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1.
Mol Neurobiol ; 2024 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-38639862

RESUMEN

Fibromyalgia (FM) is a painful chronic condition that significantly impacts the quality of life, posing challenges for clinical management. Given the difficulty of understanding the pathophysiology and finding new therapeutics, this study explored the effects of a medicinal plant, E. brasiliensis, in an FM model induced by reserpine in Swiss mice. Animals were treated with saline 0.9% (vehicle), duloxetine 10 mg/kg (positive control), or hydroalcoholic extract of E. brasiliensis leaves 300 mg/kg (HEEb). Nociceptive parameters, as well as locomotion, motor coordination, strength, anxiety, and depressive-like behaviors, were evaluated for 10 days. After that, the brain and blood were collected for further analysis of cytokines (interleukin 1? and interleukin 6), brain-derived neurotrophic factor (BDNF), and the immunocontents of total and phosphorylated Tropomyosin receptor kinase B (TrkB). The results demonstrated that the acute and prolonged treatment with HEEb was able to reduce both mechanical and thermal nociception. It was also possible to observe an increase in the strength, without changing locomotion and motor coordination parameters. Interestingly, treatment with HEEb reduces anxious and depressive-like behaviors. Finally, we observed a reduction in inflammatory cytokines in the hippocampus of animals treated with HEEb, while an increase in BDNF was observed in the prefrontal cortex (PFC). However, no alterations related to total and phosphorylated TrkB receptor expression were found. Our study demonstrated the antinociceptive and emotional effects of HEEb in mice, possibly acting on neuroinflammatory and neurotrophic mechanisms. These data provide initial evidence about the E. brasiliensis potential for treating chronic pain.

2.
Behav Sci (Basel) ; 14(4)2024 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-38667123

RESUMEN

BACKGROUND AND OBJECTIVES: Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting. MATERIALS AND METHODS: A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month. RESULTS: Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72). CONCLUSIONS: The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.

3.
Front Pain Res (Lausanne) ; 5: 1299027, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38571563

RESUMEN

In this perspective article we advocate community-based system change for people living with persistent pain. Our view is that greater use of the voluntary and community sector, in partnership with the clinical sector, creates the conditions for a "whole person" approach to pain management, leading to greater personalised care for adults living with long-term pain whilst having the potential to ease some of the pressures on General Practitioners and other clinical services. We advocate pain care that is socially connected, meaningful within socio-cultural contexts and aligned with the principles of salutogenesis. We provide an example of a UK National Health Service (NHS) commissioned pain service called "Rethinking Pain" that operationalises this perspective. Led by the voluntary and community sector, Rethinking Pain works in partnership with the clinical sector to provide a central holistic pathway of care for people experiencing persistent pain. This is the first time that this model of care has been commissioned for persistent pain in this area of England. The Rethinking Pain service is underpinned by core values to work with people to manage their pain holistically. The Rethinking Pain team proactively engage with people in the community, actively approaching and engaging those who experience the biggest health inequalities. In this article we provide an overview of the context of pain services in the UK, the rationale and supporting evidence for community-based system change, and the context, pathway, values, goals, and aspirations of the Rethinking Pain service.

4.
J Neurosci ; 44(15)2024 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-38453468

RESUMEN

The comorbidity of chronic pain and depression poses tremendous challenges for the treatment of either one because they exacerbate each other with unknown mechanisms. As the posterior insular cortex (PIC) integrates multiple somatosensory and emotional information and is implicated in either chronic pain or depression, we hypothesize that the PIC and its projections may contribute to the pathophysiology of comorbid chronic pain and depression. We show that PIC neurons were readily activated by mechanical, thermal, aversive, and stressful and appetitive stimulation in naive and neuropathic pain male mice subjected to spared nerve injury (SNI). Optogenetic activation of PIC neurons induced hyperalgesia and conditioned place aversion in naive mice, whereas inhibition of these neurons led to analgesia, conditioned place preference (CPP), and antidepressant effect in both naive and SNI mice. Combining neuronal tracing, optogenetics, and electrophysiological techniques, we found that the monosynaptic glutamatergic projections from the PIC to the basolateral amygdala (BLA) and the ventromedial nucleus (VM) of the thalamus mimicked PIC neurons in pain modulation in naive mice; in SNI mice, both projections were enhanced accompanied by hyperactivity of PIC, BLA, and VM neurons and inhibition of these projections led to analgesia, CPP, and antidepressant-like effect. The present study suggests that potentiation of the PIC→BLA and PIC→VM projections may be important pathophysiological bases for hyperalgesia and depression-like behavior in neuropathic pain and reversing the potentiation may be a promising therapeutic strategy for comorbid chronic pain and depression.


Asunto(s)
Dolor Crónico , Neuralgia , Ratones , Masculino , Animales , Hiperalgesia , Dolor Crónico/complicaciones , Depresión , Corteza Insular , Amígdala del Cerebelo/metabolismo , Neuralgia/metabolismo , Comorbilidad , Tálamo , Antidepresivos/uso terapéutico
5.
Complement Ther Med ; 81: 103030, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38437926

RESUMEN

OBJECTIVES: Evaluate a digital health intervention using Auricular Point Acupressure (APA) for chronic musculoskeletal pain in terms of participant retention, adherence, acceptability, and satisfaction. Chronic musculoskeletal pain is a global concern and there are persistent challenges in pain management. Despite the value of digital health interventions, these interventions need to be fully evaluated for feasibility. METHODS: We conducted a 3-group, longitudinal, randomized controlled trial (RCT). After Institutional Review Board approval, we posted recruitment flyers in a university, healthcare clinics, and community settings. Participants were randomized into an in-person + app group (n = 8), virtual + app group (n = 7), and a wait-list, education-enhanced control group (n = 8), evaluating our outcomes using standard feasibility measures. The 4-week intervention consisted of virtual sessions, telecommunications, and our APA app, followed by a 3-month follow-up. RESULTS: Data from 22 participants were subsequently analyzed (95.7%). All app participants adhered to the study protocol and used APA at the minimum recommended frequency and duration. The virtual + app group used APA more during the intervention and follow-up periods. All app participants found the intervention to be acceptable and at least 80% overall were satisfied with APA at the 3-month follow-up. There were no adverse events reported. CONCLUSIONS: Our digital health intervention was found to be acceptable and sustainable; participants adhered to and were satisfied with the intervention providing support for a larger RCT. CLINICAL TRIAL: #: NCT05020470.


Asunto(s)
Acupresión , Dolor Crónico , Dolor Musculoesquelético , Humanos , Dolor Musculoesquelético/terapia , Salud Digital , Dolor Crónico/terapia , Manejo del Dolor , Acupresión/métodos
6.
J Bodyw Mov Ther ; 37: 194-201, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38432806

RESUMEN

BACKGROUND: Musculoskeletal spine disorders are common causes of chronic pain and impair functionality. Laser auriculotherapy and cupping has played a significant role in the treatment of chronic pain. OBJECTIVE: to evaluate the effect of laser auriculotherapy associated with cupping at systemic acupuncture points on chronic spinal pain. METHODS: Randomized controlled clinical trial. Volunteers underwent three evaluations: an initial evaluation, a final evaluation immediately after the last intervention session, and a 15-day follow-up. The pain was identified using the numeric pain scale. The pain threshold was also evaluated against mechanical stimulation using a Digital Dynamometer at specific points in the cervical, thoracic and lumbar regions. Fifty individuals with chronic spinal pain, randomized into groups: experimental (n = 25), submitted to 10 sessions of auriculotherapy with laser and cupping therapy and control (n = 25). RESULTS: The experimental group achieved pain intensity reduction between pre and post and follow-up moments (p < 0.0001), of greatest pain in the last seven days among all moments (p < 0.0001), of least pain in the pre with post moment (p = 0.006) and follow-up (p = 0.002), and an increased pain threshold between pre and post (p = 0.023). The control group achieved a reduction in the nociceptive threshold between pre and post (p = 0.001) and follow-up (p < 0.0001). The experimental group showed reduced pain intensity (p = 0.027) and greater pain (p = 0.005) after intervention and in pain intensity (p = 0.018), greater (p < 0.0001) and less pain (p = 0.025) at follow-up, compared to the control group. CONCLUSION: Auriculotherapy with laser associated with cupping therapy may effectively reduce pain intensity and increase the nociceptive threshold.


Asunto(s)
Auriculoterapia , Dolor Crónico , Ventosaterapia , Enfermedades Musculoesqueléticas , Humanos , Columna Vertebral , Rayos Láser
7.
Front Pain Res (Lausanne) ; 5: 1291101, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38468692

RESUMEN

Objective: Where a person lives is a recognized socioeconomic determinant of health and influences healthcare access. This study aimed to compare the pain treatment profile of persons with chronic pain (CP) living in remote regions to those living in non-remote regions (near or in major urban centers). Methods: A cross-sectional study was performed among persons living with CP across Quebec. In a web-based questionnaire, participants were asked to report in which of the 17 administrative regions they were living (six considered "remote"). Pain treatment profile was drawn up using seven variables: use of prescribed pain medications, over-the-counter pain medications, non-pharmacological pain treatments, multimodal approach, access to a trusted healthcare professional for pain management, excessive polypharmacy (≥10 medications), and use of cannabis for pain. Results: 1,399 participants completed the questionnaire (women: 83.4%, mean age: 50 years, living in remote regions: 23.8%). As compared to persons living in remote regions, those living in non-remote regions were more likely to report using prescribed pain medications (83.8% vs. 67.4%), a multimodal approach (81.5% vs. 75.5%), experience excessive polypharmacy (28.1% vs. 19.1%), and report using cannabis for pain (33.1% vs. 20.7%) (bivariable p < 0.05). Only the use of prescribed medications as well as cannabis remained significantly associated with the region of residence in the multivariable models. Discussion: There are differences in treatment profiles of persons with CP depending on the region they live. Our results highlight the importance of considering remoteness, and not only rurality, when it comes to better understanding the determinants of pain management.

8.
J Pain Res ; 17: 1091-1105, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38510563

RESUMEN

Chronic pain (CP) is a leading cause of disability and a potential factor that affects biological processes, family relationships, and self-esteem of patients. However, the need for treatment of CP is presently unmet. Current methods of pain management involve the use of drugs, but there are different degrees of concerning side effects. At present, the potential mechanisms underlying CP are not completely clear. As research progresses and novel therapeutic approaches are developed, the shortcomings of current pain treatment methods may be overcome. In this review, we discuss the retinal photoreceptors and brain regions associated with photoanalgesia, as well as the targets involved in photoanalgesia, shedding light on its potential underlying mechanisms. Our aim is to provide a foundation to understand the mechanisms underlying CP and develop light as a novel analgesic treatment has its biological regulation principle for CP. This approach may provide an opportunity to drive the field towards future translational, clinical studies and support pain drug development.

9.
Cureus ; 16(2): e54589, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38524044

RESUMEN

Arthritis affects millions of lives with its pervasive effects on physical health and quality of life. Addressing the complexities of managing symptoms such as swelling, inflammation, and pain requires prolonged treatment. Naturopathy is a treatment method that enhances the body's innate ability to restore optimal health through a holistic approach including natural products and lifestyle modifications. This systematic review addresses the intersection of naturopathy and arthritis treatment to provide current evidence about its potential benefits. Four databases (PubMed, AYUSH Research Portal, Web of Science, and Google Scholar) were searched with the keywords "Naturopathy" AND "Arthritis". Randomized, non-randomized, and cross-over studies in English were included. Studies reporting perceived pain using a visual analogue scale (VAS) were selected for meta-analysis. A total of 15 studies were included in the systematic review. The studies were from Denmark, Egypt, France, Hungary, Israel, Italy, Spain, and Turkey, and the study periods ranged from 1992 to 2017. They suggested that naturopathic treatment modalities like exercise, mud compress, sand bath, or hydrotherapy may be used in addition to conventional modes of treatment for added benefit. There was a diversity of naturopathic treatment modalities and outcome evaluation methods. Most studies used mud compress or mud baths with reported improvement of symptoms. The meta-analysis of 10 studies (11 sets of data) showed a significant improvement in pain measured by VAS. The studies included in the review have a high level of heterogenicity. There is a need for more studies and uniform assessment methods with standardization of interventions for robust evidence. More clinical trials from countries where naturopathy is approved treatment modalities are needed.

11.
Front Psychol ; 15: 1331826, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38476394

RESUMEN

Background: The management of chronic pain may involve an array of tools, including radiofrequency thermocoagulation (Rf-Tc) of sensory nerve terminals. Like many other invasive procedures, Rf-Tc can generate anxiety in a lot of patients, either during the expectation of the procedure or in the course of it. Virtual reality hypnosis (VRH) is a promising tool for managing anxiety and pain in several situations, but its anxiolytic property has not been investigated in participants with chronic pain and going through a Rf-Tc procedure. Objectives: The goal of this study was to evaluate the effectiveness of VRH for reducing self-assessed anxiety in participants with chronic pain, when received in preparation for Rf-Tc. Materials and methods: This prospective, controlled trial was conducted in the Interdisciplinary Algology Centre of the University Hospital of Liège (Belgium). Participants were assigned to two groups: VRH or control (usual care). Assessment was carried-out at 4 time points: T0 (one week before Rf-Tc); T1 (pre-intervention, on the day of Rf-Tc); T2 (immediately after the VRH intervention outside of the Rf-Tc room); and T3 (right after Rf-Tc). Medical, sociodemographic data, anxiety trait and immersive tendencies were collected at T0. Anxiety state and pain intensity were assessed at each time points. Satisfaction was examined at T3. Results: Forty-two participants were quasi-randomly assigned to the VRH or control group. No statistically significant interaction group by time was observed regarding all measured variables, including primary endpoint. However, a significant effect of time was found for anxiety and pain when considering both groups together, toward a progressive reduction. Conclusion: In the context of our study, there appears to be no significant effect of VRH at reducing anxiety in participants with chronic pain undergoing Rf-Tc. Anxiety decreases along the procedure, while pain is attenuated by the local anesthetic infiltration of the Rf site. Our results suggest that the presence of a caregiver throughout the procedure might explain the progressive decrease in anxiety. Future randomized controlled trials are needed to precisely study the effectiveness of the VRH tool, and the possibility of using it as a complementary approach for anxiety during invasive procedures.

12.
Front Psychol ; 15: 1362208, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38481624

RESUMEN

Introduction: Approximately one-quarter of Canadians experience chronic pain, a debilitating condition often necessitating opioid use, which raises concerns regarding dependency and overdose risks. As an alternative, we developed the HYlaDO program (Hypnose de la Douleur, hypnosis of Pain in French), a novel self-hypnosis approach for chronic pain management. The development of this program followed the ORBIT model, a comprehensive framework for designing interventions encompassing several phases ranging from design to efficacy assessment. Methods: In the present work, we conducted a preliminary evaluation of the HYlaDO program with 21 participants (18 of the 21 patients were included in the analysis). The primary objective was to determine one session of the program's effectiveness in altering pain, anxiety and relaxation via pre-post analysis. The secondary goal was to examine the long-term effects across the same measures, in addition to the overall quality of life. Results: The results highlight the benefits of our approach, while participants reported short-term significant pain reduction, decreased anxiety, and increased relaxation. Additionally, preliminary trends suggest improvements in physical activity and quality of life metrics. Discussion: These positive outcomes highlight HYlaDO's potential as an alternative to opioid therapy for chronic pain. Encouraged by these results, we aim to extend our research to a broader and more diverse cohort, paving the way for comprehensive randomized controlled trials. This expansion will further validate HYlaDO's efficacy and its role in transforming chronic pain management.

13.
Glob Adv Integr Med Health ; 13: 27536130241236775, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38434590

RESUMEN

Background: The association between home mindfulness practice quantity in standard length mindfulness-based interventions (MBIs) and chronic pain outcomes is variable. Few studies focus on abbreviated MBIs (< 8 weeks) and distinguish between formal guided practices and informal practices in daily life. Objectives: To characterize home mindfulness practice and explore associations between home practice quantity and pre-to-post-outcome changes after an MBI for chronic pain. Methods: In this single-arm study, 21 adults with chronic pain (mean age = 54 years, 81% White, mean pain duration = 7 years) completed an MBI with four weekly group sessions. Pre and post self-report measures of pain intensity/interference, physical function, depression, anxiety, positive affect, sleep disturbance (all PROMIS measures), and pain acceptance, catastrophizing, perceived stress and mindfulness were completed, along with daily surveys of formal (mindfulness of breath, body scan) and informal (breathing space, mindfulness of daily activities) practice. Bivariate correlations and multivariable regression models were used to assess the association between days and minutes of practice and change in outcomes. Results: On average, formal practice was completed on 4.3 days per week and 13.5 minutes per day. Informal practice was completed on 3.5 days per week and 8.6 minutes per day. Formal practice was not significantly correlated with outcomes (Spearman's ρ = |.01|-|.32|), whereas informal practice was correlated with multiple outcomes (ρ = |.04|-|.66|). Number of days practiced informally was associated with improved pain interference, physical function, sleep disturbance, and catastrophizing (p's ≤ .05). Number of minutes practiced informally was associated with improved pain interference, anxiety, positive affect, and catastrophizing (p's ≤ .05). Conclusion: Informal home practice quantity, but not formal practice quantity, is associated with improved outcomes during an abbreviated MBI for chronic pain. For these MBIs, it is important to evaluate the distinct roles of formal and informal practice. ClinicalTrialsgov Registration: NCT03495856.

14.
J Am Vet Med Assoc ; 262(8): 1-7, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38503053

RESUMEN

OBJECTIVE: To describe the effect of different substance combinations administered through mesotherapy in dogs with hip osteoarthritis. ANIMALS: 104 dogs. METHODS: In this retrospective study, 4 groups (dogs treated with a combination of lidocaine, piroxicam, and thiocolchicoside [MG]; dogs treated with lidocaine, piroxicam, and Traumeel [TG]; dogs treated with lidocaine, piroxicam, and glucosamine [GG]; and dogs treated with the same combination as in MG combined with a photobiomodulation session [MPG]) were set. For all groups, the same treatment frequency was followed. Response to treatment was measured with the Canine Brief Pain Inventory (divided into pain interference score and pain severity score), Liverpool Osteoarthritis in Dogs (LOAD), and Canine Orthopedic Index (divided into function, gait, stiffness, and quality of life) before treatment and 15, 30, 60, 90, and 120 days after treatment. Cox proportional hazard regression analysis was used to investigate the influence of treatment, age, sex, body weight, breed, and Orthopedic Foundation for Animals score. RESULTS: Dogs had a mean age of 7.6 ± 3.1 years and body weight of 28.6 ± 5.5 kg. Hip osteoarthritis was classified as mild (4), moderate (70), or severe (30). Greater improvements were observed in MG and MPG. Kaplan-Meier estimators showed MG and MPG had longer periods with clinically significant results. Treatment was the covariable that contributed more frequently to the outcomes observed. CLINICAL RELEVANCE: The combination used in MG, particularly combined with photobiomodulation, produced longer-lasting clinically significant results.


Asunto(s)
Enfermedades de los Perros , Mesoterapia , Piroxicam , Animales , Perros , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/terapia , Estudios Retrospectivos , Masculino , Femenino , Piroxicam/uso terapéutico , Piroxicam/administración & dosificación , Piroxicam/análogos & derivados , Mesoterapia/veterinaria , Colchicina/uso terapéutico , Colchicina/administración & dosificación , Lidocaína/uso terapéutico , Lidocaína/administración & dosificación , Quimioterapia Combinada/veterinaria , Osteoartritis/veterinaria , Osteoartritis/tratamiento farmacológico , Glucosamina/uso terapéutico , Glucosamina/administración & dosificación , Extractos Vegetales/uso terapéutico , Extractos Vegetales/administración & dosificación , Osteoartritis de la Cadera/veterinaria , Osteoartritis de la Cadera/tratamiento farmacológico , Antiinflamatorios no Esteroideos/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Terapia por Luz de Baja Intensidad/veterinaria
15.
J Oral Rehabil ; 51(7): 1175-1183, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38532257

RESUMEN

BACKGROUND: Chronic pain is persistent or recurrent pain lasting longer than 3 months. The experience of temporomandibular disorder (TMD)-related pain is modulated by emotional and social factors, with mindfulness encapsulating these aspects. OBJECTIVE: To investigate the association between cognitive-behavioural-emotional characteristics, mindfulness and the painful experience in women with chronic pain-related TMD. METHODS: A cross-sectional study was conducted, including 90 women aged between 18 and 61 years old, diagnosed with chronic pain-related TMD according to the Diagnostic Criteria for Temporomandibular Disorder, considering both temporomandibular joint and muscle pain. Specific instruments were employed to assess cognitive-behavioural-emotional aspects. The Mindful Attention Awareness Scale and the Five Facets of Mindfulness Questionnaire scales evaluated the level and construct of mindfulness. The relationship between variables was analysed using bivariate association tests (.05 > p < .20), followed by multiple regression tests (p < .05). RESULTS: The heightened experience of pain correlated with increasing age, a low level of education, the attribution of the locus of control by chance, and lower levels of mindfulness (p < .05). The heightened experience of pain was negatively influenced by mindfulness levels (p < .05). On the other hand, the painful experience was mainly influenced by facets describing negative formulation, distraction, non-reactivity and non-judgement (p < .05). CONCLUSION: Demographic, cognitive-behavioural-emotional data and levels of mindfulness and its facets presented different influence weights on the painful experience. These findings provide support for future studies focusing on mindfulness strategies, education and pain management in women with chronic pain-related TMD.


Asunto(s)
Dolor Crónico , Emociones , Dolor Facial , Atención Plena , Dimensión del Dolor , Trastornos de la Articulación Temporomandibular , Humanos , Femenino , Trastornos de la Articulación Temporomandibular/psicología , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/fisiopatología , Adulto , Estudios Transversales , Persona de Mediana Edad , Dolor Crónico/psicología , Dolor Crónico/fisiopatología , Adulto Joven , Dolor Facial/psicología , Dolor Facial/fisiopatología , Emociones/fisiología , Adolescente , Encuestas y Cuestionarios
16.
J Obstet Gynaecol Can ; 46(1): 102283, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38341225

RESUMEN

OBJECTIVE: To provide evidence-based recommendations for the management of chronic pelvic pain in females. TARGET POPULATION: This guideline is specific to pelvic pain in adolescent and adult females and excluded literature that looked at pelvic pain in males. It also did not address genital pain. BENEFITS, HARMS, AND COSTS: The intent is to benefit patients with chronic pelvic pain by providing an evidence-based approach to management. Access to certain interventions such as physiotherapy and psychological treatments, and to interdisciplinary care overall, may be limited by costs and service availability. EVIDENCE: Medline and the Cochrane Database from 1990 to 2020 were searched for articles in English on subjects related to chronic pelvic pain, including diagnosis, overlapping pain conditions, central sensitization, management, medications, surgery, physiotherapy, psychological therapies, alternative and complementary therapies, and multidisciplinary and interdisciplinary care. The committee reviewed the literature and available data and used a consensus approach to develop recommendations. Only articles in English and pertaining to female subjects were included. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE: Family physicians, gynaecologists, urologists, pain specialists, physiotherapists, and mental health professionals. TWEETABLE ABSTRACT: Management of chronic pelvic pain should consider multifactorial contributors, including underlying central sensitization/nociplastic pain, and employ an interdisciplinary biopsychosocial approach that includes pain education, physiotherapy, and psychological & medical treatments. SUMMARY STATEMENTS: RECOMMENDATIONS.


Asunto(s)
Dolor Crónico , Adulto , Femenino , Humanos , Adolescente , Dolor Crónico/diagnóstico , Dolor Crónico/terapia , Dolor Pélvico/terapia , Dolor Pélvico/cirugía
17.
Br J Oral Maxillofac Surg ; 62(3): 318-323, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38355385

RESUMEN

Patients with chronic pain have a higher prevalence of mood disorders with depression and anxiety contributing to higher pain intensity, emotional allodynia, and neuro-anatomical changes. We sought to quantify the prevalence of psychiatric comorbidities (PCs) in a tertiary referral clinic for temporomandibular disorders (TMDs). Medical records of all patients attending clinics run by three tertiary temporomandibular joint (TMJ) surgeons for the period January to April 2022 inclusive were audited for the prevalence of concomitant psychiatric conditions. A total of 166 patients were identified with a female to male ratio of 5:1 and mean (SD) age of 45.1 (15.2) years. A total of 124 (89.9%) patients were tertiary referrals and 72 (43.4%) patients had concomitant psychiatric diagnoses, with 58 (34.9%) being on some form of psychotropic medication (PM) (patients on anticonvulsants for neuropathic pain were not included). A majority of 136 (81.9%) patients had some form of intervention (including Dysport® and minimally invasive surgery) which appeared more common in patients with co-existing psychiatric issues (p < 0.05). A higher proportion of mental health issues exist among TMD patients in a tertiary referral clinic than would be expected in the general population. We suggest a holistic approach to patients with multidisciplinary care taking into account this prevalence to ensure decision-making that contextualises the patient and not simply the pathology.


Asunto(s)
Comorbilidad , Trastornos Mentales , Trastornos de la Articulación Temporomandibular , Centros de Atención Terciaria , Humanos , Trastornos de la Articulación Temporomandibular/epidemiología , Trastornos de la Articulación Temporomandibular/complicaciones , Masculino , Femenino , Persona de Mediana Edad , Trastornos Mentales/epidemiología , Trastornos Mentales/complicaciones , Adulto , Prevalencia , Dolor Crónico/epidemiología , Estudios Retrospectivos
18.
Br J Pain ; 18(1): 28-41, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38344266

RESUMEN

Background: Nearly a quarter of Canada's population suffers from chronic pain, a long-lasting medical condition marked by physical pain and psychological suffering. Opioids are the primary treatment for pain management in this condition; yet, this approach involves several undesirable side effects. In contrast to this established approach, non-pharmacological interventions, such as medical hypnosis, represent an efficient alternative for pain management in the context of chronic pain. HYlaDO is a self-hypnosis program designed to improve pain management for people with chronic pain. Purpose: This research aimed to evaluate the HYlaDO program based on the proof-of-concept level of the ORBIT model and investigated participants' subjective experience. Research design: Qualitative study. Study sample: Seventeen participants with chronic pain took part in this study. Data collection: We conducted individual semi-structured interviews with patients who had participated in HYlaDO to identify the three targets of desired change: pain, anxiety and autonomy in self-hypnosis practice. Results: Thematic analysis revealed that the practice of hetero-hypnosis and self-hypnosis decreased (i) pain and (ii) anxiety. Also, it (iii) indicated the development of an independent and beneficial self-hypnosis practice by having integrated the techniques taught. Conclusion: These results confirm that the established targets were reached and support further development, implementation and scaling up of this program. Consequently, we believe it is justified to move to the next step of program development.

19.
Front Pain Res (Lausanne) ; 5: 1322848, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38317671

RESUMEN

Background: Radiculopathy can be a debilitating condition. Amniotic membrane/umbilical cord (AM/UC) particulate is a relatively new injectable treatment modality. Herein we report the outcomes of epidural injection of AM/UC particulate in managing lumbar radiculopathy. Methods: Consecutive patients with lumbar radiculopathy who received epidural injection of AM/UC particulate for lumbar radiculopathy were included. Primary outcome was change in pain as measured by the 11-point numerical rating scale. Safety was assessed by AM/UC- and procedure-related complications. Paired t-tests were used to determine statistical significance. Results: A total of 12 patients with a mean age of 56.7 ± 21.0 years were included in the analysis. The patients were previously treated with physical therapy (91.7%), chiropractic corrective measures (16.7%), epidural steroid injection (83.3%), and radiofrequency ablation (8.3%). Two patients (16.7%) were taking opioids for chronic pain syndrome. After AM/UC injection, the average pain score decreased from 6.6 ± 1.5 to 5.2 ± 1.9 at 1-3 months, 2.0 ± 1.4 at 6 months, and 2.9 ± 1.4 at last mean follow-up of 21.3 ± 11.1 months (p < 0.001). No patients required subsequent treatment or surgery. There were also no complications. Conclusion: This case series supports the preliminary safety and shows potential benefit of epidural AM/UC particulate injection in this cohort of patients with lumbar radiculopathy pain.

20.
J Pers Med ; 14(2)2024 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-38392633

RESUMEN

(1) Background: Chronic pain, which affects more than one in five adults worldwide, has a negative impact on the quality of life, limiting daily activities and generating absences from work. The aim of the present review is to analyze the efficacy of mind-body therapies as therapeutic strategies for patients with chronic pain. (2) Methods: A systematic review with a meta-analysis was carried out, searching PubMed, Scopus, and Web of Science databases using specific keywords. We selected studies that included mind-body therapies as the primary intervention for older adults with chronic pain. The methodological quality of the articles was assessed using the PEDro scale. (3) Results: Of the 861 studies identified, 11 were included in this review, all of which employed different mind-body therapies as an intervention. The selected studies measured chronic pain as the main variable. (4) Conclusions: This review highlights the value of mind-body exercises in reducing chronic pain in older adults, suggesting their integration as a non-pharmacological therapeutic alternative that improves the quality of life, promoting a holistic approach to pain management.

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