Pain Research & Management最新文献

Background: As a critical component of clinical care, every patient should have access to acute pain service (APS). Despite significant progress in its development, acute pain is under or inadequately treated, particularly in African countries. In addition, acute pain treatment and management has received insufficient clinical attention, resulting in inadequacies in postoperative pain relief, which has continued to be a significant challenge. Aims: This study aims to assess the knowledge, perceptions, and experiences of healthcare professionals about APS delivery at King Faisal Hospital Rwanda (KFH). Methods: Nine semistructured focus group discussions (FGDs) were conducted from April to May 2023. Participants were selected via random stratified sampling, and FGDs were conducted in internal medicine, anesthesia and the operating theater, obstetrics and gynecology, the intensive care unit, pediatrics, accident and emergency, medical doctors, physiotherapy, and the surgical ward departments at KFH. Results: Participants highlighted four key areas that can serve as either barriers or facilitators to implementing APS at KFH. These include healthcare provider skills and training; the development and implementation of standardized protocols; establishing a dedicated interdisciplinary APS team; and patient awareness and education. Conclusions: Having institutional systems in place, including standardized protocols, a dedicated team, and regular training opportunities, may help strengthen APS. Patient education and ensuring patients know their care options is another facilitator to improving APS.

Background: Radiculitis-induced pain (RIP) results from dorsal root ganglion (DRG) sensitization due to inflammation. Hypoxia-inducible factor 1-alpha (HIF-1α) is linked to inflammatory responses through metabolic changes, but its role in RIP is not well understood. Gua Sha therapy has been shown to reduce inflammation and neural damage from lumbar disc herniation (LDH). This study investigates whether HIF-1α-mediated metabolic reprogramming contributes to the pain-relieving effects of Gua Sha in RIP. Methods: Male SD rats were subjected to LDH surgery and divided into six groups: sham, model, sham Gua Sha, Gua Sha, Gua Sha + DMOG, and Gua Sha + YC-1. Gua Sha was applied 5 days postsurgery, every other day for three sessions per course, totaling three courses. Changes in paw withdrawal threshold (PWT) and latency (PWL) were monitored, along with blood flow in the rats' backs. Levels of IL-1β, TNF-α, and NF-κB were assessed in serum and DRG tissue. Pathological changes and hypoxia in DRG tissues were observed using hematoxylin-eosin staining and immunofluorescence. Western blotting and qPCR measured HIF-1α, GLUT1, PFKM, and PDK1 expression, while lactic acid and ATP levels in DRG tissue were also evaluated. Results: Gua Sha increased PWT and PWL, reduced serum and DRG inflammatory factors, improved back microcirculation, alleviated DRG hypoxia, and decreased HIF-1α and related signaling factors. It also lowered lactic acid and raised ATP levels. DMOG, a HIF-1α activator, reversed these effects. HIF-1α activation did not affect serum inflammatory factors but partially improved PWT. Inhibition of HIF-1α with YC-1 did not significantly differ from Gua Sha alone. Conclusion: HIF-1α-mediated metabolic reprogramming is a pathogenic mechanism in RIP. Gua Sha alleviates RIP by enhancing microcirculation, improving DRG hypoxia, inhibiting HIF-1α-mediated reprogramming, and reducing DRG sensitization and inflammation. This study provides insights into the mechanisms of Gua Sha's therapeutic effects in RIP.

Background: This study was designed to compare the effectiveness of the transversus abdominis plane (TAP) block with the addition of morphine to bupivacaine and the TAP block with bupivacaine plus intramuscular (IM) morphine. The aim of the study was to evaluate the effect of morphine administered with the TAP block on postoperative opioid consumption and pain scores and, secondarily, to determine whether the effect was systemic or local. Methods: This prospective, double-blind, randomized controlled trial included 52 patients. In the IM group, morphine at a dose of 0.1 mg/kg based on ideal body weight (IBW) was administered IM. In addition, a bilateral TAP block was performed under ultrasound guidance using a total of 40 mL of 0.25% bupivacaine, with 20 mL injected on each side. In the TAP group, an ultrasound-guided TAP block, including a total of 40 mL of 0.25% bupivacaine and 0.1 mg/kg morphine according to the IBW of patients, was administered bilaterally. Results: Total morphine consumption 24 h was 19.08 + 11.35 in the IM group and 11.81 + 7.02 in the TAP group, with an estimated difference in means of 7.2 (95% CI: 2.0, 12.5; p=0.008). The morphine consumption after 6, 12, and 24 h was lower in the TAP group than in the IM group (p=0.033, p=0.003, and p=0.008, respectively). The VAS scores at rest and during movement did not differ between the two groups. The total 24-h ondansetron consumption was higher in the IM group (p=0.046). The postoperative heart rates, blood pressure, and peripheral oxygen saturation at 0, 1, 6, 12, and 24 h did not differ significantly between the groups. Conclusions: The addition of morphine to the TAP block may be an effective method for postoperative analgesia in gynecologic surgery and may not increase systemic side effects, due to the possible local effects of morphine administered interfacial. Trial Registration: ClinicalTrials.gov identifier: NCT05420337.

Neuropathic pain is a prevalent issue that often arises following injuries to the peripheral or central nervous system. Unfortunately, there is currently no definitive and flawless treatment available to alleviate this type of pain. However, exercise has emerged as a promising nonpharmacological and adjunctive approach, demonstrating a significant impact in reducing pain intensity. This is why physical therapy is considered a beneficial approach for diminishing pain and promoting functional recovery following nerve injuries. Regular physical activity exerts its hypoalgesic effects through a diverse array of mechanisms. These include inhibiting oxidative stress, suppressing inflammation, and modulating neurotransmitter levels, among others. It is possible that multiple activated mechanisms may coexist within an individual. However, the priming mechanism does not need to be the same across all subjects. Each person's response to physical activity and pain modulation may vary depending on their unique physiological and genetic factors. In this review, we aimed to provide a concise overview of the mechanisms underlying the beneficial effects of regular exercise on neuropathic pain. We have discussed several key mechanisms that contribute to the improvement of neuropathic pain through exercise. However, it is important to note that this is not an exhaustive analysis, and there may be other mechanisms at play. Our goal was to provide a brief yet informative exploration of the topic.

Objective: To investigate the influence of sleep quality and associated factors on balance control in individuals with chronic low back pain (CLBP). Methods: 85 participants (mean age 33.2 ± 12.5 years) with CLBP were recruited. Physical and emotional well-beings were evaluated using a battery of questionnaires. Sleep quality over the last month was assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants were dichotomized into the good sleep quality (GSQ) and poor sleep quality (PSQ) groups if their PSQI scores were ≤ 5 and > 5, respectively. Balance control was measured using the one-leg stance with eyes closed and Y-balance test. Results: The GSQ group included 37 participants, while the PSQ group comprised 48 participants. After controlling for confounds (including gender, age, disability, anxiety, depression, and fear avoidance beliefs), participants with PSQ displayed significantly poorer performance in the one-leg stance with eyes closed and lower normalized posteromedial, posterolateral, and composite scores of the Y-balance test compared with participants with GSQ. Additionally, sleep quality accounted for 16.9%-24.9% of the variance in balance control, while age explained an additional 5.2%-13.2% of the variance. Additionally, higher levels of physical disability and anxiety were associated with poorer balance control. Conclusions: Individuals with concurrent CLBP and PSQ exhibit significantly worse balance control than those with CLBP alone. Future studies should investigate whether improving sleep quality, physical disability, and anxiety can enhance balance in individuals with CLBP.

Objective: Chronic pain in knee osteoarthritis (OA) is a multidimensional phenomenon requiring thorough assessment and appropriate treatment. We assessed the impact of home-based, remotely supervised transcranial direct current stimulation (tDCS) on the overall pain experience of older adults with knee OA by simultaneously examining its effects on multiple pain domains-pain intensity, pain interference, and pain catastrophizing-using multigroup latent transition analysis (LTA). Methods: This secondary analysis of a randomized clinical trial involved 120 participants with knee OA pain, randomly assigned in a 1:1 ratio to receive 15 daily sessions of 2-mA tDCS or sham tDCS (20 min per session) over three weeks, with real-time remote supervision. Pain intensity was measured using the Numeric Rating Scale (NRS) and the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Pain interference was measured using the WOMAC functional scale. Pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). All the measures were assessed at baseline and at the end of each week (weeks 1, 2, and 3), after the participants had completed five tDCS sessions per week. Multigroup LTA enabled the simultaneous measurement of multiple pain domains and analysis of their changes as a function of intervention exposure by modeling the transition probabilities of latent classes and comparing these changes between the groups. Results: Based on the NRS, WOMAC, and PCS scores, three latent categories were identified: "high pain (all scores high)," "moderate pain (all scores moderate)," and "low pain (all scores low)." Active group participants with "moderate pain" at baseline had a 24.2% probability of transitioning to "low pain" after Week 1, whereas sham group participants remained stagnant during this interval. Notably, 37.6% of active group participants with "high pain" at Week 1 transitioned to "moderate pain," while 35.8% of those with "moderate pain" at Week 1 transitioned to "low pain" by Week 2 (after an additional five sessions). Nevertheless, no noticeable changes were observed in the sham group during this period. No pronounced intervention effects were noted by Week 3. Conclusions: Simultaneously modeling pain-related measures enriches our understanding of the efficacy of tDCS in improving the overall pain experience among older adults with knee OA. Trial Registration: ClinicalTrials.gov identifier: NCT04016272.

Context: Intense, uncontrolled pain during labor can have negative outcomes for both the mother and the baby, but this can be prevented by utilizing pain-relieving techniques. Childbirth is a natural physiological process, and it is important to prioritize non-pharmacological methods such as acupressure in managing the associated pain. Objective: The present research aims to determine the effects of acupressure on the eighth point of the extra-back meridian (EX-B8) for pain relief during childbirth in primiparous women. Design: This study was a randomized, single-blind, sham-controlled trial. Setting: This study was conducted at Shahid Rasulullah Hospital in Nikshahr, Sistan and Baluchistan Province, Iran. Patients or Other Participants: Ninety primiparous mothers in the active phase of the first stage of labor were selected and randomly divided into three groups: acupressure on EX-B8 (n = 30), sham (n = 30), and control group (n = 30). Intervention(s): The acupressure and sham groups received acupressure for 20 min during their uterine contractions at three different time points: when cervical dilatation was at 4-5 cm, 6-7 cm, and 8-10 cm, totaling 60 min. The control group received routine labor care. Main Outcome Measure(s): Pain intensity was assessed using a Numerical Rating Scale (NRS) before, 10 min after, and 20 min after the start of the intervention at three different time points. Results: Pain intensity was significantly lower in the EX-B8 acupressure group compared to the sham and control groups at all three time points of the intervention (p < 0.05). In the EX-B8 group, the greatest amount of pain relief was achieved during dilatation of 8-10 cm, compared to dilatations of 4-5 and 6-7 cm (p=0.0001). Maternal and neonatal outcomes did not differ significantly between the three groups (p > 0.05). Conclusion: The current study found that applying acupressure on EX-B8 effectively reduced pain during labor. Acupressure on this point can be recommended as an effective, low-cost, and accessible pain-relieving technique, especially at the end of the active phase of the first stage of labor. Further studies are needed to determine why acupressure on this point is more effective at the end of the active phase of labor. Trial Registration: Iranian Registry of Clinical Trials: IRCT20211108053006N1.

Background and Objective: Chronic pain represents not only an unpleasant physical condition but also numerous psychological and social consequences for older adults, potentially diminishing their quality of life. Gaining insight into the connection of pain coping mechanisms with pain acceptance and perceived social support can facilitate the development of effective approaches for the treatment and management of pain in older adults. The present study was conducted with the aim of determining the effect of pain coping strategies on perceived social support and pain acceptance in older adults with chronic pain. Methods: The current research was a descriptive, analytical, and correlational study. Participants were selected by a simple random method and comprised 363 older adults with chronic pain referred to the specialized clinics of selected medical centers in the west of Mazandaran province. Tools used to collect data included the Multidimensional Scale of Perceived Social Support (MSPSS), the chronic pain acceptance instrument in older adults (ECPAI), the pain coping strategies questionnaire (PCSQ), and the VanKroff Graded Chronic Pain Scale (VGCPS). Results: The average age of the participants was 68.18 ± 6.36 years. Based on the results of the Pearson correlation test, a positive and significant relationship was found between pain coping strategies (except catastrophizing) and perceived social support (p < 0.001). The highest correlation with perceived social support was observed in components of faith and praying, hoping, and ignoring the pain, with a coefficient of 0.35. Moreover, there was a positive and significant relationship between acceptance of pain and reinterpreting pain, return attention, talking to oneself, ignoring the pain, distractor behaviors, praying, and hoping (p < 0.001). Praying and hoping components exhibited the strongest correlation with pain acceptance, with a coefficient of 0.32. Conclusion: The results showed that coping strategies influence pain acceptance and perceived social support among older adults with chronic pain. Therefore, it is suggested that health service providers, especially nurses, implement appropriate educational, care, support, and psychological solutions in order to empower older adults to recognize and apply effective and efficient coping strategies.

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.