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Anoectochilus elatus is a new record species from Yunnan province in China discovered by our group in 2018, used in folk as the most popular Anoectochilus species A. roxburghii for medicinal and culinary purposes. The crude polysaccharide of Anoectochilus elatus (AEP) exhibited significant antinociceptive effects against both chemical and thermal nociception in vivo. Bio-guided isolation identified GJXL-1 as the leading analgesic polysaccharide in AEP. Detailed structural analyses rationalized GJXL-1 (molecular weight: 10.3 kDa) as an α-D-1,4-linked glucan unexpectedly branched at O-3, and O-6 position. GJXL-1 dose-dependently suppressed acetic acid-induced writhing in mice and decreased the serum levels of NO, IL-6 and TNF-α, which also repressed the licking times in both the first and second phases in formalin test. Furthermore, only L-nitroarginine partly reversed the analgesic activity of GJXL-1, indicating that GJXL-1's efficacy was partially mediated by NO regulation, possibly through inhibiting IRAK4/TAK1/NF-κB signaling pathway, and modulating gut microbiota and short-chain fatty acids production. In addition, the motor impairment and hypnotic effects of GJXL-1 were excluded. Our study suggests that GJXL-1 can be regarded as a promising and safe drug candidate for diverse pain disorders, and also a promising prebiotic candidate to maintain intestinal homeostasis and promote human gut health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

This paper aims to discuss the effect of traditional Chinese medicine preparation Huayu Zhitong powder in the treatment of distal radius fracture. In this paper, 200 patients with distal radius fracture were randomly divided into treatment group and control group. Patients in treatment group orally took Huayu Zhitong powder, while patients in control group were treated with traditional Shangke Jiegu tablets with traditional Chinese medicine composition. After fixed in a cast plaster, patients in the two groups were supervised the disappearance time of pain by adopting NRS (Numerical rating scale) from scale 0 to 10. Besides, they returned at day 5 and day 8 respectively, and then they were observed the swelling affected part. At day 14, day 28, and day 56 after reduction they respectively took an x-ray. Then they would be graded according to the growth of osteotylus and the clinical effects were evaluated based on the grade. Finally, the treatment group worked better in relief effect than the control group. At day 8, the treatment group worked better in detumescence than the control group. At day 28, the recovery effect in treatment group was found to be better than the other. From these, it is shown that the traditional Chinese medicine works much better in the treatment of distal radius fracture than traditional treatment medicine. Thus it is of great worth spreading for use.

The Meconopsis plants (Chinese: 绿绒篙), belonging to the family Papaveraceae, have been used as traditional Tibetan medicine (TTM) for thousands of years. Meconopsis has the effects of clearing heat, reducing swelling, and easing pain, and is mainly prescribed for heat syndromes, hepatitis, pneumonia, and pain in joints. Phytochemical studies have revealed the presence of major isoquinoline alkaloids and flavonoids. Modern pharmacological research has demonstrated its antitumor, hepatoprotective, analgestic, antimicrobial, anti-oxidant, antitussive, and anti-inflammatory activities. However, resource availability, in-depth in vivo pharmacological study and qualitative and quantitative analysis are still insufficient and deserve further efforts. This paper provides a comprehensive advance on the ethnopharmacological, phytochemical, and pharmacological studies of the genus, in hopes of promoting a better understanding of their medicinal values. [ABSTRACT FROM AUTHOR]

In the 25 years since drug abuse re-emerged in China in the 1980s, the National Institute of Drug Dependence (NIDD) has made many contributions to China's antidrug campaign. This present paper offers an account of the history, current status and future of drug dependence research at NIDD. NIDD was originally a research centre at Beijing Medical University, founded by the Chinese Ministry of Health to address the rapid spread of drug abuse in China. Originally, the main task of NIDD was to complete the commissions assigned by the government and university. Further developments transformed NIDD into a national research institute in the field of drug addiction that began to conduct its own research. NIDD has now created a professional team spread across several independent departments involved in neurobiological mechanisms, epidemiological surveys and monitoring, pre-clinical and clinical evaluation of new drugs (mainly analgesic drugs and detoxification drugs) and informatics and data analysis. As a university-based research institute, NIDD's funding derives mainly from grants provided by the government and financial support from international organizations. Its past and present research has a gained NIDD a reputation with both practitioners and policy makers in the field of drug addiction. In the future, NIDD will continue to engage in various aspects of drug addiction research and will enter the field of brain function. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Notopterygium incisum Ting ex H.T. Chang, known in Chinese as ‘Qianghuo’ is a traditional Chinese medicinal herb with the rhizome and roots associated with meridians of the kidney and urinary bladder. It is pungent, bitter and warm in nature. It has been used over the years to disperse cold, prevent painful obstructions from wind, damp and warm pain. It has also been used with other herbs to treat wind-cold exterior syndrome and wind-cold-damp bi-syndromes and has been known to grow well in regions of high altitude such as Gansu, Tibet etc. The aim of the review This systematic review focuses on the ethnopharmacological uses of this herb, including recent advances on the phytochemical and pharmacological study of N. incisum . Recent analytical methods developed for the quantitative and qualitative determination of constituents in this herb have also been reviewed. Additionally, future trends and prospects in the study of this herb have been proposed. Materials and method Various literature and electronic databases such as Pubmed, Science Direct, Springer, Wiley etc were searched and data obtained. Other online academic libraries such as Google Scholar and ethnopharmacological literature were searched systematically for more information on the herb. Results This review focuses on the ethnopharmacological uses of N. incisum and also the various chemical constituents present in the herb and their various therapeutic effects such as analgesic, anti-inflammatory, anti-cancer and antioxidants effects. Analytical methods developed for the quantitative and qualitative determination of various compounds in this herb were further reviewed. Conclusion In this paper, we have reviewed various researches conducted on N. incisum especially in areas of its ethnopharmacological use, phytochemicals, pharmacology and developed analytical methods. This herb has been used over the years in treating headache, rheumatoid arthritis, cold, diaphoretic etc, prompting many types of research into identifying which compounds are responsible for these activities and their mechanism of action. More research is needed in the area of pharmacokinetics and toxicology to give further information on the clinical use and control the quality of the herb. [ABSTRACT FROM AUTHOR]

Background: Humane treatment requires the provision of appropriate sedation and analgesia during medical diagnosis and treatment. However, limited information is available about the status of procedural analgesic interventions in Chinese hospitals. Therefore, a nationwide survey was established to identify challenges and propose potential improvement strategies. Methods: Forty-three members of the Pain Group of Chinese Society of Anesthesiology established and reviewed the questionnaire, which included (1) general information on the hospitals, (2) the sedation/analgesia rate in gastrointestinal endoscopy, labor, flexible bronchoscopy, hysteroscopy in China, (3) staff assignments, (4) drug use for procedural analgesic interventions, and (5) difficulties in procedural analgesic interventions. The data were obtained using an online questionnaire sent to the chief anesthesiologists of Chinese hospitals above Grade II or members of the Pain Group of Chinese Society of Anesthesiology. Results: Valid and complete questionnaires were received from 2198 (44.0%) hospitals, of which 64.5% were Grade III. The overall sedation/analgesia rates were as follows: gastroscopy (50.6%), colonoscopy (53.7%), ERCP (65.9%), induced abortion (67.5%), labor (42.3%), hysteroscopy (67.0%) and fiber bronchoscopy (52.6%). Compared with Grade II hospitals, Grade III hospitals had a higher proportion of procedural analgesic interventions services except for induced abortion. On average (median [IQR]), each anesthesiologist performed 5.7 [2.3—11.4] cases per day, with 7.3 [3.2—13.6] performed in Grade III hospitals and 3.4 [1.8—6.8] performed in Grade II hospitals (z = -7.065, p < 0.001). Conclusions: Chinese anesthesiologists have made great efforts to achieve procedural analgesic interventions, as evidenced by the increased rate. The uneven health care provided by hospitals at different levels and in different regions and the lack of anesthesiologists are the main barriers to optimal procedural analgesic interventions. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Sophora flavescens (Fabaceae), also known as Kushen (Chinese: 苦参), has been an important species in Chinese medicine since the Qin and Han dynasties. The root of Sophora flavescens has a long history in the traditional medicine of many countries, including China, Japan, Korea, India and some countries in Europe. In traditional Chinese medicine (TCM), Sophora flavescens has been used extensively, mainly in combination with other medicinal plants in prescriptions to treat fever, dysentery, hematochezia, jaundice, oliguria, vulvar swelling, asthma, eczema, inflammatory disorders, ulcers and diseases associated with skin burns. The aim of this review is to provide updated and comprehensive information regarding the botany, ethnopharmacology, phytochemistry, biological activities and toxicology of Sophora flavescens and to discuss possible trends and opportunities for further research on Sophora flavescens . Materials and methods We systematically searched major scientific databases (PubMed, Elsevier, SpringerLink, Google Scholar, Medline Plus, ACS, “ Da Yi Yi Xue Sou Suo ( http://www.dayi100.com/login.jsp )”, China Knowledge Resource Integrated (CNKI) and Web of Science) for information published between 1958 and 2015 on Sophora flavescens . Information was also acquired from local classic herbal literature, conference papers, government reports, and PhD and MSc dissertations. Results The broad spectrum of biological activities associated with Sophora flavescens has been considered a valuable resource in both traditional and modern medicine. Extracts are taken either orally or by injection. More than 200 compounds have been isolated from Sophora flavescens , and the major components have been identified as flavonoids and alkaloids. Recent in vitro and in vivo studies indicate that at least 50 pure compounds and crude extracts from Sophora flavescens possess wide-ranging antitumor, antimicrobial, antipyretic, antinociceptive, and anti-inflammatory pharmacological abilities. The anticancer and anti-infection abilities of these components are especially attractive areas for research. Conclusions Sophora flavescens is a promising traditional medicine, but there is a need for more precise studies to test the safety and clinical value of its main active crude extracts and pure compounds and to clarify their mechanisms of action. Moreover, some existing studies have lacked systematic methods and integration with the existing literature, and some of the experiments were isolated, used small sample sizes and were unreliable. More validated data are therefore required. [ABSTRACT FROM AUTHOR]

What is known and objective: Esketamine is an N‐methyl‐D‐aspartic acid (NMDA) receptor antagonist, which has stronger sedative and analgesic effects and fewer adverse events than ketamine. The effects of low‐dose esketamine on haemodynamics and postoperative quality of recovery in elderly patients have not been evaluated. To evaluate whether low‐dose esketamine can be safely used for anaesthesia induction in the elderly. Methods: Eighty elderly patients were selected for unilateral total knee replacement under general anaesthesia from February 2021 to August 2021. Patients were randomly divided into two groups (n = 40): control group (C group) and esketamine group (K group). During induction of anaesthesia, the control group was intravenously injected with normal saline of equal volume, and the esketamine group was intravenously injected with 0.2‐mg/kg esketamine. Both groups were induced by etomidate, sufentanil and rocuronium and maintained by combined intravenous and inhaled anaesthesia during operation. Main outcome measures: HR, SBP, DBP, MAP and BIS values were recorded before induction of anaesthesia (T0), immediately before endotracheal intubation (T1), 1min(T2) and 5min(T3) after endotracheal intubation, surgical skin incision (T4), 1min(T5) and 5min(T6) after surgical skin incision. Results: Compared with the C group, SBP, DBP, MAP, HR and BIS of the K group were significantly higher at T1‐T3 (p < 0.05). There were no significant differences in SBP, DBP, MAP, HR and BIS between the two groups at T4‐T6 (p > 0.05). Compared with T0, SBP, MAP and BIS values of the two groups at T1‐T6 were decreased (p < 0.05). DBP of the K group at T2 was not significantly different from DBP at T0 (p < 0.05), but DBP of the C group decreased from T1 to T6 (p < 0.05). Compared with T0, HR in both groups decreased at T1, T3, T4, T5 and T6 (p < 0.05). Compared with the C group, the incidence of cough in the K group was significantly lower (p < 0.05); There was no significant difference in the number of myoclonus during induction between the two groups (p > 0.05). Compared with the C group, the number of hypotension episodes in the K group during induction was much smaller (p < 0.05). There were no significant differences in the incidence of hypertension, bradycardia and tachycardia (p > 0.05). There were no significant differences in postoperative recovery quality and incidence of adverse events between the two groups (p > 0.05). What is new and conclusion: Low‐dose esketamine for anaesthesia induction in the elderly undergoing knee arthroplasty may better maintain the stability of haemodynamics and has no adverse effect on the quality of early recovery after operation. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Carthamus tinctorius L. (Compositae), a widely used traditional Chinese medicine, was known as Hong hua (Chinese: ▪), safflower. Safflower with a wide spectrum of pharmacological effects has been used to treat dysmenorrhea, amenorrhea, postpartum abdominal pain and mass, trauma and pain of joints, etc. The present paper reviews the advancements in investigation of botany and ethnopharmacology, phytochemistry, pharmacology and toxicology of safflower. Finally, the possible tendency and perspective for future investigation of this plant are discussed, too. Materials and methods: The information on safflower was collected via piles of resources including classic books about Chinese herbal medicine, and scientific databases including Pubmed, Google Scholar, ACS, Web of science, CNKI and others. Results: Over 104 compounds from this plant have been isolated and identified, and quinochalcones and flavonoids are considered as the characteristic and active constituents of safflower. Safflower with its active compounds possesses wide-reaching biological activities, including dilating coronary artery, improving myocardial ischemia, modulating immune system, anticoagulation and antithrombosis, antioxidation, antiaging, antihypoxia, antifatigue, antiinflammation, anti-hepatic fibrosis, antitumor, analgesia, etc. Conclusions: As an important traditional Chinese medicine, it is important to investigate the pharmacological effects and molecular mechanisms of this plant based on modern realization of diseases' pathophysiology. More bioactive components should be identified using bioactivity-guided isolation strategies, and the possible mechanism of action as well as potential synergistic or antagonistic effects of multi-component mixtures derived from safflower need to be evaluated integrating pharmacological, pharmacokinetic, bioavailability-centered and physiological approaches. Further studies on safflower can lead to the development of new drugs and therapeutics for various diseases, and how to utilize it better should be paid more attention to. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to describe the current clinical situation of patients with painful diabetic peripheral neuropathy (DPN) and related anxiety, depression, and the quality of life of patients in mainland China, and to report the current status of the use of analgesics. Methods: Between June 15, 2021, and October 15, 2021, a total of 401 participants participated in the study. Recruitment was carried out using a multi-level sampling method. Participants' demographics, medical history, analgesic use, Michigan Symptom Score (MNSI), Numerical Rating Scale (NRS) pain score, Patient Health Questionnaire 9 (PHQ-9) score, Generalized Anxiety Disorder 7 (GAD) -7) Score, quality of life score (SF-12) and diabetes treatment status were collected. Results: Among the participants, there were 236 male patients and female patients. Participants were 322 patients over 40 years old. Regarding the use of analgesics: 132 patients reported using analgesics, 221 patients reported not using analgesics, and 48 patients reported having used analgesics. The results of the scale showed that the scores of NRS, GAD-7, PHQ-9 and SF-12 were 5.12 ± 2.15, 6.33 ± 3.67, 8.46 ± 4.07 and 47.84 ± 19.92 for patients who used analgesics, Compared with patients who did not use analgesics (NRS: 1.99 ± 1.7, GAD-7: 1.81 ± 2.81, PHQ-9: 3.13 ± 4.10, SF-12: 78.34 ± 21.66) there are significant differences (p< 0.001). In addition, patients' NRS scores are also closely related to GAD-7, PHQ-9 and SF-12 scores. Conclusion: The severity of symptoms, mental status and quality of life of patients who used analgesics were more severe than those of patients who did not use analgesics. Pregabalin is still the preferred analgesic for patients with painful DPN, and the use of opioids in my country is extremely low, which is consistent with current international guidelines. Age, diabetic duration, DPN duration, PHQ-9 score, GAD-7 score and SF-12 scores are closely related to NRS pain scores. In addition, there are still a considerable number of patients who have not used analgesics due to financial burdens and other reasons, suggesting that China still has insufficient pain management in DPN patients. [ABSTRACT FROM AUTHOR]

Background: Patrinia scabra Bunge is a well-known herbal medicine for its favorable treatment on inflammatory diseases owing to its effective ingredients, in which iridoid glycoside plays an extremely significant role. This article aimed to improve the content of total iridoid glycosides in crude extract through a series optimization of extraction procedure. Moreover, considering that both pain and inflammation are two correlated responses triggered in response to injury, irritants or pathogen, the article investigated the anti-inflammatory and analgesic activities of P. scabra to screen out the active fraction. Method: P. scabra was extracted by ultrasonic-microwave synergistic extraction (UMSE) to obtain total iridoid glycosides (PSI), during which a series of conditions were investigated based on single-factor experiments. The extraction process was further optimized by a reliable statistical method of response surface methodology (RSM). The elution fractions of P. scabra extract were prepared by macroporous resin column chromatography. Through the various animal experiment including acetic acid-induced writhing test, formalin induced licking and flinching, carrageenan-induced mice paw oedema test and xylene-induced ear edema in mice, the active fractions with favorable analgesic and anti-inflammatory effect were reasonably screen out. Results: The content of PSI could reach up to 81.42 ± 0.31 mg/g under the optimum conditions as follows: ethanol concentration of 52%, material-to-liquid ratio of 1:18 g/mL, microwave power at 610 W and extraction time of 45 min. After gradient elution by the macroporous resin, the content of PSI increased significantly. Compared with other concentrations of elution liquid, the content of PSI in 30 and 50% ethanol eluate was increased to reach 497.65 and 506.90 mg/g, respectively. Owing to the pharmacology experiment, it was reasonably revealed that 30 and 50% ethanol elution fractions of P. scabra could relieve pain centrally and peripherally, exhibiting good analgesic and anti-inflammatory activities. Conclusion: Patrinia scabra possessed rich iridoids and exhibited significant analgesic and anti-inflammatory activities. [ABSTRACT FROM AUTHOR]

Traditional Chinese medicine has been clinically used in China for many years, with experimental studies and clinical trials having demonstrated that it is safe and valid. Among many traditional natural medicines, Chuanxiong and Asarum have been proven to be effective in the treatment of relieving pain. Actually, as well as analgesic, they have common attributes, such as anti-inflammatory, cardiovascular benefits, and anticancer activities, with volatile oils being their major components. Furthermore, Chuanxiong and Asarum have been combined as drug pairs in the same prescription for thousands of years, with examples being Chuanxiong Chatiao San and Chuanxiongxixintang. More interestingly, their combination has better therapeutic effects on diseases than a single drug. After the combination of Chuanxiong and Asarum forms a blend, a series of changes take place in their chemical components, such as the contents of the main active ingredients, ferulic acid and ligustilide, increased significantly after this progress. At the same time, the pharmacological effects of the combination appearing to be more powerful, such as synergistic analgesic. This review focuses on the chemical constituents and pharmacological activities of Chuanxiong, Asarum, and Chuanxiong Asarum compositions. [ABSTRACT FROM AUTHOR]

Background: Chronic pain and cognitive decline are common age-related conditions affecting a large segment of older populations. Little is known about the pathway of cognitive functioning during the course of pain management in older adults. Aims: The study aimed to examine the association between chronic body pain management and cognitive function over time among Chinese older adults. Methods: A total of 792 respondents aged 60 and above from urban and rural households in 28 provinces, 150 counties/districts, and 450 communities were selected from the China Health and Retirement Longitudinal Study (2013–2015). Cognitive function was measured in three domains: episodic memory, mental status, and global cognitive function. Difference-in-differences approach and mixed-effects linear regression models were employed to assess the association between chronic body pain management and cognitive function over time. Results: Scores of mental status were found to decline slower by 0.49 unit (SE = 0.22, p < 0.05) in respondents who received pain management using analgesics, complementary and alternative medicine, or both from 2013 to 2015 after controlling for basic demographic and health confounders. Conclusion: Chronic pain management was associated with slower decline in domain-specific cognitive function, mental status over time. Findings of the study may contribute to understanding the mechanism of change in diverse cognitive abilities attributable to pain symptoms. More research is needed to elucidate the mediating effect of pain on cognitive decline, which could lead to testing of the impact of pain management on cognitive function among older population in both clinical and community settings. [ABSTRACT FROM AUTHOR]

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Background: Urinary catheterization is universally used during surgery, and the incidence of postoperative catheter-related bladder discomfort (CRBD) is very high during recovery. We conducted this study to identify the incidence and predictors of postoperative CRBD after gynaecological surgery in the post-anesthesia care unit (PACU). Methods: This was a prospective observational study. Patients undergoing gynaecological surgery under general anesthesia with intra-operative urinary catheterization were enrolled. We collected the clinical data, incidence and severity of CRBD, and postoperative pain for the patients. Predictive factors of CRBD were analysed by univariate and multivariate analysis. Results: A total of 407 patients were included in this study. The incidence of CRBD after gynaecological surgery was 64.6% (mild CRBD: 22.8%; moderate CRBD: 34.2%; and severe CRBD: 7.6%). Univariate analysis showed that age, type of surgery, type of laparoscopic surgery, additional analgesics, and postoperative pain were influencing factors for CRBD. Based on multivariate logistic regression analysis, age ≥ 50 years, uterus-related laparoscopic surgery, and lack of additional analgesics were independent predictors of moderate or severe CRBD. Conclusions: This observational study revealed that the incidence of CRBD after gynaecological surgery in PACU was very high. Age ≥ 50 years, uterus-related laparoscopic surgery, and lack of additional analgesics were independent predictors of CRBD. Trial registration: ChiCTR1800016390. Registered on 30 May 2018. [ABSTRACT FROM AUTHOR]

Introduction: Prolonged-release oxycodone/naloxone (OXN PR), combining an opioid analgesic with selective blockade of enteric µ-opioid receptors, provided effective analgesia and improved bowel function in patients with moderate-to-severe pain and opioid-induced constipation in clinical trials predominantly conducted in Western countries. This double-blind randomized controlled trial investigated OXN PR (N = 116) versus prolonged-release oxycodone (OXY PR, N = 115) for 8 weeks at doses up to 50 mg/day in patients with moderate-to-severe, chronic, non-malignant musculoskeletal pain and opioid-induced constipation recruited in China.Methods: A total of 234 patients at least 18 years of age with non-malignant musculoskeletal pain for more than 4 weeks that was moderate-to-severe in intensity and required round-the-clock opioid therapy were randomized (1:1) to OXN PR or OXY PR. The primary endpoint was bowel function using the Bowel Function Index (BFI). Secondary endpoints included safety, Brief Pain Inventory-Short Form (BPI-SF), use of analgesic and laxative rescue medication, and health-related quality of life (EQ-5D).Results: While BFI scores were comparable at baseline, at week 8 improvements were greater with OXN PR vs OXY PR (least squares mean [LSM] difference (95% CI) - 9.1 (- 14.0, - 4.2); P < 0.001. From weeks 2 to 8, mean BFI scores were in the range of normal bowel function (≤ 28.8) with OXN PR but were in the range of constipation (> 28.8) at all timepoints with OXY PR. Analgesia with OXN PR was similar and non-inferior to OXY PR on the basis of modified BPI-SF average 24-h pain scores at week 8: LSM difference (95% CI) - 0.3 (- 0.5, - 0.1); P < 0.001. The most frequent treatment-related AEs were nausea (OXN PR 5% vs OXY PR 6%) and dizziness (4% vs 4%).Conclusion: OXN PR provided clinically meaningful improvements in bowel function and effective analgesia in Chinese patients with moderate-to-severe musculoskeletal pain and pre-existing opioid-induced constipation.Trial Registration: ClinicalTrials.gov, identifier NCT01918098. [ABSTRACT FROM AUTHOR]

Background: Overuse of and dependence on analgesics (including opioids and other pain medications) are major international public health problems. Objective: To identify influences on analgesic dependence among analgesic users in the general populations of different countries. Methods: Online surveys of 1,283 people with pain in the UK, USA, Australia, Germany, Egypt and China/Macau/Hong Kong. Results: Levels of analgesic overuse and dependence were highest in Egypt and lowest in China/Macau/Hong Kong. In every country except Egypt, frequency of pain and frequency of analgesic use were correlated with analgesic dependence, and scores on the Need subscale of the Pain Medication Attitudes Questionnaire (PMAQ) independently predicted analgesic dependence. In the UK, USA, Australia, and Germany, frequency of analgesic use mediated the effects of pain frequency or intensity, and Need scores mediated the effects of frequency of analgesic use. In Egypt, more recent pain, analgesic overuse, and the Emotion and Solicitude subscales of the Survey of Pain Attitudes independently predicted analgesic dependence. Conclusions: Across multiple countries, the impact of pain on analgesic dependence was mediated by frequency of analgesic use rather than overuse or abuse, and self-reported need for analgesics was the strongest independent predictor of dependence. Asking people directly about their feelings of needing analgesics could therefore identify those who could be helped to use analgesics less frequently, which should reduce their risk of dependence. [ABSTRACT FROM AUTHOR]

Background: Opioid use disorder (OUD) causes substantial public health and social problems worldwide. Poly-drug use is common in people with OUD and increases morbidity and mortality. Investigation of the patterns and characteristics of poly-drug use of prescription medicine among opioid users is needed to develop appropriate prevention and intervention strategies. Objectives: To estimate the prevalence of poly-drug use of prescription medicine among people with OUD in China using meta-analysis. Methods: We searched relevant epidemiological studies published before February 2017 in English and Chinese databases. The quality of included studies was assessed using the Agency for Healthcare Research and Quality scale. The pooled prevalences of prescription medicine use among people with OUD were estimated. Results: We included 80 eligible studies in the meta-analysis. The main prescription medicines were benzodiazepines (BZDs) and prescription opioid analgesics. The pooled prevalence of unclassified BZDs and prescription opioids was 40.6% and 23.2%, respectively. Diazepam was the most frequently co-used BZD (32.6%), followed by triazolam (32.1%), and estazolam (9.2%). Tramadol was the most commonly used prescription opioid (27.3%), followed by methadone (16.8%), buprenorphine (12.6%), pethidine (8.9%), morphine (6.5%), dihydroetorphine (3.9%), and codeine-containing cough syrup (3.7%). BZDs were mainly used for self-medication (56.1%), whereas prescription opioids were primarily coused for nonmedical purposes (69.4%). Conclusions: The results demonstrate that prescription medicine use is widespread among opioid users in China. There needs to be more consideration of poly-drug use, and early interventions and management strategies are needed to prevent poly-drug use among opioid users in China. [ABSTRACT FROM AUTHOR]

Background: Dienogest is a progestin with demonstrated efficacy in the treatment of endometriosis in European women. The objective of this study was to evaluate the efficacy and safety of dienogest in Chinese women. Patients and Methods: This 24-week, randomized, double-blind, placebo-controlled multicenter ( n = 23) study evaluated the efficacy and safety of 2 mg dienogest once daily in 255 Chinese women aged 18-45 years with laparoscopically diagnosed endometriosis and an endometriosis-associated pelvic pain (EAPP) score ≥30 mm on a 0-100 mm visual analog scale. The primary efficacy variable was absolute change in EAPP from baseline to week 24. Secondary efficacy variables included proportions of responders and intake of supportive analgesic medication. Safety variables included adverse events (AEs), laboratory parameters, and bleeding patterns. Bone mineral density (BMD) was evaluated in a subset of 140 women. Results: After 24 weeks of treatment, the difference between treatment arms for mean reduction in EAPP was statistically significant in favor of dienogest (−24.54 mm; 95% CI −29.93 to −19.15; p < 0.0001). Secondary efficacy analyses supported the significant superiority of dienogest over placebo. Dienogest was well tolerated, with few AEs associated with therapy. Dienogest had no effect on BMD levels after 24 weeks of treatment. Conclusions: Dienogest 2 mg once daily for 24 weeks was superior to placebo in reducing EAPP and was safe and well tolerated in Chinese women with endometriosis. The results are consistent with studies previously conducted in European women. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the developing course of postoperative pain in a Chinese sample of patients following thoracic surgery. Background Chronic postoperative pain following thoracic surgery including both thoracotomy and video-assisted thoracic surgery is often reported. However, research on pain trends concerning this topic is scarce with a notable lack of culturally focused studies by nurses. Design A prospective observational study. Methods The sample included patients undergoing thoracotomy ( n = 137) and video-assisted thoracic surgery ( n = 143). Pain intensity and interference of pain with function were assessed during hospitalisation (day 1 to day 7 postoperatively) and followed up by telephone at 2 weeks and then at 1, 2, 3 and 6 months after surgery. Results Moderate-to-severe pain when coughing and moving was reported in over 85% during hospitalisation, and a significant difference in pain was found between those undergoing a thoracotomy (61%) and those having video-assisted surgery (34%). Many patients whose immediate postoperative pain was poorly managed tended to report high pain levels after discharge and continued to have clinically important chronic pain 6 months after surgery. The pain intensity mean score during movement in the first five postoperative days was an important predictor of clinically important chronic pain, and those experiencing severe acute pain during hospitalisation had a higher probability of developing chronic pain. Conclusions Postoperative pain after thoracic surgery warrants greater attention because those experiencing severe acute pain during hospitalisation have a higher probability of developing chronic pain. Aggressive pain management and multimodal analgesia are recommended to prevent long-term suffering in patients. Relevance to clinical practice Chronic pain after thoracic surgery remains a challenge in clinical nursing. To improve pain management quality and to prevent the transition of acute postoperative pain to chronic pain, standardised practice protocols and comprehensive physician and nurse education are highly recommended. [ABSTRACT FROM AUTHOR]

Background: Although pre-emptive analgesia is commonly used for the management of postoperative pain in developed countries, no defined protocol has been carried out and widely practiced, especially in transabdominal hysterectomy. Keeping this in mind the present study aimed to investigate the effects of multimodal pre-emptive analgesia on pain management, stress response and inflammatory factors of patients undergoing transabdominal hysterectomy to find an optimized way of pre-emptive analgesia. Methods: One hundred patients undergoing abdominal hysterectomy were randomly divided into four groups (Trial registration: ChiCTR-IPR-15005848). Group P1 was given intravenous flurbiprofen and epidural fentanyl + ketamine before surgery; Group P2 received intravenous flurbiprofen before surgery and epidural fentanyl + ketamine after surgery; Group P3 was given epidural fentanyl + ketamine before surgery and intravenous flurbiprofen after surgery; Patients in Group C received normal saline treatment. Results: Compared with control group, the first time to request additional analgesics after surgery were significantly later (P <0.05), 24 h dosage of analgesia were significantly less (P <0.05), VAS score at all time periods after surgery were significantly lower (P <0.05) in Group P1, P2, or P3. At 12 h or 24 h after surgery, VAS score in Group P1 was significantly lower than that in group P2 or P3 (P <0.05, P <0.05). No significant adverse effects were found among the groups (P > 0.05). At 1 or 2 days after surgery, the levels of cortisol, glucose, and IL-6, TNF-α in group P1, P2, and P3 were significantly lower than those in group C (P < 0.05); while, the levels in group P2, P3 were significantly lower than those in group P1 (P < 0.05). Conclusion: Multimodal pre-emptive analgesia could significantly lower VAS score, inhibit stress response, and reduce inflammatory response in patients undergoing transabdominal hysterectomy, which can be a rational strategy for pain control in future. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the reliability and validity of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators in Chinese older adults post surgery during the anaesthesia recovery period. Background Pain assessment in older surgical patients is complicated by factors such as anaesthesia and opioid administration. Although observational pain behavioural assessment tools have been validated for those unable to self-report, research on their application during the anaesthesia recovery period is limited. Design A prospective correlational design. Methods Ninety-three older patients admitted for scheduled abdominal surgery were recruited in a university-affiliated hospital. The two observational scales were used to conduct pain assessments during the anaesthesia recovery period. On the first and the third postoperative day, participants recalled their pain intensity during the recovery period using the Numeric Rating Scale or the Faces Pain Scale-Revised. Results The internal consistency reliability of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators was 0·81 and 0·69 respectively. The correlation between scores of the two observational scales was 0·95. The recalled self-reports of pain intensity were significantly correlated. The correlation of the Pain Assessment in Advanced Dementia scale and patients' recalled self-reports was 0·55, 0·54, and the correlation between the Checklist of Nonverbal Pain Indicators and the two recalled pain scores was both 0·60. Conclusions Both the two observational scales had good reliability and validity when used to assess pain in Chinese surgical older adults during the anaesthesia recovery period. Relevance to clinical practice Observational pain scales can be useful as a tool for patients unable to self-report. Accurate use of one of the observational pain tools can help identify pain during the anaesthesia recovery period, when patients are unable to self-report, to support effective pain management during this period. [ABSTRACT FROM AUTHOR]

Medicinal plants are used as ancient style of providing helps too many ailments. Presently, variant peoples are looking on healthful plants for his or her primary health care wishes. The current review designates the morphological, active principles and ethnopharmacological aspects of Couroupita guianensis. Being it's a vital healthful plant in Chinese medication this are supposed to varied medical specialty activities like antipyretic, antidepressant, antiseptic, analgesic, anti-inflammatory, antiprotozoal, anticancer, antiulcer, antimicrobial, wound healing, antidiarrheal, antioxidant and antifertility activities. Different active constituents such as steroids, glycosides, carbohydrates, couroupitone A, couroupitone B, isatin, triterpinoids, eugenol, linoleic acid, nerol, tryptanthrin linalool, phenolic resin substances and dyes are a unit to date according in Couroupita guianesis. Well conducted biological studies area unit still required for many indications of this species. This review is useful to make interest towards Couroupita guianensis and should be helpful in rising new formulations with additional therapeutic and economical worth. [ABSTRACT FROM AUTHOR]

Background: Pain management is a critical issue in the care of cancer patients in China, especially in small city and county hospitals in southwest China. Objective: The study intended to determine Chinese physicians' competence in cancer pain management and to assess their opinions on barriers to optimal pain management. Design: A questionnaire on pain management was given to 259 fellows after their general orientation meeting at a tertiary teaching hospital. The questionnaire was adapted from an earlier study by the Eastern Cooperative Oncology Group (ECOG). Results: The majority of the fellows believed that 70% of cancer patients suffer pain. Nearly 90% (224/259) indicated that their training in cancer pain management was poor. The fellows stated that concern about morphine addiction was the primary reason they hesitated to prescribe opioids, and they identified inadequate assessment of cancer pain as the most significant barrier to optimal management of cancer pain. Conclusion: The study reflects to some extent the state of pain management in hospitals in southwest China. Medical students and physicians in China need improved pain management education. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study explored current pain status, sedation level and their trajectories in Chinese children after cardiac surgery. Background. Pain and sedation management are fundamental care practices in the critical care setting, yet they both are frequently under-implemented for children after major surgery. Design. Repeated observational design. Methods. This study was conducted in a paediatric medical centre in Shanghai, China where 170 children who underwent cardiac surgery were recruited. Pain was measured with the face, legs, activity, cry, consolability scale and sedation levels with the COMFORT Behaviour Scale at 18 fixed time-points for three consecutive postoperative days. Results. The study indicated that 95 children (55·9%) received continuous opioids for pain relief, and 61 children (35·9%) received no analgesics. Multiple sedatives were used for these children, including bolus phenobarbital for 117 children (68·8%), phenergan for 81 children (47·6%) and midazolam for three children (1·8%). The mean pain scores significantly decreased throughout the operation day (POD-0) to the 2nd postoperative day (POD-2) with the lowest score on POD-2. Less than 5% of pain assessments were identified as moderate to severe across all 2815 observations. The sedation scores significantly increased through POD-0 to POD-2 with the highest score on POD-2. The rate of over-sedation was 50·3% with <1% under-sedation occurring among all the observations. Results also suggested that the length of stay in the cardiac intensive care unit was a predictor of increased analgesic usage in the critical care setting (odds ratio: 1·72). Conclusions. Usage of analgesic and sedative agents in cardiac intensive care unit was variable and children experienced low pain scores but a high rate of over-sedation, indicating that healthcare providers should address ways to improve postoperative pain and sedation management in this population. Relevance to clinical practice. The pain and sedation status for children after cardiac surgery changed across the postoperative days. Healthcare providers should be trained in the use of reliable tools to accurately monitor children's pain and sedation levels. [ABSTRACT FROM AUTHOR]

Context: Shao Fu Zhu Yu decoction (SFD), a well-known Chinese medicine, has been used for the treatment of primary dysmenorrhea in China for more than 200 years. Objective: A crude water extract and four fractions from SFD were evaluated for their analgesic activities for the purpose of validating the ethnomedical use of SFD. Material and method: The analgesic activities were studied by measuring nociception using acetic acid-induced abdominal contractions, the hot-plate test, formalin-induced licking and oxytocin-induced writhing in estrogen-treated mouse models. Prostaglandin E2 and nitric oxide production in cultured lipopolysaccharide (LPS)-treated macrophage cells were determined. Chemical components were separated and identified in the SFD analgesic fractions using ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS). Results: Oral SFD exerted significant analgesic activities in all nociceptive models except the hot-plate test. The activity-guided fractionation demonstrated that the SFD-40% fraction was the most potent with marked inhibition of pain responses at a dose of 54 mg/kg in vivo, and significantly inhibited prostaglandin E2 and nitric oxide production in LPS-treated mouse peritoneal macrophages in vitro. Further UPLC-MS analysis showed the presence of several chemical components in the SFD-40% fraction, including ferulic acid, paeoniflorin, typhaneoside, and isorhamnetin-3- O-neohesperidoside. Discussion and conclusion: These results demonstrated that SFD has significant peripheral analgesic activities, mainly attributed to the SFD-40% fraction, and supports the use of SFD in traditional Chinese medicine. [ABSTRACT FROM AUTHOR]

Background: Soft tissue injury imposes major public health burdens worldwide. The positive effect of China's Tibetan medicine and the Lamiophlomis rotata-based herbal Pain Relieving Plaster PRP) on healing closed soft tissue injury (CSTI) has been reported. The herbs contained in Plaster are also referred as 'blood-activating and stasis-dispelling' in herbal medicine. The formula of the plaster contains four China's Tibetan medical herbs, including Lamiophlomis rotata, Oxytropis falcate Bunge, Curcuma longa Linn, and Myricaria bracteata. Two of these herbs (Lamiophlomis rotate; Curcuma longa Linn) are commonly used in different formulae of Chinese medicine. The objective of this study is to use an interdisciplinary approach to test the hypothesis that the formula and its components influence the process of CSTI. Methods: In vivo models have been established in 30 rabbit ear pinnae and studied for: (1) blood flow velocity (BFV) which was affected by pressure of 21.2 kg/cm2 for 30 second over the local rabbit ear tissue; (2) edema formation of the closed soft tissue injury; (3) in vivo local temperature change. Results: The results of in vivo studies indicated that CSTI significantly increased the velocity of blood flow and increased edema formation within the control group. The PRP extracts for 5 hours significantly slowed down the BFV of CSTI in rabbit ears, markedly decreased the elevated edema level from the 3rd to the 5th day. Conclusion: The ingredients contained in the formula have positive effects in healing CSTI and further study is worth exploring. [ABSTRACT FROM AUTHOR]