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Abnormal encoding of somatosensory modalities (ie, mechanical, cold, and heat) are a critical part of pathological pain states. Detailed phenotyping of patients' responses to these modalities have raised hopes that analgesic treatments could one day be tailored to a patient's phenotype. Such precise treatment would require a profound understanding of the underlying mechanisms of specific pain phenotypes at molecular, cellular, and circuitry levels. Although preclinical pain models have helped in that regard, the lack of a unified assay quantifying detailed mechanical, cold, and heat pain responses on the same scale precludes comparing how analgesic compounds act on different sensory phenotypes. The conflict avoidance assay is promising in that regard, but testing conditions require validation for its use with multiple modalities. In this study, we improve upon the conflict avoidance assay to provide a validated and detailed assessment of all 3 modalities within the same animal, in mice. We first optimized testing conditions to minimize the necessary amount of training and to reduce sex differences in performances. We then tested what range of stimuli produce dynamic stimulus-response relationships for different outcome measures in naive mice. We finally used this assay to show that nerve injury produces modality-specific sex differences in pain behavior. Our improved assay opens new avenues to study the basis of modality-specific abnormalities in pain behavior. [ABSTRACT FROM AUTHOR]

Introduction: To determine risk factors associated with postoperative cerebrospinal fluid leaks (CSFLs) after intrathecal drug delivery system (IDDS) and external pump implantation. Methods: The clinical data of 248 patients with advanced cancer who underwent IDDS implantation from January 2021 to December 2022 at the Department of Pain Medicine at the Hunan Cancer Hospital were retrospectively reviewed. Information regarding age, gender, height, weight, body mass index (BMI), tumour type, albumin levels, haemoglobin levels, history of diabetes and pre- and postoperative anti-tumour therapy was collected and analysed. Results: Postoperative CSFLs occurred in 7 of 231 patients (3.30%). Statistical analysis indicated that gender, age, height, weight, BMI, tumour type, albumin levels, haemoglobin levels, history of diabetes, pre- and postoperative chemotherapy, pre- and postoperative radiotherapy, preoperative immunotherapy and postoperative targeted therapy were not independent factors for CSFLs. Preoperative targeted therapy [odds ratio (OR): 16.64; 95% confidence interval (CI): 1.42, 195.56; P = 0.01] and postoperative immunotherapy (OR: 13.38; 95% CI: 1.60, 111.65; P = 0.017) were factors associated with an increased postoperative CSFL rate. Of the two locations where CSFLs can occur, the back (puncture site of catheter, n = 4) and the hypochondriac region (location of infusion port implanted, n = 3), back CSFLs occurred earlier than in the hypochondriac region (18.25 ± 6.45 vs 115 ± 62.02 days, P = 0.032). Conclusion: Based on the data from our study, the timing of preoperative targeted therapy and postoperative immunotherapy should be considered to prevent the occurrence of CSFLs in cancer pain patients who have an IDDS and external pump. [ABSTRACT FROM AUTHOR]

Ovid’s Metamorphoses tells the story of Icarus-his tragic flight with man-made wings, the melting of the wax that bound them, and the ensuing fall to his death. This moment has been immortalized across the arts and through several mediums, but none are more notable than Bruegel’s Landscape with the Fall of Icarus. Described as a “painter for poets,” Bruegel’s work served as inspiration for several writers, with this piece in particular providing the basis for ekphrastic poems by W.H. Auden and William Carlos Williams. Though each of these works has a different focus, the unifying theme is that human tragedy is too often placed on the periphery of notice. They are effective reminders to physicians and other healthcare providers about the human aspect of suffering and pain in medicine. [ABSTRACT FROM AUTHOR]

Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically, dysfunction of the cortico-mesolimbic connectome is of major importance, with overlapping signals in the nociceptive and stress systems. The endocannabinoid system plays an important role in the central processing of nociceptive signals and regulates the central stress response. Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain affect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain. The analgesic effect appears to be largely independent of the cause of pain. In this context, CBM preferentially regulates stress-associated pain processing. [ABSTRACT FROM AUTHOR]

Synthetic and semi-synthetic opioids are prescribed for the management of severe pain conditions, but their long-term use is often leading to physical dependence and addiction disorders. Understanding the complex neurobiology of the opioid system in preclinical models will be essential for the development of safe and efficacious analgesics. With rising numbers of synthetic opioid users and overdose cases, a better understanding of the neuroanatomical and cellular pathways associated with physical dependence and addiction is expected to guide treatment approaches for opioid use disorders. In this commentary, we highlight the importance of advanced genetic mouse models for studying the regional effects of opioid receptors, and we discuss the need of genetic mouse models for the investigation of the regional, circuit and cell compartment-specific role of intracellular mediators of opioid actions. [ABSTRACT FROM AUTHOR]

In high-resource countries, health disparities exist in both treatment approaches and health outcomes. Race and ethnicity can serve as proxies for other socioeconomic factors and social determinants of health such as income, education, social support, and residential neighbourhood, which strongly influence health outcomes and disparities. In regional anaesthesia and pain medicine, disparities exist across several surgical specialties including obstetrics, paediatrics, and orthopaedic surgery. Understanding these disparities will facilitate development of solutions aimed at eliminating disparities at the patient, physician/provider, and healthcare system levels. [ABSTRACT FROM AUTHOR]

Pain is a prevalent symptom in patients with serious illness and often requires interventional approaches for adequate treatment. Little is known about referral patterns and collaborative attitudes of palliative physicians regarding pain management specialists. To evaluate referral rates, co-management strategies, and beliefs of palliative physicians about the value of Pain Medicine specialists in patients with serious illness. A 30-question survey with demographic, referral/practice, and attitudes/belief questions was mailed to 1000 AAHPM physician members. Responses were characterized with descriptive statistics and further analyzed for associations between training experiences, practice environment, and educational activities with collaborative practice patterns and beliefs. The response rate was 52.6%. Most survey respondents had initial board certification primarily in internal medicine (n = 286, 56%) or family medicine (n = 144, 28%). A minority of respondents had completed a formal ABMS Hospice and Palliative Medicine fellowship (n = 178, 34%). Respondents had been in practice for a median of nine years, (range 1-38 years) primarily in community hospitals (n = 249, 47%) or academic hospitals (n = 202, 38%). The variables best associated with collaborative practices and attitudes was practice in an academic hospital setting and participation in regular joint academic conferences with pain medicine clinicians. This study shows that Palliative Care physicians have highly positive attitudes toward Pain Medicine specialists, but referrals remain low. Facilitating professional collaboration via joint educational/clinical sessions is one possible solution to drive ongoing interprofessional care in patients with complex pain. [ABSTRACT FROM AUTHOR]

Neonatal pain is a critical issue in clinical practice. The oral administration of glucose-based solutions is currently one of the most common and effective nonpharmacologic strategies for neonatal pain relief in daily minor procedures. However, a varying degree of analgesic efficacy has been reported for this treatment. Environmental, maternal, and genetic factors may explain this variability and potentially allow for a personalized analgesic approach, maximizing therapeutic efficacy and preventing side effects. We investigated the exposome (ie, the set of clinical and anthropometric variables potentially affecting the response to the therapy) and the genetic variability of the noradrenaline transporter gene (solute carrier family 6 member 2 [SLC6A2]) and 2 glucose transporter genes (solute carrier family 2 member 1 [SLC2A1] and 2 [SLC2A2]) in relation to the neonatal analgesic efficacy of a 33% glucose solution. The study population consisted in a homogeneous sample of more than 1400 healthy term newborns. No association for the exposome was observed, whereas a statistically significant association between the G allele of SLC2A1-rs1105297 and a fourfold decreased probability of responding to the therapy was identified after multiple-testing correction (odds ratio of 3.98, 95% confidence interval 1.95-9.17; P = 4.05 × 10−4). This allele decreases the expression of SLC2A1-AS1, causing the upregulation of SLC2A1 in the dorsal striatum, which has been suggested to be involved in reward-related processes through the binding of opioids to the striatal mu-opioid receptors. Altogether, these results suggest the involvement of SLC2A1 in the analgesic process and highlight the importance of host genetics for defining personalized analgesic treatments. [ABSTRACT FROM AUTHOR]

While opioids remain amongst the most effective treatments for moderate-to-severe pain, their substantial side effect profile remains a major limitation to broader clinical use. One such side effect is opioid-induced hyperalgesia (OIH), which includes a transition from opioid-induced analgesia to pain enhancement. Evidence in rodents supports the suggestion that OIH may be produced by the action of opioids at Toll-like Receptor 4 (TLR4) either on immune cells that, in turn, produce pronociceptive mediators to act on nociceptors, or by a direct action at nociceptor TLR4. And, sub-analgesic doses of several opioids have been shown to induce hyperalgesia in rodents by their action as TLR4 agonists. In the present in vitro patch-clamp electrophysiology experiments, we demonstrate that low dose morphine directly sensitizes human as well as rodent dorsal root ganglion (DRG) neurons, an effect of this opioid analgesic that is antagonized by LPS-RS Ultrapure, a selective TLR4 antagonist. We found that low concentration (100 nM) of morphine reduced rheobase in human (by 36%) and rat (by 26%) putative C-type nociceptors, an effect of morphine that was markedly attenuated by preincubation with LPS-RS Ultrapure. Our findings support the suggestion that in humans, as in rodents, OIH is mediated by the direct action of opioids at TLR4 on nociceptors. [ABSTRACT FROM AUTHOR]

Dr. Kelly Dunn and colleagues have published a study exploring individual differences in the effects of opioids. They analyzed data from 100 healthy volunteers who received hydromorphone and placebo over five test days. The study draws on previous research on how opioids affect pleasure and pain, and also examines the impact of a specific genetic polymorphism. The authors call for collaboration and pooling of resources to better understand how opioids affect individuals and to improve pain management. The data from the study are openly available for further research. [Extracted from the article]

Purpose Primary dysmenorrhea (PD) is 1 of the most prevalent gynecologic conditions. The main aim of this umbrella review was to assess the effects of therapeutic exercise (TE) on PD. Methods A systematic search was carried out in PubMed, Embase, SPORTDiscus, CINAHL, and PEDro (December 10, 2022). The outcome measures assessed were menstrual pain intensity, menstrual pain duration, and quality of life. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the advisory committee grading criteria guidelines. Results Nine systematic reviews were included. The results showed that TE, regardless of the exercise model and intensity, has a clinical effect in improving menstrual pain intensity in women with PD with moderate quality of evidence. In addition, the results showed that TE has a clinical effect in improving the duration of menstrual pain in women with PD with a limited quality of evidence. However, the results are controversial on the improvement of quality of life in women with PD with a limited quality of evidence. Conclusions TE seems an effective option to implement in women with PD to improve the intensity and duration of menstrual pain. We cannot draw robust results for quality of life due to the low number of primary studies. More research in this field can help us establish more robust conclusions, as well as to assess whether there is one exercise model or intensity of training that is more effective than others. PROSPERO number: This review was previously registered in PROSPERO (CRD42022371428). [ABSTRACT FROM AUTHOR]

Using animals for medical care has a long history. Animals have long been recognized for their ability to improve human health and well-being throughout nations and civilizations. Animal-assisted therapy is a concept that incorporates intentional and regulated interactions between individuals and animals to achieve therapeutic aims. Hippotherapy is an animal-assisted therapy consisting of medical procedures and practices that use horses to restore and enhance physical and mental health. The effectiveness of hippotherapy is evidenced by its ability to have a favorable influence on various domains, encompassing physical, psychosocial, and educational aspects. This multifaceted method entails the active involvement of the sensory, musculoskeletal, vestibular, and visual systems. Hippotherapy is an unconventional modality, leveraging horses' cyclic and repetitive motions to activate the postural reflex structures of individuals. Various studies have mostly focused on determining the efficacy of hippotherapy in the context of neurological conditions, neuro-rehabilitation, and psychiatric disorders. The primary objective of this study was to present the effectiveness of hippotherapy in the fields of rheumatology, pain medicine, and geriatrics. In addition, we provided a summary of the potential underlying mechanisms of hippotherapy. Finally, we conducted a comparison of hippotherapy and horse riding simulator interventions to provide their respective strengths and restrictions. [ABSTRACT FROM AUTHOR]

Background: Wounds inflict pain and affect human health causing high expenditure on treatment and management. Herbal crude extracts are used in traditional medicine as a treatment for wounds and other illnesses. However, the progress in the use of plants has been deterred due to their poor solubility and poor bioavailability requiring administration at high doses. It has been established that nanoencapsulation of herbal products in nanocarriers (size 1 nm to 100 nm) such as nanofibers, nanoparticles, nanospheres, and nanoliposomes greatly improves their efficacy. Due to their small and large surface area, nanocarriers are more biologically active, improve bioavailability, protect the drug from deterioration, and release it to the targeted site in a sustainable manner. Aim: The review aims to collate and appraise evidence on the efficacy of nano encapsulated herbal extracts in the treatment of induced wounds in animal models. Methods: The review will be protocol-driven and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols (PRISMA-P) and protocol guidelines for systematic review and meta-analysis for animal intervention studies. The final review will be conducted and reported with reference to PRISMA 2020 statement. Studies will be searched in Pub Med, ProQuest, Web of Science, Medline Ovid, EMBASE, and Google Scholar. The PRISMA flow criteria will be followed in screening the articles for inclusion. Data extraction form will be designed in Excel spreadsheet 2013 and data extracted based on the primary and secondary outcomes. Risk of bias assessment will be done using SYRCLE's risk of bias tool for animal studies. Data analysis will be done using narrative and quantitative synthesis. Expected results: We hope to make meaningful comparisons between the effectiveness of the herb-loaded nanomaterials and other interventions (controls) in the selected studies, based on the primary and secondary outcome measures. We expect that these findings to inform clinical practice on whether preclinical studies show enough quality evidence on the efficacy and safety of herbal-loaded nanomaterials that can be translated into clinical trials and further research. Systemic review registration: PROSPERO 330330. The protocol was submitted on the 11th of May 2022. [ABSTRACT FROM AUTHOR]

Abstract Background Objective Design Participants Approach Key Results Conclusion Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians use them and if OTAs themselves modify clinician prescribing practices.To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing.We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not.17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling.Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team.Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation.This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. [ABSTRACT FROM AUTHOR]

One of the ACGME's six core competencies, systems-based practice (SBP), is difficult to interpret and developing proficiency over a one-year fellowship poses a challenge. Given the implications that successful SBP can have on pain medicine, it is especially important for fellows to focus on this competency during their training. Here, we propose a way to implement effective SBP into a pain medicine fellowship and the impact it may have within the larger health care system. [ABSTRACT FROM AUTHOR]

In the UK more women than men are practicing medicine, and for the first time in the history of the Royal College of Anaesthetists (RCoA), the president of the RCoA, Dean of the Faculty of Pain Medicine, and Dean of the Faculty of Intensive Care Medicine are all women. However, within the subspecialty of pain medicine, there are significantly more men practicing than women, with the most recent UK estimates identifying that only 26.7% of current pain physicians are women. Both historical and modern perspectives illustrate how women often prefer to be cared for by other women, highlighting the importance of increased representation of women in pain clinics and interventional suites. We discuss current trends in pain medicine recruitment within the UK, where most pain physicians are recruited from anaesthesia training programs, including the barriers to women's representation and reasons women enter the subspecialty. We advocate for speaker gender quotas at conferences, diversity considerate workforce planning, peer support groups, adjustments to training programs, and further research to help narrow the gender gap. [ABSTRACT FROM AUTHOR]

This article discusses the important role of clinical radiology, specifically interventional radiology (IR), in pain management. With the global population aging and the prevalence of chronic pain increasing, there is a growing demand for services. Radiologists play a crucial role in diagnosing and treating various conditions, including musculoskeletal pain and oncologic pain. IR procedures are effective alternatives to strong opioid analgesics and can improve patient outcomes. However, the work and importance of clinical radiology and IR are often underrepresented, and there is a need for increased awareness and recognition of their role in pain medicine. [Extracted from the article]

Objective: Perceived injustice, a concept that arose in pain medicine, refers to an individual's experiences and perceptions of victimisation from injuries resulting in chronic pain. Here, we have undertaken a historical and clinical review on the role of perceived injustice medicine in psychiatry and a systematic review on psychotherapeutic interventions for perceived injustice. Method: For the systematic review, two studies were identified from a search of six databases. Results: Though evidence is limited, psychotherapeutic interventions show promise in addressing perceived injustice and associated symptomatology. Conclusion: Perceived injustice is a concept which may have great potential utility to psychiatry, particularly in occupational and medicolegal areas. Interventions addressing perceived injustice may help improve clinical outcomes. [ABSTRACT FROM AUTHOR]

This retrospective cohort study describes the utilization of opioids and gabapentin among patients with diabetic neuropathy who were gabapentin and opioid naïve, and assesses predictors of concomitant use of opioids and gabapentin. Using Medicare claims data (2012–2016), 22 037 patients were identified, of whom 23.42% (N = 5161) initiated opioids without concomitant gabapentin, 4.56% (N = 1004) initiated gabapentin without concomitant opioids, and 3.87% (N = 852) had concomitant use of gabapentin and opioids 12 months following their index date (date of earliest diagnosis). Concomitant gabapentin and opioid use were more common for lower doses of both drugs and for 15 days or more cumulatively. Compared to individuals aged 65–74, those aged 75–84 (OR:.759; 95% CI: 0.653–.882) or ≥ 85 years (OR:.586, 95% CI: 0.462–.743) had lower odds of concomitant use. People residing in the Northeast had lower odds of concomitant use, compared to those residing in the South (OR:.646 95% CI: 0.535–.779). Females compared to males (OR: 1.185, 95% CI: 1.027–1.367), people with higher Charlson's Comorbidity Index (CCI) scores (OR: 1.085, 95% CI: 1.037–1.135) or those having anxiety (OR: 1.462, 95% CI: 1.131–1.889) had higher odds of concomitant use. Concomitant prescriptions of opioids and gabapentin were more common for longer durations, indicating the need for interventions aimed at minimizing this prescribing practice. [ABSTRACT FROM AUTHOR]

Background and Aims: Social media provides a platform for physicians helping them change the practice in anaesthesiology as it promotes both personal and professional growth. In this cross-sectional study, we identify social media presence and engagement of Accreditation Council for Graduate Medical Education (ACGME)-accredited Regional Anesthesia and Acute Pain Medicine (RAAPM) fellowship programs, specifically on Twitter (Twitter Inc., San Francisco, CA) and Instagram (Meta Platforms Inc., Menlo Park, CA). This article presents current evidence about social media presence and engagement of ACGME-accredited RAAPM fellowship programs on Twitter and Instagram. These findings could potentially help cultivate greater social media engagement in the RAAPM community and improve recruitment of prospective applicants. Material and Methods: The list of ACGME-accredited RAAPM fellowship programs for the academic year 2020–2021 was obtained from the ACGME website. Accounts were searched by reviewing each program's website for profile links and by querying for the name of the program directly on Twitter and Instagram. Department of Anesthesiology, Perioperative and Pain Medicine accounts were analysed for posts pertaining to RAAPM elements, and RAAPM fellowship-specific accounts were investigated. Accounts that were solely focused on an anaesthesiology residency were excluded. All posts over the academic year period of 1 July 2020 to 30 June 2021 were analyzed. Results: While many programs had active departmental social media accounts during our study, there was a dearth of RAAPM-related output (3.4% of tweets and 2.7% Instagram posts). Furthermore, only 10% of programs had RAAPM fellowship-specific Twitter accounts, of which only 5% of programs were active. Finally, there were no RAAPM fellowship-specific Instagram accounts. Conclusions: While there is robust use of social media by departmental accounts, there is a paucity of RAAPM-related content and RAAPM fellowship-specific social media accounts. The current gap provides valuable opportunities for future investigations into the cyber footprint and innovative engagement strategies for the RAAPM community. [ABSTRACT FROM AUTHOR]

Introduction: Throughout its history, there have been significant advances in pain control of inguinal hernia repairs. One of the most recent developments is locoregional pain blocks. There is a multitude of literature available on laparoscopic inguinal hernia repair and transversus abdominis plane (TAP) blocks. Objectives: This paper seeks to provide a thorough and systematic literature review on the role of TAP blocks in laparoscopic inguinal hernia repairs. Methods: PubMed and Google Scholar were searched for relevant literature using predetermined medical subject heading (MeSH) terms: "(TAP block)" AND "(Laparoscopic inguinal hernia repair)". Results: A total of 166 publications were identified, from which 18 publications were included in the final review after eligibility criteria were applied. Conclusion: The majority of studies conclude that TAP blocks performed in the setting of laparoscopic inguinal hernia repair improve post-operative pain and mobility, decrease opiate analgesic usage, and are superior in pain control compared to other modalities of regional anesthesia. Thus, to improve post-operative outcomes and patient satisfaction, TAP blocks should be heavily considered for routine use in surgical practice for laparoscopic inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Background and objectives: In Kenya, where abortion is legally restricted, most abortions are induced using unsafe procedures, and lead to complications treated in public health facilities. The introduction of Manual Vacuum Aspiration (MVA) to treat incomplete abortion has improved the management of abortion complications. However, this technology comes with pain whose management has been a challenge. This paper explores the lived experiences of pain (management) during MVA to document the contributing factors. Methods: We used an ethnographic approach to explore girls and healthcare providers' experiences in offering and accessing post-abortion care in Kilifi County, Kenya. The data collection approach included participant observation and informal conversations in public health facilities and neighboring communities, as well as in-depth interviews with 21 girls and young women treated for abortion complication and 12 healthcare providers. Results: Our findings show that almost all patients described the MVA as the most painful procedure they have ever experienced. The unbearable pain was explained by various factors, including the lack of preparedness of health facilities to offer PAC services (i.e. lack of pain medicine, lack of training, inadequate knowledge and grasp of pain medication guidelines, and malfunctioning MVA kits). Moreover, the attitudes of healthcare providers and facilities management toward the MVA device limited the supply and replacement of MVA kits. Moreover, the scarcity of pain medicines also gave some providers the opportunity to abuse patients guided by their values, whereby they would deny patients pain medication as a form of "punishment" if they were suspected of inducing their abortion, especially adolescent girls. Conclusion: The study findings suggest the need for clearer guidelines on pain medication, value clarification and attitude transformation training for providers, systematizing the use of medical uterine evacuation using medical abortion drug and strengthening the supply chain of pain medication and MVA kits to reduce the pain and improve the quality of post-abortion care. [ABSTRACT FROM AUTHOR]

Patients with multiple sclerosis (MS) and spinal cord injury (SCI) commonly sustain central neuropathic pain (NP) and spasticity. Despite a lack of consistent evidence, cannabis-based medicine (CBM) has been suggested as a supplement treatment. We aimed to investigate the effect of CBM on NP and spasticity in patients with MS or SCI. We performed a randomized, double-blinded, placebo-controlled trial in Denmark. Patients aged ≥18 years with NP (intensity >3, ≤9 on a numerical rating scale (NRS0-10) and/or spasticity (>3 on NRS0-10) were randomized to treatment consisting of either delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), a combination of THC&CBD in maximum doses of 22.5 mg, 45 mg and 22.5/45 mg per day, respectively, or placebo. A baseline registration was performed before randomization. Treatment duration was six weeks followed by a one-week phaseout. Primary endpoints were the intensity of patient-reported NP and/or spasticity. Between February 2019 and December 2021, 134 patients were randomized (MS n = 119, SCI n = 15), where 32 were assigned to THC, 31 to CBD, 31 to THC&CBD, and 40 to placebo. No significant difference was found for: mean pain intensity (THC 0.42 (−0.54–1.38), CBD 0.45 (−0.47–1.38) and THC&CBD 0.16 (−0.75–1.08)), mean spasticity intensity (THC 0.24 (−0.67–1.45), CBD 0.46 (−0.74–1.65), and THC&CBD 0.10 (−1.18–1.39), secondary outcomes (patient global impression of change and quality of life), or any tertiary outcomes. We aimed to include 448 patients in the trial; however, due to COVID-19 and recruitment challenges, fewer were included. Nevertheless, in this four-arm parallel trial, no effect was found between placebo and active treatment with THC or CBD alone or in combination on NP or spasticity in patients with either MS or SCI. The trial was registered with the EU Clinical Trials Register EudraCT (2018-002315-98). [ABSTRACT FROM AUTHOR]

Introduction: Opioid agonist treatment (OAT) is the first-line treatment for opioid use disorder (OUD). Simultaneously, opioids are essential medicines in acute pain management. The literature is scarce on acute pain management in individuals with OUD, and guidelines are controversial for patients on OAT. We aimed at analyzing rescue analgesia in opioid-dependent individuals on OAT during hospitalization in the University Hospital Basel, Switzerland. Methods: Patient hospital records were extracted from the database over 6 months (Jan-Jun) in 2015 and 2018. Of the 3,216 extracted patient records, we identified 255 cases on OAT with full datasets. Rescue analgesia was defined according to established principles of acute pain management, e.g., i) the analgesic agent is identical to the OAT medication, and ii) the opioid agent is dosed above 1/6th morphine equivalent dose of the OAT medication. Results: The patients were on average 51.3 ± 10.5 years old (range: 22–79 years), of which 64% were men. The most frequent OAT agents were methadone and morphine (34.9% and 34.5%). Rescue analgesia was not documented in 14 cases. Guideline-concordant rescue analgesia was observed in 186 cases (72.9%) and consisted mostly of NSAIDs, including paracetamol (80 cases), and identical agents such as the OAT opioid (70 cases). Guideline-divergent rescue analgesia was observed in 69 (27.1%) cases, predominantly due to an underdosed opioid agent (32 cases), another agent other than the OAT (18 cases), or contraindicated agents (10 cases). Discussion: Our analysis suggests that rescue analgesia in hospitalized OAT patients was predominantly concordant with guidelines, while divergent prescriptions seemed to follow common principles of pain medicine. Clear guidelines are needed to appropriately treat acute pain in hospitalized OAT patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to assess the factors affecting the preference for the Pain Medicine subspecialty and the fellowship training programs by the pain specialists who have completed or continued the Pain Medicine fellowship training program from 2014 to 2021 in Turkey. Methods: The study was conducted in October 2020 and March 2021. By reaching out to the pain specialists who completed their fellowship or had been continuing their training by getting the right to receive a Pain Medicine fellowship. Via e-mail or WhatsApp application, an e-questionnaire link was sent to the participants, and data were collected on demographics, factors affecting the choice of Pain Medicine subspecialty, level of realization of the expectations during the training course and the level of proficiency in the field of pain specialization. Data analysis was performed using IBM SPSS Statistics 20.0 software, and tests were considered statistically significant if P < 0.05. Results: Participants reported that the factors that most affected their preferences were personal interest (55.1%), more comfortable working conditions (43.6%), and interest in an academic career (38.5%). Seventy-six participants answered the level of realization of expectations about performing interventional pain procedures using ultrasound imaging, and 31.6% reported that their expectations were not met, and 25% reported that their expectations were partially realised. Conclusion: We hope that our findings will lead to improving Pain Medicine subspecialty training programs, upgrading standards, and more comprehensive studies on these issues. [ABSTRACT FROM AUTHOR]

32251123 3 Stoppok P., Frewer A.-L., Schweda A., Geiger S., Skoda E.-M., Müßgens D., Bingel U., Teufel M., Bäuerle A. Needs and Demands for EHealth Pain Management Interventions in Chronic Pain Patients. By assessing pain incidence and intensity, and examining patients' satisfaction, the study offers valuable data to optimize pain management strategies during this critical phase of treatment. Knowledge, Attitude and Practice Survey of Prescribing Opioids for Chronic Noncancer Pain in Taiwan-Comparison of Pain and Non-Pain Physicians. This cutting-edge approach aims to enhance both the accuracy and efficiency of evaluating pain levels, offering promising prospects for improving pain management and patient care. [Extracted from the article]

Background: Previous studies have documented pain as an important concern for quality of life (QoL) and one of the most challenging manifestations for cancer patients. Thus, cancer pain management (CPM) plays a key role in treating pain related to cancer. The aim of this systematic review was to investigate CPM, with an emphasis on personalized medicine, and introduce new pharmacogenomics-based procedures for detecting and treating cancer pain patients. Methods: This study systematically reviewed PubMed from 1990 to 2023 using keywords such as cancer, pain, and personalized medicine. A total of 597 publications were found, and after multiple filtering processes, 75 papers were included. In silico analyses were performed using the GeneCards, STRING-MODEL, miRTargetLink2, and PharmGKB databases. Results: The results reveal that recent reports have mainly focused on personalized medicine strategies for CPM, and pharmacogenomics-based data are rapidly being introduced. The literature review of the 75 highly relevant publications, combined with the bioinformatics results, identified a list of 57 evidence-based genes as the primary gene list for further personalized medicine approaches. The most frequently mentioned genes were CYP2D6, COMT, and OPRM1. Moreover, among the 127 variants identified through both the literature review and data mining in the PharmGKB database, 21 variants remain as potential candidates for whole-exome sequencing (WES) analysis. Interestingly, hsa-miR-34a-5p and hsa-miR-146a-5p were suggested as putative circulating biomarkers for cancer pain prognosis and diagnosis. Conclusions: In conclusion, this study highlights personalized medicine as the most promising strategy in CPM, utilizing pharmacogenomics-based approaches to alleviate cancer pain. [ABSTRACT FROM AUTHOR]

This article discusses the trends in utilization and reimbursement of interspinous process devices (IPDs) in the Medicare population. IPDs are a less invasive treatment option for lumbar degenerative disease, but studies have found that they may only provide initial symptomatic relief and are not better than traditional surgery in improving function, disability, or quality of life. The article reports a significant increase in IPD utilization between 2017 and 2020, with percutaneous placements increasing by 1267% and open procedures decreasing by 27%. The majority of IPDs were placed by pain management/anesthesia specialists, and utilization increased by 1387% over the study period. The article suggests that further investigation is needed to understand the driving forces behind IPD utilization and to examine the indications for their use. [Extracted from the article]

This article discusses the use of policy documents, faculty opinions, and Mendeley counts in assessing the quality of research articles in the field of anaesthesia and pain medicine. The study found that policy documents and faculty opinions, which are included in the Altmetric Attention Score (AAS) algorithm, rarely cite or recommend articles, and do not correlate with the Altmetric Impact Factor (AIF). However, there was a strong correlation between AIF and readership counts from Mendeley. The authors conclude that policy documents and faculty opinions are not reliable indicators of academic quality, while Mendeley readership counts may be more useful. [Extracted from the article]

Early, acute pain following spinal cord injury (SCI) is common, can negatively impact SCI rehabilitation, and is frequently not responsive to biomedical treatment. Nonpharmacological interventions show promise in reducing pain for individuals with SCI. However, most psychological interventions rely heavily on verbal interaction between the individual being treated and the clinician, making them inaccessible for individuals with impaired verbal output due to mechanical ventilation. This case study aims to describe the adaptation and implementation of hypnotic cognitive therapy (HYP-CT) intervention for early SCI pain in the context of mechanical ventilation dependence and weaning. The participant was a 54-year-old male with C2 AIS A SCI requiring mechanical ventilation. Four sessions of HYP-CT were provided during inpatient rehabilitation with assessment prior to intervention, after the intervention sessions, and prior to discharge. The participant reported immediate reductions in pain intensity following each intervention session. Overall, he reported increases in self-efficacy and pain acceptance. He did not report any negative treatment effects and thought the intervention provided support during mechanical ventilation weaning. During treatment, he discontinued opioid pain medications and reported actively using intervention strategies. Our results support the potential for early, hypnotic cognitive therapy for individuals with SCI experiencing pain or distress while dependent on mechanical ventilation. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate discrepancies in prescription trends for analgesic medications in complex regional pain syndrome (CRPS) patients based on recommendations in the literature. Design: We conducted a retrospective case–control study. Subjects: A total of 2510 CRPS patients and 2510 demographic-matched controls participated in this study. Methods: The SlicerDicer feature in Epic was used to find patients diagnosed with CRPS I or II between January 2010 and November 2022. An equal number of age-, gender-, and race-matched controls without a CRPS diagnosis were retracted from Epic. General and CRPS-associated prescription frequencies for the following classes were retrieved for both cases and controls: benzodiazepines, bisphosphonates, calcitonin, capsaicin, neuropathic pain medications, NSAIDs, opioids, and steroids. Results: A total of 740 (29%) CRPS patients and 425 (17%) controls were prescribed benzodiazepines (95% CI 0.1–0.15), 154 (6.1%) CRPS patients and 52 (2.1%) controls were prescribed capsaicin (95% CI 0.03–0.05), 1837 (73%) CRPS patients and 927 (37%) controls were prescribed neuropathic pain medications (95% CI 0.05–0.34), 1769 (70%) CRPS patients and 1217 (48%) controls were prescribed opioids (95% CI 0.19–0.25), 1095 (44%) CRPS patients and 1217 (48%) controls were prescribed steroids (95% CI 0.08–0.14), and 1638 (65%) CRPS patients and 1765 (70%) controls were prescribed NSAIDs (95% CI −0.08–0.02), p < 0.001 for all classes. With CRPS-associated prescriptions, (95% CI 0.05–0.16, p < 0.001) more CRPS patients were prescribed opioids (N = 398, 59%) than controls (N = 327, 49%). Conclusions: CRPS is difficult to treat with significant variance in suggested treatment modalities. Based on the results of our study, there is a divergence between some published recommendations and actual practice. [ABSTRACT FROM AUTHOR]

Therapeutic interventional techniques using fluoroscopy are often used in the management of spinal pain. Currently, there are no standardized means of instruction and assessment of fluoroscopic interventional spinal procedures for physiatry trainees. The aim of our study is to evaluate the utility of an interventional spine training course for physical medicine and rehabilitation residents in improving safety and efficacy when performing these procedures. We performed a prospective multiple cohort study analyzing interventional spine knowledge and procedural ability among physical medicine and rehabilitation residents after implementing a training course that used lectures, hands-on training, and video-recorded objective structured clinical examination self-assessments. Of the total of 28 physical medicine and rehabilitation residents over the 2-yr study period, each class saw a statistically significant improvement in mean objective structured clinical examination scores from pre-examination to postexamination (P < 0.05). Written examination scores also had a statistically significant preimprovement to postimprovement in the postgraduate years 2 and 3 classes. Our study supports the use of an interventional spine course for physical medicine and rehabilitation residents, and by following the existing cohorts and adding more cohorts in the future, we will continue to demonstrate valuable and comprehensive results. [ABSTRACT FROM AUTHOR]

Objective To describe the process of revising the Pain Medicine Milestones 1.0 and implementing changes into the Pain Medicine Milestones 2.0 along with implications for pain medicine trainees. Background Competency-based medical education has been implemented in graduate medical education, including pain medicine. Milestones 1.0, introduced by the Accreditation Council for Graduate Medical Education (ACGME), has been used to assess learners in six competencies and respective sub-competencies. Recognizing areas for improvement in Milestones 1.0, the ACGME initiated the process of Milestones 2.0 and a working group was created to execute this task for pain medicine. The working group discussed revisions; consensus was sought when changes were introduced. Final milestones were agreed upon and made available for public comment prior to publication. Results Redundant sub-competencies were either merged or eliminated, reducing the number of sub-competencies. A maximum of three rows representing skill, knowledge, behavior and attitude were included for each sub-competency. Harmonized Milestones, aligning with other specialties in a predetermined ACGME framework, were adopted and modified to meet the needs of pain medicine. A supplemental guide was developed to assist educators in implementation of Milestones 2.0 and assessment of trainees. Conclusions The intent of the Milestones 2.0 was to create an improved tool that is comprehensive, easier to utilize, and of increased value for pain medicine training programs. It is expected that implementation of Milestones 2.0 will streamline pain medicine trainee assessments by educators and prepare trainees for the future practice of pain medicine while serving to be the foundation of an iterative process to match the evolution of the specialty. [ABSTRACT FROM AUTHOR]

Dostoevsky wrote that love in action is a harsh and terrible thing compared to love in dreams. That reality is particularly evident in medicine, where there is an almost universal, involuntary participation of physicians and other healthcare workers in the suffering of their patients. This paper explores this phenomenon through the paradigm of 'mystery' as explained by the French existentialist philosopher Gabriel Marcel. A mystery is different from a problem in the sense that the former requires the active immersion of the person involved in order to be truly experienced. It is a 'meta-problem' that cannot be analyzed objectively and separately from the person that it affects, without changing the nature of the thing experienced. The authors contend that the human suffering encountered in medicine is one such phenomenon, and the paper draws on illustrations of this concept in art and literature. Awareness of the subtle but important difference between mystery and problem may help physicians better understand their personal entanglement with the suffering of patients. [ABSTRACT FROM AUTHOR]

Analgesic-response variability in chronic noncancer pain (CNCP) has been reported due to several biological and environmental factors. This study was undertaken to explore sex differences linked to OPRM1 and COMT DNA methylation changes and genetic variants in analgesic response. A retrospective study with 250 real-world CNCP outpatients was performed in which data from demographic, clinical, and pharmacological variables were collected. DNA methylation levels (CpG island) were evaluated by pyrosequencing, and their interaction with the OPRM1 (A118G) and COMT (G472A) gene polymorphisms was studied. A priori-planned statistical analyses were conducted to compare responses between females and males. Sex-differential OPRM1 DNA methylation was observed to be linked to lower opioid use disorder (OUD) cases for females (p = 0.006). Patients with lower OPRM1 DNA methylation and the presence of the mutant G-allele reduced opioid dose requirements (p = 0.001), equal for both sexes. Moreover, COMT DNA methylation levels were negatively related to pain relief (p = 0.020), quality of life (p = 0.046), and some adverse events (probability > 90%) such as constipation, insomnia, or nervousness. Females were, significantly, 5 years older with high anxiety levels and a different side-effects distribution than males. The analyses demonstrated significant differences between females and males related to OPRM1 signalling efficiency and OUD, with a genetic–epigenetic interaction in opioid requirements. These findings support the importance of sex as a biological variable to be factored into chronic pain-management studies. [ABSTRACT FROM AUTHOR]

Introduction Telementoring is an evidence-based approach to meet the educational needs of primary care providers (PCPs) and to improve the quality of chronic pain care. This mixed methods study evaluated the effectiveness of pain management telementoring in improving provider knowledge, attitudes, and perceived competence. Materials and Methods The study was conducted at Madigan Army Medical Center. Using a non-randomized quasi-experimental approach, 25 providers were assigned to intervention arm and control arm (14 intervention and 13 control). Providers in the intervention group attended telementoring sessions. Videoconference technology was used to deliver weekly 90-minute TelePain sessions to the PCPs in the intervention group. The first 25-30 minutes of each session consisted of a didactic presentation led by a panel of interdisciplinary pain management clinicians. During the remaining 60 minutes, all PCPs in the intervention group presented clinical histories and asked specific management questions regarding patients of their choosing. An interdisciplinary panel of pain management clinicians provided telementoring consultations. The panel included experts from pain medicine, primary care, psychology or psychiatry, chiropractic, clinical pharmacy, and nursing. Changes in provider knowledge, attitudes, and perceived competence were evaluated using the Knowledge and Attitudes Survey Regarding Pain, KnowPain-12, and the Perceived Competence Scale (n  = 23; 12 intervention and 11 control). Qualitative interviews were conducted among a subset of providers (n  = 12; 8 intervention and 4 control), and provider narratives were analyzed using content analysis. Results Increased provider knowledge (Z  = 2.0, P  = .046 [KnowPain-12]) and perceived competence (Z  = 2.1, P  = .033) were observed among intervention group providers. Provider narratives supported more implementation of non-pharmacological pain management strategies, use of strategies to engage patients in reducing reliance on opioids, and perception of TelePain as a helpful resource especially in the context of inadequate preparation in chronic pain management during professional training. Conclusions Telementoring may hold significant potential to support providers in their efforts to decrease use of prescription opioids. Overall, this study provides further support for the value of telementoring in improving comprehensive chronic pain management in military settings. [ABSTRACT FROM AUTHOR]

Introduction: Neuropathic pain is a common and painful somatosensory nervous system disease, and its treatment remains a medical challenge. Evidence demonstrates that gut microbiota alters in neuropathic pain and, therefore, improvement of the gut flora may affect the disease. The present study aimed to evaluate the antinociceptive effect of probiotics in neuropathic pain and oxidative biomarkers' responsiveness to the probiotic treatment. Methods: Using chronic constriction injury (CCI) of the rats' sciatic nerve, neuropathic pain was induced. Investigating the analgesic effect of the probiotics mixture, 40 male rats were randomly assigned to 4 groups (n=10 for each): Sham-operated (SM), and CCI model rats orally received 1 mL saline (CS), or 100 mg/kg gabapentin (CG) or 1 mL probiotics mixture (CP) Lactobacillus plantarum, Lactobacillus delbrueckii, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Bifidobacterium bifidum (109 CFU of each) daily. Using behavioral tests, the pain was assessed on days 1, 4, 7, 14, and 21 of the study. Finally, the biochemical evaluation of sciatic nerve tissue was done. Results: Probiotics decreased cold and mechanic allodynia and thermal hyperalgesia. Reducing lipid peroxidation levels and increasing total antioxidant capacity, superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity were also significant in the probiotics group. Conclusion: These findings suggest that probiotics have analgesic effects on the CCI model of neuropathic pain via increasing the antioxidant capacity of the rats' sciatic nerve. [ABSTRACT FROM AUTHOR]

Pain after cancer remains underestimated and undertreated. Precision medicine is a recent concept that refers to the ability to classify patients into subgroups that differ in their susceptibility to, biology, or prognosis of a particular disease, or in their response to a specific treatment, and thus to tailor treatment to the individual patient characteristics. Applying this to pain after cancer, the ability to classify post-cancer pain into the three major pain phenotypes (i.e. nociceptive, neuropathic, and nociplastic pain) and tailor pain treatment accordingly, is an emerging issue. This is especially relevant because available evidence suggests that nociplastic pain is present in an important subgroup of those patients experiencing post-cancer pain. The 2021 International Association for the Study of Pain (IASP) clinical criteria and grading system for nociplastic pain account for the need to identify and correctly classify patients according to the pain phenotype early in their treatment. These criteria are an important step towards precision pain medicine with great potential for the field of clinical oncology. Within this framework, the Cancer Pain Phenotyping (CANPPHE) Network, an international and interdisciplinary group of oncology clinicians and researchers from seven countries, applied the 2021 IASP clinical criteria for nociplastic pain to the growing population of those experiencing post-cancer pain. A manual is provided to allow clinicians to differentiate between predominant nociceptive, neuropathic, or nociplastic pain after cancer. A seven-step diagnostic approach is presented and illustrated using cases to enhance understanding and encourage effective implementation of this approach in clinical practice. [ABSTRACT FROM AUTHOR]

The given document is an abstract from the ANZ Journal of Surgery. It includes summaries of several research studies related to various topics in surgery and pain medicine. The first study focuses on using deep learning for muscle segmentation in spinal surgery for pain management. The second study investigates the tolerability of transperineal prostate biopsy under local anesthetic using pre-emptive over-the-counter analgesia. The third study explores the effects of topical local anesthetic on the thickness of burn scars and the performance of burns laser. The fourth study discusses the use of intravenous methadone in the management of acute postoperative pain in a chronic cancer pain patient. The fifth study examines the effect of multi-modal pre-emptive analgesia with pregabalin and naproxen in thoracotomy surgeries and its relationship with the COMT genotype. Overall, these studies provide insights into different aspects of surgical procedures and pain management techniques. [Extracted from the article]

Although the need of adequate pain alleviation has always been felt, but the transition from immersion of body parts in ice cold water to the introduction of opium and then morphine took a long time. Over the previous few decades, the pain medicine emerged as a subspecialty of anesthesiology, but very soon it evolved itself as a whole new specialty, and with it emerged the need of clinical training. Now, most of the countries run their very own training programs, and in most of the nice hospitals pain medicine departments have been established. This editorial tales a quick look at its development around the world and particularly in Pakistan. [ABSTRACT FROM AUTHOR]

We developed a pain management system over a 3-year period. In this project, "Towards a pain-free hospital", we combined evidence-based medicine and medical expertise to develop a series of policies. The intervention mainly included the development of standard procedures for inpatient pain management, the implementation of hospital-wide pain medicine education and training, the establishment of a dashboard system to track pain status, and regular audits and feedback. This study aimed to gain an understanding of the changes in the prevalence of pain in inpatients under the care of the pain management system. The subjects of the survey are inpatients over 20 years old, and who had been hospitalized in the general ward for at least 3 days. The patients would be excluded if they were unable to respond to the questions. We randomly selected eligible patients in the general ward. Our trained interviewers visited inpatients to complete the questionnaires designed by our pain care specialists. A total of 3,094 inpatients completed the survey from 2018 to 2020. During the three-year period, the prevalence of pain was 69.5% (2018) (reference), 63.3% (2019) (OR:0.768, p<0.01), and 60.1% (2020) (OR:0.662, p <0.001). The prevalence rates of pain in patients undergoing surgery during the 3-year period were 81.4% (2018), 74.3% (2019), and 68.8% (2020), respectively. As for care-related causes of pain, injection, change in position/chest percussion, and rehabilitation showed a decreasing trend over the 3-year period of study. Our pain management system provided immediate professional pain management, and achieved a good result in the management of acute moderate to severe pain, especially perioperative pain. Studies on pain prevalence and Pain-Free Hospitals are scarce in Asia. With the aid of the policies based on evidence-based medicine and the dashboard information system, from 2018 to 2020, the prevalence of pain has decreased year by year. [ABSTRACT FROM AUTHOR]

Preprints are preliminary research reports that have not yet been peer-reviewed. They have been widely adopted to promote the timely dissemination of research across many scientific fields. In August 1991, Paul Ginsparg launched an electronic bulletin board intended to serve a few hundred colleagues working in a subfield of theoretical high-energy physics, thus launching arXiv, the first and largest preprint platform. Additional preprint servers have since been implemented in different academic fields, such as BioRxiv (2013, Biology; www.biorxiv. org) and medRxiv (2019, Health Science; www.medrxiv.org). While preprint availability has made valuable research resources accessible to the general public, thus bridging the gap between academic and non-academic audiences, it has also facilitated the spread of unsupported conclusions through various media channels. Issues surrounding the preprint policies of a journal must be addressed, ultimately, by editors and include the acceptance of preprint manuscripts, allowing the citation of preprints, maintaining a double-blind peer review process, changes to the preprint’s content and authors’ list, scoop priorities, commenting on preprints, and preventing the influence of social media. Editors must be able to deal with these issues adequately, to maintain the scientific integrity of their journal. In this review, the history, current status, and strengths and weaknesses of preprints as well as ongoing concerns regarding journal articles with preprints are discussed. An optimal approach to preprints is suggested for editorial board members, authors, and researchers. [ABSTRACT FROM AUTHOR]

Introduction: in Mexico, the first clinic specializing in pain relief was founded in 1972 by Dr. Ramón De Lille Fuentes at the Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán» (INCMNSZ). Material and methods: a historical documentary search and interviews were carried out with those who have collaborated with the Department of Pain and Palliative Medicine of the INCMNSZ since its foundation. Results: our vision is to offer pain management, palliative care, and ongoing support. To do this, we document the history and achievements of the department. Conclusions: 50 years after its foundation, the INCMNSZ Department of Pain and Palliative Medicine is a forum for scientific development and human capital training with a humanistic approach. [ABSTRACT FROM AUTHOR]

Context: Chronic Pain Structures (CPSs) provide care for patients with the most complex and refractory chronic pain in France. In 2018, 245 CPSs were accredited by the Regional Health Agencies (ARS). Despite this significant territorial coverage, the CPSs are now under threat. Objective: The aim of this study is to obtain a snapshot of the care offered by the CPSs, by specifying both the characteristics of the CPSs and the demographics of the professionals practicing there. Methodology: The survey was conducted under the aegis of the SFETD (Société française d'étude et de traitement de la douleur) among all the CPSs accredited by the ARS. CPS managers were asked to complete an online questionnaire on the characteristics of the CPS and the demographics of the medical and nonmedical staff. Results: Of the 245 CPSs, 223 (91%) responded. Although the territorial coverage of the CPSs is respected, with a median of 0.59 pain doctors per 100,000 inhabitants in France, there is great heterogeneity in the distribution of full-time equivalents (FTEs) from one region to another, with a variation of a factor of 2.8 for doctors and a factor of 5 for psychologists and nurses. The least endowed regions are the Centre-Val de Loire region and the Grand Est region. Fifty-four percent of CPSs offer consultations for both cancer pain and chronic non-cancer pain. Only 6% of CPSs are dedicated to children's pain. The median waiting time is three months, with extremes of up to a year. A total of 835 physicians, representing 388 FTEs, work in the CPSs. Only 58% of the physicians are tenured; 18% work full-time and 43% work less than 0.2 FTE. The retirement of 177 physicians is expected within five years, representing 91 FTEs, or 24% of total medical FTEs. Conclusion: The sustainability of CPS in France is threatened in the next five years. It is urgent to act. Concrete measures are proposed by the SFETD to anticipate the announced disaster. [ABSTRACT FROM AUTHOR]

Objective A local anesthetic that provides analgesia lasting at least three days could significantly improve postoperative pain management. This study evaluated the analgesic efficacy and safety of an extended-release formulation of bupivacaine based on the injectable hydrogel carrier poly(N-isopropylacrylamide-co-dimethylbutyrolactone acrylamide-co-Jeffamine M-1000 acrylamide) (PNDJ). Methods The efficacy of PNDJ containing 4% bupivacaine (SBG004) given by peri-incisional subcutaneous injection (SBG004 SC) or wound filling instillation (SBG004 WF) was evaluated compared to saline, liposomal bupivacaine, bupivacaine collagen sponge, bupivacaine-meloxicam polyorthoester, and bupivacaine HCl in a porcine skin and muscle incision model. Mechanical allodynia was assessed by withdrawal from application of von Frey filaments, and local tolerance was evaluated by histology. Bupivacaine pharmacokinetics for SBG004 SC were measured in rabbits (16.5 mg bupivacaine/kg). Results Animals demonstrated less mechanical allodynia at incisions receiving SBG004 SC for up to 96 hours postoperatively. Incisions treated with SBG004 SC tolerated more force without a withdrawal indicative of pain compared to saline for 96 hours, and compared to SBG004 WF and all active controls at 24, 48, and 72 hours except bupivacaine-meloxicam polyorthoester at 72 hours. By 49 days, SBG004 was histologically absent and was replaced with granulation tissue infiltrated with immune cells in some areas. In rabbits, Cmax was 41.6 ± 9.7 ng/mL with t 1/2 82.0 ± 35.8 hours (mean ± SD). Conclusions Peri-incisional SBG004 SC provided extended release of bupivacaine sufficient to reduce sensation of incisional pain for 96 hours, in vivo bupivacaine delivery for at least 7 days, and a favorable local and systemic toxicity profile. [ABSTRACT FROM AUTHOR]

Treatment of neuropathic pain remains inadequate despite the elucidation of multiple pathophysiological mechanisms and the development of promising therapeutic compounds. The lack of success in translating knowledge into clinical practice has discouraged pharmaceutical companies from investing in pain medicine; however, new patient stratification approaches could help bridge the translation gap and develop individualized therapeutic approaches. As we highlight in this article, subgrouping of patients according to sensory profiles and other baseline characteristics could aid the prediction of treatment success. Furthermore, novel outcome measures have been developed for patients with neuropathic pain. The extent to which sensory profiles and outcome measures can be employed in routine clinical practice and clinical trials and across distinct neuropathic pain aetiologies is yet to be determined. Improvements in animal models, drawing on our knowledge of human pain, and robust public-private partnerships will be needed to pave the way to innovative and effective pain medicine in the future. [ABSTRACT FROM AUTHOR]

Background Neuropathic pain (NP) after spinal cord injury (SCI) exacerbates disability, decreases quality of life (QOL), and is often refractory to available therapies. Patients report willingness to trade potential recovery of strength, bowel, bladder, or sexual function for pain relief. One proposed mechanism causing NP is up-regulation of transient receptor potential vanilloid 1 (TRPV 1) proteins in uninjured C fibers and dorsal root ganglia causing neuronal excitability. Recent studies have found up-regulation of TRPV 1 proteins after SCI. Objective We hypothesize the application of capsaicin 8% patch (C8P), FDA approved for NP in diabetic peripheral neuropathy and post-herpetic neuralgia, will improve pain, function and QOL in persons with SCI. Methods Randomized single-blind crossover design in which 11 persons with SCI and NP refractory to two oral pain medications received C8P or a control low dose Capsaicin 0.025% patch (CON) over two 12-week periods. Pain (VAS, MPI-SCI), quality of life (WHO-QOL), and functional status (SCIM) were measured at 2–4-week intervals. Results There was a main treatment effect of C8P over CON on VAS and MPI-SCI outcomes with pain reduction of 35% and 29% at weeks 2 and 4, respectively. C8P also demonstrated a main treatment effect over CON on the SCIM mobility subscale. WHO-QOL scores did not improve with C8P. Conclusions C8P improves pain and mobility for patients with SCI and refractory NP. Larger studies should be performed to evaluate impact of repeat applications and QOL outcomes. [ABSTRACT FROM AUTHOR]

Background: Herpes zoster (HZ) is one of the most common cutaneous adverse reactions associated with the coronavirus disease 2019 (COVID-19) vaccine and has been widely reported. This study aimed to evaluate HZ following COVID-19 vaccination from the viewpoint of pain management. Methods: A retrospective study was conducted on 42 patients with HZ who visited the pain clinic between August 2021 and October 2021. Medical records were reviewed to compare pain severity, treatment methods, treatment duration, and incidence rate of postherpetic neuralgia (PHN) in patients who received COVID-19 vaccination within 6 weeks prior to developing symptoms compared with other patients with HZ. Results: Fourteen patients developed HZ within 6 weeks after vaccination and were significantly younger than the other HZ groups. There were no significant differences in the frequency of prodromal pain, location of pain, pain severity, treatment methods, treatment duration, or incidence of PHN compared with the other HZ groups. Conclusions: COVID-19 vaccination-related HZ showed clinical features similar to those of the other HZ. [ABSTRACT FROM AUTHOR]