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Current Challenges and Future Prospects in Pain Therapy

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

Deadline for manuscript submissions: closed (20 March 2022) | Viewed by 19001

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Prof. Dr. Sabine Sator

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Department of Special Anaesthesia and Pain Medicine, Outpatient Pain Center, Vienna General Hospital (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
Interests: pain; invasive pain therapy; anaesthetics
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Special Issue Information

Dear Colleagues,

The management of any kind of pain, especially neuropathic pain, is challenging. Currently available drugs usually do not target the multiple pain mechanisms. Chronic pain creates signiﬁcant difﬁculties for many patients and can reduce their quality of life.

Chronic pain is pain that typically persists past normal healing times. It can have various origins and typically manifests within the musculoskeletal system, nervous tissues, or viscera. Chronic pain patients are often active participants rather than merely passive victims. These patients play their part by looking for solutions through attempts to suppress or ease their pain and sometimes by literally and ﬁguratively ﬁghting for control over their pain. They may look for information from physicians or the internet, trying to understand why they have pain. They may see many professionals (doctor shopping) and try many different medical treatments. They may adopt the habit of checking their body for signs of a change in the features of their pain or of its worsening and ruminate about their health problems. They may dwell on the past and imagine possible consequences of their pain in the future. Today, multidisciplinary and interdisciplinary treatments are the best approaches to treating chronic pain. These treatments can include medications, interventional procedures, physiotherapy, as well as a psychological coping treatment. Particularly, these treatments are known to be clinically effective and cost-effective when they are uniﬁed in a model focused on improving patients’ functioning. In this context, psychological research and treatment development have contributed signiﬁcantly to addressing the problem of chronic pain and will likely continue to do so.

The two most common conditions that are targeted in clinical trials of neuropathic pain are diabetic neuropathy and post-herpetic neuralgia. The management of central neuropathic pain also remains a big challenge. Psychological approaches to chronic pain have produced significant success and are widely accepted. Future prospects of finding suitable drugs for neuropathic pain depend on an improved understanding of pain mechanisms.

This Special Issue aims to discuss matters associated pain and its therapy, with a particular focus on therapy. This includes not only treatments but also the pathogenesis, the phenomenon of pain, patient experience, epidemiology and health promotion on pain patients.

Prof. Dr. Sabine Sator-Katzenschlager
Guest Editor

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Keywords

chronic pain
nociceptive pain
visceral pain
neuropathic pain
failed back surgery syndrome
chronic pelvic pain
patch therapy-capsaicin
invasive pain therapy
spinal cord stimulation
psychological treatments

Published Papers (8 papers)

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Research

16 pages, 756 KiB

Open AccessArticle

Update on Interventional Management of Neuropathic Pain: A Delphi Consensus of the Spanish Pain Society Neuropathic Pain Task Force

by Ancor Serrano-Afonso, Rafael Gálvez, Elena Paramés, Ana Navarro, Dolores Ochoa and Concepción Pérez-Hernández

Medicina 2022, 58(5), 627; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58050627 - 30 Apr 2022

Cited by 4 | Viewed by 2692

Abstract

Background and Objectives: Interventional management of neuropathic pain (NP) is available to the patients who do not obtain satisfactory pain relief with pharmacotherapy. Evidence supporting this is sparse and fragmented. We attempted to summarize and critically appraise the existing data to identify strategies that yield the greatest benefit, guide clinicians, and identify areas that merit further investigation. Material and Methods: A two-round Delphi survey that involved pain clinic specialists with experience in the research and management of NP was done over an ad hoc 26-item questionnaire made by the authors. Consensus on each statement was defined as either at least 80% endorsement or rejection after the 2nd round. Results: Thirty-five and 29 panelists participated in the 1st and 2nd round, respectively. Consensus was reached in 20 out of 26 statements. There is sufficient basis to treat postherpetic neuralgias and complex regional pain syndromes with progressive levels of invasiveness and failed back surgery syndrome with neuromodulation. Radiculopathies and localized NP can be treated with peripheral blocks, neuromodulation, or pulsed radiofrequency. Non-ablative radiofrequency and non-paresthetic neuromodulation are efficacious and better tolerated than ablative and suprathreshold procedures. Conclusions: A graded approach, from least to most invasive interventions has the potential to improve outcomes in many patients with common refractory NP conditions. Preliminary promising data warrant further research on new indications, and technical advances might enhance the safety and efficacy of current and future therapies. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Pain Therapy)

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9 pages, 1696 KiB

Open AccessArticle

The Role of Power Doppler Ultrasonography in Caudal Epidural Injection

by Yueh-Hsun Tsai, Guo-Shu Huang, Chi-Tun Tang, Fu-Chi Yang and Yi-Chih Hsu

Medicina 2022, 58(5), 575; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58050575 - 22 Apr 2022

Cited by 1 | Viewed by 1754

Abstract

Background and Objectives: Although the ultrasound-guided technique is used in caudal epidural injections, severe complications can happen if ultrasound cannot identify the occurrence of intravascular injection. To determine intraepidural and intravascular injection during caudal epidural injections, we used power Doppler ultrasonography (PDU) when injecting medications into the epidural space. Materials and Methods: This is a retrospective study that enrolled a total of 277 patients with refractory low back pain or degenerative disc from January 2019 to December 2019. The injectate flow of caudal epidural injections was examined with the assistance of PDU and confirmed by fluoroscopy. Four flow patterns were identified by PDU in our study: the “Earthworm sign,” the “Patch sign,” the ”Tubular sign” and the “Absent flow sign.” The accuracy of PDU in identifying intraepidural and intravascular injections was determined by fluoroscopy images recorded during each injection. Results: We evaluated 277 patients (mean age, 68.6 ± 13.2 years; 106 men). The “Patch sign” showed a sensitivity of 88.76% and a specificity of 80% in predicting epidural injection without intravascular injection. The “Earthworm sign” demonstrated a sensitivity of 70% and a specificity of 100% in detecting intravascular injection. The “Tubular sign” showed a specificity of 100% and a sensitivity of 9.4% in predicting successful epidural injection. The absence of a flow signal showed a sensitivity of 1.87% and a specificity of 90% in predicting successful epidural injection. Conclusions: Ultrasound-guided caudal epidural injection can accurately determine intraepidural and intravascular injections with the assistance of PDU and is thus a good alternative technique to fluoroscopy-guided caudal epidural injection. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Pain Therapy)

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9 pages, 2102 KiB

Open AccessArticle

Pain Intensity and Degree of Disability after Fragility Fractures of the Pelvis

by Alexandru Filip, Bogdan Veliceasa, Bogdan Puha, Nina Filip, Elena Cojocaru, Mihaela Pertea, Claudiu Adrian Carp, Bogdan Huzum, Ovidiu Alexa and Pol Maria Rommens

Medicina 2022, 58(4), 477; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58040477 - 25 Mar 2022

Cited by 3 | Viewed by 1854

Abstract

Background and objectives: Fragility fractures of the pelvis (FFP) are of increasing interest lately, being associated with a loss of mobility and affecting the quality of life. The aim of our study was to investigate the effect of FFP on disability and pain in patients, after one year since injury. Materials and Methods: In the study, we included 76 patients diagnosed with FFP, who were admitted to our trauma department between January 2016 and January 2019, and were above 65 years of age. The Von Korff pain intensity and disability scores were calculated in the hospital at 6 months and after 1 year. Results: Fifty-four patients were female (71%), with an average age of 75.9 ± 7.19 years. Twenty-two patients were male (29%) and had a mean age of 77.22 ± 7.33 years. We did not record significant differences regarding age between the men and women (p > 0.05). Significant improvements appeared between the baseline and the 6 month follow-up; the average pain intensity score at 6 months was 44.94 (SD 21.20) (p < 0.001), and the disability score was 54.30 (SD 21.62). The following average pain intensity and disability scores after 12 months were similar to the values at6 months: 44.48 (SD 21.74) for pain intensity and 52.36 (SD 24.53) for disability. The Von Korff pain score at 6 months and after 1 year depends on gender and on the initial Von Korff pain score (p = 0.02). The Von Korff disability score at 6 months depends on gender, the baseline pain score and the baseline disability score (p = 0.001). Conclusions: our patients reported long-lasting pain that had a severe effect on their daily routines, and they could not return to their normal status prior to injury. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Pain Therapy)

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14 pages, 12947 KiB

Open AccessArticle

Cutoff Values for Providing the Ideal Intravenous Patient-Controlled Analgesia According to the Intensity of Postoperative Pain—A Retrospective Observational Study

by Keum Young So and Sang Hun Kim

Medicina 2021, 57(10), 1065; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101065 - 06 Oct 2021

Viewed by 1460

Abstract

Background and Objectives: The cutoff values were analyzed for providing the ideal intravenous patient-controlled analgesia (PCA) that could reduce rescue analgesics or antiemetics requirements, based on the grades of postoperative pain intensity (PPI). Materials and Methods: PCA regimens of 4106 patients were retrospectively analyzed, and they were allocated into three groups with low, moderate, and high PPI grades (groups L, M, and H, respectively) based on numeric rating scores obtained 6 h postoperatively. Opioid and non-opioid analgesic doses were converted into fentanyl-equivalent doses (DOSE-FEN-OP and DOSE-FEN-NONOP, respectively). The primary endpoint was the cutoff values of these parameters. Results: With respect to the PCA settings to reduce rescue analgesic and antiemetic requirements, group L required a background infusion rate (BIR) of 1.75–3 mL/h, bolus volume of 0.5–1.25 mL, and lockout interval of ≤12.5 min. Group M required a BIR of 1.75 mL/h, bolus volume of 0.5–1.75 mL, and lockout interval of ≤5 min. Group H required a BIR of 1.75 mL/h, bolus volume of 0.5 mL, and lockout interval of ≤5 min. In assessments of the analgesic doses to reduce rescue analgesic requirement, the DOSE-FEN-OP was at least 950 μg of fentanyl regardless of group, while the DOSE-FEN-NONOP was ≥250 μg, ≥550 μg, and ≥700 μg for the L, M, and H groups, respectively. In assessments of the analgesic doses to reduce rescue antiemetic requirement, DOSE-FEN-OP was ≤950 μg for groups L and M and ≤850 μg for Group H, while DOSE-FEN-NONOP was ≤50 μg, ≤450 μg, and ≤700 μg for groups L, M, and H, respectively. Conclusion: The ideal PCA for reduction in rescue analgesics or antiemetics can be achieved by adjustment of PCA settings and drug dosages carefully with these cutoff values depending on the expected grades of PPI. Especially, the ideal PCA can be provided by adjusting the lockout interval and bolus volume rather than BIR and by applying smaller bolus doses and shorter lockout intervals with an increasing PPI grade. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Pain Therapy)

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9 pages, 835 KiB

Open AccessArticle

Treatment of Patellofemoral Pain Syndrome with Dielectric Radiofrequency Diathermy: A Preliminary Single-Group Study with Six-Month Follow-Up

by Manuel Albornoz-Cabello, Cristo Jesús Barrios-Quinta, Isabel Escobio-Prieto, Raquel Sobrino-Sánchez, Alfonso Javier Ibáñez-Vera and Luis Espejo-Antúnez

Medicina 2021, 57(5), 429; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57050429 - 28 Apr 2021

Cited by 2 | Viewed by 2218

Abstract

Background and Objectives: Notwithstanding patellofemoral pain syndrome (PFPS) being one of the most common causes of pain in the front of the knee in outpatients, few studies have shown the effects of radiofrequency on knee pain and function in this population. The aim of the present study was to determine whether outpatients diagnosed with PFPS obtained improvement in pain and function after treatment by dynamic application of monopolar dielectric diathermy by emission of radiofrequency (MDR). Materials and Methods: An experimental study was conducted with 27 subjects with PFPS. Subjects were treated with 10 sessions of MDR in dynamic application. The visual analogue scale (VAS), the Kujala scale, the DN4 questionnaire, the lower extremity function scale (LEFS), the range of movement (ROM) in knee flexion and extension and the daily drug intake were measured pre- and post-intervention and at the time of the follow-up (six months). Results: Statistically significant differences were found in pain perception (VAS: F_1,26 = 92.43, p < 0.000, ŋ² = 0.78 and DN4: F_1.26 = 124.15, p < 0.000, ŋ² = 0.82), as well as improvements in functionality (LEFS: F_1.26 = 72.42, p < 0.000, ŋ² = 0.74 and Kujala: F_1.26 = 40.37, p < 0.000, ŋ² = 0.61]) and in ROM (Flexion: F_1.26 = 63.15, p < 0.000, ŋ² = 0.71). No statistically significant changes in drug intake were found. Conclusions: The present study shows that the dynamic application of MDR seems effective in reducing pain and increasing functionality and knee flexion in patients with PFPS, after a follow-up of six months. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Pain Therapy)

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9 pages, 694 KiB

Open AccessArticle

Correlation between the Neuropathic PainDETECT Screening Questionnaire and Pain Intensity in Chronic Pain Patients

by Sebastian Lukas König, Michal Prusak, Sibylle Pramhas and Marita Windpassinger

Medicina 2021, 57(4), 353; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57040353 - 07 Apr 2021

Cited by 8 | Viewed by 2050

Abstract

Background and Objectives: Pain is a multidimensional phenomenon with a wide range regarding the location, intensity and quality. Patients with chronic pain, in particular those suffering from mixed pain, often present a special challenge. The PainDETECT questionnaire (PD-Q) is a screening instrument designed to classify whether a patient has neuropathic pain (NP), often rated as more distressing compared to nociceptive pain. The objective of this study was to investigate whether the PD-Q score correlates with pain intensity, measured with the numeric rating scale (NRS), in chronic pain patients in an outpatient setting. Materials and Methods: A questionnaire-based study was conducted to identify the associations between the unidimensional NRS scale for pain intensity and the PD-Q score for screening of an NP component in an outpatient setting. Participants were asked to fill in the questionnaire themselves. Results: One hundred seventy-six participants completed the PD-Q questionnaire and rated pain on the NRS scale at the baseline visit. The PD-Q and NRS scores significantly correlated at the baseline visit and the 1-month follow-up visit in chronic pain patients. The identification of a neuropathic component in chronic pain may permit more targeted and effective pain management. Conclusions: The findings of our questionnaire suggest that a significant proportion of chronic pain patients had manifested features of NP at the first visit to the outpatient clinic. The PD-Q is a useful screening tool to alert clinicians of NP that may need further diagnostic evaluation or therapeutic intervention and may also help to predict treatment response. Further research is needed to investigate if a correlation is predictive of treatment response when pain therapy targets NP. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Pain Therapy)

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10 pages, 860 KiB

Open AccessArticle

Bell’s Palsy—Retroauricular Pain Threshold

by Aleksandar Kopitović, Filip Katanić, Sandro Kalember, Svetlana Simić, Nina Vico and Slobodan Sekulić

Medicina 2021, 57(3), 263; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030263 - 13 Mar 2021

Cited by 2 | Viewed by 3183

Abstract

Background and objectives: Non-motor symptoms in the form of increased sensitivity are often associated with the onset of idiopathic Bell’s palsy (IBP). The aims were to determine whether the pain threshold in the retroauricular regions (RAR) in IBP patients and the time of its occurrence is related to IBP severity. Materials and Methods: The study was conducted among 220 respondents (142 IBP patients, 78 healthy subjects (HS)). The degree of IBP was graded using the House–Brackmann and Sunnybrook Grading Scales (II—mild dysfunction, VI—total paralysis), whereas the pain thresholds were measured using the digital pressure algometer. Results: We found no difference in the degree of the pain threshold between the right and left RAR in the HS group. IBP patients belonging to groups II, III, IV, and V had lower pain thresholds in both RARs than HS and IBP patients belonging to group VI. There was no difference in the degree of pain threshold in RAR between the affected and unaffected side in IBP patients. The incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups II and III of IBP patients is noticeably lower and the incidence of retroauricular pain that occurred only after the onset of paralysis is more frequent. Also, we found that the incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups V and VI of IBP patients was more frequent. Conclusions: The degree of pain threshold lowering in RAR (bilaterally) is inversely related to the severity of IBP. We suggest that the occurrence of retroauricular pain before the onset of facial weakness is associated with higher severity of IBP while the occurrence after the onset is associated with lower severity of IBP. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Pain Therapy)

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12 pages, 332 KiB

Open AccessArticle

The Importance of Perceived Relevance: A Qualitative Evaluation of Patient’s Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program

by Joshua W. Pate, Elizabeth Tran, Seema Radhakrishnan and Andrew M. Leaver

Medicina 2021, 57(1), 46; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57010046 - 07 Jan 2021

Cited by 2 | Viewed by 2545

Abstract

Background and objectives: Limited evidence exists exploring perceptions of which aspects of a pain management program are perceived as valuable and impactful. The aim of this study was to explore patient beliefs about which aspects of a pain management program were valued and/or had perceived impact. Materials and Methods: One-on-one structured interviews were conducted with 11 adults three months after their completion of the Spark Pain Program at Westmead Hospital, Sydney, Australia. Concepts in the transcripts were inductively identified and explored, utilizing thematic analysis to better understand their relevance to the study aim. Results: Four themes emerged: (1) “The program overall was positive, but…”; (2) “I valued my improved knowledge and understanding of pain, but…”; (3) “I valued the stretching/relaxation/pacing/activity monitoring”; and (4) “I valued being part of a supportive and understanding group”. Participants reported that they liked being treated as an individual within the group. A lack of perceived personal relevance of key messages was identified in some participants; it appears that patients in pain programs must determine that changes in knowledge, beliefs, and attitudes are personally relevant in order for the changes to have a significant impact on them. Conclusions: This study provides new insights into aspects of a pain management program that were perceived as valuable and impactful, areas that “missed the mark”, and hypotheses to guide the implementation of service delivery and program redesign. Full article

(This article belongs to the Special Issue Current Challenges and Future Prospects in Pain Therapy)

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