate. Participants completed a standard online questionnaire, covering various topics such as subcategory fields, online platforms for supplemental education, clinical experience, postgraduate practice success, and training adequacy.</p><p><strong>Results: </strong>Surveys were completed by 39/56 (69%) standing members of the Association of Pain Program Directors (APPD). All PDs allowed fellows to participate in industry-related and professional society-related procedural workshops, with 59% encouraging these workshops. PDs emphasized the importance of integrity, professionalism, and diligence for long-term success. Fifty-four percent of PDs expressed the need for extension of fellowship training to avoid supplemental education by industry or pain/spine societies.</p><p><strong>Conclusion: </strong>This study highlights the challenge of providing adequate training in all Pain Medicine subtopics within a 12-month pain medicine fellowship. PDs suggest the need for additional training for fellows and discuss the importance of curriculum standardization.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"895-903"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140326930","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":"Lacertus notch as a sign of lacertus syndrome.","authors":"Jean-Paul Brutus, Thiên-Trang Vo, Min Cheol Chang","doi":"10.1111/papr.13372","DOIUrl":"10.1111/papr.13372","url":null,"abstract":"<p><strong>Objective: </strong>Many clinicians are unfamiliar with a diagnosis of lacertus syndrome (LS). We investigated the value of the lacertus notch sign in diagnosing LS.</p><p><strong>Methods: </strong>We included 56 consecutive patients (112 upper extremities) who had neuropathic pain and neurological symptoms of the hand. The presence of LS and the lacertus notch sign in each upper extremity was assessed.</p><p><strong>Results: </strong>Of the 83 upper extremities with LS, 54 (65.1%) had a lacertus notch sign, whereas 29 (34.9%) did not. Of the 29 upper extremities without LS, 9 (31.0%) and 20 (69.0%) had and did not have a lacertus notch sign, respectively. The rates of lacertus notch presence in upper extremities with and without LS were significantly different. Of the 63 upper extremities with a lacertus notch sign, 54 (85.7%) were diagnosed with LS, whereas 9 (14.3%) were not. Of the 49 upper extremities without a lacertus notch sign, 20 (40.8%) were diagnosed with LS, and 29 (59.2%) were not. We observed significant differences in the rates of LS in upper extremities with and without lacertus notch.</p><p><strong>Conclusions: </strong>The presence of the lacertus notch sign is useful for diagnosing LS. When patients with neuropathic pain and neurological symptoms present with a lacertus notch sign, clinicians should consider the possibility of LS.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"891-894"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140326929","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":"Corrigendum.","authors":"Eugene R Viscusi","doi":"10.1111/papr.13376","DOIUrl":"10.1111/papr.13376","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"969-970"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865099","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":"Pudendal nerve blockade for persistent genital arousal disorder (PGAD): A clinical review and case report.","authors":"Michael J Gyorfi, Alaa Abd-Elsayed","doi":"10.1111/papr.13362","DOIUrl":"10.1111/papr.13362","url":null,"abstract":"<p><strong>Background: </strong>Persistent genital arousal disorder (PGAD) is a condition characterized by unwanted and potentially painful genital sensations or spontaneous orgasms without stimulation. We present a case of a 55-year-old woman with refractory genital arousal disorder that was treated with serial pudendal nerve blocks.</p><p><strong>Case: </strong>RW is a 55-year-old woman with chronic pelvic pain, pudendal neuralgia, MDD, SI, GAD, CRPS, and persistent genital arousal disorder for 11 years. Her PGAD was refractory to conservative management, physical therapy, and bilateral clitoral artery embolization. We performed bilateral pudendal nerve blocks with Kenalog and Bupivacaine, which provided almost complete relief for 2-3 months. We performed a bilateral pudendal nerve radiofrequency ablation; however, there was minimal benefit. RW continues to have significant relief with serial pudendal nerve blocks.</p><p><strong>Summary and conclusion: </strong>Persistent genital arousal disorder is often refractory to medication and physical therapy requiring significant intervention such as entrapment surgery or artery embolization. Our case demonstrates pudendal nerve blocks as a potential treatment modality with minimal side effects.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"852-855"},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094419","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}