Pain Management

The ‘Opioid Crisis’, which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid-related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses […]

Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a seven-year period from a population-based sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. […]

Adverse life events (ALEs) are a risk factor for chronic pain; however, mechanisms underlying this association are not understood. This study examined whether cumulative ALE exposure impairs endogenous inhibition of pain (assessed from pain report) and spinal nociception (assessed from nociceptive flexion reflex; NFR) in healthy, pain-free Native Americans (n=124) and non-Hispanic Whites (n=129) during […]

To examine the “age-related positivity effect” and its sex differences in the pain-depression relationship among Chinese community-dwelling older adults.Cross-sectional design.The study was conducted with a sample of 1,913 older adults in Jinan, China. Data were collected on pain intensity, age, sex, depressive symptoms, and potential covariates.The hierarchical linear regression analyses revealed that pain intensity was […]

Localized provoked vulvodynia (LPV) is the most common cause of chronic dyspareunia in premenopausal women, characterized by pain with light touch to the vulvar vestibule surrounding the vaginal opening. The devastating impact of LPV includes sexual dysfunction, infertility, depression, and even suicide. Yet, its etiology is unclear. No effective medical therapy exists; surgical removal of […]

To combat the opioid epidemic, prescribers need accurate information about pediatric home opioid requirements to manage acute pain after surgery. Current opioid use estimates come from retrospective surveys; this study used medication adherence technology (eCAP) to track home opioid use.To describe children’s pain treatment at home after laparoscopic appendectomy, and to compare self-reported opioid analgesic […]

The purpose of the study was to investigate factors associated with early discontinuation of low-dose ketamine infusions due to adverse drug events (ADEs).A retrospective, matched case-control study of surgical patients who received low-dose ketamine infusions for postoperative pain over 6 years was conducted. Forty-seven study patients, who required early discontinuation of their infusion due to […]

The way people respond to pain is based on psychological mechanisms, beliefs and expectations. Mindfulness meditation (MM) has been shown to regulate pain and mental suffering through different mechanisms such as positive reappraisal, attentional and emotional regulation. Yet, subjective experience and meaning of pain in connection with MM are still largely unexplored.The present mixed-methods study […]

The aims of this longitudinal study were to 1) identify categories of adverse childhood experiences (ACEs) (i.e., neglect, abuse, household dysfunction in childhood) that increase risk for internalizing mental health problems, pain-related impairment, and poorer quality of life and 2) examine the moderating role of posttraumatic stress symptoms (PTSS) in these associations, in a clinical […]

Lidocaine continuous subcutaneous infusion (L-CSCI) for neuropathic pain in hospice patients has limited evidence for its safety and efficacy, and guidelines are lacking. This study assesses a series of patients admitted to a hospice over a six-month period that had neuropathic pain and received L-CSCI. The primary outcome was improvement in patient-rated distress from pain […]

Recent studies in pediatric patients have suggested that ketamine, an N-methyl-D-aspartate receptor (NMDA) antagonist, given at sub-anesthetic doses can effectively decrease pain scores, provide analgesic effects, and in some cases, reduce opioid requirements. Our study aims to assess impact of low-dose ketamine on reducing pain scores and total opioid requirements during an acute pain crisis […]

Together, neck pain and back pain are the first cause of disability worldwide, accounting for more than 10% of the total years lived with disability. In this context, chiropractic care provides a safe and effective option for the management of a large proportion of these patients. Chiropractic is a healthcare profession mainly focused on the […]

The sacroiliac joint (SIJ) is a common source of pain in patients with low back pain. Untreated pain from the SIJ can lead to prolonged discomfort and financial burden. Interventional treatments for SIJ-related pain include intraarticular steroid injection and radiofrequency ablation but both procedures provide pain relief for a limited duration. Cryoneurolysis is another neuroablative […]

A 21-year-old otherwise healthy male with severe asymptomatic mitral regurgitation underwent a mitral valve repair via right thoracotomy and right femoral cannulation for cardiopulmonary bypass. Due to his age and health status, the anesthetic was planned to facilitate early extubation. Immediately on arrival to the intensive care unit, the patient complained of severe right calf […]

Opioid-induced hyperalgesia (OIH) occurs when opioids paradoxically enhance the pain they are prescribed to ameliorate. To address a lack of perioperative awareness, we present an educational review of clinically relevant aspects of the disorder. Although the mechanisms of OIH are thought to primarily involve medullary descending pathways, it is likely multifactorial with several relevant therapeutic targets. We […]

Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a common, difficult-to-treat, and dose-limiting side effect associated with Oxaliplatin (OXA) treatment. In this study, we evaluated the effect of three antioxidants – namely N-acetylcysteine, α-lipoic acid and vitamin E – upon nociceptive parameters and antitumor efficacy of OXA in a tumor-bearing Swiss mice model. Oral treatment with antioxidants inhibited […]

The use and impact of guided imagery in the acute care setting is limited.The purpose of this quality improvement project was to evaluate the feasibility of a guided imagery intervention to change pain scores, anxiety scores, and opioid analgesia usage among hospitalized adults in an acute care setting.Quality improvement project using three measurements (baseline, 24 […]

The technique of radiofrequency neurotomy (RFN) of the facet joints has been used for decades to treat persistent low back pain to good effect in carefully selected patients. Traditionally, the target is the medial branches of the dorsal root supplying the facet joint. An alternative denervation target is the facet joint capsule. Capsule-targeting techniques may […]

Fibromyalgia Syndrome (FMS) is a chronic centralized pain disorder characterized by widespread pain and fatigue. Of those affected by FMS, the majority are women, and minimal research exists involving men. The purpose of this paper is to describe the pain and fatigue experiences of men with FMS from two Western countries, Spain and the United […]

One of the most widely used instruments to identify symptoms that may be related to central sensitization is the Central Sensitization Inventory (CSI). Although this instrument has been translated and validated in Spanish patients with chronic musculoskeletal pain, no psychometric analysis has been carried out in breast cancer survivors. The aim of this study was […]

Chronic pain is a major public health concern, as is the associated use of opioid medications, highlighting the importance of alternative treatments such as spinal cord stimulation (SCS). Here we present the final 24-month results of the Avalon study which investigated the use of the first closed-loop SCS system in chronic pain patients. The system […]

Introduction: Knee osteoarthritis is a degenerative joint disease that is secondary to degradation of articular cartilage, reformation of subchondral bone through degradation and proliferation as well as presence of synovitis. Materials & methods: This systematic review was conducted and reported as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: A total of 30 […]

Despite emerging evidence of associations between dysmenorrhea, enhanced pain sensitivity, and functional neuroimaging patterns consistent with chronic pain, it is unknown whether dysmenorrhea is prospectively associated with chronic pain development. Gaining a better understanding of this relationship could inform efforts in prevention of chronic pain. Using data from the national Midlife in the United States […]

Guidelines recommend self-management for most people living with persistent musculoskeletal low back pain (PMLBP) when surgery is ruled out. Conveying this message to patients can be challenging. This study examined patients’ perceptions of reassuring communications from surgical spine team practitioners attempting to deliver this message in a single consultation.Pre-consultation baseline measures included levels of pain, […]

In recent years, the delivery of health services has undergone a major paradigm shift towards expanded outpatient services and widespread use of telemedicine. Post herpetic neuralgia (PHN) is a treatment recalcitrant neuropathic pain condition referring to pain persisting more than three months from the initial onset of an acute herpes zoster. QUTENZA® (capsaicin 8% patch) […]

As in other fields of medicine, development of new medications for management of neuropathic pain has been difficult since preclinical rodent models do not necessarily translate to the clinics. Aside from ongoing pain with burning or shock-like qualities, neuropathic pain is often characterized by pain hypersensitivity (hyperalgesia and allodynia), most often towards mechanical stimuli, reflecting […]

Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size, suggests that visual illusions used to target central processing could restore coherence of […]

The purpose of the current study was to determine whether auditory prepulse inhibition (PPI) and/or prepulse facilitation (PPF) were altered in people with fibromyalgia (FM) when compared with controls. Eyeblink responses were recorded from 29 females with FM and 27 controls, while they listened to three blocks of auditory stimuli that delivered pulses with either […]

Distraction tasks that place continuous, high demand on executive resources have been shown to reduce pain intensity and pain unpleasantness ratings in healthy adult samples. We examined the effects of a high-demand ‘working memory’ 1-back task compared to a low-demand ‘motor control’ task on pain intensity and unpleasantness ratings in healthy children. Additionally, dispositional mindfulness […]

Preclinical and clinical pain science have since long suffered from lack of joint ventures that, as securely as possible, have approached problems that are relevant for the understanding of clinical pain phenomenologies and treatment (Yezierski & Hansson, 2018), the core of translational pain medicine. The uncoupling of the two has led to loss of momentum […]

The Multidimensional Pain Inventory (MPI) is frequently used in the assessment of chronic pain. Three subgroups have been derived from MPI: Adaptive Coper (AC), Dysfunctional (DYS) and Interpersonally Distressed (ID). The primary aim of was to examine whether outcome of Interdisciplinary Multimodal Pain Rehabilitation Programs (IMMRPs) differed across the MPI subgroups.Chronic pain patients (N=34 513), […]

This study aimed to explore the application value of nalbuphine in pulsed radiofrequency operation of trigeminal ganglion in patients with postherpetic neuralgia (PHN). Thirty patients with PHN were randomly divided into the nalbuphine (Nalbu) group and ketorolac tromethamine (KT) group and received CT-guided pulsed radiofrequency surgery on trigeminal ganglion. The numeric rating scale (NRS) scores […]

Only few studies have investigated the prevalence and risk factors of headaches among the Saudi population. The study aimed to estimate the prevalence of headache and to explore its associated risk factors Al-Kharj, Saudi Arabia.The multistage sampling technique was used to enroll 1200 population-based participants who were asked to complete a self-administered questionnaire about headaches, […]

Hospitalized children experience moderate-to-severe pain after laparoscopic appendectomy, but knowledge of children’s pain experiences after discharge home is limited. Accurate pain assessments are needed to guide appropriate pain treatment.To describe children’s pain at home after laparoscopic appendectomy.Prospective exploratory and descriptive METHODS: A convenience sample of 100 patients, aged 10-17 years, who spoke or wrote in […]

Fifty million American adults have chronic pain, and nearly 20 million have high-impact, or disabling, chronic pain, with higher prevalence associated with advancing age. Patient-centered pain management has been cited as a national priority to ensure that patient values and preferences guide clinical decisions. However, explicit, and practical strategies for implementing patient-centered pain management have […]

Neoplasm-related pain is often suboptimally treated, contributing to avoidable suffering and increased medical resource use and costs. We hypothesized that dementia may contribute to increased resource use and costs in patients hospitalized for neoplasm-related pain in the United States.To examine how persons with cancer and dementia use medical resources and expenditures in US hospitals compared […]

Unlike motor symptoms, the effects of deep brain stimulation (DBS) on non-motor symptoms associated with dystonia remain unknown.The objective of this study was to assess the effects of DBS on evoked experimental pain and cutaneous sensory thresholds in a crossover, double-blind on/off study and compare these results with those of healthy volunteers (HV).Sixteen patients with […]

Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity […]

Remifentanil, a rapid onset rapid offset synthetic opioid and potent analgesic, is often used for procedural conscious sedation in spontaneous ventilation, especially when delivered in target controlled infusion (TCI), which allows precise titration. We assessed efficacy, tolerance, and adverse events related with the use of remifentanil TCI during various procedures.Prospective, observational.Two teaching hospitals.We enrolled 434 […]

To determine the incidence of addiction and dependence in persons with chronic noncancer pain (CNCP) who are treated with oxycodone.Systematic review following PRISMA guidelines.PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library were searched from inception to January 2020. Of 1,320 retrieved citations screened by two independent raters at title and abstract and full-text screening, six […]

To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.Mixed-methods study with survey collection and semistructured interviews.Multiple academic hospitals in New York.One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and […]

The aim of this study was to assess the introduction of an analgesic ladder and targeted education on oxycodone use for patients presenting to the emergency department (ED).A retrospective pre-post implementation study was conducted. Data were extracted for patients presenting from June to July 2016 (preintervention) and June to July 2017 (post-intervention).The EDs of a […]

The limited access to opioids remains a reality in developing countries. Recent evidence suggests that opioid epidemics are getting worse with the COVID-19 crisis. The increase in opioid abuse could be attributed to the extended lockdowns and the social distancing recommendations, hindering chronic pain patients’ access to regular office visits and monitoring in addition to […]

We examined changes in opioid prescriptions after outpatient laparoscopic cholecystectomy (LC) before and after (1) an educational intervention for surgical residents and (2) subsequent changes in state regulations for handling these prescriptions.A single-institution retrospective review evaluated opioids prescribed on discharge in morphine milligram equivalents (MMEs) over three periods: Period 1, prior to educational intervention (October […]

The opioid epidemic is a public health crisis in the United States (US) and is associated with devastating consequences, including opioid misuse and related overdose. In response to the opioid crisis, the US Department of Health and Human Services is advancing improved practices in pain management. Strategies to help mitigate opioid risks include physician safety […]

The coronavirus disease 2019 (COVID-19) pandemic has had harmful effects on the opioid epidemic. While a negative effect was predicted, we report on this reality in the hospital setting. We have seen a sharp rise in hospitalized patients with opioid use disorder (OUD). Our data should encourage ongoing efforts to reduce barriers in accessing medications […]

To investigate the associations between temporomandibular disorders (TMDs) and sleep disorders in adult subjects.The PubMed, Embase, Evidence-Based Medicine Reviews, and ProQuest Dissertations & Theses databases were searched for studies published in English up to September 2019. Unpublished/gray literature and reference lists of identified articles were also examined. Inclusion criteria were male and female adults, presence […]

Inflammatory Bowel Disease (IBD) is a life-long disorder that often begins between the ages of 15 and 30. Anecdotal reports suggest cannabinoids may be an effective treatment. This study sought to determine whether home cage wheel running is an effective method to assess IBD, and whether THC, the primary psychoactive compound in cannabis, can restore […]

To evaluate the diagnostic value of non-nerve-selective MRI sequences in posttraumatic trigeminal neuropathic pain (PTNP).This study retrospectively analyzed all MRI protocols performed between February 2, 2012 and June 20, 2018 commissioned by the Department of Oral and Maxillofacial Surgery, University Hospitals Leuven. Demographic, clinical, and radiologic data were extracted from the records of patients with […]

Misuse of prescription opioids is a public health crisis in the United States. In 2016, it was estimated that 3.3 million Americans were misusing prescription opioids (SAMHSA, 2017) and nearly 63,632 deaths were due to prescription opioid misuse. From 1999 to 2010, the number of prescription opioid drugs sold to health care facilities from pharmaceutical […]

To review randomized clinical trials on arthrocentesis for managing temporomandibular disorders (TMD) and to discuss the clinical implications.On March 10, 2019, a systematic search of relevant articles published over the last 20 years was performed in PubMed, as well as in Scopus, the authors’ personal libraries, and the reference lists of included articles. The focus […]

To investigate the effect of masticatory muscle contraction on the pressure pain threshold (PPT) of the lateral pole of the temporomandibular joint (TMJ) in patients with TMJ arthralgia and in asymptomatic individuals.A total of 72 individuals divided into two groups (group 1: patients with unilateral TMJ arthralgia [n = 36]; group 2: control group, asymptomatic […]

To test the feasibility and acceptability of a customized six-session cognitive behavioral therapy (CBT) group intervention for adults with recurrent trigeminal neuralgia (TN).Fifteen participants with TN were recruited from a specialist facial pain unit in London, United Kingdom. The effects of the group intervention were evaluated using validated self-report measures, which the participants completed before […]

To investigate whether localized sensitization of the sternocleidomastoid (SCM) muscle using nerve growth factor (NGF) would affect masseter and anterior temporalis muscle sensitivity and pain profiles.A total of 28 healthy participants attended two sessions (T0 and T1). At T0, the maximum voluntary occlusal bite force (MVOBF), as well as pressure pain thresholds (PPT), mechanical sensitivity, […]

The bidirectional relationship between pain and working memory (WM) deficits is well-documented but poorly understood. Pain catastrophizing – exaggerated, negative cognitive and emotional responses toward pain – may contribute to WM deficits by occupying finite, shared cognitive resources. The present study assessed the role of pain catastrophizing as both a state-level process and trait-level disposition […]

To investigate perceived expressed emotion (EE) and self-esteem in adolescents with primary headaches and to assess the psychologic factors, especially perceived EE, that may play a mediating role in the relationship between pain severity and psychosocial quality of life (QoL).The sample of this single-center cross-sectional case-control study consisted of 102 adolescents with migraine without aura, […]

To clarify the mechanisms of hypersensitivity and spontaneous pain in intraoral structures in rats with diabetes mellitus (DM) accompanied by reduced saliva.Adult male Sprague-Dawley rats received a single injection of streptozocin (50 mg/kg) to induce DM. Saliva volume, intraoral hypersensitivity to menthol and capsaicin solutions, and head-withdrawal thresholds (HWTs) to noxious heat and mechanical stimulation […]

While patient perceptions of burden to caregivers is of recognized clinical significance among people with chronic pain, perceived burden to treating physicians has not been studied. This study examined how people with chronic pain perceived levels of medical evidence (low vs high) and pain severity (4,6,8/10) to influence physician burden and how burden then mediated […]

To evaluate if early improvements in pain and function with subcutaneous tanezumab are meaningful and sustained over 24 weeks.Patients with moderate-to-severe osteoarthritis (hip or knee) in Europe and Japan were randomized to placebo, tanezumab 2.5 mg, or tanezumab 5 mg (baseline, Week 8, and Week 16). Outcomes included: average daily index joint pain score, Western […]

Emotions are involved in the identification of safety cues in the environment, and are also related to social interaction through recognition of emotional facial expressions. Heart rate variability (HRV) can be an indicator of the adaptive response of the autonomic nervous system to stressful conditions, including pain. This study aimed to investigate the emotional processing […]