Acute Pain Management of Chronic Pain Patients in Ambulatory Surgery Centers

Global trends and performance of dry needling from 2004 to 2024: a bibliometric analysis

Background

Many doctors are incorporating dry needling into their clinical practice. Despite this growing trend, there has not been a comprehensive bibliometric analysis conducted in this field. Thus, this study aims to investigate the current research landscape, key research contributors, and popular research topics in dry needling, and to analyze the developmental trends within this area of study.

Methods

The study utilized the Web of Science Core Collection (WoSCC) as the main data source. Scientific literature was gathered through title (TI) searches for original clinical research papers on dry needling published between 2004 and 2024, using 'dry needling' or 'dry needle' as the search term. Statistical analyses and visualizations of the literature information, such as keywords, countries, research institutions, and authors, were conducted using the bibliometric.com online platform and VOSviewer. This approach aimed to statistically analyze and visualize the key research entities, hotspots, and frontiers in dry needling research. Additionally, the study delved into collaborative networks, research outputs, hot topics, and trends within the field of dry needling.

Results

This investigation encompassed 468 publications, with the year 2021 topping the charts for the highest publication output, amassing a total of 271 articles. The journal "Acupuncture in Medicine" emerged as the most frequently cited publication. The most impactful article was titled "Acupuncture and dry-needling for low back pain: An updated systematic review within the framework of the Cochrane Collaboration." Spain took the lead as the most productive country in this domain, with the United States closely following. Cesar Fernández-de-las-Peñas emerged as the most prolific author in the field. The Universidad Rey Juan Carlos in Spain was recognized as the most productive institution for research in dry needling. As for journal keywords, "dry needling," "trigger point," and "myofascial pain syn-drome" were the triumvirate of terms most recurrently encountered.

Conclusion

The field of dry needling research has witnessed significant growth in recent years, characterized by the emergence of novel trends such as comparative studies with acupuncture, exploration into the mechanisms of action, and a transition toward interdisciplinary approaches. As medical models evolve, the focus is expanding from the exclusive treatment of muscle pain to broader applications. Despite this progress, the domain is underscored by a paucity of large-scale, multicenter clinical trials and animal studies. There exists an imperative for enhanced collaboration among academic and research institutions. A more profound exploration and comprehensive research endeavors are essential to enhance our understanding and broaden the clinical application of dry needling techniques.

Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder

Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. Such care requires stakeholder alignment across multiple specialties and care settings. With the intention of codifying this alignment into a reliable and efficient processes, a consortium of 15 professional healthcare societies was convened in a year-long modified Delphi consensus process and summit. This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of 'complex' patients as they undergo surgical procedures.

Patient Fear of Pain: The Pre-Operative Period in the Neurosurgery Clinic

PURPOSE

This study was conducted as a descriptive study to determine the pain fears of patients undergoing surgery in the neurosurgery clinic.

MATERIAL AND METHOD

The study was conducted with 151 patients hospitalized in the neurosurgery clinic who met the inclusion criteria. Data were collected with the patient information form and the fear of pain scale-III. Ethics committee approval, institutional permission, and written consent from individuals were obtained before the study.

RESULTS

It was determined that the mean fear of pain score was 64.59 ± 18.43, 41.7% of the patient were fear of surgical incisional pain. Fear of surgical incisional pain is responsible for 22.0% and female gender is responsible for 29% of the change in fear of pain scores.

CONCLUSION

As a result, it was determined that the pain fear level of the patients in the pre-operative period was moderate. Increasing the practices to reduce the patients' fear of pain should be recommended.

The relation of adherence to the DASH diet with migraine attack frequency and pain intensity in Iranian women: a cross-sectional study

BACKGROUND

Migraine is a debilitating neurological discomfort characterized by moderate to severe unilateral headaches. Adherence to healthy dietary patterns like the DASH diet has been considered a complementary solution to migraine management.

OBJECTIVE

In this study, we assessed the relation of adherence to the DASH diet with migraine attack frequency and pain intensity in women with migraine.

METHODS

285 female women with migraine were recruited in the current study. Migraine was diagnosed by a single neurologist based on the third edition of the International Classification of Headache Disorders (ICHD-III). Migraine attack frequency was determined based on the number of attacks per month. Pain intensity was assessed by the Visual Analogue Scale (VAS) and migraine index. Last year dietary intakes of women were collected using a semi-quantitative food frequency questionnaire (FFQ).

RESULTS

Almost 91% of the women had migraine without aura. Most of the participants reported more than 15 attacks per month (40.7%) and pain intensity in the range of 8-10 in every attack (55.4%). Based on the ordinal regression, those in the first tertile of the DASH score had significantly higher odds for attack frequency (OR = 1.88; 95% CI: 1.11-3.18; P = .02) and migraine index score (OR = 1.69; 95% CI: 1.02-2.79; P = .04, respectively) than those in the third tertile.

CONCLUSION

This study showed that a higher DASH score is associated with a lower migraine attack frequency and migraine index score in female sufferers.

A Survey Study of Surgeons and Anesthesiologists Regarding Perioperative Multimodal Analgesia for Opioid-Tolerant Patients

PURPOSE

Perioperative pain management of opioid-tolerant patients can be challenging. Although regional anesthesia and multimodal analgesics may be beneficial, these modalities are often underused. It is unclear whether practice patterns for perioperative pain management are determined by the knowledge, attitudes, and beliefs of surgeons and anesthesiologists.

DESIGN

Descriptive survey.

METHODS

Using a Qualtrics survey, we polled a randomly selected group of 25 surgeons and 25 anesthesiologists regarding their knowledge, attitudes, beliefs, and practices for pain management in an opioid-tolerant patient.

FINDINGS

Of 25, 23 anesthesiologists and 18/25 surgeons responded to the survey. Demographics were similar between the 2 groups. Most of the participant surgeons and anesthesiologists believed that pain management may be challenging in an opioid-tolerant patient. However, only 56% of surgeons would recommend a preoperative pain consultation. Most surgeons and anesthesiologists believed in the efficacy of regional anesthetics. However, 43% of surgeons would not advocate for a regional block, perhaps due to their perception of the added perioperative time. Multimodal analgesics were widely accepted by both surgeons and anesthesiologists.

CONCLUSIONS

There is an urgent need to reinforce the importance of patient-centered care, with a specific focus on addressing knowledge gaps and improving perceptions for all the members of the team, including surgeons, anesthesiologists, and perioperative nursing teams, if optimal outcomes are to be achieved for our patients.

Postoperative Pain Control Following Shoulder Arthroplasty: Rethinking the Need for Opioids

The use of opioid pain medication regimens to control perioperative pain has led to significant patient and societal consequences. There are several alternative, opioid-sparing and opioid-minimizing pain regimens that have been shown to provide equal, if not superior, pain relief with fewer secondary consequences. This article provides an in-depth review of the current evidence regarding efficacy, safety, and feasibility of a perioperative opioid-sparing clinical pathway for patients undergoing shoulder arthroplasty.

The Effect of Preoperative Pain Fear on Postoperative Pain, Analgesic Use, and Comfort Level

BACKGROUND

Preoperative assessment of pain fear could provide essential information for improving perioperative care and could be the first step toward targeted pain management.

AIMS

The aim of this study is to determine the effect of preoperative pain fear on postoperative pain, analgesic use, and comfort level.

METHOD

This cross-sectional study was conducted with 201 patients in the general surgery service between January 2022 and March 2022. A sociodemographic questionnaire, Visual Analog Scale (VAS), pain fear, and general comfort scales were used for data collection. Correlation analysis was performed to examine the relationship between scales, and p < .05 was considered statistically significant.

RESULTS

The mean age of the individuals participating in the study was 51.22±15.89 and 69.2% of them were women. The average score of pain fear was 63.77±21.47, and the average score of the VAS was 7.63±1.82 after the surgery before analgesics and 5.06±1.58 six hours after surgery. The mean comfort level was 132.88±9.26. A significant and positive correlation was detected between the total pain fear and the VAS score, analgesic use, and comfort level (p < .05).

CONCLUSIONS

In this research, findings demonstrated that as the patients' pain fear increased, postoperative pain severity and amount of analgesia increased. Providing pain management with analgesics increases comfort in patients, but it may cause secondary problems in patients who use high-dose analgesics. Therefore, reducing pain fear, which is one of the main factors in pain, is essential in pain management.

Perioperative and Periprocedural anesthetic management of opioid tolerant patients and patients with active and medically treated opioid use disorder

PURPOSE OF REVIEW

The increasing prevalence of opioid tolerant individuals, in combination with the expanding scope and utilization of nonoperating room anesthesia (NORA) necessitates ongoing investigation into best clinical practice for managing surgical/procedural pain in this population. The purpose of this article is to review recent guidelines, identify specific challenges, and offer considerations for managing pain in patients who are opioid tolerant secondary to opioid use disorder (OUD), with or without medications for the treatment of OUD.

RECENT FINDINGS

A comprehensive preoperative evaluation in conjunction with a multidisciplinary, multimodal pain approach is optimal. NORA adds unique situational and environmental challenges for optimizing acute on chronic pain control in tolerant individuals while maintaining safety. Direct and partial/mixed mu-agonists should typically be continued throughout the perioperative period, while mu-antagonists (naltrexone) should be held 72 h. Postprocedural discharge instructions and follow-up must be carefully arranged and ensured.

SUMMARY

Clinical recommendations continue to evolve as new consensus guidelines are published, although institution-specific guidelines are most often followed. This review focuses on most recent best practices, within NORA and operating room settings, for managing opioid tolerant patients, patients with OUD and those on medications for the treatment of OUD.

Effect of non-steroidal anti-inflammatory drugs on fracture healing in children: A systematic review

BACKGROUND

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications in the United States. Although they are safe and effective means of analgesia for children with broken bones, there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture healing.

AIM

To assess whether NSAID exposure is a risk factor for fracture nonunion in children.

METHODS

We systematically reviewed the literature reporting the effect of NSAIDs on bone healing. We included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID exposure. The outcomes of interest were delayed union or nonunion. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. A final table was constructed summarizing the available evidence.

RESULTS

A total of 120 articles were identified and screened, of which 6 articles were included for final review. Nonunion in children is extremely rare; among the studies included, there were 2011 nonunions among 238822 fractures (0.84%). None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time period. Additionally, children are likely to take these medications for only a few days after injury or surgery, further decreasing their risk of adverse side-effects.

CONCLUSION

This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone healing. Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.

Analgesic benefit of metamizole and ibuprofen vs. either medication alone: a randomized clinical trial

BACKGROUND

Postoperative pain relief remains a key problem after surgery. Multimodal pain therapy has proven beneficial in alleviating pain to a certain extent. However, when combining non-opioids, the focus has been on NSAIDs and paracetamol, but effects of combined use are only moderate. Metamizole could be a potent adjunct, due to its preclusion in several countries, data on its combined use are sparse, despite its common use in many countries. The aim of this study was to examine whether the combination of metamizole and ibuprofen is superior in relieving postoperative pain to either drug alone.

METHODS

For this randomized, placebo-controlled, cross-over study, 35 patients undergoing bilateral lower third molar extraction were randomized. Each patient received three applications of 1000mg metamizole + 400mg ibuprofen for surgery on one side and either 1000mg metamizole + placebo or 400mg ibuprofen + placebo on the other side. Pain ratings, rescue-medication (tramadol), and sleep were assessed for 18 hours.

RESULTS

The combined treatment of metamizole and ibuprofen showed lower mean pain scores over 12 hours than ibuprofen (2.4±1.3 vs 3.8±1.6; P=0.005)). Further, combined treatment showed lower mean pain scores over 6 hours than ibuprofen (2.0±1.2 vs. 3.1±1.6; P=0.022) or metamizole alone (2.0±1.2 vs. 3.3±1.7; P=0.015). Consumption of rescue medication was lowest in the combination-group (25% vs. 46%-metamizole; 50%-ibuprofen). The trial was stopped prematurely as the COVID-pandemic halted elective surgeries.

CONCLUSIONS

Combined use enables superior pain control compared to ibuprofen after molar extraction and tends to be superior to metamizole alone. The premature study-termination may overestimate this effect.

Relation of hypertension with episodic primary headaches and chronic primary headaches in population of Rafsanjan cohort study

Headache has a variety of types, such as episodic primary headaches (EPH) and chronic primary headache (CPH) in its primary form. There is a positive correlation between these two types of headaches and hypertension (HTN), but in some works this correlation has been reported negatively. Therefore, we planned to study HTN-CPH as well as HTN-EPH correlation in our population. A sample of Rafsanjan population (10,000 individuals) entered the cohort study, as one of the Prospective Epidemiological Research Studies in Iran (PERSIAN). We compared the frequency of HTN categories in CPH and EPH cases with a normal population. Out of 9933 participants (46.6% males and 53.4% females) about 29% had EPH and 7.5% had CPH. HTN was found in 24.27% of EPH cases and 31.98% of CPH cases. HTN was also found to be associated with EPH and CPH in the crude model. Two Categories of HTN (Long controlled and uncontrolled) were not associated with EPH. On the other hand, CPH showed associations with all of the HTN categories. After included all variables and confounders, EPH and CPH had association with HTN without any considerable changes. There is strong HTN-EPH as well as HTN-CPH correlations in the studied population.

Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis

Background

Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated.

Methods

This paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field.

Results

At the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non‐mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors.

Conclusions

The information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.