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Ji C, Zhao J, Nie Q, Wang S. The role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials. J Psychosom Obstet Gynaecol 2024; 45:2291635. [PMID: 38146963 DOI: 10.1080/0167482x.2023.2291635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION The abundant functions of music and its effects on human's mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention. OBJECTIVE This study aims to investigate the benefits of music therapy on prenatal and delivery experiences of pregnant women. METHOD A systematic search for articles was conducted in electronic databases including CINAHL, Web of Science, PubMed/Medline, and CNKI. A total of 240 articles were identified, and 17 studies were selected for this review. The extracted data included author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments, and results. The data were organized chronologically based on the publication year of each study. RESULT The articles indicated that music therapy has advantages in reducing pain during childbirth, lowering anxiety and stress levels in mothers, improving sleep quality, and increasing fetal movements, basal fetal heart rate, and accelerations. CONCLUSION Based on the findings, it can be concluded that music therapy is an effective approach to enhance the experience of pregnant women during pregnancy and delivery. Therefore, its implementation in obstetrical clinical practice is highly recommended.
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Affiliation(s)
- Chao Ji
- Department of Obstetrics, Qingdao Municipal Hospital, Qingdao, China
| | - Jing Zhao
- Department of Obstetrics, Qingdao Municipal Hospital, Qingdao, China
| | - Qiaole Nie
- Musical anesthesia, Beijing Yuedi Music Analgesia Labor Institute, China
| | - Shuo Wang
- Labor Union, Qingdao Women and Children's Hospital, Qingdao, China
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Meng J, Zhang T, Hao T, Xie X, Zhang M, Zhang L, Wan X, Zhu C, Li Q, Wang K. Functional and Structural Abnormalities in the Pain Network of Generalized Anxiety Disorder Patients with Pain Symptoms. Neuroscience 2024; 543:28-36. [PMID: 38382693 DOI: 10.1016/j.neuroscience.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
Pain symptoms significantly impact the well-being and work capacity of individuals with generalized anxiety disorder (GAD), and hinder treatment and recovery. Despite existing literature focusing on the neural substrate of pain and anxiety separately, further exploration is needed to understand the possible neuroimaging mechanisms of the pain symptoms in GAD patients. We recruited 73 GAD patients and 75 matched healthy controls (HC) for clinical assessments, as well as resting-state functional and structural magnetic resonance imaging scans. We defined a pain-related network through a published meta-analysis, including the insula, thalamus, periaqueductal gray, prefrontal cortex, anterior cingulate cortex, amygdala, and hippocampus. Subsequently, we conducted the regional homogeneity (ReHo) and the gray matter volume (GMV) within the pain-related network. Correlation analysis was then employed to explore associations between abnormal regions and self-reported outcomes, assessed using the Patient Health Questionnaire-15 (PHQ-15) and pain scores. We observed significantly increased ReHo in the bilateral insula but decreased GMV in the bilateral thalamus of GAD compared to HC. Further correlation analysis revealed a positive correlation between ReHo of the left anterior insula and pain scores in GAD patients, while a respective negative correlation between GMV of the bilateral thalamus and PHQ-15 scores. In summary, GAD patients exhibit structural and functional abnormalities in pain-related networks. The enhanced ReHo in the left anterior insula is correlated with pain symptoms, which might be a crucial brain region of pain symptoms in GAD.
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Affiliation(s)
- Jie Meng
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China
| | - Ting Zhang
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China
| | - Tong Hao
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China
| | - Xiaohui Xie
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China
| | - Mengdan Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China
| | - Lei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China
| | - Xingsong Wan
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui Province, China; Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Chunyan Zhu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China; Institute of Artificial Intelligence, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Qianqian Li
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China.
| | - Kai Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui Province, China; Institute of Artificial Intelligence, University of Science and Technology of China, Hefei, Anhui Province, China.
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Silva GN, Brandão VG, Perez MV, Sobrinho SL, Villardi JGDCC, Sacramento PMD, Ribeiro LCP, Alvim Fiorelli RK. Immunotherapeutic Properties of Dexmedetomidine on Pain Management and Cardiovascular Function in Videolaparoscopic Cholecystectomies: A Randomized, Two-Arm, Double-Blinded, Placebo-Controlled Trial. Surg Innov 2024; 31:137-147. [PMID: 38383315 DOI: 10.1177/15533506241234591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Laparoscopy represented one of the most innovative surgical techniques approached in the surgery field. Dexmedetomidine association with general anesthesia promotes the response control to trauma by altering the neuroinflammatory reflex, provides better clinical outcomes in the postoperative period and reduces the excessive use of drugs with risk for addiction. This trial aims to evaluate the potential drug treatment of dexmedetomidine on organic function, with the targets in neuroinflammation, perioperative pain control and blood pressure measurements in a medium-sized surgical model. METHODS Fifty-two patients were randomized in two groups: Sevoflurane and Dexmedetomidine - A (dexmedetomidine infusion [1 μg/kg loading, .2-.5 μg/kg/h thereafter]) vs Sevoflurane and Saline .9% - B. Three blood samples were collected at three times: before surgery, 4 to 6 hours after surgery and 24 hours postoperatively. The primary outcome was inflammatory and endocrine mediators dosage analisys. Finally, we evaluated pain and opioid use as secondary outcomes, also the hemodynamic values. RESULTS In Dexmedetomidine group A, a reduction of Interleukin 6 was found during 4-6 hours after surgery. A reduction of IL-10 was noted in the measurement of its values 24 hours after the procedure, with statistical significance. Also, systolic and diastolic blood pressure, as well heart rate were attenuated, and there was a lower incidence of pain and opioid consumption in the first postoperative hour (P < .0001) in the anesthetic recovery room. CONCLUSIONS Dexmedetomidine provided anti-inflammatory activity, sympatholytic effect and analgesia with cardiovascular safety. It reinforces the therapeutic nature of highly selective α2-adrenergic agonists when combined within anesthetic interventions.
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Affiliation(s)
- Gustavo Nascimento Silva
- Department of Anesthesiology, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Virna Guedes Brandão
- Department of Anesthesiology, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Marcelo Vaz Perez
- Department of Surgery and Anesthesia, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Sandoval Lage Sobrinho
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | | | | | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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Moore A, Straube S, Fisher E, Eccleston C. Cannabidiol (CBD) Products for Pain: Ineffective, Expensive, and With Potential Harms. J Pain 2024; 25:833-842. [PMID: 37863344 DOI: 10.1016/j.jpain.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
Cannabidiol (CBD) attracts considerable attention for promoting good health and treating various conditions, predominantly pain, often in breach of advertising rules. Examination of available CBD products in North America and Europe demonstrates that CBD content can vary from none to much more than advertised and that potentially harmful other chemicals are often included. Serious harm is associated with chemicals found in CBD products and reported in children, adults, and the elderly. A 2021 International Association for the Study of Pain task force examined the evidence for cannabinoids and pain but found no trials of CBD. Sixteen CBD randomized trials using pharmaceutical-supplied CBD or making preparations from such a source and with pain as an outcome have been published subsequently. The trials were conducted in 12 different pain states, using 3 oral, topical, and buccal/sublingual administration, with CBD doses between 6 and 1,600 mg, and durations of treatment between a single dose and 12 weeks. Fifteen of the 16 showed no benefit of CBD over placebo. Small clinical trials using verified CBD suggest the drug to be largely benign; while large-scale evidence of safety is lacking, there is growing evidence linking CBD to increased rates of serious adverse events and hepatotoxicity. In January 2023, the Food and Drug Administration (FDA) announced that a new regulatory pathway for CBD was needed. Consumers and health care providers should rely on evidence-based sources of information on CBD, not just advertisements. Current evidence is that CBD for pain is expensive, ineffective, and possibly harmful. PERSPECTIVE: There is no good reason for thinking that CBD relieves pain, but there are good reasons for doubting the contents of CBD products in terms of CBD content and purity.
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Affiliation(s)
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Claverton Down, Bath, UK
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Stombaugh DK, Singh K, Malek A, Kleiman A, Walters S, Zaaqoq A, Dawson M, McNeil JS, Kern J, Mazzeffi M. Preoperative Alcohol Use, Postoperative Pain, and Opioid Use After Coronary Artery Bypass Surgery. J Cardiothorac Vasc Anesth 2024; 38:957-963. [PMID: 38310067 DOI: 10.1053/j.jvca.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/07/2024] [Accepted: 01/12/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Chronic alcohol use is associated with chronic pain and increased opioid consumption. The association between chronic alcohol use and acute postoperative pain has been studied minimally. The authors' objective was to explore the association among preoperative alcohol use, postoperative pain, and opioid consumption after coronary artery bypass grafting (CABG). DESIGN A retrospective cohort study. SETTING At a single academic medical center. PARTICIPANTS Patients having isolated CABG. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographics, comorbidities, and baseline alcohol consumption were recorded. Primary outcomes were mean pain score and morphine milligram equivalent (MME) consumption on postoperative day 0. Among 1,338 patients, there were 764 (57.1%) who had no weekly preoperative alcohol use, 294 (22.0%) who drank ≤1 drink per week, 170 (12.7%) who drank 2-to-7 drinks per week, and 110 (8.2%) who drank 8 or more drinks per week. There was no significant difference in mean pain score on postoperative day 0 in patients who consumed different amounts of alcohol (no alcohol = 5.3 ± 2.2, ≤1 drink = 5.2 ± 2.1, 2 to 7 drinks = 5.3 ± 2.3, 8 or more drinks = 5.4 ± 1.9, p = 0.66). There was also no significant difference in median MME use on postoperative day 0 in patients who consumed different amounts of alcohol (no alcohol = 22.5 mg, ≤1 drink = 21.1 mg, 2-to-7 drinks = 24.8 mg, 8 or more drinks = 24.5 mg, p = 0.14). CONCLUSIONS There is no apparent association among mild-to-moderate preoperative alcohol consumption and early postoperative pain and opioid use in patients who underwent CABG.
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Affiliation(s)
- D Keegan Stombaugh
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - Karen Singh
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - Amir Malek
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - Amanda Kleiman
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - Susan Walters
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - Akram Zaaqoq
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - Michelle Dawson
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - John Steven McNeil
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - John Kern
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Michael Mazzeffi
- University of Virginia, Department of Anesthesiology, Charlottesville, VA.
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Nichols SJ, Yanes JA, Reid MA, Robinson JL. 7 T characterization of excitatory and inhibitory systems of acute pain in healthy female participants. NMR Biomed 2024; 37:e5088. [PMID: 38140895 DOI: 10.1002/nbm.5088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
Current understanding of the physiological underpinnings of normative pain processing is incomplete. Enhanced knowledge of these systems is necessary to advance our understanding of pain processes as well as to develop effective therapeutic interventions. Previous neuroimaging research suggests a network of interrelated brain regions that seem to be implicated in the processing and experience of pain. Among these, the dorsal anterior cingulate cortex (dACC) plays an important role in the affective aspects of pain signals. The current study leveraged functional MRS to investigate the underlying dynamic shifts in the neurometabolic signature of the human dACC at rest and during acute pain. Results provide support for increased glutamate levels following acute pain administration. Specifically, a 4.6% increase in glutamate was observed during moderate pressure pain compared with baseline. Exploratory analysis also revealed meaningful changes in dACC gamma aminobutyric acid in response to pain stimulation. These data contribute toward the characterization of neurometabolic shifts, which lend insight into the role of the dACC in the pain network. Further research in this area with larger sample sizes could contribute to the development of novel therapeutics or other advances in pain-related outcomes.
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Affiliation(s)
- Steven J Nichols
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Julio A Yanes
- Exponent Inc., Washington, District of Columbia, USA
| | - Meredith A Reid
- Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama, USA
| | - Jennifer L Robinson
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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Madhan S, Nascimento GG, Ingerslev J, Cornelis M, Pinholt EM, Cattaneo PM, Svensson P. Health-related quality of life, jaw function and sleep-disordered breathing among patients with dentofacial deformity. J Oral Rehabil 2024; 51:684-694. [PMID: 38239176 DOI: 10.1111/joor.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/15/2023] [Accepted: 10/30/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Patients with dentofacial deformity (DFD) requiring orthognathic treatment have poor aesthetics, jaw function and psychological well-being, which potentially affect the quality of life. This study aimed to investigate the health-related general, oral and orthognathic quality of life, jaw function and sleep-disordered breathing at different stages of orthognathic surgical treatment. METHODS A total of 120 consecutive patients with DFD were recruited and grouped as pre-orthodontic treatment (group 1), pre-surgery (group 2), 4 months post-surgery (group 3), 24 months post-surgery (group 4) and in addition 30 controls without DFD (group 0). Outcomes were assessed using general health Short Form Survey (SF-36), Oral Health Impact (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ), STOP-Bang and Jaw Function Limitation Scale (JFLS) questionnaires. In addition, presence or absence of pain was recorded. Data were tested with analysis of variance, Kruskal-Wallis test, Tukey post hoc test and structural equation modelling (SEM). RESULTS Results revealed SF-36 (p = .814) and STOP-Bang (p = .143) total scores did not differ between control and treatment groups. In contrast, OHIP-14, OQLQ and JFLS total scores differed between groups (p = .001). Higher scores were observed in groups 1 (p = .001), 2 (p = .001) and 3 (p = .041) compared to group 0, indicating poor oral health in patients with DFD. Importantly, in group 4, oral health-related quality of life was better, and OHIP-14 (p = .936) and JFLS (p = .572) scores did not differ from controls. OQLQ scores of group 4 were significantly lower than group 1 (p = .001) but higher than group 0 (p = .013). SEM results revealed a significant negative associations of pain with JFLS and OQLQ; OHIP-14 with OQLQ; OHIP-14 with SF-36; and finally STOP-Bang with SF-36. Positive associations were observed between JFLS and OHIP-14; OHIP-14 and OQLQ. CONCLUSION Oral health-related quality of life and jaw function appears to be improved 24 months after orthognathic surgery. Pain and limitation in jaw function had a negative association with health-related quality of life.
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Affiliation(s)
- Sivaranjani Madhan
- Sections for Orthodontics and Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- Visiting Researcher, Department of Oral Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Gustavo G Nascimento
- Section for Periodontology, Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- National Dental Research Institute Singapore, Duke-NUS Medical School, Singapore, Singapore
| | - Janne Ingerslev
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Marie Cornelis
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Else Marie Pinholt
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark
- Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Paolo M Cattaneo
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- Faculty of Odontology, Malmø University, Sweden
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Secrest S, Miller-Matero LR, Chrusciel T, Salas J, Sullivan MD, Zabel C, Lustman P, Ahmedani B, Carpenter RW, Scherrer JF. Baseline Characteristics From a New Longitudinal Cohort of Patients With Noncancer Pain and Chronic Opioid Use in the United States. J Pain 2024; 25:984-999. [PMID: 37907114 PMCID: PMC10960712 DOI: 10.1016/j.jpain.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
Retrospective cohort studies have consistently observed that long-term prescription opioid use is a risk factor for new major depressive episodes. However, prospective studies are needed to confirm these findings and establish evidence for causation. The Prescription Opioids and Depression Pathways cohort study is designed for this purpose. The present report describes the baseline sample and associations between participant characteristics and odds of daily versus nondaily opioid use. Second, we report associations between participant characteristics and odds of depression, dysthymia, anhedonia, and vital exhaustion. Patients with noncancer pain were eligible if they started a new period of prescription opioid use lasting 30 to 90 days. Participants were 54.8 (standard deviation ± 11.3) years of age, 57.3% female and 73% White race. Less than college education was more common among daily versus nondaily opioid users (32.4% vs 27.3%; P = .0008), as was back pain (64.2% vs 51.3%; P < .0001), any nonopioid substance use disorder (12.8% vs 4.8%; P < .0001), and current smoking (30.7% vs 18.4% P < .0001). High pain interference (50.9% vs 28.4%; P < .0001) was significantly associated with depression, as was having more pain sites (6.9 ± 3.6 vs 5.7 ± 3.6; P < .0001), and benzodiazepine comedication (38.2% vs 23.4%; P < .0001). High pain interference was significantly more common among those with anhedonia (46.8% vs 27.4%; P < .0001), and more pain sites (7.0 ± 3.7 vs 5.6 ± 3.6; P < .0001) were associated with anhedonia. Having more pain sites (7.9 ± 3.6 vs 5.5 ± 3.50; P < .0001) was associated with vital exhaustion, as was back pain (71.9% vs 56.8%; P = .0001) and benzodiazepine comedication (42.8% vs 22.8%; P < .0001). Patients using prescription opioids for noncancer pain have complex pain, psychiatric, and substance use disorder comorbidities. Longitudinal data will reveal whether long-term opioid therapy leads to depression or other mood disturbances such as anhedonia and vital exhaustion. PERSPECTIVE: This study reports baseline characteristics of a new prospective, noncancer pain cohort study. Risk factors for adverse opioid outcomes were most common in those with depression and vital exhaustion and less common in dysthymia and anhedonia. Baseline data highlight the complexity of patients receiving long-term opioid therapy for noncancer pain.
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Affiliation(s)
- Scott Secrest
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
| | - Lisa R. Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO. 63104 U.S.A
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle WA. 98195
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Patrick Lustman
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Blvd, Suite 301, St. Louis, MO. 63108
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Ryan W. Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., Saint Louis, MO. 63121
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd. St. Louis, MO 63104 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
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Tran V, Winters E, Stroulia E, Hadjistavropoulos T. Implementation and evaluation of a pain assessment app and novel community platform for long-term care health professionals. Aging Ment Health 2024; 28:611-620. [PMID: 36546682 DOI: 10.1080/13607863.2022.2158307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE A tablet app, based on the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II), has been shown to have clinical utility and unique advantages. We aimed to replicate and extend the previous validation of the app through the implementation and evaluation of a new community platform involving a quality indicator (QI) monitoring feature and a resource community portal (CP) that work in conjunction with an updated version of the app. METHODS We employed a mixed-methods multiple-baseline design across 11 long-term care (LTC) units. Units were randomly assigned to conditions which varied in number of app features available. Data included unit-level QIs as well as questionnaires and semi-structured interviews with health professionals. RESULTS Following use of the app, we found improvements in unit-level QIs regardless of availability of the QI/CP features. During interviews, participants expressed a preference for the app over a paper version of the PACSLAC-II due to reasons such as the app's ability to summarize information. Utilization of the community portal websites was unrelated to staff questionnaire-assessed stress/burnout. CONCLUSIONS Despite the positive effects on the care of residents, the COVID-19 pandemic presented challenges and interfered with the long-term maintenance of the QI results.
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Affiliation(s)
- Vivian Tran
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Emily Winters
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Eleni Stroulia
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
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10
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Russo E, Festa BM, Costantino A, Bernardocchi A, Spriano G, De Virgilio A. Postoperative Morbidity of Different Tonsillectomy Techniques: A Systematic Review and Network Meta-Analysis. Laryngoscope 2024; 134:1696-1704. [PMID: 37843298 DOI: 10.1002/lary.31116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain. METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were postoperative bleeding incidence and mean postoperative pain score. RESULTS A total of 6464 patients were included for five different interventions (cold dissection tonsillectomy; extracapsular coblation tonsillectomy; intracapsular coblation tonsillectomy [ICT]; bipolar diathermy tonsillectomy [BDT]; monopolar diathermy tonsillectomy). ICT showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean postoperative pain score (1.74 ± 0.68) with a 94.0% chance of ranking first, whereas BDT showed both the highest absolute risk of bleeding incidence (10.75%) and the highest mean postoperative pain score (5.67 ± 1.43). CONCLUSIONS ICT seems to offer better postoperative outcomes, in terms of reduced risk of bleeding and reduced pain. Further prospective studies are advised to confirm these findings. LEVEL OF EVIDENCE NA Laryngoscope, 134:1696-1704, 2024.
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Affiliation(s)
- Elena Russo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Alice Bernardocchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
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Amna S, Øhlenschlaeger T, Saedder EA, Sigaard JV, Bergmann TK. Review of clinical pharmacokinetics and pharmacodynamics of clonidine as an adjunct to opioids in palliative care. Basic Clin Pharmacol Toxicol 2024; 134:485-497. [PMID: 38275186 DOI: 10.1111/bcpt.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024]
Abstract
Clonidine is an α-adrenoceptor agonist acting on receptors in the brain and peripheral tissues, leading to a reduction in sympathetic outflow and release of certain neurotransmitters. Clonidine has multiple uses across various medical conditions. One of its uses is as adjuvant to anaesthetic and analgesic agents specially opioids, mostly administered through intravenous and epidural routes. The opioids, effective in cancer pain management, are associated with various side effects such as sedation, pruritus, constipation, nausea, respiratory depression, tolerance and dependence. Combination of clonidine with opioids seems to help to achieve better pain management and less need of opioids. Use of clonidine in palliative care has been less common, but it is gradually gaining recognition for its potential benefits in managing symptoms like cancer pain and agitation. This combination approach has been explored in palliative care settings, including cancer pain and agitation, where patients experience complex and refractory symptoms. It seems to be well tolerated and gives better symptom relief. The available literature on clonidine's use in cancer pain and agitation management, especially in subcutaneous form, is limited and outdated. Therefore, the optimal dosing, safety profile and overall effectiveness of subcutaneous clonidine requires further exploration through prospective research studies.
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Affiliation(s)
- Sarwat Amna
- Department of Palliative Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark
| | | | - Eva Aggerholm Saedder
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jarl Voss Sigaard
- Department of Palliative Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Troels Korshøj Bergmann
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
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Soreau A, Ferey C, Hardouin JB, Draper-Rodi J, Sarzeaud R, Benoist H, Ostelo RW, Merdy O. Translation, validity and reliability of the pain attitudes and beliefs scale for physiotherapists in French. Physiother Res Int 2024; 29:e2078. [PMID: 38430539 DOI: 10.1002/pri.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/29/2023] [Accepted: 02/13/2024] [Indexed: 03/04/2024]
Abstract
BACKGROUND The Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) questionnaire evaluates manual therapists' biomedical and biopsychosocial beliefs regarding the management of chronic low back pain. Its usage in clinical settings is an important step in the implementation of national guidelines and policies to improve patient management. OBJECTIVES The objective of this study was to translate the PABS-PT questionnaire into French, to adapt it culturally, and to conduct a psychometric analysis. DESIGN Qualitative and cross-sectional study. METHOD The translation process followed published guidelines with cross-cultural validation by an expert committee. We followed a forward and backward translation procedure and an expert committee, including the original author of the questionnaire and a linguistics expert ensuring good cultural adaptation, issued a finalised version. Psychometric analysis of the French version of the questionnaire was conducted among 390 French manual therapists in two phases. The first phase evaluated structural validity as well as external validity compared with the TSK and BBQ questionnaires. Then, reliability and scalability were analysed. The second phase evaluated test-retest reproducibility by sending the same questionnaire 3 months later. RESULTS The validity study revealed three subscales: the classic biomedical subscale and two subscales for biopsychosocial beliefs (aetiology of pain and physical activity). With 21 items in total for the PABS-PT-FR, the structural validity scores were good (BM: alpha = 0.82, H = 0.38; Physical Activity: alpha = 0.62, H = 0.32; Aetiology of Pain: alpha = 0.55, H = 0.29). CONCLUSIONS This study provides a validated tool to assess French physiotherapists' and, more generally, healthcare providers' beliefs about chronic low back pain, with a new insight into the BPS subscale internal construct.
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Affiliation(s)
- Alexis Soreau
- Institut des Hautes Études Ostéopathiques (IdHEO), St-Herblain, France
| | - Cassandre Ferey
- Institut des Hautes Études Ostéopathiques (IdHEO), St-Herblain, France
- UMR INSERM 1246 - SPHERE, Nantes Université, Université de Tours, Tours, France
| | - Jean-Benoit Hardouin
- UMR INSERM 1246 - SPHERE, Nantes Université, Université de Tours, Tours, France
- Service de santé publique - Plateforme de Méthodologie et de Biostatistique - CHU de Nantes, Nantes, France
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, UK
- National Council for Osteopathic Research, London, UK
| | - Robert Sarzeaud
- Institut des Hautes Études Ostéopathiques (IdHEO), St-Herblain, France
| | - Hélène Benoist
- Freelance Translator (English and Spanish into French), Finistère, France
| | - Raymond W Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Olivier Merdy
- Institut des Hautes Études Ostéopathiques (IdHEO), St-Herblain, France
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Arslan-Carlon V, Qadan M, Puttanniah V, Seier K, Gönen M, Yang G, Fischer M, DeMatteo RP, Kingham TP, Jarnagin WR, D’Angelica MI. Randomized Prospective Trial of Epidural Analgesia after Open Hepatectomy. Ann Surg 2024; 279:598-604. [PMID: 38214168 PMCID: PMC10939918 DOI: 10.1097/sla.0000000000006205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To evaluate whether patient-controlled epidural analgesia (PCEA) improves postoperative pain during ambulation following elective open hepatectomy. BACKGROUND Strategies to alleviate postoperative pain are a critical element of recovery after surgery. However, the optimal postoperative pain management strategy following open hepatectomy remains unclear. METHODS We conducted a prospective, nonblinded, randomized comparison of PCEA (intervention) versus intravenous patient-controlled analgesia (IV PCA; control) for postoperative pain following elective open hepatectomy. The primary end point was pain during ambulation on postoperative day (POD) 2. The study was powered to detect a clinically significant 2-point difference on the pain numeric rating scale (NRS). Secondary end points included pain at rest, morbidity, time to return of bowel function, and length of stay. RESULTS From 2015 to 2020, 231 patients were randomized (116 patients in the PCEA arm and 115 in the IV PCA arm). The incidence of epidural failure was 3% (n=4/116), with no epidural-related complications. Patients in the PCEA arm had a <2-point difference in NRS pain scores during ambulation on POD 2 vs. IV PCA (median 4.0 vs. 5.0, P <0.001). There was no difference in overall complications between the PCEA and IV PCA arms (33% vs. 40%, P =0.276). Secondary outcomes, including pain scores at rest, were similar between the study arms. CONCLUSIONS PCEA was safe following open hepatectomy and was associated with a small difference in pain with activity on POD 2 that did not reach our pre-specified definition of clinical significance.
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Affiliation(s)
- Vittoria Arslan-Carlon
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Vinay Puttanniah
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Seier
- Department of Biostatistics & Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gönen
- Department of Biostatistics & Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gloria Yang
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary Fischer
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ronald P. DeMatteo
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Keefner T, Minton M, Antonen K. Embracing Emotional Pain: A Case Study of Adolescent Suicidality and Spirituality. J Am Psychiatr Nurses Assoc 2024; 30:397-408. [PMID: 36016492 DOI: 10.1177/10783903221118932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suicidality continues to be the second leading cause of adolescent death. Nurses are in a prime position to address the emotional pain associated with adolescent suicidality but report skepticism and discomfort. Moreover, spirituality is identified as a protective factor against suicidality, yet a gap exists related to exploring spirituality within the context of the emotional pain associated with adolescent suicidality. Building awareness of adolescents' spirituality and emotional pain associated with suicidality is essential to address nurse skepticism and discomfort. AIMS The purpose of this study was to explore young adults' experiences of suicide attempt(s) during adolescence in the context of spirituality using a case study application of participant narratives to Minton and Antonen's B.L.E.S.S. acronym. METHOD A multiple-case study design was used to provide an alternative perspective for understanding adolescent suicidality from a spiritual context. Reed's theory of self-transcendence and the B.L.E.S.S. acronym guided the analysis and interpretation. Convenience online sampling resulted in six adult participants who provided email narratives of their adolescent experiences. Email data collection was guided by Fritz and Vandermause. Analysis of participant narratives followed the protocol of Baxter and Jack. RESULTS Participant's narratives revealed self-transcendence that paralleled the five truths about emotional pain and spirituality inherent in the B.L.E.S.S. acronym. CONCLUSION This case study provides nurses a guide for counteracting the barriers of skepticism and stigma to promote help-seeking behavior associated with adolescent suicidality. Further research is needed for the application of the B.L.E.S.S. acronym with other population samples.
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Affiliation(s)
- Tamara Keefner
- Tamara Keefner, PhD, RN, CNE, University of South Dakota, Vermillion, SD, USA
| | - Mary Minton
- Mary Minton, PhD, RN, CHPN, South Dakota State University, Brookings, SD, USA
| | - Kathy Antonen
- Kathy Antonen, PhD, South Dakota School of Mines and Technology, Rapid City, SD, USA
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Kaizu Y, Miyata K, Arii H. Post-hip-fracture knee pain in older adults prolongs their hospital stays: A retrospective analysis using propensity score matching. Physiother Res Int 2024; 29:e2080. [PMID: 38426246 DOI: 10.1002/pri.2080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND PURPOSE Post-hip-fracture knee pain (PHFKP) occurs in ∼28%-37% of patients and contributes to a prolonged length of hospital stay (LOS). Analyses of LOS prolongation due to PHFKP have been limited to univariate analyses that do not consider important confounding factors. After adjusting for important confounding factors, we investigated whether the presence or absence of PHFKP makes a difference in LOS in patients with hip fractures. METHODS We conducted a retrospective review of the medical records of patients who had undergone postoperative rehabilitation after surgery for a hip fracture. Demographic and clinical information, discharge parameters, and PHFKP development information were collected from the medical records. Using propensity score matching, we performed a two-group comparison of LOS, the functional independence measure (FIM) motor score (FIMm), FIMm gain, and FIMm effectiveness in patients with and without PHFKP. Six variables were included in the calculation of propensity scores: age, sex, body mass index, fracture type, American Society of Anesthesiologists physical status, and independence in activities of daily living at discharge. One-way analysis of variance was used to examine the details of the relationships between LOS and (i) the time of PHFKP development and (ii) pain intensity. RESULTS We analyzed the cases of 261 patients, of whom 87 (33.3%) developed PHFKP. In propensity score matching, 80 patients were each matched to a patient in the PHFKP or non-PHFKP group. After propensity score matching, a between-group comparison revealed that the PHFKP group had a longer LOS (+11 days) than the non-PHFKP group, and there were no differences in FIMm gain or FIMm effectiveness. The timing of PHFKP development and pain intensity were not related to the LOS. DISCUSSION Even after adjusting for confounders, the development of PHFKP was found to prolong LOS. Clinicians should be aware of possible LOS prolongation in hip fracture patients with PHFKP.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Hospital, Takasaki, Gunma, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
| | - Hironori Arii
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Hume NE, Zerfas I, Wong A, Klein-Fedyshin M, Smithburger PL, Buckley MS, Devlin JW, Kane-Gill SL. Clinical Impact of the Implementation Strategies Used to Apply the 2013 Pain, Agitation/Sedation, Delirium or 2018 Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption Guideline Recommendations: A Systematic Review and Meta-Analysis. Crit Care Med 2024; 52:626-636. [PMID: 38193764 PMCID: PMC10939834 DOI: 10.1097/ccm.0000000000006178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES To summarize the effectiveness of implementation strategies for ICU execution of recommendations from the 2013 Pain, Agitation/Sedation, Delirium (PAD) or 2018 PAD, Immobility, Sleep Disruption (PADIS) guidelines. DATA SOURCES PubMed, CINAHL, Scopus, and Web of Science were searched from January 2012 to August 2023. The protocol was registered with PROSPERO (CRD42020175268). STUDY SELECTION Articles were included if: 1) design was randomized or cohort, 2) adult population evaluated, 3) employed recommendations from greater than or equal to two PAD/PADIS domains, and 4) evaluated greater than or equal to 1 of the following outcome(s): short-term mortality, delirium occurrence, mechanical ventilation (MV) duration, or ICU length of stay (LOS). DATA EXTRACTION Two authors independently reviewed articles for eligibility, number of PAD/PADIS domains, quality according to National Heart, Lung, and Blood Institute assessment tools, implementation strategy use (including Assess, prevent, and manage pain; Both SAT and SBT; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment [ABCDEF] bundle) by Cochrane Effective Practice and Organization of Care (EPOC) category, and clinical outcomes. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. DATA SYNTHESIS Among the 25 of 243 (10.3%) full-text articles included ( n = 23,215 patients), risk of bias was high in 13 (52%). Most studies were cohort ( n = 22, 88%). A median of 5 (interquartile range [IQR] 4-7) EPOC strategies were used to implement recommendations from two (IQR 2-3) PAD/PADIS domains. Cohort and randomized studies were pooled separately. In the cohort studies, use of EPOC strategies was not associated with a change in mortality (risk ratio [RR] 1.01; 95% CI, 0.9-1.12), or delirium (RR 0.92; 95% CI, 0.82-1.03), but was associated with a reduction in MV duration (weighted mean difference [WMD] -0.84 d; 95% CI, -1.25 to -0.43) and ICU LOS (WMD -0.77 d; 95% CI, -1.51 to 0.04). For randomized studies, EPOC strategy use was associated with reduced mortality and MV duration but not delirium or ICU LOS. CONCLUSIONS Using multiple implementation strategies to adopt PAD/PADIS guideline recommendations may reduce mortality, duration of MV, and ICU LOS. Further prospective, controlled studies are needed to identify the most effective strategies to implement PAD/PADIS recommendations.
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Affiliation(s)
- Nicole E Hume
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Isabelle Zerfas
- Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI
| | - Adrian Wong
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Pamela L Smithburger
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
- Department of Pharmacy and Therapeutics, UPMC, Pittsburgh, PA
| | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ
| | - John W Devlin
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Pharmacy and Therapeutics, School of Pharmacy, Northeastern University, Boston, MA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
- Department of Pharmacy and Therapeutics, UPMC, Pittsburgh, PA
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Weeder MM, Kleinhenz MD, Reppert EJ, Weaver LF, Johnson BT, Leslie AA, Smith KJ, Curtis AK, Fritz BR, Coetzee JF. Comparison of firocoxib and meloxicam for pain mitigation in goats undergoing surgical castration. J Am Vet Med Assoc 2024; 262:498-505. [PMID: 38190805 DOI: 10.2460/javma.23.10.0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE This study sought to determine whether firocoxib (FIRO) or meloxicam (MEL) was effective at providing analgesia after surgical castration in goats. ANIMALS 18 intact male crossbred goats (6 to 8 months old) were enrolled with a mean weight of 32.6 (± 2.9) kg. METHODS Surgical castration was done under injectable anesthesia by a licensed veterinarian. Twelve bucks were surgically castrated and given either FIRO (n = 6) or MEL (n = 6). Six bucks served as controls (CNTLs) and were not castrated. Outcome measurements included visual analogue scale, infrared thermography, plasma cortisol, plasma substance P, and kinetic gait analysis. All outcome measurements were obtained at -24, 4, 8, 24, 48, and 72 hours. RESULTS All 3 treatments were significantly different from each other at the 24- and 48-hour time points, with MEL animals having lower visual analogue scale scores when compared to FIRO animals; CNTL animals exhibited the lowest plasma cortisol levels (3.19 ng/mL; 95% CI, -1.21 to 7.59 ng/mL) followed by FIRO (7.45 ng/mL; 95% CI, 3.10 to 11.80 ng/mL) and MEL (10.24 ng/mL; 95% CI, 5.87 to 14.60 ng/mL). FIRO had an average mean decrease in gait velocity change (-54.17 cm/s; 95% CI, -92.99 to -15.35 cm/s), while MEL had an increase in gait velocity when compared to baseline values (14.54 cm/s; 95% CI, -24.27 to 53.36 cm/s). Control animals had an average mean of -3.06 cm/s (95% CI, -41.88 to 35.75 cm/s). CLINICAL RELEVANCE Results from this study showed that there were some analgesic effects from administering MEL when compared to bucks that received a placebo treatment (CNTL).
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Affiliation(s)
- Mikaela M Weeder
- 1Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Michael D Kleinhenz
- 1Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Emily J Reppert
- 1Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Leslie F Weaver
- 1Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Blaine T Johnson
- 1Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Alyssa A Leslie
- 1Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Kristen J Smith
- 1Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Andrew K Curtis
- 2Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Bailey R Fritz
- 2Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Johann F Coetzee
- 2Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS
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Xiong X, Xiao CQ, Yang YC, Li YJ, Cheng QY, Wang XY, Liu Y. Temporomandibular disorder patients with excessive daytime sleepiness present greater pain intensity and reduced jaw function. J Oral Rehabil 2024; 51:639-647. [PMID: 38100233 DOI: 10.1111/joor.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/20/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Sleep disorders are associated with temporomandibular disorders (TMDs). Limited studies have focused on excessive daytime sleepiness (EDS) and its impact on jaw functions in TMD patients. OBJECTIVE The aim of the present investigation was to identify the impact of EDS on pain and jaw function in TMD patients. METHODS A total of 338 TMD patients (50 males and 288 females) was included. The Epworth Sleepiness Scale (ESS) was used to classify patients into EDS group (score ≥ 10) and non-EDS group (score < 10). The Jaw Functional Limitation Scale 8-item (JFLS-8) was used to assess the severity of jaw dysfunction. Pain intensity was evaluated using the Visual Analogue Scale (VAS). Anxiety and depression were evaluated using the Generalised Anxiety Disorder 7-item (GAD-7) and the Patient Health Questionnaire 9-item (PHQ-9). All included patients were diagnosed with pain-related TMD (PT), intra-articular TMD (IT) or combined TMD (CT). RESULTS Compared with non-EDS patients, EDS patients exhibited more severe jaw dysfunction, greater pain intensity and higher PHQ-9 scores (p < .05). Multivariate analyses showed that EDS (B = 3.69), female gender (B = 3.69), and elevated GAD-7 score (B = 0.73) were significantly associated with an increased score on the JFLS-8 (p < .05). Moreover, bivariate logistic regression analysis indicated a significant relationship between EDS and PT (OR = 2.70, p = .007). CONCLUSION The presence of EDS was more closely related to PT, but the causal relationship between them needs to be further confirmed. More concern and intervention to alleviate poor sleep quality might be highlighted during the treatment of TMD, especially PT subtype.
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Affiliation(s)
- Xin Xiong
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chu-Qiao Xiao
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yi-Chun Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi-Jun Li
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Qiao-Yu Cheng
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Yi Wang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yang Liu
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Picton FA, Fontaine SJ, McBrearty AR. Magnetic collars improve owner-reported pain scores in dogs with osteoarthritis in a blinded crossover study. J Am Vet Med Assoc 2024; 262:526-534. [PMID: 38215525 DOI: 10.2460/javma.23.10.0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To investigate changes in owner-reported pain, interference of pain on function, and quality of life (QOL) in dogs with clinically suspected osteoarthritis when wearing a collar containing a static magnet. ANIMALS 16 dogs over 5 years old weighing between 10 and 40 kg with a clinical diagnosis of osteoarthritis and on stable treatment. METHODS A prospective, blinded crossover study in which dogs wore a collar containing a static magnet or placebo for two 4-week study arms separated by a 2-week washout period. Clients completed the Canine Brief Pain Inventory prior to collar placement and then weekly throughout each arm. Changes in QOL, pain severity, and pain interference scores from the beginning to the end of these arms and changes between the arms were calculated and analyzed using Wilcoxon signed rank tests. RESULTS 40% of included dogs were on stable doses of NSAIDs. The pain severity scores (PSS), pain interference scores (PIS), and QOL scores were not significantly different at the start of the arms. There was no significant change in PSS or PIS from the start to end of the placebo arms (median changes, 0 and -0.1). Both PSS and PIS reduced significantly during the magnet arms (median changes, -1.0 and -1.2, respectively). The QOL scores did not change significantly in either arm (median changes, 0 and 0). CLINICAL RELEVANCE This preliminary study suggests that magnetic collars reduce owner-reported pain severity and pain interference on function in dogs with clinically suspected osteoarthritis, and further, larger investigations are now warranted.
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Affiliation(s)
- Fiona A Picton
- 1College of Medicine, Veterinary and Life Sciences, School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, Scotland, UK
- 2Nestlé Purina Petcare, Lija, Malta
| | - Samantha J Fontaine
- 1College of Medicine, Veterinary and Life Sciences, School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, Scotland, UK
| | - Alix R McBrearty
- 1College of Medicine, Veterinary and Life Sciences, School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, Scotland, UK
- 3Vets Now Hospital, Glasgow, Scotland, UK
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Suhood AY, Summers SJ, Opar DA, Astill T, An WW, Rio E, Cavaleri R. Bilateral Corticomotor Reorganization and Symptom Development in Response to Acute Unilateral Hamstring Pain: A Randomized, Controlled Study. J Pain 2024; 25:1000-1011. [PMID: 37907112 DOI: 10.1016/j.jpain.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/08/2023] [Accepted: 10/21/2023] [Indexed: 11/02/2023]
Abstract
Accumulating evidence demonstrates that pain induces adaptations in the corticomotor representations of affected muscles. However, previous work has primarily investigated the upper limb, with few studies examining corticomotor reorganization in response to lower limb pain. This is important to consider, given the significant functional, anatomical, and neurophysiological differences between upper and lower limb musculature. Previous work has also focused on unilateral corticomotor changes in response to muscle pain, despite an abundance of literature demonstrating that unilateral pain conditions are commonly associated with bilateral motor dysfunction. For the first time, this study investigated the effect of unilateral acute hamstring pain on bilateral corticomotor organization using transcranial magnetic stimulation (TMS) mapping. Corticomotor outcomes (TMS maps), pain, mechanical sensitivity (pressure pain thresholds), and function (maximal voluntary contractions) were recorded from 28 healthy participants at baseline. An injection of pain-inducing hypertonic (n = 14) or pain-free isotonic (n = 14) saline was then administered to the right hamstring muscle, and pain ratings were collected every 30 seconds until pain resolution. Follow-up measures were taken immediately following pain resolution and at 25, 50, and 75 minutes post-pain resolution. Unilateral acute hamstring pain induced bilateral symptom development and changes in corticomotor reorganization. Two patterns of reorganization were observed-corticomotor facilitation and corticomotor depression. Corticomotor facilitation was associated with increased mechanical sensitivity and decreased function bilaterally (all P < .05). These effects persisted for at least 75 minutes after pain resolution. PERSPECTIVE: These findings suggest that individual patterns of corticomotor reorganization may contribute to ongoing functional deficits of either limb following acute unilateral lower limb pain. Further research is required to assess these adaptations and the possible long-term implications for rehabilitation and reinjury risk in cohorts with acute hamstring injury.
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Affiliation(s)
- Ariane Y Suhood
- Brain Stimulation and Rehabilitation Lab, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Simon J Summers
- Brain Stimulation and Rehabilitation Lab, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia; School of Biomedical Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Opar
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia; School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Tom Astill
- Brain Stimulation and Rehabilitation Lab, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Winko W An
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Ebonie Rio
- School of Allied Health, La Trobe University Melbourne, Melbourne, Victoria, Australia; The Victorian Institute of Sport, Albert Park, Victoria, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation Lab, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia; School of Biomedical Science, Queensland University of Technology, Brisbane, Queensland, Australia; Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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21
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Rafferty C, Ward J. Fibromyalgia is linked to increased subjective sensory sensitivity across multiple senses. Perception 2024; 53:276-286. [PMID: 38410035 PMCID: PMC10960319 DOI: 10.1177/03010066241234037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024]
Abstract
Changes in subjective sensory sensitivity - reporting sensory stimuli as being atypically intense or weak - are a transdiagnostic symptom of several disorders. The present study documents for the first time the sensory sensitivity profile of fibromyalgia, taking a questionnaire measure that asks about different sensory modalities and both hyper- and hyposensitivity (the Glasgow Sensory Questionnaire, GSQ). The fibromyalgia group had higher overall scores on this measure. This was linked more strongly to sensory hypersensitivity and was pervasive across all senses that were surveyed. Although differences in hyposensitivity were found, these were sporadic (perhaps linked to the symptoms of fibromyalgia itself) and did not resemble the pattern documented for autism (e.g., self-stimulating and repetitive behaviours were not a feature of fibromyalgia). We suggest that individual differences in subjective sensory hypersensitivity may be a multisensory dispositional trait linked to fibromyalgia which ultimately becomes most pronounced for pain.
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22
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Hosseindoost S, Inanloo SH, Pestehei SK, Rahimi M, Yekta RA, Khajehnasiri A, Rad MA, Majedi H, Dehpour AR. Cellular and molecular mechanisms involved in the analgesic effects of botulinum neurotoxin: A literature review. Drug Dev Res 2024; 85:e22177. [PMID: 38528637 DOI: 10.1002/ddr.22177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/02/2024] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
Botulinum neurotoxins (BoNTs), derived from Clostridium botulinum, have been employed to treat a range of central and peripheral neurological disease. Some studies indicate that BoNT may be beneficial for pain conditions as well. It has been hypothesized that BoNTs may exert their analgesic effects by preventing the release of pain-related neurotransmitters and neuroinflammatory agents from sensory nerve endings, suppressing glial activation, and inhibiting the transmission of pain-related receptors to the neuronal cell membrane. In addition, there is evidence to suggest that the central analgesic effects of BoNTs are mediated through their retrograde axonal transport. The purpose of this review is to summarize the experimental evidence of the analgesic functions of BoNTs and discuss the cellular and molecular mechanisms by which they can act on pain conditions. Most of the studies reviewed in this article were conducted using BoNT/A. The PubMed database was searched from 1995 to December 2022 to identify relevant literature.
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Affiliation(s)
- Saereh Hosseindoost
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hassan Inanloo
- Department of Urology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Khalil Pestehei
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Rahimi
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Atef Yekta
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Critical Care, and Pain, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajehnasiri
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Critical Care, and Pain, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hossein Majedi
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Alfredo PP, Johnson MI, Bjordal JM, Santos ATS, Peres GB, Junior WS, Casarotto RA. Efficacy of diadynamic currents as an adjunct to exercise to manage symptoms of knee osteoarthritis in adults: A randomized controlled clinical trial. Clin Rehabil 2024:2692155241236611. [PMID: 38533579 DOI: 10.1177/02692155241236611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To investigate the effect of diadynamic currents administered prior to exercises on pain and disability in patients with osteoarthritis of the knee. DESIGN A randomized-controlled trial. SETTING Special Rehabilitation Services in Taboão da Serra. PARTICIPANTS Patients with bilateral knee osteoarthritis. INTERVENTION Participants were randomly allocated to Group I (diadynamic currents and exercises; n = 30, 60 knees) or Group II (exercises alone; n = 30, 60 knees) and were treated three times a week for 8 weeks. MAIN OUTCOME MEASURES The primary outcome measures were change in knee pain evaluated by visual analog scale and disability Index Score (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscle strength (dynamometer), a composite score for pain and disability (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and a drug diary to measure consumption of rescue pain medication (paracetamol). All measurements were collected at baseline, 8 weeks, and 6 months from baseline (follow-up). RESULTS There were 60 participants with a mean (SD) age of 63.40 (8.20) years. Between-group differences in the follow-up (8 weeks and 6 months) were observed for pain at rest, pain during activities of daily living and disability. There was improvement in Group I that was maintained for the three variables 6 months after treatment. Mean difference for pain at rest was -3.08 points (95% confidence interval -4.13; -2.02), p < 0.01 with an effect size of 1.4; mean difference for pain during activities of daily living was -2.40 points (95% confidence interval -3.34; -1.45), p < 0.01 with an effect size of 1.24; and mean difference for disability was -4.08 points (95% confidence interval -5.89; -2.26), p < 0.01 with an effect size of 1.04. CONCLUSION Patients with symptomatic knee osteoarthritis receiving 8 weeks of treatment with diadynamic currents as an adjunct to a program of exercises had significantly greater improvements in pain and disability than those receiving exercises alone. Beneficial effects were sustained for 6 months.
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Affiliation(s)
- Patrícia Pereira Alfredo
- Department of Speech Therapy, Physical Therapy and Occupational Therapy, School of Medicine, São Paulo University, São Paulo, Brazil
| | - Mark I Johnson
- Centre for Pain Research, School of Health, Portland Building, Leeds Beckett University, Leeds, UK
| | - Jan Magnus Bjordal
- School of Health and Social Science, Institute of Physical Therapy, Bergen University College, Bergen, Norway
| | - Adriana Teresa Silva Santos
- Human Performance Research Laboratory, Institute of Motor Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Giovani Bravin Peres
- Graduate Program in Environmental and Experimental Pathology, Paulista University- UNIP, São Paulo, Brazil
| | | | - Raquel Aparecida Casarotto
- Department of Speech Therapy, Physical Therapy and Occupational Therapy, School of Medicine, São Paulo University, São Paulo, Brazil
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24
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Homan M, Rath SUL, Green VLS, Hutson J, Myers MJ, Guggenheimer JD. Examining the Impact of Far-Infrared Technology on Quality of Life in Older Adults. Int J Aging Hum Dev 2024:914150241231188. [PMID: 38532698 DOI: 10.1177/00914150241231188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
The purpose of this study was to examine the effects of far-infrared (FIR) heat on quality of life (QOL) in older adults. Participants were assigned to either a convective heat group (CON) or a convective and FIR group. Participants received six, 30-min heat sessions over the course of three weeks. Pre- and post-assessments included physical measures such as range of motion, gait speed, Timed Up and Go, and hand grip strength. Standardized questionnaires were used to determine pain severity and its interference with daily life, and the impact pain had on overall QOL. Pain severity was significantly reduced (from 3.31 to 2.5, p < .05) in the FIR group from pre-to-post, and pain interference was significantly reduced (from 1.26 to 0.43, p < .05) in the CON group from pre-to-post testing. Findings suggest that heat therapy was successful in reducing pain over time.
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25
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Ayaz NP, Sherman DW. The Similarities and Differences of Nurse-Postoperative Patient Dyads' Attitudes, Social Norms, and Behaviors Regarding Pain and Pain Management. J Perianesth Nurs 2024:S1089-9472(23)01096-1. [PMID: 38530678 DOI: 10.1016/j.jopan.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE Pain is an expected symptom in surgical patients, despite advances in pharmacology, surgical procedures, and perioperative care. The aim of this study was to examine the similarities and differences between nurse-postoperative patient dyads of the same or differing cultures/ethnicities with regard to perceptions, social norms, and behaviors related to pain and pain management. DESIGN This was a descriptive qualitative study. METHODS The sample consisted of six nurses (2 Hispanic, 2 Black, 2 Caucasian) and 12 patients of the same and different culture/ethnicity than their nurse) on a postoperative unit within 48 hours of surgery. A structured interview guide was developed to explore the attitudes, social norms, and behaviors of nurses related to pain and pain management, and a separate interview guide was developed for postoperative patients. All transcripts were analyzed and coded using Carini's principles. FINDINGS Nurses used the pain scale to quantify pain intensity but did not conduct a comprehensive pain assessment. Nurses were concerned about opioid side effects and addiction and hesitated to provide opioids after the first postoperative day. Patients expected complete and immediate pain relief, with no worry about short-term opioid use. Patients did not believe that culture played a role in their care, but nurses were more comfortable caring for patients from the same cultural background. The use of complementary and nonpharmacologic pain management techniques was not well known by nurses and patients, but should be used in conjunction with medications. CONCLUSIONS Nursing education stresses cultural competence, but nurses emphasize "treating all patients the same," which creates a cognitive dissonance, with implications for education. Nurses should conduct a comprehensive pain assessment to inform pain management and nonpharmacologic and complementary therapies should be available on the postoperative unit.
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Affiliation(s)
- Nur Pinar Ayaz
- Nursing Deparment, Faculty of Health Sciences Hitit University, Corum, Turkey.
| | - Deborah Witt Sherman
- Graduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
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26
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Deniz B, Sarıalioğlu A. The Effect of Breast Milk Odor on the Pain and Stress Levels of the Newborn During the Endotracheal Suction Procedure. Breastfeed Med 2024. [PMID: 38526230 DOI: 10.1089/bfm.2023.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Objective: The study aimed to determine the effect of the breast milk odor on the pain and stress levels of the newborn during the endotracheal suction procedure. Method: The study was conducted in the randomized-controlled experimental design at the neonatal intensive care unit of the hospital in eastern Turkey between March 2022 and December 2023. The study population included newborns at the 37th to 41st gestational weeks who were receiving mechanical ventilation treatment in the neonatal intensive care unit of a hospital in eastern Turkey. All newborns who met the inclusion criteria during the data collection phase were included in the study. The study was completed with 88 newborns (44 in the intervention group and 44 in the control group). The Newborn Introductory Information Form, ALPS-Neo Newborn Pain and Stress Assessment Scale, and follow-up form were used to collect the study data. The breast milk odor of the mothers of the newborns was used as the intervention group in the study. The mothers of the newborns were contacted to obtain breast milk, and the information was obtained from the mother on the day of the procedure. One milliliter of breast milk was taken and dropped into a sterile sponge, and it was held 10 cm away from the baby's nose from 5 minutes before to 5 minutes after endotracheal suction. A routine endotracheal suction process was performed in the control group. Ethical principles were followed in the study. Results: We found that the intervention group's pain and stress score averages were lower than the control group during and after the endotracheal suction procedure (p < 0.05). Conclusion: We found that the breast milk odor reduced the pain, stress levels, and crying duration of newborns during the endotracheal suction process.
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Affiliation(s)
- Büşra Deniz
- Department of Child Health and Diseases Nursing, Şanlıurfa Training and Research Hospital, Erzurum, Turkey
| | - Arzu Sarıalioğlu
- Department of Child Health and Diseases Nursing, Atatürk University, Erzurum, Turkey
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27
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McKendrick G, Davis W, Sklar M, Brown N, Pattillo E, Finan PH, Antoine D, Walters V, Dunn KE. The IMPOWR Network Divided or Single Exposure Study (DOSE) Protocol: A Randomized Controlled Comparison of Once Versus Split Dosing of Methadone for the Treatment of Comorbid Chronic Pain and Opioid Use Disorder. Subst Use Addctn J 2024:29767342241239167. [PMID: 38528704 DOI: 10.1177/29767342241239167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The Divided or Single Exposure (DOSE) trial is a double-blind, placebo-controlled examination of once versus split dosing of methadone for comorbid pain and opioid use disorder (OUD) among persons receiving methadone for OUD treatment. METHODS This multisite trial consists of a 12-week active intervention phase and 6-month follow-up period. Persons receiving methadone who endorse clinically-significant chronic pain are randomized into once-daily dosing or split dosing that is managed remotely via an electronic pillbox. Clinical pain is assessed weekly and using ecological momentary assessments. Experimentally-evoked pain is assessed using a quantitative sensory testing battery. Additional outcomes related to OUD, including withdrawal and craving, are also collected. RESULTS The study hypothesizes that persons assigned to the split dosing condition will report lower pain and opioid withdrawal relative to persons assigned to the traditional once-daily dosing strategy. CONCLUSIONS Split dosing is a relatively common technique in OUD treatments; therefore, if data support this hypothesis, there is high potential for implementation.
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Affiliation(s)
| | - Will Davis
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Michael Sklar
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Nicole Brown
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Emma Pattillo
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Patrick H Finan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Denis Antoine
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Vickie Walters
- Institute for Behavior Resources, Inc., REACH Health Services, Baltimore MD, USA
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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Feldberg G, Ricciardi JBS, Zorzi AR, Yamaguti-Hayakawa GG, Ozelo MC. Promoting pain coping skills in haemophilia: A remote intervention integrating exercise and pain education. Haemophilia 2024. [PMID: 38523258 DOI: 10.1111/hae.14991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Chronic joint pain is a significant and widespread symptom in people with haemophilia (PWH). Despite medical advancements, effective pain management remains challenging. AIM This study presents an innovative approach that integrates remote physical exercises, pain neuroscience education, and coping strategies to address chronic pain in PWH. METHODS The remote intervention consisted of sixteen 5-min videos encompassing physical exercises for chronic pain management and pain education strategies. These videos formed an 8-week remote intervention program. Clinical and physical assessments were conducted before and after the intervention. RESULTS A total of thirty-one PWHs, with a median age of 34 years (ranging from 16 to 59 years), completed the remote intervention. The study revealed significant improvements in pain intensity, disability, and physical performance among PWH with chronic pain. Enhanced functional capacity was evident in the Timed Up and Go and Single Leg Stance tests, accompanied by improved scores on the Functional Independence Score in Haemophilia (FISH). Although lacking a control group, our findings are consistent with other successful exercise and pain education programs. CONCLUSIONS This innovative intervention holds promise for managing chronic pain in PWH, underscoring patient empowerment, education, and collaboration. Notably, our study stands out by uniquely combining pain education and coping strategies, bolstering evidence for effective pain management.
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Affiliation(s)
- Glenda Feldberg
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Janaína B S Ricciardi
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Alessandro R Zorzi
- Department of Orthopedic, Rheumatology and Traumatology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, Brazil
| | - Gabriela G Yamaguti-Hayakawa
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Margareth C Ozelo
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
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van der Heijden PAHH, Bongers MY, Veersema S, Dieleman JP, Geomini PMAJ. The impact of embedment of the side arms of 52 mg levonorgestrel-intrauterine device on bleeding and pain: a prospective cohort study. J Gynecol Obstet Hum Reprod 2024:102777. [PMID: 38531476 DOI: 10.1016/j.jogoh.2024.102777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/17/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE The purpose of this study was to analyse the impact of embedment of side arms of the levonorgestrel 52 mg intrauterine device (LNG-IUD) in the myometrium (assessed by three-dimensional transvaginal ultrasound (3D-TVUS)) on uterine bleeding and pain. MATERIALS AND METHODS We performed a prospective cohort study in a large Dutch teaching hospital between February 2015 and December 2016. Participants over 18 years of age who selected a LNG-IUD for contraception or because of heavy menstrual bleeding were eligible for inclusion. Six weeks after insertion, a 3D-TVUS was performed to diagnose embedment of the side arms. At that moment participants filled in questionnaires about their bleeding pattern and pelvic pain. Menstruation patterns 'no bleeding', 'regular menstruation', 'sometimes a day of spotting (maximum once a week)' were classified as favourable bleeding pattern. Menstruation patterns 'heavy menstrual bleeding', 'several days a week bleeding days', 'several days a week spotting days', 'continuously spotting', and 'completely irregular cycle' were classified as unfavourable bleeding pattern. Univariate and multivariate logistic regression analysis was used to calculate odds ratios (OR) and 95%-confidence intervals (CI). The multivariate analysis included endometrial thickness, reason for insertion and parity. The analysis of pelvic pain additionally included previous insertion. RESULTS A total of 220 participants were evaluated for the study of whom 176 returned the questionnaires. Embedment of the side arms was observed in 43 of the 176 responding participants (24.4%). Favourable bleeding pattern was reported by 25/43 (58.1%) participants with embedment and 53/133 (39.8%) participants without embedment (ORadj 1.8, 95% CI 0.9-3.9). Pelvic pain was reported by 4/43 (9.3%) participants with embedment and 24/133 (18.1%) participants without embedment (ORadj 0.3; CI 0.1-1.2). CONCLUSIONS The present study suggests that embedment of the side arms of the LNG-IUD in the myometrium assessed by 3D-TVUS is not associated with a unfavourable bleeding pattern nor pelvic pain six weeks after insertion. From this point of view, we do not recommend to perform standard 3D-TVUS for the purpose of excluding or demonstrating embedment.
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Affiliation(s)
- P A H H van der Heijden
- Departement of Obstetrics and Gynaecology, Anna Hospital in Geldrop, Bogardeind 2, 5664 EH Geldrop, the Netherlands; Departement of Obstetrics and Gynaecology, Máxima Medical Center in Veldhoven, de Run 4600, 5504 DB Veldhoven, the Netherlands.
| | - M Y Bongers
- Departement of Obstetrics and Gynaecology, Máxima Medical Center in Veldhoven, de Run 4600, 5504 DB Veldhoven, the Netherlands; Grow, research school of Oncology and Reproduction, Maastricht University Medical Center in Maastricht, P. Debyelaan 25, 6229 HX, the Netherlands
| | - S Veersema
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - J P Dieleman
- Department of Science, Máxima Medical Center in Veldhoven, de Run 4600, 5504 DB Veldhoven, the Netherlands
| | - P M A J Geomini
- Departement of Obstetrics and Gynaecology, Máxima Medical Center in Veldhoven, de Run 4600, 5504 DB Veldhoven, the Netherlands
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Vollert J, Kumar A, Coady EC, Cullinan P, Dyball D, Fear NT, Gan Z, Miller EF, Sprinckmoller S, Schofield S, Bennett A, Bull AMJ, Boos CJ, Rice ASC, Kemp HI. Pain after combat injury in male UK military personnel deployed to Afghanistan. Br J Anaesth 2024:S0007-0912(24)00098-9. [PMID: 38521656 DOI: 10.1016/j.bja.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Chronic pain after injury poses a serious health burden. As a result of advances in medical technology, ever more military personnel survive severe combat injuries, but long-term pain outcomes are unknown. We aimed to assess rates of pain in a representative sample of UK military personnel with and without combat injuries. METHODS We used data from the ADVANCE cohort study (ISRCTN57285353). Individuals deployed as UK armed forces to Afghanistan were recruited to include those with physical combat injuries, and a frequency-matched uninjured comparison group. Participants completed self-reported questionnaires, including 'overall' pain intensity and self-assessment of post-traumatic stress disorder, anxiety, and depression. RESULTS A total of 579 participants with combat injury, including 161 with amputations, and 565 uninjured participants were included in the analysis (median 8 yr since injury/deployment). Frequency of moderate or severe pain was 18% (n=202), and was higher in the injured group (n=140, 24%) compared with the uninjured group (n=62, 11%, relative risk: 1.1, 95% confidence interval [CI]: 1.0-1.2, P<0.001), and lower in the amputation injury subgroup (n=31, 19%) compared with the non-amputation injury subgroup (n=109, 26%, relative risk: 0.9, 95% CI: 0.9-1.0, P=0.034). Presence of at least moderate pain was associated with higher rates of post-traumatic stress (RR: 3.7, 95% CI: 2.7-5.0), anxiety (RR: 3.2, 95% CI: 2.4-4.3), and depression (RR: 3.4, 95% CI: 2.7-4.5) after accounting for injury. CONCLUSION Combat injury, but not amputation, was associated with a higher frequency of moderate to severe pain intensity in this cohort, and pain was associated with adverse mental health outcomes.
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Affiliation(s)
- Jan Vollert
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Alexander Kumar
- Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Loughborough, UK
| | - Emma C Coady
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Cullinan
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Dyball
- King's Centre for Military Health Research, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK; Academic Department of Military Mental Health, King's College London, London, UK
| | - Zoe Gan
- Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Eleanor F Miller
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, UK
| | - Stefan Sprinckmoller
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, UK
| | - Suzie Schofield
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Alexander Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Loughborough, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - Christopher J Boos
- Department of Cardiology, University Hospital Dorset, NHS Trust, Poole, UK
| | - Andrew S C Rice
- Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - Harriet I Kemp
- Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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García-López H, Calle-Ortega F, García-Robles P, Del-Rey RR, Obrero-Gaitán E, Cortés-Pérez I. Effectiveness of transcutaneous electrical nerve stimulation improves pain intensity, disability and quality of life in patients with fibromyalgia syndrome: a systematic review with meta-analysis. Disabil Rehabil 2024:1-11. [PMID: 38511391 DOI: 10.1080/09638288.2024.2331069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The transcutaneous electrical nerve stimulation (TENS) is one of the most frequently electrophysical agents employed in reducing the impact of FMS. This meta-analysis intended to determine the effectiveness of TENS on pain, disability, and quality of life (QoL) in patients with FMS. METHODS According to PRISMA, we performed a meta-analysis (CRD42023456439), searching in PubMed Medline, PEDro, CINAHL Complete, Web of Science, and Scopus, since inception up to October 2023. This review focused on controlled clinical trials evaluating the effect of TENS on pain, disability, and QoL in patients with FMS. The pooled effect was estimated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95%CI). RESULTS Twelve studies, providing data from 944 patients, were included (PEDro score of 5.6 points). Meta-analyses showed that TENS interventions are effective in improving pain (SMD = -0.61; 95%CI -1 to -0.16); disability (SMD = -0.27; 95%CI -0.41 to -0.12); and physical dimension of QoL (SMD = 0.26; 95%CI 0.08 to 0.44). Additionally, when TENS is used as a unique therapy, it represents the best therapeutic option for improving pain, disability, and QoL. CONCLUSIONS This meta-analysis, including the largest number of studies, showed that TENS intervention is an effective therapy to reduce pain and disability and increase QoL in FMS patients.
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Affiliation(s)
- Héctor García-López
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain
| | - Fabián Calle-Ortega
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain
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Hamilton AJ, Bourke L, Ranmuthugala G, Glenister KM, Simmons D. Chronic pain and the use of complementary and alternative medicine in rural Victoria, Australia. Aust J Rural Health 2024. [PMID: 38511486 DOI: 10.1111/ajr.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE The relationship between chronic pain and complementary and alternative medicine (CAM) use is poorly understood, and the situation in rural Australia is particularly unclear. The objective here was to determine the socio-demographic factors associated with the use of CAM for the treatment of chronic pain in a region of rural Australia. METHODS This secondary analysis used data from a population health survey, Crossroads-II, to assess the relationships of various socio-demographic factors with the use of CAM by those suffering from chronic pain. DESIGN Face-to-face surveys at households randomly selected from residential address lists. SETTING A large regional centre and three nearby rural towns in northern Victoria, Australia. PARTICIPANTS Sixteen years of age and older. MAIN OUTCOME MEASURES Use of a CAM service to treat chronic pain. RESULTS Being female (2.40 [1.47, 3.93], p < 0.001) and having a bachelor's degree (OR 2.24 [1.20, 4.20], p < 0.001) had a significant positive relationship with the use of CAM overall to redress chronic pain and those 50 years and older had greater odds of using manipulation therapies relative to those below 50 years (50-64: OR 0.52 [0.32, 0.86], p = 0.010; 65+: 0.37 [0.18, 0.75], p = 0.005). CONCLUSION In the studied region, females and those with university education have the greatest odds of using CAM to treat chronic pain. This study needs to be complemented with more mechanistic investigations into the reasons people make the decisions they make about using CAM for the management of chronic pain.
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Affiliation(s)
- Andrew J Hamilton
- Department of Rural Health, Melbourne Medical School, University of Melbourne, Shepparton, Victoria, Australia
| | - Lisa Bourke
- Department of Rural Health, Melbourne Medical School, University of Melbourne, Shepparton, Victoria, Australia
| | - Geetha Ranmuthugala
- Department of Rural Health, Melbourne Medical School, University of Melbourne, Shepparton, Victoria, Australia
| | - Kristen M Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, Victoria, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Penrith, New South Wales, Australia
- Macarthur Diabetes, Endocrinology and Metabolism Service, Campbelltown Hospital, Campbelltown, New South Wales, Australia
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Golding J, Bickerstaffe I, Iles-Caven Y, Northstone K. Paternal health in the first 12-13 years of the ALSPAC study. Wellcome Open Res 2024; 8:8. [PMID: 37476649 PMCID: PMC10354460 DOI: 10.12688/wellcomeopenres.18639.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 07/22/2023] Open
Abstract
The Avon Longitudinal Study of Parents and Children (ALSPAC) collected information from the enrolled pregnancy onwards to identify features of the environment in which the study child was brought up. Among data collected were features concerning the health of the mothers' partners - generally the study father. This was an important feature since the father's physical and mental health can have a long-term effect on the family. In this Data Note we describe the data available on the father's health from pregnancy until 12 years after the offspring was born. Not only is this a valuable addition to the environmental information available for studies of the child's development and the mental health of the mother over time, but it will provide a useful description of the father himself during adulthood.
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Affiliation(s)
- Jean Golding
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Iain Bickerstaffe
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Yasmin Iles-Caven
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
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Mickle AM, Staud R, Garvan CS, Kusko DA, Sambuco N, Addison BR, Vincent KR, Redden DT, Goodin BR, Fillingim RB, Sibille KT. Dispositional traits help explain individual differences in relationships between a radiographic knee osteoarthritis measure, pain, and physical function. Ther Adv Musculoskelet Dis 2024; 16:1759720X241235805. [PMID: 38516228 PMCID: PMC10956141 DOI: 10.1177/1759720x241235805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/02/2024] [Indexed: 03/23/2024] Open
Abstract
Background The concordance between radiograph-derived Kellgren-Lawrence (KL) scores for knee osteoarthritis (KOA) and experimental and clinical pain and KOA-related physical function is conflicting. Objectives We investigate whether the inclusion of dispositional traits reduces variability between KOA radiographic findings, experimental pain, clinical pain, and function in individuals with knee pain. Design This study is a cross-sectional, secondary analysis of data collected from the UPLOAD-II study. Methods Adults aged 45-85 years with and without knee pain were enrolled. Data collected included sociodemographics, knee radiographs, experimental pain, clinical pain and function, and trait affect. Vulnerable and protective dispositional traits were classified from combined positive and negative trait affect measures. KL scores were determined from the knee radiographs. Unadjusted and adjusted (age, sex, comorbidities, and body mass index) regression analyses were completed with SAS version 9.4 (Cary, NC, USA). Results The study included 218 individuals with a mean age of 58 years, 63.6% women, and 48.2% non-Hispanic black adults. Dispositional traits were associated with the experimental pain measures. No association between radiographic KOA and experimental pain was observed. In a combined and adjusted analysis, dispositional traits were predictive of knee punctate pain temporal summation (p = 0.0382). Both dispositional traits and radiographic KOA scores independently and combined were predictive of Graded Chronic Pain Scale pain and function, and Western Ontario and McMaster University pain and function (ps ⩽ 0.01). Improvements in R2 were noted across all models with the inclusion of dispositional traits. Conclusion Consideration of dispositional traits reduces the variability between radiographic KOA and pain and function. Non-pathological and associated pain-related psychological factors and dispositional traits might serve as parsimonious proxy tools to improve clinical assessments. Registration N/A.
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Affiliation(s)
- Angela M. Mickle
- Department of Physical Medicine & Rehabilitation, University of Florida, Campus Box 100242, 2004 Mowry Road, Gainesville, FL 32610, USA
- Department of Community Dentistry, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Cynthia S. Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Daniel A. Kusko
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicola Sambuco
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Brittany R. Addison
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin R. Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - David T. Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Anesthesiology, Washington University, St. Louis, MO, USA
| | - Roger B. Fillingim
- Department of Community Dentistry, University of Florida, Gainesville, FL, USA
- Pain Research Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Kimberly T. Sibille
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
- Pain Research Center of Excellence, University of Florida, Gainesville, FL, USA
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Wang Y, Shu J, Yang H, Hong K, Yang X, Guo W, Fang J, Li F, Liu T, Shan Z, Shi T, Cai S, Zhang J. Nav1.7 Modulator Bearing a 3-Hydroxyindole Backbone Holds the Potential to Reverse Neuropathic Pain. ACS Chem Neurosci 2024; 15:1063-1073. [PMID: 38449097 DOI: 10.1021/acschemneuro.3c00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Chronic pain is a growing global health problem affecting at least 10% of the world's population. However, current chronic pain treatments are inadequate. Voltage-gated sodium channels (Navs) play a pivotal role in regulating neuronal excitability and pain signal transmission and thus are main targets for nonopioid painkiller development, especially those preferentially expressed in dorsal root ganglial (DRG) neurons, such as Nav1.6, Nav1.7, and Nav1.8. In this study, we screened in virtual hits from dihydrobenzofuran and 3-hydroxyoxindole hybrid molecules against Navs via a veratridine (VTD)-based calcium imaging method. The results showed that one of the molecules, 3g, could inhibit VTD-induced neuronal activity significantly. Voltage clamp recordings demonstrated that 3g inhibited the total Na+ currents of DRG neurons in a concentration-dependent manner. Biophysical analysis revealed that 3g slowed the activation, meanwhile enhancing the inactivation of the Navs. Additionally, 3g use-dependently blocked Na+ currents. By combining with selective Nav inhibitors and a heterozygous expression system, we demonstrated that 3g preferentially inhibited the TTX-S Na+ currents, specifically the Nav1.7 current, other than the TTX-R Na+ currents. Molecular docking experiments implicated that 3g binds to a known allosteric site at the voltage-sensing domain IV(VSDIV) of Nav1.7. Finally, intrathecal injection of 3g significantly relieved mechanical pain behavior in the spared nerve injury (SNI) rat model, suggesting that 3g is a promising candidate for treating chronic pain.
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Affiliation(s)
- Yuwei Wang
- School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Jirong Shu
- Guangdong Chiral Drug Engineering Laboratory, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510000, China
| | - Haoyi Yang
- School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Kemiao Hong
- Guangdong Chiral Drug Engineering Laboratory, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510000, China
| | - Xiangji Yang
- Guangdong Chiral Drug Engineering Laboratory, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510000, China
| | - Weijie Guo
- School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Jie Fang
- School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Fuyi Li
- School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Tao Liu
- School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Zhiming Shan
- Department of Anesthesiology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen 518020, China
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Taoda Shi
- Guangdong Chiral Drug Engineering Laboratory, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510000, China
| | - Song Cai
- School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Jian Zhang
- School of Pharmaceutical Sciences, Health Science Center, Shenzhen University, Shenzhen 518060, China
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Bardazzi F, Starace M, Loi C, Filippi F, Peron I, Sacchelli L. More than mere lipomas? J Dtsch Dermatol Ges 2024. [PMID: 38506609 DOI: 10.1111/ddg.15362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/06/2024] [Indexed: 03/21/2024]
Affiliation(s)
| | - Michela Starace
- Dermatology Unit, IRCSS AOU di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Dermatology Unit, IRCSS AOU di Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology Unit, IRCSS AOU di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Isabella Peron
- Dermatology Unit, IRCSS AOU di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Jordan A, Parchment A, Gauntlett-Gilbert J, Jones A, Donaghy B, Wainwright E, Connell H, Walden J, Moore DJ. Understanding the impacts of chronic pain on autistic adolescents and effective pain management: a reflexive thematic analysis adolescent-maternal dyadic study. J Pediatr Psychol 2024; 49:185-194. [PMID: 38324735 PMCID: PMC10954305 DOI: 10.1093/jpepsy/jsae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE Sensory elements are core features in chronic pain and autism, yet knowledge of the pain experience in autistic adolescents is limited. Little is known regarding how autistic adolescents experience chronic pain, manage their pain and perceive psychological treatment for their chronic pain. METHODS Ten autistic adolescents (6 female, 3 male, and 1 self-identified as agender) with chronic pain and their mothers (n = 10) participated in semistructured interviews concerning their perceptions of living with chronic pain. Participants were recruited from U.K. pain management services. According to preference, interviews were conducted individually (n = 10) or dyadically (n = 10 participants across 5 dyads). Data were analyzed using inductive reflexive thematic analysis. RESULTS Two themes were generated. Theme 1, "overstimulated and striving for control" described how adolescents' experience of heightened sensitivity enhanced adolescents' levels of anxiety and subsequent pain, illustrating a reciprocal relationship between anxiety, pain, and sensory elements. Theme 2, "not everyone fits the mold" captured how autistic adolescents positioned themselves as distinct from others due to the unique nature of being autistic and living with pain. This sense of difference negatively impacted adolescents' ability to engage with and benefit from the standard treatment for chronic pain. CONCLUSIONS Findings suggest that autistic adolescents living with pain experience pain and face barriers to effective pain treatment. Our results identify the need for educational resources to facilitate clinicians to better understand the experience of autistic adolescents living with pain. In turn, such understanding may improve treatment and outcomes in this population.
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Affiliation(s)
- Abbie Jordan
- Department of Psychology, University of Bath, Bath, United Kingdom
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amelia Parchment
- NIHR Applied Research Collaboration Greater Manchester, University of Manchester, Manchester, United Kingdom
| | - Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal United Hospitals Bath, Bath, United Kingdom
- Centre for Health and Clinical Research, University of the West of England, Bristol, United Kingdom
| | - Abigail Jones
- Department of Psychology, University of Bath, Bath, United Kingdom
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Bethany Donaghy
- Research Centre for Brain & Behaviour, Liverpool John Moores University, Liverpool, United Kingdom
| | - Elaine Wainwright
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Hannah Connell
- Bath Centre for Pain Services, Royal United Hospitals Bath, Bath, United Kingdom
| | - Joseline Walden
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - David J Moore
- Research Centre for Brain & Behaviour, Liverpool John Moores University, Liverpool, United Kingdom
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Blackler G, Lai-Zhao Y, Klapak J, Philpott HT, Pitchers KK, Maher AR, Fiset B, Walsh LA, Gillies ER, Appleton CT. Targeting STAT6-mediated synovial macrophage activation improves pain in experimental knee osteoarthritis. Arthritis Res Ther 2024; 26:73. [PMID: 38509602 PMCID: PMC10953260 DOI: 10.1186/s13075-024-03309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Pain from osteoarthritis (OA) is one of the top causes of disability worldwide, but effective treatment is lacking. Nociceptive factors are released by activated synovial macrophages in OA, but depletion of synovial macrophages paradoxically worsens inflammation and tissue damage in previous studies. Rather than depleting macrophages, we hypothesized that inhibiting macrophage activation may improve pain without increasing tissue damage. We aimed to identify key mechanisms mediating synovial macrophage activation and test the role of STAT signaling in macrophages on pain outcomes in experimental knee OA. METHODS We induced experimental knee OA in rats via knee destabilization surgery, and performed RNA sequencing analysis on sorted synovial tissue macrophages to identify macrophage activation mechanisms. Liposomes laden with STAT1 or STAT6 inhibitors, vehicle (control), or clodronate (depletion control) were delivered selectively to synovial macrophages via serial intra-articular injections up to 12 weeks after OA induction. Treatment effects on knee and hindpaw mechanical pain sensitivity were measured during OA development, along with synovitis, cartilage damage, and synovial macrophage infiltration using histopathology and immunofluorescence. Lastly, crosstalk between drug-treated synovial tissue and articular chondrocytes was assessed in co-culture. RESULTS The majority of pathways identified by transcriptomic analyses in OA synovial macrophages involve STAT signaling. As expected, macrophage depletion reduced pain, but increased synovial tissue fibrosis and vascularization. In contrast, STAT6 inhibition in macrophages led to marked, sustained improvements in mechanical pain sensitivity and synovial inflammation without worsening synovial or cartilage pathology. During co-culture, STAT6 inhibitor-treated synovial tissue had minimal effects on healthy chondrocyte gene expression, whereas STAT1 inhibitor-treated synovium induced changes in numerous cartilage turnover-related genes. CONCLUSION These results suggest that STAT signaling is a major mediator of synovial macrophage activation in experimental knee OA. STAT6 may be a key mechanism mediating the release of nociceptive factors from macrophages and the development of mechanical pain sensitivity. Whereas therapeutic depletion of macrophages paradoxically increases inflammation and fibrosis, blocking STAT6-mediated synovial macrophage activation may be a novel strategy for OA-pain management without accelerating tissue damage.
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Affiliation(s)
- Garth Blackler
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5B5, Canada
| | - Yue Lai-Zhao
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5B5, Canada
- Bone and Joint Institute, Western University, London, ON, N6A 5B5, Canada
| | - Joseph Klapak
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5B5, Canada
| | - Holly T Philpott
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5B5, Canada
- Bone and Joint Institute, Western University, London, ON, N6A 5B5, Canada
| | - Kyle K Pitchers
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5B5, Canada
| | - Andrew R Maher
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5B5, Canada
| | - Benoit Fiset
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, QC, H3A 1A3, Canada
| | - Logan A Walsh
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, QC, H3A 1A3, Canada
- Department of Human Genetics, McGill University, Montreal, QC, H3A 0C7, Canada
| | - Elizabeth R Gillies
- Department of Chemistry, Western University, London, ON, N6A 5B5, Canada
- Department of Chemical and Biochemical Engineering, Western University, London, ON, N6A 5B5, Canada
| | - C Thomas Appleton
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5B5, Canada.
- Bone and Joint Institute, Western University, London, ON, N6A 5B5, Canada.
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada.
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Behrends M, Larson MD. Measurements of pupillary unrest using infrared pupillometry fail to detect changes in pain intensity in patients after surgery: a prospective observational study. Can J Anaesth 2024:10.1007/s12630-024-02716-2. [PMID: 38504035 DOI: 10.1007/s12630-024-02716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 03/21/2024] Open
Abstract
PURPOSE The pupil displays chaotic oscillations, also referred to as pupillary unrest in ambient light (PUAL). As pain has previously been shown to increase pupillary unrest, the quantitative assessment of PUAL has been considered a possible tool to identify and quantify pain. Nevertheless, PUAL is affected by various states, such as vigilance, cognitive load, or emotional arousal, independent of pain. Furthermore, systematically applied opioids are known to reduce PUAL, thus potentially limiting its usefulness to detect pain or changes in pain intensity. To test the hypothesis that PUAL can reliably identify changes in pain intensity in a clinical setting, we measured PUAL in patients experiencing substantial pain relief when regional anesthesia interventions were applied after surgery. METHODS We conducted an observational study at an academic surgery centre following institutional review board approval. Eighteen patients with unsatisfactory pain control following surgery underwent regional anesthesia procedures to improve pain control. We used infrared pupillometry to assess pupillary unrest before and after the regional block. We then compared the changes in pupillary unrest with the changes in pain scores (numeric rating scale [NRS], range 0-10). RESULTS Eighteen patients received epidural anesthesia (n = 14) or peripheral nerve blocks (n = 4), resulting in improvement of mean (standard deviation [SD]) NRS pain scores from 7.2 (1.7) to 1.9 (1.8) (difference in means, -2.2; 95% confidence interval [CI], -6.3 to -4.1; P < 0.001). Nevertheless, pupillary unrest did not change as pain decreased; the mean (SD) PUAL was 0.113 (0.062) before analgesia and 0.112 (0.068) after analgesia (difference in means, -0.001; 95% CI, -0.018 to 0.015; P = 0.88). CONCLUSION In this prospective observational study, pupillometric measurements of pupillary unrest did not identify changes in pain intensity in a postoperative, predominantly opioid-exposed patient population. While the sample size was small, the use of measurements of pupillary unrest to detect and quantify pain has to be questioned.
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Affiliation(s)
- Matthias Behrends
- Department of Anesthesia and Perioperative Care, University of California, 521 Parnassus Avenue, #4307, San Francisco, CA, 94117, USA.
| | - Merlin D Larson
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
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Eliasof A, Liu-Chen LY, Li Y. Peptide-derived ligands for the discovery of safer opioid analgesics. Drug Discov Today 2024:103950. [PMID: 38514040 DOI: 10.1016/j.drudis.2024.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
Drugs targeting the μ-opioid receptor (MOR) remain the most efficacious analgesics for the treatment of pain, but activation of MOR with current opioid analgesics also produces harmful side effects, notably physical dependence, addiction, and respiratory depression. Opioid peptides have been accepted as promising candidates for the development of safer and more efficacious analgesics. To develop peptide-based opioid analgesics, strategies such as modification of endogenous opioid peptides, development of multifunctional opioid peptides, G protein-biased opioid peptides, and peripherally restricted opioid peptides have been reported. This review seeks to provide an overview of the opioid peptides that produce potent antinociception with much reduced side effects in animal models and highlight the potential advantages of peptides as safer opioid analgesics. Teaser: Peptide-based opioid ligands are promising candidates for the discovery and development of efficacious, safer, and non-/less addictive analgesics.
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Affiliation(s)
- Abbe Eliasof
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA
| | - Lee-Yuan Liu-Chen
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Yangmei Li
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA.
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Ripmeester EGJ, Steijns JSJJ, Wijnands KAP, Stassen RHMJ, Pitelka V, Peeters LCW, Cremers A, Astryde NMSA, Chabronova A, Surtel DAM, Emans PJ, van den Akker GGH, van Rietbergen B, van Rhijn LW, Caron MMJ, Welting TJM. The BMP7-Derived Peptide p[63-82] Reduces Cartilage Degeneration in the Rat ACLT-pMMx Model for Posttraumatic Osteoarthritis. Cartilage 2024:19476035241233659. [PMID: 38501739 DOI: 10.1177/19476035241233659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE Osteoarthritis (OA) is characterized by articular cartilage erosion, pathological subchondral bone changes, and signs of synovial inflammation and pain. We previously identified p[63-82], a bone morphogenetic protein 7 (BMP7)-derived bioactive peptide that attenuates structural cartilage degeneration in the rat medial meniscal tear-model for posttraumatic OA. This study aimed to evaluate the cartilage erosion-attenuating activity of p[63-82] in a different preclinical model for OA (anterior cruciate ligament transection-partial medial meniscectomy [anterior cruciate ligament transection (ACLT)-pMMx]). The disease-modifying action of the p[63-82] was followed-up in this model for 5 and 10 weeks. DESIGN Skeletally mature male Lewis rats underwent ACLT-pMMx surgery. Rats received weekly intra-articular injections with either saline or 500 ng p[63-82]. Five and 10 weeks postsurgery, rats were sacrificed, and subchondral bone characteristics were determined using microcomputed tomography (µCT). Histopathological evaluation of cartilage degradation and Osteoarthritis Research Society International (OARSI)-scoring was performed following Safranin-O/Fast Green staining. Pain-related behavior was measured by incapacitance testing and footprint analysis. RESULTS Histopathological evaluation at 5 and 10 weeks postsurgery showed reduced cartilage degeneration and a significantly reduced OARSI score, whereas no significant changes in subchondral bone characteristics were found in the p[63-82]-treated rats compared to the saline-treated rats. ACLT-pMMx-induced imbalance of static weightbearing capacity in the p[63-82] group was significantly improved compared to the saline-treated rats at weeks 5 postsurgery. Footprint analysis scores in the p[63-82]-treated rats demonstrated improvement at week 10 postsurgery. CONCLUSIONS Weekly intra-articular injections of p[63-82] in the rat ACLT-pMMx posttraumatic OA model resulted in reduced degenerative cartilage changes and induced functional improvement in static weightbearing capacity during follow-up.
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Affiliation(s)
- Ellen G J Ripmeester
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Jessica S J J Steijns
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Karolina A P Wijnands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Roderick H M J Stassen
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Vasek Pitelka
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Laura C W Peeters
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Andy Cremers
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Nzekui M S A Astryde
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Alzbeta Chabronova
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Don A M Surtel
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Pieter J Emans
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guus G H van den Akker
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Lodewijk W van Rhijn
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein M J Caron
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim J M Welting
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Lorio MP, Tate JL, Myers TJ, Block JE, Beall DP. Perspective on Intradiscal Therapies for Lumbar Discogenic Pain: State of the Science, Knowledge Gaps, and Imperatives for Clinical Adoption. J Pain Res 2024; 17:1171-1182. [PMID: 38524692 PMCID: PMC10959304 DOI: 10.2147/jpr.s441180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Specific clinical diagnostic criteria have established a consensus for defining patients with lumbar discogenic pain. However, if conservative medical management fails, these patients have few treatment options short of surgery involving discectomy often coupled with fusion or arthroplasty. There is a rapidly-emerging research effort to fill this treatment gap with intradiscal therapies that can be delivered minimally-invasively via fluoroscopically guided injection without altering the normal anatomy of the affected vertebral motion segment. Viable candidate products to date have included mesenchymal stromal cells, platelet-rich plasma, nucleus pulposus structural allograft, and other cell-based compositions. The objective of these products is to repair, supplement, and restore the damaged intervertebral disc as well as retard further degeneration. In doing so, the intervention is meant to eliminate the source of discogenic pain and avoid surgery. Methodologically rigorous studies are rare, however, and based on the best clinical evidence, the safety as well as the magnitude and duration of clinical efficacy remain difficult to estimate. Further, we summarize the US Food and Drug Administration's (FDA) guidance regarding the interpretation of the minimal manipulation and homologous use criteria, which is central to designating these products as a tissue or as a drug/device/biologic. We also provide perspectives on the core evidence and knowledge gaps associated with intradiscal therapies, propose imperatives for evaluating effectiveness of these treatments and highlight several new technologies on the horizon.
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Simmich J, Andrews NE, Claus A, Murdoch M, Russell TG. Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study. JMIR Form Res 2024; 8:e46820. [PMID: 38498031 DOI: 10.2196/46820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 02/06/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance. OBJECTIVE The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods. METHODS People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test. RESULTS The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI -2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and -77.6 (95% CI -107.7 to -61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points. CONCLUSIONS In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment.
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Affiliation(s)
- Joshua Simmich
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Nicole Emma Andrews
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
- The Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- Occupational Therapy Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Andrew Claus
- The Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Megan Murdoch
- The Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Trevor Glen Russell
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
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Zhang Y, Lu C, Yao Z, Chen Y, Luo S. Evaluation of thermal shock therapy for reducing pain during intense pulsed light therapy: An intrapatient randomized controlled study. J Cosmet Dermatol 2024. [PMID: 38497418 DOI: 10.1111/jocd.16294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Intense pulsed light (IPL) is used for the treatment and improvement of various skin issues. However, patients often experience local skin burning and pain after IPL treatment. Cooling and analgesic measures are indispensable. AIMS To investigate the clinical effect of thermal shock therapy on pain relief and reduction of adverse reactions during IPL therapy. PATIENTS/METHODS A total of 60 female patients with facial photoaging who received IPL therapy were enrolled in the study. As a comparative split-face study, one side of the face was randomly selected as the control side. The other side was given thermal shock therapy before and after the IPL treatment immediately as analgesic side. The visual analog scale (VAS) was used to evaluate the pain degree of the patients. The telephone follow-ups regarding the occurrence of adverse reactions were conducted respectively on the 2nd day, 7th day, and 1 month after treatment. RESULTS The VAS score and skin temperature of analgesia side was lower than that of control side at different stages of treatment. In terms of adverse reactions, the incidence of transient facial redness on the analgesic side was lower than that on the control side. Two patients showed slight secondary pigmentation on the control side, and the other patients showed no other adverse reactions on both sides. CONCLUSIONS Thermal shock therapy assisted IPL therapy can reduce skin temperature during treatment, effectively relieve patients' pain, reduce the occurrence of adverse reactions caused by heat injury, and improve patients' comfort level.
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Affiliation(s)
- Yuanwen Zhang
- Department of Burns and Plastic Surgery, No.926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, China
| | - Chuncheng Lu
- Department of Burns and Plastic Surgery, No.926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, China
| | - Zhihui Yao
- Department of Burns and Plastic Surgery, No.926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, China
| | - Yongxin Chen
- Department of Burns and Plastic Surgery, No.926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, China
| | - Shilan Luo
- Department of Burns and Plastic Surgery, No.926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, China
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Sear C. Peripheral neuropathic pain: supporting patients with self-management. Nurs Stand 2024:e12318. [PMID: 38495010 DOI: 10.7748/ns.2024.e12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
Peripheral neuropathic pain is a complex condition that can adversely affect people's quality of life. Alongside pharmacological interventions, nurses can support patients to self-manage their pain using non-pharmacological interventions such as lifestyle changes and exercise. To do this effectively, nurses should be able to recognise the signs and symptoms of peripheral neuropathic pain and be able to educate patients on appropriate self-management approaches. It is important that nurses provide education, advice and information in a way that patients can understand and check this understanding. This article provides an overview of how nurses can support patients to self-manage peripheral neuropathic pain by using various non-pharmacological interventions.
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Affiliation(s)
- Charlotte Sear
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Harefield, England
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Jackson MA, Burn CC, Hedley J, Brodbelt DC, O'Neill DG. Dental disease in companion rabbits under UK primary veterinary care: Frequency and risk factors. Vet Rec 2024; 194:e3993. [PMID: 38439116 DOI: 10.1002/vetr.3993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/03/2024] [Accepted: 01/25/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Some prior evidence has suggested that lop-eared rabbits and those with brachycephalic skull conformations have a higher dental disease risk. This retrospective cohort study reports the frequency and conformational risk factors for primary-care veterinary diagnosis with dental disease in companion rabbits in the UK. METHODS Anonymised VetCompass clinical records were manually reviewed to confirm dental disease cases. Risk factor analysis used multivariable binary logistic regression modelling. RESULTS From 161,979 rabbits under primary veterinary care in 2019, the 1-year period prevalence of overall dental disease was 15.36% (95% confidence interval [CI]: 14.78-15.96). The prevalence of dental disease affecting incisors was 3.14% (95% CI: 2.87-3.44), and for cheek teeth it was 13.72% (95% CI: 13.17-14.29). Neither lop-eared conformation nor brachycephalic skull conformation was significantly associated with increased odds of dental disease. Dental disease odds increased as age increased and decreased as bodyweight increased. LIMITATIONS This study retrospectively accessed clinical records, so breed names may sometimes be imprecise. CONCLUSION The high overall prevalence of dental disease represents a major welfare concern for all companion rabbits, regardless of conformation. This information can be used to encourage regular routine dental assessment of rabbits of all conformations to promote earlier diagnosis, paying particular attention to older rabbits and those with low bodyweight.
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Affiliation(s)
- Maria A Jackson
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Charlotte C Burn
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Joanna Hedley
- Beaumont Sainsbury Animal Hospital, Royal Veterinary College, London, UK
| | - Dave C Brodbelt
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Dan G O'Neill
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
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Majumdar JR, Grbic J, Carlsson S, Barreiro D, Marte M, Laudone V, Assel MJ, Masson G. Impact of Replacing Fentanyl With Hydromorphone as the First-Line Postoperative Opioid Among Patients Undergoing Outpatient Cancer Surgery. J Perianesth Nurs 2024:S1089-9472(23)01051-1. [PMID: 38493405 DOI: 10.1016/j.jopan.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 03/18/2024]
Abstract
PURPOSE In response to a nationwide fentanyl shortage, our institution assessed whether changing our first-line postoperative intravenous opioid from fentanyl to hydromorphone impacted patient outcomes. The primary research aim was to evaluate the association between first-line opioid and rapidity of recovery. DESIGN The study team retrospectively obtained data on all consecutive patients extracted from the electronic medical record. The rapidity of recovery was defined as the time from entry into the postanesthesia care unit to the transition to Phase 2 for ambulatory extended recovery patients and as the length of total postanesthesia care unit stay for outpatients. METHODS Following intent-to-treat-principles, we tested the association between study period and rapidity of recovery (a priori clinically meaningful difference: 20 minutes) using multivariable linear regression, adjusting for anesthesia type (general vs monitored anesthesia care), American Society of Anesthesiologst physical status (ASA) score (1-2 vs 3-4), age, service, robotic procedure, and surgery start time. FINDINGS Ambulatory extended recovery patients treated in the hydromorphone period had, on average, a 0.25 minute (95% confidence interval [CI] -6.5, 7.0), nonstatistically significant (P > .9) longer time to transition. For outpatient procedures, those who received hydromorphone had, on average, 8.5-minute longer stays (95% CI 3.7-13, P < .001). Although we saw statistical evidence of an increased risk of resurgery associated with receiving hydromorphone (0.5%; 95% CI -0.1%, 1.0%; P = .039 on univariate analysis), the size of the estimate is clinically and biologically implausible and is most likely a chance finding related either to multiple testing or confounding. CONCLUSIONS The multidisciplinary team concluded that the increase in postoperative length of stay associated with hydromorphone was not clinically significant and the decrease waste of prefilled syringes outweighed the small potential increased risk of resurgery compared to the shorter-acting fentanyl. We will therefore use hydromorphone moving forward.
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Affiliation(s)
- Jennifer R Majumdar
- Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY; Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY.
| | - John Grbic
- Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sigrid Carlsson
- Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY; Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Donna Barreiro
- Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marie Marte
- Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vincent Laudone
- Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Melissa J Assel
- Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Geema Masson
- Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY
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Klinge PM, Leary OP, Allen PA, Svokos K, Sullivan P, Brinker T, Gokaslan ZL. Clinical criteria for filum terminale resection in occult tethered cord syndrome. J Neurosurg Spine 2024:1-9. [PMID: 38489815 DOI: 10.3171/2024.1.spine231191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Tethered cord syndrome (TCS) comprises three symptom categories: back/leg pain, bowel/bladder, and neurological complaints. MRI typically reveals a low-lying conus medullaris, filum terminale (FT) pathology, or lumbosacral abnormalities. FT resection is established in TCS but not in radiologically occult TCS (OTCS). This study aims to identify patients with OTCS who are likely to benefit from FT resection. METHODS The authors recruited 149 patients with OTCS (31 pediatric, 118 adult) treated with FT resection-including only cases with progressive TCS, negative spine MRI, and no concurrent neurological/urological conditions. A comprehensive questionnaire collected patient self-reported symptoms and clinical findings at the preoperative and at 3- and 12-month follow-up examinations. Based on questionnaire data, the authors extracted a 15-item symptoms and findings scale to represent the three TCS symptom categories, assigning 1 point for each item present. RESULTS OTCS presents without radicular/segmental sensorimotor findings, but with leg/back pain and conus dysfunction, in addition to leg fatigue and spasticity; the latter indicating an upper motoneuron pathology. The 15-item scale showed clinical improvement in 89% of patients at the 3-month follow-up and 68% at the 12-month follow-up. Multivariate analysis of the scale revealed that it accurately predicts outcome of FT resection in 82% of cases. Patients with a preoperative score exceeding 6 points are most likely to benefit from surgery. CONCLUSIONS By applying the study's inclusion criteria and incorporating the novel 15-item scale, surgeons can effectively select candidates for FT resection in patients with OTCS. The observed outcomes in these selected patients are comparable to those achieved in degenerative spine surgery.
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Affiliation(s)
- Petra M Klinge
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Owen P Leary
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Philip A Allen
- 2Department of Psychology, University of Akron, Ohio; and
| | - Konstantina Svokos
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Patricia Sullivan
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Thomas Brinker
- 3Department of Neurosurgery, Medical School Hannover, Germany
| | - Ziya L Gokaslan
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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Deol BB, Binns-Emerick L, Kang M, Patel P. Palliative care in the older adult with cancer and the role of the geriatrician: a narrative review. Ann Palliat Med 2024; 0:apm-23-504. [PMID: 38509648 DOI: 10.21037/apm-23-504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Palliative care can offer individuals improved quality of care and life. While many individuals would benefit from palliative care, only a minority will receive it. Integrating palliative care with geriatrics can help relieve this deficit, help with basic symptom management, advanced care planning (ACP) and develop goals of care to assure that the care provided is congruent with the individual's priorities. The purpose of this narrative review is to demonstrate the importance that the geriatrician can have when participating in the administration of palliative care; to present geriatric-specific issues that are imperative to manage when palliatively treating the older adult with cancer. METHODS Data were identified by searching PubMed (January 2000 to July 2023) using the following search terms: palliative care, older adults, and cancer care. The search was repeated using geriatrics, pain, fatigue, anxiety, and depression. Non-English articles and observational studies were excluded. Additional review of literature was undertaken using relevant references of identified articles. KEY CONTENT AND FINDINGS Providing the right service at the right time for older adults with undergoing palliative care is imperative. It is important that clinicians, especially geriatricians, have basic skills in providing this level of care to older patients while working in conjunction with palliative care teams. Older adults are a heterogeneous group, thus utilizing comprehensive geriatric assessment helps the palliative care team to successfully treat individuals. Addressing goals of care, symptom management and ACP can help to maintain quality of life and independence of the older adult. The aging process can affect how the individual perceives and manage their symptoms related to their cancer care including pain, fatigue, anxiety/ depression, etc. CONCLUSIONS Embedding primary care geriatrics in the palliative care arena helps to provide more access to this care. This integration helps providers address basic symptom management, advance care planning and work with individuals on goals of care to assure the care being provided is congruent individual's priorities. Older adults respond to symptoms different than their younger counterparts. Management of these symptoms has to be addressed in a manner commiserate with their age.
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Affiliation(s)
- Bibban Bant Deol
- Department of Internal Medicine-Division of Geriatrics, Wayne State University, School of Medicine, Detroit, MI, USA
| | - Lisa Binns-Emerick
- Department of Internal Medicine-Division of Geriatrics, Wayne Health, Wayne State University, Detroit, MI, USA; Rosa Parks Geriatric Center, Detroit Medical Center, Detroit, MI, USA
| | - Mohammad Kang
- Department of Internal Medicine-Division of Geriatrics, Wayne State University, School of Medicine, Detroit, MI, USA
| | - Pragnesh Patel
- Department of Internal Medicine-Division of Geriatrics, Wayne State University, School of Medicine, Detroit, MI, USA
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Gülşah B, Suner-Keklik S. Effects of short-term upper extremity exercise training in office workers during COVID-19 restrictions: A randomized controlled trial. Work 2024:WOR230190. [PMID: 38489203 DOI: 10.3233/wor-230190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND During COVID-19 pandemic, physical inactivity and inactivity-related health problems have deepened in many individuals, including office workers. It is not yet known whether there are exercise programs through telerehabilitation that will provide rapid relief in a short time in office workers who apply part or full-time teleworking system. OBJECTIVE To comparatively investigate influences of short-term upper extremity exercise trainings (UEET) on pain, musculoskeletal discomforts (MSD), physical activity (PA), mood, and quality of life (QOL) in office workers during COVID-19 restrictions. METHODS Thirty office workers were divided into exercise (EG) (UEET and walking advice) and control (CG) (walking advice) groups. The UEET was applied for at least 20-40 minutes/day, 5-7 days/week for a one week between February 2022 and June 2022. Office workers' pain, MSD, PA level, mood and QOL were measured. RESULTS Baseline characteristics of groups (EG: 37.8±7.04 years, CG: 41.6±7.97 years) were similar (p > 0.05). Following UEET, scores of office workers in EG on total step count, vigorous PA, moderate-intensity PA, walking, total PA, physical functioning, and body pain subscales of QOL significantly increased compared to scores of office workers in CG, while scores on neck, back and hip discomforts and anxiety and depression significantly decreased (p < 0.05). CONCLUSIONS One-week UEET and walking advice can improve office workers' daily step counts, MSD, PA levels, mood, and QOL. Office workers who have a busy work schedule may do these UEET and walking exercises in break times to relieve perception of discomfort.
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Affiliation(s)
- Barğı Gülşah
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Democracy University, Izmir, Turkey
| | - Sinem Suner-Keklik
- Physiotherapy and Rehabilitation Department, Health Science Faculty, Sivas Cumhuriyet University, Sivas, Turkey
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