Pain Management Techniques Research Articles

The Reasons for the Rejection of Spinal Interventional Pain Management Techniques in Patients with Chronic Lower Back Pain

We investigated the reasons for the rejection of spinal interventional pain management techniques (SIPMT) in patients with lower back pain. The patients included in the study applied to an algology outpatient clinic with complaints of chronic lower back pain and were recommended SIPMT. The demographic data, systemic diseases, diagnoses, suggested SIPMT, and reasons why certain patients refused SIPMT, were all evaluated. Among the 196 patients who were recommended SIPMT, 61 (31.1%) refused the treatment. The most common reasons for refusing SIPMT was a belief that the injection would not be a definitive solution (63.9%), belief that the pain would recur after the injection (55.7%), the inability to avoid work that would strain the lower back after the injection (39.3%), and the fear that the pain would worsen (37.7%). Patients have a wide range of concerns about SIMPT. If the wide range of concerns patients have about SIMPT can be more comprehensively considered, refusal of such treatments due to unnecessary concerns can be prevented.

A comparison of the effects of connective tissue massage and classical massage on chronic mechanical low back pain.

The study aimed to compare the effects of connective tissue massage (CTM) and classical massage (CM) in patients with chronic mechanical low back pain on pain and autonomic responses and to determine the most effective manual therapy method. Seventy individuals with chronic mechanical low back pain were randomly divided into CTM (n = 35) and CM (n = 35) groups. The participants were given a 4-week treatment protocol consisting of a hot pack, exercise, and CTM or CM for 20 sessions. A visual analog scale was used to measure pain intensity. Heart rate, blood pressure, and skin temperature were measured for the evaluation of autonomic responses. In addition, disability (Oswestry disability index), quality of life (short form 36), and sleep quality (Pittsburgh sleep quality index) were evaluated. Participants were assessed before and after the 4-week treatment period as well as at the end of the 6-week follow-up period. In addition, visual analog index measurements were repeated at the end of each treatment week. Pain intensity was decreased in both groups (P < .05). However, CM was more effective than CTM at the end of the 2nd week (P < .05). In autonomic responses results, there were increases in peripheral skin temperatures in both groups (P < .05). Disability, quality of life, and sleep quality improved in both groups (P < .05). There were no differences between the groups relating to autonomic responses, disability, quality of life, and sleep quality (P > .05). The results of this study showed that massages were similar effect. The fact that CM is a frequently used technique in pain management and is as effective as CTM in autonomic responses will make it more preferred in the clinic.

Pure Laparoscopic Donor Left Hepatectomy Reduces Postoperative Analgesic Use and Pain Scale

BackgroundMany recent reports have described the efficacy and safety of pure laparoscopic donor hepatectomy (PLDH). Here we investigated the extent to which this technique could reduce patients’ experienced pain. MethodsAmong donor left hepatectomy procedures performed between July 2011 and November 2022, we retrospectively analyzed 20 open donor hepatectomy (ODH), 20 laparoscopy-assisted donor hepatectomy (LADH), and 5 PLDH cases. We compared these 3 procedures regarding the total amount of postoperative analgesic use (narcotics and non-narcotics) and the first date when the donor was completely pain-free, as evaluated by the patients using a pain scale. ResultsTotal postoperative fentanyl use did not significantly differ among the 3 procedures: median (range), ODH, 0.5 mg (0-2 mg); LADH 1.2 mg (0-7 mg); PLDH, 0.5 mg (0-3.5; P = .172). The percentage of patients who completely discontinued analgesics on postoperative day (POD) 5 was significantly higher for PLDH (80%) than for ODH (35%) or LADH (20%) (P = .041). The day when 50% of donors were completely pain-free on a pain scale was POD9 for ODH, POD11 for LADH, and POD5 for PLDH, significantly shorter in the PLDH group (P = .004). ConclusionAt our institution, we found that PLDH was a useful technique for postoperative pain management compared with PDH and LADH. Our results suggest that PLDH effectively reduces the duration of postoperative analgesia use. Further studies are warranted as the number of PLDH cases gradually increases.

Child maltreatment and pediatric pain: A survey of healthcare professionals' pain knowledge and pain management techniques.

Children who have been maltreated are at an increased risk of having their pain under-recognized and undertreated by healthcare professionals, and thus, are more susceptible to adverse outcomes associated with undertreated pain. This study's aims were to examine: (1) if healthcare professionals' pediatric pain knowledge is associated with their pain assessment methods, (2) if maltreatment-specific pain knowledge is associated with consideration of child maltreatment when deciding on a pain management strategy, and (3) if pediatric pain knowledge would relate to maltreatment-specific pain knowledge. A sample (N = 108) of healthcare professionals responded to a survey designed to examine their current knowledge and utilization of pediatric pain assessment and management with emphasis on the effects of child maltreatment. Findings revealed healthcare professionals' knowledge of pediatric pain is independent of their pain assessment and management practices. However, general pain knowledge was associated with maltreatment-specific pain knowledge and generally, healthcare professionals were knowledgeable of child maltreatment's impact on pediatric pain. Participants who considered a history of maltreatment were also more likely to employ sensitive questioning strategies when asking children about their pain.

Knowledge Attitude and Practices about Neuromodulation Techniques for Management of Refractory Diabetic Neuropathy Pain Among Physicians in India

Knowledge Attitude and Practices about Neuromodulation Techniques for Management of Refractory Diabetic Neuropathy Pain Among Physicians in India

Valsalva maneuver: An effective non-pharmacological technique for pain management in nursing procedures

Pain is a physiological but unpleasant reaction during nursing procedures. Also, to help a person grasp an internal or external threat, pain is regarded as an emotional sense and experience linked to tissue damage [1]. Several chemical mediators, including prostaglandin, histamine, and substance P, are released after tissue damage, causing pain to be transferred to the cerebral cortex via nerve fibers. The brain releases endorphins and alleviates or destroys the pain related to the stimulator [2]. Pain causes various complications such as hemodynamic changes, failure to seek treatment, fear, and anxiety in the patient [3, 4]. Various studies have been performed to evaluate the effects of different methods on pain management. These methods classify into pharmacological and non-pharmacological pain management. Pharmacological pain management includes the use of EMLA cream, intradermal injection of lidocaine, and intravenous injection of fentanyl, ketamine, and propofol medications [5, 6].

Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in postoperative pain management after laparoscopic sleeve gastrectomy

Background Patients undergoing abdominal surgeries may benefit from an ultrasound-guided quadratus lumborum block (QLB) as one of the postoperative pain management techniques. Objective This study compares the effects of bilateral ultrasound guided Transversus abdominis plane (TAP) block versus bilateral ultrasound guided QLB on postoperative analgesia in patients having laparoscopic sleeve gastrectomy (LSG) under general anaesthesia (GA). Patients and methods 45 patients who were scheduled for elective LSG participated in a randomized controlled trial. All patients were given 1–2 μg/kg of intravenous fentanyl as intraoperative narcotic during GA. QLB Group (15 patients): received ultrasound-guided QLB using 0.2 mL/kg of 0.25% bupivacaine per side after induction of general anaesthesia. TAP Group (15 patients): received ultrasound-guided TAP block using 0.2 mL/kg of 0.25% bupivacaine per side after induction of general anaesthesia. Control Group (15 patients): received general anaesthesia and then 1 gm IV paracetamol and 30 mg IV ketorolac within first hour and 8 h postoperative. Results QLB group used pethidine as rescue analgesia mush less than other groups with highly statistically significant difference (P value&lt;0.001). Also, there was statistically significant difference between groups in number of patients needed rescue analgesia (60% of QLB group, 86.7% of TAP group and 100% of control group). Also, the QLB group had superior clinical pain scores than the other groups with a statistically significant difference at PACU arrival, 30 min, 2 h, and 4 h postoperative. The TAP group had a lower VAS score than the control group, with a statistically significant difference at PACU arrival and 4 h postoperative. In comparison to the TAP group, the VAS score was lower in the QLB group, with a statistically significant difference at 30 min postoperatively. MAP was significantly lower in the QLB group than in the control group at PACU entry, 30 min, and 6 h postoperatively. However, MAP was lower in the QLB group than in the TAP group, with a statistically significant difference only at the 12- and 24-hour post-operative time points. HR was less significantly in QLB group than control group at 30, 2, 12, 24 h postoperatively, when comparing the HR between the QLB and TAP groups, the difference became statistically significant only at the 12-hour post-operative time. Conclusion In compared to TAP block and IV analgesics, QLB was the most efficient method for delivering analgesia following LSG.

Nurses' Perception of Caring for Patients With Substance Use Disorder.

The objective of this research was to explore the perceptions of nurses regarding patients with substance use disorder (SUD), healthcare provided, and desired resources to care for this population properly. This study used a cross-sectional, descriptive design. Data were collected via an anonymous 12-item survey and three open-ended questions. Data were analyzed using descriptive statistics and conventional content analysis. Nurses with less than 1 year of experience reported more significant challenges when caring for patients with SUD. These challenges included difficulties in managing pain, implementing alternative pain management techniques, and knowing who to contact when problems occur. The study revealed many needs of nurses to provide compassionate care for patients with SUD. Findings indicate a need for education for nurses, especially novice nurses, who care for patients with SUD.

The Utilization of Radiofrequency Techniques for Upper Extremity Pain Management

BACKGROUND: In the 1990s, radiofrequency ablation emerged as a novel therapeutic approach tool for pain alleviation that did not result in neurological harm. Radiofrequency techniques are emerging methods as a possible option for upper extremity pain management. Furthermore, joint pain can result from multiple etiologies, and the management can differ based on what joint is affected. With the various management methods available to treat joint pain, radiofrequency ablation could be an effective, minimally invasive, promising intervention. OBJECTIVES: This study aimed to review the current and historical uses of radiofrequency in upper extremity pain compared to other management methods and to address the utilization of radiofrequency in upper extremity pain management. STUDY DESIGN: This is a narrative review of relevant studies on using radiofrequency techniques in upper extremity pain management. METHODS: On June 26, 2022, Medline/PubMed, Google Scholar, ERIC, and the Cochrane Database of Systematic Reviews were searched for relevant literature documenting the use of radiofrequency techniques in treating upper extremity pain. The terms “radiofrequency,” “pain,” “upper extremity,” “shoulder,” “elbow,” and “wrist” were used, resulting in 61 studies fitting the inclusion criteria. A narrative review was then undertaken. RESULTS: Radiofrequency ablation and its techniques are among the contemporary medical procedures that could be cost-effective solutions for patients suffering from chronic and postoperative pain. Its utilization for shoulder-related pain has been frequently studied, as it showed significant improvement with a high satisfaction rate as a solo procedure. When compared to intraarticular corticosteroid injections or local anesthetics, it was found to be more effective than local anesthetics. Although it did not appear superior to intraarticular corticosteroid injections, it had the advantage of infrequent repeat treatment. By comparison, studies involving the elbow and wrist showed promising results but were not as thorough as studies on the shoulder. Therefore, considering the possible side effects and complications, caution is warranted. LIMITATIONS: The paucity of articles available on its application to the elbow and wrist joints. More articles are necessary for the generalizability of the results. CONCLUSION: Radiofrequency techniques are a promising, minimally invasive procedure for controlling upper extremity pain. More studies on the topic, especially on elbow and wrist pain, are warranted for the generalizability of the results. KEY WORDS: Radiofrequency, pain management, upper extremity, shoulder, elbow, wrist, corticosteroid injection, local anesthetics

Recent Advances in Local Anesthesia: A Review of Literature.

Even if local anesthetic is still the mainstay of pain management in dentistry, research will keep striving for novel and effective pain management techniques. The majority of research efforts are focused on improving anesthetic medications, delivery systems, and related methods. There are more recent technologies available that can assist the dentist in providing better pain relief with fewer unpleasant injections and fewer negative adverse effects. The purpose of the current review of the literature is to compile evidence that will convince dentists to employ modern local anesthetics, as well as other methods and techniques to reduce patient discomfort while administering anesthesia.

Cooling spray or lidocaine spray and needle insertion pain in hemodialysis patients: an open-label cross-over randomized clinical trial

BackgroundThe needle insertion pain to perform hemodialysis is the main challenge and a common problem that requires pain management techniques for patients’ comfort.AimThis study aimed to compare the effects of cooling and lidocaine sprays on needle insertion pain in hemodialysis patients.MethodsIn this randomized cross-over clinical trial study, the hemodialysis patients were selected through convenience sampling according to inclusion criteria and randomly assigned to three intervention groups using the block randomization method. Each patient received three interventions in a cross-over design: Cooling spray or 10% lidocaine spray or placebo spray. There was a 2-week wash-out time between each intervention. The pain score was measured four times for each patient by the Numerical Rating Scale.ResultsForty-one hemodialysis patients were included. The results showed a significant interaction between time and group (p < 0.05), so only observations of time 1 with adjustment for baseline values were used to evaluate the effect of the intervention. Patients receiving cooling spray reported 2.29 less pain score on average compared to placebo (B=-2.29, 95% CI: -4.17 to -0.43; p < 0.05); Also, patients receiving cooling spray reported a 1.61 lower pain score than those receiving lidocaine spray, but this difference was not statistically significant (95% CI: -0.26 to 3.48; p > 0.05).ConclusionThe cooling spray was effective in reducing the needle insertion pain. Although it was impossible to compare the pain scores at different times and following different interventions, the present study results can help supplement the existing knowledge regarding cooling and lidocaine sprays.

Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis.

Thoracic epidural analgesia (TEA) and thoracic paravertebral blocks (PVB) are well-established techniques for pain management in thoracotomy. Here, we examine the efficacy of various thoracic fascial plane blocks vs TEA and PVB for intraoperative and postoperative analgesia for video assisted thoracoscopy surgery (VATS) with network meta-analysis. A search for prospective randomized control studies using adult patients undergoing VATS with general anesthesia. The interventions of interest were any regional anesthesia techniques used for postoperative pain control after VATS. Primary outcomes of interest were 24-hour opioid requirement and 24-hour pain scores. A Bayesian network meta-analysis was conducted. We identified 42 studies that fulfilled our inclusion criteria. For patients who underwent VATS, TEA (MD = -27MME, 95% CI = -46.2 to -9MME), ESP (MD = -20MME, 95% CI -33 to -7.9MME), PVB (MD = -15MME, 95% CI = -26 to -4.5MME) demonstrated significant opioid sparing efficacy, as well as reduction in cumulative 24-hour static pain scores. However, exclusion of one study due to high risk of bias revealed that TEA did not significantly reduce opioid consumption, nor did it reduce the incidence of PONV, pulmonary complications, or LOS when compared to ESP, SAP, PVB, ICN, or PECS blocks. Our findings suggest that TEA did not provide superior pain relief compared to ESP, SAP, PVB, ICN, or PECS blocks following VATS. Therefore, we propose ESP as a suitable intervention for the prevention of postoperative pain after VATS.

Focused ultrasound-induced inhibition of peripheral nerve fibers in an animal model of acute pain

BackgroundModerate-to-severe acute pain is prevalent in many healthcare settings and associated with adverse outcomes. Peripheral nerve blockade using traditional needle-based and local anesthetic-based techniques improves pain outcomes for some patient...

Neuraxial Anesthesia during the COVID-19 Pandemic: Report from a Large Academic Medical Center.

Three primary neuraxial techniques reduce labor pain: epidural, dural puncture epidural (DPE), and combined spinal-epidural (CSE). This study aims to determine whether neuraxial analgesia techniques changed after the onset of the coronavirus disease 2019 (COVID-19) pandemic. Given that a dural puncture confirms neuraxial placement, we hypothesized that DPE was more frequent in women with concerns for COVID-19. A single-center retrospective cohort study comparing neuraxial analgesia techniques for labor and delivery pain management before and after the onset of the COVID-19 pandemic and in patients with and without SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) at a maternity hospital in Dallas, Texas, with a large delivery service. Statistical analyses included the Chi-square test for categorical and Kruskal-Wallis test for nonparametric ordinal comparisons. The Cochran-Mantel-Haenszel test was used to assess the association between neuraxial technique and accidental dural puncture or postdural puncture headache. Of 10,971 patients who received neuraxial analgesia for labor, 5,528 were delivered in 2019 and 5,443 in 2020. Epidural analgesia was the most common neuraxial technique for labor pain in 2019 and 2020. There was no difference in the frequency of neuraxial analgesia techniques or the rates of accidental dural puncture or postdural puncture headaches comparing all deliveries in 2019 to 2020. Despite a significant increase in DPEs relative to epidurals in the SARS-CoV-2-positive group compared with the SARS-CoV-2-negative group in 2020, there was no significant difference in postdural puncture headaches or accidental dural punctures. The advantages of a DPE, specifically the ability to confirm epidural placement using a small gauge spinal needle, likely led to an increase in the placement of this neuraxial in SARS-CoV-2-positive patients. There was no effect on the frequency of postdural puncture headaches or accidental dural punctures within the same period. · Epidural analgesia was the most common neuraxial technique for labor pain management.. · Dural puncture epidural placements increased in SARS-CoV-2-positive patients.. · Rates of postdural puncture headaches and accidental dural puncture after neuraxial placement did not change..

Safety and Efficacy of Radiofrequency Ablation and Epidural Steroid Injection for Management of Cervicogenic Headaches and Neck Pain: Meta-Analysis and Literature Review.

Dysfunction of the cervical spine and its anatomical features, mostly innervated by the C1, C2, and C3 spinal nerves, can result in a secondary headache known as cervicogenic headache (CHA), mainlycharacterized by unilateral pain. The usefulness of pharmaceutical medications and physical therapy is currently the subject of scant literature. Interventional pain management techniques can be applied when conservative treatment is unsuccessful. This study looks at radiofrequency ablation (RFA)and epidural steroid injection (ESI)to identify their safety and efficacy in managing patients with cervicogenic headaches and neck pain.Three databases - PubMed, Cochrane CENTRAL Library, and Embase were searched, and 110 studies were identified. Nine screening processes were included for review and meta-analysis. Statistical evaluation was conducted through STATA version 17 (College Station, TX: StataCorpLLC) and effect measures were reported through random effects model risk ratios.The main subject of focus included three following outcomes: incidences of pain relief, degree and duration of pain, and incidences of adverse effects. The findings showed both interventions relieved pain by afactor of >50%, demonstrating a relative effects risk ratio of 1.45 (-0.50, 3.39) for RFA: pain relief, 84.76 (82.82, 86.69) RFA: adverse effects, and 19.46 (18.80, 20.11) ESI: pain relief at 95% confidence interval.The efficacy of RFA and ESI differ. Both interventions are effective in the reduction of cervicogenic headache pain intensity. However, their complication rates and pain duration are considerably different. With ESI,the headaches can still recur weekly, demanding the use of oral analgesics to deal with them. On the other hand,RFA has a low complication rate.Improving guidance from imaging technologies, RFA has the potential to be the most effective interventional treatment.

Pain management: A deeper look at rural and urban nurses' perceptions and experiences.

About 11.4 million individuals admitted to misusing an opioid in the past year. The purpose of this study was to determine if nurses' definitions of pain management differed by location, and to assess the challenges treating patients with pain management concerns. This study fills a gap by comparing quantitative and qualitative feedback from nurses on pain management concerns in their practice location. Data were collected using an electronic survey emailed to licensed nurses across the United States. The mixed methods survey used multiple choice, select all that apply, and open-ended responses to gather data on nurses' perceptions of pain management. One hundred and eighty nurses completed the survey and were included in the study. Sixty-six percent practiced in an urban hospital. Rural and urban nurses defined pain management as nonopioids and opioids. Seventy-one percent of urban nurses defined pain management as physical therapy compared to only 61% of rural nurses. Similarly, 62% of urban nurses identified homeopathic medicines and treatments as pain management techniques compared to 52% of rural nurses. From the qualitative data, 32% of rural nurses stated that patients with pain management concerns only want pain medications compared to 14% of urban nurses. Nurses have a critical position in and valuable perspective on the opioid epidemic. Rural communities are relatively disadvantaged in combatting the opioid epidemic. The finding that rural residents only want pain medication instead of alternative pain management options further challenges the country's rural health care workforce.

Radical Cystectomy as a Cause of an Increased Neuroendocrine Response

The present study compared the neuroendocrine response in patients undergoing conventional cystectomy with two postoperative pain management techniques: epidural analgesia (EA) and intermittent opioid analgesia (IOA) on adrenocorticotropic hormone (ACTH), cortisol, glucose levels for 48 hours. We hypothesize that appropriate analgesic regime can attenuate stress response reaction. Forty-four patients scheduled for radical conventional cystectomy were assigned to one of the two study groups: group A (n=22) with EA, group B (n=22) with IOA. The surgical stress factor induced significant hypothalamic-pituitary-adrenal (HPA) axis responses in both groups. The ACTH and cortisol levels were higher than baseline for both groups, but more significantly in group B. Blood glucose level was elevated few hours after the surgical intervention and was back to baseline level by the following morning. The results suggest that EA might have more advantages associated with reduced postoperative pain and attenuated neuroendocrine response when open access is the preferred operative technique. There is a need of randomized multicentre trials to evaluate the quality of life, the survival and the role of pain management at least 12 months after radical cystectomy.

A new pain management technique following multilevel lumbar spine surgery – A ‘nouvelle’ cocktail

A new pain management technique following multilevel lumbar spine surgery – A ‘nouvelle’ cocktail

Efficacy of pericapsular nerve group (PENG) block on perioperative pain management in elderly patients undergoing hip surgical procedures: a protocol for a systematic review with meta-analysis and trial sequential analysis

IntroductionAn increasing number of elderly patients suffer from hip diseases associated with moderate to severe perioperative pain during the accelerating global ageing process. Optimal analgesia can decrease perioperative complications and...

Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis.

Nerve block is widely used for pain management after video-assisted thoracoscopic surgery (VATS). Thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus anterior plane block (SAPB), and intercostal nerve block (ICNB) are alternative treatments. Network meta-analysis based on Bayesian analyses was performed to obtain results for direct comparison, indirect comparison, and network comparison, and to make rankings based on probabilities. Covariates were adjusted to determine the effect of the covariates on results of this study. The study identified 61 randomized controlled trials (RCTs) (4468 patients). There were results of probability ranking for the first ("best" treatment): 24 h morphine consumption, TPVB > ESPB > ICNB > SAPB. Covariate adjustment allowed the four treatments to change somewhat in the likelihood of the best choice. TPVB ranks best in our analysis. ESPB is a viable alternative. SAPB and ICNB seem to play a limited role in postoperative pain management.