Effective Pain Relief Research Articles

Evaluation of Pain-Relieving Effect of The Herbal Remedy “Hoang Ky Que Chi Ngu Vat Thang” in Animal Model

Evaluation of Pain-Relieving Effect of The Herbal Remedy “Hoang Ky Que Chi Ngu Vat Thang” in Animal Model

Trends in Risk-Adjusted Initiation and Reduction of Opioid Use among Veterans With Dementia in US Department of Veterans Affairs Community Living Centers.

Proper initiation and reduction of opioids is important in providing effective and safe pain relief to Veterans with dementia, including in Community Living Centers (CLCs). We examined the trends in aggregated monthly risk-adjusted opioid administration days and dosage over 3 opioid safety regulatory periods: pre-Opioid Safety Initiative period (October 1, 2012-June 30, 2013; period 1), pre-CDC Clinical Practice Guideline period (January 1, 2014-November 30, 2015, period 2) and post-Veterans Affairs Clinical Practice Guideline period (March 1, 2017-September 30, 2018; period 3). A retrospective study between October 1, 2012, and September 30,2018. 4995 long-stay CLC residents with dementia who had incident (incident cohort, n= 2609) or continued (continued opioid cohort, n= 2386) opioid administration in CLCs. CLC Minimum Data Set (MDS) assessments data and bar-code medication administration data were used. Opioid initiation was examined for incident opioid cohort and reduction was examined using continued opioid cohort. We first computed aggregated monthly risk-adjusted opioid administration days, opioid with benzodiazepine administration days and opioid dosage, and then examined risk-adjusted incident and continued opioid administration trends over the regulatory periods controlling for facility-level characteristics. Among the incident opioid cohort, compared to period 1, there were 1.9 and 2.1 fewer risk-adjusted opioid administration days per month in periods 2 and 3, respectively; 1.5 fewer risk-adjusted days per month with opioid and benzodiazepine administration in both periods 2 and 3; and 2.2 and 3.7 morphine milligrams equivalent per day (MMED) lower risk-adjusted dosage in periods 2 and 3, respectively. Among the continued opioid cohort, compared to period 1, there were 1.6 and 2.9 fewer risk-adjusted days with opioid and benzodiazepine administration days per month in periods 2 and 3, respectively, and 5.3 MMED lower risk-adjusted dosage per month in period3. CLC providers initiated and reduced opioid administration in fewer days and at lower dosage among Veterans with dementia across the regulatory periods. The result was likely due to systemic efforts from health care professionals, CLC administrators, and policy makers or VA central office, aiming to reduce opioid misuse and improve quality of care in nursing home residents with dementia. What is still unknown is whether pain was well controlled or nonpharmacologic treatments were utilized.

Anti-neuropathic Pain Mechanistic Study on A. conyzoides Essential Oil, Precocene II, Caryophyllene, or Longifolene as Single Agents and in Combination with Pregabalin.

Neuropathic pain has become a contributor to the global burden of illness. However, the currently available drugs exhibit inadequate pain relief and significant side effects. Our previous study demonstrated that the essential oil of Ageratum conyzoides exerts potent antineuropathic pain activity through opioid receptor activation. Precocene II, longifolene, and caryophyllene are the largest component of the A. conyzoides essential oil. The objective of the study was to determine the anti-neuropathic pain activity of precocene II, longifolene, and caryophyllene as single agents and in combination with pregabalin. Possible mechanisms of action involving the opioid receptor, ATP-sensitive potassium channel, and gammaaminobutyric acid (GABA) were further investigated. The experimental animals (male mice Swiss Webster) were divided randomly into seven groups, namely, Normal control (naïve mice), Negative control (CMC 1%), Sham (CMC 1%), Positive control (Pregabalin 0,195 mg/ 20 g BW of mice), Test I (Precocene II 21.09 mg/Kg BW), Test II (Longifolene 9.94 mg/Kg BW), and Test III (Caryophyllene 3.64 mg/Kg BW). Each group contained 3 animals. The test groups that demonstrated anti-neuropathic pain activity were further tested in combination with pregabalin, followed by mechanistic studies. The negative, positive, and test I-III groups were induced with chronic constriction injury. The results of the study demonstrated that caryophyllene and longifolene, but not precocene II, exerted anti-neuropathic pain activity. The caryophyllene was shown to involve in the activation of opioid receptors and ATP-sensitive potassium channels. It was also reported to increase GABA concentration in the spinal cord. We further found that longifolene exerted its action via opioid receptor activation. The combination of A. conyzoides essential oil, longifolene, or caryophyllene with pregabalin demonstrated additive anti-neuropathic pain activity. Taken together, the results of the present study suggested that the A. conyzoides essential oil and caryophyllene have the potential to be developed as novel drugs to treat neuropathic pain.

Nutritional Supplements in the Clinical Management of Tendinopathy: A Scoping Review.

Tendinopathy has a high prevalence and incidence in the general population and among athletes, with a lack of consensus among medical practitioners on optimal management strategies. The objective of this scoping review was to evaluate current research on the use of nutritional supplements for treating tendinopathies, including what supplements have been used and what outcomes, outcome measures, and intervention parameters have been reported. Databases searched included Embase, SPORTDiscus, the Cochrane Library, MEDLINE, CINAHL, and AMED. This scoping review considered primary studies investigating nutritional supplements for tendinopathies and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews. A total of 1527 articles were identified with 16 included in the review. Studies investigated a range of nutritional supplements in the clinical management of various tendinopathies, including several commercially available proprietary blends of several ingredients. TendoActive (mucopolysaccharides, type I collagen, and vitamin C) was used in 2 studies, TENDISULFUR (methylsulfonylmethane, hydrolyzed collagen, L-arginine, L-lysine, vitamin C, bromelain, chondroitin, glucosamine, Boswellia, and myrrh) was used in 3 studies, and Tenosan (arginine-L-alpha ketoglutarate, hydrolyzed collagen type I, methylsulfonylmethane, vitamin C, bromelain, and vinitrox) was used in 2 studies. Collagen peptides were used in 2 studies, with omega-3 fatty acids, combined fatty acids and antioxidants, turmeric rhizome combined with Boswellia, β-hydroxy β-methylbutyric, vitamin C in isolation and combined with gelatin, and creatine investigated in one study each. Despite a paucity of studies to date, findings from this review suggest that several nutritional compounds may be beneficial in the clinical management of tendinopathies, by exerting anti-inflammatory effects and improving tendon healing. Nutritional supplements may have potential as an adjunctive method to standard treatment methods such as exercise, where their pain-relieving, anti-inflammatory, and structural tendon effects may augment the positive functional outcomes gained from progressive exercise rehabilitation.

Comparative Pharmacology and Toxicology of Tramadol & Tapentadol

Pain is a common symptom in various health conditions and can significantly impact a person's quality of life if not managed properly. Although non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are widely used for mild to moderate pain, they may not suffice for moderate to severe pain requiring combination therapy. In such cases, synthetic drugs like Tramadol and Tapentadol offer effective pain relief with improved safety profiles. This article aims to compare the pharmacokinetics, pharmacodynamics, and safety profiles of Tapentadol and Tramadol.
 Tapentadol, a direct-acting synthetic opioid, demonstrates a reliable mode of action as it starts working upon reaching the bloodstream. In contrast, Tramadol requires metabolic conversion into active metabolites, resulting in a delayed onset of action. Furthermore, Tramadol's effectiveness is dependent on the presence of the CYP2D6 enzyme, with approximately 6% of Caucasians being deficient in this enzyme. Dosage adjustments may be required for individuals with impaired liver or kidney function.
 Both Tapentadol and Tramadol primarily affect mu-opioid receptors (MOR), providing potent pain relief. However, Tramadol also inhibits the reuptake of noradrenaline and serotonin, while Tapentadol lacks an effect on serotonin. Tapentadol exhibits a higher affinity for MOR receptors, making it a more potent central acting painkiller compared to Tramadol. Nevertheless, Tapentadol's increased opioid activity increases the likelihood of mild and transient opioid-like side effects, such as drowsiness, constipation, and respiratory depression.
 In terms of toxicology, both Tapentadol and Tramadol offer a safer alternative to morphine with reduced side effects. Tapentadol's greater opioid activity translates into a higher potential for opioid-related side effects, whereas Tramadol's serotonergic activity is associated with a higher incidence of vomiting and nausea. The absence of significant effects on CYP450 enzymes distinguishes Tapentadol from Tramadol, reducing the likelihood of drug interactions.
 Overall, Tapentadol demonstrates several advantages over Tramadol, including faster onset of action, greater pain relief, and fewer side effects related to serotonergic activity. However, it is essential to consider that Tapentadol, although more effective, carries a higher probability of side effects associated with its increased opioid activity. Clinicians should carefully evaluate individual patient characteristics and requirements when selecting between these two medications for pain management.

Low-dose naltrexone for treatment of pain in patients with fibromyalgia: a randomized, double-blind, placebo-controlled, crossover study.

Fibromyalgia (FM) is a chronic fluctuating, nociplastic pain condition. Naltrexone is a µ-opioid-receptor antagonist; preliminary studies have indicated a pain-relieving effect of low-dose naltrexone (LDN) in patients with FM. The impetus for studying LDN is the assumption of analgesic efficacy and thus reduction of adverse effects seen from conventional pharmacotherapy. First, to examine if LDN is associated with analgesic efficacy compared with control in the treatment of patients with FM. Second, to ascertain the analgesic efficacy of LDN in an experimental pain model in patients with FM evaluating the competence of the descending inhibitory pathways compared with controls. Third, to examine the pharmacokinetics of LDN. The study used a randomized, double-blind, placebo-controlled, crossover design and had a 3-phase setup. The first phase included baseline assessment and a treatment period (days -3 to 21), the second phase a washout period (days 22-32), and the third phase a baseline assessment followed by a treatment period (days 33-56). Treatment was with either LDN 4.5 mg or an inactive placebo given orally once daily. The primary outcomes were Fibromyalgia Impact Questionnaire revised (FIQR) scores and summed pain intensity ratings (SPIR). Fifty-eight patients with FM were randomized. The median difference (IQR) for FIQR scores between LDN and placebo treatment was -1.65 (18.55; effect size = 0.15; P = 0.3). The median difference for SPIR scores was -0.33 (6.33; effect size = 0.13; P = 0.4). Outcome data did not indicate any clinically relevant analgesic efficacy of the LDN treatment in patients with FM.

Effect of processing with vinegar on efficacy of Curcuma longa in treatment of dysmenorrhea in rats with syndrome of liver depression and Qi stagnation

This study compared the effects of Curcuma longa before and after processing with vinegar on the rat model of dysmenorrhea with the syndrome of liver depression and Qi stagnation to reveal the mechanism of vinegar processing in improving the role of C. longa in soothing liver and relieving pain. The rat model of dysmenorrhea with the syndrome of liver depression and Qi stagnation was established according to the Preparation of the Animal Model of Dysmenorrhea(Draft) and the chronic unpredictable stress me-thod. The changes in the body weight, organ indexes, writhing latency, writhing score, and serum levels of six liver function indicators, sex hormones, pain factors, and blood rheological indicators were measured to evaluate the efficacy of C. longa processed with vinegar or not in treating dysmenorrhea in the rats with syndrome of liver depression and qi stagnation. Compared with the model group, the C. longa group(processed with vinegar or not) showed slow weight loss, increase in writhing latency, and decrease in writhing response(P<0.05). The inhibition rates on writhing in raw C. longa, vinegar-processed C. longa, and positive groups were 33.780%, 64.611%, and 62.466%, respectively. The significantly higher inhibition rate of the vinegar processing group indicated that vinegar-processed C. longa demonstrated more significant therapeutic effect. The vinegar-processed C. longa group showed lower levels of alanine aminotransferase(ALT), alkaline phosphatase(ALP), aspartate aminotransferase(AST), direct bilirubin(DBIL), and total bilirubin(TBIL) and higher level of albumin(ALB)(P<0.05), which indicated that vinegar processing enhanced the therapeutic effect of C. longa on liver injury. The serum levels of estradiol(E_2) and oxytocin(OT) were lower in the vinegar-processed C. longa group(P<0.05), indicating that the vinegar-processed C. longa could regulate the sex hormone levels, reduce the activity of uterine smooth muscle and contraction of uterus, and alleviate the symptoms of dysmenorrhea in rats. Moreover, the vinegar-processed C. longa group showed lower interleukin-6(IL-6) and arginine vasopressin(AVP) levels and higher beta-endorphin(β-EP) level(P<0.05), which indicated that vinegar-processed C. longa regulated the levels of pain factors to exert the pain-relieving effect. Drug intervention decreased the whole blood viscosity low-cut, medium-cut and high-cut values, plasma viscosity, whole blood reduction viscosity low-cut and high-cut values, erythrocyte cumulative pressure, and equation K value of erythrocyte sedimentation rate(P<0.05), and the vinegar-processed C. longa group outperformed other groups. This result indicated that vinegar processing enhanced the function of C. longa in improving the local blood rheology. C. longa processed with vinegar can enter the liver to relieve the da-mage to the heart, liver, kidney, and uterus, repair the liver function, and recover the sex hormone levels and immune function by regulating the levels of sex hormones and pain factors and improving the blood rheology. It activates the pain-relieving mechanism to relieve the pain, protect the liver, and fight inflammation, which is consistent with the theory that vinegar processing facilitates C. longa entering the liver to sooth liver and relieve pain.

Gallic acid attenuates the Chronic construction injury of sciatic nerve induced neuropathic pain in mice

Gallic acid (GA) is one of the natural flavonoids and it is known to protect the neuronal system from various endogenous neurodegenerative processes. The present study is focused on evaluating the role of GA in chronic construction injury (CCI) of sciatic nerve-induced neuropathic pain. The test compound i.e., gallic acid (20 and 40mg/kg), and reference compound i.e., pregabalin (PrG: 5mg/kg) were administered intravenously for 10 consecutive days. The sciatic nerve injury-induced neuralgic sensations were assessed with multiple test methods like acetone drop, pinprick, plantar, tail-flick, and tail pinch tests at different time points i.e., 0, 4th, 8th, 12th, and 16th days. The biochemical level changes i.e., thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH), superoxide anion, calcium, myeloperoxidase (MPO), and tumor necrosis factor–α (TNF-α) were estimated in sciatic nerve samples. The administration of GA and PreG was shown a significant ameliorative effect against the CCI-induced pain response in a dose-dependent manner. Moreover, it also attenuated the tissue biochemical changes. The observed effects of GA were similar to reference drug PreG treated groups. Hence, GA has neuroprotective and pain relief effects against the CCI-induced neuralgia. It may be due to its natural free radical scavenging; regulation of inflammatory proteins; expression of antioxidant proteins, reduction of intracellular free calcium, and prevention of neuroinflammatory actions.

Clinical use of botulinum toxin typeA in pain medicine

Botulinum toxin has been used for decades in the treatment of a variety of painful diseases. Botulinum toxin not only blocks neuromuscular transmission, but also the secretion of neuropeptides, such as substanceP, glutamate and calcitonin gene-related peptide (CGRP) and thus inhibits neurogenic inflammation. In addition, it has amodulatory pain-relieving effect via retrograde transport into the central nervous system. In addition to approval for the treatment of dystonia or spasticity, onabotulinum toxin A is also approved for the prophylaxis of chronic migraine if the oral prophylactic migraine medication has had an insufficient effect or has not been tolerated. In addition, botulinum toxin is also recommended in guidelines as athird-line treatment for neuropathic pain, but in Germany this is an off-label application. This article provides an overview of the current clinically relevant areas of application of botulinum toxin in the field of pain medicine.

Ultrasound-guided transforaminal epidural injection with fluoroscopy confirmation for the treatment of unilateral lumbar radiculopathy: A randomized controlled non-inferiority study

BackgroundUltrasound (US)-guided injections for chronic pain has multiple advantages over traditional radiologic method. The study was performed to exam the clinical outcomes of lumbar transforaminal epidural injection (LTFEI) between US and fluoroscopy (FL) guidance for lumbar radiculopathy (LRP). MethodsA total of 164 patients with LRP were randomly assigned into US and FL group to receive LTFEI in a 1:1 ratio. Pain relief and functional disability were assessed by numeric rating scale (NRS) and Modified Oswestry Disability Questionnaire (MODQ) scores before treatment, 1 month and 3 months post-intervention. Contrast spread pattern, fluoroscopic image number and complications were also recorded. The primary outcome was accurate rate of contrast dispersing into lumbar epidural space, and non-inferiority margin was predefined at −15 %. ResultsThe accuracy of LTFEI was 90.2 % and 91.5 % in US and FL group, and the lower limit of the 95 %CI of mean difference between two modalities (−4.9 % (95 %CI: −12.8 %, 3.1 %)) was above the non-inferiority margin. Procedure time in US group (531.90 ± 67.12 s) was shorter than FL group (904.20 ± 120.20 s) (p < 0.05), while radiation dosage in the US group was lower than in the FL group (3047.20 ± 569.53 vs. 8807.50 ± 1039.10 μGy m2, p < 0.001). Both groups didn’t differ in pain reduction (F = 1.050, p = 0.306) and functional improvement (F = 0.103, p = 0.749) during follow-up period. No severe complications occurred in both groups. ConclusionsUS-guided LTFEI confirmed by FL was not inferior to conventional FL method in terms of accurate rate of lumbar epidural contrast dispersion. Effective pain relief and functional ability improvement were comparable between two modalities, and US technique had advantages of less radiation exposure and possible facilitation of avoiding critical vessels around intervertebral foramen.

The Role of Post-Operative Radiotherapy for Non-Spine Bone Metastases (NSBMs).

Non-spine bone metastases (NSBMs) can cause significant morbidity and deterioration in the quality of life of cancer patients. This paper reviews the role of post-operative radiotherapy (PORT) in the management of NSBMs and provides suggestions for clinical practice based on the best available evidence. We identified six retrospective studies and several reviews that examined PORT for NSBMs. These studies suggest that PORT reduces local recurrence rates and provides effective pain relief. Based on the literature, PORT was typically delivered as 20 Gy in 5 fractions or 30 Gy in 10 fractions within 5 weeks of surgery. Complete coverage of the surgical hardware is an important consideration when designing an appropriate radiation plan and leads to improved local control. Furthermore, the integration of PORT in a multidisciplinary team with input from radiation oncologists and orthopedic surgeons is beneficial. A multimodal approach including PORT should be considered for an NSBM that requires surgery. However, phase III studies are needed to answer many remaining questions and optimize the management of NSBMs.

Regional anesthesia in the emergency department outside the operating theatre.

Moderate to severe pain is common and remains a significant problem in the emergency department and regional anesthesia provides optimal and safe pain relief. This review aims to discuss the benefits, indications of the most common ultrasound-guided regional anesthesia techniques that can be provided by clinicians in the emergency department as part of multimodal analgesia. We will also comment on the education and training for effective and safe ultrasound-guided regional anesthesia in the emergency department. The emergence of multiple new fascial plane blocks that provide easier to learn alternatives, yet effective analgesia for specific patient groups can now safely be taught and utilized in the emergency department. Emergency physicians are perfectly placed to utilize the advantages of ultrasound-guided regional anesthesia. Various techniques can now be employed to cover most of the painful injuries presenting to the emergency department, thus modifying the morbidity and outcomes of emergency patients. Some of the new techniques require minimal training, provide safe and effective pain relief with low risk of complications. Ultrasound-guided regional anesthetic techniques should form an integral part of the curriculum of emergency department physicians.

Continuous Epidural Analgesia Versus Continuous Peripheral Nerve Block in Unilateral Lower Extremity Pediatric Orthopedic Surgery: A Matched Case Comparison Study.

Introduction Continuous epidural analgesia (CEA) provides effective postoperative pain relief but includes a substantial side effect profile. Continuous peripheral nerve blocks (CPNBs) have fewer side effects and may quicken ambulation. The purpose of this study was to compare the morphine milligram equivalents (MMEs), need for analgesic rescue, visual analog scale (VAS) pain scores, time to ambulation, postoperative blood pressures, length of stay (LOS), and adverse event rates. Methods This was a matched case comparison study of pediatric patients (ages 8-17) undergoing unilateral lower limb surgery (41 CEA and 36 CPNB). Patients with a history of chronic pain, previous lower extremity surgery, and developmental delay were excluded. The Chi-square test and Student's t-test were used, and p-values < 0.05 were considered significant. Results There were no statistically significant differences in demographics or the American Society of Anesthesiologists (ASA) grade. There were no significant differences in postoperative MMEs, the need for analgesic rescue, or VAS scores on any postoperative day. The CEA group had a longer time to ambulation (2.56 ± 0.93 days versus 1.89 ± 0.69 days, p = 0.004). The CEA group demonstrated a higher number of days of systolic hypotension (0.61 ± 0.97 mmHg versus 0.06 ± 0.23 mmHg, p = 0.0009) and diastolic hypotension (1.90 ± 1.24 mmHg versus 1.00 ± 0.93 mmHg, p = 0.0006). There were no significant differences in the length of stay between the CEA and CPNB groups (5.08 versus 4.24, p = 0.28). There was no statistically significant difference between the rates of pruritus, light-headedness, and altered mental status. The CEA group demonstrated higher rates of nausea (51.2% versus 13.9%, p = 0.001), constipation (36.6% versus8.3%, p = 0.004), urinary retention (9.8% versus0%, p = 0.006), and average number of minor adverse events per patient (1.02 versus0.25, p = 0.002). Conclusions CPNBs and CEAs demonstrate equivalent postoperativeopioid use after unilateral lower extremity surgery in the pediatric population. In our population, a low complication rate and a decreased time to ambulation were seen in the CPNB group. There may be certain select scenarios priorly managed with a CEA that can be appropriately managed with a CPNB. A prospective multicenter study incorporating patient satisfaction data could further facilitate the incorporation of CPNB in pediatric pain management protocols after orthopedic surgery.

Effect of infrared belt and hot water bag on labor pain intensity among primiparous: a randomized controlled trial

BackgroundLabor pain is complex, paradoxical and varied in every parturient woman. Management of labor pain has been a crucial component in maternity care. Heat therapy is one of the proposed method for labor pain relief. Infrared is one of the methods of heat therapy but there is any study in this regard. This study aimed to compare the effect of the infrared belt and hot water bag on the severity of pain in the first stage of labor among primiparous women.MethodsIn this clinical trial in the first stage of labor, 20-min cycles of heat therapy were conducted at the dilations of 4–5 and 6–7 cm in the intervention group 1 by an infrared belt and in the intervention group 2 by hot water bag, respectively. The control group received routine care. The severity of the pain was measured by the short-form McGill Pain Questionnaire.ResultsIn total, 136 women consented to participate in this clinical trial study. The mean score of pain intensity was significantly lower in the two intervention groups compared to the control group (P < 0.001). The mean pain intensity was significantly lower in the infrared belt group than in the hot water bag group (P < 0.001).ConclusionsBased on these findings, heat therapy with an infrared belt reduced the severity of pain in the first stage of labor. The infrared belt could be used and recommended as a safe and effective pain relief in childbirth and maternity care.Trial registrationThis study was registered in the Iran Clinical Trial Center with the code of IRCT20190805044446N1.

ID: 200950 Differential Targeted Multiplexed, High-Frequency and Conventional Spinal Cord Stimulation Reduce Streptozotocin induced Mechanical Hypersensitivity

Treatment of painful diabetic peripheral neuropathy (PDPN) patients remains a major challenge, as most pharmacological options still are unsuccessful. For these patients, spinal cord stimulation (SCS) can be a last resort treatment option. Although SCS often provides effective pain relief, a substantial number of PDPN patients do not respond to the treatment. Novel stimulation paradigms such as Differential Targeted Multiplexed (DTM) SCS are suggested to further improve the efficacy of SCS on pain relief and increase responder rates. DTM-SCS is a combination of more than one electrical field delivered with signals at different stimulation parameters (1). The aim of this study was to investigate the effects of DTM-SCS on pain relief in an animal model for PDPN and compare this to Sham-SCS, conventional (Con-) SCS and High frequency (HF-) SCS.

WOMEN’S SOURCES OF INFORMATION AND KNOWLEDGE ABOUT EPIDURAL ANALGESIA

Labor pain is one of the greatest pains experienced by women throughout their life. Relief of this pain is an important issue for women in labor [1]. Epidural analgesia is the most effective pain relief method and is considered the gold standard of labor analgesia [2]. Nevertheless, scientific studies reveal limited parturient knowledge about epidural anesthesia [3,4]. This study has been conducted to assess the knowledge, sources of information, and attitudes regarding epidural analgesia among young mothers. The study was conducted at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics. The study took place in November 2022 by using a pre-designed questionnaire. A total of 102 questionnaires were distributed to parturient and 100 were returned, the response rate was 98%. The study shows that more than two-thirds of women agree that epidural analgesia is the most effective method for labor pain management. The internet remains the main source of information for women. The demographic variables were not associated with the desire to request epidural analgesia in the future. Women who know about the effectiveness of epidural analgesia are more likely to choose an epidural in the future. Therefore, it is important to provide more information about the methods of labor pain relief to women during pregnancy.

ID: 212826 Investigation of 10KHz Spinal Cord Stimulation on Small Fiber Painful Diabetic Neuropathy (PDN)

A large multicenter RCT1 recently demonstrated that spinal cord stimulation (SCS) at 10 kHz provides effective pain relief for patients with painful diabetic neuropathy (PDN). These outcomes remain durable to 24 months.2 Patient-reported outcomes suggest profound improvements in pain, function, and quality of life with 10kHz SCS in PDN patients, but more objective quantitative measures of nerve pathology and function can confirm these clinical outcomes and suggest the mechanism of action for the observed clinical improvements.

ID: 211449 Rapid Onset of Analgesia During Trial Period Utilizing Fast-Acting Sub-Perception Therapy SCS

Sub-perception Spinal Cord Stimulation (SCS) offers patients an opportunity to obtain pain relief without paresthesia. Onset of maximum pain relief using traditional sub-perception techniques (e.g., 1-10 kHz) can take up to several hours and even days to occur (unlike conventional paresthesia-based SCS), thereby prolonging and potentially compromising therapy optimization.1-3 Newly uncovered low frequency-based (90 Hz) Fast-Acting Sub-Perception Therapy (FAST) SCS is now often observed to provide pain relief below threshold of perception within seconds to minutes – a characteristic more analogous to traditional paresthesia-dependent SCS.4, 5 Obtaining a quick response to sub-perception therapies, especially during SCS trials, is key as it has the potential to determine expected response and provide customized therapies for effective pain relief. Here, we assessed the effectiveness and onset time of FAST during trial period in a multicenter observational case-series.

Timing of Percutaneous Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures

BACKGROUND: Percutaneous balloon kyphoplasty (PKP) is widely used to treat osteoporotic vertebral compression fractures (OVCFs). In addition to rapid and effective pain relief, the ability to recover the lost height of fractured vertebral bodies and reduce the risk for complications are believed to be the main advantages of this procedure. However, there is no consensus on the appropriate surgical timing for PKP. OBJECTIVES: This study systematically evaluated the relationship between the surgical timing of PKP and clinical outcomes to provide more evidence for clinicians to choose the intervention timing. STUDY DESIGN: Systematic review and meta-analysis. METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for relevant randomized controlled trials and prospective, and retrospective cohort trials published up to November 13, 2022. All included studies explored the influence of PKP intervention timing for OVCFs. Data regarding clinical and radiographic outcomes and complications were extracted and analyzed. RESULTS: Thirteen studies involving 930 patients with symptomatic OVCFs were included. Most patients with symptomatic OVCFs achieved rapid and effective pain relief after PKP. In comparison to delayed PKP intervention, early PKP intervention was associated with similar or better outcomes in terms of pain relief, improvement of function, restoration of vertebral height, and correction of kyphosis deformity. The meta-analysis results showed there was no significant difference in cement leakage rate between early PKP and late PKP (odds ratio [OR] = 1.60, 95% CI, 0.97–2.64, P = 0.07), whereas delayed PKP had a higher risk for adjacent vertebral fractures (AVFs) than early PKP (OR = 0.31, 95% CI: 0.13–0.76, P = 0.01). LIMITATIONS: The number of included studies was small, and the overall quality of the evidence was very low. CONCLUSIONS: PKP is an effective treatment for symptomatic OVCFs. Early PKP may achieve similar or better clinical and radiographic outcomes for treating OVCFs than delayed PKP. Furthermore, early PKP intervention had a lower incidence of AVFs and a similar rate of cement leakage compared with delayed PKP. Based on current evidence, early PKP intervention might be more beneficial to patients. KEY WORDS: Percutaneous balloon kyphoplasty, osteoporotic vertebral compression fractures, osteoporosis, surgery, operative timing

The Effect of Exercise on Pain in People with Cancer: A Systematic Review with Meta-analysis.

Cancer-related pain is common and undertreated. Exercise is known to have a pain-relieving effect in non-cancer pain. This systematic review aimed to evaluate (1) the effect of exercise on cancer-related pain in all cancers, and (2) whether the effect of exercise differed according to exercise mode, degree of supervision, intervention duration and timing (during or after cancer treatment), pain types, measurement tool and cancer type. Electronic searches were undertaken in six databases to identify exercise studies evaluating pain in people with cancer, published prior to 11 January 2023. All stages of screening and data extraction were conducted independently by two authors. The Cochrane risk of bias tool for randomised trials (RoB 2) was used and overall strength of evidence was assessed using the GRADE approach. Meta-analyses were performed overall and by study design, exercise intervention and pain characteristics. In total, 71 studies reported in 74 papers were eligible for inclusion. The overall meta-analysis included 5877 participants and showed reductions in pain favouring exercise (standardised mean difference - 0.45; 95% confidence interval - 0.62, - 0.28). For most (> 82%) of the subgroup analyses, the direction of effect favoured exercise compared with usual care, with effect sizes ranging from small to large (median effect size - 0.35; range - 0.03 to - 1.17). The overall strength of evidence for the effect of exercise on cancer-related pain was very low. The findings provide support that exercise participation does not worsen cancer-related pain and that it may be beneficial. Better pain categorisation and inclusion of more diverse cancer populations in future research would improve understanding of the extent of benefit and to whom. CRD42021266826.