Clinical Journal of Pain

OBJECTIVES: Severe postoperative pain requiring opioid treatment has been reported in 20-40% of hemorrhoidectomy patients. Compared to morphine, nalbuphine offers better hemodynamic stability, a lower risk of respiratory depression, and a lower potential for addiction. Nalbuphine was developed from intravenous form into an oral form (PHN131) to alleviate moderate-to-severe pain. METHODS: A randomized, double-blind, placebo-controlled, multiple-dose, parallel-design trial was conducted to evaluate the safety and efficacy of PHN131 in patients undergoing hemorrhoidectomy...

OBJECTIVES: Chronic pain is a significant health concern that adversely affects all aspects of life, including emotional well-being. Opioids are prescribed for the management of refractory, severe chronic pain although they have been associated with adverse effects, including addiction and overdose. The aim of this study was to examine factors that predict thoughts of self-harm among adults with chronic pain who are prescribed opioids. METHODS: Seven hundred sixty-five (N=765) persons with opioid-treated chronic lower back pain completed the Current Opioid Misuse Measure (COMM) and other validated questionnaires as part of a larger study...

OBJECTIVES: The Patient-Specific Functional Scale (PSFS) has been used to assess physical functioning in various chronic pain populations. There is a lack evidence for its use with diverse pain populations who have high impact chronic pain (HICP). The primary aim of this study was to assess the psychometric properties of the PSFS with a heterogeneous sample of patients with HICP. METHODS: A retrospective observational study of prospective functional outcomes collected before and after participation an intensive pain management program (IPMP): (PSFS, Disabilities of the Arm, Shoulder, and Hand; Lower Extremity Functional Scale; Neck Disability Index; Oswestry Disability Index), Multidimensional Patient Impression of Change, pain intensity, pain limitation, and fear avoidance from the charts of 509 IPMP completers...

OBJECTIVE: Transforaminal epidural steroid injections (TESIs) are widely administered for sciatica. The aim of this trial was to evaluate the effectiveness of TESIs in patients with acute sciatica (<8 wk). METHODS: This study was conducted in two Dutch hospitals. Participants (n=141) were randomly assigned to: 1) usual care and TESI of 1ml of 40mg/ml Methylprednisolone plus 1ml of 0.5% Levobupivacaine (intervention 1); 2) usual care and transforaminal epidural injection with 1 ml of 0...

OBJECTIVES: 1) To assess the ability to generate both kinesthetic and visual motor imagery in participants with carpal tunnel syndrome (CTS), compared with asymptomatic participants. 2) To assess the influence of psychophysiological and functional variables in the motor imagery (MI) process. METHODS: 20 patients with unilateral CTS and 18 healthy subjects were recruited. an observational case-control study with a non-probability sample was conducted to assess visual and kinesthetic movement imagery ability and psychophysiological variables in patients with CTS compared to asymptomatic participants in a control group (CG)...

OBJECTIVES: Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing acceptance and commitment therapy (ACT) and compassion focused therapy (CFT), could improve psychological wellbeing and disability in chronic pain patients with high levels of self-criticism in comparison to a wait-list control group. METHODS: Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition...

OBJECTIVES: This study aimed to investigate the perioperative analgesic effects of anterior quadratus lumborum block (QLB) for total laparoscopic hysterectomy (TLH). METHODS: One hundred patients undergoing TLH were randomized to receive an anterior QLB or placebo before general anesthesia. The primary and secondary outcomes were postoperative sufentanil consumption, intraoperative remifentanil demand, time to first opioid demand, numeric rating scale (NRS) pain scores, heart rate, mean arterial pressure, and complications within 24 h after surgery...

OBJECTIVES: The quality of postoperative pain management is often poor. A 'bundle', a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a 'Perioperative Pain Management Bundle' and whether this would be associated with improved multi-dimensional pain-related Patient-Reported-Outcomes (PROs). METHODS: PAIN OUT, a perioperative pain registry, offers tools for auditing pain-related PROs and obtaining information about perioperative pain management during the first 24 hours after surgery...

OBJECTIVE: This study aims to determine the effectiveness of pregabalin for control of symptoms in mild to moderate idiopathic Carpal tunnel syndrome (CTS). METHODS: In this randomized, placebo-controlled trial, 146 mild to moderate idiopathic CTS patients were randomized into pregabalin (n=74) and placebo group (n=72). Per protocol analysis was done in 131 patients; pregabalin (n=65) and placebo (n=66). Drug titration dose was 50 mg once daily for 1st week, twice daily for 2nd week and thrice daily for next 6 weeks...

OBJECTIVES: Acute postoperative pain (APP) is the main cause of postoperative dissatisfaction; however, traditional methods of pain assessment provide limited insights into the dynamics and development of APP. This study used the experience sampling method (ESM) to understand the dynamics of APP over time in relation to various patient factors. METHODS: Forty patients scheduled to undergo total knee replacement surgery were recruited in this study. Following an initial assessment, a short report questionnaire was sent to the patients via 10 digital alerts per day to assess the pain levels during two preoperative and the first 6 postoperative days...

OBJECTIVES: The aim of the study was to assess short-term changes in shoulder muscle activity elicited by dry needling in chronic unilateral shoulder pain patients. METHODS: A double-blind, placebo-controlled clinical trial was conducted, in which 30 volunteers with unilateral shoulder pain (USP) were recruited and randomly assigned to either real or sham dry needling conditions. Pain intensity scores, pressure pain threshold (PPT), glenohumeral internal rotation angles, and electromyographic activity during isotonic shoulder tasks (shoulder flexion and extension) were assessed before, immediately and 72 h after the intervention in the infraspinatus and deltoid muscles...

OBJECTIVE: Predictors of pain persistence have been identified among patients undergoing treatment for chronic pain or related conditions, but correlates of pain persistence in the general population remain underexplored. We identify socioeconomic variables associated with pain onset or persistence over a 6-10 year period in a nationally representative cohort. METHODS: Using panel data from the National Longitudinal Survey of Youth-1997, we examined the presence of pain interference at age 29 and chronic pain at ages 35-39...

OBJECTIVES: Limited research has investigated parent-targeted interventions in pediatric chronic pain, though these interventions may be an important part of family-centered care. Further, parent perspectives and feedback regarding these interventions are scant in the literature, even though they are crucial for developing, refining, and optimizing treatment options. This study aimed to understand how parents experience and perceive their participation in a Cognitive Behavioral Therapy (CBT) based, parent-targeted group intervention that was delivered either in-person or virtually, with a focus on the treatment components they found most important...

OBJECTIVE: Chronic pain has economic costs on par with cardiovascular disease, diabetes, and cancer. Despite this impact on the health care system and an increasing awareness of the relationship between pain and mortality, efforts to identify simple symptom-based risk factors for the development of pain, particularly in children, have fallen short. This is critically important as pain that manifests during childhood often persists into adulthood. To date no longitudinal studies have examined symptoms in pain-free children that presage a new, multisite manifestation of pain in the future...

OBJECTIVES: Various approaches to quadratus lumborum block (QLB) have been found to be an effective analgesic modality after cesarean delivery (CD). However, the evidence for the superiority of any individual approach still needs to be discovered. Therefore, we conducted this network meta-analysis to compare and rank the different injection sites for QLB for pain-related outcomes after CD. MATERIALS AND METHODS: PubMed, EMBASE, SCOPUS, and the Cochrane Central Registers of Controlled Trials (CENTRAL) were searched for randomized controlled trials evaluating the role of any approach of QLB with placebo/no block for post-CD pain...

OBJECTIVES: Prolonged postoperative opioid use increases risk for new post-surgical opioid use disorder. We evaluated preoperative phenotypic factors predicting prolonged postoperative opioid use. METHODS: We performed a secondary analysis of a prospective observational cohort (n=108) undergoing total knee arthroplasty (TKA) for osteoarthritis with 6-week and 6-month follow-up. Current opioid use and psychosocial, pain, and opioid-related characteristics were assessed at preoperative baseline...

OBJECTIVES: The effectiveness of Evoke closed-loop spinal cord stimulation (CL-SCS), a novel modality of neurostimulation, has been demonstrated in a randomised controlled trial (RCT). The objective of this cost-utility analysis was to develop a de novo economic model to estimate the cost-effectiveness Evoke CL-SCS when compared to open-loop SCS (OL-SCS) for the management of chronic back and leg pain. METHODS: A decision tree followed by a Markov model were used to estimate costs and outcomes of Evoke CL-SCS versus OL-SCS over a 15-year time horizon from the UK National Health Service perspective...

OBJECTIVE: In response to COVID-19, virtual, group-based interdisciplinary pain management programmes (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low intensity and pre-neuromodulation PMPs based on Acceptance and Commitment Therapy (ACT) as part of routine care during the pandemic. METHODS: Depending on patients' needs, participants completed a virtual high- or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022...

OBJECTIVE: To determine the impact of mobile-phone telemonitoring on patients' adherence and satisfaction to post-trauma pain treatment. MATERIALS AND METHODS: We conducted a prospective randomized clinical trial including patients with minor trauma discharged from the emergency department (ED) with analgesic treatment. Patients were randomized to one of three groups, control group where patients received a phone call on day-7, short message service (SMS) group where patients received a daily text message to remind them to take their treatment during 7 days and mobile-phone based telemonitoring (TLM) group...

OBJECTIVES: We tested the hypothesis that patients who received methocarbamol postoperatively experience less severe pain and require smaller doses of opioids than those who did not receive methocarbamol. MATERIALS AND METHODS: This is a retrospective cohort study of patients undergoing surgery involving the musculoskeletal system. Of 9089 patients, 704 received methocarbamol during 48 hours postoperatively, while 8385 did not receive methocarbamol. The patients who received methocarbamol postoperatively and the patients who did not receive methocarbamol were compared on the time-weighted average (TWA) pain score and opioid dose requirements in morphine milligram equivalents (MME) during the first 48 hours postoperatively, using propensity score-weighted regression models to adjusting for preoperative and intraoperative covariates...