Pain Research & Management最新文献

Background: Office hysteroscopy (OH) is the standard diagnostic method for evaluating intrauterine and endocervical pathology, yet the fear of procedural pain remains a major barrier to patient acceptance. This study examined whether menstrual pain can be used as a clinical reference to anticipate OH procedural pain and explored other predictors of procedural discomfort.

Methods: A historical cohort study was conducted among women undergoing OH for abnormal uterine bleeding or postmenopausal bleeding at a tertiary referral hospital between 2014 and 2024. All procedures were performed by a single experienced hysteroscopist using a 4.9-mm vaginoscopic technique with preprocedural acetaminophen. Menstrual pain and OH procedural pain were assessed using a 0-10 visual analogue scale (VAS). Demographic and clinical variables were extracted from medical records. Associations with OH pain were evaluated using Mann-Whitney U tests and multivariable linear regression.

Results: A total of 488 women were included (median age: 45 years and median BMI: 24.5 kg/m²). Median VAS for menstrual pain was 1.0 (interquartile range [IQR]: 0-3) and for OH pain was 0.0 (IQR: 0-2). Mean OH pain was lower than mean menstrual pain. In bivariate analyses, younger age, nulliparity, and higher menstrual pain were associated with higher OH pain. In multivariable analysis, menstrual pain and nulliparity remained independent predictors of higher OH procedural pain, while increasing age was associated with slightly lower pain.

Conclusion: OH was generally well tolerated, with pain typically lower than menstrual pain. Although menstrual pain, parity, and age explained only a modest proportion of pain variability, menstrual pain history offers a simple and patient-centered way to help clinicians set realistic expectations about procedural discomfort.

Objective: To examine the effects of music therapy, inhalation aromatherapy, and their combination on pain intensity, anxiety, and fear in patients undergoing coronary angiography.

Methods: This randomized controlled trial included 128 patients assigned to four groups: control, music therapy, aromatherapy, and combined music + aromatherapy. Interventions were applied 5-10 min before the procedure and continued during angiography. Visual analog scales for assessing pain (VAS-P), anxiety (VAS-A), and fear (VAS-F), and the State Anxiety Inventory (SAI) were assessed pre- and postprocedure. Data were analyzed using mixed-design ANOVA to examine time, group, and time × group effects, and effect sizes (η ²) were calculated.

Results: Significant time × group interactions were found for pain (η ² = 0.205), fear (η ² = 0.527), anxiety (η ² = 0.550), and state anxiety (η ² = 0.546) (all p < 0.001). All intervention groups showed greater reductions in pain, anxiety, and fear compared with the control group (p < 0.001). No significant differences were observed among the three intervention groups (p > 0.05), although the combined intervention yielded the largest improvements.

Conclusion: Music therapy and inhalation aromatherapy reduce pain, anxiety, and fear in patients undergoing coronary angiography effectively and can be recommended as nonpharmacological nursing interventions. Trial Registration: ClinicalTrials.gov.: NCT05622383.

Background: Hospital-associated deconditioning is complex and multifactorial and has been shown to be closely linked to immobility, which, in turn, has serious consequences. Additionally, pain is seen as one major contributing factor impeding mobility and, therefore, increasing immobility. This study aimed to compare pain management interventions between mobile and immobile patients.

Design: A cross-sectional study using real-world data focusing on patients in Austrian hospitals.

Methods: Data were collected by trained nurses in three periods (2021-2023). Patients were classified as mobile or immobile based on the mobility subscale of the Braden Scale. Statistical analysis involved, e.g., chi-square and Mann-Whitney tests, with p < 0.05 being considered significant.

Results: A total of 3214 patients had pain, of which 1661 were mobile and 1553 were immobile. Immobile patients were statistically significantly older, had more comorbidities, and were also more care dependent than mobile patients, measured with the Care Dependency Scale. Regarding pain management statistically significant, associations can be found between mobile and immobile patients regarding physiotherapy (24.7 vs. 53.1), occupational therapy (6.4 vs. 9.2), and pharmacological treatments (79.5 vs. 91.6), while mobile patients showed associations with alternative therapies such as acupuncture (1.1. vs. 0.3) and relaxing therapies (3.9 vs. 2.3).

Conclusion: Our study showed that immobile patients were associated with conventional interventions, while mobile patients showed an association with alternative therapies. In order to reduce these disparities, increasing the awareness of healthcare professionals in order to personalized pain management strategies is needed. Future research, especially qualitative or mixed-method studies, focusing on the decision making of mobile and immobile patients and including other pain specific aspects such as pain intensity or location is also recommended.

Background: Intravenous (IV) line insertion causes pain and stress in children. However, we know about the permanent effects of painful experiences on a child's life, but this main clinical complaint has been underestimated and left untreated. This study was conducted to compare the effect of the nonpharmacological method of "distraction" and two medicinal methods, "nasal midazolam" and "oral melatonin," on reducing pain and stress caused by IV line insertion in children.

Methods: Patients were randomly assigned to one of the four groups: control, distraction, oral melatonin, and nasal midazolam. Pain and stress scores were measured and compared using a standard questionnaire during and after IV insertion.

Results: In this study, the partial η ² = 0.12 for stress and 0.085 for pain. Parental presence showed a stronger effect (p value < 0.05), with a partial η ² = 0.27 in reducing stress and 0.30 in reducing pain. The underlying disease of the child had no significant relationship with pain and anxiety (p value > 0.05).

Conclusion: In this study, we found that the levels of stress and pain were statistically significant between the 4 study groups: the children who had not managed to reduce pain and anxiety before IV insertion (control group), the oral melatonin group, the nasal midazolam group, and the distraction group (p value = 0.016 and p value = 0.002, respectively). Oral melatonin is more effective than nasal midazolam in reducing pain and stress caused by venipuncture in children.

Trial registration: Iranian Registry of Clinical Trials (IRCT): 20220128053852N2.

Background: Oral mucositis (OM) is a debilitating complication of cancer therapy, particularly in head and neck cancer patients, with significant adverse effects on quality of life (QoL). Although numerous interventions have been investigated, their impact on QoL remains inconsistently reported and poorly synthesized.

Methods: An umbrella review was conducted following PRISMA 2020 and Joanna Briggs Institute (JBI) guidelines. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched from inception to March 2024. Reviews were eligible if they evaluated any therapeutic intervention for OM and reported QoL-related outcomes using validated tools. Methodological quality was appraised using AMSTAR 2, and findings were narratively synthesized and thematically categorized. The protocol was registered in PROSPERO (CRD420251044088).

Results: Eight systematic reviews (257 primary studies) met the inclusion criteria. Photobiomodulation, honey, black mulberry, and botanical agents such as SAMITAL showed consistent improvement in QoL domains, including pain relief, oral function, and emotional well-being. Gabapentin demonstrated potential in reducing opioid use and early mucositis-related pain, though findings were mixed across trials. QoL was most commonly assessed using the EORTC QLQ-C30, FACT-HN, and UW-QOL. Overall, heterogeneity in intervention protocols and QoL instruments limited comparability.

Conclusions: This review highlights the most promising interventions for improving QoL in patients with OM. Standardizing QoL measurement and prioritizing patient-reported outcomes in future trials is essential to inform evidence-based supportive oncology care.

Background: Intraoperative EEG provides a noninvasive window into cortical dynamics under anesthesia, but conventional spectral analysis cannot capture nonstationary modulation patterns linked to nociceptive processing. This study applied Holo-Hilbert spectral analysis (HHSA) to characterize cross-frequency modulation patterns in relation to the Surgical Pleth Index (SPI) during general anesthesia.

Methods: Frontal EEG from 134 female patients undergoing gynecologic surgery was analyzed. Ten-minute segments were first examined to define canonical modulation structures, followed by one-minute epochs synchronized with SPI values to assess dynamic changes. HHSA decomposed each epoch into amplitude modulation patterns across carrier frequencies (1/64-64 Hz). Group comparisons between pain and no-pain epochs were performed using t-tests with Bonferroni correction. A linear mixed-effects model evaluated the effects of SPI, minimum alveolar concentration (MAC), heart rate (HR), and mean arterial pressure (NIBP-m) on alpha-band modulation (8-16-Hz carrier modulated by 3-8-Hz amplitude).

Results: HHSA revealed two dominant cross-frequency interactions within the alpha-carrier band (8-16 Hz): one modulated by 3-6-Hz (high-delta to theta) and another by 1-2-Hz (low-delta) oscillations, indicating layered modulation under anesthesia. During nociceptive states (SPI > 60), modulation power increased in the alpha and high-delta bands, while theta and low-delta modulation weakened. Alpha-band modulation power rose with SPI and declined with MAC.

Conclusions: HHSA revealed distinct cross-frequency modulation patterns reflecting the cortical balance between nociception and analgesia. Alpha-band modulation serves as a physiologically grounded EEG marker for individualized nociception monitoring under general anesthesia.

Introduction: In the emergency department (ED), commonly used analgesics for pain management are nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, and opioids. The aim of this clinical trial was to evaluate the effectiveness of intravenous (IV) or oral (PO) paracetamol, combined with intramuscular (IM) diclofenac, in patients with acute limb injuries.

Methods: This study utilized a double-blind, randomized controlled design to evaluate three different treatment groups. The trial included healthy adult males aged 18-65 years, who arrived at the ED with acute limb injuries, and an initial pain score of at least 5 on the Numerical Rating Scale (NRS). Participants were randomly assigned in equal numbers to one of three groups: one group received IM diclofenac (75 mg/3 mL), along with oral paracetamol (1000 mg); the second group was given IM diclofenac plus IV paracetamol (1000 mg in 100 mL); and the third group received IM diclofenac (75 mg/3 mL), accompanied by a placebo. The main goal of the study was to compare the average pain reduction among the three groups at 30 min after treatment (t30).

Results: A total of 162 participants were recruited between October 2022 and February 2023. Pain levels were assessed at baseline (t0) and continued to be monitored up to 90 min after medication was administered (t90). The average reduction in pain scores for each group was as follows: diclofenac plus oral paracetamol resulted in a mean decrease of 2.5 ± 0.03, diclofenac plus IV paracetamol had a mean reduction of 2.6 ± 0.03, and diclofenac with placebo showed a mean decrease of 2.2 ± 0.04. These results indicate there was no statistically significant difference in pain relief among the three groups. Additionally, none of the groups required rescue pain medication, and no adverse events were reported in any group.

Conclusion: The results demonstrate that the three treatment groups achieved similar levels of pain relief within the observed timeframe, offering no significant advantage in terms of speed or extent of pain reduction. Nonetheless, additional studies are warranted to explore the potential synergistic effects of combining paracetamol with NSAIDs via various administration routes, as well as to assess possible adverse events, and the necessity for supplemental analgesia. Trial Registration: ClinicalTrials.gov identifier: NCT04199572.

Background: Repetitive transcranial magnetic stimulation (rTMS) of the left primary motor cortex (M1) shows promise for treating neuropathic pain (NP) after spinal cord injury (SCI), but its efficacy remains limited. This study investigated whether combining rTMS on M1 with premotor cortex (PMC) could improve pain relief in SCI patients with NP.

Materials and methods: Thirty-nine subjects with NP post-SCI were randomly assigned to three groups: M1 + PMC (10-Hz rTMS on left M1 and PMC), M1 (10-Hz rTMS on left M1), and sham. They underwent daily rTMS sessions for 4 weeks with 2 days off each week. Pain was assessed using the numerical rating scale (NRS) and the Short-Form McGill Pain Questionnaire-2 (SF-MPQ2). Functional near-infrared spectroscopy (fNIRS) measured activations in bilateral M1, PMC, and primary somatosensory cortex (S1) during a handgrip task.

Results: Pain intensity gradually declined in the M1 + PMC, M1, and sham groups over time. Both the M1 and M1 + PMC groups experienced greater reductions in NRS scores compared to the sham group (p < 0.05), with the M1 + PMC group showing the most significant reduction (p < 0.05). The M1 + PMC group showed pain relief from Weeks 1 to 6, along with notable inhibition of left M1 and the left PMC activation. The decrease in the oxyhemoglobin (HbO) concentration in the left PMC is significantly positively correlated with the improvement of the NRS score (r = 0.607, p = 0.028) and SF-MPQ2 (r = 0.595, p = 0.032), respectively.

Conclusions: High-frequency rTMS targeting both left M1 and the left PMC is more effective for NP after SCI than targeting left M1 alone, indicating a synergistic benefit. Trial Registration: Chinese Clinical Trials Registry: ChiCTR2000029024.

Background: Insulin resistance (IR) has been linked to chronic severe pain (CSP) in previous studies. The triglyceride-glucose (TyG) index serves as an indicator of IR. However, whether TyG control level affects the further CSP incidence has not been well established. In this study, we aimed to identify the association between TyG control level and the risk of CSP.

Methods: Participants with a continuous statement of severe pain in two consecutive waves of investigation from the China Health and Retirement Longitudinal Study were defined as CSP. The TyG control level was divided into four classes. The association between the baseline TyG and TyG control level CSP incidence was analyzed through logistic regression and restricted cubic spline analysis.

Results: A total of 113 (3.18%) of 3546 participants were diagnosed as CSP within 9 years. The TyG index has a significant correlation with high CSP incidence (OR = 1.51 (95% CI, 1.16-1.96), p = 0.020). Further research analyzed the trajectory of TyG changes. After adjusting for various confounding factors, comparing to Class 1 with the best control of TyG, the OR for Class 4 with the worst control was 2.30 (95% CI, 1.01-5.25) with p = 0.048. In restricted cubic spline regression, the relationship between the TyG index and cumulative TyG and CSP is linear.

Conclusions: The TyG index should be regarded as a simple indicator of CSP incidence. Continuous monitoring of the TyG index is more suitable for predicting CSP incident risk compared to a one-time TyG measurement, and long-term, well-controlled management of the TyG index may be an efficient approach to reduce the risk of CSP incidence.

Objective: We aimed to evaluate the association between the radiological grade of lumbar foraminal spinal stenosis (LFSS) and the outcomes of dorsal root ganglion (DRG) pulsed radiofrequency (PRF) treatment.

Materials and methods: This is an observational, single-center study. Patients with LFSS who had undergone lumbar DRG-PRF treatment were evaluated according to the radiological grade of stenosis: Grades 1, 2, and 3. Severity of pain, presence of neuropathic pain, and functional status were assessed using a numerical rating scale (NRS), the Douleur Neuropathique en 4 (DN4) Questionnaire, and the Oswestry Disability Index (ODI) at baseline, first, and third months. The groups by grade consisted of 18, 22, and 23 patients, respectively, for Grades 1, 2, and 3.

Results: NRS scores are similar at baseline and first month, but higher in Group 3 than in Groups 1 and 2 at the third month (p = 0.010, p = 0.04). Similarly, DN4 scores are similar at baseline and first month, but higher in Group 3 than in Group 1 (p = 0.017). ODI scores and weekly analgesic intake at baseline, first, and third months are similar. There are significant decreases in the NRS, DN4, ODI, and weekly analgesic consumption in all groups during follow-up (p < 0.05). The ratios of meaningful pain relief were 72.2%, 68.2%, and 69.6% at the first month, and 50.0%, 63.6%, and 43.5% at the third month for Grades 1, 2, and 3 groups, respectively, without significant differences at the first and third months (p > 0.05).

Conclusion: The DRG-PRF treatment is effective for pain and functional disability in LFSS in all grades, although pain scores remained higher in Grade 3 stenosis at the third month. Studies with larger sample sizes for each stenosis grade may provide more accurate and detailed information.