Synopsis
A hyperexcitable central nervous system, i.e. central sensitization, is a potential pathophysiological mechanism contributing to chronic pain. This study aims to advance the understanding of central sensitization in patients with chronic low back pain (CLBP) using psychophysical assessments and brain imaging methods. Preliminary results of 31 CLBP patients suggest that psychophysical measures of spinal and supraspinal pain modulation depend on used stimulus modality and body region, i.e., painful versus non-painful body region. A multimodal approach integrating the psychophysical assessments with brain imaging measures might provide novel insights into central sensitization in CLBP.
Disclosures
Synopsis
The central mechanisms underlying Fibromyalgia syndrome remain undetermined; however, there is increasing evidence to suggest that neurochemical imbalances may play a critical role in the pathophysiology of the condition. The DLPFC is a heterogeneous cortical structure involved in cognitive, affective, and sensory processing of pain known to mediate top down pain modulation. We provide the first evidence of excitatory/inhibitory imbalance within the DLPFC in fibromyalgia syndrome, which we demonstrated to be positively associated with acute/clinical pain measures and the degree of resting state functional connectivity to affective pain circuitry (dorsal anterior cingulate cortex). Together these results suggest a dysregulation of excitation and inhibition in top-down pain modulatory networks with potential pathophysiological implications in pain processing. Furthermore, this evidence provides potential pharmacological and neuromodulatory therapeutic targets for the treatment of fibromyalgia syndrome.
Disclosures
In the largest RCT of SCS for painful diabetic neuropathy (PDN), 216 patients with symptoms refractory to conventional treatments were randomized 1:1 to continue with conventional medical management (CMM) alone or add 10 kHz SCS to CMM. Outcomes are durable to 6-month follow-up with 5.4% (5/93) of CMM subjects as pain responders compared with 85.1% (74/87) of 10 kHz SCS+CMM subjects (p < 0.001). Investigators observed sensory improvements in 3.3% (3/92) of CMM subjects versus 61.9% (52/84) of 10 kHz SCS+CMM subjects (p < 0.001). This study provides Level I evidence for high frequency SCS to treat PDN patients with refractory symptoms.
Study funded by Nevro Corp.
Synopsis
Understanding patient preference for cLBP treatment is useful to improve targeting of therapies and increase adherence resulting in improved outcomes. This study developed and used the first discrete choice measure of patient preferences for nonsurgical treatments. In 206 persons with cLBP, the strongest preference was for best chance & longest duration of pain relief (β=1.96, p<0.001 & β=0.90, p<0.001). Avoiding long-term side-effects (β=-0.67, p<0.001) was preferred over avoiding a rare risk of permanent, serious injury’ (β=-0.28, p=0.012). Patients strongly preferred one-on-one support from a trusted therapy provider at every session, and improvement of strength was the strongest outcome preference.xtagstartz/p>xtagstartz/p>
Synopsis
Natural experiment quality improvement project with overall reduction in opioid prescriptions per 100 people by 49%. Achieving a greater reduction of opioid prescriptions than the U.S. and California each year (2016-2019) by at least 43.2% and as high as 67.5%. Categorized chronic pain patients (High Dose (HD), Moderate Dose (MD), Low Dose (LD) and Very Low Dose (VLD) defined by morphine equivalents of ³90, 50-89, 20-49) were reduced by 63.6%, 65.2%, 53.1% and 59.3% respectively. Categorized acute pain patients classified by Day’s Supply (DS) of opioid medication (1-8, 9-17 and > 18 DS) had reductions of 36.5%, 73.1% and 80.7% respectively.
Disclosures
Synopsis
Real-world evidence concerning the use of prescription treatments for opioid-induced constipation (OIC) in the emergency department (ED) is lacking. This retrospective analysis compared healthcare resource utilization in hospitals and healthcare costs among patients reporting to the ED who received OIC treatment (n=11,135, 93% used methylnaltrexone SC) versus those who did not (n=21, 474). Overall, patients who received prescription OIC treatment were more likely to be discharged home, less likely to be hospitalized, had a reduced hospital stay, and a mean of $1152 less in total healthcare costs per ED encounter than patients who did not receive prescription OIC treatment.
Disclosures
Synopsis
Osteoarthritis of the knee joint is a major cause of pain worldwide However, treatments designed to control it are insufficient. Although surgery may be indicated, many older patients are inappropriate surgical candidates. Radiofrequency ablation is an effective pain treatment especially when performed following new insights on 3 dimensional human anatomy This is relevant for improved ablation of nerves supplying the knee joint The technique presented addresses this important issue by following the anatomical distribution of innervation It effectively arranges the cannulas by performing a non-traditional approach and places them in a sagittal plane one in front of the other for a larger lesion.
Disclosures
Synopsis
The NIH HEAL (Helping to End Addiction Long-term) SM Initiative is an aggressive, trans-NIH effort to speed scientific solutions to stem the national opioid public health crisis. Within the HEAL initiative, NINDS developed the Early Phase Pain Investigation Clinical Network (EPPIC-Net) to focus on understanding pain mechanisms and developing effective, non-addictive treatments for pain by carrying-out phase 2 clinical trials of novel, non-addictive pain therapies. EPPIC-NET accepts application on a rolling basis. Academic and industry researchers from the USA and internationally are welcome to apply.
Disclosures
Synopsis
We endeavored to investigate outcomes associated with use of multiple neurostimulation modalities as compared with conventional SCS settings alone in a prospective, randomized controlled trial. The primary endpoint was proportion of subjects permanently implanted with an SCS system capable of multiple neurostimulation modalities demonstrating 50% or greater reduction in average overall pain intensity at 3-months post-randomization. The study met its primary endpoint based on a pre-specified cohort of 89 randomized subjects (p<0.001). The results provide further support for the advantages of using neuromodulation systems capable of patient-specific stimulation options that enable highly customized therapy for treatment of chronic pain.
Disclosures
Synopsis
As more SCS systems that provide multiple neurostimulation approaches continue to become available, it will be necessary to evaluate usage of these devices and associated clinical outcomes. In this study, long-term outcomes were assessed in patients using a new SCS system designed to customize SCS using combination therapy, waveform automation, and a device algorithm engineered for manipulatable control of stimulation field shape. Twenty-three percent of all patients reported being pain free (NRS = 0) at last follow-up. Given the variability of experience associated with chronic pain, the SCS-implanted patient population may particularly benefit from devices that enable individualized treatment customization.
Disclosures