Human Studies

The intraoperative administration of methadone is effective in reducing postoperative painPreventative analgesic interventions may provide protection against the development of persistent postoperative pain WHAT THIS ARTICLE TELLS US THAT IS NEW: Using data from two previously completed trials, it was observed that a single intraoperative dose of methadone was associated with fewer episodes of pain during the first month after cardiac surgery and the first 3 months after spinal surgeryFewer spine surgery patients who received methadone intraoperatively were receiving opioids 3 months after surgery, suggesting a possible reduction in chronic opioid use BACKGROUND:: Methadone is a long-acting opioid that has been reported to reduce postoperative pain scores and analgesic requirements and may attenuate development of chronic postsurgical pain. The aim of this secondary analysis of two previous trials was to follow up with patients who had received a single intraoperative dose of either methadone or traditional opioids for complex spine or cardiac surgical procedures.

We aimed to investigate the factors associated with variations in postoperative pain trajectories over time in patients using intravenous patient-controlled analgesia (IV-PCA) for postoperative pain.

Chronic musculoskeletal pain affects more than 20% of the population, and the prevalence is increasing, causing suffering, loss of quality of life, disability, and an enormous expenditure on healthcare resources. The most common location for chronic pain is the spine. Many of the treatments used are mainly passive (pharmacological and invasive) and poor outcomes. The treatments currently applied in the public health system do not comply with the recommendations of the main clinical practice guidelines, which suggest the use of educational measures and physical exercise as the first-line treatment. A protocol based on active coping strategies is described, which will be evaluated through a clinical trial and which could facilitate the transfer of the recommendations of the clinical practice guidelines to a primary care setting.

Given the readily increasing membership of the pain physician community, efforts toward correcting notable gender disparities are instrumental. The under-representation of women is particularly prevalent within leadership roles in academic medicine, thought to be driven largely by diminished research efforts. Consequently, we aimed to characterize gender differences among the highest impact pain literature.

Musculoskeletal pain reduces corticomotor excitability (CE) and methods modulating such CE reduction remain elusive. This study aimed to modulate pain-induced CE reduction by performing action observation and motor imagery (AOMI) during experimental muscle pain. Twelve healthy subjects participated in three cross-over and randomized sessions separated by one week. During the AOMI session subjects performed an AOMI task for 10 mins. In the AOMI+PAIN session, hypertonic saline was injected in the first dorsal interosseous (FDI) muscle prior to performing the AOMI task. In the PAIN session, subjects remained at rest for 10 min or until pain-resolve after the hypertonic saline injection. CE was assessed using transcranial magnetic stimulation motor-evoked potentials (TMS-MEPs) of the FDI muscle at baseline, during, immediately after, and 10 min after AOMI and/or PAIN. Facilitated TMS-MEPs were found after two and four mins of AOMI performance (P<0.017) whereas a reduction in TMS-MEPs appeared at four mins (P<0.017) during the PAIN session. Performing the AOMI task during pain counteracted the reduction in CE, as evident by no change in TMS-MEPs during the AOMI+PAIN session (P>0.017). Pain intensity was similar between the AOMI+PAIN and PAIN sessions (P=0.71). This study, that may be considered a pilot, demonstrated the counteracting effects of AOMI on pain-induced reduction in CE and warrants further studies in a larger population. PERSPECTIVE: This is the first study to demonstrate a method counteracting the reduction in corticomotor excitability associated with acute pain and advances therapeutic possibilities for individuals with chronic musculoskeletal pain.