Acute Pain Therapy Research Articles

Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update.

A crisis in pain management persists, as does the epidemic of opioid overdose deaths, addiction, and diversion. Pain medicine is meeting these challenges by returning to its origins: the Bonica model of multidisciplinary pain care. The 2018 Academic Consortium White Paper detailed the historical context and magnitude of the pain crisis and the evidence base for nonpharmacologic strategies. More than 50% of chronic opioid use begins in the acute pain care setting. Acupuncture may be able to reduce this risk. This article updates the evidence base for acupuncture therapy for acute pain with a review of systematic reviews and meta-analyses on postsurgical/perioperative pain with opioid sparing and acute nonsurgical/trauma pain, including acute pain in the emergency department. To update reviews cited in the 2018 White Paper, electronic searches were conducted in PubMed, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials for "acupuncture" and "acupuncture therapy" and "acute pain," "surgery," "peri-operative," "trauma," "emergency department," "urgent care," "review(s) ," "systematic review," "meta-analysis," with additional manual review of titles, links, and reference lists. There are 22 systematic reviews, 17 with meta-analyses of acupuncture in acute pain settings, and a review for acute pain in the intensive care unit. There are additional studies of acupuncture in acute pain settings. The majority of reviews found acupuncture therapy to be an efficacious strategy for acute pain, with potential to avoid or reduce opioid reliance. Future multicenter trials are needed to clarify the dosage and generalizability of acupuncture for acute pain in the emergency department. With an extremely low risk profile, acupuncture therapy is an important strategy in comprehensive acute pain care.

Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial

IntroductionLow back pain is a common problem and a substantial source of morbidity and disability worldwide. Patients frequently visit the emergency department (ED) for low back pain, but many experience...

Being Part of the Solution: Initiating Medication-Assisted Treatment in the Emergency Department.

The current literature on the management of opioid use syndrome includes methods to prevent opioid use, complementary therapy for acute and chronic pain, and outpatient services to assist patients. This article contributes to a method of medication-assisted treatment that can be initiated from an emergency department visit. Key implications for emergency nursing practice found in this article include understanding medication-assisted treatment principles, pathophysiology of opioid use disorder, and pharmacology of buprenorphine.

Fast Relief of Acute Musculoskeletal Pain in Different Body Parts Following Exercise - A Randomized Double-Blind Placebo-Controlled Human Study with Curcuma longa and Boswellia serrata Extracts

Acute pain in different parts of the body viz., head and neck, trunk, upper and lower limbs tend to be perceived differently. A randomized double-blinded placebo-controlled study was conducted on 232 healthy participants with acute musculoskeletal pain. The participants were randomized in a 1:1 ratio to receive a single dose of 1000 mg of Curcuma longa and Boswellia serrata extract formulation (CBF, Rhuleave-K) or placebo. The participants were categorized according to the location of the pain- head and neck, upper limb, lower limb, trunk, and general body following exercise. Pain intensity was analyzed using a numerical rating scale (NRS) at intervals of 30 minutes up to 6 hours. NRS was taken at rest, on movement and applying pressure on the affected part. The perceptible pain relief (PPR) and meaningful pain relief (PPR) was assessed using the double stopwatch method. In the CBF group, the pain intensity in the head and neck region had a 100% reduction at rest, on movement and pressure (p=0.02) and in generalized body pain, 100% at rest and movement and 97% reduction on applying pressure (p=0.06). Pain in the upper limb, trunk, and lower limb respectively showed a significant reduction of 99%, 97%, and 97% (p<0.001) in the CBF group at rest, on movement and pressure whereas the placebo group showed negligent change. The PPR and MPR obtained at head and neck (40, 160 min), upper limb (52, 167 min), trunk (75, 216 min), lower limb (74, 175 min), and generalized body pain (75, 240 min) in CBF group were significantly faster than the placebo group (p<0.001). CBF can be recommended as a fast-acting alternative to current therapies for acute musculoskeletal pain affecting head and neck, upper and lower limbs, trunk, and general body pain.

Manipulative therapy for acute neck pain?

Manipulative therapy for acute neck pain?

Topical therapy of acute nociceptive pain: results of an open randomized clinical trial of the domestic drug Alental cream

Evaluation of the therapeutic efficacy, safety and tolerability of the drug Alental cream for external use (VERTEX, LLS, Russia) compared with the original drug - Aertal cream for external use (Gedeon Richter, LLS, Hungary) for local therapy of acute nociceptive pain syndrome in patients who have suffered traumatic ankle injury. The study included 131 patients who had suffered an injury to the soft tissues of the ankle joint. The 1st comparison group received the drug Alental cream, the 2nd group - Aertal cream. The duration of therapy was 7 days. The effectiveness of the drugs was evaluated during treatment based on the dynamics of the intensity of pain syndrome and other symptoms of trauma, as well as the assessment of these changes by the doctor and the patient. The safety analysis included the registration of adverse events according to clinical and laboratory studies. Alental cream in terms of therapeutic efficacy was equivalent to the registered original preparation Aertal cream. The analysis of the assessment of the dynamics of clinical and laboratory parameters, the safety of treatment, including the frequency of adverse events, did not reveal significant differences between the two drugs. Alental cream can be used as a means for local therapy of acute nociceptive pain syndrome in traumatic soft tissue injuries.

Kako prepoznati i lečiti herpes zoster infekciju?

Herpes zoster (HZ) is a common, infectious vesicular dermatosis caused by the reactivation of the varicella-zoster virus (VZV). It is a common clinical problem, especially in people over 50 and immunocompromised patients. Treatment of HZ consists of antiviral drugs, analgesics in the control of acute pain and adequate topical therapy that prevents the occurrence of secondary infection and promotes healing process. This paper presents the most important information related to the etiology and pathogenesis of HZ, epidemiological data and so far known risk factors, the spectrum of clinical manifestations and methods used in the diagnosis of this disease. Therapeutic modalities used in the treatment of HZ and accompanying complications are especially presented, and the need for the timely introduction of antiviral therapy is emphasized, as well as the importance of preventive vaccination of older age groups. Herpes zoster, due to its frequency and associated complications, is a significant public health problem. Due to the global increase in the number of people with compromised immune systems, whether due to age, disease or immunosuppressive therapy, there has been a significant increase in population risk for HZ and postherpetic neuralgia as the most common complication of this disease. For that reason, as well as due to the possible role of HZ in the development of vasculopathy, strokes and heart attacks, experts strongly recommend prevention of HZ by comprehensive vaccination of the elderly.

Expert consensus on the emergency diagnosis and therapy of acute chest pain (English version)

Expert consensus on the emergency diagnosis and therapy of acute chest pain (English version)

Nurses' Ability to Recognize and Prevent Opioid-Induced Respiratory Depression: An Evidenced-Based Practice Project.

Opioids are the primary therapy for acute postoperative pain, despite being associated with opioid-induced respiratory depression (OIRD). The purpose of this study was to improve nurses' knowledge, confidence, and ability to recognize, prevent, and treat OIRD in postoperative inpatients and evaluate the feasibility of using the Pasero Opioid-Induced Sedation Scale (POSS). Registered nurses completed three tools: (1) an Opioid Knowledge Self-Assessment, which was administered pre- and post-education; (2) a Confidence Scale, which was administered pre- and post-education; and (3) a POSS Perceptions and Usability Scale that was administered post-education. Nurses were educated on the POSS and then immediately following the training practiced by undertaking a patient assessment using the instrument. They then completed the POSS Perceptions and Usability Scale to rate their perception of the feasibility of using the POSS. Between preeducation and posteducation, participant knowledge increased in the following areas: recognizing opioid-induced side effects, dose selection, risk factors for oversedation, and information to make clinical decisions. However, there was a drop in scores when asked about knowledge of who is at risk for opioid-related side effects. These findings support our conclusion that OIRD education improves nursing confidence and knowledge. There was significant agreement between the nurse and subject matter experts POSS scores, indicating that this tool is easy to use.

Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

(1) Background: Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); (2) Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, respectively; (3) Results: Six studies were included. The overall pooled effect size for neck pain was very large −1.37 (95% CI, −2.41, −0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((−2.8 (46%) (95% CI, −2.1, −3.4) vs. −1.7 (30%) (95% CI, −1.1, −2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported; (4) Conclusions: SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings.

Pain Assessment after Cesarean Section with a Standardized Pain Questionnaire

Background: The importance of postoperative pain management after Cesarean Section (CS) becomes clear in view of the increasing CS rates and the negative long-term consequences of inadequate acute pain therapy. The aim of this study was to describe postoperative pain after CS, to assess patient satisfaction with postoperative pain management and to identify reasons associated with stronger postoperative pain. Methods: Assessment of postoperative pain took place on the first postoperative day after CS using the PAIN OUT Outcome and Process Questionnaire. To cover a wide range of risk factors, information regarding demography, intervention, anesthesia and pain therapy as well as relevant obstetric parameters were recorded. These factors were analyzed for correlation with postoperative pain. Results: Overall maximum pain intensity was high (7.3±1.6) but only short-lasting. Adequate pain management relieved pain by 70% (minimal pain intensity 2.1±1.6) and resulted in a good patient satisfaction in 70%. Severe postoperative pain was significantly associated with greater impairment in activity and uncertainty (p <0.01, r = 0.46). A weak correlation was found between maternal age and intensity of postsurgical pain (Pearson coefficient: 0.29, p=0.021) with women ≥35 years having stronger pain. Intensity of postsurgical pain was rated statistically significant lower by nulliparous women (6.9±1.5) compared with parity ≥1 women (7.7±1.7) (p=0.04). Conclusion: Risk factors for higher pain intensity after CS were maternal age ≥35 years and parity ≥1. Therefore, a sufficient and individual pain management especially in these women is mandatory.

Critical incidents in acute pain management-A risk analysis of CIRS reports

HintergrundTätigkeitsgebiete mit vielen Schnittstellen, wie die Akutschmerztherapie, gelten per se als Bereiche, in denen ein erhöhtes Risiko für Fehler und Zwischenfälle besteht.Ziel der ArbeitZiele waren die Risikoidentifikation und Graduierung des Risikos von gemeldeten Zwischenfällen im Kontext der Akutschmerztherapie.Material und MethodenAus 5365 Fällen des bundesweiten Meldesystems CIRSmedical Anästhesiologie wurden 508 Berichte mit dem Selektionskriterium „Schmerz“ identifiziert und 281 Berichte (55 %) analysiert und anhand einer Risikomatrix graduiert.ErgebnisseDiese eingeschlossenen Fälle standen im Kontext parenteraler Analgetikaapplikationen (40 %) und rückenmarknaher (40 %) bzw. peripherer Regionalanästhesieverfahren (23 %) sowie der patientenkontrollierten Analgesie in 13 % der Meldungen (Mehrfachnennung möglich). Die meisten Ereignisse waren anhand der Schilderungen auf fachliche Fehler, Kommunikationsdefizite und ein Abweichen von der Routine zurückzuführen. Sie basierten meist auf Zugangs‑, Dosis- oder Wirkstoffverwechslungen. Etwa ein Drittel der Fehlerquellen war organisatorischer Art. Ein mögliches vitales Risiko war anhand der Berichte in 59 % der Fälle anzunehmen; 16 % der Fälle gingen mit tatsächlichen vitalen Komplikationen einher. Die Risikograduierung ergab zusammengefasst in Risikoklassen in 7 % ein „extrem hohes“, in 62 % ein „hohes“, in 25 % ein „moderates“ und in 6 % ein „niedriges“ Risiko.DiskussionInsgesamt stellte sich ein relevantes Risikopotenzial für die Patienten dar. Gerade Zwischenfälle mit menschlichen Fehlern, Abweichen von der Routine und organisatorischen Aspekten gehen mit hohem Risiko einher.

Procedure Specific Pain Therapy - the PROSPECT Idea

Acute pain therapy following operative or interventional procedures has become a compulsory component of a modern perioperative patient management. A structured pain regimen has several clear advantages: it leads to an improvement of the patients' quality of life in the short term, it reduces perioperative morbidity in the medium term, it reduces pain chronification in the long term, at the same time improving the economic efficiency due to an accelerated mobilization, a reduction of the hospitalization and an avoidance of complication inherent costs.This article provides detailed information on the change of paradigm, away from a generalized and rather unspecific acute pain therapy towards a problem oriented procedure specific regimen. It points out two examples of the PROSPECT (PROcedure SPECific pain managemenT) methodology and explains its background.

Effect of Bilateral Quadratus Lumborum Block Type I on Patient Satisfaction and Incidence of Chronic Postsurgical Pain Following Cesarean Section-A Randomized Controlled Trial.

Background: Quadratus lumborum block (QLB) provides a reduction in pain scores and opioid consumption after cesarean section (CS). Intrathecal morphine (ITM) is still considered as the gold standard of acute postoperative pain therapy, but it does have some significant side effects. The aim of this clinical study was to evaluate whether performing the quadratus lumborum block type I in patients undergoing CS would be associated with an increased satisfaction of pain therapy and a decreased incidence of chronic postsurgical pain (CPSP). Methods: Sixty patients scheduled for elective CS were enrolled. All patients received spinal anesthesia and were randomly allocated to either the QLB group (received bilateral quadratus lumborum block type I with the use of 24 m mL 0.375% ropivacaine) or the control group (received no block). The level of satisfaction was evaluated using a three-step scale and the answers provided in a questionnaire regarding the patients’ satisfaction with the method of postoperative pain treatment in the first 48 h. After a 6-month period, all patients were interviewed to evaluate the incidence and possible severity of CPSP. Results: Satisfaction scores were significantly lower in the QLB group than in the control group (p = 0.0000). There were no significant differences between the QLB and control groups regarding the occurrence of chronic postsurgical pain after 6 months following CS (p = 0.102). No statistical differences between the groups were recorded when we compared the results of the questionnaire after a period of 48 h from CS (the number of participants were limited in number). Conclusions: QLB type I is an analgetic option that increased the satisfaction of parturients with pain therapy after CS compared to patients who did not receive the block, and there is a tendency for a lower incidence of CPSP.

Comparative study of combination therapy with non-steroidal anti inflammatory drugs and different doses of low level laser therapy in acute low back pain

According to various side effects of medication in low back pain, respecting conservative therapy, owing to the widespread use of laser therapy in recent decades, related therapeutic outcomes were different and contradictory. The current study aimed at comparing the effect of non-steroidal drugs and laser therapy with different doses in patients with acute low back pain. MethodsThe current randomized, placebo-controlled study was conducted on 65 patients randomly assigned to four groups. In group 1(N = 20), only drug therapy and in group 2(N = 15), laser therapy (3 J/cm 2) in addition to medication was administrated to the patients. For group 3(N = 15), a therapeutic plan similar to that of group 2 was given; however, the laser dose was 6 J/cm 2. Finally, drug therapy plus placebo laser therapy was applied to group 4(N = 15). Pain was compared among the groups using visual analogue scale and Oswestry low back pain disability questionnaire. ResultsSignificant difference between baseline pain scores and those of the weeks 1, 2, 3, and 4 of laser therapy in all intervention groups. Also, the results of the intergroup analyses showed a significant difference between group 1 compared with groups 2 and 3. There was a significant ODI difference between the groups after laser therapy. ConclusionFindings showed that laser therapy plus drug therapy in comparison with drug therapy alone was a more effective method to relieve pain and disability in patient with acute low back pain; however, evidence to support this finding is still inadequate.

Intranasal Ketamine for Acute Pain.

The aim was to review current evidence regarding the off-label use of intranasal ketamine for acute pain presenting in the setting of the emergency department, and secondary to pediatric limb injuries, renal colic, digital nerve block, and migraines. In all 5 indications reviewed, ketamine demonstrated efficacy in reducing pain. However, when compared with other agents, ketamine did not demonstrate superiority over opioids in pediatric limb injuries or renal colic and was not as efficacious as standard therapy for migraine relief. Ketamine was also associated with a greater incidence of transient adverse reactions, such as dizziness, bitter aftertaste, fatigue, and vomiting than opioid therapies. The current body of evidence is insufficient to support the use of intranasal ketamine over other standard therapies for acute pain. However, current evidence can be used when developing dosing strategies, preparing for adverse reactions, and generating hypotheses for future, more robust research.

Annals for Educators - 3 November 2020.

Annals for Educators - 3 November 2020.

B vitamins and nonsteroidal anti-inflammatory drugs: the efficacy of the combination for nonspecific back pain

Back pain significantly affects quality of life in patients. Therapy for acute and chronic nonspecific back pain (NBS) includes non-drug and drug treatments. The non-drug treatment includes educational conversations with a patient, recommendations to maintain an active lifestyle, therapeutic exercises, behavioral and cognitive-behavioral therapy, and mindfulness. Manual therapy and injections of anesthetics into the area of tender joints may be prescribed. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for drug treatment of acute and chronic NBS. Antidepressants may be prescribed for chronic pain and depression symptoms. B vitamins (thiamine, pyridoxine, and cyanocobalamin) can be considered as adjuvant analgesics in NBS. The results of animal experimental studies have shown that B vitamins at high doses have analgesic and anti-inflammatory effects. Clinical studies, a systematic review, and a meta-analysis published in 2020 demonstrated the safety and advantages of combination therapy with NSAIDs and B vitamins over NSAID monotherapy in the treatment of acute NBS and exacerbations of chronic NBS. The addition of B vitamins to NSAIDs can reduce the duration of treatment by 2 times. By reducing the duration of pharmacotherapy, the risk of adverse reactions to NSAIDs decreases and the patient returns to daily activities more quickly. It is advisable to conduct further, larger studies of combined pharmacotherapy for NBS.

CME Answers: Crowned Dens Syndrome - the Chameleon of Neck Pain

CME Answers: Crowned Dens Syndrome - the Chameleon of Neck Pain Abstract. Crowned Dens Syndrome (CDS) is a rare, under-diagnosed differential diagnosis of acute neck pain. Diagnosis is a challenge in clinical practice due to the similarity of symptoms to other diseases. Knowing this differential diagnosis of acute neck pain, unnecessary examinations and expensive therapy attempts can be avoided with a targeted approach. With this article we would like to sensitize colleagues accordingly.

CME: Crowned-Dens-Syndrome - the Chameleon of Neck Pain

CME: Crowned-Dens-Syndrome - the Chameleon of Neck Pain Abstract. Crowned Dens Syndrome (CDS) is a rare, under-diagnosed differential diagnosis of acute neck pain. Diagnosis is a challenge in clinical practice due to the similarity of symptoms to other diseases. Knowing this differential diagnosis of acute neck pain, unnecessary examinations and expensive therapy attempts can be avoided with a targeted approach. With this article we would like to sensitize colleagues accordingly.