Chronic Pain Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Neurology".

Deadline for manuscript submissions: closed (1 November 2019) | Viewed by 85753

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Guest Editor
Centre for Pain Research, School of Health, Portland Building, Leeds Beckett University, Leeds, UK
Interests: pain; perception; pain management; analgesia; neuromodulation therapy; transcutaneous electrical nerve stimulation (TENS); individuality in pain; pain education; epidemiology of pain; sports-injuries and pain
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Dear Colleagues,

Chronic pain is a global health problem. Chronic pain is problematic for individuals in terms of suffering and impaired quality of life. Chronic pain is also problematic for society in terms of costs for health care, sickness benefit and lost productivity, which is greater than for heart disease, diabetes or cancer. Chronic pain affects up to 30% of people worldwide but health care policies often overlook this silent pandemic because people do not die directly from pain. Unlike other diseases and functional impairments, pain is not visible. The International Association for the Study of Pain (IASP) consider chronic pain to be a disease entity in its own right. The International Classification of Diseases (ICD-11) of the World Health Organization categorises chronic pain as cancer-related, postsurgical and posttraumatic, secondary musculoskeletal, secondary visceral, neuropathic, and secondary headache and orofacial. In addition, ICD-11 introduced a new phenomenological coding for chronic primary pain to acknowledge the increasing number of conditions that defy traditional classification (e.g., chronic widespread pain, fibromyalgia and irritable bowel syndrome). Chronic pain is multifaceted and there are a wide variety of modifiable and non-modifiable risk factors including a history of previous pain or mental illness, existing co-morbidities, age, sex, genetic heritage, and socioeconomic background.

A biopsychosocial framework and stepped model of care utilising pharmacological and non-pharmacological treatments is optimal for the management of chronic pain. This involves multidisciplinary teams working with patients to co-create explanations for pain and to implement suitable care plans to improve health and wellbeing. Nevertheless, a biomedical framework that relies on drug medication still dominates due to the entrenched practice and resource constraints of health service delivery. Recently, concerns about an epidemic of opioid abuse and overdose deaths has emerged due to open-ended prescribing of opioids for chronic pain. Clearly, there needs to be more effort to integrate non-pharmacological interventions into clinical practice. There are numerous non-pharmacological interventions including pain education (e.g., Explain Pain), health promotion (e.g., exercise and diet therapy), psychological therapies, electrical stimulation (e.g., peripheral, spinal cord and brain stimulation), electrophysical agents (e.g., thermo, electro, and photo therapies), manual therapies (e.g., massage, manipulation and mobilisation), complimentary therapies (e.g., acupuncture), visual feedback (e.g., mirror box and body illusions) and kinesiology taping. One challenge facing practitioners is deciding which non-pharmacological intervention(s) to select for which patient.

The purpose of this Special Issue is to discuss matters associated with chronic pain and its management, with a particular focus on non-pharmacological approaches. The scope of the issue is deliberately broad to encourage coverage of a wide range of topics and perspectives related to the management of chronic pain. This includes not only non-pharmacological treatments but also the phenomenon of chronic pain, patient experience, epidemiology (especially in resource-poor and/or non-Western countries), service delivery, health promotion, and pain education for patients or health care professionals.

Prof. Mark I. Johnson
Guest Editor

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Keywords

  • chronic pain
  • pain management
  • analgesia
  • neuromodulation therapy
  • psychological therapies
  • pain education
  • health promotion
  • pain services
  • pain perception
  • pain epidemiology

Published Papers (19 papers)

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Research

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11 pages, 1177 KiB  
Article
Comparison of the Analgesic Effect of Ropivacaine with Fentanyl and Ropivacaine Alone in Continuous Epidural Infusion for Acute Herpes Zoster Management: A Retrospective Study
by Hee Yong Kang, Chung Hun Lee, Sang Sik Choi, Mi Kyoung Lee, Yeon Joo Lee and Jong Sun Park
Medicina 2020, 56(1), 22; https://doi.org/10.3390/medicina56010022 - 8 Jan 2020
Cited by 2 | Viewed by 2363
Abstract
Background and Objectives: Currently, few studies have reported the effects of opioids during continuous epidural infusion (CEI) to control pain owing to herpes zoster (HZ). This study aimed to retrospectively compare the effectiveness of epidural opioids in the treatment of acute HZ [...] Read more.
Background and Objectives: Currently, few studies have reported the effects of opioids during continuous epidural infusion (CEI) to control pain owing to herpes zoster (HZ). This study aimed to retrospectively compare the effectiveness of epidural opioids in the treatment of acute HZ pain. Materials and Methods: We reviewed medical records of 105 patients who were divided into two groups: R group (CEI with ropivacaine) and RF group (CEI with ropivacaine and fentanyl). Clinical efficacy was evaluated using the numeric rating scale (NRS) score for 6 months after the procedures. We compared the percentage of patients with complete remission in each group. We investigated the complication rates during CEI. Results: No significant differences in the NRS scores were observed between the two groups in the 6-month period. The adjusted odds ratio (OR) for patients included in the complete remission was 0.6 times lower in the RF group than in the R group (95% confidence interval: 0.22–1.71, p = 0.35). The OR for complications during CEI was higher in the RF group than in the R group. However, the difference was not statistically significant. Conclusions: No difference was observed in the management of HZ pain and the prevention of postherpetic neuralgia between the two groups. The incidence of complications tended to be higher in the RF group than in the R group. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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12 pages, 1035 KiB  
Article
Rehabilitation Program Combined with Local Vibroacoustics Improves Psychophysiological Conditions in Patients with ACL Reconstruction
by Jung-Min Park, Sihwa Park and Yong-Seok Jee
Medicina 2019, 55(10), 659; https://doi.org/10.3390/medicina55100659 - 30 Sep 2019
Cited by 6 | Viewed by 3213
Abstract
Background and objective: This study investigated the therapeutic effect of applying local body vibration (LBV) with built-in vibroacoustic sound on patients who had an anterior cruciate ligament (ACL) reconstruction. Materials and Methods: Twenty-four participants were randomly classified into a LBV group [...] Read more.
Background and objective: This study investigated the therapeutic effect of applying local body vibration (LBV) with built-in vibroacoustic sound on patients who had an anterior cruciate ligament (ACL) reconstruction. Materials and Methods: Twenty-four participants were randomly classified into a LBV group (LBVG; n = 11) or a non-LBV group (nLBVG; n = 13). Both groups received the same program; however, the LBVG received LBV. Psychological measures included pain, anxiety, and symptoms; physiological measures included systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR), breathing rate (BR), sympathetic activation (SA), parasympathetic activation (PSA), range of motion (ROM), and isokinetic muscle strength at Weeks 0, 4, and 8. Results: Among the psychophysiological variables, pain, anxiety, symptoms, SBP, BR, and SA were significantly reduced in both groups, whereas HR, PSA, isokinetic peak torque (PT) of the knee joint, and ROM were significantly improved only in the LBVG. Comparing both groups, a significant difference appeared in pain, symptom, SA, PSA, isokinetic PT, and ROM at Weeks 4 and 8. Conclusions: The results indicate that the LBV intervention mitigated the participants’ pain and symptoms and improved their leg strength and ROM, thus highlighting its effectiveness. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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15 pages, 794 KiB  
Article
Factors Affecting Psychological Stress in Healthcare Workers with and without Chronic Pain: A Cross-Sectional Study Using Multiple Regression Analysis
by Yuta Sakamoto, Takeru Oka, Takashi Amari and Satoshi Shimo
Medicina 2019, 55(10), 652; https://doi.org/10.3390/medicina55100652 - 27 Sep 2019
Cited by 6 | Viewed by 4144
Abstract
Background and Objectives: Pain affects psychological stress and general health in the working population. However, the factors affecting psychological job stress related to chronic pain are unclear. This study aimed to clarify the structural differences among factors affecting psychological job stress in workers [...] Read more.
Background and Objectives: Pain affects psychological stress and general health in the working population. However, the factors affecting psychological job stress related to chronic pain are unclear. This study aimed to clarify the structural differences among factors affecting psychological job stress in workers with chronic pain and those without pain. Materials and Methods: A stepwise multiple regression analysis revealed the differences in structure between the psychological stress of workers with chronic pain and those with no pain. Psychological job stress by the Brief Job Stress Questionnaire was used as the dependent variable, with psychological state (depression and anxiety), specifically that characteristic of chronic pain (pain catastrophizing); information on the nature of the pain (intensity and duration); and number of years of service as independent variables. Selected independent variables were evaluated for collinearity. Results: In the model with psychological stress as a dependent variable (chronic pain: r2 = 0.57, F = 41.7, p < 0.0001; no-pain: r2 = 0.63, F = 26.3, p < 0.0001), the difference between the experiences of workers with chronic pain and those with no pain was that chronic pain was associated with depression (Beta = 0.43, p < 0.0001) and no pain with anxiety (Beta = 0.34, p < 0.0001). In the model with chronic pain-related depression as a dependent variable (r2 = 0.62, F = 41.7, p < 0.0001), job-life satisfaction (Beta = −0.18, p = 0.0017) and magnification (a dimension of pain catastrophizing; Beta = 0.16, p < 0.0001) were significant. Conclusions: The results of this study suggest that the psychological characteristics of chronic pain, such as depression and magnification, should be considered when evaluating and intervening in the job stress of workers with chronic pain. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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18 pages, 401 KiB  
Article
Empathic Accuracy in Chronic Pain: Exploring Patient and Informal Caregiver Differences and Their Personality Correlates
by Carlos Suso-Ribera, Verónica Martínez-Borba, Alejandro Viciano, Francisco Javier Cano-García and Azucena García-Palacios
Medicina 2019, 55(9), 539; https://doi.org/10.3390/medicina55090539 - 27 Aug 2019
Cited by 4 | Viewed by 2609
Abstract
Background and objectives: Social factors have demonstrated to affect pain intensity and quality of life of pain patients, such as social support or the attitudes and responses of the main informal caregiver. Similarly, pain has negative consequences on the patient’s social environment. However, [...] Read more.
Background and objectives: Social factors have demonstrated to affect pain intensity and quality of life of pain patients, such as social support or the attitudes and responses of the main informal caregiver. Similarly, pain has negative consequences on the patient’s social environment. However, it is still rare to include social factors in pain research and treatment. This study compares patient and caregivers’ accuracy, as well as explores personality and health correlates of empathic accuracy in patients and caregivers. Materials and Methods: The study comprised 292 chronic pain patients from the Pain Clinic of the Vall d’Hebron Hospital in Spain (main age = 59.4 years; 66.8% females) and their main informal caregivers (main age = 53.5 years; 51.0% females; 68.5% couples). Results: Patients were relatively inaccurate at estimating the interference of pain on their counterparts (t = 2.16; p = 0.032), while informal caregivers estimated well the patient’s status (all differences p > 0.05). Empathic accuracy on patient and caregiver status did not differ across types of relationship (i.e., couple or other; all differences p > 0.05). Sex differences in estimation only occurred for disagreement in pain severity, with female caregivers showing higher overestimation (t = 2.18; p = 0.030). Patients’ health status and caregivers’ personality were significant correlates of empathic accuracy. Overall, estimation was poorer when patients presented higher physical functioning. Similarly, caregiver had more difficulties in estimating the patient’s pain interference as patient general and mental health increased (r = 0.16, p = 0.008, and r = 0.15, p = 0.009, respectively). Caregiver openness was linked to a more accurate estimation of a patient’s status (r = 0.20, p < 0.001), while caregiver agreeableness was related to a patient’s greater accuracy of their caregivers’ pain interference (r = 0.15, p = 0.009). Conclusions: Patients poorly estimate the impact of their illness compared to caregivers, regardless of their relationship. Some personality characteristics in the caregiver and health outcomes in the patient are associated with empathic inaccuracy, which should guide clinicians when selecting who requires more active training on empathy in pain settings. Full article
(This article belongs to the Special Issue Chronic Pain Management)
14 pages, 924 KiB  
Article
Chronic Pain Patients’ Gaze Patterns toward Pain-Related Information: Comparison between Pictorial and Linguistic Stimuli
by Jieun Lee, Jaewon Beom, Seoyun Choi, Seulgi Lee Amy Wachholtz and Jang-Han Lee
Medicina 2019, 55(9), 530; https://doi.org/10.3390/medicina55090530 - 25 Aug 2019
Cited by 5 | Viewed by 2455
Abstract
Background and Objectives: The attentional bias and information processing model explained that individuals who interpret pain stimuli as threatening may increase their attention toward pain-related information. Previous eye tracking studies found pain attentional bias among individuals with chronic pain; however, those studies investigated [...] Read more.
Background and Objectives: The attentional bias and information processing model explained that individuals who interpret pain stimuli as threatening may increase their attention toward pain-related information. Previous eye tracking studies found pain attentional bias among individuals with chronic pain; however, those studies investigated this phenomenon by using only one stimulus modality. Therefore, the present study investigated attentional engagement to pain-related information and the role of pain catastrophizing on pain attentional engagement to pain-related stimuli among chronic pain patients by utilizing both linguistic and visual stimulus. Materials and Methods: Forty chronic pain patients were recruited from the rehabilitation center, the back pain clinic, and the rheumatology department of Chung-Ang University Hospital in Seoul, Korea. Patients observed pictures of faces and words displaying pain, presented simultaneously with neutral expressions, while their eye movements were measured using the eye tracking system. A t-test and ANOVA were conducted to compare stimulus pairs for the total gaze duration. Results: Results revealed that chronic pain patients demonstrated attentional preference toward pain words but not for pain faces. An ANOVA with bias scores was conducted to investigate the role of pain catastrophizing on attentional patterns. Results indicated that chronic pain patients with high pain catastrophizing scores gazed significantly longer at pain- and anger-related words than neutral words compared to those with low pain catastrophizing scores. The same patterns were not observed for the facial expression stimulus pairs. Conclusions: The results of the present study revealed attentional preference toward pain-related words and the significant role of pain catastrophizing on pain attentional engagement to pain-related words. However, different patterns were observed between linguistic and visual stimuli. Clinical implications related to use in pain treatment and future research suggestions are discussed. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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13 pages, 351 KiB  
Article
Somatosensory and Motor Differences between Physically Active Patients with Chronic Low Back Pain and Asymptomatic Individuals
by Juan Nieto-García, Luis Suso-Martí, Roy La Touche and Mónica Grande-Alonso
Medicina 2019, 55(9), 524; https://doi.org/10.3390/medicina55090524 - 23 Aug 2019
Cited by 7 | Viewed by 2607
Abstract
Background and Objectives: Chronic low back pain (CLBP) is the most common occupational disorder due to its associated disability and high risk of recurrence and chronicity. However, the mechanisms underlying physical and psychological variables in patients with CLBP remain unclear. The main [...] Read more.
Background and Objectives: Chronic low back pain (CLBP) is the most common occupational disorder due to its associated disability and high risk of recurrence and chronicity. However, the mechanisms underlying physical and psychological variables in patients with CLBP remain unclear. The main objective of this study was to assess whether there were differences between physically active patients with nonspecific CLBP compared with asymptomatic individuals in sensorimotor and psychological variables. Materials and Methods: This was an observational cross-sectional design with a nonprobabilistic sample. The sample was divided into two groups: individuals with nonspecific CLBP (n = 30) and asymptomatic individuals as a control (n = 30). The psychological variables assessed were low back disability, fear of movement, pain catastrophizing, and self-efficacy. The sensorimotor variables assessed were two-point discrimination, pressure pain threshold, lumbopelvic stability, lumbar flexion active range of motion, and isometric leg and back strength. Results: Statistically significant differences between the groups in terms of catastrophizing levels (p = 0.026) and fear of movement (p = 0.001) were found, but no statistically significant differences between groups were found in self-efficacy (p > 0.05). No statistically significant differences between the groups in any of the sensorimotor variables were found (p > 0.05). Conclusion: No sensorimotor differences were found between patients with asymptomatic and chronic low back pain, but differences were found in the psychological variables of catastrophizing and fear of movement. Full article
(This article belongs to the Special Issue Chronic Pain Management)
12 pages, 279 KiB  
Article
The Beliefs and Attitudes of Cypriot Physical Therapists Regarding the Use of Deep Friction Massage
by Alexios Pitsillides and Dimitrios Stasinopoulos
Medicina 2019, 55(8), 472; https://doi.org/10.3390/medicina55080472 - 12 Aug 2019
Cited by 2 | Viewed by 3121
Abstract
Background: Deep friction massage (DFM) is a widely used technique by physical therapists worldwide for chronic pain management. According to Dr. James Cyriax, compliance with the proposed guidelines is vital to obtain the desired therapeutic results. Objectives: This study explored the [...] Read more.
Background: Deep friction massage (DFM) is a widely used technique by physical therapists worldwide for chronic pain management. According to Dr. James Cyriax, compliance with the proposed guidelines is vital to obtain the desired therapeutic results. Objectives: This study explored the beliefs and attitudes of Cypriot physical therapists to DFM and their compliance with the suggested guidelines to identify any empirical-based application patterns and compare them to the suggestions of Cyriax. In addition, the prevalence of DFM use in clinical practice in Cyprus was investigated. Methods: Questionnaires, consisting of 18 multiple choice questions and a table of six sub-questions, were distributed to 90 local physical therapists. Results: A total of 70% of respondents declared that they perform DFM in their daily practice. The respondents answered 11 out of the 19 technical questions in compliance with the guidelines. Conclusion: The study revealed the DFM application pattern of Cypriot physical therapists. The compliance percentage of this pattern to Cyriax guidelines was 58% in general and 62.5% for patients with chronic conditions. Full article
(This article belongs to the Special Issue Chronic Pain Management)
8 pages, 574 KiB  
Article
Prediction of Chronic Lower Back Pain Using the Hierarchical Neural Network: Comparison with Logistic Regression—A Pilot Study
by Yutaka Owari and Nobuyuki Miyatake
Medicina 2019, 55(6), 259; https://doi.org/10.3390/medicina55060259 - 9 Jun 2019
Cited by 4 | Viewed by 3190
Abstract
Background: Many studies have reported on the causes of chronic lower back pain (CLBP). The aim of this study is to identify if the hierarchical neural network (HNN) is superior to a conventional statistical model for CLBP prediction. Linear models, which included multiple [...] Read more.
Background: Many studies have reported on the causes of chronic lower back pain (CLBP). The aim of this study is to identify if the hierarchical neural network (HNN) is superior to a conventional statistical model for CLBP prediction. Linear models, which included multiple regression analysis, were executed for the analysis of the survey data because of the ease of interpretation. The problem with such linear models was that we could not fully consider the influence of interactions caused by a combination of nonlinear relationships and independent variables. Materials and Methods: The subjects in our study were 96 people (30 men aged 72.3 ± 5.6 years and 66 women aged 71.9 ± 5.4 years) who participated at a college health club from 20 July 2016 to 20 March 2017. The HNN and the logistic regression analysis (LR) were used for the prediction of CLBP and the accuracy of each analysis was compared and examined by using our previously reported data. The LR verified the fit using the Hosmer–Lemeshow test. The efficiencies of the two models were compared using receiver performance analysis (ROC), the root mean square error (RMSE), and the deviance (−2 log likelihood). Results: The area under the ROC curve, the RMSE, and the −2 log likelihood for the LR were 0.7163, 0.2581, and 105.065, respectively. The area under the ROC curve, the RMSE, and the log likelihood for the HNN were 0.7650, 0.2483, and 102.787, respectively (the correct answer rates were HNN = 73.3% and LR = 70.8%). Conclusions: On the basis of the ROC curve, the RMSE, and the −2 log likelihood, the performance of the HNN for the prediction probability of CLBP is equal to or higher than the LR. In the future, the HNN may be useful as an index to judge the risk of CLBP for individual patients. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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23 pages, 2263 KiB  
Article
A Single Site Population Study to Investigate CYP2D6 Phenotype of Patients with Persistent Non-Malignant Pain
by Helen Radford, Karen H. Simpson, Suzanne Rogerson and Mark I. Johnson
Medicina 2019, 55(6), 220; https://doi.org/10.3390/medicina55060220 - 28 May 2019
Cited by 7 | Viewed by 3269
Abstract
Background and Objectives: Codeine requires biotransformation by the CYP2D6 enzyme, encoded by the polymorphic CYP2D6 gene, to morphine for therapeutic efficacy. CYP2D6 phenotypes of poor, intermediate, and ultra-rapid metabolisers are at risk of codeine non-response and adverse drug reactions due to altered [...] Read more.
Background and Objectives: Codeine requires biotransformation by the CYP2D6 enzyme, encoded by the polymorphic CYP2D6 gene, to morphine for therapeutic efficacy. CYP2D6 phenotypes of poor, intermediate, and ultra-rapid metabolisers are at risk of codeine non-response and adverse drug reactions due to altered CYP2D6 function. The aim of this study was to determine whether genotype, inferred phenotype, and urinary and oral fluid codeine O-demethylation metabolites could predict codeine non-response following a short course of codeine. Materials and Methods: There were 131 Caucasians with persistent pain enrolled. Baseline assessments were recorded, prohibited medications ceased, and DNA sampling completed before commencing codeine 30 mg QDS for 5 days. Day 4 urine samples were collected 1–2 h post morning dose for codeine O-demethylation metabolites analysis. Final pain assessments were conducted on day 5. Results: None of the poor, intermediate, ultra-rapid metabolisers and only 24.5% of normal metabolisers responded to codeine. A simple scoring system to predict analgesic response from day 4 urinary metabolites was devised with overall prediction success of 79% (sensitivity 0.8, specificity 0.78) for morphine and 79% (sensitivity 0.76, specificity 0.83) for morphine:creatinine ratio. Conclusions: In conclusion, this study provides tentative evidence that day 4 urinary codeine O-demethylation metabolites could predict non-response following a short course of codeine and could be utilised in the clinical assessment of codeine response at the point of care to improve analgesic efficacy and safety in codeine therapy. We offer a scoring system to predict codeine response from urinary morphine and urinary morphine:creatinine ratio collected on the morning of day 4 of codeine 30 mg QDS, but this requires validation before it could be considered for use to assess codeine response in clinical practice. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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11 pages, 310 KiB  
Article
Factors Predicting Favorable Short-Term Response to Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy
by Dong Yoon Park, Seok Kang and Joo Hyun Park
Medicina 2019, 55(5), 162; https://doi.org/10.3390/medicina55050162 - 18 May 2019
Cited by 9 | Viewed by 2567
Abstract
Background and Objectives: The purpose of this retrospective study was to identify predictors of short-term outcomes associated with a lumbosacral transforaminal epidural steroid injection (TFESI). Materials and Methods: The medical records of 218 patients, who were diagnosed with lumbosacral radiculopathy and treated with [...] Read more.
Background and Objectives: The purpose of this retrospective study was to identify predictors of short-term outcomes associated with a lumbosacral transforaminal epidural steroid injection (TFESI). Materials and Methods: The medical records of 218 patients, who were diagnosed with lumbosacral radiculopathy and treated with a TFESI, were reviewed in this retrospective study. A mixture of corticosteroid, lidocaine, and hyaluronidase was injected during TFESI. Patients with >50% pain relief on the numerical rating scale compared with the initial visit constituted the good responder group. Demographic, clinical, MRI, and electrodiagnostic data were collected to assess the predictive factors for short-term outcomes of the TFESI. Results: A multivariate logistic regression analysis demonstrated that a shorter duration of symptoms and a positive sharp wave (PSW)/fibrillation (Fib) observed in electrodiagnostic study (EDx) increased the odds of significant improvement 2–4 weeks after the TFESI. Conclusions: Shorter duration of symptoms and PSW/Fib on EDx were predictors of favorable short-term response to TFESI. Full article
(This article belongs to the Special Issue Chronic Pain Management)
9 pages, 294 KiB  
Article
Pharmacogenetic Testing in Acute and Chronic Pain: A Preliminary Study
by Lorenzo Panella, Laura Volontè, Nicola Poloni, Antonello Caserta, Marta Ielmini, Ivano Caselli, Giulia Lucca and Camilla Callegari
Medicina 2019, 55(5), 147; https://doi.org/10.3390/medicina55050147 - 16 May 2019
Cited by 5 | Viewed by 2086
Abstract
Background and Objectives: Pain is one of the most common symptoms that weighs on life’s quality and health expenditure. In a reality where increasingly personalized therapies are needed, the early use of genetic tests that highlights the individual response to analgesic drugs could [...] Read more.
Background and Objectives: Pain is one of the most common symptoms that weighs on life’s quality and health expenditure. In a reality where increasingly personalized therapies are needed, the early use of genetic tests that highlights the individual response to analgesic drugs could be a valuable help in clinical practice. The aim of this preliminary study is to observe if the therapy set to 5 patients suffering of chronic or acute pain is concordant to the Pharmacogenetic test (PGT) results. Materials and Methods: This preliminary study compares the genetic results of pharmacological effectiveness and tolerability analyzed by the genetic test Neurofarmagen Analgesia®, with the results obtained in clinical practice of 5 patients suffering from acute and chronic pain. Results: Regarding the genetic results of the 5 samples analyzed, 2 reports were found to be completely comparable with the evidences of the clinical practice, while in 3 reports the profile of tolerability and effectiveness were partially discordant. Conclusion: In light of the data not completely overlapping with results observed in clinical practice, further studies would be appropriate in order to acquire more information on the use of Neurofarmagen in routine clinical settings. Full article
(This article belongs to the Special Issue Chronic Pain Management)

Review

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10 pages, 325 KiB  
Review
Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
by Valeriu Ardeleanu, Alexandra Toma, Kalliopi Pafili, Nikolaos Papanas, Ion Motofei, Camelia Cristina Diaconu, Manfredi Rizzo and Anca Pantea Stoian
Medicina 2020, 56(1), 25; https://doi.org/10.3390/medicina56010025 - 9 Jan 2020
Cited by 43 | Viewed by 7038
Abstract
Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest [...] Read more.
Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice. Full article
(This article belongs to the Special Issue Chronic Pain Management)
48 pages, 605 KiB  
Review
Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews
by Carole A. Paley and Mark I. Johnson
Medicina 2020, 56(1), 6; https://doi.org/10.3390/medicina56010006 - 24 Dec 2019
Cited by 29 | Viewed by 12048
Abstract
Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological [...] Read more.
Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain. Full article
(This article belongs to the Special Issue Chronic Pain Management)
19 pages, 1176 KiB  
Review
Molecular Basis of Cancer Pain Management: An Updated Review
by Ayappa V. Subramaniam, Ashwaq Hamid Salem Yehya and Chern Ein Oon
Medicina 2019, 55(9), 584; https://doi.org/10.3390/medicina55090584 - 12 Sep 2019
Cited by 10 | Viewed by 10556
Abstract
Pain can have a significantly negative impact on the quality of life of patients. Therefore, patients may resort to analgesics to relieve the pain. The struggle to manage pain in cancer patients effectively and safely has long been an issue in medicine. Analgesics [...] Read more.
Pain can have a significantly negative impact on the quality of life of patients. Therefore, patients may resort to analgesics to relieve the pain. The struggle to manage pain in cancer patients effectively and safely has long been an issue in medicine. Analgesics are the mainstay treatment for pain management as they act through various methods on the peripheral and central pain pathways. However, the variability in the patient genotypes may influence a drug response and adverse drug effects that follow through. This review summarizes the observed effects of analgesics on UDP-glucuronosyl (UGT) 2B7 isoenzyme, cytochrome P450 (CYP) 2D6, μ-opioid receptor μ 1 (OPRM1), efflux transporter P-glycoprotein (P-gp) and ATP-binding cassette B1 ABCB1/multiple drug resistance 1 (MDR1) polymorphisms on the mechanism of action of these drugs in managing pain in cancer. Furthermore, this review article also discusses the responses and adverse effects caused by analgesic drugs in cancer pain management, due to the inter-individual variability in their genomes. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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21 pages, 625 KiB  
Review
Movement Control Impairment and Low Back Pain: State of the Art of Diagnostic Framing
by Soleika Salvioli, Andrea Pozzi and Marco Testa
Medicina 2019, 55(9), 548; https://doi.org/10.3390/medicina55090548 - 29 Aug 2019
Cited by 12 | Viewed by 5804
Abstract
Background and objectives: Low back pain is one of the most common health problems. In 85% of cases, it is not possible to identify a specific cause, and it is therefore called Non-Specific Low Back Pain (NSLBP). Among the various attempted classifications, the [...] Read more.
Background and objectives: Low back pain is one of the most common health problems. In 85% of cases, it is not possible to identify a specific cause, and it is therefore called Non-Specific Low Back Pain (NSLBP). Among the various attempted classifications, the subgroup of patients with impairment of motor control of the lower back (MCI) is between the most studied. The objective of this systematic review is to summarize the results from trials about validity and reliability of clinical tests aimed to identify MCI in the NSLBP population. Materials and Methods: The MEDLINE, Cochrane Library, and MedNar databases have been searched until May 2018. The criteria for inclusion were clinical trials about evaluation methods that are affordable and applicable in a usual clinical setting and conducted on populations aged > 18 years. A single author summarized data in synoptic tables relating to the clinical property; a second reviewer intervened in case of doubts about the relevance of the studies. Results: 13 primary studies met the inclusion criteria: 10 investigated inter-rater reliability, 4 investigated intra-rater reliability, and 6 investigated validity for a total of 23 tests (including one cluster of tests). Inter-rater reliability is widely studied, and there are tests with good, consistent, and substantial values (waiter’s bow, prone hip extension, sitting knee extension, and one leg stance). Intra-rater reliability has been less investigated, and no test have been studied for more than one author. The results of the few studies about validity aim to discriminate only the presence or absence of LBP in the samples. Conclusions: At the state of the art, results related to reliability support the clinical use of the identified tests. No conclusions can be drawn about validity. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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19 pages, 392 KiB  
Review
The Landscape of Chronic Pain: Broader Perspectives
by Mark I. Johnson
Medicina 2019, 55(5), 182; https://doi.org/10.3390/medicina55050182 - 21 May 2019
Cited by 20 | Viewed by 5629
Abstract
Chronic pain is a global health concern. This special issue on matters related to chronic pain aims to draw on research and scholarly discourse from an eclectic mix of areas and perspectives. The purpose of this non-systematic topical review is to précis an [...] Read more.
Chronic pain is a global health concern. This special issue on matters related to chronic pain aims to draw on research and scholarly discourse from an eclectic mix of areas and perspectives. The purpose of this non-systematic topical review is to précis an assortment of contemporary topics related to chronic pain and its management to nurture debate about research, practice and health care policy. The review discusses the phenomenon of pain, the struggle that patients have trying to legitimize their pain to others, the utility of the acute–chronic dichotomy, and the burden of chronic pain on society. The review describes the introduction of chronic primary pain in the World Health Organization’s International Classification of Disease, 11th Revision and discusses the importance of biopsychosocial approaches to manage pain, the consequences of overprescribing and shifts in service delivery in primary care settings. The second half of the review explores pain perception as a multisensory perceptual inference discussing how contexts, predictions and expectations contribute to the malleability of somatosensations including pain, and how this knowledge can inform the development of therapies and strategies to alleviate pain. Finally, the review explores chronic pain through an evolutionary lens by comparing modern urban lifestyles with genetic heritage that encodes physiology adapted to live in the Paleolithic era. I speculate that modern urban lifestyles may be painogenic in nature, worsening chronic pain in individuals and burdening society at the population level. Full article
(This article belongs to the Special Issue Chronic Pain Management)

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10 pages, 4039 KiB  
Case Report
Pain and Function in the Runner a Ten (din) uous Link
by Peter Francis, Isobel Thornley, Ashley Jones and Mark I. Johnson
Medicina 2020, 56(1), 21; https://doi.org/10.3390/medicina56010021 - 7 Jan 2020
Cited by 2 | Viewed by 2997
Abstract
A male runner (30 years old; 10-km time: 33 min, 46 s) had been running with suspected insertional Achilles tendinopathy (AT) for ~2 years when the pain reached a threshold that prevented running. Diagnostic ultrasound (US), prior to a high-volume stripping injection, confirmed [...] Read more.
A male runner (30 years old; 10-km time: 33 min, 46 s) had been running with suspected insertional Achilles tendinopathy (AT) for ~2 years when the pain reached a threshold that prevented running. Diagnostic ultrasound (US), prior to a high-volume stripping injection, confirmed right-sided medial insertional AT. The athlete failed to respond to injection therapy and ceased running for a period of 5 weeks. At the beginning of this period, the runner completed the Victoria institute of sports assessment–Achilles questionnaire (VISA-A), the foot and ankle disability index (FADI), and FADI sport prior to undergoing an assessment of bi-lateral gastrocnemius medialis (GM) muscle architecture (muscle thickness (MT) and pennation angle (PA); US), muscle contractile properties (maximal muscle displacement (Dm) and contraction time (Tc); Tensiomyography (TMG)) and calf endurance (40 raises/min). VISA-A and FADI scores were 59%/100% and 102/136 respectively. Compared to the left leg, the right GM had a lower MT (1.60 cm vs. 1.74 cm), a similar PA (22.0° vs. 21.0°), a lower Dm (1.2 mm vs. 2.0 mm) and Tc (16.5 ms vs. 17.7 ms). Calf endurance was higher in the right leg compared to the left (48 vs. 43 raises). The athlete began a metronome-guided (15 BPM), 12-week progressive eccentric training protocol using a weighted vest (1.5 kg increments per week), while receiving six sessions of shockwave therapy concurrently (within 5 weeks). On returning to running, the athlete kept daily pain (Numeric Rating Scale; NRS) and running scores (miles*rate of perceived exertion (RPE)). Foot and ankle function improved according to scores recorded on the VISA-A (59% vs. 97%) and FADI (102 vs. 127/136). Improvements in MT (1.60 cm vs. 1.76 cm) and PA (22.0° vs. 24.8°) were recorded via US. Improvements in Dm (1.15 mm vs. 1.69 mm) and Tc (16.5 ms vs. 15.4 ms) were recorded via TMG. Calf endurance was lower in both legs and the asymmetry between legs remained (L: 31, R: 34). Pain intensity (mean weekly NRS scores) decreased between week 1 and week 12 (6.6 vs. 2.9), while running scores increased (20 vs. 38) during the same period. The program was maintained up to week 16 at which point mean weekly NRS was 2.2 and running score was 47. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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1 pages, 199 KiB  
Erratum
Factors Affecting Psychological Stress in Healthcare Workers with and without Chronic Pain: A Cross-Sectional Study Using Multiple Regression Analysis
by Yuta Sakamoto, Takeru Oka, Takashi Amari and Satoshi Shimo
Medicina 2020, 56(1), 7; https://doi.org/10.3390/medicina56010007 - 24 Dec 2019
Viewed by 1661
Abstract
The authors did not realize the error made in the front matter in the proofreading phase [...] Full article
(This article belongs to the Special Issue Chronic Pain Management)
5 pages, 242 KiB  
Opinion
Cyriax Friction Massage—Suggestions for Improvements
by Alexios Pitsillides and Dimitrios Stasinopoulos
Medicina 2019, 55(5), 185; https://doi.org/10.3390/medicina55050185 - 21 May 2019
Cited by 7 | Viewed by 6534
Abstract
Background and objectives: Cyriax friction massage is a widely known and used technique in the field of chronic pain management. Despite its frequent use in daily clinical practice, the technique lacks evidence to support its therapeutic value. While this might be due to [...] Read more.
Background and objectives: Cyriax friction massage is a widely known and used technique in the field of chronic pain management. Despite its frequent use in daily clinical practice, the technique lacks evidence to support its therapeutic value. While this might be due to various factors, the authors of this paper suggest that the technique might need to be improved and/or modernized according to the recent literature. The purpose of this letter is to further analyze our point of view. Materials and Methods: Using the most relevant methods to the subject literature, the authors intended to point out a few technical details that might need reconsideration and/or modernization. Results: An appropriate terminology is suggested in the text. Further, suggestions are made regarding the technique’s interval time, a possible addition of self-treatment, a discussion of the combination with Mill’s manipulation, tendon positioning and other parameters. Conclusions: As a therapeutic value has not yet been clearly documented, and since the modernization and/or improvement of the technique might be needed, we suggest that this technique should not be used as a first-line treatment for the management of chronic pain. Full article
(This article belongs to the Special Issue Chronic Pain Management)
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