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

Endodontic therapy has been regarded as a safe treatment option with highly promising results in preserving natural teeth. Numerous factors may influence the longevity of endodontically treated teeth (ETT), thus altering their success/survival rate. Thisstudy aimed to determine the survival and success rates of endodontically treated premolars and molars with different complex restorative/prosthodontic treatments.

A total of 190 patients with an ETT were included, who had received final coronal restoration up to 14 days after the temporary one and at least one year prior to the enrollment. The investigator evaluated the quality of endodontic filling, coronal restoration, mobility, and proximal contacts. Data were analyzed with multiple binary logistic regression and the Chi-Square test.

The average duration of follow-up was 28.6±11.9 months. Overall, 89.4% (170/190) of the teeth survived. The overall success rate for the investigated teeth was 70.5% (134/190). Success rates of 100% for crown, 95.7% for post and core crown (PCC), and 94.7% for amalgam build-up with post were achieved. However, the success rates were 75%, 52.5%, and 50% for amalgam build-up, composite build-up, and PCC with crown lengthening, respectively. The Chi-square test revealed that there was a significant difference between the different restorations in terms of success (P<0.001). Multiple binary logistic regression models revealed that coronal leakage (P=0.048), obturation void (P=0.037), obturation length (P=0.020), mobility (P=0.002), type of the restoration (P<0.001), and proximal contact (P<0.001) were significant predictors for success. However, apicallucency, root length, marginal caries, tooth type, and post did not appear to be significant indicators of success (P>0.05).

ETT with minimal mobility, exhibiting underfilled obturations without visible voids, and having received crown/PCC/amalgam build-up with a post, along with the presence of both proximal contacts, tend to exhibit a significantly high success rate.

The patients with unusual symptoms present a diagnostic challenge for clinicians and may lead to misdiagnoses and inappropriate or unnecessary treatments. Endodontic diseases can present with a variety of symptoms, and it is possible for odontogenic pain to resemble non-odontogenic pain, which can complicate treatment due to the distinct management plans of the two conditions. This report details the successful management of vague pain, and popping sensations in the left maxilla triggered by cold exposure. Previous clinicians were unable to identify the pain's origin, leading to unnecessary treatments. A clinical examination, and cone-bea m computed tomography evaluation revealed the presence of a missed second mesiobuccal root canal. The canal was located using an operating microscope and ultrasonics. Non-surgical endodontic retreatment was completed in two visits, successfully. This report highlights the critical importance of identifying the diverse symptoms that may arise from endodontic origin, as these can complicate clinical diagnosis.

Angiostrongylus cantonensis is a parasitic nematode that typically inhabits the pulmonary arteries of rats but can also reside in the central nervous systems of rats and mollusks. Humans can become infected with A. cantonensis by eating infected hosts or consuming contaminated food, especially if it is raw or undercooked. This infection can lead to various neurological symptoms, including neuropathic pain, which is often an early indication of the condition. In this report, we present a case in which the patient experienced neuropathic pain as the initial clinical manifestation of A. cantonensis infection.

We present a rare case of a 27-year-old female who required intensive care unit (ICU) monitoring due to heavy sedation after receiving high doses of sedative-analgesics for back pain. The patient reported experiencing severe, slow-progressing low back pain radiating to her arms and legs. The pain was described as sharp, tingling, and numbing, severely limiting her movements. To manage the pain, a combination of morphine, intermittent fentanyl, ketamine, dexmedetomidine, duloxetine, and pregabalin was administered. Consequently, the patient had to be intubated due to the effects of the analgesics.During the first two weeks in the ICU, diagnosis proved challenging as the MRI was normal and the initial lumbar puncture revealed only an eosinophilic infection. However, during a follow-up lumbar puncture, multiple parasites were discovered in the cerebrospinal fluid, which were identified as A. cantonensis . The patient remains on a ventilator as the infection has affected the spinal nerve roots, cord, meninges, and brain. We explore the crucial role of ICU care in providing both supportive and definitive treatment for this patient.

This report underscores the critical role of the ICU in providing care for a patient with a progressively deteriorating condition without an initial definitive diagnosis. The ICU's ability to deliver optimal pain relief and sedation, advanced monitoring, and prompt therapy for deteriorating symptoms was of utmost significance. Furthermore, the multidisciplinary team in the ICU was instrumental in managing the continuum of care for the patient.

 Labor pain management is crucial in obstetric care. Magnesium sulfate (MgSO₄) has been identified as a potential analgesic due to its muscle relaxant and neuroprotective properties. This study evaluated the efficacy of intravenous magnesium sulfate in reducing labor pain among primiparous women, hypothesizing that MgSO₄ would not significantly impact labor pain intensity compared to a placebo.

 In this double-blind trial at Al-Yarmouk Educational Hospital, 60 primiparous women were randomized to receive either MgSO₄ (4 g intravenous loading dose, followed by 1 g/hour maintenance) or placebo during early active labor. Pain intensity was assessed using a Visual Analog Scale (VAS) at 30-minute intervals for two hours post-administration. Secondary outcomes included labor duration, need for additional analgesia, and maternal satisfaction. Data were analyzed using independent t-tests and chi-square tests.

 No significant differences were observed in pain intensity reduction, labor duration, requirement for additional analgesia, or maternal satisfaction between the MgSO₄ and placebo groups at any time point post-administration. Both groups demonstrated comparable safety profiles, with no serious adverse effects reported.

 Intravenous MgSO₄, at the dosage used in this study, did not significantly reduce labor pain intensity, affect labor outcomes, or improve maternal satisfaction compared to placebo in primiparous women. These findings highlight the complexity of labor pain management. Further research is warranted to explore different dosages, administration timings, or combinations with other strategies to fully understand MgSO₄''s potential role in obstetric analgesia.

Buprenorphine therapy has emerged as a primary therapy method for both opioid addiction and chronic pain; however, the «one size fits all» approach to buprenorphine administration is no longer tenable. This review analyzes the pharmacology of both dosing approaches and their clinical outcomes, safety profiles, and societal implications, providing valuable insights for healthcare professionals.

Multiple databases were used in conjunction with a set of inclusion and exclusion criteria to source articles to assess the consensus of best methods for treating opioid use disorder (OUD). This comprehensive review discusses two distinct dosing strategies, microdosing and macrodosing, through a detailed literature search to assess the differences and similarities of each strategy.

Microdosing entails administering minimal buprenorphine doses, with promise in pain alleviation and addiction management while mitigating the risks of dependence and side effects typically associated with traditional opioids. In contrast, macrodosing employs higher buprenorphine doses, which is well-established for OUD and chronic pain management but raises concerns concerning misuse and overdose.

Tailoring buprenorphine therapy to patients’ individual needs is essential in the face of contemporary healthcare challenges related to pain management and opioid addiction.

Surgical interventions and radiotherapy for head and neck cancer frequently result in substantial instances of acute and chronic discomfort. Optimizing pain management techniques stands as a pivotal factor in enhancing the well-being and overall quality of life for patients. This comprehensive review discusses various pain conditions encountered after head and neck cancer and explores a multidimensional approach to pain management. The review highlights the significance of incorporating multimodal analgesia, physical therapy, psychological support, palliative care, and emerging techniques including nerve blocks to achieve efficacious pain control. Such an endeavor necessitates cooperation among head and neck surgeons, radiotherapists, and pain specialists.

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 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.

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.

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.