Pain management最新文献

Introduction: Managing osteoarthritis aims to relieve pain, improve joint function and quality of life. Current guidelines recommend combining non-drug and pharmacological approaches. A non-medication solution integrating an endorphin-stimulating millimeter wave device, mobile application, and coaching program was evaluated.

Methods: This combined approach is evaluated in a real-world evidence study over three months in patients with osteoarthritis-related pain. The primary endpoint was patient-perceived change at three months using the Patient Global Impression of Change (PGIC). Secondary outcomes, assessed at baseline and three months, included pain intensity (mean and maximum), frequency of pain crises, quality of life, sleep, mental health, and medication use.

Results: Among 156 participants completing follow-up, 80.1% reported improvement (PGIC > 4). Quality of life improved by 29.8%, while sleep and mental health improved by 13.1% and 13.5%, respectively. Mean and maximum pain intensity decreased by 33.9% and 33.1%. Pain crises became less frequent, and patients reported reduced medication use.

Conclusion: These results align with recent randomized controlled trial findings, supporting millimeter wave neuromodulation as an innovative, non-drug strategy targeting both nociceptive and nociplastic pain mechanisms to improve quality of life in osteoarthritis patients.

Objective: This study investigates the effects of cathodal, anodal, and intermittent electrical stimulation on pain intensity associated with arterial blood sampling, venous blood sampling, and intramuscular injection.

Methods: In a triple-blind clinical trial, 160 patients requiring arterial, venous blood sampling, and intramuscular injection were randomly divided into four groups. Three intervention groups received 5 mA anodal, cathodal direct, or alternating currents during the procedure, while the control group received only a topical eutectic mixture of local anesthetics (EMLA). Pain intensity was measured using the visual analog scale (VAS) immediately after the procedure, while procedure duration, number of attempts, and heart rate changes were recorded as secondary outcome.

Results: All forms of electrical stimulation significantly reduced procedural pain compared to EMLA. Cathodal direct current demonstrated the greatest analgesic effect, with mean VAS score reductions of 2-3 points across all procedures. The time required for arterial blood sampling in the cathodal group was significantly less than with EMLA, while no difference was observed in the procedure time and frequency of attempts in other processes. Furthermore, electrical stimulation groups, particularly the cathodal mode, exhibited lower post-procedure heart rates, suggesting attenuated physiological stress responses.

Conclusion: We found that applying electric currents during the procedure reduces the pain of blood sampling or injections. The greatest analgesia was observed with cathodal direct current stimulation compared to other groups.

Clinical trial registration: Date of registration: 27 January 2024. Clinical Trials.gov Identifier: IRCT20240123060780N1. URL: https://irct.behdasht.gov.ir/trial/75119.

Introduction: The cervical plexus block (CPB) delivers analgesia for surgeries in the head and neck . Patient-controlled analgesia (PCA) has been utilized to enhance pain management. This study evaluates combined bilateral superficial and deep CPB versus PCA in postoperative pain management after total laryngectomy.

Materials and methods: Randimized two equal groups: the CPB group (n = 25), who received combined bilateral US-guided superficial and deep CBP, and the PCA group (n = 25), who received PCA. The primary outcome was postoperative visual analog scale (VAS) . The secondary outcomes were hemodynamic changes, fentanyl consumption, first rescue analgesia, hospital stay, and postoperative complications.

Results: Postoperative VAS scores (at 2 and 4 h) were greater in the PCA group compared to the CPB group, p values (0.031, 0.044), respectively. The results were comparable at 6 and 12 h; while at 18 and 24 h, they were elevated in the CPB. The intraoperative hemodynamics were elevated in the PCA group at skin incision and after 30 min. Fentanyl consumption, first rescue analgesia, hospital stay, and postoperative complications were comparable.

Conclusion: Ultrasound-guided combined bilateral superficial and deep CPB provided superior analgesia in the early postoperative period compared to PCA.

Clinical trial registration: https://pactr.samrc.ac.za PACTR202403682323400.

Aims: In low back pain (LBP) research, recovery is commonly used as an outcome measure. However, there is no method used to measure recovery or acceptable definition for recovery. This research aims to investigate patients' perceptions of recovery from LBP.

Materials & methods: A cross-sectional survey was conducted in which 350 patients with chronic LBP participated. Demographic and clinical information was collected by a comprehensive and inclusive questionnaire. A checklist of improvement indicators was given to the patients and completed by them. It was aimed to identify the most important criteria for recovery in patients with chronic LBP.

Results: The results showed that pain reduction alone is not a reliable indicator of recovery. The patients' view about the recovery from chronic LBP includes a wide range of factors in different areas of symptomatic improvement, fear of recurrence injury, functional disability, fatigue and reduced energy level. Also, a significant correlation was observed between recovery indicators and pain duration, body mass index, and pain intensity in patients with chronic LBP.

Conclusions: The framework of recovery for patients with chronic LBP is complicated and is a highly individual structure. It is determined by the impact of symptoms on activities of daily living factors.

Aims: The aim of this observational study is to describe the use of epiduroscopy to decrease the enlargement of the ligamentum flavum (LF) in patients with spinal stenosis, as well as the selection of the appropriate patient and the safety measures that enhance procedural success.

Materials & methods: We introduce the patient selection protocol, define the appropriate indication and the safety measures to use the epiduroscopy as a tool to decrease the size of the LF and increase space, reducing possible complications.

Results: Among patients included in the study, there were no cases of access difficulty or coccydynia, and one case of urinary incontinence occurred in a patient with Schizas grade D (very severe) stenosis. In patients with grade C or lower stenosis, we have not found any case of sphincter incontinence.In four patients, we found paresthesias and in one patient a transient increase in pain. Dural puncture was performed in three patients, none developed headache.

Conclusions: Exclusion of patients with very severe canal stenosis according to magnetic resonance imaging (MRI) criteria, the use of sacral hiatus measurements and the neurophysiological monitoring helps diminish the occurrence of neurological complications of epiduroscopy in patients with spinal stenosis.

Clinical trial registration: https://www.clinicaltrials.gov identifier is NCT03863067.

Recent advancements in wearable data measurement technologies have allowed for real-time collection of biosignals related to spinal function and back pain. These data also have the potential to completely transform back pain treatment paradigms, to improve diagnostic movement phenotyping and to track treatment effectiveness longitudinally. The primary objective of the present scoping review was to investigate the status of development and trends in the use of wearable sensor technologies employed to measure biosignals related to spinal function and back pain, to identify the major developments and future trends for this field.Until recently, much of the wearable sensor data related to spinal function and back pain have come from a relatively small number of technologies, were sampled by a judiciously placed single device, and were analyzed using traditional statistical modeling techniques. However, based on the state of the literature, the field of wearable sensors for spine appears to have reached an inflection point where the previous limiting factors are no longer significant barriers. The growing number of wearable sensor types, combined with real-time interpretation using machine-learning algorithms, is paving the way for objective and comprehensive evaluations of spinal movements that can guide both research and clinical practice.Literature Search: PubMed, Web of Science and EMBASE, all articles prior to 9 April 2025.

Aims: This systematic review aims to analyze and explore the risks, benefits, and efficacy of performing Mesencephalotomy in patients with unilateral facial pain secondary to cancer.

Methods: This study followed PRISMA guidelines and used the PubMed and "Biblioteca Virtual em Saúde" (BVS) databases. The risk of bias for all included studies was assessed individually with the "Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I)" tool.

Results: Six articles were included in this review. The surgical outcomes were promising, supporting the safety and efficacy of mesencephalotomy for malignant facial pain and surpassing the general efficacy reported in the literature.

Conclusions: Mesencephalotomy should be considered a viable approach to pain management in patients with facial pain secondary to malignant neoplasms. This intervention has the potential for broader application within the field of palliative Care. This research is not registered in any database.