Editorial

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4 pages, 281 KiB

Open AccessEditorial

Editorial to the Special Issue: “Recent Advances in the Management of Chronic Pain”

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Marco Cascella

Int. J. Environ. Res. Public Health 2023, 20(19), 6875; https://doi.org/10.3390/ijerph20196875 - 02 Oct 2023

Viewed by 830

Abstract

Chronic pain is a complex biopsychosocial phenomenon with far-reaching implications, not only in terms of clinical care but also in the realms of social and economic impact [...] Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

Research

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17 pages, 691 KiB

Open AccessArticle

“Working Together”: Perspectives of Healthcare Professionals in Providing Virtual Care to Youth with Chronic Pain during the COVID-19 Pandemic

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Int. J. Environ. Res. Public Health 2023, 20(6), 4757; https://doi.org/10.3390/ijerph20064757 - 08 Mar 2023

Cited by 1 | Viewed by 1063

Abstract

Background: The onset of the coronavirus disease in 2019 necessitated a rapid transition to virtual care for chronic pain treatment. Methods: A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Interviews were conducted in February 2021 with a sample [...] Read more.

Background: The onset of the coronavirus disease in 2019 necessitated a rapid transition to virtual care for chronic pain treatment. Methods: A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Interviews were conducted in February 2021 with a sample of healthcare professionals (HCPs; n = 6) who had provided multidisciplinary treatment (MDT) through an outpatient hospital pediatric chronic pain program. Satisfaction surveys were distributed to all MDT professionals employed by the clinic in April 2021 (n = 13 of 20 eligible; 65% response rate). Participants represented medicine, rehabilitation, and mental health professionals. Results: Analysis of interviews generated five themes: (1) adaptation to virtual care, (2) benefits of virtual care, (3) limitations of virtual care, (4) shifting stance on virtual care over time, and (5) considerations for implementing virtual care. The satisfaction survey data revealed that respondents were able to effectively provide appropriate diagnoses, recommendations, and/or care plans for pediatric chronic pain via virtual care (n = 12, 92.3%). Detailed survey responses are presented by discipline. Conclusions: This study provides a rich exploration of HCPs’ experiences in providing MDT for pediatric chronic pain within a virtual care model. The current results may contribute to the future development of guidelines for virtual care delivery with pediatric chronic pain populations. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

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11 pages, 351 KiB

Open AccessArticle

Somatosensory Impairment and Chronic Pain Following Stroke: An Observational Study

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Int. J. Environ. Res. Public Health 2023, 20(2), 906; https://doi.org/10.3390/ijerph20020906 - 04 Jan 2023

Cited by 1 | Viewed by 1954

Abstract

Background: Chronic pain and somatosensory impairment are common following a stroke. It is possible that an interaction exists between pain and somatosensory impairment and that a change in one may influence the other. We therefore investigated the presence of chronic pain and self-reported [...] Read more.

Background: Chronic pain and somatosensory impairment are common following a stroke. It is possible that an interaction exists between pain and somatosensory impairment and that a change in one may influence the other. We therefore investigated the presence of chronic pain and self-reported altered somatosensory ability in individuals with stroke, aiming to determine if chronic pain is more common in stroke survivors with somatosensory impairment than in those without. Methods: Stroke survivors were invited to complete an online survey that included demographics, details of the stroke, presence of chronic pain, and any perceived changes in body sensations post-stroke. Results: Survivors of stroke (n = 489) completed the survey with 308 indicating that they experienced chronic pain and 368 reporting perceived changes in somatosensory function. Individuals with strokes who reported altered somatosensory ability were more likely to experience chronic pain than those who did not (OR = 1.697; 95% CI 1.585, 2.446). Further, this difference was observed for all categories of sensory function that were surveyed (detection of light touch, body position, discrimination of surfaces and temperature, and haptic object recognition). Conclusions: The results point to a new characteristic of chronic pain in strokes, regardless of nature or region of the pain experienced, and raises the potential of somatosensory impairment being a rehabilitation target to improve pain-related outcomes for stroke survivors. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

10 pages, 1168 KiB

Open AccessArticle

Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up

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Int. J. Environ. Res. Public Health 2022, 19(20), 13354; https://doi.org/10.3390/ijerph192013354 - 16 Oct 2022

Cited by 3 | Viewed by 2004

Abstract

Chronic low back pain (CLBP) due to osteoarthritis represents a therapeutic challenge worldwide. Opioids are extensively used to treat such pain, but the development of tolerance, i.e., less susceptibility to the effects of the opioid, which can result in a need for higher [...] Read more.

Chronic low back pain (CLBP) due to osteoarthritis represents a therapeutic challenge worldwide. Opioids are extensively used to treat such pain, but the development of tolerance, i.e., less susceptibility to the effects of the opioid, which can result in a need for higher doses to achieve the same analgesic effect, may limit their use. Animal models suggest that ultra-low doses of opioid antagonists combined with opioid agonists can decrease or block the development of opioid tolerance. In this retrospective study, we tested this hypothesis in humans. In 2019, 53 patients suffering from CLBP were treated with either Oxycodone and Naloxone Prolonged Release (27 patients, OXN patients) or Oxycodone Controlled Release (26 patients, OXY patients). The follow-up period lasted 2 years, during which 10 patients discontinued the treatment, 5 out of each group. The remaining 43 patients reached and maintained the targeted pain relief, but at 18 and 24 months, the OXY patients showed a significantly higher oxycodone consumption than OXN patients to reach the same level of pain relief. No cases of respiratory depression or opioid abuse were reported. There were no significant differences in the incidence of adverse effects between the two treatments, except for constipation, more common in OXY patients. From our results, we can affirm that a long-term opioid treatment with oxycodone-naloxone combination, when compared with oxycodone only, may significantly hinder the development of opioid tolerance. We were also able to confirm, in our cohort, the well known positive effect of naloxone in terms of opioid-induced bowel dysfunction incidence reduction. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

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Review

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11 pages, 348 KiB

Open AccessReview

Raising Awareness on the Clinical and Social Relevance of Adequate Chronic Pain Care

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Int. J. Environ. Res. Public Health 2023, 20(1), 551; https://doi.org/10.3390/ijerph20010551 - 29 Dec 2022

Cited by 5 | Viewed by 1421

Abstract

Appropriate pain care should be regarded as a right and effectively guaranteed to people with chronic pain (CP). Law 38, enacted in Italy in 2010, establishes the citizen’s right not to suffer. Twelve years later, such right appears still disregarded in Italy and [...] Read more.

Appropriate pain care should be regarded as a right and effectively guaranteed to people with chronic pain (CP). Law 38, enacted in Italy in 2010, establishes the citizen’s right not to suffer. Twelve years later, such right appears still disregarded in Italy and the current access to adequate pain care reveals significant shortcomings. In addition, a mismatch between CP-associated burden and the available healthcare resources in the framework of our national health system has been observed. This article gathers the perspectives of a Board of Italian anesthesiologists on the state of the art of CP management in Italy and aims at strengthening the scientific rationale and clinical relevance of pursuing the enforceability of the right not to suffer and at promoting widespread multidisciplinary care of patients with CP. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

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Open AccessReview

Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies

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Ander Dorken-Gallastegi

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Int. J. Environ. Res. Public Health 2022, 19(18), 11754; https://doi.org/10.3390/ijerph191811754 - 17 Sep 2022

Cited by 9 | Viewed by 2763

Abstract

In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity [...] Read more.

In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strategies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescription practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated questionnaires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

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Other

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6 pages, 511 KiB

Open AccessCase Report

Wireless Peripheral Nerve Stimulation for The Upper Limb: A Case Report

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Elena Giovanna Bignami

Int. J. Environ. Res. Public Health 2023, 20(5), 4488; https://doi.org/10.3390/ijerph20054488 - 03 Mar 2023

Viewed by 1274

Abstract

Peripheral neuro-stimulation (PNS) has been proved to be effective for the treatment of neuropathic pain as well as other painful conditions. We discuss two approaches to PNS placement in the upper extremity. The first case describes a neuropathic syndrome after the traumatic amputation [...] Read more.

Peripheral neuro-stimulation (PNS) has been proved to be effective for the treatment of neuropathic pain as well as other painful conditions. We discuss two approaches to PNS placement in the upper extremity. The first case describes a neuropathic syndrome after the traumatic amputation of the distal phalanx of the fifth digit secondary to a work accident with lack of responsiveness to a triple conservative therapy. An upper arm region approach for the PNS was chosen. The procedure had a favorable outcome; in fact, after one month the pain symptoms were absent (VAS 0) and the pharmacological therapy was suspended. The second case presented a patient affected by progressive CRPS type II in the sensory regions of the ulnar and median nerve in the hand, unresponsive to drug therapy. For this procedure, the PNS device was implanted in the forearm. Unfortunately, in this second case the migration of the catheter affected the effectiveness of the treatment. After examining the two cases in this paper, we changed our practice and suggest the implantation of PNS for radial, median and/or ulnar nerve stimulation in the upper arm region, which has significant advantages over the forearm region. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

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3 pages, 251 KiB

Open AccessViewpoint

Buprenorphine Microdosing Cross Tapers: A Time for Change

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Int. J. Environ. Res. Public Health 2022, 19(24), 16436; https://doi.org/10.3390/ijerph192416436 - 08 Dec 2022

Viewed by 1649

Abstract

Buprenorphine is a partial opioid agonist that is Food and Drug Administration (FDA) approved to treat chronic pain and opioid use disorder (OUD). The national prescribing guidelines in the United States (US) recommend that patients transitioning from full opioid agonists to buprenorphine first [...] Read more.

Buprenorphine is a partial opioid agonist that is Food and Drug Administration (FDA) approved to treat chronic pain and opioid use disorder (OUD). The national prescribing guidelines in the United States (US) recommend that patients transitioning from full opioid agonists to buprenorphine first undergo 12 or more hours of active opioid withdrawal, in order to avoid buprenorphine-precipitated opioid withdrawal. This opioid-free period imposes a significant barrier for many patients. Evidence is accumulating that using microdoses of buprenorphine to cross taper from full-agonist opioids to buprenorphine is a safe and effective way to avoid opioid withdrawal and uncontrolled pain. This microdose cross-tapering strategy is already being used across the US. The US prescribing guidelines and buprenorphine training would benefit from acknowledging this new approach. Additionally, to facilitate this strategy, the FDA should approve transdermal buprenorphine formulations for OUD and manufacturers could produce lower dose formulations of sublingual buprenorphine. The time has come for us to embrace buprenorphine microdosing cross tapers as a new standard of care. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

8 pages, 575 KiB

Open AccessCase Report

Neurostimulation for Chronic Low Back Pain during Pregnancy: Implications for Child and Mother Safety

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Massimo Antonio Innamorato

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Marco Cascella

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Elena Giovanna Bignami

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Int. J. Environ. Res. Public Health 2022, 19(23), 15488; https://doi.org/10.3390/ijerph192315488 - 22 Nov 2022

Cited by 1 | Viewed by 2310

Abstract

Pain therapy for low back pain in pregnancy is a very topical issue. In fact, it is necessary to balance the patient’s needs to control pain with the need to manage a pregnancy without negative effects on the fetus. We report a case [...] Read more.

Pain therapy for low back pain in pregnancy is a very topical issue. In fact, it is necessary to balance the patient’s needs to control pain with the need to manage a pregnancy without negative effects on the fetus. We report a case of a 37-year-old woman with low back pain treated with neurostimulation before pregnancy. She described severe chronic low back pain unresponsive to pharmacologic treatments. We first implanted a subcutaneous stimulator into the patient, and then a definitive stimulator resulting in excellent pain control. The improvement in her quality of life allowed the woman to become pregnant. We decided to stop neurostimulation with the patient during pregnancy. The patient completed her pregnancy without complications and the baby was born healthy. During the pregnancy, the woman took only paracetamol when needed. However, this painful symptomatology, completely anecdotal, is not attributable solely to the previous spine problem but probably also to the changes occurring during pregnancy. At the end of pregnancy, the neurostimulator was reactivated without any discomfort for the patient, who is now pain free. This case report provides a first line of evidence of a possible treatment of low back pain in women intending to become pregnant, with risk-free management for both the patient and the child. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Chronic Pain)

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