Pain Phenomena Research Articles

‘Another world of pain’—athlete and sport physiotherapist perspectives on the unique experience of pain in sport

Our objective was to explore athlete’s and sports physiotherapists’ experiences of sports-related pain in the upper and lower limb. Using a constructivist and pragmatic perspective, we carried out focus groups...

Nonodontogenic Causes of Toothache: A Case Series and Narrative Review

Abstract Chronic orofacial pain is a complex and frequently misdiagnosed condition that significantly impacts individuals’ well-being. Accurately diagnosing orofacial pain can be challenging due to the overlap between headaches and orofacial regions. Patients who complain of tooth pain may actually be experiencing pain unrelated to dental issues. It is crucial for clinicians to accurately pinpoint the source and location of the pain to devise effective treatment plans. Nonodontogenic facial pain can stem from various causes such as musculoskeletal, neuropathic, or neurovascular issues. In addition, toothaches can result from conditions originating from other areas like systemic disorders related to the heart, nose, throat, or sinuses. Referred pain phenomena are acknowledged in the literature but are poorly understood, presenting significant treatment challenges. This is worrisome because such patients are more prone to developing chronic pain conditions, and invasive treatments may exacerbate their suffering and overall health. In the current review paper, three cases are detailed: one of myofascial pain, the second of trigeminal neuralgia, and the third of posttraumatic trigeminal neuropathy. In all three cases, dentists were the initial point of consultation as the pain was perceived in the teeth, resulting in unnecessary dental interventions. There remains a lack of knowledge regarding nonodontogenic toothache among clinicians. Increasing awareness of nonodontogenic toothache can help avoid unnecessary interventions and improve overall pain relief for patients.

Assessing Gender Differences for Non-Predictable Breakthrough Cancer Pain Phenomenon: A Secondary Analysis from IOPS-MS Study.

Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that "breaks through" a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) subtype occurs in the absence of any specific activity. Evidence showed that gender differences exist in pain response sensitivity and clinical pain risk. This analysis aimed to signify the gender differences for the NP-BTcP phenomenon. This is a secondary analysis of the Italian Oncologic Pain multiSetting-Multicentric Survey (IOPS-MS), the largest study on BTcP. The subset of NP-BTcP cases for non-gender-specific cancer was considered. Univariable and multivariate analyses were conducted to identify gender differences for the NP-BTcP profile about its intensity, number of episodes per day, and type. A metastatic status-stratified analysis was performed to compare gender with the main clinical variables among the population with NP-BTcP. Males exhibited a higher occurrence of BTcP in the thorax region compared to females (15% vs 11%, respectively, p = 0.03). Males also had a higher onset of BTcP, a higher BTcP therapy dosage (33% vs 28%, p = 0.04, mean: 201 vs 186, p = 0.02) and a lower Karnofsky score (mean: 46.9 vs 49.2, p = 0.03) compared to females. Similar gender differences were found for metastatic patients in the BTcP site (14% vs 8.5%, respectively; p = 0.01), peak onset (33% vs 27%, p = 0.02), BTcP therapy dosage (199 vs 185, p=0.04), and Karnofsky score (mean 47.5 vs 50.4, p = 0.009). Phenotype 2 was more characterized by non-metastatic males (41% vs 23%, p = 0.020) while non-metastatic females presence was predominant among others. In this study, gender differences according to site, onset and dosage of BTcP were found. The phenotype characterization of BTcP needs to be further investigated for a possible useful function in the management of cancer-related pain in non-metastatic patients.

Advancing the integration of biosignal-based automated pain assessment methods into a comprehensive model for addressing cancer pain

BackgroundTailoring effective strategies for cancer pain management requires a careful analysis of multiple factors that influence pain phenomena and, ultimately, guide the therapy. While there is a wealth of research on automatic pain assessment (APA), its integration with clinical data remains inadequately explored. This study aimed to address the potential correlations between subjective and APA-derived objectives variables in a cohort of cancer patients.MethodsA multidimensional statistical approach was employed. Demographic, clinical, and pain-related variables were examined. Objective measures included electrodermal activity (EDA) and electrocardiogram (ECG) signals. Sensitivity analysis, multiple factorial analysis (MFA), hierarchical clustering on principal components (HCPC), and multivariable regression were used for data analysis.ResultsThe study analyzed data from 64 cancer patients. MFA revealed correlations between pain intensity, type, Eastern Cooperative Oncology Group Performance status (ECOG), opioids, and metastases. Clustering identified three distinct patient groups based on pain characteristics, treatments, and ECOG. Multivariable regression analysis showed associations between pain intensity, ECOG, type of breakthrough cancer pain, and opioid dosages. The analyses failed to find a correlation between subjective and objective pain variables.ConclusionsThe reported pain perception is unrelated to the objective variables of APA. An in-depth investigation of APA is required to understand the variables to be studied, the operational modalities, and above all, strategies for appropriate integration with data obtained from self-reporting.Trial registrationThis study is registered with ClinicalTrials.gov, number (NCT04726228), registered 27 January 2021, https://classic.clinicaltrials.gov/ct2/show/NCT04726228?term=nct04726228&draw=2&rank=1

Unconscious Pleasure as Dispositional Pleasure

ABSTRACT A good deal of recent debate over the nature of pleasure and pain has surrounded the alleged phenomenon of unconscious sensory pleasure and pain, or pleasures and pains whose subjects are entirely unaware of them while experiencing them. According to Ben Bramble, these putative pleasures and pains present a problem for attitudinal theories of pleasure and pain, since these theories claim that what makes something a sensory pleasure or pain is that one has a special sort of pro- or con-attitude toward it at the time one experiences it. In this paper, I look at the two existing defences of attitudinal theories against this worry and explain (following Bramble) that each is inadequate. I show that this inadequacy is in part a result of existing attitudinal theories failing to recognize an important distinction in pro- and con-attitudes, and I propose and defend an amended attitudinal view that does recognize this distinction. I then offer a more promising response to the objection from unconscious sensory pleasures and pains: that experiences of apparently unconscious pleasure or pain only seem pleasant or unpleasant because their subjects are disposed to experience pleasantness or unpleasantness. In this sense, unconscious pleasures and pains are not really pleasures or pains at all.

Valleix's Sign.

Some patients present with clinical symptoms of localized tenderness and pain associated with a specific peripheral nerve, such as the ulnar nerve at the elbow or the sciatic nerve, which has been called, although rarely, "Valleix point" or "Valleix phenomenon". The purpose of this article was to translate and research the 719-page book "Traité des névralgies ou affections douloureuses des nerfs" dated 1841, dedicated solely to nerve pain (neuralgia), written by the French physician François Louis Isidore Valleix (1807-1855). He may have been the first person to observe and describe this phenomenon of localized pain, but he was probably also the first to describe distal nerve radiation, which he called "élancement" or lancinating, or stabbing. He described the phenomenon of a nerve producing pain at points along its course that we now understand to be sites of compression, clearly describing cubital and fibular tunnel syndromes, which he called neuralgias. He also described some rarer sites of compression, such as supraorbital and occipital neuralgia, notalgia paresthetica, and ACNES, but he did not describe the most common site of compression today, the median nerve at the wrist. Valleix's descriptions are clear and precede the classic 1915 reports of Hoffmann's and Tinel's signs by 74 years.

Age- and Sex-Dependent Effects of Moderate Exercise on Endogenous Pain Inhibition in Rats.

Diffuse noxious inhibitory controls (DNICs), or the pain inhibits pain phenomenon, refer to reduced pain-like behaviors that are displayed following a noxious conditioning stimulus located far from the test stimulus and have also been referred to as "descending control of nociception" when measured in awake-behaving animals. In this study, we sought to determine the impact of moderate long-term exercise on the DCN response and determine if this effect differed across age and sex. After a six-week exercise program consisting of 30 min of moderate treadmill running 5 days a week, the animals' forepaws were injected with capsaicin, and DCN responses were assessed using thermal withdrawal latencies of the hind paw. Young, exercised male and female rats displayed prolonged DCN responses relative to their sedentary counterparts, with the young exercised male group displaying longer-lasting DCN facilitation than the young exercised females. Exercise did not impact DCN responses in either male or female aged rats. Additionally, the serum testosterone levels did not change following exercise in any group. Importantly, the levels of corticosterone did not change following the exercise program, indicating that changes in the DCN response are not due to stress-induced analgesia. Our findings suggest that moderate exercise can facilitate the DCN response in young animals, even when this exercise does not change the levels of serum testosterone.

Self-stigma and its reduction in patients with bipolar affective disorder

IntroductionThe phenomenon of self-stigma in patients with bipolar affective disorder (BD) has been studied much less than in other mental disorders (Favre, Richard-Lepourie, 2023). However, self-stigma has equally negative psychosocial consequences for them (Shargh et al, 2015). Therefore, identifying the clinical and psychological characteristics of self-stigma in BD patients, especially in the initial stages of the disease, and developing on this basis new directions for their psychosocial rehabilitation to reduce self-stigma is relevant.ObjectivesTo identify clinical and psychological characteristics of self-stigma in BD patients, to identify targets for psychosocial rehabilitation.Methods«Questionnaire for assessing the phenomenon of self-stigmatization of mentally ill people» (Mikhailova et al., 2005), «Insight Scale for Psychosis» - ISP (Birchwood et al., 1994). We examined 17 patients (12 women and 5 men) with a diagnosis of bipolar affective disorder (F31.xxx according to ICD-10). The average age of the patients was 25.52±4.55 years. The duration of the disorder is 0.5-3 years.ResultsIt was shown, that patients with BD had a high level of self-stigma. Indicator «General level of self-stigma» was 1.22±0.73 points, that higher its average values. The main component in the structure of self-stigmatization was an overestimation of possible limitations of one’s own internal activity and self-realization (1.96 ± 0.87 and 1.62 ± 0.82 points, respectively) associated with the disease. Idealization of one’s pre-illness qualities and achievements (1.62±0.82 points) and the formation of misconceptions about the loss of previous opportunities will able to lead to negative personal changes and limit the activity of patients. Correlation analysis revealed significant (p≤0.01) correlations between the «Patient’s ability to recognize painful phenomena as symptoms of mental illness» scale of the ISP scale and individual parameters of the questionnaire for assessing self-stigma: «Imagination of one’s own failure due to illness» - r = 0, 52; «Fear of becoming insolvent due to illness» - r=0.54; «Idealization of the «healthy self», r=0.51. Thus, in BD patients, self-stigma is associated with low awareness of the disease and misconceptions about it and about themselves.ConclusionsPsychoeducation programs, aimed at formation an adequate perception of mental disorder, the ability to recognize its symptoms, and destigmatization trainings to increase the social activity are needed for BD patients. Such trainings were developed during the research and are currently being tested.Disclosure of InterestNone Declared

Asuhan Kebidanan Komplementer Penanganan Nyeri Pinggang Pada Ibu Hamil Trimester III

Pain is a very common problem in pregnancy, especially in the third trimester of pregnancy. The phenomenon of back pain during pregnancy is one of the most frequently reported complaints among pregnant women, varying from 50% to 70%, based on previous studies in various countries. This study aimed to treat low back pain in the third trimester, in pregnant women, by complementary midwifery care standards. The method used is descriptive, namely describing or describing complementary midwifery care for pregnant women with low back pain problems, with a case study approach. The process of collecting data using direct interviews with patients and families, home visits, performing physical examinations, observing, and making discussions using related journals or books. The results after 3 visits of complementary midwifery care in patients with low back pain (waist) in third-trimester pregnant women resolved the problem and the intervention was stopped. Problems that occur in patients can be resolved and the intervention is stopped.

Синдром функциональной абдоминальной боли: обзор литературы

ABSTRACT INTRODUCTION. About 40–60% of adult patients with complaints of abdominal pain suffer from functional gastrointestinal disorders. Currently, functional disorders of the gastrointestinal tract are associated with disturbances in the gut-brain interaction. Abdominal pain syndrome can be one of the leading manifestations of irritable bowel syndrome, functional dyspepsia syndrome and abdominal migraine. The exclusion of organic disorders of the gastrointestinal tract is an essential condition for the diagnosis of functional disorders. The basic principles of the treatment of functional abdominal pain syndrome should be aimed at correcting the psychological disorders involved in the formation of pain sensation. MATERIAL AND METHODS. A review of the literature on this topic was conducted in the following databases: PubMed, Research Gate, Elsevier. The following phrases were used to search for literature: “Functional abdominal pain syndrome”, “Disorders of the gastrointestinal tract”. DISCUSSION. Functional abdominal pain syndrome is a rather complex and ambiguous disease, which is based on complex cerebroabdominal connections (direct and reverse). This diagnosis is an exception, in other words, the diagnosis takes place when there are no obvious organic causes of the disease. The diagnosis of the functional abdominal pain syndrome is long and complex and includes various instrumental and laboratory methods of examination. Various methods are used in the treatment of the functional abdominal pain syndrome, ranging from non-drug methods (cognitive behavioral therapy, hypnotherapy) and ending with the use of medicines (antidepressants). It is important to keep in mind that the diagnosis and treatment of the functional abdominal pain syndrome requires the active participation of doctors of different specialties who are able to build a personalized diagnostic and therapeutic route using a biopsychosociocultural approach. CONCLUSION. Functional abdominal pain syndrome attracts special attention in the diagnostic and therapeutic aspect. Although the exclusion of organic diseases is an essential condition for the diagnosis of the functional abdominal pain syndrome, it is necessary to take into account the connection and involvement of mental factors in the phenomenon of abdominal pain. Taking into account the complexity of the mechanisms involved in the development of functional gastrointestinal diseases, the basic principles of functional abdominal pain syndrome treatment should be aimed at correcting psychological disorders involved in the formation of pain sensation. KEYWORDS: functional abdominal pain syndrome, disturbances in the gut-brain interaction, interaction

The Phenomenon of Post Digestive Surgery Patient’s Pain in West Java Indonesia

Introduction: The high prevalence of pain in post-digestive surgery patients shows urgency in handling pain management. The role of a nurse anesthetist is needed to conduct pain assessment and pain management to solve the problem. Objective: This study aimed to analyze the phenomenon of pain in post-digestive surgery patients in the inpatient room of Hospital X in West Java, Indonesia. Methods: This research used a quantitative observational approach with 30 post-digestive surgery patients. Sampling used an accidental sampling technique, with an observation sheet using Visual Analogue Scale indicators, then analyzed descriptively. Results and Discussion: Results showed that most of the respondents complained of severe pain after being given the analgesic of Tramadol 100 mg and ketorolac 60 mg drip. Conclusion: This study concludes that the level of pain in post-digestive surgery patients at X Hospital 4 hours after post-surgery is on the severe pain scale. So, it is recommended that pain assessment be further improved and further research on postoperative pain management.

Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies.

Despite research advances and urgent calls by national and global health organizations, clinical outcomes for millions of people suffering with chronic pain remain poor. We suggest bringing the lens of complexity science to this problem, conceptualizing chronic pain as an emergent property of a complex biopsychosocial system. We frame pain-related physiology, neuroscience, developmental psychology, learning, and epigenetics as components and mini-systems that interact together and with changing socioenvironmental conditions, as an overarching complex system that gives rise to the emergent phenomenon of chronic pain. We postulate that the behavior of complex systems may help to explain persistence of chronic pain despite current treatments. From this perspective, chronic pain may benefit from therapies that can be both disruptive and adaptive at higher orders within the complex system. We explore psychedelic-assisted therapies and how these may overlap with and complement mindfulness-based approaches to this end. Both mindfulness and psychedelic therapies have been shown to have transdiagnostic value, due in part to disruptive effects on rigid cognitive, emotional, and behavioral patterns as well their ability to promote neuroplasticity. Psychedelic therapies may hold unique promise for the management of chronic pain.

Personal Experience of Suffering

Using elements of K. Wojtyła’s philosophical anthropology, I make an attempt to look at the phenomenon of suffering through the experience of the suffering subject, through the uniquely personal experience of ‘I am suffering.’ The personal experience of suffering involves the inclusion of the phenomena of pain and suffering within the domain of self-consciousness, i.e. within the field of experiencing oneself, the sense of one's own identity, including the striving for fulfilment. In this perspective, the experience of suffering has to do with the person-specific openness to transcendence, which makes it possible to show the positive side to the experience of suffering. Both in the field of self-consciousness and in the personal experience of self-determination, the experience of ‘I am suffering’ can serve the person in the realisation of personal truth (about the good), involving and stimulating actions towards fulfilment.

Epidemiology and Functional Impact of Early Peripheral Neuropathy Signs in Older Adults from a General Population

Introduction: Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an epidemiological distribution of signs of PN among 2,996 community-dwelling participants in Good Aging in Skåne Study, age 60–97, and their impact on physical and autonomic function. Methods: Signs of PN were measured with Utah Early Neuropathy Scale (UENS). Associations between UENS and physical tests, pain, and dysautonomic phenomena were calculated for each sex, adjusted for age, with estimated marginal means (EMM) and odds ratios (ORs) in four UENS quantiles (Q1–Q4). Results: Participants in Q4 had worse EMM for: time to complete Timed Up and Go test (Q4–Q1: male 10.8–9.6 s; female 11.7–10.2 s), 15 m Walk test (Q4–Q1: male 11.1–9.9 s; female 11.2–10.4 s), and fewer repetitions in Step test (Q4–Q1: male 15.2–17.0 steps; female 14.5–15.8 steps). Higher OR of failing one-leg balance 60 s test {male 2.5 (confidence interval [CI] 95%: 1.7–3.8); female 2.1 (1.1–3.2)}, Foam Pad Balance test (male 4.6 [CI 95%: 3.2–6.7]; female 1.8 [1.3–2.6]), and lower physical quality of life were seen in Q4 compared to Q1. Participants in Q4 had higher OR for walking aid usage, falls, fear of falling, pain, and urinary incontinence, while in males, higher OR for orthostatic intolerance, fecal incontinence, and constipation. Conclusions: In a general population, 20–25% of older adults who have highest UENS scores, a sensitive measure of early PN, express slower gait, worse balance, lower quality of life, pain, falls and fear of falling, and autonomic symptoms.

A Statistical Analysis of the Impact of Remittances on Economic Growth in the Balkans

Remittances have been the positive consequences of the painful phenomena of poor countries. Emigration has been in the past of the European Continent and continues to be a significant feature in many countries of Eastern and South-Eastern Europe. The states of the Western Balkans have been interested in this phenomenon in a sustainable way in the last 20 years due to war, changes in economic systems, or political instability. In the various studies related to the effects of Remittances in the countries of origin, direct and positive impacts on GDP have been observed, but in other cases, these impacts are questioned since Remittances also mean that the workforce or human resources are not active in the country of origin and at the same time create a lack of GDP growth. For this reason, remittances and their fluctuations have never had a positive impact on the GDP of the countries of origin. The objective of this paper is to identify if there is a positive and direct impact between the level of remittances in relation to the Gross Domestic Product and economic growth for the five countries of the Western Balkans (Serbia, Bosnia Herzegovina, Montenegro, North Macedonia, and Albania) during the period 2000-2021 with annual data according to World Bank data.

Blank pain and pathological mourning in the analytic situation

ABSTRACT This paper presents an account of the psychoanalytic treatment of pathological mourning in the context of early psychic trauma. I introduce the concept of blank pain, understood as a negative of early trauma, to describe a distinct type of unthinkable anxiety. And I treat pathological mourning as a defence against the unbearable pain of the latter. Clinical observations reveal the extent to which, in a situation where the patient reacts to environmental failure by maintaining a façade (an insincere self), the construction of meaning depends on the use the patient makes of the analytic process and the setting. Considering these observations, I explore the relationship between the structural phenomenon of blank pain and defensive pathological mourning through the therapeutically mutative action of processive interventions and co-enacted scenarios.

Myodystonic pain syndromes in pathogenesis neurological diseases

Myodistonic pain syndrome is a common cause of algia in the neck, back, limbs, emanating from skeletal muscles and adjacent fascia. Pathophysiologically, in this condition, myogenic trigger points are formed, which, increasing muscle tone, cause their spasm. The resulting discomfort can be both local and causing reflected signs in other areas. The article presents the main mechanisms of implementation and clinical classification of neurological manifestations of myodistonic pain phenomena from the position of pathomorphology of muscular and tendon-ligament localization. Separately, the possibility of a pathogenetic approach to preventive and therapeutic measures in the clinical manifestations of myodistonic pain syndromes is considered. In general, the article contains historical bibliographic material on the study of the development and formation of an autonomous scientific direction of myogenic pain pathology.

Assessing the occurrence and severity of pre- and postendodontic pain in anemic and healthy female patients.

The objective of this current survey was to assess both the occurrence and severity of pre- and post-endodontic pain among female individuals, distinguishing between those with anemia and those without. In the current study, we included a total of 60 women with anemia (hemoglobin < 11) and those without anemia (hemoglobin > 13). We recorded the occurrence and severity of pain before and at 24, 48, and 72 h following root canal treatment using a visual analog scale (VAS)ranging from 0 to 10. Additionally, we collected data on patient age, tooth type, as well as pulpal and periapical conditions. Statistical analysis was carried out using two-way ANOVA, pairedt-tests, and Pearson correlation coefficient. The significance level for statistical tests was set at p ≤ .05. The incidence of preoperative pain in both anemic and non-anemic patients was 80%. The total incidence of post-operative pain was recorded as 71.7% (82.2% in anemic and 61.1% in non-anemic women). Compared with the pretreatment pain incidence and intensity, the values increased in 24 h but declined in 48 hand 72 h after treatment. Considering the posttreatment pain intensity, the mean values were higher in the three time intervals (24, 48, and 72 h) in anemic patients. Pulpal and periapical status, in contrast to age and tooth type, significantly contributed to the intensity of posttreatment pain. Regarding the importance of pain phenomenon in human life, it is recommended to consider anemia as an important risk factor for post-endodontic pain. Early diagnosis and analgesic treatment interventions in anemic females, alongside the pain control during root canal treatment, could promote the patient's satisfaction and quality of care.

DUPLICATION OF THE SMALL INTESTINE IN EMERGENCY PEDIATRIC SURGERY

Duplication of the gastrointestinal tract is a rare congenital surgical malformation. The frequency of the anomaly is 1:4500 ofnewborns, the most frequent localization of the duplication is the iliac region of the small intestine – 33%, duplications of the jejunum make up 7-10% of the total number of cases. The complexity of diagnosis and choice of surgical tactics is due to the absence of specifi c symptoms, possible asymptomatic presence for a long time, clinical manifestations characteristic of other diseases. The article presents an example of a clinical case of doubling of the jejunum in a pediatric patient complicated by peptic ulcer and diff use peritonitis. Complaints, features of the diagnostic process at the prehospital stage, selected surgical tactics, and causes of complications were analyzed.Morphologic signs of jejunal duplication are given. The given clinical example proves that the cause of dyspeptic phenomena of long duration and abdominal pain of unknown origin in pediatric patients may be surgical pathology, in particular, doubling of the gastrointestinal tract complicated by infl ammation of the small intestine. Therefore, such patients need the consultation of a pediatric surgeon, search and detection of possible surgical pathology, including doubling of the intestine. The diagnostic methods for detecting this anomaly are radiography, ultrasound, and contrast- enhanced computed tomography (CECT). Perforation in GI duplication is one of the causes of peritonitis that should be considered by emergency pediatric surgeons in their practice. Timely determination of the patient’s gastrointestinal tract duplication allows the emergency surgeon to optimize diagnostic measures, optimal choice of surgical approach, predict the volume of surgical intervention, avoid possible complications, reduce the time and cost of treatment. Since the fi nal confirmation of the diagnosis of gastrointestinal tract duplication is the result of morphological examination, its performance is mandatory.

Problem-based learning method in the context of a flipped classroom: Outcomes on pain management course acquisition

Introduction: A deep understanding of physiology, physiopathology, pharmacology, and the management of pain is crucial for nurse anaesthetists to ensure the well-being of their patients. Thus, the teaching strategies should enhance the transition from acquiring the fundamental pain phenomena, to developing translational and critical thinking. The aim of the study is to determine if the flipped classroom that is considered an active learning approach is most effective compared to the traditional method in teaching pain management and if it improves students' academic performance. Methods: This study was quasi experimental, at a higher institute of nursing professions, among third-year anaesthesia resuscitation nursing students. participants were randomly allocated into either: the flipped classroom group where PBL was used (FG, n = 19), or the traditional lecture-based classroom group (TG, n = 19). The results and impact of the above approach were appreciated via the analysis of the summative assessment of the class group and from the questionnaire submitted to students. Results: The present study revealed that in the midterm exam, the mean score of the flipped classroom group (14.0) which is significantly higher (p&lt;0.01) than the traditional lecture group (11.9). Moreover, the standard deviation of this latter is slightly higher (2.41) which indicates scores far from the average. Also, a significant difference between the averages of the two approaches in favor of flipped classroom Group was revealed (p&lt;0.01). Conclusion: The assessment of student’s grades and their appreciation of both teaching approaches showed a preference for the PBL. Keywords: Flipped Classroom, Nursing Education, Pain Management, Problem-Based Learning