Pain Management Commons^™

Artificial Intelligence And Machine Learning In Cancer Pain: A Systematic Review, Vivian Salama, Brandon Godinich, Yimin Geng, Laia Humbert-Vidan, Laura Maule, Kareem A Wahid, Mohamed A Naser, Renjie He, Abdallah S R Mohamed, Clifton D Fuller, Amy C Moreno

Faculty, Staff and Student Publications

Background/objectives: Pain is a challenging multifaceted symptom reported by most cancer patients. This systematic review aims to explore applications of artificial intelligence/machine learning (AI/ML) in predicting pain-related outcomes and pain management in cancer.

Methods: A comprehensive search of Ovid MEDLINE, EMBASE and Web of Science databases was conducted using terms: "Cancer," "Pain," "Pain Management," "Analgesics," "Artificial Intelligence," "Machine Learning," and "Neural Networks" published up to September 7, 2023. AI/ML models, their validation and performance were summarized. Quality assessment was conducted using PROBAST risk-of-bias andadherence to TRIPOD guidelines.

Results: Forty four studies from 2006 to 2023 were included. Nineteen studies used …

Use Of Peripheral Nerve Blocks For Total Hip Arthroplasty, Leon Grinman, Brett Elmore, Alberto E Ardon, Adnan Hussain, Mohammed Faysal Malik, Nadia Hernandez, Mackenzie Janice Jacoby

Faculty, Staff and Student Publications

Purpose of review: The purpose of this review is to summarize the recent literature regarding regional anesthesia (RA) techniques and outcomes for total hip arthroplasty (THA) in the face of changing surgical techniques and perioperative considerations.

Recent findings: Based on large meta-analyses, peripheral nerve blocks are indicated for THA. Each block has its own risks and benefits and data for outcomes for particular techniques are limited. New surgical techniques, improved use of multimodal analgesia, and improved ultrasound guided regional anesthetics lead to better pain control for patients undergoing THA with less associated risks. Block selection continues to be influenced by …

Methods For Pragmatic Randomized Clinical Trials Of Pain Therapies: Immpact Statement, David Hohenschurz-Schmidt, Dan Cherkin, Andrew S C Rice, Robert H Dworkin, Dennis C Turk, Michael P Mcdermott, Matthew J Bair, Lynn L Debar, Robert R Edwards, Scott R Evans, John T Farrar, Robert D Kerns, Michael C Rowbotham, Ajay D Wasan, Penney Cowan, Mckenzie Ferguson, Roy Freeman, Jennifer S Gewandter, Ian Gilron, Hanna Grol-Prokopczyk, Smriti Iyengar, Cornelia Kamp, Barbara I Karp, Bethea A Kleykamp, John D Loeser, Sean Mackey, Richard Malamut, Ewan Mcnicol, Kushang V Patel, Kenneth Schmader, Lee Simon, Deborah J Steiner, Christin Veasley, Jan Vollert

Faculty, Staff and Student Publications

Pragmatic, randomized, controlled trials hold the potential to directly inform clinical decision making and health policy regarding the treatment of people experiencing pain. Pragmatic trials are designed to replicate or are embedded within routine clinical care and are increasingly valued to bridge the gap between trial research and clinical practice, especially in multidimensional conditions, such as pain and in nonpharmacological intervention research. To maximize the potential of pragmatic trials in pain research, the careful consideration of each methodological decision is required. Trials aligned with routine practice pose several challenges, such as determining and enrolling appropriate study participants, deciding on the …

Psychosocial Outcomes Of Pain And Pain Management In Adults With Osteogenesis Imperfecta: A Qualitative Study, Whitney S Shepherd, Andrew D Wiese, Hannah E Cho, W Conor Rork, M Usman Baig, Kristin M Kostick, Dianne Nguyen, Erin M Carter, Members Of The Bbdc, Chaya N Murali, Marie-Eve Robinson, Sophie C Schneider, Brendan Lee, V Reid Sutton, Eric A Storch

Faculty, Staff and Students Publications

Objectives

Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and fractures, short stature, dental abnormalities, hearing loss, scoliosis, and chronic pain. Despite a growing literature on the functional outcomes of OI, limited research has explicitly examined the psychosocial outcomes of pain within OI.

Methods

Adults with OI (N=15) were interviewed to understand pain-related experiences through a thematic analysis of semi-structured interview data. Research team members, genetic research experts, and OI clinicians developed an interview guide focused on topics related to pain and mental health challenges. Participants’ transcripts were coded by two independent coders; codes were then merged …

The Benefits And Risks Of Pudendal Nerve Block And Dorsal Root Ganglion Stimulation In Pudendal Neuralgia, Pooja A. Patel

Rowan-Virtua Research Day

Context: Pudendal neuralgia is a chronic neuropathic pain syndrome worsening throughout daily activities. Although temporarily relieved when standing or lying down, it is often misdiagnosed, improperly treated, and/or refractory to treatment leading to a negative impact on quality of life. The lack of research in proper diagnosis and interventional management (such as dorsal root ganglion stimulation (DRGS) and pudendal nerve block) further contributes to the delay in relief from the chronic pain. Objective: The goal of this scoping review is to assess if research exists on benefits and risks of pudendal nerve block and dorsal root ganglion and …

Improving Pain Air Cycles With Implementation Of Evidence-Based Reassessment Strategies, Carissa Corraro Dnp (C), Bsn, Rn.

Posters

The purpose of this quality improvement project was to implement evidence-based strategies (i.e., compliance audits, educational in-services, badge reels, and Posters with QR codes) to increase compliance of oncology nurses’ documentation of pain assessments and reassessments.

Virtual Reality For Pain Management During High-Resolution Manometry: A Randomized Clinical Trial, Ilan Palte, Sarah Stewart, Hal Rives, James A Curtis, Necati Enver, Andrew Tritter, Katerina Andreadis, Valentina Mocchetti, Felice Schnoll-Sussman, Amir Soumekh, Rasa Zarnegar, Philip Katz, Anaïs Rameau

Faculty, Staff and Student Publications

Objective: High-resolution esophageal manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM is typically performed in the office with local anesthesia only, and many patients find it unpleasant and painful. The aim of this study was to examine the effects of the use of a virtual reality (VR) headset on pain and anxiety outcomes in patients with dysphagia undergoing HRM.

Methods: Patients with dysphagia were prospectively recruited and randomized to undergo HRM with and without VR distraction. Data collected included the State-Trait Anxiety Inventory-6 (STAI-6), the Short-Form McGill Pain Questionnaire, heart rate, and galvanic skin …

Pain Management By Chemogenetic Control Of Sensory Neurons, Yize Li, Xin Ge, Ru-Rong Ji

Faculty, Staff and Student Publications

In this study, Perez-Sanchez et al.1 developed a chemogenetic method aimed at alleviating pain in mouse models while dampening excitability in human sensory neurons. This analgesic effect was attained through the introduction of human α7 nicotinic acetylcholine receptor and glycine receptor pore domain via virus-mediated expression in sensory neurons, forming a chloride channel. The activation of this channel was made possible by specific agonists. This study highlights the potential for treating clinical pain by gene therapy.

An Opioid-Minimizing Multimodal Pain Regimen Reduces Opioid Exposure And Pain In Trauma-Injured Patients At High Risk For Opioid Misuse: Secondary Analysis From The Mast Trial, Constanza De Dios, Robert Suchting, Charles Green, James M Klugh, John A Harvin, Heather E Webber, Joy M Schmitz, Scott D Lane, Jin H Yoon, Angela Heads, Kandice Motley, Angela Stotts

Faculty, Staff and Student Publications

BACKGROUND: Screening to identify patients at risk for opioid misuse after trauma is recommended but not commonly used to guide perioperative opioid management interventions. The Multimodal Analgesic Strategies for Trauma trial demonstrated that an opioid-minimizing multimodal pain regimen reduced opioid exposure in a heterogeneous trauma patient population. Here, we assess the efficacy of the Multimodal Analgesic Strategies for Trauma multimodal pain regimen in a critical patient subgroup who screened at high risk for opioid misuse.

METHODS: The Multimodal Analgesic Strategies for Trauma trial compared an opioid-minimizing multimodal pain regimen (oral acetaminophen, naproxen, gabapentin, lidocaine patch, as-needed opioid) against an original …

One Immune System Plays Many Parts: The Dynamic Role Of The Immune System In Chronic Pain And Opioid Pharmacology, Sanam Mustafa, Juliana E Bajic, Benjamin Barry, Samuel Evans, Kariel R Siemens, Mark R Hutchinson, Peter M Grace

Faculty, Staff and Student Publications

The transition from acute to chronic pain is an ongoing major problem for individuals, society and healthcare systems around the world. It is clear chronic pain is a complex multidimensional biological challenge plagued with difficulties in pain management, specifically opioid use. In recent years the role of the immune system in chronic pain and opioid pharmacology has come to the forefront. As a highly dynamic and versatile network of cells, tissues and organs, the immune system is perfectly positioned at the microscale level to alter nociception and drive structural adaptations that underpin chronic pain and opioid use. In this review, …

Utilizing Primary Care To Engage Patients On Opioids In A Psychological Intervention For Chronic Pain, Sikander Chohan, Lyuba Gavrilova Bs, Leah Hect, Kristi Autio, Erin Tobin, Brian K. Ahmedani, Lisa R. Miller-Matero

Medical Student Research Symposium

Introduction: Chronic pain is commonly encountered in primary care. It is often treated with opioids, which can cause overdose and death. Psychological interventions are an effective alternative, yet difficulty engaging patients with opioid prescriptions has led to their underutilization. Offering these interventions in primary care settings may alleviate this barrier.

Objective: Determine whether opioid prescriptions are related to patients engaging in a brief psychological intervention for chronic pain management in primary care.

Study Design: Secondary analysis of a pilot randomized clinical trial (RCT) of a 5-session psychological intervention for chronic pain. Patients with chronic pain (N= 220) were approached to …

Physical Activity As A Means Of Improving Quality Of Life In Individuals With Chronic Pain, Tracy Tauro

Rowan-Virtua Research Day

Pharmacologic management of chronic pain has variable results, sometimes resorting to ineffective and dangerous opioids that can potentiate substance abuse in a vulnerable population.

Exercise is unique in its ability to positively impact both the molecular and psychological aspects of chronic pain. Its role in decreasing inflammation as well as improving mental health make it an excellent option for improving quality of life.

Physicians should work with their patients to develop a patient-centered exercise plan to manage chronic pain.

The Power And Challenge Of Lipid (A)Symmetry Across The Membrane And Cell, Heather E Webber, Joy M Schmitz

Faculty, Staff and Student Publications

Current treatments for substance use disorders (SUDs) are far from ideal, with no U.S. Food and Drug Administration-approved pharmacotherapies to treat stimulant and other use disorders. New approaches are urgently needed to combat the increasing prevalence of SUDs and overdose deaths. It is widely accepted that addiction is a chronic disease of the brain involving changes in neural circuitry associated with cognitive and reward functioning. Brain stimulation techniques are novel methods that can modulate these circuits directly and thus hold considerable promise for treating SUDs.

An Investigation Of Occupational Therapy Utilizing Sensory Modulation To Manage Co-Morbid Chronic Pain And Substance Use In Order To Promote Occupational Performance And Recovery, Claire Ruth

Student Capstone Papers

Background: Those with chronic pain have worse drug and alcohol treatment outcomes and higher rates of relapse compared to those without pain or with reduced pain (Ilgen et al., 2020).

Methods: A descriptive study was employed with the aim of determining what are the sensory processing pattens of those with co-morbid chronic pain and in recovery for substance use. All participants completed the Adolescent and Adult Sensory Profile, the Brief Pain Inventory, and the Personal Recovery Outcome Measure (PROM).

Results: From the preliminary findings, individuals with co-morbid chronic pain and substance use may have atypical sensory processing …

Role Of Micro-Rna For Pain After Surgery: Narrative Review Of Animal And Human Studies, Juan P Cata, Aysegul Gorur, Xiaoyi Yuan, Nathaniel K Berg, Anil K Sood, Holger K Eltzschig

Faculty, Staff and Student Publications

One of the most prevalent symptoms after major surgery is pain. When postoperative pain treatment is unsatisfactory, it can lead to poor surgical recovery, decreased quality of life, and increased health care costs. Current analgesics, single or in combination, have limited efficacy due to low potency, limited duration of action, toxicities, and risk of addiction. The lack of nonaddictive strong analgesics along with the over prescription of opioids has led to an opioid epidemic in the United States. Therefore, there is an urgent need for the development of newer analgesics. Microribonucleic acids (miRNAs) are small noncoding RNA molecules that modulate …

The Efficacy Of Biofeedback In The Treatment Of Tension Headaches, Micahel Earl Waters

Graduate Theses

Fifteen adults from the general population with chronic tension headaches were divided into four groups. Four were assigned to relaxation instructions, biofeedback (EMG and temperature), and home relaxation practice; four were assigned to relaxation instructions and biofeedback; four were assigned to biofeedback alone; and three were assigned to a no-treatment group. Subjects completed a ten-day baseline period followed by a three-week treatment period. Measures were taken of headache frequency, duration, intensity, frontalis EMG, and temperature recordings. Comparisons of pre- and post-treatment data indicated that not one treatment group was significantly different from any other treatment group, including the no-treatment group, …