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The latest medical research on Pain Medicine

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Pericapsular nerve group (PENG) block: what have we learned in the last 5 years?

Regional Anesthesia and Pain Medicine

This educational article discusses the current understanding of the pericaspular nerve group block (PENG) of the hip regarding its mechanism of act...

Comparative anatomical study of digital block with the WALANT, interdigital, and transthecal techniques.

Regional Anesthesia and Pain Medicine

Interdigital block and transthecal block through the flexor sheath are commonly used techniques for the anesthesia of isolated fingers. The wide-awake local anesthetic no-tourniquet technique is a relatively new approach for local anesthesia during finger procedures. The anatomical spread of local anesthetics with the wide-awake local anesthetic no tourniquet technique has not been described adequately.This anatomical study aimed to assess the distribution of a local anesthetic dye solution to the digital nerves. The study was designed to compare the nerve staining effect using the wide-awake local anesthetic no tourniquet and the transthecal and interdigital techniques in cadavers. We hypothesized that the wide-awake local anesthetic no tourniquet technique stains digital nerves more effectively than the interdigital and transthecal digital injection techniques.

14 blocks were performed using anatomical landmarks. 2 mL of a mixture of local anesthetic, methylene blue, and contrast medium were injected. Before dissection, the specimens were passed through an X-ray scanner to assess the spread of the mixture. Finally, anatomical dissections were performed to evaluate the specific hand nerve implications.

In the wide-awake local anesthetic no tourniquet group, the local anesthetics spread to the nerves of each finger but not the common nerve. In the transthecal and interdigital groups, the spread extended from the common nerve to the lateral aspect of the adjacent fingers.

The wide-awake local anesthetic no tourniquet technique was as effective as conventional techniques in the digital blockade, achieving specific spread on the targeted nerves.

Prolonged administration of intrathecal baclofen in a patient with generalized grade 4 tetanus.

Regional Anesthesia and Pain Medicine

This case report presents the management of a 62-year-old woman with generalized grade 4 tetanus, focusing on the innovative use of intrathecal baclofen (ITB) therapy. The patient initially presented with a laceration and subsequently developed severe tetanic spasms, necessitating interventions beyond standard tetanus immunoglobulin and antibiotics due to the condition's progressive and life-threatening nature. The preference for ITB over oral baclofen is highlighted, considering ITB's enhanced bioavailability in the central nervous system and its efficacy in reducing spinal cord reflexes, which is critical for managing severe spasticity.On her return to the emergency department with symptoms of tetanus, the patient received ITB following the failure of oral baclofen to control the spasms. ITB administration necessitated a lumbar drain, which was later substituted with a tunneled intrathecal catheter due to the extended requirement for baclofen infusion and the unavailability of suitable infusion pumps. This scenario represented a significant application of a CADD-Solis external pump for continuous ITB infusion.Transitioning the patient from ITB to oral baclofen was a crucial management step to facilitate discharge and recovery, underscoring the importance of a careful approach to prevent withdrawal symptoms and maintain care continuity. Despite initial complications, including an infection signaled by leucocytosis and confirmed through cerebrospinal fluid culture, the patient was effectively treated and discharged.

This report contributes to the sparse literature on prolonged ITB use for generalized grade 4 tetanus treatment, underlining the need for interdisciplinary collaboration for the best patient outcomes. It showcases the potential of ITB in spasticity management, in reducing the need for sedation, and in shortening the duration of mechanical ventilation, advocating for a tailored approach that utilizes a full spectrum of pharmacological and supportive therapies.

Analgesic benefits of regional anesthesia in the perioperative management of transition-related surgery: a systematic review.

Regional Anesthesia and Pain Medicine

Transition-related surgery is an effective treatment for gender dysphoria, but the perioperative analgesic management of transgender patients is nuanced and potentially complicated by higher rates of mood and substance use disorders. Regional anesthetic techniques are known to reduce pain severity and opioid requirements; however, little is known regarding the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery.

We performed a systematic review of the literature to evaluate original reports characterizing the analgesic effectiveness of regional anesthetic techniques for patients undergoing chest and/or genital transition-related surgery. Our primary outcomes were pain severity and opioid requirements on the first postoperative day.

Of the 1863 records identified, 10 met criteria for inclusion and narrative synthesis. These included two randomized controlled trials, three cohort studies, and five case reports/series, comprising 293 patients. Four reports described 243 patients undergoing chest surgery, of whom 86% were transgender men undergoing mastectomy with pectoralis nerve blocks or local anesthetic instillation devices. The remaining six reports comprised 50 patients undergoing genital surgery, of whom 56% were transgender women undergoing vaginoplasty with erector spinae plane blocks or epidural anesthesia. Three studies directly compared regional techniques to parenteral analgesia alone. Two of these studies reported lower pain scores and opioid requirements on the first postoperative day with nerve blocks compared with none while the third study reported no difference between groups. Complications related to regional anesthetic techniques were rare among patients undergoing transition-related surgery.

Despite the ever-growing demand for transition-related surgery, the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery is very understudied and insufficient to guide clinical practice. Our systematic review of the literature serves to underscore regional anesthesia for transition-related surgery as a priority area for future research.

Probing white matter microstructure in youth with chronic pain and its relation to catastrophizing using neurite orientation dispersion and density imaging.

Pain

Chronic pain is common in young people and can have a major life impact. Despite the burden of chronic pain, mechanisms underlying chronic pain dev...

Parental narrative style moderates the relation between pain-related attention and memory biases in youth with chronic pain.

Pain

Negatively biased pain memories robustly predict maladaptive pain outcomes in children. Both attention bias to pain and parental narrative style ha...

Statistical modeling of acute and chronic pain patient-reported outcomes obtained from ecological momentary assessment.

Pain

Ecological momentary assessment (EMA) allows for the collection of participant-reported outcomes (PROs), including pain, in the normal environment ...

American Society of Pain and Neuroscience Best Practice (ASPN) Guideline for the Treatment of Sacroiliac Disorders.

Journal of Pain

Clinical management of sacroiliac disease has proven challenging from both diagnostic and therapeutic perspectives. Although it is widely regarded ...

"Pronation Compensation Sign" as a New Diagnostic Tool for Carpal Tunnel Syndrome: A Prospective Preliminary Study.

Journal of Pain

Carpal tunnel syndrome (CTS) is commonly encountered in clinical practice. Diagnostic tools that currently exist include painful provocative maneuvers, invasive nerve conduction studies and the use of tests that require physician's direct participation in an era of sanitary crisis and virtual consultations. Therefore, having an easily accessible, reliable and practical tool for diagnosing CTS would be highly beneficial. Herein, we investigated the diagnostic value of the "pronation compensation sign" that we described for diagnosing CTS.

We included 18 hands with and 18 hands without CTS (age: CTS hands = 52.5 ± 13.8 years, non-CTS hands = 43.2 ± 12.3 years; sex ratio: CTS hands = 12:8, non-CTS hands = 9:9). The presence of the "pronation compensation sign" was evaluated in each included hand. The presence of the "pronation compensation sign" were compared between CTS and non-CTS hands using the chi-squared test. Statistical significance was set at p < 0.05. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated of the "pronation compensation sign" for CTS.

All 18 hands with CTS showed a positive "pronation compensation sign", while those without CTS were negative. All 18 hands that were positive for the "pronation compensation sign" were hands with CTS, while those that were negative were hands without CTS. The sensitivity and specificity of the "pronation compensation sign" for diagnosing CTS were both 100%. The PPV and NPV of the "pronation compensation sign" for CTS were both 1.000. The rates of the presence of the "pronation compensation sign" were significantly different between hands with and without CTS (p < 0.001).

The "pronation compensation sign" seems a useful tool for diagnosing CTS. We believe that the "pronation compensation sign" will help clinicians diagnose CTS with high diagnostic accuracy.

Identification of Key Genes and Pathways in Oxaliplatin-Induced Neuropathic Pain Through Bioinformatic Analysis.

Journal of Pain

The mechanism of Chemotherapy-induced neuropathic pain (NP) remains obscure. This study was aimed to uncover the key genes as well as protein networks that contribute to Oxaliplatin-induced NP.

Oxaliplatin frequently results in a type of Chemotherapy-induced NP that is marked by heightened sensitivity to mechanical and cold stimuli, which can lead to intolerance and discontinuation of medication. We investigated whether these different etiologies lead to similar pathological outcomes by targeting shared genetic targets or signaling pathways. Gene expression data were obtained from the Gene Expression Comprehensive Database (GEO) for GSE38038 (representing differential expression in the spinal nerve ligation model rats) and GSE126773 (representing differential expression among the Oxaliplatin-induced NP model rats). Differential gene expression analysis was performed using GEO2R.

Protein-protein interaction (PPI) analysis identified 260 co-differentially expressed genes (co-DEGs). Subsequently, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed three shared pathways involved in both models: Kaposi sarcoma-associated herpesvirus (KSHV) infection, Epstein-Barr virus (EBV) infection, and AGE-RAGE signaling pathway in diabetic complications. Further bioinformatics analysis highlighted eight significantly up-regulated genes in the NP group: Mapk14, Icam1, Cd44, IL6, Cxcr4, Stat1, Casp3 and Fgf2. Our results suggest that immune dysfunction, inflammation-related factors or regulating inflammation factors may also be related to Oxaliplatin-induced NP. Additionally, we analyzed a dataset (GSE145222) involving chronic compression of DRGs (CCD) and control groups. CCD model is a classic model for studying NP. We assessed these hub genes' expression levels. In contrast with the control groups, the hub genes were up-regulated in CCD groups, the difference was statistically significant, except Stat1.

Our research significantly contributes to elucidating the mechanisms underlying the occurrence as well as the progression of Oxaliplatin-induced NP. We have identified crucial genes and signaling pathways associated with this condition.

Grape seed-derived procyanidins decreases neuropathic pain and nerve regeneration by suppression of TLR4-Myd88 signaling.

Molecular Pain

Recent studies have shown that peripheral nerve regeneration process is closely related to neuropathic pain. Toll-like receptor 4 (TLR4) signaling was involved in different types of pain and nerve regeneration. TLR4 induced the recruitment of myeloid differentiation factor-88 adaptor protein (MyD88) and NF-κB-depended transcriptional process in sensory neurons and glial cells, which produced multiple cytokines and promoted the induction and persistence of pain. Our study aimed to investigate procyanidins's effect on pain and nerve regeneration via TLR4-Myd88 signaling.

Spinal nerve ligation (SNL) model was established to measure the analgesic effect of procyanidins. Anatomical measurement of peripheral nerve regeneration was measured by microscopy and growth associated protein 43 (GAP43) staining. Western blotting and/or immunofluorescent staining were utilized to detect TLR4, myeloid differentiation factor-88 adaptor protein (MyD88), ionized calcium-binding adapter molecule 1 (IBA1) and nuclear factor kappa-B-p65 (NF-κB-p65) expression, as well as the activation of astrocyte and microglia. The antagonist of TLR4 (LPS-RS-Ultra, LRU) were intrathecally administrated to assess the behavioral effects of blocking TLR4 signaling on pain and nerve regeneration Result:Procyanidins reduced mechanical allodynia, thermal hyperalgesia and significantly suppressed the number of nerve fibers regenerated and the degree of myelination in SNL model. Compared with sham group, TLR4, MyD88, IBA1 and phosphorylation of NF-κB-p65 were upregulated in SNL rats which were reversed by procyanidins administration. Additionally, procyanidins also suppressed activation of spinal astrocytes and glial cells.

Suppression of TLR4-MyD88 signaling contributes to the alleviation of neuropathic pain and reduction of nerve regeneration by procyanidins.

Pain reflects the informational value of nociceptive inputs.

Pain

Pain perception and its modulation are fundamental to human learning and adaptive behavior. This study investigated the hypothesis that pain percep...