Incidence Of Pain Research Articles

Responsiveness of hand-held dynamometry for measuring changes in trunk muscle strength in people with chronic low back pain

ObjectiveTo assess the responsiveness of a hand-held dynamometer (HHD) in evaluating changes in trunk isometric strength in people with chronic low back pain (LBP).BackgroundReduced trunk muscle strength has been associated with pain incidence and severity in people with chronic LBP. Trunk muscle strength is an important functional outcome that is measured in clinical practice and research. However, the responsiveness of clinical tools such as HHD for measuring changes in trunk muscle strength remains underexplored.MethodsMaximum isometric trunk strength was measured using both a HHD and an isokinetic dynamometer (ID) in 21 participants with chronic LBP both before and after 6 weeks of progressive trunk resistance exercises. Effect sizes (ES) and standardised response mean (SRM) were used to evaluate the internal responsiveness of the HHD measures. External responsiveness was determined by correlating the change scores measured with the HHD with those obtained using the ID.ResultsFollowing the progressive resistance exercise programme, there was a significant improvement in trunk muscle strength measured with the HHD with moderate to large ES (0.40–0.85) and SRM (0.60- 0.74), indicating moderate to high internal responsiveness. Pearson's correlations revealed a weak correlation between changes in trunk strength measured with the HHD and those measured with the ID (r = 0.22- 0.26), indicating inadequate external responsiveness.ConclusionsAlthough the use of a HHD was shown to have internal responsiveness for detecting changes in trunk muscle strength, the inadequate external responsiveness warrants further investigation. Future research should also explore the responsiveness of HHD in people with chronic LBP with higher pain and disability levels using comparable measurement setups.

Study of PEG-rhG-CSF for the prevention of neutropenia in concurrent chemoradiotherapy for nasopharyngeal carcinoma.

To study the efficacy and safety of Polyethylene glycolated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in the prevention of neutropenia during concurrent chemoradiotherapy for nasopharyngeal carcinoma (NPC). This is a single-center, prospective, randomized controlled study conducted from June 1, 2021, to October 31, 2022 on patients diagnosed with locally advanced NPC. Participants were divided into an experimental group and a control group. The experimental group received PEG-rhG-CSF injections post-chemotherapy cycles, whereas the control group received standard care without additional intervention. Outcomes assessed included grade 3/4 neutropenia incidence, blood cell count changes, febrile neutropenia rates, delays or interruptions in chemotherapy/radiotherapy due to hematological toxicity, oral mucositis incidents, and bone pain occurrences, comparing these between both groups. 1. 88 patients with locally advanced NPC were included, the incidence of grade 3 neutropenia in the experimental group was lower than that in the control group (P = 0.026); 2. The white blood cell count and neutrophil count in D7, D10, D14, and D21 in the experimental group were higher than those in the control group (P<0.01); 3. The rate of delayed chemotherapy in the experimental group was lower than that in the control group (2.3% vs. 29.5%), P = 0.001; the rate of interruption of radiotherapy in the experimental group was lower than that in the control group (2.3% vs.27.3%), P = 0.003; 4. The incidence of bone pain in the experimental group was 34.1%, of which most were mild bone pain, and no severe bone pain occurred. The leukocyte and neutrophil counts of the patients in the bone pain group were significantly higher than those of the patients in the no bone pain group, P(WBC) = 0.001, P(ANC) = 0.002. The preventive use of PEG-rhG-CSF decreases the incidence of neutropenia in patients undergoing concurrent chemoradiotherapy for NPC, thereby reducing rates of chemotherapy delays and radiotherapy interruptions, with mild adverse reactions that are tolerable by patients.

A prospective observational study on persistent postoperative pediatric pain, 4P: The study protocol.

Access to adequate pain treatment is a fundamental right, yet international data suggest that a considerable number of children experience acute and persistent pain. Little is known about the occurrence of both acute and persistent pain in children. The incidence of persistent postoperative pain in children is an unexplored area but international studies suggest that many children experience long-term pain after surgery, with a major impact on daily life. In 4P, Persistent Postoperative Pediatric Pain, we want to estimate the incidence of acute and persistent postoperative pediatric pain. The European Society for Paediatric Anaesthesiology has developed guidelines for perioperative pain management. We aim to examine how well these guidelines are followed and whether adherence to guidelines influences the pain experienced after surgery. 4P is a prospective observational study of children aged 1-17, planned for surgery in southern Sweden 2023-2024. After agreement from all caregivers, data concerning preoperative pain, pre-emptive analgesia, perioperative management and postoperative pain will be collected. Via an electronic management software, pain will be evaluated at home (or in hospital) at 24h, 3, 6 and 12 months after surgery. We will include 1000 patients. 4P will prospectively follow a large number of children after general pediatric surgeries and evaluate the occurrence of postoperative pain, both acute (APOP) and persistent (PPOP). The study will assess pain treatment regimens and identify risk factors associated with the development of acute and persistent pediatric postoperative pain. Prospectively posted at ClinicalTrials.gov, identifier NCT06035042.

Clavulanic acid prevents paclitaxel-induced neuropathic pain through a systemic and central anti-inflammatory effect in mice.

Paclitaxel (PCX) based treatments, commonly used to treat breast, ovarian and lung cancers, have the highest incidence of chemotherapy-induced neuropathic pain, affecting from 38 to 94​% of patients. Unfortunately, analgesic treatments are not always effective for PCX-induced neuropathic pain (PINP). This study aimed to evaluate the antinociceptive effect of clavulanic acid (CLAV), a clinically used β-lactam molecule, in both therapeutic and preventive contexts in mice with PINP. A single dose of CLAV administered after the onset of PINP significantly reduced mechanical hyperalgesia. Interestingly, preventive administration of CLAV prevented PINP development. The effect of preventive CLAV on PINP was associated with increased levels of IL-10 and IFN-β in serum, and decreased levels of IL-1β and TNF-α in both the serum and CNS. Immunostaining experiments revelated that CLAV increased the levels of glutamate transporter type 1 (GLT-1) and toll-like receptor type 4 (TLR4) in the spinal cord, while reducing levels of the astrocytic marker the glial fibrillary acidic protein (GFAP). Notably, co-incubation with CLAV and PCX in triple-negative breast cancer cells did not interfere with PCX-induced cytotoxic effects. Hence, these findings suggest that CLAV could be employed as a clinical treatment aimed at preventing PINP without compromission the cytotoxic efficacy of PCX.

Cryoneurolysis for Post Operative Pain Following Chest Surgery: Contemporary Evidence and Future Directions.

Management of acute and chronic pain following surgery remains a critical patient management challenge, with poor pain management associated with negative patient satisfaction, increased opioid consumption and a high incidence of adverse events. Chest surgery specifically carries a high incidence of significant early and chronic post operative pain. The high incidence, prolonged duration of pain, and adverse effects associated with chronic opioid analgesia, has given rise to the need for non-opioid pain management strategies. Cryoneurolysis, also known as cryoanalgesia, has emerged as a promising option for both acute and chronic pain management. While cryoneurolysis was first developed over fifty years ago, its utilization was limited by technical implementation challenges and limitations in identifying target structures percutaneously. Advances both in cryoneurolysis delivery devices as well as ultrasound have reinvigorated interest in the technique, with recent studies highlighting the advantages of cryoneurolysis, including its favorable side effect profile, long duration of efficacy and relative technical simplicity. The purpose of this review is to examine techniques for cryoneurolysis, and explore recent evidence for safety and efficacy of the technique following different surgical procedures.

Research Progress on the Posterior Midline Lumbar Spinous Process-Splitting Approach.

The traditional posterior median approach laminectomy is widely used for lumbar decompression. However, the bilateral dissection of paraspinal muscles during this procedure often leads to postoperative muscle atrophy, chronic low back pain, and other complications. The posterior midline spinous process-splitting approach (SPSA) offers a significant advantage over the traditional approach by minimizing damage to the paraspinal muscles. SPSA reduces the incidence of muscle atrophy and chronic low back pain while maintaining the integrity of the posterior spinal structures. The technique involves longitudinal splitting of the spinous process, which allows for adequate access to the lamina for decompression without detaching the paraspinal muscles. As a result, it provides a clearer surgical field and facilitates muscle preservation, which reduces the risk of postoperative complications. Additionally, SPSA requires only standard surgical instruments, making it accessible in most surgical settings. This paper reviews the anatomical considerations, surgical techniques, and clinical applications of the SPSA, highlighting its effectiveness in reducing muscle atrophy and improving recovery outcomes. The paper also discusses its potential in treating conditions such as lumbar spinal stenosis, disc herniation, and spondylolisthesis. Furthermore, it emphasizes the need for future research to establish the long-term benefits of SPSA and refine surgical techniques. The results suggest that SPSA is a promising alternative to traditional approaches, with better outcomes in terms of muscle preservation and overall recovery.

Improving Sternal Closure Outcomes in Cardiac Surgery: Polyethylene Suture Tapes vs. Steel Wires.

Background: Steel wires are often inadequate for sternal closure for patients at high risk of sternal complications. This study compares a novel sternal closure system to conventional steel wires to assess its potential to reduce sternal complication rates and improve clinical outcomes. Methods: A retrospective study was conducted on 300 consecutive patients undergoing cardiac surgery via median sternotomy. A total of 150 patients underwent steel wire sternal closure, while 150 underwent suture tape closure. Preoperative, intraoperative, and postoperative data were collected and analyzed for both groups. Results: Rates of sternal wound infections (1% vs. 5%, p = 0.0363) and sternal dehiscence (0% vs. 5%, p = 0.0297) were lower in the suture tape group. Suture tape patients had significantly less pain at 14 and 30 days (p = 0.0002 and 0.0071). The requirement for sternal protection adjuncts was eliminated with suture tape closure. Sternal closure time was significantly shorter in the suture tape group (11 vs. 19 min, p < 0.0001). Conclusions: Suture tapes proved safe, feasible, and effective for sternal closure, demonstrating significant advantages for sternal closure over steel wires, with reduced rates of sternal dehiscence, infection, postoperative incisional pain, and closure time. These superior outcomes and the elimination of sternal protection adjuncts can potentially reduce healthcare costs. Our experiences suggest that this novel sternal closure system has significant potential, with larger prospective studies warranted to optimize sternal closure strategies.

Rationale and design for the thoracic Paravertebral Adjunctive Dexamethasone Palmitate Reducing chronic pain After cardiac surgery (PANDORA) trial: a parallel-group, double-blinded, randomised controlled, single-centre study

IntroductionMinimally invasive cardiac surgery (MICS) is important for enhanced recovery in cardiac surgery. However, the incidence of chronic postsurgical pain (CPSP) is high and is associated with worsened quality of...

Acupuncture relieves postoperative pain of mixed hemorrhoids through the P2X7/ERK axis in Dorsal root ganglion.

Haemorrhoids are a common anorectal disease primarily treated through surgery, often leading to complications such as pain. The efficacy of acupuncture in relieving postoperative pain in mixed haemorrhoids has not been well-documented. This study included 90 patients undergoing haemorrhoid surgery and their Visual Analogue Score (VAS), inflammatory factor levels, Hamilton Depression Rating Scale (HAMD), and analgesic drug use were accessed. A rat incisional pain model was also constructed to monitor behavioral responses, with assessments including Sucrose Preference Test (SPT) and Open Field Test (OFT). The levels of ATP and proinflammatory cytokines in the dorsal root ganglion (DRG) were measured using luciferase assay and ELISA. We also examined P2X7 and ERK1/2 levels in DRG tissues of anal incisional pain rat model. In a Chronic Constriction Injury (CCI) rat model treated with BzATP, a potent agonist for P2X7 receptors, followed by acupuncture for 15 days, postoperative pain and behavioral responses were observed and assessed, alongside mechanistic studies of ATP and inflammatory factors in DRG tissues. Patients receiving acupuncture had significantly lower VAS scores, reduced levels of inflammatory factors, improved depression scores, and decreased analgesic drug use. In the animal model, acupuncture increased pain thresholds, improved behavioral responses, reduced ATP content and inflammatory factors, and modulated the P2X7/ERK axis. In the CCI model, BzATP increased P2X7 and ERK1/2 levels, pain sensitivity, and anxiety, which were mitigated by acupuncture. Our data suggest that acupuncture significantly alleviates postoperative pain following haemorrhoid surgery and modulates the pain response through the P2X7/ERK axis.

High Glycemic Index Foods Increase Oxidative Stress and Cause Chronic Musculoskeletal Pain

Chronic musculoskeletal pain is a widespread condition that impacts quality of life and poses significant health care challenges. Recent research shows that dietary factors, especially the consumption of high glycemic index (GI) foods, play an important role in exacerbating musculoskeletal pain through metabolic and inflammatory pathways. High GI foods cause a rapid spike in blood glucose, which causes increased production of reactive oxygen species (ROS) resulting in oxidative stress. Oxidative stress disrupts normal cellular function, increases the production of pro-inflammatory cytokines, and exacerbates chronic inflammation, a major driver of musculoskeletal pain. This review discusses the mechanisms by which high GI foods increase oxidative stress and contribute to the onset and persistence of chronic musculoskeletal pain and discusses oxidative damage increasing degradation of musculoskeletal tissue, delaying recovery, and worsening pain perception. Previous studies linking high GI diets to increased oxidative stress and the incidence of musculoskeletal pain provide evidence of the potential for dietary modification as a non-invasive therapeutic strategy. In conclusion, reducing foods with a high glycemic index and adopting a diet rich in antioxidants and low glycemic index to reduce oxidative stress and inflammation is very necessary. Understanding the impact of diet on oxidative stress offers a promising avenue for the prevention and treatment of chronic musculoskeletal pain. Further research is needed to strengthen this association and develop targeted dietary interventions for CMP patients.

NRG1-ErbB4 signaling in the cerebrospinal fluid-contacting nucleus regulates thermal pain in mice.

The cerebrospinal fluid-contacting nucleus(CSF-contacting nucleus) is a pair of unique nuclei in the brain parenchyma which has long been demonstrated to play an important role in pain signal processing. However, the role of the CSF-contacting nucleus in postoperative pain is still unclear. Here, our works showed that c-Fos expression in the CSF-contacting nucleus was increased in response to incisional pain. The activation of the CSF-contacting nucleus by chemogenetics could induce thermal hyperalgesia in naive mice without effecting the pain in mice suffering from incision pain. The inhibition of the CSF-contacting nucleus alleviated incision pain, but had no effect on the basal pain in naive mice. Furthermore, with immunofluorescence staining and Western blot techniques, the NRG1-ErbB4 signaling in the CSF-contacting nucleus was upregulated during the acute pain phase. And, by activating NRG1-ErbB4 signaling in the CSF-contacting nucleus specifically, the naïve mice displayed thermal hyperalgesia while inhibiting this signaling could reverse the hyperalgesia caused by CSF-contacting nucleus activation, and execute an analgesic effect during the painful phase in mice. Our study suggested that the CSF-contacting nucleus plays a regulatory role in thermal pain in mice via NRG1-ErbB4 signaling.

Exploring the impact of perioperative analgesia on postoperative chronic analgesic prescriptions in patients with lung cancer undergoing minimally invasive thoracic surgery: A retrospective observational study.

Lung cancer surgery is associated with a high incidence of chronic postsurgical pain (CPSP), which necessitates long-term analgesic prescriptions. However, while essential for managing pain, these have shown various adverse effects. Current guidelines recommend using peripheral nerve blocks over epidural anaesthesia for perioperative analgesia in minimally invasive thoracic surgery (MITS). However, the impact of perioperative analgesia on chronic analgesic prescriptions remains unclear. Therefore, this study investigated chronic analgesic prescription patterns following MITS in patients with lung cancer who received either perioperative epidural anaesthesia or nerve block. We conducted a retrospective cohort study using data from the Japanese Diagnosis Procedure Combination database. Data were extracted from patients with primary lung cancer who underwent MITS between April 2018 and March 2022. Patients were divided into two groups based on the perioperative analgesia they received: the epidural anaesthesia group and the nerve block group. We compared the proportion of analgesic prescriptions 3-6 months postoperatively between both groups using multivariable logistic regression analysis. Inverse probability of treatment weighting was used to balance the covariates between the two groups. Among the 38,719 eligible patients, 4513 (11.6%) were prescribed postoperative analgesics. We found no significant difference in the proportion of analgesic prescriptions between the epidural anaesthesia and nerve block groups (odds ratio, 1.00; 95% confidence interval, 0.99-1.01). This nationwide retrospective study suggests that the choice between perioperative epidural anaesthesia or nerve block in patients with lung cancer undergoing MITS does not influence the proportion of postoperative chronic analgesic prescriptions.

Photobiomodulation as part of multimodal analgesia to improve pain relief and wound healing after elective caesarean section: A protocol for randomized controlled trial.

Caesarean section (CS) is the most common inpatient surgical procedure performed in Canada. CS is known to cause moderate-to-severe pain, which is suggested to be associated with postpartum depression and persistent pain. Existing limitations in multimodal analgesia and conscious attempts to avoid opioids highlight the need for non-pharmacological strategies. Photobiomodulation therapy (PBMT) uses light-emitting diode (LED) and laser and has suggested potential for improving pain control and wound healing. This study aims to evaluate the effectiveness of PBMT as part of existing multimodal analgesia after elective CSs. This placebo-controlled, two-arm, multi-centre, parallel-design randomized controlled trial includes women aged ≥16 years with planned CS under spinal anesthesia (Clinical Trials Registration: NCT05738239). Patients will be randomized post-CS to intervention (n = 90) or placebo (n = 90). Study interventions will be carried out using equipment supported by Meditech International Incorporated (approved by Health Canada for pain relief). Patients will receive a maximum of 5 post-surgical treatment sessions of active PBMT (intervention: LED therapy: DUO 240 [red at 660nm and near-infrared at 840nm] applied parallel to the abdominal incision scar, followed by BIOFLEX LDR-100 laser probe (660nm red light) and the LD1-200 laser probe (825nm near-infrared light), applied at the incision wound edges) or non-effective doses of LED array and laser therapy (placebo), 4-6 hrs post-CS, and at 8am and 7pm of postoperative days 1 and 2. Patients, research assistants involved in patient recruitment and follow-up, health care providers, and data analysts will be blinded. All patients will have access to routine multimodal analgesia. Patients will be followed up in hospital on the evening of surgery and on postoperative days 1 and 2 (morning, noon, and evening); at 6 weeks; and at 3 months by telephone. Primary outcome is pain intensity with movement (elicited by asking the patient to move from supine to sitting position) using 0-10 Numerical Rating Scale (0 = no pain, 10 = worst possible pain). The results of this study may result in improved pain control, maternal satisfaction and wound healing; decrease the use of perioperative opioids; potentially decrease the incidence of postpartum depression and persistent pain; and overall lead to better postoperative outcomes thereby decreasing healthcare costs.

Ligasure Hemorrhoidectomy Versus Milligan Morgan Hemorrhoidectomy Prospective Randomized Study

Background: Hemorrhoidectomy is a frequently performed surgical procedure associated with postoperative pain. The use of Ligasure could result in a decreased incidence of pain and bleeding, as coagulation with high-frequency currency has minimal thermal spread and limited tissue damage. Objective: The research compares Ligasure pile excision with surgical diathermy excision for the treatment of III-IV-grade piles. Patients and Methods: Eighty patients with pile III or IV degrees were randomized into two groups: Group one (LS) and group two (diathermy). The study evaluates the mean postoperative pain, intraoperative bleeding, and intraoperative time requirement, early and late complications. All patients were followed up for of 10-12 months. Results: The operating time is considerably shortened in Ligasure group (LS); postoperative pain disappears earlier in LS than in diathermy. Additionally, there was less intraoperative bleeding in LS, and short duration hospital stay as compared to diathermy group. Conclusion: LS is an efficient procedure in degree III or IV pile excision. Therefore, the procedure enhances the use of LS as one of the acceptable modality surgical options for grade III–IV pile. Keywords: Hemorrhoidectomy, ligasure™ vessel sealing system, milligan morgan technique.

Research progress in neuropathic pain after spinal cord injury: a bibliometric study from 2013 to 2024.

The incidence of neuropathic pain (NP) after spinal cord injury (SCI) is quite high. This pain is clinically challenging to treat and has an debilitating effect on patients. In recent years, NP is a popular topic of research and a number of relevant articles have been published in academic journals. The purpose of this article is to analyze the global research trend of NP after SCI using bibliometric methods. The literature was screened from 2013 to 2024 based on the Web of Science core collection (WOSCC). These publications, including annual publications, journals, authors, references, and keywords via CiteSpace, were analyzed in order to help understand the current research direction and hotspots in this field. A total of 2022 publications were included in the analysis. The results showed that an overall upward trend in the number of publications in the study period. The top five productive journals are Spinal Cord, Journal of Neurotrauma, Pain, Experimental Neurology, and Journal of Spinal Cord Medicine, the journals related to spinal cord or pain. The top five most productive scholars are Armin Curt, Michael G. Fehlings, Wu Junfang, John L. K. Kramer, and Farinaz Nasirinezhad. Keyword bursts showed that signaling pathway, neuroinflammation, neuralgia, spinal cord stimulation, inhibition, and depression have become new research hotspots in the field of NP after SCI. This study provides a basis for the study of pain after SCI. It summarizes past research on NP following SCI and offers valuable reference data for further exploration of research trends and issues of focus in this field.

Correlation between the severity of endometriosis and the occurrence of placenta accreta spectrum in the subsequent pregnancy

Objective: To investigate the correlation between endometriosis (EMs) severity and placenta accreta spectrum (PAS) risk in the subsequent pregnancy. Method: Clinical records of 2,142 patients who underwent laparoscopic surgery for EMs at Fujian Provincial Maternal and Child Health Hospital from January 2014 to January 2018, who had achieved pregnancy and were delivered, were analyzed. Baseline data, EMs stage, The Revised American Fertility Society (R-AFS) score, levels of serum indexes, and pregnancy and neonatal outcomes were recorded. The outcome of interest was the occurrence of PAS. The correlation between the R-AFS score, endometriosis staging, and PAS was explored, and the R-AFS threshold was identified. Results: PAS was associated with a higher incidence of chronic pelvic pain (OR = 8.68, 95%CI: 1.18-45.79, P = 0.014) and infertility for &gt;five years (OR = 2.5, 95%CI: 1.35-4.65, P = 0.003), elevated serum levels of cancer antigens, higher incidence of postpartum hemorrhage, and placenta previa (P &lt; 0.05). PAS rate was higher in women with higher EMs staging and R-AFS score and ovarian EMs combined with deep infiltrating endometriosis (DIE) (P &lt; 0.001). After adjusting for confounders, both R-AFS score (AOR = 1.02, 95%CI: 1.01-1.03, P &lt; 0.001) and ovarian EMs with DIE (AOR = 3.31, 95%CI: 1.54-6.67, P = 0.001) were independent risk factors for PAS. R-AFS score of 29 was identified as a threshold for an increased risk of PAS. Conclusion: The risk of PAS in patients with endometriosis increases with the R-AFS score. PAS is more likely to occur in women with ovarian EMs combined with DIE. It is necessary to implement a specific monitoring program during pregnancy in patients with a history of severe EMs doi: https://doi.org/10.12669/pjms.41.1.11145 How to cite this: Wang Z, Xie Y, Mao Y, Yan S, Huang J, Lin S. Correlation between the severity of endometriosis and the occurrence of placenta accreta spectrum in the subsequent pregnancy. Pak J Med Sci. 2025;41(1):55-63. doi: https://doi.org/10.12669/pjms.41.1.11145 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cumulative incidence of chronic pain after visiting a Dutch emergency department with acute pain

BackgroundChronic pain is a substantial problem in modern healthcare resulting in health care overutilization. The cumulative incidence of developing chronic pain after visiting the emergency department with acute pain has been determined for specific patient groups only. If the cumulative incidence of chronic pain in emergency department patients with acute pain is high, more proactive measures are justified to limit development of chronic pain. The primary objective was to study the cumulative incidence of chronic pain in patients visiting Dutch emergency departments with acute pain. In addition, we compared the Health-Related Quality of Life (HRQOL) and pain related interference with work.MethodsIn this prospective multicenter cohort study data was collected from adult patients visiting the emergency department with acute pain. Chronic pain was defined by means of a numeric rating scale (NRS) of ≥ 1 measured 90 days after the initial visit. HRQOL was measured with European Quality of Life (EQ-5D-5 L) and Short Form (SF-36) questionnaires.Results1906 patients were included of which 825 had complete data. Of these, 559 patients (67.8%; 95%CI: 64.5 − 70.9%) scored an NRS ≥ 1 after 90 days. Incidence with completed analyses (with imputed data) was similar. Patients with chronic pain reported a significantly lower HRQOL; EQ-5D-5 L index (median 0.82 vs. 1.00) and significantly more pain related hindrance (median 1.00 vs. 0.00).Conclusions67.8% of the responders scored NRS ≥ 1 90 days after ED-visit with acute pain. Regardless of the used definition, chronic pain is associated with a lower HRQOL and more pain related hindrance.

Rationale and design of a large trial of perioperative ketamine for prevention of chronic post-surgical pain

BackgroundChronic post-surgical pain (CPSP) is recognised as one of the most common and debilitating complications of major surgery. Progression from acute to chronic pain after surgery involves sensitisation of central nervous system pathways with the N-methyl-D-aspartate (NMDA) receptor having a central role. Ketamine is a potent, non-selective NMDA antagonist commonly used for management of acute postoperative pain. Inconsistent but largely supportive evidence from small trials of a preventative effect of perioperative ketamine on CPSP risk suggests that a confirmative large trial is needed.MethodsThe ROCKet (Reduction Of Chronic Post-surgical Pain with Ketamine) Trial is a multicentre, double-blind, placebo-controlled, individually randomised superiority trial conducted in 36 hospitals across Australia, New Zealand, and Hong Kong. The trial aims to recruit 4884 patients undergoing abdominal, thoracic, or major orthopaedic surgery. Eligible participants are randomised equally to perioperative intravenous ketamine or placebo for up to 72 h. Incidence of pain in the area of the index surgery is measured by structured telephone interview at 3 months (primary trial endpoint) and 12 months. Pain severity, nature, and associated psychological and quality of life indices are measured using the modified Brief Pain Inventory short form, Neuropathic Pain Questionnaire, Kessler K-10 Psychological Distress Scale, Pain Catastrophising Scale, EQ-5D-3L, and measures of healthcare utilisation and costs. The trial is being conducted by the Department of Critical Care, University of Melbourne, and the Australian and New Zealand College of Anaesthetists Clinical Trials Network. The trial is funded by the Australian National Health and Medical Research Council.DiscussionThe ROCKet trial will clarify the effectiveness of ketamine in primary prevention of CPSP. In addition, it will provide high-quality, prospective data on the epidemiology of CPSP which will better inform further research into prevention and management of CPSP.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12617001619336) on the date of 12/11/2017.

The median effective dose of ciprofol combined with sufentanil in suppressing the laryngeal mask airway insertion response in both young and older adult patients

BackgroundCiprofol, a novel intravenous anesthetic, exhibits similar sedation mechanisms and pharmacokinetic properties to propofol. However, ciprofol demonstrates greater potency and is associated with reduced injection pain compared to propofol. Given the varying sensitivities to anesthetic agents across different age groups, this study aims to determine the median effective dose (ED50) of ciprofol required to suppress the laryngeal mask airway (LMA) insertion response in both young and older adult patients, as well as to assess its potential adverse reactions.MethodsIn this study, 46 patients scheduled for surgery under general anesthesia with LMA insertion were recruited. Upon entering the operating room, patients were intravenously administered ciprofol (0.4 mg·kg− 1) and sufentanil (0.3 µg·kg− 1), followed by LMA insertion after three minutes. To derive robust confidence intervals for both ED50 and ED95, we performed an analysis using a logistic regression model combined with bootstrap resampling.ResultsIn the young adult group, the ED50 and ED95 of ciprofol for suppressing the LMA insertion response were 0.38 mg·kg− 1 (95% CI, 0.35–0.41) and 0.46 mg·kg− 1 (95%CI, 0.40–0.56), respectively. In the older adult group, the respective ED50 and ED95 were 0.29 mg·kg− 1 (95% CI, 0.26–0.32) and 0.37 mg·kg− 1 (95% CI, 0.30–0.78). Regarding adverse reactions, although there were differences in the incidence of injection pain, hypotension, and bradycardia between the young and older groups, no statistically significant differences were observed between the two groups.ConclusionIn this study, significant differences were observed in the ED50 of ciprofol for suppressing the LMA insertion response between young and older adult patients. The ED50 of ciprofol for young adult patients was 0.38 mg·kg− 1 (95% CI, 0.35–0.41), while for older adult patients it was0.29 mg·kg− 1 (95% CI, 0.26–0.32).Trial registrationThis study was registered on February 17, 2024, with the China Clinical Trial Registration Center (www.chictr.org.cn; Registration Number: ChiCTR2400080891).

Efficacy of Perineural Dexmedetomidine in Ultrasound-guided Interscalene Block on Rebound Pain After Shoulder Arthroscopy.

This prospective, randomized, double-blind trial was performed to investigate the effect on rebound pain incidence of mixing dexmedetomidine (DEX) with local anesthetics in a combined injection interscalene block (ISB) during shoulder arthroscopy. Forty-seven patients were enrolled in this study. Patients were randomly assigned to 2 groups: Group DEX and Group Control received ultrasound-guided ISB using 12mL of 0.5% ropivacaine with 50ug of DEX or without DEX. Pain scores at 6, 12, 24, and 48 hours after surgery were assessed with Numeric Pain Rating Scale (NRS). Additional analgesic requirements and side effects in the first 48 hours postoperatively, as well as sleep disturbance on the night and other complications of surgery were examined. The incidence of rebound pain was significantly lower in the Group DEX than in the Group Control. Perineural DEX decreased pain scores at 12 and 24 hours postoperatively. Group DEX had a prolonged time for the first analgesic request, PCA sufentanil consumption in Group DEX was less than Group Control during the first 48 hours postoperatively. The number of patients with sleep disturbance and nausea and vomiting in the DEX Group was lower on the first night postoperative. Perineural DEX added to ISB exerts a beneficial effect on the incidence of rebound pain after ISB in patients undergoing shoulder arthroscopy. Perineural DEX facilitated the implementation of multimodal analgesia in the early stage after operation.