Acute Pain Reduction Research Articles

Role of Offload Taping for Total Knee Arthroplasty

This article intends to utilize offload rigid taping as an adjunct to pain management after total knee arthroplasty (TKA). TKA is a common orthopedic surgery. A dramatic rise in TKA surgeries is foreseen as TKA surgeries are projected to take place with an increasing rate of younger TKA recipients under 60 years of age. Approximately 40% of surgical patients usually experience severe to acute postoperative pain after TKA. A study by Scott F. Dye et al. suggests that most knee pain does not arise from the degenerated articular cartilage in osteoarthritic patients. Rather, the anterior fat pad is the main culprit behind the nociceptive stimuli. As an experimental clinical trial, offload taping was administered on the 2nd postoperative day after TKA to understand its effect on pain scores using the visual analog scale. It was found that the administration of offload taping resulted in a significant reduction in acute pain at rest and during ambulation in such patients.

A comparison of magnesium sulfate plus morphine with morphine alone for acute pain reduction in long-bone fractures; a double blind randomized clinical trial

Introduction: Acute pain is a common symptom in patients with bone fractures referring to the emergency department (ED). Objectives: The present study aimed at evaluating the efficacy of intravenous (IV) magnesium sulfate in controlling acute pain of long-bone fractures in EDs. Patients and Methods: The present double-blind, randomized clinical trial was conducted on patients with isolated limb fractures referred to Golestan hospital of Ahvaz from 2019 to 2020. Patients in the intervention group were injected with 0.1 mg/kg morphine plus 30 mg/kg magnesium sulfate and 0.1 mg/kg morphine alone in the morphine group. The patient’s pain scores were measured at 0, 15, 30, 45 and 60 minutes after injection. The patients’ condition was monitored every 10 minutes, including respiratory and pulse rate, blood pressure, and knee reflex. Results: The present study was conducted on 64 patients with long-bone fractures allocated to two groups of IV morphine plus magnesium sulfate and IV morphine alone (each of 32). The hemodynamic factors and mean body temperature did not significantly change after intervention and had a similar level in both groups. Before the intervention, the mean score of pain was measured in the morphine and magnesium sulfate plus morphine groups using a visual analogue scale. Results which were 8.87±0.83 and 8.93±0.94, respectively, showing no significant differences (P=0.69). After 60 minutes, the pain score reduced considerably in both groups. Conclusion: In the study, magnesium sulfate plus morphine could better reduce pain than morphine alone without influencing the respiratory rate. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (IRCT20190617043913N1; https://en.irct.ir/trial/40370, ethical code# IR.AJUMS.REC.1398.143).

Kinesiotaping for Acute Pain Due to Uncomplicated Traumatic Injury of the Shoulder or Chest Wall

IntroductionTraumatic injuries of the shoulder or chest wall are commonly treated in the Emergency Department (ED). A complementary treatment is kinesiotaping, an elastic tape often used to treat musculoskeletal dysfunction and pain. However, the added pain-reducing effect of kinesiotape in comparison to standard conservative treatment is unknown. The aim of this study was to determine the effect of kinesiotaping on pain relief compared to standard treatment with pain medication and immobilization in patients with uncomplicated traumatic injury of the shoulder or chest wall in the ED. MethodA pilot randomized controlled trial (RCT) was conducted in the ED of a teaching hospital in the Netherlands from January 2021 until the end of March 2021. Patients diagnosed with uncomplicated isolated rib fractures, rib contusions, clavicle fracture, disruption of the AC joint and fracture of the proximal humerus were assigned to two treatment groups. The control group received the standard treatment with oral analgesics (acetaminophen q6h 1000 mg and NSAID (according to prescription) and if shoulder injury also a sling. The intervention group received kinesiotaping in addition to the same standard treatment. Pain intensity was measured with 0–10 Numeric Rating Scale (NRS) just before treatment (T1) and after 15 min (T2). On day 4 both groups were assessed with NRS in a follow up phone call (T3). ResultsA total of 251 patients presented with traumatic injury of the shoulder or chest wall in the study period, 85 patients were approached to participate and 2 of them were excluded. The remaining 83 were randomly allocated to kinesiotaping (n = 40) or control group (n = 43), 57 of them completed the study and had sufficient data for complete analysis In both groups, pain intensity after 15 min and 4 days significantly reduced compared with baseline. Regarding the reduction of pain intensity on day 4, kinesiotaping was significantly superior compared to the control group with a difference in pain reduction of 2.45 compared with 0.88 in control group (p = 0.018). ConclusionCompared to standard treatment alone, kinesiotaping combined with standard care appears to be more effective in terms of acute pain reduction in patients with uncomplicated traumatic injury of the shoulder or chest wall. Further research is recommended.

Low-Dose-Ketamine as an adjunct to morphine for acute pain in the ED:

Background: Seventy percent of the yearly 1.8 million emergency contacts to the Danish hospitals arrives from patients in pain. Pain management is an essential and challenging part of emergency medicine and ineffective analgesia for patients attending the emergency department (ED) is common and can lead to complications, extended hospital stays and course of illness. Opioid-tolerant patients are an increasing challenge requiring different acute pain management, ie. needing much larger doses of opioids – which for a number of reasons they do not receive. The rising need for opioid sparing treatment and the difficulties in pain treatment of patients with a current use of opioids calls for clinical studies investigating effect and safety of alternatives. Low-Dose-Ketamine (LDK) has been studied as an analgesic and been shown to be useful in the reduction of acute pain in the postoperative setting. This study will evaluate the efficacy and safety of LDK as an adjunct to morphine in the treatment of pain in the ED. Hypothesis: LDK as an adjunct to morphine will be superior to morphine alone as regards of analgesic effect. The combination of morphine and LDK will result in a larger pain reduction in patients with a current use of opioids than patients with no prior use.
 Methods: Randomized, double-blinded trial, investigating the combination of LDK and morphine versus IV morphine alone regarding analgesic effect. 152 patients fulfilling all inclusion criteria and no exclusion criteria will be stratified (prior use of opioids and no prior use of opioids) and randomized in a 1:1 ratio in the two groups. Perspectives: This is the first study to examine the effect of LDK as an adjunct to morphine in a general patient population in the ED with pain and to compare it with the effect for patients with a prior use of opioids. This study could present a better pain treatment for patients with and without a prior use of opioids.
 Results: Pending – study still running.
 Conclusion: Pending – study still running.

Weakness in patients with subacromial pain syndrome is local and more pronounced in females

BackgroundSubacromial pain syndrome is the predominant cause of shoulder pain, accounting for approximately half of all shoulder complaints. This population presents with weakness of the involved shoulder. However, there is a gap in our understanding of how pain contributes to this weakness, and whether there are sex related differences. MethodsRegional and global isometric strength was tested at the involved shoulder joint and remote joints (uninvolved shoulder and both knees) in patients with subacromial pain syndrome. Data were collected before and after acute pain reduction with a subacromial injection. FindingsPatients demonstrated weakness at the involved shoulder while remote joints demonstrated normal strength. When compared to healthy controls, male patients were shown to exhibit greater levels of weakness than female patients at the involved shoulder, based on comparisons with sex-matched controls using z-scores. Pain reduction (through an anesthetic injection) had no influence on strength in the short-term. InterpretationWeakness in patients appears to be sex dependent and is not resolved with reduction of pain. This calls into question the assumptions of the physiological causes of this weakness.

Comparison of the effect of psychosocial skills training on acute and chronic musculoskeletal pain intensity: The effectiveness of early intervention in the reduction of acute musculoskeletal pain.

Pain, as a psychological experience, is caused by complex interactions among sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions. The psychosocial approach is one of the important approaches in managing musculoskeletal pain in patients. Therefore, this study aimed to determine and compare the effects of psychosocial skills training on pain intensity in patients with acute and chronic musculoskeletal pain. In this quasi-experimental study, 64 patients with acute and chronic musculoskeletal pain were selected using convenience sampling. Both groups received psychosocial training in pain management in groups of 8-10 people over six 1-h sessions. The data were collected at baseline, after the intervention, and 3months later using a numerical rating scale (NRS). Then, the data were entered into the SPSS 22 software and were analysed using descriptive and inferential statistics. In this study, the mean age of the participants was 50.10±10.63years and 60.9% of them were female. Based on the results, time had a significant effect on pain intensity (p<0.001), but the effect of group on pain intensity was not statistically significant (p=0.07). The group×time effect on pain intensity was also statistically significant (p<0.001). Psychosocial training had a positive impact on the reduction of pain among the patients with acute and chronic musculoskeletal pain. Additionally, the training was more effective in patients with acute pain due to early training. These findings can help healthcare providers in the field of musculoskeletal pain management, especially in patients with acute pain.

Effects of Acute and Chronic Stretching on Pain Control

ABSTRACT While muscle stretching has been commonly used to alleviate pain, reports of its effectiveness are conflicting. The objective of this review is to investigate the acute and chronic effects of stretching on pain, including delayed onset muscle soreness. The few studies implementing acute stretching protocols have reported small to large magnitude decreases in quadriceps and anterior knee pain as well as reductions in headache pain. Chronic stretching programs have demonstrated more consistent reductions in pain from a wide variety of joints and muscles, which has been ascribed to an increased sensory (pain) tolerance. Other mechanisms underlying acute and chronic pain reduction have been proposed to be related to gate control theory, diffuse noxious inhibitory control, myofascial meridians, and reflex-induced increases in parasympathetic nervous activity. By contrast, the acute effects of stretching on delayed onset muscle soreness are conflicting. Reports of stretch-induced reductions in delayed onset muscle soreness may be attributed to increased pain tolerance or alterations in the muscle's parallel elastic component or extracellular matrix properties providing protection against tissue damage. Further research evaluating the effect of various stretching protocols on different pain modalities is needed to clarify conflicts within the literature.

Pain relief by movement representation strategies: An umbrella and mapping review with meta‐meta‐analysis of motor imagery, action observation and mirror therapy

AbstractObjectiveTo develop a mapping and umbrella review with a meta‐meta‐analysis (MMA) to critically evaluate the current evidence of motor imagery (MI), action observation and mirror therapy (MT) on pain intensity.MethodsThe study involved a systematic search of PubMed, PEDro, Scielo, EBSCO and Google Scholar.ResultsTen systematic reviews were included in the qualitative synthesis, 70% of which showed high methodological quality. Three reviews found a significant reduction in chronic musculoskeletal pain as the result of applying movement representation methods (MRM) plus usual‐care (UC), with a large clinical effect (standardized mean difference [SMD] of −1.47; 95% CI −2.05 to −0.88; heterogeneity Q = 1.66; p = 0.44; I2 = 0%). However, two reviews showed no statistically significant reduction in acute and postsurgical pain as a result of applying MI plus UC. Four reviews showed no significant reduction in phantom limb pain (PLP) as a result of applying MT plus UC interventions. In four reviews, the MMA showed a significant reduction in complex regional pain syndrome (CRPS) as a result of applying MT plus UC, with a large clinical effect (SMD −1.27; 95% CI −1.87 to −0.67; heterogeneity Q = 3.95; p = 0.27; I2 = 24%). In two reviews, the MMA showed no significant differences in poststroke pain as a result of applying MT plus UC.ConclusionResults show that MRM could be effective for chronic musculoskeletal pain, with low to moderate‐quality evidence. The results also show a reduction in pain intensity through MT interventions in patients with CRPS, although these results were not found in patients with PLP or poststroke pain.SignificanceThis umbrella review analysed systematic reviews evaluating movement representation techniques, with the aim of synthesizing the available evidence regarding motor imagery, action observation and mirror therapy on pain. The results provide relevant information about the potential clinical use of movement representation techniques in different types of patients with painful conditions.

Liposomal bupivacaine use in exploratory lingual nerve microsurgery: does liposomal bupivacaine use decrease postoperative pain and opioid consumption compared to bupivacaine hydrochloride? A pilot study.

The purpose of this study was to determine if liposomal bupivacaine 1.3% (LB), Exparel (Pacira Pharmaceuticals), is more effective than bupivacaine hydrochloride 0.25% (BH), Marcaine (Hospira), in reducing postoperative pain and opioid consumption in patients undergoing exploratory lingual nerve microsurgery. The investigators hypothesized that patients who received LB would have a greater reduction in acute postoperative pain, and therefore, a reduction in total opioid use over 72 hours postoperatively. This was a retrospective study. All patients had undergone outpatient lingual nerve microsurgery at University Hospital in Newark, NJ, by principal investigator (VBZ). The research design consisted of two groups. One group received BH, while the other received LB. Participants were administered a telephone questionnaire after obtaining verbal consent. Subjective pain intensity from 0 to 72 hours postoperatively was evaluated on a numeric rating scale (NRS). Additionally, total opioid consumption was evaluated. Sample size was composed of 20 patients: 11 patients in the BH group, and 9 patients in the LB group. Less perceived pain was reported by subjects in the LB group, and more significantly, less opioid pill consumption. The purpose of this study was to conduct a retrospective analysis addressing the following question: "Does LB use decrease postoperative pain and opioid consumption in exploratory lingual nerve microsurgery?" Results showed that intraoperative use of LB was associated with decreased postoperative pain, and decreased opioid pill consumption, when compared to BH, through its prolonged duration of action. The results from this pilot study support LB use in lingual nerve microsurgery.

The Effectiveness of Transversus Abdominis Plane and Quadratus Lumborum Blocks in Acute Postoperative Pain Following Cesarean Section-A Randomized, Single-Blind, Controlled Trial.

Acute pain intensity related to cesarean section (CS) may be extensive and is often underestimated. This may influence mothers’ quality of life and their children’s development. Regional analgesia techniques that include transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) have proven their efficacy in the postoperative period after CS. Although several randomized controlled studies and one meta-analysis have investigated the utility of TAPB and QLB in the reduction of acute and chronic pain after CS, only one study directly compared both types of regional blocks and revealed superiority of QLB over TAPB. Our study aimed to reevaluate the effectiveness of transversus TAPB and QLB in controlling acute postoperative pain after CS. We recruited 197 women with singleton pregnancies undergoing CS under spinal anesthesia. The patients were randomized to receive either TAPB or QLB after CS. The acute postoperative pain was evaluated using the visual analog scale (VAS) at 2, 4, 8, 12 and 24 h after the operation. No significant difference in acute postoperative pain intensity between the groups was found. The patients who received TAPB had a higher demand for supplemental morphine injections (p < 0.039). In our study, none of the evaluated regional blocks demonstrated an advantage over the other regarding acute postoperative pain management.

Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery.

Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery.

The Effect of Virtual Reality on Anxiety and Pain in Patients Undergoing Gynecological Surgery (VRAP-G); a Randomized Controlled Trial

Background: Lack of postoperative acute pain management is associated with increased morbidity, longer recovery time, more opioid use and subsequently increased health care costs. There is increasing evidence that Virtual Reality (VR) is effective in the reduction of acute pain. Alternative methods to reduce postoperative pain and multimodal analgesia are necessary for acute postoperative pain management and to reduce opioid use and their adverse effects. The aim of this study is to explore the effect of VR on pain in the postoperative period after elective gynecological surgery. Methods and Design: The study concerns a non-blinded, single center, randomized controlled trial. Eligible women fulfilling the inclusion criteria and receive elective gynecological surgery in the Zuyderland Medical Center will be randomized for participation. The study population will be randomly divided into the intervention group (VR-group) or the standard care- group. The intervention group can choose for an immersive guided relaxation VR experience or an interactive VR experience during the pre- and postoperative period additional to the usual standard care. The participants randomized to the standard caregroup will receive only the usual standard care pre-and postoperative. The primary outcome is postoperative pain measured on a Numeric Rating Scale (NRS). A total of 30 patients have to be included in each group. This means that a total of 60 women will have to be included in this study. Secondary outcomes are; evaluating pre-and postoperative anxiety, pain catastrophizing, analgesic use, length of hospital stay between both groups and to explore tolerability, feasibility and satisfaction of VR use. Discussion: This study will provide insight as to whether in women who receive gynecological surgery, VR is an effective method to reduce postoperative pain and subsequently opioid use.

Preventing pain after breast surgery: A systematic review with meta-analyses and trial-sequential analyses.

The aim of this systematic review was to indirectly compare the efficacy of any intervention, administered perioperatively, on acute and persistent pain after breast surgery. We searched for randomized trials comparing analgesic interventions with placebo or no treatment in patients undergoing breast surgery under general anaesthesia. Primary outcome was intensity of acute pain (up to 6hr postoperatively). Secondary outcomes were cumulative 24-hr morphine consumption, incidence of postoperative nausea and vomiting (PONV), and chronic pain. We used an original three-step approach. First, meta-analyses were performed when data from at least three trials could be combined; secondly, trial sequential analyses were used to separate conclusive from unclear evidence. And thirdly, the quality of evidence was rated with GRADE. Seventy-three trials (5,512 patients) tested loco-regional blocks (paravertebral, pectoralis), local anaesthetic infiltrations, oral gabapentinoids or intravenous administration of glucocorticoids, lidocaine, N-methyl-D-aspartate antagonists or alpha2 agonists. With paravertebral blocks, pectoralis blocks and glucocorticoids, there was conclusive evidence of a clinically relevant reduction in acute pain (visual analogue scale>1.0cm). With pectoralis blocks, and gabapentinoids, there was conclusive evidence of a reduction in the cumulative 24-hr morphine consumption (> 30%). With paravertebral blocks and glucocorticoids, there was conclusive evidence of a relative reduction in the incidence of PONV of 70%. For chronic pain, insufficient data were available. Mainly with loco-regional blocks, there is conclusive evidence of a reduction in acute pain intensity, morphine consumption and PONV incidence after breast surgery. For rational decision making, data on chronic pain are needed. This quantitative systematic review compares eight interventions, published across 73 trials, to prevent pain after breast surgery, and grades their degree of efficacy. The most efficient interventions are paravertebral blocks, pectoralis blocks and glucocorticoids, with moderate to low evidence for the blocks. Intravenous lidocaine and alpha2 agonists are efficacious to a lesser extent, but with a higher level of evidence. Data for chronic pain are lacking.

Management of Temporomandibular Joint Arthritis using Low Level Laser Therapy method

Background: Many studies have recommend using low-level laser therapy (LLLT) in pain reduction in acute and chronic musculoskeletal pain. Objective: To clinically evaluate the effectiveness and validity of (LLLT) for management symptoms of temporomandibular joint (TMJ) arthritis. Methodology: A clinical study included patients with TMJ arthritis signs and symptoms, were randomly categorized into two groups of ten patients each. Patients of the first group were subjected to pre adjusted (LLLT) over four weeks together with NSAIDs. Patients were evaluated clinically according to following groups: (T1) before any treatment (T2) after six sessions of laser therapy application. (T3) after 12 laser therapy sessions applications. (T4) one month after the last session application. The second group received only (NSAIDs). They were evaluated at the same time intervals of the first group. Evaluation criteria were: • Maximum mouth opening which measured in mm using ruler. • Presence or absence of pain at TMJ area. The VAS method was used to quantify pain at TMJ area with palpation. Results: Evaluation of maximum mouth opening in mm showed highly marked significant clinical improvement In (LLLT and NSAIDs) group. The same clinical improvement was noted in (NSAIDs) group.Comparison of results between the two groups showed a marked significant clinical improvement in pain reduction in favor of the (LLLT and NSAIDs) group during all evaluation periods. Same clinical improvement in pain reduction in favor for (LLLT and NSAIDs) group was noted in (VAS).Conclusion. (LLLT) in patients with TMJ arthritis is safe and effective technique to be used.

The Effect of Intraoperative Ketamine and Magnesium Sulfate on Acute Pain and Opioid Consumption After Spine Surgery

Ketamine and magnesium in brain act as an N-methyl-D-aspartate receptor antagonist that has been shown to be useful in the reduction of acute postoperative pain and analgesic consumption in a variety of surgical interventions. We hypothesized that combination of low dose ketamine and magnesium would reduce early postoperative opiate consumption and analgesic requirement after 6 weeks. This was a randomized, prospective, controlled-placebo trial involving elective and eligible patients undergoing lumbar spine surgery. Seventy patients in the treatment group were administered 0.5 mg/kg intravenous ketamine and 1 gram of magnesium as an intravenous bolus slowly during 3 minute before incision and 0.25 mg/kg/hr ketamine and 0,5 g/hr magnesium intravenous infusion during surgery. Seventy patients in the placebo group received saline of equivalent volume. Patients were observed for48 h postoperatively and followed up at 6 weeks. The primary outcome was 48h morphine consumption. The severity of pain was lower in the intervention group than in the placebo group during 48 hr post-operatively, morphine consumption in this group also decreased significantly during this period. Intraoperative ketamine-magnesium reduces opiate consumption in the 48-h postoperative period. This combination may also reduce pain intensity throughout the postoperative period in this patient population.

Effect of triage nurse-led application of the ottawa ankle rules on pain and patient satisfaction with emergency department care

ObjectiveThe Ottawa Ankle Rules (OAR) is an evidence-based clinical decision tool used to predict fractures and need for radiographs in foot and ankle injury. Prior studies show that its use by both physicians and non-physicians reduces unnecessary radiographs and emergency department (ED) length of stay. This study evaluated the effect of triage nurse-led application of OAR on pain and satisfaction with ED care in patients with acute ankle injury. MethodsA quasi-experimental design was used. Data was collected from 96 participants using the numerical pain rating scale and the Brief Emergency Department Patient's Satisfaction Scale. The intervention group had 46 participants and the control group had 50 participants. ResultsThere was no statistically significant difference in level of pain on arrival (U = 1028, p = 0.34) and on discharge (U = 991, p = 0.21) from the ED between the control and intervention group. There was a significant difference between the control and intervention group in overall satisfaction with care received in the ED (t = 5.60; p = 0.000). There was also a significant difference between the two groups in their satisfaction with: ED staff (t = 4.12; p = 0.00); ED environment (t = 4.00; p = 0.00); physician care (t = 4.60; p = 0.00); general patient satisfaction (t = 6.60; p = 0.00); and patient family satisfaction (t = 3.44; p = 0.001). ConclusionTriage nurse application of the OAR improved patient satisfaction with ED care, but did not lead to a significant reduction in acute ankle injury related pain.

Reflexoterapia podal para lombalgia aguda ocupacional: ensaio clínico randomizado duplo cego

Objetivo: Comparar os efeitos da reflexoterapia podal no alívio da lombalgia aguda ocupacional da equipe de enfermagem. Método: ensaio clínico randomizado, controlado, duplo-cego. Participaram 36 profissionais efetivos, randomicamente alocados. A coleta de dados foi realizada com Escala Visual e Analógica de intensidade da dor, antes e depois das intervenções e Questionário para Lombalgia, aplicado no início e fim da pesquisa. Para normalidade da amostra utilizou-se o teste Shapiro Wilk; teste Qui-quadrado ou Exato de Fisher para calcular associação das variáveis categóricas; teste de Wilcoxon para distribuição não paramétrica e teste t para dados paramétricos. Resultado e Discussão: reflexoterapia podal apresentou efeito significativo (p=0,000)nas etapas de intervenção para alívio da intensidade da dor lombar aguda, tanto no escore do EVA, quanto no Questionário para Lombalgia (p=0,0002). Conclusões: a reflexoterapia apresentou efeitos estatisticamente significativos na redução da lombalgia agudados profissionais da Enfermagem. Descritores: Transtornos Traumáticos Cumulativos; Dor lombar; Reflexoterapia.

Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain

IntroductionAffordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products. Purpose of the StudyThe purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist. DiscussionThe following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions—immersive VR embodiment therapy for phantom limb (chronic) pain. ConclusionVR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients’ pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera–based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations.

The Role of Exparel Plus Meloxicam for Postoperative Pain Management.

Acute postoperative pain reduction is a major target against the opioid crisis. While opioids have traditionally been the mainstay for postoperative analgesia, current practice has focused on a multimodal approach to pain control, including ultrasound-guided blocks with longer acting local anesthetic agents. Non-steroidal anti-inflammatory drugs (NSAIDs), such as meloxicam, are an important class of medications utilized to manage pain in the perioperative period. An additional treatment used in perioperative or postoperative pain relief is Exparel, a bupivacaine (sodium channel blocker) liposomal injectable suspension with a 3-4-day duration of action. The long-acting mechanism and formulation of Exparel consistently has demonstrated decreased opioid use and pain scores in patients undergoing many different surgical procedures. A concern is that pH negatively alters the efficacy of bupivacaine, as in cases of inflamed tissue and acidic fluid pH. For this reason, a combination medication with both meloxicam and bupivacaine has been developed, which normalizes pH and has anti-inflammatory and anti-pain conduction properties. Clinical studies demonstrate that this combination agent can be extremely beneficial in treating postoperative pain. This manuscript summarizes the newest developments with regard to liposomal bupivacaine and the non-steroidal meloxicam, their roles in effective treatment of postoperative pain, contraindications, special considerations of using these medications, and future considerations. HTX-011 pairs up a new extended-release formulation of the local anesthetic bupivacaine with meloxicam, a well-established non-steroidal anti-inflammatory drug (NSAID).

The place of exercise in the treatment and prevention of muscular-skeletal pain (literature review)

Topicality. Musculoskeletal pain is the most common complaint from office workers is often associated with repetitive computer work. The topical character of the problem is also due to the high level of disability, behind only respiratory diseases. For the treatment and prevention often recommend physical exercises, but patients Express concerns about physical activity and recommended exercises in the aspect of the fear of strengthening existing pain syndrome. Is of considerable clinical interest the answer to the question: can physical exercise to have an adverse effect on the condition of the patient with chronic pain syndrome. As well as what type of physical exercise the most effective for therapeutic and prophylactic purpose of office workers, mostly working with the computer. Purpose – a literature review on the issue the treatment and prevention of musculoskeletal pain with physical exercise among office workers. Conclusions. Exercise significantly improves physical health parameters, helping to reduce musculoskeletal pain and improve quality of life. Improve the ergonomics of the workplace prevents the development of carpal tunnel syndrome in the dominant hand, but does not affect an existing neck pain, shoulder, lumbar spine, and prevent them. Exercises for relaxation in the workplace reduce the sensitivity pericardialna neck muscles, reduce neck pain, headache. Strength training with weights muscle have high clinical significance and lead to significant prolonged relief of muscular pain in the neck. Total training for fitness (Nordic walking, running, Cycling) showed only a small yet statistically significant acute pain reduction. Exercise General fitness can be recommended for the organization of "life style" and improve employability. Organization of free time of an office worker in physical activity may be one way of reducing the incidence of vertebral pathology office workers. Further study of preventive health the value of physical exercise programs.