Treatment Of Pain In Patients Research Articles

The effect of spinal correction surgery on the tractography data of the pain pathway in scoliosis patients: a preliminary report

Study designCross-sectional study. ObjectivePain in individuals with opered scoliosis is usually evaluated with a postural analysis or questionnaire. In this study, we evaluated pain in individuals with scoliosis who underwent spinal correction surgery by tractography and compared it with individuals with non-opered scoliosis and healthy individuals. DesignFifteen healthy individuals, 15 non-operated scoliosis patients and 15 operated scoliosis patients were included in the study. MethodsAll female participants in this prospectively planned study used their right hand as the dominant hand. Bilateral tractography analysis of the pain pathways was performed with DSI Studio software using brain magnetic resonance images (MRI) of the participants. Statistical analysis of the study was performed with IBM SPSS 23.0 and p<0.05 values were considered significant. ResultsIt was observed that the tractography values of the operated scoliosis group were similar to the control group (p˃0.05). In the non-operated scoliosis group, tractography findings related to nerve conduction velocity such as fiber count, fiber ratio and axial diffusivity (AD) were found to be higher than the other two groups (p<0.05). Fractional anisotropy (FA) values of the unoperated scoliosis group were significantly different between the pain pathways projected from the right/left side of the body (p<0.05). ConclusionThe fact that the pain path tractography values of patients with scoliosis who underwent surgery were similar to those of healthy individuals may be evidence of decreased pain sensation reaching the brain. Surgery may be a good choice in the treatment of pain in patients with scoliosis.

Evaluation of the efficacy of trigger points combined with extracorporeal shock waves in the treatment of plantar fasciitis: heel temperature and plantar pressure

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain. Among conservative treatments, extracorporeal shock wave therapy (ESWT) is considered effective for refractory PF. Studies have shown that applying ESWT to the trigger points (TrPs) in the triceps surae may play an important role in pain treatment in patients with PF. Therefore, the purpose of this study was to combine the concept of trigger points and ESWT to explore the effect of this combination on plantar temperature and pressure in patients with PF.MethodsAfter applying inclusion and exclusion criteria, 86 patients with PF were recruited from the pain clinic of Huadong Hospital, Fudan University and randomly divided into experimental (n = 43) and control groups (n = 43). The experimental group was treated with extracorporeal shock waves to treat the medial heel pain point and the gastrocnemius and soleus TrPs. The control group was only treated with extracorporeal shock waves at the medial heel pain point. The two groups were treated twice with an interval of 1 week. Primary measurements included a numerical rating scale (NRS) score (overall, first step, heel pain during daily activities), and secondary measurements included heel temperature, Roles–Maudsley score (RMS), and plantar pressure. All assessments were performed before treatment (i.e., baseline) and 6 and 12 weeks after treatment.ResultsDuring the trial, 3 patients in the experimental group withdrew from the study, 2 due to interruption of the course of treatment by the COVID-19 epidemic and 1 due to personal reasons. In the control group, 3 patients fell and were removed due to swelling of the heel. Therefore, only 80 patients with PF were finally included. After treatment, the two groups showed good results in NRS score (overall, first step, heel pain during daily activities), RMS, and plantar temperature, especially in the experimental group, who showed a significantly better effect than the control group.ConclusionESWT of the heel combined with the triceps trigger point of the calf can more effectively improve the pain, function and quality of life of refractory PF than ESWT of the heel alone. In addition, ESWT of the heel combined with the triceps trigger point of the calf can effectively reduce the skin temperature of the heel on the symptomatic side, indicating that the heel temperature as measured by infrared thermal imaging may be used as an independent tool to evaluate the therapeutic effect for patients with chronic PF. Although extracorporeal shock waves combined with TrPs treatment can cause changes in the patients’ gait structure, plantar pressure is still difficult to use as an independent tool to evaluate the therapeutic effect for PF.Trial registrationRegistered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on 12/17/2021 with the following code: ChiCTR-INR-2,100,054,439.

Effectiveness of gabapentin in treatment of pain in patients with alcoholic polyneuropathy

Alcoholic polyneuropathy is a pressing problem in modern society. This neurological disease is characterized by impaired functions of many peripheral nerves due to the toxic effects of alcohol and its metabolites on nerve fibers. A study was conducted to assess the effectiveness of the use of Gabapentin-SZ (North Star Co., Russia) in alcohol polyneuropathy, involving 47 adult patients (31 men and 16 women). The study found significant efficacy of Gabapentin-SZ in treating pain in patients with alcohol polyneuropathy. Significant improvement was noted after 14 days of therapy.

The effectiveness of using pulsed electromagnetic fields for osteoarthritis of the knee joint

BACKGROUND: Osteoarthritis is one of the most common forms of pathology of the musculoskeletal system with significant impairment of motor function, which is one of the main causes of disability in the population.&#x0D; AIM: This study was aimed at testing the effectiveness of the portable device "ALMAG+" with pulsed electromagnetic fields in the treatment of pain in patients with osteoarthritis of the knee joint.&#x0D; MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial included patients with radiographic evidence of knee osteoarthritis and persistent pain greater than 40 mm on a visual analogue scale (VAS). The study included daily treatment with pulsed electromagnetic fields from the ALMAG+ device for 1 month in 60 patients with knee osteoarthritis. The primary outcome measure was reduction in pain intensity assessed by VAS and WOMAC scales. Secondary outcomes included the 36-item Short Form Medical Outcomes Study version 2 (SF-36 v2) quality of life, pressure pain threshold, and changes in non-steroidal anti-inflammatory drug/analgesic use.&#x0D; RESULTS: Sixty-six patients were enrolled in the study, and 60 completed the study. After 1 month of treatment, pulsed electromagnetic fields caused a significant reduction in pain VAS and WOMAC scores compared to placebo. In addition, patients receiving pulsed electromagnetic fields improved pain tolerance, which was reflected in changes in pain threshold, and physical condition. We obtained a significant and statistically significant effect of the organized pulsed electromagnetic fields factor on VAS pain scores (F=47.6; p=0.00006); assessments of the severity of pain, joint function and stiffness on the scales of the WOMAC questionnaire also significantly changed under the influence of the pulsed electromagnetic fields factor (F=14.7; p=0.001). 26% of patients in the pulsed electromagnetic fields group discontinued non-steroidal anti-inflammatory drug/analgesic therapy. No adverse events were identified during treatment.&#x0D; CONCLUSION: These results suggest that pulsed electromagnetic fields therapy is effective in relieving pain in patients with knee osteoarthritis and also affects pain threshold, stiffness, and physical functioning. In the future, it is desirable to conduct larger studies, including those comparing the effectiveness of pulsed electromagnetic fields therapy with standard pharmacological approaches for osteoarthritis.

PECULIARITIES OF PAIN MANAGEMENT IN PATIENTS WITH GUNSHOT WOUNDS IN MEDICAL AND NURSING TEAMS

Background. The experience of military doctors in the treatment of pain in patients after gunshot wounds indicates that chronicization of pain in this category of patients may occur much earlier - at the time of injury. Gunshot wounds are accompanied by high intensity pain. At the stage of treatment in medical and nursing teams, effective pain relief is important, because in the long term, more than 70% of such patients are diagnosed with chronic pain. Therefore, studying the features of pain management at this stage of treatment can play an important role in improving the results of their treatment.&#x0D; Aim: To study the peculiarities of pain treatment in patients after gunshot wounds at the stage of treatment in nursing teams.&#x0D; Materials and methods. We used EZR v.1.35 (R statistical software version 3.4.3, R Foundation for Statistical Computing, Vienna, Austria). Criteria: Shapiro-Wilk, Mann-Whitney, Friedman, chi-square, Bonferroni correction.&#x0D; Results. The results of the study of pain management in nursing teams in 769 patients after gunshot wounds indicate that before analgesia, the VAS values on admission to the stages of treatment in nursing teams in group 1 were statistically different from group 2 (p&lt;0.001). In group 2, this figure was higher. Special attention should be paid to the issue of pain relief during evacuation from the battlefield to the medical and nursing team, because in both groups of observation at the time of admission to the medical and nursing team, the pain intensity of the VAS was 7-8 points, which meets the criteria for high intensity.&#x0D; Conclusion. At the stage of treatment in nursing teams, more attention should be paid to the treatment of pain in patients with gunshot wounds, as we should try to achieve high-quality pain control. Probably ineffectively treated high intensity pain can potentially have an impact on the chronicization of pain in the future. The absence or insufficiency of analgesia can have a significant impact on the long-term outcomes of pain treatment.

Diabetes Complications and Pain Among Mexican Americans Aged 80 and Older.

Diabetes is common among Hispanic older adults; however, the association between diabetic complications and pain has not been widely studied in this population. Our objective was to examine the association between diabetes complications and pain over 6 years among Mexican Americans aged 80 years and older. We used data from Waves 7 to 9 (2010-2016) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (n = 853). Participants were categorized as having no diabetes, diabetes without complications, and diabetes with complications. Pain was defined as reporting pain when standing or walking (pain on weight-bearing) and having pain that limited daily activities (pain interference). We used generalized estimating equations to estimate the odds of pain over 6 years as a function of diabetes status controlling for socioeconomic and health characteristics. At baseline, the mean age was 85.7 (standard deviation = 3.9) years, 65.2% female, 68.5% had no diabetes, 14.7% had diabetes without complications, and 16.9% had diabetes with complications. Those with diabetes without complications had lower odds of reporting pain on weight-bearing and pain interference, compared to those with no diabetes. Among those reporting diabetes (n = 269), those with complications had higher odds of pain on weight-bearing and pain interference, compared to those without complications. Those with both micro and macro complications had over 2 times the odds of pain, compared to those having no complications. The lower burden of pain in those with diabetes but no complications may reflect optimal management of diabetes. Routine screening and treatment of pain in patients with diabetes complications can mitigate excess disability and increase the quality of life for patients with diabetes.

PECULIARITIES OF PAIN MANAGEMENT IN PATIENTS WITH GUNSHOT WOUNDS IN MEDICAL AND NURSING TEAMS

Summary. During the Anti-Terrorist Operation/Joint Forces Operation in eastern Ukraine, gunshot wounds account for about 74% of the casualties. Such injuries are accompanied by high intensity pain. At the stage of treatment in medical and nursing teams, effective pain management is important, because in the long term, more than 70% of these patients suffer from chronic pain. Therefore, studying the features of pain management at this stage of treatment can play an important role in improving the results of their treatment.&#x0D; Objective. To study the peculiarities of pain treatment in patients after gunshot wounds at the stage of treatment in medical and nursing teams.&#x0D; Methods. Study of patients with gunshot and mine-blast wounds. A visual analog scale was used to study the intensity of pain. The results of the study were analyzed using the EZR v.1.35 package (R statistical software version 3.4.3, R Foundation for Statistical Computing, Vienna, Austria). The Shapiro-Wilk, Mann-Whitney, Friedman, and Bonferroni correction criteria were used.&#x0D; Results. The results of the study of 769 patients after gunshot wounds indicate that: 1) upon admission to the nursing teams (before anesthesia), the VAS pain intensity in group 1 was statistically different from group 2 (p&lt;0.001) – in group 2, this indicator was higher; 2) the dynamics of VAS pain intensity during 2 days of observation shows no difference between the observation groups: 1 day – p=0.636, 2 days – p=0.465; 3) intervals between analgesia during the 1st day indicate a statistically significant difference between the groups (p=0.001), and on the 2nd day of observation no such difference was observed (p=0.818).&#x0D; Conclusion. At the time of admission to the medical and nursing team, the pain intensity according to the VAS was 7-8 points, which meets the criteria for high intensity. This intensity of pain is likely to affect the chronicization of pain in the future. The number of injured anatomical areas of the body is important for determining the tactics of pain treatment in patients with gunshot wounds, because the intervals between the administration of painkillers indicate that those patients who were injured in 3 or more anatomical areas of the body more often needed the administration of painkillers.

Low-dose naltrexone for treatment of pain in patients with fibromyalgia: a randomized, double-blind, placebo-controlled, crossover study.

Fibromyalgia (FM) is a chronic fluctuating, nociplastic pain condition. Naltrexone is a µ-opioid-receptor antagonist; preliminary studies have indicated a pain-relieving effect of low-dose naltrexone (LDN) in patients with FM. The impetus for studying LDN is the assumption of analgesic efficacy and thus reduction of adverse effects seen from conventional pharmacotherapy. First, to examine if LDN is associated with analgesic efficacy compared with control in the treatment of patients with FM. Second, to ascertain the analgesic efficacy of LDN in an experimental pain model in patients with FM evaluating the competence of the descending inhibitory pathways compared with controls. Third, to examine the pharmacokinetics of LDN. The study used a randomized, double-blind, placebo-controlled, crossover design and had a 3-phase setup. The first phase included baseline assessment and a treatment period (days -3 to 21), the second phase a washout period (days 22-32), and the third phase a baseline assessment followed by a treatment period (days 33-56). Treatment was with either LDN 4.5 mg or an inactive placebo given orally once daily. The primary outcomes were Fibromyalgia Impact Questionnaire revised (FIQR) scores and summed pain intensity ratings (SPIR). Fifty-eight patients with FM were randomized. The median difference (IQR) for FIQR scores between LDN and placebo treatment was -1.65 (18.55; effect size = 0.15; P = 0.3). The median difference for SPIR scores was -0.33 (6.33; effect size = 0.13; P = 0.4). Outcome data did not indicate any clinically relevant analgesic efficacy of the LDN treatment in patients with FM.

Value of the number of injured anatomical parts of the body and surgeries for pain chronicity in patients with gunshot wounds and blast injuries

The outcome of pain treatment in patients with wounds at different stages of management is important, because chronic pain is diagnosed in 83.3 % of victims with blast injuries, and in 70 % of people with gunshot wounds. In civilian life, chronic pain occurs in 11–40 % of cases in a similar category of patients. The reasons for such a high frequency of chronicity have not been sufficiently studied. Thus, the study on the influence of the number of injured anatomical parts of the body on the results of pain treatment will play an important role and contribute to improving the latter in this category of patients. One of the factors that can influence pain chronicity is the number of injured anatomical parts of the body.

Adding tactile feedback increases avatar ownership and makes virtual reality more effective at reducing pain in a randomized crossover study

Severe pain is a widespread health problem in need of novel treatment approaches. In the current study we used real water to give virtual objects (i.e., animated virtual water) more realistic physical properties (wet liquid qualities). Healthy volunteers aged 18–34 participated in a within-subject randomized study comparing participants’ worst pain during brief thermal stimuli with (1) No Immersive Virtual Reality (VR), versus (2) during VR + no tactile feedback versus (3) VR + real water (with tactile feedback from co-located real objects). Tactile feedback significantly decreased pain intensity (VR analgesia, p < 0.01), compared to VR with no tactile feedback, and compared to No VR (baseline). Tactile feedback made the virtual water feel significantly more real, increased participant’s sense of presence, and both VR conditions were distracting (significantly reduced accuracy on an attention demanding task). As a non-pharmacologic analgesic, mixed reality reduced pain by 35% in the current study, comparable to the analgesia from a moderate dose of hydromorphone in previous published experimental studies. Tactile feedback also significantly increased avatar embodiment, the participants illusion of ownership of the virtual hands, which has potential to improve the effectiveness of avatar therapy for chronic pain in future studies. Mixed reality should be tested as treatment in pain patients.

The effectiveness of laserpuncture associated with vitamin B12 in the treatment of temporomandibular disorders and orofacial pain

A low-power laser is presented as a treatment proposal for painful Temporomandibular Disorders (TMD). This randomized clinical trial evaluated the effectiveness of laserpuncture using low power laser in the treatment of pain in patients with temporomandibular disorders with and without concomitant administration of vitamin B12 (methylcobalamin). A questionnaire was applied to the participants to assess the location of the orofacial pain in conjunction with the request for blood vitamin B12 dosage. The groups were randomly divided, being Group 1: placebo laserpuncture and placebo vitamin B12; Group 2: effective laserpuncture and placebo vitamin B12, and Group 3: effective laserpuncture and effective vitamin B12. The study consisted of 45 adult patients (over 18 years old), regardless of sex and race, with signs and symptoms of TMD, where pain was the main complaint. In all sessions, pain was assessed using a visual analogue scale, before and after laser therapy. Laserpuncture was applied to points of Traditional Chinese Medicine, used for treating Temporomandibular Disorders, using a laser device with an infrared wavelength and energy of 3J. Eight sessions were heldand two sessions per week for 4 weeks. Groups 2 and 3 showed improvement in pain symptoms after treatment. Group 3 patients in the fourth session already showed the effective result of the treatment. Laserpuncture when associated with the use of vitamin B12 becomes more efficient for treating TMD.

Features of pain in patients with gunshot wounds depending on the location of injury at the stages of treatment

The incidence of gunshot wounds during the Anti-Terrorist Operation/Joint Force Operation is 54–70 %. More attention should be paid to the problem of pain treatment in patients with gunshot wounds, because about 70 % have negative treatment outcomes, which leads to pain chronicity. Chronic pain, in turn, is associated with several mutually aggravating factors — this can lead to the development of extremely serious long-term consequences. The features of pain in this category of patients have not been sufficiently studied. Taking into account continuity and consistency, clear and high-quality pain control is necessary at all stages of treatment.

The development of a music therapy pain assessment model

&#x0D; Pain is often defined by its symptomatology and etiology. Unrelieved pain can negatively impact every area of an individual’s life, including personal relationships, employment, and one’s involvement in social activities. Unrelieved pain may induce fear, anxiety, and depression. Disease management includes the evaluation of pain. Scoring levels of pain frequently is a required measurement listed prominently on the patient bedside flowchart. Evaluating pain is a required appraised and evaluated inquiry- the outcomes of which influences the most pertinent domains of health and healing. As recouperation and discharge planning are so often at the forefront of hospitalists’ thinking, at times the nuances of how pain is evaluated in the quest to find and extinguish associated influences may be lost in the shuffle of a desired immediacy for change. Subtleties that lead toward resulting exacerbations may result from clinician haste. This article presents an overview of the critical elements that are significant to address when considering music therapy applications for the treatment of pain in patients of all ages and diagnoses.

Prolonged blockade of the sciatic nerve in the treatment of pain in patients with chronic limb-threatening ischemia: prospective longitudinal clinical study

BACKGROUND: Systemic multimodal analgesia does not always relieve ischemic pain, and the side effects of its components may be intolerable in patients with comorbid and physically debilitation with chronic limb-threatening ischemia (CLTI). An alternative effective and safe method of pain relief for patients with CLTI is needed.&#x0D; OBJECTIVE: To evaluate the efficacy and safety of prolonged popliteal sciatic nerve block in patients with CLTI at the stages of treatment.&#x0D; MATERIALS AND METHODS: A prospective clinical study was performed in 31 patients with CLTI. Pain intensity was assessed by a numerical rating scale at the stages of treatment: (1) on admission, (2) presence of systemic multimodal analgesia (paracetamol, ketoprofen, tramadol, and morphine), (3) after catheter insertion to the popliteal sciatic nerve and prolonged nerve block with 0.5% ropivacaine solution, (4) after revascularization without anesthesia, (5) after revascularization in the presence of nerve blockade, and (6) upon discharge. Catheter insertion was performed under ultrasound control and neurostimulation. Pain intensity, frequency of insomnia, and forced lowering of the limb, need for narcotic analgesics, and patient satisfaction with treatment were assessed.&#x0D; RESULTS: Regional block before surgery provided better pain relief than systemic multimodal analgesia (p 0.001) and reduced the need for narcotic analgesics (p 0.001). Insomnia was observed less frequently with prolonged blockade of the sciatic nerve than with systemic multimodal analgesia (p 0.05), as well as forced lowering of the limb (p 0.05). Revascularization of the lower extremity has an analgesic effect; however, pain relief is required for most patients. Pain relief through sciatic nerve block at all stages of CLTI treatment, sleep normalization, and freedom from forced posture improved the quality of life and satisfaction with treatment. No complications associated with the regional blockade were recorded.&#x0D; CONCLUSION: Prolonged popliteal sciatic nerve block effectively relieves pain in patients with CLTI, is safe, and can be an alternative to systemic anesthesia.

PAIN INTENSITY OF PATIENTS DURING REHABILITATION AFTER MINE BLAST WOUNDS

In 83.3 % of cases, patients who received mine blast wounds suffer from chronic pain. Such injuries are characterized by significant damage. Data on the treatment of pain during rehabilitation are presented by several clinical cases. Therefore, a broader coverage of this issue will be of some importance for the perspective of further research in this direction.&#x0D; The goal of the work. To investigate the results of pain treatment in patients after mine blast wounds at the rehabilitation stage.&#x0D; Methods. The treatment of 280 patients with mine blast wounds during rehabilitation was analyzed. The intensity of pain was diagnosed using a visual analog scale. Statistical methods: Shapiro-Wilk, Mann-Whitney, Friedman, chi-square, Bonferroni corrections, absolute frequency of the symptom and relative frequency (%). When analyzing the data in all cases, the critical significance level was 0.05.&#x0D; Results. Patients after mine blast wounds, both at the time of discharge from inpatient treatment and during rehabilitation, still experienced pain intensity of 2 points, which in the future transformed into chronic pain. After 1, 3 and 6 months after treatment, it was found that the intensity of pain in groups 1 and 2 did not differ statistically (р=0.488, р=0.876, р=0.165, respectively), but after 12 months – statistically differed (р=0.035) and in group 2 were higher than in group 1.&#x0D; Conclusions. Based on the obtained data, it can be concluded that during discharge from inpatient treatment, rehabilitation and within 12 months after treatment, the patients felt pain, albeit weak. The lack of further effective treatment can cause a whole cascade of negative consequences.

The relationship of chronic pain with performed surgical interventions and injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment

Resume. Chronic pain in injured patients is a negative outcome of pain management in the stages of treatment. Chronic pain is diagnosed in 83.3% of patients with mine-explosive wounds, and in 70% of patients with gunshot wounds. The frequency of chronic pain also depends on the type of injury and the number of injured anatomical parts of the body. So, in patients with gunshot wounds in 1 or 2 anatomical parts of the body, chronic pain is diagnosed in 69.7% of cases, and in 3 or more cases - in 71.2% of cases. Also, in patients with mine-explosive wounds - 82.2% and 91.7% of cases, respectively. Patients in civilian life who have received serious injuries suffer from chronic pain in 11-40% of cases. Considering the high frequency of chronic pain in this category of patients, the study of the relationship between the operations performed and the injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment with chronic pain will play an important role, and will also contribute to the improvement of the treatment of this category of patients .&#x0D; The goal of the work. To investigate the relationship of chronic pain with performed surgical interventions and injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment.&#x0D; Materials and methods. Study of patients with gunshot and mine-explosive injuries. The tool for pain intensity research was a visual analog scale. The method of constructing univariate and multivariate logistic regression models was used to analyze the relationship between the risks of receiving a negative treatment result and factor characteristics. The quality of the models was evaluated by the area under the ROC curve. To quantify the degree of influence of the factor characteristic, the odds ratio indicator was calculated.&#x0D; Results of the research. Studying the relationship of chronic pain with performed surgical interventions and injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment, it was found that there is a relationship (AUC=0.54 95% CI 0.51-0.57) of the risk of chronicity pain with the number of injured anatomical parts of the body - with the number of injured 3 or more, the risk of pain chronicity increases (p=0.010), OR=1.45 (95% CI 1.09-1.92) compared to patients who have injured 1 or 2 parts of the body. Also, two factors related to the risk of chronic pain were found - the number of injured anatomical parts of the body and the type of injury, AUC=0.56 (95% CI 0.53-0.59).&#x0D; Conclusions. The tactics of pain treatment in patients with gunshot and mine-explosive wounds at the stages of treatment should take into account the type of injury and the number of injured anatomical parts of the body. This, potentially, can reduce cases of chronic pain, and will also contribute to the improvement of treatment results for this category of patients.

Intercostal nerve cryoanalgesia in the treatment of pain in patients operated on by the modified Nuss method with the BackOnFeet application-a new strategy to improve outcomes.

The surgical Nuss correction of the funnel chest deformity is a painful procedure without an established consensus of pain relief methods. High doses and long duration of opioids requirements impedes the ERAS protocol introduction. The aim of this study was to evaluate the effectiveness of intraoperative intercostal nerve cryolysis in terms of pain management in relation to the routinely used multimodal analgesia in Poland. We also assessed the impact of using the proprietary "BackOnFeet" application on the quality of life of patients after surgery in relation to the ERAS protocol. The prospective, single-centre, non-randomised, before-after pilot study was conducted. Inclusion criteria were: funnel-shaped chest deformity, age range 11-18 years, first chest wall operation, agreement for the cryolysis and regional analgesia, no history of chronic painkillers use. The results of the "control group" (multimodal analgesia with regional analgesia commonly performed in Poland) were assessed. The interdisciplinary perioperative protocol with the "BackOnFeet" application and intraoperative intercostal nerve cryoanalgesia were introduced to the "intervention group". Eighteen children were treated with standard protocol typical for Polish management and matched to eighteen patients who received cryoanalgesia and the "BackOnFeet" application access "intervention group". We noticed lower NRS points in first 24 h (p = 0.0048), shortening of time of opioid use (p = 0.0002), hospitalisation time (p = 0,01), improved quality of postoperative rehabilitation (p < 0.0001) and quality of life (p < 0.0001) among the "intervention group". Intraoperative intercostal nerves cryolysis performed during the minimally invasive Nuss correction of funnel deformation in combination with bilateral is more effective in terms of acute pain management in relation to the routinely used multimodal analgesia in Poland, allowing for the shortening of time of opioid use, hospitalisation time, improved quality of postoperative rehabilitation and enabled ERAS protocol introduction. The use of the proprietary "BackOnFeet" application has a positive effect on the quality of life of patients after surgery.

Non-pharmacological Interventions on Pain and Quality of Life in Chemotherapy Induced Polyneuropathy: Systematic Review and Meta-Analysis.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment, resulting in pain, numbness, instability, and thus affecting quality of life (QoL), occasionally leading to discontinuation of chemotherapy. Pharmacological treatments are not sufficient. Non-pharmacological interventions (NPIs) have also been tried. This study aimed to systematically review the efficacy of NPIs on pain and QoL in patients suffering from CIPN. The databases searched were Pubmed, Cohrane, and Scopus for randomized controlled trials (RCTs) published in the last 5 years (2017-2022). Studies were considered eligible, if they assessed adult patients suffering from CIPN because of any chemotherapeutic drug for any type and any stage of cancer and if study protocols included non-pharmacological intervention with a structured protocol. A total of 1,496 records were identified. Finally, 10 RCTs including 495 patients (253 in the intervention group and 242 in the control group) were included for meta-analysis. Intervention protocols included acupuncture (n=6), exercise (n=3), and yoga (n=1). NPIs significantly reduced neuropathic pain. However, the effect on QoL was not significant. NPIs are beneficial in the treatment of pain in patients with CIPN but their impact on QoL is not statistically supported. Larger sample sizes, more homogenous in outcome measures and interventions are needed to further explore NPIs' efficacy on CIPN symptoms.

Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery – a prospective pilot study

Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery – a prospective pilot study

Focused Ultrasound and RadioTHERapy for non-invasive palliative pain treatment in patients with bone metastasis: a study protocol for the three armed randomized controlled FURTHER trial

BackgroundCancer-induced bone pain (CIBP), caused by bone metastases, is a common complication of cancer and strongly impairs quality of life (QoL). External beam radiotherapy (EBRT) is the current standard of care for treatment of CIBP. However, approximately 45% of patients have no adequate pain response after EBRT. Magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) may improve pain palliation in this patient population. The main objective of this trial was to compare MR-HIFU, EBRT, and MR-HIFU + EBRT for the palliative treatment of bone metastases.Methods/designThe FURTHER trial is an international multicenter, three-armed randomized controlled trial. A total of 216 patients with painful bone metastases will be randomized in a 1:1:1 ratio to receive EBRT only, MR-HIFU only, or combined treatment with EBRT followed by MR-HIFU. During a follow-up period of 6 months, patients will be contacted at eight time points to retrieve information about their level of pain, QoL, and the occurrence of (serious) adverse events. The primary outcome of the trial is pain response at 14 days after start of treatment. Secondary outcomes include pain response at 14 days after trial enrolment, pain scores (daily until the 21st day and at 4, 6, 12 and 24 weeks), toxicity, adverse events, QoL, and survival. Cost-effectiveness and cost-utility analysis will be conducted.DiscussionThe FURTHER trial aims to evaluate the effectiveness and cost-effectiveness of MR-HIFU—alone or in combination with EBRT—compared to EBRT to relieve CIBP. The trial will be performed in six hospitals in four European countries, all of which are partners in the FURTHER consortium.Trial registrationThe FURTHER trial is registered under the Netherlands Trials Register number NL71303.041.19 and ClinicalTrials.gov registration number NCT04307914. Date of trial registration is 13–01-2020.