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Riis TS, Feldman DA, Losser AJ, Okifuji A, Kubanek J. Noninvasive targeted modulation of pain circuits with focused ultrasonic waves. Pain 2024:00006396-990000000-00670. [PMID: 39073370 DOI: 10.1097/j.pain.0000000000003322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/10/2024] [Indexed: 07/30/2024]
Abstract
ABSTRACT Direct interventions into deep brain circuits constitute promising treatment modalities for chronic pain. Cingulotomy and deep brain stimulation targeting the anterior cingulate cortex have shown notable improvements in the unpleasantness of pain, but these interventions require brain surgeries. In this study, we have developed an approach that can modulate this deep brain affective hub entirely noninvasively, using low-intensity transcranial-focused ultrasound. Twenty patients with chronic pain received two 40-minute active or sham stimulation protocols and were monitored for one week in a randomized crossover trial. Sixty percent of subjects experienced a clinically meaningful reduction of pain on day 1 and on day 7 following the active stimulation, while sham stimulation provided such benefits only to 15% and 20% of subjects, respectively. On average, active stimulation reduced pain by 60.0% immediately following the intervention and by 43.0% and 33.0% on days 1 and 7 following the intervention. The corresponding sham levels were 14.4%, 12.3%, and 6.6%. The stimulation was well tolerated, and no adverse events were detected. Side effects were generally mild and resolved within 24 hours. Together, the direct, ultrasonic stimulation of the anterior cingulate cortex offers rapid, clinically meaningful, and durable improvements in pain severity.
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Affiliation(s)
- Thomas S Riis
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Daniel A Feldman
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Department of Radiology, University of Utah, Salt Lake City, UT, United States
| | - Adam J Losser
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Akiko Okifuji
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, UT, United States
| | - Jan Kubanek
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
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Whetten J, Medina L, Krabbenhoft C, Will V, Reising M, Maska BK, Phillips JK. Health Resource Utilization and Cost Impact of Integrative Medicine Services for Newly Diagnosed Chronic Pain Patients. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38976483 DOI: 10.1089/jicm.2024.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background: Integrative medicine (IM) is the healing-oriented practice of medicine that emphasizes the relationship between practitioner and patient. It considers the whole person, their environment, lifestyle, and social and cultural factors. It is evidence based and makes use of all appropriate therapies, conventional and complimentary. Objective: To evaluate the impact of IM services on health outcomes and care costs of chronic pain management patients compared with standard care. Methods: This article uses University of New Mexico hospital billing data from 10/2016 to 09/2019 to identify patients with nervous system or musculoskeletal pain. A total of 1,304 patients were matched using propensity scores into IM services (treatment: 652) and standard care (control: 652) cohorts for difference-in-differences analysis. The patients were matched based on age, sex, race, zip code, insurance type, ICD-10s, prescriptions, health care events, and medical claim costs. Results: Patients who used IM services had better health outcomes and lower costs at 3-month, 6-month, and 12-month follow-up. At the 12-month follow-up, the IM group showed a 19% decrease in utilization of inpatient care, a 37% decrease in Emergency Department utilization, and an 11.3% reduction in claim costs compared with the control group. Conclusion: Patients who utilize IM services as part of chronic pain management have overall lower health care costs and better health outcomes. Unfortunately, in the health system studied, less than 3% of patients utilize these services. Promotion of and education about IM services should be aimed at both patients and their providers.
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Affiliation(s)
- Justin Whetten
- University of New Mexico Health System, Albuquerque, NM, USA
| | - Laura Medina
- University of New Mexico Health System, Albuquerque, NM, USA
| | | | - Vanessa Will
- University of New Mexico Health System, Albuquerque, NM, USA
| | - Mary Reising
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM USA
| | - Breanna K Maska
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM USA
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Poß-Doering R, Keller S, Zugaj M, Seidling H, Paul C, Stolz R, Kaufmann-Kolle P, Straßner C. [General practice care for patients with chronic non-cancer pain: A rapid review as part of the RELIEF project]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 185:1-9. [PMID: 38472021 DOI: 10.1016/j.zefq.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/21/2023] [Accepted: 01/27/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Approximately one fifth of the German population suffers from chronic pain, which is often associated with limitations in coping with everyday life, social isolation and psychological comorbidities such as anxiety and depression. The importance of a treatment approach that considers biological, psychological, and social factors (bio-psycho-social model) as well as non-drug interventions is emphasized in current guidelines, but presents challenges for primary care practices. To support the implementation of evidence-based best practice recommendations, the RELIEF project (Resource-oriented case management to implement recommendations for patients with chronic pain and frequent use of analgesics in general practices) aims to develop a case management program for the primary care of patients with chronic non-tumor pain. METHODS Prior to intervention development, a rapid review was conducted to identify best practice recommendations for the care of patients with chronic non-tumor pain, barriers and strategies to their implementation, and gaps in care in current guidelines and literature. Selective searches of guidelines, PubMed, the Cochrane Library, bibliographies of relevant publications, and the gray literature focused on assessment and monitoring, education, promotion of self-care, and rational pharmacotherapy. RESULTS Numerous recommendations on assessment and monitoring were identified, but only a few studies examined their feasibility in primary care practices. Guidelines contained few specific recommendations on content and format of patient education on chronic pain. Recommendations for non-drug self-care measures were mainly related to physical activity, relaxation techniques, behavioral therapy techniques and external applications. Especially for the area of physical activity, numerous barriers but also strategies for a successful implementation could be identified. DISCUSSION In a potential primary care model for patients with chronic non-tumor pain, pain assessment should aim to identify patients who need support in implementing medication and non-medication interventions in the primary care setting and/or could benefit from specialized care. To implement recommendations for pain education, primary care physicians need educational materials in a variety of formats and levels of detail that ideally could be processed by patients at home and then get addressed in practices using simple key questions. Non-drug measures should be an explicit part of the treatment plan. CONCLUSION Many of the identified recommendations for the treatment of patients with chronic non-tumor pain can also be considered relevant for the primary care setting. Specific guidelines and concepts for primary care physicians that include setting-specific characteristics at the physician, patient, and system levels would be desirable for a successful implementation of these recommendations.
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Affiliation(s)
- Regina Poß-Doering
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Deutschland.
| | - Sabrina Keller
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Deutschland
| | - Marco Zugaj
- Universitätsklinikum Heidelberg, Klinik für Anästhesiologie, Sektion Schmerzmedizin, Heidelberg, Deutschland
| | - Hanna Seidling
- Universitätsklinikum Heidelberg, Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Heidelberg, Deutschland
| | - Cinara Paul
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Deutschland
| | - Regina Stolz
- Universitätsklinikum Tübingen, Institut für Allgemeinmedizin & interprofessionelle Versorgung, Heidelberg, Deutschland
| | - Petra Kaufmann-Kolle
- aQua - Institut für angewandte Qualitätsförderung und, Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland
| | - Cornelia Straßner
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Deutschland
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Ngo K, Lopez Mateos D, Han Y, Rouen KC, Ahn SH, Wulff H, Clancy CE, Yarov-Yarovoy V, Vorobyov I. Elucidating molecular mechanisms of protoxin-II state-specific binding to the human NaV1.7 channel. J Gen Physiol 2024; 156:e202313368. [PMID: 38127314 PMCID: PMC10737443 DOI: 10.1085/jgp.202313368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/08/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Human voltage-gated sodium (hNaV) channels are responsible for initiating and propagating action potentials in excitable cells, and mutations have been associated with numerous cardiac and neurological disorders. hNaV1.7 channels are expressed in peripheral neurons and are promising targets for pain therapy. The tarantula venom peptide protoxin-II (PTx2) has high selectivity for hNaV1.7 and is a valuable scaffold for designing novel therapeutics to treat pain. Here, we used computational modeling to study the molecular mechanisms of the state-dependent binding of PTx2 to hNaV1.7 voltage-sensing domains (VSDs). Using Rosetta structural modeling methods, we constructed atomistic models of the hNaV1.7 VSD II and IV in the activated and deactivated states with docked PTx2. We then performed microsecond-long all-atom molecular dynamics (MD) simulations of the systems in hydrated lipid bilayers. Our simulations revealed that PTx2 binds most favorably to the deactivated VSD II and activated VSD IV. These state-specific interactions are mediated primarily by PTx2's residues R22, K26, K27, K28, and W30 with VSD and the surrounding membrane lipids. Our work revealed important protein-protein and protein-lipid contacts that contribute to high-affinity state-dependent toxin interaction with the channel. The workflow presented will prove useful for designing novel peptides with improved selectivity and potency for more effective and safe treatment of pain.
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Affiliation(s)
- Khoa Ngo
- Biophysics Graduate Group, University of California, Davis, Davis, CA, USA
- Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, USA
| | - Diego Lopez Mateos
- Biophysics Graduate Group, University of California, Davis, Davis, CA, USA
- Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, USA
| | - Yanxiao Han
- Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, USA
| | - Kyle C. Rouen
- Biophysics Graduate Group, University of California, Davis, Davis, CA, USA
- Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, USA
| | - Surl-Hee Ahn
- Department of Chemical Engineering, University of California, Davis, Davis, CA, USA
| | - Heike Wulff
- Department of Pharmacology, University of California, Davis, Davis, CA, USA
| | - Colleen E. Clancy
- Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, USA
- Department of Pharmacology, University of California, Davis, Davis, CA, USA
- Center for Precision Medicine and Data Science, University of California, Davis, Davis, CA, USA
| | - Vladimir Yarov-Yarovoy
- Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, USA
- Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, CA, USA
| | - Igor Vorobyov
- Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, USA
- Department of Pharmacology, University of California, Davis, Davis, CA, USA
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Carabot F, Fraile-Martínez O, Donat-Vargas C, Santoma J, Garcia-Montero C, Pinto da Costa M, Molina-Ruiz RM, Ortega MA, Alvarez-Mon M, Alvarez-Mon MA. Understanding Public Perceptions and Discussions on Opioids Through Twitter: Cross-Sectional Infodemiology Study. J Med Internet Res 2023; 25:e50013. [PMID: 37906234 PMCID: PMC10646670 DOI: 10.2196/50013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Opioids are used for the treatment of refractory pain, but their inappropriate use has detrimental consequences for health. Understanding the current experiences and perceptions of patients in a spontaneous and colloquial environment regarding the key drugs involved in the opioid crisis is of utmost significance. OBJECTIVE The study aims to analyze Twitter content related to opioids, with objectives including characterizing users participating in these conversations, identifying prevalent topics and gauging public perception, assessing opinions on drug efficacy and tolerability, and detecting discussions related to drug dispensing, prescription, or acquisition. METHODS In this cross-sectional study, we gathered public tweets concerning major opioids posted in English or Spanish between January 1, 2019, and December 31, 2020. A total of 256,218 tweets were collected. Approximately 27% (69,222/256,218) were excluded. Subsequently, 7000 tweets were subjected to manual analysis based on a codebook developed by the researchers. The remaining databases underwent analysis using machine learning classifiers. In the codebook, the type of user was the initial classification domain. We differentiated between patients, family members and friends, health care professionals, and institutions. Next, a distinction was made between medical and nonmedical content. If it was medical in nature, we classified it according to whether it referred to the drug's efficacy or adverse effects. In nonmedical content tweets, we analyzed whether the content referred to management issues (eg, pharmacy dispensation, medical appointment prescriptions, commercial advertisements, or legal aspects) or the trivialization of the drug. RESULTS Among the entire array of scrutinized pharmaceuticals, fentanyl emerged as the predominant subject, featuring in 27% (39,997/148,335 posts) of the tweets. Concerning user categorization, roughly 70% (101,259/148,335) were classified as patients. Nevertheless, tweets posted by health care professionals obtained the highest number of retweets (37/16,956, 0.2% of their posts received over 100 retweets). We found statistically significant differences in the distribution concerning efficacy and side effects among distinct drug categories (P<.001). Nearly 60% (84,401/148,335) of the posts were devoted to nonmedical subjects. Within this category, legal facets and recreational use surfaced as the most prevalent themes, while in the medical discourse, efficacy constituted the most frequent topic, with over 90% (45,621/48,777) of instances characterizing it as poor or null. The opioid with the greatest proportion of tweets concerning legal considerations was fentanyl. Furthermore, fentanyl was the drug most frequently offered for sale on Twitter, while methadone generated the most tweets about pharmacy delivery. CONCLUSIONS The opioid crisis is present on social media, where tweets discuss legal and recreational use. Opioid users are the most active participants, prioritizing medication efficacy over side effects. Surprisingly, health care professionals generate the most engagement, indicating their positive reception. Authorities must monitor web-based opioid discussions to detect illicit acquisitions and recreational use.
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Affiliation(s)
- Federico Carabot
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Oscar Fraile-Martínez
- Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Carolina Donat-Vargas
- Institute for Global Health, Barcelona, Spain
- Centro de Investigación Biomédica en Red | Epidemiología y Salud Pública (CIBER) Epidemiología y Salud Pública, Madrid, Spain
- Cardiovascular and Nutritional Epidemiology, Unit of Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Javier Santoma
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Madrid, Spain
- Filament Consultancy Group, London, United Kingdom
| | - Cielo Garcia-Montero
- Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Mariana Pinto da Costa
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Rosa M Molina-Ruiz
- Department of Psychiatry and Mental Health, San Carlos Clinical University Hospital, IdiSSC, Madrid, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Melchor Alvarez-Mon
- Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, Centro de Investigación Biomédica en Red | Enfermedades Hepáticas y Digestivas (CIBEREHD), Alcalá de Henares, Spain
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
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Stolz R, Kaschdailewitsch E, Kröger B, Noack B, Mahler C. [Evidence-based naturopathic nursing interventions in pain management]. Schmerz 2023; 37:336-343. [PMID: 37039897 PMCID: PMC10511583 DOI: 10.1007/s00482-023-00705-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/12/2023]
Abstract
Nurses are confronted with patients suffering from acute and/or chronic pain in all nursing care settings and within all target groups. Although national and international guidelines on chronic pain emphasize the importance of non-pharmacological interventions (for example, hot and cold applications) and educational approaches such as teaching self-management strategies to deal with pain, the most common applied intervention for chronic and acute pain is a pharmacological therapy. The aim of this article is to provide an overview of the potential of naturopathic nursing interventions for the care of patients with chronic and/or acute pain, focusing on so-called external applications such as wraps and compresses, which are safe, have a low-risk profile and are easy to apply, thus making them suitable for self-application. The use of non-pharmacological interventions as well as the counselling and training of patients in naturopathic applications offer nurses the possibility to work in an autonomous field of nursing promoting nursing as an attractive health profession.
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Affiliation(s)
- Regina Stolz
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Elke Kaschdailewitsch
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Birgit Kröger
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Bettina Noack
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Cornelia Mahler
- Abteilung Pflegewissenschaft, Institut für Gesundheitswissenschaften, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 9, 72076, Tübingen, Deutschland.
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7
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Ramdin C, Azer A, Ghafoor N, Attaalla K, Ghbrial M, Nelson L. Prevalence and services for the treatment of chronic pain at residential substance treatment centers. J Addict Dis 2023:1-6. [PMID: 37665562 DOI: 10.1080/10550887.2023.2251856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Introduction: Studies suggest that a large proportion of patients with substance use disorders (SUDs) also have underlying chronic pain. There is limited data on prevalence of chronic pain treatment as a component of residential substance use treatment. This initiative sought to investigate the prevalence and type of chronic pain services offered at these residential programs.Methods: This study was a retrospective review of information obtained from residential substance use treatment facility websites contained in SAMHSA's treatment navigator. Nine hundred-fifty out of 2952 websites were randomly selected for analysis. The primary outcome was prevalence of facilities that had chronic pain programs. Services offered were specified as available. Descriptive statistics were used to summarize data.Results: Nine-hundred nine websites (95.7%, [94,97]) were accessible. Twenty-six facilities (2.9%,[1.9,4.2]) had a chronic pain program and of these 22 (84.6%, [64.3,95.0]) specified services offered. Common services included physical therapy (6, 27.3%), massage (12, 54.6%), and acupuncture (10, 45.5%). Of the remaining sites, 630 (69.3%, [66.2,72.3]) specified services offered, including yoga (122, 19.4%) and exercise (199, 31.6%).Conclusion: Our study demonstrated that despite most facilities offering adjunctive services, few had chronic pain programs. This suggests that there is a possible need for better updating of facility websites or possibly an area for improvement in residential substance use treatment settings.
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Affiliation(s)
- Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amanda Azer
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Naila Ghafoor
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kyrillos Attaalla
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mina Ghbrial
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Ngo K, Mateos DL, Han Y, Rouen KC, Ahn SH, Wulff H, Clancy CE, Yarov-Yarovoy V, Vorobyov I. Elucidating Molecular Mechanisms of Protoxin-2 State-specific Binding to the Human Na V1.7 Channel. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.27.530360. [PMID: 36909474 PMCID: PMC10002706 DOI: 10.1101/2023.02.27.530360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Human voltage-gated sodium (hNaV) channels are responsible for initiating and propagating action potentials in excitable cells and mutations have been associated with numerous cardiac and neurological disorders. hNaV1.7 channels are expressed in peripheral neurons and are promising targets for pain therapy. The tarantula venom peptide protoxin-2 (PTx2) has high selectivity for hNaV1.7 and serves as a valuable scaffold to design novel therapeutics to treat pain. Here, we used computational modeling to study the molecular mechanisms of the state-dependent binding of PTx2 to hNaV1.7 voltage-sensing domains (VSDs). Using Rosetta structural modeling methods, we constructed atomistic models of the hNaV1.7 VSD II and IV in the activated and deactivated states with docked PTx2. We then performed microsecond-long all-atom molecular dynamics (MD) simulations of the systems in hydrated lipid bilayers. Our simulations revealed that PTx2 binds most favorably to the deactivated VSD II and activated VSD IV. These state-specific interactions are mediated primarily by PTx2's residues R22, K26, K27, K28, and W30 with VSD as well as the surrounding membrane lipids. Our work revealed important protein-protein and protein-lipid contacts that contribute to high-affinity state-dependent toxin interaction with the channel. The workflow presented will prove useful for designing novel peptides with improved selectivity and potency for more effective and safe treatment of pain.
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Affiliation(s)
- Khoa Ngo
- Biophysics Graduate Group, University of California, Davis
- Department of Physiology and Membrane Biology, University of California, Davis
| | - Diego Lopez Mateos
- Biophysics Graduate Group, University of California, Davis
- Department of Physiology and Membrane Biology, University of California, Davis
| | - Yanxiao Han
- Department of Physiology and Membrane Biology, University of California, Davis
| | - Kyle C. Rouen
- Biophysics Graduate Group, University of California, Davis
- Department of Physiology and Membrane Biology, University of California, Davis
| | - Surl-Hee Ahn
- Department of Chemical Engineering, University of California, Davis
| | - Heike Wulff
- Department of Pharmacology, University of California, Davis
| | - Colleen E. Clancy
- Department of Physiology and Membrane Biology, University of California, Davis
- Department of Pharmacology, University of California, Davis
- Center for Precision Medicine and Data Science, University of California, Davis
| | - Vladimir Yarov-Yarovoy
- Department of Physiology and Membrane Biology, University of California, Davis
- Department of Anesthesiology and Pain Medicine, University of California, Davis
| | - Igor Vorobyov
- Department of Physiology and Membrane Biology, University of California, Davis
- Department of Pharmacology, University of California, Davis
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Macionis V. Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion. FRONTIERS IN PAIN RESEARCH 2023; 4:1037376. [PMID: 36890855 PMCID: PMC9986610 DOI: 10.3389/fpain.2023.1037376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/12/2023] [Indexed: 02/22/2023] Open
Abstract
It has been unexplained why chronic pain does not invariably accompany chronic pain-prone disorders. This question-driven, hypothesis-based article suggests that the reason may be varying occurrence of concomitant peripheral compressive proximal neural lesion (cPNL), e.g., radiculopathy and entrapment plexopathies. Transition of acute to chronic pain may involve development or aggravation of cPNL. Nociceptive hypersensitivity induced and/or maintained by cPNL may be responsible for all types of general chronic pain as well as for pain in isolated tissue conditions that are usually painless, e.g., neuroma, scar, and Dupuytren's fibromatosis. Compressive PNL induces focal neuroinflammation, which can maintain dorsal root ganglion neuron (DRGn) hyperexcitability (i.e., peripheral sensitization) and thus fuel central sensitization (i.e., hyperexcitability of central nociceptive pathways) and a vicious cycle of chronic pain. DRGn hyperexcitability and cPNL may reciprocally maintain each other, because cPNL can result from reflexive myospasm-induced myofascial tension, muscle weakness, and consequent muscle imbalance- and/or pain-provoked compensatory overuse. Because of pain and motor fiber damage, cPNL can worsen the causative musculoskeletal dysfunction, which further accounts for the reciprocity between the latter two factors. Sensitization increases nerve vulnerability and thus catalyzes this cycle. Because of these mechanisms and relatively greater number of neurons involved, cPNL is more likely to maintain DRGn hyperexcitability in comparison to distal neural and non-neural lesions. Compressive PNL is associated with restricted neural mobility. Intermittent (dynamic) nature of cPNL may be essential in chronic pain, because healed (i.e., fibrotic) lesions are physiologically silent and, consequently, cannot provide nociceptive input. Not all patients may be equally susceptible to develop cPNL, because occurrence of cPNL may vary as vary patients' predisposition to musculoskeletal impairment. Sensitization is accompanied by pressure pain threshold decrease and consequent mechanical allodynia and hyperalgesia, which can cause unusual local pain via natural pressure exerted by space occupying lesions or by their examination. Worsening of local pain is similarly explainable. Neuroma pain may be due to cPNL-induced axonal mechanical sensitivity and hypersensitivity of the nociceptive nervi nervorum of the nerve trunk and its stump. Intermittence and symptomatic complexity of cPNL may be the cause of frequent misdiagnosis of chronic pain.
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Zhang Y, Li Z, Su Q, Ge H, Cheng B, Tian M. The duration of postoperative analgesic use after total knee arthroplasty and nomogram for predicting prolonged analgesic use. Front Surg 2022; 9:911864. [PMID: 35959127 PMCID: PMC9360610 DOI: 10.3389/fsurg.2022.911864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Total knee arthroplasty is currently a reliable treatment for end-stage knee osteoarthritis. However, chronic postsurgical pain (CPSP) is substantially thought to reduce patient satisfaction. NSAID-based oral analgesics were used to manage CPSP, but research on the duration of postoperative analgesic use (DAU) and prolonged analgesic use (PAU) are presently scarce. Methods Preoperative, perioperative, and one-year or above postoperative follow-up data were collected from 162 patients who underwent total knee arthroplasty between 1 June 2018 and 1 March 2019, and the DAU and the discontinuation time of each patient after discharge were recorded. Observational statistical analysis, diagnostic test, and predictive nomogram construction were performed on the collected data. Results The 3-month DAU has good diagnostic utility for poor outcome of postoperative months twelve (POM12). The constructed nomogram shows that gender, preoperative Numeric Rating Scale (NRS) movement pain scores, duration of surgery, postoperative days three (POD3) moderate to severe movement pain, and POD3 pain rescue medication were significant prognostic predictors of PAU after discharge. The area under the curve (AUC) of the 3-month, 6-month, and 12-month nomogram receiver operating characteristic (ROC) curves were calculated to be 0.741, 0.736, and 0.781. Conclusion PAU was defined as more than three months of NSAID-based oral analgesic use after TKA. Prognostic predictors of PAU after TKA were identified, and visualized nomogram was plotted and evaluated. The evaluation indicated that the prediction model had the good predictive ability and was a valuable tool for predicting PAU after discharge.
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Affiliation(s)
- Yi Zhang
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Orthopaedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zihua Li
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qihang Su
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Heng’an Ge
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Biao Cheng
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Correspondence: Biao Cheng Meimei Tian
| | - Meimei Tian
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Correspondence: Biao Cheng Meimei Tian
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11
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Smith CA, Roman J, Mammis A. The Role of Spinal Cord Stimulation in Reducing Opioid Use in the Setting of Chronic Neuropathic Pain: A Systematic Review. Clin J Pain 2022; 38:285-291. [PMID: 35132028 DOI: 10.1097/ajp.0000000000001021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to examine research on the impact of spinal cord stimulation (SCS) on the reduction of preimplantation opioid dose and what preimplantation opioid dose is associated with a reduction or discontinuation of opioid use postimplantation. METHODS Systematic review of literature from PubMed, Web of Science, and Ovid Medline search of "opioid" and "pain" and "spinal cord stimulator." Inclusion criteria included original research providing data on SCS preimplantation opioid dosing and 12 months postimplantation opioid dosing or that correlated specific preimplantation opioid dose or opioid dose cutoff with significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. RESULTS Systematic review of the literature yielded 17 studies providing data on pre-SCS and post-SCS implantation dose and 4 providing data on the preimplantation opioid dose that significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. Data from included studies indicated that SCS is an effective tool in reducing opioid dose from preimplantation levels at 12 months postimplantation. Data preliminarily supports the assertion that initiation of SCS at a preimplantation opioid dose of ≤20 to ≤42.5 morphine milligram equivalents increases the likelihood of postimplantation elimination of opioid use. DISCUSSION SCS is an effective treatment for many types of chronic pain and can reduce or eliminate chronic opioid use. Preimplantation opioid dose may impact discontinuation of opioid use postimplantation and the effectiveness of SCS in the relief of chronic pain. More research is needed to support and strengthen clinical recommendations for initiation of SCS use at lower daily opioid dose.
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Affiliation(s)
- Cynthia A Smith
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Jessica Roman
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Antonios Mammis
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY
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12
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Facco E. Pain, the uknown: epistemological issues and related clinical implications. Minerva Anestesiol 2021; 87:1255-1267. [PMID: 34263590 DOI: 10.23736/s0375-9393.21.15920-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the huge development of pain management in the past decades, pain remains elusive and many patients still remain in the middle of the ford struggling between low drug efficacy and their overuse. A reason for pain elusiveness is its nature of subjective phenomenon, escaping the meshes of the objectivist, mechanist-reductionist net prevailing in medicine. Actually, pain is not only a symptom but an essential aspect of life, consciousness and contact with the world and its noetic and autonoetic components play a key role in the development of the concepts of pleasure-unpleasure and good-evil. The intensity and tolerability of pain and suffering also depends on what the pain means to the patient. The outstanding effects of placebo and nocebo, behavioral and non-pharmacological techniques warrant the need for a shift from the traditional positivist idea of patient as passive carrier of disease to the patient as active player of recovery and move toward a patient's centered approach exploiting individual resources for recovery. Among the mentioned techniques, hypnosis has proved to increase pain threshold up to the level of surgical analgesia, improve acute and chronic pain as well as coping and resilience, helping to decrease both drug overuse and the costs of pharmacological therapy. The wealth of available data suggest the need for a holistic approach, aiming to take care of the individual as an inseparable mind-body unit in its interplay with the environment, where patient's inner world, his/her experience and cognition are taken into due account as powerful resources for recovery through a phenomenological-existential approach.
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Affiliation(s)
- Enrico Facco
- Studium Patavinum, Department of Neurosciences, University of Padua, Padua, Italy - .,Institute F. Granone, Italian Center of Clinical and Experimental Hypnosis (CIICS), Turin, Italy -
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13
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Liao HY, Lin YW. Electroacupuncture Attenuates Chronic Inflammatory Pain and Depression Comorbidity through Transient Receptor Potential V1 in the Brain. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2021; 49:1417-1435. [PMID: 34224338 DOI: 10.1142/s0192415x2150066x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic pain is one of the highest costs in clinical therapy, often appearing comorbid with depression. They present with overlapping clinical conditions and common pathological pathways especially in neuroinflammation, both of which can be reversed by electroacupuncture (EA). Transient receptor potential V1 receptor (TRPV1) is a Ca[Formula: see text] permeable ion channel that responds to brain inflammation and has a known role in the development of chronic pain and depression. Here, we investigate the role of TRPV1 and its related molecules in a mouse model of inflammation-induced chronic pain and depression using Complete Freund's adjuvant (CFA). We measured inflammatory mediators in plasma and evaluated the TRPV1 signaling pathway in the medial prefrontal cortex (mPFC), hypothalamus, and periaqueductal gray (PAG) of the mouse brain. Mechanical and thermal hyperalgesia as well as depressive-like behaviors were induced using the open field test and forced swimming test. Therapeutic effects were observed in EA and Trpv1[Formula: see text] mice in measures of chronic pain and depression. Inflammatory mediators induced by CFA injection were attenuated by EA and Trpv1 deletion. TRPV1 and downstream molecules were significantly decreased in the mPFC, hypothalamus, and PAG of mice, effects which were reversed by EA and Trpv1 knockout. We provide novel evidence that these inflammatory mediators modulate the TRPV1 signaling pathway and suggest new potential therapeutic targets for chronic pain and depression.
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Affiliation(s)
- Hsien-Yin Liao
- College of Chinese Medicine, School of Post-Baccalaureate Chinese Medicine, Taiwan
| | - Yi-Wen Lin
- College of Chinese Medicine, Graduate Institute of Acupuncture Science, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung 40402, Taiwan
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14
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TRPV1 Responses in the Cerebellum Lobules VI, VII, VIII Using Electroacupuncture Treatment for Chronic Pain and Depression Comorbidity in a Murine Model. Int J Mol Sci 2021; 22:ijms22095028. [PMID: 34068557 PMCID: PMC8126051 DOI: 10.3390/ijms22095028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/22/2022] Open
Abstract
Depression is a prominent complex psychiatric disorder, usually complicated through expression of comorbid conditions, with chronic pain being among the most prevalent. This comorbidity is consistently associated with a poor prognosis and has been shown to negatively impact patient outcomes. With a global rise in this condition presenting itself, the importance of discovering long-term, effective, and affordable treatments is crucial. Electroacupuncture has demonstrated renowned success in its use for the treatment of pain and is a widely recognized therapy in clinical practice for the treatment of various psychosomatic disorders, most notably depression. Our study aimed to investigate the effects and mechanisms of Acid-Saline (AS) inducing states of chronic pain and depression comorbidity in the cerebellum, using the ST36 acupoint as the therapeutic intervention. Furthermore, the role of TRPV1 was relatedly explored through the use of TRPV1−/− mice (KO). The results indicated significant differences in the four behavioral tests used to characterize pain and depression states in mice. The AS and AS + SHAM group showed significant differences when compared to the Control and AS + EA groups in the von Frey and Hargreaves’s tests, as well as the Open-Field and Forced Swimming tests. This evidence was further substantiated in the protein levels observed in immunoblotting, with significant differences between the AS and AS + SHAM groups when compared to the AS + EA and AS + KO groups being identified. In addition, immunofluorescence visibly served to corroborate the quantitative outcomes. Conclusively these findings suggest that AS-induced chronic pain and depression comorbidity elicits changes in the cerebellum lobules VI, VII, VIII, which are ameliorated through the use of EA at ST36 via its action on TRPV1 and related molecular pathways. The action of TRPV1 is not singular in CPDC, which would suggest other potential targets such as acid-sensing ion channel subtype 3 (ASIC3) or voltage-gated sodium channels (Navs) that could be explored in future studies.
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15
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Gottesman-Katz L, Latorre R, Vanner S, Schmidt BL, Bunnett NW. Targeting G protein-coupled receptors for the treatment of chronic pain in the digestive system. Gut 2021; 70:970-981. [PMID: 33272979 PMCID: PMC9716638 DOI: 10.1136/gutjnl-2020-321193] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/21/2020] [Accepted: 11/07/2020] [Indexed: 12/14/2022]
Abstract
Chronic pain is a hallmark of functional disorders, inflammatory diseases and cancer of the digestive system. The mechanisms that initiate and sustain chronic pain are incompletely understood, and available therapies are inadequate. This review highlights recent advances in the structure and function of pronociceptive and antinociceptive G protein-coupled receptors (GPCRs) that provide insights into the mechanisms and treatment of chronic pain. This knowledge, derived from studies of somatic pain, can guide research into visceral pain. Mediators from injured tissues transiently activate GPCRs at the plasma membrane of neurons, leading to sensitisation of ion channels and acute hyperexcitability and nociception. Sustained agonist release evokes GPCR redistribution to endosomes, where persistent signalling regulates activity of channels and genes that control chronic hyperexcitability and nociception. Endosomally targeted GPCR antagonists provide superior pain relief in preclinical models. Biased agonists stabilise GPCR conformations that favour signalling of beneficial actions at the expense of detrimental side effects. Biased agonists of µ-opioid receptors (MOPrs) can provide analgesia without addiction, respiratory depression and constipation. Opioids that preferentially bind to MOPrs in the acidic microenvironment of diseased tissues produce analgesia without side effects. Allosteric modulators of GPCRs fine-tune actions of endogenous ligands, offering the prospect of refined pain control. GPCR dimers might function as distinct therapeutic targets for nociception. The discovery that GPCRs that control itch also mediate irritant sensation in the colon has revealed new targets. A deeper understanding of GPCR structure and function in different microenvironments offers the potential of developing superior treatments for GI pain.
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Affiliation(s)
- Lena Gottesman-Katz
- Molecular Pathobiology, New York University, New York, New York, USA,Division of Pediatric Gastroenterology, Columbia University Medical Center/New York Presbyterian, New York, New York, USA
| | - Rocco Latorre
- Molecular Pathobiology, New York University, New York, New York, USA
| | - Stephen Vanner
- Gastrointestinal Diseases Research Unit, Division of Gastroenterology, Queens University, Kingston, Ontario, Canada
| | - Brian L Schmidt
- Bluestone Center, New York University, New York, New York, USA
| | - Nigel W Bunnett
- Molecular Pathobiology, New York University, New York, New York, USA
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16
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Urits I, Schwartz R, Herman J, Berger AA, Lee D, Lee C, Zamarripa AM, Slovek A, Habib K, Manchikanti L, Kaye AD, Viswanath O. A Comprehensive Update of the Superior Hypogastric Block for the Management of Chronic Pelvic Pain. Curr Pain Headache Rep 2021; 25:13. [PMID: 33630172 DOI: 10.1007/s11916-020-00933-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This is a comprehensive review of the superior hypogastric block for the management of chronic pelvic pain. It reviews the background, including etiology, epidemiology, and current treatment available for chronic pelvic pain. It then presents the superior hypogastric block and reviews the seminal and most recent evidence about its use in chronic pelvic pain. RECENT FINDINGS Several definitions exist for chronic pelvic pain (CPP), making the diagnosis more challenging for the clinician; however, they commonly describe continuous pain lasting 6 months in the pelvis, with an overwhelming majority of patients being reproductive-aged women. This pain is often one of mechanical, inflammatory, or neuropathic. It is generally underdiagnosed and affects anywhere between 5 and 26% of women. The diagnosis of chronic pelvic pain is clinical, consisting of mainly of a thorough history and physical and ruling out other causes. The pathophysiology is often endometriosis (70%) and also includes PID, adhesions, adenomyosis, uterine fibroids, chronic processes of the GI and urinary tracts, as well as pelvic-intrinsic musculoskeletal causes. Treatment includes physical therapy, cognitive behavioral therapy, and oral and parenteral opioids. Interventional techniques provide an added tier of treatment and may help to reduce the requirement for chronic opioid use. Superior hypogastric plexus block is one of the available interventional techniques; first described in 1990, it has been shown to provide long-lasting relief in 50-70% of patients who underwent the procedure. Two approaches described so far, both under fluoroscopy, have seen similar results. More recently, ultrasound and CT-guided procedures have also been described with similar success. The injectate includes local anesthetic, steroids, and neurolytic agents such as phenol or ethanol. CPP is a common debilitating condition. It is diagnosed clinically and is underdiagnosed globally. Current treatments can be helpful at times but may fall short of satisfactory pain relief. Interventional techniques provide an added layer of treatment as well as reduce the requirement for opioids. Superior hypogastric plexus block provides long-lasting relief in many patients, regardless of approach. Evidence level is limited, and further RCTs could help provide better tools for evaluation and patient selection.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Ruben Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
| | - Jared Herman
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - David Lee
- Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Christopher Lee
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA
| | - Alec M Zamarripa
- Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Annabel Slovek
- Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
| | - Kelly Habib
- Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA.,Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
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17
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Wang J, Liu Y, Hu F, Yang J, Guo X, Hou X, Ju C, Wang K. Activation of Neuronal Voltage-Gated Potassium Kv7/KCNQ/M-Current by a Novel Channel Opener SCR2682 for Alleviation of Chronic Pain. J Pharmacol Exp Ther 2021; 377:20-28. [DOI: 10.1124/jpet.120.000357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
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18
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Martinez-Calderon J, Flores-Cortes M, Clavero-Cano S, Morales-Asencio JM, Jensen MP, Rondon-Ramos A, Diaz-Cerrillo JL, Ariza-Hurtado GR, Luque-Suarez A. The Role of Positive Psychological Factors in the Association between Pain Intensity and Pain Interference in Individuals with Chronic Musculoskeletal Pain: A Cross-Sectional Study. J Clin Med 2020; 9:E3252. [PMID: 33053655 PMCID: PMC7599728 DOI: 10.3390/jcm9103252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/27/2022] Open
Abstract
This study aimed to test the cross-sectional mediating and moderating role that positive psychological factors play in the association between pain intensity and pain interference in individuals with chronic musculoskeletal pain. A descriptive cross-sectional study using mediation analyses was conducted, including 186 individuals with chronic musculoskeletal pain. We conducted cross-sectional mediation and moderation analyses to determine whether the positive psychological factors mediated or moderated the association between pain intensity and pain interference. Pain acceptance, pain self-efficacy, and optimism were all significantly and weakly related to pain interference when controlling for pain intensity. Pain self-efficacy and pain acceptance partially mediated the association between pain intensity and pain interference. On the other hand, the multiple mediation model did not show significant effects. The three positive psychological factors were not found to significantly moderate the association between pain intensity and pain interference. The findings suggest that in chronic musculoskeletal pain patients, the treatments may focus on [i] what they are capable of doing to manage the pain (i.e., pain self-efficacy) and [ii] being better able to accept the pain as pain waxes and wanes might be also particularly helpful. However, these results must be tested in longitudinal studies before drawing any causal conclusion.
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Affiliation(s)
- Javier Martinez-Calderon
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, 29071 Málaga, Spain; (J.M.-C.); (M.F.-C.); (A.R.-R.); (A.L.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Malaga, Spain;
| | - Mar Flores-Cortes
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, 29071 Málaga, Spain; (J.M.-C.); (M.F.-C.); (A.R.-R.); (A.L.-S.)
| | - Susana Clavero-Cano
- Servicio Andaluz de Salud, Distrito de Atención Primaria Costa del Sol, U.G.C. Las Albarizas, 29600 Marbella, Málaga, Spain
| | - Jose Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Malaga, Spain;
- Department of Nursing, Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, USA;
| | - Antonio Rondon-Ramos
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, 29071 Málaga, Spain; (J.M.-C.); (M.F.-C.); (A.R.-R.); (A.L.-S.)
- Servicio Andaluz de Salud, Distrito de Atención Primaria Costa del Sol, U.G.C. Las Lagunas, 29650 Mijas, Málaga, Spain
| | - Juan Luis Diaz-Cerrillo
- Servicio Andaluz de Salud, Distrito de Atención Primaria Costa del Sol, U.G.C. La Carihuela, 29620 Torremolinos, Málaga, Spain;
| | - Gina Rocío Ariza-Hurtado
- Servicio Andaluz de Salud, Distrito de Atención Primaria Costa del Sol, U.G.C. San Pedro de Alcántara, 29670 Marbella, Málaga, Spain;
| | - Alejandro Luque-Suarez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, 29071 Málaga, Spain; (J.M.-C.); (M.F.-C.); (A.R.-R.); (A.L.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Malaga, Spain;
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19
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Karris MY, Berko J, Mazonson PD, Loo TM, Spinelli F, Zolopa A. Association of Pain and Pain Medication Use with Multiple Characteristics of Older People Living with HIV. AIDS Res Hum Retroviruses 2020; 36:663-669. [PMID: 32515203 PMCID: PMC7414800 DOI: 10.1089/aid.2020.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
People living with HIV (PLWH) experience chronic pain that may impact function. Gaps in knowledge exist for factors that impact pain and pain medication use in older (age 50+) PLWH. Data for this study were obtained from the Aging with Dignity, Health, Optimism and Community (ADHOC) cohort, an observational study of older PLWH from 10 clinics across the United States. Participants self-reported socioeconomic, psychosocial, and health factors via an online questionnaire. Of 1,051 participants, 66% reported pain. In a multivariable regression model, multimorbidity and tobacco use were associated with a greater likelihood of experiencing pain, whereas being male, black, and having higher cognitive function were associated with a lower likelihood of experiencing pain. Of the 696 participants who reported pain, 46% reported using pain medication. In a multivariable regression model, pain medication use was associated with multimorbidity and with lower income. Recognition of the factors associated with pain and pain medication use in this vulnerable population may lead to strategies that mitigate negative health outcomes.
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Affiliation(s)
- Maile Y. Karris
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jeff Berko
- Mazonson & Santas, Inc., Larkspur, California, USA
| | | | | | | | - Andrew Zolopa
- ViiV Healthcare, Raleigh, North Carolina, USA
- Stanford University (Emeritus Professor), Palo Alto, California, USA
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20
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Locke HN, Brooks J, Arendsen LJ, Jacob NK, Casson A, Jones AKP, Sivan M. Acceptability and usability of smartphone-based brainwave entrainment technology used by individuals with chronic pain in a home setting. Br J Pain 2020; 14:161-170. [PMID: 32922777 PMCID: PMC7453483 DOI: 10.1177/2049463720908798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Brainwave entrainment (BWE) using rhythmic visual or auditory stimulation has many potential clinical applications, including the management of chronic pain, where there is a pressing need for novel, safe and effective treatments. The aim of this study was to gain qualitative feedback on the acceptability and usability of a novel BWE smartphone application, to ensure it meets the needs and wishes of end users. METHODS Fifteen participants with chronic pain used the application at home for 4 weeks. Semi-structured telephone interviews were then carried out. A template analysis approach was used to interpret the findings, with an initial coding template structured around the constructs of a theoretical framework for assessing acceptability of healthcare interventions. Structured data analysis generated a final modified coding structure, capturing themes generated across participants' accounts. RESULTS The four main themes were 'approach to trying out the app: affective attitude and ethicality', 'perceived effectiveness', 'opportunity costs and burden' and 'intervention coherence and self-efficacy'. All participants were willing to engage with the technology and welcomed it as an alternative approach to medications. Participants appreciated the simplicity of design and the ability to choose between visual or auditory stimulation. All the participants felt confident in using the application. CONCLUSION The findings demonstrate preliminary support for the acceptability and usability of the BWE application. This is the first qualitative study of BWE to systematically assess these issues.
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Affiliation(s)
- Helen N Locke
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Community Healthcare NHS Trust and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Joanna Brooks
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Laura J Arendsen
- Division of Functional and Restorative Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Nikhil Kurian Jacob
- Department of Electrical and Electronic Engineering, The University of Manchester, Manchester, UK
| | - Alex Casson
- Department of Electrical and Electronic Engineering, The University of Manchester, Manchester, UK
| | - Anthony KP Jones
- Human Pain Research Group, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Community Healthcare NHS Trust and Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Human Pain Research Group, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
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21
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Yang J, Bauer BA, Wahner-Roedler DL, Chon TY, Xiao L. The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain? J Pain Res 2020; 13:411-417. [PMID: 32110089 PMCID: PMC7038776 DOI: 10.2147/jpr.s244173] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION From 1986, the World Health Organization (WHO) analgesic ladder has been used as the simple and valuable pain-relieving guidance in the pharmaceutical pain management, however, with the development of medical history, notions about pain physiology and pain management have already updated. Is the analgesic ladder still appropriate for chronic non-cancer pain (CNCP) patients? This study aims to analyse the current usage of the analgesic ladder in patients with CNCP by evaluating previously published pertinent studies. METHODS Literature published in English from January 1980 to April 2019 and cited on PubMed database was included. Analysis on the analgesic ladder, current status of CNCP management, and a new revised ladder model were developed based on relevant literature. RESULTS The WHO analgesic ladder for cancer pain is not appropriate for current CNCP management. It is revised into a four-step ladder: the integrative therapies being adopted at each step for reducing or even stopping the use of opioid analgesics; interventional therapies being considered as step 3 before upgrading to strong opioids if non-opioids and weak opioids failed in CNCP management. DISCUSSION A simple and valuable guideline in past years, the WHO analgesic ladder is inappropriate for the current use of CNCP control. A revised four-step analgesic ladder aligned with integrative medicine principles and minimally invasive interventions is recommended for control of CNCP.
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Affiliation(s)
- Juan Yang
- Department of Pain Medicine, Shenzhen Nanshan People’s Hospital, Shenzhen518052, People’s Republic of China
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN55905, USA
| | - Brent A Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN55905, USA
| | | | - Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN55905, USA
| | - Lizu Xiao
- Department of Pain Medicine, Shenzhen Nanshan People’s Hospital, Shenzhen518052, People’s Republic of China
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22
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Moreira de Barros GA, Calonego MAM, Mendes RF, Castro RAM, Faria JFG, Trivellato SA, Cavalcante RS, Fukushima FB, Dias A. [The use of analgesics and risk of self-medication in an urban population sample: cross-sectional study]. Rev Bras Anestesiol 2019; 69:529-536. [PMID: 31703816 DOI: 10.1016/j.bjan.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. METHOD Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. RESULTS 416 subjects were included; 45.7% (n=190) had chronic pain, with females (72.3%; p=0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. CONCLUSIONS The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.
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Affiliation(s)
- Guilherme Antonio Moreira de Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Comissão de Medicina Paliativa, Rio de Janeiro, RJ, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil.
| | - Marco A Marchetti Calonego
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Rannier F Mendes
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil
| | - Raphael A M Castro
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - João F G Faria
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Stella A Trivellato
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Rodney S Cavalcante
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Fernanda B Fukushima
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil
| | - Adriano Dias
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Saúde Pública, Botucatu, SP, Brasil
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23
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Moreira de Barros GA, Calonego MAM, Mendes RF, Castro RAM, Faria JFG, Trivellato SA, Cavalcante RS, Fukushima FB, Dias A. The use of analgesics and risk of self-medication in an urban population sample: cross-sectional study. Braz J Anesthesiol 2019. [PMID: 31703816 PMCID: PMC9391871 DOI: 10.1016/j.bjane.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Guilherme Antonio Moreira de Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Comissão de Medicina Paliativa, Rio de Janeiro, RJ, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil.
| | - Marco A Marchetti Calonego
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Rannier F Mendes
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil
| | - Raphael A M Castro
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - João F G Faria
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Stella A Trivellato
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Rodney S Cavalcante
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Fernanda B Fukushima
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil
| | - Adriano Dias
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Saúde Pública, Botucatu, SP, Brasil
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24
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Marino MJ, Luong A, Yao WC, Citardi MJ. Nonpharmacological Relaxation Technology for Office-Based Rhinologic Procedures. ORL J Otorhinolaryngol Relat Spec 2019; 81:48-54. [PMID: 30836361 DOI: 10.1159/000488323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Office-based rhinologic procedures are increasingly performed to control costs and enhance patient convenience. Adequate management of pain and anxiety is essential for the technical performance of these procedures, in addition to ensuring patient comfort. Pharmacologic agents are often used to manage anxiety and pain. Nonpharmacological adjuncts may be useful for achieving these effects without oral opioids and benzodiazepines. METHODS Charts of patients who underwent office-based rhinologic procedures with the NuCalm system (Solace Lifesciences, Inc., Wilmonton, DE, USA) in combination with local anesthesia were reviewed. NuCalm is a proprietary system that combines cranial electrotherapy stimulation, neuroacoustic software, light-blocking lenses, and topical γ--aminobutyric acid. Patients rated their pain and anxiety before, during, and after the procedure. RESULTS Twenty-five patients underwent office procedures using the NuCalm system. Preoperative anxiety (2.00) was significantly higher than postoperative anxiety (1.25) according to patient reporting on a 5-point scale (p = 0.005). Preoperative pain (1.83) was not significantly different from intraoperative (2.54) and postoperative pain (2.04, p = 0.054). CONCLUSIONS A variety of office-based rhinologic procedures are technically feasible and can be performed with adequate patient comfort without the use of oral drugs. Adjuncts to pharmacologic agents may enhance pain control and anxiety management and improve patient tolerance of these procedures.
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Affiliation(s)
- Michael J Marino
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA,
| | - Amber Luong
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - William C Yao
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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25
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Bordeleau M, Carrondo Cottin S, Meier K, Prud'Homme M. Effects of Tonic Spinal Cord Stimulation on Sensory Perception in Chronic Pain Patients: A Systematic Review. Neuromodulation 2018; 22:149-162. [PMID: 30506960 DOI: 10.1111/ner.12893] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Even if spinal cord stimulation (SCS) is widely used and effective in treating intractable chronic neuropathic pain conditions, little is known about its possible impacts on sensory perception. Quantitative sensory testing (QST) is a useful tool to assess this issue. The aim of this study was to review the impact of tonic SCS on somatosensory perception quantified by QST in chronic pain patients. MATERIALS AND METHODS Relevant articles and abstracts were searched in all languages from CINAHL, Cochrane, Embase, MEDLINE, and Web of Knowledge data bases. Data were extracted and included studies were assessed for risk of bias. RESULTS Out of 5610 records, 15 peer-reviewed articles were eligible and included. The results are heterogeneous due to inadequate comparability among studies for populations (a total of 224 patients diagnosed with more than 13 chronic pain conditions), QST parameters (22 measured with 25 different devices) and experimental procedures (study design, comparator, evaluation time, and area tested). The wide variety of studies, designs, populations, and measures included in this review did not lead to strong evidence on how conventional ("tonic") SCS affects sensory processing in patients with chronic pain. CONCLUSIONS The data available tend to suggest that conventional SCS does not interfere with perception of external stimuli. New studies that follow a standardized procedure and consider the possible influence of sensory profile, after-effect bias, and confounding factors are required to confirm this observation. Moreover, the impact on sensory perception of other SCS modalities and alternative electrical neuromodulation therapies could also be explored.
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Affiliation(s)
- Martine Bordeleau
- Centre de recherche du CHU de Québec - Université Laval, Axe neurosciences, Quebec city, Quebec, Canada
| | - Sylvine Carrondo Cottin
- Centre de recherche du CHU de Québec - Université Laval, Axe neurosciences, Quebec city, Quebec, Canada
| | - Kaare Meier
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michel Prud'Homme
- Centre de recherche du CHU de Québec - Université Laval, Axe neurosciences, Quebec city, Quebec, Canada
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26
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Cornett EM, Budish R, Latimer D, Hart B, Urman RD, Kaye AD. Management of Challenging Pharmacologic Issues in Chronic Pain and Substance Abuse Disorders. Anesthesiol Clin 2018; 36:615-626. [PMID: 30390782 DOI: 10.1016/j.anclin.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug abuse and addiction are persistent problems in the United States and around the world. This is an ongoing issue for health care providers, as substance abuse is seen in 25% to 40% of patients admitted to hospitals for general treatment. Many patients with substance use disorders have a higher risk for adverse events; however, only a small percentage will volunteer information regarding prior substance use. This article discusses the present opioid crisis, mechanisms behind chronic pain and substance abuse, current clinical findings, treatment therapies, and abuse deterrents.
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Affiliation(s)
- Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Rebecca Budish
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Dustin Latimer
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Brendon Hart
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis street, Boston, MA 02115, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU Health Science Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA; Department of Pharmacology, LSU Health Science Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA
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27
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White PF. An alternative approach to solving the opioid epidemic: is there a role for non-pharmacologic analgesic therapies? Postgrad Med 2018; 131:1-5. [PMID: 30232921 DOI: 10.1080/00325481.2018.1520589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Paul F White
- a Department of Anesthesiology & Pain Management , Cedars Sinai Medical Center , Los Angeles , CA , USA.,b The White Mountain Institute , The Sea Ranch , CA , USA
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28
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Abstract
The current opioid crisis highlights an urgent need for better paradigms for prevention and treatment of chronic pain and addiction. Although many approach this complex clinical condition with the question, "Is this pain or is this addiction?," it is more than the sum of its parts. Chronic pain among those with dependence and addiction often evolves into a complex disabling condition with pain at multiple sites, psychosocial dysfunctions, medical and psychiatric disorders, polypharmacy, and polysubstance use, all interacting with each other in complex ways (multimorbidity). The authors offer an integrative therapeutic approach to manage this complex clinical scenario.
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Affiliation(s)
- Ajay Manhapra
- Veteran Affairs New England Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, USA; Advanced PACT Pain Clinic, VA Hampton Medical Center, 100 Emancipation Drive, PRIME 5, Hampton, VA 23667, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - William C Becker
- Opioid Reassessment Clinic, VA Connecticut Healthcare System, 950 Campbell Avenue, Mailstop 151B, West Haven, CT 06516, USA; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, West Haven, CT, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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29
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Khanal M, Gohil SV, Kuyinu E, Kan HM, Knight BE, Baumbauer KM, Lo KWH, Walker J, Laurencin CT, Nair LS. Injectable nanocomposite analgesic delivery system for musculoskeletal pain management. Acta Biomater 2018; 74:280-290. [PMID: 29803784 PMCID: PMC6020057 DOI: 10.1016/j.actbio.2018.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 05/17/2018] [Accepted: 05/23/2018] [Indexed: 01/04/2023]
Abstract
Musculoskeletal pain is a major health issue which results from surgical procedures (i.e. total knee and/or hip replacements and rotator cuff repairs), as well as from non-surgical conditions (i.e. sympathetically-mediated pain syndrome and occipital neuralgia). Local anesthetics, opioids or corticosteroids are currently used for the pain management of musculoskeletal conditions. Even though local anesthetics are highly preferred, the need for multiple administration presents significant disadvantages. Development of unique delivery systems that can deliver local anesthetics at the injection site for prolonged time could significantly enhance the therapeutic efficacy and patient comfort. The goal of the present study is to evaluate the efficacy of an injectable local anesthetic nanocomposite carrier to provide sustained analgesic effect. The nanocomposite carrier was developed by encapsulating ropivacaine, a local anesthetic, in lipid nanocapsules (LNC-Rop), and incorporating the nanocapsules in enzymatically crosslinked glycol chitosan (0.3GC) hydrogels. Cryo Scanning Electron Microscopic (Cryo SEM) images showed the ability to distribute the LNCs within the hydrogel without adversely affecting their morphology. The study demonstrated the feasibility to achieve sustained release of lipophilic molecules from the nanocomposite carrier in vitro and in vivo. A rat chronic constriction injury (CCI) pain model was used to evaluate the efficacy of the nanocomposite carrier using thermal paw withdrawal latency (TWL). The nanocomposite carriers loaded with ropivacaine and dexamethasone showed significant improvement in pain response compared to the control groups for at least 7 days. The study demonstrated the clinical potential of these nanocomposite carriers for post-operative and neuropathic pain. STATEMENT OF SIGNIFICANCE Acute or chronic pain associated with musculoskeletal conditions is considered a major health issue, with healthcare costs totaling several billion dollars. The opioid crisis presents a pressing clinical need to develop alternative and effective approaches to treat musculoskeletal pain. The goal of this study was to develop a long-acting injectable anesthetic formulation which can sustain a local anesthetic effect for a prolonged time. This in turn could increase the quality of life and rehabilitation outcome of patients, and decrease opioid consumption. The developed injectable nanocomposite demonstrated the feasibility to achieve prolonged pain relief in a rat chronic constriction injury (CCI) model.
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Affiliation(s)
- Manakamana Khanal
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, USA; Institute for Regenerative Engineering, The Raymond Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, USA
| | - Shalini V Gohil
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, USA; Institute for Regenerative Engineering, The Raymond Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, USA
| | - Emmanuel Kuyinu
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, USA; Institute for Regenerative Engineering, The Raymond Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, USA
| | - Ho-Man Kan
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, USA; Institute for Regenerative Engineering, The Raymond Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, USA
| | - Brittany E Knight
- Department of Neuroscience, University of Connecticut Health Center, Farmington, USA
| | - Kyle M Baumbauer
- The Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, Storrs, USA; Department of Neuroscience, University of Connecticut Health Center, Farmington, USA
| | - Kevin W-H Lo
- Institute for Regenerative Engineering, The Raymond Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, USA; Department of Medicine, University of Connecticut Health Center, Farmington, USA; Department of Endocrinology, University of Connecticut Health Center, Farmington, USA
| | - Joseph Walker
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, USA
| | - Cato T Laurencin
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, USA; Institute for Regenerative Engineering, The Raymond Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, USA; Department of Biomedical Engineering, University of Connecticut, Storrs, USA; Department of Material Science and Engineering, Institute of Material Science, University of Connecticut, Storrs, USA; Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, USA
| | - Lakshmi S Nair
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, USA; Institute for Regenerative Engineering, The Raymond Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, USA; Department of Biomedical Engineering, University of Connecticut, Storrs, USA; Department of Material Science and Engineering, Institute of Material Science, University of Connecticut, Storrs, USA.
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