• 【具有NMDA拮抗剂活性的天然衍生肽抑制神经病理性疼痛。】 复制标题 收藏 收藏
    DOI:10.1016/s0006-8993(97)00183-2 复制DOI
    作者列表:Siegan JB,Hama AT,Sagen J
    BACKGROUND & AIMS: :Chronic pain may result from hyperexcitability following activation of spinal NMDA receptors. A naturally-derived mammalian peptide, histogranin, may possess NMDA antagonist activity. This study explored the possibility that stable analog [Ser1]Histogranin (SHG) could reduce chronic pain. Neuropathic pain was induced using the chronic constriction injury model (CCI). Intrathecal injection of SHG markedly attenuated the hyperalgesia and allodynia resulting from CCI, nearly normalizing responses. These results suggest that the natural peptide histogranin may be a novel adjunct in neuropathic pain management.
    背景与目标: : 脊髓NMDA受体激活后过度兴奋可能导致慢性疼痛。天然衍生的哺乳动物肽组织蛋白可能具有NMDA拮抗剂活性。这项研究探讨了稳定的类似物 [Ser1] 组织蛋白 (SHG) 可以减轻慢性疼痛的可能性。使用慢性收缩损伤模型 (CCI) 诱发神经病理性疼痛。鞘内注射SHG可显着减轻由CCI引起的痛觉过敏和异常性疼痛,几乎使反应正常化。这些结果表明,天然肽组织粒蛋白可能是神经性疼痛管理的新型辅助手段。
  • 【冰按摩对艾滋病患者神经性疼痛的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.jana.2006.07.002 复制DOI
    作者列表:Ownby KK
    BACKGROUND & AIMS: :Peripheral neuropathic pain is a unique form of chronic pain that afflicts up to 50% of persons with AIDS. The purpose of this pilot study was to examine the effects of ice massage to reduce neuropathic pain and improve sleep quality and to determine the feasibility of a larger study. A repeated measures design was used. The three treatments consisted of ice massage, dry-towel massage, and presence. Consecutive sampling was used to select 33 persons with AIDS who had neuropathic pain. Although the results of the study were negative, there was a decrease in pain intensity over time with both the ice massage and towel massage, suggesting that the intervention has some clinical benefit.
    背景与目标: : 周围神经性疼痛是一种独特的慢性疼痛形式,困扰多达50% 的艾滋病患者。这项初步研究的目的是检查冰按摩减轻神经性疼痛和改善睡眠质量的效果,并确定进行更大规模研究的可行性。使用了重复测量设计。这三种治疗方法包括冰按摩,干毛巾按摩和在场。连续抽样选择33例患有神经性疼痛的艾滋病患者。尽管研究结果为阴性,但随着时间的推移,冰按摩和毛巾按摩的疼痛强度有所降低,这表明该干预措施具有一定的临床益处。
  • 【一项开放标签扩展研究,旨在研究THC/CBD口腔粘膜喷雾剂和口腔粘膜THC喷雾剂在强效阿片类镇痛药难治的晚期癌症相关疼痛患者中的长期安全性和耐受性。】 复制标题 收藏 收藏
    DOI:10.1016/j.jpainsymman.2012.07.014 复制DOI
    作者列表:Johnson JR,Lossignol D,Burnell-Nugent M,Fallon MT
    BACKGROUND & AIMS: CONTEXT:Chronic pain in patients with advanced cancer poses a serious clinical challenge. The Δ9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray (U.S. Adopted Name, nabiximols; Sativex(®)) is a novel cannabinoid formulation currently undergoing investigation as an adjuvant therapy for this treatment group. OBJECTIVES:This follow-up study investigated the long-term safety and tolerability of THC/CBD spray and THC spray in relieving pain in patients with advanced cancer. METHODS:In total, 43 patients with cancer-related pain experiencing inadequate analgesia despite chronic opioid dosing, who had participated in a previous three-arm (THC/CBD spray, THC spray, or placebo), two-week parent randomized controlled trial, entered this open-label, multicenter, follow-up study. Patients self-titrated THC/CBD spray (n=39) or THC spray (n=4) to symptom relief or maximum dose and were regularly reviewed for safety, tolerability, and evidence of clinical benefit. RESULTS:The efficacy end point of change from baseline in mean Brief Pain Inventory-Short Form scores for "pain severity" and "worst pain" domains showed a decrease (i.e., improvement) at each visit in the THC/CBD spray patients. Similarly, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 scores showed a decrease (i.e., improvement) from baseline in the domains of insomnia, pain, and fatigue. No new safety concerns associated with the extended use of THC/CBD spray arose from this study. CONCLUSION:This study showed that the long-term use of THC/CBD spray was generally well tolerated, with no evidence of a loss of effect for the relief of cancer-related pain with long-term use. Furthermore, patients who kept using the study medication did not seek to increase their dose of this or other pain-relieving medication over time, suggesting that the adjuvant use of cannabinoids in cancer-related pain could provide useful benefit.
    背景与目标:
  • 【微生物群调节小鼠的内脏疼痛。】 复制标题 收藏 收藏
    DOI:10.7554/eLife.25887 复制DOI
    作者列表:Luczynski P,Tramullas M,Viola M,Shanahan F,Clarke G,O'Mahony S,Dinan TG,Cryan JF
    BACKGROUND & AIMS: :The perception of visceral pain is a complex process involving the spinal cord and higher order brain structures. Increasing evidence implicates the gut microbiota as a key regulator of brain and behavior, yet it remains to be determined if gut bacteria play a role in visceral sensitivity. We used germ-free mice (GF) to assess visceral sensitivity, spinal cord gene expression and pain-related brain structures. GF mice displayed visceral hypersensitivity accompanied by increases in Toll-like receptor and cytokine gene expression in the spinal cord, which were normalized by postnatal colonization with microbiota from conventionally colonized (CC). In GF mice, the volumes of the anterior cingulate cortex (ACC) and periaqueductal grey, areas involved in pain processing, were decreased and enlarged, respectively, and dendritic changes in the ACC were evident. These findings indicate that the gut microbiota is required for the normal visceral pain sensation.
    背景与目标: 内脏疼痛的感知是一个复杂的过程,涉及脊髓和高阶脑结构。越来越多的证据表明肠道菌群是大脑和行为的关键调节剂,但肠道细菌是否在内脏敏感性中起作用尚待确定。我们使用无菌小鼠 (GF) 评估内脏敏感性,脊髓基因表达和与疼痛相关的大脑结构。GF小鼠表现出内脏超敏反应,并伴有脊髓中Toll样受体和细胞因子基因表达的增加,这通过出生后用常规定植 (CC) 的微生物群定植而标准化。在GF小鼠中,前扣带回皮层 (ACC) 和导水管周围灰色 (涉及疼痛处理的区域) 的体积分别减少和扩大,并且ACC的树突状变化明显。这些发现表明,正常的内脏疼痛感需要肠道菌群。
  • 【一种用于植入可植入门静脉系统的技术,用于硬膜外长期施用阿片类药物治疗癌症疼痛。】 复制标题 收藏 收藏
    DOI:10.1177/0310057X8501300206 复制DOI
    作者列表:Cherry DA,Gourlay GK,Cousins MJ,Gannon BJ
    BACKGROUND & AIMS: :The feasibility of using a subcutaneously implanted portal system attached to a conventional 16-gauge epidural catheter has been evaluated in 50 patients with sever pain associated with cancer. This technique allowed for the percutaneous epidural administration of morphine at 8-12-hourly intervals for pain control. The mean duration of implantation was 12 weeks and the longest period a portal remained in situ was 36 weeks. Five portals had to be removed for various reasons. The injection system has blocked on eight occasions due to catheter blockage (six times) and portal blockage (two occasions). These patients have continued to obtain excellent analgesia when either catheter or portal were replaced. In a cadaver, 300 injections were simulated using either 22-gauge Huber point needles or disposable needles (25 gauge) and the injectate examined by both light and scanning electron microscopy. Both needle types resulted in particulate contamination which was greater with the recommended Huber point needles.
    背景与目标: : 已在50例与癌症相关的严重疼痛患者中评估了使用固定在常规16号硬膜外导管上的皮下植入门静脉系统的可行性。该技术允许以8-12小时的间隔经皮硬膜外施用吗啡以控制疼痛。植入的平均持续时间为12周,而原位保留的最长时间为36周。由于各种原因,必须删除五个门户。由于导管阻塞 (六次) 和门静脉阻塞 (两次),注射系统有八次阻塞。当更换导管或门静脉时,这些患者继续获得出色的镇痛效果。在尸体中,使用22号Huber点针或一次性针 (25号) 模拟300注射,并通过光学和扫描电子显微镜检查注射物。两种类型的针头都会导致颗粒污染,推荐的Huber点针头会更大。
  • 【神经性疼痛治疗: 从长凳到床边。】 复制标题 收藏 收藏
    DOI:10.1055/s-0032-1329204 复制DOI
    作者列表:Backonja MM
    BACKGROUND & AIMS: :Neuropathic pain is a result of complex interactions between peripheral and central mechanisms with multiple potential therapeutic targets. However, the complexity of these mechanisms and relative youth of translational pain research, which is in its infancy, have prevented translation of successful basic bench research to human therapy. Most of the clinically available neuropathic pain treatments are borrowed from other therapeutic areas, such as antidepressants and antiepileptics, or involve application of older therapy, such as opioids. Exceptions are ziconotide, tapentadol, and the high-concentration capsaicin patch. Similar to all other analgesic agents, these provide only partial pain relief in subsets of patients. The standard of care for patients with chronic neuropathic pain is multimodal and multidisciplinary. For most patients to achieve and maintain satisfactory pain relief a combination of therapeutic agents is necessary, providing the empiric basis for rational polypharmacy, which has become a standard approach as well.
    背景与目标: 神经性疼痛是周围和中枢机制与多个潜在治疗靶点之间复杂相互作用的结果。然而,这些机制的复杂性以及尚处于起步阶段的转化疼痛研究的相对年轻,阻碍了成功的基础研究转化为人类治疗。大多数临床上可用的神经性疼痛治疗方法都是从其他治疗领域借来的,例如抗抑郁药和抗癫痫药,或者涉及应用较旧的治疗方法,例如阿片类药物。齐康宁、他喷他多和高浓度辣椒素贴剂是例外。与所有其他镇痛剂相似,这些镇痛剂仅可部分缓解患者的疼痛。慢性神经性疼痛患者的护理标准是多模式和多学科。为了使大多数患者达到并保持令人满意的疼痛缓解,必须结合治疗剂,为合理的多药治疗提供经验基础,这也已成为一种标准方法。
  • 【宫颈利多卡因治疗IUD插入性疼痛: 一项随机对照试验。】 复制标题 收藏 收藏
    DOI:10.1016/j.ajog.2012.09.018 复制DOI
    作者列表:McNicholas CP,Madden T,Zhao Q,Secura G,Allsworth JE,Peipert JF
    BACKGROUND & AIMS: OBJECTIVE:Anticipated pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. STUDY DESIGN:We performed a double-blind, randomized controlled trial of women undergoing IUD insertion. Participants were randomly assigned to 2% lidocaine or placebo gel. Study gel (3 mL) was placed 3 minutes prior to IUD insertion. Pain scores were measured at various time points using a 10-point visual analog scale. RESULTS:Of the 200 participants randomized, 199 completed the study. Pain scores among lidocaine and placebo arms were similar at tenaculum placement (lidocaine and placebo: median, 4; range, 0-10; P = .15) and with insertion (lidocaine: median, 5; range, 1-10; placebo: median, 6; range, 0-10; P = .16). These results did not differ by parity. CONCLUSION:Topical or intracervical 2% lidocaine gel prior to IUD insertion does not decrease pain scores.
    背景与目标:
  • 【神经性疼痛中脊髓上神经胶质网络的重塑以伤害性杏仁核的反应性神经胶质增生为特征。】 复制标题 收藏 收藏
    DOI:10.1002/j.1532-2149.2012.00255.x 复制DOI
    作者列表:Marcello L,Cavaliere C,Colangelo AM,Bianco MR,Cirillo G,Alberghina L,Papa M
    BACKGROUND & AIMS: BACKGROUND:Many brain areas participate to supraspinal control of nociception. In these regions, few studies have investigated the role of glial cells in supraspinal plasticity and the effect of 7-day intrathecal nerve growth factor-like (BB14®, Blueprint Biotech, Milano, Italy) treatment. METHODS:In male Sprague-Dawley rats, we evaluated by immunohistochemistry the morphological and molecular rearrangement of neuroglial network occurring in several supraspinal brain regions involved in pain processing following spared nerve injury (SNI) of the sciatic nerve. In particular, the medial prefrontal cortex, the amygdala (Amy), the nucleus accumbens (Acb), the thalamus and the periaqueductal gray were analysed. RESULTS:Despite the modifications occurring in the dorsal horn of spinal cord following SNI, no significant changes in the Iba1 and glial fibrillary acidic protein (GFAP) expression were detected in all the analysed supraspinal regions, except for the Amy, showing a remarkable GFAP increase. Interestingly, neuropathic rats also displayed a significant increase of glial transporters (GTs) in all the supraspinal regions. Finally, the analysis of vesicular glutamate transporter 1 (vGLUT1) and vesicular gamma-aminobutyric acid (GABA) transporter (vGAT) expression revealed a significant enhancement of glutamatergic/GABAergic ratio in all selected brain regions of SNI animals, except for Acb. Both glial activation in the Amy and alteration of GTs and vGLUT/vGAT levels observed in neuropathic animals were largely reversed by BB14® treatment. CONCLUSIONS:All together, these data strengthen the role of supraspinal neuroglial network plasticity in the establishment of neuropathic pain syndrome. The hallmark is represented by the divergence between glial reaction confined to Amy and the widespread changes in the GT distribution and glutamate/GABA ratio detected in the other supraspinal region.
    背景与目标:
  • 【股内侧横截面积的增加与膝关节骨关节炎的疼痛,软骨损失和关节置换风险降低有关。】 复制标题 收藏 收藏
    DOI:10.1002/art.34681 复制DOI
    作者列表:Wang Y,Wluka AE,Berry PA,Siew T,Teichtahl AJ,Urquhart DM,Lloyd DG,Jones G,Cicuttini FM
    BACKGROUND & AIMS: OBJECTIVE:Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross-sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA). METHODS:One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs). RESULTS:After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = -0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient -10.9 [95% CI -19.5, -2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient -16.8 [95% CI -28.9, -4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]). CONCLUSION:In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement.
    背景与目标:
  • 【患者对腰痛了解多少?对互联网上可用信息质量的分析。】 复制标题 收藏 收藏
    DOI:10.3233/THC-2012-0682 复制DOI
    作者列表:Galbusera F,Brayda-Bruno M,Freutel M,Seitz A,Steiner M,Wehrle E,Wilke HJ
    BACKGROUND & AIMS: :Previous surveys showed a poor quality of the web sites providing health information about low back pain. However, the rapid and continuous evolution of the Internet content may question the current validity of those investigations. The present study is aimed to quantitatively assess the quality of the Internet information about low back pain retrieved with the most commonly employed search engines. An Internet search with the keywords "low back pain" has been performed with Google, Yahoo!® and Bing™ in the English language. The top 30 hits obtained with each search engine were evaluated by five independent raters and averaged following criteria derived from previous works. All search results were categorized as declaring compliant to a quality standard for health information (e.g. HONCode) or not and based on the web site type (Institutional, Free informative, Commercial, News, Social Network, Unknown). The quality of the hits retrieved by the three search engines was extremely similar. The web sites had a clear purpose, were easy to navigate, and mostly lacked in validity and quality of the provided links. The conformity to a quality standard was correlated with a marked greater quality of the web sites in all respects. Institutional web sites had the best validity and ease of use. Free informative web sites had good quality but a markedly lower validity compared to Institutional websites. Commercial web sites provided more biased information. News web sites were well designed and easy to use, but lacked in validity. The average quality of the hits retrieved by the most commonly employed search engines could be defined as satisfactory and favorably comparable with previous investigations. Awareness of the user about checking the quality of the information remains of concern.
    背景与目标: : 以前的调查显示,提供腰痛健康信息的网站质量很差。然而,互联网内容的快速和持续发展可能会质疑这些调查的当前有效性。本研究旨在定量评估使用最常用的搜索引擎检索到的有关下背痛的互联网信息的质量。Google,Yahoo!进行了带有关键字 “腰痛” 的互联网搜索。®和必应™用英语。每个搜索引擎获得的前30名点击率由五个独立的评分者进行评估,并按照先前作品得出的标准进行平均。所有搜索结果都被分类为声明是否符合健康信息的质量标准 (例如HONCode),并且基于网站类型 (机构,免费信息,商业,新闻,社交网络,未知)。这三个搜索引擎检索到的点击质量极其相似。这些网站有明确的目的,易于浏览,并且大多缺乏所提供链接的有效性和质量。对质量标准的符合性与网站在各个方面的明显更高的质量相关。机构网站具有最佳的有效性和易用性。与机构网站相比,免费的信息网站质量良好,但有效性明显较低。商业网站提供了更多有偏见的信息。新闻网站设计精良,易于使用,但缺乏有效性。最常用的搜索引擎检索到的点击的平均质量可以定义为令人满意的,并且可以与以前的调查进行比较。用户对检查信息质量的意识仍然值得关注。
  • 【转移性骨病和疼痛患者静脉注射氯膦酸盐的随机对照试验。】 复制标题 收藏 收藏
    DOI:10.1016/s0885-3924(97)00075-4 复制DOI
    作者列表:Ernst DS,Brasher P,Hagen N,Paterson AH,MacDonald RN,Bruera E
    BACKGROUND & AIMS: :To evaluate the effectiveness of intravenous clodronate in ameliorating refractory bone pain in patients with metastatic bone disease, 60 patients with established osseous metastases and persistent bone pain were randomized to receive either clodronate (600 mg or 1500 mg in 500 mL of normal saline) or 500 mL of saline as placebo. After 2 weeks, the patients were crossed over to receive the alternate treatment. After another 2 weeks, each patient and investigator made a blinded choice. Daily visual analogue scales (VAS) and analgesic diaries were recorded throughout the study period. Forty-six patients were evaluable (77%). A treatment x period interaction was identified in the VAS and daily morphine equivalent dose (DMED) scores. First period analysis of the VAS scores for general pain, pain at rest, and pain upon movement demonstrated an average reduction of 13, 14, and 24 mm, respectively, from baseline, but were not significantly different from changes following placebo. The average change in DMED was -6.4 (SE = 2.9) following clodronate and was +24.6 (SE = 14.9) following placebo (p = 0.03). In the blinded choice of which agent resulted in improvement in pain, 26 (57%) patients chose clodronate, 12 (26%) chose placebo, and eight (17%) had no preference (p = 0.0021). For the investigators who also made a blinded selection, clodronate was chosen in 30 (65%) patients, placebo in ten (22%) patients, and no difference was apparent in six (13%) (p < 0.0001). Intravenous clodronate appeared to have analgesic effect in patients with refractory bone pain due to metastatic bone disease. The optimal dose and duration of effect require further evaluation, particularly in patients with stable disease and persistent bone pain.
    背景与目标: : 为了评估静脉注射氯膦酸盐缓解转移性骨病患者难治性骨痛的有效性,将60例已确定骨转移和持续性骨痛的患者随机分为氯膦酸盐 (600 mg或1500 mg,500 mL生理盐水) 或500 mL生理盐水作为安慰剂。2周后,患者交叉接受替代治疗。再过2周后,每位患者和研究者都做出了盲法选择。在整个研究期间记录每日视觉模拟量表 (VAS) 和镇痛日记。46例患者可评估 (77%)。在VAS和每日吗啡等效剂量 (DMED) 评分中确定了治疗x期相互作用。一般疼痛,静息疼痛和运动时疼痛的VAS评分的第一阶段分析显示,与基线相比分别平均降低了13、14和24毫米,但与安慰剂后的变化没有显着差异。氯膦酸盐后DMED的平均变化为-6.4 (SE = 2.9),安慰剂后为 + 24.6 (SE = 14.9) (p = 0.03)。在盲目选择哪种药物导致疼痛改善的过程中,26 (57%) 名患者选择氯膦酸盐,12 (26%) 选择安慰剂,8 (17%) 没有偏好 (p = 0.0021)。对于也进行盲法选择的研究者,在30 (65%) 例患者中选择氯膦酸盐,在10 (22%) 例患者中选择安慰剂,在6 (13%) 例患者中没有明显差异 (p <0.0001)。静脉注射氯膦酸盐似乎对转移性骨病引起的难治性骨痛患者具有镇痛作用。最佳剂量和效果持续时间需要进一步评估,尤其是在疾病稳定和持续性骨痛的患者中。
  • 【慢性疼痛患者的阿片类药物从大剂量吗啡到经皮丁丙诺啡 (Transtec) 旋转。】 复制标题 收藏 收藏
    DOI:10.1111/j.1533-2500.2007.00119.x 复制DOI
    作者列表:Freye E,Anderson-Hillemacher A,Ritzdorf I,Levy JV
    BACKGROUND & AIMS: :Opioid rotation is increasingly becoming an option to improve pain management especially in long-term treatment. Because of insufficient analgesia and intolerable side effects, a total of 42 patients (23 male, 19 female; mean age 64.1 years) suffering from severe musculoskeletal (64%), cancer (21%) or neuropathic (19%) pain were converted from high-dose morphine (120 to >240 mg/day) to transdermal buprenorphine. The dose of buprenorphine necessary for conversion (at least 52.5 microg/h) was titrated individually by the treating physician. No conversion recommendations were given and the treating physician used his or her own judgment for dose adjustment. Pain relief, overall satisfaction and quality of sleep (very good, good, satisfactory, poor, or very poor), and the incidence and severity of adverse drug reactions over a period of at least 10 weeks and up to 1 year was assessed. Following rotation, patients experiencing good/very good pain relief increased from 5% to 76% (P < 0.001). Only 5% reported insufficient relief. Relief was achieved with buprenorphine alone in 77.4%, while 17% needed an additional opioid for breakthrough pain. Sleep quality (good/very good) increased from 14% to 74% (P < 0.005). Adverse effects were reported in 11.9%, mostly because of local irritation, did not result in termination of therapy. Neither tolerance nor refractory effect following rotation from morphine to buprenorphine was noted. Conversion tables with a fixed conversion ratio are of limited value in patients treated with high-dose morphine.
    背景与目标: : 阿片类药物旋转正日益成为改善疼痛管理的一种选择,尤其是在长期治疗中。由于镇痛不足和无法忍受的副作用,共有42例患者 (男性23例,女性19例; 平均年龄64.1岁) 患有严重的肌肉骨骼 (64% 例),癌症 (21%) 或神经性 (19%) 疼痛从大剂量吗啡 (120至> 240 mg/天) 转化为透皮丁丙诺啡。转化所需的丁丙诺啡剂量 (至少52.5微克/小时) 由治疗医师单独滴定。没有给出转换建议,治疗医生使用他或她自己的判断进行剂量调整。评估了疼痛缓解,总体满意度和睡眠质量 (非常好,良好,满意,差或非常差),以及至少10周和长达1年的药物不良反应的发生率和严重程度。旋转后,疼痛缓解良好/非常好的患者从5% 增加到76% (P <0.001)。只有5% 报告救济不足。77.4% 年仅使用丁丙诺啡可缓解,而17% 需要额外的阿片类药物来缓解突破性疼痛。睡眠质量 (良好/非常好) 从14% 增加到74% (P <0.005)。11.9% 年报告了不良反应,主要是由于局部刺激,并未导致治疗终止。从吗啡旋转为丁丙诺啡后,没有发现耐受性或难治性。在接受大剂量吗啡治疗的患者中,具有固定转换率的转换表的价值有限。
  • 13 Cervical spine and shoulder pain. 复制标题 收藏 收藏

    【颈椎和肩部疼痛。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Hawkins RJ,Bilco T,Bonutti P
    BACKGROUND & AIMS: :The complex problem of combined neck and shoulder pain was investigated in 26 operations in 13 patients who had a shoulder procedure (subacromial decompressions or rotator cuff repairs) and an anterior cervical spine fusion. This select group of complex patients illustrates the diagnostic studies required to determine whether the pain comes primarily from the cervical spine, shoulder, or both. Good pain relief was accomplished after 24 of the 26 surgical procedures (average follow-up, 4.3 years). In the 13 patients, eight presented with nearly equal neck and shoulder pain as the chief complaint, whereas in the remaining five patients, the initial complaint was predominantly neck pain with only minor shoulder involvement. The shoulder pain became more significant after the anterior cervical fusion in these five patients. This study emphasizes the need for a careful evaluation of patients with combined neck-shoulder pain syndrome in a systematic approach allowing appropriate treatment.
    背景与目标: : 在13例接受肩部手术 (肩峰下减压或肩袖修复) 和颈椎前路融合术的患者中,对26例颈肩疼痛的复杂问题进行了研究。这一组复杂的患者说明了诊断研究,以确定疼痛是否主要来自颈椎,肩膀或两者。在26次外科手术中的24次 (平均随访4.3年) 后,疼痛缓解良好。在13例患者中,有8例的颈部和肩部疼痛几乎是主要主诉,而在其余5例患者中,最初的主诉主要是颈部疼痛,仅轻微的肩部受累。在这五名患者中,颈椎前路融合后,肩部疼痛变得更加明显。这项研究强调需要以系统的方法对合并颈肩疼痛综合征的患者进行仔细评估,以进行适当的治疗。
  • 【腹腔镜术后减轻疼痛的简单肺复张手法的随机临床试验。】 复制标题 收藏 收藏
    DOI:10.1002/bjs.9202 复制DOI
    作者列表:Khanna A,Sezen E,Barlow A,Rayt H,Finch JG
    BACKGROUND & AIMS: BACKGROUND:Shoulder tip and abdominal pain following laparoscopic procedures are well recognized causes of postoperative morbidity. In this double-blind randomized clinical trial attempts were made to reduce postoperative pain in patients undergoing laparoscopic surgery by implementing a simple intraoperative technique. METHODS:Patients undergoing elective laparoscopic cholecystectomy or laparoscopic transabdominal preperitoneal inguinal hernia repair were randomized to receive either the current standard treatment (control group) or an intervention to remove residual carbon dioxide. In the intervention group, the pneumoperitoneum was removed at the end of the operation by placing the patient in the Trendelenburg position and utilizing a pulmonary recruitment manoeuvre consisting of two manual inflations to a maximum pressure of 60 cmH2 O. In the control group, residual pneumoperitoneum was evacuated at the end of the procedure by passive decompression via the open operative ports. RESULTS:Seventy-six randomly assigned patients, 37 in the intervention group and 39 in the control group, were recruited. Overall postoperative pain scores were significantly lower in the intervention group (P = 0·001). Median (interquartile range) pain scores were significantly lower in the intervention group compared with the control group at both 12 h (3·5 versus 5; P < 0·010) and 24 h (3 versus 4·5; P < 0·010). CONCLUSION:Active evacuation of residual pneumoperitoneum following laparoscopic procedures, by means of two pulmonary recruitment manoeuvres in the Trendelenburg position, reduces postoperative pain significantly. This simple and safe technique can be implemented routinely after abdominal laparoscopy. REGISTRATION NUMBER:NCT01720433 (http://www.clinical trials.gov).
    背景与目标:
  • 【唑来膦酸对下腰痛患者Modic类型和体积变化的影响。】 复制标题 收藏 收藏
    DOI:10.1186/s12891-017-1632-z 复制DOI
    作者列表:Koivisto K,Järvinen J,Karppinen J,Haapea M,Paananen M,Kyllönen E,Tervonen O,Niinimäki J
    BACKGROUND & AIMS: BACKGROUND:Modic changes (MC) are associated with low back pain (LBP). In this study, we compared changes in size and type of MC, after a single intravenous infusion of 5 mg zoledronic acid (ZA) or placebo, among chronic LBP patients with MC on magnetic resonance imaging (MRI), and evaluated whether the MRI changes correlate with symptoms. METHODS:All patients (N = 19 in ZA, 20 in placebo) had MRI at baseline (0.23-1.5 T) and at one year (1.5-3 T). We evaluated the level, type and volume of all the MC. The MC were classified into M1 (M1 (100%)), predominating M1 (M1/2 (65:35%)) or predominating M2 (M1/2 (35:65%)), and M2 (M2 (100%)). The first two were considered M1-dominant, and the latter two M2-dominant. Volumes of M1 and M2 were calculated separately for the primary MC, which was assumed to cause the symptoms, and the other MC. We analysed the one-year treatment differences in M1 and M2 volumes using analysis of covariance with adjustments for age, sex, body mass index, and smoking. The correlations between the MRI changes and the changes in LBP symptoms were analysed using Pearson correlations. RESULTS:In the ZA group, 84.2% of patients had M1-dominant primary MC at baseline, compared to 50% in the placebo group (p = 0.041). The primary MC in the ZA group converted more likely to M2-dominant (42.1% ZA, 15% placebo; p = 0.0119). The other MC (15 ZA, 8 placebo) were on average 42% smaller and remained largely M2-dominant. The M1 volume of the primary MC decreased in the ZA group, but increased in the placebo group (-0.83 cm3 vs 0.91 cm3; p = 0.21). The adjusted treatment difference for M1 volume was -1.9 cm3 (95% CI -5.0 to 1.2; p = 0.22) and for M2 volume 0.23 cm3 (p = 0.86). In the MC that remained M1-dominant, volume change correlated positively with increased symptoms in the placebo group, whereas the correlations were negative and weak in the ZA group. CONCLUSIONS:Zoledronic acid tended to speed up the conversion of M1-dominant into M2-dominant MC and decrease the volume of M1-dominant MC, although statistical significance was not demonstrated. TRIAL REGISTRATION:The registration number in ClinicalTrials.gov is NCT01330238 and the date of registration February 11, 2011.
    背景与目标:

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