Clinical Management of Chronic Pain

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 18 September 2024 | Viewed by 12462

Special Issue Editor


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Guest Editor
Department of Interdisciplinary Medicine, Aldo Moro University, 70124 Bari, Italy
Interests: acute and chronic pain; interventional pain management; neuropathic pain; hemodynamic goal-directed therapy; critically ill

Special Issue Information

Dear Colleagues,

Chronic pain is a complex phenomenon defined by the International Association for the Study of Pain as persistent or recurrent pain lasting more than 3 months or that lasts beyond normal tissue healing. According to its etiology, it can be classified as primary or secondary. The overall prevalence of chronic pain in the general population is about 20% and its burden is huge in terms of personal and socioeconomic costs. Disability, emotional imbalance, and social isolation are frequently associated with chronic pain, giving rise to a vicious circle that compromises the quality of life of affected patients. Modern pain management must be tailored to each specific patient, considering several aspects that embrace the intensity of pain, its pathophysiology, the patient’s comorbidities, the social context, and psychological aspects. Pharmacological, non-pharmacological, and also interventional techniques should be chosen on an individualized basis, with the aim of achieving “precision pain medicine”. Answers to the questions, “What is the pathophysiological process that causes chronic pain in this patient, and how can I recognize it?”, and subsequently, “What works for this patient?”, represent challenges for the future that need to be met in order to improve clinical patient care.

The aim of this Special Issue is to summarize the most recent evidence on precision pain medicine, with a focus on diagnosis and treatment. Research articles, reviews, and communications are welcome.

Dr. Mariateresa Giglio
Guest Editor

Manuscript Submission Information

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Keywords

  • chronic pain
  • opioid
  • pain therapy
  • neuropathic pain
  • interventional techniques

Published Papers (7 papers)

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Research

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13 pages, 1803 KiB  
Article
YAP Ultralate Laser-Evoked Responses in Fibromyalgia: A Pilot Study in Patients with Small Fiber Pathology
by Elena Ammendola, Silvia Giovanna Quitadamo, Emmanuella Ladisa, Giusy Tancredi, Adelchi Silvestri, Raffaella Lombardi, Giuseppe Lauria and Marina de Tommaso
J. Clin. Med. 2024, 13(11), 3078; https://doi.org/10.3390/jcm13113078 - 24 May 2024
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Abstract
Background: The investigation of C-fiber-evoked ultralow-level responses (ULEPs) at somatic sites is difficult in clinical practice but may be useful in patients with small fiber neuropathy. Aim: The aim of the study was to investigate changes in LEPs and ULEPs in patients [...] Read more.
Background: The investigation of C-fiber-evoked ultralow-level responses (ULEPs) at somatic sites is difficult in clinical practice but may be useful in patients with small fiber neuropathy. Aim: The aim of the study was to investigate changes in LEPs and ULEPs in patients with fibromyalgia affected or not by abnormal intraepidermal innervation. Methods: We recorded LEPs and ULEPs of the hand, thigh and foot in 13 FM patients with a normal skin biopsy (NFM), 13 patients with a reduced intraepidermal nerve fiber density (IENFD) (AFM) and 13 age-matched controls. We used a YAP laser, changing the energy and spot size at the pain threshold for LEPs and at the heat threshold for ULEPs. Results: ULEPs occurred at a small number of sites in both the NFM and AFM groups compared to control subjects. The absence of ULEPs during foot stimulation was characteristic of AFM patients. The amplitude of LEPs and ULEPs was reduced in patients with AFM at the three stimulation sites, and a slight reduction was also observed in the NFM group. Conclusions: The present preliminary results confirmed the reliability of LEPs in detecting small fiber impairments. The complete absence of ULEPs in the upper and lower limbs, including the distal areas, could confirm the results of LEPs in patients with small fiber impairments. Further prospective studies in larger case series could confirm the present findings on the sensitivity of LEP amplitude and ULEP imaging in detecting small fiber impairments and the development of IENFD in FM patients. Full article
(This article belongs to the Special Issue Clinical Management of Chronic Pain)
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13 pages, 1794 KiB  
Article
Medial or Lateral, That Is the Question: A Retrospective Study to Compare Two Injection Techniques in the Treatment of Knee Osteoarthritis Pain with Hyaluronic Acid
by Giacomo Farì, Rachele Mancini, Laura Dell’Anna, Vincenzo Ricci, Simone Della Tommasa, Francesco Paolo Bianchi, Ilaria Ladisa, Carlo De Serio, Silvia Fiore, Danilo Donati, Maurizio Ranieri, Andrea Bernetti and Marisa Megna
J. Clin. Med. 2024, 13(4), 1141; https://doi.org/10.3390/jcm13041141 - 17 Feb 2024
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Abstract
Background: Mild-to-moderate knee osteoarthritis (KOA) can be successfully treated using intra-articular hyaluronic acid (IA-HA). The medial infrapatellar (MIP) approach and lateral infrapatellar (LIP) approach are two of the most used techniques for performing IA-HA, but it is still not clear which one [...] Read more.
Background: Mild-to-moderate knee osteoarthritis (KOA) can be successfully treated using intra-articular hyaluronic acid (IA-HA). The medial infrapatellar (MIP) approach and lateral infrapatellar (LIP) approach are two of the most used techniques for performing IA-HA, but it is still not clear which one is preferable. Objectives: The study aims to find the best knee injection technique between MIP and LIP approaches. Methods: In total, 161 patients were enrolled, divided into two groups (MIP or LIP). Each technique was performed once a week for three weeks. Patients were evaluated using the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Roles and Maudsley Score (RMS) at T0 (before the first injection), T1 (one week after the third injection) and T2 (six months after). Results: NRS, KOOS and RMS showed a statistically significant improvement in both groups at all the detection times, without significant differences. No differences were detected between the groups in terms of systemic effect effusions, while the MIP group presented a mildly higher number of bruises in comparison with the LIP group (p = 0.034). Conclusions: Both the IA-HA techniques are equally effective in measured outcomes. The MIP approach seems to produce some local and transient side effects. So, the choice of the LIP or MIP approach depends on the operator’s skill and experience. Full article
(This article belongs to the Special Issue Clinical Management of Chronic Pain)
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13 pages, 1106 KiB  
Article
Improved Outcomes and Therapy Longevity after Salvage Using a Novel Spinal Cord Stimulation System for Chronic Pain: Multicenter, Observational, European Case Series
by Philippe Rigoard, Maxime Billot, Renaud Bougeard, Jose Emilio Llopis, Sylvie Raoul, Georgios Matis, Jan Vesper and Hayat Belaïd
J. Clin. Med. 2024, 13(4), 1079; https://doi.org/10.3390/jcm13041079 - 14 Feb 2024
Cited by 1 | Viewed by 878
Abstract
Spinal cord stimulation (SCS) is proven to effectively relieve chronic neuropathic pain. However, some implanted patients may face loss of efficacy (LoE) over time, and conversion to more recent devices may rescue SCS therapy. Recent SCS systems offer novel stimulation capabilities, such as [...] Read more.
Spinal cord stimulation (SCS) is proven to effectively relieve chronic neuropathic pain. However, some implanted patients may face loss of efficacy (LoE) over time, and conversion to more recent devices may rescue SCS therapy. Recent SCS systems offer novel stimulation capabilities, such as temporal modulation and spatial neural targeting, and can be used to replace previous neurostimulators without changing existing leads. Our multicenter, observational, consecutive case series investigated real-world clinical outcomes in previously implanted SCS patients who were converted to a new implantable pulse generator. Data from 58 patients in seven European centers were analyzed (total follow-up 7.0 years, including 1.4 years after conversion). In the Rescue (LoE) subgroup (n = 51), the responder rate was 58.5% at the last follow-up, and overall pain scores (numerical rating scale) had decreased from 7.3 ± 1.7 with the previous SCS system to 3.5 ± 2.5 (p < 0.0001). Patients who converted for improved battery longevity (n = 7) had their pain scores sustained below 3/10 with their new neurostimulator. Waveform preferences were diverse and patient dependent (34.4% standard rate; 44.8% sub-perception modalities; 20.7% combination therapy). Our results suggest that patients who experience LoE over time may benefit from upgrading to a more versatile SCS system. Full article
(This article belongs to the Special Issue Clinical Management of Chronic Pain)
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18 pages, 1926 KiB  
Article
Exploring Facial Thermography Patterns in Women with Chronic Migraine
by Bruno Veloso Fracasso, Renato Bender Castro, Marcos Leal Brioschi and Taís Malysz
J. Clin. Med. 2023, 12(23), 7458; https://doi.org/10.3390/jcm12237458 - 1 Dec 2023
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Abstract
(1) Background: Chronic migraine is a debilitating neurological condition affecting millions worldwide. This study delves into the facial point-of-care (POC) thermographic patterns of women with chronic migraine, aiming to shed light on the condition’s pathophysiology and diagnostic potential. (2) Methods: Using infrared POC [...] Read more.
(1) Background: Chronic migraine is a debilitating neurological condition affecting millions worldwide. This study delves into the facial point-of-care (POC) thermographic patterns of women with chronic migraine, aiming to shed light on the condition’s pathophysiology and diagnostic potential. (2) Methods: Using infrared POC thermography, the facial temperature distribution of 24 female participants with chronic migraine were analyzed. (3) Results: The findings revealed significant temperature asymmetry in women with right-sided unilateral headaches, particularly in the right frontal and temporal regions. Notably, individuals with bilateral pain did not exhibit thermal pattern differences, suggesting potential diagnostic complexities. While these results offer valuable insights, further research with larger samples is warranted (4) Conclusions: Facial thermography holds promise as an adjunctive tool for migraine diagnosis and understanding its neurophysiological basis; however, cautious interpretation is advised, given the need for validation and expanded investigations. Improved diagnostic criteria and treatment strategies may emerge from this ongoing exploration, ultimately enhancing the quality of life of chronic migraine sufferers. Full article
(This article belongs to the Special Issue Clinical Management of Chronic Pain)
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Review

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13 pages, 701 KiB  
Review
Clinical Patient-Relevant Outcome Domains for Persistent Spinal Pain Syndrome—A Scoping Review and Expert Panels
by Ferdinand Bastiaens, Jessica T. Wegener, Raymond W. J. G. Ostelo, Bert-Kristian W. P. van Roosendaal, Kris C. P. Vissers and Miranda L. van Hooff
J. Clin. Med. 2024, 13(7), 1975; https://doi.org/10.3390/jcm13071975 - 28 Mar 2024
Viewed by 673
Abstract
Large variation exists in the monitoring of clinical outcome domains in patients with persistent spinal pain syndrome (PSPS). Furthermore, it is unclear which outcome domains are important from the PSPS patient’s perspective. The study objectives were to identify patient-relevant outcome domains for PSPS [...] Read more.
Large variation exists in the monitoring of clinical outcome domains in patients with persistent spinal pain syndrome (PSPS). Furthermore, it is unclear which outcome domains are important from the PSPS patient’s perspective. The study objectives were to identify patient-relevant outcome domains for PSPS and to establish a PSPS outcomes framework. PubMed, CINAHL, Cochrane, and EMBASE were searched to identify studies reporting views or preferences of PSPS patients on outcome domains. The Arksey and O’Malley framework was followed to identify outcome domains. An expert panel rated the domains based on the importance for PSPS patients they have treated. A framework of relevant outcome domains was established using the selected outcome domains by the expert panel. No studies were found for PSPS type 1. Five studies with 77 PSPS type 2 patients were included for further analysis. Fourteen outcome domains were identified. An expert panel, including 27 clinical experts, reached consensus on the domains pain, daily activities, perspective of life, social participation, mobility, mood, self-reliance, and sleep. Eleven domains were included in the PSPS type 2 outcomes framework. This framework is illustrative of a more holistic perspective and should be used to improve the evaluation of care for PSPS type 2 patients. Further research is needed on the prioritization of relevant outcome domains. Full article
(This article belongs to the Special Issue Clinical Management of Chronic Pain)
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13 pages, 1287 KiB  
Review
The Calm after the Storm: A State-of-the-Art Review about Recommendations Put Forward during the COVID-19 Pandemic to Improve Chronic Pain Management
by Marimée Godbout-Parent, Tristan Spilak, M. Gabrielle Pagé, Manon Choinière, Lise Dassieu, Gwenaelle De Clifford-Faugère and Anaïs Lacasse
J. Clin. Med. 2023, 12(23), 7233; https://doi.org/10.3390/jcm12237233 - 22 Nov 2023
Viewed by 826
Abstract
The COVID-19 pandemic has brought its fair share of consequences. To control the transmission of the virus, several public health restrictions were put in place. While these restrictions had beneficial effects on transmission, they added to the pre-existing physical, psychosocial, and financial burdens [...] Read more.
The COVID-19 pandemic has brought its fair share of consequences. To control the transmission of the virus, several public health restrictions were put in place. While these restrictions had beneficial effects on transmission, they added to the pre-existing physical, psychosocial, and financial burdens associated with chronic pain, and made existing treatment gaps, challenges, and inequities worse. However, it also prompted researchers and clinicians to seek out possible solutions and expedite their implementation. This state-of-the-art review focuses on the concrete recommendations issued during the COVID-19 pandemic to improve the health and maintain the care of people living with chronic pain. The search strategy included a combination of chronic pain and pandemic-related terms. Four databases (Medline, PsycINFO, CINAHL, and PubMed) were searched, and records were assessed for eligibility. Original studies, reviews, editorials, and guidelines published in French or in English in peer-reviewed journals or by recognized pain organizations were considered for inclusion. A total of 119 articles were analyzed, and over 250 recommendations were extracted and classified into 12 subcategories: change in clinical practice, change in policy, continuity of care, research avenues to explore, group virtual care, health communications/education, individual virtual care, infection control, lifestyle, non-pharmacological treatments, pharmacological treatments, and social considerations. Recommendations highlight the importance of involving various healthcare professionals to prevent mental health burden and emergency overload and emphasize the recognition of chronic pain. The pandemic disrupted chronic pain management in an already-fragile ecosystem, presenting a unique opportunity for understanding ongoing challenges and identifying innovative solutions. Numerous recommendations were identified that are relevant well beyond the COVID-19 crisis. Full article
(This article belongs to the Special Issue Clinical Management of Chronic Pain)
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20 pages, 1425 KiB  
Review
A Manifesto in Defense of Pain Complexity: A Critical Review of Essential Insights in Pain Neuroscience
by Javier Picañol Párraga and Aida Castellanos
J. Clin. Med. 2023, 12(22), 7080; https://doi.org/10.3390/jcm12227080 - 14 Nov 2023
Cited by 3 | Viewed by 7124
Abstract
Chronic pain has increasingly become a significant health challenge, not just as a symptomatic manifestation but also as a pathological condition with profound socioeconomic implications. Despite the expansion of medical interventions, the prevalence of chronic pain remains remarkably persistent, prompting a turn towards [...] Read more.
Chronic pain has increasingly become a significant health challenge, not just as a symptomatic manifestation but also as a pathological condition with profound socioeconomic implications. Despite the expansion of medical interventions, the prevalence of chronic pain remains remarkably persistent, prompting a turn towards non-pharmacological treatments, such as therapeutic education, exercise, and cognitive-behavioral therapy. With the advent of cognitive neuroscience, pain is often presented as a primary output derived from the brain, aligning with Engel’s Biopsychosocial Model that views disease not solely from a biological perspective but also considering psychological and social factors. This paradigm shift brings forward potential misconceptions and over-simplifications. The current review delves into the intricacies of nociception and pain perception. It questions long-standing beliefs like the cerebral-centric view of pain, the forgotten role of the peripheral nervous system in pain chronification, misconceptions around central sensitization syndromes, the controversy about the existence of a dedicated pain neuromatrix, the consciousness of the pain experience, and the possible oversight of factors beyond the nervous system. In re-evaluating these aspects, the review emphasizes the critical need for understanding the complexity of pain, urging the scientific and clinical community to move beyond reductionist perspectives and consider the multifaceted nature of this phenomenon. Full article
(This article belongs to the Special Issue Clinical Management of Chronic Pain)
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