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Barut S, Sabancı Baransel E, Çelik OT, Uçar T. The trends and hotspots of research on non-pharmacological interventions for labor pain management: a bibliometric analysis. J Psychosom Obstet Gynaecol 2024; 45:2322614. [PMID: 38444387 DOI: 10.1080/0167482x.2024.2322614] [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: 01/22/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION This study aimed to examine important points of focus, trends, and depth of research on non-pharmacological interventions for the management of labor pain worldwide from a macro perspective and present an extensive definition of research fields regarding non-pharmacological interventions. METHODS Bibliometric methods were used in this study. With comprehensive keyword lists, the Web of Science and PubMed databases were searched using different screening strategies for publications made until 25 February 2023. RESULTS Studies on non-pharmacological interventions in the management of labor pain have continued to develop since 2003 with great momentum. In this study, the most productive country in research on non-pharmacological interventions was found to be Iran, while Australia, the USA, China, and the United Kingdom were the most notable ones in terms of collaboration. The most prevalently studied non-pharmacological interventions were hydrotherapy and acupuncture. The results of the co-word analysis revealed 5 main themes about this field of research. CONCLUSION The results of this study showed that interest in studies on non-pharmacological interventions in the management of labor pain has increased, the quality of research in the field is high, international collaboration is increasingly higher, and technological approaches have started to emerge in relevant studies.
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Affiliation(s)
- Sümeyye Barut
- Department of Midwifery, Fırat University, Elazığ, Türkiye
| | | | | | - Tuba Uçar
- Department of Midwifery, İnönü University, Malatya, Türkiye
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Lin W, Yang Y, Zhuo Y, Qiu C, Guo Y, Yao Y. Efficacy of intraoperative systemic lidocaine on quality of recovery after laparoscopic colorectal surgery: a randomized controlled trial. Ann Med 2024; 56:2315229. [PMID: 38346397 PMCID: PMC10863528 DOI: 10.1080/07853890.2024.2315229] [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: 10/15/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection. PATIENTS AND METHODS We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg-1 bolus over 10 min, followed by continuous infusion at 2 mg kg-1 h-1 until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events. RESULTS Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1-6; p = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (p = 0.004 and p < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption (p < 0.001 and p = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank p < 0.001), yet ambulation time was similar between groups (log-rank test, p = 0.11). CONCLUSIONS In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract).Trial registration: Chinese Clinical Trial Registry; ChiCTR1900027635.
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Affiliation(s)
- Wenjun Lin
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ying Yang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yifen Zhuo
- Department of Anesthesiology, Xiamen Haicang Hospital, Xiamen, China
| | - Chunlin Qiu
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yanhua Guo
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yusheng Yao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
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Anderson ND, Shaner JL, Braunecker S, Potter LG. Regional Anesthesia in the Austere Environment: Lessons Learned from Current Out-of-Hospital Practice. Wilderness Environ Med 2024; 35:234-242. [PMID: 38380990 DOI: 10.1177/10806032241231257] [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: 02/22/2024]
Abstract
INTRODUCTION Pain management for trauma in the extreme environment is vital for both casualty comfort and aiding safe extrication. However, adequate pain management in a resource-limited environment can be challenging and is often limited. We conducted a scoping review of the use of regional anesthesia in the prehospital environment, evaluating which regional anesthetic procedure was performed for various indications, their efficacy, and the type of healthcare provider delivering the anesthetic. METHODS A PRISMA-guided systematic literature review was conducted of Medline, Embase, and Cochrane databases for studies reporting the use of regional anesthesia in the prehospital environment published before June 30, 2022. RESULTS Thirty studies met the criteria and were included in the review. The most common types of regional anesthesia were fascia-iliaca compartment block (n = 317, from 12 studies) and femoral nerve block (n = 210, from 8 studies), along with various other blocks for a range of indications. These blocks had good efficacy and a low-risk profile and could be delivered by a wide range of healthcare providers. CONCLUSIONS Regional anesthesia is an effective and non-resource-heavy pain management tool in prehospital environments, which may be applicable to austere settings. It can cover a wide range of injuries and can avoid systemic complications for casualties that may already be challenging to manage in out-of-hospital settings. Additionally, regional anesthesia can be effectively delivered by a wide range of providers. This review provides a holistic summary of pain management using regional anesthesia in the prehospital environment, with a discussion on its potential use in more extreme settings.
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Affiliation(s)
| | - Julie L Shaner
- Department of Orthopaedic Surgery, University of Florida, College of Medicine, Jacksonville, FL
| | - Stefan Braunecker
- Department of Anesthesiology, University of Florida, College of Medicine, Jacksonville, FL
| | - Lydia G Potter
- Emergency Medicine Academic Centre, Cardiff University, Cardiff, UK
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Kammerer E, Fawcett-Arsenault J, Iliscupidez L, Ali S. Healthcare Professionals' Perspectives on Improving Family-Centred Pain Care in a Tertiary Pediatric Centre. Can J Nurs Res 2024; 56:171-177. [PMID: 38258330 PMCID: PMC11032002 DOI: 10.1177/08445621241228063] [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: 01/24/2024] Open
Abstract
BACKGROUND Despite being a core component of family-centered and compassionate care, children's pain is often undertreated in Canadian hospitals. Nurses' and other healthcare professionals' (HCPs) ability to understand and respond to a child and their family's pain care needs is integral to improving this care in a family-centered manner. PURPOSE To understand nurses' and other HCPs' perceptions of child and family needs to make care more collaborative and patient- and family-centered. METHODS Eighteen participants were recruited and represented the specialties of nursing (n = 8), psychology (n = 1), child life services (n = 2), medicine/surgery (n = 3), and administration/leadership (n = 4); 3 of the administrators had a nursing background. Transcripts were analysed using a semantic, inductive approach with two coders using a codebook to ensure reliability. RESULTS Participants felt that pain care was important, but that it needs to take greater priority in the hospital. In our analysis, we identified four core needs that nurses and other HCPs have to provide better pain care: 1. Better acknowledgement of child and family experiences; 2. Better visual and written knowledge translation tools for patients and families; 3. Better provision of verbal pain education to children and families by nurses and other HCPs; and 4. Help for patients and families to advocate for better pain care when they feel their needs are not being met. CONCLUSIONS Nurses and other HCPs value patient- and family-centered pain care, and wish to empower families to advocate for it when it is sub-optimal.
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Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joelle Fawcett-Arsenault
- Patient and Family Centred Care, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lexyn Iliscupidez
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Geller JE. I am Dying. J Pain Symptom Manage 2024; 67:e915-e916. [PMID: 37402437 DOI: 10.1016/j.jpainsymman.2023.06.030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/30/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Jennifer E Geller
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
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Jung M, Xia T, Ilomäki J, Pearce C, Nielsen S. Opioid characteristics and nonopioid interventions associated with successful opioid taper in patients with chronic noncancer pain. Pain 2024; 165:1327-1335. [PMID: 38112755 PMCID: PMC11090027 DOI: 10.1097/j.pain.0000000000003133] [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: 05/27/2023] [Revised: 10/27/2023] [Accepted: 11/04/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Current research indicates that tapering opioids may improve pain and function in patients with chronic noncancer pain. However, gaps in the literature remain regarding the choice of opioid and nonopioid interventions to support a successful taper. This study used an Australian primary care data set to identify a cohort of patients on long-term opioid therapy commencing opioid taper between January 2016 and September 2019. Using logistic regression analysis, we compared key clinical factors associated with differing taper outcomes. Of a total of 3371 patients who commenced taper, 1068 (31.7%) completed taper within 12 months. In the 3 months after commencement of taper, compared with those who did not complete taper, patients who successfully completed opioid taper were less likely to be prescribed buprenorphine (odds ratio [OR] 0.691; 95% CI: 0.530-0.901), fentanyl (OR, 0.429; 95% CI: 0.295-0.622), and long-acting (LA) opioids, including methadone (OR, 0.349; 95% CI: 0.157-0.774), oxycodone-naloxone (OR, 0.521; 95% CI: 0.407-0.669), and LA tapentadol (OR, 0.645; 95% CI: 0.461-0.902), but more likely to be prescribed codeine (OR, 1.308; 95% CI: 1.036-1.652). Compared with those who did not complete taper, patients who successfully tapered were less likely to be prescribed any formulations of oxycodone (short-acting [SA]: OR, 0.533; 95% CI: 0.422-0.672, LA: OR, 0.356; 95% CI: 0.240-0.530) and tramadol (SA: OR, 0.370; 95% CI: 0.218-0.628, LA: OR, 0.317; 95% CI: 0.234-0.428). The type of opioid prescribed in the months after commencement of taper seems to influence the taper outcomes. These findings may inform prospective studies on opioid taper.
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Affiliation(s)
- Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher Pearce
- Melbourne East General Practice Network (trading as Outcome Health), Surrey Hills, Australia
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Sier MA, Tweed TT, Nel J, Daher I, Bakens MJ, van Bastelaar J, Stoot JH. Hyperbaric bupivacaine versus prilocaine for spinal anesthesia combined with total intravenous anesthesia during oncological colon surgery in a 23-hour stay enhanced recovery protocol: A non-randomized study. Medicine (Baltimore) 2024; 103:e37957. [PMID: 38728520 PMCID: PMC11081582 DOI: 10.1097/md.0000000000037957] [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: 12/11/2023] [Accepted: 03/29/2024] [Indexed: 05/12/2024] Open
Abstract
After the success of the enhanced recovery after surgery protocol, perioperative care has been further optimized in accelerated enhanced recovery pathways (ERPs), where optimal pain management is crucial. Spinal anesthesia was introduced as adjunct to general anesthesia to reduce postoperative pain and facilitate mobility. This study aimed to determine which spinal anesthetic agent provides best pain relief in accelerated ERP for colon carcinoma. This single center study was a secondary analysis conducted among patients included in the aCcelerated 23-Hour erAS care for colon surgEry study who underwent elective laparoscopic colon surgery. The first 30 patients included received total intravenous anesthesia combined with spinal anesthesia with prilocaine, the 30 patients subsequently included received spinal anesthesia with hyperbaric bupivacaine. Primary endpoint of this study was the total amount of morphine milligram equivalents (MMEs) administered during hospital stay. Secondary outcomes were amounts of MMEs administered in the recovery room and surgical ward, pain score using the numeric rating scale, complication rates and length of hospital stay. Compared to prilocaine, the total amount of MMEs administered was significantly lower in the bupivacaine group (n = 60, 16.3 vs 6.3, P = .049). Also, the amount of MMEs administered and median pain scores were significantly lower after intrathecal bupivacaine in the recovery room (MMEs 11.0 vs 0.0, P = .012 and numeric rating scale 2.0 vs 1.5, P = .004). On the surgical ward, median MMEs administered, and pain scores were comparable. Postoperative outcomes were similar in both groups. Spinal anesthesia with hyperbaric bupivacaine was associated with less opioid use and better pain reduction immediately after surgery compared to prilocaine within an accelerated ERP for elective, oncological colon surgery.
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Affiliation(s)
- Misha A.T. Sier
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Thaís T.T. Tweed
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Johan Nel
- Department of Anesthesiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Imane Daher
- Department of Gastroenterology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Maikel J.A.M. Bakens
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Jan H.M.B. Stoot
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
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Fan X, Zhang S, Sun S, Bi W, Li S, Wang W, Chen X, Fang Z. GFAP palmitoylcation mediated by ZDHHC23 in spinal astrocytes contributes to the development of neuropathic pain. Reg Anesth Pain Med 2024:rapm-2023-104980. [PMID: 38050183 DOI: 10.1136/rapm-2023-104980] [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: 09/03/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Cancer pain has a significant impact on patient's quality of life. Astrocytes play an important role in cancer pain signaling. The direct targeting of astrocytes can effectively suppress cancer pain, however, they can cause many side effects. Therefore, there is an urgent need to identify the specific signaling pathways or proteins involved within astrocytes in cancer pain as targets for treating pain. METHODS A neuropathic cancer pain (NCP) model was established by inoculating mouse S-180 sarcoma cells around the right sciatic nerve in C57BL/6 mice. Spontaneous persistent pain and paw withdrawal thresholds were measured using von Frey filaments. The NCP spinal cord dorsal horn (L4-L6) and mouse astrocyte cell line MA-C were used to study protein palmitoylation using acyl-biotin exchange, real-time polymerase chain reaction, ELISA, western blotting, and immunofluorescent staining. RESULTS In a cancer pain model, along with tumor growth, peripheral nerve tissue invasion, and cancer pain onset, astrocytes in the dorsal horn of the spinal cord were activated and palmitoyltransferase ZDHHC23 expression was upregulated, leading to increased palmitoylation levels of GFAP and increased secretion of inflammatory factors, such as (C-X-C motif) ligand (CXCL)10 (CXCL-10), interleukin 6, and granulocyte-macrophage colony-stimulating factor. These factors in turn activate astrocytes by activating the signal transducer and activator of transcription 3 (STAT3) signaling pathway. A competitive peptide targeting GFAP palmitoylations was designed to effectively alleviate morphine tolerance in cancer pain treatment as well as cancer pain signaling and inflammatory factor secretion. CONCLUSIONS In a rodent model, targeting GFAP palmitoylation appears to be an effective strategy in relieving cancer pain and morphine tolerance. Human translational research is warranted.
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Affiliation(s)
- Xiaoqing Fan
- Hefei Cancer Hospital of CAS; Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences (CAS), Hefei, Anhui, People's Republic of China
- Science Island Branch, Graduate School of University of Science and Technology of China, Hefei, Anhui, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People's Republic of China
| | - Siyu Zhang
- Hefei Cancer Hospital of CAS; Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences (CAS), Hefei, Anhui, People's Republic of China
- Science Island Branch, Graduate School of University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Suling Sun
- Hefei Cancer Hospital of CAS; Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences (CAS), Hefei, Anhui, People's Republic of China
- Science Island Branch, Graduate School of University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Wenxu Bi
- Hefei Cancer Hospital of CAS; Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences (CAS), Hefei, Anhui, People's Republic of China
- Science Island Branch, Graduate School of University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Shuyang Li
- Hefei Cancer Hospital of CAS; Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences (CAS), Hefei, Anhui, People's Republic of China
- School of Basic Medicine, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Wei Wang
- Hefei Cancer Hospital of CAS; Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences (CAS), Hefei, Anhui, People's Republic of China
- School of Basic Medicine, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xueran Chen
- Hefei Cancer Hospital of CAS; Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences (CAS), Hefei, Anhui, People's Republic of China
- Science Island Branch, Graduate School of University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Zhiyou Fang
- Hefei Cancer Hospital of CAS; Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences (CAS), Hefei, Anhui, People's Republic of China
- Science Island Branch, Graduate School of University of Science and Technology of China, Hefei, Anhui, People's Republic of China
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Mittal A, Wakim J, Huq S, Wynn T. Effectiveness of Virtual Reality in Reducing Perceived Pain and Anxiety Among Patients Within a Hospital System: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e52649. [PMID: 38722681 DOI: 10.2196/52649] [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: 09/11/2023] [Revised: 12/04/2023] [Accepted: 03/06/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Within hospital systems, diverse subsets of patients are subject to minimally invasive procedures that provide therapeutic relief and necessary health data that are often perceived as anxiogenic or painful. These feelings are particularly relevant to patients experiencing procedures where they are conscious and not sedated or placed under general anesthesia that renders them incapacitated. Pharmacologic pain management and topical anesthetic creams are used to manage these feelings; however, distraction-based methods can provide nonpharmacologic means to modify the painful experience and discomfort often associated with these procedures. Recent studies support distraction as a useful method for reducing anxiety and pain and as a result, improving patient experience. Virtual reality (VR) is an emerging technology that provides an immersive user experience and can operate through a distraction-based method to reduce the negative or painful experience often related to procedures where the patient is conscious. Given the possible short-term and long-term outcomes of poorly managed pain and enduring among patients, health care professionals are challenged to improve patient well-being during medically essential procedures. OBJECTIVE The purpose of this pilot project is to assess the efficacy of using VR as a distraction-based intervention for anxiety or pain management compared to other nonpharmacologic interventions in a variety of hospital settings, specifically in patients undergoing lumbar puncture procedures and bone marrow biopsies at the oncology ward, patients receiving nerve block for a broken bone at an anesthesia or surgical center, patients undergoing a cleaning at a dental clinic, patients conscious during an ablation procedure at a cardiology clinic, and patients awake during a kidney biopsy at a nephrology clinic. This will provide the framework for additional studies in other health care settings. METHODS In a single visit, patients eligible for the study will complete brief preprocedural and postprocedural questionnaires about their perceived fear, anxiety, and pain levels. During the procedure, research assistants will place a VR headset on the patient and the patient will undergo a VR experience to distract from any pain felt from the procedure. Participants' vitals, including blood pressure, heart rate, and rate of respiration, will also be recorded before, during, and after the procedure. RESULTS The study is already underway, and results support a decrease in perceived pain by 1.00 and a decrease in perceived anxiety by 0.3 compared to the control group (on a 10-point Likert scale). Among the VR intervention group, the average rating for comfort was 4.35 out of 5. CONCLUSIONS This study will provide greater insight into how patients' perception of anxiety and pain could potentially be altered. Furthermore, metrics related to the operational efficiency of providing a VR intervention compared to a control will provide insight into the feasibility and integration of such technologies in routine practice. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52649.
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Affiliation(s)
- Ajay Mittal
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jonathan Wakim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Suhaiba Huq
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Tung Wynn
- College of Medicine, University of Florida, Gainesville, FL, United States
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Nishtar M, Mark R, Langford DJ, McDermott MP, Markman JD, Evans SR, France FO, Park M, Sharma S, Turk DC, Dworkin RH, Gewandter JS. Evaluating the balance of benefits and harms in chronic pain clinical trials: prioritizing individual participants over individual outcomes. Reg Anesth Pain Med 2024; 49:363-367. [PMID: 37963675 PMCID: PMC11081843 DOI: 10.1136/rapm-2023-104809] [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: 06/30/2023] [Accepted: 09/26/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Randomized clinical trials (RCTs) generally assess efficacy and safety separately, with the conclusion of whether a treatment is beneficial based solely on the efficacy endpoint. However, assessing and combining efficacy and safety domains, using a single composite outcome measure, can provide a more comprehensive assessment of the overall effect of a treatment. Furthermore, composite outcomes can incorporate information regarding the relationship between the individual outcomes. In fact, such outcomes have been suggested in the clinical trials literature for at least 15 years. OBJECTIVES To (1) identify whether recent primary publications of chronic pain RCTs from major pain journals included a composite outcome measure of benefits and harms and (2) discuss the potential benefits of such outcomes in various stages of treatment development, including as outcome measures in RCTs, and to support decisions of Data and Safety Monitoring Boards and ordering of treatments in the context of treatment guidelines. EVIDENCE REVIEW RCTs published in 6 major pain journals published between 2016 and 2021 that investigated interventions for chronic pain were reviewed. FINDINGS Of 73 RCTs identified, only 2 included a composite outcome measure of benefits and harms. Both of these articles compared 2 active treatments. CONCLUSIONS Composite outcomes of benefits and harms are underutilized in chronic pain RCTs. The advantages and challenges of using such outcomes are discussed.
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Affiliation(s)
- Mahd Nishtar
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Remington Mark
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Dale J Langford
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - John D Markman
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA
| | - Scott R Evans
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Fallon O France
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Meghan Park
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Sonia Sharma
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, New York, USA
| | - Dennis C Turk
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Robert H Dworkin
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Jennifer S Gewandter
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
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Fogel H, Yeritsyan D, Momenzadeh K, Kheir N, Yeung CM, Abbasian M, Lozano EM, Nazarian RM, Nazarian A. The Effect of Cannabinoids on Single-level Lumbar Arthrodesis Outcomes in a Rat Model. Spine J 2024:S1529-9430(24)00217-1. [PMID: 38704096 DOI: 10.1016/j.spinee.2024.04.031] [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] [Received: 11/28/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND CONTEXT The opioid epidemic is a public health crisis affecting spine care and pain management. Medical marijuana is a potential non-opioid analgesic yet to be studied in the surgical setting since its effects on bone healing are not fully understood. Studies have demonstrated analgesic and potentially osteoinductive properties of cannabinoids with endocannabinoid receptor expression in bone tissue. PURPOSE We hypothesize that tetrahydrocannabinol (THC) and cannabidiol (CBD) will not decrease bone healing in spinal fusion. STUDY DESIGN Seventy-eight adult Sprague-Dawley rats were used for this study. Utilizing allogenic bone grafts (6 donor rats), posterolateral inter-transverse lumbar fusion at the L4-L5 level was performed. The animals were equally divided into four treatment groups, each receiving 0.1ml intraperitoneal injections weekly as follows: placebo (saline), 5mg/kg THC, 5mg/kg CBD, and a combination of 5mg/kg THC and 5mg/kg CBD (Combo). METHODS Callus tissue was harvested 2- and 8-weeks post-surgery for qPCR assessment to quantify changes in the expression of osteogenic genes. Manual palpation was done to assess the strength of the L4-L5 arthrodesis on all rats. μCT image-based callus analysis and histology were performed. One-way ANOVA followed by post hoc comparisons was performed. RESULTS μCT demonstrated no significant differences. Treatment groups had slightly increased bone volume and density compared to control. qPCR at two weeks indicated downregulated RANKL/OPG ratios skewing towards osteogenesis in the CBD group, with the THC and CBD+THC groups demonstrating a downward trend (P>0.05). ALPL, BMP4, and SOST were significantly higher in the CBD group, with CTNNB1 and RUNX2 also showing an upregulating trend. The CBD group showed elevation in Col1A1 and MMP13. Data at eight weeks showed ALPL, RUNX2, BMP4, and SOST were downregulated for all treatment groups. In the CBD+THC group, RANK, RANKL, and OPG were downregulated. OPG downregulation reached significance for the THC and CBD+THC group compared to saline. Interestingly, the RANKL/OPG ratio showed upregulation in the CBD and CBD+THC groups. RANKL showed upregulation in the CBD group. At 2 and 8 weeks, the CBD treatment group showed superior histological progression, increasing between time points. CONCLUSION This study demonstrates that CBD and THC have no adverse effect on bone healing and the rate of spinal fusion in rats. Osteogenic factors were upregulated in the CBD-treated groups at two weeks, which indicates a potential for bone regeneration. In this group, compared to control, the RANKL/OPG ratio at the early healing phase demonstrates the inhibition of osteoclast differentiation, enhancing bone formation. Interestingly, it shows promoted osteoclast differentiation at the later healing phase, enhancing bone remodeling. This aligns with the physiological expectation of a lower ratio in the early phases and a higher ratio in the later remodeling phases. CLINICAL SIGNIFICANCE CBD and THC showed no inhibitory effects on bone healing in a spinal fusion model. Moreover, histologic and gene expression analysis demonstrated that CBD may, in fact, enhance bone healing. Further research is needed to confirm the safe usage of THC and CBD in the post-operative setting following spinal fusions.
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Affiliation(s)
- Harold Fogel
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Edith Martinez Lozano
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rosalynn M Nazarian
- The Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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12
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Kuchyn I, Sapunar D, Horoshko V. Patterns of anatomical injury and anaesthesia procedures in wounded Ukrainian soldiers from Anti-Terrorist Operation/Operation Joint Forces: 2014-2021. BMJ Mil Health 2024:e002633. [PMID: 38697751 DOI: 10.1136/military-2023-002633] [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: 11/22/2023] [Accepted: 03/30/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION The study aims to analyse the causes and anatomical patterns of explosive and gunshot wounds in Ukrainian soldiers acquired during the Anti-Terrorist Operation/Operation Joint Forces. We also investigated how general and regional anaesthesia procedures affected post-operative pain in wounded soldiers. METHODS A retrospective observational study was done based on the medical records of Ukrainian soldiers wounded in the Anti-Terrorist Operation/Operation Joint Forces between 2014 and 2021. The collected data included the American Society of Anesthesiologists score, mechanism of injury, the pattern of anatomical injury, pain intensity and the choice of anaesthesia given. Pain intensity was diagnosed using a Numerical Rating Scale. RESULTS A total of 280 combat casualties with explosive (75.7%) and gunshot (24.3%) wound injuries were included in the study. Most of the wounded soldiers had one body region affected by injury (59.3%). In most of the cases, the affected body regions were lower (48.2%) and upper (33.8%) limbs. In 62.5% of patients, regional anaesthesia was used, while general anaesthesia was used in 37.5% of cases. The pain significantly decreased after initial treatment at the field medical unit regardless of the anaesthesia type or the number of affected body regions. CONCLUSION Understanding the sources and anatomical patterns of war-related injuries in recent conflicts is an important element in reducing the mortality and suffering of wounded soldiers. The high percentage of injured extremities in our cohort emphasises the importance of regional anaesthesia in contemporary wars.
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Affiliation(s)
- Iurii Kuchyn
- Postgraduate Department of Surgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - D Sapunar
- University of Split School of Medicine, Split, Croatia
| | - V Horoshko
- National Military Medical Clinical Center Main Military Clinical Hospital, Kyiv, Ukraine
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Grant SA, Kopp S, Albrecht E. Research priorities in regional anaesthesia: where should we focus? Br J Anaesth 2024:S0007-0912(24)00206-X. [PMID: 38702237 DOI: 10.1016/j.bja.2024.04.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/15/2024] [Accepted: 04/08/2024] [Indexed: 05/06/2024] Open
Abstract
Using a modified Delphi technique, an international group of regional anaesthetists generated a list of top research priorities in regional anaesthesia. The list of unanswered research questions was created from a questionnaire completed by >500 anaesthetists and distilled into 11 priorities grouped into four themes: clinical practice and efficacy, pain management, technology and equipment, and training and assessment.
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Affiliation(s)
- Stuart A Grant
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.
| | - Sandy Kopp
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Eric Albrecht
- Department of Anesthesiology Lausanne University Hospital, Lausanne, Switzerland
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14
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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; 30:800-808. [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] [MESH Headings] [Grants] [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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Chang P, Amaral LJ, Asher A, Clauw D, Jones B, Thompson P, Warner AS. A perspective on a precision approach to pain in cancer; moving beyond opioid therapy. Disabil Rehabil 2024; 46:2174-2183. [PMID: 37194659 DOI: 10.1080/09638288.2023.2212916] [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: 09/11/2022] [Accepted: 05/07/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Cancer-related pain is primarily treated with opioids which while effective can add significant patient burden due to side effects, associated stigma, and timely access. The purpose of this perspective discussion is to argue for a precision approach to pain in cancer based on a biopsychosocial and spiritual model which we argue can offer a higher quality of life while limiting opioid use. CONCLUSIONS Pain in cancer represents a heterogenous process with multiple contributing and modulating factors. Specific characterization of pain as either nociceptive, neuropathic, nociplastic, or mixed can allow for targeted treatments. Additional assessment of biopsychosocial and spiritual issues can elucidate further points of targeted intervention which can lead to overall greater pain control.
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Affiliation(s)
- Philip Chang
- Philip Chang - Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Arash Asher
- Arash Asher - Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Bronwen Jones
- Bronwen Jones - Cedars Sinai Medical Center, Los Angeles, CA
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Bergmans RS, Clauw DJ, Flint C, Harris H, Lederman S, Schrepf A. Chronic overlapping pain conditions increase the risk of long COVID features, regardless of acute COVID status. Pain 2024; 165:1112-1120. [PMID: 38112577 PMCID: PMC11017744 DOI: 10.1097/j.pain.0000000000003110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/09/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Chronic overlapping pain conditions (COPCs) refer to conditions that have similar central nervous system pathophysiologic mechanisms driving widespread pain as well as common comorbid symptoms such as fatigue and problems with sleep, memory, and mood. If COPCs predict the onset of long COVID, this could offer a valuable orientation for long COVID-related research and clinical care. This retrospective cohort study aimed to determine whether having a COPC predicts the onset of long COVID features using US electronic health records and 1:1 propensity score matching without replacement. The study cohorts included (1) people with acute COVID (n = 1,038,402), (2) people with acute influenza (n = 262,092), and (3) a noninfected cohort comprising people with a routine healthcare encounter (n = 1,081,593). Having a COPC increased the risk of long COVID features in all 3 study cohorts. Among those with COVID, having a pre-existing COPC increased the risk by 1.47 (95% CI = 1.46, 1.47). In the influenza cohort, COPCs increased the risk by 1.39 (95% CI = 1.38, 1.40). In the noninfected cohort, COPCs increased the risk by 1.57 (95% CI = 1.56, 1.59). These findings reinforce the likelihood that nociplastic mechanisms play a prominent role in long COVID. Recognizing that this ubiquitous nonspecific syndrome occurs frequently in the population can inform precision medicine therapies that avoid the pitfalls of viewing long COVID exclusively in the framework of postinfectious disease.
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Affiliation(s)
- Rachel S. Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Daniel J. Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Herb Harris
- Tonix Pharmaceuticals, Chatham, NJ, United States
| | | | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
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Biskupiak J, Oderda G, Brixner D, Wandstrat TL. Gastrointestinal adverse effects associated with the use of intravenous oliceridine compared with intravenous hydromorphone or fentanyl in acute pain management utilizing adjusted indirect treatment comparison methods. J Comp Eff Res 2024; 13:e230041. [PMID: 38497192 PMCID: PMC11036942 DOI: 10.57264/cer-2023-0041] [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: 03/24/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Background: In the absence of head-to-head comparative data from randomized controlled trials, indirect treatment comparisons (ITCs) may be used to compare the relative effects of treatments versus a common comparator (either placebo or active treatment). For acute pain management, the effects of oliceridine have been compared in clinical trials to morphine but not to fentanyl or hydromorphone. Aim: To assess the comparative safety (specifically differences in the incidence of nausea, vomiting and opioid-induced respiratory depression [OIRD]) between oliceridine and relevant comparators (fentanyl and hydromorphone) through ITC analysis. Methods: A systematic literature review identified randomized clinical trials with oliceridine versus morphine and morphine versus fentanyl or hydromorphone. The ITC utilized the common active comparator, morphine, for the analysis. Results: A total of six randomized controlled trials (oliceridine - 2; hydromorphone - 3; fentanyl - 1) were identified for data to be used in the ITC analyses. The oliceridine data were reported in two studies (plastic surgery and orthopedic surgery) and were also reported in a pooled analysis. The ITC focused on nausea and vomiting due to limited data for OIRD. When oliceridine was compared with hydromorphone in the ITC analysis, oliceridine significantly reduced the incidence of nausea and/or vomiting requiring antiemetics compared with hydromorphone (both orthopedic surgery and pooled data), while results in plastic surgery were not statistically significant. When oliceridine was compared with hydromorphone utilizing data from Hong, the ITC only showed a trend toward reduced risk of nausea and vomiting with oliceridine that was not statistically significant across all three comparisons (orthopedic surgery, plastic surgery and combined). An ITC comparing oliceridine with a study of fentanyl utilizing the oliceridine orthopedic surgery data and combined orthopedic and plastic surgery data showed a trend toward reduced risk that was not statistically significant. Conclusion: In ITC analyses, oliceridine significantly reduced the incidence of nausea and/or vomiting or the need for antiemetics in orthopedic surgery compared with hydromorphone and a non-significant trend toward reduced risk versus fentanyl.
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Affiliation(s)
| | - Gary Oderda
- College of Pharmacy, University of Utah, UT USA
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Trager RJ, Cupler ZA, Srinivasan R, Casselberry RM, Perez JA, Dusek JA. Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data. BMJ Open 2024; 14:e078105. [PMID: 38692725 PMCID: PMC11086504 DOI: 10.1136/bmjopen-2023-078105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Patients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management. However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored. We hypothesised that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over 1-year follow-up, compared with those receiving usual medical care. DESIGN Retrospective cohort study. SETTING US medical records-based dataset including >115 million patients attending academic health centres (TriNetX, Inc), queried 9 November 2023. PARTICIPANTS Opioid-naive adults aged 18-50 with a new diagnosis of radicular LBP were included. Patients with serious pathology and tramadol use contraindications were excluded. Variables associated with tramadol prescription were controlled via propensity matching. INTERVENTIONS Patients were divided into two cohorts dependent on treatment received on the index date of radicular LBP diagnosis (CSM or usual medical care). PRIMARY AND SECONDARY OUTCOME MEASURES Risk ratio (RR) for tramadol prescription (primary); markers of usual medical care utilisation (secondary). RESULTS After propensity matching, there were 1171 patients per cohort (mean age 35 years). Tramadol prescription was significantly lower in the CSM cohort compared with the usual medical care cohort, with an RR (95% CI) of 0.32 (0.18 to 0.57; p<0.0001). A cumulative incidence graph demonstrated that the reduced incidence of tramadol prescription in the CSM cohort relative to the usual medical care cohort was maintained throughout 1-year follow-up. Utilisation of NSAIDs, physical therapy evaluation and lumbar imaging was similar between cohorts. CONCLUSIONS This study found that US adults initially receiving CSM for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up. These findings should be corroborated by a prospective study to minimise residual confounding.
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Affiliation(s)
- Robert James Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Roshini Srinivasan
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Regina M Casselberry
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Ferry J, Lewis O, Lloyd J, El-Boghdadly K, Kearns R, Albrecht E, Altermatt F, Ashokka B, Ayad AE, Aziz ES, Aziz L, Jagannathan B, Bouarroudj N, Chin KJ, Delbos A, de Gracia A, Ip VHY, Kwofie K, Layera S, Lobo CA, Mohammed M, Moka E, Moreno M, Morgan B, Polela A, Rahimzadeh P, Tangwiwat S, Uppal V, Vaz Perez M, Volk T, Wong PBY, Bowness JS, Macfarlane AJR. Research priorities in regional anaesthesia: an international Delphi study. Br J Anaesth 2024; 132:1041-1048. [PMID: 38448274 DOI: 10.1016/j.bja.2024.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/18/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. METHODS We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as 'definitely' include in any round, it was accepted. Indicative questions rated as 'definitely' or 'probably' by <50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. RESULTS There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven 'highest priority' research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. CONCLUSIONS We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas.
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Affiliation(s)
- Jenny Ferry
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - Owen Lewis
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - James Lloyd
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - Kariem El-Boghdadly
- Department of Anaesthesia & Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Rachel Kearns
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Eric Albrecht
- University Hospital of Lausanne, Lausanne, Switzerland; Department of Anaesthesia, University of Lausanne, Lausanne, Switzerland
| | - Fernando Altermatt
- Department of Anesthesiology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Amany E Ayad
- Department of Anesthesia, ICU and Pain, Cairo University, Cairo, Egypt
| | - Ezzat S Aziz
- Department of Anesthesia, ICU and Pain, Cairo University, Cairo, Egypt
| | - Lutful Aziz
- Department of Anaesthesia and Pain Medicine, Evercare Hospital, Dhaka, Bangladesh
| | | | | | - Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
| | - Alain Delbos
- Department of Anesthesia, Medipole Garonne, Toulouse, France
| | - Alex de Gracia
- Hospital Rafael Estevez, Caja de Seguro Social, Aguadulce, Panama
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Kwesi Kwofie
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sebastian Layera
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | | | | | - Eleni Moka
- Creta InterClinic Hospital, Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Milena Moreno
- Department of Anaesthesiology, Pontifical Xavierian University, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Columbia
| | - Bethan Morgan
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Arthur Polela
- Department of Anaesthesia and Critical Care, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vishal Uppal
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Marcelo Vaz Perez
- Departament of Anesthesiology and Pain Therapy of Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Centre, Homburg, Germany; Faculty of Medicine, Saarland University, Homburg, Germany
| | - Patrick B Y Wong
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - James S Bowness
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
| | - Alan J R Macfarlane
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Storgaard IK, Jensen EK, Bøgevig S, Balchen T, Springborg AH, Royal MA, Møller K, Werner MU, Lund TM. Population pharmacokinetic-pharmacodynamic model of subcutaneous bupivacaine in a novel extended-release microparticle formulation. Basic Clin Pharmacol Toxicol 2024; 134:676-685. [PMID: 38504615 DOI: 10.1111/bcpt.14004] [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: 12/11/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
The objective of this study was to develop a population pharmacokinetic-pharmacodynamic model of subcutaneously administered bupivacaine in a novel extended-release microparticle formulation for postoperative pain management. Bupivacaine was administered subcutaneously in the lower leg to 28 healthy male subjects in doses from 150 to 600 mg in a phase 1 randomized, placebo-controlled, double-blind, dose-ascending study with two different microparticle formulations, LIQ865A and LIQ865B. Warmth detection threshold was used as a surrogate pharmacodynamic endpoint. Population pharmacokinetic-pharmacodynamic models were fitted to plasma concentration-effect-time data using non-linear mixed-effects modelling. The pharmacokinetics were best described by a two-compartment model with biphasic absorption as two parallel absorption processes: a fast, zero-order process and a slower, first-order process with two transit compartments. The slow absorption process was found to be dose-dependent and rate-limiting for elimination at higher doses. Apparent bupivacaine clearance and the transit rate constant describing the slow absorption process both appeared to decrease with increasing doses following a power function with a shared covariate effect. The pharmacokinetic-pharmacodynamic relationship between plasma concentrations and effect was best described by a linear function. This model gives new insight into the pharmacokinetics and pharmacodynamics of microparticle formulations of bupivacaine and the biphasic absorption seen for several local anaesthetics.
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Affiliation(s)
- Ida Klitzing Storgaard
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Kjær Jensen
- Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark
- DanTrials, Zelo Phase 1 Unit, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Søren Bøgevig
- Department of Clinical Pharmacology, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Torben Balchen
- DanTrials, Zelo Phase 1 Unit, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Anders Holten Springborg
- Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark
- DanTrials, Zelo Phase 1 Unit, Copenhagen University Hospitals, Copenhagen, Denmark
| | | | - Kirsten Møller
- Department of Neuroanaesthesiology, Neuroscience Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads Utke Werner
- Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark
- DanTrials, Zelo Phase 1 Unit, Copenhagen University Hospitals, Copenhagen, Denmark
- Department of Clinical Science, Lund University, Lund, Sweden
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Jee S, Conn AM, Manly JT. Let's Stop the Pain: A Trauma-Informed Care Approach to Pediatric Vaccination. Clin Pediatr (Phila) 2024; 63:444-446. [PMID: 37548406 DOI: 10.1177/00099228231191939] [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: 08/08/2023]
Abstract
Exposure to pain during routine vaccinations and other injections can cause lifelong anxiety for pediatric patients that may persist into adulthood. Teaching pediatric providers and staff to use intentional and humane approaches to pain management, including distraction, positioning, and use of purposeful language can help to mitigate these fears. We share our experience with assessing pre and post changes to pain management in our pediatric outpatient setting caring for underserved patients and implementing a trauma-informed care approach.
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Affiliation(s)
- Sandra Jee
- Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
- Finger Lakes Children's Environmental Health Center, Rochester, NY, USA
- Center for Community Health, Rochester, NY, USA
| | - Anne-Marie Conn
- Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Jody Todd Manly
- Mount Hope Family Center, Department of Psychology, University of Rochester, Rochester, NY, USA
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Huhtala S, Palomaa AK, Tuomikoski AM, Pölkki T. Effectiveness of distraction-based interventions for relieving anxiety, fear, and pain in hospitalized children during venous blood sampling: a systematic review protocol. JBI Evid Synth 2024; 22:889-895. [PMID: 37921627 PMCID: PMC11081472 DOI: 10.11124/jbies-22-00057] [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: 11/04/2023]
Abstract
OBJECTIVE The aim of this review is to evaluate the effectiveness of active compared with passive distraction-based interventions for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling. INTRODUCTION Venous blood sampling remains the most common procedure that causes anxiety, fear, and pain among the pediatric population. It is important that health care professionals relieve a child's pain and the related emotions because untreated pain may have long-term effects on children's growth and development. It is necessary to determine which interventions are effective in relieving these outcomes in preschool and school-age children during blood sampling. INCLUSION CRITERIA This review will include randomized controlled trials and quasi-experimental studies that include active and passive distraction-based interventions for relieving hospitalized preschool and school-age children's anxiety, fear, and pain during venous blood sampling. METHODS CINAHL, PubMed, Scopus, and the Cochrane Library databases will be searched for published studies. MedNar, Google Scholar, and PsycEXTRA databases will be searched for in-progress and unpublished studies. Two independent researchers will perform critical appraisal and data extraction using the JBI methodology. Data describing randomized controlled trials and quasi-experimental studies will be pooled in a statistical meta-analysis. If statistical analysis is not possible, the findings will be reported narratively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess certainty in the quality of evidence. REVIEW REGISTRATION PROSPERO CRD42023455617.
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Affiliation(s)
- Saija Huhtala
- Kajaani University of Applied Sciences, Kajaani, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Anna-Kaija Palomaa
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Nursing Research Foundation, Helsinki, Finland
| | - Tarja Pölkki
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Nursing Research Foundation, Helsinki, Finland
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23
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Jarman MP, Jin G, Chen A, Losina E, Weissman JS, Berry SD, Salim A. Short-term outcomes of prehospital opioid pain management for older adults with fall-related injury. J Am Geriatr Soc 2024; 72:1384-1395. [PMID: 38418369 PMCID: PMC11090711 DOI: 10.1111/jgs.18830] [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: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia. METHODS We linked Medicare claims data with prehospital patient care reports for older adults (≥65) with fall-related injury in Illinois between January 1, 2014 and December 31, 2015. We used weighted regression models (logistic, multinomial logistic, and Poisson) to assess the association between prehospital opioid analgesia and incidence of inpatient delirium, hospital disposition, and length of stay. RESULTS Of 28,150 included older adults, 3% received prehospital opioids. Patients receiving prehospital opioids (vs. no prehospital opioids) were less likely to be discharged home from the emergency department (adjusted probability = 0.30 [95% CI: 0.25, 0.34] vs. 0.47 [95% CI: 0.46, 0.48]), more likely to be discharged to a non-home setting after an inpatient admission (adjusted probability = 0.43 [95% CI: 0.39, 0.48] vs. 0.30 [95% CI: 0.30, 0.31]), had inpatient length of stay 0.4 days shorter (p < 0.001) and ICU length of stay 0.7 days shorter (p = 0.045). Incidence of delirium did not vary between treatment and control groups. CONCLUSIONS Few older adults receive opioid analgesia in the prehospital setting. Prehospital opioid analgesia may be associated with hospital disposition and length of stay for older adults with fall-related injury. However, our findings do not provide evidence of an association with inpatient delirium. These findings should be considered when developing guidelines for prehospital pain management specific to the older adult population.
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Affiliation(s)
- Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Annie Chen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elena Losina
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Salim
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Woemn's Hospital, Boston, Massachusetts, United States
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Goh MPY, Samsul RN, Mohaimin AW, Goh HP, Zaini NH, Kifli N, Ahmad N. The Analgesic Potential of Litsea Species: A Systematic Review. Molecules 2024; 29:2079. [PMID: 38731572 PMCID: PMC11085224 DOI: 10.3390/molecules29092079] [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: 04/06/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Various plant species from the Litsea genus have been claimed to be beneficial for pain relief. The PRISMA approach was adopted to identify studies that reported analgesic properties of plants from the Litsea genus. Out of 450 records returned, 19 primary studies revealed the analgesic potential of nine Litsea species including (1) Litsea cubeba, (2) Litsea elliptibacea, (3) Litsea japonica, (4) Litsea glutinosa, (5) Litsea glaucescens, (6) Litsea guatemalensis, (7) Litsea lancifolia, (8) Litsea liyuyingi and (9) Litsea monopetala. Six of the species, 1, 3, 4, 7, 8 and 9, demonstrated peripheral antinociceptive properties as they inhibited acetic-acid-induced writhing in animal models. Species 1, 3, 4, 8 and 9 further showed effects via the central analgesic route at the spinal level by increasing the latencies of heat stimulated-nocifensive responses in the tail flick assay. The hot plate assay also revealed the efficacies of 4 and 9 at the supraspinal level. Species 6 was reported to ameliorate hyperalgesia induced via partial sciatic nerve ligation (PSNL). The antinociceptive effects of 1 and 3 were attributed to the regulatory effects of their bioactive compounds on inflammatory mediators. As for 2 and 5, their analgesic effect may be a result of their activity with the 5-hydroxytryptamine 1A receptor (5-HT1AR) which disrupted the pain-stimulating actions of 5-HT. Antinociceptive activities were documented for various major compounds of the Litsea plants. Overall, the findings suggested Litsea species as good sources of antinociceptive compounds that can be further developed to complement or substitute prescription drugs for pain management.
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Affiliation(s)
- May Poh Yik Goh
- Herbal Research Group, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei; (M.P.Y.G.); (R.N.S.); (A.W.M.); (N.K.)
- PAP Rashidah Saádatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei;
| | - Raudhatun Na’emah Samsul
- Herbal Research Group, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei; (M.P.Y.G.); (R.N.S.); (A.W.M.); (N.K.)
- Environmental and Life Sciences, Faculty of Science, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei
| | - Amal Widaad Mohaimin
- Herbal Research Group, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei; (M.P.Y.G.); (R.N.S.); (A.W.M.); (N.K.)
- Environmental and Life Sciences, Faculty of Science, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei
| | - Hui Poh Goh
- PAP Rashidah Saádatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei;
| | - Nurul Hazlina Zaini
- UBD Botanical Research Centre, Institute for Biodiversity and Environmental Research, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei;
| | - Nurolaini Kifli
- Herbal Research Group, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei; (M.P.Y.G.); (R.N.S.); (A.W.M.); (N.K.)
- PAP Rashidah Saádatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei;
| | - Norhayati Ahmad
- Herbal Research Group, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei; (M.P.Y.G.); (R.N.S.); (A.W.M.); (N.K.)
- Environmental and Life Sciences, Faculty of Science, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei
- UBD Botanical Research Centre, Institute for Biodiversity and Environmental Research, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Bandar Seri Begawan BE 1410, Brunei;
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25
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Guyer D, Steinhoff T, Maxwell AWP, Szymanski T, Shahamatdar S, Pinto M, Almhanna K. Palliative care tumor board: a narrative review and presentation of a novel conference to enhance collaboration and coordination of pain and symptom management for patients with advanced cancer. Ann Palliat Med 2024; 0:apm-22-1366. [PMID: 38735690 DOI: 10.21037/apm-22-1366] [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: 05/14/2024]
Abstract
BACKGROUND AND OBJECTIVE The World Health Organization endorses that palliative care has a significant impact on the outcomes of patients with cancer. Integration of palliative care into standard oncology practice has been shown to improve a variety of patient outcomes. In this article, we present our experience with the development of a palliative care tumor board. METHODS Starting in June 2021, we implemented a multidisciplinary palliative care and oncology tumor board focused on pain and symptom management. Complex cases were presented bimonthly. We retrospectively reviewed our experience. Data were collected on the attendees, the case presented, and the resultant therapeutic decisions made. KEY CONTENT AND FINDINGS Between June 2021 and September 2022, tumor board meetings were conducted in person and virtually. An average of twelve people attended, including physicians and nurse practitioners from the palliative care, oncology, interventional radiology, radiation oncology, psychiatry, pediatric palliative care, and physical medicine and rehab disciplines. There were 68 patients presented with the most frequently discussed cancer being breast cancer, followed by lung cancer. A total of 18 patients (26%) were referred for procedure, including 7 patients (10%) for radiation and 11 patients (16%) for interventional procedures, and 34 patients (50%) had medication changes as outcomes of the meeting. CONCLUSIONS The development of a biweekly palliative care conference modeled after traditional oncologic tumor board meetings allows patients to be discussed in a multidisciplinary setting and commonly results in changes in the management for pain and other cancer-related symptoms.
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Affiliation(s)
- Dana Guyer
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA; Alpert Medical School of Brown University, Providence, RI, USA; Department of Geriatrics and Palliative Care, Alpert Medical School of Brown University, Providence, RI, USA
| | - Timothy Steinhoff
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA; Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Aaron W P Maxwell
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA; Alpert Medical School of Brown University, Providence, RI, USA; Department of Interventional Radiology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Tara Szymanski
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA
| | | | - Mauricio Pinto
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Khaldoun Almhanna
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA; Alpert Medical School of Brown University, Providence, RI, USA; Department of Oncology, Alpert Medical School of Brown University, Providence, RI, USA
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26
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Obeagu EI, Obeagu GU. Management of diabetes mellitus patients with sickle cell anemia: Challenges and therapeutic approaches. Medicine (Baltimore) 2024; 103:e37941. [PMID: 38669382 PMCID: PMC11049766 DOI: 10.1097/md.0000000000037941] [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: 11/26/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
The coexistence of diabetes mellitus (DM) and sickle cell anemia (SCA) poses significant challenges in clinical management due to the complex interactions and overlapping complications associated with both conditions. Managing diabetes in individuals with SCA requires a comprehensive approach that addresses the unique physiological and pathological aspects of both diseases. This paper reviews the challenges encountered in the management of DM in patients with SCA and explores therapeutic strategies and approaches to optimize patient care. Challenges in the management of DM in individuals with SCA stem from several factors, including the impact of hemoglobin variants on glycemic control assessment, increased susceptibility to infections, altered immune response, and complications associated with both diseases. Moreover, the coexistence of SCA and DM heightens the susceptibility to infections due to compromised immune function, emphasizing the need for vigilant preventive measures, including vaccinations and close monitoring for infectious complications. Close collaboration among healthcare providers specializing in diabetes, hematology, and other relevant fields is crucial for developing comprehensive care plans. Individualized treatment strategies that balance glycemic control, pain management, and preventive care are essential to mitigate complications and optimize the overall health outcomes of patients with both DM and SCA. In conclusion, managing diabetes in the context of SCA necessitates a nuanced and patient-centered approach. By addressing the challenges and employing tailored therapeutic strategies, healthcare providers can improve the quality of life and health outcomes for individuals affected by both conditions.
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Brooks AK, Athawale A, Rush V, Yearout A, Ford S, Rejeski WJ, Strahley A, Fanning J. Successes and lessons learned from a mobile health behavior intervention to reduce pain and improve health in older adults with obesity and chronic pain: a qualitative study. Front Pain Res (Lausanne) 2024; 5:1340400. [PMID: 38726351 PMCID: PMC11079154 DOI: 10.3389/fpain.2024.1340400] [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: 11/17/2023] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Chronic pain is a prevalent issue among older adults in the United States that impairs quality of life. Physical activity has emerged as a cost-effective and non-pharmacological treatment for chronic pain, offering benefits such as improved physical functioning, weight loss, and enhanced mood. However, promoting physical activity in older individuals with chronic pain is challenging, given the cyclical relationship between pain and sedentary behavior. The Mobile Intervention to Reduce Pain and Improve Health (MORPH) trial was designed as an innovative, mobile health (mHealth) supported intervention to address this issue by targeting daylong movement, weight loss, and mindfulness to manage pain in older adults with chronic multisite pain. The objective of this paper is to provide the result of a qualitative analysis conducted on post-intervention interviews with MORPH participants. Methods At the conclusion of the MORPH study, 14 participants were interviewed regarding their experience with the program. All interviews were conducted by phone before being transcribed and verified. A codebook of significant takeaways was created based on these accounts. Summaries were further synthesized into themes using the principles of thematic analysis. Results Three key themes of the MORPH intervention emerged from the qualitative interviews: MORPH technology (smart scales, Fitbit, MORPH Companion App) facilitated program adherence and accountability; MORPH intervention components (food tracking and mindfulness activities) facilitated program adherence and awareness, respectively; and, group meetings provided motivational support and accountability. Mobile health technologies, including a dedicated MORPH app, facilitated self-monitoring strategies, helped to break the cycle of old habits, and provided participants with immediate feedback on successes; however, technical issues required timely support to maintain engagement. Food tracking contributed to adherence and accountability for weight loss. Mindfulness activities increased participants' awareness of anxiety provoking thoughts and pain triggers. Finally, social support via group meetings and connection, played a crucial role in behavior change, but participants noted consistency in the delivery medium was essential to fostering genuine connections. Conclusion Overall, the study results highlight the key considerations related to program technology, intervention components, and the value of social support that can help to guide the development of future interventions similar to MORPH.
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Affiliation(s)
- Amber K. Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Abha Athawale
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Virginia Rush
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Abigail Yearout
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Ashley Strahley
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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Emmet DK, Davis G, Pierce-Talsma S, Shubrook JH, Mehling W. Interoceptive bodily awareness in patients seeking pain relief with osteopathic manipulative treatment: an observational cohort pilot study. J Osteopath Med 2024; 0:jom-2022-0081. [PMID: 38650438 DOI: 10.1515/jom-2022-0081] [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: 04/23/2022] [Accepted: 02/14/2024] [Indexed: 04/25/2024]
Abstract
CONTEXT Interoceptive bodily awareness (IBA) is one's attentional focus on and relationship with comfortable and uncomfortable (e.g., pain) internal body sensations. Integrating IBA into research on osteopathic manipulative treatment (OMT) is growing, both as an outcome and predictor of treatment outcomes; however, it has yet to be studied in a clinical setting. OBJECTIVES We aimed to conduct a pilot study to measure IBA, with the Multidimensional Assessment of Interoceptive Awareness (MAIA), in patients seeking OMT for pain, and to test if OMT exposure may be associated with higher IBA as measured by the MAIA. The primary outcome was the change in MAIA scores, and the secondary outcomes were reduction in pain intensity, reduction in pain interference, and increase in participants' perception of change post-OMT. METHODS A convenience sample was recruited from individuals presenting for OMT appointments at a College of Osteopathic Medicine OMT teaching clinic. Participants were recruited into our single-arm observational cohort study (n=36), and categorized into one of two groups, OMT-naïve (n=19) or OMT-experienced (n=17), based on prior exposure to OMT. We measured MAIA scores and clinical pain-related outcomes prior to, immediately after, and at 1 and 3 weeks after a usual-care OMT session in the clinic. Covariates including experience with mind-body activities, non-OMT body work, and physical and emotional trauma were also collected to explore potential relationships. We utilized t tests to compare MAIA scores and pain outcomes between groups and across time points. Stepwise regression models were utilized to explore potential relationships with covariates. RESULTS The OMT-experienced group scored higher on the MAIA scales "Not-worrying" (p=0.002) and "Trusting" (p=0.028) at baseline. There were no significant changes in the MAIA scores before and after the single OMT session. Analysis of secondary outcomes revealed that all pain outcomes significantly decreased post-OMT (p<0.05), with the largest relative improvements in the acute pain and OMT-naïve subgroups, with diminishing effects over time. CONCLUSIONS Assessing IBA with MAIA in a clinical OMT setting is feasible. There were significant positive correlations between OMT exposure and two of the eight MAIA scales. Future studies are justified to further explore this relationship.
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Affiliation(s)
- Danielle K Emmet
- Department of Physical Medicine and Rehabilitation, New York Presbyterian 12295 , Weill Cornell Medicine and Columbia University , New York, USA
| | - Glenn Davis
- College of Osteopathic Medicine, 155229 Touro University California , Vallejo, CA, USA
| | - Stacey Pierce-Talsma
- College of Osteopathic Medicine, 115985 University of New England , Biddeford, ME, USA
| | - Jay H Shubrook
- College of Osteopathic Medicine, 155229 Touro University California , Vallejo, CA, USA
| | - Wolf Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, 8785 University California San Francisco , San Francisco, CA, USA
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Kammien AJ, Hu K, Collar J, Rancu AL, Zhao KL, Grauer JN, Colen DL. The Correlation of Surgical Setting With Perioperative Opioid Prescriptions for Wide-Awake Carpal Tunnel Release. Hand (N Y) 2024:15589447241247247. [PMID: 38654508 DOI: 10.1177/15589447241247247] [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: 04/26/2024]
Abstract
BACKGROUND Prior studies have compared perioperative opioid prescriptions between carpal tunnel release (CTR) performed wide-awake and with traditional anesthetic techniques, but the association of opioid prescriptions with surgical setting has not been fully explored. The current study assessed the association of opioid prescriptions with surgical setting (office or operating room) for wide-awake CTR. METHODS Patients with open CTR were identified in an administrative claims database (PearlDiver). Exclusion criteria included age less than 18 years, preoperative data less than 6 months, postoperative data less than 1 month, bilateral surgery, concomitant hand surgery, and traditional anesthesia (general anesthesia, sedation, or regional block). Patients were stratified by surgical setting (office or operating room) and matched by age, sex, Elixhauser Comorbidity Index, and geographic region. Prior opioid prescriptions, opioid dependence/abuse, substance use disorder, back/neck pain, generalized anxiety, and major depression were identified. Opioid prescriptions within 7 days before and 30 days after surgery were characterized. RESULTS Each matched cohort included 5713 patients. Compared with patients with surgery in the operating room, fewer patients with office-based surgery filled opioid prescriptions (45% vs 62%), and those prescriptions had lower morphine milligram equivalents (MMEs, median 130 vs 188). These findings were statistically significant on univariate and multivariate analysis. CONCLUSIONS Following office-based CTR, fewer patients filled opioid prescriptions, and filled prescriptions had lower MME. This likely reflects patient and provider attitudes about pain control and opioid utilization. Further patient- and provider-level investigation may provide additional insights that could aid in efforts to reduce perioperative opioid utilization across surgical settings.
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Affiliation(s)
| | - Kevin Hu
- Yale School of Medicine, New Haven, CT, USA
| | - John Collar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - K Lynn Zhao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - David L Colen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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Riffin C, Mei L, Brody L, Herr K, Pillemer KA, Reid MC. Program of All-Inclusive Care for the Elderly: an untapped setting for research to advance pain care in older persons. Front Pain Res (Lausanne) 2024; 5:1347473. [PMID: 38712020 PMCID: PMC11070459 DOI: 10.3389/fpain.2024.1347473] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/10/2024] [Indexed: 05/08/2024] Open
Abstract
The Program of All-Inclusive Care for the Elderly (PACE) is a community-based care model in the United States that provides comprehensive health and social services to frail, nursing home-eligible adults aged 55 years and older. PACE organizations aim to support adequate pain control in their participants, yet few evidence-based pain interventions have been adopted or integrated into this setting. This article provides a roadmap for researchers who are interested in collaborating with PACE organizations to embed and evaluate evidence-based pain tools and interventions. We situate our discussion within the Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework that considers multi-level influences to implementation and evaluation of evidence-based programs. Within each CFIR domain, we identify key factors informed by our own work that merit consideration by research teams and PACE collaborators. Inner setting components pertain to the organizational culture of each PACE organization, the type and quality of electronic health record data, and availability of staff to assist with data abstraction. Outer setting components include external policies and regulations by the National PACE Association and audits conducted by the Centers for Medicare and Medicaid Services, which have implications for research participant recruitment and enrollment. Individual-level characteristics of PACE organization leaders include their receptivity toward new innovations and perceived ability to implement them. Forming and sustaining research-PACE partnerships to deliver evidence-based pain interventions pain will require attention to multi-level factors that may influence future uptake and provides a way to improve the health and well-being of patients served by these programs.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lauren Mei
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, IA, United States
| | - Karl A. Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - M. Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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de Sire A, Marotta N, Sconza C, Lippi L, Drago Ferrante V, Respizzi S, Invernizzi M, Ammendolia A. Oxygen-ozone therapy for pain relief in patients with trapeziometacarpal osteoarthritis: a proof-of-concept study. Disabil Rehabil 2024:1-7. [PMID: 38644616 DOI: 10.1080/09638288.2024.2342491] [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: 11/23/2023] [Accepted: 04/05/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE Trapeziometacarpal osteoarthritis (TMC-OA) is a prevalent hand disorder affecting a growing number of people worldwide. While a multidisciplinary approach might provide additional advantages, the analgesic and anti-inflammatory role of intra-articular oxygen-ozone (O2O3) injections combined with physical therapy is still unknown. To assess the impact of a multimodal therapeutic approach combining O2O3 injections with physical therapy in patients with TMC-OA. MATERIALS AND METHODS A prospective open-label study conducted in the Physical and Rehabilitation Medicine Unit of the "Renato Dulbecco" University Hospital of Catanzaro. We assessed patients with TMC-OA who had not responded to standard medical therapy. Participants received O2O3 therapy and targeted physical therapy for 4 weeks. Pain relief, muscle strength, and physical functioning were assessed at baseline and after 4, 12 and 24 weeks (respectively T0, T1, T2, and T3). RESULTS Seventeen patients with a mean age of 67.1 ± 6.1 years were included in the study. Short-term improvements in pain intensity were observed (T0: 6.221 ± 1.514; T1: 3.172 ± 1.1451; p < .001) and were maintained over a 24-week follow-up period (T0: 6.221 ± 1.514; T3: 4.393 ± 1.438; p: 0.006). Significant changes were reported also in terms of muscle strength and physical functioning. O2O3 therapy was well-tolerated with no adverse effects. CONCLUSIONS A combination of O2O3 injections and physical therapy might be considered in patients with TMC-OA. Further investigation is warranted to assess the effectiveness of O2O3 therapy in managing TMC-OA.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical and Rehabilitative Medicine Unit, Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Cristiano Sconza
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, Budapest, Hungary
| | - Vera Drago Ferrante
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Stefano Respizzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Chai S, Roney P, Fagan J, Rosario ER. Assessment of a novel Ehlers-Danlos syndromes disability index. Front Rehabil Sci 2024; 5:1280582. [PMID: 38707743 PMCID: PMC11066269 DOI: 10.3389/fresc.2024.1280582] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
Background The Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders characterized by disruptions in collagen synthesis and processing. These disorders lead to various symptoms, including hypermobility, musculoskeletal conditions, and chronic pain that can significantly limit patients' daily living. In the absence of a curative treatment, an EDS specific disability index that tracks changes in patient-reported outcomes can facilitate the investigation of new treatment options and enhance the quality of life for EDS patients. Methods An EDS-specific disability index was created using survey data and input from clinicians. A total of 222 EDS patients in a multidisciplinary clinical program completed the index during their initial visit. Exploratory and confirmatory factor analyses were conducted to determine the index's factor solution and assess its goodness-of-fit. Paired t-tests were performed with follow-up visit data collected over the course of one year. Results The exploratory and confirmatory factor analyses indicated a two-factor solution, accounting for 42.40% of the variance. The index demonstrated adequate fit to the data, supported by Tucker and Lewis's index (0.85) and root mean square error of approximation (0.1). Data from follow-up visits showed significant improvement in three symptom related variables and one function related variable in addition to the total score and the symptom subscale score when compared to the initial visit. Conclusion The development of an EDS-specific disability index is a crucial step in creating a clinical tool that enables healthcare professionals to gain a deeper understanding of the impact EDS has on patients' lives and potentially identify new therapeutic interventions.
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Affiliation(s)
- Stephen Chai
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
| | - Patricia Roney
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
| | - John Fagan
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
| | - Emily Rose Rosario
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
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Xiao Y, He J. Analyzing the application of dezocine combined with psychological care in the postoperative pain management of patients with hemifacial spasm. Int J Neurosci 2024:1-8. [PMID: 38602339 DOI: 10.1080/00207454.2024.2341919] [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: 02/27/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To analyze the application of Dezocine combined with psychological care in the postoperative pain management. METHODS This is a retrospective study. A total of 186 HFS patients who underwent Microvascular Decompression (MVD) at First People's Hospital of Zunyi between January 2020 and January 2022 were selected as the study subjects. Patients were divided into two groups based on different treatment interventions. The control group (n = 93) received routine perioperative care without preemptive analgesia, while the observation group (n = 93) received preemptive analgesia and combined psychological care on the basis of the control group's intervention. RESULTS At 30 min post-laryngeal mask removal (T3), no significant difference in Ramsay Sedation Scale scores existed between control and observation groups (p > 0.05). The observation group showed significantly lower RSS scores at immediate mask removal (T2) and VAS scores at T3 compared to controls (p < 0.05). Following intervention, the observation group had notably lower SAS and SDS scores than controls (p < 0.05). Baseline (T0) and 5 min pre-removal (T1) exhibited no significant differences in mean arterial pressure (MAP) and heart rate (HR) values between groups (p > 0.05). However, at T2 and T3, the observation group displayed significantly lower MAP and HR values than controls (p < 0.05). No significant differences in pulse oxygen saturation (SpO2) values existed between groups at any time point (p > 0.05). CONCLUSION Compared to standard perioperative care alone, Dezocine combined with preemptive analgesia and psychological care effectively reduces postoperative pain during the awakening period, lowers the risk of immediate extubation-related agitation, and maintains stable hemodynamics in the postoperative period.
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Affiliation(s)
- Ying Xiao
- Department of Neurosurgery, First People's Hospital of Zunyi City, Guizhou Province, China
| | - Jiqiong He
- Department of Stomatology, First People's Hospital of Zunyi City, Guizhou Province, China
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Reed JR, Parks SK, Kaniaru A, Hefley J, Yauger Y, Edwards JV, Glymph DC. Ketamine Use for Palliative Care in the Austere Environment: Is Ketamine the Path Forward for Palliative Care. Am J Hosp Palliat Care 2024:10499091241246520. [PMID: 38631682 DOI: 10.1177/10499091241246520] [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: 04/19/2024] Open
Abstract
The goal of palliative care is to focus on the holistic needs of the patient and their family versus the pathology of the patient's diagnosis to reduce the stress of illness. U.S. servicemembers deployed to austere environments worldwide have significantly less access to palliative care than in military treatment facilities in the U.S. Preparation for future conflicts introduces the concept of prolonged medical management for an environment where urgent casualty evacuation is impossible. Ketamine is currently widely used for analgesia and anesthesia in the care of military service members and its use has increased in combat zones of Iraq and Afghanistan due to the favorable preservation of respiratory function, minimal changes in hemodynamics, and lower pain scores compared to opioids. Ketamine acts as a non-competitive antagonist on N-methyl-D aspartate (NMDA) receptors. Its anesthesia and analgesic effects are complex and include both presynaptic and postsynaptic neurons in brain and spinal cord. The use of palliative care to minimize suffering should not be withheld due to the logistical boundaries of austere military environments or lack of guidelines for recommended use. The use of ketamine for palliative care is a new clinical management strategy to provide both sedation and pain management for an acute pain crisis or comfort measures for the terminally ill. This makes ketamine an attractive consideration for palliative care when managing critically wounded patients for an extended time.
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Affiliation(s)
- John R Reed
- Dwight D. Eisenhower Army Medical Center, Fort Eisenhower, GA, USA
| | | | - Antony Kaniaru
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Justin Hefley
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Young Yauger
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Wang Z, Wang F, Jiang X, Wang W, Xing Y, Qiu X, Sun C, Tang L. Nitrous Oxide to Reduce Wound Care-Related Pain in Adults: A Systematic Review and Meta-Analysis. Adv Wound Care (New Rochelle) 2024. [PMID: 38511513 DOI: 10.1089/wound.2023.0211] [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: 03/22/2024] Open
Abstract
Significance: As an essential procedure, wound care comes with acute pain, which is short but high in intensity, causing patients to fear and affecting subsequent treatment. Nitrous oxide (N2O) is used to relieve pain related to wound care; however, evidence regarding its application is conflicting. Thus, this systematic review and meta-analysis was performed to evaluate the efficacy of N2O in wound care-related pain. Recent Advances: Randomized controlled trials that investigated the effect of N2O in adults undergoing wound care were systematically searched from PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov up to February 2023. The primary outcome was the pain score. Secondary outcomes included patients' satisfaction and side effects. Critical Issues: Through screening the 265 identified articles, seven and six studies were finally included in the systematic review and meta-analysis, respectively. Pooled analysis suggested that there was no significant difference in reducing wound care-related pain between the N2O group and the control group (mean difference [MD], -0.02, 95% confidence interval [CI], -1.46, 1.42; p = 0.98, I2 = 96%). Subgroup analyses indicated that there was a significant difference in favor of N2O for burns, not for ulcers, and N2O was superior to oxygen and similar to topical or intravenous anesthesia. There was no significant difference in patients' satisfaction or the incidence of side effects between groups. Future Directions: This review suggests that N2O might be effective for pain management in patients undergoing wound care. Caution must be taken when interpreting these results due to the high risk of biased methods in the included studies.
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Affiliation(s)
- Ziyang Wang
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Fei Wang
- Department of Anesthesiology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, People's Republic of China
| | - Xiaochen Jiang
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Weifeng Wang
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Yihui Xing
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Xueling Qiu
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Shandong First Medical University, Tai'an, People's Republic of China
| | - Chenxi Sun
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- Graduate Training Base of Jinzhou Medical University, The 960th Hospital of People's Liberation Army of China, Jinzhou, People's Republic of China
| | - Lu Tang
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
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Ullsten A, Campbell-Yeo M, Eriksson M. Parent-led neonatal pain management-a narrative review and update of research and practices. Front Pain Res (Lausanne) 2024; 5:1375868. [PMID: 38689885 PMCID: PMC11058235 DOI: 10.3389/fpain.2024.1375868] [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: 01/24/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills. Methods In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research. Results Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change. Conclusion Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.
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Affiliation(s)
- Alexandra Ullsten
- Center for Clinical Research and Education, Region Värmland, Karlstad, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- MOM-LINC Lab, IWK Health Halifax, Halifax, NS, Canada
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Hebard S, Weaver G, Hansen WB, Ruppert S. Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study. JMIR Form Res 2024; 8:e53665. [PMID: 38607664 PMCID: PMC11053396 DOI: 10.2196/53665] [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: 10/25/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual's intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. OBJECTIVE This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. METHODS A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. RESULTS After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (-1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. CONCLUSIONS While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees.
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Affiliation(s)
| | - GracieLee Weaver
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States
| | | | - Scarlett Ruppert
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States
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Noh H, Suntai Z, Won C, Jeong H, Lee LH. A Qualitative Exploration of Rural Older Adults' Experiences With Pain From Chronic Illnesses and Its Treatment. Res Aging 2024:1640275241246279. [PMID: 38613140 DOI: 10.1177/01640275241246279] [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: 04/14/2024]
Abstract
Pain is one of the most common concerns among chronically ill older adults. However, access to pain management is not equitable among certain populations, including rural residents. This qualitative study explored rural older adults' experiences with pain and its treatment. Eighteen participants were recruited from rural counties of Alabama, who were age 60+, cognitively intact, community-dwelling, had one or more chronic/serious illnesses, and experienced pain. Open-ended questions were asked in individual interviews, and inductive, thematic analysis was used for data analysis. Findings revealed the impact of pain (physical limitations, psychological distress, and coping strategies), the impact of COVID-19 (physical/mental health and pain management), challenges in pain management in rural areas (lack of provider and healthcare resources, transportation-related issues, mistrust, and limited insurance coverage) and suggestions to address these challenges. Program and policy-level interventions are crucial in improving the resources and education/training needed for effective pain management for rural older adults.
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Affiliation(s)
- Hyunjin Noh
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Chorong Won
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - Haelim Jeong
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - Lewis H Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
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Zacha S, Biernawska J. Cryoanalgesia as the Essential Element of Enhanced Recovery after Surgery (ERAS) in Children Undergoing Thoracic Surgery-Scoping Review. J Pers Med 2024; 14:411. [PMID: 38673038 PMCID: PMC11051180 DOI: 10.3390/jpm14040411] [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: 03/17/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
This article aims to present cryoanalgesia as an inventive strategy for pain alleviation among pediatric patients. It underlines the tremendous need to align pain management with the principles of the enhanced recovery after surgery (ERAS) approach. The aim of the study was to review the patient outcomes of nerve cryoanalgesia during surgery reported with regard to ERAS in the literature. The literature search was performed using PubMed and Embase to identify articles on the use of cryoanalgesia in children. It excluded editorials, reviews, meta-analyses, and non-English articles. The analysis focused on the study methods, data analysis, patient selection, and patient follow-up. This review includes a total of 25 articles. Three of the articles report the results of cryoanalgesia implemented in ERAS protocol in children. The research outcome indicates shortened hospital stay, potential reduction in opioid dosage, and significant progress in physical rehabilitation. This paper also describes the first intraoperative utilization of intercostal nerve cryoanalgesia during the Nuss procedure in Poland, highlighting its effectiveness in pain management. Adding the cryoanalgesia procedure to multimodal analgesia protocol may facilitate the implementation of the ERAS protocol in pediatric patients.
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Affiliation(s)
- Sławomir Zacha
- Department of Pediatric Orthopedics and Oncology of Musculoskeletal System, Pomeranian Medical University in Szczecin, 70-252 Szczecin, Poland
| | - Jowita Biernawska
- Department of Anesthesiology and Intensive Therapy, Pomeranian Medical University in Szczecin, 70-252 Szczecin, Poland;
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Zhang J, Ma K, Yan J, Pan P, Yin J, Lin F, Chen H, Zhao W, Chen M, Zhang Z, Liu M, Gu X, Liao X, Zhang C, Cheng W. Current Status of Cognition and Clinical Practice of Refractory Cancer Pain in Shanghai: A Questionnaire Survey. J Pain Res 2024; 17:1413-1422. [PMID: 38618294 PMCID: PMC11015849 DOI: 10.2147/jpr.s452605] [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: 12/19/2023] [Accepted: 04/04/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose This study aimed to assess the current status of clinical practice of refractory cancer pain (RCP) among a sample of physicians specializing in cancer pain management in Shanghai. Methods From 2019 to 2021, a questionnaire survey was conducted among physicians engaged in diagnosis and treatment of cancer pain through the questionnaire WJX network platform in Shanghai, China. Results A total of 238 responses participated in the survey. This survey reports physicians' understanding and incidence rate of breakthrough cancer pain (BTCP). The choice of analgesics and satisfaction of analgesic effect were investigated. We also investigated doctors' knowledge of the diagnostic criteria for RCP and their tendency to choose analgesics. Oral immediate-release morphine and intravenous or subcutaneous morphine injection have been the common treatment approach for transient cancer pain exacerbations. The main barriers to pain management are lack of standardized treatment methods for RCP, lack of knowledge related to RCP, and single drug dosage form. Doctors believe the most necessary measures to improve the current situation of poor cancer pain control include improving medical staff's understanding and treatment techniques for RCP, updating treatment techniques and methods, and improving the configuration of drug types in medical institutions. Clinicians expect to improve understanding and treatment techniques through systematic training. Conclusion Despite multiple available analgesic measures, the treatment of RCP remains challenging. Improving the understanding of medical staff towards RCP, improving treatment techniques, and increasing the accessibility of multiple drug types are important ways to improve the satisfaction of cancer pain management in the future.
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Affiliation(s)
- Jing Zhang
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Ke Ma
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jun Yan
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China
| | - Pingsheng Pan
- Department of Oncology, Fangta Hospital of Traditional Chinese Medicine in Songjiang District, Shanghai, People’s Republic of China
| | - Jiangshan Yin
- Department of Oncology, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai, People’s Republic of China
| | - Fuqing Lin
- Department of Anaesthesiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Hui Chen
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Weiwei Zhao
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Menglei Chen
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Zhe Zhang
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Minghui Liu
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xiaoli Gu
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xinghe Liao
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Chenyue Zhang
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Wenwu Cheng
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
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Ingelson B, Dahlke S, O'Rourke H, Hunter KF. Nurses' knowledge and beliefs on pain management practices with hospitalised persons living with dementia: A qualitative descriptive study. J Clin Nurs 2024. [PMID: 38590077 DOI: 10.1111/jocn.17164] [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: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
AIM To understand nurses' knowledge, beliefs and experiences affect pain management practices in hospitalised persons living with dementia (PLWD). DESIGN Naturalistic inquiry using qualitative descriptive design. METHODS Semi-structured interviews were conducted with 12 registered nurses who worked in one acute care hospital in Southern California from October to November 2022. Data were analysed using content analysis to identify themes. RESULTS Two themes were developed: improvising pain assessment, which included how pain was documented, and administration hesitancy referring to nurse's concerns about PLWD's confusion. Nurses described the challenges of assessing pain in hospitalised PLWD particularly if they were non-verbal and/or demonstrating responsive behaviours. Nurse's years of experience, dementia stigma, and their unconscious biases affected nurses' pain management practices. CONCLUSIONS The study findings highlight the complex challenges of pain management in hospitalised PLWD that are exacerbated by nurses' knowledge deficits, negative stereotypical beliefs, dementia stigma and unconscious biases towards older people that contributes to undermanaged pain in hospitalised PLWD. IMPLICATIONS A comprehensive strategy using an implementation framework is needed to address nurse's knowledge gaps, unconscious bias, dementia stigma and techniques that enhance communication skills is suggested. Building a foundation in these areas would improve pain management in hospitalised PLWD. IMPACT Improving pain management in hospitalised PLWD would improve the quality of life, decrease hospital length of stay, prevent readmissions, and improve nurse satisfaction. REPORTING METHOD The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT CONTRIBUTIONS Improving pain management in hospitalised PLWD would prevent long term confusion, episodes of delirium and improve quality of life as they recover from their acute illness for which they required hospital care.
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Affiliation(s)
- Beverly Ingelson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah O'Rourke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Mahon RM, Rajbhandari P, Brown TA, Engler LJ, Bhalla T. Improving perioperative acetaminophen administration for safer and cost-effective multimodal analgesia in pediatric surgery: A QI initiative. Paediatr Anaesth 2024. [PMID: 38578161 DOI: 10.1111/pan.14893] [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] [Received: 12/20/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The use of acetaminophen in the perioperative period has emerged as an attractive option for providing safer and cost-effective analgesia in children. AIMS The primary aim of our project was to increase the use of acetaminophen (both oral and intravenous) in the perioperative period from a baseline of 39.5% to 50% for all surgical patients within 24 months. The secondary aim was to increase the use of enteral acetaminophen from 10% to 52.5% during the same period. METHODS A multidisciplinary team was formed, and model for improvement was chosen as the QI methodology. The primary measure was the total percentage of surgical patients receiving any form of perioperative acetaminophen, while our secondary measure was the percentage use of oral acetaminophen administration. We also tracked the average maximum PACU (Post Anesthesia Care Unit) pain scores and the percentage of patients receiving IV opioids. Multiple interventions were conducted, including education, increasing the availability of acetaminophen, and optimizing the electronic medical record (EMR). Monthly data was collected using an automated report in the EMR. RESULTS We successfully achieved our goal, increasing the use of acetaminophen from 39.5% to 70% within four months. Despite some fluctuations, by the end of 24 months, we not only met but surpassed our goal, with 63% of patients receiving perioperative acetaminophen. Similarly, the usage of oral acetaminophen increased from a baseline of 10% to 78%. Our average maximum PACU pain scores improved from 5.4 to 5.2, and the percentage of patients receiving rescue opioids decreased from 15.4 to 13.1. CONCLUSION We successfully achieved and sustained our goals of improving acetaminophen use for our surgical patients without worsening pain scores or worsening use of intravenous opioids. Future directions include further refining our strategies and exploring additional opportunities to optimize pain management in pediatric perioperative settings.
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Joseph K, Mills J. Improvements from a small-group multidisciplinary pain self-management intervention for women living with pelvic pain maintained at 12 months. Aust N Z J Obstet Gynaecol 2024. [PMID: 38581105 DOI: 10.1111/ajo.13817] [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: 01/29/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND A small-group multidisciplinary pain self-management program for women living with pelvic pain, with or without endometriosis, was developed to address identified unmet treatment needs. Following completion, over 80% of participants demonstrated clinically significant improvement across a number of domains. There was no clinically significant deterioration on any measure and benefits continued at three months follow-up. AIMS This study examines patient-reported outcomes at 12 months following program completion to ascertain maintenance of these improvements. MATERIALS AND METHODS Self-report measures assessed quality of life across the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials domains prior to, at completion and 12 months following participation. RESULTS At 12 months follow-up, improvement was seen in mean group scores for all baseline measures for 57% of participants who returned valid 12-month follow-up data, with clinically significant improvement seen for within-subject scores for 50% of these participants for pain severity and also for pain-related activity interference. Improvements were also reported in key predictors of long-term outcomes, pain self-efficacy and catastrophic worry, with 92% reporting improvement in each of these two constructs. There were 83% of respondents who reported feeling both improvement in overall sense of wellbeing and improvement in their physical ability compared to before the program. CONCLUSIONS Results suggest that a six-week multidisciplinary small-group intervention increases participants' abilities to self-manage pain and improves quality of life with lasting clinically significant improvements.
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Affiliation(s)
- Karen Joseph
- Pelvic Pain NZ, Christchurch, New Zealand
- University of Otago, Christchurch, New Zealand
| | - Jessica Mills
- Pelvic Pain NZ, Christchurch, New Zealand
- University of Otago, Christchurch, New Zealand
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Sear C. Peripheral neuropathic pain: supporting patients with self-management. Nurs Stand 2024; 39:71-75. [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] [MESH Headings] [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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Bulls HW, Hamm M, Wasilewski J, Olejniczak D, Bell SG, Liebschutz JM. "To prescribe or not to prescribe, that is the question": Perspectives on opioid prescribing for chronic, cancer-related pain from clinicians who treat pain in survivorship. Cancer 2024. [PMID: 38567685 DOI: 10.1002/cncr.35299] [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: 01/25/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Opioid pain management in cancer survivorship is a complex and understudied topic. METHODS The authors conducted in-depth, qualitative interviews to understand clinician approaches to opioid pain management in chronic cancer pain and to generate ideas for improvement. They used a rigorous, inductive, qualitative, descriptive approach to examine clinician (n = 20) perspectives about opioid pain management in survivorship, including oncologists (n = 5), palliative care clinicians (n = 8), primary care clinicians (n = 5), and pain management specialists (n = 2). RESULTS The findings indicated that no consistent medical home exists for chronic pain management in cancer survivors and that there are fundamental differences in how each subspecialty approaches chronic pain management in survivorship (e.g., "Do we think of this as noncancer pain or cancer pain?… This is in this limbo zone-this gray zone-because it's cancer-related pain, right?"). Simultaneously, clinicians are influenced by their peers' perceptions of their opioid prescribing decisions, sparking intraprofessional tension when disagreement occurs. In these instances, clinicians described overthinking and doubting their clinical decision-making as well as a sense of judgment, pressure, and/or shame. Finally, clinicians acknowledged a fear of consequences for opioid prescribing decisions. Specifically, participants cited conflict with patients, sometimes escalating to aggression and threats of violence, as well as potential disciplinary actions and/or legal consequences. CONCLUSIONS Participants suggested that opportunities to improve chronic cancer pain care include developing clear, systematic guidance for chronic cancer pain management, facilitating clinician communication and consultation, creating tailored survivorship care plans in partnership with patients, and developing accessible, evidence-based, complementary pain treatments.
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Affiliation(s)
- Hailey W Bulls
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Challenges in Managing and Preventing Pain Clinical Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Megan Hamm
- Qualitative, Evaluation, and Stakeholder Engagement Services, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia Wasilewski
- Qualitative, Evaluation, and Stakeholder Engagement Services, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Donna Olejniczak
- Division of General Internal Medicine, Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah G Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Seng EC, Mehdipour S, Simpson S, Gabriel RA. Tracking persistent postoperative opioid use: a proof-of-concept study demonstrating a use case for natural language processing. Reg Anesth Pain Med 2024; 49:241-247. [PMID: 37419509 DOI: 10.1136/rapm-2023-104629] [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: 06/24/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Large language models have been gaining tremendous popularity since the introduction of ChatGPT in late 2022. Perioperative pain providers should leverage natural language processing (NLP) technology and explore pertinent use cases to improve patient care. One example is tracking persistent postoperative opioid use after surgery. Since much of the relevant data may be 'hidden' within unstructured clinical text, NLP models may prove to be advantageous. The primary objective of this proof-of-concept study was to demonstrate the ability of an NLP engine to review clinical notes and accurately identify patients who had persistent postoperative opioid use after major spine surgery. METHODS Clinical documents from all patients that underwent major spine surgery during July 2015-August 2021 were extracted from the electronic health record. The primary outcome was persistent postoperative opioid use, defined as continued use of opioids greater than or equal to 3 months after surgery. This outcome was ascertained via manual clinician review from outpatient spine surgery follow-up notes. An NLP engine was applied to these notes to ascertain the presence of persistent opioid use-this was then compared with results from clinician manual review. RESULTS The final study sample consisted of 965 patients, in which 705 (73.1%) were determined to have persistent opioid use following surgery. The NLP engine correctly determined the patients' opioid use status in 92.9% of cases, in which it correctly identified persistent opioid use in 95.6% of cases and no persistent opioid use in 86.1% of cases. DISCUSSION Access to unstructured data within the perioperative history can contextualize patients' opioid use and provide further insight into the opioid crisis, while at the same time improve care directly at the patient level. While these goals are in reach, future work is needed to evaluate how to best implement NLP within different healthcare systems for use in clinical decision support.
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Affiliation(s)
- Eri C Seng
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Soraya Mehdipour
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Sierra Simpson
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Rodney A Gabriel
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
- Division of Regional Anesthesia, Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
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Paulander AS, Lindholm C, Torgrip R, Kumlin M, Eulau L. Use of person-centred music to manage wound dressing-related pain: a mixed method case study. J Wound Care 2024; 33:cxxx-cxxxix. [PMID: 38588059 DOI: 10.12968/jowc.2024.33.sup4a.cxxx] [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: 04/10/2024]
Abstract
OBJECTIVE To determine whether person-centred music (PCMusic) contributes to reducing pain during painful leg ulcer dressing change procedures indicated by: decreased levels of indicators related to stress; decreased pain scores; and a more favourable treatment climate during the dressing change procedure. METHOD A case study of a 51-year-old female patient with chronic inherited disease weakening her connective tissues. Quantitative data entailed temporal measurements of stress indicators including: heart pulse rate; oxygen saturation (SpO2); saliva cortisol; and a visual analogue scale (VAS). Qualitative data comprised phenomenological treatment descriptions and patient/licensed practical nurse (LPN) questionnaires. RESULTS The patient's body temperature remained steady throughout all treatments. Blood pressure was excluded due to missing data. No significant pulse rate differences in relation to music/no music could be observed during treatment. Comparing PCMusic to the patient's own other music (POOM), the pulse rate was greater in both magnitude and variation when the patient listened to POOM. Oxygen saturation showed no significant difference between PCMusic and music/no music. No significant difference was observed pre-/post-debridement with music. Similarly, no significant difference was observed pre-/post-debridement with no music. Treatment with no music showed the highest VAS score; PCMusic treatments had the lowest scores. Qualitative data showed that both patient and LPNs found that PCMusic decreased pain during dressing change. CONCLUSION The results of this case study indicate that PCMusic is a suitable complementary treatment to decrease patient pain. Patients' general health status is important when using quantitative stress/pain marker measurements. For cohort selection in future studies, we suggest healthy patients undergoing slightly painful or unpleasant treatments, patients in postoperative care and obstetric care.
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Affiliation(s)
| | - Christina Lindholm
- 2 Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Ralf Torgrip
- 3 Analytical Chemistry and Statistics, Stockholm University, Stockholm, Sweden
| | - Maria Kumlin
- 2 Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Louise Eulau
- 2 Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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Elliott T, Merlano Gomez M, Morris D, Wilson C, Pilitsis JG. A scoping review of mechanisms of auricular acupuncture for treatment of pain. Postgrad Med 2024:1-11. [PMID: 38501597 DOI: 10.1080/00325481.2024.2333232] [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: 11/06/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES Auricular acupuncture (AA) is becoming increasingly common in primary care clinics, emergency departments and peri-operatively for pain relief. Over the last decade, since the last comprehensive reviews were published, the literature has expanded. In this scoping review, we seek to document the efficacy of AA in treating both acute and chronic pain, describe the mechanism of action of AA in treating pain, and discuss how AA has been integrated into Western medicine to date. METHODS The authors performed a MEDLINE search inclusive of articles from 1966 to June 2023 including articles written in English identifying literature. We included human studies when more than 3 patients were included. Three hundred and fourteen unique articles were identified and 152 were selected by title screen. After abstract review, 117 were chosen for full-text review. Following full-text review, 33 articles were excluded and 21 added from references, totaling 105 articles included in our scoping review. RESULTS AA reduces pain severity in patients with both acute and chronic pain. The best studies in the acute settings have occurred in the peri-operative setting where sham AA is employed, multiple sessions of AA are given, and medication dosing is carefully monitored. In these cases, AA reduced pain and post-operative medications. In patients with chronic pain, multiple sessions of AA resulted not only in pain relief but also in improvements in function and disability. Literature suggests that AA works through multiple mechanisms with the most compelling data coupled to the autonomic nervous system and neuroendocrine system. Curriculums designed to teach AA and aid in implementation have been published. CONCLUSION AA is an accessible, effective means of pain relief. AA is relatively straightforward to learn, and protocols and curriculums exist to teach healthcare professionals this valuable skill. Overcoming implementation barriers, including patient education, are essential next steps.
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Affiliation(s)
- Trish Elliott
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Maria Merlano Gomez
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Deborah Morris
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Candy Wilson
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA
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Salmonsen CB, Lange KHW, Rothe C, Kleif J, Bertelsen CA. Cutaneous sensory block area of the ultrasound-guided subcostal transversus abdominis plane block: an observational study. Reg Anesth Pain Med 2024; 49:289-292. [PMID: 37640451 DOI: 10.1136/rapm-2023-104753] [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: 06/14/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVES The transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach. METHODS Thirty patients undergoing elective laparoscopic cholecystectomy received a subcostal US-TAP with 20 mL 2.5 mg/mL ropivacaine bilaterally. Measurements were performed 150 min after block application. The CSBA was mapped using cold sensation and a sterile marker, photodocumented, and transferred to a transparency. The area of the CSBA was calculated from the transparencies. RESULTS The median CSBA of the subcostal US-TAP was 174 cm2 (IQR 119-219 cm2; range 52-398 cm2). In all patients, the CSBA had a periumbilical distribution. In 42 of the 60 (70%) unilateral blocks, the CSBA had both an epigastric and infraumbilical component; in 12 of the 60 (20%) unilateral blocks, it covered only the epigastrium; and in 4 of the 60 (7%) unilateral blocks, it had only an infraumbilical distribution. No CSBA was found in 2 of the 60 (3%) unilateral blocks. In none of the patients did the CSBA cover the abdominal wall lateral to a vertical line through the anterior superior iliac spine. CONCLUSION The subcostal US-TAP results in a heterogeneous non-dermatomal CSBA with varying size and distribution across the medial abdominal wall.
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Affiliation(s)
- Christopher Blom Salmonsen
- Department of Surgery, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Graduate School, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kai Henrik Wiborg Lange
- Department of Anesthesiology, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Rothe
- Department of Anesthesiology, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Jakob Kleif
- Department of Surgery, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Anders Bertelsen
- Department of Surgery, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bertolini B, Dos Santos Felix MM, de Andrade ÉV, Raponi MBG, Calegari IB, Barichello E, da Silva Pires P, Barbosa MH. Postoperative Pain Management in Coronary Artery Bypass Grafting: An Integrative Review. J Perianesth Nurs 2024; 39:294-302. [PMID: 37999687 DOI: 10.1016/j.jopan.2023.07.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To identify pharmacological and nonpharmacological interventions adopted for pain relief in the postoperative period of coronary artery bypass graft surgery. DESIGN Integrative review. METHODS Studies published in English, Spanish, and Portuguese from January 2010 to December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Literature on Health Science, PubMed, and Web of Science. Two hundred studies were identified and eleven were included. Methodological analysis was performed using the Medical Education Research Study Quality Instrument. FINDINGS The studies found were organized into three thematic categories: pharmacological interventions (methadone, morphine, lidocaine gel, remifentanil, sufentanil, and nefopam), nonpharmacological interventions (low-level laser therapy, light-emitting diode, Class IV laser, and transcutaneous nerve stimulation) and anesthetic techniques (dexmedetomidine, ultrasound-guided pectoral nerve block, high thoracic epidural analgesia, and perioperative parasternal block with levobupivacaine). CONCLUSIONS A greater tendency to use drug strategies for postoperative pain relief was identified. The drugs used demonstrated efficacy and safety in the treatment of pain, with the exception of nefopam, which showed little benefit in this population. Nonpharmacological interventions, used as adjuvants to drug treatment, were shown to be safe, effective, and well tolerated by the patients.
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Affiliation(s)
- Bruna Bertolini
- Stricto sensu Graduate Program Health Care. Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Márcia M Dos Santos Felix
- Stricto sensu Graduate Program Health Care. Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Érica V de Andrade
- Stricto sensu Graduate Program Health Care. Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Maria B G Raponi
- Medical school. Nursing School. Federal University of Uberlandia, Uberlândia, MG, Brazil
| | - Isadora B Calegari
- Stricto sensu Graduate Program Health Care. Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Elizabeth Barichello
- Stricto sensu Graduate Program Health Care. Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Patrícia da Silva Pires
- Multidisciplinary Institute in Health-Campus Anísio Teixeira. Federal University of Bahia, BA, Brazil
| | - Maria H Barbosa
- Stricto sensu Graduate Program Health Care. Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
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