Optimal Pain Management Research Articles

Dissecting the link between PD-1/PD-L1-based immunotherapy and cancer pain: mechanisms, research implications, and artificial intelligence perspectives

Cancer-related pain represents one of the most common complaints of cancer patients especially for those with advanced-stage of disease and/or bone metastases. More effective therapeutic strategies are needed not only to improve the survival of cancer patients but also to relieve cancer-related pain. In the last decade, immune checkpoint inhibitor (ICI)-based immunotherapy targeting programmed cell death-1 (PD-1) and its ligand 1 (PD-L1) has revolutionized cancer care. Beyond its anticancer role, PD-1/PD-L1 axis pathway is involved in many other physiological processes. PD-L1 expression is found in both malignant tissues and normal tissues including the dorsal root ganglion, and spinal cord. Through its interaction with PD-1, PD-L1 can modulate neuron excitability, leading to the suppression of inflammatory, neuropathic, and bone cancer pain. Therefore, since the intricate relationship between immunotherapy and pain should be largely dissected, this comprehensive review explores the complex relationship between PD-1/PD-L1-based immunotherapy and cancer-related pain. It delves into the potential mechanisms through which PD-1/PD-L1 immunotherapy might modulate pain pathways, including neuroinflammation, neuromodulation, opioid mechanisms, and bone processes. Understanding these mechanisms is crucial for developing future research directions in order to optimize pain management strategies in cancer patients. Finally, this article discusses the role of artificial intelligence (AI) in advancing research and clinical practice in this context. AI-based strategies, such as analyzing large datasets and creating predictive models, can identify patterns and correlations between PD-1/PD-L1 immunotherapy and pain. These tools can assist healthcare providers in tailoring treatment plans and pain management strategies to individual patients, ultimately improving outcomes and quality of life for those undergoing PD-1/PD-L1-based immunotherapy.

Systematic Approaches to Optimize Opioid Prescribing in Surgical Patients

The opioid crisis has highlighted the urgent need to optimize pain management strategies in surgical settings, prompting a shift towards opioid-sparing therapies. While opioids are crucial for alleviating moderate to severe postoperative pain, their over prescription poses significant risks, including addiction and overdose. This paper examines the feasibility of achieving opioid-free surgical recovery, particularly for minor and minimally invasive procedures, with the goal of extending this practice to more invasive surgeries through enhanced recovery after surgery (ERAS) programs. It also considers the cultural factors that influence patient expectations regarding pain management in countries with lower opioid prescribing rates, such as Japan and Germany, emphasizing the need for tailored approaches in the United States. The study advocates for the exclusion of opioids at every stage of the perioperative experience, promoting opioid-free anesthesia and analgesia. A framework for optimizing opioid prescribing practices in surgical contexts is proposed, highlighting the vital roles of acute pain specialists and pharmacists in developing comprehensive pain management strategies. By incorporating multimodal analgesia techniques, including non-opioid medications and alternative therapies, healthcare providers can effectively mitigate the risks associated with opioids while ensuring adequate pain relief

Clinical pharmacist interventions on pain management in cancer patients (PharmaCAP) in low resource settings: a multicenter feasibility-pilot randomized controlled trial.

Cancer pain management is frequently insufficient worldwide, especially in low- and middle-income countries where significant challenges related to workforce resources persist. Clinical pharmacists could potentially enhance outcomes in this context, yet their role remains largely unexplored. This study aimed to assess the feasibility and acceptability of integrating clinical pharmacists into the multidisciplinary team (MDT) to manage cancer pain and assess preliminary outcomes in cancerpatients receiving pain treatment. This pilot study was undertaken to inform a future definitive randomized controlled trial (RCT). The protocol was registered with ClinicalTrials.gov (NCT05021393). The PharmaCAP trial was conducted in two oncology centers in Nepal, where patients were randomly enrolled into usual care (UC) or an intervention group (PharmaCAP). The latter received a clinical pharmacist-led medication review, which involved a comprehensive assessment of the patient's current medications, identification of potential drug-related problems, and personalized recommendations for optimizing pain management. This was accompanied by pain assessment, educationand counseling on pain management strategies. Baseline and 4-weeks post-intervention assessments measured primary outcomes, i.e., feasibility metrics (recruitment of the patients, retention of patients, patient satisfaction). Secondary outcomes included pain intensity, health-related QoL, anxiety, depression, barriers to pain management, and medication adherence at 4weeks. Out of 140 screened patients, 108 were evaluated for eligibility, with 16 opting out primarily due to lack of interest (n = 11) and communication barriers (n = 5). A total of ninety-two participants with cancer pain were randomized into two groups, with 91 patients successfully recruited and 85 (93.4%) completing 4weeks post-intervention assessment). Completion rates for the UC and PharmaCAP groups were 91.3% and 93.4%, respectively. The primary feasibility outcomes were positive: 100% of patients found random allocation acceptable. Retention rates were high, with 91.3% in the UC group and 93.4% in the PharmaCAP group, despite a few dropouts due to being unreachable, COVID-related issues, and changes in treatment centers. No evidence of contamination between groups was found, as participants did not discuss interventions or influence each other's attitudes, ensuring effective isolation of interventions The PharmaCAP intervention showed significant improvement in QoL (P < 0.001), physical functioning (P < 0.001), and financial difficulties (P < 0.001). There was also clinical benefit observed in anxiety and depression (P < 0.001) and enhancements in medication adherence (P < 0.001). While pain intensity decreased in both groups, the difference was not statistically significant. Satisfaction with the PharmaCAP intervention was high, with 93.0% of participants expressing satisfaction and 88.3% acknowledging that the clinical pharmacists effectively addressed their drug-related queries. Findings of this RCT demonstrate that integrating clinical pharmacists into the MDT team in low low-resource setting is feasible and shows promise in improving QoL, reducing anxiety and depression, and enhancing medication adherence among cancer patients. These findings support the feasibility of conducting a full-scale RCT. Enabling clinical pharmacists to assist with cancer pain management in low-resource settings can benefit patients, healthcare teams, and health systems. ClinicalTrials.gov NCT05021393. Registered on 25th August 2022.

Machine learning approach to predict postoperative pain after spinal morphine administration during caesarean delivery

BackgroundA major barrier to optimal pain management is the difficulty in predicting and assessing patients at high risk for significant pain across multiple locations within the institution in a timely manner. This is compounded by the fragmented display of clinical information on enterprise clinical platform, which further hinders delay the reviews and hence the increased risk of untreated pain. We evaluated and compared the predictive performance of six modelling techniques in predicting significant pain, defined as the maximum pain score of 3 or more on movement at the 13th to 24th hour after spinal morphine administration during caesarean delivery. MethodsWe retrieved medical records from women who underwent caesarean delivery and received postoperative spinal morphine in a single specialist maternity hospital in Singapore between Aug 2019 and Aug 2022. We extracted 120 clinical variables from the medical records of eligible patients and further selected 23 to improve algorithm accuracies. The dataset was split randomly, with 80 % of patients (n = 5248) used for training the models, and 20 % (n = 1313) reserved for validation. ResultsThe study cohort comprised 6561 patients with an incidence of significant postoperative pain of 7.9 %. Ridge regression demonstrated the best performance with both the full (AUC: 0.649) and selected (AUC: 0.719) feature sets. By reducing the number of features, Ridge regression, LASSO, Elastic net, and XGBoost showed similar in AUC (0.704–0.719), sensitivity (0.644–0.695), specificity (0.644–0.705), positive predictive value (0.155–0.179), and negative predictive value (0.949–0.955) in predicting significant postoperative pain. These were attributed to the top three variables, mainly the last recorded postoperative pain score (on movement) before the prediction point, mean and standard deviation of the hourly maximum postoperative pain score (at rest) at 0th to 12th hour. ConclusionsFuture research will aim to refine these models and explore their implementation in clinical settings to enhance real-time pain management and risk stratification for women after caesarean delivery.

Consensus Statement on Pain Management for Pregnant Patients with Opioid-Use Disorder from the Society for Obstetric Anesthesia and Perinatology, Society for Maternal-Fetal Medicine, and American Society of Regional Anesthesia and Pain Medicine.

Pain management in pregnant and postpartum people with an opioid-use disorder (OUD) requires a balance between risks associated with opioid tolerance, including withdrawal or return to opioid use, considerations around social needs of the maternal-infant dyad, and the provision of adequate pain relief for the birth episode that is often characterized as the worst pain a person will experience in their lifetime. This multidisciplinary consensus statement between the Society for Obstetric Anesthesia and Perinatology (SOAP), Society for Maternal-Fetal Medicine (SMFM), and American Society of Regional Anesthesia and Pain Medicine (ASRA) provides a framework for pain management in obstetric patients with OUD. The purpose of this consensus statement is to provide practical and evidence-based recommendations and is targeted to health care providers in obstetrics and anesthesiology. The statement is focused on prenatal optimization of pain management, labor analgesia, and postvaginal delivery pain management, and postcesarean delivery pain management. Topics include a discussion of nonpharmacologic and pharmacologic options for pain management, medication management for OUD (eg, buprenorphine, methadone), considerations regarding urine drug testing, and other social aspects of care for maternal-infant dyads, as well as a review of current practices. The authors provide evidence-based recommendations to optimize pain management while reducing risks and complications associated with OUD in the peripartum period. Ultimately, this multidisciplinary consensus statement provides practical and concise clinical guidance to optimize pain management for people with OUD in the context of pregnancy to improve maternal and perinatal outcomes.

Synergistic Epistasis and Systems Biology Approaches to Uncover a Pharmacogenomic Map Linked to Pain, Anti-Inflammatory and Immunomodulating Agents (PAIma) in a Healthy Cohort

The global public health addiction crisis has been stark, with over 932,400 deaths in the USA and Canada from opioid overdose since 1999–2020, surpassing the mortality rates at the top of the HIV/AIDS epidemic. Both nations exhibit opioid consumption rates significantly above the norm for developed countries. Analgesic type of opioids present both therapeutic benefits and substantial health risks, necessitating balanced drug regulation, careful prescribing, and dedicated opioid stewardship. The role of the cytochrome P450 2D6 (CYP2D6) system (Enzymatic functions) in metabolizing opioids highlights the potential of genotype-guided analgesia. By integrating Pharmacogenomics (PGx), this approach aims to optimize pain management, enhance safety, and reduce addiction risks. This understanding prompted the utilization of multifactor dimensionality reduction (MDR) to explore a range of phenotypes including PGx and gene–gene interactions (GGI) in a healthy cohort, thereby personalizing pain management strategies. The study sampled 100 unrelated healthy Western Iranians and 100 individuals from the 1000 Genome Project. Pre-testing involved searching for PGx annotations (variants associated with drug-gene-diseases) related to pain sensitivity and inflammation using the PharmGKB database, which identified 128 relevant genes. A questionnaire helped select 100 participants who had never used potent opioids but also other psychoactive agents (e.g., nicotine, amphetamines, etc.) and disease-related drugs. Whole-exome sequencing (WES) was then employed to analyze these genes in an Iranian cohort. Further analyses included MDR for identifying synergistic gene annotations and GGI for exploring complex gene interactions through the Visualization of Statistical Epistasis Networks (ViSEN). The study identified a Pain, Anti-Inflammatory, and Immunomodulating agents (PAIma) panel from the 128 genes, resulting in 55,590 annotations across 21 curated pathways. After filtering, 54 significant structural or regulatory variants were identified. This research also highlighted novel gene relationships involving the CYP3A5 gene, hsa-miR-355-5p, Paliperidone, and CYP2D6, which warrant further investigation. This study offers a novel pharmacogenetic framework that could potentially transform opioid prescribing practices to mitigate misuse and enhance personalized pain management. Further validation of these findings from multi countries and ethnic groups could guide clinicians in implementing DNA-based opioid prescribing, aligning treatment more closely with individual genetic profiles.Graphical abstract

Protocol for scoping review: Mapping the landscape of acute pain management in sports-related musculoskeletal injuries.

Acute pain management is critical in sports-related musculoskeletal injuries to facilitate recovery and minimize long-term impact. While current practices vary, incorporating both pharmacological and non-pharmacological approaches, the quality and breadth of existing evidence have not been thoroughly assessed. This scoping review aims to explore the clinical role of different pain management strategies and provide a comprehensive overview of the field. The review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) guidelines. Searches will be conducted in major peer-reviewed databases and relevant gray literature. Studies involving athletes of any level undergoing treatment for acute musculoskeletal injuries will be considered. Data extraction will include study and participant characteristics, intervention details, reported outcomes, efficacy comparisons, and economic analyses. This review will provide a descriptive synthesis of the data, utilizing statistical analysis, figures, and tables where relevant to introduce the different treatment modalities. In line with PRISMA-P and PRISMA-ScR guidelines, this scoping review incorporates studies of diverse designs. The data synthesis involves descriptive statistics and narrative presentations, aimed at exploring the relationship between study results and research objectives. This scoping review will evaluate various pain management interventions for acute musculoskeletal injuries in sports, mapping the current evidence and identifying gaps in research. The findings will help inform clinical practices and guide future research efforts to optimize pain management strategies in sports medicine.

The Impact of Standardized Training Resident on Pain Management in Patients with Advanced Lung Cancer.

This study aimed to investigate the effects of Standardized Training Resident on pharmacological interventions for pain management in patients with advanced lung cancer. A total of 84 patients with advanced lung cancer and associated pain were enrolled in the study from December 2019 to August 2023 and were divided into two groups based on their attending physician: a group managed by physician-ST Training Physicians (joint group) (n = 42) and physician-only group (usual group) (n = 42). The Brief Pain Inventory (BPI), oral morphine equivalent, and length of hospital stay. Furthermore, the Pain Management Index (PMI) was calculated. Health-related quality of life (HRQoL) was assessed at the 4-week follow-up using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). At week 4, compared to the usual group, the four BPI pain intensity categories were significantly lower in the joint group [worst pain: 4 (3-5) vs 8 (7-9); least pain: 1 (0-2) vs 3 (1-4); average pain: 2 (1-2) vs 5 (4-6); pain right now: 1.2 (0.7-1.9) vs 4 (3-5)] (all P > 0.05). The hospital stay duration was significantly reduced; for the seven pain interference categories, there were no significant improvements in the joint group. Significantly more patients achieved adequate pain control in the joint group than the usual group (p = .002). A reduction in OMEDD scores was observed for both cohorts, and the joint group's reduction was statistically more significant (p = 0.016). There were no significant differences in HRQoL between the two groups. Standardized Training for Radiation Oncology Physicians may lead to improved pharmacological interventions and enhanced pain relief. Recognizing the importance of these trainees in the healthcare team is crucial for achieving optimal pain management outcomes.

Topical Anesthesia in Cutaneous Head and Neck Surgery: A Randomized Controlled Trial.

Cutaneous head and neck surgery can safely and effectively be performed using local anesthetic (LA). However, optimizing pain management during LA administration is paramount for patient comfort and procedural efficacy. The primary objective of this study was to investigate the comparative effectiveness of EMLA cream and ethyl chloride (EC) spray in mitigating pain associated with LA administration in cutaneous head and neck surgery. Randomized controlled trial. University-affiliated tertiary head and neck oncology center. Sample size calculation was performed followed by computer randomization into the following groups: EMLA, EMLA placebo (aqueous cream), EC, and a control group (no topical agent). Demographics, pain, and procedural experience scores were recorded perioperatively. Statistical analysis was performed to analyse differences between groups utilizing the Mann-Whitney U test, Kruskall-Wallis test, Chi-square test, and Spearman's Rho. 121 cutaneous lesions with a median patient age of 76 were analyzed. There were no statistically significant differences in pain scores (median [IQR]) between patients receiving EMLA (4 [3.75]), EMLA placebo (4.8 [3.6]), EC (5.8 [2.8]), and no treatment (5 [4.1], P = .19). Procedural experience scores were clinically similar (P = .02). Risk factors associated with elevated nociceptive sensitivity were surgical site (scalp, P = .01), malignant lesions (P < .01) and lesion surface area (rs = 0.22, P = .01). EMLA and EC did not mitigate LA-associated pain in patients undergoing cutaneous head and neck surgery and as such practitioners should reconsider their use of these in this regard. Patients' operative experience remains excellent regardless of topical anesthetic use. Ib.

Assessing the Association of Pain Intensity Scales on Quality of Life in Elderly Patients with Chronic Pain: A Nursing Approach.

Chronic pain is prevalent among the elderly and significantly affects their quality of life (QoL). Pain intensity scales are crucial tools in evaluating the severity of pain and tailoring management strategies. This study investigates the relationship between various pain intensity scales and QoL among elderly patients with chronic pain, highlighting the implications for nursing practice. A cross-sectional study was conducted with 150 elderly patients (aged 65 and above) in Riyadh, Saudi Arabia. Participants were assessed using the Numeric Rating Scale (NRS), Visual Analog Scale (VAS), and McGill Pain Questionnaire (MPQ) alongside the 36-Item Short-Form Health Survey (SF-36) to evaluate QoL. Data analysis involved Pearson correlation and multiple regression to explore the association of pain intensity on QoL. All pain scales showed significant negative correlations with QoL. The MPQ exhibited a significant association, suggesting its comprehensive nature captures the multidimensional association of pain more effectively. Regression analysis identified pain intensity, age, and duration of chronic pain as significant predictors of reduced QoL. The findings emphasize the importance of selecting appropriate pain assessment tools that reflect the complex nature of pain in elderly patients. Implementing comprehensive pain assessments like the MPQ can enhance individualized care strategies and potentially improve the QoL in this population. This study underscores the role of nurses in optimizing pain management approaches tailored to the elderly.

Comparative efficacy of intrathecal morphine and adductor canal block in the knee arthroplasty population: a retrospective multi-centre cohort study

BackgroundFinding the balance of good postoperative analgesia while facilitiating mobility is important for a safe and satisfactory patient experience during Total Knee Arthroplasty (TKA). This study aimed to compare the efficacy of intrathecal morphine, adductor canal block, and their combination in optimizing pain management and postoperative recovery in TKA patients. This retrospective analysis of prospectively collected data evaluated postoperative pain scores, time to mobilisation, and length of hospital stay.Methods1006 consecutive patients undergoing elective TKA across two large tertiary centres were included over six years. They were divided into one of four groups according to the type of analgesia received: Group N patients received no neuraxial morphine or regional block. Group B patients received adductor canal block (ACB) only. Group M patients received intrathecal morphine (ITM) but no regional block. Group BM patients received both ACB and ITM.ResultsPatients who received an ACB had faster postoperative mobilization compared to those without (p < 0.001). Patients in Group BM had the lowest pain scores at rest (Visual Analogue Scale (VAS) 2.9) and with movement (VAS 5.3), while Group B patients experienced the highest pain scores at rest (VAS 3.7) and on movement (VAS 6.5) (p = 0.005). Patients who received ITM had the lowest opioid requirements (p < 0.001). There was no significant differences between groups in requirement for rescue pain management strategies (p = 0.06).ConclusionsThe combination of ITM and ACB in patients undergoing TKA provides improved postoperative analgesia with lower postoperative opioid requirement and earlier mobilization compared with ACB or ITM alone.

Reducing Opioid Consumption and Length of Stay After Bariatric Surgery: A Nonpharmacologic ERAS Intervention Bundle

PurposeTo reduce opioid consumption and decrease length of stay (LOS) in bariatric surgical patients by implementing an evidence-based, nonpharmacologic enhanced recovery after surgery (ERAS) intervention bundle. DesignEvidence-based practice project. MethodsWe developed and implemented a nonpharmacologic ERAS bundle from existing American Society of PeriAnesthesia Nurses Standards and bariatric and subspecialty surgical ERAS protocols to standardize the postoperative nursing care of bariatric patients. The bundle consisted of early ambulation, immediate initiation and prolonged use of oxygenation, prevention of nausea and vomiting, frequent use of incentive spirometry, and application of ice packs to surgical sites. The two project outcomes were opioid consumption and patient LOS. We used descriptive statistics to summarize opioid consumption and LOS among surgical bariatric patients at baseline and post intervention and independent samples t tests to determine the statistical significance of pre- or post-LOS changes. FindingsAfter implementing the ERAS bundle in 31 bariatric surgical patients, we found that the percentage of patients given an opioid substantially decreased by 13.8%, with both fentanyl and hydromorphone (Dilaudid) consumption meaningfully decreasing by 11.0% and 25.6%, respectively. The average LOS significantly decreased (P = .015) by 23 minutes per patient following the intervention, from 1 hour and 58 minutes to 1 hour and 35 minutes, representing a 19.5% reduction in total patient time in the PACU. ConclusionsUse of a nonpharmacologic ERAS bundle and standardizing postoperative care decreased overall PACU bariatric surgical patient opioid consumption and significantly reduced PACU LOS. Optimizing pain management for bariatric patients in the PACU could lead to improved pain control and reduced reliance on opioids during their entire hospital stay, enhancing health care outcomes and improving patient safety. Perioperative leaders and educators can use our example to develop initiatives that decrease opioid use and LOS to improve care for the high-acuity bariatric patient population.

Perioperative management and fast track in knee arthroplasty

Knee arthroplasty is an established surgical treatment for advanced osteoarthritis of the knee. In view of the rising number of surgical procedures, increasing costs in the healthcare system with aparallel increase in patient age and comorbidities, an evidence-based perioperative management is gaining importance. Fast Recovery concepts comprise arange of evidence-based strategies for optimizing the perioperative course. By reducing perioperative risks and optimizing pre-, peri- and postoperative processes, complications can be reduced, as well as perioperative morbidity, while comprising faster convalescence. This review is based on asystematic literature search in the PubMed, Cochrane Library and Web of Science databases on the topic of perioperative optimization and evidence for Fast Recovery programs in knee resurfacing. In knee arthroplasty, Fast Recovery protocols lead to asignificant reduction in the length of stay in hospital without an increase in complication rates. Patients also benefit from afaster return to mobility and areduced level of postoperative pain. The involvement of multidisciplinary teams, the optimization of pain therapy, the minimization of blood loss and early mobilization are key elements of these protocols. The implementation of Fast Recovery protocols in the perioperative care of patients is an effective strategy to improve surgical outcomes. Essential for the success of such programs is individualized multidisciplinary patient care with preoperative risk assessment, optimized pain management and early physiotherapeutic mobilization. Future research should focus on the long-term effects of these approaches and their adaptation to different patient populations.

Mediating and Suppressing Effects of Coping Styles Between Resilience and Empathy for Pain in Clinical Nurses: A Cross-Sectional Study.

This study aimed to investigate the current state of empathy for pain among clinical nurses, analyze the relationship between resilience and empathy for pain, and explore the mediating effects of coping styles. This was a multicenter cross-sectional study conducted among 1601 clinical nurses in Guangdong Province, China. The convenience sampling method was used to collect data from Sociodemographic information, the 14-Item Resilience Scale, the Simplified Coping Style Questionnaire, and the Chinese version of the Empathy for Pain Scale from June to September 2023. To analyze the relationship between resilience, coping styles, and empathy for pain among clinical nurses with descriptive statistics, Spearman correlation analysis, and mediation analysis. The empathy for pain score among Chinese clinical nurses was 2.92 ± 0.79, with the empathy reactions dimension at 3.56 ± 0.74, and the body and mind discomfort reactions dimension at 2.70 ± 0.89. Clinical nurses' resilience was positively related to the coping styles and the empathy reactions dimension, whereas negatively associated with the body and mind discomfort reactions dimension. Coping styles were negatively related to the empathy for pain and the body and mind discomfort reactions dimension, whereas positive with the empathy reactions dimension. Coping styles partially mediated between resilience and empathy reactions dimension (β=0.127, 95% CI: 0.070~0.183), accounting for 56.19% of the total effect. There were suppressing effects of coping styles between resilience and empathy for pain (β=-0.157, 95% CI: -0.189~-0.126), the body and mind discomfort reactions dimension (β=-0.172, 95% CI: -0.203~-0.142). The effects of resilience on clinical nurses' empathy for pain were partially mediated and suppressed by coping styles. During clinical pain management, nursing administrators should focus on developing clinical nurses' resilience and positive coping strategies to improve nurses' physical and mental health, optimize pain management, and foster a heightened sense of empathy for pain.

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

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

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.

Orthostatic intolerance during early mobilization following thoracoscopic lung resection: a prospective observational study

BackgroundEarly postoperative mobilization is important for enhanced recovery but can be hindered by orthostatic intolerance. However, study on postoperative orthostatic intolerance in thoracoscopic lung resection is limited. Thus, this investigation aims to examine the prevalence and variables contributing to orthostatic intolerance on the first day following thoracoscopic lung cancer resection.MethodsA prospective observational study was conducted from February 01 to May 05, 2023, at the First Affiliated Hospital of Chongqing Medical University. Typically, 215 subjects subjected to thoracoscopic lung resection were enrolled in this study. Their general information, disease, and treatment information were collected, and the occurrence of orthostatic intolerance was recorded.ResultsTypically, 64 patients (29.77%) demonstrated orthostatic intolerance during early mobilization, and 43.75% failed to walk. The prevalence of nausea, dizziness, and impaired vision was 60.94%, 92.19%, and 25.00%, respectively, and no patient experienced syncope. The factors shown to be independently linked with orthostatic intolerance were being female (OR = 2.98, 1.53 to 5.82) and high pain level during sitting (OR = 2.69, 1.79 to 4.04). Individuals with orthostatic intolerance had a longer postoperative hospital stay with a mean of 5.42 days against 4.25 days (p = 0.003).ConclusionsOrthostatic intolerance was prevalent following thoracoscopic lung cancer resection and affected patients’ capability to mobilize and prolonged postoperative hospitalization. Being female and having high pain levels during sitting were identified as independent factors for orthostatic intolerance. This suggests that more emphasis should be given to risky patients, and for these groups, we may optimize pain management to adjust the risk of emerging orthostatic intolerance, facilitating early mobilization and early postoperative rehabilitation.

Artificial Intelligence in Pain Management: Advancing Translational Science in Digital Health Research from Bench to Bedside

Artificial Intelligence (AI) is rapidly transforming the landscape of healthcare, with particularly profound implications in the field of pain management. This chapter delves into the integration of AI-driven tools that revolutionize the way pain is assessed, monitored, and treated. Through the use of predictive modeling, real-time monitoring, and personalized treatment plans, AI significantly enhances the precision, efficiency, and effectiveness of pain management strategies. The discussion extends to various AI applications, shedding light on the ethical considerations that accompany these technological advancements, as well as outlining future research directions. Collectively, these insights underscore the immense potential of AI to not only improve pain management practices but also to significantly elevate patient outcomes. Central to this transformation is the role of translational science in bridging the gap between theoretical AI models and their practical, clinical applications. This "bench to bedside" approach ensures that innovations in AI are not merely confined to research environments but are actively integrated into real-world patient care. For instance, AI-powered predictive analytics in pain management, driven by sophisticated machine learning algorithms, have progressed from computational experiments to clinical trials, and ultimately, to widespread implementation in healthcare settings. These AI models are now being utilized in hospitals to assess patient pain levels in real-time, predict opioid requirements, and optimize pain management protocols. This progression exemplifies how translational science is facilitating a paradigm shift in healthcare, positioning AI as an indispensable tool in modern pain management.

Healthcare providers perspective of chronic pain management in persons with traumatic spinal cord injury accessing the public system in a region of South Africa

Purpose Persons with traumatic spinal cord injury (PWTSCI) have expressed a lack of education from healthcare providers and poor shared-decision making between providers and clients. The aim was to explore the healthcare providers’ perspective on factors influencing the optimal management of chronic pain. Methods Healthcare providers were recruited from two institutions at tertiary healthcare level. Interviews explored current chronic pain management practices, influencing factors and recommendations for improvement. Data saturation occurred after interviewing 11 participants. Thematic analysis was used through a socio-ecological model. Results The challenges to optimal pain management include appropriate assessment and management of psychological health (intrapersonal level), substance abuse amongst patients (intrapersonal level), access to medication for providers and lack of knowledge by providers (interpersonal and organizational level). To improve chronic pain management, an interdisciplinary team approach should be operationalized at policy and organizational level, monitoring and adjustment of interventions should take place (interpersonal), and family members/caregivers should be involved in the planning and monitoring (interpersonal). Conclusion Factors, at the interpersonal, intrapersonal, organizational and policy levels, influence optimal chronic pain management in the traumatic spinal cord injury (TSCI) population. To mitigate challenges, guidelines for chronic pain management should be developed, particularly for low-resourced developing countries.

Comparative Analysis of Oral Clonidine Versus Oral Gabapentin on Subarachnoid Block Duration and Postoperative Analgesic Needs.

Pain, an inherently subjective experience, plays a pivotal role in the body's defence mechanism by signalling tissue damage or potential harm. Thus, optimal postoperative pain management is a cornerstone of modern surgical practice, essential for improving recovery outcomes and overall patient well-being. In this study, a total of 60 patients were randomly assigned to two groups of 30 each: Group C (clonidine) and Group G (gabapentin). Group C received oral clonidine 100 mcg and Group G received oral gabapentin600 mg one hour prior to the subarachnoid block. Duration of sensory and motor block, hemodynamic parameters, Visual Analog Scale (VAS) scores, time to rescue analgesia and any side effect of both drugs were assessed in both groups. The duration of motor and sensory blockade, as well as intraoperative hemodynamics and respiratory rates, were comparable between the two groups. Group G exhibited significantly lower VAS scores from 150 minutes postoperatively up to 12 hours (p < 0.001). Additionally, Group G experienced longer duration of postoperative analgesia (16.8±3.9 hours) compared to Group C (9.27±1.7 hours). About 26.6% of the patients in Group C and 6.7% of the patients in Group G presented with postoperative nausea and vomiting (PONV). Oral gabapentin at a dosage of 600 mg demonstrates superior efficacy as a premedication compared to oral clonidine 100 mcg for patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia. Group G demonstrated extended postoperative analgesia, lower VASscores, and a reduced incidence of PONV, indicating its superiority over clonidine as an analgesic adjunct.