The Clinical Journal Of Pain[JOURNAL]
Sun
200 papers
Toward Validation of Clinical Measures to Discriminate Between Nociceptive, Neuropathic, and Nociplastic Pain: Cluster Analysis of a Cohort With Chronic Musculoskeletal Pain.
Hodges PW, Sanchez R, Pritchard S … +3 more , Turnbull A, Hahne A, Ford J
Clin J Pain · 2025 May · PMID 40035192 · Full text
OBJECTIVES: The International Association for the Study of Pain defines 3 pain types presumed to involve different mechanisms-nociceptive, neuropathic, and nociplastic. Based on the hypothesis that pain types should guid...
OBJECTIVES: The International Association for the Study of Pain defines 3 pain types presumed to involve different mechanisms-nociceptive, neuropathic, and nociplastic. Based on the hypothesis that pain types should guide the matching of patients with treatments, work has been undertaken to identify features to discriminate between them for clinical use. This study aimed to evaluate the validity of features to discriminate between pain types. MATERIALS AND METHODS: Subjective and physical features were evaluated in a cohort of 350 individuals with chronic musculoskeletal pain attending a chronic pain management program. The analysis tested the hypothesis that, if features nominated for each pain type represent 3 different groups, then (1) cluster analysis should identify 3 main clusters of patients, (2) these clusters should align with the pain type allocated by an experienced clinician, (3) patients within a cluster should have high expression of the candidate features proposed to assist identification of that pain type. Supervised machine learning interrogated features with the greatest and least importance for discrimination, and probabilistic analysis probed the potential for the coexistence of multiple pain types. RESULTS: Results confirmed that data could be best explained by 3 clusters. Clusters were characterized by a priori specified features and agreed with the designation of the experienced clinician with 82% accuracy. Supervised analysis highlighted features that contributed most and least to the classification of pain type, and probabilistic analysis reinforced the presence of mixed pain types. DISCUSSION: These findings support the foundation for further refinement of a clinical tool to discriminate between pain types.
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.
Moreno JE, Nestor BA, Mitcheson M … +1 more , Nelson S
Clin J Pain · 2025 Mar · PMID 39928544 · Publisher ↗
OBJECTIVES: Chronic pain (CP) significantly impacts emotional and physical well-being and overall quality of life across diverse populations in the United States (US). Notably, under-represented minoritized (URM) groups,...
OBJECTIVES: Chronic pain (CP) significantly impacts emotional and physical well-being and overall quality of life across diverse populations in the United States (US). Notably, under-represented minoritized (URM) groups, such as Hispanic/Latinx (H/L) youth, may experience disproportionate effects due to health disparities and lack of access to quality health care. However, this remains understudied. This study aimed to examine the association between CP and its related psychosocial factors-depressive and anxiety symptoms, and pain catastrophizing-in H/L youth, as compared with Non-Hispanic White (NHW) youth. METHODS: The current study sample included 58 self-identifying H/L and 58 NHW youth seeking CP treatment at a large Northeastern tertiary pain clinic, ages 12 to 18 years old, (M=15.49, SD=1.71), of which 88% identified as biologically female. Participant samples for each group were age and-sex-matched. RESULTS: 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 with H/L youth with pain. DISCUSSION: 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 with their Hispanic/Latinx youth counterparts. Further investigation of pain-coping mechanisms among H/L 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.
Measuring and Contextualizing School Refusal in Pediatric Chronic Pain: Establishing the Psychometric Properties of the SChool REfusal EvaluatioN Measure for Youth With Chronic Pain.
Stewart CE, Gambhir R, Aladin S … +1 more , Logan DE
Clin J Pain · 2025 Apr · PMID 39912283 · Publisher ↗
OBJECTIVE: School refusal is a longstanding difficulty for youth with chronic pain. Yet, research is hindered by a lack of adequate measurement tools to assess and describe the complex interpersonal and system-level fact...
OBJECTIVE: School refusal is a longstanding difficulty for youth with chronic pain. Yet, research is hindered by a lack of adequate measurement tools to assess and describe the complex interpersonal and system-level factors contributing to school refusal. This study investigates the utility of the SChool REfusal EvaluatioN (SCREEN) measure and its psychometric properties in a sample of youth with chronic pain. MATERIALS AND METHODS: Youth undergoing multidisciplinary evaluation at outpatient pain clinics completed self and parent-report questionnaires. Descriptive data examined school refusal. Internal consistency and construct validity were tested. Multiple regressions examined the parent and child factors related to school refusal. RESULTS: In all, 698 youth with chronic pain participated. Two-thirds reported symptoms suggesting at-risk or clinically significant symptoms of school refusal. Cronbach alpha scores were in the acceptable to good range on the SCREEN. Convergent validity for the interpersonal discomfort subscale of the SCREEN was established. The child's fear of pain, stress, peer relationships, and parent protective behaviors significantly correlated with SCREEN total scores. Participants enrolled in fully in-person school during the study period reported significantly higher scores on the interpersonal discomfort scale than those enrolled in remote learning. DISCUSSION: Our results provide evidence that youth with chronic pain experience significant challenges with school functioning and offer some support for the reliability and validity of the SCREEN in a sample of youth with chronic pain, a population for which few appropriate measures of school functioning have been established. The SCREEN measure may aid in assessing school refusal, with good clinical potential to quantify risk and identify modifiable factors.
General Anesthesia Combined With Quadratus Lumborum Block Reduces Emergence Delirium in Children After Laparoscopic Surgery: A Randomized Clinical Trial.
Xie H, Wei W, Xu Y … +8 more , Zhang N, Li B, Fan Y, Huang F, Gao Y, Ma D, Tan Y, Zhao T
Clin J Pain · 2025 Apr · PMID 39902635 · Full text
BACKGROUND: Emergency delirium (ED) is a common and serious postoperative complication, especially after pediatric surgery. Quadratus lumborum block (QLB) is a critical component of the multimodal, opioid-sparing analges...
BACKGROUND: Emergency delirium (ED) is a common and serious postoperative complication, especially after pediatric surgery. Quadratus lumborum block (QLB) is a critical component of the multimodal, opioid-sparing analgesia regimens, which provide effective analgesia, reduce opioid consumption, and attenuate surgical stress response. Therefore, this trial was designed to validate the hypothesis that the adjunctive use of QLB reduces the incidence of ED after laparoscopic surgery in children. MATERIALS AND METHODS: Children aged 1 to 6 years who underwent laparoscopic surgery under general anesthesia were randomly divided into general anesthesia combined with QLB group (Group G+Q) or general anesthesia group (Group G). The primary outcome was the incidence of ED in the postanesthesia care unit (PACU), the incidence of delirium 24 hours postoperatively, extubation time, length of stay in PACU, opioid consumption, and pain score were recorded. From July 2020 to October 2022, 292 children were randomized and 287 completed the study. RESULTS: The incidence of delirium in Group G+Q was significantly lower than that in Group G in PACU (16.1% vs. 47.9%, P <0.001) and 24 hours postoperatively (3.4% vs. 11.1%; P <0.05). The time of extubation time (21.2±11.4 vs. 18.2±11.8 min; P <0.05) and PACU stay in Group G were significantly longer than Group G+Q (57.2±20.3 vs. 48.9±20.4 min, P <0.01) compared with Group G. DISCUSSION: General anesthesia combined with QLB can significantly reduce the incidence of ED, shorten the extubation time and PACU residence time, and improve the quality of resuscitation.
High-impact Chronic Pain in a Cohort of Urologic Chronic Pelvic Pain Syndrome Patients: A Retrospective MAPP Research Network Study.
Wang T, Bergmans R, Minc A … +11 more , Krieger J, Harris RE, Lai HH, Clemens JQ, Harte SE, Kaplan C, Williams DA, Naliboff B, Gallop R, Till S, Schrepf A
Clin J Pain · 2025 Apr · PMID 39881480 · Publisher ↗
OBJECTIVES: An emerging concept in the chronic pain literature, high-impact chronic pain (HICP), refers to pain that occurs very frequently and results in major disruption of daily life. Previous epidemiologic investigat...
OBJECTIVES: An emerging concept in the chronic pain literature, high-impact chronic pain (HICP), refers to pain that occurs very frequently and results in major disruption of daily life. Previous epidemiologic investigations have noted that lower educational attainment, age, and race appear to be associated with the frequency of HICP, but condition-specific investigations of HICP have been less common. MATERIALS AND METHODS: Here we investigate HICP status and its clinical/demographic correlates in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network symptom pattern study. RESULTS: Participants were 476 urologic pelvic pain syndrome (UCPPS) patients, 64% of whom were female. Of these, 22% were classified as having HICP based on responses to several questions about pain interference in daily life. We confirmed that African American individuals and those with lower educational attainment were more likely to experience HICP (both P <0.05). In addition, those with HICP demonstrated much greater levels of disability, genitourinary pain, urinary symptoms, widespread pain, and pelvic floor tenderness and were more likely to experience pain in response to consuming standardized amounts of water (all P <0.05). Binary logistics regression showed that genitourinary pain, widespread pain, and race were the strongest predictors of pain in multivariate models. Furthermore, HICP status was associated with more self-reported health care utilization over the subsequent 18 months ( P <0.05). DISCUSSION: These findings suggest that HICP affects more than 1 of 5 UCPPS patients, with significant associated morbidity. Demographic and clinical characteristics associated with HICP may be useful for identifying at-risk UCPPS patients.
Hyperbaric Oxygen Therapy for Management of Complex Regional Pain Syndrome.
Cha J, Bosco G, Moon RE … +2 more , Melloni G, Camporesi EM
Clin J Pain · 2025 Apr · PMID 39878056 · Publisher ↗
OBJECTIVES: Complex regional pain syndrome remains a challenging condition characterized by severe, persistent pain and a variety of inflammatory and trophic symptoms. This study aimed to analyze the current literature t...
OBJECTIVES: Complex regional pain syndrome remains a challenging condition characterized by severe, persistent pain and a variety of inflammatory and trophic symptoms. This study aimed to analyze the current literature to evaluate hyperbaric oxygen therapy (HBOT)'s efficacy in treating complex regional pain syndrome (CRPS), focusing on both sympathetically maintained pain (SMP) and sympathetically independent pain (SIP) subtypes. METHODS: A comprehensive literature search was conducted in PubMed Clinical Queries using the MeSH term "Complex Regional Pain Syndromes" OR the keyword "CRPS" AND "Hyperbaric Oxygen Therapy" OR the keyword "HBOT." The selected publication types included a randomized controlled trial, a retrospective observational study, a comparative study, a retrospective case series, and case reports. The search was restricted to articles published in English between January 1994 and October 2024. The results from the search were used to compile this review. Patients were categorized into SMP, SIP, or indeterminate groups based on the presence of prior sympathetic nerve block history or disease duration. RESULTS: Thirteen studies involving 280 participants were reviewed. Of the patients, 42.5% were categorized as SMP, 48.2% as SIP, and 9.3% as indeterminate. HBOT treatment ranged from 3 to 63 sessions, typically using 2.4 atmospheres absolute for 90 minutes. The results indicated significant symptom relief and functional improvement across both SMP and SIP subtypes, suggesting the broad efficacy of HBOT for CRPS management. DISCUSSION: This review of the current literature suggests that HBOT may offer significant symptom relief, regardless of CRPS subtype or disease duration. HBOT's anti-inflammatory and neuroplasticity promoting properties make it a valuable noninvasive option for CRPS patients, potentially improving outcomes when combined with other therapeutic modalities. Further research is necessary to refine patient selection and optimize treatment protocols.
Can Erector Spinae Plane Block Replace Intrathecal Morphine in Cesarean Section? A Prospective Randomized Controlled Study on Opioid Consumption.
Sirin BY, Teomete G, Bilgili B
Clin J Pain · 2025 Apr · PMID 39807628 · Publisher ↗
OBJECTIVES: After cesarean, optimal analgesia is important for early mobilization, mitigating thromboembolic risks, and mother-infant communication. Our study compared the postoperative analgesic effects of intrathecal m...
OBJECTIVES: After cesarean, optimal analgesia is important for early mobilization, mitigating thromboembolic risks, and mother-infant communication. Our study compared the postoperative analgesic effects of intrathecal morphine (ITM) and erector spinae plane block (ESPB) in elective cesarean section under spinal anesthesia. METHODS: Eighty-two patients were randomized into ESPB and ITM groups. Both groups received spinal anesthesia with 10 mg of heavy bupivacaine. In the ITM group, ITM (100 mcg) was added. The ESPB group received bilateral T10 level ESPB with 20 mL 0.25% bupivacaine postoperatively. Postoperative pain control included intravenous paracetamol 4x1 g, intravenous patient-controlled analgesia with tramadol, and diclofenac 75 mg for rescue analgesia when Numeric Rating Scale (NRS) >4. NRS, tramadol consumption, and side effects were recorded 24 hours postoperatively. The primary outcome of this study is to compare 24-hour postoperative opioid consumption after cesarean sections. Secondary outcomes include postoperative pain scores, rescue analgesia needs, and side effects. RESULTS: NRS scores ≤4 at all time intervals and were comparable among groups. The total 24-hour tramadol consumption was significantly higher in the ESPB group (median: 75; Q1, Q3 [40, 140]) compared with ITM (50 [27.5, 60], P = 0.008). Tramadol consumption was similar among groups during 0 to 6 and 6 to 12 hours. In the 12 to 24 hours, tramadol consumption was significantly higher in the ESPB group (22.5 [15, 57.5]) compared with ITM (15 [12.5, 25], P = 0.005). In the ITM group, nausea and vomiting were observed in 3 patients and itching in 1 patient; no adverse effects were observed in the patients in the ESPB group. CONCLUSION: For patients undergoing cesarean section under spinal anesthesia, ITM reduced opioid consumption more effectively than ESPB. ESPB is not recommended as a primary analgesic option for cesarean sections.
Sleep, Pain Catastrophizing, and Pain Intensity in Treatment Seeking Adults With Opioid Use Disorder.
Ault A, Wilkerson AK, McCauley JL … +14 more , Muzzy W, Mappin GM, Yonce S, Barth KS, Brady KT, George MS, Wedin S, Christon LM, Flanagan JC, Yates-Johnson A, Tutek J, Lin T, Uhde TW, Borckardt JJ
Clin J Pain · 2025 Feb · PMID 39801166 · Publisher ↗
OBJECTIVES: Opioid use disorder (OUD) is a large, growing, and difficult-to-treat problem. It has been associated with poor sleep, which has a relationship of mutual exacerbation with pain. These interrelationships have...
OBJECTIVES: Opioid use disorder (OUD) is a large, growing, and difficult-to-treat problem. It has been associated with poor sleep, which has a relationship of mutual exacerbation with pain. These interrelationships have prompted interest in how pain catastrophizing (pain-related distortions of cognition), interacts with pain and sleep quality and quantity in those with OUD. METHODS: Participants with chronic pain and OUD (N = 105) completed a battery of self-report assessments. A subset of these participants (N = 63) wore an actigraphy watch for 2 weeks. Six mediation models were evaluated in this cross-sectional study interrelating pain intensity, pain catastrophizing, and sleep in previously published work were run 3 times each, measuring global sleep quality through the Pittsburgh Sleep Quality Index, self-reported total sleep time (TST) through Pittsburgh Sleep Quality Index, and objective TST through actigraphy. RESULTS: Three models yielded statistically significant results: (1) the relationship between global sleep quality and pain intensity mediated by pain catastrophizing (z = -2.00, P = 0.045), (2) the relationship between objective TST and pain intensity mediated by pain catastrophizing (z = -2.15, P = 0.032), and (3) the relationship between pain intensity and objective TST mediated by pain catastrophizing (z = -2.36, P = 0.018). CONCLUSION: Pain catastrophizing is a significant mediator of the relationship between the mutually exacerbating factors of sleep quality and pain intensity, and is, therefore, an important treatment target in this population. In addition, objective TST and self-reported TST were only moderately correlated and behaved differently in mediation models, suggesting that more research is needed to understand the relationship between perceived sleep quality and sleep quantity.
Factors Associated With Postoperative Pain Trajectory, Nausea, and Vomiting After Total Knee Arthroplasty: A Retrospective Study.
Chen TH, Wu CC, Chen JP
Clin J Pain · 2025 Mar · PMID 39782064 · Publisher ↗
OBJECTIVES: Postoperative pain, nausea, and vomiting (PONV) adversely affect postoperative rehabilitation after total knee arthroplasty (TKA). We aimed to identify factors associated with postoperative pain trajectory a...
OBJECTIVES: Postoperative pain, nausea, and vomiting (PONV) adversely affect postoperative rehabilitation after total knee arthroplasty (TKA). We aimed to identify factors associated with postoperative pain trajectory and PONV and evaluated the effects of different analgesic modalities. METHODS: We retrospectively reviewed patients undergoing unilateral primary TKA from 2017 to 2022. Patients received either general or spinal anesthesia. Patient-controlled analgesia (PCA) included patient-controlled epidural analgesia (PCEA) and intravenous analgesia (PCIA). Outcome variables included maximal pain intensity at certain times (before surgery, and 24 h and 48 h after surgery); and incidence of PONV. A generalized estimating equation was used to determine the correlation between PCA usage and longitudinal pain score at 48 hours follow-up after surgery. Multivariable logistic regression analyses were used to evaluate PONV after adjusting for potential confounders. RESULTS: In total, 2510 patients were included in the analyses. Patients without PCA intervention and with higher BMI reported greater acute postoperative pain. Furthermore, women and lower BMI were associated with higher rates of PONV. After adjusting for confounding factors, the PCEA group had a lower pain score than both the no PCA group (β estimate =-0.443, 95% CI= [-0.561 to -0.324], P <0.001) and the PCIA group (mean difference=-0.227, 95% CI = [-0.328 to -0.126], P <0.001). CONCLUSION: General anesthesia and PCA had no effect on the PONV incidence after TKA. Greater BMI correlated with higher pain scores but a lower likelihood of PONV. Epidural PCA provided superior acute postoperative analgesia without increasing the incidence of PONV.
It's Not Written All Over My Face: Constructing Chronic Pain as Invisible in Pain Clinic Consultations and Interviews.
Declercq J
Clin J Pain · 2025 Mar · PMID 39782005 · Full text
OBJECTIVES: 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 co...
OBJECTIVES: 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. MATERIALS AND METHODS: The qualitative approach of interactional sociolinguistic analysis is used to analyze 37 consultations and 11 semistructured 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 the phenomenon under scrutiny. RESULTS: 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 broadly. CONCLUSION: The discussion explores how on these 3 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), whereas, at the same time, the lack of traceable tissue injury is constructed as medically normal for chronic pain. This also relates to how patients and health care providers often orient to the stigma around chronic pain.
Budget Impact Analysis of Integrative Medicine Practices for Pediatric Patients With Chronic Pain.
Gong CL, Okoro CC, Wan R … +3 more , Lopez C, Ngo NH, Gold JI
Clin J Pain · 2025 Mar · PMID 39781917 · Full text
OBJECTIVES: Chronic pain is a leading cause of morbidity in children and adolescents globally but can be managed with a combination of traditional Western medicine and integrative medicine (IM) practices. This combinatio...
OBJECTIVES: Chronic pain is a leading cause of morbidity in children and adolescents globally but can be managed with a combination of traditional Western medicine and integrative medicine (IM) practices. This combination has improved various critical health outcomes, such as quality of life, sleep, pain, anxiety, and health care utilization. These IM practices include acupuncture, yoga, biofeedback, massage, mindfulness, or any combination of these modalities. The current article developed a budget impact model to estimate the institutional costs of implementing these practices among adolescents. METHODS: A decision tree was used to estimate the reduction in hospitalizations and emergency department (ED) use based on a previously published retrospective analysis of children receiving IM practices comparing utilization rates 1-year pre-implementation and post-implementation of IM services (Figure 1). Costs associated with implementing each modality were based on hourly compensation rates for licensed professionals administering each service and equipment associated with delivery (eg, acupuncture needles, biofeedback equipment, and sensors). The cost of each hospitalization and ED visit was derived from the literature. In addition, cost savings were estimated based on government-contracted and commercial-contracted reimbursement rates for each service. RESULTS: Cost savings were approximated to range from $1344 to $3439 per patient, with even greater cost savings of up to $6000 and $4132 when accounting for governmental and commercial payer reimbursement, respectively. DISCUSSION: IM leads to improved pain relief when combined with traditional medicine and yields significant cost savings, thus supporting the routine implementation of IM alongside traditional medicine in health care settings.
Analgesic Safety and Efficacy of Perioperative Posterior Cervical Muscle Plane Blocks in Elective Posterior Cervical Spine Surgery: A Systematic Review With Meta-analyses.
Weisbrod LJ, Ceesay OI, Schmidt C … +2 more , Haynatzki R, Surdell DL
Clin J Pain · 2025 Mar · PMID 39781902 · Publisher ↗
OBJECTIVE: Posterior cervical spine surgery can result in significant discomfort in the postoperative period. Postoperative pain management presents a challenge, particularly in the elderly population that is more sensi...
OBJECTIVE: Posterior cervical spine surgery can result in significant discomfort in the postoperative period. Postoperative pain management presents a challenge, particularly in the elderly population that is more sensitive to adverse effects from analgesia. We compared outcomes after perioperative posterior cervical muscle plane blocks versus patients who received general anesthesia only. METHODS: MEDLINE, EMBASE, and the Cochrane Library were searched for articles concerning the use of blocks in posterior cervical spinal surgery from January 1, 1974 to December 11, 2023. Data from studies meeting inclusion criteria were analyzed. Fixed-effect and random-effect models were used to establish odds ratios and mean differences with 95% CIs for each outcome. RESULTS: The results of the pooled analysis showed that in patients undergoing elective posterior cervical spine surgery, a perioperative posterior cervical muscle plane block resulted in a statistically significant decrease in numerical pain rating scores at 2 hours postoperatively, 12 hours postoperatively, adverse events, and postoperative nausea/vomiting. A preoperative posterior cervical block resulted in a decrease in the duration of surgery, and numerical pain rating scores at 24 hours postoperatively, though not to a level of statistical significance. CONCLUSION: These meta-analyses suggest that perioperative posterior cervical muscle plane blocks are safe and result in improved postoperative analgesic efficacy when compared with controls. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of perioperative posterior cervical blocks for elective posterior cervical spine surgery.
Comparing Analgesic Efficacies of Combined Fascial Plane Blocks for Postoperative Pain Following Laparoscopic Cholecystectomy.
Liotiri D, Diamantis A, Zacharoulis D
Clin J Pain · 2025 Feb · PMID 39773875 · Publisher ↗
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Safety and Efficacy of Opioid-sparing Anesthesia Compared With Traditional Opioid Anesthesia: A Scoping Review.
Lauretta MP, Marino L, Bilotta F
Clin J Pain · 2025 Feb · PMID 39773820 · Publisher ↗
OBJECTIVES: The rationale of adoption opioid-sparing anesthesia (OSA) is to achieve perioperative analgesia with a minimal amount of opioids combined with nonopioid adjuvants during and after surgery, namely multimodal a...
OBJECTIVES: The rationale of adoption opioid-sparing anesthesia (OSA) is to achieve perioperative analgesia with a minimal amount of opioids combined with nonopioid adjuvants during and after surgery, namely multimodal anesthesia. The OSA approach was originally developed to overcome the known complications of opioid-based anesthesia (OA), and the present scoping review (ScR) aims at providing clinical evidence of the safety and efficacy of OSA with respect to OA. METHODS: This ScR is mainly focused on studies presenting evidence on the safety and efficacy of OSA versus OA. PubMed and EMBASE databases were utilized to find relevant studies. The search strategy included the following keywords: "opioid sparing anesthesia complications, opioid sparing anesthesia efficacy, opioid sparing anesthesia safety." The findings from the 25 included studies were categorized into the following subsections: article characteristics, goals of the studies, OSA protocols, and surgical settings analyzed. RESULTS: In the 25 reviewed studies, evidence related to the impact of OSA versus OA was considered. Intraoperative safety and efficacy end points include hemodynamic stability and anesthetic/analgesic requirements. Postoperative end points include early cognitive dysfunction, opioid-induced bowel disorder, the physical status of mothers and newborns after labor and emergency cesarean, systemic immune and inflammation modifications, postoperative recovery, in-hospital and long-term opioid requirement, early postoperative pain, and chronic postsurgical pain. The studies reported lower intraoperative mean arterial pressure and heart rate fluctuations when α 2 agonists were adopted, while no differences were recorded for other complication rates. Analysis of OSA approaches for the postoperative conditions includes α 2 agonists, NMDA receptor blocking agents, gabapentinoids, nefopam hydrochloride, and locoregional anesthesia techniques with a positive impact on most of the end points considered. DISCUSSION: The clinical implementation of OSA encompasses the perioperative use of nonopioid drugs and locoregional anesthesia techniques. The reviewed studies reported OSA as a feasible approach to reduce opioid-related complications with no impact on patient safety.
Assessment of Relationship Between Dietary Factors, Socioeconomic Factors, Behavioral Factors, Physical Measurement, and Risk of Migraine: A Univariable and Multivariable Mendelian Randomization Study.
Zhang Y, Liu H, Chen X … +1 more , Dong D
Clin J Pain · 2025 Feb · PMID 39692196 · Publisher ↗
OBJECTIVE: Although numerous studies have identified associations between socioeconomic, behavioral, dietary, and physical factors and migraine, the causal nature of these relationships has yet to be adequately establish...
OBJECTIVE: Although numerous studies have identified associations between socioeconomic, behavioral, dietary, and physical factors and migraine, the causal nature of these relationships has yet to be adequately established. MATERIALS AND METHODS: We utilized 2-sample Mendelian randomization (MR) to elucidate the causal associations of 28 distinct traits for socioeconomic factors, behavioral factors, dietary factors, and physical measurement with migraine. In the univariable MR analysis, the inverse-variance weighted method served as the primary analytic approach. Robustness checks included the Cochran Q test, Egger intercept test, and leave-one-out analysis. A multivariable MR analysis framework was utilized to assess the direct causal impacts of these traits on migraine risk. RESULTS: The univariable MR analysis analysis revealed that genetic predispositions to higher coffee intake (Odds Ratio (OR) = 0.547; 95% CI = 0.359-0.834; P = 0.005), greater oily fish intake (OR = 0.556; 95% CI = 0.394-0.785; P = 0.001), and higher educational attainment (OR = 0.916; 95% CI = 0.884-0.949; P < 0.001) were associated with reduced migraine risk. In contrast, predispositions to higher poultry intake (OR = 4.690; 95% CI = 1.377-15.977; P = 0.013) and longer mobile phone use (OR = 1.526; 95% CI = 1.080-2.157; P = 0.017) correlated with increased risk. These associations remained consistent in the multivariable MR analysis after adjusting for stroke and particulate matter air pollution. CONCLUSIONS: Our study robustly supports the significant causal roles of specific socioeconomic, behavioral, and dietary factors with physical measurement in the development of migraine. Notably, coffee intake, oily fish intake, and educational attainment appear protective, whereas poultry intake and extensive mobile phone use elevate risk. These insights pave the way for developing targeted preventive strategies for migraine.
Study on the Effectiveness of Ultrasound-guided Pulsed Radiofrequency Therapy for Shoulder Pain Caused by Trigger Points.
Shen W, Xie NH, Cong XY … +1 more , Zheng YJ
Clin J Pain · 2025 Feb · PMID 39682050 · Publisher ↗
OBJECTIVES: This study compares ultrasound-guided pulsed radiofrequency (UG-PRF) with ultrasound-guided dry needling (UG-DN) for treating painful shoulder periarthritis (PSP). MATERIALS AND METHODS: Twenty-four patients...
OBJECTIVES: This study compares ultrasound-guided pulsed radiofrequency (UG-PRF) with ultrasound-guided dry needling (UG-DN) for treating painful shoulder periarthritis (PSP). MATERIALS AND METHODS: Twenty-four patients with PSP were chosen from the Pain Department of the Sixth People's Hospital of Nantong between August 2022 and December 2023. They were divided into 2 groups, UG-PRF (n = 12) and UG-DN (n = 12), using a random number table. Both groups received 1 treatment session and stretching exercises afterwards. The study aims to analyze and compare the levels of pain severity (measured by Visual Analog Scale) and shoulder joint function (assessed using Shoulder Pain And Disability Index) among patients before treatment, at the 4-week mark posttreatment, and at the 12-week mark posttreatment. RESULTS: There was no significant difference between the 2 groups initially. After treatment, the UG-PRF group had a larger decrease in Visual Analog Scale score compared with the UG-DN group at 4 weeks (-1.3 ± 0.4; 95% CI: -2.2 ∼ -0.5) and 12 weeks posttreatment (-1.1 ± 0.5; 95% CI: -2.1 ∼ -0.0). Moreover, the UG-PRF group displayed markedly lower scores on the Shoulder Pain And Disability Index in comparison to the UG-DN group at both the 4-week (-17.3 ± 6.9; 95% CI: -31.7 ∼ -2.9) and 12-week (-17.0 ± 7.4; 95% CI: -32.3 ∼ -1.7) follow-up assessments. Furthermore, 87.5% of patients reported clinically significant improvements according to the Patient Global Impression of Change evaluation. CONCLUSION: Both UG-PRF and UG-DN therapy are effective treatments for PSP, with UG-PRF showing better results in reducing pain and improving shoulder mobility.
Efficacy of Perineural Dexmedetomidine in Ultrasound-guided Interscalene Block on Rebound Pain After Shoulder Arthroscopy.
Huan X, Zhang T, Zhou M … +1 more , Wang L
Clin J Pain · 2025 Feb · PMID 39682043 · Publisher ↗
OBJECTIVES: This prospective, randomized, double-blind trial was performed to investigate the effect on rebound pain incidence of mixing dexmedetomidine (DEX) with local anesthetics in a combined injection interscalene b...
OBJECTIVES: This prospective, randomized, double-blind trial was performed to investigate the effect on rebound pain incidence of mixing dexmedetomidine (DEX) with local anesthetics in a combined injection interscalene block (ISB) during shoulder arthroscopy. METHODS: Forty-seven patients were enrolled in this study. Patients were randomly assigned to 2 groups: Group DEX and Group Control received ultrasound-guided ISB using 12 mL of 0.5% ropivacaine with 50 ug of DEX or without DEX. Pain scores at 6, 12, 24, and 48 hours after surgery were assessed with Numeric Pain Rating Scale (NRS). Additional analgesic requirements and side effects in the first 48 hours postoperatively, as well as sleep disturbance on the night and other complications of surgery were examined. RESULTS: The incidence of rebound pain was significantly lower in the Group DEX than in the Group Control. Perineural DEX decreased pain scores at 12 and 24 hours postoperatively. Group DEX had a prolonged time for the first analgesic request, PCA sufentanil consumption in Group DEX was less than Group Control during the first 48 hours postoperatively. The number of patients with sleep disturbance and nausea and vomiting in the DEX Group was lower on the first night postoperative. DISCUSSION: Perineural DEX added to ISB exerts a beneficial effect on the incidence of rebound pain after ISB in patients undergoing shoulder arthroscopy. Perineural DEX facilitated the implementation of multimodal analgesia in the early stage after operation.
Occurrence of Opioid-Related Neurocognitive Symptoms Associated With Long-term Opioid Therapy.
León C, Sung ML, Reisman JI … +8 more , Liu W, Kerns RD, Gordon KS, Mitra A, Kwon S, Yu H, Becker WC, Li W
Clin J Pain · 2025 Feb · PMID 39682036 · Full text
OBJECTIVE: Neurocognitive symptoms (NCSs) may be early indicators of opioid-related harm. We aimed to evaluate the incidence and potential attribution of opioid-related NCS among patients on long-term opioid therapy (LOT...
OBJECTIVE: Neurocognitive symptoms (NCSs) may be early indicators of opioid-related harm. We aimed to evaluate the incidence and potential attribution of opioid-related NCS among patients on long-term opioid therapy (LOT) by using natural language processing to extract data from the electronic health records within the Veterans Health Administration. METHODS: We conducted a retrospective cohort study of patients prescribed LOT in 2018. NCS were identified from clinical notes across 3 periods: 6 months before LOT initiation, during LOT, and 1-year post-LOT discontinuation. Opioid-related NCS included cognitive impairment, sedation, light-headedness, altered mental status, and intoxication. We calculated incidence rates, incidence rate ratios, and hazard ratios to evaluate the occurrence and potential opioid attribution of NCS across these periods. RESULTS: Among 55,652 patients, 3.1% experienced opioid-related NCS, with the highest incidence observed during LOT. Prevalence of NCS was greater in patients who were: between 55 and 64 (3.6%) or 65 and 74 years old (3.2%), Asian (4.8%, P = 0.02), and had received treatment for substance use disorders (7.1%, P = 0.01). In adjusted proportional hazards models, identified Asian race (hazard ratio: 2.20 [95% CI: 1.09-4.44], P = 0.03), and cooccurring conditions dementia (1.50 [1.12-2.00], 0.01), depression (1.31 [1.14-1.49], <0.01), posttraumatic stress disorder (1.18 [1.02-1.37], 0.02), substance use disorder (1.62 [1.36-1.92], 0.01), cardiovascular disease (1.18 [1.01-1.37], 0.04), chronic obstructive pulmonary disease (1.16 [1.01-1.33], 0.03), cirrhosis (1.73 [1.34-2.24], 0.01), chronic kidney disease (1.41 [1.19, 1.66]; 0.01) and traumatic brain injury (1.42 [1.06-1.91], 0.02) were associated with increased likelihood of NCS. Likelihood of NCS increased with LOT dose and decreased with LOT duration. CONCLUSION: This study suggests that opioid-related NCS are most likely to occur during LOT, indicating a potential temporal association with opioid use. These findings highlight the importance of monitoring NCS in patients on LOT as part of a broader strategy to mitigate opioid-related harms.
Reflections on: "Preoperative Bilateral External Oblique Intercostal Plus Rectus Sheath Block for Postoperative Pain Management Following Laparoscopic Cholecystectomy: A Noninferior Double-blind Placebo-controlled Trial".
Sethuraman RM, Vinothkumar S, Aravindan R … +1 more , Babu A
Clin J Pain · 2025 Jan · PMID 39668789 · Publisher ↗
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Letter to the Editor in Response to Recent Xie et al "Perioperative Regional Anesthesia Pain Outcomes in Children: A Retrospective Study of 3160 Regional Anesthetics in Routine Practice".
Clarke A, Hagen JG, Kattail D … +1 more , Alrayashi W
Clin J Pain · 2025 Jan · PMID 39668788 · Publisher ↗
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