Update and future perspective of behavioral medicine in the treatment for chronic pain

Astragalin relieves inflammatory pain and negative mood in CFA mice by down-regulating mGluR5 signaling pathway

As a flavonoid compound, astragalin (AST) is found in a variety of medicinal plants. In clinical studies, AST has anti-inflammatory and analgesia effects on rheumatoid arthritis, bronchopneumonia diseases and so on, but its specific role and mechanism is still not clear. This study aimed to investigate the effect and molecular mechanism of AST on inflammatory pain and pain-related emotions in complete Freund's adjuvant (CFA) mice. In this study, we observed that AST significantly alleviated CFA-induced inflammatory pain and associated emotional disturbances in mice. The mechanism may be related to down-regulating mGluR5-mediated PKCλ-ERK1/2-FOXO6 signaling pathway in CFA mice. Treatment with the mGluR5-specific inhibitor MTEP resulted in the downregulation of proteins associated with the PKCλ-ERK1/2-FOXO6 pathway, similar to the effects observed with AST administration. These results suggested that AST might play a crucial role in the management of inflammatory pain and related emotions, shedding light on its underlying mechanism for treating such conditions.

A Comprehensive Analysis of the Cancer Chronic Pain Experience: A Narrative Review

Cancer-related chronic pain (CP) represents a critical clinical issue through the disease, severely compromising the quality of life (QoL) of patients and the family environment. The current review employed a narrative method to synthesize the main results about the impact of cancer-related CP on QoL, adopting a multidimensional and threefold vision: patients, caregivers, and patient–caregiver perspective. Evidence emphasizes the importance of considering a bidirectional perspective (patient–caregiver) to understand better the pain experience throughout the cancer continuum and its consequences on QoL of patients and caregivers. Moreover, a holistic and multidimensional approach to cancer-related CP and its impact on QoL of patients and caregivers is still needed, in which the interconnection between physical, psychological, and social factors should be analyzed. Theoretical and methodological issues for orienting future social and family research initiatives were discussed.

A virtual reality system for pain and anxiety management during outpatient hysteroscopy-A randomized control trial

BACKGROUND

Visual and acoustic virtual reality (VR) has been increasingly explored as a non-pharmacological tool for pain relief in clinical settings.

OBJECTIVE

We aimed to evaluate the effectiveness of VR as a distraction technique in the management of acute pain during operative hysteroscopy in the outpatient setting.

METHODS

A prospective, open-label, randomized control trial in a tertiary university-affiliated medical centre between April and August 2020. Overall, 82 women were randomly allocated to undergo operative hysteroscopy either with the use of VR (n = 44, study group) or with standard treatment (control group, n = 38). VR was applied throughout the procedure and no anaesthesia was given. The primary outcome measures included self-reported intraoperative pain. Other objectives included vital parameters as pulse rate (PR) and respiratory rate (RR) before and during the first 3 min of the procedure. Pain and anxiety outcomes were measured as numeric rating scores.

RESULTS

The baseline parameters were similar between groups. The mean duration for the procedure was 8.1 ± 3.2 vs. 7.3 ± 6.0 min for the study and the control groups (p = 0.23). There were no statistically significant differences between the reported pain scores during the procedure [median (interquartile range) 5.0 (3.0-7.2) vs. 5.0 (3.0-8.0), respectively; p = 0.67]. While neither intraoperative heart rate nor respiratory rate differed between groups [14.0 (13.0-16.0) vs. 14.0 (11.0-16.5); p = 0.77)], the increase of heart rate was found greater in the VR group [+7.0 (8.5) vs. +1.0 (12.2); p = 0.01].

CONCLUSION

VR was not effective in reducing pain during an outpatient operative hysteroscopy.

SIGNIFICANCE

The use of a Virtual reality system was found ineffective in reducing pain during and after an office operative hysteroscopy without anaesthesia, in a thorough examination of both continuous physiological parameters and women's self-reported measures.

Level of self-reported pain’s interference with work, and association with number of prescriptions and healthcare expenditures

Objectives

To examine the associations between pain interfering with work and family income and health status and to quantify the impact of pain on pharmaceutical utilization and cost using data from the Medical Expenditure Panel Survey (MEPS).

Methods

The study population included adult respondents to a MEPS pain question asking how much pain interfered with normal work (including both work outside the home and housework) from 2007 to 2014 (n = 71 593 respondents). Generalized linear models estimated the association between pain and family income, self-reported health status, number of prescriptions and healthcare expenditures (prescription drug and total). Control variables included age, gender, education, marital status, poverty, race, immigration status, region, obesity, work status and insurance coverage.

Key findings

Nearly 43% of respondents reported pain did not interfere at all with their work, 32% responded it did ‘a little bit’, 14% said ‘moderately’, 8% reported ‘quite a bit’, and 3% said ‘extremely’. Older respondents were significantly more likely to report pain interfering with work than younger ones. Women were more likely than men to report pain interfering with work. Obesity was significantly associated with pain, with 5.3% of obese respondents stating pain extremely interfered with work compared to 2.2% of nonobese respondents. Those who reported pain interfered ‘extremely’ had, on average, 46 prescriptions filled per year compared to only 5 prescriptions for those reporting less severe pain. This translated into significantly higher prescription drug and total costs.

Conclusion

Innovative targeted interventions are needed to mitigate the severe consequences of pain on health, well-being and cost.