Azargan Pain Clinic, Tehran, Iran.
Advanced Spine on Park Avenue.
Pain Physician. 2020 Aug;23(4S):S311-S318.
The COVID-19 pandemic has emerged and has challenged us to look for alternatives to bring about a paradigm shift in interventional chronic pain management. As the disease lowers the body's immune system, the use of medications that suppress the immune system are not recommended during the COVID-19 pandemic.
The purpose of this study was to review medications other than steroids used for interventional pain management and the emphasis on mitigation of the untoward consequences of steroid injections on the immune system during the COVID-19 pandemic.
The literature was searched for articles in English with key words COVID-19, immunity, steroid for pain management injections with steroid, local anesthetics, dextrose water, normal saline, pain and genetic medicine, pain, and regenerative medicine. The sources of articles were PubMed, Embase, and open Google search.
The medications used for interventional pain management include steroids and opioids. The side effects of these medications are well known but have never been looked at as critically as they are now. Many other medications have been used for interventional pain procedures to relieve pain, such as dextrose water, normal saline solution, local anesthetics, and many adjuvants. Regarding regenerative therapy, despite plenty of evidence in literature, we have not yet considered it as a routine therapy for chronic pain injections. It is now time to move on beyond steroids and consider other types of medications and treatment options.The use of these medications in clinical practice is less auspicious, and thus more research is needed on the practical applications. Further areas for research include studies to determine definitive efficacy and safety assessment and determine whether or not the analgesic effects of these drugs are duration or dose-dependent. The optimal identification of candidates, volume, concentration, and intervals of injection are essential for routine application in interventional chronic pain practice.
The future of interventional pain practice is trending toward regenerative medicine and genetic research. Numerous scientific studies have been conducted to investigate the genetic basis of phenotypic variability in individuals with different ethnic groups in terms of susceptibility to chronic pain, as well as response to treatment for the personalized medicine model. Despite the preliminary data on genetic variations, there is no evidence for the use of a pharmacogenomics-based approach to personalized medicine for patients with chronic pain. The field of medicine therefore needs further research in pharmacogenetics, including large-scale prospective studies that focus on pain pathways. However, recent research, including larger studies and larger-scale genomic perspectives, may yield more promising findings in the future. The COVID-19 pandemic proved the need for medications with the most impact and least complications.
COVID-19 大流行已经出现，这促使我们寻找替代方案，以期在介入性慢性疼痛管理方面实现范式转变。由于疾病会降低人体的免疫系统，因此在 COVID-19 大流行期间不建议使用抑制免疫系统的药物。
本研究旨在回顾除类固醇以外用于介入性疼痛管理的药物，并强调在 COVID-19 大流行期间减轻类固醇注射对免疫系统的不良后果。
用英文关键词 COVID-19、免疫、用于疼痛管理的类固醇注射、局部麻醉剂、葡萄糖水、生理盐水、疼痛和基因医学、疼痛和再生医学搜索英文文献。文章来源包括 PubMed、Embase 和开放的 Google 搜索。
用于介入性疼痛管理的药物包括类固醇和阿片类药物。这些药物的副作用众所周知，但从未像现在这样受到重视。许多其他药物也被用于介入性疼痛程序以缓解疼痛，例如葡萄糖水、生理盐水、局部麻醉剂和许多佐剂。关于再生疗法，尽管文献中有大量证据，但我们尚未将其视为慢性疼痛注射的常规疗法。现在是超越类固醇并考虑其他类型的药物和治疗方案的时候了。这些药物在临床实践中的使用并不理想，因此需要对其实际应用进行更多的研究。进一步的研究领域包括确定明确的疗效和安全性评估的研究，以及确定这些药物的镇痛效果是否与剂量或持续时间有关。确定候选人、注射量、浓度和间隔的最佳方法对于介入性慢性疼痛实践中的常规应用至关重要。
介入性疼痛实践的未来趋势是再生医学和基因研究。已经进行了许多科学研究，以调查不同种族人群中个体对慢性疼痛的易感性以及对个性化医学模型治疗的反应的遗传基础。尽管有关于遗传变异的初步数据，但没有证据表明使用基于药物基因组学的方法来治疗慢性疼痛患者。因此，医学领域需要进一步研究药物遗传学，包括关注疼痛途径的大型前瞻性研究。然而，最近的研究，包括更大规模的研究和更大规模的基因组研究，未来可能会产生更有希望的发现。COVID-19 大流行证明了需要使用影响最大、并发症最少的药物。
