Acute Pain Conditions Research Articles

New generation capsaicin-diclofenac containing, silicon-based transdermal patch provides prolonged analgesic effect in acute and chronic pain models.

Pain is one of the major public health burdens worldwide, however, conventional analgesics are often ineffective. Capsaicin -the active compound of Capsicum species, being responsible for their pungency - has been part of traditional medicine long ago. Capsaicin is a natural agonist of the Transient Receptor Potential Vanilloid 1 receptor - localized on capsaicin-sensitive sensory neurons and strongly involved in pain transmission -, and has been in focus of analgesic drug research for many years. In this study, we aimed to develop a sustained release transdermal patch (transdermal therapeutic system, TTS) combining the advantages of low-concentration capsaicin and diclofenac embedded in an innovative structure, as well as to perform complex preclinical investigations of its analgesic effect. Drug delivery properties of the TTS were investigated with Franz cell and flow-through cell tests. Analgesic effect of the TTS was examined in in vivo models of acute postoperative and inflammatory, chronic neuropathic and osteoarthritic pain. Modified silicone polymer matrix-based TTS containing low-concentration capsaicin and diclofenac has been developed, releasing both compounds according to zero-order kinetics. Moreover, capsaicin and diclofenac facilitated the liberation of each other. Combined TTS significantly reduced acute postoperative and inflammatory pain, as well as chronic neuropathic and osteoarthritic pain. Interestingly, in acute postoperative and chronic osteoarthritic pain, capsaicin prolonged and potentiated the pain-relieving effect of diclofenac. New generation combined low-concentration capsaicin-diclofenac containing TTS can be an effective therapeutic tool in acute and chronic pain states involving neuropathic and inflammatory components.

Pharmacologic Management of Acute Pain in Children

Several pharmacologic options exist for the management of acute pediatric pain; however, their comparative effectiveness remains uncertain. To assess the relative benefits and harms of pharmacotherapy for acute pediatric pain through a network meta-analysis of randomized clinical trials. Cochrane Database of Systematic Reviews, Medline, Embase, CINAHL, Web of Science, and Scopus to October 2023. Trials that enrolled children (aged <18 years) with acute pain and randomized them to receive a pharmacologic analgesic vs an alternate analgesic or placebo were included. Pairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. A frequentist random-effects model was used for all meta-analyses, and the certainty of evidence was assessed for treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcomes were pain severity (range, 0-10 cm using a visual analog scale; minimally important difference [MID], 1 cm), need for rescue medication, symptom relief, and adverse drug events. A total of 41 trials involving 4935 children were included. High- to moderate-certainty evidence found that compared with placebo, nonsteroidal anti-inflammatory drugs (NSAIDs) (weighted mean difference [WMD], -1.29; 95% CI, -1.89 to -0.70; modeled risk difference [RD] for achieving the MID, 16%), ketamine (WMD, -1.12; 95% CI, -2.09 to -0.14; modeled RD for achieving the MID, 14%), and mid-high potency opioids (WMD, -1.19; 95% CI, -1.83 to -0.55; modeled RD for achieving the MID, 15%) reduced pain. Only NSAIDs reduced the need for rescue medication (relative risk [RR], 0.31; 95% CI, 0.14 to 0.68; modeled RD, 16% fewer patients). Neither NSAIDs (RR, 0.69; 95% CI, 0.31 to 1.55) nor acetaminophen (RR, 0.63; 95% CI, 0.21 to 1.87) increased the risk of short-term gastrointestinal adverse events. All other comparisons showed moderate-certainty evidence of little to no difference from placebo or were supported by low/very low-certainty evidence. Compared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids are effective in reducing acute pediatric pain. NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children.

What do ultrasound vocalizations really mean in rats with different origins of pain?

This study is to assess how 22 kHz and 50 kHz spontaneous ultrasound vocalization (USV) calls would be affected by different origins of pain so as to validate the use of USV in pain studies. Five well-established rat models of pain were used to evaluate various parameters of spontaneous 22 kHz and 50 kHz calls in adult male rats in terms of both acute and chronic or inflammatory and neuropathic or somatic and visceral origins. The effects of local lidocaine blockade of the injection site and intraperitoneal administration of antidepressant (amitriptyline) and anticonvulsant (gabapentin) were examined as well in typical inflammatory and neuropathic pain models, respectively. The major new gains were as follows: (1) naive rats staying alone and engaging dyadic social interaction with a naive or a conspecific in pain emitted similar power and amounts of both 22 kHz and 50 kHz spontaneous USV calls; however, rats suffering from various origins of pain emitted significantly less USV calls of both 22 kHz and 50 kHz in terms of both number and time. (2) Local blockade of the injury sites of inflammatory pain could reverse the impaired emission of both 22 kHz and 50 kHz spontaneous calls, so did the treatment of the rats with neuropathic pain by amitriptyline and gabapentin. Emissions of both 22 kHz and 50 kHz spontaneous calls were impaired by acute and chronic pain conditions regardless of inflammatory and neuropathic or somatic and visceral origins.

Tomatidine, A Promising Steroidal Alkaloid Alleviates Various Noxious Stimuli Induced Nociception in Mice Model

Background Nociception, often described as the body’s ability to sense and respond to harmful stimuli, represents a global discomfort that profoundly impacts individuals across the globe. It functions as a fundamental warning process, alerting organisms against potential threats and promoting protective behaviors. However, when dysregulated or chronic, nociception can become a significant burden, leading to persistent pain and diminished quality of life. Various analgesic drugs play a crucial role in alleviating pain and improving the quality of life for millions of people worldwide. While analgesic drugs provide significant relief for acute and chronic pain conditions, they can cause side effects ranging from mild gastrointestinal disturbances, drowsiness, and constipation to major complications such as cardiovascular damage and nephrotoxicity. Purpose Hence, we investigated the potency of a phytochemical tomatidine against various noxious stimuli-induced nociception. Methods Tomatidine pain-relieving potency has been assessed against heat stimuli and chemical-induced visceral pain. The neuropathic pain-relieving potency of tomatidine was examined with glutamate and capsaicin-induced mice models. Results Tomatidine potency against intense pain was examined with a formalin-induced biphasic nociception model. Carrageenan induced an inflammatory response, peritoneal leukocyte infiltration, and air pouch model were performed to analyze the anti-inflammatory effect of tomatidine against inflammatory cytokines-induced nociception. The antisedative potency of tomatidine was confirmed with open-field test analysis. Our results confirm that tomatidine effectively inhibited nociception induced by thermal and chemical stimuli. It also alleviates the inflammatory cytokines stimulated pain and does not render any sedative effect in mice models. Conclusion To conclude tomatidine is a potent nonsedative antinociceptive drug that can be formulated as an analgesic.

Role of D1- and D2-like dopamine receptors within the CA1 hippocampal region in the stress-induced antinociceptive response in the exposure to acute pain.

Exposure to stressful conditions such as forced swim stress (FSS) induces antinociception. Previous reports determined that dopamine receptors in the CA1 hippocampal area are important in chronic pain processing. Considering that neural mechanisms behind acute and chronic pain differ significantly, in this study, we have investigated the role of dopamine receptors within the CA1 region in the FSS-induced antinociceptive response in the acute pain induced by the tail-flick test in the rat. The cannula was implanted unilaterally in the CA1 region of the animal brain. Animals received drugs or vehicles 5 min before FSS exposure. SCH23390 as the D1-like dopamine receptor (D1R) antagonist and Sulpiride as the D2-like dopamine receptor (D2R) antagonist were microinjected into the CA1 area at three doses (0.25, 1, and 4 μg/0.5 μl vehicle); the vehicle groups received saline instead of SCH23390 and dimethyl sulfoxide instead of Sulpiride. After exposure to FSS, the tail-flick test was done. The findings of this study revealed that FSS significantly attenuates nociceptive response during the tail-flick test ( P < 0.0001). Moreover, intra-CA1 microinjection of SCH23390 and Sulpiride significantly reduces the FSS-induced antinociception in the inducing acute pain ( P < 0.0001). The comparison of effective dose of 50% for D1R and D2R antagonists showed that both receptors in the CA1 almost equally reduce the FSS-induced antinociception in the tail-flick test. The result of this study supports the hypothesis, that the dopaminergic system in CA1 is involved in triggering a stress-induced antinociceptive response in acute pain conditions.

The effects of chronic neuropathic pain states on the discriminative stimulus effect of fentanyl and other MOR agonists.

Pleasant subjective effects of drugs (e.g., euphoria) have been demonstrated to contribute to their abuse potential. In humans, there is some evidence that acute pain states may decrease the positive subjective effects of opioids; however, no studies have directly tested the impact of a long-lasting pain state. Therefore, the goal of this study was to directly evaluate the discriminative stimulus of mu opioid receptor (MOR) agonist, fentanyl, or the non-opioid drug of abuse, cocaine, in the presence or absence of spared nerve injury (SNI) induced chronic neuropathic pain. Prior to surgery, MOR agonists (fentanyl, morphine, nalbuphine) dose-dependently increased % fentanyl-like responding, as expected; surprisingly, after surgery, we saw small, significant rightward shifts in the fentanyl and morphine dose response curves in both sham and SNI groups suggesting that the observed shifts were not due to chronic pain. In both sham and SNI groups, there was an increase in the generalization of nalbuphine to the fentanyl-discriminative stimulus. There was no change in the discriminative stimulus of cocaine (or amphetamine substitutions) over 4 months of SNI-induced chronic neuropathic pain or sham states, suggesting that the SNI model failed to alter the discriminative stimuli of fentanyl and cocaine. Following induction of chronic neuropathic pain, there was an observed increase in quinpirole-induced generalization to the cocaine discriminative stimulus. In the future, studies should directly examine the abuse potential of low efficacy MOR agonists and dopaminergic agonists in the presence and absence of chronic pain states.

Opioid analgesic and antidepressant use during pregnancy andthe risk of spontaneous preterm birth: A nested case-control study.

Given the high prevalence of both mental health and acute pain conditions during pregnancy, use of antidepressants and analgesic opioids in this period is widespread. Whether single and combined use of these medications is associated with spontaneous preterm birth (sPTB) remains unclear. To investigate the association between maternal prescription opioid and antidepressant medication exposures for co-occurring mental health and acute pain management, either alone or in combination, and sPTB. We used Tennessee Medicaid data (2007-2019) linked to birth certificates to conduct a nested case-control study among 15- to 44-year-old pregnant patients with singleton live births. Cases were identified as spontaneous live births between 24 and <37 gestational weeks using a validated birth certificate-based algorithm. We selected up to 10 controls per case, matched on estimated pregnancy start date and other factors. We identified analgesic opioid and antidepressant pharmacy fills to define medication exposures in the 60 days before index date (case delivery date) and categorised them as unexposed, opioid-only, antidepressant-only and combined exposure. We estimated odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression, adjusting for confounders. We assessed the additive interaction between opioids and antidepressants by estimating relative excess risk due to interaction. We identified 25,406 eligible cases of sPTB and 225,771 matched controls. Opioid-only and combined exposures were associated with higher odds of sPTB relative to unexposed (adjusted OR 1.29, 95% CI 1.23, 1.35 and 1.22, 95% CI 1.06, 1.40, respectively), while antidepressant-only exposure was not (1.04, 95% CI 0.96, 1.12). No additive interaction was identified for combined exposure. Exposure to prescription opioids during pregnancy, but not antidepressants, was associated with increased relative odds of sPTB. Co-exposure to opioids and antidepressants did not elevate the odds of sPTB above what we observed for opioid-only exposure.

Clinical Efficacy of Auricular Vagus Nerve Stimulation in the Treatment of Chronic and Acute Pain: A Systematic Review and Meta-analysis.

Current guidelines for pain treatment recommend a personalized, multimodal and interdisciplinary approach as well as the use of a combination of drug and non-drug therapies. Risk factors for chronification should already be reduced in patients with acute pain, e.g., after surgery or trauma. Auricular vagus nerve stimulation (aVNS) could be an effective non-drug therapy in the multimodal treatment of chronic and acute pain. The aim of this systematic review and meta-analysis is to evaluate the clinical efficacy and safety of aVNS in treating chronic and acute pain conditions. A systematic literature search was performed regarding the application of auricular electrical stimulation in chronic and acute pain. Studies were classified according to their level of evidence (Jadad scale), scientific validity and risk of bias (RoB 2 tool) and analyzed regarding indication, method, stimulation parameters, duration of treatment and efficacy and safety. A meta-analysis on (randomized) controlled trials (using different comparators) was performed for chronic and acute pain conditions, respectively, including subgroup analysis for percutaneous (pVNS-needle electrodes) and transcutaneous (tVNS-surface electrodes) aVNS. The visual analog pain scale (VAS) was defined as primary efficacy endpoint. A total of n = 1496 patients were treated with aVNS in 23 identified and analyzed studies in chronic pain, 12 studies in acute postoperative pain and 7 studies in experimental acute pain. Of these, seven studies for chronic pain and six studies for acute postoperative pain were included in the meta-analysis. In chronic pain conditions, including back pain, migraine and abdominal pain, a statistically significant reduction in VAS pain intensity for active compared to sham aVNS or control treatment with an effect size Hedges' g/mean difference of - 1.95 (95% confidence interval [CI]: - 3.94 to 0.04, p = 0.008) could be shown and a more favorable effect in pVNS compared to tVNS (- 5.40 [- 8.94; - 1.85] vs. - 1.00 [- 1.55; - 0.44]; p = 0.015). In acute pain conditions, single studies showed significant improvements with aVNS, e.g., in kidney donor surgery or tonsillectomy but, overall, a non-statistically significant reduction in VAS pain intensity for active compared to sham aVNS or control with - 0.70 [- 2.34; 0.93] (p = 0.15) could be observed in the meta-analysis. In acute pain results vary greatly between studies depending especially on co-medication and timepoints of assessment after surgery. A significant reduction in analgesics or opiate intake was documented in most studies evaluating this effect in chronic and acute pain. In 3 of the 12 randomized controlled trials in patients with chronic pain, a sustainable pain reduction over a period of up to 12months was shown. Overall, aVNS was very well tolerated. This systematic review and meta-analysis indicate that aVNS can be an effective and safe non-drug treatment in patients with specific chronic and acute postoperative pain conditions. Further research is needed to identify the influence of simulation parameters and find optimal and standardized treatment protocols while considering quality-of-life outcome parameters and prolonged follow-up periods. A more standardized approach and harmonization in study designs would improve comparability and robustness of outcomes.

Sex differences in the orofacial antinociceptive effect of metformin and the role of transient receptor potential channels.

Metformin is classified as a biguanide and is used in the treatment of type 2 diabetes. It is used worldwide and has been investigated in drug repositioning. The present study aims to investigate whether there is sexual dimorphism in the orofacial antinociceptive effect of metformin and the participation of TRP channels. Acute nociceptive behavior was induced by administering cinnamaldehyde or capsaicin to the upper lip. Nociceptive behavior was assessed through orofacial rubbing, and the effects of pre-treatment with metformin (125 or 250mg/Kg) or vehicle (control) were tested on the behavior. Nociceptive behavior was also induced by formalin injected into the temporomandibular joint. The chronic pain model involved infraorbital nerve transection (IONX) was evaluated using Von Frey electronic filaments. Trpv1 gene expression was analyzed in the nerve ganglion. Docking experiments were performed. Metformin, but not the vehicle, produced antinociception (p < 0.0001) in all acute nociceptive behaviors in both sexes, and these effects were attenuated by the TRPV1 antagonist capsazepine and the TRPA1 antagonist HC-030031. In IONX with better (**p < 0.01, ****p < 0.0001 vs. control) results in females. TRPV1 gene expression was observed in the metformin treated group (*p < 0.05 vs. control). Docking experiments revealed that metformin may interact with TRPV1 and TRPA1 channels. Metformin promotes orofacial antinociception in both sexes in acute pain and is more effective in chronic pain in females than in males, through the modulation of TRPV1 and TRPA1 channels. These preclinical findings suggest a potential repositioning of metformin as an analgesic agent in acute and chronic orofacial pain states.

Comparison of pharmacotherapeutic analgesic response and safety profile of tapentadol with other opioids.

Tapentadol is a unique opioid analgesic due to its dual mechanism of action. Compared to other opioids with a classical mechanism of action, its analgesic potential is not far behind them, and its advantages are: a better safety profile in terms of a lower potential for drug-drug interactions and a lower potential for causing adverse events, and it is safe to use in sensitive populations. Tapentadol in the form of a immediate release formulation is an adequate drug of choice for achieving a pharmacotherapeutic analgesic response in acute pain conditions, while in the form of a extended release formulation it is an adequate pharmacotherapeutic analgesic solution for chronic pain syndromes of various etiology. Due to the specificity of the mechanism of action, tapentadol adequately relieves both pain components - nociceptive and neuropathic, and has an indication area for mixed pain syndrome as well. Based on this, the need for the use of co-analgesics is reduced, and thus the incidence of possible interactions and adverse events is reduced.

A novel opioid/pramipexole combination treatment for the management of acute pain: a pilot study.

Despite their dangerous side effects, opioid drugs remain a standard of care for moderate to severe pain with few alternatives. Strategies to maintain the analgesic effects of opioids while minimizing the associated risks are needed. Pre-clinical studies have shown using a dopamine 3 receptor (D3R) agonist as an adjuvant to morphine provides superior analgesia against painful stimuli compared to morphine alone. Our objective was to test if adjunct treatment with a D3R agonist can lead to a reduction in opioid use while maintaining effective analgesia. This study was set up as a double-blinded, placebo-controlled randomized trial. Enrollment included acute renal colic patients presenting to the emergency department, from which patients were randomized to either the "control" or "study arm". The control group received standard treatment of care (morphine, 0.1 mg/kg; i.v.) and an oral placebo pill. The experimental group received half-dosed morphine and oral pramipexole pill (0.25 mg). Pain measurements including a numerical pain scale and visual analog scale were collected from enrollees at baseline and every subsequent 15 min. A total of 19 patients completed the study, 10 in the experimental arm and 9 in the control arm. During the study period, effective analgesia (50% decrease from baseline) was achieved in 80% of patients in the experimental arm vs. 33.3% in the control arm. Our pilot clinical trial demonstrated that D3R recruitment can serve as an effective adjuvant to low-dose morphine for control of renal colic pain and potentially other acute pain conditions. ClinicalTrials.gov, identifier, (NCT04160520).

A SYSTEMATIC REVIEW OF PARENTS' PATTERNS AND BARRIERS TO BRINGING CHILDREN TO THE DENTIST

Caries at an early age is a global problem that affects almost half of preschool children, the prevalence of early childhood caries (ECC) globally varies widely. One of the causes of caries in children less than 5 years old is the delay in the first visit to the dentist. The purpose of this study is to identify patterns of service utilization and obstacles that cause low visits to dentists so that programs can be planned that are able to increase the number of dental visits. A literature review was conducted using PubMed, ProQuest, SpringerLink, and ScienceDirect databases with keywords such as Dental care, Dental attendance, dental utilization, and Oral health promotion. The data were then thematically analyzed to uncover trends, common challenges, and effective interventions across the literature. The results of this systematic review show a pattern in visiting the dentist, including visiting for routine dental checkups, preventive treatments, acute pain conditions that have been experienced and trauma. The patterns of use of dental and oral health services in children are influenced by the level of parental education, the type of dental health care that is covered by limited health insurance, low socio-economic factors, socio-demographic factors, and lack of adequate insurance. This study aims to offer valuable insights into the patterns of dental care utilization and the obstacles preventing higher visitation rates to dental services. The findings are synthesized to highlight consistencies and gaps, ultimately providing insights to inform the development of programs aimed at improving dental visit rates.

Does Pain Explain Trends in Disability? An Analysis of Middle-Aged and Older U.S. Adults, 2002-2018.

This article investigates the role of pain in disability trends in the United States, within the context of recent unfavorable disability trends and the concurrent rise in pain. We conducted a 2-part analysis using National Health Interview Survey data from 2002 to 2018 for U.S. adults aged 45-84. First, we assessed how changes in the prevalence of 5 site-specific types of pain (headaches/migraines, joint, low back, neck, and facial/jaw pain) associated with disability trends. Second, we used self-reported causes of disability and examined whether there has been a change in the proportion of individuals who attribute their disability to 1 of 5 chronic or acute painful conditions. The 5 site-specific types of pain, individually and collectively, were significantly associated with increases in disability. If site-specific chronic pain had not increased during the study period, the trend for functional limitations would have been 40% lower, and that for activity limitations would have shown a slight decline instead of an increase. Attributions of functional limitations to painful conditions increased by 23% during the 2002-2018 period, representing an additional 9.82 million Americans experiencing pain-attributable disability. Arthritis/rheumatism, back/neck problems, and other musculoskeletal/connective conditions were the primary sources of pain-related disability. Our research provides the first systematic, national examination of how pain is contributing to disability trends in the United States. The findings have implications for disability reduction policies and shed light on the far-reaching consequences of pain for overall population health.

Cells and circuits for amygdala neuroplasticity in the transition to chronic pain

Maladaptive plasticity is linked to the chronification of diseases such as pain, but the transition from acute to chronic pain is not well understood mechanistically. Neuroplasticity in the central nucleus of the amygdala (CeA) has emerged as a mechanism for sensory and emotional-affective aspects of injury-induced pain, although evidence comes from studies conducted almost exclusively in acute pain conditions and agnostic to cell type specificity. Here, we report time-dependent changes in genetically distinct and projection-specific CeA neurons in neuropathic pain. Hyperexcitability of CRF projection neurons and synaptic plasticity of parabrachial (PB) input at the acute stage shifted to hyperexcitability without synaptic plasticity in non-CRF neurons at the chronic phase. Accordingly, chemogenetic inhibition of the PB→CeA pathway mitigated pain-related behaviors in acute, but not chronic, neuropathic pain. Cell-type-specific temporal changes in neuroplasticity provide neurobiological evidence for the clinical observation that chronic pain is not simply the prolonged persistence of acute pain.

Opioid prescribing requirements to minimize unused medications after an emergency department visit for acute pain: a prospective cohort study.

Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids. In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period. We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (p < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets). Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse. ClinicalTrials.gov, no. NCT03953534.

The association between primary care appointment lengths and opioid prescribing for common pain conditions

BackgroundWhile brief duration primary care appointments may improve access, they also limit the time clinicians spend evaluating painful conditions. This study aimed to evaluate whether 15-minute primary care appointments resulted in higher rates of opioid prescribing when compared to ≥ 30-minute appointments.MethodsWe performed a retrospective cohort study using electronic health record (EHR), pharmacy, and administrative scheduling data from five primary care practices in Minnesota. Adult patients seen for acute Evaluation & Management visits between 10/1/2015 and 9/30/2017 scheduled for 15-minute appointments were propensity score matched to those scheduled for ≥ 30-minutes. Sub-groups were analyzed to include patients with acute and chronic pain conditions and prior opioid exposure. Multivariate logistic regression was performed to examine the effects of appointment length on the likelihood of an opioid being prescribed, adjusting for covariates including ethnicity, race, sex, marital status, and prior ED visits and hospitalizations for all conditions.ResultsWe identified 45,471 eligible acute primary care visits during the study period with 2.7% (N = 1233) of the visits scheduled for 15 min and 98.2% (N = 44,238) scheduled for 30 min or longer. Rates of opioid prescribing were significantly lower for opioid naive patients with acute pain scheduled in 15-minute appointments when compared to appointments of 30 min of longer (OR 0.55, 95% CI 0.35–0.84). There were no significant differences in opioid prescribing among other sub-groups.ConclusionsFor selected indications and for selected patients, shorter duration appointments may not result in greater rates of opioid prescribing for common painful conditions.

Peripheral Nerve Stimulation in Postoperative Analgesia: A Narrative Review.

Recent research has shown the effectiveness of peripheral nerve stimulators (PNS) in managing chronic pain conditions. Ongoing studies aim to explore its potential application in treating acute postoperative pain states. The purpose of this systematic review is to assess the role of PNS in providing relief for postoperative pain. Clinical studies investigating the use of peripheral nerve stimulators (PNS) for analgesia following various surgeries, such as total knee arthroplasty, anterior cruciate ligament repair, ankle arthroplasty, rotator cuff repair, hallux valgus correction, and extremity amputation, have shown promising results. Lead placement locations include the brachial plexus, sciatic, femoral, tibial, genicular, perineal, sural, radial, median, and ulnar nerves. These studies consistently report clinically significant reductions in pain scores, and some even indicate a decrease in opioid consumption following PNS for postoperative pain. PNS involves the subcutaneous placement of electrode leads to target peripheral nerve(s) followed by delivery of an electric current via an external pulse generator. While the precise mechanism is not fully understood, the theory posits that PNS modulates electrical stimulation, hindering the signaling of nociceptive pain. PNS presents itself as an alternative to opioid therapy, holding promise to address the opioid epidemic by offering a nonpharmacologic approach for both acute and chronic pain states.

Effect of low-dose radiotherapy in rotator cuff calcific tendinitis: A case report

&amp;lt;p style=&amp;quot;text-align: justify;&amp;quot;&amp;gt;Rotator cuff calcific tendinitis (RCCT) is an acute or chronic painful condition due to the presence of calcific deposits inside or around the tendons of the rotator cuff. Effective treatment of RCCT is crucial for restoring shoulder function, alleviating pain, and enhancing the patient&amp;amp;rsquo;s quality of life. The treatment of RCCT is mainly divided into surgical and non-surgical treatment. Conservative treatment has been regarded as the first-line therapy, but the effectiveness of these treatments is still not well-established. When conservative treatment fails, invasive treatment, either minimally invasive or surgical, is usually indicated. Nowadays, low-dose radiotherapy has been used for the treatment of various benign conditions, including calcific tendinitis. We presented a 56-year-old female patient with intense pain and limited mobility of her left shoulder. X-rays and ultrasound of the left shoulder showed a massive oval calcification along the greater part of the m. supraspinatus measuring 41x8mm. The patient was first treated with diclopram, peranton gel, and rest. After that, it was decided to try low-dose radiotherapy. It was performed on the Vitalbeam radiotherapy platform with a conformal technique in doses of Gy 8 and 10 fractions. After the last fraction, the pain gradually disappeared and mobility was regained. The ultrasonography control 2 months after the last session showed the total disappearance of the calcification. The use of low-dose radiotherapy for benign conditions is a topic of ongoing debate in the medical community. In this case, low-dose radiotherapy proved to be an adequate method of choice without accompanying side effects, resulting in complete healing and improvement of quality of life.&amp;lt;/p&amp;gt;

Ultrasound-Guided Off-Plan Lumbar Seated Erector Spinae Plane Blocks : Are There Advantages?

The erector spinae plane block (ESPB) has been widely used as a treatment strategy for a variety of acute and chronic painful conditions. ESPBs are typically performed under ultrasound guidance [USG] in an in-plane long axis approach, targeting the tip of the lumbar transverse process while the patient lies prone. Off-Plane Seated Injection Technique-ESPB [OPSIT-E] represents a useful alternative in situations where a standard prone spine injection would be technically challenged by circumstances which may include morbid obesity, orthopnoea, recent upper limbs surgeries, chest pain from recent pacemaker implant, and in a subjects were in-plane approaches may be complicated by skin lesions. A seated forward flexed off-plane injection position, may also flatten the lumbar lordosis, shift adipose tissue more anteriorly, lessening skin to target distance and facilitating bony landmark identification, in high BMI and hyperlordotic subjects. The relatively larger curved transverse arc radius of the curvilinear probe [GE G1-5] in comparison to its transverse arc, also appears to offer improved central field of skin-transducer contact, earlier needle visualization, improved acute angle trajectory visualization of deep structures, which may be due to less crepuscular beam dispersion in comparison to transverse probe orientation. Even with a linear probe, the orthogonal technique facilitates a more perpendicular vector, lessening needle transit to target distance, which may in turn decrease procedure time, and improve patient comfort. The OPSITE, may also be easier to teach, learn, and master, as other studies have generally reported a higher rate of off-lane injection success among novice vascular interventionists.

Emerging Medications and Strategies in Acute Pain Management: Evolving Role of Novel Sodium and Calcium Channel Blockers, Peptide-Based Pharmacologic Drugs, and Non-Medicinal Methods.

The present investigation evaluated integration of novel medication technology to enhance treatment options, while improving patient outcomes in acute pain management. In this regard, we focused on determining the role of development and utilization of cutting-edge pharmaceutical advancements, such as targeted drug delivery systems, as well as non-pharmacologic interventions in addressing acute pain states. Further research in this area is warranted related to the need for increased patient comfort and reduced adverse effects. Recent innovations and techniques are discussed including pharmacologic drugs targeting sodium and calcium channels, peptide-based pharmacologic drugs, and non-medicinal methods of alleviating pain such as soothing music or virtual reality. The present investigation included review of current literature on the application of these innovative technologies, analyzing mechanisms of action, pharmacokinetics, and clinical effectiveness. Our study also investigated the potential benefits in terms of pain relief, reduced side effects, and improved patient adherence. The research critically examines the challenges and considerations associated with implementing these technologies in acute pain management, considering factors like cost, accessibility, and regulatory aspects. Additionally, case studies and clinical trials are highlighted which demonstrate practical implications of these novel medication technologies in real-world scenarios. The findings aim to provide healthcare professionals with a comprehensive understanding of the evolving landscape in acute pain management while guiding future research and clinical practices toward optimizing their use in enhancing patient care.