Pain Research & Management最新文献

Objectives: The aim of this systematic review and meta-analysis from randomized controlled trials is to assess opioids with or without low-dose naloxone during the perioperative period at pain intensity and opioids-related adverse events. Methods: We searched of Medline, Embase, International Clinical Trials Registry Platform, and the Cochrane Library up to May 31, 2023. We included randomized controlled trials (RCTs) of low-dose naloxone combined with opioids in adults reporting pain intensity or opioid-related adverse event during the perioperative period. Results: A total of 18 RCTs with 1784 participants were included. We could not reach a consistent conclusion for pain intensity due to high heterogeneity. High certainty evidence showed that low-dose naloxone combined with opioids reduced the risk of nausea (relative risk (RR): 0.82 and 95% confidence interval (CI): 0.70-0.96), cough (RR: 0.52 and 95% CI: 0.30-0.90) and postoperative nausea and vomiting (RR: 0.58 and 95% CI: 0.40-0.80). Moderate certainty evidence showed that low-dose naloxone combined with opioids did not reduce vomiting, urinary retention, sedation, dizziness, respiratory depression, headache, drowsiness, shivering, skin itch, hypotension, and sweating. Conclusions: Our findings show that the use of low-dose naloxone in combination with opioids can lower the risk of somnolence and coughing, postoperative nausea, and vomiting.

Chronic pain (CP) is a condition that looms over the global social and health scenarios. After many years without having national data, an extensive overview of this disorder in Italy has been published in the first Rapporto Censis Grünenthal (Censis Grünenthal Pain Report). It confirms that 19.8% of the Italian adult population suffers from moderate or severe CP, and the vast majority of patients (86.2%) are not aware of the existence of pain management (PM) centers. Starting with the Rapporto Censis Grünenthal data analysis by the representatives of three Italian pain scientific societies, several unmet needs were highlighted for which affordable, innovative, and technological strategies were proposed. These solutions focused on interventions in three strategic areas: (1) information, education, and awareness about CP among patients and physicians; (2) organization of pain center networks to adequately cover the national territory, promoting a multimodal-interdisciplinary approach; and (3) use of currently available novel technologies to foster access to treatment. For this purpose, the authors suggested feasible solutions, such as promoting public educational campaigns to raise awareness of the existence of pain centers and the right to receive a proper PM, as indicated in Italy by the pioneering law 38/2010. Regarding organizational gaps, the authors highlighted the possibility of drawing on international models to improve pain centers with completely dedicated staff and community-based pain services while supporting the development of specialized procedural PM standards. Concerning technologies, investments in telehealth and digital tools would improve access to therapies throughout the territory, enabling efficient clinical assessment and helping deliver the most suitable treatments. Overall, greater awareness of the impact of CP and a better allocation of resources are needed to improve patient quality of life, thereby reducing costs for the healthcare system.

Purpose: This study evaluates the response to a motor imagery intervention using visual or auditory inputs in patients with persistent pelvic pain. A secondary objective is to assess how patients' mental visualization capacity influences intervention outcomes. Methods: Forty patients diagnosed with persistent pelvic pain were enrolled in a randomized trial with six motor imagery sessions over 2 weeks. Patients were assigned to interventions delivered through images or audio recordings. Pain intensity, attention to pain, and the ability to mentally visualize and perceive movements were assessed. Results: Participants receiving auditory stimulus-based interventions showed a nonsignificant reduction in pain intensity (from 7.1 points [SD: 1.9] to 6.1 points [SD: 2.4]; p=0.091), while those in the visual input group experienced no change. Attention to pain improved in the visual group (from 30.2 points [SD: 6.2] to 27.6 points [SD: 6.8]; p=0.194), whereas it remained stable in the auditory group. Importantly, the participants' ability to mentally visualize and perceive movements did not significantly impact the outcomes. Conclusions: Auditory motor imagery appears to be a promising, less intrusive approach for managing persistent pelvic pain, with home-based interventions showing potential where access to conventional care is limited. This study highlights the importance of personalized motor imagery approaches, demonstrating superior efficacy for auditory interventions compared to visual ones. Limitations include a brief intervention period and recruitment challenges, yet motor imagery remains a viable therapeutic option. Trial Registration: ClinicalTrials.gov identifier: NCT06343649.

Objective: This meta-analysis aims to evaluate the impact of preoperative ketamine gargle on postoperative throat pain in patients undergoing general anesthesia with endotracheal intubation (ETI). Methods: A comprehensive search was conducted in databases including PubMed, Cochrane Library, Web of Science, ScienceDirect, Scopus, ClinicalTrials.gov, and others. Data analysis was performed using RevMan 5.4 and Stata Statistical Software 18 (StataCorp., Texas., United States of America). Odds ratio with 95% confidence interval (CI) and mean difference were calculated for outcomes: incidence of postoperative 0, 2, 4, 8, and 24 h sore throat and anesthesia time. The overall certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, with trial sequential analysis (TSA) performed to establish implications for further research. Main outcome: A total of ten RCTs involving 593 patients were included in the analysis. The results demonstrated a significant reduction in the incidence of postoperative sore throat at 0, 2, 4, 8, and 24 h after the operation (0 h: OR: 0.14; 95% CI: 0.04-0.47; p=0.002; I ² = 67%; 2 h: OR: 0.30; 95% CI: 0.17-0.52; p < 0.0001; I ² = 31%; 4 h: OR: 0.32; 95% CI: 0.20-0.52; p < 0.00001; I ² = 0%; 8 h: OR: 0.40; 95% CI: 0.23-0.70; p=0.001; I ² = 29%; 24 h: OR: 0.36; 95% CI: 0.25-0.51; p < 0.00001; I ² = 0%) in patients who received ketamine gargle compared to those who received a placebo. In addition, our meta-analysis indicated that ketamine gargle did not result in a reduction in anesthesia time (min) (MD: -1.16; 95% CI: -6.44-4.11; p=0.67). Conclusion: Our meta-analysis demonstrated the efficacy of prophylactic ketamine gargle in reducing the incidence of POST across all studied time intervals in patients requiring tracheal intubation of general anesthesia compared to placebo.

Background: Acute postoperative pain is a common problem in clinical practice and merits attention considering its potential long-term adverse effects. This systematic review covers current knowledge on methods for individual prediction of postoperative pain. Methods: A systematic literature search was conducted using the PubMed, EMBASE, and CINAHL databases for original studies with adult patients published in English between 2016 and 2022. Inclusion required assessment of risk factors preoperatively and assessment of postoperative pain. No reviews, meta-analyses, or study protocols were included, nor studies with outcomes other than pain or where risk factor analysis was not performed preoperatively. A two peer-reviewed system was utilized using the screening and data collection tool Covidence, with a focus on new tools for preoperative pain prediction. The results were only analyzed qualitatively. Results: The search yielded 1950 abstracts to be screened. In total, 208 articles were subjected to full-text review, and 107 articles were included in the data synthesis of this review. The evaluated scientific methods were grouped and analyzed separately. Psychometric questionnaires and methods for quantitative sensory testing are still being studied. New methods proposed include the evaluation of pain induced by tourniquet inflation, venous cannulation, or pin-prick stimulation, the analgesia/nociception index, electroencephalographic recording, and other new equipment developed for this purpose. Conclusion: Various screening methods have been proposed to identify patients prone to postoperative pain. The focus has shifted from procedure-specific to individualized strategies to improve early management of pain. However, many traditional predictive methods still have a questionable role in clinical practice. Trial Registration: ClinicalTrials.gov identifier: CRD42022298479.

Objective: This study aimed to evaluate the analgesic efficacy of oral magnesium supplements, administered as an analgesic adjuvant to ibuprofen, on acute postoperative pain within 72 h following mandibular third molar (MTM) surgery. Materials and Methods: This triple-blind, placebo-controlled, split-mouth randomized study was conducted among 25 patients (50 MTMs), who intended to remove both MTMs. All patients underwent two surgeries separated by an interval of at least 4 weeks. For each surgery period, patients were randomly assigned with either receiving NSAIDs plus oral magnesium supplement (25 MTMs) or NSAIDs plus placebo (25 MTMs) for three days after surgery. The postoperative pain intensity at rest and movement were primarily evaluated at 24 h, postoperatively. Participants were also asked to record pain intensity at 6, 48, and 72 h, postoperatively, rescue analgesic consumption, time to first rescue analgesic, and magnesium-related adverse events. Results: The combination of ibuprofen plus oral magnesium supplement significantly decreased pain intensity at rest 24 h, postoperatively, compared to placebo (estimated mean difference -15.08; 95%CI -29.01 to -1.14). However, the pain intensity at rest and movement were similar between groups at other time points. There was no significant difference among groups in terms of rescue analgesic consumption and time to first rescue analgesic. No magnesium-related adverse event was observed. Conclusion: The addition of oral magnesium supplement as an analgesic adjuvant to NSAIDs significantly decreased pain intensity at rest 24 h following MTM surgery. Nevertheless, this result might not provide clinically relevant benefits for pain control following MTM surgery. Trial Registration: ClinicalTrials.gov identifier: TCTR20221003004.

Introduction: A child's concept of pain comprises their understanding of what pain is, the purpose of pain, and biological processes underpinning pain. The concept of pain can influence pain experiences, pain beliefs, and pain-related behaviour. This study aimed to assess the concept of pain among children attending primary schools in Gqeberha in the Eastern Cape of South Africa. A secondary aim was to explore demographic and pain-related information that may contribute to a child's concept of pain. Materials and Methods: A cross-sectional study with an analytic component was used. The cross-culturally adapted Concept of Pain Inventory (COPI) was used to assess the concept of pain amongst 12-year-old school-attending children. Children from seven primary schools that were selected via stratified random sampling participated. Participants completed the adapted COPI and a sociodemographic questionnaire. Descriptive statistics and inferential analysis were used to analyse the data. Results: There were 119 participants. Participants' concept of pain partially aligned with contemporary pain science (mean = 34.39 out of 56; standard deviation = 6.49), indicating a partial understanding of the factors influencing pain. Demographic factors and pain-related information investigated did not influence participants' concept of pain. However, differences in the concept of pain were observed amongst participants from different schools. Conclusions: Participants had a developing concept of pain that was partially aligned with contemporary pain science. Participants had pain knowledge strengths and gaps that can be used to develop a tailored school-based pain education intervention for them. There were indications that contextual factors may have influenced the participants' concept of pain. Further studies to explore socioenvironmental factors that influence pain knowledge in children are recommended.

General anaesthesia (GA) as a pharmacological behaviour management strategy may be indicated for dental extractions in children unable to cooperate in the dental chair. Pain is the most common postoperative complication in children following dental GA. There is conflicting evidence available on the efficacy of local anaesthetic (LA) agents for postoperative pain management following dental extraction. Therefore, this review aimed to evaluate the efficacy of different pharmacological analgesic techniques on postoperative pain following dental extractions under GA in children. A search of PubMed, Embase, Scopus and CINAHL was conducted on 17/10/2023 to identify studies eligible for inclusion in this review. Two independent reviewers performed search screening, data extraction and critical appraisal. Results were narratively described due to heterogeneity of pain assessment tools and management strategies. The search yielded 8742 results, of which 15 studies were included. Methods of pain assessment varied greatly across included studies, with 14 different pain scales used across the 15 studies. Included studies suggest preoperative oral paracetamol and oral ibuprofen as well as postoperative topical bupivacaine lowered pain scores. This review underscores the challenges in reliably assessing pain in children and highlights the necessity for age-specific validated pain assessment tools.

Background: Neuropathic pain (NP) is a chronic condition caused by abnormal neuronal excitability in the nervous system. Current treatments for NP are often ineffective or poorly tolerated. Hence, we reviewed the efficacy and safety of novel drugs or devices that target neuronal excitability in NP patients compared with placebo, sham, or usual care interventions. Methods: Six databases were searched for parallel randomized controlled trials (RCTs) reporting novel devices (rTMS, SCS, and TENS) or drugs (EMA401, capsaicin 8% patch, and Sativex) for NP. Data were extracted and quality was assessed using the ROB2 tool. The random-effects inverse variance method was used for analysis. Results: In our review of 30 RCTs with 4251 participants, device-based interventions were found to be more effective in reducing pain scores than control interventions (SMD = -1.27, 95% CI: -1.92 to -0.62). However, high heterogeneity was seen (p < 0.01, I ² = 91%), attributable to the etiology of NP (R ² = 58.84%) and year of publication (R ² = 49.49%). Funding source and type of control comparator were ruled out as cause of heterogeneity. Although drug interventions did not differ from placebo interventions in absolute pain reduction (SMD = -1.21, 95% CI: -3.55 to 1.13), when comparing relative change in pain intensity from baseline, drug interventions were found to be effective (SMD = 0.29, 95% CI: 0.04-0.55). Asymmetry in the funnel plot was visualized, suggesting publication bias. Certainty of evidence was very low according to GRADE assessment. Conclusions: Our review indicates that device-based interventions are more effective than control interventions in reducing pain intensity in NP. Nevertheless, available evidence is limited due to heterogeneity and publication bias, prompting the need for more high-quality RCTs to confirm the efficacy and safety of these interventions.

Background: The neuropathic characteristics of pain occurring after an osteoporosis (OP)-related fracture are often under-recognized. The aim of this pilot study is to identify, in patients suffering from pain localized on the site of a previous osteoporotic fracture, the presence of neuropathic characteristics, their medical management, and their impact on quality of life. Methods: This pilot cross-sectional study on consecutive patients in University Hospital, Rheumatology Department, Clermont-Ferrand, France, was approved by the Ethics Committee (IRB number 2023-CF34). Pain was evaluated with the Numeric Pain Rating Scale (NPRS), Neuropathic Component of Chronic pain (NCCP) was screened with the DN4 questionnaire, and sleep was assessed with the Pittsburg questionnaire. Depression, anxiety, quality of life, and concomitant treatment were also evaluated. Results were expressed using effect sizes (ESs) and 95% confidence intervals. Results: Fifty new patients with a history of at least one fully documented fragility vertebral fracture (VF) or nonvertebral fracture (NVF) due to osteoporosis, in the last 2 years minus the previous 6 months, were included. Findings show that 21% patients with VF and 28% patients with NVF reported NCCP (DN ≥ 4). NCCP patients had more intense pain (NPRS = 5.1 ± 2.9 vs. 2.9 ± 2.7, ES = 0.82 [0.18; 1.44], p=0.019) and impaired sleep compared to patients without NCCP (ES = 0.71 [0.08; 1.33], p=0.043). A remarkable point was that patients had no specific oral or topical treatment for NCCP and were only taking on demand paracetamol and nonsteroidal anti-inflammatory drugs. Conclusions: Future research should focus on the neuropathic characteristics of pain patients with OP, in order to better manage OP-related pain.