جستجوی مقالات مرتبط با کلیدواژه « pain management » در نشریات گروه « پزشکی »

Idiopathic clubfoot deformity is a relatively common congenital pediatric foot deformity. A percutaneous Achilles tenotomy (PAT) is required to correct the equinus deformity as it is the most resistant component of clubfoot deformity. Although this procedure is mainly performed with local anesthesia, performing this procedure with general anesthesia has significant advantages.

The purpose of this study was to compare the safety and efficacy of post-procedural pain management of PAT in the treatment of clubfoot with the Ponseti method when performed in a clinic setting with local anesthetic or under general anesthesia

This is a multicentric prospective observational evaluation on children less than one year of age with idiopathic clubfoot whom referred for Ponseti casting and PAT. This procedure was done in the control group with local anesthesia and in the intervention group with Sevoflurane mask 8% (MAC 2) and maintenance of anesthesia with Sevoflurane mask 4% (N2O/O2, 50%). The neonatal infant pain scale (NIPS), the amount of milk, and mood changes were evaluated as a criterion to measure the pain level.

NIPS score in the intervention group was significantly lower than the control group. Children in the intervention group consume significantly more milk than the control group. Furthermore, 76% of children in the intervention group were classified as "calm," 24% as "relatively restless," and no child was classified as "severely restless." While in the control group, 54% of children were classified as "severely restless," and the remaining 46% as "relatively restless."

Our result showed that using general anesthesia to perform achillotomy in the treatment of clubfoot in children could be associated with less pain in these patients and without significant complications.

Despite the widespread use of opioids to manage severe pain, its systemic administration results in side effects. Among the subcutaneous and transdermal drug delivery systems developed to deal with adverse effects, microneedles have drawn attention due to their rapid action, high drug bioavailability, and improved permeability. SUF is an effective injectable opioid for treating severe pain. In this study, we investigated the analgesic effects of SUF using dissolvable microneedles.

SUF polymeric dissolvable microneedles were constructed through the mold casting method and characterized by SEM and FTIR analysis. Its mechanical strength was also investigated using a texture analyzer. Fluorescence microscopy was applied in vitro to measure the penetration depth of microneedle arrays. Irritation and microchannel closure time, drug release profile, and hemocompatibility test were conducted for the validation of microneedle efficiency. Hot plate test was also used to investigate the analgesic effect of microneedle in an animal model.

Local administration of SUF via dissolving microneedles had an effective analgesic impact. One hour after administration, there was no significant difference between the subcutaneous and the microneedle groups, and the mechanical properties were within acceptable limits.

Microneedling is an effective strategy in immediate pain relief compared to the traditional methods.

The primary objective of this study is to examine the relationship between alexithymia and Post-Traumatic Stress Disorder (PTSD) among patients experiencing varying degrees of Chronic Pain (CP).

Method and Materials: 

This study utilized a descriptive causal-comparative approach. The participants were drawn from patients referred to pain and physiotherapy clinics in Tehran from 2022 to 2023. Out of 300 CP patients, 150 patients with high CP levels and an equal number with low CP levels were purposively chosen. The participants completed the Graded Chronic Pain Scale (GCPS), Perth Alexithymia Questionnaire (PAQ), and Post- traumatic Stress Disorder Checklist (PCL). Data analysis was performed using SPSS-24 software, employing multivariate analysis of variance.

The findings revealed a significant difference in the levels of alexithymia and PTSD between the two groups (P<0.001). Patients with high levels of CP demonstrated increased negative-difficulty identifying feelings (F=241.87), positive-difficulty identifying feelings (F=389.01), negative-difficulty describing feelings (F=190.61), positive-difficulty describing feelings (F=347.81), general-externally orientated thinking (F=376.28), re- experiencing (F=246.75), avoidance (F=100.74), negative alterations (F=378.01), hyper-arousal (F=388.46), and emotional numbness (F=388.47) compared to their counterparts(P<0.001).

These findings underscore the intricate relationship between CP, alexithymia, and PTSD. Therefore, the need for comprehensive assessment and management strategies addressing the interplay of these factors in patient care is highlighted.

The objective of this review is to conduct a thorough analysis of the utilization of acupuncture as a non-pharmacological method for managing pain, with a specific focus on its effectiveness in addressing chronic musculoskeletal pain and headaches.

Method and Materials:

 A comprehensive search was conducted on electronic databases such as PubMed and Google Scholar to identify relevant studies published until January 2024. The search employed keywords such as "acupuncture," "acupuncture mechanism," "headache," "musculoskeletal pain," and "pain management." Studies were included if they assessed the use of acupuncture in different clinical populations and reported outcomes related to pain intensity, functional status, and cost-effectiveness. Ultimately, a total of 6 articles were selected for the final analysis.

The studies included in this review encompassed a diverse range of patient populations, specifically focusing on individuals who received acupuncture treatment. The findings indicated that acupuncture was associated with improved pain control and reduced reliance on medication among patients suffering from chronic musculoskeletal pain and headaches. Additionally, one study demonstrated the long-term cost-effectiveness of utilizing acupuncture in this manner..

The results of this review provide support for the implementation of acupuncture as part of non-pharmacological approaches in clinical settings. Future research should concentrate on identifying the most effective combinations of acupuncture and standard care, as well as elucidating the mechanisms that underlie the synergistic effects of this treatment modality.

We aimed to investigate the impact of multidisciplinary educational team-based clinical nursing pathway on the psychological resilience, treatment adherence, pain management and quality of life in cancer patients.

From 2019 to 2020, eighty two cancer patients were selected and randomly divided into the control group and the observational group. Both groups were treated with routine oncology nursing and the multidisciplinary educational team-based clinical nursing pathway, respectively. Psychological resilience, pain management and qualify of life were assessed by the Chinese version of the Connor-Davidson resilience scale, revised American Pain Society Patient Outcome Questionnaire and the Nottingham health profile, respectively. Treatment adherence was semi-quantitatively classified as “good”, ”fair” and “bad”.

Patient’s psychological resilience, compliance, pain outcome and quality of life were similar between the control group and the observational group on admission. Patient’s psychological resilience, compliance and pain outcome in the observational group were significantly superior to those in the control group one day prior to discharge and 2 months post-discharge (all P<0.05). The scores of energy, emotions, sleep and mobility were significantly different between the observational group and the control group one day prior to discharge and 2 months post-discharge (all P<0.05). Significant improvements were observed with regard to the scores of energy, sleep and mobility in the control group 2 months post-discharge, whereas the scores of energy, emotions, sleep and mobility improved dramatically in the observational group (all P<0.05).

Compared with routine oncology nursing, multidisciplinary educational team-based clinical nursing pathway could improve patient’s psychological resilience, treatment adherence, pain management and quality of life.

 Total knee arthroplasty (TKA) is a standard surgical procedure for individuals with debilitating knee arthritis. Effective postoperative pain management is essential for successful recovery, although traditional opioid-based methods have limitations.

 This study aimed to compare the efficacy of Apotel and Remifentanil patient-controlled analgesia in managing postoperative pain after TKA.

 This double-blind, randomized, controlled clinical trial took place at Amir-al-Momenin and Qods Hospitals in Arak, Iran, spanning from June 2022 to September 2023. Sixty-two eligible patients scheduled for knee joint replacement were randomly assigned to receive either Apotel (Group A) or Remifentanil (Group R) as part of multimodal analgesia administered via a pain pump for postoperative pain relief in TKA. The study assessed hemodynamic parameters, pain levels (measured using the Visual Analog Scale), analgesic duration, and narcotic consumption. Statistical analyses were performed using SPSS v.27 and Plotly.

 Subjects exhibited no statistically significant differences in age, gender distribution, duration of surgery, or anesthesia. The hemodynamic status assessment in the recovery room showed no significant differences in SPO2, PR, or MAP between the groups. However, Remifentanil demonstrated superior effectiveness in reducing pain over 24 hours post TKA surgery compared to Apotel, as evidenced by lower average Visual Analog Scale (VAS) scores (P < 0.001), longer duration without the need for narcotic painkillers (P < 0.001), and lower cumulative opioid analgesic consumption in Group R (P < 0.001).

 Remifentanil demonstrates superior pain control in a multimodal pain management approach compared to Apotel, providing sustained pain reduction over 24 hours post-surgery. Moreover, Remifentanil offers longer-lasting pain relief and results in lower cumulative narcotic painkiller consumption compared to Apotel.

 The ganglion impar block is a minimally invasive technique used for alleviating pain associated with coccydynia.

 This research evaluates the effectiveness of the ganglion impar block in treating patients with coccydynia who have not benefited from conservative treatments.

 This cross-sectional analysis reviewed the clinical records of coccydynia patients who received ganglion impar block injections at Urmia Imam Khomeini Hospital, Urmia, Iran, between 2020 and 2022. Data regarding age, gender, body mass index (BMI), onset of pain, and levels of patient satisfaction post-treatment were gathered from the medical records.

 The study comprised 26 patients, with 4 (15.4%) being male and 22 (84.6%) female. The average age and BMI were 39.15 ± 14.24 years and 28.91 ± 2.14 kg/m2, respectively, which did not show significant variation (P = 0.19). The average Visual Analogue Scale (VAS) score before the ganglion impar block was 6.23 ± 2.35, which reduced to 4.47 ± 2.41 immediately after the procedure. At the 1-month follow-up, the average VAS score had further decreased to 3.47 ± 0.79. The decrease in VAS scores, both immediately after the procedure and at the 1-month follow-up, was statistically significant. The success rate of the block (defined as a reduction in pain of at least 20% from the baseline) was significantly high immediately and one-month post-procedure (P < 0.001). Out of the 26 patients treated with the impar block, satisfaction rates were 42.3% excellent, 27% good, 19.2% fair, and 11.5% poor.

 The study endorses the trans-sacro-coccygeal “needle inside needle” method for providing relief to patients suffering from coccydynia. The findings revealed significant patient satisfaction, with the majority describing their experience as excellent.

 Postoperative pain management is crucial for improving patient outcomes following posterior cervical spine surgery. Opioids are effective but carry a risk of respiratory depression. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used but may not provide adequate pain relief and have potential complications. The inter-semispinalis plane (ISPB) block is a novel technique for postoperative analgesia in cervical spine surgery.

 This study aims to evaluate and compare the efficacy of the ISPB with general anesthesia in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications.

 This double-blind, randomized controlled trial was blinded to both the patient and the assessor. Fifty adult patients (18 - 60 years old) undergoing elective posterior cervical spine surgery were enrolled. The participants were divided into 2 groups: The ISPB group (receiving bilateral ultrasound-guided ISPB at the C5 level) and the control group (receiving general anesthesia only), with each group comprising 25 patients. The study assessed intraoperative fentanyl use, postoperative VAS pain levels, the need for rescue analgesia, and complications.

 The ISPB group showed significantly lower intraoperative fentanyl consumption (median 100 vs. 100 - 150 μg, P = 0.022) and lower postoperative pain scores at 1, 8, 12, and 48 hours (P = 0.016, 0.009, 0.005, 0.016). Additionally, the ISPB group required less postoperative pethidine (20% vs. 64%, P = 0.002) and had a longer delay before requesting pethidine (hazard ratio 0.215, P = 0.001). Surgeon satisfaction was significantly higher in the ISPB group (P = 0.003). These results suggest that the ISPB can effectively reduce pain and analgesic requirements.

 The ISPB is an effective analgesic technique for posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and enhancing surgeon satisfaction without increasing complications. This approach has the potential to improve postoperative care and patient outcomes in this surgical population.

 Controversy remains about the positive role of music during general anesthesia and postoperative recovery. We, therefore, tested the hypothesis that intraoperative exposure to classical music reduces the propofol necessary to maintain the bispectral index (BIS) close to 50 during vitrectomy surgery.

 This double-blind clinical study is evaluating 50 patients undergoing vitrectomy surgery under general anesthesia. Patients were randomly assigned to music and white noise groups, and relevant sounds were played to patients after induction of anesthesia. The two groups were compared for the use of propofol as an anesthetic to maintain a BIS near 50 and for postoperative pain, anxiety, nausea, and vomiting.

 Propofol consumption to maintain the set BIS score was much lower in the music group than in the white noise group (78.72 ± 25.76 microgram/kg/min and 117.91 ± 36.78 microgram/kg/min, respectively, P-value = 0.000). Postoperative pain scores were also much lower in the music group than in the white noise group (P-value = 0.000) and anxiety levels between these two groups did not differ (P-value = 0.870). No patient in the music group had complaints of postoperative nausea and vomiting (PONV) compared to six patients in the white noise group (P-value = 0.011).

 Listening to music during general anesthesia for vitrectomy surgery can reduce the use of anesthetics, postoperative pain, and PONV. Further, controlled studies are necessary to confirm our results.

This study was conducted to provide a comprehensive analysis of multimodal pain prevention strategies, focusing on their effectiveness in managing and preventing various types of chronic pain.

Method and Materials:

 In this systematic review comprehensive search of electronic databases PubMed was conducted to identify relevant studies published up to January 2024. The search strategy included terms related to multimodal pain prevention, such as "pain management," "non-pharmacological interventions," and "integrated pain care." Studies were included if they evaluated multimodal pain prevention strategies in various clinical populations and reported outcomes related to pain intensity, functional status, adverse effects, and patient satisfaction. The methodological quality of the included studies was assessed, and data were synthesized to provide an overview of the findings.

The search yielded a total of 6 studies that met the inclusion criteria. The included studies encompassed a diverse range of patient populations, focusing on those experiencing chronic pain, and receiving palliative care. Multimodal pain prevention strategies were found to be associated with improved pain control and reduced drug consumption in patients experiencing chronic pain. Furthermore, non-pharmacological interventions, such as physical therapy, cognitive-behavioral therapy were shown to enhance pain management outcomes in various clinical contexts. The integration of these modalities in a coordinated and individualized manner appeared to be particularly beneficial in addressing the complex nature of pain.

The findings support the use of multimodal approaches in clinical practice and emphasize the importance of individualized, patient-centered care in pain management. Future research should focus on identifying the most effective combinations of interventions and elucidating the mechanisms underlying the synergistic effects of multimodal approaches.

Low back pain (LBP) is a common health problem worldwide and the primary cause of years lived with disability. Studies on the non-surgical management approaches for disc-related LBP are sparse and scarce, so a clear and structured guideline in this area would be useful. This study summarizes the non-surgical management approaches for disc-related LBP in a review.

Intervention studies and review articles relating to the non-surgical approaches for disc-related LBP treatment were curated from PubMed, EMBASE, Cochrane, and Google Scholar databases before July 1, 2022.

Several management approaches are suggested in the studies for disc-related LBP, including medications, acupuncture, lumbar orthoses, exercise therapy, manual therapy, physical therapy modalities, and spinal injections. Some of these options have been studied more, like exercise therapy and injections, and there are more favorable reports for them. Some others have been less studied and need to be investigated in future studies, like different physical therapy modalities.

Recommendations are based on low- to moderate-quality evidence or consensus in the management approach studies for disc-related LBP. Therefore, the authors recommend intensifying research efforts concerning all aspects of the non-surgical management of LBP.

A 44-year-old man with a three-day history of pain in right axilla, subsequently accompanied by the appearance of vesiculopapular rashes on the right portion of his torso, attended a medical facility. The patient had neither reported any special skin contact in that area, nor fever and other symptoms. Upon examination, the examiner revealed the appearance of some other similar vesiculopapular rashes. These two affected sites were located in a linear arrangement, namely, the T7 dermatome. Considering the particular arrangement of rashes and form of manifestation, a clinical diagnosis of herpes zoster was made. The patient underwent empirical treatment of herpes zoster, including Virabex (valaciclovir) tablet 1g TDS, pregabalin capsule once nightly, and hydroxyzine hydrochloride tablet once every night. The pain and itching resolved within one week after the prescription, and the rashes mostly disappeared within 20 days. Here, the daily state of rashes are presented to the audience.

Phantom limb pain (PLP) presents complex challenges in treatment, lacking standardized clinical approaches, and understanding its mechanisms remains elusive. Noninvasive brain stimulation (NIBS), specifically transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), seems promising in treating chronic pain, including PLP. These modalities can modulate neural activity, offering potential benefits by acting on interconnected neural networks beyond the stimulation site. Studies from Jan 1, 2003, to 2021 were reviewed on PubMed, Google Scholar, and the Web of Science using the keywords PLP, neuromodulation, transcranial direct current stimulation, transcranial magnetic stimulation, pain management, and their combinations. The language was limited to English. A single-session treatment has the potential to change the intensity of PLP for several hours. On the other hand, a multi-session treatment approach can decrease both the intensity and frequency of PLP for an extended period of several months. Additional research with a greater sample size and extended follow-up periods is necessary to determine the precedence of utilizing tDCS, rTMS and the potential for integration with other treatments for individuals with amputation experiencing PLP.

The aim of this paper was to provide a comprehensive review of using low-level laser therapy (LLLT) as a therapeutic method for recurrent aphthous stomatitis (RAS), including analyzing its underlying mechanisms, clinical applications, and potential benefits.

A database search was conducted to identify relevant papers investigating the use of LLLT for RAS treatment. Articles published in scientific journals and selected for review in Science Direct, Google Scholar, and PubMed were categorized and analyzed.

During the initial search, a total of 88 articles were found. Five phases were performed to select articles, and eventually, 8 papers that met the inclusion criteria were chosen.

This literature review supports the idea that LLLT is a non-invasive and potentially effective therapy for RAS symptoms by accelerating the healing process and having beneficial effects in reducing pain and inflammation.

Although patients› self-report is the gold standard for pain, many patients admitted to the intensive care units are unable to communicate and express their pain. Accordingly, the nurse must have special abilities to diagnose and manage pain in such conditions. This study assesses nurses’ knowledge, attitude, and performance regarding pain management of non-verbal critically ill adult patients in intensive care units.

This cross-sectional descriptive study was conducted from February to May 2020 among nurses working in four national referral hospitals in Dar es Salaam, Tanzania. The study sample included 202 intensive care unit nurses who were recruited by the census. The data was collected using pre-validated questionnaires, including the knowledge and attitudes survey regarding pain tools, and a performance tool by Eunkyoung. The data were analyzed using the chi-square test, one sample t-test, and Spearman correlation coefficient in the SPSS software, version 20. The significance level was set at P<0.05.

The mean knowledge and attitude score was 13.26±2.75, indicating inadequate knowledge and negative attitude. The mean performance score was 2.08±0.16, indicating low performance. No significant relationship was detected between nurses’ knowledge and attitude and their performance according to the t-test (t=2.84, P=0.09) and the Spearman correlation coefficient (r=0.12, P=0.102). Meanwhile, no significant relationships were found between the nurses’ knowledge, attitude, and performance and their demographic characteristics.

Planning to increase knowledge and improve the attitude and performance of ICU nurses for better pain management of non-verbal patients is necessary. It is recommended to evaluate the pain of these patients based on the observation of behavioral indicators of pain and choose the appropriate tool for pain assessment.

This study evaluated the current practices of opioid and non-opioid analgesic administration for postoperative pain management in gynecological surgeries, aiming to optimize pain relief while minimizing side effects.

A cross-sectional, prospective Drug Utilization Evaluation (DUE) study was conducted at Al-Zahra Hospital, Tabriz, Iran. Medical records of 100 patients undergoing gynecological surgery were reviewed over five months. Data on prescribed analgesics, pain scores, and adherence to APS2016 and ERAS2016 guidelines were collected and analyzed statistically.

Meperidine (pethidine) and diclofenac were the most frequently prescribed analgesics. The average patient pain score was 2.48 units. A combination of meperidine, diclofenac, and acetaminophen was identified as the most effective regimen for pain control. Prescribed regimens demonstrated 41.4±27.3% theoretical and 60.60 ± 28.77% practical compliance with APS2016 and ERAS2016 guidelines. While achieving the primary objective of pain relief with minimal side effects, compliance with established guidelines could be further improved through educational interventions.

Optimizing analgesic regimens for postoperative pain management requires careful consideration of individual patient needs, including the benefits of opioid analgesics in achieving greater pain reduction. Adherence to evidence-based guidelines and ongoing educational programs for healthcare professionals are crucial for ensuring optimal pain relief with minimal side effects.