Reduction In Pain Intensity Research Articles

A multidisciplinary pain management program for patients with chronic low back pain: a randomized, single-blind, controlled, feasibility study

BackgroundMultidisciplinary programs are the first recommendation for non-specific chronic low-back pain, but implementing this type of program is complicated to get up and running. The primary aim of this study was to assess the feasibility and appropriateness of the PAINDOC multidisciplinary program for subjects with chronic low-back pain. The secondary objectives were to evaluate the decrease in pain intensity, pain-related disability and pain catastrophizing, as well as the improvement in quality of life with this program. Furthermore, another of the secondary objectives was to calculate the sample size for a future randomized clinical trial.MethodsThis study was conducted in a hospital pain unit using two successive recruitment waves. First, the feasibility outcomes (recruitment, completion, and drop-out rates) of a 5-month non-random prospective cohort (n = 227) were recorded. Then, the clinical outcomes (pain intensity, quality of life, disability, and pain catastrophizing) were recorded from a prospective, controlled, two-armed and single-blind feasibility study (ClinicalTrials.gov, NCT05974072). It included 41 participants that were randomly allocated to either the pharmacological treatment (n = 21) arm or PAINDOC program (n = 20) arm.ResultsThe recruitment rate was 66%, with the completion rate standing at 80.7% and the drop-out rate at 19.3%. Significant differences and a medium size effect were observed between groups in terms of pain intensity (p = .017, r = .408) at the 4-month follow-up. The intragroup analysis of the PAINDOC group revealed significant lessening in pain intensity (p = < 0.001) and improvements in quality of life (p = .030).ConclusionsThis study showed that the PAINDOC multidisciplinary program is a feasible treatment for patients with non-specific chronic low-back pain. Furthermore, the exploratory results of this study suggest that it could be an effective treatment to reduce pain intensity and improve on self-reported quality of life in these patients, although a future randomized clinical trial is needed to determine its effectiveness.Trial registrationNCT05974072 (registration date July 11, 2023; retrospectively registered; ClinicalTrials.gov).

Physical function and perceived pain following inpatient intensive interdisciplinary pain treatment for children and adolescents.

Chronic pain among children and adolescents negatively impacts overall functioning and quality of life. Although Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to reduce functional impairment and perceived pain, overall evidence is limited and restricted by small sample sizes and limited diversity in pain diagnoses. To determine whether children and adolescents with chronic pain participating in an inpatient IIPT program experience improvements in their physical function and perceived pain. Cross-sectional, secondary analysis. Inpatient acute rehabilitation. Children and adolescents with chronic pain (n = 258; females/males = 204/54; age = 16.5 ± 2.6) admitted to a 4-week inpatient IIPT program from November 2011 to January 2023. Participants attended individual and group sessions involving physical therapy, occupational therapy, aquatic therapy, cognitive behavioral therapy, school-related tasks, and meditation. The sessions focused on improving strength, endurance, and function, while helping participants modify physical sensations, catastrophic thinking, and maladaptive behaviors. Collected at admission and discharge: pain intensity (Numerical Pain Rating Scale; scale: 0-10), lower extremity function (Lower Extremity Functional Scale [LEFS]; scale: 0-80), upper extremity function (Upper Extremity Functional Index [UEFI]; scale: 0-80), motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition short form [BOT-2 SF]; scale: 0-70), and occupational performance and satisfaction (Canadian Occupational Performance Measure [COPM]; scale: 0-10 for both). Overall, participants reported significant improvements (p < .05) in median LEFS (median change [MC] = +30.5; 25th, 75th percentile range [PR] = 19, 42), UEFI (MC = +21; PR = 12.8, 31), BOT-2 SF (MC = +9; PR = 5, 15), COPM performance (MC = +4; PR = 2.8, 5.4), and COPM satisfaction (MC = +5.6; PR = 3.8, 7.2). Moreover, participants reported significant reduction (p < .05) in median pain intensity (MC = -3; PR = 1, 5). For a majority of participants, MC surpassed previously reported minimally clinical important difference thresholds. Findings highlight the relevance of inpatient IIPT programs in enhancing physical function and reducing perceived pain in children and adolescents with chronic pain.

Efektivitas Terapi Akupunktur pada Pasien Osteoarthritis Lutut : Literature Review

Knee osteoarthritis is a degenerative disease that causes stiffness, pain, and joint deformity, potentially impacting patients' quality of life. Acupuncture is a non-pharmacological therapy option. This study aimed to evaluate the effectiveness of acupuncture therapy in knee osteoarthritis patients using literature searches on PubMed®, Cochrane®, and ScienceDirect® with the keyword "effectiveness therapy of acupuncture for knee osteoarthritis." The analysis showed that acupuncture could reduce pain intensity and improve quality of life through the regulation of inflammatory factor inhibition, neurological activity modulation, stimulation of ?-endorphin release, and antioxidant activation. Further studies are needed to ensure long-term effects and optimize therapy combinations for treating knee osteoarthritis patients.

Transforaminal lumbar epidural injection of dexmedetomidine versus magnesium sulfate combined with dexamethasone for lower limb radicular pain management: a randomized, clinical trial.

Epidural steroid injections are frequently used to treat chronic radicular pain of a discogenic origin; however, their efficacy remains limited. Magnesium sulfate and dexmedetomidine are emerging adjuvants with the potential to enhance the effectiveness and prolong the therapeutic duration of steroid injections. In this randomized, double-blind study, 90 patients with unilateral lower limb radiculopathy due to lumbar disc prolapse who did not respond to conservative treatment for 12 weeks were assigned to three groups. The control group received dexamethasone (4 mg), lidocaine 2% (40 mg), and saline. The magnesium group received magnesium sulfate (200 mg) with dexamethasone and lidocaine. The dexmedetomidine group received dexmedetomidine (50 mcg), dexamethasone, lidocaine, and saline. Pain intensity was assessed using the visual analog scale at 1 week and 1, 3, and 6 months post-treatment. Secondary outcomes included the Modified Oswestry Disability Index (MODI), analgesic consumption, and procedure-related complications. Both magnesium and dexmedetomidine significantly reduced pain, disability, and analgesic consumption for up to 3 months. By 6 months, the magnesium group demonstrated significant improvement in pain scores and MODI and a decline in ibuprofen use compared to the control and dexmedetomidine groups. Magnesium significantly reduced pain intensity, disability, and analgesic consumption over a 6-month observation period.

Modulation of Affective and Sensory Qualities of Acute Nociceptive Pain by Curcuma longa and Boswellia serrata Extract Formulation: A Randomized, Double-Blind, Placebo-Controlled Design in Subjects With Exercise-Induced Acute Musculoskeletal Pain.

Introduction Excessive repetitive physical activity most often leads to acute musculoskeletal pain. The management of acute pain is one of the primary concerns. The nociceptive pain has both sensory and affective qualities, patterns, and intensity. In this article, we focus on the effect of a turmeric-Boswellia formulation on that aspect at different locations of the body. Methods This multicentric study with a randomized, double-blind, placebo-controlled design enrolled 232 subjects in a male-to-female ratio of 1:1. The test dosage was 1,000 mg of turmeric-Boswellia extract (TBE) and a similar placebo in a parallel design allocation of 1:1 ratio. Healthy subjects with acute musculoskeletal pain of exercise-related origin with a numerical pain rating score of ≥ 5 were included in the study. The study duration was six hours, and the efficacy was analyzed using the short form of the McGill Pain Questionnaire, having subscales visual analog scale (VAS) and present pain index (PPI). Results There was a significant reduction in pain in the McGill total score (p < 0.001) of the TBE group, with a 98% change from the baseline compared to the placebo. The sensory and affective domains showed a significant reduction of 98% (p < 0.001) and 97% (p < 0.001) in pain in the TBE group from the baseline compared to placebo. The VAS had a 97% (p < 0.001), and PPI had 96% (p < 0.001) pain relief in the TBE group from the baseline compared to placebo. In the sensory domain, the most common pain descriptor reported by the participant was "tender," and in the affective domain, it was "tiring-exhaustive." The descriptor frequency of "tender" reduced from 65% in baseline to 1%, and "tiring-exhaustive" reduced from 61% to 3% at the end of six hours for the TBE group, while the placebo showed negligible change. The mean pain intensity of all pain descriptors in the TBE group showed more than 95% change from baseline. Conclusion It can be concluded that the turmeric-Boswellia formulation was very effective for exercise-induced musculoskeletal pain irrespective of location and had a significant reduction in pain intensity for sensory as well as affective pain sensations.

Application of Transcutaneous Electrical Acupoint Stimulation (TEAS) for Management of Postoperative Pain After Gynecological Surgeries: A Meta-Analysis.

Transcutaneous Electrical Acupoint Stimulation (TEAS) is a noninvasive technique that involves the application of electrical stimulation to specific acupoints on the skin. This meta-analysis aimed to evaluate the clinical efficacy of TEAS in alleviating postoperative pain after gynecological surgeries. A systematic search of multiple electronic databases was carried out to identify relevant studies that investigated the use of TEAS for postoperative pain management in gynecological surgery settings. After screening and data extraction, a total of 10 randomized controlled trials (RCTs) were included in the meta-analysis. The results of the meta-analysis showed that TEAS was associated with reduction in postoperative pain intensity compared to control interventions, such as sham stimulation or conventional analgesics. However, this reduction was statistically insignificant (p > .05). Additionally, TEAS was found to be effective in reducing the consumption of analgesic medications and improving patient satisfaction with pain management. The assessment of certainty of evidence revealed a grading of low to moderate. Overall, the findings of this meta-analysis suggest that TEAS may be a promising adjunctive therapy for alleviating postoperative pain in gynecological surgery patients. However, caution should be exercised when interpreting the results and making clinical recommendations based on the low to moderate quality of the current evidence. Further high-quality studies are needed to confirm these results and establish optimal treatment protocols for TEAS in this patient population.

Data Insights on the Risks of Local Heat and Massage in Gouty Arthritis Treatment.

Gouty arthritis is a common inflammatory condition caused by the deposition of uric acid crystals in the joints, leading to intense pain, swelling, and functional impairment. Thermal therapies, including hot and cold fomentation, are often used as adjunctive treatments for managing inflammation and pain in various musculoskeletal conditions. However, the efficacy of these therapies in acute gout remains underexplored. This study aims to compare the effects of hot fomentation versus cold fomentation in patients experiencing acute gout flares, assessing pain reduction, swelling, joint mobility, and overall patient satisfaction. A randomized controlled trial was conducted with 2,400 patients diagnosed with acute gouty arthritis, divided into two equal groups: Group A received hot fomentation (38°C-42°C) and Group B received cold fomentation (5°C-10°C). Both interventions were applied twice daily for 20 min over 5 days, alongside standard gout care. Pain intensity was measured using the visual analog scale (VAS), while joint circumference, range of motion, and patient satisfaction were recorded at baseline, day 3, and day 5. Statistical analyses compared outcomes between the two groups. Cold fomentation significantly reduced pain intensity (VAS score reduction of 68% by day 5) compared to hot fomentation (26% reduction, P < 0.001). Joint swelling decreased by 25% in the cold group versus 5% in the hot group, with cold therapy also leading to greater improvements in joint mobility (average increase of 15° vs. 5°, P < 0.01). Notably, 35% of patients in the hot fomentation group experienced flare-ups, compared to only 2% in the cold fomentation group (P < 0.001). Patient satisfaction was also higher in the cold group, with 85% of participants reporting satisfaction versus 30% in the hot group. This study demonstrates that cold fomentation is significantly more effective than hot fomentation in managing acute gouty arthritis. Cold therapy provided superior pain relief, reduced swelling, improved joint mobility, and minimized the risk of symptom exacerbation. In contrast, hot fomentation often worsened symptoms, making it unsuitable for acute gout management. These findings suggest that cold fomentation should be the preferred thermal therapy for gout flare-ups, while heat applications should be avoided.

Efficacy of Duloxetine for Postspine Surgery Pain: A Systematic Review and Meta-Analysis.

Duloxetine, a serotonin and norepinephrine reuptake inhibitor (SNRI), is used to treat various health conditions, including major depressive disorder, generalized anxiety disorder, fibromyalgia, and off-label for chemotherapy-induced pain. We conducted this systematic review and meta-analysis aiming to test the current evidence regarding effectiveness and safety of duloxetine for postspine surgeries pain. We searched the Cochrane Central Register of Controlled Trials, PubMed, Scopus and Web of science databases for relevant articles up to March 2024. The following search terms were Used in combination using the Boolean operators ((Duloxetine Hydrochloride) AND ((Pain, Postoperative) OR (Postoperative Period) OR (Postoperative Cognitive Complications) OR (Delayed Emergence from Anesthesia) OR (Postoperative Care) OR (spine surgery)) without time constrain for the search. Meta-analysis was performed using Review Manager (RevMan version 5.4) on the extracted outcome data that present in at least 3 of the included studies. Mean difference (MD) was used as the effect size for continuous outcomes with a 95% confidence interval (CI) or standardized mean difference (SMD) in case of different outcome reporting scales. Pooled analysis showed that duloxetine significantly reduces pain intensity after 24 h from the operation compared to placebo (SMD = -1.11, 95% CI [-2.16 to -0.07], p = 0.04) with no significant difference in pain after 2 and 48 h. Meta-analysis revealed that duloxetine shows a significant reduction in the amount of analgesic consumption after 24h postoperative; (MD = -3.33, 95% CI [-5.53 to -1.13], p = 0.003). The analysis did not show any statistically significant difference between duloxetine and placebo in patients experiencing nausea or vomiting (RR = 1.37, 95% CI [0.62 to 3.00] CONCLUSION: The findings of this study suggest that duloxetine may be effective in reducing pain 24h after spine surgery. Furthermore, there is a promising effect of duloxetine in treating chronic postoperative pain. However, it is important to acknowledge that further research is warranted to thoroughly evaluate the efficacy and safety of duloxetine for relieving chronic postoperative pain.

Local Application of Honey for Postoperative Pain Management and Associated Outcomes Following Tonsillectomy in Children: A Systematic Review and Meta-Analysis.

This study investigates the effect of locally applied honey on pain intensity, analgesia consumption, pain relief and nighttime awakenings in children following tonsillectomy, addressing conflicting evidence and the lack of differentiation between adult and paediatric populations in previous reviews. A systematic search was conducted across multiple databases, including Cochrane Library, ClinicalTrials.gov, MEDLINE, Web of Science and Google Scholar. Randomised controlled trials (RCTs) comparing pain outcomes in children receiving honey in addition to standard treatments versus those receiving standard treatments alone were included. Pain intensity was measured with the VAS tool. Meta-analysis was performed using STATA version 14 software. Also, risk of bias and certainty of evidence were evaluated. Out of 537 articles, seven studies (n = 710) with RCT design met the inclusion criteria. The average duration for measuring pain intensity was 7.37 days. Pooled effect size showed a statistically significant reduction in pain intensity in the honey intervention group compared to the control group (WMD: -0.90, 95% CI [-1.32, -0.48], p < 0.001, I2: 92.5%; certainty of evidence: low). Also, the results demonstrated that honey significantly decreased the average time required for pain relief and analgesic consumption in the intervention group compared to the control group. One study was deemed low risk of bias, four studies were of intermediate quality and two studies were evaluated as high. While honey shows promise in reducing post-tonsillectomy pain, cautious use is advised due to the limited quality of evidence. More robust RCTs are needed to address biases and reinforce confidence in the findings.

Bitter Orange Aromatherapy: A Natural Solution to Reduce Pain During the First Stage of Labor

Labor pain is a significant challenge for expectant mothers, affecting both the psychological and physiological aspects of pregnant woman. Non-pharmacological pain management approaches, such as aromatherapy, have gained attention for their effectiveness and minimal side effects. This study aimed to assess the impact of bitter orange aromatherapy on reducing labor pain during the first stage of labor at Inpatient Clinic Pratama Ibu Hawa in 2024. A quasi-experimental design with pre-test and post-test measures was employed, involving 22 multigravida women in active labor. The intervention group received bitter orange aromatherapy via a diffuser for 60 minutes, while the control group received standard care. Pain intensity was measured using the Visual Analog Scale (VAS). The results indicated a significant reduction in pain intensity after the intervention, with a notable shift from moderate to mild pain in the experimental group (p = 0.000, 95% CI = (5.098-8.876). These findings suggest that bitter orange aromatherapy is an effective non-pharmacological intervention for reducing labor pain, improving maternal comfort, and enhancing the overall labor experience. The study highlights the potential for integrating aromatherapy into routine maternal care, offering an accessible and cost-effective alternative to pharmacological methods. Further research is needed to explore its broader application and long-term benefits in various clinical settings.

Efficacy and safety of low-intensity ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis.

Myofascial Pain Syndrome (MPS) is a common pain disorder characterized by the presence of trigger points within the muscles or fascia. Low-intensity ultrasound therapy, as a noninvasive modality, has indeed found application in the management of MPS, but its efficacy for myofascial pain syndrome has still been controversial. The objective of this systematic review was to assess the safety and efficacy of low-intensity ultrasound therapy for MPS. We searched PubMed, Embase, PEDro, Web of Science, and CENTRAL for RCTs on ultrasound therapy in MPS patients. We included RCTs comparing ultrasound with other therapies or placebo-sham ultrasound. Clinical outcomes included pain scores and physical functional performance. Risk of bias and heterogeneity were assessed. Two authors of the review independently evaluated the risk of bias of each trial and extracted the data. This systematic review included sixteen RCTs involving a total of 1063 participants with MPS. None of the included studies reported adverse events. Comparing with sham or no treatment, the application of low-intensity ultrasound yielded additional benefits for pain (SMD [CI] = - 1.04 [- 1.72, - 0.36], P < 0.0003), with high heterogeneity (χ2 = 116.63, P < 0.00001, I2 = 91%). Patients receiving low-intensity ultrasound had improved on pressure pain threshold. Compared with other treatments, there were no differences in outcomes functional scores. The current study indicates that low-intensity ultrasound effectively reduces pain intensity in MPS patients. The heterogeneity regarding the parameters of ultrasound, including frequency, intensity, time was found to be high among the included studies. Each therapeutic modality works differently in various situations and may lead to multitudinous effects. The positive impact of low-intensity ultrasound on functional improvement needs to be further analyzed through more high-quality clinical trials with large sample sizes in the future. This study was registered on the following website: https://www.crd.york.ac.uk/PROSPERO/ . The PROSPERO registered ID is CRD42023472032.

Resolution of Nonspecific Low Back Pain in Athletes with Core Stability Exercises: A Systematic Review

Abstract Background: Complaints of nonspecific low back pain (NSLBP) have been reported by several athletes, which consequently affects their sports performance. The integration of local trunk muscles and sensory processes necessary for stability and reducing back pain can be impacted using core stabilization exercises. The current review aims to synthesize evidence that evaluates the effect of core stability exercises (CSE) in athletes with NSLBP. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to conduct this systematic review. The Physiotherapy Evidence Database and various electronic databases in the English language, such as PubMed, the Cochrane Library, Google Scholar, and other search engines, were searched for relevant research that had been published between 2018 and 2022. Results: Out of 18,016 studies on the initial search, 16,766 studies were removed because they were duplicates, ineligible by automation tools, and after title screening. An abstract review was done for the remaining 1250 studies. Five articles were initially included in this systematic review but eventually, in 2022, one of the articles was retracted from the public domain. Four full-text randomized controlled trials on core strengthening in athletes with NSLBP were assessed for eligibility and were included in this qualitative review. Conclusions: The findings from the included studies indicate that CSE significantly reduces pain intensity and disability, thereby playing a crucial role in the management of NSLBP. CSE should be considered when managing NSLBP in athletes, with a potential for even greater benefits when combined with other therapies.

Effectiveness of pharmacological therapies for fibromyalgia syndrome in adults: an overview of Cochrane Reviews.

To summarise and evaluate Cochrane reviews of pharmacological therapies for adults with fibromyalgia syndrome (FMS) pain. Systematic search of Cochrane Database of Systematic Reviews to May 2024. Generic quality assessment used AMSTAR-2 criteria, validity checks of potentially critical factors in evaluation of analgesic efficacy, and assessment of susceptibility of results to publication bias. Pain outcomes were participant-reported pain relief of ≥ 30% or ≥ 50%, or PGIC much or very much improved. Twenty-one reviews (87 trials, 17,631 patients) were included. All rated moderate (15) or high-quality (6) using AMSTAR-2 and at least seven of eight critical pain criteria were met by 13 of 21 reviews. Diagnosis of FMS used recognised criteria. Seven reviews found no trials (carbamazepine, clonazepam, lamotrigine, phenytoin, oxycodone, topiramate, or valproate), seven had limited and inadequate data (antipsychotics, cannabinoids, combination therapy, gabapentin, lacosamide, monoamine oxidase inhibitors, NSAIDs), and two were subject to publication bias (amitriptyline, SSRI). Mirtazapine had moderate evidence of no effect. Duloxetine, milnacipran, and pregabalin had moderate/good evidence of substantial pain relief for 4-12 weeks in around 1 in 10 adults with moderate or severe FMS pain, without evidence of efficacy beyond six months. Serious adverse events were no more common than with placebo. There was no evidence about who might benefit or experience adverse events. There was no substantial efficacy evidence for other medicines. Duloxetine, milnacipran, and pregabalin had good evidence that about 1 person in 10 with moderate or severe pain experienced pain intensity reduction by at least 50%.

Effectiveness of pharmacological therapies for fibromyalgia syndrome in adults: an overview of Cochrane Reviews.

To summarise and evaluate Cochrane reviews of pharmacological therapies for adults with fibromyalgia syndrome (FMS) pain. Systematic search of Cochrane Database of Systematic Reviews to May 2024. Generic quality assessment used AMSTAR-2 criteria, validity checks of potentially critical factors in evaluation of analgesic efficacy, and assessment of susceptibility of results to publication bias. Pain outcomes were participant-reported pain relief of ≥ 30% or ≥ 50%, or PGIC much or very much improved. Twenty-one reviews (87 trials, 17,631 patients) were included. All rated moderate (15) or high-quality (6) using AMSTAR-2 and at least seven of eight critical pain criteria were met by 13 of 21 reviews. Diagnosis of FMS used recognised criteria. Seven reviews found no trials (carbamazepine, clonazepam, lamotrigine, phenytoin, oxycodone, topiramate, or valproate), seven had limited and inadequate data (antipsychotics, cannabinoids, combination therapy, gabapentin, lacosamide, monoamine oxidase inhibitors, NSAIDs), and two were subject to publication bias (amitriptyline, SSRI). Mirtazapine had moderate evidence of no effect. Duloxetine, milnacipran, and pregabalin had moderate/good evidence of substantial pain relief for 4-12 weeks in around 1 in 10 adults with moderate or severe FMS pain, without evidence of efficacy beyond six months. Serious adverse events were no more common than with placebo. There was no evidence about who might benefit or experience adverse events. There was no substantial efficacy evidence for other medicines. Duloxetine, milnacipran, and pregabalin had good evidence that about 1 person in 10 with moderate or severe pain experienced pain intensity reduction by at least 50%.

Effect of shockwave therapy on plantar fasciitis in postnatal women: a randomized controlled trial

BackgroundPlantar fasciitis (PF) is a widespread foot issue that can be especially frustrating during pregnancy; it is accompanied by pain in the heel, falling, disability, and reduced quality of life (QoL). This study aimed to explore the efficacy of shockwave therapy (SWT) on PF in postnatal women.Material and methodsForty-four postnatal women with PF were randomly distributed into two groups equal in number. Group (A) was given analgesic drugs (Ibuprofen 200 mg, one tablet/day) and performed plantar fascia-stretching exercises only for 6 weeks, while group (B) followed the same treatment as group (A) plus SWT, twice weekly for 6 weeks. All participating women in both groups were evaluated pre- and post-treatment through the Numeric Pain Rating Scale (NPRS) to evaluate pain intensity levels, the Foot Function Index (FFI) to evaluate foot pain and disability related to PF, and the Six-Minute Walk Test (SMWT) to evaluate the functional exercise capacity and QoL of the affected women.ResultsBoth groups showed significant improvements in all outcomes post-treatment (p = 0.001). Group B demonstrated superior improvements in NPRS (p = 0.001), FFI (p = 0.022), and SMWT (p = 0.001) compared to group A.ConclusionShockwave therapy is a beneficial method for reducing pain intensity, enhancing foot functional level, and improving QoL of postpartum women with plantar fasciitis.

Complementary Approaches to Postoperative Pain Management: A Review of Non-pharmacological Interventions.

Postoperative pain significantly affects many surgical patients. While opioids are crucial for pain management, they come with unwanted side effects. Alternatives like nonsteroidal anti-inflammatory drugs, N-methyl-D-aspartate (NMDA) receptor antagonists, and regional anesthesia techniques such as nerve blocks are utilized, but these also have limitations. This underscores the need for complementary non-pharmacological interventions to enhance postoperative pain control and reduce opioid dependence. This study aimed to synthesize evidence on the efficacy of nondrug approaches for managing postoperative pain. The study examined the effects of non-pharmacological interventions such as preoperative patient education, mind-body modalities, and physical therapies. Findings suggest that these approaches can reduce pain intensity, decrease opioid consumption, and enhance recovery outcomes. The study also highlighted the pivotal role of healthcare professionals in implementing these strategies. However, it identified workload constraints and insufficient training as barriers to effective utilization in clinical practice. Integrating non-pharmacological interventions into multimodal pain management regimens can improve postoperative pain control and reduce reliance on opioids. Further research is crucial to definitively establish the efficacy of individual interventions and optimize their combined use in clinical practice. Additionally, enhanced training programs for nurses and initiatives to facilitate the implementation of these strategies are necessary for their successful adoption.

Complex treatment of patients with chronic non-specific back pain and comorbid disorders: a prospective clinical study

A complex approach including an educational program, ergonomics, kinesiotherapy and pharmacotherapy is effective in the treatment of patients with chronic non-specific back pain (CNBP). The efficacy of complex treatment with personalized kinesiotherapy in patients with CNBP and comorbid disorders has not yet been sufficiently investigated.Objective: to evaluate the efficacy of a complex treatment including special kinesiotherapy, standard pharmacological and non-pharmacological methods in patients with CNBP and comorbid disorders.Material and methods. The study included 60 patients (12 men and 48 women, mean age 38.3±8.7 years) with CNBS and comorbid disorders (neck pain, insomnia, tension type headaches, anxiety and/or depressive symptoms). Patients were randomized into two groups: group 1 received complex treatment, including special kinesiotherapy, standard therapy (educational program, standard kinesiotherapy, non-steroidal anti-inflammatory drugs, muscle relaxers, antidepressants in some patients), group 2 – standard therapy. The clinical and psychological parameters of all patients were analyzed at baseline, and after 1, 3 and 6 months of treatment.Results. After 1 month of treatment, the clinical effect (CE) in terms of CNBS (reduction of back pain (BP) intensity according to the numerical rating scale and Oswestry questionnaire by 30% or more) was achieved in 80% of patients in group 1, which is statistically significantly (p&lt;0.05) higher than in group 2 (46.7% of patients). By month 3 of observation, the number of patients achieving CE increased to 86.7% in group 1 and decreased to 36.6% in group 2. After 6 months, all patients in group 1 maintained the achieved CE, while in group 2 only 30% of patients maintained CE. In group 1, a complete regression of BP was observed in more than one third of patients at month 3 and 6 of observation (33.3 and 36.6%, respectively). In group 2, no regression of BP was observed in any case. In group 1, in contrast to group 2, a statistically significant (p&lt;0.05) decrease in scores on the Beck Pain Catastrophizing Scale, the Kinesiophobia Scale, Beck Anxiety and Depression Scale, the Insomnia Severity Index, Headache Impact Index and Neck Pain Disability Index was observed. The decrease continued until the 6th month of observation.Conclusion. A complex treatment comprising special kinesiotherapy, standard non-drug and drug therapy leads to a rapid (after 1 month) positive effect in patients with CNBP and comorbid disorders that lasts over a long period of time (6 months).

Balancing Tradition and Science: Acupuncture in Pain Control

Introduction: Pain management is a critical component of healthcare, addressing acute and chronic conditions that significantly impact quality of life. Traditional pharmacological approaches, while effective, often present side effects and dependency risks. Acupuncture, rooted in traditional Chinese medicine, has emerged as a complementary and alternative therapy, leveraging the body’s natural mechanisms to alleviate pain through the strategic insertion of fine needles at acupoints. Purpose of Work: This research investigates the role of acupuncture in pain management, examining its efficacy across various pain conditions, understanding its physiological mechanisms, and evaluating its integration into modern medical practice. It seeks to assess the scientific evidence supporting acupuncture and its potential as a non-pharmacological pain management strategy. State of Knowledge: Studies have demonstrated acupuncture's effectiveness in reducing pain intensity for conditions such as migraines, osteoarthritis, fibromyalgia, and postoperative pain. Mechanistic research highlights its role in modulating neural pathways, enhancing endogenous opioid release, and reducing inflammation. Guidelines from health organizations now recognize acupuncture as a viable option in multidisciplinary pain management. Material and methods: The study methodology entailed defining the objectives, conducting a systematic literature search, and implementing a structured process for screening relevant studies. The research encompassed a comprehensive search across scientific databases, such as PubMed and Google Scholar. Summary: Acupuncture presents a promising, evidence-supported intervention for pain management. By combining traditional techniques with modern scientific insights, acupuncture addresses the growing need for holistic, safe, and effective approaches to alleviating pain and enhancing patient well-being.

Effect of Transcutaneous Auricular Vagus Nerve Stimulation in Chronic Low Back Pain: A Pilot Study.

Background/Objectives: Chronic low back pain (CLBP) is a common condition with limited long-term treatment options. Vagus nerve stimulation (VNS) has shown potential for pain improvement, but its use in CLBP remains underexplored. Our aim was to evaluate the efficacy, feasibility and tolerability of transcutaneous auricular vagus nerve stimulation (taVNS) in reducing pain and improving functional outcomes in CLBP patients. Methods: Thirty adults with CLBP (VAS ≥ 40/100) participated in this open-label pilot study (NCT05639270). Patients were treated with a taVNS device on the left ear for 30 min daily over a period of 3 months. The primary outcome was a reduction in pain intensity (VAS) at 1 month. Secondary outcomes included pain intensity at 3 months, disability (Oswestry Disability Index, ODI), quality of life (EQ-5D-5L), catastrophizing and psychological distress. In addition, compliance and adverse events were monitored. Results: After 1 month, 27 patients were evaluated. VAS scores decreased significantly by 16.1 (SD = 17.9) mm (p < 0.001) and by 22.5 (25) mm (p < 0.001) after 3 months (24 patients were analyzed). Functional disability improved with an average reduction in ODI of 11.9 (11.1) points (p < 0.001) after 3 months. Other patient-reported outcomes also improved significantly over the 3-month period. Overall, 51.9% of the patients achieved clinically meaningful pain reduction (≥20 mm), and no serious adverse events were reported. Treatment adherence was good, with half of the patients achieving 80% adherence. Conclusions: This pilot study suggests that taVNS is a feasible, safe and potentially effective treatment for CLBP that warrants further investigation in a randomized controlled trial compared to sham stimulation.

Impact of Sport on the Course of Endometriosis

Endometriosis is a common condition affecting approximately 10% of women of reproductive age and leads to many unpleasant symptoms, such as pelvic pain, painful intercourse, and fertility issues. Although treatment primarily involves surgical and hormonal approaches, growing evidence suggests that physical activity may play a beneficial role in alleviating symptoms of the disease. The aim of this paper is to review the literature on the impact of physical activity on the symptoms of endometriosis and evaluate the role of exercise in improving the quality of life for patients. Available research indicates that regular physical activity, including aerobic and strength exercises, can reduce pain intensity, improve well-being, and decrease the need for pain medications. Additionally, exercise positively affects mental health, reducing stress, anxiety, and depression, which, in turn, improves the course of the disease. The findings suggest that physical activity should be considered an integral part of endometriosis treatment, serving as a supportive therapeutic approach. However, further controlled studies and long-term observations are necessary to determine the optimal type, intensity, and frequency of exercise for women with endometriosis.