Tag: pubmed

Pain Physician. 2025 Mar;28(2):147-154.

ABSTRACT

BACKGROUND: The optimal dosing and delivery strategies for intrathecal ziconotide are debated. Previous research suggests that high volume, low concentration dosing techniques may decrease side effects and enhance analgesic effect. Previous studies that have investigated the effects of diluting ziconotide have examined continuous infusions of the medication through an intrathecal pump.

OBJECTIVES: This study investigates the trial phase to determine if diluting the bolus dose leads to improved outcomes. The hypothesis of the authors is that the dilution of ziconotide will improve the trial outcomes.

STUDY DESIGN: This single-center, retrospective, case-control study included 62 patients with chronic pain refractory to conservative therapy who received a one-time intrathecal bolus dose of ziconotide.

METHODS: The study included 62 patients who received a single outpatient trial dose of ziconotide. The study was approved by an institutional review board. Data were collected from electronic medical records. Doses ranged from a total of 2.5 µg-5 µg in a volume of 0.5 mL-5 mL. The primary endpoints were the number of patients that achieved significant pain relief (>= 50%) and the presence or absence of side effects. Statistical analysis was performed using a c2 test to evaluate side effects and meaningful pain relief and an unpaired, 2-tailed t test to evaluate pain relief percentage.

RESULTS: There were no differences in side effects experienced by the patients in the Undiluted Group compared to the patients in the Diluted Group (21% vs 25%; P = 0.679). There were no differences in pain relief in the Undiluted Group compared to the Diluted Group (59% vs 61%; P = 0.880). The mean (SD) pain relief in the Undiluted Group was 46% (± 40%) compared to 51% (± 41%) in the Diluted Group (P = 0.645). A power analysis revealed a 68% power to detect a difference between the groups.

LIMITATIONS: These results are limited by the accuracy of the chart review and sample size; therefore, additional investigation may be warranted.

CONCLUSION: This study demonstrates there is no substantial difference between diluted and undiluted bolus doses of intrathecal ziconotide in regard to analgesic effect or side effects.

PMID:40168566

Pain Physician. 2025 Mar;28(2):E147-E156.

ABSTRACT

BACKGROUND: Opioid medications are widely used for pain management, but their impact on obstructive sleep apnea (OSA) remains controversial. Given the high prevalence of OSA and the increasing use of opioids, understanding the causal relationship between the condition and this type of medication is critical.

OBJECTIVES: This study aims to investigate the causal relationship between opioid use and OSA using a bidirectional 2-sample Mendelian randomization (MR) analysis. Specifically, the study seeks to determine whether exposure to opioid use increases the risk of developing OSA and whether OSA influences the likelihood of opioid use.

STUDY DESIGN: The study employed a bidirectional 2-sample MR analysis to explore the causal relationship between opioid use and OSA. Genetic variants from large-scale genome-wide association studies (GWAS) were used as instrumental variables to ensure robust causal inference.

SETTING: The study utilized data from 2 large-scale GWAS datasets. Opioid use data were obtained from the UK Biobank, while OSA data were sourced from the FinnGen study. Both datasets predominantly included patients of European ancestry with similar demographic characteristics.

METHODS: This study employed a 2-sample bidirectional Mendelian randomization (MR) approach to investigate the causal relationship between opioid use and obstructive sleep apnea (OSA). Genetic instruments for opioid use and OSA were selected from large-scale genome-wide association studies (GWAS) conducted in European populations, ensuring consistency in genetic backgrounds. The inverse variance-weighting (IVW) method was used as the primary analysis to estimate causal effects, supplemented by the weighted median, MR-Egger, simple mode, and weighted mode methods to ensure robustness. Sensitivity analyses, including MR-Egger regression, leave-one-out analysis, and MR-PRESSO, were conducted to assess pleiotropy, heterogeneity, and the influence of individual SNPs on the results.

RESULTS: The IVW method demonstrated a significant causal effect of opioid use on the risk of developing OSA, with a causal effect size of 0.28 (OR = 1.32, 95% CI = 0.09 to 0.46, P-value = 0.004). This association was supported by the weighted median method, though the MR-Egger, simple mode, and weighted mode methods did not achieve statistical significance but showed a consistent direction of effect. Conversely, no significant causal relationship was observed between OSA and opioid use across all methods, suggesting that OSA did not significantly influence opioid use.

LIMITATIONS: The primary limitations of this study include the use of binary phenotypes for opioid use and OSA, which precludes the assessment of dose-response relationships. Additionally, the genetic data were derived predominantly from European populations, limiting the generalizability of the findings to other ethnic groups. Potential pleiotropy and unmeasured confounders, although addressed through various sensitivity analyses, may still introduce bias into the results.

CONCLUSION: This study provides strong evidence of a unidirectional causal relationship in which opioid use increases the risk of developing OSA. These findings underscore the importance of monitoring patients who use opioids for potential respiratory complications, particularly OSA.

PMID:40168564

Pain Physician. 2025 Mar;28(2):71-81.

ABSTRACT

BACKGROUND: Lumbar spinal stenosis is the most common cause for spinal surgery of older adults. It is associated with pain in the legs and back as well as impaired ambulation. Minimally Invasive Lumbar Decompression (MILD®, Vertos Medical) is a percutaneous, image-guided lumbar decompression technique for central canal stenosis secondary to a hypertrophied ligamentum flavum. However, whether MILD can achieve adequate beneficial results in patients with lumbar spinal stenosis remains undetermined.

OBJECTIVE: To assess the efficacy and complications of MILD for lumbar spinal stenosis.

STUDY DESIGN: A systematic review and meta-analysis.

METHODS: Electronic databases were searched to identify all clinical trials of patients undergoing MILD surgery. Primary outcomes included Visual Analog Scale scores (VAS) or Oswestry Disability Index scores (ODI) at baseline, < 6 months posttreatment, = one year posttreatment. Secondary outcomes included postoperative complications. For continuous variables, the treatment effects were calculated by weighted mean difference and 95% CI. The statistical significance was defined as P < 0.05.

RESULTS: There were 334 trials identified; 12 of them, with data from 500 patients, were included in our analysis. MILD treatment resulted in a significant decrease in the mean pain score compared to the baseline (P < 0.01). There is a consistent pattern of decreased mean ODI scores following MILD compared to the baseline (P < 0.01).

LIMITATIONS: The included MILD clinical trials did not have the same exclusion and inclusion criteria. While all clinical trials in this study adopted conservative treatments prior to MILD, there were no standardized treatment modalities and length of time. All of the studies employed subjective outcome tools including VAS and ODI. However, these self-reported outcome tools are subject to bias.

CONCLUSIONS: Our study suggests MILD is an effective and safe surgical technique for patients with stenosis from ligamentum flavum hypertrophy. This technique resulted in significant clinical improvement, as indicated by changes in pain scores and ODI scores. In addition, adverse events were low compared to other surgical decompression techniques. To further confirm this, more well designed and powered randomized trials are needed.

PMID:40168556

J Cataract Refract Surg. 2025 Mar 31. doi: 10.1097/j.jcrs.0000000000001661. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this project is to compare the accuracy, safety, and consistency of near-square and asymmetric trapezoid side-port incisions in cataract surgery.

SETTING: Aier Eye Hospital of Wuhan University, Wuhan Hubei Province, China.

DESIGN: Prospective pilot study.

METHODS: The patients were divided into Groups A and B using the random number table method. Group A received a near-square side-port incision (SPI) with a 22G needle, and Group B received an asymmetric trapezoid SPI with a 15-degree blade. We contrasted the differences in incision length, width, and shape; surgical time; and postoperative intraocular pressure (IOP) between the two groups.

RESULTS: Eighty eyes from 80 patients were included. The mean external width of incision in Group A was much smaller than that in Group B (p < .01), while the internal width in Group A was significantly larger (p < .01). In Group A, there is no statistically significant difference between the external and internal incision diameters (p = .081). In Group B, the external diameter is obviously larger than the internal diameter (p < .01). The incision diameter consistency in Group A was higher than that in Group B. There was no statistically significant difference in incision length between the two groups (p = 0.67). One day after surgery, there were no significant differences in incision morphology (p = 1.0; .723) or operating time between the two groups (p = .89). There was no obvious incision leakage in either group after surgery (p =.337).

CONCLUSIONS: The present study suggests that a near-square side-port with a 22G needle is smaller and results in better incision consistency. Moreover, the 22G needle is inexpensive and can be easily obtained.

PMID:40168526 | DOI:10.1097/j.jcrs.0000000000001661

J Glob Health. 2025 Apr 2;15:04070. doi: 10.7189/jogh.15.04070.

ABSTRACT

BACKGROUND: The outbreak of Mpox in China has rendered the promotion of effective preventive measures among susceptible populations particularly crucial. We aimed to explore the correlates and develop a model for Mpox vaccination intention.

METHODS: We distributed a questionnaire to a sample of 2403 men who have sex with men to investigate whether they would get a Mpox vaccine. The participants were randomly split into a training set and a testing set in a ratio of 3:1. We screened relevant variables by the least absolute shrinkage and selection operator (LASSO) regression analysis and included them into a Mpox vaccination intention model, which used a multivariate logistic regression analysis and presented the findings as a nomogram. We used the receiver operating characteristic curve, calibration curve, Kolmogorov-Smirnov test, lift test, and population stability index to test the validity and stability of the model.

RESULTS: Of the 2403 participants in our sample, 87.1% intended to get an Mpox vaccine. Five of the thirty-one screened variables, i.e. Mpox knowledge, social support, vaccination internal rewards, vaccination external rewards, and vaccination response efficacy, were included in the vaccination intention model. The model demonstrated strong risk differentiation (Kolmogorov-Smirnov value = 0.46), moderate predictive power (training area under the curve = 0.7709), and good calibration fit, indicating robust performance.

CONCLUSIONS: Our proposed model has a good performance and is highly stable, while our findings suggest that governments should design targeted public health strategies, integrating social engagement and leveraging peer and community education to promote Mpox vaccination.

PMID:40168515 | DOI:10.7189/jogh.15.04070

J Strength Cond Res. 2024 Oct 1;38(10):e595-e599. doi: 10.1519/JSC.0000000000004922. Epub 2024 Aug 14.

ABSTRACT

Cabarkapa, D, Cabarkapa, DV, Aleksic, J, Mihajlovic, F, and Fry, AC. The impact of the official Basketball Champions League game on lower-body neuromuscular performance characteristics. J Strength Cond Res 38(10): e595-e599, 2024-Considering the extensive use of force plate technology in an applied sports setting and the lack of scientific literature during the actual competition, the purpose of the present study was to investigate the acute impact of an official basketball game on lower-body neuromuscular performance characteristics. Eight professional male basketball players volunteered to participate in this investigation. Upon completion of a standardized warm-up procedure, each athlete performed 3 maximum-effort countermovement vertical jumps (CVJs) with no arm swing while standing on a uniaxial force plate system sampling at 1,000 Hz. Then, 3 days after the baseline testing procedures, the athletes completed an identical CVJ testing protocol immediately after the completion of an official basketball game. Paired sample t-tests were used to examine statistically significant pregame and postgame differences in CVJ performance (p < 0.05). The findings reveal that force-time metrics examined during both eccentric and concentric phases of the CVJ tend to remain relatively unchanged in response to the game stimulus. Also, no differences in outcome metrics such as vertical jump height and reactive strength index-modified have been observed. However, despite not reaching the level of statistical significance, it should be noted that eccentric peak velocity, force, and power did demonstrate a moderate decrease postgame when compared with the baseline measurements (g = 0.509-0.627), suggesting that the eccentric phase of the jumping movement might be more sensitive in detecting acute fatigue-induced performance changes within this specific group of professional athletes.

PMID:40168066 | DOI:10.1519/JSC.0000000000004922

J Vet Intern Med. 2025 May-Jun;39(3):e70064. doi: 10.1111/jvim.70064.

ABSTRACT

BACKGROUND: While there is agreement that horses experience pain during the actual headshaking attacks, there is still a lack of research about the time between the individual episodes in this species.

OBJECTIVES: To evaluate the signs of pain in horses with TMHS at rest in the absence of common triggering factors.

ANIMALS: Twenty TMHS horses (not head shaking at the time of pain assessment), 20 horses with colic, and 20 clinically healthy horses.

METHODS: Descriptive study assessing pain in TMHS horses during the absence of clinical signs using the Horse Grimace scale (HGS). To grade the pain shown with TMHS, horses with moderate gastrointestinal pain conditions and a healthy horses’ group were also included. For evaluation, videos were taken on two consecutive days from both sides of the face (healthy, TMHS) or before analgesics were applied (colic). Eight photos per horse were extracted from the videos, randomized, and evaluated by three examiner groups, each comprising two persons: (a) last-year veterinary medicine students without previous use of the HGS, (b) experienced veterinarians without experience in using the HGS, and (c) experienced veterinarians who regularly apply the HGS. All examiners were blinded to the underlying condition.

RESULTS: Median HGS scores in the groups (healthy, gastrointestinal, TMHS) differed significantly from each other (p < 0.05). Healthy horses had median HGS scores below 2 (median 1.2, range: 0.1-2.4), whereas TMHS horses had higher median HGS scores (5.6, range 2.4-7.4), and colic horses had the highest HGS scores (6.6, range: 3.8-8.4). There was a statistically significant difference for all facial action units (FAU) when the different horse groups were compared (p < 0.05). Effect sizes were large for the healthy horses’ group (ES-1.23) and for the colic horses (ES 0.86), and small to medium for the TMHS horses (ES 0.37).

CLINICAL IMPORTANCE: The results of this study show that pain occurs between individual TMHS attacks in severely affected horses and that the quality of life of these horses must be questioned and evaluated individually.

PMID:40168040 | DOI:10.1111/jvim.70064

JMIR Ment Health. 2025 Apr 1;12:e65356. doi: 10.2196/65356.

ABSTRACT

BACKGROUND: Digital mental health interventions (DMHIs) are a promising approach to reducing the public health burden of mental illness. DMHIs are efficacious, can provide evidence-based treatment with few resources, and are highly scalable relative to one-on-one face-to-face psychotherapy. There is potential for DMHIs to substantially reduce unmet treatment needs by circumventing structural barriers to treatment access (eg, cost, geography, and time). However, epidemiological research on perceived barriers to mental health care use demonstrates that attitudinal barriers, such as the lack of perceived need for treatment, are the most common self-reported reasons for not accessing care. Thus, the most important barriers to accessing traditional psychotherapy may also be barriers to accessing DMHIs.

OBJECTIVE: This study aimed to explore whether attitudinal barriers to traditional psychotherapy access might also serve as barriers to DMHI uptake. We explored the relationships between individuals’ structural versus attitudinal barriers to accessing psychotherapy and their indicators of potential use of internet-delivered guided self-help (GSH).

METHODS: We collected survey data from 971 US adults who were recruited online via Prolific and screened for the presence of psychological distress. Participants provided information about demographic characteristics, current symptoms, and the use of psychotherapy in the past year. Those without past-year psychotherapy use (640/971, 65.9%) answered questions about perceived barriers to psychotherapy access, selecting all contributing barriers to not using psychotherapy and a primary barrier. Participants also read detailed information about a GSH intervention. Primary outcomes were participants’ self-reported interest in the GSH intervention and self-reported likelihood of using the intervention if offered to them.

RESULTS: Individuals who had used psychotherapy in the past year reported greater interest in GSH than those who had not (odds ratio [OR] 2.38, 95% CI 1.86-3.06; P<.001) and greater self-reported likelihood of using GSH (OR 2.25, 95% CI 1.71-2.96; P<.001). Attitudinal primary barriers (eg, lack of perceived need; 336/640, 52.5%) were more common than structural primary barriers (eg, money or insurance; 244/640, 38.1%). Relative to endorsing a structural primary barrier, endorsing an attitudinal primary barrier was associated with lower interest in GSH (OR 0.44, 95% CI 0.32-0.6; across all 3 barrier types, P<.001) and lower self-reported likelihood of using GSH (OR 0.61, 95% CI 0.43-0.87; P=.045). We found no statistically significant differences in primary study outcomes by race or ethnicity or by income, but income had a statistically significant relationship with primary barrier type (ORs 0.27-3.71; P=.045).

CONCLUSIONS: Our findings suggest that attitudinal barriers to traditional psychotherapy use may also serve as barriers to DMHI use, suggesting that disregarding the role of attitudinal barriers may limit the reach of DMHIs. Future research should seek to further understand the relationship between general treatment-seeking attitudes and attitudes about DMHIs to inform the design and marketing of DMHIs.

PMID:40168039 | DOI:10.2196/65356

JAMA Netw Open. 2025 Apr 1;8(4):e252728. doi: 10.1001/jamanetworkopen.2025.2728.

ABSTRACT

IMPORTANCE: There are several apparent research gaps based on the intersectional sociodemographic dimensions of drug-related mortality disparities. Relatively marginal evidence exists on the potential roles of intersecting forms of race and sexual marginalization on the disparities across drug-related mortality.

OBJECTIVE: To examine intersectional sex-specific White and Black racial disparities in drug poisoning mortality across states from 2010 to 2020.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used unintentional fatal drug poisoning mortality data from the Centers for Disease Control and Prevention’s Web-Based Injury Statistics Query and Reporting System. Trends from 2010 through 2020 were analyzed by Black men, Black women, White men, and White women across states. One-sided Mann-Kendall trend analysis was used to examine statistically significant increasing or decreasing trends in age-adjusted mortality rates. Statistical analysis was performed from June to July 2024.

EXPOSURES: White and Black groups intersecting with male and female sex.

MAIN OUTCOMES AND MEASURES: Analysis of age-adjusted mortality rates, excess years of potential life lost (reference group: White men), years of potential life lost ratios (reference group: White men), and percentage change to highlight state differences.

RESULTS: From a total sample of 518 724 unintentional fatal drug poisoning deaths (9.0% in Black men, 3.9% in Black women, 29.0% in White women, and 58.1% in White men), 11 820 781 years of potential life lost were recorded. Black men had the highest mean (SD) age-adjusted mortality rate (23.25 [22.65]), followed by White men (22.49 [14.32]), with lower rates for White women (11.71 [5.96]) and Black women (9.01 [8.04]) (P < .001). Compared with White men, both Black men (τ = 0.298, slope = 0.002, intercept = 0.381, P < .001) and Black women (τ = 0.157, slope = 0.0004, intercept = 0.271, P < .001) had worsening YPLL over time, while White women (τ = -0.146, slope = -0.0003, intercept = 0.5252, P < .001) showed improvement in their YPLL over time compared with White men. At the state level, there was a disproportionate burden of deaths due to drug poisonings, with Maryland showing the highest increase in mortality rates among Black men (485.4%), while decreases were observed for White women in states such as Alaska (-23.0%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of overdose deaths, disparities in overdose mortality were evident, with Black men and Black women experiencing a pronounced and increasing burden of mortality compared with their White counterparts. Addressing these disparities will require a multipronged approach targeting the social, physical, economic, and policy risk environments.

PMID:40168026 | DOI:10.1001/jamanetworkopen.2025.2728

JAMA Netw Open. 2025 Apr 1;8(4):e252834. doi: 10.1001/jamanetworkopen.2025.2834.

ABSTRACT

IMPORTANCE: Medicare beneficiaries, particularly those dually eligible for Medicaid, must navigate complex coverage options. The State Health Insurance Assistance Program (SHIP) provides counseling on Medicare options, but little is known about the quality of counseling sessions.

OBJECTIVE: To characterize experiences connecting to SHIP counselors, and to characterize the accuracy and completeness of information provided by counselors in response to questions about Medicare coverage options.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study of 131 SHIP sites across the US, mystery shoppers posed as individuals newly eligible for Medicare. Shops occurred via telephone, in-person, and videoconference encounters from September 2023 to August 2024. Statistical analysis was performed from August to September 2024.

EXPOSURE: Mystery shoppers followed scripts with questions about coverage decisions corresponding to general Medicare eligibility and dual eligibility for Medicare and Medicaid.

MAIN OUTCOMES AND MEASURES: Responses were categorized as (1) accurate and complete, (2) accurate but incomplete, (3) not substantive, and (4) incorrect. This was a descriptive study without hypotheses.

RESULTS: Shoppers attempted 306 encounters. Of these, 122 (39.9%) could not be completed, most often because shoppers did not receive return calls. Within the 184 completed shops, the mean (SD) percentage of accurate and complete answers was 40.0% (25.7%). The percentage of responses with accurate answers (whether complete or incomplete) ranged from 26.1% (when asked whether a specific clinician was in network for a specific plan) to 94.3% (when asked about differences between traditional Medicare [TM] and Medicare Advantage [MA]). Responses were unlikely to be inaccurate (mean [SD], 6.7% [5.4%]). Fewer than half of counselors (44.8% [43 of 96]) mentioned Dual-Eligible Special Needs Plans (D-SNPs) as an option for mystery shoppers posing as dual eligibles.

CONCLUSIONS AND RELEVANCE: In this study of the accuracy of Medicare information provided by SHIP counselors, shoppers encountered challenges in reaching SHIP sites, indicating possible capacity constraints; responses varied in accuracy and completeness, with better performance on questions about TM vs MA comparisons, and weaker performance on questions about integrated care plans and specific MA plan details. Given recent growth in MA and federal efforts to counter deceptive marketing practices from agents or brokers-in part by directing beneficiaries to SHIPs-policymakers should consider providing SHIP with additional resources for training and capacity improvements.

PMID:40168025 | DOI:10.1001/jamanetworkopen.2025.2834