The latest medical research on Pain Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about pain medicine gathered by our medical AI research bot.

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Functional connectivity of the amygdala is linked to individual differences in emotional pain facilitation.

Pain

The amygdala is central to emotional processing of sensory stimuli, including pain. Because recent findings suggest that individual differences in ...

Intraoperative methadone administration and postoperative pain control: a systematic review and meta-analysis.

Pain

Postoperative pain is not adequately managed in greater than 40% of surgical patients and is a high priority for perioperative research. In this me...

The influence of visual experience and cognitive goals on the spatial representations of nociceptive stimuli.

Pain

Localizing pain is crucial as it allows detecting which part of the body is being hurt and identifying in its surrounding which stimulus is produci...

Cannabinoid effects on responses to quantitative sensory testing among individuals with and without clinical pain: a systematic review.

Pain

There has been an explosion of interest in the utility of cannabinoids as potential analgesics. This systematic review critically synthesizes the e...

Impact of caloric restriction on peripheral nerve injury-induced neuropathic pain during aging in mice.

Eur J Pain

The incidence of peripheral neuropathy development and chronic pain is strongly associated with the arrival of senescence. The gradual physiologica...

Spinal Cord Stimulation for Management of Pain in Chronic Pancreatitis: A Systematic Review of Efficacy and Complications.

Neuromodulation

Spinal cord stimulation (SCS) has been used to manage pain in patients with chronic pancreatitis (CP). The aim of this systematic review was to summarize the effectiveness and complications of SCS in the management of pain associated with CP.

An exploratory systematic review was performed through a literature search of the PubMed, Medline, EMBASE, SCOPUS, and Cochrane databases.

Seven studies including 31 patients met the inclusion criteria. There was one observational cohort study, two case series, and four case reports. The estimated median age of the study group was 44 years (range 21-87 years) in primarily nonalcoholic CP (74%, 23/31). The SCS leads were typically placed at the level of T6-T8 in the epidural space. All patients reported an improvement in pain. The estimated median reduction of visual analogue pain scores was 61% (range 50%-100%) with an estimated median reduction of morphine equivalent opioid use of 69% (range 25%-100%) at the end of follow-up (less than one to greater than two years). Infection at the site of the lead occurred in 2 of the 31 (6%) and lead migration in 2 of the 31 (6%) patients.

This systematic review suggests that SCS has a potentially efficacious role in reducing pain and opioid use in patients with CP.

Predictors of Reduced Opioid Use With Spinal Cord Stimulation in Patients With Chronic Opioid Use.

Neuromodulation

Spinal cord stimulation (SCS) has gained traction as an alternative to chronic opioid therapy in light of the opioid crisis. Prior reports vary widely in their estimates of its effect on opioid consumption. We therefore aimed to address the following questions: 1) Does chronic opioid use change after SCS? 2) Which patient characteristics predict reduced opioid consumption after SCS?

Claims from a private health insurance company were used to identify patients with SCS implantation from 2003 to 2014. We required 12 months of continuous data before and after surgery (i.e., a minimum total observation period of two years), and at least two opioid prescription fills in the six months before surgery. Daily morphine equivalent dose (MED) was calculated from prescription medication claims. Diagnosis codes identified common comorbidities.

Hundred forty-five patients met inclusion criteria. MED of 65 was the most statistically meaningful preoperative dose threshold. Approximately half of patients decreased opioid use >20% after SCS implantation. Logistic regression analysis revealed age (p = 0.0362), gender (p = 0.0076), and preoperative daily MED < 65 (p = 0.0322) as predictors of meaningful reduction, which was defined as a 20% reduction in MED.

With only half of chronic opioid users demonstrating meaningful opioid reduction after SCS implantation, we demonstrate that current SCS technology does not reliably help a larger number of patients reduce opioid usage. Women, older age, and preoperative MED < 65 are predictive of meaningful opioid reduction but only one of these is modifiable. As not all patients saw benefit from their therapies, there is still much room for improvement in the treatment of refractory chronic pain that is associated with failed back surgery syndrome and chronic regional pain syndrome.

Systemic Opioid Reduction and Discontinuation Following Implantation of Intrathecal Drug-Delivery Systems for Chronic Pain: A Retrospective Cohort Analysis.

Neuromodulation

The study evaluated systemic opioid utilization before and after initiation of intrathecal drug therapy in patients with chronic, noncancer pain, as well as the effect of opioid elimination on payer costs.

This was a retrospective cohort analysis of administrative claims data (2011-2016), evaluating patients using systemic opioids for chronic, noncancer pain, newly implanted with an intrathecal drug-delivery system. Patients were excluded for spasticity, cancer, and device explant. The primary outcome was reduction or discontinuation of systemic morphine milligram equivalents during a 395-day follow-up period. The secondary outcome was total commercial insurer payments.

Of 9223 total patients, 631 met selection criteria. From baseline to 395-day follow-up, average daily morphine milligram equivalents decreased in 81.5% of patients, and 43.3% discontinued systemic opioid therapy entirely. Among patients who continued systemic opioids, average daily morphine milligram equivalents decreased in 74.9% of patients. Logistic regression found that morphine milligram equivalents of <50 mg/day prior to initiation of intrathecal drug delivery was associated with two times the odds of discontinuation vs. ≥90 mg/day (odds ratio = 2.08, 95% confidence interval 1.42-3.02, p = 0.001). Mean annual payer costs were reduced 29% for patients who discontinued vs. continued systemic opioids (-$11,115 per patient).

A meaningful proportion of patients discontinue or decrease systemic opioid use following initiation of intrathecal drug delivery. Standard of care should include opioid dose tapering prior to intrathecal drug delivery to maximize the probability of systemic opioid discontinuation.

Remifentanil for abdominal surgery is associated unexpectedly unfavorable outcomes.

Pain

Insufficient perioperative pain treatment is known as a highly predictive risk factor for the development of chronic postoperative pain. Remifentan...

Pain as a predictor of frailty over time among older Mexican Americans.

Pain

The objective of this study was to examine pain as a predictor of frailty over 18 years of follow-up among older Mexican Americans who were non-fra...

Heightened Risk for Pain in Young Adult Women with a History of Childhood Maltreatment: A Prospective Longitudinal Study.

Pain

A child maltreatment history is reported more frequently among adults with chronic pain compared to the general population; unfortunately, studies ...

A randomized controlled trial of five daily sessions and continuous trial of four weekly sessions of repetitive transcranial magnetic stimulation for neuropathic pain.

Pain

We conducted a multicenter, randomized, patient and assessor-blinded, sham-controlled trial to investigate the efficacy of repetitive transcranial ...