Chronic Pain Research Articles

Phenoconversion in Women and Men With Isolated REM Sleep Behavior Disorder: A Retrospective Cohort Study.

Isolated REM sleep behavior disorder (iRBD) is strongly associated with synucleinopathies. Previous iRBD cohort studies have primarily focused on older (>50 years), male-predominant cohorts. Risk of phenoconversion in women and younger adults remains unclear. The study aimed to determine clinical features associated with conversion to a defined neurodegenerative disorder in women and men with iRBD. One hundred eighty-six women and 186 men with iRBD were matched by polysomnography month. Baseline clinical variables and subsequent neurodegenerative outcomes were abstracted by chart review. Kaplan-Meier curves assessed conversion rates. Cox proportional hazards modeling evaluated factors associated with phenoconversion risk. Age at iRBD diagnosis was younger in women compared with men (54.9 vs 62.5 years, p < 0.01). Forty-eight patients (12.9%), including 18 women (9.7%) and 30 men (16.1%), phenoconverted during a median follow-up of 6.0 years. Conversion rates were lower in antidepressant users and patients with chronic pain or psychiatric comorbidity while rates were higher in those with vascular comorbidity. Only age at diagnosis (HR 1.09, 95% CI 1.06-1.13) was associated with phenoconversion after adjusting for RBD symptom duration; sex; antidepressant use; and psychiatric, chronic pain, and vascular comorbidities. Age at diagnosis was independently associated with phenoconversion risk in women and men with iRBD.

Influence of Qigong Wuqinxi on Pain, Sleep, and Tongue Features in Older Adults

ABSTRACT Background Chronic pain and sleep disorders are commonly seen symptoms in community-dwelling older adults at traditional Chinese medicine (TCM) clinics. TCM modalities such as herbal medication and acupuncture have side effects and usage limitations. Therefore, nonpharmacological and noninvasive interventions may be applied to relieve the symptoms of these conditions. Purpose This study was designed to test the effect of Qigong Wuqinxi exercise on chronic pain, sleep quality, TCM constitutions, and tongue features in community-dwelling older adults. Methods This was a cluster randomized controlled trial. Older adults in two community care centers who met the inclusion criteria were assigned by drawing lots to either the experimental group (n = 32) or the control group (n = 31). Experimental group members practiced the Qigong Wuqinxi exercise for 50 minutes three times each week for 12 weeks, whereas those in the control group maintained their normal daily routine. Before and after the 12-week study, data on chronic pain, sleep quality, TCM constitutions, and tongue features were collected from all participants to assess the effectiveness of the intervention. Between-group pretest and posttest comparisons were analyzed using independent samples t tests, and within-group differences were analyzed using paired t tests. Results The experimental group reported significantly greater average posttest improvements in chronic pain, yang deficiency, phlegm-stasis, thick fur, and red dots than the control group (all ps &lt; .05). The maximum change in pretest to posttest pain scores favored the experimental group (−0.56 ± 0.76 vs. 0.39 ± 1.91, p = .011). Also, the experimental group had a significantly better change in the pain interference index (−3.31 ± 3.30 vs. −0.58 ± 1.91, p &lt; .001). In addition, the experimental group exhibited greater improvements in yang-deficiency tendency (−2.38 ± 4.89 vs. 0.35 ± 4.67, p = .027), phlegm and stasis tendency (−2.19 ± 4.52 vs. 1.77 ± 2.47, p &lt; .001), thick fur (1.44 ± 11.28 vs. 6.03 ± 6.04, p = .049), and red dots (−5.09 ± 21.45 vs. 2.81 ± 4.03, p = .048). However, no significant between-group difference in posttest sleep quality (p = .357) was observed. Conclusions/Implications for Practice The Qigong Wuqinxi exercise was found to positively improve chronic pain and TCM constitutions in community-dwelling older adults and may be promoted in community care centers to improve the health status of older adults.

Anxiety and depressive disorders in patients with primary painful bladder syndrome. Part 1: Symptoms and clinical progression

The article is dedicated to affective disorders developing in patients with primary painful bladder syndrome. The causes of their development and influence on the quality of patients’ life are considered. An overview of the etiopathogenic links between anxiety and depressive disorders and bladder pain is presented. it should be noted that common comorbidity with depressive and anxiety disorders is a risk factor for the unfavorable course and chronicity of pain conditions that requires to involve a psychotherapist or psychiatrist for examination and treatment of patients with primary painful bladder syndrome, and, if the somatoform nature of primary painful bladder syndrome is found, for prescribing relevant drug and non-drug treatment.

NSW cannabis medicines advisory service retrospective enquiry analysis to inform clinical guidance resource development

AbstractBackgroundAn innovative New South Wales government funded statewide Cannabis Medicines Advisory Service (CMAS) operated between January 2018 and June 2022. The service provided comprehensive patient‐specific and evidence‐based information to support health professionals in prescribing and patient care decisions. This study aimed to describe real‐world data collected by CMAS.MethodsA sub‐set of de‐identified, patient‐specific enquiries collected between January 2021 and June 2022 (n = 123/567; 21.7%) were analyzed using R version 4.2.1. Diagnosis, indication, and comorbidities were coded using Medical Dictionary for Regulatory Activities (MedDRA) terminology.ResultsMost patient‐specific enquiries from medical practitioners were from general practitioners (n = 103/123; 83.7%). Female (n = 53/123; 43.1%) and male (n = 59/123; 48.0%) patients were similarly represented. Sex was not specified for 8.9% (n = 11/123) of patients. The mean age of patients was 52.1 years (range &lt;10–90). The most common three diagnoses were osteoarthritis, anxiety, and chronic pain. Indications that were most frequently reported included chronic pain, anxiety, back pain, non‐neuropathic pain, and insomnia. Comedications were most commonly non‐opioid and opioid analgesics and antidepressants. Most practitioners were considering prescribing a cannabidiol (CBD) product for their patient. Cannabinoid composition selection guidance provided by CMAS was predominantly (delta‐9‐tetrahydrocannabinol) THC:CBD ~1:1, followed by CBD‐only products. CMAS was contacted by health professionals regarding the management of potential adverse events for five patients.ConclusionThe findings of this study shed light on the information medical practitioners were seeking to inform their clinical decision‐making about medical cannabis and can inform the development of clinical guidance resources.

Fear of movement interacts with trunk mobility, and pain intensity to predict disability in patients with chronic low back pain: a classification and regression tree (CART) analysis.

Low back pain significantly impacts global health, particularly in low-income areas where primary care challenges are prevalent. Assessing both biophysical and psychological factors associated with low back pain-related disability is crucial for developing effective screening and management strategies. This study aimed to examine the association between fear of movement, trunk mobility, pain intensity, physical activity, and low back pain-related disability, and to identify key factors contributing to higher disability levels in patients with chronic low back pain. This cross-sectional study analyzed data from 381 chronic low back pain patients aged over 18, collected at a primary care ambulatory between 2015 and 2019. Variables measured included pain intensity, fear of movement, physical activity, trunk mobility, and disability. A Classification and Regression Tree approach was used to model disability predictors. Fear of movement was the main driver of high disability (OR = 17.3, 95%CI 8.9-33.7). Two profiles were particularly prone to higher disability: patients with high fear of movement (>47.5) and pain intensity > 1.5; and those with lower fear of movement but poor trunk mobility (>36.5 cm). Patients with better trunk mobility and low pain intensity (≤3.5) showed significantly less disability (OR = 0.06, 95%CI 0.02-0.17). The findings highlight the need for integrating better psychological and biophysical assessments in managing chronic low back pain. Understanding how fear of movement, trunk mobility, and pain interaction can improve screening accuracy and optimize care in resource-limited settings, using valid and feasible tools for these scenarios.

Causes of chronic pain unrelated to surgical trauma after groin hernia repair: a prospective cohort study.

Chronic inguinal pain (CIP) can be caused by musculoskeletal or neurological pathologies and by surgical trauma after inguinal hernia repair among other. The aim of this prospective cohort observational study was to find the incidence and causes of CIP unrelated to surgical trauma 12 months after inguinal hernia repair. During sixteen months patients consulting a hernia center for groin-related symptoms were included in the study. Patients were evaluated by surgeons and filled out preoperatively the Inguinal Pain Questionnaires and a Numerical Rating Scale pain-questionnaire. For patients undergoing inguinal hernia repair, postoperative questionnaires similar to the pre-operative ones were sent out at 12 months. Patients scoring pain on pain questionnaires were evaluated by phone and physical examination. 289 patients (78.1%) of 370 repaired patients filled in the postoperative questionnaires. 62 (21.4%) patients scored pain, of these patients 5 (1.7%, 5/289) answered incorrectly in the pain questionnaires and 14 (4.8%, 14/289) had non-surgical trauma causes of pain: 5 musculoskeletal, 4 neurological and 3 other medical pathologies. This cohort study found CIP unrelated to surgical trauma in 4.8% of patients undergoing a groin hernia repair. Most causes of pain unrelated to surgical trauma were musculoskeletal and neurological pathologies. Nearly a third of patients scoring inguinal pain on pain-questionnaires did not have chronic post-surgical pain (CPSP), therefore incidence of CPSP should not be based solely on pain questionnaires. Clinical assessment of patients with pain is necessary to excluded CIP unrelated to the surgical trauma.

Use of machine learning to identify prognostic variables for outcomes in chronic low back pain treatment: a retrospective analysis

ABSTRACT Objectives Most patients seen in physical therapy (PT) clinics for low back pain (LBP) are treated for chronic low back pain (CLBP), yet PT interventions suggest minimal effectiveness. The Cochrane Back Review Group proposed ‘Holy Grail’ questions, one being: ‘What are the most important (preventable) predictors of chronicity’ for patients with LBP? Subsequently, prognostic factors influencing outcomes for CLBP have been described, however results remain conflicting due to methodological weaknesses. Methods This retrospective observational cohort study examined prognostic risk factors for PT outcomes in CLBP treatment using a sub-type of AI. Bootstrap random forest supervised machine learning analysis was employed to identify the outcomes-associated variables. Results The top variables identified as predictive were: FOTO™ predicted functional status (FS) change score; FOTO™ predicted number of visits; initial FS score, age; history of jogging/walking, obesity, and previous treatments; provider education level; medication use; gender. Conclusion This article presents how AI can be used to predict risk prognostic factors in healthcare research. Improving predictive accuracy helps clinicians predict outcomes and determine most appropriate plans of care and may impact research attrition rates.

A COMPARATIVE STUDY BETWEEN DRY NEEDLING AND KINETIC CHAIN ACTIVATION TECHNIQUE WITH SPECIFIED EXERCISE PROGRAMME IN PAINFUL ARC SYNDROME

Objective: Many researcher have reported that painful arc syndrome arises from multiple lesion i. e. minor tear of supraspinatus tendon, supraspinatus tendinitis, calcified deposit in the supraspinatus tendon, subacromial bursitis, crack fracture of greater tuberosity of humerus and bicipital tenosynovitis. In this study, dry needling and KCAT technique with specific exercise programme has been done to reduce pain and improve functioning and their by prevent shoulder pathologies. The objective of the study is. 1) To evaluate the effectiveness of kinetic chain activation in painful arc syndrome. 2) To evaluate the effectiveness of dry needling therapy in painful arc syndrome. 3) To evaluate the effectiveness of a specific exercise program. Methods: 50 patient diagnosed with painful arc syndrome by the physiotherapy department orthopedic department OPD will be initially assessed for the inclusion or exclusion criteria. prior to the treatment procedure patients are oriented to the study and taken informed consent, patient is divided in to two groups(Group A and Group B) and both groups will be assessed for the pre-test parameter. Outcome measure – shoulder pain and disability scale and goniometry is used for measuring pre-test and post-test. Results: The study was significant in reducing pain level and improving function with the pretest. At the end of 6 w treatment program with, both group A (dry needling) and group B(KCAT) showed improvement in painful arc syndrome. Based on results, the study supports research hypothesis that there was a significant improvement in ROM and significant reduction in SPADI score associated with painful arc syndrome. Patient participated in group B shows more significant changes. Conclusion: The study showed that significant improvement in symptoms of group B as compared to group A from the initial level to week 6. At the end of 6 w training programme both group A and group B Shows improvements in symptoms but the result of study supports that group B (KCAT CONCEPT-finger fanning technique) B is more efficient compare to group A(dry needling).

Pain chronification risk assessment: advanced phenotyping and scoring for prediction and treatments tailored to individualized patient profile

AbstractAcute pain is a physiologic, protective life-important warning neurological signal indicating multi-level tissue modulations caused by a broad spectrum of health adverse events such as stress overload, mechanical trauma, ischemia–reperfusion, sterile and infection-triggered inflammation, single- and multi-organ damage, acute and chronic wounds, tissue remodeling and degeneration, amongst others. On the other hand, pain chronification results in a pathologic transformation from the protective pain signaling into persistent debilitative medical condition with severe consequences including but not restricted to phenotype-specific behavioral patterns, reduced quality of life, and cognitive and mood disorders. Who is predisposed to an increased vs. decreased pain sensitivity and to the pain chronification? The motivation of personalized medicine that “same size does not fit all” is getting obvious also for an advanced approach in algesiology. Consequently, an in-depth patient stratification is essential for the paradigm change in overall pain management from currently applied reactive medical services to the cost-effective predictive, preventive, and personalized medicine (PPPM/3PM) in primary (reversible damage to health and targeted protection against health-to-disease transition) and secondary (personalized protection against disease progression) care. To this end, specifically innovative concepts of phenotyping elaborated in this study play a crucial role in patient stratification for predicting pain-associated outcomes, evidence-based targeted prevention of the pain chronification, and creation of treatment algorithms tailored to individualized patient profiles.

Executive functioning is associated to everyday interference of pain in patients with chronic pain.

Dysfunction in executive functions is common among patients with chronic pain. However, the relationships between executive functioning and pain management have not been extensively studied. In this study, 189 outpatients (160 women, 29 men; mean age 33.15) with chronic pain underwent an extensive neuropsychological assessment, including several tests of executive functions. In addition, all participants completed self-assessment questionnaires regarding pain and interference of pain in everyday life. After adjusting for effects of age, education, and depression, several aspects of executive functioning were significantly associated with self-assessed everyday interference of pain (rs = 0.13-0.22, all ps < 0.05). This indicates that lower performance on tests of executive functioning was significantly associated with a higher degree of pain interference and a lower degree of life control. Pain characteristics such as pain intensity, pain duration, and pain spreading were not associated with executive functioning. These results suggest that preserved executive functions are related to better coping with pain, but not directly to the pain itself, in patients with chronic pain. Depression was also associated with self-management of pain, indicating that patients with lower executive functioning in combination with depression may need special attention during rehabilitation.

UK medical cannabis registry: A clinical outcome analysis of medical cannabis therapy in chronic pain patients with and without co-morbid sleep impairment.

Chronic pain (CP) affects 35.0%-51.3% of the UK population, with 67%-88% reporting sleep disturbances. Cannabis-based medicinal products (CBMPs) have shown therapeutic potential in managing CP. Evidence suggests poor sleep worsens pain perception; therefore, this study aimed to assess patient-reported outcome measures (PROMs) following CBMP treatment in CP patients with and without co-morbid sleep impairment. A prospective cohort study of CP patients from the UK Medical Cannabis Registry was conducted. Participants were separated by baseline single-item sleep quality scale (SQS) score into sleep impaired (SQS ≤3) and unimpaired (SQS ≥4) cohorts. The primary outcome assessed changes in PROMs from baseline to 1-, 3-, 6-, and 12-months. Participants completed the following: SQS, General Anxiety Disorder-7, EQ-5D-5L, Brief Pain Inventory (BPI), and Short-Form McGill Pain Questionnaire-2. Significance was defined as p < 0.050. 1139 participants met the inclusion criteria (sleep impaired: n = 517, 45.4%; sleep unimpaired: n = 622, 54.61%). The sleep impaired cohort showed improvements in all PROMs at each follow-up (p < 0.010). The sleep unimpaired cohort showed similar results (p < 0.050), except in SQS and ED-5Q-5L: self-care and anxiety/depression scores (p > 0.050). However, the sleep impaired cohort observed greater improvements in BPI pain severity (p < 0.050) and SQS (p < 0.001) than the sleep unimpaired cohort at all follow-ups. 2817 adverse events were self-reported between both cohorts (p = 0.197). These findings align with literature that shows associated improvements in pain outcomes following CBMP administration. Sleep impaired individuals were more likely to experience greater pain severity improvements. However, this was not confirmed on multivariate logistic regression analysis and instead may be confounded by baseline pain severity. Whilst these results show promise for the effects of CBMPs on CP, they must be examined within the limitations of the study design. These findings provide further evidence to support the design of subsequent randomized controlled trials to verify causality between CBMPs and pain outcomes.

Factors associated with pain-related functional interference in people with chronic low back pain enrolled in a physical exercise programme: the role of pain, sleep, and quality of life.

To identify the factors associated with the pain-related functional interference level in people with chronic low back pain. Cross-sectional. Chronic low back pain patients. Sociodemographic data, pain intensity, pain-related functional interference, physical functioning and fitness, sleep quality, anxiety and depression, social support, and health-related quality of life were recorded. Descriptive and bivariate analyses were performed. A linear regression model was carried out to identify the factors associated with the pain-related functional interference level. 99 participants were involved (mean age: 54.37 SD: 12.44; women: 67.7%). 37.4%, 27.3%, and 35.4% were classified into low, moderate, and high pain-related functional interference level groups, respectively. Higher pain-related functional interference was associated with higher pain intensity (β: 0.724; p = 0.026), worse sleep quality (β: 0.077; p = 0.012), worse quality of life (physical (β: -0.539; p < 0.001) and mental (β: -0.289; p < 0.001), and lower consumption of weak opioids (β: -3.408; p = 0.037). Beyond the pain experience and intensity among people with chronic low back pain, several biopsychosocial factors associated with this condition has been identified. Furthermore, higher pain intensity, worse sleep quality, worse quality of life, and weak opioids' consumption have been related to the pain-related functional interference of this population.

Health Care Service Utilization Among People with HIV, Chronic Pain, and Depression: Utilization and Cost Outcomes from the HIV-PASS Study.

In the United States (U.S.), 90% of annual health care expenditures are devoted to people with chronic physical and mental health conditions. For people with HIV (PWH), two common, chronic comorbidities are pain and depression. This report assesses the impact of a brief psychotherapy intervention for PWH and comorbid chronic pain and depression on health care service utilization. Data from the HIV Pain and Sadness Study (HIV-PASS) randomized trial were used. Electronic health records were reviewed to tabulate use of the following services: (a) outpatient rehabilitation; (b) outpatient psychiatric; and (c) hospital-based (e.g., emergency department). Estimated average marginal effects were analyzed to determine how many times a participant accessed the service and the charge at each event. The sample consisted of 187 adults recruited from three U.S. sites. Individuals randomized to the three-month, seven session HIV-PASS intervention had average charges for hospital-based services that were significantly less during the post-treatment phase (months 4-12; 95%CI: -$16,612, -$131; p =.046) than those randomized to the comparison condition. On average, comparison condition participants were charged $8,371 more for hospital services in the 8-month period following intervention. No significant differences between treatment conditions were observed in use of outpatient rehabilitation, outpatient psychiatric services, or hospital-based care. Consistent with predictions, lower health care charges among those randomized to the HIV-PASS behavioral intervention were incurred for hospital services, indicating that a brief behavioral intervention could lead to decreased use of more emergent and expensive care services among persons with HIV, depression, and chronic pain.

A COMPARATIVE STUDY ON DYNAMIC NECK EXERCISE VERSUS ISOMETRIC NECK EXERCISES WITH THERABAND IN CHRONIC NECK PAIN

Objective: To compare the efficacy of dynamic neck exercises versus isometric neck exercises with theraband in chronic neck pain Methods: 60 patients with chronic neck pain selected as per the inclusion criteria; all the conditions in exclusion criteria was excluded. By dividing them into group A (n =30) (treated with dynamic neck exercise), group B (n=30) (treated with isometric neck exercise with theraband). Results: After screening of the 60 patients for study eligibility, a total of 30 patients were included for analysis, of whom 30 were in the control group A (Dynamic neck exercise with theraband) and 30 were in group B (Isometric neck exercise with theraband) Analysis pre-test and post-test score within and between the values of groups are tabulated with intervention of the result of the study. Group B showed significant change in ROM and Neck pain. Conclusion: Isometric Exercise is very well known for its pain reliving and long-lasting properties, but variability of techniques make it difficult to document but Theraband is known to provide consistency in training whilst preventing fatigue. Hence, patients in group B (treated with Theraband) showed decrease in VAS (Visual Analog Score) and NDI (Neck Disability Index) scores, which prove that isometric with theraband is better in treating Chronic Neck Pain.

Shear wave elastography based analysis of changes in fascial and muscle stiffness in patients with chronic non-specific low back pain

BackgroundThe quantitative assessment of individual muscle and fascial stiffness in patients with low back pain remains a challenge. This study aimed to compare the stiffness of the thoracolumbar fascia (TLF), erector spinae (ES), and multifidus (MF) in patients with and without chronic non-specific low back pain (CNLBP) using shear wave elastography (SWE). It also sought to explore the relationship between muscle and fascial stiffness and the levels of pain and dysfunction in patients with CNLBP.MethodsIn this cross-sectional study, 30 patients with CNLBP (age 27.40 ± 4.57 years, 19 males, 11 females, BMI 22.96 ± 2.55 kg/m2) and 32 healthy controls (age 27.94 ± 4.94 years, 15 males, 17 females, BMI 22.52 ± 2.26 kg/m2) were enrolled. Stiffness of the TLF, ES, and MF was measured using SWE, and Young’s modulus values were recorded. The numeric rating scale (NRS) for quantifying pain intensity and the Oswestry Disability Index (ODI) scores were recorded for the case group to examine their correlations with the resilience index.ResultsThe CNLBP group exhibited significantly higher shear modulus values at the L4-5 bilateral TLF (left: p = 0.014, d = 0.64; right: p = 0.002, d = 0.86), ES (left: p = 0.013, d = 0.66; right: p = 0.027, d = 0.58), and MF (left: p = 0.009, d = 0.69; right: p = 0.002, d = 0.85) compared to the control group. Comparable findings were observed for the right ES (p = 0.026, d = 0.59) and left MF (p = 0.020, η2 = 0.09) at L1-2. Strong correlations were observed between the shear modulus of the bilateral TLF (left: r = 0.57, p = 0.001; right: r = 0.65, p &amp;lt; 0.001) at L4-5 and the NRS scores. Moderate correlations were noted between the shear modulus of the ES (left: r = 0.42, p = 0.022; right: r = 0.48, p = 0.007) and MF (left: r = 0.50, p = 0.005; right: r = 0.42, p = 0.023) at L4-5 and the NRS scores. Additionally, the shear modulus of the MF (r = 0.50, p = 0.005) on the left side of L1-2 showed similar correlations. Strong correlations were observed between the shear modulus of the bilateral TLF (left: r = 0.60, p &amp;lt; 0.001; right: r = 0.58, p &amp;lt; 0.001) at L4-5 and the ODI scores. Moderate correlations were observed between the shear modulus of the right TLF (r = 0.43, p = 0.017), ES (r = 0.38, p = 0.037), and MF (r = 0.44, p = 0.015) at L1-2, as well as the bilateral MF (left: r = 0.46, p = 0.011; right: r = 0.45, p = 0.012) at L4-5, and the ODI scores. No significant correlations were found at other measurement sites.ConclusionIn patients with CNLBP, the stiffness of the lumbar fascia and muscles is generally higher than in individuals without LBP. However, this increase is not uniform across all lumbar regions, with the most significant changes observed in the L4-5 segments. In addition, higher stiffness may be associated with pain and dysfunction, primarily manifested in the TLF.

Clinical measures in chronic neuropathic pain are related to the Kennedy and endocannabinoid pathways.

Chronic neuropathic pain (CNP) is a debilitating condition, often refractory to currently available drugs. Understanding biochemical alterations in peripheral tissues such as blood will be useful for understanding underlying pathophysiological processes relating to CNP. We collected blood from two independent cohorts of CNP and pain-free controls (CNP n = 129/Controls n = 127) in the UK and Ireland to investigate the relationship between CNP-associated molecular/biochemical alterations and a range of clinical and pain metric parameters. Multiple statistical comparisons were conducted on the data, with selected variables included in one or more of the intended inferential analyses (six models). Gene expression analysis showed that choline phosphotransferase (CHPT1) was increased (p < .001) in the CNP group compared to controls. The levels of phosphatidylcholine, a metabolite of CHPT1 in the Kennedy Pathway, were significantly (p = .008) decreased in the plasma of patients with CNP. Given the relationship between the Kennedy pathway and endocannabinoids, plasma endocannabinoids and related N-acylethanolamines were quantified in clinical samples by HPLC-Tandem Mass Spectrometry. Plasma levels of the endocannabinoid 2-arachidonoylglycerol were higher in CNP samples compared to controls, and in the statistical models applied, 2-arachidonoylglycerol significantly increased the odds of CNP (p < .001). The expression of genes related to the synthesis and catabolism of endocannabinoids also corroborated the increased plasma 2-arachidonoylglycerol levels in patients with CNP. Endocannabinoid levels, expression of genes related to endocannabinoid metabolism, age, sex, depression and anxiety state together were strong predictors of CNP. The observed molecular changes indicate that lipid metabolism is altered in CNP and thus may represent a viable target for novel analgesics or biomarker development.

Chronic Low Back Pain Post-Caesarean Delivery: A Physiotherapist’s Perspective

This short review investigated the connection between neuraxial anaesthesia and chronic low back pain (CLBP) following caesarean sections, highlighting an important area of concern as the prevalence of such surgeries increases. Several risk factors for developing CLBP were identified, including needle size and patient posture during the procedure. Emphasis was placed on the crucial role of physiotherapists in distinguishing between pregnancy-related back pain and pain resulting from anaesthesia, as well as monitoring postoperative symptoms. Effective physiotherapy interventions were discussed, focusing on improving posture, enhancing mobility, and addressing psychosocial factors that may impact recovery. By advocating for a multidisciplinary approach, the review highlighted the necessity for comprehensive strategies that consider both physical and psychological aspects of recovery, ultimately aiming to optimise outcomes for women after caesarean delivery. Keywords: Chronic low back pain, Neuraxial anaesthesia, Caesarean section, Physiotherapy interventions, Risk factors, Multidisciplinary approach

USO INDISCRIMINADO DOS OPIOIDES POR PROFISSIONAIS DE SAÚDE: UMA REVISÃO INTEGRATIVA

Introduction: The opioid epidemic is a global public health crisis that affects several regions, including one that is not always highlighted: health professionals. General objective: to analyze the complexity of the indiscriminate use of opioids by health professionals. Method: This is an integrative literature review, following five stages with a search in the LILACS, BDENF, MEDLINE, and SciELO databases from 2019 to 2024. Results: 109 articles were found; 06 articles were used to prepare the study. Discussion: According to the Brazilian guidelines on opioid abuse, patients with chronic pain and healthcare professionals are among the groups most at risk of acquiring opioid dependence. Concern about the abuse of psychoactive substances by healthcare professionals is not new. Historically, the population of doctors and other healthcare workers has been more exposed to the risk of abusing psychoactive substances, including prescription drugs such as benzodiazepines, opiates and amphetamines. Conclusion: The disordered use of opioids by healthcare professionals is a multifaceted problem that requires a comprehensive and collaborative approach to combat. Healthcare institutions, regulatory bodies and society in general have an important role to play in promoting a safer and more supportive working environment. Emphasizing the importance of the mental health and well-being of healthcare professionals, as well as implementing preventive measures and effective interventions, is essential to reducing opioid use and ensuring that these professionals can continue to provide quality care while protecting their own health and safety.

Pain-Associated Diagnoses in Childhood Before the Diagnosis of Attention-Deficit/Hyperactivity Disorder: A Population-Based Study

Background: Pediatric pain significantly affects children’s lives, leading to school absenteeism, impaired social interactions, and psychological distress. The perception of sensory signals as pain is influenced by the brain’s noradrenergic system, and recent evidence suggests that chronic pain may impact cognitive functioning and emotional regulation. Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with alterations in the dopaminergic/noradrenergic systems, which could affect pain perception. Pain-associated conditions and frequent analgesic use in childhood may be linked to ADHD development and could serve as early indicators, yet data on this potential association remain limited. Study Aim: This population-based case-control study in Israel aimed to assess the prevalence of pain-related diagnoses prior to ADHD diagnosis in children aged 5 to 18. The study included children registered with Leumit Health Services (LHS) between 1 January 2006, and 30 June 2021. Children diagnosed with ADHD were compared to matched controls, selected based on age, gender, socioeconomic status, and other sociodemographic factors, who were never diagnosed with ADHD during the study period. Results: Children with ADHD (N = 18,756) and controls (N = 37,512) were precisely matched for sociodemographic characteristics. Individuals with ADHD exhibited significantly higher frequencies of diverse pain conditions, including those associated with illness [headache, earaches, and throat pain (odds ratios [OR] = 1.156 [95%CI 1.085, 1.232], 1.295 [95%CI 1.217, 1.377], and 1.080 [95%CI 1.019, 1.145], respectively; p &lt; 0.01)] and injury [sprains and strains (OR = 1.233 [95% CI 1.104,1.376)]. Analgesics were more frequently purchased by individuals with ADHD, particularly paracetamol (OR = 1.194 [95%CI 1.152, 1.237], p &lt; 0.001) and ibuprofen (OR = 1.366 [95%CI 1.318, 1.416], p = 0.001). Conclusions: This study highlights a potential connection between ADHD and pediatric pain. The elevated rates of pain diagnoses and analgesic usage among children with ADHD underscore the need for further research.

Erector spinae plane block for cancer pain relief: a systematic review.

Despite advances in pain management, cancer-related pain remains a critical issue for many patients. In recent years, there has been a growing interest in the use of fascial plane blocks, such as the Erector Spinae Plane Block (ESPB), for managing chronic pain, including in the oncology field. We conducted a systematic review to synthetize existing evidence on the use of ESPB for cancer pain management. We selected studies published between January 2016 to April 2024. A systematic search in Pubmed and Embase databases was performed. The search strategy included the following keywords and/or MeSH terms according to the controlled vocabulary of the databases sought: ((erector spinae plane block) OR (ESP block) OR (ESPB) AND ((cancer pain). We considered eligible Randomized, nonrandomized studies, case series and case reports reporting data on the use of ESPB in patients with cancer pain. The search revealed 34 studies. Among these, we found one RCT, three retrospective studies, two case series, and 28 case reports for a total of 135 patients. Studies included described the use of ESPB for the management of various types of cancer pain across different conditions, including chronic thoracic cancer-related pain, abdominal visceral pain and pain related to bone metastases. Single-shot ESPB was performed in 26 studies while continuous ESPB and the use of a peripheral nerve catheter for continuous analgesia were described in 8 studies. Neurolytic ESPB was performed in 6 studies for a total of 10 patients There was a high clinical heterogeneity in terms of technique, drugs, and use of adjuvants. The lack of comparators was a major flaw, together with the low level of evidence in the majority of the included studies. The evidence supporting the use of ESPB for cancer pain management is currently scarce, heterogeneous, and of low quality. To better understand its potential and provide robust clinical guidance, future research needs to focus on rigorous comparative studies, standardization of techniques and larger sample sizes.