Pain Research & Management最新文献

Background: Pectus excavatum is a common congenital chest wall deformity that can lead to significant cardiopulmonary compression and psychological distress. The minimally invasive Nuss procedure is the standard treatment, but it often results in severe postoperative pain. Effective perioperative pain management is essential to enhance recovery and improve patient outcomes. Objectives: This study aimed to synthesize the most effective evidence on perioperative pain management in patients with pectus excavatum and to provide evidence-based management methods for clinical teams and patients undergoing this surgery. Methods: Guided by the "6S" pyramid model, we retrieved evidence on perioperative pain management from relevant websites, databases, and unpublished gray literature. The search timeframe ranged from 2014 to December 2024. Two researchers independently evaluated the literature quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) for guidelines and the Joanna Briggs Institute (JBI) critical appraisal tool for other types of literature. Two researchers independently extracted and summarized the evidence according to the principle of high-quality evidence and newly published evidence. Results: A total of 39 articles were retrieved, of which 6 were guidelines, 6 were expert consensus, 7 were systematic reviews, 1 was a clinical decision, 11 were randomized controlled trials, and 8 were cohort studies. Overall, 35 pieces of evidence from seven dimensions-general principles, education and counseling, pain assessment, preemptive analgesia, intraoperative analgesia, postoperative pain management, and pain management after discharge-were summarized. Conclusions: This study summarized the best evidence on perioperative pain management in patients with pectus excavatum, providing a comprehensive and scientific approach to enhance recovery and patient satisfaction.

Background: Persistent pain is a complex global issue, which has a significant impact on quality of life. Poor health literacy further impacts the quality of life in people with persistent pain. It is recommended that education be provided to improve health-related knowledge. VR is an engaging learning tool and could improve health literacy. Research exploring the feasibility of physiotherapists using VR to develop health literacy is minimal. Objectives: To determine the feasibility of a VR-based pain education system among physiotherapists and understand barriers and facilitators to its adoption in clinical practice. Methods: Semistructured interviews were conducted with physiotherapists in the United Kingdom after they used a VR-based pain education system, which combines sensory-altering experiences with pain science education. Thematic analysis was used to identify considerations related to its feasibility and its potential to influence health literacy in patients with persistent pain. Results: All participants (n = 12) believed that the VR system could develop several aspects of health literacy, such as information understanding and appraisal. Challenges to clinical integration include allowing for increased clinical time and system training and ensuring the use of VR represents both personalized and evidence-based care. Conclusion: The VR pain management system was considered a feasible adjunct to address health literacy by increasing the plausibility of information and addressing health-related understanding, appraisal, and application. Future research is required to validate the effectiveness of VR-based education systems to improve health literacy.

Background: Chronic pain is one of the most common reasons for seeking medical care and is associated with depression and reduced quality of life. This study aims to explore the association of depression and quality of life with chronic pain, and medication management among patients with chronic pain. Methods: A cross-sectional study was conducted among patients visiting the outpatient departments of two tertiary care hospitals in Pokhara, Nepal. Validated questionnaires were used to collect information regarding socio-demographics, pain intensity (face pain scale), quality of life (EQ-5D-3L), depression (PROMIS depression questionnaire) and medications prescribed for pain management. Descriptive statistics, univariate analysis, correlation and multiple regression were used to analyse the data. Results: Three hundred eighty-five participants were enrolled in the study, and most were females 248 (64.4%). Low back pain (n = 96; 24.9%) was the most commonly reported pain condition. The participants' mean pain and quality of life scores were 4.5 ± 1.97 and 0.59 ± 0.37, respectively. NSAIDs were the most prescribed medication. About 25.2% of the participants had mild, 25.5% moderate and 3.4% severe depression. A significant difference in depression and quality of life score was observed between genders (p < 0.001), among participants with different education levels (p < 0.001), with comorbidity (p < 0.001) and pain duration (p < 0.001). A significant reverse association of quality of life with depression (β = -0.326, p < 0.001), pain score (β = -0.292, p < 0.001) and duration of pain (β = -0.208, p < 0.001) was observed. Conclusion: The quality of life among patients with chronic pain was correlated with the pain score, depression score and duration of pain.

Introduction: Labor pain is a well-known physiological phenomenon considered to be the most severe pain experienced by women of childbearing age. One nonpharmacological method used to alleviate labor pain is acupressure. This study aimed to examine the impact of acupressure on the BL23 points on pain intensity during the active phase of the first stage of labor. Method: This randomized, sham-controlled clinical trial took place at Tehran Baharlu Hospital in Iran from August 23 to October 21, 2023. Ninety first-time pregnant women in active labor were randomly assigned to one of three groups: acupressure on BL23 (n = 30), sham acupressure (between the seventh and eighth thoracic vertebra, 2 Cun from the midline) (n = 30), and a control group (n = 30). The sham and acupressure groups received 60 min of acupressure at three different time points during cervical dilatation at 4-5 cm, 6-7 cm, and 8-10 cm. The control group received standard labor care. Pain severity was assessed using a Numerical Rating Scale before, 10 min after, and 20 min after the intervention at each time point. Result: Pain intensity was significantly lower in the BL23 acupressure group compared to the control and sham groups at all three time points (p < 0.0001). Pain intensity decreased in the BL23 acupressure group after 10 min of intervention at all time points (p < 0.001) and continued to decrease throughout the intervention (p < 0.001). The reduction in pain in the BL23 acupressure group was evident before the start of the second and third interventions (p=0.33 and p=0.36, respectively). Twenty minutes of pressure on BL23 points at different dilatation stages were equally effective in reducing pain (p=0.13). No adverse effects on maternal and neonatal outcomes were observed in the BL23 acupressure group compared to the other groups (p > 0.05). Conclusion: This study demonstrates that applying acupressure to the BL23 points during the active phase of the first stage of labor significantly reduces labor pain. However, the pain relief provided by this intervention is temporary, with its effects diminishing over time rather than offering permanent relief. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20230513058166N1.

Myofascial pain syndrome (MPS) is a prevalent musculoskeletal disorder characterized by myofascial trigger points (MTrPs), which can significantly impact an individual's quality of life. This study aimed to evaluate the efficacy of Kinesio taping (KT) in reducing pain intensity and increasing pressure pain threshold (PPT) in individuals with MPS. A comprehensive search was performed across five electronic databases (PubMed, Web of Science, Cochrane Library, Embase, and SCOPUS) from inception to May 2024. Randomized controlled trials (RCTs) comparing KT to a control group, including no intervention, placebo, or sham taping, in individuals with MPS were included. Data on pain intensity and PPT were extracted and pooled using RevMan 5.4 software. A total of 15 RCTs were included in the systematic review and meta-analysis. The pooled analysis showed a significant reduction in pain intensity in the KT group compared to the control group immediately after intervention (mean difference [MD] = -1.07, 95% confidence interval (CI) [-1.93, -0.20], p = 0.02), within the first week (standardized mean difference [SMD] = -1.44, 95% CI [-2.39, -0.49], p = 0.003), and after 2-3 weeks (SMD = -0.97, 95% CI [-1.46, -0.49], p < 0.0001). However, the effect diminished after 4-6 weeks (MD = -0.90, 95% CI [-1.65, -0.14], p = 0.02). Regarding PPT, KT significantly increased PPT within the first week (MD = 4.32, 95% CI [2.47, 6.16], p < 0.00001) but not immediately after intervention or after 2-3 and 4-6 weeks. This meta-analysis provides evidence that KT is effective in reducing pain intensity and increasing PPT in individuals with MPS, particularly in the immediate and short-term periods. However, the effects on pain reduction and PPT diminish over time, suggesting a need for reapplication or combination with other interventions for sustained long-term benefits.

Objective: Despite the availability of studies, there is a lack of available literature on the treatment of psychological and gastrointestinal causes of noncardiac chest pain (NCCP). Physiotherapeutic techniques involving diaphragmatic breathing, Jacobson's relaxation and dynamic neuromuscular stabilization (DNS) could address these causes through the activation of parasympathetic system. Hence, this study aims to evaluate the combined effect of diaphragmatic breathing, Jacobson's relaxation and DNS along with pharmacological therapy on patients with gastrointestinal and psychological causes of NCCP. Design: Randomized controlled trial. Setting: Cardiology OPD of a tertiary care hospital. Subjects: Eighty-eight subjects with NCCP. Methods: The intervention group received diaphragmatic breathing, Jacobson's relaxation technique, DNS and pharmacological treatment for 4 weeks. The control group was given pharmacological treatment with patient education. The Beck Depression Inventory (BDI) score, Hamilton Depression Rating Scale (HDRS) score, gastroesophageal reflux disease (GERD) questionnaire score and Numerical Pain Rating Scale (NPRS) score were measured at baseline and after 4 weeks of intervention. Results: The baseline characteristics and outcome measures were assessed, and no significant differences were noted in their mean values (p > 0.05). After 4 weeks of intervention, a statistically significant difference was observed in BDI, HDRS, GERD questionnaire score and NPRS in both the groups (p < 0.001). However, the GERD questionnaire and NPRS showed statistically significant decrease in the intervention group (GERD questionnaire: 28.39 ± 9.74 and NPRS: 4.57 ± 0.91) compared with the control group (GERD questionnaire: 35.54 ± 12.23 and NPRS: 4.95 ± 0.96) with p < 0.05. Conclusion: The diaphragmatic breathing exercises, Jacobson's relaxation technique and DNS are beneficial for reducing GERD symptoms and pain in patients with NCCP. These techniques are safe and cost-effective treatment for addressing the psychological and gastrointestinal causes of NCCP. These can be incorporated along with the pharmacological treatment to enhance the outcomes. However, future researches with long-term follow-ups are required. Trial Registration: Clinical Trials Registry - India: CTRI/2025/02/081294.

Objective: Patient adherence to treatment recommendations is less than optimal within chronic pain management. Behaviour change techniques (BCTs) and frameworks can be used to maximise engagement with desired behaviours but are also underused. This study sought the perceptions of nurses to explore the perceived barriers and facilitators to utilising BCTs in clinical practice in chronic pain settings. Methods: Eight qualified nurses participated in semi-structured interviews. Reflexive thematic analysis was conducted to understand barriers and facilitators to the use of BCTs in practice. Results: Three themes were identified (1) behaviour change embedded in current practice, (2) complexities in chronic pain as barriers in implementing behaviour change and (3) from experience to expertise: training and supervision needs. Findings suggest that nurses engage in some BCTs (17 were discussed across all interviews), without explicit knowledge of specific BCTs and how to use them. The use of BCTs is restricted by patients' medical complexities, including mental health comorbidities, unhelpful biomedical beliefs about pain and opioid reliance. Furthermore, the opportunity to effectively utilise BCTs is impeded by a lack of training and clinical supervision. Conclusions: Improving nurses' capabilities by enhancing BCT training and clinical supervision is required. Furthermore, organisational change is recommended to create the opportunity for nurses to effectively utilise BCTs. Specifically, organisations should devote necessary resources, backed by effective implementation strategies, to enhance such engagement.

Background: Peripheral sensitization mediated by the Transient Receptor Potential Vanilloid 4-Calcium/calmodulin-dependent protein kinase II (TRPV4-CaMKII) signaling pathway plays a fundamental role in the generation and maintenance of neuropathic pain (NP). Tuina, a safe and effective therapy in traditional Chinese medicine, shows analgesic effects; however, the underlying mechanisms remain unclear. We aimed to investigate whether Tuina alleviates pain by modulating the TRPV4-CaMKII/CREB/NLRP3 signaling pathway. Methods: The Chronic Constriction Injury (CCI) model of the sciatic nerve was used to simulate clinical NP. Tuina was applied to the Yinmen (BL37), Yanglingquan (GB34), and Chengshan (BL57) acupoints once daily for 14 days. Mechanical Withdrawal Threshold (MWT) and Thermal Withdrawal Latency (TWL) were assessed to evaluate the analgesic effect of Tuina. Its protective effects on dorsal root ganglion (DRG) neurons were evaluated using Nissl staining. The whole-cell patch clamp technique recorded excitability changes in DRG neurons and assess the effects of Tuina on peripheral sensitization. Western blot (WB), immunofluorescence (IF), and enzyme-linked immunosorbent assay (ELISA) helped detect changes in the TRPV4-CaMKII/CREB/NLRP3 pathway and expression of inflammation-related cytokines in DRG neurons. Results: Tuina significantly alleviated mechanical allodynia and thermal hyperalgesia in CCI rats and exerted a protective effect on DRG neurons. Patch clamp recordings showed that Tuina inhibited hyperexcitability in DRG neurons. Mechanistically, Tuina downregulated the expression of the TRPV4-CaMKII/CREB/NLRP3 signaling pathway and reduced the secretion of TNF-α, IL-1β, and IL-18. Conclusion: The analgesic effect of Tuina in CCI rats is associated with reduced peripheral sensitization via modulation of the TRPV4-calcium signaling cascade.

Background: Spinal cord stimulation (SCS) serves as a treatment option for neuropathic pain conditions. Despite its widespread use and technological advancements over the last decade, the long-term efficacy of SCS remains a topic of debate. Consequently, there is an increasing demand for real-world, long-term data regarding its effectiveness. Material and Methods: In 2018, the Belgian government launched a nationwide platform to monitor all SCS therapies. Five and a half years after its start, a full data extraction was conducted. In the present study, we update the findings of Bernaerts et al. (2024) from the 3-week trial period and the long-term follow-up of patients with persistent spinal pain syndrome and focus on the completion rates of the follow-ups and the battery lifetime of the implantable pulse generators (IPGs). Results: Findings indicate that "yellow flags" or psychological variables can be confirmed as significant predictors of recovery and satisfaction following the trial. Additionally, these yellow flags were able to predict long-term disability. Analysis revealed that patients who completed the follow-up module displayed more active and less passive coping strategies for their pain, along with lower levels of illness anxiety prior to the trial's start, better physical and psychological functioning, and greater recovery and satisfaction with the trial's outcomes. However, adherence to the chronic follow-up module declined over time. Moreover, we investigated the battery life of both rechargeable and nonrechargeable batteries across various indication types. The real-world dataset indicated no significant differences in battery lifetime between rechargeable and nonrechargeable IPGs for each indication type. Conclusions: The long-term outcomes of neuromodulation are intricate and influenced by various factors. Data extracted from the Neuro-Pain® registry increasingly enable us to identify confounding factors and predictors of treatment success with greater precision. Trial Registration: ClinicalTrials.gov identifier: NCT06835868.

Background: The quadratus lumborum block (QLB) and erector spinae plane (ESP) block are relatively new regional analgesic techniques that provide analgesia to the abdominal wall and reduce postoperative opioid consumption. We compared the effectiveness of ultrasound-guided bilateral ESP block versus bilateral QLB in patients undergoing laparoscopic kidney surgery. Methods: Adult patients who underwent laparoscopic nephrectomy or nephron-sparing surgery (NSS) within the study period were included. Patients were randomly assigned to one of two groups: group I received an ultrasound-guided ESP block with 30 mL of 0.35% ropivacaine on each side and group II received an ultrasound-guided QLB 1 with 30 mL of 0.35% ropivacaine on each side. Results: A total of 84 patients were included, with 45 patients in the ESP block group and 39 in the QLB group. The mean dosage of oxycodone in the ESP block group was 22.66 mg and in the QLB group was 22.66 mg. There was no difference in oxycodone consumption within the first 24 h after surgery between the groups (p=0.77). Conclusion: The effect of ultrasound-guided bilateral QLB and ESP blocks in patients undergoing laparoscopic kidney surgery was found to be similar in terms of postoperative pain and opioid consumption. There were no significant differences between the blocks in opioid consumption or pain scores. Both techniques appear to be effective and safe components of multimodal analgesia strategy for laparoscopic nephrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT05446727.