Pain management最新文献

The aim of this study is to describe a protocol for evaluating the effects of transcutaneous electrical nerve stimulation (TENS) on pain following breast augmentation surgery. Fifty-four women will be randomly allocated into two groups: active TENS and placebo. Pain will be assessed at rest and during movement, before and immediately after TENS application. Secondary outcomes include pain one-hour post-treatment, respiratory muscle strength, patient satisfaction, and analgesic use in the first four hours post-surgery. The results of this clinical trial could enhance the management of post-operative pain in breast augmentation surgery using non-pharmacological interventions, potentially reducing costs and improving patient experience.Clinical Trial Registration: RBR-96h3k97.

Background: Adhesive capsulitis (AC) causes shoulder pain and limited range of motion. While ultrasound-guided suprascapular nerve block, glenohumeral joint hydrodilatation, and physical therapy are effective individually, their combined use is not well-studied.

Objective: This study evaluates the effect and safety of combining ultrasound-guided suprascapular nerve block, glenohumeral joint hydrodilatation, and physical therapy on range of motion and pain, comparing diabetic and non-diabetic patients.

Design: Retrospective Cohort; Level of Evidence 3.

Methods: 150 patients (30-75 years) with AC received ultrasound-guided suprascapular nerve block, glenohumeral joint hydrodilatation with corticosteroid injection, and subsequent physical therapy. Baseline Visual Analog Scale (VAS) pain score, active forward flexion, and external rotation range of motion were measured using a goniometer. At 3 months post-procedure, range of motion and pain were reevaluated.

Results: Significant improvements in active forward flexion (median improvement of 25 degrees) and external rotation (median improvement of 19 degrees) were observed at 3 months (p < 0.001). No complications were reported.

Conclusion: Combining ultrasound-guided suprascapular nerve block, glenohumeral joint hydrodilatation, and physical therapy is safe, effective, and improves pain, flexion, and external rotation range of motion in patients with adhesive capsulitis.

Introduction: While many studies have been published on Ultrasound-guided regional anesthesia in the Emergency Department (ED), there has been no previous study assessing the current state of the literature based in the form of a scoping review.

Objective: The purpose of this study is to evaluate the current state of the literature on UGRA performed in the ED setting.

Methods: EMBASE, MEDLINE, CINAHL, and Cochrane databases were searched for studies. Following PRISMA-ScR guidelines (Figure 1), two reviewers evaluated each title and abstract and were included if they described a UGRA technique performed on patients in the ED by an ED provider. Cohen's kappa coefficients were calculated for each level of review.[Figure: see text].

Results: Of the 1,456 abstracts, a total of 53 articles were included in the analysis, of which 28 (52.8%) were case series and 11 (20.8%) were randomized control trials (RCTs). The most common types of nerve block represented in these studies were femoral nerve/fascia iliaca (14), brachial plexus (7), and forearm (radial, ulnar, median nerves) (7). 47 of the 53 articles were published in or after the year 2010.

Conclusion: Current literature supporting UGRA use in the ED is growing but unbalanced, requiring large population studies to demonstrate safety and efficacy of these techniques.

Objective: Music is a promising strategy to address the physical, psychological, and social needs of people with chronic pain. To better understand its potential in the treatment of chronic pain, this study aims to assess the state of knowledge regarding the effects of music in the context of chronic pain treatment.

Methods: A scoping review was conducted in eight databases using music, chronic pain, and treatment concepts and associated keywords. Studies were included in the review if they reported some effects of any form of music on chronic pain or concomitant conditions.

Results: Sixty-three studies were identified. Results showed numerous benefits of music-based interventions on chronic pain and common concomitant difficulties including emotional regulation, anxiety and depression symptoms, and social issues. Though literature supports varied forms of music-based interventions, those that account for participants' preferences and that encourage self-management and autonomy appeared to be the most effective.

Conclusions: Despite the benefits of music in the management of pain and concomitant difficulties, there remain few examples of applied music interventions in services designed for people who experience chronic pain. More research is needed to identify the musical modalities that would be the most adapted and effective to complement chronic pain services.

Aims: Chronic pain affects up to 37.8% of older adults with higher prevalence among those in under-resourced communities. While there are many treatments for chronic pain, there are complexities to treating under-resourced older adults in community clinics, including multimorbidity, barriers to treatment access, and varying degrees of openness to different treatment approaches. Understanding patient and clinic staff perceptions of treatment options for chronic pain is critical for implementing treatment approaches that will work sustainably in the community. This study aimed to understand clinic staff and patients' perspectives on chronic pain treatment experiences.

Methods: Focus groups and individual interviews were analyzed using a hybrid inductive-deductive approach.

Results: Themes are: (1) Limited patient and clinic resources and availability affecting pain treatment experiences (e.g., copays, transportation challenges, and conflicting responsibilities), (2) Discrepancies in patient and staff approaches to treatment and the importance of trialing different pain management techniques to alleviate pain (e.g., trialing multiple treatments with varied success), and (3) Conflict between patients' desire for pain elimination vs. staffs' focus on symptom reduction and function (e.g., patient-staff disconnect).

Conclusions: These findings are important for determining how treatments can best fit the needs of under-resourced older adults with chronic pain.

The simultaneous use of spinal cord stimulation (SCS) and an implantable cardioverter-defibrillator (ICD) is safe and effective in selected patients with refractory chest pain. Our case highlights successful pain management with SCS without compromising ICD function. Careful patient selection, low device settings, and ongoing monitoring are crucial for achieving optimal outcomes.

Objective: To investigate the benefits of topical 8% capsaicin patches for the decrease of postsurgical neuropathic pain level and area.

Methods: A systematic review with pooled analysis was conducted utilizing the PRISMA 2020 guidelines. Five commonly used databases were employed utilizing a search string made from MeSH terms and boolean operators. Retrieved articles were then subjected to title and abstract appraisal, followed by full-text appraisal by two independent reviewers and an adjudicator to break ties.

Results: A total of 127 articles were retrieved from five commonly used databases. Of the 127 articles, 20 were subjected to full-text appraisal, with 12 remaining for inclusion. Due to a heterogeneity greater than the 50% threshold provided by Cochrane, a random-effects pooled-analysis was conducted in lieu of meta-analysis. The random-effects pooled-analysis denotes an overall Cohen's d of 1.09 (95% CI: 0.58-1.56; p < 0.001). All studies that investigated neuropathic pain area denote a decrease in pain size, with some denoting a continued reduction with subsequent application.

Conclusion: Further larger randomized-controlled trials are required to strengthen the position of topical capsaicin patches in the physician's armamentarium.

Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42024542508.

Coccydynia, also termed chronic pain in the tailbone, is a complex condition with limited treatment options for refractory cases. This case series introduces a novel approach for treating refractory coccydynia using cryoablation of the sacrococcygeal nerves under combined ultrasound and fluoroscopy guidance. Two female patients, suffering from chronic pain for over six months and unresponsive to conservative interventions, underwent cryoablation. Both patients reported significant pain relief, with more than 50% reduction in their numeric rating scale scores, and no major complications were observed during or after the procedure. Furthermore, we propose a clinical treatment algorithm to assist in selecting appropriate interventions for refractory coccydynia, based on the anatomical source of the pain. The findings suggest that cryoablation may be a valuable option for patients with persistent coccygeal pain; however, larger prospective studies are required to confirm its efficacy and long-term safety.

Aim: To determine the efficacy of transdermal anti-inflammatory patches in the treatment of acute and chronic musculoskeletal pain.Methods: A comprehensive search of: Cochrane Central register of controlled trials, EMBASE, MEDLINE, CINAHL and PubMed, for studies using transdermal anti-inflammatory patches vs placebo for management of musculoskeletal pain, e.g. soft tissue injuries or tendonitis (last search January 2024). Cochrane Risk of Bias Tools v1 was used for quality assessment and GRADE determined certainty of evidence. Meta-analysis was performed.Results: Twenty-three randomized placebo-controlled trials (n = 4729) were included. There was low-certainty evidence that transdermal patches provided statistically and clinically significant pain relief on movement at long-term follow-up for chronic musculoskeletal pain (effect size -2-69 (95% CI: -4.14, -1.24) and at short-term follow-up which was non-clinically significant, (-1.24: 95% CI: -1.78, -0.69).Conclusion: Several types of transdermal anti-inflammatory patches may offer short-term and long-term pain relief for acute and chronic musculoskeletal conditions. However, the clinical significance of this effect for the long-term pain relief was based on low-certainty evidence of transdermal anti-inflammatory patches versus placebo; for short-term pain there was an overall non-clinically significant improvement. Performing a meta-analysis for all outcomes was not possible due to insufficiency in the evidence-base.Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42020185944.