Low-level laser therapy in acute pain management after complex tooth extraction

Recent advances in postoperative pain therapy

Consensus Agreement on the Design and Conduct of Clinical Studies with Low-Level Laser Therapy and Light Therapy for Musculoskeletal Pain and Disorders

Editorial I: Acute pain management: scientific evidence revisited

Controlled-release opioids cause harm and should be avoided in management of postoperative pain in opioid naïve patients

To evaluate the efficiency of therapeutic Ultrasound, low level laser and compression therapy for healing of venous Leg ulcers and Compare the effect of modalities on the ulcers. Three groups were included in the study. Group I: 20 patients with leg ulcers treated with low level laser therapy. Group II: 20 patients with leg ulcers treated with ultrasound therapy. Group III: 20 patients with leg ulcers treated by compression therapy (four layer bandage) were used in this study. All patients were subjected to detailed history, clinical evaluation in addition to X-ray of legs and feet, and Doppler ultrasound of both legs. The main variables for follow up were the measurement of the area of the lesions under aseptic conditions at 0, 1, 2, 3 months and qualitative clinical evaluation of the ulcers by physician and by the patient. The results from group I, group II and group III were obtained and then compared with each others. According to the size of the ulcer, some ulcers heal within 1 month which is (15.6%) in group I, (10%) in group II, and (28.5%) in group III. Some ulcers heal within 2 months which is (28%) in group I, (23.3%) in group II and (37%) in group III. The remaining ulcers heal within 3 months or more which are (56%) in group I, (66.6%) in group II and (34.2%) in group III. Thus the percentage of healing denoting that compression bandage technique used in group III is the most efficient in healing of chronic venous leg ulcer followed by laser therapy and lastly US therapy (P = 0.04 at the end of the first month and P = 0.03 at the end of the third month). Compression therapy is the most efficient treatment of venous leg ulcers. Low level laser therapy and Ultrasound therapy are useful methods as a conservative treatment of venous leg ulcers and can be used in ulcers of small size.

A Potential Role for Steroids in Acute Pain Management in Patients with Trigeminal Neuralgia

Effective pain assessment and management is widely reported as sub optimal due to inadequate knowledge and negative attitudes among nurses. To determine nurses' attitudes, knowledge and education needs towards acute pain management in acute hospital settings METHODS: PRISMA (2021) and guidelines from the University of York, CRD (2009) informed the design and conduct of this review. We included studies with registered nurses involved in direct adult patient care and acute pain management in hospital settings. Seven databases were searched (10 June 2020 and 21 January 2022): Medline (EBSCO), EMBASE (Ovid), CINAHL Complete (EBSCO), PsycINFO (EBSCO), Applied Social Science Index and Abstracts (ASSIA), Web of Science and the WHO Library Global Index Medicus. The review outcomes were nurses' knowledge, attitudes and education needs towards acute pain assessment and management. The CASP Cohort Assessment tool was used to independently conduct a quality assessment of included studies. Data extraction was conducted by paired reviewers working independently of each other. A meta-analysis of findings relating to nurses' knowledge and attitudes towards acute pain management was undertaken using MedCalc software. Ten articles with 1,478 participants met the inclusion criteria. Five studies addressed the review items of knowledge and attitudes while the remaining studies focused on knowledge alone. No study measured educational needs. This meta-analysis found that only 45.59% (95% CI: 20.46-71.97) of the 1090 respondents had adequate or above adequate levels of knowledge about acute pain management. The proportion of participants with positive attitudes was 25.76% (95% CI: 11.01-44.12). High levels of variability exists across the included studies which reduces their comparability. To improve homogeneity and comparability, adaptation of instruments should be kept to a minimum. Reporting knowledge and attitudes separately may highlight education, both theoretical and clinical as the focus for improving assessment and management of acute pain.

Podiatric physicians have come to realize that opioid use disorder (OUD) is a public health crisis causing morbidity, mortality, lost productivity, and legal cost in the United States. Opioid analgesics are efficient first-line pain relievers for acute and chronic lower-extremity pain syndrome. Perioperative pain management strategies have been proposed using opioid stewardship, but there are few standardized protocols to guide podiatric medical providers treating patients with OUD. First, we describe the pharmacology of therapeutic agents used as medications for addiction treatment for OUD and substance use disorder (SUD). Second, we offer criteria for selecting acute pain and perioperative management in patients with OUD and SUD per current medical literature. Finally, we review the literature applying opioid stewardship in the context of prescribing opioid analgesics in the presence of OUD and SUD. Three hypothetical clinical scenarios grounded in clinical-based literature are described with congruent data and founded guidelines. The first and second scenarios describe acute pain and perioperative management in patients with OUD receiving methadone and buprenorphine-naloxone, respectively. The third scenario describes acute pain and perioperative management in a patient with SUD receiving intravenous naltrexone. We hope that the lower-extremity specialist will appreciate that thoughtful management of acute perioperative pain among patients who receive medications for addiction treatment for OUD is critically important given the risks of destabilization during the perioperative period. The literature reveals the lack of rigorous evidence on acute pain management in patients who receive medication for OUD; however, some clinical evidence supports the practice of continuing methadone or buprenorphine for most patients during acute pain episodes.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Low-level laser (light) therapy (LLLT) involves absorption of photons being in the mitochondria of cells leading to improvement in electron transport, increased mitochondrial membrane potential (MMP), and greater ATP production. Low levels of reactive oxygen species (ROS) are produced by LLLT in normal cells that are beneficial. We exposed primary cultured murine cortical neurons to oxidative stressors: hydrogen peroxide, cobalt chloride and rotenone in the presence or absence of LLLT (3 J/cm², CW, 810 nm wavelength laser, 20 mW/cm²). Cell viability was determined by Prestoblue™ assay. ROS in mitochondria was detected using Mito-sox, while ROS in cytoplasm was detected with CellRox™. MMP was measured with tetramethylrhodamine. In normal neurons LLLT elevated MMP and increased ROS. In oxidatively-stressed cells LLLT increased MMP but reduced high ROS levels and protected cultured cortical neurons from death. Although LLLT increases ROS in normal neurons, it reduces ROS in oxidatively-stressed neurons. In both cases MMP is increased. These data may explain how LLLT can reduce clinical oxidative stress in various lesions while increasing ROS in cells in vitro.

To review the topics presented in the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline for Acute Pain Management and provide updated information on therapeutic issues as necessary. AHCPR Clinical Practice Guideline for Acute Pain Management: Operative or Medical Procedures and Trauma. A MEDLINE search (1990 to June 1996) of English-language literature pertaining to pain assessment and management was performed. Reference lists from relevant articles also served as a literature source. All articles identified from the data sources were evaluated. Relevant information, as determined by the authors, was included in the review. Inadequate acute pain management continues to be recognized as a problem due to limited health professional education on the treatment of pain, inadequate patient empowerment, negative connotations associated with opioid analgesics (e.g., fear of "addiction"), federal regulations associated with prescribing opioid analgesics, and difficulty in assessing pain. The widespread inadequacy in pain management prompted the development of the AHCPR Clinical Practice Guideline for Acute Pain Management, which was published in 1992. In addition to reviewing the pain guideline, this article includes updated information on ketorolac tromethamine, tramadol, local anesthetics, sedation, regional anesthetic techniques, and the management of opioid adverse effects. The AHCPR Clinical Practice Guideline for Acute Pain Management is a comprehensive, yet functional, review for clinicians. Most issues relating to acute pain assessment and management are adequately discussed. Overall, this guideline is a worthwhile general resource to clinicians. It is important, however, for clinicians managing acute pain issues to supplement this guideline with more detailed and current information.

Background: Recurrent aphthous stomatitis (RAS) are the most common oral ulceration in lesions of the oral mucosa. Treatment aims to reduce pain and healing time. Low-level Diode laser therapy can relieve pain, anti-inflammatory, reduce edema, stimulate cell biology, and stimulate healing. Low-level Diode laser therapy is an alternative therapy to conventional drug use, promising to help improve the quality of life, improve the patient's quality of life and avoid complications caused by long-term drug use. Objectives: To evaluate the therapeutic effect of a low-level Diode laser on RAS treatment to reduce pain, size of ulcers, and healing time. Materials and methods: A clinical study was conducted on 30 patients who presented RAS lesions were treated with low-level laser therapy. The patients were evaluated for the size, position, pain score, form of ulcers, healing time before and immediately, fourth and sixth day after treatment. The data was analyzed using SPSS 20. Results: The VAS score pre-treatment was 4.33±1.65, immediately post-treatment was 1.20±1.06. The size of ulcers pre-treatment was 4.58±2.35mm, and post-treatment fourth day was 2.47±2.30mm. The healing time was 5.04±0.32 days. Conclusion: Low-level Diode laser therapy is effective in RAS treatment to reduce pain, size of ulcers, and healing time.

Background:Low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are effective in alleviating pain and improving functionality in patients with adhesive capsulitis (AC); however, no study has compared the efficacy of these two laser treatments.Objective:To compare the effectiveness of LLLT and HILT in improving the shoulder joint range of motion and functional status and in reducing pain level in patients with AC.Trial Design:Prospective, randomized, parallel group, patient- and assessor-blinded.Methods:A total of 45 patients (aged: 18–65 years) with complaint of shoulder pain were evaluated for inclusion criteria, which included being aged 18–65 years and a diagnosis of AC based on physical examinations. Using computer-generated random numbers, eligible patients were randomized into two groups: HILT + stretching exercise and LLLT + stretching exercise groups. Both HILT and LLLT were performed three times/week for 3 weeks. Functional status and pain of the patients were evaluated with Shoulder Pain and Disability Index (SPADI) and Visual Analog Scale (VAS), while shoulder joint range of motion was measured with goniometry. All assessments were done before and 3 weeks after treatment.Results:A total of 40 patients (20 in each group) completed the study. At baseline, there was no statistically significant difference in the demographic and clinical characteristics between both groups. Both the LLLT and HILT groups showed significant improvement in the VAS and SPADI scores 3 weeks after treatment; however, the improvement was significantly higher in the HILT group than the LLLT group. There was no significant improvement in goniometric scores in both groups compared with baseline. No injury or other musculoskeletal complications were recorded during or after the treatments.Conclusion:HILT + stretching exercise treatment was more effective than LLLT + stretching exercise for improving functional parameters and pain in patients with AC.Trial Registration:ClinicalTrials.gov Identifier: NCT05469672.Funding:None

There are currently no pain-relevant performance measures in place that can support efforts to enhance pain care, and research on pain management in nonsurgical, nonmalignant acute pain is sparse. The development of parenteral patient-controlled analgesia predated the World Health Organization analgesic ladder and provided clinical backdrop to individualization of acute pain management. One of the differences between acute and chronic pain management is that interventional approaches such as epidural or intrathecal analgesia are used more frequently with chronic pain and at least for postoperative pain used as frequently as the primary pain management strategy. Understanding perioperative acute pain management is important to palliative specialists. Aggressive early multimodality postoperative pain management reduces pain intensity and reduces the risk of chronic pain. Transdermal opioids and oral sustained-release opioids should not be used for acute pain management.

Clinical Pain Management: Acute Pain