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Tutelman PR, Chambers CT, Parker JA, Eisen SJ, Noel M. Preliminary development of a measure of parental behavioral responses to everyday pains in young children: the PREP. Pain Rep 2024; 9:e1154. [PMID: 38586593 PMCID: PMC10994502 DOI: 10.1097/pr9.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Everyday pains are experienced frequently by young children. Parent responses shape how young children learn about and experience pain. However, research on everyday pains in toddlers and preschoolers is scarce, and no self-report measures of parent responses to their child's pain exist for this age group. Objectives The objective of this study was to develop a preliminary self-report measure of parent behavioral responses to everyday pains in the toddler and preschool years (the PREP) and examine its relationship with child age, sex, and parent and child distress. Methods Items for the PREP were based on a behavioural checklist used in a past observational study of caregiver responses to toddler's everyday pains. Parents (N = 290; 93% mothers) of healthy children (47.9% boys) between 18 and 60 months (Mage = 34.98 months, SD = 11.88 months) completed an online survey of 46 initial PREP items, demographic characteristics, and their child's typical distress following everyday pains. An exploratory factor analysis was performed on the PREP items that describe observable actions parents may take in response to their young child's everyday pains. Results The final solution included 10 items across 3 factors: Distract, Physical Soothe, and Extra Attention and explained 60% of the model variance. All PREP subscales were related to child distress; only Physical Soothe and Extra Attention were related to parent distress. Conclusion This study was a preliminary step in the development and testing of a new self-report measure of parental responses to everyday pains during early childhood.
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Affiliation(s)
- Perri R. Tutelman
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Departments of Oncology and
- Psychology, University of Calgary, Calgary, AB, Canada
| | - Christine T. Chambers
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Jennifer A. Parker
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
| | - Samantha J. Eisen
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
| | - Melanie Noel
- Psychology, University of Calgary, Calgary, AB, Canada
- Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Owerko Centre, Calgary, AB, Canada
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Inami C, Haruta M, Ohta Y, Tanaka M, So M, Sobue K, Akay Y, Kume K, Ohta J, Akay M, Ohsawa M. Real-time monitoring of cortical brain activity in response to acute pain using wide-area Ca 2+ imaging. Biochem Biophys Res Commun 2024; 708:149800. [PMID: 38522402 DOI: 10.1016/j.bbrc.2024.149800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
Previous human and rodent studies indicated that nociceptive stimuli activate many brain regions that is involved in the somatosensory and emotional sensation. Although these studies have identified several important brain regions involved in pain perception, it has been a challenge to observe neural activity directly and simultaneously in these multiple brain regions during pain perception. Using a transgenic mouse expressing G-CaMP7 in majority of astrocytes and a subpopulation of excitatory neurons, we recorded the brain activity in the mouse cerebral cortex during acute pain stimulation. Both of hind paw pinch and intraplantar administration of formalin caused strong transient increase of the fluorescence in several cortical regions, including primary somatosensory, motor and retrosplenial cortex. This increase of the fluorescence intensity was attenuated by the pretreatment with morphine. The present study provides important insight into the cortico-cortical network during pain perception.
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Affiliation(s)
- Chihiro Inami
- Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-dori, Mizuho-ku, Nagoya, 467-8603, Japan
| | - Makito Haruta
- Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5, Takayama, Ikoma-shi, Nara, Japan
| | - Yasumi Ohta
- Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5, Takayama, Ikoma-shi, Nara, Japan
| | - Motoshi Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine. Nagoya City University, 1 Kawasumi, Mizuho-ku, Nagoya, 467-8601, Japan
| | - MinHye So
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine. Nagoya City University, 1 Kawasumi, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine. Nagoya City University, 1 Kawasumi, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Yasemin Akay
- Biomedical Engineering Department, University of Houston, 3517 Cullen Blvd, Houston, TX, 77204, USA
| | - Kazuhiko Kume
- Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-dori, Mizuho-ku, Nagoya, 467-8603, Japan
| | - Jun Ohta
- Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5, Takayama, Ikoma-shi, Nara, Japan
| | - Metin Akay
- Biomedical Engineering Department, University of Houston, 3517 Cullen Blvd, Houston, TX, 77204, USA
| | - Masahiro Ohsawa
- Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-dori, Mizuho-ku, Nagoya, 467-8603, Japan; Department of Integrative Neuroscience, National Center for Geriatrics and Gerontology, Obu, Aichi, 474-8511, Japan; Laboratory of Systems Pharmacology, Faculty of Pharma-Sciences, Teikyo University, Itabashi, Tokyo, 173-8603, Japan.
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Wu W, Yang D, Sui D, Zhu M, Luo G, Yang Z, Wang Y, Luo H, Ling L, Zhang Z, Wu Y, Feng G, Li H. Efficacy and safety of Pien Tze Huang capsules in patients with herpes zoster: A multicenter, randomized, double-blinded, and placebo-controlled trial. Phytomedicine 2024; 127:155453. [PMID: 38452692 DOI: 10.1016/j.phymed.2024.155453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Herpes zoster (HZ) is a common medical condition accompanied by several distressing symptoms, including acute pain. Pien Tze Huang (PZH) is a well-known traditional Chinese medicine (TCM) with numerous pharmacological effects, including antiviral properties, neuroprotection, and immunity regulation. PURPOSE To investigate the efficacy and safety of PZH capsules in patients with HZ. STUDY DESIGN A multicenter, double-blinded, randomized, and placebo-controlled trial from 8 hospitals in 5 cities of China. METHODS Eligible participants were randomly assigned to the PZH capsule and placebo group at a 1:1 ratio. Treatment was conducted for 14 days with a window period of no more than 2 days. For the first 7 days, participants received antiviral drugs combined with PZH capsules (0.6 g/time, 3 times a day) or placebos. For the remaining 7 days, they were only treated with PZH capsules (0.6 g/time, 3 times a day) or placebos. RESULTS We included 222 patients in the full analysis set (FAS), and 187 patients in the per protocol set (PPS). The change of numeric rating scale pain scores from baseline to the seventh day (±1 day) after treatment in the PZH capsule group was statistically superior to the placebo group (FAS: 2.33 vs. 1.71, 97.5%CI: 0.03 ∼ 1.19; PPS: 2.29 vs. 1.51, 97.5%CI: 0.18 ∼ 1.38). In the PPS, there was a significant difference in the time (days) of pain relief between the placebo group and the PZH capsule group (Mean (SD): 5.71 (3.76) vs. 4.69 (3.57), p = 0.046). On the seventh day (±1 day) after treatment, the level of CD8+ cells in the PZH capsule group were higher than those of the placebo group (FAS: Mean (SD): 24.08 (6.81) vs. 21.93 (8.19), p = 0.007; PPS: Mean (SD): 24.26 (6.93) vs. 22.15 (8.51), p = 0.012). The level of cytotoxic lymphocyte cells found similar results on the seventh day (±1 day) (FAS: Mean (SD): 12.17 (4.65) vs. 10.55 (4.15), p = 0.018; PPS: Mean (SD): 12.25 (4.65) vs. 10.11 (3.93), p = 0.002). No serious adverse events were noted and PZH capsules were well tolerated. CONCLUSION PZH capsules confer therapeutic effects on HZ with the TCM symptom of stagnated heat of liver channel by substantially reducing the pain intensity, shortening the time of pain relief as well as regulating the immune function. On the basis of the efficacy and safety profiles, PZH capsules may be a promising complementary therapy for the treatment of HZ.
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Affiliation(s)
- Wenfeng Wu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, PR China; Department of Dermatology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, PR China
| | - Dingquan Yang
- Department of Dermatology, CHINA-JAPAN Friendship Hospital, Beijing, PR China
| | - Daoshun Sui
- Department of Dermatology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, PR China
| | - Minghua Zhu
- Department of Dermatology, The Guangdong Second Provincial Traditional Chinese Medicine Hospital, Guangzhou, PR China
| | - Guangpu Luo
- Department of Dermatology, The Dermatology Hospital of Southern Medical University, Guangzhou, PR China
| | - Zhonghui Yang
- Department of Dermatology, The Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, PR China
| | - Yongfeng Wang
- Department of Dermatology, The Affiliated Hospital of Shanxi University of Chinese Medicine, Xianyang, PR China
| | - Hong Luo
- Department of Dermatology, The First Hospital of Changsha, Changsha, PR China; Department of Dermatology, The Third People's Hospital of Shenzhen, Shenzhen, PR China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Zexin Zhang
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, PR China
| | - Yanmei Wu
- Guangzhou Evidence-Based Medicine Tech Co. Ltd, Guangzhou, PR China
| | - Guoming Feng
- Guangzhou Evidence-Based Medicine Tech Co. Ltd, Guangzhou, PR China
| | - Hongyi Li
- Department of Dermatology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, PR China.
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Moreau S, Thérond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01246-2. [PMID: 38587725 DOI: 10.1007/s11916-024-01246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.
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Affiliation(s)
- Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Alexandra Thérond
- Department of Psychology, Université du Québec a Montréal, 100 Sherbrooke St W, Montréal, QC, H2X 3P2, Canada.
| | - Ivo H Cerda
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Alicia Pan
- Northeastern University, Boston, MA, USA
| | - Jacob Tharpe
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Bernardes LS, Fernandes AM, de Carvalho MA, Ottolia J, Hamani M, Oliveira I, Kubota GT, Aparecida da Silva V, Veloso A, Burlachini de Cavalho MH, de Amorin Filho AG, Arenholt LTS, Leutscher PC, de Andrade DC. ASSESSMENT OF HUMAN FETUSES UNDERGOING ACUTE PAIN: VALIDATION OF THE FETAL-7 SCALE. J Pain 2024:104527. [PMID: 38599264 DOI: 10.1016/j.jpain.2024.104527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Improvements in fetal ultrasound have allowed for the diagnosis and treatment of fetal diseases in the uterus, often though surgery. However, little attention has been drawn to the assessment of fetal pain. To address this gap, a fetal pain scoring system, known as the Fetal-7 scale, was developed. The present study is a full validation of the Fetal-7 scale. The validation involved two steps: i. four fetuses with indication of surgery were evaluated in three conditions perioperatively: acute pain, rest, and under loud sound stimulation. Facial expressions were assessed by 30 raters using screenshots from 4D high-definition ultrasound films; ii., assessment of sensitivity and specificity of the Fetal-7 scale in 54 healthy fetuses and two fetuses undergoing acute pain after preoperative anesthetic intramuscular injection. There was high internal consistency with Cronbach's alpha (α) of 0.99. Intra-rater reliability of the Fetal-7 scale (test-retest) calculated by intraclass correlation coefficient (ICC) was 0.95, and inter-rater reliability was 0.99. The scale accurately differentiated between healthy fetuses at rest and those experiencing acute pain (sensitivity of 100% and specificity of 94.4%). The Fetal-7 scale is a valid tool for assessing acute pain-related behavior in third trimester fetuses and may be of value in guiding analgesic procedures efficacy in these patients. Further research is warranted to explore the presence of post-operative pain in fetuses and its effects afterbirth. PERSPECTIVE: Recordings with three-dimension ultrasound of human fetuses undergoing pre-operative anesthetic injections revealed complex facial expressions during acute pain, similar to those collected in newborns. This study presented the validation process and cut-off value of the Fetal-7 scale, paving the way for the study of pain before birth in humans.
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Affiliation(s)
- Lisandra Stein Bernardes
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Gynecology and Obstetrics Department, University of Sao Paulo, Brazil; SEPACO Maternity Hospital, São Paulo, Brazil; Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark.
| | - Ana Mércia Fernandes
- Pain Center, Department of Neurology, University of Sao Paulo, Brazil; Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Mariana Azevedo de Carvalho
- Gynecology and Obstetrics Department, University of Sao Paulo, Brazil; SEPACO Maternity Hospital, São Paulo, Brazil
| | - Juliana Ottolia
- Gynecology and Obstetrics Department, University of Sao Paulo, Brazil; SEPACO Maternity Hospital, São Paulo, Brazil
| | - Michele Hamani
- Pain Center, Department of Neurology, University of Sao Paulo, Brazil
| | - Inaeh Oliveira
- Pain Center, Department of Neurology, University of Sao Paulo, Brazil
| | | | | | - Adriano Veloso
- Computational Science Department, Universidade Federal de Minas Gerais, Brazil
| | | | | | - Louise Thomsen Schmidt Arenholt
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Christian Leutscher
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain, Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Pain Center, Department of Neurology, University of Sao Paulo, Brazil
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Holbert MD, Kimble RM, Watt K, Griffin BR. Barriers and facilitators to burn first aid practice in the prehospital setting: A qualitative investigation amongst emergency medical service clinicians. Burns 2024; 50:674-684. [PMID: 38065804 DOI: 10.1016/j.burns.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/15/2023] [Accepted: 12/01/2023] [Indexed: 04/08/2024]
Abstract
First aid cooling for burn injuries improves re-epithelialisation rates and reduces scarring. The objective of this research was to explore and describe barriers and facilitators to the provision of optimal first aid for acute burn patients in the prehospital setting. Emergency medical service (EMS) clinicians in Queensland were invited via email to participate in a survey designed to assess experience, knowledge, and attitudes regarding provision of optimal burn first aid in the prehospital setting (N = 4500). Barriers and facilitators to administering optimal first aid in the prehospital environment were assessed via two open-ended questions with free-text response boxes. An inductive approach to qualitative content analysis was used to analyze free-text data. In total, we included 326 respondents (7.2% response rate). Responses (n = 231) regarding barriers to first aid were classified into 12 categories, within five overarching dimensions. The most common of these was identified as pain. Similarly, free text responses (n = 276) regarding facilitators of burn first aid formed eight dimensions with 21 subcategories - most commonly fast and effective pain relief. Factors influencing burn first aid provision in the prehospital setting were wide-ranging and varied, with pain identified as the most prominent.
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Affiliation(s)
- Maleea D Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane 4101, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane 4067, Queensland, Australia; Faculty of Health, School of Nursing and Midwifery, Griffith University, Brisbane 4111, Queensland, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane 4101, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane 4067, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, South Brisbane 4101, Queensland, Australia
| | - Kerrianne Watt
- Information Support, Research & Evaluation, Office of the Medical Director, Queensland Ambulance Service, Kedron 4031, Queensland, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4810 Queensland, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane 4101, Queensland, Australia; Faculty of Health, School of Nursing and Midwifery, Griffith University, Brisbane 4111, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, South Brisbane 4101, Queensland, Australia
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7
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Cohen SB, Dabi Y, Burke Y, Mamadov N, Manoim N, Mashiach R, Berkowitz E, Bouaziz J, Nicolas-Boluda A, Grazia Porpora M, Ziv-Baran T. Laparoscopic nerve lysis for deep endometriosis improves quality of life and chronic pain levels: A pilot study. J Gynecol Obstet Hum Reprod 2024; 53:102778. [PMID: 38570115 DOI: 10.1016/j.jogoh.2024.102778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES To assess the benefit of surgical management of patients with endometriosis infiltrating pelvic nerves in terms of pain, analgesic consumption, and quality of life (QOL). METHODS We conducted a retrospective cohort study In an Endometriosis referral center at a tertiary care university affiliated medical center. Patients diagnosed with endometriosis that underwent laparoscopic neurolysis for chronic pain were included. Patients rated their pain before and after surgery and differentiated between chronic pain and acute crises. Patients were requested to maintain a record of analgesic consumption and to evaluate their quality-of-life (QOL). RESULTS Of the 21 patients in our study 15 (71.5 %) had obturator nerve involvement, 2 (9.5 %) had pudendal nerve involvement and 4 (19 %) had other pelvic nerve involvement. Median postoperative follow - up was of 8 months. All but 2 patients (9.6 %) had significant chronic pain improvement with a mean decrease of VAS of 3.05 (±2.5). Analgesic habits changed postoperatively with a significant decrease of 66 % of patients' daily consumption of any analgesics. Surgery improved QOL in 12 cases (57.1 %) and two patients (9.6 %) completely recovered with a high QOL. CONCLUSION Neurolysis and excision of endometriosis of pelvic nerves could results in significant improvement of quality of life.
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Affiliation(s)
- Shlomo B Cohen
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yohann Dabi
- Sorbonne University,Department of obstetrics and gynecology Tenon Hospital (AP-HP), Paris, France.
| | - Yechiel Burke
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nicole Mamadov
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Manoim
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elad Berkowitz
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jerome Bouaziz
- Department of Research, One Clinic, 25 Boulevard Pasteur, 75015 Paris, France
| | - Alba Nicolas-Boluda
- Department of Research, One Clinic, 25 Boulevard Pasteur, 75015 Paris, France
| | | | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Saldanha U, Aldwinkle R, Chen A, Raut S, Penta D, Valazquez YA, Sen S. Fascia iliaca catheters for donor site pain after split-thickness skin grafting for acute burn injury: a retrospective review. J Burn Care Res 2024:irae052. [PMID: 38512052 DOI: 10.1093/jbcr/irae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Indexed: 03/22/2024]
Abstract
The management of acute burn pain poses significant challenges. Regional techniques have become increasingly popular in perioperative burn pain management. Continuous nerve block catheters are particularly useful for split thickness skin grafts where donor site pain can exceed that of the burn-injured site. Donor skin is frequently harvested from the anterolateral thigh. The fascia iliaca (FI) compartment block provides blockade of both the lateral femoral cutaneous nerve and the femoral nerve and thus, it is a useful modality for burn donor pain. Our institution initiated a protocol in which continuous fascia iliaca catheters were placed in patients undergoing split-thickness skin grafting of the anterolateral thigh. This retrospective review seeks to assess the impact of this modality on post-operative pain scores and opioid requirements. Oral morphine equivalent administration was significantly lower in the FI group than the control group starting with POD 0, which is the day of the FI catheter insertion (188 vs 327mg, p<0.001). Over the next 4 postoperative days, OME administration remained lower in the FI group compared to control patients, although not statistically significant on POD 3-4. There was a significant difference in OME administered between the FI group and the control group on POD 5 (159.5 vs 209.2mg, p<0.05). Our retrospective study evaluating the role of fascia iliaca catheters in burn patients undergoing split thickness skin grafting surgery showed significantly lower opioid consumption on postoperative days 1-5 compared to patients without a fascia iliaca catheter.
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Affiliation(s)
- Usha Saldanha
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Robin Aldwinkle
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Amy Chen
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Snehal Raut
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Deepthi Penta
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Yakelin Arroyo Valazquez
- University of California, Davis School of Medicine, 4610 X Street Sacramento , CA 95817, United States of America
| | - Soman Sen
- Department of Surgery, University of California Medical Center, 2315 Stockton Blvd. Sacramento, CA 95817, United States of America
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Kwon OB, Hwang DW, Kang DH, Yoo SJ, Lee DH, Kwon M, Jang SW, Cho HW, Kim SD, Park KS, Kim ES, Lee YJ, Kim D, Ha IH. Effectiveness of lumbar motion style acupuncture treatment on inpatients with acute low back pain: A pragmatic, randomized controlled trial. Complement Ther Med 2024; 82:103035. [PMID: 38513746 DOI: 10.1016/j.ctim.2024.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND AND PURPOSE This parallel, single-center, pragmatic, randomized controlled study aimed to investigate the effectiveness and safety of motion style acupuncture treatment (MSAT; a combination of acupuncture and Doin therapy) to reduce pain and improve the functional disability of patients with acute low back pain (aLBP) due to road traffic accidents. MATERIALS AND METHODS Ninety-six patients with aLBP admitted to the Haeundae Jaseng Hospital of Korean Medicine in South Korea due to traffic accidents were treated with integrative Korean medicine (IKM) with additional 3-day MSAT sessions during hospitalization (MSAT group, 48 patients) or without (control group, 48 patients), and followed up for 90 days. RESULTS The mean numeric rating scale (NRS) scores of low back pain (LBP) of the MSAT and control groups were both 6.7 (95% confidence interval [CI]: 6.3, 7.1) at baseline. After completing the third round of all applicable treatment sessions (the primary endpoint in this study), the mean NRS scores of the MSAT and control groups were 3.76 (95% CI: 3.54, 3.99) and 5.32 (95% CI: 5.09, 5.55), respectively. The difference in the mean NRS score between the two groups was 1.56 (95% CI: 1.25, 1.87). CONCLUSION IKM treatment combined with MSAT can reduce pain and improve the range of motion of patients with aLBP. TRIAL REGISTRATION This trial is registered at ClinicalTrial.gov (NCT04956458).
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Affiliation(s)
- Oh-Bin Kwon
- Department of Acupuncture & Moxibustion, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Dong Wook Hwang
- Department of Korean Medicine Rehabilitation, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Dong-Hyeob Kang
- Department of Korean Medicine Rehabilitation, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Sang-Joon Yoo
- Department of Korean Medicine Rehabilitation, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Do-Hoon Lee
- Department of Korean Medicine Rehabilitation, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Minjin Kwon
- Department of Internal Korean Medicine, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Seon-Woo Jang
- Department of Oriental Neuropsychiatry, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Hyun-Woo Cho
- Department of Korean Medicine Rehabilitation, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Sang Don Kim
- Department of Korean Medicine Rehabilitation, Haeundae Jaseng Hospital of Korean Medicine, Busan 48102, Republic of Korea
| | - Kyong Sun Park
- Department of Korean Medicine Obstetrics and Gynecology, Jaseng Hospital of Korean Medicine, Seoul 06110, Republic of Korea
| | - Eun-San Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540, Gangnam-gu, Seoul 06110, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540, Gangnam-gu, Seoul 06110, Republic of Korea
| | - Doori Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540, Gangnam-gu, Seoul 06110, Republic of Korea.
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540, Gangnam-gu, Seoul 06110, Republic of Korea.
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Oon MB, Nik Ab Rahman NH, Mohd Noor N, Yazid MB. Patient-controlled analgesia morphine for the management of acute pain in the emergency department: a systematic review and meta-analysis. Int J Emerg Med 2024; 17:37. [PMID: 38454338 PMCID: PMC10921802 DOI: 10.1186/s12245-024-00615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/21/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The ideal pain control approach is typically viewed as titration of analgesia for pain reduction and periodic pain evaluation. However, this method takes time and is not always possible in the crowded Emergency Department. Therefore, an alternative way to improve pain care in the Emergency Department is needed to avoid this unpleasant sensation in the patients. The best solution to tackle this situation is using Patient Controlled Analgesia (PCA), in the form of a PCA pump. STUDY OBJECTIVES This systematic review and meta-analysis was designated to evaluate the efficacy of PCA morphine in treating acute pain at Emergency Department. METHODS We searched databases Cochrane Central Register of Controlled Trials (CENTRAL), Medline, and Google Scholar up to February 2022 and identified randomized controlled trials with English language only that compare PCA morphine to IV morphine in treating patients presenting with acute pain at Emergency Department. RESULTS Eight trials were included in our review, comprising 1490 participants. We compared PCA morphine vs. IV morphine. There were no differences in the pain score between PCA and IV morphine (standard mean difference [SMD] = -0.20, p = 0.25). Further subgroup analyses (origin of the pain, time of assessment and the durations) showed no difference except for the dosages as the PCA morphine reduced the pain compared to IV morphine in low and high dosages but only two studies were involved. However, the analysis showed PCA morphine increased patient satisfaction and reduced the number of patients who required additional analgesia compared to IV morphine (MD 0.12, P < 0.001), (MD 0.47, P < 0.001) respectively. Data obtained in this review pertaining to adverse effects such as nausea, vomiting, pruritus, and drowsiness is limited since not all the trials reported the events. CONCLUSIONS PCA morphine do appear to have a beneficial effect on the outcome of patient satisfaction and the number of patients who required additional analgesia. However, further studies targeting a larger sample size is required to increase the certainty of the evidence.
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Affiliation(s)
- Muhammad Baihaqi Oon
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
| | - Nik Hisamuddin Nik Ab Rahman
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
| | - Mohd Boniami Yazid
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
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Langford R, Pogatzki-Zahn EM, Morte A, Sust M, Cebrecos J, Vaqué A, Ortiz E, Fettiplace J, Adeyemi S, López-Cedrún JL, Bescós S, Gascón N, Plata-Salamán C. Co-crystal of Tramadol-Celecoxib Versus Tramadol or Placebo for Acute Moderate-to-Severe Pain After Oral Surgery: Randomized, Double-Blind, Phase 3 Trial (STARDOM1). Adv Ther 2024; 41:1025-1045. [PMID: 38183526 PMCID: PMC10879371 DOI: 10.1007/s12325-023-02744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Co-crystal of tramadol-celecoxib (CTC) is the first analgesic co-crystal for acute pain. This completed phase 3 multicenter, double-blind trial assessed the efficacy and safety/tolerability of CTC in comparison with that of tramadol in the setting of moderate-to-severe pain up to 72 h after elective third molar extraction requiring bone removal. METHODS Adults (n = 726) were assigned randomly to five groups (2:2:2:2:1): orally administered twice-daily CTC 100 mg (44 mg rac-tramadol hydrochloride/56 mg celecoxib; n = 164), 150 mg (66/84 mg; n = 160) or 200 mg (88/112 mg; n = 160); tramadol 100 mg four times daily (n = 159); or placebo four times daily (n = 83). Participants in CTC groups also received twice-daily placebo. The full analysis set included all participants who underwent randomization. The primary endpoint was the sum of pain intensity differences over 0 to 4 h (SPID0-4; visual analog scale). Key secondary endpoints included 4-h 50% responder and rescue medication use rates. Safety endpoints included adverse events (AEs), laboratory measures, and Opioid-Related Symptom Distress Scale (OR-SDS) score. RESULTS All CTC doses were superior to placebo (P < 0.001) for primary and key secondary endpoints. All were superior to tramadol for SPID0-4 (analysis of covariance least squares mean differences [95% confidence interval]: - 37.1 [- 56.5, - 17.6], - 40.2 [- 59.7, - 20.6], and - 41.7 [- 61.2, - 22.2] for 100, 150, and 200 mg CTC, respectively; P < 0.001) and 4-h 50% responder rate. Four-hour 50% responder rates were 32.9% (CTC 100 mg), 33.8% (CTC 150 mg), 40.6% (CTC 200 mg), 20.1% (tramadol), and 7.2% (placebo). Rescue medication use was lower in the 100-mg (P = 0.013) and 200-mg (P = 0.003) CTC groups versus tramadol group. AE incidence and OR-SDS scores were highest for tramadol alone. CONCLUSIONS CTC demonstrated superior pain relief compared with tramadol or placebo, as well as an improved benefit/risk profile versus tramadol. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02982161; EudraCT number, 2016-000592-24.
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Affiliation(s)
| | | | | | | | | | - Anna Vaqué
- ESTEVE Pharmaceuticals, Barcelona, Spain
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12
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Dunworth S, Barbeito A, Nagavelli H, Higgins D, Edward S, Williams M, Pyati S. Transitional Pain Service: Optimizing Complex Surgical Patients. Curr Pain Headache Rep 2024; 28:141-147. [PMID: 38117461 DOI: 10.1007/s11916-023-01204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW The care of patients with complex postsurgical pain can be challenging and burdensome for the healthcare system. Transitional pain service (TPS) is a relatively new concept and has not been widely adopted in the USA. This article explores the benefits and barriers of transitional pain services and describes the development of a TPS at our institution. RECENT FINDINGS Evidence from a few institutions that have adopted TPS has shown decreased postsurgical opioid consumption for patients on chronic opioids and decreased incidence of chronic postsurgical opioid use for opioid-naïve patients. The development of a transitional pain service may improve outcomes for these complex patients by providing longitudinal and multidisciplinary perioperative pain care. In this article, we describe the implementation of a TPS at a tertiary medical center. Our TPS model involves a multidisciplinary team of anesthesiologists, pain psychologists, surgeons, and advanced practice providers. We provide longitudinal care, including preoperative education and optimization; perioperative multimodal analgesic care; and longitudinal follow-up for 90 days post-procedure. With our TPS service, we aim to reduce long-term opioid use and improve functional outcomes for our patients.
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Affiliation(s)
- Sophia Dunworth
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Atilio Barbeito
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Harika Nagavelli
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Diana Higgins
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Shibu Edward
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Melvania Williams
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Srinivas Pyati
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA.
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA.
- Present address: Department of Anesthesiology, Duke University School of Medicine, Durham Veterans Affairs Healthcare System, PO Box 3094, Durham, NC, 27701, USA.
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Langford R, Margarit C, Morte A, Cebrecos J, Sust M, Ortiz E, Giménez-Arnau JM, de Leon-Casasola O. Co-crystal of tramadol-celecoxib (CTC) for acute moderate-to-severe pain. Curr Med Res Opin 2024; 40:455-468. [PMID: 38205948 DOI: 10.1080/03007995.2023.2276118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE This narrative review aims to provide a clinical perspective on the potential role of co-crystal of tramadol-celecoxib (CTC) in the management of acute moderate-to-severe pain by synthesizing the available preclinical and clinical data, with emphasis on phase 3 trials. METHODS A non-systematic literature review was performed using a targeted PubMed search for articles published between January 1, 2000, and May 2, 2023; all publication types were permitted, and selected articles were limited to those published in English. Search results were manually reviewed to identify references based on their preclinical and clinical relevance to CTC and management of acute moderate-to-severe pain. RESULTS The crystalline structure of CTC alters the physicochemical properties of tramadol and celecoxib, modifying their pharmacokinetics. If taken in a free combination, tramadol reduces absorption of celecoxib. Conversely, administration of CTC slows tramadol absorption and lowers its maximum plasma concentration, while increasing celecoxib plasma concentration through its enhanced release. In clinical studies across models of acute moderate-to-severe pain, CTC demonstrated an early onset of analgesia, with improved efficacy and lower rescue medication use, compared with either agent alone. CTC's safety profile was in line with that expected for the individual components; no additive effects were observed. CTC exhibited tramadol-sparing effects, with efficacy seen at lower daily/cumulative opioid doses vs. tramadol alone. CONCLUSIONS Results from phase 3 trials suggest that the modified physicochemical properties of tramadol and celecoxib in CTC translate into an improved clinical benefit-risk profile, including fewer opioid-related adverse effects due to lower overall opioid dosing.
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Affiliation(s)
| | - Cesar Margarit
- Hospital General Universitario de Alicante, Alicante, Spain
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Borges RB, Caumo W, Bavaresco C, Stefani LPC, Santos VSD, Castro SMDJ. The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study. Braz J Anesthesiol 2024; 74:744425. [PMID: 36894010 DOI: 10.1016/j.bjane.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use. METHODS This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery. RESULTS We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%-90.3%) and specificity of 93.5% (91.5-95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity. CONCLUSIONS These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.
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Affiliation(s)
- Rogério Boff Borges
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Unidade de Bioestatística, Diretoria de Pesquisa, Porto Alegre, RS, Brazil.
| | - Wolnei Caumo
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Laboratório de Dor e Neuromodulação, Porto Alegre, RS, Brazil
| | - Caroline Bavaresco
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil
| | - Luciana Paula Cadore Stefani
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil
| | | | - Stela Maris de Jezus Castro
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Unidade de Bioestatística, Diretoria de Pesquisa, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Instituto de Matemática e Estatística, Departamento de Estatística, Porto Alegre, RS, Brazil
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Cosgun MF, Salviz EA, Bingul ES, Guzel M, Senturk E, Dinc MO, Aktas S, Savran-Karadeniz M. Comparison of ultrasonography-guided lateral versus medial costoclavicular brachial plexus block in pediatric patients : A randomized clinical trial. Anaesthesiologie 2024; 73:93-100. [PMID: 38227022 DOI: 10.1007/s00101-023-01365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/15/2023] [Accepted: 10/27/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND AIMS Costoclavicular brachial plexus block is gaining popularity due to its ease of application. Lateral and medial costoclavicular approaches have recently been defined. In the current study, we aimed to investigate the procedural execution of these approaches in the pediatric population. METHODS In this study 55 children aged between 2 and 10 years were randomized to receive lateral (LC group) or medial (MC group) costoclavicular brachial plexus block after induction of general anesthesia for postoperative analgesia. All patients received bupivacaine (1 mg/kg, 0.25%) within the center of the cord cluster. The number of needle maneuvers was recorded as primary outcome. Block performing features (ideal ultrasound-guided brachial plexus cords visualization, needle pathway planning time, needle tip and shaft visualization difficulty, requirement of extra needle maneuver due to insufficient local anesthetic distribution, block performance time, total procedure difficulty) and postoperative pain-related data (block intensities, pain scores and analgesic requirements) were all compared as secondary outcomes. RESULTS The LC group patients required less ultrasound visualization time (median 14 s, range 11-23 s vs. median 42 s, range 15-67 s, p < 0.001) and fewer needle maneuvers (median 1, range 1-2 vs. median 3, range 2-4, p < 0.001) compared to the MC group. Similarly, the median block performance duration was shorter (median 67 s, range 47-94 s vs. median 140s, 90-204 s, p < 0.01) and procedures were perceived as easier (median 4, range 4-5 vs. median 3, range 2-5, p = 0.04) in the LC group. All other parameters were comparable (p > 0.05). CONCLUSION The lateral approach required less needle maneuvers than the medial approach. Both techniques represented a good safety profile with favorable analgesic features.
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Affiliation(s)
- Mehmet F Cosgun
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul University, 34093, Istanbul, Turkey
| | - Emine A Salviz
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul University, 34093, Istanbul, Turkey
- Department of Anaesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Emre S Bingul
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul University, 34093, Istanbul, Turkey
| | - Mehmet Guzel
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul University, 34093, Istanbul, Turkey
| | - Emre Senturk
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul University, 34093, Istanbul, Turkey
| | - Merve O Dinc
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul University, 34093, Istanbul, Turkey
| | - Salih Aktas
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul University, 34093, Istanbul, Turkey
- Department of Anaesthesiology, Medical Park Hospital, Pendik, Istanbul, Turkey
| | - Meltem Savran-Karadeniz
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul University, 34093, Istanbul, Turkey.
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Guo J, Zhao F, Bian J, Hu Y, Tan J. Low-dose ketamine versus morphine in the treatment of acute pain in the emergency department: A meta-analysis of 15 randomized controlled trials. Am J Emerg Med 2024; 76:140-149. [PMID: 38071883 DOI: 10.1016/j.ajem.2023.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To compare the effectiveness and safety of ketamine and morphine in adult patients with acute pain in emergency department (ED) by using a meta-analysis method. METHODS This study was based on the Cochrane methodology for conducting a meta-analysis. Only randomized controlled trials (RCTs) were eligible for this study, with an experimental group that received low-dose ketamine and a control group that received morphine. The participants were adults who had acute pain in the ED. The primary outcome measures were the numeric rating scale (NRS) and visual analog scale (VAS). The secondary outcome measures were the complete resolution of pain, NRS reduction ≥3 points, NRS reduction ≥50% or 60%, change of NRS score, change of VAS score, rescue analgesia, satisfaction and adverse events. Subgroup analysis was performed for studies with intravenous and intranasal administration of ketamine. The Review Manager Database was used to analyze the included studies. RESULTS 15 RCTs involving 1768 patients were included. The ketamine group had lower NRS scores than morphine group at 30 min (MD, -0.77 [95% CI, -0.93 to -0.61]; p < 0.00001), while the morphine had better analgesic effects at 120 min after treatment (MD, 0.33 [95% CI, 0.15 to 051]; p = 0.0003). The subjects of complete resolution of pain in the ketamine group performed better than those in the morphine group at 15 min (RR 3.18, 95% CI 1.75 to 5.78; p = 0.0001). Compared with the morphine group, the ketamine group had a lower incidence of adverse events requiring intervention (RR, 0.34 [95% CI, 0.18 to 0.66]; p = 0.001). Subgroup analysis of intravenous ketamine showed that ketamine had lower VAS score than the morphine group at 30 min. However, also on the 30-min VAS score, intranasal ketamine analgesia was less effective than morphine. CONCLUSIONS Ketamine had better analgesic effects in the early stages after treatment, while morphine maintained more durable effects. Compared with morphine, ketamine had a lower incidence of adverse events requiring intervention. The results of subgroup analysis showed that intravenous administration of ketamine was more effective than intranasal administration.
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Affiliation(s)
- Juan Guo
- Department of Critical Care Medicine, Changdu People's Hospital of Xizang, 854000 Changdu, Xizang, China
| | - Fei Zhao
- Department of Critical Care Medicine, Changdu People's Hospital of Xizang, 854000 Changdu, Xizang, China
| | - Jinglan Bian
- Department of Critical Care Medicine, Changdu People's Hospital of Xizang, 854000 Changdu, Xizang, China
| | - Yunlong Hu
- Department of Critical Care Medicine, Changdu People's Hospital of Xizang, 854000 Changdu, Xizang, China
| | - Jixiang Tan
- Department of Critical Care Medicine, Changdu People's Hospital of Xizang, 854000 Changdu, Xizang, China; Department of Emergency & Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China.
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Hameed M, Samad K. Response to letter to the editor on "Continuous paravertebral block combined with multilevel single-shot intercostal nerve blocks for pain control after thoracotomy". J Anesth 2024; 38:152-153. [PMID: 38212408 DOI: 10.1007/s00540-023-03308-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Malika Hameed
- Department of Anesthesiology, Aga Khan University, 2nd floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Khalid Samad
- Department of Anesthesiology, Aga Khan University, 2nd floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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Sethi V, Qin L, Cox E, Trocóniz IF, Della Pasqua O. Model-Based Meta-Analysis Supporting the Combination of Acetaminophen and Topical Diclofenac in Acute Pain: A Therapy for Mild-to-Moderate Osteoarthritis Pain? Pain Ther 2024; 13:145-159. [PMID: 38183573 PMCID: PMC10796861 DOI: 10.1007/s40122-023-00569-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/16/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Acetaminophen and topical diclofenac (AtopD) have complementary mechanisms of action and are therefore candidates for combination use in osteoarthritis (OA) pain. However, an evidence gap exists on their combination use in OA pain. This study aimed to assess the effects of this combination and compare its performance relative to monotherapies on pain score reduction and opioid-sparing effect by leveraging evidence from acute pain setting using a model-based meta-analysis (MBMA). METHODS A literature search was conducted using the MEDLINE database to identify randomized controlled trials (RCTs) studying the combination for acute pain. Subsequently, an MBMA of RCTs was implemented in conjunction with extrapolation principles to infer efficacy in the population of interest. Pain score reduction and opioid-sparing effect (OSE) were selected as the measures of efficacy. RESULTS A total of 11 RCTs encompassing 1396 patients were included. Exploratory evaluation revealed AtopD combination to show greater pain score reduction versus acetaminophen monotherapy. However, pain score reduction was more susceptible to confounding by opioid patient-controlled analgesia (PCA) than OSE. Therefore, a parsimonious MBMA evaluating OSE was developed from 5 of the 11 RCTs (n = 353 patients). The analysis revealed a statistically significant interaction coefficient, suggesting a reduction of 32% in opioid use with the combination versus acetaminophen monotherapy. Differences in the effect size of the combination were less conclusive versus diclofenac monotherapy. CONCLUSION Our results indicate greater pain reduction and opioid-sparing efficacy for the AtopD combination versus acetaminophen monotherapy. Given the similar pain pathways and mechanisms of action of the two drugs in acute and mild-to-moderate OA pain, comparable beneficial effects from the combination therapy may be anticipated following extrapolation to chronic OA pain. Prospective RCTs and real-world studies in OA pain are needed to confirm the differences in the efficacy of the combination treatment observed in our study.
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Affiliation(s)
- Vidhu Sethi
- Medical Affairs, Haleon (Formerly GSK Consumer Healthcare), GSK Asia House, Rochester Park, Singapore, 139234, Singapore
| | - Li Qin
- Quantitative Science, Certara, Princeton, USA
| | - Eugène Cox
- Quantitative Science, Certara, Princeton, USA
| | - Iñaki F Trocóniz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Oscar Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, BMA House, Tavistock Square, London, WC1H 9JP, UK.
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK.
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Nguyen AP, Palzes VA, Binswanger IA, Ahmedani BK, Altschuler A, Andrade SE, Bailey SR, Clark RE, Haller IV, Hechter RC, Karmali R, Metz VE, Poulsen MN, Roblin DW, Rosa CL, Rubinstein AL, Sanchez K, Stephens KA, Yarborough BJH, Campbell CI. Association of initial opioid prescription duration and an opioid refill by pain diagnosis: Evidence from outpatient settings in ten US health systems. Prev Med 2024; 179:107828. [PMID: 38110159 PMCID: PMC11046737 DOI: 10.1016/j.ypmed.2023.107828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The Centers for Disease Control and Prevention's 2022 Clinical Practice Guideline for Prescribing Opioids for Pain cautioned that inflexible opioid prescription duration limits may harm patients. Information about the relationship between initial opioid prescription duration and a subsequent refill could inform prescribing policies and practices to optimize patient outcomes. We assessed the association between initial opioid duration and an opioid refill prescription. METHODS We conducted a retrospective cohort study of adults ≥19 years of age in 10 US health systems between 2013 and 2018 from outpatient care with a diagnosis for back pain without radiculopathy, back pain with radiculopathy, neck pain, joint pain, tendonitis/bursitis, mild musculoskeletal pain, severe musculoskeletal pain, urinary calculus, or headache. Generalized additive models were used to estimate the association between opioid days' supply and a refill prescription. RESULTS Overall, 220,797 patients were prescribed opioid analgesics upon an outpatient visit for pain. Nearly a quarter (23.5%) of the cohort received an opioid refill prescription during follow-up. The likelihood of a refill generally increased with initial duration for most pain diagnoses. About 1 to 3 fewer patients would receive a refill within 3 months for every 100 patients initially prescribed 3 vs. 7 days of opioids for most pain diagnoses. The lowest likelihood of refill was for a 1-day supply for all pain diagnoses, except for severe musculoskeletal pain (9 days' supply) and headache (3-4 days' supply). CONCLUSIONS Long-term prescription opioid use increased modestly with initial opioid prescription duration for most but not all pain diagnoses examined.
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Affiliation(s)
- Anh P Nguyen
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States of America.
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States of America; Colorado Permanente Medical Group, Denver, CO, United States of America; Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - Brian K Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, United States of America
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Susan E Andrade
- Meyers Primary Care Health Institute/Fallon Health, Worcester, MA, United States of America
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Robin E Clark
- Department of Family Medicine and Community Health, University of Massachusetts Chan School of Medicine, Worcester, MA, United States of America
| | - Irina V Haller
- Essentia Institute of Rural Health, Duluth, MN, United States of America
| | - Rulin C Hechter
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | | | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Melissa N Poulsen
- Department of Population Health Sciences, Geisinger, Danville, PA, United States of America
| | - Douglas W Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, MD, United States of America
| | - Carmen L Rosa
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States of America
| | - Andrea L Rubinstein
- Department of Pain Medicine, The Permanente Medical Group, Santa Rosa, CA, United States of America
| | - Katherine Sanchez
- Baylor Scott & White Research Institute, Dallas, TX, United States of America; School of Social Work, University of Texas at Arlington, Arlington, TX, United States of America
| | - Kari A Stephens
- Department of Family Medicine, University of Washington, Seattle, WA, United States of America
| | - Bobbi Jo H Yarborough
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States of America
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America; Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States of America
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20
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Jabbari S, Zakaria ZA, Ahmadimoghaddam D, Mohammadi S. The oral administration of Lotus corniculatus L. attenuates acute and chronic pain models in male rats. J Ethnopharmacol 2024; 319:117181. [PMID: 37734474 DOI: 10.1016/j.jep.2023.117181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Lotus corniculatus L. (Fabaceae) traditionally used in Persian folk medicine to heal peritoneal inflammation and back pain. AIM OF THE STUDY To explore the antinociceptive (acute pain) and anti-neuropathic (chronic pain) activities of Lotus corniculatus leaves essential oil (LCEO) in addition to uncovering the possible mechanisms of antinociception. MATERIALS AND METHODS LCEO as well as the pure oleanolic acid (OA) compound, were assayed for their effects on acute (formalin induced paw licking test or FIPT) and chronic (cervical contusion injury models on the fifth cervical vertebra or CCS; 14-day intervals) pain. The possible involvements of NO-cGMP-K+ channel, TRPV, dopamine, cannabinoid, PPAR, adrenergic, and opioid mechanisms in the antinociceptive activity of LCEO have studied by formalin test. The levels of p53 and inflammatory markers were measured using a streptavidin biotin immune peroxidase complex and ELISA methods, respectively. RESULTS The LCEO and OA exerted antinociceptive activity in the first-phase of FIPT. Pretreatment with antagonists of TRPV1, dopamine D2, cannabinoid type1 and 2, and NO-cGMP-K+ channel blockers (glibenclamide, L-NAME and methylene blue) attenuated the antinociceptive effect of LCEO in FIPT. In addition, LCEO and OA meaningfully reduced hyperalgesia (days 6-14) and mechanical allodynia (days 2-14) in the CCS model. LCEO suppressed the apoptotic marker (p53) in CCS model and also ameliorated IL-2, TNF-α, and IL-1 in the spinal cord. CONCLUSION Finally, LCEO inhibited acute (possibly via the modulation of opioid, TRPV, dopamine, cannabinoid mechanisms as well as NO-cGMP-K+ channel) and chronic pain (via suppressing apoptotic and inflammatory markers) in male rats. The results also suggest that OA has analgesic activity against acute and chronic pain conditions.
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Affiliation(s)
- Sajjad Jabbari
- Department of Biology, Faculty of Sciences, Islamic Azad University, Tehran North Branch, Tehran, Iran.
| | - Zainul Amiruddin Zakaria
- Borneo Research on Algesia, Inflammation and Neurodegeneration (BRAIN) Group, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia.
| | - Davoud Ahmadimoghaddam
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Saeed Mohammadi
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
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21
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Shepherd WS, Wiese AD, Cho HE, Rork WC, Baig MU, Kostick KM, Nguyen D, Carter EM, Murali CN, Robinson ME, Schneider SC, Lee B, Sutton VR, Storch EA. Psychosocial Outcomes of Pain and Pain Management in Adults with Osteogenesis Imperfecta: A Qualitative Study. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09991-z. [PMID: 38281305 DOI: 10.1007/s10880-023-09991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/30/2024]
Abstract
Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and fractures, short stature, dental abnormalities, hearing loss, scoliosis, and chronic pain. Despite a growing literature on the functional outcomes of OI, limited research has explicitly examined the psychosocial outcomes of pain within OI. Adults with OI (N = 15) were interviewed to understand pain-related experiences through a thematic analysis of semi-structured interview data. Research team members, genetic research experts, and OI clinicians developed an interview guide focused on topics related to pain and mental health challenges. Participants' transcripts were coded by two independent coders; codes were then merged across coders and quotation outputs were subsequently abstracted (paraphrased then thematically classified) to identify common themes. Themes related to pain management variability regarding pain type, pain risk management and accessibility, pain outcomes (e.g., behavior, cognitive, affective), and pain exacerbating factors (e.g., individual, contextual) were identified. Participants reported chronic and acute pain, and despite the inaccessibility and stigmatization of pain medications (e.g., opioids), pharmacological treatments were the most common pain management approach. Participants reported negative pain outcomes, such as limited daily functioning and activity participation, fear, anger, anxiety, depression, and difficulty concentrating. Lastly, participants suggested that lack of physician and community knowledge on chronic pain in OI indirectly exacerbates both subjective pain intensity and outcomes. Although limited by a small, nondiverse sample, the current study provides valuable exploration of the unique pain experiences of adults with OI that may have implications for proactive management, treatment development, and clinician training.
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Affiliation(s)
- Whitney S Shepherd
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Hannah E Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - W Conor Rork
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - M Usman Baig
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Kristin M Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Dianne Nguyen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Erin M Carter
- Hospital for Special Surgery, New York City, NY, USA
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | | | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA.
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22
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Beck M, Schreiber KL, Wilson JM, Flowers KM, Edwards RR, Chai PR, Azizoddin DR. A secondary analysis: the impact of pre-existing chronic pain among patients with cancer presenting to the emergency department with acute pain. Support Care Cancer 2024; 32:129. [PMID: 38270721 DOI: 10.1007/s00520-024-08314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Patients with cancer may experience pain from cancer itself or its treatment. Additionally, chronic pain (CP) predating a patient's cancer diagnosis may make the etiology of pain less clear and the management of pain more complex. In this brief report, we investigated differences in biopsychosocial characteristics, pain severity, and opioid consumption, comparing groups of cancer patients with and without a history of CP who presented to the emergency department (ED) with a complaint of cancer-related pain. METHODS This secondary analysis of a prospective cohort study included patients with cancer who presented to the ED with a complaint of pain (≥ 4/10). Sociodemographic, clinical, psychological, and pain characteristics were assessed in the ED and subsequent hospitalization. Mann-Whitney U-, T-, and Chi-square tests were used to compare differences between patients with and without pre-existing CP before cancer. RESULTS Patients with pre-existing CP had lower income (p = 0.21) and less formal education (p = 0.25) and were more likely to have a diagnosis of depression or substance use disorder (p < 0.01). Patients with pre-existing CP reported significantly greater pain severity in the ED and during hospitalization compared to those without pre-existing CP (p < 0.05), despite receiving greater amounts of opioid analgesics (p = 0.036). CONCLUSION Identifying a history of pre-existing CP during intake may help identify patients with cancer with difficult to manage pain, who may particularly benefit from multimodal interventions and supportive care. In addition, referral of these patients for the management of co-occurring pain disorders may help decrease the usage of the ED for undertreated pain.
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Affiliation(s)
- Meghan Beck
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Desiree R Azizoddin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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23
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Talbot J, Stuckey R, Wood N, Gordon A, Crossingham G, Weatherby S. Switching anti-CGRP monoclonal antibodies in chronic migraine: real-world observations of erenumab, fremanezumab and galcanezumab. Eur J Hosp Pharm 2024:ejhpharm-2023-003779. [PMID: 38182276 DOI: 10.1136/ejhpharm-2023-003779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVES The anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAb) are effective in migraine; however, few studies have examined the benefit of switching from one anti-CGRP-mAb to another. In order to better inform clinical practice in this situation, we present our real-world findings of switching anti-CGRP-mAb in chronic migraine. METHODS Individuals with chronic migraine that switched anti-CGRP-mAb treatment (erenumab, fremanezumab or galcanezumab) due to ineffectiveness or adverse effects were retrospectively identified. Headache diary data before and up to 6 months after anti-CGRP-mAb switch were analysed. Main outcome measures were monthly red days (days with headaches limiting activity or requiring triptans), headache days (days with any kind of headache), triptan use, other analgesic use and headache disability (Headache Impact Test-6 (HIT-6) score) at 3 months. RESULTS The analysis included 66 instances of switching among 54 individuals. There were non-significant reductions of -1.2 (-2.7, 0.3) red days from baseline at 3 months, with 10 individuals (15%) showing ≥50% improvement and 22 (33%) experiencing a ≥30% improvement. Improvements in headache days, triptan days, other painkiller use and HIT-6 score were non-significant. When individuals that switched due to side effects were excluded from the analysis, significant reductions in headache (Friedman p=0.044) and a trend for improvement in red days (Friedman p=0.083) were observed. With regard to side effects, on 12 occasions these improved or resolved on switching to a different anti-CGRP-mAb, while new symptoms were reported on eight occasions following a switch. CONCLUSION We recorded modest improvements in headache outcomes, although significant results were only observed in those that switched anti-CGRP-mAb due to ineffectiveness. Switching may therefore be a viable option for these individuals.
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Affiliation(s)
- Jamie Talbot
- Department of Neurology, Derriford Hospital, Plymouth, UK
- University of Birmingham, Birmingham, UK
| | | | - Natasha Wood
- Department of Neurology, Derriford Hospital, Plymouth, UK
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24
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Goswami D, Arora MK, Iyer KV, Tangirala NR, Sharma JB, Kumar S, Kalaivani M. To assess the analgesic efficacy of adjuvant magnesium sulfate added with ropivacaine over ropivacaine alone as a continuous infiltration in total abdominal hysterectomy wound: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2024; 40:140-146. [PMID: 38666179 PMCID: PMC11042103 DOI: 10.4103/joacp.joacp_239_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/02/2022] [Accepted: 11/24/2022] [Indexed: 04/28/2024] Open
Abstract
Background and Aims Magnesium sulfate (MgSO4) has been demonstrated to have analgesic property in various clinical settings. This study explores if addition of MgSO4 to ropivacaine increases its analgesic efficacy when infiltrated continuously in the postsurgical wound following total abdominal hysterectomy. Material and Methods This randomized controlled trial was conducted at a tertiary care referral hospital in New Delhi, India. Fifty-two patients were randomized into two groups to receive the intervention of which 48 were able to complete the study. The first group (n = 26) received 0.25% ropivacaine infiltration and the second group (n = 26) received 0.25% ropivacaine with 5% MgSO4 at the incision site for 48 h postoperatively. Primary objective was to compare the total postoperative opioid (morphine) consumption by the study participants in both the groups and the secondary objectives were pain scores at rest and at movement, patient satisfaction score, and wound quality of life on the 7th postoperative day among the two groups. Results Both the groups were comparable in their demographic characteristics. The median morphine consumed at 48 h postoperatively was 16.5 [0-77] mg in the ropivacaine group and 13[1-45] mg in the ropivacaine with MgSO4 group and the difference was statistically insignificant (P = 0.788). There was no statistical difference between the groups with respect to the pain scores, patient satisfaction, or wound quality of life at 7 days. Conclusion The addition of MgSO4 to ropivacaine does not confer any additional postoperative analgesic benefits over ropivacaine alone in continuous wound infiltration following total abdominal hysterectomy.
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Affiliation(s)
- Devalina Goswami
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Mahesh K. Arora
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Karthik V. Iyer
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | | | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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25
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Marmor MT, Mahadevan V, Solans BP, Floren A, Jarlsberg L, Cohen I, Savic R. Inpatient pain alleviation after orthopaedic trauma surgery-are we doing a good job? Eur J Orthop Surg Traumatol 2024; 34:569-576. [PMID: 37650973 DOI: 10.1007/s00590-023-03670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Poor pain alleviation (PPA) after orthopaedic surgery is known to increase recovery time, readmissions, patient dissatisfaction, and lead to chronic postsurgical pain. This study's goal was to identify the magnitude of PPA and its risk factors in the orthopaedic trauma patient population. METHODS A single-institution's electronic medical records from 2015 to 2018 were available for retrospective analysis. Inclusion criteria included orthopaedic fracture surgery patients admitted to the hospital for 24 h or more. Collected variables included surgery type, basic demographics, comorbidities, inpatient medications, pain scores, and length of stay. PPA was defined as a pain score of ≥ 8 on at least three occasions 4-12 h apart. Associations between collected variables and PPA were derived using a multivariable logistic regression model and expressed in adjusted odds ratios. RESULTS A total of 1663 patients underwent fracture surgeries from 2015 to 2018, and 25% of them reported PPA. Female sex, previous use of narcotics, increased ASA, increased baseline pain score, and younger age without comorbidities were identified as significant risk factors for PPA. Spine procedures were associated with increased risk of PPA, while procedures in the hip, shoulder, and knee had reduced risk. Patients experiencing PPA were less likely to receive NSAIDs compared to other pain medications. CONCLUSIONS This study found an unacceptably high rate of PPA after fracture surgery. While the identified risk factors for PPA were all non-modifiable, our results highlight the necessity to improve application of current multimodal approaches to pain alleviation including a more personalized approach to pain alleviation.
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Affiliation(s)
- Meir T Marmor
- Department of Orthopedic Surgery, University of California, 2550 23rd Street, San Francisco, CA, 94110, USA.
| | - Varun Mahadevan
- Department of Orthopedic Surgery, University of California, 2550 23rd Street, San Francisco, CA, 94110, USA
| | - Belén P Solans
- Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA
| | - Alexander Floren
- Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA
| | - Leah Jarlsberg
- Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA
| | - Isaac Cohen
- Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA
| | - Rada Savic
- Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA
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Bellosta-López P, Doménech-García V, Ortiz-Lucas M, Lluch-Girbés E, Herrero P, Sterling M, Christensen SWM. Longitudinal Changes and Associations Between Quantitative Sensory Testing and Psychological Factors in Whiplash-Associated Disorders: A Systematic Review and Meta-Analyses-Based Data Synthesis. J Pain 2024; 25:12-30. [PMID: 37517451 DOI: 10.1016/j.jpain.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Whiplash-associated disorders (WAD) represent a multifactorial condition often accompanied by altered nociceptive processing and psychological factors. This systematic review on acute and chronic WAD aimed to investigate the relationship between quantitative sensory testing (QST) and psychological factors and quantify whether their trajectories over time follow a similar pattern to disability levels. Eight databases were searched until October 2022. When 2 prospective studies examined the same QST or psychological variable, data synthesis was performed with random-effects meta-analysis by pooling within-group standardized mean differences from baseline to 3-, 6-, and 12-month follow-ups. From 5,754 studies, 49 comprising 3,825 WAD participants were eligible for the review and 14 for the data synthesis. Altered nociceptive processing in acute and chronic WAD, alongside worse scores on psychological factors, were identified. However, correlations between QST and psychological factors were heterogeneous and inconsistent. Furthermore, disability levels, some QST measures, and psychological factors followed general positive improvement over time, although there were differences in magnitude and temporal changes. These results may indicate that altered psychological factors and increased local pain sensitivity could play an important role in both acute and chronic WAD, although this does not exclude the potential influence of factors not explored in this review. PERSPECTIVE: Acute WAD show improvements in levels of disability and psychological factors before significant improvements in nociceptive processing are evident. Facilitated nociceptive processing might not be as important as psychological factors in chronic WAD-related disability, which indicates that chronic and acute WAD should not be considered the same entity although there are similarities. Nonetheless, pressure pain thresholds in the neck might be the most appropriate measure to monitor WAD progression.
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Affiliation(s)
- Pablo Bellosta-López
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Víctor Doménech-García
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - María Ortiz-Lucas
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Pablo Herrero
- iHealthy Research Group. IIS Aragon/University of Zaragoza. Department of Physiatry and Nursing. Faculty of Health Sciences, Zaragoza, Spain
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Herston, Australia; Centre of Research Excellence, Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Steffan W M Christensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
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Zarnegar R, Vounta A, Li Q, Ghoreishizadeh SS. Nociception related biomolecules in the adult human saliva: A scoping review with additional quantitative focus on cortisol. Mol Pain 2024; 20:17448069241237121. [PMID: 38385158 PMCID: PMC10916496 DOI: 10.1177/17448069241237121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
Nociception related salivary biomolecules can be useful patients who are not able to self-report pain. We present the existing evidence on this topic using the PRISMA-ScR guidelines and a more focused analysis of cortisol change after cold pain induction using the direction of effect analysis combined with risk of bias analysis using ROBINS-I. Five data bases were searched systematically for articles on adults with acute pain secondary to disease, injury, or experimentally induced pain. Forty three articles met the inclusion criteria for the general review and 11 of these were included in the cortisol-cold pain analysis. Salivary melatonin, kallikreins, pro-inflammatory cytokines, soluable TNF-α receptor II, secretory IgA, testosterone, salivary α-amylase (sAA) and, most commonly, cortisol have been studied in relation to acute pain. There is greatest information about cortisol and sAA which both rise after cold pain when compared with other modalities. Where participants have been subjected to both pain and stress, stress is consistently a more reliable predictor of salivary biomarker change than pain. There remain considerable challenges in identifying biomarkers that can be used in clinical practice to guide the measurement of nociception and treatment of pain. Standardization of methodology and researchers' greater awareness of the factors that affect salivary biomolecule concentrations are needed to improve our understanding of this field towards creating a clinically relevant body of evidence.
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Affiliation(s)
- Roxaneh Zarnegar
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Angeliki Vounta
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Qiuyuan Li
- Department of Rehabilitation, Shenzhen University General Hospital, Shenzhen, China
| | - Sara S Ghoreishizadeh
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Department of Electronic and Electrical Engineering, University College London, London, UK
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Nair A, Dudhedia U, Thakre M, Borkar N. Efficacy of memantine premedication in alleviating postoperative pain- A systematic review and meta-analysis. Saudi J Anaesth 2024; 18:86-94. [PMID: 38313717 PMCID: PMC10833015 DOI: 10.4103/sja.sja_398_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/30/2023] [Accepted: 06/04/2023] [Indexed: 02/06/2024] Open
Abstract
Many premedication agents with opioid-sparing properties have been used in patients undergoing various elective surgeries. Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist that has been used by many researchers as an opioid-sparing strategy. Various databases like PubMed, Scopus, Cochrane Library, and clinicaltrials.gov were searched after registering the review protocol in PROSPERO for randomized-controlled trials (RCTs) that investigated the efficacy and safety of memantine premedication in adult patients undergoing various elective surgeries. The risk of bias (RoB-2) scale was used to assess the quality of evidence. From the 225 articles that were identified after a database search, 3 studies were included for a qualitative systematic review and a quantitative meta-analysis. The pooled analysis revealed that the use of memantine provided better pain scores at 2nd (mean difference: -0.82, 95% CI: -1.60, -0.05, P = 0.04) with significant heterogeneity (P = 0.06; I² =71%), and 6 hours postoperatively (mean difference: -1.80, 95% CI: -2.23, -1.37, P < 0.00001), but not at 1 hour. The sedation scores at 1 hour were higher in the memantine group but comparable in the 2nd hour. The number of doses of rescue analgesia and nausea/vomiting in the postoperative period was comparable in both groups. The results of this review suggest that memantine premedication could provide better pain scores in the immediate postoperative period with acceptable adverse effects. However, the current evidence is insufficient to suggest the routine use of memantine as a premedication before elective surgeries.
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Affiliation(s)
- Abhijit Nair
- Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman, Ibra-414, Sultanate of Oman
| | - Ujjwalraj Dudhedia
- Department of Anaesthesiology and Pain Management, Dr. L. H. Hiranandani Hospital, Powai Mumbai, Maharashtra State, India
| | - Manish Thakre
- Department of Psychiatry, Government Medical College, Nagpur, Maharashtra State, India
| | - Nitinkumar Borkar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Zheng HY, Chen YM, Xu Y, Cen C, Wang Y. Excitatory neurons in the lateral parabrachial nucleus mediate the interruptive effect of inflammatory pain on a sustained attention task. J Transl Med 2023; 21:896. [PMID: 38072957 PMCID: PMC10712130 DOI: 10.1186/s12967-023-04583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Attentional deficits are among the most common pain-induced cognitive disorders. Pain disrupts attention and may excessively occupy attentional resources in pathological states, leading to daily function impairment and increased disability. However, the neural circuit mechanisms by which pain disrupts attention are incompletely understood. METHODS We used a three-choice serial reaction time task (3CSRTT) to construct a sustained-attention task model in male C57BL/6J mice. Formalin or complete Freund's adjuvant was injected into a paw to establish an inflammatory pain model. We measured changes in 3CSRTT performance in the two inflammatory pain models, and investigated the neural circuit mechanisms of pain-induced attentional deficits. RESULTS Acute inflammatory pain impaired 3CSRTT performance, while chronic inflammatory pain had no effect. Either inhibition of the ascending pain pathway by blockade of the conduction of nociceptive signals in the sciatic nerve using the local anesthetic lidocaine or chemogenetic inhibition of Ca2+/calmodulin-dependent protein kinase IIα (CaMKIIα) neurons in the lateral parabrachial nucleus (LPBN) attenuated the acute inflammatory pain-induced impairment of 3CSRTT performance, while chemogenetic activation of CaMKIIα neurons in the LPBN disrupted the 3CSRTT. Furthermore, the activity of CaMKIIα neurons in the LPBN was significantly lower on Day 2 after complete Freund's adjuvant injection than on the day of injection, which correlated with the recovery of 3CSRTT performance during chronic inflammatory pain. CONCLUSIONS Activation of excitatory neurons in the LPBN is a mechanism by which acute inflammatory pain disrupts sustained attention. This finding has implications for the treatment of pain and its cognitive comorbidities.
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Affiliation(s)
- Huan-Yu Zheng
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China
| | - Yu-Meng Chen
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China
| | - Yao Xu
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China
| | - Cheng Cen
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China.
| | - Yun Wang
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China.
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China.
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Kumar S, Hameed M, Shehzad R, Samad K. The comparison of the analgesic efficacy of continuous paravertebral block alone compared with continuous paravertebral and intercostal nerve block for thoracotomy in adults: a randomized controlled trial. J Anesth 2023; 37:923-929. [PMID: 37747499 DOI: 10.1007/s00540-023-03255-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The study aims to compare the analgesic efficacy of two analgesic interventions, continuous paravertebral (PVB) nerve block alone with continuous paravertebral and intercostal nerve block (PVB/ICB) in patients undergoing thoracotomy. METHODS A total of 70 patients undergoing thoracotomy were randomly enrolled in either continuous paravertebral nerve block (PVB) group or in continuous paravertebral and intercostal nerve block (PVB/ICB) group and received corresponding blocks. Analgesic efficacy measured by Visual Analog Scale (VAS) pain score, hemodynamic effects, total narcotic consumption, sedation score, patient's length of stay in hospital and patient's satisfaction with the analgesic technique were recorded. RESULTS Demographic characteristics of the patients were similar in both groups. The mean VAS pain score was not statistically significant in both groups at 24 h. The mean pulse rate and blood pressures were comparable in both groups for the first 24 h. Nalbuphine consumption was significantly higher in PVB group as compared to PVB/ICB group at 1 h (p = 0.01), 6 h (p = 0.03) and 12 h (p = 0.009) and 24 h (p = 0.03). The mean total nalbuphine consumption in the PVB group was higher (28.29 mg vs. 22.63 mg) and statistically significant then PVB/ICB group (p = 0.03). The total tramadol consumption as a rescue analgesic was higher in the PVB group (131.42 mg) as compared to PVB/ICB group (120 mg) after 24 h but not statistically significant (p = 0.17). CONCLUSION Continuous paravertebral nerve block with intercostal nerve block provides effective post-operative pain relief after thoracotomy with reduced narcotic consumption compared to continuous paravertebral nerve block alone. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrails.gov NCT04715880.
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Affiliation(s)
- Sundeep Kumar
- Department of Anesthesiology, Aga Khan University, 2nd Floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Malika Hameed
- Department of Anesthesiology, Aga Khan University, 2nd Floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Rizwana Shehzad
- Department of Anesthesiology, Aga Khan University, 2nd Floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Khalid Samad
- Department of Anesthesiology, Aga Khan University, 2nd Floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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Noyek S, Lund T, Jordan A, Hoppe T, Mitchell R, Mitchell R, Stinson J, Noel M. Exploring the Lived Experiences of Pain in Military Families: A Qualitative Examination. J Pain 2023; 24:2340-2351. [PMID: 37473902 DOI: 10.1016/j.jpain.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
Chronic pain in Canadian Veterans is twice that of the general population and the prevalence of their related mental health concerns is alarmingly high. This likely puts their children at an increased risk of developing pain and mental health problems that can pervasively impact daily life and persist into adulthood. Pain care and military culture of (acute and chronic) pain have been identified as a top priority of Canadian Veterans. This study aimed to gain an in-depth understanding of the pain experiences of Canadian Armed Forces families. Thirty-five semi-structured qualitative interviews were conducted. Demographic information was collected; age, gender, and ethnicity were reported. Twelve Canadian Armed Forces members/Veterans, 17 youth, and 6 spouses were interviewed. Ninety-two percent of Veteran participants reported chronic pain. Reflexive thematic analyses generated four themes: 1) Military mindset: herd culture and solider identity, 2) The culture of pain within military families, 3) Inseparability of mental health and pain, and 4) Breaking the cycle and shifting the military mindset. Military culture and identity create a unique context within which pain expression and experience is integrally shaped within these families. This study sheds light on how pain is experienced and perceived within military families and can inform research on and efforts to foster resilience in these families. PERSPECTIVE: This is the first qualitative study to explore the lived experiences of pain in Canadian military families. Findings underscore the key role that military culture and identity plays in how pain is experienced and perceived in all family members.
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Affiliation(s)
- Samantha Noyek
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Tatiana Lund
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Tom Hoppe
- The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Canada
| | - Rebekah Mitchell
- The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Canada
| | - Ryan Mitchell
- The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Canada
| | - Jennifer Stinson
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada
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Ruhe MM, Veldhuis LI, Azijli-Abdelloui K, Schepers T, Ridderikhof ML. Prehospital analgesia in suspected hip fracture patients: adherence to national prehospital pain management guidelines. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02385-8. [PMID: 37957364 DOI: 10.1007/s00068-023-02385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Patients with hip fractures frequently present at the emergency department (ED). Despite high pain scores, prehospital pain management is often inadequate and insufficient. In the Netherlands, the emergency medical services (EMS) exhibit a high level of training, supported by a comprehensive pain treatment protocol. This study aimed to assess adherence to the protocol and hypothesized that prehospital pain management in hip fracture patients was both sufficient and adequate. METHODS This was a retrospective observational cohort study of patients with suspected hip fractures. The median differences in numerical rating scale (NRS) pain scores between the initial score in the ambulance and upon arrival at the ED were compared. Furthermore, adherence to the ambulance pain protocol was studied. RESULTS From September 2016 to March 2021, 436 ambulance-transported hip fracture patients were included, of whom 81% received analgesics by EMS. The median initial pain score measured by EMS was 8; this number decreased to 5 at ED presentation, a significant decrease (ρ < 0.001). In case a prehospital NRS pain score was assessed, 66.5% of the patients were treated according to the protocol. In 80% of patients, the protocol was not followed correctly, primarily due to missing NRS pain scores. CONCLUSION In suspected hip fracture patients, initial prehospital pain scores were high and most patients received analgesics from EMS. This resulted in a significant decrease in pain. In nearly 67% of patients in whom an NRS pain score was assessed in the prehospital phase, pain management was according to protocol. However, in 80% of the total population the pain protocol was not adhered to, mainly due to missing NRS pain scores.
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Affiliation(s)
- Michelle Manon Ruhe
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Lars I Veldhuis
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Kaoutar Azijli-Abdelloui
- Department of Emergency Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
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Sultan E, Sarno D, Nelson ER. Simulation-Based Education in Acute and Chronic Pain Training. Curr Pain Headache Rep 2023; 27:639-643. [PMID: 37715889 DOI: 10.1007/s11916-023-01164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE OF REVIEW The use of simulation-based education (SBE) in medical training has expanded greatly and has grown to include high fidelity and task simulation along with hybrid models using patient actors to enhance education and training of critical events as well as technical skills. RECENT FINDINGS In the field of anesthesiology, SBE has been particularly useful for crisis resource management and rare critical scenarios and new research into the use of SBE using task simulation for procedural skill development has been done highlighting the benefits to subspecialty procedural training. Medical simulation has become a common practice in medical training and research. SBE has demonstrated positive outcomes in improving technical skills, knowledge, comfort, and clinical performance. The widespread implementation of SBE in regional anesthesia and chronic pain training varies, with cost and availability being factors. Nonetheless, SBE has shown great potential in enhancing education and preparing physicians in subspecialties of anesthesia.
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Affiliation(s)
- Ellile Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Danielle Sarno
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Ehren R Nelson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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Didvar F, Ghaffari F, Shamsalinia A. Evaluating and Ranking the Factors Affecting the Acute Pain Management in Older Adults with Dementia after Hip Fracture Surgery: Second-Order Confirmatory Factor Analysis. Iran J Nurs Midwifery Res 2023; 28:751-757. [PMID: 38205413 PMCID: PMC10775869 DOI: 10.4103/ijnmr.ijnmr_386_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/20/2023] [Accepted: 05/31/2023] [Indexed: 01/12/2024]
Abstract
Background Even though nurses take various measures to decrease acute pain after surgery in older adults with dementia, it is unclear why most of them suffer from severe pain. This study aimed to evaluate the factors affecting acute pain management in older adults with dementia after hip fracture surgery. Materials and Methods This cross-sectional study used single-stage cluster and convenience sampling to select 330 nurses working in hospitals located in Western Mazandaran, Iran, in 2020. The demographic characteristic questionnaire and the Obstacles to Postoperative Pain Management in Dementia Scale (OPOPMDS) were used to collect data. Results The study results confirmed the modified model. The second-order Confirmatory Factor Analysis (CFA) indicated that the Critical Ratio (CR) for all three factors was more than 1.96, and the significance level was considered 0.05. Based on the values of standard coefficients, older people-related (β = 0.86, p < 0.001), system-related (β = 0.70, p < 0.001), and healthcare provider-related (β = 0.61, p < 0.001) factors had the highest impacts on the OPOPMD. Conclusions The study results suggested that older adult-related factors had the most significant impact on the OPOPMD.
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Onesimo R, Sforza E, Bedeschi MF, Leoni C, Giorgio V, Rigante D, De Rose C, Kuczynska EM, Romeo DM, Palmacci O, Massimi L, Porro M, Gonfiantini MV, Selicorni A, Allegri A, Maghnie M, Zampino G. How pain affect real life of children and adults with achondroplasia: A systematic review. Eur J Med Genet 2023; 66:104850. [PMID: 37758167 DOI: 10.1016/j.ejmg.2023.104850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/11/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
The clinical features of achondroplasia can cause acute self-limited pain that can evolve into chronic pain. Pain causes a low quality of life, in terms of physical, emotional, social, and school functioning in both adult and children with achondroplasia. We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement to describe prevalence, assessment tools, causes and management strategies of pain in this rare disease. We found that shoulder and knee pain is typically referred during infancy, while knee pain is generally referred around 5-6 years of age. The prevalence of general pain in adolescence can be as high as 90%. Chronic pain in the achondroplasia population increases with age, with up to 70% of adults reporting general pain and back pain. Recognizing the multiple determinants of acute and chronic pain in patients with achondroplasia may enable physicians to better understand and manage this burden, particularly with the advent of new drugs that may modify some of the striking features of achondroplasia.
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Affiliation(s)
- Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | | | | | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | - Valentina Giorgio
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica Del Sacro Cuore, Rome, 00168, Italy.
| | - Donato Rigante
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | - Cristina De Rose
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | - Eliza Maria Kuczynska
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | - Domenico Marco Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168, Rome, Italy; Pediatric Neurology Unit, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy.
| | - Osvaldo Palmacci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica Del Sacro Cuore, Rome, Italy.
| | - Luca Massimi
- Neurochirurgia Pediatrica, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy; Dipartimento di Neuroscienze, Università Cattolica Del Sacro Cuore, Italy.
| | - Matteo Porro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Service, Milan, Italy.
| | | | - Angelo Selicorni
- Department of Paediatrics, Presidio S. Fermo, ASST Lariana, Como, Italy.
| | - Anna Allegri
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS IstitutoGianninaGaslini, 16147, Genoa, Italy.
| | - Mohamad Maghnie
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS IstitutoGianninaGaslini, 16147, Genoa, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132, Genoa, Italy.
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
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Sammons T, Shanks S. Efficacy of red low-level laser for postoperative pain management: A review of literature. J Perioper Pract 2023; 33:350-357. [PMID: 36394302 DOI: 10.1177/17504589221124757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Many patients who undergo surgical procedures experience acute postoperative pain, with less than half receiving adequate pain relief. Recent advancements in postoperative pain management include the market clearance by the US Food and Drug Administration for the utilisation of red low-level laser therapy in providing postoperative pain relief. The Food and Drug Administration market clearance was based on clinical data from randomised controlled trials that supported the safety and effectiveness of visible red laser therapy across various surgical procedures. This review of literature aims to evaluate the mechanisms of action, the dose-response curves and clinical outcomes of red low-level laser for postoperative pain management. A literature search was limited to randomised controlled trials that evaluated the use of red low-level laser therapy on postoperative pain. The results from the literature search found that seven studies met the search qualifications. The literature review findings demonstrated that red low-level laser therapy is a safe and effective treatment alternative for postoperative pain management. In addition to postoperative pain reduction, the findings of the literature revealed that red low-level laser therapy may promote healing and reduce the consumption of postoperative prescription analgesic drugs.
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Kawji Y, Almoaswes H, Bise C, Kawji L, Murphy A, Reed TD, Klapper RJ, Ahmadzadeh S, Shekoohi S, Cornett EM, Kaye AD. Electronic Health Record Recording of Patient Pain: Challenges and Discrepancies. Curr Pain Headache Rep 2023; 27:737-745. [PMID: 37740879 DOI: 10.1007/s11916-023-01170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE OF REVIEW In the present review, various categories of pain, clinician-observed pain scales, and patient-reported pain scales are evaluated to better understand factors that impact patient pain perceptions. Additionally, the expansion of areas that require further research to determine the optimal way to evaluate pain scale data for treatment and management are discussed. RECENT FINDINGS Electronic health record (EHR) data provides a starting point for evaluating whether patient predictors influence postoperative pain. There are several ways to assess pain and choosing the most effective form of pain treatment. Identifying individuals at high risk for severe postoperative pain enables more effective pain treatment. However, there are discrepancies in patient pain reporting dependent on instruments used to measure pain and their storage in the EHR. Additionally, whether administered by a physician or another healthcare practitioner, differences in patient pain perception occur. While each scale has distinct advantages and limitations, pain scale data is a valuable therapeutic tool for assisting clinicians in providing patients with optimal pain control. Accurate assessment of patient pain perceptions by data extraction from electronic health records provides a potential for pain alleviation improvement. Predicting high-risk postoperative pain syndromes is a difficult clinical challenge. Numerous studies have been conducted on factors that impact pain prediction. Postoperative pain is significantly predicted by the kind of operation, the existence of prior discomfort, patient anxiety, and age.
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Affiliation(s)
- Yasmeen Kawji
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Hanna Almoaswes
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Claire Bise
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Lena Kawji
- Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Adrienne Murphy
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Tanner D Reed
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Rachel J Klapper
- Department of Radiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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Jones J, Lee K, Jones M, Gadsden J. Lower Extremity Peripheral Nerve Blocks for Patients at Risk for Acute Compartment Syndrome. Orthop Clin North Am 2023; 54:417-425. [PMID: 37718081 DOI: 10.1016/j.ocl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
A delayed acute compartment syndrome (ACS) diagnosis often results in devastating complications; however, the sensitivity of the classic signs and symptoms is very low. All analgesic modalities have been implicated in delaying the diagnosis, but there is very little evidence linking peripheral nerve blocks (PNBs) with delays in diagnosis. In fact, there is evidence that PNBs may facilitate an early diagnosis; this may be in part due to differences in how ischemic and inflammatory pain is transmitted through unique nociceptive pathways. Collaboration is required to optimize care for patients at risk for ACS.
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Affiliation(s)
- Jerry Jones
- East Memphis Anesthesia Services, Department of Anesthesiology, University of Tennessee Health Science Center, Memphis, USA.
| | - Kevin Lee
- College of Medicine, The University of Tennessee Health Science Center, Memphis, USA
| | - Madeline Jones
- College of Arts and Sciences, The University of Tennessee, Knoxville, USA
| | - Jeff Gadsden
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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Lutfallah S, Wajid I, Sinnathamby ES, Maitski RJ, Edinoff AN, Shekoohi S, Cornett EM, Urman RD, Kaye AD. Low-Level Laser Therapy for Acute Pain: A Comprehensive Review. Curr Pain Headache Rep 2023; 27:607-613. [PMID: 37578732 DOI: 10.1007/s11916-023-01149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE OF REVIEW An analysis of data conducted in 2015 by the National Health Interview Survey (NHIS) found that an estimated 25.3 million adults (11.2%) have experienced pain every day for the preceding 3 months, and nearly 40 million adults (17.6%) have experienced a severe level of pain. RECENT FINDINGS Multiple reviews have analyzed the current management of acute pain; however, much of the current literature only focuses on pharmacological methods of analgesia, such as opiates, ketamine, or non-steroidal anti-inflammatory drugs (NSAIDs). Publications that discuss non-pharmacological options often criticize the limitations of available research for these therapies, making further exploration of this type of treatment necessary. The present investigation aims to summarize current knowledge on the use of low-level laser therapy (LLLT), a cold laser non-pharmacological approach, in managing acute pain and to discuss important clinical findings and considerations when it comes to utilizing this treatment option in patients.
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Affiliation(s)
- Salim Lutfallah
- School of Medicine, Louisiana State University, New Orleans, New Orleans, LA, 70112, USA
| | - Irza Wajid
- Louisiana State University Health Science Center New Orleans, 1900 Perdido Street, New Orleans, LA, 70115, USA
| | - Evan S Sinnathamby
- LSUHSC-New Orleans School of Medicine, 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Rebecca J Maitski
- LSUHSC-New Orleans School of Medicine, 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Amber N Edinoff
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Richard D Urman
- Department of Anesthesiology, Ohio State University Health Sciences Center, The Ohio State University, N437 Doan Hall, 410 W. 10Th Avenue, Columbus, OH, 43210, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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Gomez M, Jeudy J, Petit A, Brunet J, Saint-Cast Y, Rabarin F, Cesari B, Raimbeau G, Bigorre N. Acute pain after digital crushing and nicotine intoxication. Cigarettes are always a false friend. A prospective study. Orthop Traumatol Surg Res 2023; 109:103425. [PMID: 36183973 DOI: 10.1016/j.otsr.2022.103425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/27/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nicotine addiction is a public health problem. Our hypothesis was that the degree of nicotine dependence is positively correlated with the perceived intensity of acute pain. MATERIALS AND METHODS A single-center prospective comparative observational study was conducted from 2019 to 2021. Patients included presented distal phalanx extra-articular trauma of less than 24hours' progression. We compared a group of smokers with a group of non-smokers. A Digital Pain Scale (DPS) was assessed at time of trauma, at first consultation, and once a day until the fifth day post-trauma. A Fagerström test was performed. The primary endpoints were the correlation between dependence and DPS and the correlation between the amount of tobacco consumed and DPS. The secondary endpoints were analgesic consumption according to Fagerström, DPS and tobacco consumption. RESULTS Sixty-seven patients were included: 26 smokers, 41 non-smokers. No significant correlation was found between dependence level or amount of tobacco used and DPS. Consumption of level II analgesics was significantly 2-fold higher in the smoking group on the second, third and fifth day: respectively, 2.15 tablets versus 1.22 (p=0.02), 1.27 versus 0.49 (p=0.01), and 0.69 versus 0.20 (p=0.04). CONCLUSION Patients who smoke are exposed to more frequent and more intense pain and consume more palliative painkillers. LEVEL OF EVIDENCE IIB; exposed vs. non-exposed cohort.
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Affiliation(s)
- Mathurin Gomez
- Département de chirurgie osseuse, centre hospitalier universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France.
| | - Jérôme Jeudy
- Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - Alexandre Petit
- Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - Jérôme Brunet
- Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - Yann Saint-Cast
- Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - Fabrice Rabarin
- Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - Bruno Cesari
- Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - Guy Raimbeau
- Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - Nicolas Bigorre
- Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France
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Diwan S, Feigl G, Nair A, Sancheti P. The Paraneural Sciatic Sheaths in Longitudinal Axis at the Level of Greater Trochanter: An Ultrasound Cadaveric and Clinical Correlation Study. J Med Ultrasound 2023; 31:305-308. [PMID: 38264587 PMCID: PMC10802874 DOI: 10.4103/jmu.jmu_121_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2024] Open
Abstract
Background Paraneural sheath engulfing the sciatic nerve (SN) between the ischial tuberosity and the greater trochanter is well known. Methods In order to explore the anatomical planes separating the paraneurium from the epineurium in SN, we conducted a cadaveric study (two patients and four specimens), followed by a clinical study in 10 patients. Results We demonstrated an elevation of 5-7 layers of paraneural tissues after an in-plane injection in the longitudinal axis of the proximal SN, which was possibly the last of the paraneural sheath. In the clinical study, the block provided low pain scores with no rescue analgesia postoperatively and no neurological deficit at the time of discharge. Conclusion This is probably the first series which has described the elevation of several layers of paraneural tissues after an in-plane injection in the longitudinal axis of the proximal SN.
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Affiliation(s)
- Sandeep Diwan
- Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India
| | - Georg Feigl
- Department of Macroscopic and Clinical Anatomy, Institute of Anatomy and Clinical Morphology, Witten/Herdecke University, Witten, Germany
| | - Abhijit Nair
- Department of Anesthesiology, Ibra Hospital, North Sharqiya Governorate, Ibra, Sultanate of Oman
| | - Parag Sancheti
- Department of Orthopedics, Sancheti Hospital, Pune, Maharashtra, India
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Stolz R, Kaschdailewitsch E, Kröger B, Noack B, Mahler C. [Evidence-based naturopathic nursing interventions in pain management]. Schmerz 2023; 37:336-343. [PMID: 37039897 PMCID: PMC10511583 DOI: 10.1007/s00482-023-00705-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/12/2023]
Abstract
Nurses are confronted with patients suffering from acute and/or chronic pain in all nursing care settings and within all target groups. Although national and international guidelines on chronic pain emphasize the importance of non-pharmacological interventions (for example, hot and cold applications) and educational approaches such as teaching self-management strategies to deal with pain, the most common applied intervention for chronic and acute pain is a pharmacological therapy. The aim of this article is to provide an overview of the potential of naturopathic nursing interventions for the care of patients with chronic and/or acute pain, focusing on so-called external applications such as wraps and compresses, which are safe, have a low-risk profile and are easy to apply, thus making them suitable for self-application. The use of non-pharmacological interventions as well as the counselling and training of patients in naturopathic applications offer nurses the possibility to work in an autonomous field of nursing promoting nursing as an attractive health profession.
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Affiliation(s)
- Regina Stolz
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Elke Kaschdailewitsch
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Birgit Kröger
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Bettina Noack
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Cornelia Mahler
- Abteilung Pflegewissenschaft, Institut für Gesundheitswissenschaften, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 9, 72076, Tübingen, Deutschland.
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Chelly JE, Klatt B, O’Malley M, Groff Y, Kearns J, Khetarpal S, Sadhasivam S. The Role of Inhalation Aromatherapy, Lavender and Peppermint in the Management of Perioperative Pain and Opioid Consumption Following Primary Unilateral Total Hip Arthroplasty: A Prospective, Randomized and Placebo-Controlled Study. J Pain Relief 2023; 12:003. [PMID: 38343757 PMCID: PMC10854480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Introduction Aromatherapy is claimed to be effective for the treatment of psychosocial disorders, but objective evidence of its effectiveness is still lacking. Psychosocial disorders have been demonstrated to increase postoperative pain and opioid consumption by up to 50%. This study was designed to assess the effectiveness of Aromatherapy in controlling postoperative pain and opioid in anxious patients. Methods This prospective, randomized, placebo-controlled study was conducted on anxious patients who underwent primary unilateral total hip arthroplasty. After obtaining signed informed consent, each patient was asked to complete a PROMIS (Patient-Reported Outcomes Measurement Information System) anxiety survey. Patients whose T score were >57.2 were randomized to either an active treatment (Lavender Peppermint Elequil® aromatab®) or a placebo Elequil®-aromatab® treatment. Demographics, pain, opioid consumption, PONV, and psychosocial surveys were collected on Postoperative Day POD1, POD2, POD7 and POD30. At the time of discharge and on POD30, each patient was asked to complete a satisfaction questionnaire, and they were asked to complete an SF12 survey on POD30. Difference between means was assessed using absolute standardized mean differences. Results Sixty patients were included in the intend-to-treat analysis. Use of lavender and peppermint was associated with a decrease of 26% in pain (POD7; 0.46), 33% in opioid consumption (POD2; 0.42), and 48% in acetaminophen consumption (POD7; 0.54) and a 78% decrease in PONV (POD2; 0.44). Psychosocial scores decreased following surgery (p=0.001). Overall satisfaction ratings at discharge were similar, as were functional recovery scores. Discussion Our data provides evidence that in patients with preoperative anxiety, lavender and peppermint aromas decreases postoperative pain and opioid requirement compared to placebo. Additional research is required to conform our data. Conclusion This randomized placebo control study provides evidence of the usefulness of inhalation of lavender and peppermint aromas in patients undergoing primary unilateral total hip arthroplasty.
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Affiliation(s)
- Jacques E Chelly
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Brian Klatt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Michael O’Malley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Yram Groff
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Jeremy Kearns
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Sharad Khetarpal
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Senthil Sadhasivam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA
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Simensen R, Fjose LO, Rehn M, Hagemo J, Thorsen K, Heyerdahl F. Comparison of three regimens with inhalational methoxyflurane versus intranasal fentanyl versus intravenous morphine in pre-hospital acute pain management: study protocol for a randomized controlled trial (PreMeFen). Trials 2023; 24:571. [PMID: 37670364 PMCID: PMC10478438 DOI: 10.1186/s13063-023-07590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Pre-hospital pain management has traditionally been performed with intravenous (IV) morphine, but oligoanalgesia remain a recognized problem. Pain reduction is essential for patient satisfaction and is regarded as a measure of successful treatment. We aim to establish whether non-invasive methods such as inhalation of methoxyflurane is non-inferior to intranasal fentanyl or non-inferior to the well-known IV morphine in the pre-hospital treatment of acute pain. METHOD/DESIGN The PreMeFen study is a phase three, three-armed, randomized, controlled, non-inferiority trial to compare three regimens of analgesics: inhalation of methoxyflurane and intranasal (IN) fentanyl versus IV morphine. It is an open-label trial with a 1:1:1 randomization to the three treatment groups. The primary endpoint is the change in pain numeric rating scale (NRS) (0-10) from baseline to 10 min after start of investigational medicinal product administration (IMP). The non-inferiority margin was set to 1.3, and a sample size of 270 patients per protocol (90 in each treatment arm) will detect this difference with 90% power. DISCUSSION We chose a study design with comparison of analgesic regimens rather than fixed doses because of the substantial differences in drug characteristics and for the results to be relevant to inform policymakers in the pre-hospital setting. We recognize that easier administration of analgesics will lead to better pain management for many patients if the regimens are as good as the existing, and hence, we chose a non-inferiority design. The primary endpoint, the change in pain (NRS) after 10 min, is set to address the immediate need of pain reduction for patients with acute prehospital pain. On a later stage, more analgesic methods are often available. PreMeFen is a non-inferiority randomized controlled trial comparing three analgesic regimens aiming to establish whether inhalation of methoxyflurane or intranasal fentanyl is as good as IV morphine for fast reduction of acute pain in the prehospital setting.
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Affiliation(s)
- Randi Simensen
- Division of Pre-Hospital Services, Innlandet Hospital Trust, Kastbakkvegen 9, 2390, Moelv, Norway.
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.
- Division of Pre-Hospital Services, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Lars Olav Fjose
- Division of Pre-Hospital Services, Innlandet Hospital Trust, Kastbakkvegen 9, 2390, Moelv, Norway
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Marius Rehn
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Division of Pre-Hospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jostein Hagemo
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Division of Pre-Hospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Thorsen
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Fridtjof Heyerdahl
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Division of Pre-Hospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zengin EN, Alagöz A, Yiğit H, Sazak H, Şekerci S, Zengin M. The effect of body mass index on thoracic paravertebral block analgesia after video-assisted thoracoscopic surgery; a prospective interventional study. BMC Anesthesiol 2023; 23:297. [PMID: 37667207 PMCID: PMC10476386 DOI: 10.1186/s12871-023-02264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND To investigate the effects of body mass index (BMI) on intensity postoperative pain in patients who underwent thoracic paravertebral block (TPVB) for postoperative analgesia after video-assissted thoracoscopic surgery (VATS). METHODS Patients aged 18-80 years, ASA I-III, and BMI 18-40 kg/m2 who underwent elective VATS were included in the study. The patients were divided into 3 groups according to their BMI levels. TPVB was performed under ultrasound-guidance at the fifth thoracic vertebrae, and 30 ml of 0.25% bupivacaine was injected. The patient-controlled analgesia (PCA) was performed by using morphine and multimodal analgesia was performed. As a rescue analgesic agent, 0.5 mg/kg tramadol was given to patients intravenously when a score of visual analog scale (VAS) at rest was ≥ 4. The primary outcome was determined as VAS scores at rest and cough. Secondary outcomes were determined as postoperative morphine consumption, additional analgesic requirement, and side effects. RESULTS The post-hoc test revealed that the VAS resting scores at the 4th hour (p: 0.007), 12th hour (p: 0.014), and 48th hour (p: 0.002) were statistically significantly lower in Group I compared to Group II. Additionally, VAS resting scores were also statistically significantly lower in Group I compared to Group III at all time points (p < 0.05). Similarly, the post-hoc test indicated that the VAS coughing scores at the 4th hour (p: 0.023), 12th hour (p: 0.011), and 48th hour (p: 0.019) were statistically significantly lower in Group I compared to Group II. Moreover, VAS coughing scores were statistically significantly lower in Group I compared to Group III at all time points (p < 0.001). Furthermore, there were statistically significant differences in terms of additional analgesic use between the groups (p: 0.001). Additionally, there was a statistically significant difference in terms of morphine consumption via PCA and morphine milligram equivalent consumption between the groups (p < 0.001). CONCLUSIONS Higher postoperative VAS scores with TPVB applied in obese patients and the consequent increase in additional analgesics and complications require more specific postoperative management in this patient group.
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Affiliation(s)
- Emine Nilgün Zengin
- Ministry of Health Ankara Bilkent City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Ali Alagöz
- University of Health Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Hülya Yiğit
- Ministry of Health Ankara Bilkent City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Hilal Sazak
- University of Health Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Sumru Şekerci
- Ministry of Health Ankara Bilkent City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Musa Zengin
- Ministry of Health Ankara Etlik City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
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Alver S, Ciftci B, Güngör H, Gölboyu BE, Ozdenkaya Y, Alici HA, Tulgar S. Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial. Braz J Anesthesiol 2023; 73:595-602. [PMID: 37201747 PMCID: PMC10533976 DOI: 10.1016/j.bjane.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). METHODS Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. RESULTS The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). CONCLUSION In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. REGISTER NUMBER NCT05199922.
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Affiliation(s)
- Selcuk Alver
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Bahadir Ciftci
- Istanbul Medipol University, School of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Hande Güngör
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | | | - Yasar Ozdenkaya
- Istanbul Medipol University, Department of General Surgery, Istanbul, Turkey
| | - Haci Ahmet Alici
- Istanbul Medipol University, Department of Algology, Istanbul, Turkey
| | - Serkan Tulgar
- Samsun University, Faculty of Medicine, Samsun Training and Research Hospital, Department of Anesthesiology and Reanimation, Samsun, Turkey
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Adegbola A, Gritsenko K, Medrano EM. Perioperative Use of Ketamine. Curr Pain Headache Rep 2023; 27:445-448. [PMID: 37392333 DOI: 10.1007/s11916-023-01128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE OF REVIEW Postoperative pain continues to be one of the most common challenges following surgeries. Multimodal analgesia has been of particular focus as non-opioid alternatives have been encouraged due to concerns of the opioid epidemic. Ketamine has been an especially useful adjunct in multimodal pain regimens within the past few decades. This article highlights the current use and advances surrounding the perioperative use of ketamine. RECENT FINDINGS Ketamine has antidepressive effects at subanesthetic doses. Intraoperative ketamine may be beneficial in reducing postoperative depression. Additionally, newer studies are exploring whether ketamine can be useful in reducing postoperative sleep disturbances. Ketamine continues to be a great tool in perioperative pain control, especially during an opioid epidemic. As its use continues to expand and gain more popularity in the perioperative period, more research could shed light on the additional nonanalgesic benefits of ketamine use.
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Affiliation(s)
- Abimbola Adegbola
- Montefiore Medical Center, 111 E 210Th Street, Bronx, NY, 10467, USA.
| | - Karina Gritsenko
- Montefiore Medical Center, 111 E 210Th Street, Bronx, NY, 10467, USA
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Elilary Montilla Medrano
- Montefiore Medical Center, 111 E 210Th Street, Bronx, NY, 10467, USA
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
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Abstract
PURPOSE OF REVIEW The Acute Perioperative Pain Service has been established as a relatively new but important concept and service in clinical patient care. Many surgical institutions have dedicated inpatient acute pain services with variable compositions. This review aims to investigate the purpose, clinical and economic implications, and future direction of the Acute Perioperative Pain Service (APPS). RECENT FINDINGS There is growing evidence of the multiple benefits of a dedicated APPS, especially pertaining to patients at higher risk of poorly controlled postoperative pain. Healthcare providers furthermore realize the importance of the perioperative pain management continuity of care, consisting of preoperative pain evaluations and post-discharge follow-up in an outpatient pain management setting, in coordination with the primary teams. The Transitional Pain Service (TPS) has emerged as the next step in this evolution and has been successfully implemented at various medical centers. With the growing number of surgical procedures and the increasing complexity of the patient population, effective management of acute postoperative pain continues to be challenging, despite ongoing advances in clinical care, analgesic modalities, and research. The APPS is becoming the clinical standard of care for managing postoperative pain, and its role continues to expand worldwide.
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Affiliation(s)
- Ibrahim Al-Saidi
- Columbia University Irving Medical Center, New York, USA.
- NewYork-Presbyterian/Columbia Univ Med Ctr, 622 W 168th St, NY, PH5-133 10032, New York, USA.
| | - Alex Russell
- Columbia University Irving Medical Center, New York, USA
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Rogger R, Bello C, Romero CS, Urman RD, Luedi MM, Filipovic MG. Cultural Framing and the Impact On Acute Pain and Pain Services. Curr Pain Headache Rep 2023; 27:429-436. [PMID: 37405553 PMCID: PMC10462520 DOI: 10.1007/s11916-023-01125-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE OF REVIEW Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management. RECENT FINDINGS The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training.
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Affiliation(s)
- Rahel Rogger
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carolina S. Romero
- Anesthesia, Critical Care and Pain Department, Hospital General Universitario de Valencia, Universitad Europea de Valencia, Valencia, Spain
| | - Richard D. Urman
- Department of Anaesthesiology, The Ohio State University, Columbus, OH USA
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Mark G. Filipovic
- Department of Anaesthesiology and Pain Medicine, Pain Center, Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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Baumann L, Bello C, Georg FM, Urman RD, Luedi MM, Andereggen L. Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors. Curr Pain Headache Rep 2023; 27:437-444. [PMID: 37392334 PMCID: PMC10462493 DOI: 10.1007/s11916-023-01127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE OF REVIEW Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD. RECENT FINDINGS This narrative review captures a subset of recent advances in the field targeting the literature on patients' risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. To reduce OUD, providers should evaluate both the individual patient's risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.
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Affiliation(s)
- Livia Baumann
- Department of Anaesthesiology and Pain Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Filipovic Mark Georg
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Markus M Luedi
- Faculty of Medicine, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St, Gallen, St. Gallen, Switzerland
| | - Lukas Andereggen
- Faculty of Medicine, University of Bern, Bern, Switzerland.
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
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