Painful Procedures Research Articles

The Effectiveness of Nonpharmacological Interventions to Reduce Procedural Pain of Pediatric Oncology Patients: A Systematic Review and Meta-analysis.

Relieving procedural pain in pediatric oncology is an important facilitator of the cancer treatment process. To synthesize the effect of nonpharmacological interventions on reducing the procedural pain of pediatric oncology patients in randomized controlled trials. A meta-analysis and systematic review for randomized controlled trials. The PROSPERO has registered the meta-analytic approach used in this review. For studies published in English from the earliest record to May 2023, comprehensive and systematic literature searches were carried out using PubMed, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Science Direct, Springer Link, Scopus, EMBASE, Ovid, ELSEVIER, ProQuest and the CENTRAL, and Taylor & Francis. Two researchers used the Cochrane Collaboration method to assess the risk of bias in the included studies. Four hundred ninety-four participants in 7 trials met the eligibility requirements. The primary findings showed no evidence of a significant publishing bias. This study revealed that nonpharmacological therapies significantly reduced procedural pain. Virtual reality techniques outperform nondigital distraction techniques in subgroup analysis of intervention types when it comes to lowering procedural pain in pediatric oncology patients. In pediatric oncology, nonpharmacological therapies significantly and positively reduce procedural pain. No adverse events were reported in the included studies. Nonpharmacological therapies can be utilized by pediatric oncology nurses to mitigate procedural pain associated with needles. The findings of this study will contribute to the application of effective nonpharmacological interventions by clinical nurses and will provide guidance for the planning of further research.

Acupuncture in Pediatrics: A Scoping Review.

Background: The use of acupuncture for common pediatric conditions continues to grow in the United States. Six previous reviews have summarized the research; however, approximately 8 years have accumulated adding to this growing body of literature. Objectives: The aim of this article is to provide a scoping review of acupuncture research in pediatric conditions and a summary of the effectiveness of acupuncture in the pediatric population. Methods: A systematic search was performed to identify clinical trials and reviews published between August 2015 and October 2023. Trials and reviews were excluded if they were not: (1) acupuncture specific, (2) data limited to pediatric patients, and (3) published in English. The literature was assessed and synthesized into a scoping review and commentary. Results: Seventy-one publications were identified (42 clinical trials and 29 reviews) that represented 17 conditions and 10 countries; the top 2 were China and the United States. The top five areas of new research (based on numbers of clinical trials) are pain, cerebral palsy (CP), attention-deficit hyperactivity disorder, autism spectrum disorder, and nausea and vomiting. Conclusions: Clinical trials in pediatric acupuncture represent a small but important subset of acupuncture literature. Data are positive for postoperative nausea and vomiting and promising for CP, nocturnal enuresis, perioperative pain, procedural pain, and tic disorders. Several factors preclude additional firm conclusions from being drawn, including a limited number of trials, small sample size (n < 100) of the majority of randomized controlled trials (78.6%), and heterogeneity of treatment approaches. Continued research on the use of acupuncture for pediatric conditions is warranted, particularly in conditions demonstrating recent promising evidence.

ASRA answers: is the use of skin wheals in interventional pain procedures an obsolete practice

ASRA answers: is the use of skin wheals in interventional pain procedures an obsolete practice

Learning to Communicate With Patients About Potentially Painful Gynecologic Procedures.

Doing painful procedures is a part of obstetrics and gynecology practice. Patients' pain experiences are subjective, diverse, and based on life experiences that can include trauma, adverse childhood events, and previous labor. Learners should have opportunities to gain knowledge about pain and the informed consent process during preclinical medical education, to observe and practice informed consent exchanges that include a discussion of pain and pain management with standardized and real patients during different stages of their training, to receive timely feedback from seasoned clinicians who understand that shared decision-making is an essential component of an informed consent discussion, and to learn from every patient encounter in order to inform the next one (reflective practice).

Factors Causing Incomplete Colonoscopy Reported by the Endoscopist: A Population-based Study.

Colonoscopy is a primary diagnostic method for colorectal cancer screening. Ensuring completeness is critical for its effectiveness. The aim of this study is to explores patient and procedure-related contributors to incomplete colonoscopy in a Danish high volume endoscopy unit. A population-based register study was conducted, using data from electronic health records from a Danish hospital was analyzed, covering all colonoscopies performed between July 2015 and August 2019. The primary outcome assessed was the completeness of the index colonoscopy, with incomplete cases further classified based on the causes for incompleteness that were assessed and documented in real-time by the endoscopist. Data also included patient demographics and comorbidities, and profession of the endoscopist. Among 33,128 colonoscopies, prevalence of incomplete colonoscopies was 6.55%, with inadequate bowel preparation as the leading cause (60.3%). Men were more prone to inadequate bowel preparation, while procedural pain, non-passability, and stenosis were associated with women. Physician endoscopists exhibited higher incomplete colonoscopy rates compared to nurse endoscopists, and patients with higher comorbidity scores were more likely to have incomplete colonoscopy. This study highlights the prevalence of incomplete colonoscopy and recognizes modifiable risk factors like inadequate bowel preparation and procedural pain. Findings underscore the need for personalized interventions, stressing ongoing endoscopist education and targeted strategies to improve colonoscopy effectiveness.

A Review of Nonsurgical Neurolytic Procedures for Neuropathic Pain.

Ideally, a physical or chemical nonsurgical neurolytic procedure provides targeted neurolysis to relieve pain for a suitable length of time without causing complications. This narrative review focuses on five nonsurgical neurolytic procedures that are well-established and well-documented in the literature for the treatment of refractory neuropathic pain and peripheral neuropathies, in particular: two physical nonsurgical neurolytic techniques (cryoablation and radiofrequency ablation) and three chemoneurolytic agents (alcohol injection, phenol injection, and a high-concentration capsaicin 8% topical system). Using the definition of nonsurgical physical and chemical neurolytic procedures for neuropathic pain, a focused literature search of the PubMed database for English-language, human studies published through July 2024 included, but was not limited to, the following search terms: "neuropathic pain" AND "cryoablation", "cryoneurolysis", "radiofrequency ablation", "alcohol neurolysis", "alcohol injection", "phenol neurolysis", "phenol injection", "chemoneurolysis", "topical capsaicin", and "TRPV1." While attempts were made to identify prospective clinical trials for each type of neurolytic procedure, information regarding the conduct and safety and efficacy of some of these nonsurgical neurolytic procedures was primarily limited to case studies and anecdotal evidence. The risk benefit basis of each technique is discussed, and recommendations for proper use based on the literature are summarized. Most techniques require ultrasound or fluoroscopy guidance. Pain relief typically ranges from 3 to 12 months, with repeat neurolytic procedures often required to maintain suitable levels of pain relief. The authors provide their insights as to the best utilization of these identified nonsurgical physical and chemoneurolytic procedures for the treatment of refractory neuropathic pain in different patient populations based on neural targets. Together, these five nonsurgical neurolytic techniques provide patients and physicians with a variety of options for the treatment of refractory neuropathic pain.

Effect of Lignocaine Infiltration versus Intravenous Dexmedetomidine on Haemodynamic Response during Skull Pin Holder Application for Craniotomy: A Prospective Interventional Study

Introduction: The use of a skull pin holder during craniotomy is a painful procedure that induces haemodynamic changes. This may lead to raised intracranial pressure, brain bulging, or intracranial haemorrhage. Effectively managing these stress responses is very important, as they may increase morbidity and mortality in neurosurgical patients. Aim: To compare the effects of lignocaine infiltration and intravenous dexmedetomidine on the haemodynamic stress response to skull pin holder application during craniotomy. Materials and Methods: This prospective interventional study was conducted on 122 patients over a period from June 2020 to June 2021 in the Neurosurgery operation theatre of Government Medical College, Kozhikode, Kerala, India, a tertiary care teaching centre. Patients were divided into two groups: Group-L received 3 mL of 2% lignocaine with 1 in 200,000 adrenaline at each premarked pin site, while Group-D received intravenous dexmedetomidine at a dose of 0.5 mcg/kg over 10 minutes before the induction of general anaesthesia. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded at baseline, after induction, post-intubation, pre-pin application and at intervals of 1, 2, 3, 4, 5, 10 and 15 minutes post pin application. Stata version 14.2 was used for data analysis. Statistical comparison between the groups was conducted using the independent t-test and Chi-square test. Results: There was no statistically significant difference in HR and blood pressure between the groups immediately after skull pin application. However, Group-D exhibited a significant reduction in HR at 10 and 15 minutes (p&lt;0.001) post pin application compared to Group-L. Additionally, a statistically significant reduction in SBP, DBP and MAP was observed among the groups at 5, 10 and 15 minutes post pin application, with a greater reduction in Group-D. Conclusion: Intravenous dexmedetomidine at a dose of 0.5 mcg/ kg was as effective as lignocaine infiltration at the premarked pin site in reducing the haemodynamic stress response to the application of the skull pin holder. Dexmedetomidine at this dosage also showed a greater reduction in HR and blood pressure after five minutes post pin application and did not require any additional pharmacological measures.

Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT

Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT

Phase-specific changes in hip joint loading during gait following sacroiliac joint fusion: Findings from a finite element analysis.

Phase-specific changes in hip joint loading during gait following sacroiliac joint fusion: Findings from a finite element analysis.

Regional Anesthesia Techniques for Breast Cancer Surgeries-A Narrative Review.

Postoperative pain of breast cancer procedures can be debilitating and if not treated properly can lead to acute and chronic complications. Regional anesthesia techniques are very useful in providing adequate pain relief and can be applied either as a supplement to general anesthesia or surgical anesthesia in these surgeries. The application of ultrasound has revolutionized the field of regional anesthesia for breast cancer procedures, especially in the last decade. A thorough understanding of the application of each technique with precise knowledge of the sensory supply of the breast and axilla and the types of breast cancer surgeries can help us to choose the proper technique(s). In this article, the commonly used regional anesthesia techniques for breast cancer surgeries are discussed.

Preoperative thoracic epidural analgesia with and without erector spinae plane block for thoracotomy: A retrospective study.

Preoperative thoracic epidural analgesia with and without erector spinae plane block for thoracotomy: A retrospective study.

Distraction-based interventions for children in the emergency care setting: A realist synthesis based on primary research.

The literature underscores the prevalence of pain as the most common presenting symptom in the Emergency Care Setting (ECS) and is associated with anxiety and stress for children. On top of that painful procedures are often required as part of their treatment, making procedural pain a common experience. The substantial evidence supporting the effectiveness of distraction-based interventions (DBI) in relieving pain and anxiety and reducing stress underscores the urgency of addressing this issue. However, the fragmented adoption of standardised DBI highlights the need for further research and implementation. To conduct a realist synthesis based on primary research exploring "what works for whom under what circumstances, how and why?" when implementing DBI in the ECS. Empirical research evidence was retrieved systematically from eight databases covering health and social sciences. The studies were synthesised based on the principles of realist science, drawing on Pawson and Tilley's (1997) and Dalkin et al.'s (2015) programme theory development, which explains the contexts and mechanisms that generate positive outcomes about DBI for children in the ECS. Of the 2099 studies screened, 64 were included. Screening was conducted 2023 to December 2024. A synthesis of the findings generated five Programme Theories (PT). PT1 focuses on the personalisation of DBI for children in the ECS, PT2 explains the importance of parental participation, PT3 highlights the importance of healthcare workers (HCWs) commitment to adopting DBI in practice, PT4 draws attention to policy-level efforts necessary for implementation support, and PT5 focuses on engaging all stakeholders in the implementation process. To the authors' knowledge, this is the first study to apply a realist lens to understand the use of DBI in children attending the ECS and present the mechanisms that enable and/or inhibit its implementation and utilisation in everyday clinical practice. This realist synthesis provides methodological guidance in the form of PT that can be utilised by clinical practitioners to adopt and implement DBI within the healthcare setting.

Longitudinal Utilization of Invasive Pain Treatment Procedures Among Veterans with Chronic Pain Following Use of Whole Health Services and Complementary and Integrative Health Therapies.

To assess whether Whole Health, a system of care that emphasizes non-pharmacological approaches for chronic pain management, is associated with changes in downstream utilization of invasive pain treatment procedures. Longitudinal retrospective cohort analysis of VHA administrative data. A total of 53,412 Veterans with chronic pain were identified between April and September 2018, with 584 initiating Whole Health and 3794 initiating a complementary and integrative health (CIH) therapy independent of Whole Health (CIH-only). Whole Health included use of coaching, personal health planning, and other services including CIH referral. CIH therapies included chiropractic care, acupuncture, massage therapy, yoga, Tai Chi/Qigong, and meditation. Propensity score matching was used to estimate expected rates of invasive pain treatment procedures 0-3, 4-12, and 13-18 months after initiating Whole Health or CIH-only compared to similar Veterans who had not engaged in either. Overall, 14% of the population were female, 11% had received prior spine injections, 3.3% had received surgery, and 0.4% had an implantable spinal stimulator. Whole Health use was associated with 42% (-61% to -17%)lower utilization of invasive pain procedures at three months compared to matched patients who did not use Whole Health. This reduction was attenuated at 18 months: 22% (-39% to -5%). CIH-only was associated with 18% (-29% to -4%) lower utilization at three months compared with matched patients, but differences were minimal at 18 months: 1% (-9% to 9%). Whole Health care, including CIH therapies, may help patients interrupt patterns of escalating and invasive pain care.

Establishing the first ever pediatric procedural sedation clinic in a low-income country: Assessment of the safety and efficacy

BackgroundPediatric sedation clinics are rare in low-income countries. Our aim is to describe the establishment of the first-ever pediatric sedation clinic in Ethiopia and provide an assessment of its safety and efficacy over the 5 years since its establishment.MethodsA multi-phase approach was undertaken. In the first phase, we analyzed barriers to procedural pain management through repeated focus group discussions with stakeholders. Subsequently, we conducted a modified sedation provider course from the Society for Pediatric Sedation (SPS) with pre and post-training testing to document course effectiveness. Finally, we developed a procedural sedation clinic at Tikur Anbessa Specialized Hospital.In the second phase, we prospectively collected outcome data over a 5-year period from patients receiving procedural sedation at the clinic. This included assessing the efficacy of sedation and documenting any adverse events that occurred during the procedures.ResultOne hundred three providers completed the procedural sedation course. There was a 13.4% improvement in knowledge between baseline and post-course testing. A total of 2,820 patients underwent procedural sedation over the 5-year period from 2016 through 2021, and data selected from 475 (16.8%) patients were analyzed. The most common procedure performed was bone marrow aspiration/biopsy in 384 subjects (80.8%). The most common procedural sedation used was the combination of ketamine and propofol in 60.6%. The mean pain score during the procedure was 0.28/10, which was significantly lower than the pre-procedural pain score (p-value < 0.001). A total of 9 (1.9%) patients had adverse events and there was no mortality.ConclusionBased on our experience, development of a safe and effective sedation clinic is possible in resource-limited settings as evidenced by low procedural pain scores, and low adverse events rates. Provider training based on a modification of the SPS course improved overall procedural sedation knowledge.

Perioperative Pain Management in Patients With Cancer-Related Pain: A Narrative Review.

The number of cancer patients, cancer survivors, and cancer surgeries is expected to continue to grow and anesthesiologists will benefit from having a framework on how to approach treating perioperative pain in the oncologic population. This article presents general considerations for formulating a perioperative pain management plan including cancer-specific contraindications for epidurals and nerve blocks, common procedures for pain after thoracic and abdominal surgeries, and alternative pain management techniques.

Repetitive neonatal pain increases spinal cord DNA methylation of the µ-opioid receptor.

Repetitive neonatal painful procedures experienced in the neonatal intensive care unit (NICU) are known to alter the development of the nociceptive system and have long-lasting consequences. Recent evidence indicates that NICU stay affects the methylation of the opioid receptor mu 1 encoding gene (Mor-1). Additionally, a preclinical model of neonatal procedural pain established lower adult post-operative MOR-1 levels in the spinal cord. Thus, we hypothesized that neonatal procedural pain increases the DNA methylation status of Mor-1 in the spinal cord and dorsal root ganglia (DRGs). To this end, repetitive neonatal procedural pain was induced in animals, during the first postnatal week, a period equivalent to preterm human brain development. On postnatal day 10 methylation of Mor-1 promotor was assessed in the spinal cord and the DRG using bisulfite pyrosequencing. Our findings demonstrated that neonatal procedural pain increased spinal cord Mor-1 promotor DNA methylation in the ipsilateral side as compared to the contralateral side, an effect that was not observed in the control animals, nor in the DRG. This study is the first to highlight a localized and noxious-stimuli-dependent effect of repetitive neonatal procedural pain on Mor-1 promotor methylation and emphasizes the need to explore the effects of repetitive neonatal procedural pain on the epigenome. This study reveals that repetitive neonatal procedural pain is associated with increased DNA methylation of the Mor-1 promoter in the spinal cord of neonatal rats. This is the first study to identify an effect of neonatal procedural pain on DNA methylation, emphasizing the critical need for further investigation into the epigenetic consequences of neonatal procedural pain. These insights could lead to better management and treatment strategies to mitigate the long-term impacts of early pain exposure on neurodevelopment and behavior.

Virtual reality in pediatric emergency department and burn unit: a scoping review of current applications

Virtual reality (VR) represents an innovative and effective tool for reducing pain and anxiety in children undergoing painful procedures in pediatric emergency departments and burn units. VR has the ability to modulate both the sensory and emotional components of pain by immersing children in a virtual world, effectively diverting their attention from the painful experience. Specifically, VR distraction competes for the patient’s attentional resources, reducing their focus on the painful stimulus and, consequently, diminishing the perception of pain. The primary objective of this review was to assess and summarize the current knowledge regarding the use of VR for painful procedures in pediatric emergency and burn units by comparing and analyzing the existing literature. Of the 340 articles reviewed, 25 met the selection criteria and were included in the analysis. These studies examined the use of VR in venous procedures (such as venipuncture, cannulation, and blood sampling) as well as other procedures, including laceration repair and burn wound care. The findings indicated that 20 studies reported a reduction in pain scores, while 9 studies noted a reduction in anxiety scores. Additionally, three studies demonstrated a reduction in procedural time. Overall, the studies supported the efficacy, safety, and feasibility of VR in managing procedural pain and anxiety in pediatric settings. Furthermore, VR use contributed to a reduction in parental and medical stress levels, as well as a decrease in the time spent in the pediatric emergency room. Studies involving larger sample sizes may provide further evidence of VR’s effectiveness across different procedures and age groups.

The effectiveness of oral and sublingual ketamine in pain management: a systematic review and meta‐analysis

AbstractAimThe aim of this study was to undertake a systematic review and meta‐analysis to determine the effectiveness of oral and sublingual ketamine in pain management.Data SourcesA systematic search was conducted utilising four databases: MEDLINE, CINAHL, Embase, and Web of Science.Study SelectionThe study included randomised controlled trials investigating the use of oral or sublingual ketamine in the management of pain in inpatient or outpatient settings compared to any alternative oral or sublingual comparator, including placebo.ResultsTwenty‐one studies were included for systematic review, all assessing oral ketamine, including one comparing oral to sublingual ketamine. Of these, 12 studies evaluated oral ketamine in procedural pain, with 10 studies finding oral ketamine significantly better than the comparator at reducing procedural pain. Two studies focused on oral ketamine in postoperative pain, both finding oral ketamine reduced the requirement for additional analgesia compared to placebo. Five studies investigated oral ketamine in chronic pain with heterogenous results. Of the remaining two studies, one compared various doses of oral ketamine and the other compared oral to sublingual ketamine.Fifteen studies were included for meta‐analysis. Among them, seven studies compared oral ketamine to placebo and found oral ketamine was superior to placebo in reducing pain (p &lt; 0.01). Eight studies compared oral ketamine to other oral medications such as methadone, codeine, midazolam, and dexmedetomidine and showed no significant benefit of oral ketamine in reducing pain (p = 0.18).ConclusionThe results suggest oral ketamine is an effective analgesic in the procedural setting.

White noise’s effect on premature infants’ physiological parameters during peripheral intravenous catheter insertion

BackgroundEarly and continuous exposure to painful stimuli in premature infants leads to short-and long-term complications. Listening to white noise is an accessible and inexpensive non-invasive method that can be used as a safe nursing intervention in hospitals. This study aimed to assess white noise’s effect on premature Infants’ physiological parameters during peripheral intravenous catheter insertion.MethodsThe present experimental study was conducted on 40 premature Infants. From 5 min before Indwelling catheters to 10 min after, white noise was played through headphones to infants at a controlled volume in the test group. Using a monitor, physiological parameters were recorded from 10 min before to 30 min after the Indwelling catheter. Statistical analysis was done through the SPSS version 27 software program.ResultsRegarding respiratory rate, there was no statistically significant difference between the two groups in the first, second, and sixth stages (p < 0.05). However, in the third, fourth, and fifth stages, RR in the control group was significantly higher than the test group (p ≤ 0.05). In terms of mean arterial blood pressure, there was no statistically significant difference between the two groups in any of the stages (p < 0.05). In terms of heart rate, there was no statistically significant difference between the two groups in the first, second, and sixth stages (p < 0.05). However, in the third, fourth, and fifth stages, HR in the control group was significantly higher than the test group (p ≤ 0.05). Regarding oxygen saturation percentage, there was no statistically significant difference between the two groups in the first, second, third, and sixth stages (p < 0.05). In contrast, in the fourth and fifth stages, the oxygen saturation percentage in the test group was significantly higher than in the control group (p < 0.05).ConclusionsAlthough in both groups the painful procedure led to an increase in physiological variables (respiratory rate, heart rate, mean arterial blood pressure) and a decrease in blood oxygen saturation, in the test group these variables approached their initial state more quickly within half an hour after exposure to white noise. This confirms that the effect of white noise on the improvement of physiological variables is gradual.Clinical trial numberNot applicable.

Dexmedetomidine for analgesia and sedation for procedural pain or discomfort in newborn infants.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of dexmedetomidine compared with opioids, non-opioids and placebo in providing sedation and analgesia for procedural pain in newborn infants.