Acute Pain Management Research Articles

Practice variations in pharmacological management of acute renal colic pain: A cross-sectional survey study.

Despite advancements in acute pain management and minimally invasive surgical techniques, persistent postsurgical pain can occur in up to 30% to 50% of patients. Psychological and social factors are increasingly recognized as contributors to pain outcomes, yet the impact of specific social determinants of health on persistent postoperative pain remains unclear. We conducted a retrospective observational study using the All of Us Research Program database. Adults who underwent surgical procedures after the year 2000 were included if they had available social determinants of health (SDoH) survey data and no prior diagnosis of persistent postoperative pain. Persistent postoperative pain was defined via SNOMED codes as a diagnosis occurring at least 1 year after the surgery date. Multivariable logistic regression was performed to assess the association between 21 independent variables derived from All of Us SDoH survey items and persistent postoperative pain, controlling for age, sex, race, ethnicity, and surgery type. A Bonferroni-corrected significance threshold (P < .002) was applied. There were 8065 participants included in the final analysis with 641 (7.9%) developing persistent postoperative pain. Food insecurity had the strongest association with persistent postoperative pain (odds ratio [OR] = 1.83, 95% confidence interval [CI], 1.45-2.30, P < .001). Having greater social support (OR = 0.96, 95% CI, 0.94-0.99, P = .002) and lower residential density (OR = 0.72, 95% CI, 0.61-0.85, P < .001) was protective. These findings underscore the importance of routinely assessing and addressing socioeconomic and psychosocial factors in perioperative care to help prevent long-term pain.

Objective To compare three therapeutic strategies in the management of acute post-traumatic pain at emergency department (ED) discharge. Methods We conducted a prospective, randomized, controlled trial including patients ≥18 years with acute post-traumatic pain. They were randomized to receive oral paracetamol (n = 506), paracetamol-codeine (P-Cod group; n = 489) and paracetamol-caffeine (P-Caf group; n = 505) for 7 days. The primary endpoint was the rate of participants achieving at least 50% reduction in Numerical Rating Scale (NRS) from baseline by the 7th day after ED discharge. Secondary endpoints included the need for rescue analgesics, adverse effects, and patient satisfaction. Results At day-7, success rate were 85.8%, 93.9%, and 90.1% in paracetamol, P-Cod, and P-Caf groups, respectively. The differences were statistically significant between the paracetamol and P-Caf groups (p = .02), the paracetamol and P-Cod groups ( p ≤ .001); and the P-Cod and P-Caf groups ( p = .04). The need for rescue analgesics was significantly higher in paracetamol group (47.6%) compared to P-Caf (7.5%) and P-Cod group (7.4%); whereas, no significant difference was found between P-Cod and P-Caf groups. Most of the adverse effects (95.7%) were observed in P-Cod group. Finally, patients treated with paracetamol alone were the least satisfied. Conclusion The combination of codeine or caffeine with paracetamol was equally effective and superior to paracetamol alone. If we consider the better tolerance, paracetamol combined with caffeine appears to be a suitable analgesic option for post trauma patients.

The minimal important difference (MID) is established for pain intensity scores in acute pain management, but not for rescue opioid consumption. This scoping review aimed to estimate the MID in rescue opioid consumption for acute pain among adult patients in the postoperative and emergency settings. We searched MEDLINE, Embase, CENTRAL, clinicaltrials.gov and clinicaltrialsregister.eu for studies published in English from inception to May 2024. We included studies investigating the MID of rescue opioid consumption in adults with acute pain in the postoperative and emergency settings. Because limited studies explicitly investigated the MID, we also included studies assessing the dose-response relationship between opioid consumption and relevant anchors (e.g., pain intensity scores). The primary outcome was MID for 0-24 h rescue opioid consumption; secondary outcomes included longer postoperative periods. We screened 11,748 citations and included 14 studies (8190 patients). Three studies explicitly evaluated MID for rescue opioid consumption. In the remaining 11 studies, we estimated the MID using a 10-point difference (0-100 scale) in pain intensity score as an anchor. The anchor-based estimates ranged from 2 to 5 mg IV morphine equivalents, varying by population, method and context. Based on the currently available evidence, we propose a provisional MID of 5 mg IV morphine equivalent in rescue opioid consumption for acute pain. This is lower than the value used in most sample size calculations. These results can guide sample size calculations and support patient-centered approaches in acute pain settings. PROSPERO identifier: CRD42024547409.

Acute pain management in the neonate

Pain following pediatric adenotonsillectomy is prevalent, frequently severe, and often inadequately managed. The effectiveness of propofol or sevoflurane anesthesia in acute postoperative pain management is unknown. We conducted a single-blind, randomized controlled trial to examine the postoperative analgesic effectiveness of propofol or sevoflurane anesthesia. 144 children aged 2-7 years were enrolled and randomly assigned to receive either propofol or sevoflurane anesthesia, with 142 completing the study. The primary outcome was the proportion of acute postoperative pain measured by the Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores > 3 within 24 h between the two groups. Secondary outcomes included postoperative pain assessed by the parent's postoperative pain measure (PPPM) scale and numeric rating scale (NRS) on the 1, 2, 3, 7, and 14 postoperative days, as well as perioperative adverse events. The incidence of acute pain FLACC > 3 within 24 h showed comparable results between both groups (30 of 71 [42.3%] vs. 34 of 71 [47.9%]; odds ratio [OR] = 0.78, 95% confidence interval [CI]: [0.28, 2.18]; p = 0.500). The propofol group demonstrated higher pain scores on postoperative days 2-3, with between-group median differences (ΔNRS at activity = 1, ΔPPPM = 1) below minimal clinically important difference thresholds (ΔNRS > 1, ΔPPPM > 3). The incidence and intensity of acute postoperative pain in the first 24 h after adenotonsillectomy did not differ significantly between pediatric patients who received maintenance anesthesia with propofol or with sevoflurane. The two general anesthesia techniques exhibited comparable clinical efficacy with respect to pain prognosis within 2 weeks. The Chinese Clinical Trial Registry (ChiCTR2300075847, Date of registration: September 3, 2023).

Ultrasound-guided TAP block: A promising strategy for managing acute pancreatitis pain in a prospective interventional study.

Evaluation of Low-Dose Ketamine and Dexmedetomidine Compared to Morphine for Control of Traumatic Limb Pain in the Emergency Department: A Randomized Clinical Trial.

Response to Concerns on "Ketorolac as an Analgesic in Pediatric Acute Pain Management: A Systematic Review and Meta-analysis".

Acute Pain Management of Rib Fractures: A Narrative Review

The purpose of this review is to summarize and apply existing literature to acute and chronic pain management for patients using buprenorphine for opioid use disorder (OUD). Pain management in patients taking buprenorphine for OUD presents many challenges for clinicians. Buprenorphine has unique pharmacological properties compared to full μ-opioid receptor agonists, including a strong affinity for and slow dissociation from the μ opioid receptor. Patients using buprenorphine have more pain than those not utilizing chronic opioid therapy, as occurs with most chronic opioid use. This may be due to the development of tolerance or hyperalgesia or may be part of the OUD process. Management of chronic pain should be approached the same as with any patient, focusing on nonpharmacological and nonopioid therapies, as opioid therapies have been shown to have very little efficacy for chronic pain. Management of acute pain is based on maintaining a stable dose of buprenorphine and supplementing with full μ-opioid receptor agonists, nonopioid analgesics, and nonpharmacological therapies. Transitioning to buprenorphine, in either the inpatient or outpatient setting, can be done with standard, low-dose, or high-dose induction based on the clinical situation. Transitions to and from the acute care setting require extensive communication and are enhanced by multidisciplinary teams. It is imperative that providers be knowledgeable about buprenorphine and how to optimize it for OUD as well as pain. Pain management with buprenorphine can be tailored to the patient and clinical situation, but any therapeutic plan must contain a holistic approach and involve extensive communication that includes the patient and all relevant providers to achieve safe and effective care.

This case study highlights the need for palliative care (PC) clinicians to expand their knowledge of rare complications associated with Immune Checkpoint Inhibitors (ICIs) in cancer treatment. We describe a 73-year-old male with metastatic squamous cell carcinoma of the tongue who developed ICI-mediated keratitis as a side effect of pembrolizumab. The patient's preexisting opioid regimen for chronic pain complicated the management of acute ocular pain, necessitating a multidisciplinary approach. This case demonstrates how a thorough understanding of novel cancer therapies and their adverse effects is critical for PC teams to facilitate timely diagnosis, initiate effective treatment, and enhance patient outcomes.

Purpose This study aimed to evaluate the application of Healthcare Failure Mode and Effect Analysis (HFMEA) to optimize the patient-controlled analgesia management process for patients experiencing acute pain after general anesthesia. Methods In this retrospective study, the experimental group included 475 patients who underwent general anesthesia between July and December 2024, whereas the control group included 503 patients between January and June 2024. The experimental group received an HFMEA-optimized analgesia management process, whereas the control group received the standard nursing protocol. Patients’ pain scores, post-anesthesia care unit (PACU) stay length, and risk priority number (RPN) values were compared before and after HFMEA implementation. Results Following implementation, RPN values decreased from high to low risk, pain scores dropped significantly, and PACU stay was shortened ( p &amp;lt; 0.05). Conclusion Implementation of an HFMEA-optimized analgesia process for patients with acute post-general anesthesia pain improves pain control and speeds recovery.

Ethical Dilemmas and Approaches to Acute Pain Management in Patients With Substance Use Disorders

Comparison of total morphine milligram equivalents at hospital discharge between opioid-naive and opioid-experienced surgical patients: a single-centre retrospective cohort study

Background: Pain is one of the most common complaints among all age groups. Adult patients can express pain more clearly. Unfortunately, pediatric patients cannot perform this. This study aimed to assess the extent of knowledge of healthcare providers regarding acute pediatric pain management. Methods: A cross-sectional study was conducted utilizing the modified Knowledge and Attitude Survey Regarding Pain (KASRP) questionnaire through face-to-face interviews. The modified version included 34 questions (24 true/false questions and 10 MCQs). This study targeted anesthesiologists, pediatricians, and pediatric nurses through interviews. Demographic and educational data were analyzed as factors affecting the results of the KASRP questionnaire. The total score was classified as poor, fair, or good. Results: A total of 137 participants were enrolled in this study. The mean age was 31.8 years, and of the participants, 62.8% were women, 30.0% were anesthesia physicians, 25.5% were pediatric physicians, and 44.5% were pediatric nurses. The participants scored an average of 20.7 out of 34. Performance was categorized as poor, fair, or good, with 22.6%, 64.2% and 13.2% of participants falling into each category, respectively. The mean score of correct responses was higher for anesthesiologists (p = 0.0001). Specialists achieved higher mean scores than residents. Completion of pediatric pain management courses and the use of assessment tools were linked to higher performance. Conclusions: Pediatric nurses achieved lower scores for knowledge of acute pediatric pain management than physicians. Anesthesiologists achieved the highest score, probably because of their training in pain management. All healthcare providers should attend pain management courses.

The ongoing opioid epidemic in the United States highlights the need for novel analgesics with reduced risk of misuse, dependence, and adverse central nervous system effects. Suzetrigine (trade name Journavx), a first-in-class selective Nav1.8 (a sodium channel expressed in peripheral nociceptors) inhibitor, was approved by the FDA in early 2025 and marketed as the first non-opioid analgesic in over two decades. Current studies have shown that suzetrigine has potential in treating acute pain perioperatively for minimally to moderately painful ambulatory procedures. However, suzetrigine appears less potent than hydrocodone-acetaminophen in this context, and it remains unclear how effective suzetrigine is in treating more severe postoperative pain. Notably, all current studies are limited to short durations of treatment; further studies will be required to delineate suzetrigine’s long-term efficacy, safety, and addiction potential to be utilized in the management of chronic pain patients. This article provides a review of the current literature available on the use of suzetrigine in treating acute pain.

The changing face of acute low back pain management by physiotherapists, osteopaths and chiropractors in the UK: a 20-year comparison from 2003 to 2023

Opioid Dispensing Trends Among Children and Adolescents Aged ≤ 19 Years in the United States: 2018-2022.

This study analyzed the relationship between aging and reported pain during the acute postoperative period in a retrospective analysis of 2,600 adult patients who underwent abdominal surgeries. Data included demographics, diagnoses, surgical, and pain assessments. Severe pain was defined as reported pain intensity ≥ 7 on the numeric rating score during the first 24 hours postsurgery. Patients were grouped into three different age categories: 18-44, 45-64, and ≥ 65 years. Comparisons among groups were performed using the Chi-square test. Multivariate logistic regression was used to estimate the likelihood of patients reporting pain intensity ≥ 7. The likelihood of reporting severe pain was significantly lower in older (> 65 years; OR, 0.48; CI, 0.39-0.60) and middle-aged (45-64 years; OR, 0.77; CI, 0.63-0.91) patients as compared with younger patients (18-44 years). Factors increasing the likelihood of reporting severe pain included female sex (OR, 1.34; CI, 1.13-1.58), history of chronic pain (OR, 2.03; CI, 1.58-2.60), and incidence of depression and/or anxiety (OR, 1.65; CI, 1.29-2.12). Findings suggest that patients ≥ 65 years are significantly less likely to experience severe acute postoperative pain following a major abdominal surgery. Nurse anesthetists' awareness of age-specific acute postoperative pain management can lead to better patient pain outcomes.