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Pain is a complex experience consisting of sensory, affective, behavioural and physiological components. The management of pain is therefore best achieved with an approach which acknowledges that the experience of pain is produced through the interaction of biological, psychological and sociocultural factors. Effective pain management requires preoperative patient engagement and education to manage expectations regarding pain relief and an inpatient pain service to coordinate the implementation of evidence-based postoperative pain management protocols and facilitate continuous staff education. Multimodal postoperative analgesia, built on an opioid-sparing ethos, is an essential component of perioperative pain management. Effective pain management enhances recovery after surgery by facilitating early patient mobilization, a reduction in respiratory and cardiac complications and amelioration of the stress response to surgery with consequent improved wound healing. Inadequate pain control can contribute to prolonged hospitalization and the development of chronic postsurgical pain. [ABSTRACT FROM AUTHOR]

The presence of pain is a protective mechanism that serves to prevent the body from further harm. However, when pain becomes pathological, it becomes a socio-economic disease burden that impacts a significant portion of the population. This article aims to discuss the physiology of pain that forms the basis for understanding the processes that allow pain to become chronic. It describes the definition of pain and the various types of pain receptors involved in the processing and perception of pain. The physiology, pathways and processes involved in the activation and ongoing experience of pain are well described in terms of four distinct events, known as transduction, transmission, modulation, and perception. The events described lend emphasis to the subjectivity of pain and the importance of a multidisciplinary approach to the effective management of chronic pain conditions. [ABSTRACT FROM AUTHOR]

Pregnancy-induced anti-nociception is a continuous dialogue between increased levels of endogenous opioids, activation of spinal kappa and delta receptors as well as altered hormonal concentrations. Pain of labour is a multi-factorial subjective algesic experience. It has two components: visceral and somatic. Understanding the interplay between various factors can help in developing newer pain-relieving strategies during labour. Labour pain is an excellent model of acute pain, which is highest on the pain rating scale when compared to other painful life experiences. The two major pathways that attenuate nociceptive inputs in the dorsal horn consist of local control from inhibitory interneurons and the descending inhibitory system from the supra-spinal level. Pain inhibitory neurotransmitters, such as serotonin, noradrenaline, glycine, and GABA, play an important role in pain modulation at the inhibitory interneurons and the descending pain inhibitory system. Labour pain is a nociceptive experience that not only involves inhibitory neurotransmitters but other contributing factors such as hormonal levels, previous experiences, stress, and socioeconomic factors. Visceral/peripheral factors are also important for the subjective experience of pain. Therefore, more studies are warranted to understand the role of pain inhibitory neurotransmitters in central and peripheral modulation of labour pain. [ABSTRACT FROM AUTHOR]

Pain is a complex experience consisting of sensory, affective, behavioural and physiological components. Pain management is therefore best achieved through an approach which acknowledges the complex interaction between biological, psychological and sociocultural factors. Effective pain management requires preoperative patient engagement and education in order to manage expectations and a structured inpatient service to facilitate evidence-based postoperative pain management and continuous staff education. Multimodal postoperative analgesia, built on an opioid-sparing ethos, is an essential component of perioperative pain management. Effective pain management facilitates early mobilization and a reduction in respiratory and cardiac complications and reduces the stress response to surgery which in turn improves wound healing and recovery. Inadequate pain control can lead to morbidity and mortality including prolonged hospital stays and the development of chronic postoperative pain. [ABSTRACT FROM AUTHOR]

Following a surgical procedure, pain is a physiological response which requires medical and nursing intervention. The physiological process of pain is described, with a specific review of the literature around the use of local anaesthetic following thoracic surgery as part of multi-modal care. [ABSTRACT FROM AUTHOR]

Central sensitization is a physiological mechanism associated with enhanced sensitivity and pain responses. At present, central sensitization cannot be determined directly In humans, but certain signs and symptoms may be suggestive of it. Although central sensitization has received increasing attention in the clinical literature, there is a risk that certain distinctions are being lost. This paper summarizes current knowledge of the physiology of central sensitization and its possible manifestations in patients, in order to inform a debate about the relevance of central sensitization for physical therapists. It poses 6 challenges associated with the application of central sensitization concepts in clinical practice and makes suggestions for assessment, treatment, and use of terminology. Physical therapists are asked to be mindful of central sensitization and consider potential top-down as well as bottom-up drivers, in the context of a person-centered bio-psychosocial approach. [ABSTRACT FROM AUTHOR]

In spite of systematic investigations, the existence of a specific cortex that could encode for the intensities of somatosensory stimuli, including within nociceptive ranges, is still a matter of debate. The present consensus is that pain is expressed in a distributed network made of thalamus, SII, insula, ACC, and, less consistently, SI. Here we argument that there must be an entrance to this network. The common denominator to every functional imaging study is that the subjects can distinguish between noxious and non-noxious stimuli, or between two different intensities of noxious stimuli. This is associated with a consistent activation of the insula-SII cortices while activations in other brain areas may be missing or sub-significant. In other words, the operculo-insular cortex activations are the most robust pain-related activations across studies, whatever the manipulation of the pain components, except the discriminative one. Intra-cerebral recordings also pointed out this piece of cortex as being able to encode for pain intensity. As a last physiological argument, stimulating directly the brain with small intensities standardized electrical shocks elicited pain sensations selectively if the electrode was in the operculo-insular cortex. Human models of disease confirmed that epileptic discharges in the insular cortex can produce ictal pain. Insular epilepsy (or propagation of discharges to the insular cortex) is the only focal epilepsy to be possibly associated with painful symptoms. Finally, unique and focal lesions of the posterior operculo-insular cortices were able to remove (or at least to impair) thermosensory and nociceptive functions. Thus, the operculo-insular area can be presented as the only area in the brain to respond to the features of a primary thermosensory and nociceptive cortex. This area is likely to be the starting point of the nociceptive-related networks. Future investigations are necessary to determine how this "pain symphony" between these different brain areas is temporally orchestrated. Developments of new targets for functional neurosurgery could benefit of such localized and initiating processes, for instance focal neurostimulations. [ABSTRACT FROM AUTHOR]

Abstract Pain is a complex experience consisting of sensory, affective, behavioural and physiological components. Pain management is therefore best achieved through an approach which acknowledges the complex interaction between biological, psychological and sociocultural factors. Effective pain management requires preoperative patient engagement and education in order to manage expectations and a structured inpatient service to facilitate evidence-based postoperative pain management and continuous staff education. Multimodal postoperative analgesia, built on an opioid-sparing ethos, is one component of postoperative pain management and is essential for achieving patient satisfaction and enhanced recovery. Effective pain management facilitates early mobilization and a reduction in respiratory and cardiac complications, reducing the stress response to surgery in turn improving wound healing and recovery. Inadequate pain control can lead to higher morbidity and mortality, prolonged hospital stays and the development of chronic postoperative pain. [ABSTRACT FROM AUTHOR]

Pain recognition, assessment, and management is a primary focus and an integral part of veterinary rehabilitation. Evidence-based pain mitigation protocols will use both pharmacologic tools and nonpharmacologic methods to create a customized, safe, and effective treatment plan. A multimodal, patient-centered approach will allow for the best outcomes for pain relief and improved quality of life., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Pain should be regarded as a complex experience consisting of sensory, affective, behavioural and physiological components. Pain management is therefore best achieved by an approach which acknowledges the complex interactions between biological, psychological and sociocultural factors. Effective pain management requires thorough patient preparation and education to manage expectations and a robustly structured inpatient service for postoperative pain management and continuous staff education. Postoperative analgesia is one component of postoperative pain management and is essential for achieving patient satisfaction and enhanced recovery. Effective pain management facilitates early mobilization and a reduction in respiratory and cardiac complications reducing the stress response to surgery in turn improving wound healing and recovery. Inadequate pain control can lead to higher morbidity and mortality, prolonged hospital stay and the development of chronic postoperative pain. [ABSTRACT FROM AUTHOR]

Objectives: Pain neuroscience education (PNE) has been shown to be effective in reducing pain in people with chronic musculoskeletal pain. Knowledge of pain physiology is necessary to undertake PNE, and a measure for such knowledge is necessary. The Knowledge and Attitudes of Pain (KNAP), a comprehensive assessment of knowledge, attitudes, and beliefs regarding pain for healthcare practitioners, was developed in 2020 through the assessment of construct validity, reliability, and responsiveness in Dutch and English. This study aimed to conduct cross-cultural adaptation of the KNAP into Japanese and to verify test-retest reliability among Japanese undergraduate physical therapy and occupational therapy students., Methods: Cross-cultural adaptation was performed using Beaton's five-step process. Subsequently, the KNAP was completed by participants with a 2-week interval. The study included second-, third-, and fourth-year undergraduate physical therapy and occupational therapy students., Results: A total of 50 students participated in the pilot test and a Japanese version of KNAP was created. Thirty-nine students completed the Japanese version of KNAP twice. Of the 30 items on the KNAP, the quadratic weighted kappa value was less than 0.4 for only one item (item 15), but reliability was interpreted as sufficient for the overall score, with an intraclass correlation coefficient (95% confidence interval) for the total score of 0.89 (0.80-0.94)., Conclusions: This study has developed the Japanese KNAP, which has shown preliminary evidence of adequate test-retest reliability in Japanese undergraduate physical therapy and occupational therapy students., Competing Interests: CONFLICTS OF INTEREST: The authors report no conflicts of interest., (2022 The Japanese Association of Rehabilitation Medicine.)

Background: Dry needling (DN) is often used for the treatment of muscle pain among physiotherapists. However, little is known about the mechanisms of action by which its effects are generated. The aim of this randomized controlled trial was to determine if the use of DN in healthy subjects activates the sympathetic nervous system, thus resulting in a decrease in pain caused by stress., Methods: Sixty-five healthy volunteer subjects were recruited from the University of Alcala, Madrid, Spain, with an age of 27.78 (SD = 8.41) years. The participants were randomly assigned to participate in a group with deep DN in the adductor pollicis muscle or a placebo needling group. The autonomic nervous system was evaluated, in addition to local and remote mechanical hyperalgesia., Results: In a comparison of the moment at which the needling intervention was carried out with the baseline, the heart rate of the dry needling group significantly increased by 20.60% (SE = 2.88), whereas that of the placebo group increased by 5.33% (SE = 2.32) ( p = 0.001, d = 1.02). The pressure pain threshold showed significant differences between both groups, being significantly higher in the needling group (adductor muscle p = 0.001; d = 0.85; anterior tibialis muscle p = 0.022, d = 0.58)., Conclusions: This work appears to indicate that dry needling produces an immediate activation in the sympathetic nervous system, improving local and distant mechanical hyperalgesia.