The Association between Perceived Injustice Following Traumatic Injury and Its Impact on Pain-Related, Mental Health and Functional Health Outcomes: A Systematic Review

Background: There is growing evidence suggesting that those who suffer traumatic injury display high levels of perceived injustice which impedes their recovery, both physically and mentally. Aim: The aim of this systematic review was to examine the association between perceived injustice and pain-related, mental health and functional outcomes in patients who have suffered a traumatic injury. Methods: In May 2023, a systematic review of the literature was performed on the electronic databases of PubMed, Google Scholar, Embase, and the Cochrane Database of Systemic Reviews. Papers were collected and analysed as per PRISMA guidelines for systematic reviews. The outcomes of interest were pain intensity, pain interference, disability, depression, anxiety, and quality of life. The initial search identified 59 papers. Of these papers, five studies met the inclusion criteria and were subsequently analysed (N = 1172). Each of the papers was published in peer-reviewed journals in the English language. Individuals with pain or pathology prior to the trauma and those who were not hospitalised following the trauma were excluded from the study. Results: Of the papers reviewed, each study indicated significant associations between perceived injustice and pain, disability, depression, anxiety, post-traumatic stress disorder, as well as reduced return to work status. Conclusion: This systematic review investigated the relationship between perceived injustice and pain-related, mental health, and functional outcomes in trauma patients. The results highlight the negative role that perceived injustice has on recovery following traumatic injury. Further, it provokes the need for future research regarding the implementation of therapeutic interventions and the development of predictive models of injustice.

An Analysis of Pain Following Traumatic Spinal Cord Injury among Adults in Zimbabwe

The purpose of the study was to analyse on pain following traumatic spinal cord injury, its prevalence, the types of pain present, the common treatments used and their perceived effectiveness in the management of these reported pain types. A cross sectional study was carried out at St Giles Rehabilitation Centre and from members of the Spinal Injuries Association of Zimbabwe (SIAZ). A researcher-administered questionnaire was used to collect data from 24 participants with traumatic spinal cord injury. The questionnaire elicited information on demographic data, pain characteristics and the perceived effectiveness of the common treatments used. Among the 24 participants in the study, 17 were males (70.8%) and 7 were females (29.2%). Pain prevalence was 79.2% among the study participants and approximately a fifth (21.03%) of all participants rated their pain as severe. Eight (33.3%) of the participants had neuropathic pain while 11 (45.8%) had both nociceptive and neuropathic pain types. However, no association was found between sex, age, time post injury when tested against the presence of pain (p > 0.05). Weather changes aggravated almost every type of pain reported. Both pharmacological and non-pharmacological methods were used to manage the pain but their perceived effectiveness was rated as low. The majority of the traumatic spinal cord injured people experienced some pain and this pain was severe in a fifth of all participants. Pain significantly affected their quality of life. Physiotherapists and other medical professionals need to be aware of this and should employ pain reducing modalities and empathy when dealing with these patients.

Chronic pelvic pain,psychiatric disorders and early emotional traumas:Results of a cross sectional case-control study

AIM To compare the prevalence of psychiatric disorders and early emotional traumas between women with chronic pelvic pain(CPP) and healthy women.METHODS One hundred women in reproductive age,50 of them had CPP(according to the criteria set by the International Association for Study of Pain),and 50 were considered healthy after the gynecological evaluation.The eligibility criteria were defined as follows:chronic or persistent pain perceived in the pelvis-related structures(digestive,urinary,genital,myofascial or neurological systems).Only women in reproductive age with acyclic pain for 6 mo,or more,were included in the present study.Menopause was the exclusion criterion.The participants were grouped according to age,school level and socioeconomic status and were individually assessed through DSM-IV Structured Clinical Interview(SCID-I) and Early Trauma Inventory Self-report-short form(ETISR-SF Brazilian version).Descriptive statistics,group comparison tests and multivariate logistics regression were used in the data analysis.RESULTS The early emotional traumas are highly prevalent,but their prevalence did not differ between the two groups.The current Major Depressive Disorder was more prevalent in women with CPP.The CPP was associatedwith endometriosis in 48% of the women.There was no difference in the prevalence of disorders when endometriosis was taken into account(endometriosis vs other diseases:P > 0.29).The current Major Depressive Disorder and the Bipolar Disorder had greater occurrence likelihood in the group of women with CPP(ODDS = 5.25 and 9.0).CONCLUSION The data reinforce the link between mood disorders and CPP.The preview evidences about the association between CPP and early traumas tended not to be significant after a stronger methodological control was implemented.

Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury

BACKGROUND: Rapid and effective pain relief in acute traumatic limb injuries(ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous(IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.METHODS: In this double-blind randomized clinical trial, 320 patients with ATLI, who presented to the emergency department(ED) from February 2016 to April 2016, were randomly divided into two groups. One group(160 patients) received 0.1 mg/kg IV morphine. The other group(160 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specif ic intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.RESULTS: Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up(P value=0.00). However, at 10, 30, and 60-minute follow-ups no signifi cant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12(7.7%) patients in the fentanyl group and in 48(31.6%) patients in the morphine group(P value=0.00). No signifi cant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups.CONCLUSION: Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

Clinical Application of Minimally Invasive Surgery in Pain and Complications after Spinal Trauma

Objective:To study and evaluate the incidence of pain and complications in patients with spinal trauma after minimally invasive treatment.Methods:The research period was selected from January 2018 to December 2020,and 40 patients with spinal trauma were selected.According to the random number table scheme,they were divided into the study group and the control group.The treatment scheme of the control group was traditional surgery,and the treatment scheme of the study group was minimally invasive surgery.The indicators of the two groups were compared and analyzed.Results:Compared with the two groups of surgery and postoperative recovery related indicators,the study group had more advantages(P<0.05);Compared two groups of postoperative NRS score,VAS score and the incidence of complications,the study group had more advantages(P<0.05).Conclusion:Minimally invasive treatment of spinal trauma has significant clinical effect,which can effectively relieve postoperative pain and reduce the incidence of various complications.

Inconsolable Pain--Analysis of the Psychological Trauma in Beloved from Voiceless Perspective

Beloved is a landmark work written by Toni Morrison. To analyze the psychological trauma of American black people in Beloved, it is uncovered that American black people need to establish self-awareness and self-cognition and rebuild self cultural systems and self-values, so that they could develop their social status and finally get rid of discrimination and oppression.

The Use of Antiepileptic Drugs in Acute Neuropsychiatric Conditions: Focus on Traumatic Brain Injury, Pain, and Alcohol Withdrawal

Antiepileptic drugs (AEDs), have demonstrated efficacy treating a number of acute conditions, encompassing a broad range of symptoms and syndromes, in addition to being first-line treatment for epilepsy. Clinically, since their inception, AEDs have been used off-label for acute and chronic medical conditions, both as primary and as adjuvant therapies. In this review, we describe the observed clinical effectiveness of AEDs across a set of commonly encountered acute conditions in the general hospital: traumatic brain injury, pain, alcohol withdrawal. In describing the individual benefits and usages of specific agents, the applicability of these agents to other common neuropsychiatric conditions may be further explored.

Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain

BACKGROUND: Musculoskeletal complaints, especially non-traumatic neck and back pain, are routinely encountered in the emergency department(ED) and lead to ED overcrowding, a burgeoning wait time for physiotherapy and outpatient orthopedic reviews. The study aimed to evaluate the impact of early physiotherapy evaluation and treatment(EPET) vs. standard care(SC) on clinical outcomes for patients presenting to the ED with non-traumatic neck and back pain.METHODS: A retrospective observational study of 125 patients who presented to the ED with non-traumatic neck and back pain with/without peripheral symptoms from July 2010 to February 2011. Neck Disability Index(NDI), Modifi ed Oswestry Low Back Pain Disability Questionnaire(MODI) and 11-point Numeric Pain Rating Scale were used as outcome measures and compared between groups at a mean of 34 days from their initial ED visit.RESULTS: We identifi ed a total of 125 patients. EPET group comprised 62 patients(mean age, 45 years; men, 63%) and SC group comprised 63 patients(mean age, 45 years; men, 43%). The EPET and SC groups received physiotherapy at a median of 4 and 34 days respectively from their fi rst ED visit. EPET patients had signifi cantly lower levels of disability(9.0% vs. 33.4%, Welch t-test, P<0.001) and pain(median value, 1 vs. 4 points, Mann-Whitney U-test, P<0.001) compared with SC patients.CONCLUSION: Early access to physiotherapy in ED was associated with reduced pain and disability levels. EPET protocol can potentially decrease the demand on outpatient orthopedic services, thereby freeing up available resources to treat patients who are more likely to benefi t from it.

Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder(PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder(OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.AIM To perform a systematic review on the association between PTSD, chronic noncancer pain(CNCP), and opioid intake(i.e., prescription, misuse, and abuse).METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention,Comparator, and Outcomes(PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases:Pub Med, MEDLINE, Psyc INFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling,confounding variables, and the statistical analysis.RESULTS A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men(81.6%). The most common chronic pain condition was musculoskeletal pain:back pain(47.14% across studies;range: 16%-60.6%), arthritis and joint pain(31.1%;range: 18%-67.5%), and neck pain(28.7%;range: 3.6%-63%). In total,42.4% of the participants across studies had a diagnosis of PTSD(range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.CONCLUSION Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.

Tietze’s Syndrome in the emergency department: A rare etiology of atraumatic chest pain

Tietze’s Syndrome is an uncommon disorder that presents with painful, tender, non-suppurative swelling of the anterior chest wall. We report a case of a female patient who presented to the emergency department with a chief complaint of atraumatic chest pain and swelling of the anterior chest wall. After a thorough history and physical examination, as well as basic laboratory tests and chest radiography, she was diagnosed with Tietze’s Syndrome. The expedient accurate diagnosis of Tietze’s Syndrome is important for the physical and emotional well-being of a patient, and avoids overlooking more dangerous pathologies. Tietze’s Syndrome needs to be considered in the differential diagnosis of a patient presenting with spontaneous swelling of the anterior chest.

Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty

BACKGROUND Development of infrapatellar saphenous neuroma(ISN)is a well-recognized reason for knee pain following total knee arthroplasty(TKA).So far,very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient satisfaction.AIM To present the results of surgical treatment for ISN after primary TKA,the level of pain relief,and the improvement of knee motion and function.METHODS Fifteen patients(13 women,2 men)with persistent medial pain for more than six months after primary TKA,due to osteoarthritis,underwent surgical excision of ISN.ISN diagnosis was confirmed with the presence of Tinel’s sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local anesthetic.Component loosening,malalignment,instability and infection were excluded systematically in all patients as a source of pain.Pain relief in terms of visual analog scale(VAS),active knee range of motion(ROM),and the Knee Society Score(KSS)for pain and function were evaluated preoperatively and at least six months postoperatively.RESULTS The mean patients’age was 71.3±5.4 years old.The mean interval between TKA and neuroma excision was 10 mo(range,6 to 14 mo),while the mean follow-up was 8 mo(range:6 to 11 mo).All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after surgery.Pain on the VAS scale improved from 8.6±1.3 preoperatively to 0.8±0.9 at the final follow-up(P=0.001).KSS pain and function scores were improved from 49.3±5.9 and 62.7±12.8 before surgery to 91.8±4.2 and 75.3±11.3 after surgery,respectively(P=0.001 and P=0.015).Active knee ROM was also increased postoperatively from 96±4 to 105±6 degrees(P=0.001).There were no complications and no further operations required.CONCLUSION ISN should be considered a potential cause of persistent pain following TKA.Neuroma excision not only provides immediate pain relief and resolution of symptoms but may also improve the knee range of motion.

Comparison of the body pain and trauma degree between uni-portal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer

Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-small cell lung cancer who received radical operation in our hospital between February 2013 and February 2016 were selected and divided into the uniportal group (n=52) who received uniportal video-assisted thoracoscopic surgery and the three-portal group (n=56) who received three-portal video-assisted thoracoscopic surgery after the operation methods and related laboratory results were reviewed. Before operation and 24 h after operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were compared between the two groups of patients.Results: Before operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were not statistically significant between the two groups of patients. 24 h after operation, serum pain mediators NE, DA and 5-HT levels of observation group were lower than those of control group;oxidative stress indexes MDA and O2- levels were lower than those of control group while SOD and GSH-Px levels were higher than those of control group;inflammation indexes IL-6, IL-8, CRP and TNF-α levels were lower than those of control group.Conclusion: Uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer causes less surgery trauma, and patients' postoperative pain and systemic inflammatory stress response are lighter.

From Pain to Healing:Cure for Trauma in Bone by Fae Myenne Ng

Fae Myenne Ng, one of dominant writers in American literary circle currently, had been making her efforts in Bone for ten years. In Bone, Ng depicts the trauma Chinese-Americans suffered profoundly while trying to offer therapy to the traumatized. The narrator, Leila and her stepfather Leon come to terms with trauma by their own ways. What's more, Ng records her own life experience in a way to work through trauma and remains her own understanding about the solution to trauma.

Clinical observation of Guipi Decoction Combined with non steroidal drugs on sleep in elderly patients with acute traumatic pain and Qi deficiency constitutionabortion

Objective:To explore the effect of Guipi Decoction Combined with non steroidal anti-inflammatory drugs on sleep time of elderly patients with traumatic pain and Qi deficiency constitution during hospitalization.Methods:A total of 52 elderly patients hospitalized in the orthopedic(trauma)ward of the Second Affiliated Hospital of Zhejiang Chinese Medical University from November 2020 to may 2021 were randomly divided into control group and treatment group.Patients in the control group were treated with loxoprofen sodium tablets immediately after admission,and placebo was added to loxoprofen sodium tablets from the second day of admission;The patients in the treatment group were treated with loxoprofen sodium tablets after admission.Guipi Decoction was added on the basis of loxoprofen sodium tablets from the second day of admission.Before and after admission,all patients used the TCM constitution classification judgment table to evaluate the score of qi deficiency and VAS;From the first day to the fourth day after admission,the bracelet was worn to monitor the sleep time(total sleep time,deep sleep time,light sleep time and awakening times)every night.The patients were scored by VAS after taking drugs every morning.Results:Finally 25 patients in the control group and 24 patients in the treatment group completed the experiment.There was no significant difference in gender,age,fracture location,chronic medical history VAS score and TCM Qi deficiency constitution score,between two groups at admission(P>0.05).At the time of discharge,the score of qi deficiency constitution in the treatment group was 33.724±12.634;The TCM Qi deficiency constitution score of the control group was 42.25±15.912,and there was significant difference between the two groups(P<0.05);and there was significant difference in VAS score between the two groups at discharge(P<0.05).There were significant differences in total sleep time,light sleep time,deep sleep time and night awakening times between the two groups on the second,third and fourth day of admission(P<0.05).Conclusion:1.Guipi Decoction can significantly improve the sleep time of patients with Qi deficiency acute traumatic pain.2.Guipi Decoction can not only improve the constitution of patients with Qi deficiency bias,but also improve the VAS score at discharge.

Drugs used for pain management in gastrointestinal surgery and their implications

Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.

A study on the effectiveness of intravenous tramadol in the management of severe traumatic pain in emergency department

Introduction:Patients with pain contribute to 60%-70% of emergency department(ED)attendance and the tramadol is among analgesic of choice in ED.However,the use of intravenous tramadol is limited to moderate pain intensity because of its weak opiod agonist properties.We conducted a study to examine the effectiveness of intravenous tramadol among patients who suffer from severe traumatic pain.Methodology:In this prospective study,eligible patients received a loading dose of intravenous tramadol(2mg/kg).If visual analogue score(VAS)more than 30 mm after the loading dose,intermittent bolus intravenous tramadol 20mg will be administered every 10 minutes.At 30 minutes of study,rescue medication(i.e.morphine or pethidine)will be provided to those patients with VAS more than 30 mm.VAS score,vital signs and side effects were recorded for every 10 minutesResults:Forty-seven patients who suffered from fracture and soft tissue injury were analysed.The median VAS score on presentation and at 30 minutes was 90 mm 20 mm respectively.The median total dose of IV tramadol received by the patients at 30 minutes was 150 mg(IQR=34.0).There was a significant change in medium pain score at 10,20 and 30 minutes treatment(P<0.001).Vital signs were within normal range throughout the study period.About 66.1% of them had side effects of tramadol.The common side effects were sleepiness(75.0%)and dizziness(56.3%).Conclusion:The intravenous tramadol is a safe and effective analgesia in severe traumatic patients if an initial and intermittent dose is given adequately.

Comparing role of ATP between acute pain in neuromyelitis optica spectrum disorder and peripheral neuropathic pain

In this article, we present our previous research, which highlighted adenosine triphosphate(ATP) as the cause of neuropathic pain during the acute phase of neuromyelitis optica spectrum disorder(NMOSD). In NMOSD pathology, damageassociated molecular patterns(DAMPs), including ATP, are released from damaged astrocytes, triggering the activation of innate immune cells. ATP is a central mediator of acute pain in NMOSD.

Lighting the shades of hidden pain:a role for spinal cord neurons and microglia in vestibulodynia

Vulvodynia,a chronic pain disorder affecting the vulvar region,represents a significant challenge in both diagnosis and treatment within the field of women’s health.This condition is characterized by chronic pain that significantly affects the quality of life of afflicted women.The present perspective paper examines the role of spinal sensitization and microglial activation in vulvodynia.

Application of virtual reality technology improves the functionality of brain networks in individuals experiencing pain

Medical procedures are inherently invasive and carry the risk of inducing pain to the mind and body.Recently,efforts have been made to alleviate the discomfort associated with invasive medical procedures through the use of virtual reality(VR)technology.VR has been demonstrated to be an effective treatment for pain associated with medical procedures,as well as for chronic pain conditions for which no effective treatment has been established.The precise mechanism by which the diversion from reality facilitated by VR contributes to the diminution of pain and anxiety has yet to be elucidated.However,the provision of positive images through VR-based visual stimulation may enhance the functionality of brain networks.The salience network is diminished,while the default mode network is enhanced.Additionally,the medial prefrontal cortex may establish a stronger connection with the default mode network,which could result in a reduction of pain and anxiety.Further research into the potential of VR technology to alleviate pain could lead to a reduction in the number of individuals who overdose on painkillers and contribute to positive change in the medical field.