Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications

BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few years.AIM The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:CRD42021279639.Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in pain.RESULTS After full-text screening,we included 14 studies in the qualitative synthesis.Of these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients enrolled.There was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome explored.The MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an outcome.In 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not well-specified.The included studies were found to have a low-moderate risk of bias.CONCLUSION Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury.Intravenous ketamine may cause more adverse events than other routes of administration.

Current protocol to achieve dental movement acceleration and pain control with Photo-biomodulation

When designing a study on dental movement acceleration or pain control during orthodontic treatment,it is crucial to consider effective parameters.The objective of this editorial is to compile the most effective parameters supported by evidence that should be considered in future studies to achieve complete parameter homogenization.The protocol currently recommended to homogenize the parameters and facilitate the development of further meta-analysis in terms of acceleration of movement and pain control in orthodontics is Wavelength:810 nm,2.2 J per surface,0.1 W in continuous mode/0.1 W average power in a superpulsed,sweeping movement,1mm from the mucosa,22 seconds along the vestibular surface and 22 seconds along the lingual surface,the recommended speed of movement is 2 mm/sec,1 application during each orthodontic control,to achieve dental movement acceleration and repeat the dose at 24 h to ensure pain elimination.The energy density and power density will depend on the spot size used in the equipment and the distance from the mucosa.It will strengthen the evidence of photobiomodulation as the best therapy to accelerate tooth movement and at the same time control the pain produced by orthodontic treatments.

Virtual Reality in Surgery: Double Blind, Randomized Clinical Trial of Pain Control and Augmented Satisfaction

Introduction: Virtual reality (VR) utilizing a head-mounted display allows viewers to immerse themselves in a virtual environment. This technology may be useful in attenuating pain and anxiety and reducing patient subjective stress as well as objective physiological increase in heart rate and blood pressure. Aside from the improved experience, physiological stress is reduced which results in improved patient outcomes. Patients and methods: Eligible participants were all adults aged 18 or over who had non craniofacial lesions requiring minor surgery. A total of 99 adult patients who were capable of independent consent were randomized to receive a virtual reality experience (VR) or standard music distraction (no VR). Patients were recruited for the study during their office visit when scheduling minor procedure surgery. This was a single center, double-blind, controlled study conducted at Guthrie Clinic Robert Packer Hospital in Sayre, Pennsylvania between March 2019 to January 2020 (pre-pandemic). Ethics approval for this study was obtained from the Institutional Review Board of the Guthrie Clinic. Results: The change in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) significantly decreased from pre-procedure to mid-procedure in the VR group compared with standard. Herein our results are presented. Conclusions: Reductions in intraprocedural SBP, DBP and HR can be achieved when using VR. Although subjective reporting of pain and anxiety were not different between groups, VR significantly improves patient satisfaction compared with non VR standards.

RANDOMIZED CONTROL STUDY ON DEPRESSION INDUCED BY CHRONIC PAIN TREATED WITH ACUPUNCTURE

Objective To study and verify the efficacy of acupuncture on depression caused by chronic pain and to further analyze the advantages of acupuncture. Methods According to random number table, the cases were randomized into experimental group and western medicine group, treated with acupuncture and antidepression drug （deanxit） respectively. Hamilton Depressive Scale （HAMD） and Visual Analogue Scale （VAS） were adopted for the evaluation before treatment and in the 1, 2 and 4 weeks after treatment in two groups successively. Results ① Very significant differences had been achieved on the comparisons of HAMD, VAS and HAMD reducing rate before and after treatment in experimental group （P 〈 0.01）. Very significant differences had been achieved in the comparisons of HAMD, VAS and HAMD reducing rate before and after treatment in western medicine group （P 〈 0.01 ）. ③Significant differences in HAMD reducing rate^＊ and VAS score^＊ ＊ had been achieved in the comparison between experiment group and western medicine group 1 week after treatment （^＊ P〈0.01, ^＊ ＊ P〈0.05）. ④ The significant differences had not been received in HAMD, VAS score and HAMD reducing rate in 2 and 4 weeks after treatment in the comparison between experimental group and western medicine group （P 〉0.05）. ⑤ No any harmful effect happened in experimental group after treatment, but it happened in western medicine group. Conclusion Both acupuncture and deanxit have achieved the definite therapeutic effects on depression caused by chronic pain, with similar efficacy. But the effects of acupuncture are obtained more quickly. In comparison of western medicine, acupuncture has no side and harmful effect. Additionally, acupuncture applies the multi-targeting and holistic modulation to the whole body.

Cognition and Sociodemographic Determinants for Effective Pain Control in Patients with Cancer Pain: a Cross-sectional Survey in China

This cross-sectional study aimed to investigate cancer patients'cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China.In seven tertiary hospitals across China,372 patients experiencing cancer pain were surveyed through a self-designed questionnaire to assess the factors associated with effective pain control.Patients'demographic data and pain control-related factors were recorded.Cluster sampling and binary logistic regression models were used to investigate the association between predictive factors and effective pain control.The survey showed that the majority of the patients were more than 45 years old(76.3%),and 64.4%had an average annual income of more than 20000 RMB.One-third of the patients suffered from cancer pain for more than 3 months,and 75.1%received professional guidance during medication.The barriers to pain control for patients included preference to enduring pain and refusing analgesics(62.9%),negligence towards drug usage(28.5%),concerns about the addiction(48.2%)and adverse reaction(56.4%).The average annual family income,pro fessional guidance,knowledge of pain medication,adherence to analgesics,and concerns about addiction to analgesics were significantly correlated to the effect of patients'pain control.The study presents major barriers to optimal pain control among patients with cancer in China.Our findings suggest that educational programs and medical insurance reimbursement support from the government are urgently needed to overcome the cognitive barriers toward effective pain management and to relieve the economic burden among patients with cancer pain in China.

Preoperative Pain Management of Patients with Hip Fractures: Blind Fascia Iliaca Compartment Block Compared to Ultrasound Guided Femoral Nerve Block—A Randomized Controlled Trial

Introduction: Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy in pain management of these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. Method: We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise test three hours after block administration. Results: A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with an NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). Conclusion: Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally efficient in providing pain management in the preoperative period.

Efficacy of Perioperative Intravenous Lidocaine for Multimodal Analgesia

Given the rising incidence of opioid misuse and opioid-related deaths worldwide, it is imperative to find nonopioid analgesic adjuncts for perioperative pain management. Perioperative opioid exposure in opioid-naïve patients for even minor surgical procedures may result in significant opioid dependence. Although the use of intravenous lidocaine in the perioperative period is not novel, recently it has been proposed as an important adjunct to multimodal analgesia. In addition to improving acute pain, lidocaine may reduce the incidence of chronic post-operative pain syndrome (CPPS), improve bowel function, and decrease post-operative nausea and vomiting (PONV) thereby speeding up the post-operative recovery process. Furthermore, lidocaine has efficacy in a variety of procedures including abdominal, gynecological, and urological surgeries. The aim of this narrative review is to evaluate the effects of intravenous lidocaine compared to traditional analgesic methods on post-operative pain control and recovery for various surgical procedures.

Effectiveness of acupuncture versus spinal-epidural anesthesia on labor pain： a randomized controlled trial

OBJECTIVE: To evaluate the effectiveness of acupuncture analgesia(AA) compared with combined spinal-epidural anesthesia(CSEA) for labor pain relief and labor outcomes.METHODS: We evaluated 131 primiparous women who received respiratory guidance during maternal uterine contractions and received either AA(n =43), CSEA(n = 45), or no additional treatment(control, n = 43). The groups were compared regarding visual analog scale(VAS) scores for abdominal and back pain, and labor outcomes.RESULTS: The abdominal VAS scores of the AA and CSEA groups were significantly lower than that of the control group. In addition, the VAS scores of the CSEA group were significantly lower than that of the AA group at 10 and 60 min after intervention.The back pain VAS scores of the AA and CSEA groups were significantly lower than that of the control group at 5, 10, and 60 min after intervention. The duration of the active phase of labor in the CSEA group was significantly longer than that of the AA and control groups. The rates of oxytocin use(4.70%), urinary retention(4.70%), and postpartum hemorrhage [(273.7 ± 53.6) m L] in the AA group were significantly lower than in the CSEA group [46.70%, 24.20%, and(320.0 ± 85.6) m L, respectively].CONCLUSION: Both AA and CSEA were effective for labor pain relief, CSEA provided more effective pain relief, while AA was associated with a shorter duration of labor and fewer adverse effects.and each has its advantages and disadvantages.