Treatment Of Pain Research Articles

Smart pain relief: Harnessing conservative Q learning for personalized and dynamic pain management

Pain represents a multifaceted sensory and emotional experience often linked to tissue damage, bearing substantial healthcare costs and profound effects on patient well-being. Within intensive care units, effective pain management is paramount. However, determining suitable dosages of primary pain management drugs like morphine remains challenging due to their reliance on diverse patient-specific factors, including cardiovascular responses and pain intensity. To date, only a singular effort has explored personalized pain treatment recommendations through reinforcement learning. Regrettably, this pioneering study faced limitations stemming from incomplete patient state observations, a restricted action space, and the use of Deep Q-Networks, known for their sample inefficiency and lack of clinical interpretability. In our work, we introduced a Conservative Q-learning-based system for pain recommendation, enriching it with expanded state and action spaces. Additionally, we developed a comprehensive pipeline for both qualitative and quantitative evaluations, focusing on assessing the trained model’s performance. Our findings indicate a slight performance improvement over the clinician’s policy, offering a more clinically sensible and understandable approach compared to the current state-of-the-art methodologies.

430 Decreasing Time to Initial Pain Intervention in the Pediatric Emergency Department

430 Decreasing Time to Initial Pain Intervention in the Pediatric Emergency Department

Understanding Medical Cannabis: A Simple Guide to CBD and THC

There is an ongoing debate in the literature about the place of cannabinoid therapy in everyday clinical practice. The overview examined systematic reviews and meta-analyses on the use of medical marijuana (MM) in specific or diseases, such as epilepsy, multiple sclerosis, pain, nausea and vomiting during chemotherapy, cachexia, and sleep disorders. We analyzed different cannabinoids like CBD, THC, dronabinol, nabilone, and THC:CBD combinations (Nabiximol) to understand their effects on various medical conditions, dose effectiveness, and side effects. CBD showed promise epilepsy, Nabilone showed a significant reduction in pain and insomnia, Nabiximol has been effective in reducing spasticity, pain, and sleep disturbance in multiple sclerosis patients. Nabilone and dronabinol improve nausea and vomiting due to chemotherapy, but the evidence is low. The results on the effectiveness of MM in the treatment of cachexia and cancer pain are inconclusive. Outcomes suggest that side effects typically were mild to moderate in severity. The type of cannabinoid (including CBD and THC content) and amount of dose, were found to potentially influence the results obtained in the trials, affecting both the effectiveness and the side effects experienced by patients. Young people, elderly, and children are particularly vulnerable and, despite ongoing research in these age groups, we still know too little about whether and in which clinical conditions the use of medical cannabis is justified. The analyzed studies faced limitations due to heterogeneity in methodology, dosages, and outcome measures and highlighting potential controversies in interpreting the results, so further research is needed.

Epidural Steroid Injections and Fracture Incidence Among Older Individuals with Radiculopathy.

Epidural steroid injections (ESIs) are a common and often effective treatment for radicular back pain. While oral glucocorticoids increase fracture incidence, little is known regarding fracture risk after ESI. This study investigated the incidence of fractures among individuals who received ESI and those who did not. We hypothesized that ESI exposure would be associated with an increased incidence of osteoporotic fracture and specifically vertebral fractures. Using 2005-2018 5% Medicare data, individuals with radicular pain who had ≥1 ESI and those who did not (non-ESI) were matched 1:10 by age, sex, and month of radicular pain diagnosis using exposure density sampling (EDS). Using a high-dimensional propensity score (HDPS) calculated based on the top 500 covariates across multiple data dimensions, ESI and non-ESI individuals were matched 1:1. Fractures were identified using validated ICD-9/10 diagnosis codes. Fracture incidence rate (IR) was calculated by group, and hazard ratios (HR) compared using Cox regression. 25 062 ESI patients and 221 735 non-ESI patients who met eligibility criteria were identified using EDS. Mean age was 76years (74% female). Among ESI-treated individuals, there were 2296 fractures, IR 49.1 (95% CI: 47.2-51.2) per 1000 person years. For non-ESI individuals, there were 11 917 fractures, IR 35.2 (95% CI: 34.5-35.8). Individuals who received ESI had a greater hazard of fracture at typical osteoporotic sites, HR 1.39 (95% CI 1.33-1.46) by EDS and 1.32 (1.12-1.54) by HDPS, and greater hazard of vertebral fracture, 1.54 (1.45-1.64) by EDS and 1.69 (1.38-2.07) by HDPS. Patients who received greater cumulative ESI doses (≥3 in 1year) had a higher risk of fractures within the first six months of follow-up. ESI exposure in older individuals is associated with an increased risk of fracture, suggesting there may be lasting detrimental skeletal effects of ESI. Further research into strategies to reduce fracture risk in this population is warranted.

Chronic Pain and Chronic Bias in Women’s Healthcare

Gender bias against women with respect to the treatment of chronic pain is evident in several ways. Recent studies reveal that women receive poorer pain management care and have less access to such care. Such disparities are further perpetuated in the type of pain management offered to females in the form of psychotherapy as compared to men who typically receive pharmacological medications. The 2023 documentary Below the Belt shows real life journeys of women battling endometriosis, illustrating how the medical system in modern America marginalizes female pain management. Women’s health issues receive less research funding, inspiring the gender biases that are prevalent across all aspects of medical healthcare and healthcare research. In addition, a lack of focus on gender and sex disparities in medical school curricula further perpetuates the problem, as medical practitioners are not educated on the differences in experience between populations. Raising issues of gender awareness and differences in care for males and females at the start of the medical journey enables the issue of gender bias in medical care to be dealt with at the root of the system. This paper aims to highlight the impact of gender bias in women’s healthcare for chronic pain within every step of the medical process.

Therapeutic Efficacy of Adipose Tissue-Derived Components in Neuropathic Pain: A Systematic Review

Background: Neuropathic pain results from a defect in the somatosensory nervous system caused by a diversity of etiologies. The effect of current treat-ment with analgesics and surgery is limited. Studies report the therapeutic use of adipose tissue-derived components to treat neuropathic pain as a new treatment modality. Objective: The aim of this systematic review was to investigate the therapeutic clinical efficacy of adipose tissue-derived components on neuro-pathic pain. Methods: PubMed, Medline, Cochrane and Embase databases were searched until August 2023. Clinical studies assessing neuropathic pain after autologous fat grafting or the therapeutic use of adipose tissue-derived com-ponents were included. The outcomes of interest were neuropathic pain and quality of life. Results: In total, 433 studies were identified, of which 109 dupli-cates were removed, 324 abstracts were screened and 314 articles were excluded. In total, ten studies were included for comparison. Fat grafting and cellular stromal vascular fraction were used as treatments. Fat grafting indications were post-mastectomy pain syndrome, neuromas, post-herpetic neuropathy, neuro-pathic scar pain and trigeminal neuropathic pain. In seven studies, neuropathic pain levels decreased, and overall, quality of life did not improve. Conclusions: The therapeutic efficacy of adipose tissue-derived components in the treatment of neuropathic pain remains unclear due to the few performed clinical trials with small sample sizes for various indications. Larger and properly designed (randomized) controlled trials are required.

Local and Systemic Peptide Therapies for Soft Tissue Regeneration: A Narrative Review.

Background: The musculoskeletal system, due to inherent structure and function, lends itself to contributing toward joint pain, whether from inflammatory disorders such as rheumatoid arthritis, degenerative diseases such as osteoarthritis, or trauma causing soft tissue injury. Administration of peptides for treatment of joint pain or inflammation is an emerging line of therapy that seeks to offer therapeutic benefits while remaining safe and relatively non-invasive. Purpose: The purpose of this study is to review the current literature on existing oral peptide agents, intra-articular peptide agents, and new developments in human trials to assess route of administration (RoA) for drug delivery in terms of soft tissue regeneration. Study Design: Narrative Review. Methods: A comprehensive literature search was conducted using the PubMed database. The search included medical subject headings (MeSH) terms related to peptide therapy, soft tissue regeneration, and RoA. Inclusion criteria comprised articles focusing on the mechanisms of action of peptides, clinical or biochemical outcomes, and review articles. Exclusion criteria included insufficient literature or studies not meeting the set evidence level. Conclusion: The review identified various peptides demonstrating efficacy in soft tissue repair. Oral and intra-articular peptides showed distinct advantages in soft tissue regeneration, with intra-articular routes providing localized effects and oral routes offering systemic benefits. However, both routes have limitations in bioavailability and absorption. Still in their infancy, further inquiries/research into the properties and efficacy of emerging peptides will be necessary before widespread use. As a viable alternative prior to surgical intervention, peptide treatments present as promising candidates for positive outcomes in soft tissue regeneration.

Nigella sativa oil on chronic constrictive injury (CCI) induced neuropathic pain of sciatic nerve in Wistar rats

Background: Various adverse effects have been reported with conventional treatments of neuropathic pain. Nigella sativa (N. sativa), a medicinal herb, has been shown to possess several beneficiary effects. Objective: To assess the effects of N. sativa oil on neuropathic pain and ATP sensitive potassium channel (KATP) in Wistar rats. Methods: This experimental study was conducted on 120 Wistar rats (200±50gm). On the basis of treatments, all rats were grouped into Group I [normal control (NC) normal saline (NS) 5 ml/kg]; Group II [sham control (SC) {sham surgery + NS}], Group III [CCI control (CCIC) {Chronic constriction injury to sciatic nerve (CCI) + NS}]; Group IV [N. sativa oil experimental (NSOexp) {CCI + N.sativa (400 mg/kg)}], Group V [Glibenclamide experimental (Gliexp) {CCI + N. sativa (400 mg/kg) + glibenclamide (15 mg/kg)}] groups. Both the NSO and NS were administered orally once daily for consecutive 21 days and single dose of glibenclamide was given intraperitoneally on the day of experiment, to the respective rats. Then on the basis of neuropathic pain evaluation tests, all the groups were subdivided into ‘a’ [for sciatic functional index (SFI) in walking track analysis], ‘b’ [for tail flick latency (TFL) in cold tail immersion test], ‘c’ [for paw withdrawal threshold (PWT) in von Frey test], and ‘d’ (for rection time in hot plate test). The statistical analysis was done by one way ANOVA followed by Bonferroni post hoc test. Results: In this study, significantly (pd”0.001) higher SFI, TFL, PWT and reaction time were found in NSO exp rats when compared to those of CCIC rats. In addition, there were significant (pd”0.001) differences in the above-mentioned variables between rats of NSO exp group and Gliexp group. Conclusion: From the present study it might be concluded that, N. sativa prevents worsening of neuropathic pain in Wistar rats by blocking KATP channel. J Bangladesh Soc Physiol 2023;18(1): 35-45

Psychological Interventions for Chronic Pain: An Umbrella Review of Systematic Reviews and Meta-Analyses of Randomized Controlled Trials

Background: There is a continuous increase in the number of studies showing that psychological interventions help reduce chronic pain. Systematic review studies that analyze the effect are also increasing. The aim of this umbrella review was to synthesise the best available research evidence for the effectiveness of standardised psychological interventon for adults with chronic pain.Methods: Using MEDLINE (PubMed) and Cochrane CENTRAL search engines, four systematic reviews met the study criteria, including 60 randomized control trials and 7,025 patients with chronic pain.Results: Compared to waiting control and treatment as usual, psychological interventions displayed medium effect sizes for pain intensity (SMD −0.35, CI −0.42 to −0.29, 4 reviews, N=4,061), pain disability (SMD −0.44, CI −0.51 to −0.36, 3 reviews, N=2,609), and physical functioning (SMD 0.38, CI 0.29 to 0.48, 2 reviews, N=1,699). Additionally, psychological interventions exhibited a medium effect size in reducing pain intensity (SMD −0.34, CI −0.42 to −0.26, 2 reviews, N=2,508) and pain disability (SMD −0.43, CI −0.51 to −0.35, 2 reviews, N=2,563) in chronic low back pain.Conclusions: The results reaffirm that psychological interventions, along with drug or conventional treatments, can be helpful in managing chronic pain.

12. vascular pain Ischemic pain in the extremities and Raynaud's syndrome.

Peripheral artery diseases (PAD) and Raynaud's syndrome are associated with substantial morbidity. PAD, through the restriction of blood flow to the extremities, may lead to critical limb ischemia with symptoms of pain at rest which may eventually progress to severe limb ischemia with gangrene. This serious and painful clinical condition requires extensive medical care, is limb-threatening and, in case of delayed or unsuccessful treatment, is associated with a high mortality rate. In Raynaud's syndrome, the blood supply to certain parts of the body, usually the fingers and toes and less frequently the nose or ears, is restricted because of vasculopathy of the smaller vessels at acral sites. Under certain circumstances, with cold as the most well-known provoking factor, blood flow restriction occurs, leading to demarcated color changes and symptoms such as pain, paresthesia, and numbness. In severe cases of Raynaud syndrome tissue ischemia may lead to necrosis and the need for amputation of the affected area. In this narrative review, the literature on the diagnosis and interventional pain treatment of PAD and Raynaud's syndrome was updated and summarized. This review focused on interventional pain treatment. In PAD, the effects of the intervention on limb salvage, ulcer healing, and ischemic pain were summarized. Additionally, results with respect to skin microcirculation and quality of life were reported if available. In Raynaud's syndrome, we focused on the effect of the intervention on peripheral blood flow metrics and pain intensity during attacks. In PAD, prevention and treatment of risk factors are important. Initially, conservative treatment and pharmacological therapy are preferred first-line therapies. However, when disease progression occurs, interventional management may be considered. The literature search yielded conflicting evidence for sympathectomy as a treatment for PAD. Spinal cord stimulation (SCS) as a treatment modality for advanced PAD had high-quality evidence for limb salvage in subgroups of patients but conflicting evidence for other outcome measures such as pain, wound healing, and quality of life. The literature search for interventional pain management in Raynaud's syndrome was limited to only one randomized controlled trial (RCT) studying the effect of thoracic sympathectomy. This study had several limitations and hence the level of evidence for this interventional treatment is very low. No RCTs studying SCS in patients with Raynaud's syndrome were found. In both PAD and Raynaud's syndrome, additional RCTs are needed to substantiate interventional (pain) management and bolster the evidence base for sympathectomy and SCS as treatment options.

Efficacy of pain treatment therapies for chronic pain among clients in assisted living facilities: A systematic review

Background: More than 60% of residents in assisted living homes experience pain, a complex and subjective emotion. Here, we examine the effectiveness of pain management treatments for residents in assisted living facilities who suffer from chronic pain. Method: In this review, the PRISMA Statement was adhered to. Included were intervention studies, whether or not they were randomized. Retrospective studies, studies without a control group, and studies without an intervention were among the studies that were excluded. Subjects having chronic pain who were 60 years of age or older, of any gender, and permanently residing in an institutional environment, such as a assisted living facilities or residential care facility, were included in studies that matched the qualifying requirements. Result: Eight papers total—three non-randomized and five randomized controlled trials—were included in our systematic review. Acupuncture, massage, music therapy, and analgesics are among the interventions employed. Analgesics was the most effective intervention. Exercise had similar effects to social interventions on neuropsychiatric symptoms, pain, and medication intake in older adults with chronic pain; Epsom salt hot fermentation is more effective than regular salt; and acupressure is anticipated to be a beneficial and effective nursing intervention for the elderly with chronic pain. Conclusion: The most beneficial treatment outcome was obtained from the analgesic medication therapy. Alternative therapies without the use of drugs provide modest to significant therapeutic results.

Top 10 Clinical Pearls in Vasculitic Neuropathies.

Vasculitic neuropathies are a diverse group of inflammatory polyneuropathies that result from systemic vasculitis (e.g., polyarteritis nodosa, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis), vasculitis resulting from rheumatological disorders (e.g., rheumatoid arthritis and Sjögren's syndrome), paraneoplastic conditions, viruses, and medications. Occasionally, vasculitis is restricted to the peripheral nerves and termed nonsystemic vasculitic neuropathy. Presenting with an acute or subacute onset of painful sensory and motor deficits, ischemia to individual peripheral nerves results in the classic "mononeuritis multiplex" pattern. Over time, overlapping mononeuropathies will result in a symmetrical or asymmetrical sensorimotor axonal polyneuropathy. The diagnosis of vasculitic neuropathies relies on extensive laboratory testing, electrodiagnostic testing, and nerve and/or other tissue biopsy. Treatment consists primarily of immunosuppressant medications such as corticosteroids, cyclophosphamide, rituximab, methotrexate, or azathioprine, in addition to neuropathic pain treatments. Frequently, other specialists such as rheumatologists, pulmonologists, and nephrologists will comanage these complex patients with systemic vasculitis. Prompt recognition of these conditions is imperative, as delays in treatment may result in permanent deficits and even death.

Perceived Community Control in Adults with Acute Low Back Pain: A Community-Based Study

Background: Low back pain (LBP) is the leading cause of disability for individuals and societies globally. Prior investigations have predominantly centered around biological and psychological factors. Addressing social determinants is critical for enhancing the effectiveness and equity of pain interventions. We aimed to characterize social factors, sleep, and pain among adults with acute LBP, focusing on perceived community control. Methods: A community-based sample of adults with acute LBP was recruited from two cities in North Carolina, United States, and followed up at 3 months. We used descriptive statistics to characterize social factors, sleep, and pain, overall and by levels of perceived community control. Results: In total, 110/131 enrolled participants had data on perceived community control (lower scores indicate higher control). Overall, the median perceived community control was 14 (interquartile range [IQR] = 11, 15). People with high perceived community control also had, on average, higher perceived individual control, better-perceived neighborhood walkability, lower number of sites with bothersome comorbid pain, and higher sleep quality. A higher proportion of participants with high perceived community control were of male sex, White race, and had a higher socioeconomic position. Conclusions: Community control and related constructs may be further explored in future intervention development as potentially modifiable social factors that may reduce pain burden.

Pregabalin for the Treatment of Neuropathic Pain: A Systematic Review of Patient-Reported Outcomes

Pregabalin for the Treatment of Neuropathic Pain: A Systematic Review of Patient-Reported Outcomes

Analysis on Syndrome and Treatment of Shaoyin Cold Type Acute Tonsillitis

Acute tonsillitis belongs to the category of "milk moth" in traditional Chinese medicine. TCM clinical syndrome differentiation is often divided into two types: wind-heat pathogens affecting the lung meridian and dietary excess leading to heat accumulation in the lungs and stomach. The author's clinical practice found that some acute tonsillitis patients are often manifested as Shaoyin cold type, and the syndrome and treatment of general acute tonsillitis are totally different. "Throat Science Family Instructions" put forward the specific treatment of pharyngeal pain is Shaoyin typhoid type, and the prescription is Banxia Gangui Decoction, which is composed of eight kinds of drugs: Guizhi, Banxia, Fuling, Jiegeng, Yiyiren, Buguzhi, Ganjiang, and Zexie. It is traditionally used to treat symptoms such as sore throat, diarrhea, deep and thin pulse, and white tongue coating without thirst. Combining theory and clinical experience, the author reports successful clinical outcomes using this decoction to treat acute tonsillitis of the Shaoyin cold type. This paper aims to analyze the internal connection between Banxia Gangui Decoction and Shaoyin cold type acute tonsillitis. The paper outlines the symptom characteristics, etiology and pathogenesis, treatment based on syndrome differentiation, differential diagnosis of this condition, along with the therapeutic rationale for Banxia Gangui Decoction. A case study is included.

Back on track - digital health applications to treat back pain of rheumatic patients? Results of a qualitative interview study.

Non-specific low back pain (NLBP) is prevalent among patients with rheumatic conditions. Digital health applications (DiGAs) provide reimbursed, personalized home treatment for patients, promising to overcome limitations of traditional healthcare systems. However, the adoption and effectiveness of back pain-specific DiGAs in rheumatology are not well understood. This study aims to explore the experiences and perspectives of a diverse group of rheumatology stakeholders regarding the use of DiGAs for back pain management. Qualitative interviews and a focus group discussion were conducted with a wide range of stakeholders including rheumatic patients, rheumatologists, nurses and DiGA producers. The data were analysed using qualitative content analysis. The study included 15 interviews (10 rheumatic patients, 4 rheumatologists, 1 DiGA producer) and 1 focus group with mixed participants (n = 12). Most stakeholders valued the instant access to personalized and effective back pain treatment provided by DiGAs. Patients appreciated the flexibility and ease of use of DiGAs which can be used anywhere and anytime. Concerns were raised about insufficient guidance regarding correct execution of exercises, which was seen as potentially dangerous and unsettling for patients. Healthcare professionals (HCPs) highlighted barriers, such as the lack of reimbursement, time constraints, and inadequate DiGA-specific education as barriers to prescribing DiGAs. Additionally, poor patient onboarding often led to delays, increased skepticism, and premature discontinuation of therapy. Stakeholders emphasized the challenges of current care driven by a shortage of HCPs and generally supported usage of back pain DiGAs. Various barriers and solution approaches were identified to enhance the performance, usability, and implementation of DiGAs in rheumatology.

Exceeding the guideline-recommended maximum daily dose of opioids for long-term treatment of non-cancer pain in Germany – a large retrospective observational study

BackgroundHigh-dose long-term opioid therapy (LTOT) has been associated with increased mortality and hospitalizations. Therefore, the evidence-based German guideline on LTOT for chronic non-cancer pain (CNCP) recommends to only exceed the maximum daily dose (MDD) of opioids in exceptional cases. This study aimed to determine the portion of LTOT patients who exceeded the guideline-recommended MDD and identify predictors of exceeding in administrative claims data.MethodsThe retrospective observational analysis of opioid prescriptions in patients receiving LTOT for CNCP was based on administrative claims by a large German statutory health insurance company. Patients with at least two quarters of opioid prescriptions between January 2018 and June 2019 were included and followed up for two years. Predictors were identified by logistic regression. In addition, the number of patients still in opioid therapy and the extent of exceeded MDDs were analyzed over time.ResultsThe sample consisted of 113,475 patients. Overall, 10.5% of the patients exceeded the guideline-recommended MDD averaged over the observation period. Strong predictors for exceeding the MDD were receiving opioid prescriptions from > 7 physicians (OR = 7.66, p < .001), receiving predominantly strong opioids (OR = 6.79, p < .001) and receiving opioids for at least one year prior to inclusion (OR = 5.35, p < .001). Within the non-exceeding group, 28.1% discontinued opioid therapy. In contrast, 9.9% of patients in the exceeding group discontinued opioid therapy, whereas the vast majority remained on treatment until the end of the observation period. Furthermore, a slight increase in prescribed doses was observed over time.ConclusionsThe results indicate that a moderate proportion of patients exceeded the guideline-recommended MDD. However, certain patient groups were more likely to receive high doses. This applied in particular to those who were already on treatment at the time of inclusion and continued to receive opioids until the end of the observation period. Further research should examine whether the continuous opioid therapy among the patients with exceeding the guideline-recommended MDD might be related to specific indications, a lack of therapeutic options or avoidance of withdrawal.Trial registrationGerman Clinical Trials Register (drks.de/search/en). Identifier: DRKS00024854. Registered 28 April 2021.

Development of a Quality Evaluation Method for Allii Macrostemonis Bulbus Based on Solid-Phase Extraction–High-Performance Liquid Chromatography–Evaporative Light Scattering Detection Chromatographic Fingerprinting, Chemometrics, and Quantitative Analysis of Multi-Components via a Single-Marker Method

As a traditional Chinese medicine (TCM), Allii Macrostemonis Bulbus (AMB) is a key herb for the treatment of thoracic paralytic cardiac pain, but its quality evaluation method has not yet been fully clarified. In this study, chromatographic fingerprints of AMB were developed using solid-phase extraction–high-performance liquid chromatography–evaporative light scattering detection (SPE-HPLC-ELSD) to evaluate the quality of AMB from various origins and processing methods. This was achieved by employing chemical pattern recognition techniques and verifying the feasibility and applicability of the quality evaluation of AMB through the quantitative analysis of multi-components via a single-marker (QAMS) method. Through the analysis of the fingerprints of 18 batches of AMB, 30 common peaks were screened, and 6 components (adenosine, syringin, macrostemonoside T, macrostemonoside A, macrostemonoside U, and macrostemonoside V) were identified. Moreover, three differential markers (macrostemonoside A, macrostemonoside T, and macrostemonoside U) were screened out using chemometrics techniques, including principal component analysis (PCA), hierarchical cluster analysis (HCA), and orthogonal partial least squares discriminant analysis (OPLS-DA). Subsequently, a QAMS method was established for macrostemonoside T and macrostemonoside U using macrostemonoside A as an internal reference. The results demonstrate the method’s accuracy, reproducibility, and stability, rendering it suitable for the quality evaluation of AMB. This study provides a theoretical basis for drug quality control and the discovery of quality markers for AMB.

Efficacy of various forms of capsaicin in the treatment of neuropathic pain – literature review

Efficacy of various forms of capsaicin in the treatment of neuropathic pain – literature review

Patients’ reasons for consulting a general practitioner at the time of having dental problems: a qualitative study

IntroductionMany patients consult general practitioners instead of dentists for their oral and dental problems every year. This study aims to find the reasons why patients consult general practitioners when they have dental problems.MethodsThe sample consisted of patients visiting dentists and general practitioners in Kerman, Iran. A thematic interview guide, semi-structured questions, and a mind map that allowed for structured and open-ended questions were prepared and used for the interviews. All interviews were recorded and transcribed verbatim by a final-year student. Data collection, transcription, and analysis were conducted simultaneously to allow for new topics to be raised and theoretical saturation to be reached. When researchers determined that sufficient information was available for analysis and understanding of patient opinions and beliefs, the interview process was stopped. As all audio conversations were recorded with the participant’s permission, no note-taking was done during the interviews, which allowed for greater focus on the participants’ conversation. The obtained data was analyzed using the content analysis.ResultsA total of 52 patients were included in this study. The codes related to patients participating in this research, along with the number of respondent groups related to each code were as follows: patient’s perceptions of general practitioner(GP) and dental practitioner’s scope of work [21], flawed dental system (34), dental anxiety [28], financial considerations [25], and more accessibility to GPs (31). Dental abscesses and dental pain were reported as the most common reasons for consulting GPs.ConclusionMost participants agreed that dental problems are more effectively treated by dentists. Reasons for visiting a general practitioner included lack of a specific dentist, dissatisfaction with dental treatments, lack of a dentist nearby, absence of emergency dental care, and familiarity with a physician. The most common reasons for visits were toothache and dental abscesses. Patients also sought treatment for TMJ pain, referred nerve pain, wisdom tooth pain, numbness and tingling in the jaw, gum inflammation, oral lesions, and ulcers. Furthermore, other factors such as opening hours, appointment systems and waiting time can also affect patient’s consult behaviors regarding dental problems.