Clinical Pain Research Articles

Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland.

The Scottish Computed Tomography of the Heart (SCOT-HEART) trial demonstrated that management guided by coronary CT angiography (CCTA) improved the diagnosis, management, and outcome of patients with stable chest pain. We aimed to assess whether CCTA-guided care results in sustained long-term improvements in management and outcomes. SCOT-HEART was an open-label, multicentre, parallel group trial for which patients were recruited from 12 outpatient cardiology chest pain clinics across Scotland. Eligible patients were aged 18-75 years with symptoms of suspected stable angina due to coronary heart disease. Patients were randomly assigned (1:1) to standard of care plus CCTA or standard of care alone. In this prespecified 10-year analysis, prescribing data, coronary procedural interventions, and clinical outcomes were obtained through record linkage from national registries. The primary outcome was coronary heart disease death or non-fatal myocardial infarction on an intention-to-treat basis. This trial is registered at ClinicalTrials.gov (NCT01149590) and is complete. Between Nov 18, 2010, and Sept 24, 2014, 4146 patients were recruited (mean age 57 years [SD 10], 2325 [56·1%] male, 1821 [43·9%] female), with 2073 randomly assigned to standard care and CCTA and 2073 to standard care alone. After a median of 10·0 years (IQR 9·3-11·0), coronary heart disease death or non-fatal myocardial infarction was less frequent in the CCTA group compared with the standard care group (137 [6·6%] vs 171 [8·2%]; hazard ratio [HR] 0·79 [95% CI 0·63-0·99], p=0·044). Rates of all-cause, cardiovascular, and coronary heart disease death, and non-fatal stroke, were similar between the groups (p>0·05 for all), but non-fatal myocardial infarctions (90 [4·3%] vs 124 [6·0%]; HR 0·72 [0·55-0·94], p=0·017) and major adverse cardiovascular events (172 [8·3%] vs 214 [10·3%]; HR 0·80 [0·65-0·97], p=0·026) were less frequent in the CCTA group. Rates of coronary revascularisation procedures were similar (315 [15·2%] vs 318 [15·3%]; HR 1·00 [0·86-1·17], p=0·99) but preventive therapy prescribing remained more frequent in the CCTA group (831 [55·9%] of 1486 vs 728 [49·0%] of 1485 patients with available data; odds ratio 1·17 [95% CI 1·01-1·36], p=0·034). After 10 years, CCTA-guided management of patients with stable chest pain was associated with a sustained reduction in coronary heart disease death or non-fatal myocardial infarction. Identification of coronary atherosclerosis by CCTA improves long-term cardiovascular disease prevention in patients with stable chest pain. The Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Edinburgh and Lothian's Health Foundation Trust, British Heart Foundation, and Heart Diseases Research Fund.

Identifying Patient Subgroups in the Heterogeneous Chronic Pain Population Using Cluster Analysis.

Chronic pain is an ill-defined disease with complex biopsychosocial aspects, posing treatment challenges. We hypothesized that treatment failure results, at least partly, from limited understanding of diverse patient subgroups. We aimed to identify subgroups using psychological variables, allowing for more tailored interventions. In a retrospective cohort study, we extracted patient-reported data from two Dutch tertiary multidisciplinary outpatient pain clinics (2018-2023) for unsupervised hierarchical clustering. Clusters were defined by anxiety, depression, pain catastrophizing, and kinesiophobia. Sociodemographics, pain characteristics, diagnosis, lifestyle, health-related quality of life and treatment efficacy were compared among clusters. A prediction model was built utilizing a minimum set of questions to reliably assess cluster allocation. Among 5,466 patients with chronic pain, three clusters emerged. Cluster 1 (n=750) was characterized by high psychological burden, low health-related quality of life, lower educational levels and employment rates, and more smoking. Cluster 2 (n=1,795) showed low psychological burden, intermediate health-related quality of life, higher educational levels and employment rates, and more alcohol consumption. Cluster 3 (n=2,909) showed intermediate features. Pain reduction following treatment was least in cluster 1 (28.6% after capsaicin patch, 18.2% after multidisciplinary treatment), compared to >50% for both treatments in clusters 2 and 3. A model incorporating 15 psychometric questions reliably predicted cluster allocation. In conclusion, our study identified distinct chronic pain patient clusters through 15 psychological questions, revealing one cluster with notably poorer response to conventional treatment. Our prediction model, integrated in a web-based tool, may help clinicians improve treatment by allowing patient-subgroup targeted therapy according to cluster allocation. PERSPECTIVE: Hierarchical clustering of chronic pain patients identified three subgroups with similar pain intensity and diagnoses but distinct psychosocial traits. One group with higher psychological burden showed poorer treatment outcomes. A web-based tool using this model could help clinicians tailor therapies by matching interventions to specific patient subgroups for improved outcomes.

Photobiomodulation therapy in diabetes: Benefits for pain relief, quality of life, and wound healing.

Globally, 537 million people suffer from diabetes mellitus (DM), a condition often associated with sensory disturbances, wound development, and chronic pain, which significantly affects the quality of life and imposes a substantial economic burden. This study evaluated the effects of photobiomodulation (PBM) therapy on nociceptive and sensory changes in diabetic patients to understand pain manifestations and explore PBM's molecular mechanisms on wound healing. Twenty patients with type 2 DM underwent clinical assessments, completed pain and quality of life questionnaires, and had their pain sensitivity evaluated using the quantitative sensory test (QST). A 5 mm skin biopsy was taken for fibroblast culture. PBM therapy, using 660 nm red light, was administered twice weekly for 7 weeks on lower limb wounds. Results indicated that DM patients faced significant sensory impairments, impacting their quality of life. PBM therapy improved pain scores, alleviated neuropathic pain, and enhanced sensory function, leading to better quality of life and reduced anxiety and depression. It also accelerated wound healing, enhancing mobility and autonomy. Invitro studies showed PBM therapy increased cell proliferation through the ERK signaling pathway and modulation of matrix metalloproteinases (MMP-1/8 and 2) and tissue inhibitors of metalloproteinases (TIMP).

Efficiency of glass ionomer sealant application in reducing hypersensitivity in MIH-molars in schoolchildren immediately and after 12 weeks.

This prospective clinical study aimed to clinically investigatethe efficiency of (GIC) glass-ionomer cement application (Ionostar Plus + Easy Glaze, VOCO) in reducing hypersensitivity in permanent molars affected by molar incisor hypomineralisation when assessed immediately (15 min) and 12 weeks after its application. Children with at least one hypersensitive MIH-affected permanent molar (MIH-TNI-3 or 4). The pre-treatment status was evaluated and only included if they did not receive a tooth-specific in-office desensitizing treatment within one month. Clinical pain assessments were performed using the schiff score air sensitivity scale (SCASS) and Wong-baker faces Scale (WBFS). This study involved 25 participants (mean age 8.6 ± 1.85 years) with 43 hypersensitive MIH-molars of which about half were SCASS 3 (n = 24, 55.8%) and SCASS 2 (n = 19, 44.2%). Regarding hypersensitivity, the reported mean SCASS score reduced significantly from 2.56 (± 0.50) at baseline to 1.14 (± 0.96) after 15 min of GIC sealant application and even further to 0.71 (± 0.89) after 12 weeks (P < 0.001, Pairedttest). Similarly, reported WBFS scores also significantly reduced from 5.81 (± 2.50; Range = 2-10) at baseline to 2.88 (± 2.31; Range = 0-10) after 15 min and to 2.95 (± 2.17) after 12 weeks, respectively (P < 0.001, Pairedttest). The mean reduction in SCASS scores was 1.3 (± 0.6) and 1.4 (± 1.0) for baseline SCASS 2 vs. 3, respectively. GIC coverage is effective in providing clear instant relief from hypersensitivity in MIH molars in schoolchildren, which improves even further over a period of 12 weeks.

Psychometric properties of the Short-Form McGill Pain Questionnaire (SF-MPQ) in adult Mexican cancer patients with chronic pain.

Pain is a frequent symptom in cancer patients (CP), and its multidimensional assessment is essential for a comprehensive approach and to establish clinical prognoses. The Short-Form McGill Pain Questionnaire (SF-MPQ) is an internationally recognized tool for the multidimensional assessment of pain, both in clinical and research settings. However, no studies have been reported in Latin America that determine its psychometric properties in CP and chronic pain. To determine the psychometric properties of the SF-MPQ in adult Mexican cancer patients with chronic pain. An instrumental design was used with a non-probabilistic convenience sample of 222 cancer patients treated at the pain clinic of a tertiary care hospital. Analyses were conducted to evaluate factorial structure (exploratory and confirmatory factor analysis [CFA]), reliability (internal consistency), measurement invariance, and criterion validity (concurrent and divergent). CFA verified a 9-item structure divided into 2 factors: (1) Affective-Nociceptive and (2) Neuropathic. A global Cronbach's alpha coefficient of .82 and a global McDonald's Omega index of .82 were identified. Configural, metric, and scalar invariance (ΔCFI ≤ .01; ΔRMSEA ≤ .015) were confirmed regarding the sex variable. Finally, the SF-MPQ showed a positive correlation with the Numerical Rating Scale (rho = .436, p< .01) and a negative correlation with the EORTC-QLQ C30 (rho = -.396, p< .01). The Mexican version of the SF-MPQ presented adequate psychometric properties and fit indices, making it a valid and reliable instrument for use in clinical and research settings in Mexico. Its use is recommended for the comprehensive assessment of pain in oncology in Mexico, as it allows for the understanding of pain characteristics beyond intensity, guiding the establishment of clinical prognoses.

A LITERARY REVIEW ARTICLE OF AMAVATA W.S.R RHEUMATOID ARTHRI-TIS

Amavatais currently the most prevalent disease, affecting a significant portion of the elderly population. The term Amavata comes from the words Ama and Vata. The state known as Ama is when different illnesses within the body have a harmful influence. Painful illness is the outcome of the Ama occupying Shleshmasthana (Asthisandhi) and combining it with Vatadosha. The clinical presentation ofAmavata closely mimics the unique variety of Rheumatological disorders called Rheumatoid Arthritis by their similarities in clinical features like pain, swelling, stiffness, fever, redness, general debility, and fatigue are almost identical to that of Amavata. Rheumatological disorder is a group of diseases with no specific medical management in any therapeutics. Amavata is one of the most challenging diseases for clinicians due to its chronicity, incurability, complications, and morbidity. Allopathic treatment provides symptomatic relief, but the underlined pathology remains untreated due to the absence of effective therapy. This gives rise to many side effects, toxic symptoms, adverse reactions, and more serious complications, such as organic lesions. The treatment procedures described are Langhan, Swedan, Tikta-Katu, Deepana, Virechana, Basti, etc. So, the present study deals with a systemic review of Amavata from all the classics of Ayurveda and its management.

'It's Not Written All Over My Face': Constructing Chronic Pain as Invisible in Pain Clinic Consultations and Interviews.

Historically in medicine and beyond, the understanding of and treatment of pain is based on finding tissue injury. The fact that for chronic pain, there often is no (longer) any traceable tissue injury, in combination with the fact that pain essentially is a private experience, poses a challenge for clinical communication. This paper therefore examines how pain is linguistically and interactionally constructed as invisible. The qualitative approach of interactional sociolinguistic analysis is used to analyse 37 consultations and 11 semi-structured interviews with patients with chronic pain, collected at a Belgian pain clinic. This fine-grained approach to studying communication provides an in-depth empirical understanding of phenomenon under scrutiny. The data show that pain is constructed as invisible on several levels: 1) on the biomechanical and clinical level in terms of its lack of visible or traceable tissue injury, 2) on the level of interaction, as pain needs to be made apparent to other people through pain displays, and 3) on the social level, as chronic pain often is not visible or apparent in society more largely. The discussion explores how on these three levels, notions of the abnormal or deviant body come into play, in which patients and health professionals complexly construct pain both as not normal (i.e. not a neutral or desirable state of being), while, at the same time, the lack of traceable tissue injury is constructed as medically normal for chronic pain. This also shows how patients and healthcare providers often orient to the stigma around chronic pain.

The Moderating Role of Ethnicity on Depressive and Anxiety Symptoms and Pain Catastrophizing in Hispanic/Latinx and Non-Hispanic/Latinx White Youth with Chronic Pain.

Chronic pain (CP) significantly impacts emotional and physical well-being and overall quality of life across diverse populations in the United States (U.S.). Notably, underrepresented minoritized (URM) groups, such as Hispanic/Latinx youth, may experience disproportionate effects due to health disparities and lack of access to quality healthcare. However, this remains understudied. This study aims to examine the association between CP and its related psychosocial factors- depressive and anxiety symptoms, and pain catastrophizing- in Hispanic/Latinx youth, as compared to Non-Hispanic White (NHW) youth. The current study sample included 58 self-identifying Hispanic/Latinx and 58 NHW youth seeking CP treatment at a large northeastern tertiary pain clinic, ages 12-18y.o., M=15.49, SD=1.71), of which 88% identified as biologically female. Participant samples for each group were age-and-sex matched. Significant associations were found between anxiety and depressive symptoms and pain catastrophizing for youth in both groups. Ethnicity significantly moderated the associations between pain catastrophizing and depressive symptoms and between anxiety and depressive symptoms, with NHW youth with pain exhibiting stronger relations between these constructs when compared to Hispanic/Latinx youth with pain. Our results suggested that for NHW youth with CP, greater tendencies toward catastrophizing and experiences of anxiety may more strongly contribute to depressive symptoms, when compared to their Hispanic/Latinx youth counterparts. Further investigation of pain-coping mechanisms among Hispanic/Latinx youth and other youth from historically marginalized populations (e.g., racial/ethnic minoritized groups) will help advance clinical understanding of sociocultural variability in links between pain-related psychosocial outcomes in the CP experience.

Percutaneous ballon compression, a better choice for primary trigeminal neuralgia compared to microvascular decompression?

Demonstrate the superiority of percutaneous balloon compression (PBC) in the treatment of primary trigeminal neuralgia (PTN) compared to trigeminal microvascular decompression (MVD). Clinical data, including immediate, short-term, and long-term pain relief, complications, duration of the operation, and postoperative hospital stay, were retrospectively analyzed for 114 patients diagnosed with PTN who were treated with either PBC or MVD between January 2018 and December 2021. There were no statistically significant differences observed in the pain relief rates between the two surgical methods at 24 h postoperatively (MVD: 91.07%, PBC: 96.55%), at 6 months postoperatively (MVD: 87.5%, PBC: 94.8%), at 1 year postoperatively (MVD: 83.90%, PBC: 94.80%), and at 2 years postoperatively (MVD: 78.60%, PBC: 72.40%). However, the incidence of meningitis following MVD was significantly higher than that following PBC (P < 0.005). Additionally, both the duration of the operation and the length of the postoperative hospital stay in the MVD group were longer than those in the PBC group (P < 0.005). PBC demonstrates efficacy comparable to MVD while offering a simpler procedure, improved safety, and a shorter postoperative hospital stay. Therefore, it may serve as a viable alternative to MVD and could become the preferred surgical approach for treating PTN in the future.

An AI recognition method for children's clinical operative pain by skin potential (SP) signal.

Children's clinical pain phenotypes are complex, and there is a lack of objective biological diagnostic markers and cognitive patterns. Detecting physiological signals through wearable devices simplifies disease diagnosis and holds the potential for remote medical applications. This research established a pain recognition model based on AI skin potential (SP) signal analysis. A total of 237 subjects participated in this study, comprising 152 boys and 85 girls, ranging in age from 2 to 16 years old. Initially, we preprocessed SP signals and built datasets for pain and non-pain conditions, including 195 pain and 97 non-pain samples. Then, we applied wavelet transform (WT) to capture the time-frequency characteristics of the signals and extract energy features and created a feature set comprising 30 features and selected 10 most relevant ones using the "SelectKBest" function.We compared six algorithms, optimized their parameters, and evaluated the stability and fitting performance of each algorithm. The random forest (RF) algorithm emerged as the best, demonstrating significant performance in pain recognition with an accuracy of 80.3% and a sensitivity of 92%. The SP signals generated by children of different genders, ages, and needling positions during indwelling needle puncture were accurately recognized. We developed a comprehensive SP recognition model, innovatively employing WT for SP signal analysis. This time-frequency analysis method, by preserving low-frequency features, is particularly suitable for SP signals. By combining pain monitoring with SP signals and ML, subjective pain experiences are transformed into quantifiable data, achieving high accuracy and real-time measurement capabilities. These advantages provide valuable technical support for clinical pediatric pain management.

Return to Sport after First Metatarsophalangeal Arthrodesis in Elite Athletes.

Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a reliable procedure in alleviating pain and restoring function. However, there is limited published literature of the outcomes of this procedure and the ability to return to sport in elite athletes. This study aims to assess the outcomes of first MTPJ arthrodesis in the elite athlete population and their ability to return to professional sport. A single-center prospective case series of elite athletes undergoing first MTPJ arthrodesis between 2004 and 2016 was conducted. Patients were assessed a minimum of 2, 6, 12 weeks and 1-year post-operation and at final follow-up. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Visual Analogue Scale (VAS) scores and assessing satisfaction. 16 elite athletes with a mean age of 27 years (range 19-32, 81%) and mean follow-up of 81 months (range 60-121 months) were included. At 1-year post-operation, 12 (75%) athletes returned to their original level of sport. Of the 4 unable to return, two soccer players dropped a division, an ATP tennis player never regained his original ranking, and a badminton player was unable to return to the same level of competition. Mean VAS scores improved from pre-operation to final follow-up (5.6 to 0.4, p < 0.001). All FAOS subscores showed significant improvement from pre-operation to final follow-up (all p < 0.05). All (100%) athletes were either very satisfied or satisfied at final follow-up. To our knowledge this is the first study investigating return to elite level sport post first MTPJ arthrodesis. Our results confirm that a significant majority will return to their elite level of sport post operatively. Improved clinical outcomes and pain reduction was achieved in all patients. IV LEVEL OF EVIDENCE: V.

A scoping review of the effectiveness of underwater treadmill exercise in clinical trials of chronic pain.

The objective of this scoping review was to investigate the available literature on physical and quality of life (QoL) outcomes of underwater treadmill exercise trials in clinical chronic pain samples. A scoping search of studies of the effectiveness of underwater treadmill exercise trials from 1947 to 2024 was conducted using the following databases: EMBASE, MEDLINE, SPORTDiscus, CINAHL, and Cochrane Reviews. To be included, studies were required to have included adult participants living with chronic pain (defined as pain lasting for 3 months or longer) who participated in an active underwater treadmill exercise intervention. No restrictions on pain diagnosis were applied. All clinical trials, including but not limited to randomized controlled trials (RCTs), feasibility trials, and pilot studies, were included in the search. Two independent reviewers determined whether studies met inclusion criteria, and a third reviewer resolved any disagreement on study inclusion. The initial search identified 2,209 studies: 314 articles were removed for duplications, 1,781 were removed because they did not meet inclusion criteria, and 113 were retained for full-text review. The full-text review yielded nine studies, all of which included samples consisting of participants with osteoarthritis. The following variables were investigated in the included studies to varying degrees: pain, QoL, mobility, balance, strength, and changes in gait kinematics. Multiple studies identified significant differences between control groups or pre-intervention groups and underwater treadmill groups or post-intervention groups in chronic pain, balance, mobility, strength, and QoL. Findings suggest that underwater treadmill exercise leads to positive changes in chronic pain, balance, mobility, strength, and QoL. However, more studies, particularly RCTs with larger samples that include individuals with chronic pain conditions other than osteoarthritis, are warranted.

Relationship Between Treatment Hours of Selected Disciplines and Change in Pain Impact During the Year Following Referral to an Interdisciplinary Pain Management Center: A Latent Class Analysis.

Introduction: Pain management clinics differ in treatments offered, and little evidence exists regarding which combinations of therapies result in best outcomes. This study analyzed clinical encounters and pain outcomes data for associations between treatment composition and outcomes. Methods: Retrospective observational study of 2,142 predominantly active-duty US service members referred to an interdisciplinary pain management center between 2014 and 2021. Latent class analysis was used to identify treatment groups with distinct outcome patterns during the year following initial assessment. The primary outcome measure was the National Institutes of Health Task Force on Research Standards for Chronic Low-Back Pain impact score. Results: Four distinct treatment groups were identified: 1 group engaged in conventional medical therapies alone (n = 726, median 3.5 treatment hours), and 3 groups used a combination of conventional, psychological, rehabilitative, and complementary therapies, with different levels of treatment hours: low (n = 814, median 15.7 h), medium (n = 177, median 40.1 h), and high (n = 425, median 72.5 h). All groups showed significant improvement in pain impact score from baseline up to 9 months but not at 12 months following initial assessment. At the 6-month time point, the group with high multimodal treatment hours had the most improvement in pain impact (-3.1 [95% CI -3.8, -2.4]) compared with the group using only conventional therapies (-1.0 points [95% CI -1.8, -0.1]) or with low multimodal treatment hours (-1.3 points [95% CI -1.9, -0.7]). There were no between-group differences at the 9- or 12-month time points. Conclusion: These results suggest that a combination of pain therapy approaches results in greater reduction in pain impact than the use of conventional medical treatment alone for up to 6 months after initiating therapy and that there may be a threshold of treatment hours that must be exceeded to achieve this benefit. Clinical trial registration: As this study is not a clinical trial, no registration was required.

The problem of pain in systemic lupus erythematosus: A comprehensive analysis of pain distribution using the CHOIR body map and PROMIS measures.

Our study investigates the associations between pain distribution, biopsychosocial factors, and Patient-Reported Outcomes Measurement Information System (PROMIS) measures in patients with systemic lupus erythematosus (SLE). Employing self-reported pain body maps, we aim to characterize the distribution of pain and its impact on biopsychosocial measures. We retrospectively analyzed the electronic health records (EHR) of 332 adult patients with SLE attending pain clinics at an academic medical center. The study included demographics, pain distribution assessed via self-reported body maps, and PROMIS assessments of biopsychosocial experiences. We used linear regression models adjusted for age and sex to investigate associations between pain distribution and PROMIS outcomes. Men, on average, indicated pain in 3.2 regions, whereas women reported pain in 5.6 regions. Women predominantly highlighted the hip, buttock, and leg region, whereas men primarily emphasized the shoulder and arm region. We found a positive correlation between pain widespreadness and worse PROMIS measures, including pain interference, behavior, fatigue, depression, anxiety, sleep disturbance, and social isolation. Additionally, widespread pain was associated with lower physical function, emotional support, and satisfaction in roles and activities. Female patients reported higher levels of pain and PROMIS measures compared to males. Our findings highlight the multidimensional impact of pain on SLE patients' lives underscoring the need for holistic pain management approaches. The intricate associations between pain distribution and biopsychosocial factors emphasize the importance of considering spatial dimensions of pain in clinical interventions. Further research is warranted to explore effective interventions addressing psychosocial aspects of pain in SLE, aiming to enhance patient symptom management and quality of life.

Peripheral inflammation enhances opioid-induced gastrointestinal motility inhibition via up-regulating spinal mu opioid receptor.

Opioids are potent analgesics in clinical pain management but exert variable analgesia in different pain types. Opioid-induced constipation is a common side effect of opioid therapy, and whether opioids induce different gastrointestinal motility inhibitions in different pain types is unknown. In this study, we evaluated the antinociceptive effects and inhibition of upper gastrointestinal transit and colonic bead expulsion of morphine, DAMGO, and Deltorphin in mouse CFA chronic inflammatory pain, SNI chronic neuropathic pain, and carrageenan chronic inflammatory pain models. Furthermore, quantitative PCR and immunofluorescence were used to investigate the mechanisms underlying the altered inhibition. Results showed that intrathecal administration of morphine, DAMGO, and Deltorphin produced higher antinociceptive effects in the CFA and carrageenan groups than in the SNI group. Upper gastrointestinal transit inhibition was significantly enhanced in the carrageenan group by morphine and DAMGO; colonic bead expulsion inhibition was also enhanced in the CFA and carrageenan groups by morphine and DAMGO, but not in Deltorphin treatment. Additionally, mu (MOR) opioid receptor mRNA and MOR-expressing cell density in the lumbar spinal cord of CFA and carrageenan mice were increased, whereas delta opioid receptor expression remained unchanged in these groups. Finally, the pharmacological blockade of MOR completely prevented the enhanced upper gastrointestinal transit inhibition in the carrageenan group by morphine and DAMGO. Altogether, our results indicate that gastrointestinal motility inhibition induced by MOR agonists can be enhanced with upregulated spinal MOR expression in chronic inflammatory pain.

CDUNeXt: efficient ossification segmentation with large kernel and dual cross gate attention

Ossification of the ligamentum flavum (OLF) is the main causative factor of spinal stenosis, but how to accurately and efficiently identify the ossification region is a clinical pain point and an urgent problem to be solved. Currently, we can only rely on the doctor’s subjective experience for identification, with low efficiency and large error. In this study, a deep learning method is introduced for the first time into the diagnosis of ligamentum flavum ossificans, we proposed a lightweight, automatic and efficient method for identifying ossified regions, called CDUNeXt. By designing lightweight module structures, utilizing large-kernel convolutions to extracts the long-distance dependencies of different features of the image, and adopting dual-cross-gate-attention(DCGA) to sequentially capture the channel and spatial dependencies so as to fast and accurate segmentation while maintaining fewer parameters and lower complexity. Experiments show that CDUNeXt achieves the best segmentation performance with an optimal balance of lighter weights and less computational cost compared to existing methods. This work fills the gap in the application of deep learning techniques in the diagnosis of ligamentum flavum ossificans, contributes to the realization of lightweight medical image segmentation networks and lays the foundation for subsequent research.

RETROSPECTIVE ANALYSIS OF PATIENTS PRESENTING TO OUR PAIN CLINIC WITHIN ONE YEAR

Objective: This study aims to retrospectively examine the demographic characteristics, main causes of pain, diagnoses and applied treatment methods of patients who applied to a pain clinic. It is expected that these data will contribute to the evaluation of current clinical practices and the development of more effective pain management strategies. Method: The study was conducted with a retrospective design between January 2023 and December 2023 with the approval of the ethics committee numbered B.30.2ATA.0.01.00./. During this period, the medical records of the patients who applied to the pain clinic were examined. The patients' (age, gender), reasons for application (pain localization) and treatment approaches (drug therapies, interventional procedures) were recorded. Results: When demographic characteristics were examined, 56.8% of the 1210 patients included in the study were female, 43.2% were male, and the mean age was determined as 47.42±20.56. When the complaints of the patients were examined, the reasons for application were back pain, leg pain and widespread body pain in order of frequency. In terms of treatment methods, the most frequently performed procedure was the plan block, followed by epidural analgesia. Conclusion: In our study, it was observed that the majority of patients applying to the pain clinic applied due to chronic pain and needed multidisciplinary treatment approaches. These data are important for the development of new strategies for pain management in clinical practices and for increasing patient satisfaction. It is recommended that more studies be conducted, especially on the effectiveness of interventional methods and the role of psychological support.

Effect of Caudal Epidural Steroid Injection on Transforaminal Epidural Steroid Injection and Dorsal Root Ganglion Pulsed Radiofrequency in Recurrent Lumbar Disc Herniation.

Background/Objectives: Recurrent lumbar disc herniation (RLDH) refers to a lumbar disc herniation (LDH) that recurs at the same level, location, and side following surgical repair. This study aimed to evaluate the efficacy of transforaminal epidural steroid injection (TESI) and dorsal root ganglion pulsed radiofrequency (DRG PRF) therapy with and without caudal epidural steroid injection (CESI) for the treatment of lumbar radicular pain (LRP) associated with RLDH. Methods: This retrospective cohort study included 57 patients treated for RLDH in a hospital pain clinic between September 2022 and February 2024. A total of 27 patients received TESI and DRG PRF therapy (Group 1) and 30 patients received TESI, DRG PRF, and CESI therapy (Group 2). We evaluated patient age, sex, symptom duration, pain medication use, number of prior LDH operations, presence of stabilization on magnetic resonance imaging (MRI), intervention received, lumbar level and side of the intervention, and Numeric Rating Scale (NRS) pain scores before and at 1, 3, and 6 months post-procedure. Treatment success was defined as an NRS score at least 50% or 4 points lower than the pre-procedure score at post-procedure 6 months. Results: There was no significant difference in NRS scores between the groups during the 6-month follow-up period. Moreover, NRS scores did not differ based on the presence of stabilization on MRI or the use of pain medication (p > 0.05). Conclusions: TESI and DRG PRF therapy were effective in the treatment of LRP associated with RLDH over a 6-month follow-up period, and adding CESI did not increase treatment success.

Long-term outcomes of Gamma Knife radiosurgery for trigeminal neuralgia patients with or without concomitant continuous pain.

The effectiveness of Gamma Knife radiosurgery (GKRS) in treating trigeminal neuralgia (TN) has been demonstrated by a number of previous studies. However, there is a lack of research specifically documenting the initial and long-term outcomes of paroxysmal and persistent pain respectively following GKRS for TN with concomitant continuous pain (CCP). This study retrospectively analyzed pain outcomes and complications in 46 TN patients with CCP and 112 patients without CCP who underwent GKRS as initial surgical intervention at our institution from January 2019 to January 2024. Pain outcomes were classified as excellent (BNI I), good (BNI II-IIIa), and poor (BNI IIIb-V). Demographic and clinical data, pain outcomes, and complications were compared between patients with and without CCP. Subsequently, risk factors for poor outcomes after GKRS were evaluated using univariate and multivariate Cox regression analysis. The initial rate of poor outcomes in TN patients with CCP was similar to that of patients without CCP (15.8% vs 14.4%, P = .878). Following a minimum 6-month follow-up, the rate of poor pain outcomes increased to 37.0% in patients with CCP, compared to 38.4% in those without CCP (P = .968). Notably, the rate of long-term complete pain relief in patients without CCP was significantly higher than in those with CCP (35.7% vs 15.2%, P < .001). Poor response to medication (P < .001) was identified as an independent risk factors for poor outcomes after GKRS. While most TN patients with or without CCP can achieve favorable pain outcomes after GKRS, individuals with CCP were less likely to achieve complete pain relief compared to those without CCP.

The Efficacy and Factors Associated With Epidural Injections in the Management of Lumbar Spinal Stenosis and in Terms of Delaying Laminectomy: A Retrospective Study.

Lumbar epidural injections have been studied as symptomatic treatments for lumbar spinal stenosis (LSS). However, results about their efficacy have been controversial, and data regarding their use is scarce. Our purpose in this article is to study the efficacy of epidural injections in the management of pain and disability in patients suffering from spinal stenosis, to study the factors which can affect their efficacy, and to discuss whether they could replace surgery or not. A retrospective study between 2021 and 2022 took place in a Pain Clinic located in Notre-Dame des Secours University Hospital-Lebanon. The study was done on 128 patients, of whom 18 were excluded because they underwent laminectomy before taking the transforaminal lumbar epidural injections. Medical records were viewed. Outcome measures were checked before and after epidural injections using the numerical pain scale and the Oswestry Disability Index (ODI) scale. Physical activity was assessed with a physical activity index. Back pain scores (9.46 ± 1.07 vs. 3.91 ± 3.13; P < 0.001), leg pain scores (9.31 ± 1.41 vs. 3.75 ± 3.17; P < 0.001), and ODI scores (27.45 ± 8.97 vs. 9.40 ± 9.42; P < 0.001) decreased after the injection compared to before it. A higher physical activity index was significantly associated with a decrease in back pain, leg pain, and ODI scores after epidural injection. In 57.8% of the patients, epidural injections were sufficient for pain management without the need for surgery. Epidural injections are effective in the management of back and leg pain associated with LSS and in improving patients' disability. Engaging in activities like walking and swimming is associated with better results. In some cases, epidural injections may replace surgery.