Differences between the healthcare systems of Quebec and France for the treatment of pain due to spinal disorders

In Quebec,Canada,the public healthcare system offers free medical services.However,patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage.In contrast,private clinics provide expedited care but are relatively scarce and entail out-of-pocket expenses.Once a patient with pain caused by a spinal disorder meets a pain medicine specialist,spinal intervention is quickly performed when indicated,and patients are provided lifestyle advice.Transforaminal epidural steroid injections are frequently administered to patients with radicular pain,and steroid injections are administered on a facet joint to control low back or neck pain.Additionally,medial branch blocks are performed prior to thermocoagulation.France’s universal healthcare system ensures accessibility at controlled costs.It emphasizes physical activity and provides free physical therapy services.However,certain interventions,such as transforaminal and interlaminar epidural injections,are not routinely used in France owing to limited therapeutic efficacy and safety concerns.This underutilization may be a potential cause of chronic pain for many patients.By examining the differences,strengths,and weaknesses of these two systems,valuable insights can be gained for the enhancement of global spinal pain management strategies,ultimately leading to improved patient outcomes and satisfaction.

Effect of low-level laser therapy on tooth-related pain and somatosensory function evoked by orthodontic treatment

Low-level laser therapy(LLLT) may have an effect on the pain associated with orthodontic treatment. The aim of this study was to evaluate the effect of LLLT on pain and somatosensory sensitization induced by orthodontic treatment. Forty individuals(12–33 years old; mean ± standard deviations: 20.8 ± 5.9 years) scheduled to receive orthodontic treatment were randomly divided into a laser group(LG) or a placebo group(PG)(1:1). The LG received LLLT(810-nm gallium-aluminium-arsenic diode laser in continuous mode with the power set at 400 mW, 2 J·cm–2) at 0 h, 2 h, 24 h, 4 d, and 7 d after treatment, and the PG received inactive treatment at the same time points. In both groups, the non-treated side served as a control. A numerical rating scale(NRS) of pain, pressure pain thresholds(PPTs), cold detection thresholds(CDTs), warmth detection thresholds(WDTs), cold pain thresholds(CPTs), and heat pain thresholds(HPTs) were tested on both sides at the gingiva and canine tooth and on the hand. The data were analysed by a repeated measures analysis of variance(ANOVA). The NRS pain scores were significantly lower in the LG group(P = 0.01). The CDTs,CPTs, WDTs, HPTs, and PPTs at the gingiva and the PPTs at the canine tooth were significantly less sensitive on the treatment side of the LG compared with that of the PG(P < 0.033). The parameters tested also showed significantly less sensitivity on the nontreatment side of the LG compared to that of the PG(P < 0.043). There were no differences between the groups for any quantitative sensory testing(QST) measures of the hand. The application of LLLT appears to reduce the pain and sensitivity of the tooth and gingiva associated with orthodontic treatment and may have contralateral effects within the trigeminal system but no generalized QST effects. Thus, the present study indicated a significant analgesia effect of LLLT application during orthodontic treatment.Further clinical applications are suggested.

Analysis of the Causes of Chronic Pain after Inguinal Hernia Repair without Tension and Its Prevention and Treatment

Purpose: Analyzing the causes of pain after tension-free repair in the inguinal hernia, and propose corresponding treatment strategies. Results: The patients in this group were followed up for 3 - 12 months. A total of 5 patients still had pain relief within 3 months after surgery. Further treatment was needed, and the incidence rate was 5%. Conclusion: Skilled surgical procedures are performed in patients with local anesthesia, and some of the absorbable repair materials can be used. The improved patch fixation and extra peritoneal repair can reduce the pain after inguinal hernia repair without tension.

TREATMENT OF EPIGASTRIC PAIN WITH SUBCUTANEOUS NEEDLING

Subcutaneous needling is a new therapeutic method which is based on the features of the meridian-collateral theory of cutaneous regions in traditional Chinese medicine and the neurohumeral theory and skin anatomy of modern medicine and is of the features of “fixed meridian but not fixed acupoints”, “micro stimulation”, and “subcutaneous needling with filiform needles” to achieve the goal of treating diseases. This method is indicated clinically to the analgesia and relaxation of spasm especially the pain caused by the disorders of the internal organs and marked therapeutic effect has been obtained. With method, 150 cases of epigastric pain were treated by our department and the total effective rate was over 90%. It is presented herein below.

Acupuncture Treatment of Abdominal Pain

Case History Mr. Li, a university student aged 23 years, paid his first visit on July 16, 2001, with the chief complaint of abdominal pain for one day. The patient stated that one day before when it happened to be the weekend, he got abdominal pain after supper, which went worse gradually and caused him to roll all over in bed. The pain was slightly alleviated half an hour later after he had taken some pain killers. Upon inquiry, the patient said that because of their newly graduation from the university, he and his classmates were so excited that they went to have a sumptuous lunch with alcoholic drinks. And in the evening he ate again a delicious supper cooked for him by his mother, after which he continued to have some fruit and dessert.

Treatment of Painful Diabetic Neuropathy With Catgut-Embedding in Acupoints

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Pathophysiology, diagnosis, and treatment of discogenic low back pain

Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of the annulus into the nucleus pulposus. Studies suggested that the degeneration of the painful disc might originate from the injury and subsequent repair of annulus fibrosus. Growth factors such as basic fibroblast growth factor, transforming growth factor β1, and connective tissue growth factor, macrophages and mast cells might play a key role in the repair of the injured annulus fibrosus and subsequent disc degeneration. Although there exist controversies about the role of discography as a diagnostic test, provocation discography still is the only available means by which to identify a painful disc. A recent study has classified discogenic low back pain into two types that were annular disruption-induced low back pain and internal endplate disruption-induced low back pain, which have been fully supported by clinical and theoretical bases. Current treatment options for discogenic back pain range from medicinal anti-inflammation strategy to invasive procedures including spine fusion and recently spinal arthroplasty. However, these treatments are limited to relieving symptoms, with no attempt to restore the disc's structure. Recently, there has been a growing interest in developing strategies that aim to repair or regenerate the degenerated disc biologically.

Acupuncture Treatment in Patients with Low Back Pain

Low back pain is the most common medical problem and very commonly treated condition with acupuncture today. The pain can arise from muscles, tendons, ligaments, bones or intervertebral discs. The pain is usually in the lower back region, gluteal region with or without radiation in the legs, with muscle tension and stiffness, limited movement or sometimes tingling and burning sensation. In the term of Traditional Chinese Medicine (TCM), pain appears if there is no good Blood and Qi flow in the body. Pain caused by Qi stagnation usually appears due to strong emotional and mental changes and stress. In this research, we included 60 patients, 28 males and 32 females, on age from 18 to 88, all treated with acupuncture for low back pain. All patients were cured with certain number of treatments. Most of the patients needed less than 5 treatments. Treatments were made with normal and fire needle and combined. The best results were achieved with fire needle acupuncture treatment. In the treatment, we used local Ashi i.e. trigger points and meridian points: BL24 (QiHaiSu), BL25 (DaChangShu), BL26 (GuanYanShu), BL27 (XioChangShu), BL28 (PangGuangShu), GB30 (HuanTiao), BL40 (WeiZhong), BL57 (ChengShen), GB37 (GuanMing) and BL60 (KunKun). Acupuncture as a treatment for low back pain is a very effective treatment giving very satisfying and positive results in a short time of period. The percentage of cured patients (relieved of the symptoms) is 100% which is a clear indicator of the success of acupuncture in the treatment of low back pain.

Systematic mechanism-orientated approach to chronic pancreatitis pain

Pain in chronic pancreatitis(CP) shows similarities with other visceral pain syndromes(i.e.,inflammatory bowel disease and esophagitis),which should thus be managed in a similar fashion.Typical causes of CP pain include increased intrapancreatic pressure,pancreatic inflammation and pancreatic/extrapancreatic complications.Unfortunately,CP pain continues to be a major clinical challenge.It is recognized that ongoing pain may induce altered central pain processing,e.g.,central sensitization or pro-nociceptive pain modulation.When this is present conventional pain treatment targeting the nociceptive focus,e.g.,opioid analgesia or surgical/endoscopic intervention,often fails even if technically successful.If central nervous system pain processing is altered,specific treatment targeting these changes should be instituted(e.g.,gabapentinoids,ketamine or tricyclic antidepressants).Suitable tools are now available to make altered central processing visible,including quantitative sensory testing,electroencephalograpy and(functional) magnetic resonance imaging.These techniques are potentially clinically useful diagnostic tools to analyze central pain processing and thus define optimum management approaches for pain in CP and other visceral pain syndromes.The present review proposes a systematic mechanism-orientated approach to pain management in CP based on a holistic view of the mechanisms involved.Future research should address the circumstances under which central nervous system pain processing changes in CP,and how this is influenced by ongoing nociceptive input and therapies.Thus we hope to predict which patients are at risk for developing chronic pain or not responding to therapy,leading to improved treatment of chronic pain in CP and other visceral pain disorders.

Stem cells and pain

ain can be defined as an unpleasant sensory and emotional experience caused by either actual or potential tissue damage or even resemble that unpleasant experience.For years,science has sought to find treatment alternatives,with minimal side effects,to relieve pain.However,the currently available pharmacological options on the market show significant adverse events.Therefore,the search for a safer and highly efficient analgesic treatment has become a priority.Stem cells(SCs)are non-specialized cells with a high capacity for replication,self-renewal,and a wide range of differentiation possibilities.In this review,we provide evidence that the immune and neuromodulatory properties of SCs can be a valuable tool in the search for ideal treatment strategies for different types of pain.With the advantage of multiple administration routes and dosages,therapies based on SCs for pain relief have demonstrated meaningful results with few downsides.Nonetheless,there are still more questions than answers when it comes to the mechanisms and pathways of pain targeted by SCs.Thus,this is an evolving field that merits further investigation towards the development of SCbased analgesic therapies,and this review will approach all of these aspects.

Acute and Persistent Post-Craniotomy Pain: A Prospective 6-Month Follow-Up Questionnaire Study

Introduction: The incidence of acute pain after craniotomy differs remarkably in previous studies, and the prevalence of persistent pain is not precisely known. We conducted 6-month follow-up surveys on the incidence and intensity of acute and persistent pain after elective craniotomy. Methods: We carried out a prospective cohort study via a series of structured questionnaires to record acute pain intensity preoperatively and postoperatively, and the incidence of persistent pain 3 and 6 months after a craniotomy in a tertiary care center. Patients scheduled for elective craniotomy were interviewed the day before surgery, postoperatively before discharge from the hospital, and 3 and 6 months after surgery. Pain was assessed on a numeric rating scale (0 - 10) at rest and movement, as well as expectations of pain before surgery, efficacy of pain therapy, and satisfaction with pain treatment. The incidence of adverse events, sleep time and interruptions caused by pain, different pain types, and drugs used for pain treatment were also recorded. Results: A total of 152 patients were enrolled in the study and completed the preoperative questionnaire;123 (81%) completed postoperative questionnaire and 108 (72%) completed the 3- and 6-month follow-ups. The average pain score at the time of the postoperative questionnaire was moderate, 4 at rest and 5 upon movement. The percentage of patients experiencing mild pain at rest and upon movement was 52% and 49%, and moderate pain was 15% and 16%, respectively. Severe postoperative pain was detected in 5% and 8% of patients at rest and upon movement, respectively. Three months after surgery, 6% of patients reported mild pain at rest, 3% moderate pain at rest, and 1% severe pain at rest. Persistent mild and moderate pain at rest after 6 months was reported by 3% and 1% of patients, respectively. The most common adverse events were postoperative nausea and vomiting (11%) and abdominal discomfort (8%). During postoperative pain treatment in the intensive care unit or post-anesthesia care unit, 92% of patients received acetaminophen, 88% fentanyl, and 24% oxycodone. During neurosurgical ward care, ibuprofen was used in 61% of patients. Satisfaction with analgesia was high throughout the study period with a median satisfaction score of 9 postoperatively and 10 at 3 and 6 months on the 0 - 10 scale. Conclusion: The findings indicate that most patients experience moderate or mild pain after craniotomy, but patient satisfaction with pain treatment is high. Persistent pain after 3 and 6 months is rare and mild in nature.

Labor Pain Treated with Acupuncture or Acupressure

Opioid-dependent women have an 80% to 90% unintended pregnancy rate, almost double the overall unintended pregnancy rate: 40% globally and 51% in north America. The prescription drug abuse milieu increases the possibility opioid abusing laboring patients. In 2012, neonatal abstinence syndrome occurred in 5.8 per 1000 hospital births. Non-pharmacological labor pain management (NPLPM) is especially recommended for laboring patients with a history of substance abuse. Therefore, literature review was performed to elucidate the efficacy and safety of acupuncture, noninvasive electro-acupuncture (EA), and acupressure in labor pain management. Compared to standard intrapartum controls, bilateral EA at JiaJin or Sanyinjiao significantly reduced visual analog scale (VAS) pain scores 30-minutes post intervention (p < 0.01) and Stage 1 active phase labor length (p < 0.05). EA achieves shorter Stage 2 labor than patient-controlled epidural analgesia (p = 0.05);and 10-point lower VAS pain scores and reduced cesarean delivery rate than no-analgesia controls, p < 0.05. Current evidence indicates that EA should have a role in NPLPM, and that acupressure may have a role in NPLPM. Nevertheless, future RCTs could strengthen the argument for increased EA and acupressure use in NPLPM.

Pharmacological pain management in chronic pancreatitis

Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge.Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders.An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established,the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive.Consequently,the management of pain by traditional methods based on nociceptive deafferentation(e.g.,surgery and visceral nerve blockade)becomes difficult and often ineffective.This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis.Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source,which should be reserved for special and carefully selected cases.In this review,we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis.In addition,future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity.

Osteopathic manipulative treatment and nutrition: An alternative approach to the irritable bowel syndrome

A simple treatment plan for manual therapists is presented based on current evidence-based literature, it is designed to lessen chronic pain and inflammation in the Irritable Bowel Syndrome (IBS). A chronic continuous or intermittent gastrointestinal tract dysfunction, IBS appears due to dysregulation of brain-gut-microbe communication. An overview of its management using Osteopathic Manipulative Treatment (OMT) is described. In IBS OMT focuses on the nervous and circulatory systems, spine, viscera, thoracic and pelvic diaphragms in order to restore homeostatic balance, normalize autonomic activity in the intestine, promote lymphatic flow and address somatic dysfunction. Lymphatic and venous congestion is treated by the Lymphatic Pump Techniques and stimulation of Chapman’s Reflex Points. The food itself, food allergies and intolerance could contribute to symptom onset or even cause IBS. Furthermore the “microbiota” greatly impacts on the bi-directional brain-gut axis communication. This paper also provides appropriate dietary modifications for patients with IBS.

Hip Joint Osteoarthritis Pain Sources and Control

Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.

Approach to Pain in Endometriosis Patients: Systematic Literature Review

Background: Endometriosis is a gynecological, multifactorial condition that affects women’s life quality, especially due to the pain inherent to it. Pain is caused by physical and psychological aspects;therefore, several factors must be analyzed, aiming to treat the whole. Conventional, drug or surgical treatments are the most used;however, the search for alternative therapeutic methods is growing. Objective: To analyze the approach to pain in women with endometriosis, seeking a better understanding of the pathophysiological mechanisms of this disease, its impact on life quality, as well as the means of treatments in use and innovations in this field. Methods: Systematic literature review, conducted in the Virtual Health Library databases between 2010 and 2021, restricted to articles in English and Portuguese with the descriptors: Endometriosis, Pain, and Treatment. After reading the abstracts, 197 articles were found, and, after reading them, 59 articles were selected. Results: This review analyzed 59 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Related factors such as acute or chronic pain, late diagnosis, discrediting symptomatic complaints and trivialization by health professionals have a profound impact on the physical and mental health of women with endometriosis. On the other hand, there are several classes of drugs, surgical procedures, and alternative therapies available for pain management. Conclusion: Given the context addressed, a certain need is suggested for health professionals to better understand the disease and adopt new behaviors or improve existing ones, such as reception, active listening, early diagnosis and comprehensive and individualized treatment. In addition, further studies are needed regarding alternative therapies, seeking to expand the scientific evidence of their benefits.

Acupuncture in the Multimodal Biopsychosocial Pain Management. <br>Towards a New Model in Clinical Practice

The last decennia the multidimensional nature of pain has been recognized and a multimodal bio-psychosocial management has been proposed. Acupuncture has progressively gained a place in this multimodal approach. The principles of traditional Chinese medicine link three major themes, nutrition and microbiome, neuroplasticity, homeostasis and the side effects of medication. For patients with chronic pain and/or chronic pain refractory to conservative medicine it is important to assess all factors involved with the chronicity. The improved biological, genetic and epigenetic knowledge has contributed to a better understanding of the mechanism of action of acupuncture and integrative medicine. Moreover neuroimaging has been able to demonstrate the brain regions activated by acupuncture and also illustrates the differences with sham or placebo. Opponents often claim an absence or weakness of evidence. These claims are based on the observations that the initial reports are predominantly case reports and studies with a poor design quality. In the last decennia well-designed randomized trials have been published, thus improving the quality of the evidence. The most important findings are summarized in this article. As with all controlled trials the inclusion and exclusion criteria as well as the standardization of the treatment do not always reflect daily practice. Therefore we report patient cases as illustration of the integrative approach.

TREATING ACUTE PAIN SYNDROME OF 60 CASES WITH ONE DISTANT ACUPOINT

This article mainly introduces the authors’experience in treating acute pain syndrome of 60 cases with one distant acupoint.The effect is very good.The method is deeply welcomedby patients and suitable for the new,nervous patients because the insertion in the important part ofthe body is avoided.This method has a quick effect and one treatment is often enough.

Case report: Effect of immunoglobulin on pain in Post-Polio Syndrome—Three case reports

Study design: Case reports. Setting: University hospital setting. Objective: To analyze the effect of intravenous immunoglobulin on neuropathic and nociceptive pain in three patients with Post-Polio Syndrome (PPS). Materials and Methods: Three patients with PPS and pain who received treatment with 90 g IvIg are described. Results: Before treatment one of the patients had pure neuropathic pain and the other two had a combination of neuropathic and nociceptive pain. There was no effect on pain in the patient with pure neuropathic pain and only effect on the nociceptive pain in the patients with a combination of neuropathic and nociceptive pain. Discussion: Pain is one of the most common symptoms in PPS. Previous studies have shown an effect on pain in PPS patients receiving IvIg. The results of the present study point to that the effect on pain is limited to nociceptive pain and that there is no effect on neuropathic pain which leads to increased knowledge of characterization of responders of IvIg treatment. Conclusion: IvIg treatment treatmentreduces nociceptive but not neuropathic pain in PPS patients.