Pain Research & Management最新文献

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.

Background: Hypoxia is not uncommon in elderly patients during painless gastrointestinal endoscopy. This study aimed to determine the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) in reducing the occurrence of hypoxia symptoms in elderly patients. Methods: Patients were randomly and equally grouped into sham control (n = 109) or TEAS group (n = 109) by using the random number table method. Patients in the TEAS group received electrical stimulation at the bilateral ST36 points 30 min before the examination until the end of the painless gastrointestinal endoscopy. Patients in the control group only had electrodes attached to bilateral nonacupoints in a similar pattern as the TEAS group without electrical stimulation. The primary endpoints measured were the incidence of hypoxia and severe hypoxia. The secondary endpoints included propofol dosage, sedation-related adverse events, hemodynamic parameters, surgical duration, patient recovery time, pain score, patient satisfaction, anesthesiologist satisfaction, and endoscopist satisfaction. Results: Of the 251 patients who participated in this study, 218 patients ended up completing the final study. The primary outcome was that, compared with group control, the incidence of hypoxia in group TEAS was reduced by 11% (19.3% vs. 8.3%, p=0.018) and the incidence of severe hypoxia did not show a significant change (7.3% vs. 2.8%, p=0.122). And there was a significant decrease in the occurrence of patients requiring emergency airway assistance (increased oxygen flow: 16.5% vs. 6.4%, p=0.019, jaw thrust: 11.0% vs. 3.7%, p=0.038, mask-assisted ventilation: 5.5% vs. 1.8%, p=0.015). Conclusion: TEAS can reduce the incidence of hypoxia in elderly patients undergoing painless gastrointestinal endoscopy. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2200059465.

Background: Lumbar facet joints are the source of pain in 15%-41% of individuals experiencing low back pain (LBP). Conventional lumbar facet radiofrequency ablation (RFA) has Level II evidence for improving pain and function. The best proven technique, the parallel technique, is technically challenging, time-consuming, and often uncomfortable for the patient. A novel RFA technique using a 3-tined cannula offers a potentially less complex and shorter procedure. Objectives: To describe the novel lumbar facet joint RFA technique with the 3-tined cannula and to evaluate its efficacy in treating chronic lumbar facet joint pain. Methods: Eligible adult patients with chronic lumbar facet joint pain, confirmed by positive medial branch blocks (MBBs), refractory to conservative treatment, received the novel RFA treatment with the 3-tined cannula. The change in pain intensity at 2 months follow-up compared to baseline, percentage of patients reporting a ≥ 30% and ≥ 50% reduction of pain intensity, patient global impression of change (PGIC), need for pain medication, walking ability, sleep quality, and patient satisfaction were evaluated. Results: A total of 44 patients were included. Patients experienced a clinically meaningful and significant pain relief at follow-up and 41% of the patients reported ≥ 50% reduction of pain. Forty-eight percent experienced at least a score of "much improved" on the PGIC. No severe side effects or complications were observed. Conclusions: Our observational study suggests that lumbar facet joint RFA using the novel technique achieves significant pain relief. The larger lesions decrease the likelihood of missing the target nerve while obviating the need to conduct numerous lesions. Limiting is the single-center set-up with a relatively short-term follow-up duration. Randomized controlled clinical trials are warranted to confirm the efficacy of the novel RFA technique to treat lumbar facet joint pain.

Background: The global rise in work-related musculoskeletal ailments has led to issues like neck discomfort, scapular muscle dysfunction, reduced neck mobility, and functional limitations. This study aimed to evaluate the effectiveness of scapular functional exercises (SFE) and cervical isometric exercises (CIE) on pain, cervical range of motion (CROM), and functional limitations in individuals with chronic mechanical neck pain (CMNP). Methods: A two-arm, parallel group pretest-post-test randomized comparative trial was conducted. Thirty participants (21 females, 9 males; average age 28.94 ± 3.77 years) were randomly divided into two groups, 1 and 2 (n = 15/group). Both groups received common treatments of CIE and hot packs, while Group 1 was given SFE additionally. To assess the outcomes, which included pain, cervical range of motion (CROM), and functional limitations, measurements were taken using a numeric pain rating scale (NPRS), a standard universal goniometer, and a neck disability index (NDI) questionnaire at the beginning of the study and 4 weeks after the interventions. A one-way multivariate followed by univariate analysis of covariance (MANCOVA and ANCOVA) was applied to examine the outcomes disparities within-group and between-group, with a significance level at 95% (i.e., p < 0.05). Results: MANCOVA analysis revealed a significant impact of interventions on CROM in all directions, NPRS, and NDI scores, even after adjusting for initial scores (F (8, 13) = 90.1; p=0.001). Univariate ANCOVA showed significant improvements in outcomes for Group 1 compared to Group 2. Conclusions: Adding SFE to CIE and conventional physiotherapy was more effective than just using CIE and conventional physiotherapy alone. This approach better alleviated neck pain, improved CROM (particularly in forward and left-side flexion), and reduced functional limitations in individuals with CMNP. Trial Registration: ClinicalTrials.gov Identifier: NCT05624021.

Background: The objective of this study was to systematically evaluate the safety and efficacy of local anesthesia, general anesthesia, and epidural anesthesia in percutaneous endoscopic lumbar discectomy (PELD). Methods: We searched PubMed, EMBASE, and OVID databases for all relevant studies. All statistical analysis was performed using STATA 17.0. Results: Fourteen studies were finally included, comprising 7 randomized controlled trials and 7 retrospective studies. The total number of subjects across these studies was 1655, with 316 undergoing general anesthesia, 789 undergoing local anesthesia, and 550 undergoing epidural anesthesia. The meta-analysis of pairwise comparisons suggests that there are no differences among epidural, general anesthesia, and local anesthesia in terms of postoperative VAS, ODI, and surgery time. Regarding complications, general anesthesia has a higher complication rate compared with local anesthesia, but there are no differences between epidural and general anesthesia or between epidural and local anesthesia. In terms of anesthesia satisfaction, both general and epidural anesthesia have higher satisfaction rates compared with local anesthesia, with no significant difference between general and epidural anesthesia. The ranking of the best probabilities shows that epidural anesthesia has the lowest postoperative VAS and highest anesthesia satisfaction. General anesthesia has the lowest ODI scores. Local anesthesia has the fewest complications and operative time. Conclusion: Local anesthesia, general anesthesia, and epidural anesthesia are all safe and effective methods for PELD. Local anesthesia has advantages in complications and operation time. Epidural anesthesia is most advantageous in anesthesia satisfaction and postoperative VAS scores. General anesthesia is most advantageous in postoperative ODI. In the future, more multicenter RCTs are needed to further compare the safety and effectiveness of different anesthesia methods in PELD.