Effective Pain Management Research Articles

Comparative efficacy of ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in instrumented lumbar spinal surgeries

ObjectiveThis study compared the efficacy of ultrasound-guided erector spinae plane block (ESPB) and wound infiltration (WI) for postoperative analgesia in patients who underwent lumbar spinal surgery with instrumentation.MethodsIn this randomized controlled trial, 80 patients were divided into two groups: ESPB (n = 40) and WI (n = 40). Postoperative pain intensity was assessed via the visual analog scale (VAS) at multiple time points within 24 h. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated.ResultsBoth ESPB and WI provided effective postoperative pain management, with no significant differences in VAS scores. However, the ESPB group demonstrated a significantly longer duration of analgesia, a shorter time to first rescue analgesia, and lower total tramadol consumption (50 ± 60 mg vs. 100 ± 75 mg; p = 0.010) than did the WI group. Furthermore, a trend toward reduced PONV incidence was observed in the ESPB group, likely due to its opioid-sparing effect.ConclusionWhile both ESPB and WI provided effective postoperative pain management, ESPB demonstrated a distinct advantage by offering a longer duration of analgesia and significantly reducing opioid consumption. These findings suggest that ESPB is more effective than WI for postoperative analgesia in lumbar spinal surgeries, providing prolonged pain relief and improving patient outcomes. Further studies are warranted to explore its long-term benefits and cost-effectiveness.Trial RegistrationClinicalTrials.govPRS: NCT06567964 Date: 08/21/2024 Retrospectively registered.

Trends and hospital practice variation for analgesia for children with sickle cell disease with vaso-occlusive pain episodes: An 11-year analysis

This cross-sectional analysis of 86,111 visits for sickle cell disease and vaso-occlusive episodes (VOE) in U.S. pediatric emergency departments between 2013 and 2023 shows increased use of NSAIDs, ketamine, and acetaminophen, with unchanged opioid use. Hospitals with a higher volume of VOE visits more frequently administered opioids. BackgroundVaso-occlusive episodes (VOEs) are a hallmark of sickle cell disease (SCD), leading to frequent emergency department (ED) visits. Effective pain management is crucial, with guidelines recommending routine use of non-steroidal anti-inflammatory drugs (NSAIDs) with opioids, and emerging evidence supporting ketamine use. However, these recommendations are based on low-certainty evidence, and the impact of these guidelines on analgesia use over time remains unclear. ObjectiveThis study aimed to analyze trends in analgesia use over an 11-year period in pediatric SCD patients presenting to U.S. EDs with VOE and assess variations in treatment across hospitals. MethodsA cross-sectional study was conducted using data from the Pediatric Health Information System covering 34 U.S. children's hospitals from January 1, 2013, to December 31, 2023. The primary outcomes were the proportions of visits where opioids, NSAIDs, acetaminophen, and/or ketamine were administered on the first calendar day of the initial visit. Secondary outcomes included the co-administration of NSAIDs with opioids. Logistic and linear regression models were used to assess trends and hospital-level variations. ResultsA total of 86,111 ED visits for VOE were analyzed. Opioids were administered in 82 % of encounters, NSAIDs in 72 %, acetaminophen in 17 %, and ketamine in 1 %. Co-administration of NSAIDs with opioids occurred in 59 % of the visits. Among discharged patients, there was a positive trend for NSAID use (slope: 1.68 %/year, 95 % CI: 0.91 %, 2.45 %) and NSAID-opioid co-administration (slope: 1.03 %/year, 95 % CI: 0.37 %, 1.69 %) over time. Acetaminophen use also increased over the study period (slope: 0.99 %/year, 95 % CI: 0.80 %, 1.17 %). In hospitalized patients, there was a significant upward trend for acetaminophen (slope: 1.29 %/year, 95 % CI: 0.69 %, 1.89 %) and ketamine (slope: 0.36 %/year, 95 % CI: 0.27 %, 0.45 %), while opioid use remained unchanged. Significant hospital-level variations were observed, with larger hospitals more likely to administer opioids but less likely to co-administer NSAIDs with opioids compared to medium-volume hospitals. ConclusionOver the past decade, the use of NSAIDs, acetaminophen, and ketamine has increased in the management of VOE in pediatric SCD patients, while opioid use remains consistent. The co-administration of NSAIDs and opioids has also increased, reflecting guideline adherence. Variations in analgesia practices across hospitals underscore the need for standardizing pain management strategies in this population.

Pharmacological management of osteoarthritis: judicious use of nonsteroidal anti-inflammatory drugs

Background: Osteoarthritis (OA) is a chronic disease characterized by persistent pain and joint deformation. Effective pain management in patients with OA necessitates accurate diagnosis and appropriate treatment planning, considering the prolonged therapy required for OA. Although non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management in patients with OA, their long-term use can lead to various adverse effects that warrant careful consideration.Current Concepts: NSAIDs inhibit cyclo-oxygenase (COX) enzymes and produce an anti-inflammatory and analgesic effect. However, this mechanism of action can produce adverse gastrointestinal, cardiovascular, and renal effects. The relative risk of gastrointestinal and cardiovascular adverse events depends on the COX selectivity of NSAIDs. Consequently, selective COX-2 inhibitor or concomitant proton pump inhibitor administration is recommended in patients at a high risk of gastrointestinal complications. Minimizing NSAID use is advised in patients at a high risk of cardiovascular adverse events; however, if this is unavoidable, short-term administration of naproxen or low-dose celecoxib should be considered. COX selectivity is not associated with adverse renal events. Therefore, acetaminophen is preferred in patients with impaired renal function, and short-term use of NSAID patches or topical formulations may be useful.Discussion and Conclusion: The choice of NSAIDs for OA should be tailored to patients’ needs, considering their risk factors, potential drug interactions, and other relevant factors. Additionally, incorporation of nonpharmacological interventions can minimize the NSAID dosage and reduce the risk of adverse effects, and regular monitoring is essential to identify adverse effects.

Ultrasound-Guided Transversus Abdominis Plane Block as an Effective Path to Reduce Opioid Consumption After Laparoscopic Bariatric Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Effective postoperative pain management is essential to the patient's recovery. The use of opioids as the primary line of pain treatment has been known to increase rates of length of stay, pulmonary complications, paralytic ileus, and nausea and vomiting. Therefore, guidelines strongly recommend alternative paths to reduce opioid consumption through multimodal analgesia, and the transversus abdominis plane block(USG-TAP) has been considered to be one of these optimistic alternatives. A comprehensive systematic search was conducted in four databases until April 2024. We only considered for this analysis randomized controlled trials that assessed the USG-TAP as part of multimodal anesthesia in patients undergoing laparoscopic bariatric surgery. Eleven studies comprising 789 patients were included in the meta-analysis. Our results showed a significant decrease in opioid consumption after the first 24h of surgery (MD - 32.02mg; 95% IC - 51.33, - 12.71; p < 0.01) and fewer patients required extra-dose of opioid (OR 0.20; 95% IC 0.07, 0.62; p < 0.01). The pain score showed to be also improved with the TAP block (MD - 0.69; 95% IC - 1.32, - 0.07; p = 0.03). No difference concerning time to deambulate, nausea and vomiting, and time of surgery was observed among the studies. This study reinforces the benefits of the use of USG-TAP block as part of multimodal analgesia in patients undergoing laparoscopic bariatric surgery.

From Aches to Answers: Understanding and Managing Hip Joint Issues in Kids

Introduction: Joint pain is a prevalent concern among pediatricians, orthopedists, and general practitioners, affecting up to 50% of children during childhood. The hip joint is particularly vulnerable, with degenerative diseases of the hip joints (DDHJ) being the leading cause of pediatric orthopedic visits. Various conditions, such as developmental dysplasia of the hip (DDH), Legg-Calve-Perthes Disease (LCPD), and slipped capital femoral epiphysis (SCFE), contribute to the spectrum of hip joint disorders in children. Material and methods: We have gathered the available materials and scientific reports, analyzing and summarizing them in a single study. Aim of study: This study aims to explore the etiology, diagnosis, and management of hip joint pain in children, focusing on DDH, LCPD, SCFE, and other related conditions. By examining the risk factors, clinical presentations, and current treatment strategies, the study seeks to enhance the understanding and early detection of these disorders, ultimately improving patient outcomes. Conclusion: Hip joint pain in children encompasses a broad differential diagnosis, ranging from self-limiting conditions like transient synovitis to serious disorders such as septic arthritis and JIA. Early identification and appropriate management of conditions like DDH, LCPD, and SCFE are crucial in preventing long-term complications. While physical activity is generally safe, intense exercise may increase the risk of musculoskeletal pain. A multidisciplinary approach, supported by further research, is essential for effective pain management and treatment optimization in pediatric patients.

Efficacy and safety of digital nerve block for pain management during sharp debridement of digital ulcers in systemic sclerosis: A prospective observational study.

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis and vascular abnormalities, often leading to the development of digital ulcers (DUs). DUs are painful and debilitating, significantly impacting patients' quality of life. Effective pain management during debridement is crucial, yet there is no consensus on the optimal approach. This study evaluates the efficacy and safety of digital nerve block (DNB) using lidocaine and mepivacaine for pain control during sharp debridement of DUs in SSc patients. This prospective observational study was conducted from September 2023 to May 2024 at the Rheumatology Operating Unit, University of Verona. Patients were randomized to receive either 1 mL of 2% lidocaine or 2% mepivacaine for DNB. Pain levels were assessed using a categorical grading scale during the injection and debridement. The outcomes were pain control and performance of lidocaine versus mepivacaine. The cohort developed 46 ulcers. The pain was abolished in almost all patients. Lidocaine achieved faster anaesthesia (127.92 ± 34.32 s) compared with mepivacaine (252.65 ± 49.89 s, p < 0.001). Mepivacaine resulted in less pain during injection (p = 0.006). No significant difference in pain levels during debridement was observed between the two anaesthetics. Three mild adverse effects (Raynaud's phenomenon) were reported. All procedures were completed successfully, and 35 ulcers healed with a mean time of 6.1 ± 7.77 weeks. DNB with mepivacaine provides effective pain control during DU debridement in SSc patients, with lower injection site pain and comparable efficacy to lidocaine. The procedure is safe, well-tolerated and facilitates successful ulcer healing. Further studies with larger cohorts are warranted to confirm these findings.

Fentanyl enhances immune cell response through TLR4/MD-2 complex.

Opioids have been shown to induce neuroinflammation and immune cell activation, that might contribute to some of the opioid side effects, such as opioid-induced tolerance and paradoxical hyperalgesia. In this context, TLR4/MD-2 complex has been proposed as an off-target site for opioid action. This study was aimed at investigating the effect of fentanyl on lipopolysaccharide (LPS)-induced TLR4/MD-2 activation in rat primary microglia and human monocyte-derived macrophages (MDM). The effect of fentanyl was first explored by measuring the expression and release of different proinflammatory mediators in primary rat microglia and human MDM by real-time PCR and ELISA. Then, the involvement of TLR4/MD-2 signaling was investigated studying NF-κB activation in HEK293 cells stably transfected with human TLR4, MD-2, and CD14 genes (HEK-Blue hTLR4 cells) and in human MDM. Fentanyl increased mRNA levels, as well as the LPS-induced secretion of proinflammatory mediators in primary microglia and MDM. Two inhibitors of TLR4/MD-2 signaling, namely the oxazoline derivative of N-palmitoylethanolamine (PEA-OXA) and CLI-095, blocked the production and release of proinflammatory cytokines by microglia stimulated with LPS and fentanyl, suggesting that TLR4/MD-2 could be the target of the proinflammatory activity of fentanyl. Finally, we showed that fentanyl in combination with LPS activated NF-κB signaling in human MDM and in HEK-Blue hTLR4 cells and this effect was blocked by inhibitors of TLR4/MD-2 complex. These results provide new insight into the mechanism of the proinflammatory activity of fentanyl, which involves the activation of TLR4/MD-2 signaling. Our findings might facilitate the development of novel inhibitors of TLR4/MD-2 signaling to combine with opioid-based analgesics for effective and safe pain management.

Severity of pain syndrome, functional activity, and quality of life in male patients with inguinal hernias in the preoperative period

According to the European Hernia Society (EHS) and the Hernia Surge Group (HSG), males with inguinal pain syndrome make up the majority of candidates for planned inguinal hernia surgeries. Chronic groin pain in the preoperative stage typically has a negative impact on such patients’ functional activity and quality of life. It is therefore considered a significant indication for planned surgery. According to recent research, appropriate functional outcomes, such as improved physical activity and patient quality of life, are as important as an accurate anatomical restoration of the inguinal region after planned inguinal hernia surgery. Objective — to assess the severity of preoperative inguinal pain syndrome, functional activity, and quality of life in male patients with inguinal hernias. Materials and methods. The study focuses on the preoperative clinical examination of 50 patients (males) with primary unilateral inguinal hernias. The patients were treated in the surgical department of the State Scientific Institution «Centre for Innovative Medical Technologies of the National Academy of Sciences of Ukraine» between 2018 and 2024. A questionnaire method was employed to assess the functional activity, quality of life, and severity of pain syndrome in patients before surgery. This method involved the use of the modified Carolinas Comfort Scale (MCCS), the European Questionnaire for the Assessment of Quality of Life (EQ‑5D‑3L), and the Visual Analogue Scale (VAS). Results. The average pain severity index on the VAS was 2.1±0.9 points. The MCCS was used to assess patients’ functional activity, resulting in an average total score of 33.7±12.1 points, which corresponded to 44.9%, classifying the patients as «not satisfied» in the clinical group. The EQ‑5D‑3L descriptive system was used to assess patients’ quality of life. We found that 30% reported moderate mobility limitations, 18% reported moderate self‑care issues, and 34% reported limitations in their daily activities. 24% of patients exhibited moderate anxiety or depression‑related symptoms. At the same time, all patients noted the presence of pain syndrome, with 76% experiencing moderate pain and 24% suffering severe pain. Conclusions. The «symptomatic» group of males with inguinal hernias exhibits a high level of local pain syndrome in the area of the hernia protrusion (2.1±0.9 on the VAS, and 24 % of patients reported a significant degree of pain severity before planned surgical intervention (&gt; 3 points) according to the EQ‑5D‑3L system). In the vast majority of cases, it significantly impairs their functional activity and quality of life (66% of patients are not satisfied with their quality of life (32.4±5.6 points on the MCCS)). Effective local pain management is an important objective in the planned surgical treatment of inguinal hernias. This necessitates further investigation into surgical technique selection and procedure adjustments.

DIRECT ANTERIOR SURGICAL APPROACH FOR TOTAL HIP ARTHROPLASTY AS AN ALTERNATIVE TO THE DIRECT LATERAL APPROACH

The frequency of total hip arthroplasty (THA) is continuously increasing. Currently, efforts are underway to improve the efficiency of this surgery, making the choice of surgical approach a key factor in its success. The direct anterior approach is gaining popularity due to faster patient recovery, but its advantages and disadvantages compared to the direct lateral approach are not yet fully understood. Objective. To compare the outcomes of the direct anterior and direct lateral approaches in primary total hip arthroplasty, as well as to identify ways to improve the results of THA performed using the direct anterior approach. Methods. A literature search was conducted in three bibliographic databases: PubMed, Scopus, and Web of Science. Results. The direct anterior approach has been found to reduce postoperative pain, blood loss, the likelihood of periprosthetic infection, and hospital stay duration. However, there is an increased risk of dislocation and revision surgery. Several randomized controlled trials have been cited, studying issues related to effective pain management, wound healing, prevention of lateral femoral cutaneous nerve injury, blood loss, prosthetic stem design, specific surgical techniques, equipment selection, early mobilization after THA, and the use of modern software for THA planning. Conclusions. The literature review revealed that patients who underwent THA via the direct anterior approach experienced less postoperative pain. The shorter incision associated with this approach also reduces intraoperative blood loss and periprosthetic infection rates. However, the risk of dislocation and subsequent revision surgeries increases, as does the incidence of nerve paralysis due to lateral femoral cutaneous nerve injury.

Temporal Dynamics of Pain: Examining the Relationship Between Intramuscular Injection Duration and Pain Perception: A Crossover Randomized Controlled Trial.

Background Effective pain management is crucial for optimizing the patient experience and satisfaction with care. Many factors affect the intensity of injection pain, and one of these factors is the duration of the injection. This study aimed to evaluate the impact of intramuscular injection duration on perceived pain intensity in adults. Methods Fifty participants received injections according to a predetermined research protocol. Each participant served as their own control group. The intervention group was administered the drug over 40 seconds. The control group was given the same drug on the other side dorsogluteal region the following day, according to the unit's routine, in 10 seconds. Pain intensity was measured using the Wong-Baker Faces Pain Rating Scale and the Numerical Rating Scale. Statistical analysis was performed using SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp), including Wilcoxon and correlation analyses, with a significance level set at p < 0.05. Results The Wilcoxon test revealed a significant decrease in pain scores for the intervention group (p < 0.05), indicating that longer injection durations were associated with lower pain intensity. Significant correlations were found between hospital phobia and the use of pain relief measures, with pain perception (p < 0.05). Conclusion This research establishes a correlation between extended durations of intramuscular injections and pain intensity. These findings have implications for pain management during medical procedures and can contribute to optimizing patient comfort.

Smart pain relief: Harnessing conservative Q learning for personalized and dynamic pain management

Pain represents a multifaceted sensory and emotional experience often linked to tissue damage, bearing substantial healthcare costs and profound effects on patient well-being. Within intensive care units, effective pain management is paramount. However, determining suitable dosages of primary pain management drugs like morphine remains challenging due to their reliance on diverse patient-specific factors, including cardiovascular responses and pain intensity. To date, only a singular effort has explored personalized pain treatment recommendations through reinforcement learning. Regrettably, this pioneering study faced limitations stemming from incomplete patient state observations, a restricted action space, and the use of Deep Q-Networks, known for their sample inefficiency and lack of clinical interpretability. In our work, we introduced a Conservative Q-learning-based system for pain recommendation, enriching it with expanded state and action spaces. Additionally, we developed a comprehensive pipeline for both qualitative and quantitative evaluations, focusing on assessing the trained model’s performance. Our findings indicate a slight performance improvement over the clinician’s policy, offering a more clinically sensible and understandable approach compared to the current state-of-the-art methodologies.

Anti-inflammatoires non stéroïdiens en prescription médicale facultative : mise au point dans la prise en charge de la douleur aiguë

Non-steroidal anti-inflammatory drugs (NSAIDs) are the second most widely used class of analgesics in France, after paracetamol. Some NSAIDs are available over the counter (OTC), without a prescription, on the advice of a pharmacist. NSAIDs have recently been the subject of safety alerts from France's Agence nationale de sécurité du médicament et des produits de santé (ANSM), highlighting a risk of worsening certain bacterial infections. This signal has not been confirmed by the European Medicines Agency (EMA) although a "risk of complications due to masking of symptoms of infection" has not been ruled out. These divergent messages can be confusing for healthcare professionals. This literature review, based on an analysis of nearly 200 scientific publications, considers the place of NSAIDs in the OTC management of migraine, tension headaches, postoperative analgesia, acute musculoskeletal and joint pain, dysmenorrhea, viral respiratory infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and their toxicity. The role of the pharmacist in dispensing NSAIDs without a prescription is also addressed. NSAIDs offer rapid and effective pain management in a context of increasingly challenging access to care. Their safety profile is reassuring and generally well established but could be strengthened by conducting an ad hoc study to rule on the safety signal issued by the ANSM definitively. Pharmacists have the knowledge and tools to ensure the safe dispensing and rational use of NSAIDs, with or without a prescription. The introduction of risk minimization measures, such as decision-support tools, could enable further progress in ensuring the safe dispensing of OTC NSAIDs.

ACUTE PANCREATITIS IN AKMOLA REGION ACCORDING TO EMERGENCY SURGERY

Background: Acute pancreatitis is a major issue in surgical practice, with high complications and mortality rates. It severely affects patient quality of life and places a significant economic strain on healthcare systems, making its study crucial for public health. This study aims to analyze trends in acute pancreatitis incidence in the Akmola region from 2009 to 2022. Materials and methods: The study is based on a retrospective analysis of data from the Ministry of Health of the Republic of Kazakhstan according to the International Classification of Diseases-10 code: K85. Methods of health statistics and time series analysis were used to assess the dynamics of morbidity. Results: There was an increase in the total number of hospitalizations from 865 cases in 2009 to 1.061 in 2022. The percentage of surgical interventions decreased from 5.7% to 4.2%, while the share of conservative treatment increased to 95.8%. The mortality rate among operated patients was 20.4% in 2019 and increased to 33.3% in 2022. The incidence of hospitalization increased from 117.1 per 100000 population in 2009 to 144.6 per 100000 population in 2022, with a decrease in the rate of late visits from 42.6 to 36.1 per 100000 population, respectively. Conclusion: It has been established that for patients in the second group according to the Enhanced Recovery After Surgery strategy, hemodynamic support and effective pain management can contribute to early patient mobilization after surgery. Early mobilization, in turn, can expedite recovery and reduce the length of hospital stay, ultimately leading to potential cost savings. Conclusion. The study highlights the need to improve medical approaches to acute pancreatitis in the Akmola region. The results indicate the critical importance of early diagnosis and timely hospitalization to reduce complications and mortality. Additional research is needed to develop more effective clinical protocols.

Treatment adherence and quality of life in colombian patients with lupus nephritis.

As with many other chronic diseases, systemic lupus erythematosus (SLE) and lupus nephritis (LN) have significant impacts on the health-related quality of life (HRQoL). Medication non-adherence is a significant challenge in the management of SLE, with consistently up to 75% of patients being non-adherent with their SLE medications. There is a need to assess the patient's perspective using patient-reported outcomes (PROs) to better understand the current impact of LN on HRQoL and treatment adherence in our region. The aim of this study was to explore the relationship between HRQoL and treatment adherence in patients with LN from the Colombian Caribbean. A cross-sectional study was conducted from June to December 2022, including patients with biopsy-proven LN. HRQoL and treatment adherence were assessed using the Lupus Quality of Life (LupusQoL) and the Compliance Questionnaire in Rheumatology 19 (CQR19) instruments, respectively. Patients were categorized as adherent or non-adherent based on medication intake (defined as >80% correct dosage). Principal component analysis (PCA) was employed to identify principal components between adherent and non-adherent patients. A total of 42 patients with LN were included. Of these, 38 (90%) were female, and the mean age was 31 ± 10 years. Proliferative class IV was the predominant histopathological profile (90%). Twenty-five (60%) patients were categorized as non-adherent. Across all LupusQoL domains, a comprehensive range of responses was observed. Pain, planning, and intimate relationships domains remained unaffected, while burden to others domain had the lowest score. Poorer planning score correlated with older age (r = -0.72; p < .05) and longer disease duration (r = -0.74; p < .05). SLEDAI-2K correlated with the pain domain (r = -0.78; p < .05). Non-adherent patients exhibited significantly worse pain domain scores compared to adherent counterparts (p < .05). PCA showed strong interactions between planning and pain, as well as between physical health and body image domains. LupusQoL pain domain scores were significantly worse in non-adherent patients compared to adherent patients. Effective pain management could be a determinant in HRQoL and treatment adherence rates in our population.

Exploring healthcare workers' barriers to effective cancer pain management at a comprehensive cancer center.

329 Background: Cancer-related pain remains a paramount concern for patients, families, and healthcare providers, significantly impacting quality of life. Numerous barriers often impede optimal pain management strategies, posing challenges to effective care delivery. Methods: This study employed a non-experimental, descriptive, cross-sectional approach within the setting of King Khalid University Hospital (KKUH), a tertiary care facility with a 1100-bed capacity, renowned for its comprehensive cancer care services. A sample of 200 healthcare workers (137 nurses, 68 physicians) working in the oncology center at KKUH participated in the study. Data were collected using the revised Barriers Questionnaire-II (BQ-II). Statistical analysis was performed using SPSS software (version 21), employing descriptive statistics and the unpaired t-test to explore differences in participant categories. Results: Healthcare providers expressed substantial barriers to cancer pain management, reflected in a mean questionnaire score of 2.5 (standard deviation [SD] = 0.8). Particularly noteworthy were the high mean scores for the harmful and physiological effects of medications subscales, at 2.7 (SD = 1.1) and 2.6 (SD = 0.9), respectively. Nurses and physicians had overall BQII scores of 1.8 (SD = 1.1) and 1.7 (SD = 0.9), respectively. A one-way analysis of variance indicated significant differences in the overall BQII scores among physicians and nurses, F(2, 182) = 6.81, p &lt; .01. Significant differences were also found in the communication (F(2, 182) = 10.55, p &lt; .01) and harmful effects (F(2, 182) = 7.26, p &lt; .01) subscales among the two groups. Conclusions: There are significant perceived barriers to cancer pain management among healthcare providers in general with a notable difference between physicians and nurses. These findings suggest the need for improved education and communication to address concerns about medication effects and enhance pain management strategies. Tailored interventions that would lead to more effective and empathetic care have been initiated.

Pain control during intrauterine device insertion: Transcutaneous electrical nerve stimulation.

Current practice lacks effective periprocedural pain management during common gynecological procedures such as intrauterine device insertion, increasing the possibility of significant pain and adverse reaction to such procedures. Because of this, pain can often be a barrier for a patient in choosing a form of contraception that best serves them. Transcutaneous electrical nerve stimulation offers an option for effective pain control during intrauterine device insertion. This case review characterizes five cases where patients were offered transcutaneous electrical nerve stimulation for pain control during intrauterine device insertion. The patients reported a range of no pain to moderate pain during intrauterine device insertion and rated their pain experience as better compared with prior insertions. Although limited to a case review, our findings suggest a promising clinical indication for transcutaneous electrical nerve stimulation as a pain management strategy for intrauterine device insertion.

The evolving landscape of neuromodulation for pain care

Here, we present five different insights on the use of neuromodulation strategies for effective pain management in clinical practice. Experts briefly illustrate the various techniques available and the complexities involved in evaluating their effectiveness. Additionally, they highlight the challenges for widespread adoption in clinical practice and explore some future directions. These viewpoints underscore the evolving landscape of neuromodulation in pain management and the ongoing efforts to optimize these treatments for diverse patient needs.

Chronic pain management and sleep disorders

Chronic pain affects the quality of life for millions of people worldwide. There is a bidirectional link between pain and sleep: poor sleep quality exacerbates pain, and pain disrupts sleep. Addressing this cycle is crucial for effective pain management and improving patients' overall health outcomes.

Efficacy of epidural anesthesia in minimally invasive cardiac surgery

Introduction: The most commonly performed minimally invasive cardiac surgery (MICS) is lateral minithoracotomy, which requires one of the most painful incisions. Adequate postoperative pain management is essential for cardiac surgery to prevent perioperative complications. Thoracic epidural analgesia (TEA) is the gold standard for thoracotomy; however, it is still controversial because of the risk of epidural hematoma following systematic heparinization. The objective of our study was to investigate the safety and efficacy of TEA following MICS. Methods: The clinical data of patients aged over 18 years who underwent elective MICS and received epidural analgesia along with general anesthesia between January 2014 and March 2019 were reviewed. Data were collected, including patient demographics, operative data, postoperative pain, postoperative course, and complications. Chronic pain was evaluated 6 months after discharge, and we defined it as a NRS score ≧3. Postoperative complications included epidural-related complications. Results: Seventy patients were included in the analysis. The mean NRS score was below 2. We collected chronic pain data from 52 patients and found that 11 patients had chronic pain. TEA-related complications were not observed. Conclusion: The current observational study revealed that TEA following lateral thoracotomy was effective for acute pain as well as chronic pain without causing any severe epidural-related complications. Protocols to prevent potential devastating complications, including epidural hematoma, should follow the American Society of Regional Anesthesia and Pain Medicine recommendation. If the rules are strictly followed, TEA can be a safe and effective pain management method for patients who undergo MICS.

Effect of Acupressure Points H7 and LI4 on Pain Intensity Post Caesarean Section in Women Giving Birth at Bhayangkara Hospital TK.I PUSDOKKES POLRI in 2024

Postoperative pain is a common problem faced by mothers after undergoing a cesareansection. Effective pain management is essential to accelerate recovery and improvepatient comfort. Acupressure, as a non-invasive treatment technique, has been known tohave the potential to relieve pain by stimulating certain points in the body. This studyaims to determine the effect of acupressure at the H7 and LI4 points on the intensity ofpost-cesarean section pain in mothers giving birth at the Bhayangkara Hospital TK1PUSDOKKES Polri in 2024. This study used a pre-experiment with a pretest-posttestwith a one-group pretest-posttest design. Sampling was carried out using a purposivesampling technique of 35 respondents. The analysis used a non-parametric test, theFriedman test. The Friedman test analysis showed a significant effect of acupressure atthe H7 and LI4 points on the intensity of post-cesarean section pain in mothers givingbirth with a p-value of 0.000. Acupressure at the H7 and LI4 points affects the intensityof post-cesarean section pain in mothers giving birth at the Bhayangkara Hospital Level1 Pusdokkes Polri in 2024. Mothers giving birth with post-cesarean section surgery areadvised to use the acupressure method to reduce dependence on analgesic drugs,thereby reducing the risk of side effects of drugs. They can be used as an alternative toconventional therapy in pain management.