Effective Pain Management Research Articles

ASSESSMENT OF KNOWLEDGE REGARDING END-OF-LIFE CARE AMONG NURSES

Background: End-of-life care is a critical component of nursing practice, aimed at providing compassionate support to patients in the final stages of life. This care focuses on ensuring patients' comfort, preserving their dignity, and addressing their emotional needs during this sensitive time. Objective: This study aims to evaluate nurses' knowledge level regarding end-of-life care practices. Methods: A cross-sectional study was conducted in a tertiary care hospital involving 108 patients who received end-of-life care over a six-month period from January to June 2023. Data collection methods included structured interviews and questionnaires directed at both the patients and their primary nurses. The data were analysed using SPSS version 25, with descriptive statistics to summarise the findings. Inferential statistics, including the chi-square test, were used to identify significant factors influencing end-of-life care quality. Results: The study involved 108 participants, primarily females (93.52%) and a minority of males (6.48%). The analysis showed that 85% of the patients experienced notable relief from physical symptoms, particularly in pain management. Moreover, 75% of the patients highlighted the importance of psychological support, while 70% emphasised the significance of spiritual care in contributing to their overall satisfaction. Including family members in care planning positively affected the emotional well-being of 65% of the patients. Key factors such as effective communication between nurses and patients (80%) and the use of individualised care plans (78%) were significantly associated with an improved quality of end-of-life care (p < 0.05). Conclusion: End-of-life care in nursing is crucial for enhancing patients' comfort, dignity, and emotional well-being. Effective pain management, psychological support, and involving family members in care planning are vital for delivering high-quality end-of-life care. Further training and resources for nurses are recommended to maintain and improve these practices.

Continuous Catheter Techniques Versus Single-Injection Nerve Blocks: A Comprehensive Review of Postoperative Pain Management Strategies.

Effective postoperative pain management is crucial for optimizing patient recovery and enhancing surgical outcomes. This review compares two prominent regional anesthesia techniques, continuous catheter techniques and single-injection nerve blocks, focusing on their efficacy, safety, and impact on patient outcomes. Single-injection nerve blocks involve administering a one-time anesthetic dose to a specific nerve or plexus, offering immediate but transient pain relief. In contrast, continuous catheter techniques utilize a catheter to deliver a continuous infusion of anesthetic, providing extended analgesia. The review synthesizes current evidence on the effectiveness of each method, highlighting that single-injection blocks are advantageous for their simplicity and rapid onset but may require supplementary pain management for longer procedures. Continuous catheter techniques, while offering prolonged pain relief, carry risks such as infection and catheter displacement. The comparative analysis of these techniques reveals that both have distinct roles in postoperative care, with choice depending on the surgical procedure and patient needs. Patient satisfaction, recovery times, and overall outcomes are critical factors in determining the optimal pain management strategy. Future research should focus on refining these techniques and exploring innovations to improve patient care and pain management outcomes. This review provides insights for clinicians to make informed decisions about postoperative pain management to enhance patient comfort and recovery.

Lidocaine-Loaded Iontophoresis-Driven Fiber-Based Microneedle Patch for Controllable and Long-Lasting Transdermal Local Analgesia

AbstractThe acute pain induced by clinical procedures, such as venipuncture, dental operations, and dermatological treatments, as well as postoperative pain, drives the advancement of anesthetic techniques aimed at alleviating discomfort. This situation underscores the ongoing significance of effective pain management strategies within the field of anesthesia. This paper presents an integrated iontophoresis (ITP)-driven fiber-based microneedle patch (IFMP) regulated by a smartphone for controllable, long-lasting lidocaine transdermal delivery. The IFMP integrates pure cotton fiber canvas-based dissolving microneedles (MNs) with ITP into a patch, with the MNs tips and gel layers significantly increasing the drug-loading capacity, achieving a one-step drug administration strategy of “dissolution, diffusion, and ITP.” Lidocaine is released via the microchannels of MNs by passive diffusion. Additionally, an electric current initiates active ITP for lidocaine delivery, creating synergy. User-requirement-based drug release by precisely modulating electrical signals in rat pain models is described herein. A smartphone application enables precise dosage control. It offers three different delivery modes: single-dose, pulse delivery, and sustained-release, ensuring rapid onset, and long-lasting pain relief. This versatility makes the system suitable for various pain conditions. The IFMP represents a promising system for patient-controlled local analgesia treatment, enabling active and long-term local self-controlled pain management in a safe and regulated manner. Graphical Abstract The iontophoresis-driven fiber-based microneedle patch combines fiber-based dissolving microneedles with iontophoresis, facilitating controlled lidocaine release through diffusion and electrical activation for enhanced effect. Precise modulation of electrical signals allows user-requirement-based drug release in rat pain models. A smart application supports precise dosing in single-dose, pulse, or sustained-release modes, ensuring efficient and prolonged pain management.

Impact of Ultrasound-Guided Regional Anesthesia on Pain Management in Orthopedic Trauma Surgery

Background: Effective pain management is critical in orthopedic trauma surgery to enhance recovery, reduce opioid consumption, and minimize complications. Ultrasound-Guided Regional Anesthesia (UGRA) has emerged as a promising technique for improving postoperative outcomes. This study aimed to evaluate the impact of UGRA on pain control, opioid consumption, postoperative complications, and patient satisfaction compared to standard pain management. Methods: This prospective, comparative study was conducted with 60 patients undergoing orthopedic trauma surgery, divided into two groups: Group A (UGRA, n = 30) and Group B (Control, n = 30) at the Department of Anaesthesia, Analgesia, and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Data on pain scores (VAS), opioid consumption, time to first ambulation, postoperative complications, patient satisfaction, and length of hospital stay were collected and analyzed. Statistical comparisons were made using appropriate tests. Results: UGRA significantly reduced pain scores at 1, 6, and 24 hours post-surgery (p < 0.001), with lower opioid consumption (10 ± 5 mg vs. 25 ± 8 mg, p < 0.001). Time to first ambulation was shorter in Group A (24 ± 4 hours vs. 30 ± 5 hours, p < 0.001). UGRA was associated with fewer complications, including nausea/vomiting (6.7% vs. 26.7%, p = 0.034) and respiratory depression (0% vs. 10%). Patient satisfaction was higher in the UGRA group (4.8 ± 0.4 vs. 3.5 ± 0.6, p < 0.001), with a shorter hospital stay (4 ± 1 days vs. 6 ± 2 days, p < 0.001). Conclusion: UGRA provides superior pain control, reduces opioid consumption and complications, and enhances patient satisfaction in orthopedic trauma surgery, contributing to faster recovery and shorter hospital stays.

Local ketorolac infiltration for postoperative pain in open trigger finger surgery: a randomized controlled trial

BackgroundMultimodal analgesia is crucial for effective postoperative pain management in minor hand surgeries, enhancing patient satisfaction. The use of local wound infiltration with Ketorolac as an adjuvant pain management strategy is proposed for open trigger finger release surgery. This study aims to compare pain scores and functional outcomes between local wound infiltration with Ketorolac and oral non-steroidal anti-inflammatory drugs.MethodsThis study is a double-blind, parallel design, randomized controlled trials. Sixty-nine patients underwent trigger finger surgery between December 2021 and October 2022 were randomized into one of three groups: oral Ibuprofen alone group, local Ketorolac alone group and local Ketorolac with oral Ibuprofen group. The assessment included postoperative numeric rating scale (NRS) pain score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, mobility of proximal interphalangeal (PIP) joint. and complications.ResultsNRS pain scores during movement of the operated fingers were significantly lower at 6 h in local Ketorolac alone group and local Ketorolac with oral Ibuprofen group compared to oral Ibuprofen alone group. However, there were no significant differences between the groups in postoperative DASH scores, grip strength, mobility of PIP joints, and complications.ConclusionsLocal infiltration of Ketorolac as an adjunct in postoperative pain management has been shown to provide superior analgesia during finger movement within the initial 6 h following trigger finger surgery, in comparison to oral NSAIDs.Clinical trial registrationThaiclinicaltrials.org identifier: TCTR20210825002. Registered 25/08/2021. https://www.thaiclinicaltrials.org/show/TCTR20210825002

Enhancing Caudal Analgesia in Pediatrics: A Comparison of Ropivacaine With and Without Clonidine for Infra-Umbilical Surgeries.

Introduction Regional anesthesia, particularly caudal blocks, is increasingly used in pediatric surgeries for effective post-operative pain management. However, the duration of analgesia with agents such as ropivacaine alone can be limited. This study investigates the effects of adding clonidine to ropivacaine in caudal blocks for pediatric patients undergoing infra-umbilical surgeries, with the purpose of enhancing the duration and quality of analgesia. Methods We conducted a randomized, double-blind study including 50 children aged one to eight years, divided equally into two groups: group R received 0.2% ropivacaine and group RC received 0.2% ropivacaine with 2 mcg/kg clonidine. Intraoperative and post-operative monitoring included heart rate, blood pressure, and respiratory parameters. Analgesia duration, sedation scores, and the need for rescue analgesia were assessed. Results Group RC exhibited significantly longer analgesia duration (18.4 ± 2.31 hours) compared to group R (10.56 ± 2.27 hours, P < 0.0001). Fewer patients in group RC required a second dose of rescue analgesia (4% vs. 32%, P = 0.023), with no significant differences in sedation scores or adverse effects between the groups. Conclusion Adding clonidine to ropivacaine in caudal blocks significantly prolongs analgesia and reduces the need for additional post-operative pain management in pediatric surgeries without increasing the risk of side effects. This study supports the use of clonidine as an effective adjuvant in pediatric pain management.

Overcoming Barriers: A Comprehensive Review of Chronic Pain Management and Accessibility Challenges in Rural America.

In the United States (U.S.), chronic pain poses substantial challenges in rural areas where access to effective pain management can be limited. Our literature review examines chronic pain management in rural U.S. settings, identifying key issues and disparities. A comprehensive search of PubMed, Web of Science, and Google Scholar identified high-quality studies published between 2000 and 2024 on chronic pain management in the rural U.S. Data were categorized into thematic areas, including epidemiology, management challenges, current strategies, research gaps, and future directions. Key findings reveal that rural populations have a significantly higher prevalence of chronic pain and are more likely to experience severe pain. Economic and systemic barriers include a shortage of pain specialists, limited access to nonpharmacologic treatments, and inadequate insurance coverage. Rural patients are also less likely to engage in beneficial modalities like physical therapy and psychological support due to geographic isolation. Additionally, rural healthcare providers more often fulfill multiple medical roles, leading to burnout and decreased quality of care. Innovative approaches such as telehealth and integrated care models show the potential to improve access and outcomes. Our review highlights the need for increased telehealth utilization, enhanced provider education, and targeted interventions to address the specific pain needs of rural populations.

Optimizing Pain Management in Emergency Departments: A Comprehensive Review of Current Analgesic Practices.

Effective pain management in Emergency Departments (EDs) is vital for improving patient comfort and clinical outcomes. This review provides a comprehensive analysis of current pain management practices in ED settings, focusing on the challenges and opportunities for optimization. The review examines pharmacologic and non-pharmacologic pain management strategies, evaluating their effectiveness and identifying inconsistencies and gaps in current practices. Key challenges in the ED environment include time constraints, variability in clinical protocols, and the need to address diverse patient needs, including those of paediatric, geriatric, and chronic pain patients. The review highlights the importance of standardized pain assessment tools and protocols to improve consistency in pain management. Innovations, such as technological advances and multimodal approaches, are explored for their potential to enhance pain management practices. Recommendations address identified challenges, including improved training for ED staff, the development of evidence-based protocols, and the integration of multimodal pain management strategies. By addressing these areas, the review aims to contribute to the development of more effective and uniform pain management practices in emergency care, ultimately leading to better patient outcomes and experiences. This review emphasizes the need for ongoing research and adaptation of best practices to meet the evolving needs of patients in emergency settings.

Exploring the factors affecting the readiness for hospital discharge after total knee arthroplasty: A structural equation model approach.

To investigate the factors that influence readiness for hospital discharge in Chinese patients after total knee arthroplasty and to identify priorities for nursing interventions. A cross-sectional study. From January to August 2022, data were collected from 339 patients at two tertiary A-level hospitals in Jinan, Shandong Province. SPSS 26.0 and Mplus 8.3 software were used for statistical analysis. Results from multiple linear regression showed that patients' age, residence status, education level, knee pain during sleep, quality of discharge teaching, self-efficacy for rehabilitation, pain control knowledge, and social support were factors influencing their readiness for hospital discharge. The results of the structural equation model had shown that there were also indirect effects of the education level, knee pain during sleep, quality of discharge teaching, and pain control knowledge. Patients' readiness for hospital discharge needs further improvement, hence physicians and nurses should judiciously allocate medical resources and concentrate their efforts on high-risk groups characterized by low readiness for hospital discharge. This study underscores the importance of physicians and nurses prioritizing key factors such as age, residency status, education level, and social support in total knee arthroplasty patients to enhance their readiness for hospital discharge. By implementing targeted discharge planning, effective pain management, and comprehensive rehabilitation education, healthcare providers can improve patient outcomes. This study identified key factors influencing readiness for hospital discharge in total knee arthroplasty patients, guiding targeted nursing interventions to improve post-operative care. STROBE. The participants recruited for this study were actively engaged in the data collection process.

Treatment of Acute Sore Throat in Malaysia: A Consensus of Multidisciplinary Recommendations Using Modified Delphi Methodology.

Using antibiotics in the treatment of acute sore throats has been linked with antimicrobial resistance (AMR) and needs to be addressed. The consensus sought to improve diagnostic accuracy, decrease unwarranted antibiotic prescriptions and enhance patient outcomes. A multidisciplinary panel of nine experts reviewed published literature and discussed current practices in managing sore throat. Ten evidence-based statements on sore throat and AMR, diagnostic accuracy and antibiotic prescribing, and symptomatic therapy were developed. A modified Delphi exercise was then carried out. A consensus was reached if at least 70% of the group agreed with the statement. All 10 statements for managing acute sore throat achieved consensus. The major concern of AMR caused by improper antibiotic prescribing, particularly in cases of viral sore throat, was recognized. This underscores the need for improved diagnostic tools, such as the McIsaac score, to reduce needless antibiotic prescriptions. To improve patient satisfaction, effective pain management using non-antibiotic alternatives such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and flurbiprofen throat lozenges was recommended. Pain and inflammation can be adequately managed with low-dose NSAIDs. The potential benefits of topical NSAIDs were acknowledged for their milder safety profile than oral formulations. A consensus was achieved on the use of a clinical diagnostic tool, prudent use of antibiotics, and symptomatic therapy in acute sore throat management. The McIsaac score and point-of-care testing (POCT) for the presence of group A beta-hemolytic Streptococcus (GABHS) can aid in the decision-making process for antibiotic use, reducing needless prescriptions. The mainstay of therapy is symptomatic treatment, which includes the use of NSAIDs.

Implementation of an Acute Pain Service in the Orthopedic Traumatology Department of the University Hospital of Batna.

Background and Objectives. Effective management of postoperative acute pain (POP) in surgical settings requires well-organized approaches. Our goal was to establish an economic model of the Acute Pain Service (APS), to ensure appropriate treatment of POP in adults undergoing orthopedic and traumatological surgery at the University Hospital Center of Batna between 2015 and 2017. Materials and Methods. A descriptive and evaluative study was conducted as part of a quality assurance initiative to establish a acute pain service (APS) between 2015 and 2017. This study focused on organization, training, information dissemination, and pain assessment. Participants included five medical practitioners, 37 paramedical professionals, as well as 104 patients audited before the PAS implementation and 136 patients audited after its establishment. All patients underwent orthopedic and traumatological surgeries. Results. The survey involved 5 physicians and 37 healthcare providers. The results of the reevaluation audit showed that practitioners acquired skills in 86% of cases, common protocols for managing postoperative pain (DPO) were present in 100% of cases, patient information was provided in 77% of cases, and the quality of DPO management was rated as good in 54% of cases. Conclusion. Implementing an organizational framework based on quality assurance principles led to a significant enhancement in postoperative pain management following the introduction of a functional analgesia unit of the acute pain service (APS).

The annoyance of singultus: a case report of a rare adverse effect after epidural steroid injection

ObjectiveCervical epidural steroid injections (ESIs) can provide effective pain management for patients suffering from chronic neck pain due to various pathological changes of the cervical spine. There are several rare adverse effects reported from interventional pain procedures, including persistent hiccups (“singultus”). Based on a limited number of cases, we propose a modified treatment algorithm for this adverse outcome (Fig. 3).Case reportSingultus has been documented as an adverse effect of interventional pain procedures, including epidural steroid, facet joint, and sacroiliac joint injections. We describe the case of a general contractor who presented to our clinic with chronic neck pain and central canal stenosis. The patient received an uncomplicated lumbar ESI in the past and was recommended for a cervical interlaminar ESI. After an uneventful C6-C7 interlaminar ESI with dexamethasone, 1% lidocaine, and normal saline the patient developed singultus. Baclofen was sent to his pharmacy, but this was unsuccessful at alleviating his hiccups. The patient was subsequently started on chlorpromazine and found relief from his symptomatology.ConclusionPersistent hiccups after ESI or interventional pain procedures can be treated with conservative measures and non-pharmacologic methods, with escalation to therapy with baclofen, gabapentin, pregabalin, metoclopramide, chlorpromazine, other antipsychotic or antidopaminergic agents, and possible dual or triple therapy if further indicated.

EFFICIENCY OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION AND PIROXICAM TO ALLEVIATE PAIN DURING ORTHODONTIC TOOTH SEPARATION - A PROSPECTIVE STUDY

Objective: This study was conducted to assess the effectiveness of TENS in comparison with TENS-Placebo and prophylactic Piroxicam (20 mg) for pain control before orthodontic tooth separation by Elastomeric separators, Brasswire and Kesling separators. Study design: 108 patients seeking orthodontic treatment were categorically administered extraoral TENS, TENS-Placebo and Piroxicam (20 mg) using Elastomeric, Kesling and Brasswire separators prior to their orthodontic treatment. The subjects were instructed to rate their pain 2, 6, 12, 24 and 48 hours after the procedure on a Visual Analog Scale. Results: No statistically significant difference was found in the mean VAS scores when TENS group was compared with Piroxicam. However, significant differences were found between the mean VAS scores when placebo TENS group was compared to the aforementioned groups. Maximum pain was perceived at 24 hours with elastomeric and Kesling springs, but brasswire separators were most painful 6 hours after placement altogether. At all time stamps, pain felt was significantly less with brasswire separators than elastomeric separators and Kesling springs. Conclusion: TENS was found to be equally effective in reducing pain as Piroxicam. TENS could be thus stated as an effective pain management modality which is safe, comfortable and easy to use and also eliminates adverse drug effects of NSAIDs like GI irritation and reduced orthodontic tooth movement.

The Relationship of Work, Social Culture, and Family Support In Providing Exclusive Breastfeeding to Mothers of Babies (0-6 Months) in The Working Area of The Puskesmas Tana Lia, Tana Lia District

Spinal anaesthetic needle prick pain is an unpleasant experience that results in losses from spinal anaesthesia, so it needs to be treated. Deep breathing relaxation techniques and lavender aromatherapy are effective non-pharmacological pain management methods. In addition to increasing comfort, reducing pain can also provide convenience and speed in the process of injecting spinal anesthetic needles. The purpose of this study was to investigate the effects of deep breathing relaxation techniques and lavender aromatherapy on the pain intensity of spinal anaesthetic needle pricks at Kardinah Hospital, Tegal. This study employed a quasi-experiment research method, utilizing a two-group post-test design. The sampling technique used purposive sampling with a total of 72 respondents who were divided into groups of deep breathing relaxation techniques and lavender aromatherapy. Data analysis used the Mann-Whitney The results of the non-parametric statistical test with the Man Whitney test obtained p = 0.000 (p &lt;0.05), so Ha was accepted, meaning that there was a difference in the pain intensity of spinal needle stick anesthesia given deep breathing relaxation techniques and lavender aromatherapy. rapy. The study concluded that there were differences in the pain intensity of spinal anaesthetic needle pricks at Kardinah Hospital, Tegal, between deep breathing relaxation techniques and lavender aromatherapy.

Perbedaan Teknik Relaksasi Pernafasan Dalam dengan Aromaterapi Lavender terhadap Intensitas Nyeri Tusukan Jarum Anestesi Spinal

Spinal anaesthetic needle prick pain is an unpleasant experience that results in losses from spinal anaesthesia, so it needs to be treated. Deep breathing relaxation techniques and lavender aromatherapy are effective non-pharmacological pain management methods. In addition to increasing comfort, reducing pain can also provide convenience and speed in the process of injecting spinal anesthetic needles. The purpose of this study was to investigate the effects of deep breathing relaxation techniques and lavender aromatherapy on the pain intensity of spinal anaesthetic needle pricks at Kardinah Hospital, Tegal. This study employed a quasi-experiment research method, utilizing a two-group post-test design. The sampling technique used purposive sampling with a total of 72 respondents who were divided into groups of deep breathing relaxation techniques and lavender aromatherapy. Data analysis used the Mann-Whitney The results of the non-parametric statistical test with the Man Whitney test obtained p = 0.000 (p &lt;0.05), so Ha was accepted, meaning that there was a difference in the pain intensity of spinal needle stick anesthesia given deep breathing relaxation techniques and lavender aromatherapy. rapy. The study concluded that there were differences in the pain intensity of spinal anaesthetic needle pricks at Kardinah Hospital, Tegal, between deep breathing relaxation techniques and lavender aromatherapy.

Parenting pain away: Quasi-experimental study of an eHealth learning platform to evaluate acceptability, feasibility, and utilisation of parent-led pain management.

To evaluate the impact of an eHealth educational resource about infant procedural pain management, given during the prenatal period, on feasibility, acceptability, knowledge, self-efficacy, and involvement. Routine health care requires newborns to have painful procedures (e.g., intramuscular injection). The impacts of untreated pain in neonates are widely recognised but adoption of effective procedural pain management strategies in clinical practice varies. There is clear evidence supporting the effectiveness of parent-led pain management during procedures (e.g., skin-to-skin care) and reputable resources to raise awareness among parents are warranted. Our team co-created Parenting Pain Away, a website to equip parents with evidence to assist with managing the pain of procedures and empower them to be involved. A quasi-experimental evaluation using a pre/post intervention design with low-risk expectant parents. Of the 41 participants, before intervention exposure participants were familiar or had used skin-to-skin care (n = 33), breastfeeding (n = 30) and sucrose (n = 13) as pain management. Most participants (n = 38) desired more information on how to be involved. Providing access to Parenting Pain Away during pregnancy was supported and participants ranked the website above average using the System Usability Scale. Parenting Pain Away did not have a statistically significant influence on outcomes. Participants reported variation in clinical support with parent-led pain management. A multifaceted approach is recommended to maintain infant procedural pain management. Equipping parents with knowledge related to infant pain management using an eHealth approach satisfied their information desires. The study findings are important considerations for perinatal care providers, policy makers, and families to finally achieve adequate procedural pain management. This study used the STROBE checklist, adhering to EQUATOR guidelines. A stakeholder group (expectant parents, parents, perinatal researchers, clinicians, and administrators) was created to inform the study design and intervention.

Exploring nalbuphine loaded chitosan nanoparticles for effective pain management through intranasal administration: a comparative study

Background Intranasal drug delivery shows potential for brain access via olfactory and trigeminal routes. Purpose This work aimed to ensure brain availability of nalbuphine via the nasal route. Method Chitosan based nanoparticles loaded with nalbuphine were successfully prepared using ionic gelation method and characterised. Result SEM results revealed that the nanoparticles were spherical in shape, with an average size of 192.4 ± 11.6 nm. Zeta potential and entrapment efficiency was found 32.8 mV and 88.43 ± 7.75%, respectively. The X-ray diffractometry and DSC results unravel a profound understanding on the physical and thermal characteristics. The in-vitro release of nalbuphine from the nanoparticles was biphasic, with an initial burst release followed by a slow-release profile. In-vitro cell study on HEK-293 cells and microscopic images of brain tissue confirmed the safety profile of formulation. In-vivo efficacy studies on animal confirmed the effectiveness of developed intranasal formulation as compared to the standard therapy. The in-vivo pharmacokinetic studies showed that the prepared nanoparticles were able to efficiently deliver nalbuphine to the brain in comparison to the other body organs. Gamma scintigraphy images showed retention of the drug in the brain. Furthermore, the efficacy studies confirmed that the nanoparticles were found significantly more effective than the marketed formulation in pain management.

Analysis of the Therapeutic Efficacy of Rhizotomy in Pain Treatment

Considering the growing burden of chronic pain and the urgent need for effective, minimally invasive treatments, rhizotomy has gained prominence as a viable therapeutic option. However, the variability in techniques, such as endoscopic, radiofrequency, and chemical rhizotomy, and the differing outcomes across patient populations underscore the necessity for a comprehensive evaluation of its efficacy. This study aims to systematically review the therapeutic effectiveness of various rhizotomy techniques in managing chronic pain, focusing on their application in conditions like lumbar facet joint pain, trigeminal neuralgia, and cancer-related pain. To achieve this, a narrative literature review was conducted, employing a structured methodology based on established guidelines from experts in the field. The review covered studies published between 2000 and 2023, sourced from reputable academic databases such as PubMed, Scopus, and Web of Science, using specific descriptors like "rhizotomy," "pain management," "endoscopic rhizotomy," and "radiofrequency." The inclusion criteria were stringent, focusing on studies that reported quantitative or qualitative outcomes related to pain relief, complications, and the impact on patients' quality of life following rhizotomy. The results of this review indicate that rhizotomy, particularly the endoscopic and radiofrequency variants, consistently provides significant pain relief and functional improvement across various conditions. The long-term benefits of selective dorsal rhizotomy, especially in reducing pain and improving function in patients with spastic cerebral palsy, were notably highlighted. However, the review also points out that the efficacy of rhizotomy can vary depending on the specific technique employed, the underlying condition being treated, and individual patient characteristics. This comprehensive analysis allows us to conclude that rhizotomy is indeed a valuable option in the realm of pain management, offering substantial benefits in terms of both pain relief and enhanced quality of life. Nevertheless, it also emphasizes the need for further research to optimize these techniques and better understand the factors that influence patient outcomes, ultimately paving the way for more personalized and effective pain management strategies.

Integrated Approach to Chronic Pain-The Role of Psychosocial Factors and Multidisciplinary Treatment: A Narrative Review.

Chronic non-malignant pain represents a growing global public health priority. Chronic pain is multifactorial, with numerous biological, psychological, and social factors contributing to this pain syndrome. It affects not only the patients, impairing their quality of life, but also their family and social environment. Chronic pain is a diagnosis and requires effective and sustainable treatment strategies. Our aim was to critically review the available evidence on the importance of different approaches in treating patients with chronic non-malignant pain, emphasizing the effectiveness of integrating psychological and social factors within a multidisciplinary framework. This was a non-systematic narrative review of the basic and recent literature analyzing approaches to the treatment of chronic non-malignant pain. The inclusion criteria for the papers were chronic non-malignant pain, treatment approach, review, and original research papers published in English in the last five years (PubMed search), and the basic literature was selected from the references of new papers according to the knowledge and experience of the authors. This literature review included 120 papers, of which 83 were basic, and 37 were new, published in the last 5 years (2018-2023). The results show that both the basic and newly published literature advocate for a biopsychosocial approach to treating chronic pain. New findings, compared to the earlier literature, indicate a new classification of chronic pain into primary and secondary. Chronic pain should be approached with a biopsychosocial model within a multidisciplinary treatment framework. This model addresses the complex interplay of biological, psychological, and social factors, offering a holistic strategy for effective pain management.

Effective Treatment of Methotrexate Induced Oral Mucositis With a Morphine Mouthwash Solution: A Case Report.

Introduction: Methotrexate (MTX) is a common medication used to treat rheumatoid arthritis (RA). MTX inhibits rapid cell turnover throughout the body which can lead to significant side effects. Patients who present with oral lesions may have suffered severe acute toxicity from MTX. Supportive pain treatment includes magic mouthwash solution and/or oral viscous lidocaine to manage pain and allow for healing. We report a case of MTX induced oral mucositis that did not respond to magic mouthwash but did improve with a morphine mouthwash solution. Case: A 67-year-old female with RA presented with worsening oral lesions over 2weeks. She reported non-compliance with folic acid for 2weeks while on MTX. Physical exam revealed ulcerating oral lesions on the mucous membranes consistent with mucositis. Pain treatment was initiated with magic mouthwash, but her pain was not well controlled after 24hours, and still unable to swallow. An oral morphine mouthwash solution was initiated, and patient reported improved pain control over the next 48hours. She was on the morphine mouthwash for 6days during which improvement in the lesions was noted. Discussion: Pain management is imperative for oral mucositis. When traditional therapies do not provide adequate control, morphine mouthwash can be considered. It is a safer alternative to systemic opioids and topical opioids may influence cell proliferation and migration, which can positively impact healing of oral lesions. Conclusion: A morphine mouthwash solution can provide effective pain management for oral mucositis lesions in patients who do not respond adequately to magic mouthwash.