首页 > 最新文献

Pain Research & Management最新文献

英文 中文
Does a Positive Response to Transforaminal Epidural Steroid Injection Identify Patients Who Can Avoid Surgery for Two Years? 经孔硬膜外类固醇注射的阳性反应是否能识别出两年内可以避免手术的患者?
IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-14 eCollection Date: 2023-01-01 DOI: 10.1155/2023/4298436
Aki Fujiwara, Keisuke Watanabe, Hideki Shigematsu, Katsuhiro Kimoto, Mitsuru Ida, Yasuhito Tanaka, Masahiko Kawaguchi

Background: Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbar radiculopathy. In clinical settings, patients often undergo repeated transforaminal epidural injections with or without steroid administration.

Objectives: To examine whether a positive response to TFESI at the first month, can in clinical settings, identify patients with radiculopathy who can avoid surgery for two years. Study Design/Setting. This prospective observational study was conducted at an academic medical center.

Methods: Individuals aged ≥20 years who had been referred to our pain center by spine surgeons were enrolled. All patients were assessed using the Numerical Rating Scale (NRS) at baseline and 1 month after the first TFESI. Patients were divided into two groups according to the NRS decrement: the positive response (PR) group achieved a ≥2.0 decrease on the NRS 1 month after the first TFESI compared to baseline and the no response (NR) group achieved a <2.0 decrease on the NRS. The incidence rates of surgery over two years were compared between the two groups. In addition, we calculated the hazard ratio of the PR group to the NR group regarding the incidence of surgery over two years using the Cox proportional hazard model, adjusting for baseline NRS.

Results: Seventy-six patients completed the two-year follow-up. In total, 8 and 68 patients had bilateral and unilateral radiculopathy, respectively. The PR and NR groups included 35 and 41 patients, respectively. The rate of surgery avoidance was 85.7% and 73.2% in the PR and NR groups, respectively. This difference was not statistically significant (p=0.26). After adjusting for baseline NRS, the hazard ratio of the PR group to the NR group regarding the incidence of surgery within two years was 0.35 (95% confidence interval: 0.11-1.11, p=0.08).

Conclusion: A positive response to TFESI may not identify patients who can avoid surgery for two years.

背景:经椎间孔硬膜外类固醇注射(TFESI)被广泛用于治疗腰神经根病。在临床环境中,患者经常在服用或不服用类固醇的情况下接受反复的经孔硬膜外注射。目的:研究在第一个月对TFESI的阳性反应是否可以在临床环境中确定可以避免手术两年的神经根病患者。研究设计/设置。这项前瞻性观察研究是在一家学术医学中心进行的。方法:年龄≥20岁的个体 我们招募了几年来被脊椎外科医生转诊到我们疼痛中心的患者。所有患者在基线和1 第一次TFESI后一个月。根据NRS的减少将患者分为两组:阳性反应(PR)组NRS1的减少≥2.0 与基线相比,第一次TFESI后一个月,无反应(NR)组获得了a结果:76名患者完成了为期两年的随访。总共有8名和68名患者分别患有双侧和单侧神经根病。PR组和NR组分别包括35名和41名患者。PR组和NR组的手术回避率分别为85.7%和73.2%。这一差异没有统计学意义(p=0.26)。在调整基线NRS后,PR组与NR组关于两年内手术发生率的风险比为0.35(95%置信区间:0.11-1.11,p=0.08)。结论:对TFESI的阳性反应可能无法确定可以避免两年手术的患者。
{"title":"Does a Positive Response to Transforaminal Epidural Steroid Injection Identify Patients Who Can Avoid Surgery for Two Years?","authors":"Aki Fujiwara, Keisuke Watanabe, Hideki Shigematsu, Katsuhiro Kimoto, Mitsuru Ida, Yasuhito Tanaka, Masahiko Kawaguchi","doi":"10.1155/2023/4298436","DOIUrl":"10.1155/2023/4298436","url":null,"abstract":"<p><strong>Background: </strong>Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbar radiculopathy. In clinical settings, patients often undergo repeated transforaminal epidural injections with or without steroid administration.</p><p><strong>Objectives: </strong>To examine whether a positive response to TFESI at the first month, can in clinical settings, identify patients with radiculopathy who can avoid surgery for two years. <i>Study Design/Setting</i>. This prospective observational study was conducted at an academic medical center.</p><p><strong>Methods: </strong>Individuals aged ≥20 years who had been referred to our pain center by spine surgeons were enrolled. All patients were assessed using the Numerical Rating Scale (NRS) at baseline and 1 month after the first TFESI. Patients were divided into two groups according to the NRS decrement: the positive response (PR) group achieved a ≥2.0 decrease on the NRS 1 month after the first TFESI compared to baseline and the no response (NR) group achieved a <2.0 decrease on the NRS. The incidence rates of surgery over two years were compared between the two groups. In addition, we calculated the hazard ratio of the PR group to the NR group regarding the incidence of surgery over two years using the Cox proportional hazard model, adjusting for baseline NRS.</p><p><strong>Results: </strong>Seventy-six patients completed the two-year follow-up. In total, 8 and 68 patients had bilateral and unilateral radiculopathy, respectively. The PR and NR groups included 35 and 41 patients, respectively. The rate of surgery avoidance was 85.7% and 73.2% in the PR and NR groups, respectively. This difference was not statistically significant (<i>p</i>=0.26). After adjusting for baseline NRS, the hazard ratio of the PR group to the NR group regarding the incidence of surgery within two years was 0.35 (95% confidence interval: 0.11-1.11, <i>p</i>=0.08).</p><p><strong>Conclusion: </strong>A positive response to TFESI may not identify patients who can avoid surgery for two years.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"4298436"},"PeriodicalIF":2.5,"publicationDate":"2023-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10590266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49691899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Racial, Ethnic, and Language-Based Inequities in Inpatient Opioid Prescribing by Diagnosis from Internal Medicine Services, a Retrospective Cohort Study. 内科服务诊断的住院阿片类药物处方中基于种族、民族和语言的不平等,一项回顾性队列研究。
IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-09-21 eCollection Date: 2023-01-01 DOI: 10.1155/2023/1658413
Mihir Joshi, Priya A Prasad, Colin C Hubbard, Nicholas Iverson, Solmaz P Manuel, Margaret C Fang, Aksharananda Rambachan

Introduction: Opioid administration is extremely common in the inpatient setting, yet we do not know how the administration of opioids varies across different medical conditions and patient characteristics on internal medicine services. Our goal was to assess racial, ethnic, and language-based inequities in opioid prescribing practices for patients admitted to internal medicine services.

Methods: We conducted a retrospective cohort study of all adult patients admitted to internal medicine services from 2013 to 2021 and identified subcohorts of patients treated for the six most frequent primary hospital conditions (pneumonia, sepsis, cellulitis, gastrointestinal bleed, pyelonephritis/urinary tract infection, and respiratory disease) and three select conditions typically associated with pain (abdominal pain, acute back pain, and pancreatitis). We conducted a negative binomial regression analysis to determine how average administered daily opioids, measured as morphine milligram equivalents (MMEs), were associated with race, ethnicity, and language, while adjusting for additional patient demographics, hospitalization characteristics, medical comorbidities, prior opioid therapy, and substance use disorders.

Results: The study cohort included 61,831 patient hospitalizations. In adjusted models, we found that patients with limited English proficiency received significantly fewer opioids (66 MMEs, 95% CI: 52, 80) compared to English-speaking patients (101 MMEs, 95% CI: 91, 111). Asian (59 MMEs, 95% CI: 51, 66), Latinx (89 MMEs, 95% CI: 79, 100), and multi-race/ethnicity patients (81 MMEs, 95% CI: 65, 97) received significantly fewer opioids compared to white patients (103 MMEs, 95% CI: 94, 112). American Indian/Alaska Native (227 MMEs, 95% CI: 110, 344) patients received significantly more opioids. Significant inequities were also identified across race, ethnicity, and language groups when analyses were conducted within the subcohorts. Most notably, Asian and Latinx patients received significantly fewer MMEs and American Indian/Alaska Native patients received significantly more MMEs compared to white patients for the top six most frequent conditions. Most patients from minority groups also received fewer MMEs compared to white patients for three select pain conditions. Discussion. There are notable inequities in opioid prescribing based on patient race, ethnicity, and language status for those admitted to inpatient internal medicine services across all conditions and in the subcohorts of the six most frequent hospital conditions and three pain-associated conditions. This represents an institutional and societal opportunity for quality improvement initiatives to promote equitable pain management.

简介:阿片类药物的给药在住院患者中极为常见,但我们不知道阿片类药的给药如何因不同的医疗条件和患者在内科服务中的特点而变化。我们的目标是评估内科服务患者在阿片类药物处方实践中基于种族、族裔和语言的不平等。方法:我们对2013年至2021年入住内科的所有成年患者进行了回顾性队列研究,确定了六种最常见的初级医院疾病(肺炎、败血症、蜂窝组织炎、胃肠道出血、肾盂肾炎/尿路感染和呼吸系统疾病)和三种典型相关疾病的亚组患者伴有疼痛(腹痛、急性背痛和胰腺炎)。我们进行了负二项回归分析,以确定以吗啡毫克当量(MME)衡量的平均每日阿片类药物与种族、民族和语言之间的关系,同时调整额外的患者人口统计、住院特征、医疗合并症、既往阿片类治疗和物质使用障碍。结果:研究队列包括61831名住院患者。在调整后的模型中,我们发现英语水平有限的患者接受的阿片类药物(66种MME,95%CI:52,80)明显少于英语患者(101种MME、95%CI:9111)。与白人患者(103例MME,95%CI:941112)相比,亚裔(59例MME、95%CI:51,66)、拉丁裔(89例MME和95%CI:77100)和多种族/族裔患者(81例MME与95%CI:65,97)接受的阿片类药物明显减少。美国印第安人/阿拉斯加原住民(227例MME,95%可信区间:110344)患者接受的阿片类药物明显增多。当在子类别中进行分析时,还发现种族、民族和语言群体之间存在显著的不平等。最值得注意的是,在前六种最常见的情况下,与白人患者相比,亚裔和拉丁裔患者接受的MME明显更少,美洲印第安人/阿拉斯加原住民患者接受的MMP明显更多。在三种选定的疼痛情况下,与白人患者相比,大多数少数族裔患者接受的MME更少。讨论在所有条件下,以及在六种最常见的医院条件和三种疼痛相关条件下,基于患者种族、民族和语言状况,住院内科服务人员的阿片类药物处方存在显著的不公平。这为质量改进举措提供了一个机构和社会机会,以促进公平的疼痛管理。
{"title":"Racial, Ethnic, and Language-Based Inequities in Inpatient Opioid Prescribing by Diagnosis from Internal Medicine Services, a Retrospective Cohort Study.","authors":"Mihir Joshi, Priya A Prasad, Colin C Hubbard, Nicholas Iverson, Solmaz P Manuel, Margaret C Fang, Aksharananda Rambachan","doi":"10.1155/2023/1658413","DOIUrl":"10.1155/2023/1658413","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid administration is extremely common in the inpatient setting, yet we do not know how the administration of opioids varies across different medical conditions and patient characteristics on internal medicine services. Our goal was to assess racial, ethnic, and language-based inequities in opioid prescribing practices for patients admitted to internal medicine services.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all adult patients admitted to internal medicine services from 2013 to 2021 and identified subcohorts of patients treated for the six most frequent primary hospital conditions (pneumonia, sepsis, cellulitis, gastrointestinal bleed, pyelonephritis/urinary tract infection, and respiratory disease) and three select conditions typically associated with pain (abdominal pain, acute back pain, and pancreatitis). We conducted a negative binomial regression analysis to determine how average administered daily opioids, measured as morphine milligram equivalents (MMEs), were associated with race, ethnicity, and language, while adjusting for additional patient demographics, hospitalization characteristics, medical comorbidities, prior opioid therapy, and substance use disorders.</p><p><strong>Results: </strong>The study cohort included 61,831 patient hospitalizations. In adjusted models, we found that patients with limited English proficiency received significantly fewer opioids (66 MMEs, 95% CI: 52, 80) compared to English-speaking patients (101 MMEs, 95% CI: 91, 111). Asian (59 MMEs, 95% CI: 51, 66), Latinx (89 MMEs, 95% CI: 79, 100), and multi-race/ethnicity patients (81 MMEs, 95% CI: 65, 97) received significantly fewer opioids compared to white patients (103 MMEs, 95% CI: 94, 112). American Indian/Alaska Native (227 MMEs, 95% CI: 110, 344) patients received significantly more opioids. Significant inequities were also identified across race, ethnicity, and language groups when analyses were conducted within the subcohorts. Most notably, Asian and Latinx patients received significantly fewer MMEs and American Indian/Alaska Native patients received significantly more MMEs compared to white patients for the top six most frequent conditions. Most patients from minority groups also received fewer MMEs compared to white patients for three select pain conditions. <i>Discussion</i>. There are notable inequities in opioid prescribing based on patient race, ethnicity, and language status for those admitted to inpatient internal medicine services across all conditions and in the subcohorts of the six most frequent hospital conditions and three pain-associated conditions. This represents an institutional and societal opportunity for quality improvement initiatives to promote equitable pain management.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"1658413"},"PeriodicalIF":2.9,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41149519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Relationship between Pain Catastrophizing and Cognitive Function in Chronic Musculoskeletal Pain: A Scoping Review. 慢性肌肉骨骼疼痛的疼痛突变与认知功能之间的关系:范围界定综述。
IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-09-09 eCollection Date: 2023-01-01 DOI: 10.1155/2023/5851450
Cory Alcon, Elizabeth Bergman, John Humphrey, Rupal M Patel, Sharon Wang-Price

Objective: Chronic musculoskeletal pain (CMP) poses a considerable threat to physical, mental, and financial health worldwide. Beyond physical difficulties, CMP has a pronounced impact on pain behaviors and cognitive function. The purpose of this scoping review was to examine the relationship between pain catastrophizing (PC) and cognitive function in CMP, identify gaps in the literature, and provide future directions for research on the topic.

Methods: Search strings were entered in the following databases: PubMed, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, and Scopus. Data from the included articles were extracted thematically based on diagnostic classification and included author(s), year of publication, country, aim, sample, methods, intervention (if applicable), and key findings.

Results: 30 articles were included after screening. The studied populations included patients with fibromyalgia, chronic low back pain, and CMP. Two studies were designed to assess the relationship between PC and cognition as the primary aim. The included studies demonstrated variable evidence regarding the relationship between PC and cognition. Only four studies included clinically relevant PC populations (i.e., Pain Catastrophizing Scale score >30), and all found significant correlations.

Conclusion: Although evidence exists for the relationship between cognitive function and PC, there is a lack of rigorous research to indicate the strength of this relationship and the specific cognitive functions affected. The literature lacks appropriate populations needed to investigate clinically relevant PC and is limited by heterogeneous neuropsychological test batteries. Future research should include populations demonstrating the behaviors being studied, intentional analysis of outcomes, and appropriate cognitive tests.

目的:慢性肌肉骨骼疼痛(CMP)对全世界的身体、心理和财务健康构成了相当大的威胁。除了身体困难之外,CMP对疼痛行为和认知功能也有显著影响。本范围综述的目的是研究CMP中疼痛灾难性(PC)和认知功能之间的关系,找出文献中的空白,并为该主题的未来研究提供方向。方法:在以下数据库中输入搜索字符串:PubMed、CINAHL、Nursing and Allied Health、Ovid Emcare、PsycInfo和Scopus。纳入文章中的数据根据诊断分类按主题提取,包括作者、发表年份、国家、目的、样本、方法、干预措施(如适用)和关键发现。结果:筛选出30篇文章。研究人群包括纤维肌痛、慢性腰痛和CMP患者。两项研究旨在评估PC与认知之间的关系,作为主要目的。纳入的研究证明了PC与认知之间关系的可变证据。只有四项研究纳入了临床相关的PC人群(即疼痛灾难量表评分>30),所有研究都发现了显著的相关性。结论:尽管有证据表明认知功能与PC之间存在关系,但缺乏严谨的研究来表明这种关系的强度以及受影响的特定认知功能。文献缺乏研究临床相关PC所需的适当人群,并且受到异质性神经心理测试组的限制。未来的研究应包括展示所研究行为的人群、对结果的有意分析和适当的认知测试。
{"title":"The Relationship between Pain Catastrophizing and Cognitive Function in Chronic Musculoskeletal Pain: A Scoping Review.","authors":"Cory Alcon, Elizabeth Bergman, John Humphrey, Rupal M Patel, Sharon Wang-Price","doi":"10.1155/2023/5851450","DOIUrl":"10.1155/2023/5851450","url":null,"abstract":"<p><strong>Objective: </strong>Chronic musculoskeletal pain (CMP) poses a considerable threat to physical, mental, and financial health worldwide. Beyond physical difficulties, CMP has a pronounced impact on pain behaviors and cognitive function. The purpose of this scoping review was to examine the relationship between pain catastrophizing (PC) and cognitive function in CMP, identify gaps in the literature, and provide future directions for research on the topic.</p><p><strong>Methods: </strong>Search strings were entered in the following databases: PubMed, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, and Scopus. Data from the included articles were extracted thematically based on diagnostic classification and included author(s), year of publication, country, aim, sample, methods, intervention (if applicable), and key findings.</p><p><strong>Results: </strong>30 articles were included after screening. The studied populations included patients with fibromyalgia, chronic low back pain, and CMP. Two studies were designed to assess the relationship between PC and cognition as the primary aim. The included studies demonstrated variable evidence regarding the relationship between PC and cognition. Only four studies included clinically relevant PC populations (i.e., Pain Catastrophizing Scale score >30), and all found significant correlations.</p><p><strong>Conclusion: </strong>Although evidence exists for the relationship between cognitive function and PC, there is a lack of rigorous research to indicate the strength of this relationship and the specific cognitive functions affected. The literature lacks appropriate populations needed to investigate clinically relevant PC and is limited by heterogeneous neuropsychological test batteries. Future research should include populations demonstrating the behaviors being studied, intentional analysis of outcomes, and appropriate cognitive tests.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"5851450"},"PeriodicalIF":2.5,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Application of Inferior Alveolar Nerve Block Device for Safe and Secure IANB by Any Operator. 下牙槽神经阻滞装置在任何操作者安全可靠IANB中的临床应用。
IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-09-08 eCollection Date: 2023-01-01 DOI: 10.1155/2023/1021918
Tomoyasu Noguchi, Kento Odaka, Ken-Ichi Fukuda

The inferior alveolar nerve block (IANB) is an established technique with a success rate of 60-80%; however, large errors have been reported among operators. Some dentists do not prefer to use IANB because of the risk of complications. Nevertheless, it is a useful technique for pain control, and a secure IANB offers significant benefits to operators and patients. This case series study aimed to investigate the efficacy of the "IANB Device," a nerve block guide for IANB, and the adverse events associated with its use in clinical practice. IANB was performed using the device on five patients who had undergone detailed computed tomography examination for chronic orofacial pain in the third division of the trigeminal nerve. Lidocaine 1% (1 mL, no adrenaline added) was used as the local anesthetic. IANB was performed by three dentists with 2, 5, and 11 years of experience in orofacial pain treatment. Thus, the data were collected in triplicate for each patient. The primary endpoints were whether adjustment of the IANB device was required, changes in the sensation threshold of the lower lip, the time to disappearance of pain, the presence or absence of tongue sensation ("Do you have numbness in your tongue?": "Yes/No"), and discomfort (visual analog scale). The incidence of any other adverse events was recorded. The procedure was judged to be successful if the pain disappeared and an elevation in the sensation threshold of the lower lip was observed. Adjustment of the IANB device was not required in any patient. A significant elevation in the sensation threshold of the lower lip and the disappearance of pain were observed in all patients. Three of the five patients reported experiencing tongue numbness. Discomfort with the use of the IANB device was less than 30 mm on the visual analog scale. No notable complications were observed. The appropriate type, concentration, and dosage of the local anesthetic must be considered during general dental treatment and oral surgical procedures. Our findings suggest that the IANB device is useful for eliminating errors between operators, enhancing safety, and improving the success rate.

下牙槽神经阻滞(IANB)是一种已建立的技术,成功率为60-80%;然而,据报道,运营商之间存在较大的错误。一些牙医不喜欢使用IANB,因为有并发症的风险。然而,这是一种有用的疼痛控制技术,安全的IANB为操作员和患者提供了显著的好处。本病例系列研究旨在调查“IANB装置”(IANB的神经阻滞指南)的疗效,以及与临床实践中使用相关的不良事件。使用该设备对五名患者进行了IANB检查,这些患者因三叉神经第三节慢性口面疼痛接受了详细的计算机断层扫描检查。利多卡因1%(1 mL,不添加肾上腺素)作为局部麻醉剂。IANB由三名牙医进行,分别为2名、5名和11名 多年的口腔面部疼痛治疗经验。因此,每个患者的数据收集一式三份。主要终点是是否需要调整IANB装置、下唇感觉阈值的变化、疼痛消失的时间、是否有舌头感觉(“你的舌头麻木了吗?”:“是/否”)和不适(视觉模拟量表)。记录任何其他不良事件的发生率。如果疼痛消失,并且观察到下唇感觉阈值升高,则该手术被判断为成功。任何患者都不需要调整IANB装置。所有患者的下唇感觉阈值显著升高,疼痛消失。五名患者中有三名报告称出现舌头麻木。使用IANB设备的不适感小于30 mm。未观察到明显的并发症。在一般牙科治疗和口腔外科手术过程中,必须考虑适当的局部麻醉剂类型、浓度和剂量。我们的研究结果表明,IANB设备有助于消除操作员之间的错误,提高安全性,提高成功率。
{"title":"Clinical Application of Inferior Alveolar Nerve Block Device for Safe and Secure IANB by Any Operator.","authors":"Tomoyasu Noguchi,&nbsp;Kento Odaka,&nbsp;Ken-Ichi Fukuda","doi":"10.1155/2023/1021918","DOIUrl":"10.1155/2023/1021918","url":null,"abstract":"<p><p>The inferior alveolar nerve block (IANB) is an established technique with a success rate of 60-80%; however, large errors have been reported among operators. Some dentists do not prefer to use IANB because of the risk of complications. Nevertheless, it is a useful technique for pain control, and a secure IANB offers significant benefits to operators and patients. This case series study aimed to investigate the efficacy of the \"IANB Device,\" a nerve block guide for IANB, and the adverse events associated with its use in clinical practice. IANB was performed using the device on five patients who had undergone detailed computed tomography examination for chronic orofacial pain in the third division of the trigeminal nerve. Lidocaine 1% (1 mL, no adrenaline added) was used as the local anesthetic. IANB was performed by three dentists with 2, 5, and 11 years of experience in orofacial pain treatment. Thus, the data were collected in triplicate for each patient. The primary endpoints were whether adjustment of the IANB device was required, changes in the sensation threshold of the lower lip, the time to disappearance of pain, the presence or absence of tongue sensation (\"Do you have numbness in your tongue?\": \"Yes/No\"), and discomfort (visual analog scale). The incidence of any other adverse events was recorded. The procedure was judged to be successful if the pain disappeared and an elevation in the sensation threshold of the lower lip was observed. Adjustment of the IANB device was not required in any patient. A significant elevation in the sensation threshold of the lower lip and the disappearance of pain were observed in all patients. Three of the five patients reported experiencing tongue numbness. Discomfort with the use of the IANB device was less than 30 mm on the visual analog scale. No notable complications were observed. The appropriate type, concentration, and dosage of the local anesthetic must be considered during general dental treatment and oral surgical procedures. Our findings suggest that the IANB device is useful for eliminating errors between operators, enhancing safety, and improving the success rate.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"1021918"},"PeriodicalIF":2.9,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10504047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10655407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Functional Alterations of the Basal Ganglia Are Associated with Voluntary Activation of the Core Stabilizing Muscles in Patients with Chronic Low Back Pain: A Cross-Sectional Study. 慢性腰痛患者基底节的功能改变与核心稳定肌的自主激活有关:一项横断面研究。
IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-08-31 eCollection Date: 2023-01-01 DOI: 10.1155/2023/2028379
Chanjuan Zhang, Xi Chen, Yi Yin, Dongfeng Xie, Jing Luo, Yinan Ai, Wenfeng Zhan, Hongjun Kan, Shuxian Zhang, Guihua Jiang, Xiquan Hu

Purpose: Deficits in voluntary activation of the core stabilizing muscles are consistently observed in patients with chronic low back pain (CLBP); however, the underlying neural mechanism remains unclear. This cross-sectional study aimed at testing the hypothesis that the impaired voluntary activation of core stabilizing muscles is associated with structural and functional alterations in the basal ganglia, thalamus, and cortex in patients with CLBP.

Methods: We obtained structural and resting-state functional magnetic resonance imaging (rs-fMRI) data from 53 patients with CLBP and 67 healthy controls and estimated the alterations in grey matter volume (GMV) and functional and effective connectivity (EC) of regions with altered GMV via whole brain analysis. The voluntary activation of the multifidus (MF) and transversus abdominis (TrA) was evaluated by ultrasound imaging in these patients.

Results: Compared with the HCs, they displayed a significant decrease in GMV in the bilateral thalamus and caudate nucleus, a significant increase in GMV in the left middle frontal gyrus, and increased resting-state functional connectivity between the right caudate nucleus and the bilateral precuneus (voxel-level p < 0.005, Gaussian random field-corrected p < 0.05). The patients also showed increased EC from the right caudate nucleus to the bilateral precuneus, which was significantly correlated with voluntary activation of the bilateral MF and TrA (all p < 0.050).

Conclusions: Grey matter alterations may be confined to regions responsible for perception, motor control, and emotion regulation in patients with CLBP. The interrupted EC from the basal ganglia to the default mode network might be involved in the impairment of voluntary activation of the core stabilizing muscles.

目的:在慢性腰痛(CLBP)患者中一直观察到核心稳定肌的自主激活缺陷;然而,其潜在的神经机制尚不清楚。这项横断面研究旨在检验核心稳定肌的自主激活受损与基底神经节、丘脑、大脑皮层的结构和功能改变有关的假设,方法:我们获得了53名CLBP患者和67名健康对照的结构和静息状态功能磁共振成像(rs-fMRI)数据,并通过全脑分析估计了GMV改变区域的灰质体积(GMV)和功能有效连接(EC)的改变。通过超声成像评估这些患者的多裂肌(MF)和腹横肌(TrA)的自主激活。结果:与HC相比,双侧丘脑和尾状核的GMV显著降低,左额中回的GMV明显升高,右尾状核和双侧楔前叶之间的静息状态功能连接增加(体素水平p<0.005,高斯随机场校正p<0.05),这与双侧MF和TrA的自主激活显著相关(均<0.050)。结论:CLBP患者的灰质改变可能局限于负责感知、运动控制和情绪调节的区域。从基底神经节到默认模式网络的EC中断可能与核心稳定肌的自主激活受损有关。
{"title":"Functional Alterations of the Basal Ganglia Are Associated with Voluntary Activation of the Core Stabilizing Muscles in Patients with Chronic Low Back Pain: A Cross-Sectional Study.","authors":"Chanjuan Zhang,&nbsp;Xi Chen,&nbsp;Yi Yin,&nbsp;Dongfeng Xie,&nbsp;Jing Luo,&nbsp;Yinan Ai,&nbsp;Wenfeng Zhan,&nbsp;Hongjun Kan,&nbsp;Shuxian Zhang,&nbsp;Guihua Jiang,&nbsp;Xiquan Hu","doi":"10.1155/2023/2028379","DOIUrl":"10.1155/2023/2028379","url":null,"abstract":"<p><strong>Purpose: </strong>Deficits in voluntary activation of the core stabilizing muscles are consistently observed in patients with chronic low back pain (CLBP); however, the underlying neural mechanism remains unclear. This cross-sectional study aimed at testing the hypothesis that the impaired voluntary activation of core stabilizing muscles is associated with structural and functional alterations in the basal ganglia, thalamus, and cortex in patients with CLBP.</p><p><strong>Methods: </strong>We obtained structural and resting-state functional magnetic resonance imaging (rs-fMRI) data from 53 patients with CLBP and 67 healthy controls and estimated the alterations in grey matter volume (GMV) and functional and effective connectivity (EC) of regions with altered GMV via whole brain analysis. The voluntary activation of the multifidus (MF) and transversus abdominis (TrA) was evaluated by ultrasound imaging in these patients.</p><p><strong>Results: </strong>Compared with the HCs, they displayed a significant decrease in GMV in the bilateral thalamus and caudate nucleus, a significant increase in GMV in the left middle frontal gyrus, and increased resting-state functional connectivity between the right caudate nucleus and the bilateral precuneus (voxel-level <i>p</i> < 0.005, Gaussian random field-corrected <i>p</i> < 0.05). The patients also showed increased EC from the right caudate nucleus to the bilateral precuneus, which was significantly correlated with voluntary activation of the bilateral MF and TrA (all <i>p</i> < 0.050).</p><p><strong>Conclusions: </strong>Grey matter alterations may be confined to regions responsible for perception, motor control, and emotion regulation in patients with CLBP. The interrupted EC from the basal ganglia to the default mode network might be involved in the impairment of voluntary activation of the core stabilizing muscles.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"2028379"},"PeriodicalIF":2.9,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10213195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Personality in Chronic Headache: A Systematic Review with Meta-Analysis. 慢性头痛患者的人格特征:Meta分析系统综述。
IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-08-28 eCollection Date: 2023-01-01 DOI: 10.1155/2023/6685372
Sara Bottiroli, Alessia Renzi, Elena Ballante, Roberto De Icco, Grazia Sances, Annalisa Tanzilli, Tomaso Vecchi, Cristina Tassorelli, Federica Galli

Background: Chronic headache (CH) is a condition that includes different subtypes of headaches and that can impair different life domains. Personality traits can play a relevant role both in the development and in coping with this medical condition. The first aim of the present study is to realize a systematic review of the personality traits associated with CH compared to healthy controls; the second objective is to carry out a quantitative meta-analysis with the studies using the same instrument to assess personality traits.

Method: The literature search encompassed articles published from 1988 until December 2022 on the major databases in the field of health and social sciences: PubMed, Scopus, PsychInfo, and Web of Science.

Results: Thirteen studies were included in the systematic review, but only three studies were deeply explored in a meta-analysis since the only ones used a common instrument for personality assessment (Minnesota Multiphasic Personality Inventory). According to the meta-analysis, different subtypes of CH patients scored higher than healthy controls on Hypochondriasis and Hysteria Scales. The systematic review showed higher levels of depressive and anxious personality dimensions and pain catastrophizing in CH compared to healthy controls. Moreover, frequent-chronic forms and medication-overuse headache were the most symptomatic and frail categories showing higher levels of dysfunctional personality traits and psychopathological symptoms.

Conclusions: These results seem to confirm a "neurotic profile" in patients suffering from CH. The identification of the main personality traits involved in the onset and maintenance of headache disorders represents an important objective for developing psychological interventions.

背景:慢性头痛(CH)是一种包括不同亚型头痛的疾病,可损害不同的生活领域。人格特征可以在发展和应对这种疾病中发挥相关作用。本研究的第一个目的是与健康对照组相比,实现对与CH相关的人格特征的系统回顾;第二个目的是对使用相同工具评估人格特征的研究进行定量荟萃分析。方法:文献检索包括1988年至2022年12月在健康和社会科学领域主要数据库PubMed、Scopus、PsychInfo和Web of Science上发表的文章。结果:系统综述包括13项研究,但只有三项研究在荟萃分析中得到了深入探讨,因为只有三项使用了一种通用的人格评估工具(明尼苏达多相人格问卷)。根据荟萃分析,CH患者的不同亚型在线粒体和歇斯底里量表上的得分高于健康对照组。系统综述显示,与健康对照组相比,CH的抑郁和焦虑人格维度以及疼痛灾难性水平更高。此外,频繁的慢性形式和药物过度使用头痛是最有症状和最虚弱的类别,表现出更高水平的功能障碍人格特征和精神病理学症状。结论:这些结果似乎证实了CH患者的“神经质特征”。识别与头痛障碍的发作和维持有关的主要人格特征是制定心理干预措施的重要目标。
{"title":"Personality in Chronic Headache: A Systematic Review with Meta-Analysis.","authors":"Sara Bottiroli,&nbsp;Alessia Renzi,&nbsp;Elena Ballante,&nbsp;Roberto De Icco,&nbsp;Grazia Sances,&nbsp;Annalisa Tanzilli,&nbsp;Tomaso Vecchi,&nbsp;Cristina Tassorelli,&nbsp;Federica Galli","doi":"10.1155/2023/6685372","DOIUrl":"10.1155/2023/6685372","url":null,"abstract":"<p><strong>Background: </strong>Chronic headache (CH) is a condition that includes different subtypes of headaches and that can impair different life domains. Personality traits can play a relevant role both in the development and in coping with this medical condition. The first aim of the present study is to realize a systematic review of the personality traits associated with CH compared to healthy controls; the second objective is to carry out a quantitative meta-analysis with the studies using the same instrument to assess personality traits.</p><p><strong>Method: </strong>The literature search encompassed articles published from 1988 until December 2022 on the major databases in the field of health and social sciences: PubMed, Scopus, PsychInfo, and Web of Science.</p><p><strong>Results: </strong>Thirteen studies were included in the systematic review, but only three studies were deeply explored in a meta-analysis since the only ones used a common instrument for personality assessment (Minnesota Multiphasic Personality Inventory). According to the meta-analysis, different subtypes of CH patients scored higher than healthy controls on Hypochondriasis and Hysteria Scales. The systematic review showed higher levels of depressive and anxious personality dimensions and pain catastrophizing in CH compared to healthy controls. Moreover, frequent-chronic forms and medication-overuse headache were the most symptomatic and frail categories showing higher levels of dysfunctional personality traits and psychopathological symptoms.</p><p><strong>Conclusions: </strong>These results seem to confirm a \"neurotic profile\" in patients suffering from CH. The identification of the main personality traits involved in the onset and maintenance of headache disorders represents an important objective for developing psychological interventions.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"6685372"},"PeriodicalIF":2.9,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10477030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10522957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes of Pain Management Training for the Fourth- and Fifth-Year Medical Students. 四年级和五年级医学生疼痛管理培训的结果。
IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-08-25 eCollection Date: 2023-01-01 DOI: 10.1155/2023/6080769
Ayano Saeki, Yumiko Takao, Keiichiro Suzuki, Munetaka Hirose

Pain management is a major medical issue. However, current medical education in Japan is inadequate with regard to training students to properly assess patients with acute and chronic pain and plan their treatment. Therefore, starting in 2019, Hyogo Medical University established a multidisciplinary educational system to better train medical students to provide pain care. The course, called clinical pain study, is offered to fourth- and fifth-year medical students. Fourth-year students learn the scientific aspects of pain through clinical practice. In this study, we assessed students' understanding of pain management based on the results of pretests and posttests performed before and after their practicum. These tests were administered from November 2019 to April 2022 to 263 fourth- and fifth-year medical students who took the clinical pain study class. The test results were compared in terms of the percentage of correct answers and the total score for each question using McNemar's chi-square test and paired t-tests, respectively. The results showed a significant improvement in the mean of the total score, confirming the improvement in medical students' knowledge (6.43 vs. 7.35 points; p < 0.001). Based on the results, overall, pain education at the university has had positive outcomes and will therefore be continued in the future.

疼痛管理是一个主要的医学问题。然而,日本目前的医学教育不足以培训学生正确评估急性和慢性疼痛患者并计划他们的治疗。因此,从2019年开始,兵库医科大学建立了多学科教育体系,以更好地培训医学生提供疼痛护理。该课程名为临床疼痛研究,面向四年级和五年级的医学生。四年级学生通过临床实践学习疼痛的科学方面。在这项研究中,我们根据实习前后的前测和后测结果,评估了学生对疼痛管理的理解。这些测试于2019年11月至2022年4月对263名参加临床疼痛研究班的四年级和五年级医学生进行。分别使用McNemar卡方检验和配对t检验,根据每个问题的正确答案百分比和总分对测试结果进行比较。结果显示,总分的平均值有了显著提高,证实了医学生知识的提高(6.43分对7.35分;p<0.001)。根据结果,总体而言,该大学的疼痛教育取得了积极成果,因此将在未来继续下去。
{"title":"Outcomes of Pain Management Training for the Fourth- and Fifth-Year Medical Students.","authors":"Ayano Saeki,&nbsp;Yumiko Takao,&nbsp;Keiichiro Suzuki,&nbsp;Munetaka Hirose","doi":"10.1155/2023/6080769","DOIUrl":"10.1155/2023/6080769","url":null,"abstract":"<p><p>Pain management is a major medical issue. However, current medical education in Japan is inadequate with regard to training students to properly assess patients with acute and chronic pain and plan their treatment. Therefore, starting in 2019, Hyogo Medical University established a multidisciplinary educational system to better train medical students to provide pain care. The course, called clinical pain study, is offered to fourth- and fifth-year medical students. Fourth-year students learn the scientific aspects of pain through clinical practice. In this study, we assessed students' understanding of pain management based on the results of pretests and posttests performed before and after their practicum. These tests were administered from November 2019 to April 2022 to 263 fourth- and fifth-year medical students who took the clinical pain study class. The test results were compared in terms of the percentage of correct answers and the total score for each question using McNemar's chi-square test and paired <i>t</i>-tests, respectively. The results showed a significant improvement in the mean of the total score, confirming the improvement in medical students' knowledge (6.43 vs. 7.35 points; <i>p</i> < 0.001). Based on the results, overall, pain education at the university has had positive outcomes and will therefore be continued in the future.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"6080769"},"PeriodicalIF":2.9,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of Dry Needling in Improving Pain and Function in Comparison with Other Techniques in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis. 与其他技术相比,干针在改善慢性颈部疼痛患者疼痛和功能方面的有效性:系统综述和荟萃分析。
IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-08-23 eCollection Date: 2023-01-01 DOI: 10.1155/2023/1523834
Mar Hernández-Secorún, Hugo Abenia-Benedí, Sergio Borrella-Andrés, Isabel Marqués-García, María Orosia Lucha-López, Pablo Herrero, Isabel Iguacel, José Miguel Tricás-Moreno, César Hidalgo-García

The purpose of this systematic review and meta-analysis was to assess the short-, mid-, and long-term effectiveness of dry needling in improving pain and functional capacity of patients with chronic neck pain. Search strategy was performed on PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus biomedical databases. The risk of bias was assessed using the RoB2 tool. Randomised controlled clinical trials in which at least 1 of the groups received dry needling were included. 662 studies were found; 14 clinical trials were selected for qualitative analysis and 13 for quantitative analysis. The quality of most of the studies included was "high." All the studies reported improvements in cervical pain and/or disability, regardless of the protocol followed and the muscles targeted. No serious adverse effects were reported. Dry needling showed to be more effective when compared with other therapies in both women and men, without differences by sex. When the analysis was carried out by age, patients over 40 years old benefitted more than those below 40 years old. Our meta-analysis supports the use of dry needling to improve pain and functional capacity in patients with chronic neck pain at short- and mid-term intervals.

本系统综述和荟萃分析的目的是评估干针在改善慢性颈部疼痛患者疼痛和功能能力方面的短期、中期和长期有效性。搜索策略在PubMed、Web of Science、Scopus、PEDro和Cochrane Library Plus生物医学数据库上执行。使用RoB2工具评估偏倚风险。随机对照临床试验包括其中至少1组接受干针治疗。发现662项研究;选择14项临床试验进行定性分析,13项进行定量分析。大多数研究的质量都是“高”的。所有研究都报告了宫颈疼痛和/或残疾的改善,无论遵循的方案和针对的肌肉如何。未报告严重不良反应。与其他疗法相比,干针在女性和男性中都更有效,没有性别差异。当按年龄进行分析时,40岁以上的患者 老年人比40岁以下的人受益更多 岁我们的荟萃分析支持在中短期使用干针来改善慢性颈部疼痛患者的疼痛和功能能力。
{"title":"Effectiveness of Dry Needling in Improving Pain and Function in Comparison with Other Techniques in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis.","authors":"Mar Hernández-Secorún,&nbsp;Hugo Abenia-Benedí,&nbsp;Sergio Borrella-Andrés,&nbsp;Isabel Marqués-García,&nbsp;María Orosia Lucha-López,&nbsp;Pablo Herrero,&nbsp;Isabel Iguacel,&nbsp;José Miguel Tricás-Moreno,&nbsp;César Hidalgo-García","doi":"10.1155/2023/1523834","DOIUrl":"10.1155/2023/1523834","url":null,"abstract":"<p><p>The purpose of this systematic review and meta-analysis was to assess the short-, mid-, and long-term effectiveness of dry needling in improving pain and functional capacity of patients with chronic neck pain. Search strategy was performed on PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus biomedical databases. The risk of bias was assessed using the RoB2 tool. Randomised controlled clinical trials in which at least 1 of the groups received dry needling were included. 662 studies were found; 14 clinical trials were selected for qualitative analysis and 13 for quantitative analysis. The quality of most of the studies included was \"high.\" All the studies reported improvements in cervical pain and/or disability, regardless of the protocol followed and the muscles targeted. No serious adverse effects were reported. Dry needling showed to be more effective when compared with other therapies in both women and men, without differences by sex. When the analysis was carried out by age, patients over 40 years old benefitted more than those below 40 years old. Our meta-analysis supports the use of dry needling to improve pain and functional capacity in patients with chronic neck pain at short- and mid-term intervals.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"1523834"},"PeriodicalIF":2.9,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10469395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10154240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial. 气质对接受牙科治疗的幼儿接受两种有意识镇静技术的影响:一项随机交叉试验。
IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-08-22 eCollection Date: 2023-01-01 DOI: 10.1155/2023/6655628
Palak Janiani, Deepa Gurunathan, Sivakumar Nuvvula

Background: Pediatric dentists often find it challenging to handle pediatric patients due to their fear, unease, and anxiety toward dental procedures. To address this, sedation agents such as intranasal midazolam and nitrous oxide are commonly used as pharmacological behavior management methods. A child's temperament affects their behavior in unfamiliar settings.

Aim: To study the effect of child temperament on the acceptance of the nasal mask and intranasal drug administration in children undergoing dental treatment.

Methods: Thirty-two anxious children aged three to five were randomly assigned to two groups. During the first visit, one group received intranasal midazolam sedation, while the other group received nitrous oxide administered through a mask. On the subsequent visit, the groups crossed over. The parent assessed the child's temperament, and the acceptance of the sedation methods was recorded. The Ohio State University Behavioral Rating Scale (OSUBRS) was employed to assess behavior during the administration of local anesthesia. Statistical analysis was carried out using the chi-square test and Mann-Whitney U test (p value <0.05).

Results: Children exhibited greater acceptance of the nasal mask compared to using the intranasal route for delivering midazolam during the induction process. A significant statistical influence of temperament was observed on the acceptance of the nasal mask and the intranasal atomisation device (p value <0.05). The mean OSUBRS scores did not show any statistically significant differences between the sedation groups (p = 0.14).

Conclusion: Most children demonstrated a more favorable acceptance of the nasal mask during the induction process; however, intranasal midazolam can serve as an effective alternative for anxious patients who struggle to keep the nitrous oxide mask on during the dental procedure. The adoption of these methods is influenced directly by the child's temperament.

背景:由于儿科患者对牙科手术的恐惧、不安和焦虑,儿科牙医经常发现处理他们很有挑战性。为了解决这一问题,镇静剂,如鼻内咪唑安定和一氧化二氮,通常被用作药理学行为管理方法。孩子的气质会影响他们在陌生环境中的行为。目的:研究儿童气质对接受牙科治疗的儿童接受鼻罩和鼻内给药的影响。方法:将32名3~5岁的焦虑儿童随机分为两组。在第一次就诊期间,一组接受了咪达唑仑鼻内镇静,而另一组则通过面罩给予一氧化二氮。在随后的访问中,这些小组进行了交叉访问。父母评估了孩子的气质,并记录了对镇静方法的接受程度。俄亥俄州立大学行为评定量表(OSUBRS)用于评估局部麻醉期间的行为。使用卡方检验和Mann-Whitney U检验进行统计分析(p值结果:与诱导过程中使用鼻内途径递送咪达唑仑相比,儿童对鼻面罩的接受度更高。观察到气质对鼻面罩和鼻内雾化装置的接受度有显著的统计影响(p值p = 0.14)。结论:大多数儿童在诱导过程中对鼻面罩表现出更有利的接受度;然而,对于那些在牙科手术中难以戴上一氧化二氮口罩的焦虑患者,咪达唑仑可以作为一种有效的替代品。这些方法的采用直接受到孩子气质的影响。
{"title":"Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial.","authors":"Palak Janiani,&nbsp;Deepa Gurunathan,&nbsp;Sivakumar Nuvvula","doi":"10.1155/2023/6655628","DOIUrl":"10.1155/2023/6655628","url":null,"abstract":"<p><strong>Background: </strong>Pediatric dentists often find it challenging to handle pediatric patients due to their fear, unease, and anxiety toward dental procedures. To address this, sedation agents such as intranasal midazolam and nitrous oxide are commonly used as pharmacological behavior management methods. A child's temperament affects their behavior in unfamiliar settings.</p><p><strong>Aim: </strong>To study the effect of child temperament on the acceptance of the nasal mask and intranasal drug administration in children undergoing dental treatment.</p><p><strong>Methods: </strong>Thirty-two anxious children aged three to five were randomly assigned to two groups. During the first visit, one group received intranasal midazolam sedation, while the other group received nitrous oxide administered through a mask. On the subsequent visit, the groups crossed over. The parent assessed the child's temperament, and the acceptance of the sedation methods was recorded. The Ohio State University Behavioral Rating Scale (OSUBRS) was employed to assess behavior during the administration of local anesthesia. Statistical analysis was carried out using the chi-square test and Mann-Whitney <i>U</i> test (<i>p</i> value <0.05).</p><p><strong>Results: </strong>Children exhibited greater acceptance of the nasal mask compared to using the intranasal route for delivering midazolam during the induction process. A significant statistical influence of temperament was observed on the acceptance of the nasal mask and the intranasal atomisation device (<i>p</i> value <0.05). The mean OSUBRS scores did not show any statistically significant differences between the sedation groups (<i>p</i> = 0.14).</p><p><strong>Conclusion: </strong>Most children demonstrated a more favorable acceptance of the nasal mask during the induction process; however, intranasal midazolam can serve as an effective alternative for anxious patients who struggle to keep the nitrous oxide mask on during the dental procedure. The adoption of these methods is influenced directly by the child's temperament.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"6655628"},"PeriodicalIF":2.9,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10465248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10130946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Application of Ketamine in Pain Management and the Underlying Mechanism. 氯胺酮在疼痛管理中的应用及其潜在机制。
IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2023-08-16 eCollection Date: 2023-01-01 DOI: 10.1155/2023/1928969
Xiaofan Ma, Jia Yan, Hong Jiang

Since ketamine was approved by the FDA as an intravenous anesthetic, it has been in clinical use for more than 50 years. Apart from its anesthetic effects, ketamine is one of the few intravenous anesthetics with potent analgesic properties. As part of the effort to develop pain management, renewed interest has focused on the use of ketamine for the treatment of acute and chronic pain. Ketamine is commonly used to treat various kinds of chronic pain syndromes and is also applied to control perioperative pain and reduce the consumption of postoperative analgesics. However, its precise mechanisms of action remain mysterious for a large part. Despite extensive research in the field, the mechanism of ketamine is still unclear. Its analgesic effect appears to be largely mediated by blockade of NMDARs, but opioid, GABA, and monoaminergic system seem to partly participate in the pain transmission procedure. Its metabolites also have an analgesic effect, which may prolong pain relief. More recently, the antidepressant effect of ketamine has been considered to reduce pain-related aversion to relieve chronic pain. Overall, the analgesic mechanism of ketamine seems to be a complex combination of multiple factors. Due to its potent analgesic properties, ketamine is an analgesic with great clinical application prospects. Exploring the precise mechanism of action of ketamine will help guide clinical medication and confirm indications for ketamine analgesia. This review aims to list the application of ketamine in pain management and discuss its analgesic mechanism.

自从氯胺酮被美国食品药品监督管理局批准为静脉麻醉药以来,它已经在临床上使用了50多年 年。除了麻醉作用外,氯胺酮是为数不多的具有强效镇痛特性的静脉麻醉药之一。作为开发疼痛管理的努力的一部分,人们重新关注氯胺酮用于治疗急性和慢性疼痛。氯胺酮通常用于治疗各种慢性疼痛综合征,也用于控制围手术期疼痛和减少术后镇痛药的消耗。然而,它的确切作用机制在很大程度上仍然是神秘的。尽管在该领域进行了广泛的研究,但氯胺酮的作用机制仍不清楚。其镇痛作用似乎主要由NMDARs的阻断介导,但阿片类药物、GABA和单胺类系统似乎部分参与了疼痛传递过程。其代谢产物还具有镇痛作用,可以延长疼痛缓解时间。最近,氯胺酮的抗抑郁作用被认为可以减少与疼痛相关的厌恶,从而缓解慢性疼痛。总体而言,氯胺酮的镇痛机制似乎是多种因素的复杂组合。氯胺酮具有较强的镇痛作用,是一种具有良好临床应用前景的镇痛药。探讨氯胺酮的确切作用机制将有助于指导临床用药和确定氯胺酮镇痛的适应证。本综述旨在列举氯胺酮在疼痛管理中的应用,并讨论其镇痛机制。
{"title":"Application of Ketamine in Pain Management and the Underlying Mechanism.","authors":"Xiaofan Ma,&nbsp;Jia Yan,&nbsp;Hong Jiang","doi":"10.1155/2023/1928969","DOIUrl":"10.1155/2023/1928969","url":null,"abstract":"<p><p>Since ketamine was approved by the FDA as an intravenous anesthetic, it has been in clinical use for more than 50 years. Apart from its anesthetic effects, ketamine is one of the few intravenous anesthetics with potent analgesic properties. As part of the effort to develop pain management, renewed interest has focused on the use of ketamine for the treatment of acute and chronic pain. Ketamine is commonly used to treat various kinds of chronic pain syndromes and is also applied to control perioperative pain and reduce the consumption of postoperative analgesics. However, its precise mechanisms of action remain mysterious for a large part. Despite extensive research in the field, the mechanism of ketamine is still unclear. Its analgesic effect appears to be largely mediated by blockade of NMDARs, but opioid, GABA, and monoaminergic system seem to partly participate in the pain transmission procedure. Its metabolites also have an analgesic effect, which may prolong pain relief. More recently, the antidepressant effect of ketamine has been considered to reduce pain-related aversion to relieve chronic pain. Overall, the analgesic mechanism of ketamine seems to be a complex combination of multiple factors. Due to its potent analgesic properties, ketamine is an analgesic with great clinical application prospects. Exploring the precise mechanism of action of ketamine will help guide clinical medication and confirm indications for ketamine analgesia. This review aims to list the application of ketamine in pain management and discuss its analgesic mechanism.</p>","PeriodicalId":19913,"journal":{"name":"Pain Research & Management","volume":"2023 ","pages":"1928969"},"PeriodicalIF":2.9,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10447145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10077935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Pain Research & Management
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1