Management Of Pain Conditions Research Articles

Claims data analysis of provider-to-provider tele-mentoring program impact on opioid prescribing in Missouri.

The objective of this study was to assess opioid prescribing patterns of primary care providers (PCPs) participating in a virtual tele-mentoring program for patients with chronic pain as compared to nonparticipants. We utilized Missouri Medicaid claims from 2013 to 2021 to compare opioid prescription dosages and daily supply of opioids prescribed by PCPs. Participants and nonparticipants were matched using propensity score matching. Missouri Medicaid data were received through partnership with the Center for Health Policy's MO HealthNet Data Project, the state's leading provider of Medicaid data. Missouri-based prescribers. Show-Me Project Extension for Community Healthcare Outcomes (ECHO), an evidence-based provider-to-provider telehealth intervention that connects PCPs with a team of specialists. We compared the rate of prescription opioid >50 morphine milligram equivalents (MMEs), mean MMEs/day, and mean number of daily supply to understand the impact of the ECHO model on providers' opioid prescribing. Patients treated by ECHO providers have 33 percent lower odds of being prescribed opioid dose >50 MME/day (p < 0.001) compared to non-ECHO providers. There is also a 14 percent reduction in the average opioid dose prescribed to patients of ECHO providers (p < 0.001). We observed a 3 percent (p < 0.001) reduction in average daily supply of opioids among patients of ECHO providers compared to the comparison group. Pain Management ECHO supports PCPs with needed education and skills to provide specialty care in the management of pain conditions and safe prescribing of opioid medications.

Hemorphin-Based Analgesia: A Mechanism of Cupping Technique?

Cupping is a time-honoured traditionalhealingmodality for pain management and remains favoured by professionals and lay people across several cultures today. However, the analgesic mechanism of cupping is stillpoorlyunderstood. In addition, clinical guidelines for standardized applications of cupping are currently lacking. The awareness ofcupping marks has provoked curiosity about the connection between skin color changes and their benefit for local pain relief. Computer simulation is a promising approach for numerical modeling the cupping-evoked erythrocyte emigration. Quantitative proteomic profiling of cupping-induced blister fluid exhibited a significant decrease in the abundance of haemoglobin β subunit. This finding provides a critical clue to paint a novel picture of the mechanism behind cupping. The hemorphins are a set of non-classical opioid peptides derived from the proteolysis of haemoglobin β subunit. In the present study, a probable mechanism of hemorphin-based cupping analgesia is proposed. The hemorphin could also act as a potential biomarker for objective and timely quantitative clinical assessment of cupping in the management of pain conditions. A seminal theory may open a new avenue for future translational research on promoting the efficacy and safety of cupping analgesia. The localanalgesiceffectof cupping is probable in the context of haemoglobin degradation that bestows the appearance of hemorphinsalong with engaging opioid receptor signalling. Exploring the potential novel mechanism of cupping analgesia facilitates seeking non-pharmacologic paininterventions.

Linking Pain and Motor Control: Conceptualization of Movement Deficits in Patients With Painful Conditions.

This Perspective proposes that approaching PRMD from a contemporary motor control perspective will uncover key mechanisms, identify treatment targets, inform assessments, and innovate treatments across sensory-perceptual, cognitive, and motor domains, all of which have the potential to improve movement and functional outcomes in patients with painful conditions.

Do dog breeds differ in pain sensitivity? Veterinarians and the public believe they do.

Humans do not respond to the pain of all humans equally; physical appearance and associated group identity affect how people respond to the pain of others. Here we ask if a similar differential response occurs when humans evaluate different individuals of another species. Beliefs about pain in pet dogs (Canis familiaris) provide a powerful test, since dogs vary so much in size, shape, and color, and are often associated with behavioral stereotypes. Using an on-line survey, we asked both the general public and veterinarians to rate pain sensitivity in 28 different dog breeds, identified only by their pictures. We found that both the general public and veterinarians rated smaller dogs (i.e. based on height and weight) as being more sensitive to pain; the general public respondents rated breeds associated with breed specific legislation as having lower pain sensitivity. While there is currently no known physiological basis for such breed-level differences, over 90% of respondents from both groups indicated belief in differences in pain sensitivity among dog breeds. We discuss how these results inform theories of human social discrimination and suggest that the perception of breed-level differences in pain sensitivity may affect the recognition and management of painful conditions in dogs.

Impact of Partner’s Sexual and Relationship Well-Being on Pain Intensity and Pain Catastrophizing in Women With Genital Pain

Sexual and relationship well-being play a major role in the management of pain conditions, namely in women experiencing genital pain. Research has shown that couple’s interactions seem to influence sexual and relationship satisfaction, as well as sexual functioning, for both women with genital pain and their partners. However, the partner’s contribution to understanding and treating pain symptoms is still unclear. This study aims to evaluate the role of several partner’s sexual and relationship variables in explaining pain intensity and pain catastrophizing in women with genital pain, above and beyond women’s variables. Thirty women (M age = 27.97; SD = 6.65) with self-reported genital pain and their partners (M age = 30.4; SD = 7.91) completed an online survey. Both members of the couple filled the Global Measure of Sexual Satisfaction and the Global Measure of Relationship Satisfaction. Sexual functioning was measured with the Female Sexual Function Index and the International Index of Erectile Function. Women also completed the Short Form McGill Pain Questionnaire and the Pain Catastrophizing Scale. Descriptive and clinical data were assessed by the General Introductory Questionnaire for Sexual Pain. Hierarchical multiple regressions were computed to test the hypotheses.

Pain Perception and Hypnosis: Findings From Recent Functional Neuroimaging Studies

Hypnosis modulates pain perception and tolerance by affecting cortical and subcortical activity in brain regions involved in these processes. By reviewing functional neuroimaging studies focusing on pain perception under hypnosis, the authors aimed to identify brain activation-deactivation patterns occurring in hypnosis-modulated pain conditions. Different changes in brain functionality occurred throughout all components of the pain network and other brain areas. The anterior cingulate cortex appears to be central in modulating pain circuitry activity under hypnosis. Most studies also showed that the neural functions of the prefrontal, insular, and somatosensory cortices are consistently modified during hypnosis-modulated pain conditions. Functional neuroimaging studies support the clinical use of hypnosis in the management of pain conditions.

Cognition and pain.

Pain and cognition share common neural substrates and are known to interact reciprocally. This has implications for treatment and management of pain conditions; pain can negatively affect cognitive performance, whereas cognitively demanding tasks may reduce pain perception. This article will review recent research investigating the impact of pain on cognition and the cognitive modulation of pain. Recent clinical and preclinical studies have provided new evidence for impairment of cognition in pain with a focus on the type of cognitive construct affected and the influence of factors such as age and pain localization. Reduced connectivity between important brain structures has emerged as a possible underlying mechanism. Imaging studies have continued to identify neuroanatomical structures involved in different types of cognitive pain modulation, and attempts have been made to delineate the descending pathways by which pain relief is achieved. New and established methods to investigate cognitive modulation of pain in animal models have revealed insights into the molecular and neurochemical mechanisms involved. Progress has been made in understanding the complex relationship between pain and cognitive function. However, both synthesis of current research findings and further novel research studies are required to maximize the therapeutic potential.

Olive (Olea europaea L.) leaf extract elicits antinociceptive activity, potentiates morphine analgesia and suppresses morphine hyperalgesia in rats

Olive (Olea europaea) leaves are used as anti-rheumatic, anti-inflammatory, antinociceptive, antipyretic, vasodilatory, hypotensive, antidiuretic and hypoglycemic agents in traditional medicine. Recently, it has been shown that olive leaf extract (OLE) has calcium channel blocker property; however, its influences on nociceptive threshold and morphine effects have not yet been clarified. All experiments were carried out on male Wistar rats. The tail-flick, hot-plate and formalin tests were used to assess the effect of OLE on nociceptive threshold. To determine the effect of OLE on analgesic and hyperalgesic effects of morphine, OLE (6, 12 and 25 mg/kg i.p.) that had no significant nociceptive effect, was injected concomitant with morphine (5 mg/kg and 1 μg/kg i.p., respectively). The tail-flick test was used to assess the effect of OLE on anti- and pro-nociceptive effects of morphine. The data showed that OLE (50-200 mg/kg i.p.) could produce dose-dependent analgesic effect on tail-flick and hot-plate tests. Administration of 200 mg/kg OLE (i.p.) caused significant decrease in pain responses in the first and the second phases of formalin test. In addition, OLE could potentiate the antinociceptive effect of 5 mg/kg morphine and block low-dose morphine-induced hyperalgesia. Our results indicate that olive leaf extract has analgesic property in several models of pain and useful influence on morphine analgesia in rats. Therefore, it can be used for the treatment and/or management of painful conditions.

Internal Qigong for Pain Conditions: A Systematic Review

The objective of this systematic review was to assess the evidence for the effectiveness of internal qigong as a treatment option for pain conditions. Nineteen databases were searched through to February 2009. Controlled clinical trials testing internal qigong in patients with pain of any origin assessing clinical outcome measures were considered. Trials using any type of internal qigong and control intervention were included. The selection of studies, data extraction, and validation were performed independently by 2 reviewers. Four randomized clinical trials (RCTs) and 3 controlled clinical trials met all inclusion criteria. One RCT suggested no significant difference for low back pain compared with electromyographic biofeedback. Two RCTs failed to show effects of internal qigong in neck pain compared with exercise therapy and waiting list control. One RCT suggested that qigong is inferior to aerobic exercise in patients with fibromyalgia. There are few RCTs testing the effectiveness of internal qigong in the management of pain conditions. Collectively, the existing trial evidence is not convincing enough to suggest that internal qigong is an effective modality for pain management. This review of controlled clinical trials focused on the effects of internal qigong, a self-directed energy healing intervention involving movement and meditation. Collectively, the existing trial evidence is not convincing enough to suggest that internal qigong is an effective modality for pain management. Future studies should be of high quality with particular emphasis on designing an adequate control intervention.

Acupuncture and traditional Chinese medicine: an overview

Methods of treatment that were once considered “alternative” are more frequently used by patients for the management of pain conditions. This paper provides a basic overview of one of those modalities: acupuncture and traditional Chinese medicine (TCM). Considered “a whole medical system” by the National Center for Complementary and Alternative Medicine, an institute within the National Institutes of Health, acupuncture and TCM have been used for hundreds of years to treat disease. A description of acupuncture and TCM techniques and an introduction to basic TCM theory will be presented as well as information on research into the mechanism of action of acupuncture, conditions treated, and basic practice information.

A double blind placebo controlled investigation into the analgesic effects of inferential currents (IFC) and transcutaneous electrical nerve stimulation (TENS) on cold-induced pain in healthy subjects

Transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) are used by physiotherapists for the management of painful conditions. It is claimed that the analgesic profiles of TENS and IFC differ although no studies have directly compared the analgesic effects of the two modalities. The aim of this double blind placebo controlled study was to compare the analgesic effects of TENS and IFC on cold-induced pain in healthy volunteers. Twenty one subjects completed six cycles of the cold-induced pain test (two pre-treatment, two during treatment, and two post-treatment). During each cycle pain threshold was recorded as the time from immersion of the subject's hand in cold water to the first sensation of pain and pain intensity and unpleasantness ratings were recorded using visual analogue scales. Subjects received one of the following treatments during the two treatment cycles: IFC, TENS, or sham electrotherapy. IFC and TENS were delivered at a ''strong but comfortable'' intensity via two electrodes applied over the anterior aspect of the forearm. Sham electrotherapy was administered by a ''dummy'' stimulator with no current output. All stimulators were visually identical. Analysis of the results found that IFC and TENS significantly elevated pain threshold when compared to sham electrotherapy (P <. 05). There were no significant differences in the magnitude of the increase in pain threshold between IFC and TENS. No significant changes in pain intensity or unpleasantness ratings were found between the three treatment groups. We conclude that there were no differences in the analgesic effects of IFC and TENS under the present experimental conditions.