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Medicina
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Persistent Pain: Advances in Diagnosis and Management
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Persistent Pain: Advances in Diagnosis and Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 9770

Special Issue Editor

Dr. Eung Don Kim

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Guest Editor
Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Republic of Korea
Interests: pain

Special Issue Information

Dear Colleagues,

Pain is one of the most exasperating factors in everyday life. Persistent pain in particular can be a major cause of lowering quality of life.

Nowadays, life expectancy is getting longer, and the importance of managing persistent pain is increasing. There are various types of intractable pain, such as neuropathic pain and musculoskeletal pain, and they all have the potential risk of developing into persistent pain. It is important to promptly diagnose and treat pain before it becomes chronic, and it is also important to manage the pain appropriately after it has already become chronic.

In this Special Issue, we would like to invite many researchers who are conducting various related studies to solve persistent pain. Please, do not hesitate submit your valuable studies on the diagnosis and treatment of pain, regardless of the type of literature. We look forward to the participation of many researchers.

Thank you.

Dr. Eung Don Kim
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pain
  • chronic pain
  • persistent pain
  • intractable pain
  • neuropathic pain
  • diagnosis
  • management
  • treatment

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Published Papers (5 papers)

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Research

13 pages, 720 KiB  
Article
Cluster Headache Management: Evaluating Diagnostic and Treatment Approaches Among Family and Emergency Medicine Physicians
by Buse Rahime Hasirci Bayir, Ezgi Nazli and Can Ulutas
Medicina 2025, 61(3), 437; https://doi.org/10.3390/medicina61030437 - 28 Feb 2025
Viewed by 486
Abstract
Background and Objectives: Cluster headaches (CHs) are one of the most painful primary headaches and negatively affect the lives of patients due to misdiagnosis. Family medicine (FM) and emergency medicine (EM) physicians are one of the most important steps in making the [...] Read more.
Background and Objectives: Cluster headaches (CHs) are one of the most painful primary headaches and negatively affect the lives of patients due to misdiagnosis. Family medicine (FM) and emergency medicine (EM) physicians are one of the most important steps in making the correct diagnosis and directing patients to headache specialists. In this study, the knowledge and management approaches of these two groups regarding CH were evaluated. Materials and Methods: Two online questionnaires were developed to gather the demographic data of physicians and to assess their knowledge about the characteristics, diagnosis, and treatment of CHs. Results: A total of 120 FM doctors and 98 EM doctors participated in this study. Answers about diagnostic criteria were similar in both groups. It was found that 70% of the participating physicians had concerns about misdiagnosing cluster headaches, and only 15% considered themselves sufficiently knowledgeable on the topic. Additionally, nearly half of the physicians were unaware that autonomic symptoms are mandatory for diagnosis and believed that NSAIDs are effective in treatment. Conclusions: In our study, for the first time, EM and FM physicians’ knowledge about the diagnosis and treatment of and professional competence in CHs was evaluated. It was found that the participants had knowledge about CHs but still considered themselves incompetent. For the correct and early diagnosis and for the proper management of CHs, EM and FM physicians, who can be called gatekeepers of CHs, need more medical education-based strategies. Full article
(This article belongs to the Special Issue Persistent Pain: Advances in Diagnosis and Management)
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13 pages, 1371 KiB  
Article
Combined Ultrasound and Fluoroscopy versus Ultrasound versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: A Retrospective Comparative Study
by Dong yuk Lee, Yongbum Park, Jun Hyeong Song, Jaeki Ahn, Kyung Hwan Cho and Suyeon Kim
Medicina 2024, 60(5), 809; https://doi.org/10.3390/medicina60050809 - 15 May 2024
Viewed by 2003
Abstract
Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and [...] Read more.
Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and Methods: A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. Results: In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups (p < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. Conclusions: When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain. Full article
(This article belongs to the Special Issue Persistent Pain: Advances in Diagnosis and Management)
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11 pages, 1124 KiB  
Article
Transforaminal Epidural Block and Erector Spinae Plane Block to Manage Acute Zoster-Associated Pain: A Retrospective Case–Control Study
by Hyojung Soh, Yeona Ko, Jungwon Shin and Eung Don Kim
Medicina 2024, 60(3), 453; https://doi.org/10.3390/medicina60030453 - 9 Mar 2024
Cited by 3 | Viewed by 1926
Abstract
Background and Objectives: Achieving adequate pain reduction in the acute phase of herpes zoster is essential for preventing postherpetic neuralgia (PHN). For this purpose, appropriate antiviral medications, oral analgesic medications, and various nerve block methods could be applied. Erector spinae plane block (ESPB) [...] Read more.
Background and Objectives: Achieving adequate pain reduction in the acute phase of herpes zoster is essential for preventing postherpetic neuralgia (PHN). For this purpose, appropriate antiviral medications, oral analgesic medications, and various nerve block methods could be applied. Erector spinae plane block (ESPB) is a simple, novel ultrasound-guided block technique, and its use has increased because the procedure is convenient and relatively safe. Although several cases have reported the zoster-associated pain (ZAP) control effect of ESPB, the efficacy of ESPB has not been compared with that of other types of nerve blocks for managing ZAP. This study aimed to compare the efficacy of ESPB with that of other types of nerve blocks for managing ZAP. Study Design: Retrospective case–control study. Materials and Methods: Medical records of 53 patients with acute thoracic herpes zoster were reviewed. We divided the participants into two groups: patients who received transforaminal epidural injection (TFEI) (n = 32) and those who received ESPB (n = 21). The efficacy of the procedure was assessed by a numerical rating scale (NRS) and by recording patient medication doses before the procedure and at 1 week, 1 month, 2 months, and 3 months after the procedure. Results: The time required for pain intensity to decrease to NRS ≤ 2 was not significantly different between the groups. The rate of medication discontinuation also was not different between the groups. There was no significant difference between the two groups in the proportion of clinically significant PHN (NRS ≥ 3) at any time point. Limitations: The relatively small sample size from a single center and the retrospective nature of the study served as limitations. Conclusions: The clinical effects of ESPB and TFEI were similar in patients with acute thoracic herpes zoster. ESPB could be considered an interventional option for ZAP management. Full article
(This article belongs to the Special Issue Persistent Pain: Advances in Diagnosis and Management)
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13 pages, 1976 KiB  
Article
Corrugator Muscle Activity Associated with Pressure Pain in Adults with Neck/Shoulder Pain
by Takahiro Yamada, Hiroyoshi Yajima, Miho Takayama, Konomi Imanishi and Nobuari Takakura
Medicina 2024, 60(2), 223; https://doi.org/10.3390/medicina60020223 - 28 Jan 2024
Viewed by 1859
Abstract
Background and Objectives: No studies have reported corrugator muscle activity associated with pain in people with pain. This study aimed to develop an objective pain assessment method using corrugator muscle activity with pressure pain stimulation to the skeletal muscle. Methods: Participants were 20 [...] Read more.
Background and Objectives: No studies have reported corrugator muscle activity associated with pain in people with pain. This study aimed to develop an objective pain assessment method using corrugator muscle activity with pressure pain stimulation to the skeletal muscle. Methods: Participants were 20 adults (a mean ± SD age of 22.0 ± 3.1 years) with chronic neck/shoulder pain. Surface electromyography (sEMG) of corrugator muscle activity at rest (baseline) and without and with pressure pain stimulation applied to the most painful tender point in the shoulder was recorded. Participants evaluated the intensity of the neck/shoulder pain and the sensory and affective components of pain with pressure stimulation using a visual analogue scale (VAS). The percentages of integrated sEMG (% corrugator activity) without and with pressure pain stimulation to the baseline integrated sEMG were compared, and the relationships between the % corrugator activity and the sensory and affective components of pain VAS scores were evaluated. Results: Without pressure stimulation, an increase in corrugator muscle activity due to chronic neck/shoulder pain was not observed. The % corrugator activity with pressure pain stimulation was significantly higher than that without stimulation (p < 0.01). A significant positive correlation between corrugator muscle activity and the affective components of pain VAS scores with pressure stimulation was found (ρ = 0.465, p = 0.039) and a tendency of positive correlation was found for the sensory component of pain VAS scores (ρ = 0.423, p = 0.063). Conclusions: The increase in corrugator muscle activity with pressure pain stimulation to the tender point in adults with chronic neck/shoulder pain was observed, although increased corrugator muscle activity resulting from the chronic neck/shoulder pain was not. These findings suggest that corrugator muscle activity with pressure pain stimulation can be a useful objective indication for tender point sensitivity assessment in the skeletal muscle with pain. Full article
(This article belongs to the Special Issue Persistent Pain: Advances in Diagnosis and Management)
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15 pages, 1884 KiB  
Article
Effectiveness of Acupotomy Combined with Epidural Steroid Injection for Lumbosacral Radiculopathy: A Randomized Controlled Pragmatic Pilot Study
by Jin-Hyun Lee, Sang-Hyun Lee, Hae Sun Suh, Man-Suk Hwang, Semin Jang, Sooil Choi, Young-Soo Lim, Sang Hyun Byun, Sang-Hoon Yoon, Sukhee Park and Tae-Yong Park
Medicina 2024, 60(1), 175; https://doi.org/10.3390/medicina60010175 - 19 Jan 2024
Viewed by 2845
Abstract
Background and Objectives: This pilot study aimed to evaluate the clinical effectiveness, cost-effectiveness, and safety of acupotomy combined with epidural steroid injection (ESI) in lumbosacral radiculopathy and examine its feasibility for the main study. Materials and Methods: This randomized, controlled, two-arm, [...] Read more.
Background and Objectives: This pilot study aimed to evaluate the clinical effectiveness, cost-effectiveness, and safety of acupotomy combined with epidural steroid injection (ESI) in lumbosacral radiculopathy and examine its feasibility for the main study. Materials and Methods: This randomized, controlled, two-arm, parallel, assessor-blinded, pragmatic study included 50 patients with severe lumbosacral radiculopathy who had insufficient improvement after an ESI. Patients were randomized (1:1 ratio) into a combined treatment (acupotomy + ESI, experimental) and an ESI single treatment (control) group. Both groups underwent a total of two ESIs once every 2 weeks; the experimental group received eight additional acupotomy treatments twice a week for 4 weeks. Types of ESI included interlaminar, transforaminal, and caudal approaches. Drugs used in ESI comprised a 5–10 mL mixture of dexamethasone sodium phosphate (2.5 mg), mepivacaine (0.3%), and hyaluronidase (1500 IU). The primary outcome was the difference in changes from baseline in the Oswestry Disability Index (ODI) scores between the groups at weeks 4 and 8. The incremental cost-utility ratio (ICUR) was calculated to evaluate the cost-effectiveness between the groups. Adverse events (AEs) were assessed at all visits. Results: Mean ODI scores for the experimental and control groups were −9.44 (95% confidence interval [CI]: −12.71, −6.17) and −2.16 (95% CI: −5.01, 0.69) at week 4, and −9.04 (95% CI: −12.09, −5.99) and −4.76 (95% CI: −7.68, −1.84) at week 8, respectively. The difference in ODI score changes was significant between the groups at week 4 (p = 0.0021). The ICUR of the experimental group versus the control group was as economical as 18,267,754 won/quality-adjusted life years. No serious AEs were observed. Conclusions: These results demonstrate the potential clinical effectiveness and cost-effectiveness of acupotomy combined with ESI for lumbosacral radiculopathy and its feasibility for a full-scale study. Larger, long-term follow-up clinical trials are needed to confirm these findings. Full article
(This article belongs to the Special Issue Persistent Pain: Advances in Diagnosis and Management)
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