Pain Management Strategies Research Articles

Balancing Tradition and Science: Acupuncture in Pain Control

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

Different doses of epidural morphine combined with multimodal analgesia strategies for postpartum pain management: study protocol for a single-centre, double-blind randomised, pragmatic clinical trial

IntroductionThe neuraxial morphine has been regarded as the gold standard for postpartum analgesia. However, the recent advancements in patient-controlled analgesia and various regional nerve blocks have led to the implementation...

Barriers and facilitators to effective pain management in elderly Arab patients: a nursing perspective through a qualitative study

BackgroundEffective pain management in elderly patients is crucial for quality of life, yet cultural and institutional factors can significantly impact care delivery, particularly in Arab healthcare settings.AimTo explore the barriers and facilitators to effective pain management in elderly Arab patients from the perspective of nurses.MethodsA qualitative descriptive study was conducted with 12 registered nurses from various departments at Tanta University Hospitals, Egypt. Data were collected through semi-structured interviews, observations, and document analysis. Content analysis was used to identify themes and subthemes.ResultsFive main themes emerged: (1) Cultural Barriers to Pain Expression, including stoicism and religious beliefs; (2) Institutional Barriers to Pain Management, such as resource limitations and time constraints; (3) Facilitators to Effective Pain Management, including family support and nurse adaptability; (4) Interdisciplinary Collaboration, emphasizing teamwork and education; and (5) Emotional and Professional Rewards for nurses. Cultural factors often led to underreporting of pain, while institutional constraints hindered thorough assessments. Nurse adaptability and family support, when present, facilitated better pain management.ConclusionThe study reveals complex interplay between cultural, institutional, and professional factors influencing pain management in elderly Arab patients. Findings suggest the need for culturally sensitive pain assessment tools, enhanced nurse education in pain management, and policies promoting family-centered care and interdisciplinary collaboration.ImplicationsResults can inform the development of culturally appropriate pain management strategies and policies in Arab healthcare settings, potentially improving care quality for elderly patients.

Dissecting the link between PD-1/PD-L1-based immunotherapy and cancer pain: mechanisms, research implications, and artificial intelligence perspectives

Cancer-related pain represents one of the most common complaints of cancer patients especially for those with advanced-stage of disease and/or bone metastases. More effective therapeutic strategies are needed not only to improve the survival of cancer patients but also to relieve cancer-related pain. In the last decade, immune checkpoint inhibitor (ICI)-based immunotherapy targeting programmed cell death-1 (PD-1) and its ligand 1 (PD-L1) has revolutionized cancer care. Beyond its anticancer role, PD-1/PD-L1 axis pathway is involved in many other physiological processes. PD-L1 expression is found in both malignant tissues and normal tissues including the dorsal root ganglion, and spinal cord. Through its interaction with PD-1, PD-L1 can modulate neuron excitability, leading to the suppression of inflammatory, neuropathic, and bone cancer pain. Therefore, since the intricate relationship between immunotherapy and pain should be largely dissected, this comprehensive review explores the complex relationship between PD-1/PD-L1-based immunotherapy and cancer-related pain. It delves into the potential mechanisms through which PD-1/PD-L1 immunotherapy might modulate pain pathways, including neuroinflammation, neuromodulation, opioid mechanisms, and bone processes. Understanding these mechanisms is crucial for developing future research directions in order to optimize pain management strategies in cancer patients. Finally, this article discusses the role of artificial intelligence (AI) in advancing research and clinical practice in this context. AI-based strategies, such as analyzing large datasets and creating predictive models, can identify patterns and correlations between PD-1/PD-L1 immunotherapy and pain. These tools can assist healthcare providers in tailoring treatment plans and pain management strategies to individual patients, ultimately improving outcomes and quality of life for those undergoing PD-1/PD-L1-based immunotherapy.

Comparative analysis of pain outcomes in operative versus diagnostic hysteroscopy: the role of menopausal status

Objectives: The study investigates the differential pain outcomes associated with operative and diagnostic hysteroscopy, with a focus on the influence of menopausal status on pain perception. This research aims to refine pain management strategies tailored to patient demographics in gynecological practices. Methods: A total of 200 patients undergoing hysteroscopy were systematically evaluated. Pain intensity was assessed using the Visual Analog Scale (VAS). The study distinguished between operative and diagnostic procedures, with particular attention to the effect of menopausal status on pain scores. Compliance with CONSORT guidelines was ensured, and relevant clinical trial registration numbers were included. Results: Pain scores did not significantly differ between operative and diagnostic hysteroscopies, suggesting that the invasiveness of the procedure might not directly correlate with pain perception. However, menopausal women reported significantly higher pain scores, indicating a possible increased sensitivity or decreased pain tolerance related to hormonal changes. Conclusions: The results affirm that existing pain management protocols effectively mitigate discomfort across different hysteroscopic procedures. Nonetheless, the distinct pain profiles of menopausal women warrant the development of customized pain management strategies. Enhancing analgesic approaches for this subgroup could improve patient care and outcomes in gynecological settings.

The Effect of Epidural Analgesia on In-Hospital Outcomes in Patients with Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may reduce AP severity and improve outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients. Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until mid-May 2024 for RCTs comparing EA with other pain management strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed a random-effects model and the Mantel-Haenszel method. Study heterogeneity was assessed using the I2 statistic. Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR = 0.69, 95% CI [0.29, 1.65], p = 0.40), mechanical ventilation (RR = 0.82, 95% CI [0.61, 1.10], p = 0.19), sepsis events (RR = 0.88, 95% CI [0.42, 1.86], p = 0.74), hospital/ICU stay (WMD = 0.49 days, 95% CI [-1.13, 2.10], p = 0.55), and pain score (WMD = 1.49, 95% CI [-0.42, 3.40], p = 0.13). However, opioid requirements were significantly lower, as reported by one study with morphine milligram equivalent of 15 mg/day compared to 52 mg/day in the control group (p = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score (I2 = 92%). The overall certainty of evidence was very low due to the small number of studies, risk of bias, and limited sample size. EA did not significantly improve in-hospital outcomes in AP patients. However, findings indicated reduced opioid consumption in the EA group, suggesting potential benefits in pain management. Further high-quality, large-scale randomized trials are needed to understand the potential benefits of EA in this population.

Pain and the risk of social isolation and loneliness in older Chinese adults: Do gender, age, and education make a difference?

ObjectivePain has long been known to affect the health and well-being of older adults. However, no longitudinal study has examined the associations between pain, social isolation, and loneliness among older adults in China. This study aims to explore the relationships between pain and older Chinese adults’ social isolation (family isolation and friend isolation) and loneliness, and whether these associations are moderated by gender, age, and education groups. MethodData derived from the four waves of the China Longitudinal Aging Social Survey (CLASS, 2014-2020). The sample included 18,692 respondents (aged 60 years and older), and mixed-effects logistic models were used. ResultsPain is not significantly associated with family isolation. In contrast, pain increases the risk of friend isolation and loneliness. Regarding the moderating roles of gender, age, and education, the results show that the relationship between pain and friend isolation is stronger among older women compared to their male counterparts. The association between pain and the risk of friend isolation is stronger among young-old adults (60-69 years) than among their older counterparts (70 years and older). Conversely, the oldest old adults (80+ years) are more likely to experience loneliness combined with pain than their younger counterparts. In addition, the negative effect of pain on the risk of loneliness is stronger among the more educated than among the less educated older adults. ConclusionsThe findings underscore the pivotal role of pain in shaping the social well-being of older adults, and highlight the need to consider sociodemographics and socioeconomic status when developing pain prevention and management strategies.

The analgesic effect of acupuncture in neuropathic pain: regulatory mechanisms of DNA methylation in the brain

Abstract Recent research has demonstrated that chronic pain, resulting from peripheral nerve injury, leads to various symptoms, including not only allodynia and hyperalgesia but also anxiety, depression, and cognitive impairment. These symptoms are believed to arise due to alterations in gene expression and neural function, mediated by epigenetic changes in chromatin structure. Emerging evidence suggests that acupuncture can modulate DNA methylation within the central nervous system, contributing to pain relief and the mitigation of comorbidities. Specifically, acupuncture has been shown to adjust the DNA methylation of genes related to mitochondrial dysfunction, oxidative phosphorylation, and inflammation pathways within cortical regions, such as the prefrontal cortex, anterior cingulate cortex, and primary somatosensory cortex. In addition, it influences the DNA methylation of genes associated with neurogenesis in hippocampal neurons. This evidence indicates that acupuncture, a treatment with fewer side effects compared with conventional medications, could offer an effective strategy for pain management.

Identifying Pain Subtypes in Patients with Craniofacial Lesions of Fibrous Dysplasia/McCune-Albright Syndrome

BackgroundFibrous dysplasia/McCune-Albright Syndrome (FD/MAS) is a genetic disorder, marked by bone lesions, often affecting the craniofacial skeleton. Pain is a prevalent yet heterogenous symptom reported by patients with craniofacial FD. Effective treatments are currently lacking, posing a significant clinical challenge to patient care. PurposeThis preliminary study examined pain profiles in craniofacial FD and aimed to identify subtypes of patients based on pain phenotypes and emotional health. Study Design, Setting, SampleA prospective, cross-sectional study involving 15 patients with FD/MAS, conducted at Boston Children’s Hospital and Massachusetts General Brigham’s Hospitals. Predictor/Exposure/Independent VariableHeadache frequency, craniofacial pain severity, neuropathic pain quality, pain interference, allodynia, photophobia, depression, and anxiety were assessed using clinical questionnaires. Main Outcome Variable(s)The primary outcome variable was the symptom profile derived from standardized clinical questionnaires and analyzed using Principal Component Analysis (PCA) and K-means clustering. CovariatesCovariates included demographic data, diagnosis, and lesion location(s). AnalysesPCA and K-means clustering of patient-reported measures of pain and emotional health were performed. Analysis of variance was conducted to determine significant differences among patients subtypes. Statistical significance was set at (p < 0.05) ResultsThe study included 15 subjects with FD/MAS, with a mean age of 36.2 (13.9) years, including one male. Clustering analysis identified three subtypes of patients with distinct symptom profiles. Cluster 1 (n=2) averaged 70 (28.3) headache days in a 90-day period, pain level of 7.5 (0.7) on a 0-10 scale, and severe anxiety, depression, allodynia, photophobia, and pain interference. Cluster 2 (n=7) patients reported an average of 5.4 (7.5) headache days, average pain level of 2.7 (2.6), mild or no anxiety, depression, allodynia, photophobia, and pain interference. Cluster 3 (n=6) patients displayed a mixed symptom profile with an average 47.3 (36.4) headache days and pain level of 5.25 (1.4). Notably, patients with temporal and skull base lesions were predominantly found in Clusters 1 and 3, which exhibited the most severe symptomatology. Conclusions and RelevanceThis study establishes a basis for future longitudinal research aimed at understanding underlying pain mechanisms and evaluating the response to personalized pain management strategies in subtypes of patients with craniofacial FD.

Pain Assessment Following Opioid Administration in Aneurysmal Subarachnoid Hemorrhage Associated Headache

Background: Headache is a debilitating complication following an aneurysmal subarachnoid hemorrhage (aSAH). Despite its impact on morbidity and quality of life, limited evidence characterizes the effectiveness of opioids. Objective: The aim of this study was to evaluate opioid associated reduction in pain scores in patients with aSAH-associated headache. Methods: This is a retrospective study of adult patients with an aSAH, Hunt and Hess grades I – III, admitted to a neurosciences intensive care unit. Descriptive and inferential statistics were used to characterize headache treatment strategies and opioid associated reduction in pain scores. Results: Opioids were used in up to 97.6% of patients for the management of aSAH-associated headache. Median reduction in pain after opioid administration was −1 (IQR: -3-0). Correlation between opioid dose and change in pain scores was negligible (rs = .01). Overall, 68.8% of patients were discharged on an opioid analgesic with predictive factors being severe headache (OR 2.52; 1.04 – 6.14) and oral morphine milligram equivalents ≥60 mg per day during the hospital stay (OR 3.02; 1.22 – 7.47). Conclusions: Opioids were associated with a small reduction in pain when assessed via the NRS. An increased opioid dose did not correlate with a greater reduction in assessed pain scores. A high percentage of patients remained on opioids throughout hospitalization and were eventually discharged on an opioid. The impact of discharge opioid prescriptions and risk of opioid persistence creates a cause for concern. It is imperative that we seek improved pain management strategies for aSAH-associated headache.

Systematic Approaches to Optimize Opioid Prescribing in Surgical Patients

The opioid crisis has highlighted the urgent need to optimize pain management strategies in surgical settings, prompting a shift towards opioid-sparing therapies. While opioids are crucial for alleviating moderate to severe postoperative pain, their over prescription poses significant risks, including addiction and overdose. This paper examines the feasibility of achieving opioid-free surgical recovery, particularly for minor and minimally invasive procedures, with the goal of extending this practice to more invasive surgeries through enhanced recovery after surgery (ERAS) programs. It also considers the cultural factors that influence patient expectations regarding pain management in countries with lower opioid prescribing rates, such as Japan and Germany, emphasizing the need for tailored approaches in the United States. The study advocates for the exclusion of opioids at every stage of the perioperative experience, promoting opioid-free anesthesia and analgesia. A framework for optimizing opioid prescribing practices in surgical contexts is proposed, highlighting the vital roles of acute pain specialists and pharmacists in developing comprehensive pain management strategies. By incorporating multimodal analgesia techniques, including non-opioid medications and alternative therapies, healthcare providers can effectively mitigate the risks associated with opioids while ensuring adequate pain relief

Evaluation of the Acceptability and Feasibility of Stress Mitigation Education and Support Delivered via Telehealth for People After Road Traffic Musculoskeletal/Orthopedic Injury.

To evaluate the acceptability and feasibility of a consumer co-designed telehealth intervention which aimed to reduce claimant distress by providing pain management strategies, informational and social support to people who had made a compensation claim following road traffic musculoskeletal injury. Eleven claimant participants who were at risk of a poor outcome completed the intervention in a one-on-one setting with the same clinician delivering the program across all sessions.They were interviewed about their experience (acceptability and feasibility including the use of telehealth). Clinicians who delivered the intervention also completed an anonymous feedback survey exploring their experiences delivering the intervention. Interviews were transcribed verbatim and thematic analysis was conducted. There were four themes which broadly related to the acceptability and feasibility of the intervention as well as the perceived benefits: (1) knowledge is power, (2) healing with social connection, (3) further along than I would have been, and (4) telehealth was acceptable and feasible. The delivery of a co-designed telehealth-delivered stress mitigation intervention to support people with a road traffic musculoskeletal injury was feasible to deliver and acceptable to people who were at risk of a poor outcome. Further research to evaluate the efficacy of the intervention on outcomes such as pain, self-efficacy, and claims costs are needed.

A review and bibliometric analysis of global research on non-pharmacologic management for neonatal and infant procedural pain.

Repeated and prolonged exposure to pain can impair neurodevelopmental, behavioral, and cognitive outcomes in newborns. Effective pain management of newborns is essential, but there is no comprehensive analysis of the status of neonatal pain non-pharmacologic management research. Original publications related to the non-pharmacological management of neonatal pain were obtained from the Web of Science Core Collection (WOSCC) between 1989 and 2024. CiteSpace and VOSviewer were used to extract information about countries/regions, institutions, authors, keywords, and references to identify and analyze the research hotspots and trends in this field. 1331 authors from 51 countries and 548 institutions published studies on the non-pharmacological management of neonatal pain between 1989 and 2024, with the number of publications showing an overall upward trend. Canada emerged as the leading country in terms of publication volume, with the University of Toronto and The Hospital for Sick Children identified as key research institutions. High-frequency keywords included "procedural pain," "management," "sucrose," "analgesia," and "preterm infant," resulting in 11 clusters. Keyword emergence analysis revealed that "neonatal pain," "analgesia," "oral sucrose," and "oral glucose" were research hotpots. Analysis of highly cited papers showed that the most referenced articles were published in the Clinical Journal of Pain. Researchers' interest in neonatal procedural pain has increased significantly over the past 30 years. This article can serve as a theoretical reference for future research on mild to moderate pain in neonates and infants, and it can provide ideas for exploring novel and secure pain management strategies.

Impact of Cooling Diabetic Patients’ Fingertips Compared to Vibrating Stimulation on Pain from the Glucometer Needle: A Cross-Over Trial Study

IntroductionBlood glucose measurements using glucometers can cause discomfort due to needle insertion. Implementing effective pain management strategies is essential to alleviate this discomfort. This study aimed to evaluate the effects of cold and vibration stimulation on pain perception during glucometer needle insertion in diabetic patients. MethodsSixty diabetic inpatients from Shahid Beheshti Hospital in Hamadan, Iran, participated in a crossover study, comprising 3 individuals with type 1 diabetes and 57 with type 2 diabetes. The cohort included 40 males and 20 females, with ages ranging from 18 to 70 years and a mean age of 55.7 years. The average duration of diabetes was 10 years. The study design consisted of six blocks, each containing three interventions: vibration stimulation (A), cold therapy (B), and a combination of both ©. The sequences of interventions (ABC, ACB, BCA, BAC, CBA, and CAB) were randomly assigned. Each participant received the interventions at three different times: before breakfast, one to two hours after lunch, and at dinner. One hand was randomly selected for the intervention, while the other served as a control, with only the needle inserted. Pain levels were assessed using the Numeric Rating Scale (NRS) for both hands. ResultsParticipants receiving vibration stimulation in one hand reported a significant reduction in pain intensity, with a mean difference of 1.21 (p < 0.001) compared to the control hand. In contrast, cold therapy did not significantly affect pain intensity, showing a mean difference of only 0.06 (p > 0.05). The combination of vibration and cold therapy also did not significantly alter pain intensity, yielding a mean difference of 0.33 (p > 0.05). A significant difference (p = 0.002) was noted among the interventions, indicating varying effects on pain intensity. ConclusionVibration stimulation effectively reduces pain associated with glucometer needle insertions. Among the methods examined, vibration stimulation proved to be the most effective for minimizing needle pain. Clinicians are encouraged to incorporate this technique into the care of diabetic patients to enhance their comfort during glucose monitoring.

Clinical pharmacist interventions on pain management in cancer patients (PharmaCAP) in low resource settings: a multicenter feasibility-pilot randomized controlled trial.

Cancer pain management is frequently insufficient worldwide, especially in low- and middle-income countries where significant challenges related to workforce resources persist. Clinical pharmacists could potentially enhance outcomes in this context, yet their role remains largely unexplored. This study aimed to assess the feasibility and acceptability of integrating clinical pharmacists into the multidisciplinary team (MDT) to manage cancer pain and assess preliminary outcomes in cancerpatients receiving pain treatment. This pilot study was undertaken to inform a future definitive randomized controlled trial (RCT). The protocol was registered with ClinicalTrials.gov (NCT05021393). The PharmaCAP trial was conducted in two oncology centers in Nepal, where patients were randomly enrolled into usual care (UC) or an intervention group (PharmaCAP). The latter received a clinical pharmacist-led medication review, which involved a comprehensive assessment of the patient's current medications, identification of potential drug-related problems, and personalized recommendations for optimizing pain management. This was accompanied by pain assessment, educationand counseling on pain management strategies. Baseline and 4-weeks post-intervention assessments measured primary outcomes, i.e., feasibility metrics (recruitment of the patients, retention of patients, patient satisfaction). Secondary outcomes included pain intensity, health-related QoL, anxiety, depression, barriers to pain management, and medication adherence at 4weeks. Out of 140 screened patients, 108 were evaluated for eligibility, with 16 opting out primarily due to lack of interest (n = 11) and communication barriers (n = 5). A total of ninety-two participants with cancer pain were randomized into two groups, with 91 patients successfully recruited and 85 (93.4%) completing 4weeks post-intervention assessment). Completion rates for the UC and PharmaCAP groups were 91.3% and 93.4%, respectively. The primary feasibility outcomes were positive: 100% of patients found random allocation acceptable. Retention rates were high, with 91.3% in the UC group and 93.4% in the PharmaCAP group, despite a few dropouts due to being unreachable, COVID-related issues, and changes in treatment centers. No evidence of contamination between groups was found, as participants did not discuss interventions or influence each other's attitudes, ensuring effective isolation of interventions The PharmaCAP intervention showed significant improvement in QoL (P < 0.001), physical functioning (P < 0.001), and financial difficulties (P < 0.001). There was also clinical benefit observed in anxiety and depression (P < 0.001) and enhancements in medication adherence (P < 0.001). While pain intensity decreased in both groups, the difference was not statistically significant. Satisfaction with the PharmaCAP intervention was high, with 93.0% of participants expressing satisfaction and 88.3% acknowledging that the clinical pharmacists effectively addressed their drug-related queries. Findings of this RCT demonstrate that integrating clinical pharmacists into the MDT team in low low-resource setting is feasible and shows promise in improving QoL, reducing anxiety and depression, and enhancing medication adherence among cancer patients. These findings support the feasibility of conducting a full-scale RCT. Enabling clinical pharmacists to assist with cancer pain management in low-resource settings can benefit patients, healthcare teams, and health systems. ClinicalTrials.gov NCT05021393. Registered on 25th August 2022.

Preoperative resting-state electrophysiological signals predict acute but not chronic postoperative pain.

The prevalence of postoperative pain is notably high among the elderly population, which poses significant challenges for their postoperative recovery. In this study, we aimed to identify preoperative predictors for acute and chronic postoperative pain in patients undergoing lumbar spinal surgery through a longitudinal investigation. We recruited 75 patients (mean age 68.29 ± 5.60 years) and collected their resting-state electroencephalography (EEG) data two hours before the surgery. The aperiodic and periodic signal components were extracted from the resting-state EEG using the Fitting Oscillations and One-Over-F algorithm. We also collected the preoperative pain ratings, demographic information and the Hospital Anxiety and Depression Scale from all patients. The postoperative pain ratings were collected ten times from Day 1 to Week 12 after surgery. We observed a high incidence of postoperative acute and chronic pain among older patients. Preoperative pain and peak alpha frequency in resting-state EEG were the primary predictors of acute postoperative pain. Although age is a significant predictor of chronic postoperative pain, its predictive performance is poor. Overall, our study provides valuable insights into the complex pattern of preoperative EEG features, preoperative pain and age in predicting postoperative pain at different stages. Our findings highlight the significance of exploring preoperative features to identify patients who are at a higher risk of developing severe postoperative pain, which can aid in the development of more personalized and effective pain management strategies. The heightened occurrence of postoperative pain among the elderly presents formidable obstacles to their recuperation. This study delves into identifying preoperative factors influencing acute and chronic postoperative pain. Our findings indicate that preoperative pain and peak alpha frequency are crucial predictors of acute postoperative pain. However, the predictive performance for chronic postoperative pain is limited, although age was a significant predictor of chronic postoperative pain. These insights contribute to the identification of patients at elevated risk for severe acute and chronic postoperative pain, offering valuable guidance for pre-surgical risk assessment.

Which patient level factors predict persistent pain after reverse total shoulder arthroplasty?

BackgroundReverse total shoulder arthroplasty (RTSA) is commonly performed to reduce pain and restore shoulder function in patients with severe shoulder conditions. While most patients experience significant pain relief and functional improvement following surgery, a subset of patients continue to report persistent pain even two years postoperatively. The aim of this study was to identify both modifiable and non-modifiable preoperative factors that contribute to the risk of persistent postsurgical pain after RTSA. By understanding these factors, clinicians can better anticipate which patients are at higher risk and develop tailored preoperative and postoperative pain management strategies to improve overall outcomes.MethodsIn this retrospective cohort study, 703 patients with complete data undergoing primary RTSA performed between 2011 and 2022 were analyzed. Persistent postsurgical pain was defined as a pain score ≥ 3 on a numeric rating scale. Multivariable regression models were used to identify patient-related and disease-related predictors of persistent postsurgical pain.ResultsThe cohort comprised 445 women (63%) and 258 men (37%) with a mean age of 74 ± 8 years at the time of surgery. Persistent postsurgical pain was reported by 18% of patients. Preoperative pain scores averaged 6.0 ± 2.5 on the NRS scale, which decreased to 1.2 ± 1.8 postoperatively. Key predictors included higher preoperative pain levels (β = 0.10, p < 0.001), worse preoperative QuickDASH scores (β = 0.09, p = 0.002), mild symptoms of anxiety or depression (β = 0.52, p = 0.001), prior contralateral TSA surgery (β = 0.34, p = 0.018) and greater number of previous ipsilateral shoulder surgeries (β = 0.44, p < 0.001). In contrast, patients with rheumatoid arthritis (β = − 0.85, p < 0.001) or primary osteoarthritis (β = − 0.82, p < 0.001) experienced lower pain levels.ConclusionOur study offers important insights into the predictors of persistent postsurgical pain two years after RTSA. Key factors, including higher preoperative pain scores, poor mental health, elevated QuickDASH scores, prior contralateral TSA surgery and a history of prior ipsilateral shoulder surgeries, were identified as significant risk indicators for persistent postsurgical pain.

Evaluation of Pain During Hysteroscopy Under Local Anesthesia, Including the Stages of the Procedure.

Hysteroscopy is an endoscopic diagnostic and therapeutic method traditionally performed under general anesthesia but increasingly under local anesthesia. Today, it is considered the gold standard in gynecology. This minimally invasive procedure allows for a detailed assessment of the uterine cavity's interior and the removal of abnormal changes within it and is applicable to patients of all ages. Background/Objectives: The purpose of the present study was to evaluate pain during hysteroscopy under local anesthesia at different stages of the procedure, identifying which stage is the most painful (GUBBINI Mini Hystero-Resectoscope; Tontarra Medizintechnik, Tuttlingen, Germany). Methods: The study included patients between the ages of 21 and 80 years. They were divided into two groups: the diagnostic hysteroscopy (HD) and the operative hysteroscopy (HO) groups. Pain measurements on the VAS scale were taken at each stage of the hysteroscopic procedure. After each stage, the operator asked the patient to indicate the maximum perceived pain value: after pericervical anesthesia was administered (VAS1), during the installation of equipment (between the removal of the speculum and the insertion of the hysteroscope into the vagina) (VAS2), after insertion of the hysteroscope and visualization of the external orifice of the cervical canal (VAS3), after passage of the hysteroscope through the cervical canal (VAS4), and after completion of the procedure in the uterine cavity (VAS5). The duration of each stage of the procedure was measured with a stopwatch: administration of pericervical anesthesia (T1), time between the removal of the speculum and the insertion of the hysteroscope into the vagina (T2), insertion of the hysteroscope into the vagina until the outer orifice of the cervical canal became visible (T3), passage of the hysteroscope through the cervical canal (T4), and the hysteroscopy procedure itself (T5). Results: The highest pain rating was for the canal passage stage (VAS4: 2.47 ± 2.48 points), followed by the procedure itself (VAS5: 2.12 ± 2.33 points). Anesthesia was also reported as quite painful, while the lowest pain was noted during the assembly stage. Overall pain scores for the entire procedure (VASmax) ranged from 3.5 ± 2.37. Conclusion: In conclusion, we found that the passage through the cervical canal was the most painful moment. Overall, hysteroscopy under pericervical anesthesia was not associated with significant pain. Special attention should be given to postmenopausal patients, as they experience more pain during the passage of the hysteroscope through the cervical canal. This group may benefit from additional pain management strategies during the procedure.

Pain After Lower Limb Amputations: Insights from the Heidelberg Amputation Registry.

Background and Objectives: The experience of unpleasant sensory phenomena after lower limb amputations (LLAs), including phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP), impacts global healthcare and adversely affects outcomes post-amputation. This study aimed to describe the distribution of PLP, PLS, and RLP among patients with LLAs registered in the Heidelberg Amputation Registry. The primary objective was to determine the prevalence of sensory abnormalities across different amputation levels and causes. Materials and Methods: In this single-center, cross-sectional study, data from 459 patients registered in the Heidelberg Amputation Registry were analyzed for the occurrence of PLP, PLS and RLP. Subsequently, logistic regression models were used to identify the independent risk factors associated with sensory disturbances following LLAs. The mean age of the LLA patients (31% female, 69% male) was 58 years (SD ± 18). Results: The patients were, on average, 44 years old (SD ± 22) at the time of amputation, with a mean duration since amputation of 15 years (SD ± 17). Transtibial amputations were the most common (43%), followed by transfemoral (39%) and partial foot amputations (10%). Hip and knee disarticulations were observed in 3.7% and 3.5% of the cohort, respectively, with hemipelvectomies accounting for 1%. Traumatic injuries (32%) and neoplastic disorders (22%) were the leading causes of LLAs, while peripheral artery disease and diabetes were responsible for 12% and 6% of cases, respectively. Importantly, a significant proportion of participants (85%) reported experiencing abnormal sensations. The prevalence rates for phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP) were 58%, 66%, and 46%, respectively. The occurrence of sensory disturbances, with the exception of RLP, was significantly affected by the level of amputation. Notably, the age at amputation emerged as an independent risk factor for developing abnormal sensations, including PLS. Conclusions: In conclusion, this study provides a comprehensive overview of sensory abnormalities in a diverse cohort of LLA patients, highlighting the age at amputation as an important factor. The findings emphasize the role of comprehensive registries in enhancing care for individuals with amputations and guiding targeted pain management strategies.

Deciphering pain: molecular mechanisms and neurochemical pathways-challenges and future opportunities.

This review delves into the intricate biological underpinnings of pain perception. It encompasses nociceptive signaling pathways, the molecular mechanisms involved, and the subjective experience of discomfort in humans. The initial focus is on nociceptor transduction, where specialized neurons transform noxious stimuli into electrical impulses. Subsequently, the review explores the central nervous system, elucidating how these signals are processed and modulated by critical elements such as ion channels, receptors, and neurotransmitters (e.g., substance P, glutamate, GABA). Shifting gears toward chronic pain, the review examines the concept of neuroplasticity, highlighting its potential to induce maladaptive responses through alterations in neural networks. The burgeoning field of pain genomics, alongside established genetic research, offers valuable insights that could pave the way for a framework of personalized pain management strategies. Finally, the review emphasizes the significance of these molecular insights in facilitating accurate therapeutic interventions. The overarching objective is to establish an integrative framework for precision medicine in pain management by incorporating this information alongside biopsychosocial models. This framework serves to translate the heterogeneous landscape of pain mechanisms into a coherent roadmap for the development of effective therapies.