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Moussaoui D, Farrell OG, Grover SR. Is it time to agree upon a standardised approach to the assessment of contributing factors and impacts of adolescent pelvic pain? J OBSTET GYNAECOL 2024; 44:2359126. [PMID: 38813795 DOI: 10.1080/01443615.2024.2359126] [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: 01/07/2024] [Accepted: 05/18/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND A biopsychosocial approach to the understanding of pelvic pain is increasingly acknowledged. However, there is a lack of standardised instruments - or their use - to assess risk factors and their impact on pelvic pain in both clinical and research settings. This review aims to identify validated tools used to assess known contributory factors to pelvic pain, as well as the validated tools to measure the impact of pelvic pain in adolescents and young adults, in order to provide a framework for future standardised, adolescent specific assessment and outcome tools. METHODS Literature searches were performed in MEDLINE, PsycInfo and PubMed. Search terms included pelvic pain, dysmenorrhoea, endometriosis, adolescent, pain measurement, quality of life, sleep, mental health, coping strategies and traumatic experience. RESULTS We found validated instruments to assess adverse childhood experiences and coping strategies, both known contributing factors to pelvic pain. The impact of pain was measured through validated tools for health-related quality of life, mental health and sleep. CONCLUSIONS Pelvic pain evaluation in adolescents should include a multi-factorial assessment of contributing factors, such as childhood adversity and coping strategies, and impacts of pelvic pain on quality of life, mental health and sleep, using validated instruments in this age group. Future research should focus on the development of consensus amongst researchers as well as input from young women to establish a standardised international approach to clinical trials involving the investigation and reporting of pelvic pain in adolescents. This would facilitate comparison between studies and contribute to improved quality of care delivered to patients.
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Affiliation(s)
- Dehlia Moussaoui
- Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Parkville, Australia
| | - Olivia G Farrell
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Sonia R Grover
- Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
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2
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Wang L, Zhao S, Shao J, Su C. The effect and mechanism of low-dose esketamine in neuropathic pain-related depression-like behavior in rats. Brain Res 2024; 1843:149117. [PMID: 38977235 DOI: 10.1016/j.brainres.2024.149117] [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: 01/09/2024] [Revised: 05/28/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Clinical evidence suggests that Esketamine (ESK) is an effective treatment for depression. However, the effects of Esketamine in treating depression-like behavior induced by neuropathic pain is unclear. The underlying molecular mechanisms require further investigation to provide new therapeutic targets for the treatment of clinical neuropathic pain-related depression. METHODS A neuropathic pain-related depression model was established in rats with spared nerve injury (SNI). Male Sprague-Dawley rats were randomly divided into four groups: Sham Group, SNI group, SNI + Normal Saline (NS) Group and SNI + ESK5mg/kg Group. Mechanical pain thresholds were measured to assess pain sensitivity in SNI rats. On the 14th day after surgery a forced swim test and sucrose preference test were used to evaluate the depressive-like behavior of rats in each group. Further, a proteomic analysis was used to quantify differentially expressed proteins. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were analyzed to explore the main protein targets of SNI in the medial prefrontal cortex. The expression of proteins was detected by Western blotting. RESULTS A neuropathic pain-related depression model was established. Compared with the Sham group, the mechanical pain threshold was decreased significantly (13.2 ± 1.0 vs. 0.7 ± 0.01 g n = 8), while immobility on the forced swim test was also decreased (93.1 ± 7.4 vs. 169.5 ± 9.6 s n = 8), and sucrose preference rate was significantly increased (98.8 ± 0.3 vs. 73.1 ± 1.4n = 7) in SNI group rats. Compared with the SNI + NS group, the mechanical pain threshold was not statistically significant, while immobility on the forced swim test was clearly decreased (161.1 ± 11.6 vs. 77.9 ± 5.0 s n = 8), and sucrose preference rate was significantly increased (53.1 ± 8.9 vs. 96.1 ± 1.4n = 7) in SNI + ESK5mg/kg group rats. To further investigate the underlying mechanism, we employed proteomics to identify proteins exhibiting more than a 1.2-fold difference (P < 0.05) in expression levels within each group for subsequent analysis. Relative to the Sham group, 88 downregulated and 104 up-regulated proteins were identified in the SNI group, while 120 and 84 proteins were up- and down-regulated in the Esketamine treatment group compared with the SNI + NS group. Compared with Sham group, the expressions of mGluR5 and Homer1a were up-regulated in the medial prefrontal cortex (mPFC) in SNI group (mGluR5:0.97 ± 0.05 vs 1.47 ± 0.15, Homer1a:1.03 ± 0.06 vs 1.46 ± 0.16n = 6), and down-regulated after intervention with Esketamine (mGluR5:1.54 ± 0.11 vs 1.06 ± 0.07, Homer1a:1.51 ± 0.13 vs 1.12 ± 0.34n = 6). CONCLUSIONS Low-dose Esketamine appeared to relieve depression-like behavior induced by neuropathic pain. The Homer1a-mGluR5 signaling pathway might be the mechanism of antidepressant effect of Esketamine.
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Affiliation(s)
- Lijuan Wang
- Department of Anesthesiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/ Hunan Cancer Hospital, Changsha, Hunan, China; Department of Medicine, Hengyang Medical School, University of South China, Hengyang, China
| | - Shuwu Zhao
- Department of Anesthesiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/ Hunan Cancer Hospital, Changsha, Hunan, China
| | - Jiali Shao
- Department of Anesthesiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/ Hunan Cancer Hospital, Changsha, Hunan, China
| | - Chen Su
- Department of Anesthesiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/ Hunan Cancer Hospital, Changsha, Hunan, China.
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3
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Tu Y, Tacey M, Yoong J. Impact of Visitor Restrictions on the Pain and Psychological Wellbeing of Palliative Care Patients: A Cohort Study. Am J Hosp Palliat Care 2024; 41:1288-1296. [PMID: 38238004 DOI: 10.1177/10499091241227241] [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] [Indexed: 09/18/2024] Open
Abstract
Aim: Palliative care patients with advanced or life-threatening illnesses in hospital during the COVID-19 pandemic are likely to be affected by visitor restrictions (VR). We aimed to explore the impact of VR on patients' levels of physical pain and psychological distress. Design: Retrospective cohort study comparing two cohorts of patients admitted to a palliative care unit in a major metropolitan hospital in Australia; the first cohort from 1 April to 30 June 2019 (pre-pandemic; n = 96), and the second from 1 April to 30 June 2020 (during pandemic; n = 95). Methods: Patient-rated pain scores (using the Symptom Assessment Scale; SAS) and clinician-rated pain and psychological/spiritual severity scores (using the Palliative Care Problem Severity Score; PCPSS) on admission and on discharge or death were compared between pre-pandemic and pandemic cohorts. Discharge pain scores and change in scores from admission to discharge were also assessed via multivariable analyses. Results: Case-mix of patients in both cohorts were similar. After adjusting for demographics and functional status, pain scores in the pandemic cohort were higher for patients deceased on discharge, compared to the pre-pandemic cohort (SAS: coefficient = 0.86, 95%CI: 0.09 to 1.64, P = 0.029; PCPSS: coefficient = 0.24, 95%CI: -0.07 to 0.86, P = 0.131, respectively). Differences in SAS and PCPSS pain and psychological/spiritual scores for those discharged alive were not statistically significant. Conclusion: Among palliative care inpatients affected by VR, we observed higher pain scores for patients discharged deceased; suggesting that VR may have impacted the physical wellbeing (pain) of these patients.
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Affiliation(s)
- Yiran Tu
- Northern Health, Epping, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Mark Tacey
- Northern Health, Epping, VIC, Australia
- Department of Radiation Oncology, Austin Health, VIC, Australia
| | - Jaclyn Yoong
- Northern Health, Epping, VIC, Australia
- Monash Health, Clayton, VIC, Australia
- Monash University, Clayton, VIC, Australia
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4
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De Lott LB, Khan N, Woodward MA, Clauw DJ, Galor A. Antidepressant Medication Use for Treatment of Chronic Ocular Pain. Cornea 2024; 43:1335-1339. [PMID: 39348714 PMCID: PMC11444518 DOI: 10.1097/ico.0000000000003646] [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: 10/05/2023] [Accepted: 06/23/2024] [Indexed: 10/02/2024]
Abstract
ABSTRACT Chronic ocular pain (COP) is a leading cause of eye care visits in the US and has a substantial impact on quality of life and visual functioning. Although many conditions underlie COP, such as dry eye disease or post-herpetic neuralgia, some people experience pain without significant ocular signs on examination or known risk factors (eg, traumatic injury). Antidepressant medications that act primarily on the central nervous system, such as tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors, are often used to treat patients with COP, but a recent Cochrane review and network meta-analysis investigating 25 different antidepressants concluded that only two serotonin and norepinephrine reuptake inhibitors, have sufficient data to support their use in chronic pain. For all other medications, the evidence was of low certainty. We contend that while these medications are not a cure-all for chronic pain or COP, it is premature to conclude that these medications have no role in their treatment. We provide a rationale for continued use of antidepressant medications as part of a multimodal targeted treatment for patients with COP.
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Affiliation(s)
- Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Noreen Khan
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center University of Michigan Medical School, Ann Arbor, MI; and
| | - Anat Galor
- Surgical Services, Miami Veterans Administration Medical Center, Bascom Palmer Eye Institute, University of Miami, Miami, FL
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Santos AD, Oliveira AS, Carvalho MTB, Barreto AS, Quintans JDSS, Quintans Júnior LJ, Barreto RDSS. H. pectinata (L.) Poit - Traditional uses, phytochemistry and biological-pharmacological activities in preclinical studies: A systematic review. JOURNAL OF ETHNOPHARMACOLOGY 2024; 333:118478. [PMID: 38909822 DOI: 10.1016/j.jep.2024.118478] [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: 03/06/2024] [Revised: 05/30/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE H. pectinata (L.) Poit, popularly known as "sambacaitá" or "canudinho", is a plant endemic to north-eastern Brazil. Its aerial parts, leaves and flowers have traditionally been used to treat gastrointestinal disorders, rhinopharyngitis, nasal congestion, bacterial and fungal infections, fever, colic, inflammation, and pain. AIM OF THE STUDY The aim of this review was to provide information on the botanical characteristics, ethnomedicinal uses, phytochemistry and biological-pharmacological activities of H. pectinata. MATERIALS AND METHODS This systematic review followed the Cochrane Handbook Collaboration and the PRISMA guidelines. The review question was what are the biological-pharmacological activities of H. pectinata presented in non-clinical studies. The search for articles was conducted in the Medline (via PubMed), Embase, Web of Science, Scopus, Virtual Health Library, SciELO, Google Scholar and the Brazilian Digital Library of Theses and Dissertations databases. Two reviewers independently selected the studies that met the inclusion criteria, extracted the data, and assessed the risk of bias of the included studies. RESULTS 39 articles were included in this review, of which 19 reported in vitro experiments, 16 in vivo studies and 4 in vivo and in vitro experiments. H. pectinata is a plant widely used in folk medicine in north-eastern Brazil for the treatment of various ailments, such as respiratory diseases, gastrointestinal disorders, bacterial and fungal infections, and general inflammation. Supporting its popular use, several in vitro and in vivo pharmacological investigations of the essential oil and extract of H. pectinata have demonstrated their anti-inflammatory, antinociceptive, antioxidant, antidepressant, anticancer, hepatoregenerative, healing, and antimicrobial activities. H. pectinata has been reported to contain 75 bioactive constituents, comprising 9 flavonoids, 54 terpenes, and 12 other compounds. CONCLUSION H. pectinata is a plant commonly used in traditional medicine. Phytochemically, it contains several bioactive constituents, including terpenes and flavonoids, and has been shown to have antinociceptive, anti-inflammatory, antimicrobial and antitumour activity, as well as hepatorregenerative and healing effects, and low toxicity.
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Affiliation(s)
- Adenilson Dos Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Alan Santos Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - André Sales Barreto
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Department of Health Education, Federal University of Sergipe, Lagarto, Sergipe, Brazil
| | - Jullyana de Souza Siqueira Quintans
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Department of Physiology, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Lucindo José Quintans Júnior
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Department of Physiology, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Rosana de Souza Siqueira Barreto
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Department of Health Education, Federal University of Sergipe, Lagarto, Sergipe, Brazil.
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Palmisani F, Segelcke D, Vollert J. Navigating the light and shadow of scientific publishing faced with machine learning and generative AI. Eur J Pain 2024. [PMID: 39360710 DOI: 10.1002/ejp.4736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/14/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND The public release of ChatGPT in November 2022 sparked a boom and public interest in generative artificial intelligence (AI) that has led to journals and journal families hastily releasing generative AI policies, ranging from asking authors for acknowledgement or declaration to the outright banning of use. RESULTS Here, we briefly discuss the basics of machine learning, generative AI, and how it will affect scientific publishing. We focus especially on potential risks and benefits to the scientific community as a whole and journals specifically. CONCLUSION While the concerns of editors, for example about manufactured studies, are valid, some recently implemented or suggested policies will not be sustainable in the long run. The quality of generated text and code is quickly becoming so high that it will not only be impossible to detect the use of generative AI but would also mean taking a powerful tool away from researchers that can make their life easier every day. SIGNIFICANCE We discuss the history and current state of AI and highlight its relevance for medical publishing and pain research. We provide guidance on how to act now to increase good scientific practice in the world of ChatGPT and call for a task force focusing on improving publishing pain research with use of generative AI.
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Affiliation(s)
- Federico Palmisani
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Daniel Segelcke
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital, Muenster, Germany
| | - Jan Vollert
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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7
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Kinnie KR, Vance DE, Patrician PA, Billings R, Aroke EN. Chronic Pain Resilience Across Clinical Populations: A Concept Analysis. Pain Manag Nurs 2024; 25:442-450. [PMID: 38849234 DOI: 10.1016/j.pmn.2024.03.019] [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: 11/15/2023] [Revised: 03/10/2024] [Accepted: 03/31/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Chronic pain resilience is a concept that is frequently used in research but lacks theoretical clarity. Understanding chronic pain resilience is germane to developing interventions to improve it and the overall quality of life among individuals with chronic pain. AIMS To uncover and clarify the unique characteristics of the concept of chronic pain resilience. DESIGN A concept analysis using Rodgers' evolutionary method. METHODS Full-text articles published after 2000 in English were used to inform the concept analysis. Scopus, PubMed, PsychINFO, Embase, and CINAHL Plus with Full Text were utilized for literature searches. Rodgers' evolutionary approach was used to clarify the attributes, antecedents, and consequences. RESULTS The search yielded 31 articles that were used in the analysis. The key attributes of chronic pain resilience included engagement in meaningful activities despite pain, maintaining positive psychological homeostasis, buffering against negative mental outcomes, seeking support, and self-empowerment. After considering surrogate terms, antecedents, attributes, and consequences, chronic pain resilience may be defined as the development of the capacity to successfully adapt to chronic pain. This adaptation results in a move toward optimal social, physical, mental, and behavioral functioning by balancing negative and positive psychosocial factors, despite the additional challenges brought about by living with chronic pain.
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Affiliation(s)
- Kiari R Kinnie
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | | | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL
| | - Edwin N Aroke
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
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Korwisi B, Hay G, Forget P, Ryan D, Treede RD, Rief W, Barke A. Patients' perspective on the chronic pain classification in the 11th revision of the International Classification of Diseases (ICD-11): results from an international web-based survey. Pain 2024; 165:2356-2363. [PMID: 38709273 DOI: 10.1097/j.pain.0000000000003248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/09/2024] [Indexed: 05/07/2024]
Abstract
ABSTRACT The 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) aims at improving the lives of persons with the lived experience of chronic pain by providing clearly defined and clinically useful diagnoses that can reduce stigma, facilitate communication, and improve access to pain management, among others. The aim of this study was to assess the perspective of people with chronic pain on these diagnoses. An international web-based survey was distributed among persons with the lived experience of chronic pain. After having seen an information video, participants rated the diagnoses on 8 endorsement scales (eg, diagnostic fit, stigma) that ranged from -5 to +5 with 0 representing the neutral point of no expected change. Overall ratings and differences between participants with chronic primary pain (CPP) and chronic secondary pain (CSP) were analyzed. N = 690 participants were included in the data analysis. The ratings on all endorsement scales were significantly higher than the neutral point of 0. The highest ratings were obtained for "openness" (2.95 ± 1.93) and "overall opinion" (1.87 ± 1.98). Participants with CPP and CSP did not differ in their ratings; however, those with CSP indicated an improved diagnostic fit of the new diagnoses, whereas participants with CPP rated the diagnostic fit of the new diagnoses similar to the fit of their current diagnoses. These results show that persons with the lived experience of chronic pain accept and endorse the new diagnoses. This endorsement is an important indicator of the diagnoses' clinical utility and can contribute to implementation and advocacy.
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Affiliation(s)
- Beatrice Korwisi
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Essen, Germany
| | - Ginea Hay
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Patrice Forget
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Anaesthesia Department, NHS Grampian, Aberdeen, United Kingdom
- Societal Impact of Pain (SIP) Platform, Brussels, Belgium
| | - Deirdre Ryan
- Societal Impact of Pain (SIP) Platform, Brussels, Belgium
- Pain Alliance Europe (PAE), Brussels, Belgium
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Essen, Germany
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9
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Wideman TH, Stilwell P, Gagnon-Mailhot M, Hudon A, Meldrum K, McIntyre V, Pagé MG, Gallagher S. Defining pain-related suffering requires partnership with people living with pain and careful critical thought: a commentary on the proposed definition by Noe-Steinmüller et al. Pain 2024; 165:2387. [PMID: 39284042 PMCID: PMC11404327 DOI: 10.1097/j.pain.0000000000003367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Affiliation(s)
- Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- Department of Sports Science and Clinical Biomechanics, Research Unit of Movement, Culture and Society, University of Southern Denmark, Denmark
| | - Mael Gagnon-Mailhot
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Anne Hudon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- Ethics Research Center (CRÉ), Montreal, QC, Canada
| | | | | | - M Gabrielle Pagé
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
| | - Shaun Gallagher
- Department of Philosophy, University of Memphis, Memphis, TN, United States
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10
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Jones HG, Rizzo RRN, Pulling BW, Braithwaite FA, Grant AR, McAuley JH, Jensen MP, Moseley GL, Rees A, Stanton TR. Adjunctive use of hypnosis for clinical pain: a systematic review and meta-analysis. Pain Rep 2024; 9:e1185. [PMID: 39263007 PMCID: PMC11390056 DOI: 10.1097/pr9.0000000000001185] [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: 10/20/2023] [Revised: 06/17/2024] [Accepted: 07/12/2024] [Indexed: 09/13/2024] Open
Abstract
Systematic reviews suggest that stand-alone hypnotic suggestions may improve pain outcomes compared with no treatment, waitlist, or usual care. However, in clinical practice, hypnosis is often provided adjunctively with other interventions, which might have different effects than those reported in previous reviews. This systematic review aimed to summarize the analgesic effects of adjunctive hypnosis in adults with clinical pain. Seven databases (MEDLINE, Embase, PsycINFO, Emcare, SCOPUS, CENTRAL, Cochrane) were searched up to January 2024. Randomised controlled trials comparing the analgesic effects of adjunctive hypnosis (hypnosis + primary intervention) with those of the primary intervention alone were included. Meta-analyses (random-effects model) calculated mean differences (MD, [95% confidence intervals]) for pain intensity (0-100). Seventy studies were pooled in meta-analyses (n = 6078). Hypnosis adjunctive to usual care had a small additional analgesic effect (chronic pain: -8.2 [-11.8, -1.9]; medical procedures/surgical pain: -6.9 [-10.4, -3.3]; burn wound care: -8.8 [-13.8, -3.9]). Hypnosis adjunctive to education had a medium additional analgesic effect for chronic pain (-11.5 [-19.7, 3.3]) but not postsurgery pain (-2.0 [-7.8, 3.7]). When paired with psychological interventions, hypnosis slightly increased analgesia in chronic pain only at the three-month follow-up (-2 [-3.7, -0.3]). Hypnosis adjunctive to medicines had a medium additional analgesic effect for chronic pain (-13.2, [-22.5, -3.8]). The overall evidence certainty is very low; therefore, there is still uncertainty about the analgesic effects of adjunctive hypnosis. However, hypnosis adjunct to education may reduce pain intensity for chronic pain. Clarification of proposed therapeutic targets of adjunctive hypnosis to evaluate underlying mechanisms is warranted.
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Affiliation(s)
- Hannah G Jones
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Department of Psychological Medicine, Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian W Pulling
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Persistent Pain Research Group, South Australian Health and Medical Research Institute (SAHMRI), Lifelong Health Theme, Hopwood Centre for Neurobiology, Adelaide, South Australia, Australia
| | - Felicity A Braithwaite
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Persistent Pain Research Group, South Australian Health and Medical Research Institute (SAHMRI), Lifelong Health Theme, Hopwood Centre for Neurobiology, Adelaide, South Australia, Australia
| | - Ashley R Grant
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Amy Rees
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Persistent Pain Research Group, South Australian Health and Medical Research Institute (SAHMRI), Lifelong Health Theme, Hopwood Centre for Neurobiology, Adelaide, South Australia, Australia
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11
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Zuo X, Chen Y, Zhu Y, Pan D, Rong X, Shen Q, Li H, Xu Y, Tang Y. Radiation-induced Chronic Pain Plagues Head and Neck Cancer Survivors: A Cross-sectional Analysis From the Cohort in Radiotherapy-related Nervous System Complications. THE JOURNAL OF PAIN 2024; 25:104612. [PMID: 38908498 DOI: 10.1016/j.jpain.2024.104612] [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: 12/17/2023] [Revised: 05/03/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
The epidemiology and prognosis of radiation-induced chronic pain, especially chronic neuropathic pain (CNP), are the understudied domain among head and neck cancer (HNC) survivors after radiotherapy (RT). This study aimed to estimate the prevalence of such chronic pain, and explore its correlations with mental health, sleep disorders, cognitive function, and quality of life (QOL) within these patients. This research encompassed HNC survivors post RT. The determination of radiation-induced chronic pain and CNP adhered to the guidelines outlined by the International Association for the Study of Pain. Multivariable regression analyses were employed to explore the relationship between pain and anxiety, depression, sleep disturbances, cognitive function, and QOL. A total of 1,071 HNC survivors post RT were included in this study. The prevalence of radiation-induced chronic pain was 67.1%, and the prevalence of RT-associated CNP was 38.3%. Compared with those reporting no pain, patients with radiation-induced chronic pain had a significantly increased risk of anxiety, depression, and sleep disorders (all P < .001). And there was a significantly negative association between chronic pain and QOL across physiological (P < .001), psychological (P < .001), social relationships (P = .001), and environmental (P = .009) domains. Compared with non-CNP, patients with RT-related CNP had a higher risk of anxiety (P = .027) and sleep disorders (P = .013). The significantly negative associations were found between CNP and the physiological (P = .001), psychological (P = .012), and social score (P = .035) in World Health Organisation Quality of Life Assessment-Bref. This study underscores the substantial prevalence of chronic pain, particularly CNP, and its potential impact on the mental health, sleep, and QOL among HNC survivors post RT. PERSPECTIVE: This study highlights the high prevalence of radiation-induced chronic pain and CNP, and their potential impacts on anxiety, depression, sleep, and QOL among the HNC survivors. Clinically, these findings have important implications for improving the care and outcomes of HNC survivors.
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Affiliation(s)
- Xuzheng Zuo
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanting Chen
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yingying Zhu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Division of Clinical Research Design, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dong Pan
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qingyu Shen
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Honghong Li
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yongteng Xu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yamei Tang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Division of Clinical Research Design, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
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Huang H, Ji F, Hu C, Huang J, Liu F, Han Z, Liu L, Cao M, Fu G. Identifying Novel Proteins for Chronic Pain: Integration of Human Brain Proteomes and Genome-wide Association Data. THE JOURNAL OF PAIN 2024; 25:104610. [PMID: 38909833 DOI: 10.1016/j.jpain.2024.104610] [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: 11/13/2023] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/25/2024]
Abstract
Numerous genome-wide association studies have identified risk genes for chronic pain, yet the mechanisms by which genetic variants modify susceptibility have remained elusive. We sought to identify key genes modulating chronic pain risk by regulating brain protein expression. We integrated brain proteomic data with the largest genome-wide dataset for multisite chronic pain (N = 387,649) in a proteome-wide association study (PWAS) using discovery and confirmatory proteomic datasets (N = 376 and 152) from the dorsolateral prefrontal cortex. Leveraging summary data-based Mendelian randomization and Bayesian colocalization analysis, we pinpointed potential causal genes, while a transcriptome-wide association study integrating 452 human brain transcriptomes investigated whether cis-effects on protein abundance extended to the transcriptome. Single-cell RNA-sequencing data and single-nucleus transcriptomic data revealed cell-type-specific expression patterns for identified causal genes in the dorsolateral prefrontal cortex and dorsal root ganglia (DRG), complemented by RNA microarray analysis of expression profiles in other pain-related brain regions. Of the 22 genes cis-regulating protein abundance identified by the discovery PWAS, 18 (82%) were deemed causal by summary data-based Mendelian randomization or Bayesian colocalization analysis analyses, with 7 of these 18 genes (39%) replicating in the confirmatory PWAS, including guanosine diphosphate-mannose pyrophosphorylase B, which also associated at the transcriptome level. Several causal genes exhibited selective expression in excitatory and inhibitory neurons, oligodendrocytes, and astrocytes, while most identified genes were expressed across additional pain-related brain regions. This integrative proteogenomic approach identified 18 high-confidence causal genes for chronic pain, regulated by cis-effects on brain protein levels, suggesting promising avenues for treatment research and indicating a contributory role for the DRG. PERSPECTIVE: The current post genome-wide association study analyses identified 18 high-confidence causal genes regulating chronic pain risk via cis-modulation of brain protein abundance, suggesting promising avenues for future chronic pain therapies. Additionally, the significant expression of these genes in the DRG indicated a potential contributory role, warranting further investigation.
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Affiliation(s)
- Haoquan Huang
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Medical Research Center of Shenshan Medical Center, Sun Yat-Sen Memorial Hospital, Shanwei, China
| | - Fengtao Ji
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chuwen Hu
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jingxuan Huang
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fan Liu
- Medical Research Center of Shenshan Medical Center, Sun Yat-Sen Memorial Hospital, Shanwei, China
| | - Zhixiao Han
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ling Liu
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Medical Research Center of Shenshan Medical Center, Sun Yat-Sen Memorial Hospital, Shanwei, China
| | - Ganglan Fu
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Medical Research Center of Shenshan Medical Center, Sun Yat-Sen Memorial Hospital, Shanwei, China.
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13
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Rodríguez-Palma EJ, Huerta de la Cruz S, Islas-Espinoza AM, Castañeda-Corral G, Granados-Soto V, Khanna R. Nociplastic pain mechanisms and toll-like receptors as promising targets for its management. Pain 2024; 165:2150-2164. [PMID: 38595206 DOI: 10.1097/j.pain.0000000000003238] [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: 11/06/2023] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
ABSTRACT Nociplastic pain, characterized by abnormal pain processing without an identifiable organic cause, affects a significant portion of the global population. Unfortunately, current pharmacological treatments for this condition often prove ineffective, prompting the need to explore new potential targets for inducing analgesic effects in patients with nociplastic pain. In this context, toll-like receptors (TLRs), known for their role in the immune response to infections, represent promising opportunities for pharmacological intervention because they play a relevant role in both the development and maintenance of pain. Although TLRs have been extensively studied in neuropathic and inflammatory pain, their specific contributions to nociplastic pain remain less clear, demanding further investigation. This review consolidates current evidence on the connection between TLRs and nociplastic pain, with a specific focus on prevalent conditions like fibromyalgia, stress-induced pain, sleep deprivation-related pain, and irritable bowel syndrome. In addition, we explore the association between nociplastic pain and psychiatric comorbidities, proposing that modulating TLRs can potentially alleviate both pain syndromes and related psychiatric disorders. Finally, we discuss the potential sex differences in TLR signaling, considering the higher prevalence of nociplastic pain among women. Altogether, this review aims to shed light on nociplastic pain, its underlying mechanisms, and its intriguing relationship with TLR signaling pathways, ultimately framing the potential therapeutic role of TLRs in addressing this challenging condition.
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Affiliation(s)
- Erick J Rodríguez-Palma
- Department of Pharmacology and Therapeutics, College of Medicine, University of Florida, Gainesville, FL, United States
- Neurobiology of Pain Laboratory, Departamento de Farmacobiología, Cinvestav, South Campus, Mexico City, Mexico
| | | | - Ana M Islas-Espinoza
- Neurobiology of Pain Laboratory, Departamento de Farmacobiología, Cinvestav, South Campus, Mexico City, Mexico
| | | | - Vinicio Granados-Soto
- Neurobiology of Pain Laboratory, Departamento de Farmacobiología, Cinvestav, South Campus, Mexico City, Mexico
| | - Rajesh Khanna
- Department of Pharmacology and Therapeutics, College of Medicine, University of Florida, Gainesville, FL, United States
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14
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Kapos FP, Craig KD, Anderson SR, Bernardes SF, Hirsh AT, Karos K, Keogh E, Reynolds Losin EA, McParland JL, Moore DJ, Ashton-James CE. Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives. THE JOURNAL OF PAIN 2024; 25:104608. [PMID: 38897311 PMCID: PMC11402600 DOI: 10.1016/j.jpain.2024.104608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.
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Affiliation(s)
- Flavia P Kapos
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Orthopaedic Surgery & Duke Clinical Research Institute, Duke University Schoool of Medicine, Durham, North Carolina.
| | - Kenneth D Craig
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven R Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Sónia F Bernardes
- Centre for Social Research and Intervention, Iscte-Lisbon University Institute, Lisbon, Portugal
| | - Adam T Hirsh
- Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana
| | - Kai Karos
- Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | | | - Joanna L McParland
- Department of Psychology, Glasgow Caledonian University, Glasgow, United Kingdom
| | - David J Moore
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Claire E Ashton-James
- Pain Management Research Institute, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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15
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Gardner P, Gilbert J, Plummer V, Hills D. Registered nurses' knowledge, attitudes and practices of pain management for aged care residents with dementia: an integrative review. Contemp Nurse 2024; 60:496-515. [PMID: 38861583 DOI: 10.1080/10376178.2024.2362290] [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: 11/14/2023] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
AIM To assess the knowledge, attitudes and practices of Registered Nurses working in residential aged care facilities pertaining to pain management for residents living with dementia. BACKGROUND Sub-optimal pain management continues for people living with dementia in residential aged care. Registered Nurses are the pivotal staff responsible for complex assessment and management of people residing in residential aged care facilities. DESIGN AND METHODS :This integrative literature review was informed by Whittemore (2005). Searching and screening followed the PRISMA guidelines. RESULTS Thirteen papers were identified, the major themes identified were gaps in knowledge and skills, uncertainty of assessment, and delays in treatment. CONCLUSION Registered Nurses require education on pain management for people living with dementia in residential aged care. Broader issues in residential aged care contribute to the problem and require examination. Research pertaining to Registered Nurses' roles pain management for residents living with dementia is required.
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Affiliation(s)
- Paul Gardner
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Julia Gilbert
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Virginia Plummer
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Danny Hills
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
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16
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Aisien E, Chibuzom CN, Osifo DO, Evbuomwan I. Post-operative Pain Control: A Comparison between Bupivacaine and Tramadol Local Wound Infiltration in Children Undergoing Herniotomy and Orchidopexy. Afr J Paediatr Surg 2024; 21:217-222. [PMID: 38520238 DOI: 10.4103/ajps.ajps_172_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/17/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Post-operative pain control improves patient's satisfaction and affects the period of admission. Local wound infiltration following hernia surgery using xylocaine or bupivacaine has been a common practice. The use of tramadol for such infiltration is relatively new and has not been studied in our environment. This study compared the efficacy of post-operative pain control between Bupivacaine and Tramadol wound infiltration in children who underwent herniotomy and orchidopexy. MATERIALS AND METHODS This was a prospective randomised study involving 104 patients. A simple random method was used to allocate the study group into two equal groups (A, n = 52 and B, n = 52) using sealed envelopes with contents labelled A or B. Pre- and post-operative respiratory rate, heart rate, and C-reactive protein (CRP) were all recorded. Time to first and subsequent analgesia was determined using face, legs, activity, cry, consolability (FLACC) pain score. RESULTS Fifteen patients in Group A and 18 patients in Group B received each two doses of supplemental analgesia within the first 24 h, ( P = 0.527). Time to first analgesia was significantly different between the two groups, (6.93 ± 0.80 h and 6.11 ± 1.08 h, P = 0.020). The mean FLACC pain score at the time of first analgesia in hours was 4.93 ± 0.59 and 4.72 ± 0.67 for Group A and B, respectively, P = 0.350. The changes in CRP were not different in the two groups, ( P = 0.665). Four patients in Group A, but none in Group B had an episode each of post-operative vomiting. CONCLUSION Tramadol showed comparable efficacy with bupivacaine in post-operative pain control by wound infiltration in children who had unilateral herniotomy or orchidopexy. Tramadol, however, achieves a longer duration of action before rescue analgesic is required. Caution is necessary to avoid post-operative vomiting.
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Affiliation(s)
- Efosa Aisien
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | | | - David Osarumwense Osifo
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Iyekeoretin Evbuomwan
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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17
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Turnbull J, Chapman V. Targeting the soluble epoxide hydrolase pathway as a novel therapeutic approach for the treatment of pain. Curr Opin Pharmacol 2024; 78:102477. [PMID: 39197248 DOI: 10.1016/j.coph.2024.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024]
Abstract
Chronic pain is a major burden and the complexities of chronic pain pathophysiology, including both peripheral and central sensitisation mechanisms, involves multiple cell types (neuronal, immune, neuroimmune, and vascular) which substantially complicates the development of new effective analgesic treatments. The epoxy fatty acids (EpFAs), including the epoxyeicosatrienoic acids (EETs), are derived from the metabolism of polyunsaturated fatty acids (PUFAs) via the cytochrome P450 enzymatic pathway and act to shut-down inflammatory signalling and provide analgesia. The EpFAs are rapidly metabolised by the enzyme soluble epoxide hydrolase (sEH) into their corresponding diol metabolites, which recent studies suggest are pro-inflammatory and pro-nociceptive. This review discusses clinical and mechanistic evidence for targeting the sEH pathway for the treatment of pain.
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Affiliation(s)
- James Turnbull
- Pain Centre Versus Arthritis & NIHR Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom.
| | - Victoria Chapman
- Pain Centre Versus Arthritis & NIHR Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
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18
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Lukacs MJ, Peters N, Minetama M, Kowalski KL, Stanley M, Jayaprakash K, Walton DM, Rushton AB. How is recovery defined and measured in patients with low back pain? A mixed study systematic review. BMC Musculoskelet Disord 2024; 25:763. [PMID: 39354445 DOI: 10.1186/s12891-024-07892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/23/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Despite the burden of low back pain (LBP) there is no currently accepted definition for its recovery, nor is there a gold standard for measurement. In addition, it is currently unclear how the perspective of patients are used in making recovery determinations. The purpose of this mixed study systematic review across both quantitative and qualitative literature was to (1) explore how recovery has been defined and measured for patients experiencing LBP, and (2) examine how the perspectives of patients and providers for recovery of LBP align or differ. METHODS This was a mixed study systematic review. Key databases were searched from inception until February 20, 2023: Medline, EMBASE, CINAHL, Cochrane, PEDro looking for sources examining definitions and measures of recovery in patients with LBP. Grey literature was identified through the ProQuest Thesis & Dissertation database. Two reviewers used the Mixed Methods Appraisal Tool for quality assessment of both qualitative and quantitative studies to explore definitions, measurements and perspective of recovery. RESULTS 466 original studies were included: 12 qualitative studies, 88 quantitative randomized control trials, 348 quantitative non-randomized studies, 16 quantitative descriptive studies, and two mixed methods studies. Most of the time recovery was not defined, with six other themes identified: comparison of scores, in relation to a singular cut-off score, improvement of absence of clinical symptoms, a return to a pre-injury state, change/improvement score from baseline and as a process/trajectory. For recovery measurements, six themes described the data: multiple measures, single measure excluding recovery, a recovery measure, recovery and an additional measure, pain and an additional measure, or indirect/ not specified. Lastly recovery perspectives were made from either the patient, provider, or a combination of patient and provider. CONCLUSION For patients living with LBP, the concept of recovery continues to lack consensus for its definition and measurement in patients with LBP. The perspectives of patients were mostly not preserved in making recovery determinations. Urgent action is needed to generate consensus across clinicians, researchers, and patients regarding how recovery should be defined and measured. A multitude of study-specific definitions limit knowledge syntheses and definition of best practice.
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Affiliation(s)
- Michael J Lukacs
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada.
- London Health Sciences Centre, Health Disciplines, London, Canada.
| | - Nicole Peters
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada
| | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Katie L Kowalski
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada
| | | | | | - David M Walton
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada
| | - Alison B Rushton
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada
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Safran SL, Follonier D, Weber E, Vayne-Bossert P, Ahrendts U, Rehberg-Klug B. Cross-cultural adaptation and psychometric validation of the French version of the Defense and Veterans Pain Rating Scale for acute and chronic pain: a prospective clinical study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:630-636. [PMID: 38870517 DOI: 10.1093/pm/pnae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Pain assessment and proper evaluation of pain are prerequisites for treatment of acute and chronic pain. Until now, most evaluations have used only resting pain intensity and a unidimensional scale, although multidimensional pain assessment and especially assessment of functional pain impact on activities are recommended. The Defense and Veterans Pain Rating Scale (DVPRS) permits this multidimensional assessment, but no validated French translation exists. OBJECTIVES To validate the French translation of the multidimensional DVPRS, called the Functional Pain Scale (FPS), in multiple settings of acute and chronic pain. STUDY DESIGN Prospective observational study. SETTING Two large hospitals in the French-speaking region of Switzerland. METHODS We recruited 232 patients from February 2022 to January 2023. Patients with acute or chronic pain in different settings received a paper questionnaire with both a numerical rating scale (NRS) and the FPS and a customized evaluation questionnaire. Correlation between the FPS and NRS, psychometric properties, and patient preferences were analyzed. RESULTS Correlation between the FPS and NRS was high for the whole group of 232 patients, as well for all subgroups. The multi-item FPS scale showed excellent internal consistency. A large majority of patients, even those >75 years of age, preferred the FPS over the NRS and stated that the FPS was easy to use. CONCLUSIONS The study confirms that the French translation of the DVPRS (the FPS) is a valid measurement instrument for acute and chronic pain evaluation in a wide range of patient groups and is easy for patients to use. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05307380.
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Affiliation(s)
| | - David Follonier
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, Genève, 1205, Switzerland
| | - Eric Weber
- Centre de Traitement de la Douleur, Service d'Anesthésie et Réanimation, Hôpital du Valais, Martigny, 1920, Switzerland
| | - Petra Vayne-Bossert
- Department of Palliative Care, Geneva University Hospitals, Genève, 1205, Switzerland
| | - Ulrike Ahrendts
- Division of Internal Medicine and Rehabilitation Beau-Séjour, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, 1205, Switzerland
| | - Benno Rehberg-Klug
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Genève, 1205, Switzerland
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20
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Artz KE, Phillips TD, Moore JM, Tibbe KE. Redesigning the Care of Musculoskeletal Conditions With Lifestyle Medicine. Mayo Clin Proc Innov Qual Outcomes 2024; 8:418-430. [PMID: 39228921 PMCID: PMC11369511 DOI: 10.1016/j.mayocpiqo.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 09/05/2024] Open
Abstract
Value-based health care has been accelerated by alternative payment models and has catalyzed the redesign of care delivery across the nation. Lifestyle medicine (LM) is one of the fastest growing medical specialties and has emerged as a high-value solution for root cause treatment of chronic disease. This review detailed a large integrated health care delivery system's value transformation efforts in the nonoperative treatment of musculoskeletal (MSK) conditions by placing patient-centric, team-based, lifestyle-focused care at the foundation. With an economic and treatment imperative to reimagine care, recognizing more intervention is not always better, a collaborative approach was designed, which placed functional improvement of the patient at the center. This article described the process of implementing LM into an MSK model of care. The change management process impacted clinical, operational, and benefit plan design to facilitate an integrated care model. A new understanding of patients' co-occurring physical impairments, medical comorbidities, and behavioral health needs was necessary for clinicians to make the shift from a pathoanatomic, transactional model of care to a biopsychosocial, longitudinal model of care. The authors explored the novel intersection of the implementation of a biopsychosocial model of care using LM principles to achieve greater value for the MSK patient population.
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Affiliation(s)
- Kristi E. Artz
- Lifestyle Medicine, Corewell Health West, Grand Rapids, MI
| | | | | | - Kara E. Tibbe
- Lifestyle Medicine, Corewell Health West, Grand Rapids, MI
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21
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Symons X, Rhee J, Tanous A, Balboni T, VanderWeele TJ. Flourishing at the end of life. THEORETICAL MEDICINE AND BIOETHICS 2024; 45:401-425. [PMID: 39162937 PMCID: PMC11358345 DOI: 10.1007/s11017-024-09679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 08/21/2024]
Abstract
Flourishing is an increasingly common construct employed in the study of human wellbeing. But its appropriateness as a framework of wellbeing at certain stages of life is contested. In this paper, we consider to what extent it is possible for someone to flourish at the end of life. People with terminal illness often experience significant and protracted pain and suffering especially when they opt for treatments that prolong life. Certain aspects of human goods, however, that are plausibly constitutive of flourishing-such as meaning and purpose, deep personal relationships, and character and virtue-can be uniquely realised when life is ending. We argue that there is a qualified sense in which one can flourish at the end of life but that one must make important modifications to the criteria implicit in conventional conceptions of flourishing. We close with a discussion of the empirical assessment of wellbeing at the end of life and explore the possibility of introducing a flourishing measure in palliative care practice.
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Affiliation(s)
- Xavier Symons
- Human Flourishing Program in the Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.
- Plunkett Centre for Ethics, The Australian Catholic University, Sydney, NSW, Australia.
| | - John Rhee
- Department of Neurology, Dana Faber Cancer Institute, Boston, MA, USA
| | - Anthony Tanous
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Tyler J VanderWeele
- Human Flourishing Program in the Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Epidemiology, TH Chan School of Public Health, Harvard University, Cambridge, MA, USA
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22
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Ramírez-Maestre C, Barrado-Moreno V, Esteve R, Serrano-Íbañez ER, de la Vega R, Ruiz-Párraga GT, Fernández-Baena M, Jensen MP, López-Martínez AE. Vulnerability Factors, Adjustment, and Opioid Misuse in Chronic Noncancer Pain Individuals. THE JOURNAL OF PAIN 2024; 25:104606. [PMID: 38871145 DOI: 10.1016/j.jpain.2024.104606] [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: 02/16/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/15/2024]
Abstract
Several person variables predate injury or pain onset that increase the probability of maladjustment to pain and opioid misuse. The aim of this study was to evaluate the role of 2 diathesis variables (impulsiveness and anxiety sensitivity [AS]) in the adjustment of individuals with chronic noncancer pain and opioid misuse. The sample comprised 187 individuals with chronic noncancer pain. The hypothetical model was tested using correlation and structural equation modeling analyses. The results show a significant association between impulsiveness and AS and all the maladjustment variables, and between impulsiveness and AS and opioid misuse and craving. However, although the correlation analysis showed a significant association between adjustment to pain and opioid misuse, the structural equation modeling analysis showed a nonsignificant association between them (as latent variables). The findings support the hypothesis that both impulsiveness and AS are vulnerability factors for maladaptive adjustment to chronic pain and opioid misuse. PERSPECTIVE: This article adds to the empirical literature by including AS and impulsiveness as antecedent variables in a model of dual vulnerability to chronic pain maladjustment and opioid misuse. The findings suggest the potential utility of assessing both factors in individuals in the first stages of chronic pain.
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Affiliation(s)
- Carmen Ramírez-Maestre
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - Victoria Barrado-Moreno
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain
| | - Rosa Esteve
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Elena R Serrano-Íbañez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Rocío de la Vega
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Gema T Ruiz-Párraga
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Alicia E López-Martínez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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23
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Centmayer R, Leiske M, Lahmann NA. Pain Prevalence and Pain Management in Nursing Home Residents With Cognitive Impairment. Results From Five Multicenter Cross-Sectional Surveys in Germany Between 2014 and 2018. Pain Manag Nurs 2024; 25:487-493. [PMID: 38853041 DOI: 10.1016/j.pmn.2024.05.005] [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: 08/03/2023] [Revised: 04/16/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Pain management depends on continuous pain assessment and a pain concept. In particular, pain assessment and treatment are major challenges for nursing home residents (NHR) with cognitive impairment (CI). Many caregivers often lack the knowledge to recognize and appropriately treat pain in this vulnerable group. Little is known about the proportion of NHR who are fundamentally dependent on external assessment for pain due to CI. OBJECTIVE The aim of the study was to determine pain prevalence and management among NHR with and without CI. A second objective was to determine the proportion of NHR who are dependent on external assessment for pain. METHODS Information on pain was collected from 3,437 NHR in multicenter cross-sectional surveys in 51 German nursing homes between 2014 and 2018. The presence of current pain in one-to-one interviews was determined as well as dependencies on third-party information, number of daily pain recordings, and administration of medication for pain. The analysis included a contingency table and log regression analyses. RESULTS Pain prevalence was 24.9% among NHR with severe CI and 40.4% among NHR without CI. Overall, 19.8% of all NHRs relied on a third-party assessment of pain. Significantly, NHR with severe CI were less likely to be classified as having pain (OR 0.51), to be assessed for pain several times a day (OR 0.53) or to receive pain medication (OR 0.55) compared with NHR without CI. No influence on pain management was shown for the type of pain assessment. CONCLUSIONS The study provides evidence of significant deficits in pain management among NHR with moderate and severe CI in nursing homes in Germany. NHR with moderate and severe CI are significantly less likely to be observed for pain or classified as pain sufferers and receive significantly less pain medication than NHR without CI. Intensive training of staff on pain management of NHR with severe CI is recommended.
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Affiliation(s)
- Rainer Centmayer
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Manfred Leiske
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Axel Lahmann
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
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24
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Serra J, Aguilar A, Barba E, Ciriza de Los Ríos C, Garcia Pravia L, Martínez V, Serrano Falcón B. Asociación Española de Neurogastroenterología y Motilidad (ASENEM) updated review on the management of functional abdominal pain. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:888-900. [PMID: 38677507 DOI: 10.1016/j.gastrohep.2024.02.005] [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: 10/23/2023] [Revised: 01/25/2024] [Accepted: 02/27/2024] [Indexed: 04/29/2024]
Abstract
Functional abdominal pain is a disorder in which central and peripheral sensitization processes converge, leading to hypersensitivity and allodynia. Differential diagnosis is made with organic digestive, renal, gynecological, endocrine, or neurological diseases. Treatment should be individualized for each patient. In cases of debilitating pain, therapy combining drugs with different mechanisms of action can be initiated, while in less severe cases, therapy with a progressive introduction of drugs based on clinical response is advised. The first line includes general lifestyle advice and antispasmodic substances, like peppermint oil, anticholinergic/antimuscarinic, and calcium channels antagonists. In the second line of treatment, neuromodulating agents are added. Finally, when these measures fail, third-line treatments such as gabapentine and atypical antipsychotics are considered. Psychological interventions should be considered if specialized therapists are available to manage these disorders.
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Affiliation(s)
- Jordi Serra
- Unidad de Motilidad Digestiva, Hospital Universitario Vall d'Hebrón, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España.
| | - Ariadna Aguilar
- Unidad de Motilidad Digestiva, Hospital Universitario Vall d'Hebrón, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - Elizabeth Barba
- Unidad de Motilidad Digestiva, Departamento de Gastroenterología, Hospital Clínic, Barcelona, España
| | - Constanza Ciriza de Los Ríos
- Servicio de Digestivo, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - Laura Garcia Pravia
- Servicio de Digestivo, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - Vicente Martínez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España; Departamento de Biología Celular, Fisiología e Inmunología, Universidad Autónoma de Barcelona, Barcelona, España
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25
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Morton J, Bloom T, Anbari A, St Marie BJ, Lepper LT, Bullock L. A Qualitative Exploration of Perinatal Opioid Users' Pain-Related Experiences. Pain Manag Nurs 2024; 25:501-509. [PMID: 38782650 DOI: 10.1016/j.pmn.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Many pregnant and postpartum individuals who misuse prescription opioids report either physical or psychological pain. The pain-related factors underlying perinatal opioid misuse are poorly understood. PURPOSE The purpose of this study was to explore the pain-related experiences of individuals with histories of perinatal prescription opioid misuse. DESIGN This study used a qualitative descriptive design. METHODS Between October 2021 and July 2022, a convenience sample of 12 childbearing-aged females with histories of perinatal opioid misuse were recruited and individually interviewed about their pain-related experiences. Semi-structured interviews were recorded, transcribed verbatim, and manually coded using thematic analysis. RESULTS Twelve participants consented to participate and provided 14 interviews. Three major themes emerged to highlight participant's experiences with pain and misuse of prescription opioids: 1) pain sources, 2) impact of pain, and 3) pain management. CONCLUSIONS Participants indicated in their interviews their childhood and adult trauma experiences created risk of initiating misuse prior to pregnancy and continued prescription opioid misuse perinatally. Both psychological and physical pain experiences were stated by participants as frequently undertreated. Participants perceived undertreatment of both types of pain influenced decisions to self-manage with prescription opioid and illegal substances of abuse. CLINICAL IMPLICATIONS The participants' shared experiences provide insights for targeted pain-related nursing interventions that could help reduce the initiation and perpetuation of misuse and assist the journey to recovery.
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Affiliation(s)
- Jamie Morton
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri.
| | - Tina Bloom
- School of Nursing, Notre Dame of Maryland University, Baltimore, Maryland
| | - Allison Anbari
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | | | - Leigh Tenkku Lepper
- School of Social Work and Public Health Department, University of Missouri, Columbia, Missouri
| | - Linda Bullock
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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26
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Costa V, Gianlorenço AC, Andrade MF, Camargo L, Menacho M, Arias Avila M, Pacheco-Barrios K, Choi H, Song JJ, Fregni F. Transcutaneous vagus nerve stimulation effects on chronic pain: systematic review and meta-analysis. Pain Rep 2024; 9:e1171. [PMID: 39131814 PMCID: PMC11309651 DOI: 10.1097/pr9.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 08/13/2024] Open
Abstract
Chronic pain is one of the major causes of disability with a tremendous impact on an individual's quality of life and on public health. Transcutaneous vagus nerve stimulation (tVNS) is a safe therapeutic for this condition. We aimed to evaluate its effects in adults with chronic pain. A comprehensive search was performed, including randomized controlled trials published until October 2023, which assessed the effects of noninvasive tVNS. Cohen's d effect size and 95% confidence intervals (CIs) were calculated, and random-effects meta-analyses were performed. Fifteen studies were included. The results revealed a mean effect size of 0.41 (95% CI 0.17-0.66) in favor of tVNS as compared with control, although a significant heterogeneity was observed (χ2 = 21.7, df = 10, P = 0.02, I 2 = 53.9%). However, when compared with nonactive controls, tVNS shows a larger effect size (0.79, 95% CI 0.25-1.33), although the number of studies was small (n = 3). When analyzed separately, auricular tVNS and cervical tVNS against control, it shows a significant small to moderate effect size, similar to that of the main analysis, respectively, 0.42 (95% CI 0.08-0.76, 8 studies) and 0.36 (95% CI 0.01-0.70, 3 studies). No differences were observed in the number of migraine days for the trials on migraine. This meta-analysis indicates that tVNS shows promise as an effective intervention for managing pain intensity in chronic pain conditions. We discuss the design of future trials to confirm these preliminary results, including sample size and parameters of stimulation.
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Affiliation(s)
- Valton Costa
- Neurosciences Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
- Spaulding Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Carolyna Gianlorenço
- Neurosciences Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
- Spaulding Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Fernanda Andrade
- Spaulding Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lucas Camargo
- Spaulding Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maryela Menacho
- Neurosciences Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
- Spaulding Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mariana Arias Avila
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - Kevin Pacheco-Barrios
- Spaulding Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, South Korea
- Neurive Co, Ltd, Gimhae, South Korea
| | - Jae-Jun Song
- Neurive Co, Ltd, Gimhae, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul, South Korea
| | - Felipe Fregni
- Spaulding Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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27
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Nair JJ, van Staden J. Anti-inflammatory Principles of the Plant Family Amaryllidaceae. PLANTA MEDICA 2024; 90:900-937. [PMID: 39029914 DOI: 10.1055/a-2369-8104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
There is considerable interest in the utilisation of plants against inflammation. Over 50 species of the plant family Amaryllidaceae are known for such usage in traditional medicine. This review was undertaken to identify the chemical principles responsible for these anti-inflammatory effects. It describes the findings from in vitro, in vivo and in silico studies, as well as the probes made on the mechanisms of action. The literature search returned over 600 hits, of which around 130 were chosen for their relevance to the text. Over 140 compounds have thus far been screened for anti-inflammatory effects. These were mostly isoquinoline alkaloids but also included other classes of secondary metabolites such as chromones, flavonoids and triterpenoids. In vitro studies were carried out in mononuclear cells such as lymphocytes, monocytes, neutrophils and macrophages, against which no serious side effects were observed. The constituents were also effective against inflammation induced by physical and chemical stimuli in a variety of murine test subjects. Chief among the compounds were the isoquinoline alkaloids lycorine and narciclasine, which displayed potent effects against pain, swelling, asthma and arthritis, amongst others. From a mechanistic perspective, several of the compounds were shown to mediate in inflammatory pathways, notably via the modulation of both pro-inflammatory (such as NF-κB, TNF-α and IL-1) and anti-inflammatory (such as IL-10 and TGF-β) factors. Useful insights also emerged from active-site docking studies of some of the compounds. The Amaryllidaceae affords a rich and diverse platform for the discovery of potential anti-inflammatory drugs.
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Affiliation(s)
- Jerald J Nair
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Johannes van Staden
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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28
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Hadland SE, Agarwal R, Raman SR, Smith MJ, Bryl A, Michel J, Kelley-Quon LI, Raval MV, Renny MH, Larson-Steckler B, Wexelblatt S, Wilder RT, Flinn SK. Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. Pediatrics 2024:e2024068752. [PMID: 39344439 DOI: 10.1542/peds.2024-068752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
This is the first clinical practice guideline (CPG) from the American Academy of Pediatrics outlining evidence-based approaches to safely prescribing opioids for acute pain in outpatient settings. The central goal is to aid clinicians in understanding when opioids may be indicated to treat acute pain in children and adolescents and how to minimize risks (including opioid use disorder, poisoning, and overdose). The document also seeks to alleviate disparate pain treatment of Black, Hispanic, and American Indian/Alaska Native children and adolescents, who receive pain management that is less adequate and less timely than that provided to white individuals. There may also be disparities in pain treatment based on language, socioeconomic status, geographic location, and other factors, which are discussed. The document recommends that clinicians treat acute pain using a multimodal approach that includes the appropriate use of nonpharmacologic therapies, nonopioid medications, and, when needed, opioid medications. Opioids should not be prescribed as monotherapy for children or adolescents who have acute pain. When using opioids for acute pain management, clinicians should prescribe immediate-release opioid formulations, start with the lowest age- and weight-appropriate doses, and provide an initial supply of 5 or fewer days, unless the pain is related to trauma or surgery with expected duration of pain longer than 5 days. Clinicians should not prescribe codeine or tramadol for patients younger than 12 years; adolescents 12 to 18 years of age who have obesity, obstructive sleep apnea, or severe lung disease; to treat postsurgical pain after tonsillectomy or adenoidectomy in patients younger than 18 years; or for any breastfeeding patient. The CPG recommends providing opioids when appropriate for treating acutely worsened pain in children and adolescents who have a history of chronic pain; clinicians should partner with other opioid-prescribing clinicians involved in the patient's care and/or a specialist in chronic pain or palliative care to determine an appropriate treatment plan. Caution should be used when treating acute pain in those who are taking sedating medications. The CPG describes potential harms of discontinuing or rapidly tapering opioids in individuals who have been on stable, long-term opioids to treat chronic pain. The guideline also recommends providing naloxone and information on naloxone, safe storage and disposal of opioids, and direct observation of medication administration. Clinicians are encouraged to help caregivers develop a plan for safe disposal. The CPG contains 12 key action statements based on evidence from randomized controlled trials, high-quality observational studies, and, when studies are lacking or could not feasibly or ethically be conducted, from expert opinion. Each key action statement includes a level of evidence, the benefit-harm relationship, and the strength of recommendation.
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Affiliation(s)
- Scott E Hadland
- Mass General for Children; Harvard Medical School, Boston, Massachusetts
| | - Rita Agarwal
- Stanford University School of Medicine, Stanford, California
| | | | - Michael J Smith
- Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Amy Bryl
- Division of Emergency Medicine, Rady Children's Hospital San Diego and Department of Pediatrics, University of California San Diego, San Diego, California
| | - Jeremy Michel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Department of Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles and Departments of Surgery and Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Madeline H Renny
- Departments of Emergency Medicine, Pediatrics, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Scott Wexelblatt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Perinatal Institute, Cincinnati, Ohio
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29
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Wang Q. Assessing pain in older people with normal, mildly impaired or severely impaired cognition. Nurs Older People 2024; 36:35-42. [PMID: 39015017 DOI: 10.7748/nop.2024.e1466] [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] [Accepted: 03/18/2024] [Indexed: 07/18/2024]
Abstract
Pain is a relatively common experience among older people, but unrelieved pain has significant functional, cognitive and emotional consequences for this population. A comprehensive and accurate pain assessment is essential for effective pain management. Self-report tools are suitable to assess pain in older people with normal or mildly impaired cognition, while observational tools are suitable for use with those with significant cognitive impairment or communication difficulties. However, pain assessment in older people can be challenging. The use of one tool on its own is rarely sufficient and it is crucial to involve family carers in assessment of pain in older people with severe cognitive impairment. This article discusses different tools and strategies, including the benefits and limitations, for assessing pain in older people.
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Affiliation(s)
- Qun Wang
- and lead for non-medical prescribing, Epsom and St Helier University Hospitals NHS Trust, Surrey, England
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30
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Baerwald C, Stemmler E, Gnüchtel S, Jeromin K, Fritz B, Bernateck M, Adolf D, Taylor PC, Baron R. Predictors for severe persisting pain in rheumatoid arthritis are associated with pain origin and appraisal of pain. Ann Rheum Dis 2024; 83:1381-1388. [PMID: 38816064 DOI: 10.1136/ard-2023-225414] [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: 12/18/2023] [Accepted: 05/04/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES To determine the proportion of patients with rheumatoid arthritis (RA) with severe persisting pain and to identify predictive factors despite treatment-controlled disease activity. METHODS This prospective multicentre study included outpatients with RA scheduled for escalation of anti-inflammatory treatment due to active disease and severe pain (Disease Activity Score 28 (DAS28)>3.2 and Visual Analogue Scale (VAS)>50). At week 24, patients were stratified into reference group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score<50), non-responders (DAS28 improvement≤1.2 and DAS28>3.2, regardless of VAS pain score) and persisting pain group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score≥50). The former two subgroups ended the study at week 24. The latter continued until week 48. Demographic data, DAS28-C reactive protein, VAS for pain, painDETECT Questionnaire (PD-Q) to identify neuropathic pain (NeP) and the Pain Catastrophising Scale were assessed and tested for relation to persisting pain. RESULTS Of 567 patients, 337 (59.4%) were classified as reference group, 102 (18.0%) as non-responders and 128 (22.6%) as patients with persisting pain. 21 (8.8%) responders, 28 (35.0%) non-responders and 27 (26.5%) persisting pain patients tested positive for NeP at week 24. Pain catastrophising (p=0.002) and number of tender joints (p=0.004) were positively associated with persisting pain at week 24. Baseline PD-Q was not related to subsequent persisting pain. CONCLUSIONS Persisting and non-nociceptive pain occur frequently in RA. Besides the potential involvement of NeP, pain catastrophising and a higher number of tender joints coincide with persisting pain.
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Affiliation(s)
- Christoph Baerwald
- Zentrum für Seltene Erkrankungen, University Hospital Leipzig, Leipzig, Germany
| | | | | | | | - Björn Fritz
- AbbVie Deutschland GmbH & Co KG, Wiesbaden, Germany
| | | | | | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Ralf Baron
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
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31
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Jiang C, Huang H, Chen L, Jiang J, Zhang H, Chen J, Chen S, Lin Z. Functional Magnetic Resonance Imaging Analysis of the Clinical Effect and Cerebral Mechanism of Tuina in Lumbar Disc Herniation: Protocol for a Randomized Controlled Parallel Group Trial. JMIR Res Protoc 2024; 13:e63852. [PMID: 39348675 DOI: 10.2196/63852] [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: 07/01/2024] [Revised: 07/18/2024] [Accepted: 08/30/2024] [Indexed: 10/02/2024] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) has become a serious public health and socioeconomic problem. Tuina is a Chinese medicine treatment method based on meridian acupuncture theory and modern anatomy. Tuina can relieve pain and muscle tension and improve functional disorders; this massage is performed by pressing, kneading, pushing, pulling, and shaking the skin, muscles, and bones. However, the mechanism of action and the effect of Tuina as an external treatment on the activities of the central nervous system to relieve LDH pain is unclear. Therefore, we performed functional magnetic resonance imaging (fMRI), which is widely used in pain-related research, as it can detect the effects of different types of pain on brain activity. OBJECTIVE Our randomized controlled parallel-group trial aims to compare the effects of Tuina with those of transcutaneous electrical nerve stimulation (TENS) with traction in patients with LDH. METHODS This trial will be conducted between May 2024 and April 2025 in the Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine. Seventy-six participants with LDH will be enrolled for this trial and randomly assigned to 2 groups: Tuina intervention group and TENS with traction intervention group. Participants in both groups will receive treatment for 14 days. fMRI will be performed for the main pain measurements by assessing the effect of the intervention on brain activity before and after the end of the intervention. Short-Form McGill Pain Questionnaire, pressure pain thresholds, and the Oswestry disability index will be used to reflect the degree of pain and lumbar dysfunction, and the results will be used as secondary outcome measurements. RESULTS The study protocol has been approved by the ethics review committee of The Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine. This study was registered on May 1, 2024, with the Chinese Clinical Trial Registry. Data collection began on May 2024 and is expected to end on April 2025. Currently, data from this trial are in the collection phase, and no data analysis has been performed. As of July 1, 2024, we have collected data from 21 patients. The results of this trial are expected to be submitted for publication in September 2025. CONCLUSIONS This clinical trial will compare the effectiveness of Tuina with that of TENS with traction in the treatment of patients with LDH and will show the cerebral mechanism of Tuina in LDH treatment by using fMRI. The results of our trial will be helpful in clarifying the cerebral mechanism of Tuina in the treatment of LDH and provide a solid foundation for Tuina therapy research. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2400083784; https://www.chictr.org.cn/showproj.html?proj=225157. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/63852.
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Affiliation(s)
- Changzheng Jiang
- Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hongye Huang
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lechun Chen
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jingjing Jiang
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huanzhen Zhang
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jincheng Chen
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shuijin Chen
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhigang Lin
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Louras M, Vanhaudenhuyse A, Panda R, Rousseaux F, Carella M, Gosseries O, Bonhomme V, Faymonville ME, Bicego A. Virtual Reality Combined with Mind-Body Therapies for the Management of Pain: A Scoping Review. Int J Clin Exp Hypn 2024:1-37. [PMID: 39347979 DOI: 10.1080/00207144.2024.2391365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 10/01/2024]
Abstract
When used separately, virtual reality (VR) and mind-body therapies (MBTs) have the potential to reduce pain across various acute and chronic conditions. While their combination is increasingly used, no study offers a consolidated presentation of VR and MBTs. This study aims to propose an overview of the effectiveness of VR combined with MBTs (i.e., meditation, mindfulness, relaxation, and hypnosis) to decrease the pain experienced by healthy volunteers or patients. We conducted a scoping review of the literature using PubMed, Science Direct and Google Scholar and included 43 studies. Findings across studies support that VR combined with MBTs is a feasible, well-tolerated, and potentially useful to reduce pain. Their combination also had a positive effect on anxiety, mood, and relaxation. However, insufficient research on this VR/MBTs combination and the lack of multidimensional studies impede a comprehensive understanding of their full potential. More randomized controlled studies are thus needed, with usability evaluation protocols to better understand the effects of VR/MBTs on patients wellbeing and to incorporate them into routine clinical practice.
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Affiliation(s)
- Mélanie Louras
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Interdisciplinary Algology Center, University Hospital of Liège, Liège, Belgium
| | - Rajanikant Panda
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Neuroscience Lab, Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Floriane Rousseaux
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Medical Hypnosis Laboratory, MaisonNeuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Québec, Canada
| | - Michele Carella
- Inflammation and Enhanced Rehabilitation Laboratory (Regional Anaesthesia and Analgesia), GIGA-I3 Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Olivia Gosseries
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau2, Liege University Hospital, Liege, Belgium
| | - Vincent Bonhomme
- Inflammation and Enhanced Rehabilitation Laboratory (Regional Anaesthesia and Analgesia), GIGA-I3 Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Marie-Elisabeth Faymonville
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Oncology Integrated Arsene Bury Center, University Hospital of Liège, Liège, Belgium
| | - Aminata Bicego
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
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Ucero-Lozano R, Pérez-Llanes R, Cuesta-Barriuso R, Donoso-Úbeda E. Immersive visualization of movement in patients with hemophilic ankle arthropathy. Multicenter, single-blind, randomized clinical trial. J Rehabil Med 2024; 56:jrm40775. [PMID: 39347694 DOI: 10.2340/jrm.v56.40775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/08/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy of immersive movement observation in adult patients with haemophilic ankle arthropathy. DESIGN Multicentre, single-blind, randomized clinical trial. SUBJECTS 48 patients with haemophilia. METHODS Patients were randomly allocated to 2 groups (180º immersive video-based visualization of movement and a control group with no intervention). Twenty-eight consecutive 15-min home sessions, 1 per day, of immersive visualization of ankle flexion-extension movement were carried out. Three evaluations were performed: pretreatment (T0), post-intervention (T1), and at 16 weeks' follow-up (T2). The primary variable was joint-pain intensity (visual analogue scale). The secondary variables were conditioned pain modulation (Conditioned Pain Modulation Index), pressure pain threshold (pressure algometer), range of motion (goniometry) and kinesiophobia (Tampa Scale of Kinesiophophia). RESULTS There were intergroup differences in pain intensity (F = 37.14; p < 0.001), conditioned pain modulation (F = 5.40; p = 0.006), and dorsal (F = 19.17; p < 0.001) and plantar (F = 9.27; p<0.001) ankle flexion. More than 50% of experimental group patients exhibited changes exceeding the minimum detectable change in pain intensity (MDC = 0.43), and the pressure pain threshold in the extensor carpi radialis longus muscle (MDC = 1.34) and malleolus (MDC = 4.93). CONCLUSIONS 180º immersive video-based visualization of movement can improve the intensity of pain, conditioned pain modulation, and ankle range of motion in patients with haemophilic ankle arthropathy.
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Affiliation(s)
- Roberto Ucero-Lozano
- Department of Physiotherapy, European University of Madrid, Madrid, Spain; InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
| | - Raúl Pérez-Llanes
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain; Department of Physiotherapy, University of Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain; Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain.
| | - Elena Donoso-Úbeda
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain; Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
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Navarro-López V, Cardozo-Burgos L, Urbe-Murguizu U, Cancelas-Felgueras MD, Del-Valle-Gratacós M. Transcranial direct current stimulation in the management of pain in oncology patients. A systematic review and meta-analysis with meta-regression of randomized controlled trials. Disabil Rehabil 2024:1-11. [PMID: 39340309 DOI: 10.1080/09638288.2024.2399227] [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: 02/08/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE To evaluate the efficacy of transcranial direct current stimulation (tDCS) in pain management in subjects with oncologic process. MATERIAL AND METHODS Several databases were searched in December 2023. Randomized Controlled Trials that evaluated the application of tDCS on pain in adults with oncologic process were selected. Random-effects meta-analysis with 95%CI were used to quantify the change scores in pain between tDCS and control groups. RESULTS Six trials with 482 participants were included. There were significant differences in favor of tDCS in pain intensity in surgical oncology patients compared to sham stimulation (p < 0.001). Non-surgical patients showed no significant effect. Meta-regression analysis in this group of patients showed that the timing of the evaluation moderated the effect of tDCS on pain (p= .042), with longer time after tDCS being associated with greater pain reduction. CONCLUSIONS The application of a-tDCS for at least 20 min, with a current density higher than 0.057 mA/cm2, applied over M1, left DLPFC, or the insula area, between 2-5 sessions appears to be an effective and safe treatment of pain in surgical oncology patients compared to sham. The tDCS appears to be more effective for high-intensity pain, and in the long term.
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Affiliation(s)
- Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Chen JL, Ho ST, Yeh CC, Hsu YC, Cheng KI, Lin TC. Assessment of opioid knowledge and attitudes among senior medical students in Taiwan's pain education curriculum: A cross-sectional questionnaire survey. BMC MEDICAL EDUCATION 2024; 24:1045. [PMID: 39334303 PMCID: PMC11430801 DOI: 10.1186/s12909-024-06043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024]
Abstract
INTRODUCTION While the opioid crisis has been a significant concern in North America, Taiwan has not encountered a similar crisis. This study investigated medical students' perceptions of opioid therapy for chronic pain management in Taiwan. METHODS A cross-sectional questionnaire survey was conducted among third- and fourth-year medical students who had completed an 18-hour pain medicine curriculum, in comparison with those who did not take the course in Mar 2022 and May 2023. The survey assessed their knowledge, attitude, and perceptions of the opioid crisis in the United States and Taiwan. RESULTS In total, 135 (88.2%) of 153 senior medical students who had completed the curriculum responded to the survey. They exhibited a better understanding of opioids (P < 0.001) and held a more negative attitude toward opioid use (P = 0.011) compared with 105 students who did not take the course. Additionally, out of 240 respondents, 177 (73.8%) acknowledged the ongoing opioid crisis in the United States, while only 70 (29.2%) disagreed with the notion of an ongoing opioid crisis in Taiwan. Furthermore, 90% of all students expressed agreement with the need for further education on chronic pain management after graduation. CONCLUSION Among senior medical students in Taiwan, those who completed an elective pain medicine curriculum demonstrated enhanced knowledge of opioids, a more cautious attitude toward opioid use, and a willingness to receive further education on chronic pain management. Over 70% of students remained uncertain or incorrectly believed that there was an opioid crisis in Taiwan.
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Affiliation(s)
- Jia-Lin Chen
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Shung-Tai Ho
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Chun-Chang Yeh
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Yung-Chi Hsu
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Tso-Chou Lin
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan.
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Purcell C, Fullen B, Barry Walsh C, Van Oirschot G, Ward T, Caulfield B. 'Another world of pain'-athlete and sport physiotherapist perspectives on the unique experience of pain in sport. BMJ Open Sport Exerc Med 2024; 10:e002020. [PMID: 39345835 PMCID: PMC11429262 DOI: 10.1136/bmjsem-2024-002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 10/01/2024] Open
Abstract
Our objective was to explore athlete's and sports physiotherapists' experiences of sports-related pain in the upper and lower limb. Using a constructivist and pragmatic perspective, we carried out focus groups comprising a deliberate criterion sample of athletes and sports physiotherapists. We used a topic guide that moved from open exploratory questions to questions focusing on the phenomena of sports-related pain in athletes. We coded, developed candidate themes and refined finalised themes using reflexive thematic analysis. A member of our research team acted as a critical friend adding additional perspectives. We followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). We completed five focus groups comprising 12 athletes (n=5 female, n=7 male) and four sports physiotherapists (n=4 male) including one initial pilot (two athletes). We developed four final themes (1-4) and nine subthemes (1.1-4.3): (1) Athlete Pain Lens (1.1-pain is part of being an athlete and 1.2-pain shapes the life of an athlete), (2) Exploring And Navigating Pain (2.1-the sports-related pain spectrum and 2.2-making sense of pain), (3) The Emotional Toll of Pain (3.1-challenging emotions and 3.2-the impact of time) and (4) Coping, Community and Communication (4.1-coping with pain, 4.2-influence of community and support network and 4.3-communication, the broken key). We highlighted the distinct and challenging phenomenon of sports-related pain experienced by athletes and physiotherapists. Through effective communication, members of the athlete's community may recognise, and adjust to these challenges.
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Affiliation(s)
- Ciarán Purcell
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Leinster, Ireland
- Physiotherapy Department, School of Allied Health, University of Limerick, Limerick, Munster, Ireland
- Sports and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
| | - Brona Fullen
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Leinster, Ireland
| | - Caoimhe Barry Walsh
- Physiotherapy Department, School of Allied Health, University of Limerick, Limerick, Munster, Ireland
| | - Garett Van Oirschot
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Leinster, Ireland
| | - Tomas Ward
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
- School of Computing, Dublin City University, Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Leinster, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
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Hoffmeyer P. CORR Insights®: Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial. Clin Orthop Relat Res 2024:00003086-990000000-01748. [PMID: 39330963 DOI: 10.1097/corr.0000000000003265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Pierre Hoffmeyer
- Emeritus Professor of the Orthopaedic Surgery Department, University of Geneva, Geneva, Switzerland
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Morgner C, Dening KH, Dening T, Gibson B. An alternative theoretical approach to develop a new conception about pain in people with dementia. MEDICAL HUMANITIES 2024; 50:545-554. [PMID: 38802249 DOI: 10.1136/medhum-2023-012718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/29/2024]
Abstract
The theoretical approach presented in this paper describes a novel experimental-theoretical methodology to conceptualise pain in people with dementia. Existing procedures for assessment of pain rely on subjective self-report using pain questionnaires and rating scales that have proven to be highly problematic where a person has dementia. Consequently, pain in people with dementia can be undetected and/or undertreated. To address that, we have developed an alternative experimental approach that builds on theoretical and methodological precedents from the arts, humanities and social sciences, for instance, visual thinking strategies, creative thinking or two-step flow of communication. Based on this approach, we designed an experimental workshop setting to ingrate these methodologies to explore pain and its expression in people with dementia. This had led to a new definition of pain as an interruption of the socially mediated process of bodily meaning-making. Furthermore, our experimental methodology could equally well be applied as a training method, where professional staff can intervene into existing implicit meanings and understandings of medical issues. These results emphasise that the future of pain research needs to consider the relational aspects of pain more seriously.
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Affiliation(s)
| | | | - Tom Dening
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Barry Gibson
- School of Clinical Dentistry & The Healthy Lifespan Institute, The University of Sheffield, Sheffield, UK
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Hernandez-Tejada MA, Desrochers M, Acierno R. Grief on pain and quality of life in combat veterans with PTSD. Eur J Psychotraumatol 2024; 15:2402627. [PMID: 39292650 PMCID: PMC11411555 DOI: 10.1080/20008066.2024.2402627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/01/2024] [Accepted: 09/01/2024] [Indexed: 09/20/2024] Open
Abstract
Background: Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health.Objective: This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment.Method: Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression. Veterans experiencing grief reported symptoms related to physical health, emotional problems, energy, and fatigue, emotional well-being, social functioning, presence of pain, and general health. PCBD appeared to have a specific association with pain and physical functioning, independent of other variables.Conclusions: This study examined the potential independent association of PCBD on physical and mental health in Veterans with PTSD. PCBD appeared to have a very specific and significant association with pain and physical functioning. In other words, the pain of grief was related to ratings of physical pain. Future research on PCBD should address the potentially bidirectional association with bodily pain, particularly chronic pain, in relation to loss, with specific attention to potential mechanisms underlying this relationship.
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Affiliation(s)
- Melba A Hernandez-Tejada
- Trauma and Resilience Center, Louis A. Faillace, MD. Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Madeleine Desrochers
- Trauma and Resilience Center, Louis A. Faillace, MD. Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ron Acierno
- Trauma and Resilience Center, Louis A. Faillace, MD. Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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d'Ussel M, Sacco E, Moreau N, Nizard J, Durand G. Assessment of decision-making autonomy in chronic pain patients: a pilot study. BMC Med Ethics 2024; 25:97. [PMID: 39294638 PMCID: PMC11409763 DOI: 10.1186/s12910-024-01096-y] [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: 04/23/2024] [Accepted: 09/02/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Patient decision-making autonomy refers to the patients' ability to freely exert their own choices and make their own decisions, given sufficient resources and information to do so. In pain medicine, it is accepted that appropriate beneficial management aims to propose an individualized treatment plan shared with the patients, as agents, to help them live as autonomously as possible with their pain. However, are patients in chronic pain centers sufficiently autonomous to participate in the therapeutic decisions that concern them? As this question still remains unanswered, a pilot study was set up to that aim. METHODS Over a 2-month period, first-time patients within a tertiary multidisciplinary pain center underwent a systematic evaluation of their autonomy using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), considered the benchmark tool for measuring a patient's ability to consent to treatment. Demographic data and pain characteristics of the patients were collected and their respective attending pain physicians were asked to clinically assess their patients' degree of autonomy. Another physician, who had not participated in the initial patient evaluation, subsequently administered the MacCAT-T questionnaire to the same patients. RESULTS Twenty-seven patients were included during the study period (21 women and 6 men), with an average age of 50 years. The average duration of pain was 8 years. Based on their clinical experience, the 4 different pain physicians in charge of these patients considered that out of 25 assessed patients, 22 of them (89%) had full decision-making capacity, with no deficit in autonomy. According to the MacCAT-T results, only 13 of these 25 patients (48%) had no deficit, while 7 (26%) had a major deficit in autonomy. The only patient characteristic that appeared to be related to autonomy was pain type, specifically nociplastic pain. The average time taken to complete the test was 20 min, and patients were very satisfied with the interview. CONCLUSION Results from the present pilot study suggest that patients suffering from chronic pain do not appear to be entirely autonomous in their decision to consent to the proposed treatment plan according to the MacCAT-T questionnaire, and physicians seem to find it difficult to properly assess this competence in a clinical setting. Further studies with larger samples are needed to better evaluate this concept to improve the complex management of these patients.
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Affiliation(s)
| | - Emmanuelle Sacco
- Département de recherche clinique, Hôpital Paris Saint-Joseph, Paris, France
| | - Nathan Moreau
- Consultation Douleurs Chroniques Oro-Faciales - Service de Médecine bucco-dentaire, Hôpital Bretonneau, AP-HP, Paris, France
- UFR d'Odontologie, Faculté de Santé, Université Paris Cité, Paris, France
| | - Julien Nizard
- Service Douleur, Soins Palliatifs et de Support, CHU de Nantes, Éthique Clinique et UIC 22, Nantes, France
- Regenerative Medicine and Skeleton, UMRS INSERM-Oniris, Nantes Université, 1229-RMeS, Nantes, France
| | - Guillaume Durand
- Centre Atlantique de PHIlosophie (UR7463), Nantes Université , Nantes, France
- Consultation d'Éthique Clinique - Centre Hospitalier de Saint-Nazaire/Clinique Mutualiste de l'Estuaire, Saint-Nazaire, France
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Zhu H, Xiao Y, Xie T, Yang M, Zhou X, Xiao B, Peng J, Yang J. Effects of educational attainment on comorbidity of pain and depression in Chinese older adults. Heliyon 2024; 10:e37595. [PMID: 39290281 PMCID: PMC11407029 DOI: 10.1016/j.heliyon.2024.e37595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/02/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024] Open
Abstract
Pain and depression comorbidity (PD) among older adults in China is common and significantly affects their physical and mental health. The psychosocial factors may affect people's feelings, understanding and expression of pain and depression, leading to inaccurate assessment of this condition. Educational attainment is thought to be associated with either pain or depression. However, we do not yet know the relationship between educational attainment and PD. Using data from the 2018 China Health and Retirement Longitudinal Study in 2018, we analyzed various variables in 7742 individuals aged 60 years and older. Our results indicate significant differences between the PD and non-PD populations in terms of social, lifestyle, and behavioral factors. We observed a significant decrease in the incidence of PD among older adults with higher levels of education (p < 0.001). This association appears to be partially mediated by cognitive ability, suggesting that educational attainment may mitigate the risk of PD through cognitive enhancement. In addition, our analysis shows that the effect of educational attainment on PD is moderated by additional psychosocial factors, including living environment and alcohol consumption patterns. Older adults with higher levels of education tend to live in urban areas and have better control over alcohol consumption, which may contribute to a lower incidence of PD. Therefore, interventions aimed at enhancing cognitive abilities, improving living environments, and promoting healthier lifestyles and habits among older adults could potentially reduce their burden of PD.
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Affiliation(s)
- Haiyan Zhu
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, China
| | - Yang Xiao
- Department of Urology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, China
| | - Tongjin Xie
- Department of Urology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, China
| | - Mohan Yang
- Department of Urology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, China
| | - Xun Zhou
- Department of Urology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, China
| | - Biao Xiao
- Department of Urology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, China
| | - Jingxuan Peng
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Jianfu Yang
- Department of Urology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, China
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Le Roux J, van Rensburg DJ, den Hollander S, Kerkhoffs G, Gouttebarge V. Pain, impairment, medication use and health-related quality of life of retired professional rugby players. SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2024; 36:v36i1a17651. [PMID: 39355554 PMCID: PMC11444486 DOI: 10.17159/2078-516x/2024/v36i1a17651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2024] Open
Abstract
Background Rugby is a physically demanding sport with a high injury rate. Professional male rugby players have a notably greater risk of sustaining injuries that require hospitalisation or surgery than male athletes from non-contact sports. Retired elite male rugby players experience physical and mental health conditions as well as varying levels of pain, negatively impacting their quality of life. Retired rugby players could use medication or substances as a coping mechanism to deal with chronic pain and a lower quality of life. However, research is scarce on how retired rugby players manage pain and how this affects their quality of life. Objectives This study aimed to understand joint pain and impairment, mental and physical quality of life, and pain medication use in retired professional male rugby players. Methods A cross-sectional study was conducted using a questionnaire completed by retired professional male rugby players. Joint pain and impairment were explored through three questions, health-related quality of life was assessed through the PROMIS-GH, and medication use was explored through 12 questions. Results Retired rugby players (N=142) reported higher scores than matched controls (N=49) for joint pain and impairment, including significantly higher scores for joint impairments for activities of daily living (p=0.047). The global mental health scores of retired rugby players were significantly lower compared to matched controls (p=0.043) and the global physical health scores were also lower in retired rugby players. Most retired rugby players reported not using prescription pain medication (75%) or over-the-counter pain medication (56%). Conclusion Professional rugby careers have a considerable impact on the joint health and overall well-being of retired players, resulting in unique challenges. The findings of this study emphasise the need for specific after-career support for challenges faced by retired rugby players.
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Affiliation(s)
- J Le Roux
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dc Janse van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - S den Hollander
- Division of Physiological Sciences and Health Through Physical Activity, Lifestyle and Sport (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Gmmj Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Ageing & Vitality, Amsterdam, The Netherlands
| | - V Gouttebarge
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Ageing & Vitality, Amsterdam, The Netherlands
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Gupta A, Vejapi M, Knezevic NN. The role of nitric oxide and neuroendocrine system in pain generation. Mol Cell Endocrinol 2024; 591:112270. [PMID: 38750811 DOI: 10.1016/j.mce.2024.112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/13/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Previous studies have indicated a complex interplay between the nitric oxide (NO) pain signaling pathways and hormonal signaling pathways in the body. This article delineates the role of nitric oxide signaling in neuropathic and inflammatory pain generation and subsequently discusses how the neuroendocrine system is involved in pain generation. Hormonal systems including the hypothalamic-pituitary axis (HPA) generation of cortisol, the renin-angiotensin-aldosterone system, calcitonin, melatonin, and sex hormones could potentially contribute to the generation of nitric oxide involved in the sensation of pain. Further research is necessary to clarify this relationship and may reveal therapeutic targets involving NO signaling that alleviate neuropathic and inflammatory pain.
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Affiliation(s)
- Aayush Gupta
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Rosalind Franklin University of Medicine and Science, USA
| | - Maja Vejapi
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA.
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44
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Song C, Qiu J, Luo M, Fu Y, Hu S, Liu W, Zhang D, Chen M, Cao Z, Yang X, Ke B. Identification of N-(((1S,3R,5S)-adamantan-1-yl)methyl)-3-((4-chlorophenyl)sulfonyl)benzenesulfonamide as novel Nav1.8 inhibitor with analgesic profile. Bioorg Med Chem Lett 2024; 110:129862. [PMID: 38944398 DOI: 10.1016/j.bmcl.2024.129862] [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: 05/24/2024] [Revised: 06/13/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
Chronic pain is a common and challenging clinical problem that significantly impacts patients' quality of life. The sodium channel Nav1.8 plays a crucial role in the occurrence and development of chronic pain, making it one of the key targets for treating chronic pain. In this article, we combined virtual screening with cell membrane chromatography techniques to establish a novel method for rapid high-throughput screening of selective Nav1.8 inhibitors. Using this approach, we identified a small molecule compound 6, which not only demonstrated high affinity and inhibitory activity against Nav1.8 but also exhibited significant inhibitory effects on CFA-induced chronic inflammatory pain. Compared to the positive drug VX-150, compound 6 showed a more prolonged analgesic effect, making it a promising candidate as a Nav1.8 inhibitor with potential clinical applications. This discovery provides a new therapeutic option for the treatment of chronic pain.
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Affiliation(s)
- Chi Song
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Jie Qiu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Menglan Luo
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Yihang Fu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Shilong Hu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Wencheng Liu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Di Zhang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Meiyuan Chen
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Zhihua Cao
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China
| | - Xi Yang
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Bowen Ke
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041 Sichuan, China.
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Velasco E, Flores-Cortes M, Guerra-Armas J, Flix-Díez L, Gurdiel-Álvarez F, Donado-Bermejo A, van den Broeke EN, Pérez-Cervera L, Delicado-Miralles M. Is chronic pain caused by central sensitization? A review and critical point of view. Neurosci Biobehav Rev 2024:105886. [PMID: 39278607 DOI: 10.1016/j.neubiorev.2024.105886] [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: 05/29/2024] [Revised: 08/28/2024] [Accepted: 09/09/2024] [Indexed: 09/18/2024]
Abstract
Chronic pain causes disability and loss of health worldwide. Yet, a mechanistic explanation for it is still missing. Frequently, neural phenomena, and among them, Central Sensitization (CS), is presented as causing chronic pain. This narrative review explores the evidence substantiating the relationship between CS and chronic pain: four expert researchers were divided in two independent teams that reviewed the available evidence. Three criteria were established for a study to demonstrate a causal relationship: (1) confirm presence of CS, (2) study chronic pain, and (3) test sufficiency or necessity of CS over chronic pain symptoms. No study met those criteria, failing to demonstrate that CS can cause chronic pain. Also, no evidence reporting the occurrence of CS in humans was found. Worryingly, pain assessments are often confounded with CS measures in the literature, omitting that the latter is a neurophysiological and not a perceptual phenomenon. Future research should avoid this misconception to directly interrogate what is the causal contribution of CS to chronic pain to better comprehend this problematic condition.
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Affiliation(s)
- Enrique Velasco
- Laboratory of Ion Channel Research, VIB-KU Leuven Center for Brain & Disease Research, Leuven, Belgium. Department of Cellular and Molecular Medicine, KU Leuven, Belgium; Neuroscience in Physiotherapy (NiP), independent research group, Elche, Spain.
| | - Mar Flores-Cortes
- International Doctorate School, Faculty of Health Sciences, University of Málaga, 29071, Málaga, Spain
| | - Javier Guerra-Armas
- International Doctorate School, Faculty of Health Sciences, University of Málaga, 29071, Málaga, Spain
| | - Laura Flix-Díez
- Department of Otorrinolaryngology, Clínica Universidad de Navarra, University of Navarra, Madrid, Spain
| | - Francisco Gurdiel-Álvarez
- International Doctorate School, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain. Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28032 Madrid, Spain
| | - Aser Donado-Bermejo
- International Doctorate School, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain. Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28032 Madrid, Spain
| | | | - Laura Pérez-Cervera
- Neuroscience in Physiotherapy (NiP), independent research group, Elche, Spain
| | - Miguel Delicado-Miralles
- Neuroscience in Physiotherapy (NiP), independent research group, Elche, Spain; Department of Pathology and Surgery. Physiotherapy Area. Faculty of Medicine, Miguel Hernandez University, Alicante, Spain
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46
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Xing Y, Yang K, Lu A, Mackie K, Guo F. Sensors and Devices Guided by Artificial Intelligence for Personalized Pain Medicine. CYBORG AND BIONIC SYSTEMS 2024; 5:0160. [PMID: 39282019 PMCID: PMC11395709 DOI: 10.34133/cbsystems.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 08/01/2024] [Accepted: 08/14/2024] [Indexed: 09/18/2024] Open
Abstract
Personalized pain medicine aims to tailor pain treatment strategies for the specific needs and characteristics of an individual patient, holding the potential for improving treatment outcomes, reducing side effects, and enhancing patient satisfaction. Despite existing pain markers and treatments, challenges remain in understanding, detecting, and treating complex pain conditions. Here, we review recent engineering efforts in developing various sensors and devices for addressing challenges in the personalized treatment of pain. We summarize the basics of pain pathology and introduce various sensors and devices for pain monitoring, assessment, and relief. We also discuss advancements taking advantage of rapidly developing medical artificial intelligence (AI), such as AI-based analgesia devices, wearable sensors, and healthcare systems. We believe that these innovative technologies may lead to more precise and responsive personalized medicine, greatly improved patient quality of life, increased efficiency of medical systems, and reducing the incidence of addiction and substance use disorders.
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Affiliation(s)
- Yantao Xing
- Department of Intelligent Systems Engineering, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Kaiyuan Yang
- Department of Intelligent Systems Engineering, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Albert Lu
- Department of Intelligent Systems Engineering, Indiana University Bloomington, Bloomington, IN 47405, USA
- Culver Academies High School, Culver, IN 46511, USA
| | - Ken Mackie
- Gill Center for Biomolecular Science, Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Feng Guo
- Department of Intelligent Systems Engineering, Indiana University Bloomington, Bloomington, IN 47405, USA
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47
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Espírito Santo J, Moita J, Nunes A. The Efficacy of Manual Therapy on Musculoskeletal Pain in Menopause: A Systematic Review. Healthcare (Basel) 2024; 12:1838. [PMID: 39337178 PMCID: PMC11431219 DOI: 10.3390/healthcare12181838] [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: 07/19/2024] [Revised: 09/04/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
(1) Background: The aim of this review was to evaluate the effects of manual therapy for musculoskeletal pain in menopausal women. (2) Methods: A comprehensive search of manuscripts published from inception until 29 February 2024 was conducted on PubMed, EBSCO Information Services (EBSCOhost), Physiotherapy Evidence Database (Pedro), Web of Science, Scientific Electronic Library Online (SciELO), Cochrane Central Register of Controlled Clinical Trials, and Scopus using Medical Subject Headings (MeSH) and free terms. Randomized controlled trials (RCT) investigating the effects of manual therapy for musculoskeletal pain in postmenopausal women were included. Articles published in non-English or non-Portuguese languages, case reports, expert opinions, dissertations, conference papers, and gray literature were excluded. Studies were screened for population, musculoskeletal pain, intervention, and pain outcome by two independent reviewers using an ad hoc data extraction form. (3) Results: A total of 5 RCTs (4 with high risk of bias and 1 with low risk of bias) were included (total sample = 245), addressing thumb carpometacarpal osteoarthritis, thoracic kyphosis, chronic neck and backache, knee osteoarthritis, and sternocostal joint pain. The combined results of these studies showed improved musculoskeletal pain in menopausal women; duration of the follow-up was between 4 weeks to 6 months. Conclusions: The majority of studies included in this systematic review were effective in reducing musculoskeletal pain in menopausal women. These results come mainly from studies with a high risk of bias with small sample sizes, and the most representative follow-up period was short-term. Therefore, the results of this systematic review should be interpreted with caution.
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Affiliation(s)
- João Espírito Santo
- Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal; (J.M.); (A.N.)
- Portugal National Centre, Foundation COME Collaboration, 8125-196 Quarteira, Portugal
- Escola Superior de Educação de Beja, Instituto Politécnico de Beja, 7800-111 Beja, Portugal
| | - João Moita
- Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal; (J.M.); (A.N.)
- Portugal National Centre, Foundation COME Collaboration, 8125-196 Quarteira, Portugal
| | - Alexandre Nunes
- Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal; (J.M.); (A.N.)
- Portugal National Centre, Foundation COME Collaboration, 8125-196 Quarteira, Portugal
- Escola Superior de Saúde Jean Piaget do Algarve, 8300-025 Silves, Portugal
- Insight: Centro de Investigação Piaget para o Desenvolvimento Humano e Ecológico, 1950-157 Lisboa, Portugal
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48
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García-Domínguez M. Chronic pain in the elderly: Exploring cellular and molecular mechanisms and therapeutic perspectives. FRONTIERS IN AGING 2024; 5:1477017. [PMID: 39328834 PMCID: PMC11424521 DOI: 10.3389/fragi.2024.1477017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024]
Abstract
Chronic pain is a debilitating condition frequently observed in the elderly, involving numerous pathological mechanisms within the nervous system. Diminished local blood flow, nerve degeneration, variations in fiber composition, alterations in ion channels and receptors, accompanied by the sustained activation of immune cells and release of pro-inflammatory cytokines, lead to overactivation of the peripheral nervous system. In the central nervous system, chronic pain is strongly associated with the activation of glial cells, which results in central sensitization and increased pain perception. Moreover, age-related alterations in neural plasticity and disruptions in pain inhibitory pathways can exacerbate chronic pain in older adults. Finally, the environmental influences on the development of chronic pain in the elderly must be considered. An understanding of these mechanisms is essential for developing novel treatments for chronic pain, which can significantly improve the quality of life for this vulnerable population.
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Affiliation(s)
- Mario García-Domínguez
- Program of Immunology and Immunotherapy, CIMA-Universidad de Navarra, Pamplona, Spain
- Department of Immunology and Immunotherapy, Clínica Universidad de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
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49
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Lu YY, Lin CY, Lu CC, Tsai HP, Wang WT, Zhang ZH, Wu CH. Bleomycin triggers chronic mechanical nociception by activating TRPV1 and glial reaction-mediated neuroinflammation via TSLP/TSLPR/pSTAT5 signals. Brain Res Bull 2024; 217:111081. [PMID: 39277019 DOI: 10.1016/j.brainresbull.2024.111081] [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: 06/23/2024] [Revised: 09/02/2024] [Accepted: 09/11/2024] [Indexed: 09/17/2024]
Abstract
Chronic pain is a universal public health problem with nearly one third of global human involved, which causes significant distressing personal burden. After painful stimulus, neurobiological changes occur not only in peripheral nervous system but also in central nervous system where somatosensory cortex is important for nociception. Being an ion channel, transient receptor potential vanilloid 1 (TRPV1) act as an inflammatory detector in the brain. Thymic stromal lymphopoietin (TSLP) is a potent neuroinflammation mediator after nerve injury. Bleomycin is applied to treat dermatologic diseases, and its administration elicits local painful sensation. However, whether bleomycin administration can cause chronic pain remains unknown. In the present study, we aimed to investigate how mice develop chronic pain after receiving repeated bleomycin administration. In addition, the relevant neurobiological brain changes after noxious stimuli were clarified. C57BL/6 mice aged five- to six-weeks were randomly classified into two group, PBS (normal) group and bleomycin group which bleomycin was intradermally administered to back five times a week over a three-week period. Calibrated forceps testing was used to measure mouse pain threshold. Western blots were used to assess neuroinflammatory response; immunofluorescence assay was used to measure the status of neuron apoptosis, glial reaction, and neuro-glial communication. Bleomycin administration induced mechanical nociception and activated both TRPV1 and TSLP/TSLPR/pSTAT5 signals in mouse somatosensory cortex. Through these pathways, bleomycin not only activates glial reaction but also causes neuronal apoptosis. TRPV1 and TSLP/TSLPR/pSTAT5 signaling had co-labeled each other by immunofluorescence assay. Taken together, our study provides a new chronic pain model by repeated intradermal bleomycin injection by activating TRPV1 and glial reaction-mediated neuroinflammation via TSLP/TSLPR/pSTAT5 signals.
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Affiliation(s)
- Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 813; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung 804, Taiwan; Department of Health and Beauty, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan
| | - Chia-Yang Lin
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Chun-Ching Lu
- Department of Orthopaedics and Traumatology, National Yang Ming Chiao Tung University Hospital, Yilan 260006, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan
| | - Hung-Pei Tsai
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Wei-Ting Wang
- National Defense Medical Center, Department of Radiology, Tri-Service General Hospital, Taipei City 114202, Taiwan
| | - Zi-Hao Zhang
- Department of Neurosurgery, Xinle City Hospital, Xinle, Hebei 050700, PR China
| | - Chieh-Hsin Wu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
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50
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Qi JY, Jin YC, Wang XS, Yang LK, Lu L, Yue J, Yang F, Liu YS, Jiang YL, Song DK, Lv T, Li XB, Zhang K, Liu SB. Ruscogenin Exerts Anxiolytic-Like Effect via Microglial NF-κB/MAPKs/NLRP3 Signaling Pathways in Mouse Model of Chronic Inflammatory Pain. Phytother Res 2024. [PMID: 39267167 DOI: 10.1002/ptr.8325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/22/2024] [Accepted: 08/17/2024] [Indexed: 09/14/2024]
Abstract
Long-term inflammation can cause chronic pain and trigger patients' anxiety by sensitizing the central nervous system. However, effective drugs with few side effects for treating chronic pain-induced anxiety are still lacking. The anxiolytic and anti-inflammatory effects of ruscogenin (RUS), an important active compound in Ophiopogon japonicus, were evaluated in a mouse model of chronic inflammatory pain and N9 cells. RUS (5, 10, or 20 mg/kg/day, i.g.) was administered once daily for 7 days after CFA injection; pain- and anxiety-like behaviors were assessed in mice. Anti-inflammatory effect of RUS (0.1, 1, 10 μM) on N9 microglia after LPS treatment was evaluated. Inflammatory markers (TNF-α, IL-1β, IL-6, CD86, IL-4, ARG-1, and CD206) were measured using qPCR. The levels of IBA1, ROS, NF-κB, TLR4, P-IKK, P-IκBα, and P65, MAPKs (ERK, JNK, and P38), NLRP3 (caspase-1, ASC, and NLRP3) were detected by Western blotting or immunofluorescence staining. The potential target of RUS was validated by molecular docking and adeno-associated virus injection. Mice in CFA group exhibited allodynia and anxiety-like behaviors. LPS induced neuroinflammation in N9 cells. Both CFA and LPS increased the levels of IBA1, ROS, and inflammatory markers. RUS (10 mg/kg in vivo and 1 μM in vitro) alleviated these alterations through NF-κB/MAPKs/NLRP3 signaling pathways but had no effect on pain hypersensitivity. TLR4 strongly interacted with RUS, and TLR4 overexpression abolished the effects of RUS on anxiety and neuroinflammation. RUS exerts anti-inflammatory and anxiolytic effects via TLR4-mediated NF-κB/MAPKs/NLRP3 signaling pathways, which provides a basis for the treatment of chronic pain-induced anxiety.
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Affiliation(s)
- Jing-Yu Qi
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Pharmacy, School of Stomatology, Fourth Military Medical University, Xi'an, China
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
- Department of Pharmacy, The Air Force Hospital of Eastern Theater Command, Nanjing, China
| | - Yu-Chen Jin
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Pharmacy, School of Stomatology, Fourth Military Medical University, Xi'an, China
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Xin-Shang Wang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Pharmacy, School of Stomatology, Fourth Military Medical University, Xi'an, China
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Liu-Kun Yang
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Liang Lu
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Jiao Yue
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Pharmacy, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Fan Yang
- Precision Pharmacy & Drug Development Center, Department of Pharmacy, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yong-Sheng Liu
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Yong-Li Jiang
- Precision Pharmacy & Drug Development Center, Department of Pharmacy, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Da-Ke Song
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Pharmacy, School of Stomatology, Fourth Military Medical University, Xi'an, China
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Tao Lv
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Xu-Bo Li
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Kun Zhang
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Shui-Bing Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Pharmacy, School of Stomatology, Fourth Military Medical University, Xi'an, China
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
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