Prevention Of Pain Research Articles

Antipsychotic initiation in mechanically ventilated patients in a medical intensive care unit

Objectives: Guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients (PADIS) in the intensive care unit (ICU) promote use of analgosedation to minimize pain, reduce anxiety, and facilitate care. They also suggest against routine use of antipsychotics (APs) for delirium. Our institution’s adaptation incorporates assessment-driven, protocol-based pain, and sedation management and suggests a short course of APs in patients with agitated delirium, defined as Confusion Assessment Method for the ICU (CAM-ICU) positive with Richmond Agitation Sedation Scale (RASS) ≥ +2. While the use of APs in the ICU is typically for delirium, a recent study assessed whether quetiapine reduced sedative requirements among non-delirious patients. The purpose of this study was to assess adherence to our institutional guideline for AP use and to describe sedative and opioid use in relation to AP initiation. Materials and Methods: This retrospective study included patients who were mechanically ventilated and received ≥ 3 new start AP doses. The primary outcome was adherence to our guideline for use of APs in agitated delirium. The secondary outcomes were CAM-ICU and RASS scores in relation to AP initiation and change in sedative and analgesic infusion rates following AP initiation. Results: Thirty-eight patients were included in the study. Five had APs initiated appropriately per our guideline. There was no clinically significant change in continuous infusion rates in the 24 h before and after AP initiation. Conclusion: Overall, AP use was liberal with patients being started on APs who did not have agitated delirium, thus indicating potential alternative indications for initiation. APs did not result in a clinically significant change in continuous infusion requirements in the 24 h following initiation.

Immigration background as a risk factor of chronic pain and high-impact chronic pain in children and adolescents living in Spain: differences as a function of age.

The number of people immigrating from one country to another is increasing worldwide. Research has shown that immigration background is associated with chronic pain (CP) and pain disability in adults. However, research in this issue in children and adolescents has yielded inconsistent results. The aims of this study were to examine (1) the association between immigration background, CP, high-impact chronic pain (HICP) in a community sample of children and adolescents; and (2) the extent these associations differed as a function of sex and age. Participants of this cross-sectional study were 1115 school children and adolescents (mean age = 11.67; 56% girls). Participants were asked to provide sociodemographic information and respond to a survey including measures of pain (location, extension, frequency, intensity, and interference). Results showed that having an immigration background was associated with a greater prevalence of CP (OR = 1.91, p <.001) and HICP (OR = 2.55, p <. 01). Furthermore, the association between immigration background and CP was higher in children (OR = 6.92, p <.001) and younger adolescents (OR = 1.66, p <.05) than in older adolescents. Children and adolescents with an immigration background are at higher risk for having CP -especially younger children- and HICP. More resources should be allocated in the prevention of CP and HICP in children and adolescents with an immigration background.

Chronic Pain and Bone-Related Pathologies: A Narrative Review.

Pain related to bone may occur as a result of trauma, bone fracture, genetic disease, arthritis, benign or malignant primary bone tumors and bone cancer metastases. We discuss the pathophysiology of chronic bone-related pain, treatment options and therapeutic perspectives. Using predefined terms, we searched PubMed, MEDLINE, and Google Scholar for meta-analyses, evidence-based reviews, and clinical practice guidelines. This narrative article reviews pathologies linked to chronic bone pain and discusses the preventive and therapeutic strategies for better bone pain management. Pathophysiology of bone-related pain is complex, especially in cancer conditions and missing gaps are underlined. Treatment of pain, after adequate evaluation, includes classical analgesics, adjuvants for neuropathic and refractory pain, specific bone drugs, surgery and non-pharmacological approaches. Prevention of chronic bone pain encompasses prevention of central sensitization and of causal diseases. Translational research, drug repurposing, an interdisciplinary approach and a person-centered assessment to evaluate, beyond pain, physical, social and functional abilities, are proposed future directions to improve chronic bone pain management and optimize independence and quality of life. Chronic bone-related pain is frequent and is associated with an impairment of quality of life. In this review, we summarize the pathophysiology of chronic bone pain, describe treatment approaches and envisage new avenues for pain alleviation. Our article will help doctors manage chronic bone pain and address unmet needs for future research to alleviate bone-related pain.

Low back pain prevention behaviors and beliefs among the Polish population in a cross-sectional survey.

Low back pain (LBP) is one of the most common problems of public health and creates a burden globally. The aim was to assess the Polish population's back pain prevention behaviors and beliefs and to examine how these health behaviors and beliefs vary across sociodemographic factors and physical activity. A cross-sectional survey was carried out among 208 randomly selected patients of the public general practitioner clinic. The differences in LBP-related beliefs and attitudes were determined due to participants' status of requiring or non-requiring LBP treatment. More than half of the respondents did not engage in behaviors that protect against back pain. Individuals with higher education levels and those who exercised at least once a week were significantly more likely to adopt behaviors to protect their backs. Less than half of the participants reported having a workplace that was adequately prepared to protect against back pain, and only 35.1% of the participants reported receiving instruction while taking up work on how to avoid back pain while working. According to respondents' opinions, preventive actions are necessary to protect against back pain. Inappropriate exercises and stress can be contributors to back pain, with these opinions reported more often by women and participants with higher education levels. Participants who received treatment for LBP showed a significantly higher expression of behaviors to protect against back pain compared to participants who did not require treatment. However, there were no significant differences in participants' beliefs about back pain prevention between the group requiring LBP treatment and the group not requiring LBP treatment. The study provides valuable insights into the association between LBP treatment, back pain prevention behaviors, and beliefs, suggesting potential avenues for future research and intervention development. By addressing workplace ergonomics and promoting a culture of back health, it may be possible to reduce the burden of LBP in Poland.

The analgesic effect of paeoniflorin: A focused review.

Pain has been a prominent medical concern since ancient times. Despite significant advances in the diagnosis and treatment of pain in contemporary medicine, there is no a therapeutic cure for chronic pain. Chinese herbaceous peony, a traditional Chinese analgesic herb has been in clinical use for millennia, with widespread application and substantial efficacy. Paeoniflorin (PF), the main active ingredient of Chinese herbaceous peony, has antioxidant, anti-inflammatory, anticancer, analgesic, and antispasmodic properties, among others. The analgesic effect of PF, involving multiple critical targets and pain regulatory pathways, has been a hot spot for current research. This article reviews the literature related to the analgesic effect of PF in the past decade and discusses the molecular mechanism of the analgesic effect of PF, including the protective effects of nerve cells, inhibition of inflammatory reactions, antioxidant effects, reduction of excitability in nociceptor, inhibition of the nociceptive excitatory neuroreceptor system, activation of the nociceptive inhibitory neuroreceptor system and regulation of other receptors involved in nociceptive sensitization. Thus, providing a theoretical basis for pain prevention and treatment research. Furthermore, the prospect of PF-based drug development is presented to propose new ideas for clinical analgesic therapy.

A Two-year Injury Survey of Male Senior High School Soccer Players: Effectiveness of a Groin Pain Prevention Program

A Two-year Injury Survey of Male Senior High School Soccer Players: Effectiveness of a Groin Pain Prevention Program

Training load as the conditioning of vertebral column dysfunction in road cyclists

Background. Spinal dysfunctions pose significant problems for road cyclists as they affect their efficiency and the quality of life. Despite this,fact only few studies are focused on the effect of training on the aforementioned dysfunctions. This gap in literature is even bigger as far as competitive/professional road cycling is concerned, despite the significant load the competitors are exposed to. This study is focused on understanding how different components of training load affect dysfunction of the vertebral column in road cyclists, both competitive and amateur ones. Additionally, the thesis how the program of adequate bioregeneration can contribute to reduction of spinal dysfunction risk is analyzed. Material and methods. The samle included 60 cyclists. The participants were divided into two groups: 30 competitive road cyclists UCI World Tour (first division) and 30 amateur road cyclists. The aim of the study was to understand the effect of different components of training load on the on the origin of spinal dysfunction in road cyclists . A questionnaire including the questions concerning personal data, the length of the road cyclist’s training period, training load, complementary training as the frequency and location of back pain, and also the questions, as the questions focused on information on the sustained injuries and contusions as well as as the access and the quality of the physiotherapeutic procedure. Results. The study using statistical tools revealed that many aspects of training affect vertebral column dysfunction in road cyclists, both competitive and amateur ones. The results also suggest that both professional and amateur cyclists should pay more attention to prevention and treatment of back pain. These procedures may involve regular workouts strengthening and stabilizing the vertebral column, control of training load as well as regular assessment by a physiotherapist. However, it was impossible to develop a concrete mathematical pattern for prognosing the aforementioned dysfunctions. Conclusion. The study provides new information on the training record in cyclists on the prevalence of back pain in road cyclists. The study found significant differences between the analyzed variables, however, in no case, the designated linear regression function allowed description of these relationships. This may indicate that the relationships are more complicated than it is suggested based on a simple linear model or that there are other factors responsible for back pain, which were not taken into consideration in this model. Further research using more complex regression models or taking into consideration additional variables are required for better understanding of the factors affecting vertebral column dysfunction in road cyclists – it will be the subject of further research by the authors.

EFEKTIFITAS METODE KANGGURU MENGURANGI RASA NYERI PENYUNTIKAN INTRAMUSCULAR PADA BAYI BARU LAHIR DI PMB SITI FATIMAH, AMD. KEB TAHUN 2023

Prevention of pain in newborns is by nonpharmacological mens effective to reduce pain in intramuscular injection of newborn. The use of kangarro method is a nonpharmacological method that can reduce intramuscular injection pain physiologically. Based on the above, researchers are interested in conducting a study entitled “Effectiveness of Kangoroo Methods to Reduce Pain in Intramuscular Injection in Newborns in PMB Siti Fatimah”.Knowing the effectiveness of kangaroo methods reduces pain in intramuscular injections in newborns in PMB Siti Fatimah, Kel Kuta Jaya Kec Pasar Kemis, Kab Tangerang.The design of this study uses quasi-experimental. With the posttest only, control group approach. Population of newborns with inclusion criteria Normal newborns weighing 2500 – 4000 grams, in stable condition not in a state of asphyxia, apnea or shock, babies without physical disabilities, born at PMB Siti Fatimah. Sampling was taken by purposive sampling with a sample of 60 respondents, 30 control groups and 30 intervention groups. This research was conducted at PMB Siti Fatimah in May-June 2023. Measurements used observation with the NIPS (Neonatal Infant Pain Scale) measurement tool. Data analysis using univariate analysis, namely the mean, median, minimum, maximum and standard deviation and bivariate analysis using the independent T-test program SPSS 25. The average intramuscular injection pain scale in the control group was 4.97, the median was 5, the minimum value was 3 and the maximum was 7 with a standard deviation of 1.65, while the average intramuscular injection pain scale in the intervention group with the kangaroo method was 2.70, the median was 3, the value minimum 2 and highest 4 with a standard deviation of 0.70. Statistical test results There is an effect of the kangaroo method on reducing pain in intramuscular injections in newborns at PMB Siti Fatimah, Amd.Keb. with a p-value of 0.000 &lt; ɑ (0.05). There is a significant effect of the kangaroo method on reducing intramuscular injection pain in newborns. It is hoped that this method can be implemented in the care of newborns, especially to reduce the pain of injecting Hb0 and Vit K given intramuscularly.

Pain@home: An integrated, holistic, multimodal, digital approach to the prevention of chronic pain.

Chronic pain is one of the most debilitating medical conditions and one of the greatest medical challenges globally. In Western countries, almost 25% of adults are suffering from recurrent and prolonged pain symptoms. Chronic pain has a huge negative impact on the quality of life of patients, such as sleep disturbances, limitation in daily activities, and prolonged sick leaves. &#x0D; The best treatment for chronic pain is preventing it from occurring in the first place through an aggressive and multimodal approach to acute pain conditions. Such an approach has been previously described as pre-emptive analgesia. Despite multiple previous research projects, the ideal approach to the prevention of chronic pain has still not been identified. We hereby propose an integrated, multidisciplinary approach to the prevention of long-lasting pain syndromes. &#x0D; This innovative approach was previously tested and refined in patient populations at high risk of developing chronic pain, such as adolescents undergoing pectus operations, and young adults undergoing scoliosis correction procedures. Its rationale is based on the early activation of a digital follow-up before the nociceptive insult has even occurred. At the moment a potential future pain-inducing medical act has been identified (eg surgical procedure, initiation of chemotherapy or radiotherapy, traumatic injury) inclusion in digital long-term monitoring is initiated. The first step in the follow-up consists of the identification of patient-specific risk factors through the application of a validated nociceptive risk identification survey. After an individual risk profile has been completed a daily follow-up is initiated through the application of diaries. &#x0D; After that, a personalized anti-nociceptive approach is conceptualized. One of the major risk factors for the chronification of pain is the presence of fear or catastrophizing behavior. If these are identified during the pre-operative screening process, an integrated and multidisciplinary approach will be tailored to tackle these problems at the individual level. In addition, the interval between the initiation of the follow-up and the start of the medical treatment is used to start a pre-emptive treatment (in most cases gabapentin). Furthermore, educational material is provided to the participating patients in order to educate them on crucial matters such as the pathophysiology of pain, the importance of physical activities, and training in coping strategies.&#x0D; &#x0D; At the moment of hospitalization, patients receive a personalized pain treatment regimen based on the pre-op home-based assessment. Experience has learned us that this improves the health-related quality of life of patients while reducing length of stay significantly. &#x0D; After discharge from the hospital, remote monitoring is reinitiated. Patients are kept under digital supervision during the entire postoperative period, with multidisciplinary support and a strong focus on the functional reintegration of the concerned patients. When functional outcomes are obtained and the use of analgesics is stopped then the remote follow-up is discontinued.&#x0D; The described care pathway is an innovative approach to the prevention of chronic pain. All healthcare providers are gathered around the patient, who is treated as much as possible in a trusted home environment. The application of digital technologies creates a unique opportunity for this long-term interdisciplinary approach.

Stakeholders’ involvement in the development and planning of an intervention aimed at integrated care for breast cancer survivors with pain complaints: practical insights and challenges

Background: Persisting pain complaints are prevalent among breast cancer survivors and can become complex in nature, increasing the need for both pain prevention and treatment in an integrated manner. &#x0D; Objective: Managing (chronic) pain requires complex models of care, provided by an interdisciplinary team of healthcare providers. However, the majority of breast cancer survivors with pain complaints are not monitored in an interdisciplinary manner. There is a lack of systematic, integrated, and coordinated follow-up care for breast cancer survivors experiencing pain. Therefore, we developed an intervention that follows a step-wise care model, aimed at timely and adequate pain management among breast cancer survivors. But, to achieve change in pain prevention and treatment, various stakeholders at multiple levels should be involved and addressed.&#x0D; Methods: To develop such an intervention and plan for its implementation and evaluation, we followed an intervention mapping approach. As such, we involved relevant stakeholders during the different stages of the development and planning process including breast cancer survivors, healthcare providers from various disciplines, representatives of professional associations who help realize sustainable implementation and adoption of the intervention, and experts in education. Throughout the duration of the research project, a steering group was also periodically consulted and their feedback was requested on the results of each project stage and as a preparation for the next stages.&#x0D; Results: To involve these stakeholders and strive for co-design, we used different methods and levels of participation. For example, stakeholders contributed to the identification of current needs and possible barriers in the implementation of the intervention in practice. Additionally, the relevancy and feasibility of the developed intervention components was evaluated before implementation. Their input also helped determine which analyses and outcome measures should be prioritized when assessing the impact of the intervention. The stakeholders’ feedback was collected through asynchronous and synchronous focus groups, and online questionnaires.&#x0D; Conclusions: This study can inform others about how to prepare for the development, implementation, and evaluation of an intervention while taking into account stakeholders’ perspectives, experiences, and needs. We would also like to share our practical insights, our challenges related to co-design, and future opportunities to achieve a higher level of stakeholder participation.

Fatigue can influence the development of late-onset pain in post-COVID-19 syndrome: An observational study.

Late-onset pain is frequent following COVID-19, and many pathogenetic mechanisms have been proposed. Identifying the main features of patients may help in designing tailored rehabilitative interventions. We enrolled post-COVID-19 patients with an increase in pain intensity of two points on the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) at 52 weeks compared to the pre-COVID-19 condition. All subjects were retrospectively monitored at 12, 26, and 52 weeks. A specific pain assessment was performed to determine the characteristics and mechanisms of pain. Catastrophizing, kinesiophobia, and other psychological symptoms were evaluated. The pressure pain threshold (PPT) and temporal summation (TS) were measured and compared in age- and sex-matched healthy controls to analyse pain characteristics. A total of 67 patients were recruited, with 20 of them presenting an increase in pain at 52 weeks. Subjects of the two subgroups were similar in demographic and clinical characteristics at baseline; significant differences in fatigue, anxiety, mobility, ability to perform daily activities, and general health perception were recorded at 26 weeks. Fatigue significantly predicted pain onset (β = 0.54, p = 0.002). Sixteen different body regions were identified as painful, with a pain intensity of 6.0 ± 1.9. Most of the samples did not show neuropathic or nociplastic mechanisms. No differences in PPT and TS were recorded between patients and healthy controls. Almost one out of three patients hospitalized for COVID-19 developed pain 1 year later, and fatigue seems responsible for chronicity. An overlapping of conditions may explain late-onset post-COVID-19 pain, and a comprehensive approach must be considered for patient management. Late-onset pain is frequent in post-COVID-19 syndrome and an overlapping of different mechanisms seems to be responsible for its development. Among many predisposing factors, fatigue in the months before seems to be one of the primary causes of pain one year following infection and its management may help to identify new strategies for prevention and treatment of late-onset pain.

Physical Activity, Social Participation, and Pain Outcomes Among Community-Dwelling Older Adults

BackgroundLittle is known regarding the effect of social participation (SP) and physical activity (PA) on pain outcomes among community-dwelling older adults in the United States. AimsTo determine whether SP and PA are associated with pain outcomes (bothersome pain and number of pain sites). DesignGuided by the biopsychosocial model of chronic pain for older adults, we analyzed data from 7,187 community dwelling participants in the National Health and Aging Trends Study. In cross-sectional analyses, we utilized logistic and negative binomial regressions. MethodsWe prospectively assessed the association between SP/ PA and new or worsening pain from baseline (2011) to 2021 using a discrete time survival analysis by logistic regression, controlling for sociodemographic and health characteristics. ResultsAt baseline, participation in 5 SP activities per month versus no activities, and performing any PA compared with no PA were significantly associated with lower likelihood of bothersome pain. Although SP and PA were associated with reporting fewer pain sites at baseline, SP was not associated with developing new or worsening pain, prospectively. However, walking and vigorous exercise compared with no PA was significantly associated with a 10% lower risk of developing new or worsening pain (adj odds ratio 0.90, 95% confidence interval [CI] 0.82-0.98). ConclusionsPhysical activity but not social participation may protect against development of new or worsening pain. More research is needed to determine whether social activity can be beneficial for pain prevention and management. Efforts to promote physical activity among older adults may reduce risk of new or worsening pain.

Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception

Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception

Physical and psychosocial work demands associated with pain and disability among skilled male Arab waiters.

Physical and psychosocial demands (e.g., serving, cleaning, fulfilling orders) can lead to work-related musculoskeletal pain (WRMSP). To assess the prevalence of WRMSP in the upper quadrant and lower back among skilled male Arab waiters; to evaluate the disability related to WRMSP; to evaluate the association between work demands and WRMSP with related disability. 100 skilled male Arab waiters working full-time, aged 18-60, participated in the cross-sectional study. Participants completed basic demographics and working conditions; the NDI; QuickDASH; the OswestryQ; workload, burnout, and job satisfaction at work; the adjusted NordicQ; and the TaskQ, compiled especially for this study. A 12-month pain prevalence, pain frequency, and work avoidance were high: neck- 42%, 60.5%, 89.5%; shoulders -53%, 78.2%, 94.4%; elbows- 46%, 78.6%, 83.3%; lower back- 45%, 44%, 78.7%, respectively. Pain prevalence in at least one site was 83%. The OswestryQ, QuickDASH, and NDI revealed mild-moderate pain and disability (14.85/50, 25.54/75, 13.74/50, respectively). Burnout score was positively associated with OswestryQ, QuickDASH, and NDI. Job satisfaction was negatively associated with 12 months of pain in the lower back, hands, arms, shoulders, and hands (NordicQ). TaskQ was positively associated with OswestryQ. Male Arab waiters who work in physically and psychologically challenging conditions report high levels of WRMSP with a high frequency and related work avoidance. Many of them must keep their jobs as they are their families' primary or sole providers. It is possible that they are trying to prevent more severe disabilities in the future by ensuring temporary rest and pain prevention.

Investigation of the causes of adolescent lumbar and shoulder-neck diseases and related mitigation approaches

With the rapid development of global economy and information technology, peoples lifestyle has undergone great changes, and the prevalence of neck and shoulder pain and low back pain has also increased, and the age of onset is trending younger, which seriously affect their study and life, resulting in greater family burden. The survey shows that in recent years, the incidence of pain has increased year by year due to the high learning pressure of teenagers, playing mobile phones and computers for a long time. Teenagers long-term incorrect sitting position, sleeping position, improper pen use and other bad living habits, mental and psychological factors may eventually induce the pain through affecting biomechanical imbalance. The author has discussed the etiology, intervention and also the prevention of general neck and shoulder pain and low back pain in order to provide more theoretical basis for the management of this pain in the future and better guide the clinic.

Efforts To Prevent Low Back Pain In Office Workers

This study looks at low back pain (LBP) prevention techniques for office workers, with particular attention to demographics, prevalence of LBP, awareness, use, satisfaction, and perceived efficacy of interventions. Results show that there is a majority age group (26–35 years old), sporadic episodes of lower back pain, and a significant discrepancy between awareness and use of ergonomic modifications. Interventions involving physical activity exhibit lower levels of awareness and satisfaction. Studies that have been compared show that while awareness has grown throughout time, there are still ongoing difficulties in putting awareness into practice. Positive opinions of educational initiatives point to improvements in the prevention of LBP holistically. In order to have a thorough grasp of the long-term effects of preventive strategies, longitudinal designs should be used in future study. The study adds knowledge to the field of LBP prevention in office environments, which is constantly changing.

Usefulness of ultrasound-guided serratus-anterior block in prevention of postoperative pain after breast surgery. A cohort study

ObjectiveTo evaluate superficial serratus anterior plane block's efficacy and side effects in preventing postoperative pain after breast cancer surgery. MethodologyA prospective cohort study was conducted on 195 adult patients undergoing breast oncological surgery under general anesthesia (Group G, n = 96) or combined general anesthesia with superficial serratus anterior plane block (Group L, n = 99).Validated preoperative data, which are predictors of chronic postoperative pain of patients, were recorded (type of surgery, age, pain in the area of the intervention and the other regions; anesthetic-surgical data, analgesic doses used, duration of surgery; pain intensity (EVN scale) at immediate postoperative period, 24 h, seven days and one month after the surgery, and complications. ResultsPain intensity, measured by the EVN scale, had a mean of 1.02 +/− 1.656 in the Postoperative Unit; 1.20 +/− 1.448 at 24 h; 0.76 +/− 1208 seven days; and 0.34 +/− 0.757 one month after surgery.Patients were operated under general anesthesia (n = 96) or general anesthesia combined with the interfascial block (n = 99). Significant differences (p < 0.05) were found in age, height, and VAS scale in PACU. Ten complications were recorded, six in Group L and four in Group G. There were no differences between groups in complications. ConclusionsSuperficial serratus anterior plane blocks are effective and safe in pain control in the immediate postoperative period for breast cancer surgery as a part of the multimodal approach. No significant differences were found one week and one month after surgery.

Increased Expression of Inflammatory Cytokines and Discogenic Neck Pain.

Although neck pain has become a serious economic and social problem worldwide, the etiology remains poorly understood. The aim of current study is to explore the possible pathogenesis of discogenic neck pain by analyzing the relationship between inflammatory cytokines and discogenic neck pain and provide a valuable reference for the prevention and treatment of discogenic neck pain. A total of 111 cervical disc samples were collected between October 1, 2021, and October 1, 2022: 38 samples from the discogenic neck pain group, 41 samples from the symptomatic control group, and 32 samples from the normal control group. The concentration of nitric oxide (NO), interleukin (IL)-1, interleukin (IL)-6, and tumor necrosis factor alpha (TNF-α) was determined using the enzyme-linked immunosorbent assay in each sample, and the degeneration degree of the target discs were evaluated using T2-weighted sagittal magnetic resonance imaging (MRI) according to the Miyazaki disc degeneration grading system. Whether the differences among the three groups were statistically significant was tested using one-way analysis of variance and an unpaired t-test, respectively. The differences of the baseline characteristics were not statistically significant between the discogenic neck pain group and the symptomatic control group (p > 0.05). The expression of inflammatory cytokines in disc samples from the discogenic neck pain group (NO: 9.89 ± 1.75, IL-1β: 10.74 ± 1.92, IL-6:31.65 ± 2.46, and TNF-α: 5.96 ± 1.91) was increased in comparison with the disc samples from both the symptomatic control group (NO: 7.15 ± 2.78, IL-1β: 8.03 ± 1.87, IL-6: 25.79 ± 2.12, and TNF-α: 4.18 ± 2.87) and the normal control group (NO: 6.11 ± 1.37, IL-1β: 5.84 ± 2.25, IL-6: 20.65 ± 1.26, and TNF-α: 2.05 ± 0.58). The differences were statistically significant (p < 0.001). Further, there were no statistical differences in the degree of degeneration between discogenic neck pain group and symptomatic control group. The increased expression of inflammatory cytokines in diseased cervical intervertebral discs might play a key role in the pathogenesis of discogenic neck pain. Although inflammation is involved in intervertebral disc degeneration, there is no linear positive correlation between the concentration of inflammatory cytokines and the degree of disc degeneration.

Expert consensus on management of pain, agitation and related issues in adult patients with critical respiratory diseases

As patients with critical respiratory diseases suffer from the discomfort of disease, frequent medical and nursing procedures, and the noise disturbance of the ICU environment, it is necessary to implement analgesia and sedation to reduce their negative stress and oxygen consumption. Special emphasis will be placed on the clinical practice of analgesia, sedation and rehabilitation in critically ill patients with respiratory diseases, as different pathophysiological features of the respective pulmonary diseases are presented, such as severe asthma and acute exacerbations of chronic obstructive pulmonary disease, as well as the exclusive situations during respiratory therapy, such as recruitment maneuvers, bedside bronchoscopy and operation of extracorporeal membrane oxygenators. To standardize the prevention and management of pain, agitation, delirium, immobility, and sleep disturbance in adult patients with critical respiratory diseases, the Chinese Thoracic Society and Critical Care Medicine Group of Chinese Association of Chest Physicians, Chinese Medical Doctor Association organized pulmonary and critical care experts to discuss 19 important issues and ultimately provided 20 recommendations based on the best available evidence.Assessment, prevention and management of pain should be prioritized before the administration of continuous infused sedatives in all patients with critical respiratory diseases. Bundles that include multiple strategies of non-pharmacological interventions to prevent and manage delirium and sleep disruption are encouraged. For the patients with stable respiratory and hemodynamic status, early mobility and exercise could be safe and beneficial. Respiratory drive control by addressing patient and ventilator factors should be the priority before administration of analog-sedation protocol in the ARDS patients. Deep sedation could be necessary in the early stage of ARDS with high respiratory drive, and during the recruitment maneuver, prone position and measurement of the respiratory mechanics. Maintaining spontaneous breathing with a lower level of sedation is recommended in COPD patients on invasive mechanical ventilation, while a deeper level of sedation, even with a short course of neuromuscular blockade, may be beneficial among severe asthma patients with high peak airway pressure. Pharmacokinetic alterations in patients with critical respiratory diseases during ECMO support are complicated as varied factors are involved, including ECMO circuit factors, drug factors, and patient factors. Therefore, the dosage of analgesics and sedatives should be adjusted according to the target of analog-sedation protocol in the respective disease.

The association between parent mental health and pediatric chronic pain: a systematic review and meta-analysis.

Mental health problems are common among parents of children with chronic pain and associated with worse outcomes for the child with chronic pain. However, the effect sizes of these associations between parent mental health and pediatric chronic pain vary widely across studies. The aim of this systematic review and meta-analysis was to generate pooled estimates of the (1) prevalence of mental health problems among parents of children with chronic pain and (2) associations between parent mental health and the (2a) presence of child chronic pain and (2b) functioning of children with chronic pain. Embase, MEDLINE, PsycINFO, Web of Science, and CINAHL were searched up to November 2022. Observational studies that examined symptoms or diagnoses of parent anxiety, depression, or general distress and the presence of child chronic pain and/or related functioning were included. From 32,848 records, 2 coders identified 49 studies to include in random-effects meta-analyses. The results revealed that mental health problems among parents of children with chronic pain were common (anxiety: 28.8% [95% CI 20.3-39.1]; depression: 20.0% [15.7-25.2]; general distress: 32.4% [22.7-44.0]). Poorer parent mental health was significantly associated with the presence of chronic pain (anxiety: OR = 1.91 [1.51-2.41]; depression: OR = 1.90 [1.51-2.38]; general distress: OR = 1.74 [1.47-2.05]) and worse related functioning (ie, pain intensity, physical functioning, anxiety and depression symptoms; r s = 0.10-0.25, all P s < 0.05) in children. Moderator analyses were generally nonsignificant or could not be conducted because of insufficient data. Findings support the importance of addressing parent mental health in the prevention and treatment of pediatric chronic pain.