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Abstract Background Endometriosis is a complex chronic disease that affects approximately 10% of women of reproductive age worldwide and commonly presents with pelvic pain and infertility. Method & outcome measures A systematic review of the literature was carried out using the databases Pubmed, Scopus, Cochrane and ClinicalTrials.gov in women with a confirmed laparoscopic diagnosis of endometriosis receiving progestins to determine a reduction in pain symptoms and the occurrence of adverse effects. Results Eighteen studies were included in the meta-analysis. Progestins improved painful symptoms compared to placebo (SMD = −0.61, 95% CI (−0.77, −0.45), P

Background Glossopharyngeal nerve (GPN) block is a useful treatment option for acute post-tonsillectomy pain. This study aimed to assess safety and efficacy of the landmark (LM) technique versus the ultrasound (US)-guided technique for GPN block in children undergoing tonsillectomy.Methods This double-blinded, parallel-group, randomized trial enrolled 54 children of both genders who were American Society of Anesthesiologists physical status grade I–II and were scheduled for tonsillectomy under general anesthesia. All patients underwent percutaneous peristyloid GPN block. In the LM group, 27 patients were managed by insertion of the needle at midpoint of the line between the mastoid process and angle of the mandible. In the US group, 27 patients were managed with the US-guided technique to locate the styloid process. The outcomes were time to first analgesic requirement, pain in rest and during swallowing, easiness of the technique, time required for the technique performance, recovery time from anesthesia, and anesthetist, surgeon, parent, and staff satisfaction.Results The post-tonsillectomy pain score during rest and swallowing, rescue analgesic request, recovery time from general anesthesia, anesthetist’, surgeon’, staff nurses’, and parents’ satisfactions were comparable between the LM technique and US-guided percutaneous peristyloid GPN block (all p ˃ 0.05). However, the LM technique was significantly easier and required shorter duration than the US-guided technique (p ˂ 0.05).Conclusion In tonsillectomy surgery, both the LM technique and the percutaneous peristyloid US-guided GPN block were safe and effective in reducing postoperative pain. Furthermore, the LM technique was easier and had shorter duration to perform than the US-guided technique.

Background: Primary gonarthrosis is a progressive disease that increases with age and leads to limitations in activities of daily living. Until surgery is performed, nonsteroidal anti-inflammatory drugs, intraarticular injections, and physical therapy methods are used. Purpose: This study aims to compare the clinical outcomes of intra- articular corticosteroid (CCS) and hyaluro nic acid (HA) injections for pain relief in primary gonartrhosis in COVID -19 pandemic period. Study Design: Retrospective Cohort Study. Methods: In this study, 88 patients who underwent intra-articular CCS and HA injection between August 2020 and March 2021 due to Kellgren-Lawrence stage 2 and higher gonarthrosis were investigated. Patients were divided into two groups. Group I represents the patients who received HA injections, and group II represents the patients who received CCS injection. Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Society Score (KSS) scores were used for the preoperative and postoperative functional evaluations of the patients. Results: Group I included 40 patients and group II included 48 patients. The mean age was 59.4 ± 7.3 years, and the average follow-up period was 12 ± 2,6 months. The pre-intervention WOMAC scores were 13,5 in Group I and 13.6 in Group II, KSS scores were 26,5 in Group I and 25,2 in Group II. While there was a significant change in the control at month 1 in both groups, no difference was found between the groups. At the 6th month control, the improvement in group 1 continued at a significant level compared to the pre-injection period, while group 2 returned to the pre-injection level. (p

Abstract Background Intra-articular injection is indicated for mild or moderate osteoarthritis (OA). However, the superiority of cell-based injection and the role of diverse cell sources are still unclear. This study aimed to compare the therapeutic effect of intra-articular injection with mesenchymal stem cells (MSCs) and cell-free methods for OA treatment. Methods A literature search of published scientific data was carried out from PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, and China National Knowledge Internet (CNKI). Randomized controlled trials (RCTs) compared the efficacy and safety of MSC and cell-free intra-articular injection treatments for OA with at least 6-month follow-up. Results Dual network meta-analysis validated the therapeutic advantages of MSC treatments (VAS, Bayesian: 90% versus 10% and SUCRA: 94.9% versus 5.1%; WOMAC total, Bayesian: 83% versus 17% and SUCRA: 90.1% versus 9.9%) but also suggested a potential negative safety induced by cell injection (adverse events, Bayesian: 100% versus 0% and SUCRA: 98.2% versus 1.8%). For the MSC source aspect, adipose mesenchymal stem cells (ADMSCs) and umbilical cord mesenchymal stem cells (UBMSCs) showed a better curative effect on pain relief and function improvement compared with bone marrow mesenchymal stem cells (BMMSCs). Conclusion Intra-articular injection of MSCs is associated with more effective pain alleviation and function improvement than cell-free OA treatment. However, the potential complications induced by MSCs should be emphasized. A comparative analysis of the MSC sources showed that ADMSCs and UBMSCs exerted a better anti-arthritic efficacy than BMMSCs. Graphical Abstract Schematic illustration of MSC-based intra-articular injection for treating OA. Three major MSCs (UBMSCs, ADMSCs, and BMMSCs) are extracted and expanded in vitro. Subsequently, the amplified MSCs are concentrated and injected into the knee joint to treat OA.

S Abbas Raza,1,* Morton Brian Keith,2,* Kar Chai Koh3,* 1Shaukat Khanum Cancer Hospital & Research Center and National Hospital, Lahore, Pakistan; 2Northbridge Medical Practice, Northbridge, New South Wales, Australia; 3Poliklinik Kepong Baru, Kuala Lumpur, Malaysia*These authors contributed equally to this workCorrespondence: Kar Chai Koh, Poliklinik Kepong Baru, Jalan Ambong Kiri Satu, Kepong Baru, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 52100, Malaysia, Email drcaseysurf@gmail.comPurpose: Pain is considered a major clinical and socioeconomic problem worldwide. Delayed gastric emptying rates allegedly influence the suitability of pain-relief medications in patient populations such as the elderly and individuals with diabetes. Faster pain relief was reportedly achieved by using a fast-dissolving paracetamol (FD-APAP) formulation. This study aims to gain insights to healthcare professionals’ (HCPs) perspectives towards using FD-APAP in addressing barriers of pain relief in patient populations susceptible to delayed gastric emptying rates.Patients and Methods: A two-step modified Delphi consensus study was conducted among a panel of 10 general practitioners (GPs) and four endocrinologists. The first step comprises in-depth discussions around evidence relevant to FD-APAP for pain management in patient populations with delayed gastric emptying rates (elderly/diabetics). The second step (a survey) was based on the summarized input from the first step. Consensus was accepted upon ≥ 70% agreement. Perspectives on pain management by FD-APAP for elderly patients were explored among GPs, while those for diabetic patients were explored among GPs and endocrinologists.Results: Consensus was achieved, whereby all panel members found FD-APAP to be favorable and relevant for pain management in the elderly and the diabetic patient populations. GPs additionally raised the consensus on the importance of considering comorbidities associated with diabetes while having minimal complications during pain management.Conclusion: The panel found the faster disintegration and absorption of FD-APAP relevant and useful for patients with delayed gastric emptying, wherein, pain in the elderly and those with diabetes could be treated effectively with limited side-effects.Keywords: fast-dissolving paracetamol, consensus, delayed gastric emptying, pain relief, elderly, diabetics

Background: The purpose of our study was to examine the clinical outcomes after arthroscopic scapulothoracic bursectomy for the treatment of scapulothoracic bursitis at a minimum of 2-year follow-up. Methods: Twenty patients who underwent arthroscopic scapulothoracic bursectomy for the treatment of symptomatic snapping scapula syndrome were identified from a single surgeon’s database. Patients were indicated for surgery if their symptoms persisted for more than 6 months and if they failed nonoperative treatment. Acquired data included patient demographics, shoulder range of motion, American Shoulder and Elbow Surgeon score, visual analog scale scores for pain, and the following Patient-Reported Outcomes Measurement Information System scores: Upper Extremity Computer Adaptive Test Version 2.0, pain intensity, and pain interference scores. Patient satisfaction and subjective shoulder value were also recorded out of 100. Fisher's test and unpaired t tests were performed for statistical analysis, and P values

Simple Summary: Weaning involves the removal of piglets from a sow, and on commercial farms, it usually occurs at between 3 and 5 weeks of age. Newly weaned piglets face physical, social, environmental, management and dietary challenges. Consequently, post-weaning, they often experience reduced feed intake, poor growth and, in some cases, diarrhoea. There are many interventions which can be employed on-farm during the suckling period to ease the transition at weaning for piglets. Strategies such as supervised farrowing, post-farrowing pain relief for sows, the use of nurse sows, cross-fostering, the administration of energy supplements/feed additives to piglets and liquid/dry creep feeding have been investigated. The objective of these strategies is to promote earlier feed exploration, increase early post-weaning feed intake and growth and improve intestinal maturity. This review focuses in particular on pain relief for sows, piglet management at birth, and the provision of supplementary milk/liquid feed and feed additives to suckling piglets. Carefully selected, these strategies have the potential to increase the lifetime growth and health of pigs from large litters. Weaning is a critical period in a pig's life. Piglets are confronted with abrupt changes to their physical and social environment, as well as management and nutritional changes. Weaning has always been associated with a growth check and is frequently accompanied by post-weaning diarrhoea in piglets. However, rapid increases in litter size in the last decade have increased within-litter piglet weight variation, with piglets now generally lighter at weaning, making the challenges associated with weaning even greater. Many interventions can be employed during the suckling period to ease the weaning transition for piglets. Pre-weaning strategies such as supervised farrowing (assistance with suckling and oxytocin provision), the provision of pain relief to sows around farrowing, split-suckling, early oral supplementation with glucose, bovine colostrum, faecal microbiota transplantation, feed additives and solid and liquid creep feeding (milk and liquid feed) have all been investigated. The objective of these strategies is to stimulate earlier maturation of the digestive tract, improve immunity, reduce latency to the first feed post-weaning and increase early post-weaning feed intake and growth. This review focuses in particular on: (1) pain relief provision to sows around farrowing, (2)split-suckling of piglets, (3) pre-weaning provision of supplementary milk and/or liquid feed, (4) other strategies to stimulate earlier enzyme production (e.g., enzyme supplementation), (5) other nutritional strategies to promote improved gut structure and function (e.g., L-glutamine supplementation), and (6) other strategies to modulate gut microbiota (e.g., probiotics and prebiotics). Correctly implementing these strategies can, not only increase post-weaning growth and reduce mortality, but also maximise lifetime growth in pigs. [ABSTRACT FROM AUTHOR]

To compare nifedipine, naproxen, or placebo for pain relief during diagnostic hysteroscopy. Double-blind, randomized controlled pilot study. University hospital. Women scheduled for office diagnostic hysteroscopy (n = 60). Women received nifedipine (2 tablets of 10 mg), naproxen (2 tablets of 250 mg), or placebo (2 tablets of 500 mg lactose) 30 to 60 minutes prior to hysteroscopy. Sixty patients were enrolled in the study (21 in the nifedipine group, 19 in the naproxen group, and 20 in the placebo group). The median pain scores during hysteroscope insertion, measured on a Visual Analog Scale (VAS), were 1 (interquartile range (IQR) 0–0), 2 (0–4) and 1 (0–1) in the nifedipine, naproxen and placebo group, respectively (P,14). The median VAS scores during hysteroscopy were 5 (IQR 2–7), 5 (4–8) and 5 (3–7) in the nifedipine, naproxen and placebo group, respectively (P,73). The median VAS scores immediately after hysteroscopy were 2 (IQR 0–4), 3 (0–6) and 3 (1–5) in the nifedipine, naproxen and placebo group, respectively (P,40). The median VAS scores 30 minutes after hysteroscopy were 1 (IQR 0–2), 1 (0–1) and 1 (0–2) in the nifedipine, naproxen and placebo group, respectively (P,63). Hysteroscope insertion failed in 1 case (naproxen group) because of cervica'l stenosis (P,32). Flushes, fatigue and vertigo, 30 minutes after the procedure, were significantly more prevalent in the nifedipine group compared to the naproxen (p <.001, p,03, p,03, respectively) and the placebo group (p <.001, p,01, p,01, respectively). Palpitations occurred only in the nifedipine group (p <.001). The day after the procedure, the headache was most prevalent in the nifedipine group compared to the naproxen group (p,001) and the placebo group (p,001). In our pilot study, pain relief and success rates for office diagnostic hysteroscopy were not significantly different between nifedipine, naproxen, and placebo. Nifedipine was associated with more, albeit tolerable, side-effects. [ABSTRACT FROM AUTHOR]

Spinal anesthesia is a commonly performed regional anesthesia technique by most anesthesiologists worldwide. This technique is learned early during training and is relatively easy to master. Despite being an old technique, spinal anesthesia has evolved and developed in various aspects. This review attempts to highlight the current indications of this technique. Understanding the finer aspects and knowledge gaps will help postgraduates and practicing anesthesiologists in designing patient-specific techniques and interventions. [ABSTRACT FROM AUTHOR]

Musculoskeletal pain is a significant burden on individuals and society. "Hoang ky que chi ngu vat thang" is a traditional Vietnamese remedy used to treat this condition, but there is a lack of clinical evidence regarding its pain relief mechanism. The objective of this study is to evaluate the analgesic effect of "Hoang ky que chi ngu vat thang" in Swiss mice. The central analgesic effect was evaluated using the hot plate latency test, and the peripheral analgesic effect was evaluated using the writhing test with acetic acid. The results of this study showed that statistically significant differences were observed between the treated groups with "Hoang ky que chi ngu vat thang" and the standard group 1 and control group (p < 0.05). Furthermore, the number of writhing pain during 25 minutes after acetic acid injection in both groups with dose 14.112 and dose 28.224 was significantly lower (p < 0.01) compared to the reference group (Lysine acetylsalicylate). Conclusively, oral doses of 14.112 g/kg and 28.224 g/kg of "Hoang ky que chi ngu vat thang" have a good analgesic effect via both central and peripheral analgesic mechanisms. [ABSTRACT FROM AUTHOR]

Electrochemotherapy (ECT) has evolved significantly during the last decade, expanding treatment indications from superficial skin lesions to advanced-stage, deep-seated tumors in hard-to-reach areas. Electrodes have also shown steady technological improvement throughout the years. Besides standard and VEG (variable geometry electrode) electrodes, the introduction of laparoscopic electrodes has brought on a new era in ECT treatment, making the minimally invasive approach a reality. The exact role of ECT in the oncological dashboard is yet to be determined; however, increased tumor response, pain relief, and a low number of adverse events may yield the way for more widespread application of the technique with possible further inclusion of ECT in international oncological guidelines. The aim of this review is to give an overview on the current status of ECT in deep-seated tumor treatment and shed light on its emerging role in local anticancer therapy. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of breast cancer in Indonesia is the highest among types of cancer in women, with an estimated pain prevalence of 40%–89%. More than 50% of cancer patients suffer from pain that has not been resolved. Cancer pain's impact will affect the comfort level and quality of life. Objectives: The purpose of this study was to analyze the effectiveness of DRM Pain Relief on the degree of pain, comfort, and quality of life among breast cancer patients. Methods: The research was a true experimental study with pre-test and post-test designs with a control group. The population was all breast cancer patients attending hospitals in Semarang and Pekalongan Districts. The research subjects were 64 respondents who met the inclusion and exclusion criteria. Respondents were selected randomly and divided into two groups, namely 32 in the treatment group (DRM Pain Relief application) and 32 in the control group (only received drugs as conventional therapy in the hospital). Data were analyzed using a multivariate test. Results: The application of DRM Pain Relief was effective in reducing the degree of pain (p <.001), and effectively increasing comfort (p <.001), as well as improving the quality of life of breast cancer patients in the components of improvement in symptom status, functional status, and global quality of life with p -value <.001,.003, <.001, respectively. Conclusion: The DRM Pain Relief effectively reduces the degree of pain, increases comfort, and improves the quality of life of breast cancer patients. [ABSTRACT FROM AUTHOR]

Labor pain is among the most severe types of physical pain that women may experience during their lifetime. Thus, pain relief is an essential part of medical care during childbirth. Epidural analgesia is considered to be the most efficient method of pain relief during labor. Nevertheless, patient preferences, contraindications, limited availability, and technical failure may require the use of alternative pain reliving methods during labor including systemic pharmacologic agents, and nonpharmacologic methods. Nonpharmacologic methods for pain alleviation during vaginal birth have become popular over the years, either as a complement to pharmacologic agents or at times as the principal therapy. Methods such as relaxation techniques (ie, yoga, hypnosis, and music), manual techniques (ie, massage, reflexology, and shiatsu), acupuncture, birthing ball, and transcutaneous electrical nerve stimulation are considered safe, although the evidence supporting their effectiveness for pain relief is not as robust as it is for pharmacologic agents. Systemic pharmacologic agents are mostly administered by inhalation (nitrous oxide) or through the parenteral route. These agents include opioids such as meperidine, nalbuphine, tramadol, butorphanol, morphine, and remifentanil, and non-opioid agents such as parenteral acetaminophen and nonsteroidal anti-inflammatory drugs. Systemic pharmacologic agents suggest a diverse armamentarium of medication for pain management during labor. Their efficacy in treating pain associated with labor varies, and some continue to be used even though they have not been proven effective for pain relief. In addition, the maternal and perinatal side effects differ markedly among these agents. There is a relative abundance of data regarding the effectiveness of analgesic drugs compared with epidural, but the data regarding comparisons among the different types of alternative analgesic agents are scarce, and there is no consistency regarding the drug of choice for women who do not receive epidural pain management. This review aims to present the available data regarding the effectiveness of the different methods of relieving pain during labor other than epidural. The data presented are mainly based on recent level I evidence regarding pharmacologic and nonpharmacologic methods for pain relief during labor. [ABSTRACT FROM AUTHOR]

The vast majority of injured patients suffer from pain. Systematic assessment of pain on admission to the emergency department (ED) is a cornerstone of translating the best treatment strategies for patient care into practice. Pain must be measured with severity scales that are validated in clinical practice, including for specific populations (such as children and older adults). Although primary care ED of trauma patients focuses on resuscitation, diagnosis and treatment, pain assessment and management remains a critical element as professionals are not prepared to provide effective and early therapy. To date, most EDs have pain assessment and management protocols that take into account the patient's hemodynamic status and clinical condition and give preference to non-pharmacological approaches where possible. When selecting medications, the focus is on those that are least disruptive to hemodynamic status. Pain relief may still be necessary in hemodynamically unstable patients, but caution should be exercised, especially when using opioids, as absorption may be impaired or shock may be exacerbated. The analgesic dose of ketamine is certainly an attractive option. Fentanyl is clearly superior to other opioids in initial resuscitation and treatment as it has minimal effects on hemodynamic status and does not cause central nervous system depression. Inhaled analgesia techniques and ultrasound-guided nerve blocks are also increasingly effective solutions. A multimodal pain approach, which involves the use of two or more drugs with different mechanisms of action, plays an important role in the relief of trauma pain. All EDs must have policies and promote the adoption of procedures that use multimodal strategies for effective pain management in all injured patients. [ABSTRACT FROM AUTHOR]

Background: Although access to nature is demonstrated to benefit health and wellbeing, adults with mobility impairments and/or low energy often face barriers in accessing nature environments and nature-based programs. This study aimed to examine the experiences and impacts of virtual forest bathing by capturing the perspectives of disabled adults with mobility impairments and/or low energy. Methods: A total of 26 adults with mobility impairments provided written and spoken qualitative feedback during and following virtual forest bathing programs and 23 participants provided feedback at a one month follow-up. Virtual programs were presented online, using an accessible format, 2D videos, and images of nature accompanied by guidance led by a certified forest bathing guide and mindfulness teacher. The programs involved disabled facilitators and participants, which created a social environment of peer support. Results: Qualitative thematic analysis revealed 10 themes comprising intervention themes (virtual delivery and soothing facilitation); process themes (nature connection, relaxation, embodiment, and memories with complex emotions); and outcome themes (happiness, agency, metaphor making, and belonging). Conclusions: Virtual forest bathing may offer an effective adjunct to improve wellbeing and provide peer support for disabled adults with mobility impairments and/or low energy. [ABSTRACT FROM AUTHOR]

Background: Pain intensity may be varied during the needle advancing through different skin layers, injection into the intradermal layer may exclude mixed pain from deeper planes. This study aimed to investigate whether compressing a three-dimensional (3D)-printed disk against the skin may relieve pain associated with intradermal injection of local anesthetic which mimics the skin test procedure. Methods: After institutional review board approval, 3D-printed disks with projections were designed for this study. Enrolled patients were randomized to receive either a disk compressing against the axillary skin during the intradermal injection of local anesthesia (compressing disk group) or an intradermal injection of local anesthesia without any compression (no compressing disk group). The primary outcomes were pain intensity (100-mm visual analog scale) and satisfaction (5-point Likert scale) as assessed by patients. Results: Ninety patients with American Society of Anesthesiologists I–II physical status receiving intradermal local anesthesia prior to an ultrasound-guided axillary approach were included. Eighty-seven patients completed the study, with 44 and 43 patients in disk and no disk groups, respectively. Pain scores were significantly different (P < 0.001) in compressing disk (median, 10; IQR, 5–20) and no compressing disk (median, 30; IQR, 20–40) groups. The median satisfaction score was 5 in both groups. No complications occurred during follow-up. Conclusion: Compressing a 3D-printed disk against the skin may reduce intradermal needle pain and offers an effective alternative for nerve block induction. [ABSTRACT FROM AUTHOR]

Background: Role of continuous infusion of local anesthetic drug in the transverse abdominal plane using a catheter inserted during the surgical closure of the wound has not been evaluated as a "sole technique" in patients undergoing open nephrectomy. Thus we designed this prospective, randomized comparative study to evaluate this aspect. Aim and Objectives: To compare the efficacy of continuous surgical transverse abdominal plane block with intravenous fentanyl infusion in open nephrectomies. The primary outcomes were post-operative tramadol consumption, pain at rest and pain while coughing. The secondary outcomes were the level of sedation, time to mobilize, and the incidence of wound infection. Material and Methods: Fifty patients undergoing elective open nephrectomy were randomly divided into two equal groups to either receive intravenous fentanyl infusion (Group A), or continuous infusion of bupivacaine in the transversus abdominis plane through a surgically inserted catheter (Group B). The independent sample t-test was applied for numerical variables, while one way Analysis of Variance (ANOVA) repeated measure was used for analyzing the continuous variables. Chi-square and Fisher's exact tests were the tools used for analyzing the dichotomical variables. Results: Tramadol consumption, pain while resting, and pain during coughing were significantly lower in Group B (p<0.001, p=0.003, p=0.001 respectively). Level of sedation and time to mobilize were also significantly lower in patients of Group B. Adverse effects were not differing significantly between groups. No wound infection was noted in either group. Conclusion: Continuous surgical wound infusion of 0.25% bupivacaine through a catheter placed by the surgeon in the transverse abdominal plane in open nephrectomy patients can be considered as an effective and safe alternative of providing postoperative pain relief than intravenous fentanyl infusion. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to compare maternal and neonatal outcome of delivery with inhaled anesthesia to delivery without pain control. Material and methods: Authors performed retrospective analysis of 260 term deliveries. In the study group (130 women) a mixture of nitrous oxide and oxygen was used. The control group included 130 patients who used no pain relief during delivery. Results: In nulliparas the pain assessment in 11-points scale was similar in both groups, but the labor was longer (350 ± 152 vs 228 ± 113 minutes; p < 0.001 for the first stage and 46 ± 37 vs 18 ± 18 minutes; p < 0.001 for the second stage), episiotomy incidence was higher (81.4% vs 41.9%; p < 0.001) and perineal laceration lower (2.3% vs 25.7%; p < 0.001) in the study group. In multiparas the pain assessment was lower in the study group (5 vs 7 points; p = 0.006), oxytocin was administered more frequently (45.5% vs 21.4%, p = 0.011), but labor duration was the same in both groups. Episiotomy was more frequent (61.4% vs 37.5%, p = 0.02), but there was no difference in perineal laceration. Apgar score was the same in the study and control group. Conclusions: We found that Entonox prolongs labor significantly and increases frequency of episiotomy in primiparas with no clear analgesic effect. Offering Entonox to the patients giving birth for the first time is thus questionable. In multiparas it has a good analgesic effect but increases probability of episiotomy with no significant influence on perineal tear, what seems not very high cost of decreased pain related to delivery. [ABSTRACT FROM AUTHOR]

Objectives: To compare the post-operative pain relief with Bupivacaine and Ropivacaine for caudal block in children in terms of mean duration of analgesia. Study design: Prospective comparative study. Place and duration: Department of Anesthesia, Combined Military Hospital Rawlakot from July 2021 till June 2022. Methodology: A total of 100 patients undergoing infra-umbilical Surgery as circumcision, herniotomy, orchidopexy and of age 1 to 10 years were included. After induction of general anesthesia, caudal block was given. Group B patients were given 1 ml/kg of 0.25% bupivacaine whereas group R patients were given 1 ml/kg of 0.25% ropivacaine. Modified Hnnallah Pain Score was used to observe the post-operative analgesic effects of the block. Score was noted every 30 minutes. Pain free duration was considered from time of caudal block till the modified Hannallah pain score of 4 or more. Injectable paracetamol 10 mg/kg was given as rescue analgesia as required. Results: Demographic data was comparable in both groups with no statistical significance. In our study, we have found duration of analgesia as 219.78 ± 35.42 minutes in the bupivacaine group compared with 198.24 ± 34.5 minutes in patients with ropivacaine group with p-value of 0.54 which is statistically significant. Conclusion: In this study, we concluded that the ropivacaine is as effective as bupivacaine in terms of post-operative pain relief for caudal block in children.

Abstract Background Spinal cord stimulation (SCS) has shown to be an effective treatment for patients with persistent spinal pain syndrome type 2 (PSPS Type 2). The method used to deliver electrical charge in SCS is important. One such method is burst stimulation. Within burst stimulation, a recharge pattern is used to prevent buildup of charge in stimulated tissues. Two variations of burst waveforms are currently in use: one that employs active recharge and one that uses passive recharge. It has been suggested that differences exist between active and passive recharge paradigms related to both efficacy of pain relief and their underlying mechanism of action. Active recharge has been shown to activate both the medial spinal pathway, engaging cortical sensorimotor areas involved in location and intensity of pain, and lateral pathway, reaching brain areas involved with cognitive-emotional aspects of pain. Passive recharge has been suggested to act via modulation of thalamic neurons, which fire in a similar electrical pattern, and thereby modulate activity in various cortical areas including those related to motivational and emotional aspects of pain. The objective of this randomized clinical trial is to assess and compare the effect of active versus passive recharge Burst SCS on a wide spectrum of pain in PSPS Type 2 patients. Methods This multicentre randomized clinical trial will take place in 6 Dutch hospitals. PSPS Type 2 patients (n=94) will be randomized into a group receiving either active or passive recharge burst. Following a successful trial period, patients are permanently implanted. Patients complete the Pain Catastrophizing Scale (PCS) (primary outcome at 6 months), Numeric Pain Rating Scale (NRS), Patient Vigilance and Awareness Questionnaire (PVAQ), Hospital Anxiety and Depression Scale (HADS), Quality of Life (EQ-5D), Oswestery Disability Index (ODI), Patient Global Impression of Change (PGIC) and painDETECT questionnaires (secondary outcomes) at baseline, after trial, 1, 3, 6 and 12 months following implantation. Discussion The BURST-RAP trial protocol will shed light on possible clinical differences and effectivity of pain relief, including emotional-motivational aspects between active and passive burst SCS in PSPS Type 2 patients. Trial registration ClinicalTrials.gov registration: NCT05421273 . Registered on 16 June 2022. Netherlands Trial Register NL9194. Registered on 23 January 2021.

The objective: to estimate efficiency of local anesthetics in the conversion of epidural analgesia during physiological childbirth into anesthesia for emergency surgery for delivery.Subjects and Methods: A randomized prospective study was conducted. The patients were divided into three groups depending on the local anesthetic being used. In the first group (n = 49), 2% solution of lidocaine was administered in combination with 0.1 mg of adrenaline, in the second group (n = 48) – 0.5% bupivacaine, in the third group (n = 46) ‒ 0.75% ropivacaine. The study evaluated the onset rate, level, duration of the sensorimotor block, the severity of the pain syndrome, and revealed the frequency of unsuccessful conversion.Results: In the 1st group, the conversion was not success in 16.3% of women, in the 2nd group ‒ in 14.6%, and in the 3rd ‒ 10.9% of cases, due to that general anesthesia was used. When assessing the pain syndrome, the minimum score on the VAS scale 3 hours after surgery was observed with ropivacaine use. The fastest sensory block developed when using 2% lidocaine solution in combination with adrenaline. The motor block preserved for the longest time after administration of bupivacaine, in this regard, patients from the 2nd group began to activate later.Conclusions. The use of 0.5% bupivacaine solution as a local anesthetic during the conversion of epidural analgesia into anesthesia provides a sufficient level of anesthesia that allows surgical intervention. However it is accompanied by a more pronounced motor block, and it has a negative effect on the early activation of maternity patients in the postoperative period. The use of 0.75% solution of ropivacaine hydrochloride provides the most favorable conditions for operative delivery which is confirmed by low estimates of the intensity of pain on the VAS scale, both immediately before surgery and three hours after surgery, the minimum time from the moment of induction to the incision of the skin, ensuring adequate sensory block, the absence of pronounced motor block, and early activation of maternity patients.

Vidhu Sethi,1 Luke Van der Laan,2 Sanjeev Gupta,3 K Cornelius Piros4 1GlaxoSmithKline Consumer Healthcare, Singapore; 2Faculty of Business, Education, Law & Arts, University of Southern Queensland, Queensland, Australia; 3Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; 4Regena Healthcare, Selangor, MalaysiaCorrespondence: Vidhu Sethi, GlaxoSmithKline Consumer Healthcare, Singapore, GSK Asia House, 23 Rochester Park, 139234, Singapore, Tel +65 96447203, Email vidhu.x.sood@gsk.comPurpose: To seek indicative evidence on clinical prescription practice and perspectives regarding combined oral paracetamol (APAP) and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) therapy for managing mild-to-moderate osteoarthritis (OA) pain.Participants and Methods: An exploratory qualitative study to investigate the perspectives towards using APAP and/or topical NSAIDs for OA pain management and whether current clinical practices are aligned with OA guidelines was conducted using a two-round modified Delphi methodology among three general practitioners, three orthopedists, and two pharmacists from Australia, Malaysia, and Sweden during January–June 2021. In the first round, 60-minute virtual in-depth interviews were conducted individually; in the second round, summary of the key findings was shared with the panel to seek clarity on the level of consensus (≥ 70% unanimity) and disagreement.Results: The healthcare professionals (HCPs) agreed that APAP was considered as a universally accepted pharmacologic for most OA patients except those with contraindications or allergies. Consensus was achieved towards APAP combination with topical NSAIDs being a safer alternative than with oral NSAIDs. However, prescription uptake of combined therapy APAP with topical NSAIDs was low among the panel due to lack of strong scientific evidence on efficacy and awareness. Differences in clinical practice across and within countries could be due to different reference sources for OA pain – clinical practice experience or local/international guidelines/medical products handbooks.Conclusion: The study suggests an opportunity to raise awareness of the suitability and potential benefits for adjuvant topical NSAIDs to APAP for effective OA pain management as well as a need for universal OA guidelines.Keywords: combination therapy, pain relief, Delphi methodology, consensus, prescription uptake

Objective To investigate the clinical effects of microwave ablation (MWA) in addition to open surgery for the treatment of lung cancer‐derived thoracolumbar metastases. Methods This was a single‐institution, retrospective, cohort study. From January 2019 to December 2020, a total of 47 patients with lung cancer‐derived thoracolumbar metastases underwent posterior spinal canal decompression and fixation surgery in our hospital. Two independent surgical teams treated these patients. One group underwent open surgery combined with MWA therapy, while the other had open surgery only (control). The pre‐ and post‐operative visual analog scale (VAS) scores and the overall survival (OS) were compared between the MWA and control groups. The Frankel Grade classification was applied for the evaluation of the post‐surgical spinal cord function. Improvement was defined as an increase of at least one rank from the pre‐operative scores. Each patient was evaluated pre‐ and post‐operatively at 48 h, 1 month, and 3‐month intervals. Data on surgical‐related complications were recorded. Results Thirty men and 17 women were included, with an average age of 57.9 ± 11.4 years (range, 26–81 years). Twenty‐eight patients underwent MWA and were in the MWA group, and 19 patients were included in the control group. Post‐operatively all patients were followed up regularly; the median follow‐up time was 12 months (range, 3–24 months), and their median OS was 14 months. Patients in the MWA group had a lower VAS score than those in the control group at the 48‐h (1.75 ± 1.01 vs 2.47 ± 0.96, P = 0.01) and 1‐month (1.79 ± 0.92 vs 2.53 ± 1.35, P = 0.048) check‐ups. At the 3‐month evaluation, the VAS score differences between the two groups were not significant (P = 0.133). After surgery, spinal cord function improvement was not significantly different between the MWA and control groups (P = 0.515). MWA therapy combined with open surgery was not associated with increased OS compared with the control group (P = 0.492). Conclusion MWA can be an effective and safe pain‐relief method but may not extend the OS of patients with lung cancer.

Objective: To compare mean resting pain relief and passive external rotation improvement by Intra-articular Steroid versus intra-articular Platelet Rich Plasma injection in patients with adhesive capsulitis. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi Pakistan, from Jan to Jun 2019. Methodology: A total of 60 patients were included in the study. Group-A and B received Intra-articular 40mg Triamcinolone Acetonide with 1 ml 1% Lignocaine and platelet-rich plasma injections in affected shoulders, respectively. Pain severity was assessed on the Numeric Rating Scale, and passive external rotation was assessed by goniometry at baseline, i.e., preintervention, six weeks and 12 weeks intervals. Results: In our study, the NRS scale for pain was 3.030.76 at six weeks and 1.230.77 at 12 weeks with PRP versus 5.070.87 at six weeks and 3.200.89 with Corticosteroids at 12 weeks post-intervention, with the p-value of

Trachyspermum ammi (L.) Sprague (commonly known as ajwain) contains ingredients that attenuate menstrual problems, especially cramping. In this study, we evaluated the impact of ajwain on the pain intensity in a sample of Iranian female college students with primary dysmenorrhea (PD) in comparison to mefenamic acid (MFA). This study was an open-label, randomized, parallel-group clinical trial conducted in the university dormitories in Tehran, Iran, from September 2018 to May 2019. Seventy patients were randomly assigned to two groups of ajwain and MFA. The participants in the ajwain group were treated with a 500 mg ajwain capsule three times a day for seven days, from the 26th cycle day to the 3rd day of the menstrual cycle, for three consecutive cycle periods. The other group received MFA capsules with the first dose of 500 mg and then 250 mg every eight hours, if necessary, from the first day of the menstrual cycle. The two groups were compared in terms of the pain intensity by the visual analog scale (VAS) in pre-intervention cycle and three consecutive cycles during the study. Maximum pain intensity, mean pain, and duration of pain after the intervention were significantly reduced in both groups. The mean VAS score significantly decreased in the ajwain group compared to the MFA group post-intervention (p < 0.02). Moreover, passing blood clots was significantly reduced in the ajwain group (p < 0.03). The findings of this study suggest that ajwain may be effective in pain relief in PD without adverse effects.

This study presents an innovative wound dressing system that offers a highly effective therapeutic solution for treating painful wounds. By incorporating the widely used non-steroidal anti-inflammatory drug diclofenac, we have created an active wound dressing that can provide targeted pain relief with ease. The drug was embedded within a biocompatible matrix composed of polyhydroxyethyl methacrylate and polyhydroxypropyl methacrylate. The multilayer structure of the dressing, which allows for sustained drug release and an exact application, was achieved through the layer-by-layer coating technique and the inclusion of superparamagnetic iron platinum nanoparticles. The multilayered dressings' physicochemical, structural, and morphological properties were characterised using various methods. The synergistic effect of the incorporated drug molecules and superparamagnetic nanoparticles on the surface roughness and release kinetics resulted in controlled drug release. In addition, the proposed multilayer wound dressings were found to be biocompatible with human skin fibroblasts. Our findings suggest that the developed wound dressing system can contribute to tailored therapeutic strategies for local pain relief. [ABSTRACT FROM AUTHOR]

Background: Lateral epicondylitis is an increasingly debilitating condition in working population. Evidence for conservative treatment modalities has been inconclusive. Percutaneous pie crusting of the common extensor origin at the lateral epicondyle at the time of local corticosteroid injection (CSI) has been proposed sparsely. The objective of this study was to analyze if concomitant CSI and pie-crusting of the common extensor origin provides better outcome than CSI alone in lateral epicondylitis. Methods: This case-control study on 236 patients was conducted at a single center between January 1, 2020, and May 31, 2022. Patients were divided into two groups (n=118 each) based on their preference. Group A underwent CSI alone and group B underwent pie crusting along with CSI. The clinical and functional outcomes of all patients were evaluated at 2, 4, 6, and 12-week post-procedure using the visual analog scale (VAS) and Nirschl score. The mean time for return to daily activities was also compared. Results: Both groups showed significant improvement in post-procedure outcome at successive follow-ups on intragroup longitudinal analysis (VAS: F=558.384 vs. F=1,529.618, Nirschl: F=791.468 vs. F=1,284.951). On intergroup analysis, VAS of group B was superior to that of group A; however, it was statistically significant (P<0.05) only from the 6-week follow-up onwards. Nirschl score of group B was significantly better throughout the period of follow-up (P<0.05). Group B returned to daily activities faster than Group A (6.2±0.44 weeks vs. 7.18±0.76 weeks). Conclusions: Concomitant pie crusting with CSI is recommended for lateral epicondylitis as it provides significantly better results than CSI alone. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research was to learn if 900 mg of vaginal isonicotinic acid hydrazide (INH) reduced pain and improved insertion ease during diagnostic outpatient hysteroscopy (DOH) in nulliparous infertile patients, when administered 12 hours before DOH. Materials and Methods: A double-blinded, randomized, controlled study was carried out at a university teaching hospital. Primary infertile women (150) were allocated randomly to receive 900 mg of INH vaginally or a placebo 12 hours before DOH for infertility assessment. Patients were requested to assess the intensity of their pain on a visual analogue scale ranging from 1 to 10 during the DOH, which was the study's primary objective. Secondary outcomes were the time it took to insert the hysteroscope via the external cervical os and to view the uterus, patient satisfaction, postprocedural analgesic needs, and the ease with which DOH was performed. Results: Both groups shared baseline features. The INH group had a reduced mean pain score during DOH (3.9 ± 0.8 versus 5.8 ± 0.8; p < 0.001). DOH was easier in the INH group; ease of insertion score in the INH group was lower than in the placebo group (5.3 ± 0.1 versus 7.3 ± 1.1; p < 0.001). The INH group had greater satisfaction (7.6 ± 1.3 versus 5.1 ± 0.9; p < 0.001) and needed less analgesia (p = 0.02) than the placebo group. Both groups had comparable adverse effects. Conclusions: In nulliparous infertile women, 900 mg of vaginal INH 12 hours before DOH reduces perceived pain more effectively than a placebo, facilitating easier hysteroscope insertion and improving patient satisfaction. (J GYNECOL SURG 39:43) [ABSTRACT FROM AUTHOR]

Simple Summary: Surgical castration of piglets is generally recognized as a painful procedure. Thus, for animal welfare reasons, the German Animal Welfare Act stipulates the use of effective anesthesia during castration. However, whether local anesthesia provides adequate analgesia has been an ongoing debate in Germany. In the present study, we compared the behavior of 178 piglets allocated to various test groups in an observation arena before any of the applied procedures, after administration of the local anesthetic, and 0, 2 and 24 h after surgical castration. The local anesthetic and the injection techniques were evaluated and optimized in three sequential study parts. Overall, the results revealed that when local anesthesia was used, piglets less frequently showed pain-associated behaviors—such as changes in tail position—than piglets of the control group that had been castrated without local anesthesia. Non-castrated piglets showed the fewest pain-associated behaviors in the observation arena. In several test groups, the piglets showed changes in tail position, tail wagging, or hunched-back posture on the day following the procedure. These behaviors differed significantly from those shown before the procedure. The administration of local anesthetics in the present study considerably reduced castration-related pain. However, because local anesthesia has a limited duration of effect, adverse effects due to castration-related pain were still observable one day after castration. Surgical castration of piglets is generally recognized as a painful procedure, but there is currently no gold standard for the assessment of pain behavior in piglets. However, pain assessment is essential for evaluating the effectiveness of local anesthetics. In this study, we investigated the efficacy of four local anesthetics in terms of pain relief during and after surgical castration in three sequential study parts. To do so, we filmed 178 piglets before the applied procedures, after injection of the local anesthetic, and up to 24 h after castration (five observation times in total) in an observation arena and compared their behavior before and after castration and between treatments and control groups. The results showed significant differences in the behavior of the piglets before and after castration and between the sham-castrated control group and the control group castrated without anesthesia. The different local anesthesia treatment groups showed diverging differences to the control groups. The most frequently shown pain-associated behaviors of the piglets were changes in tail position and hunched back posture. We observed a reduction but no complete elimination of the expressed pain-associated behaviors after local anesthesia. Several behavioral changes—such as changes in tail position, hunched back posture or tail wagging—persisted until the day after castration. Owing to the limited duration of the effects of the local anesthetics, local anesthesia did not influence long-term pain. [ABSTRACT FROM AUTHOR]

Introduction: Epidural analgesia is one of the preferred mode of perioperative management. Neuraxial opioids like fentanyl when used in epidural offer advantage of augmenting local anaesthetic effect and reducing the anaesthetic and analgesic requirement. Aim: To compare the adequacy of analgesia, requirement of rescue analgesics between 0.125% bupivacaine with 2 mcg/cc fentanyl and 0.125% levobupivacaine with 2 mcg/cc fentanyl. Materials And Methods: The randomised clinical study was carried out from September 2016 to May 2017 in 70 patients (35 in each group) of American Society of Anaesthesiologists (ASA) 1 and 2 scheduled for elective gynae-oncological surgeries. The epidural analgesia in group Bupivacaine with Fentanyl (BF) was 0.125% Bupivacaine with 2 mcg/cc Fentanyl and group Levobupivacaine with Fentanyl (LF) was 0.125% Levobupivacaine with 2 mcg/cc fentanyl. All data was statistically analysed and compared using Student t-test, Chisquare/Fisher-Exact test. Results: Total of 70 patients were analysed, 35 each in Group BF (mean age: 50.06±7.19 years) and Group LF (mean age: 46.43±8.41 years). Both the groups were compatible with regard to demographic data and haemodynamic variables. The mean Visual Analogue Scale (VAS) score was higher in group BF compared to group LF at 0,1,4,6,1,2 and 18 hours but the observed difference in both the groups was not statistically significant except at 2nd (p-value: 0.016) and 24th hour (p-value 0.017). Number of rescue analgesics as epidural boluses (p-value=0.001) and paracetamol (p-value=0.044) requirement were more in group BF compared to group LF respectively. Conclusion: On account of adequate postoperative analgesia, haemodynamic stability, levobupivacaine with fentanyl is a better option than bupivacaine with fentanyl for epidural infusion. [ABSTRACT FROM AUTHOR]

Background: Opioids continue to be widely prescribed for chronic noncancer pain, despite the awareness that opioids provide only short-time pain relief, lead to dose accumulation, have numerous adverse effects, and are difficult to wean. As an alternative, we previously showed advantages of using pharmaceutical-grade cannabis in a population of chronic pain patients with fibromyalgia. It remains unknown whether combining an opioid with pharmaceutical-grade cannabis has advantages, such as fewer side effects from lesser opioid consumption in chronic pain. Methods: Trial design: a single-center, randomized, three-arm, open-label, exploratory trial. Trial population: 60 patients with fibromyalgia according to the 2010 definition of the American College of Rheumatologists. Intervention: Patients will be randomized to receive up to 4 daily 5 mg oral oxycodone sustained release (SR) tablet, up to 5 times 150 mg inhaled cannabis (Bediol®, containing 6.3% Δ9-tetrahydrocannabinol and 8% cannabidiol), or the combination of both treatments. Treatment is aimed at self-titration with the daily maximum doses given. Treatment will continue for 6 weeks, after which there is a 6-week follow-up period. Main trial endpoint: The number of side effects observed during the course of treatment using a composite adverse effect score that includes the following 10 symptoms: dizziness (when getting up), sleepiness, insomnia, headache, nausea, vomiting, constipation, drug high, hallucinations, and paranoia. Secondary and tertiary endpoints include pain relief and number of oxycodone doses and cannabis inhalations. Discussion: The trial is designed to determine whether self-titration of oxycodone and cannabis will reduce side effects in chronic pain patients with fibromyalgia. Trial registration {2a and 2b}: EU trial register 2019–001861-33, URL https://www.clinicaltrialsregister.eu, on July 17, 2019; World Health Organization International Clinical Trials Research Platform NL7902, URL https://trialsearch.who.int, on July 26, 2019. [ABSTRACT FROM AUTHOR]

Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. The introduction of ultrasound technology for epidural insertion presents a novel challenge of acquiring new knowledge and skill set. As with acquiring any new skill, there will be initial challenges for both the novice and experienced anesthesiologist. From correlating anatomy with sonoanatomy and visualizing needles and fluid dynamics in real-time below the skin surface, ultrasound provides opportunities and unique challenges for vascular access and regional anesthesia. Purpose The purpose of this study was to evaluate the utility of ultrasound in the process of epidural catheter inserion and whether it can replace the conventional loss-ofresistance (LOS) technique or at least help with better performance by the staff. Patients and methods A total of 30 patients scheduled for thoracotomy were randomly categorized by closed envelopes method into two equal groups (15 patients each): group I patients received epidural anesthesia with ultasound guidance, and group II patients received epidural anesthesia with the conventional palpation technique. We recorded time from first puncture till LOS, number of skin punctures till LOS, redirections, and bone contacts. Failure and complications were recorded as well. Patient satisfaction was assessed after catheter insertion and removal, which was 24 h postoperatively in the postanesthesia care unit. Results A significant increase in insertion time was recorded in group I (P<0.001). The number of skin punctures till LOS was significantly lower in group I (P=0.043), and needle redirections were also lower in group I (P=0.020). Vertebrae were less hit by the needle in group I (P=0.026). A case of epidural failure was recorded in group II, and also an accidental hemorrhagic tap was recorded in the same group. Patient satisfaction both after catheter insertion and removal was higher in group I (P=0.031 and 0.002, respectively). Conclusion From the primary endpoints assessed in this work, one can declare that usage of ultrasound had consumed time owing to lack of experience by the operator, yet it led to less puncture attempts, redirections, and bone contacts and reduced failure rates and complication rates, which led to increased satisfaction. The technique requires more practice and training to familiarize anesthesia staff with it to lower the procedure time. [ABSTRACT FROM AUTHOR]

In patients undergoing caesarean section (CS) with spinal anesthesia, the superiority of one intrathecal opioid over another one is not fully established. In order to investigate this, we joined the PAIN OUT Project (NCT02083835) for a two-year period. We surveyed patients undergoing elective CS with intrathecal anesthesia. Patients were asked to complete an anonymous questionnaire. Primary outcomes were: worst pain experienced, time spent in severe pain, relief received by treatment, satisfaction about pain management, wish for more pain treatment. We included 144 patients. The two main pain management combinations used were: bupivacainemorphine (B-M, n=100) and bupivacaine-fentanyl (B-F, n=32). There were no differences in any of the primary outcomes between the groups. The B-F population received more intravenous/intramuscular opioids during the intraoperative (p<0.01) and the postoperative (p<0.001) period. The choice of morphine or fentanyl as adjunct to local anesthetic in spinal anesthesia for CS does not affect the patient's experience with regards to pain management. [ABSTRACT FROM AUTHOR]

Introduction: Chemotherapy-induced oral mucositis (COM) is a prominent complication of chemotherapy (CT). Non-thermal CO2 laser therapy (NTCLT) has been demonstrated as an innovative and safe photobiomodulative approach in some kinds of painful oral lesions. The purpose of this study was to evaluate the palliative effects of one session of NTCLT on COM lesions. Methods: Patients with painful COM (WHO grade: ≥ 2) were included in this before-after clinical trial based on the eligibility criteria. The oral lesions were irradiated with a CO2 laser (power: 1 W, scanning the lesions with the rapid circular motion of the defocused handpiece) through a thick layer (3-4 mm) of a transparent gel containing a high-water content. The severity of pain in the lesions was self-assessed using a 0-to-10 visual analogue scale (VAS) for 7 consecutive days. The evaluating physician visited the patients on the 3rd and 7th days in search of any kind of complications. Results: Seventeen adult patients with 35 patches of OM due to chemotherapy of solid tumors completed the trial. Immediately after NTCLT, the mean for non-contact VAS pain scores of the lesions significantly declined from 4.91 ± 2.356 to 0.29 ± 0.622 (P < 0.001) and the mean for contact VAS pain scores from 7.77 ± 1.57 to 1.31 ± 1.18 (P < 0.001). The mean VAS pain scores of the lesions showed statistically significant differences between the follow-up periods compared to the baseline (P < 0.001). The process was completely pain-free and required no anesthesia. After NTCLT, no kind of thermal adverse effects such as irritation, destruction, aggravation and even erythema were observed. Conclusion: Based on the results of this before-after clinical trial, NTCLT has the potential to be considered as a non-invasive and safe palliative option for the pain management of patchy OM due to chemotherapy of solid tumors. [ABSTRACT FROM AUTHOR]

To compare the clinical efficacy of percutaneous vertebroplasty (PVP) alone and microwave ablation (MWA) combined with PVP for the treatment of painful spinal metastases from non-small cell lung cancer (NSCLC). From October 2014 to October 2021, the data of 58 NSCLC patients with refractory painful spinal metastases (visual analog scale score ≥ 5) were retrospectively collected and analyzed. Patients in Group A (n = 30) and Group B (n = 28) received PVP alone and MWA combined with PVP, respectively. The primary endpoint was pain relief. The secondary endpoints were quality of life (QoL), local tumor progression (LTP), and complications. The technical success rate was 100% in both groups. Patients in both groups showed similar pain relief at 1–12 weeks, but patients in Group B still showed sustained pain relief at 24 weeks compared to those in Group A (p = 0.03). The assessment of QoL showed similar changes. LTP (33.00% vs. 7.14%, p = 0.02) and cement leakage rates (40.00% vs. 7.14%, p = 0.03) were lower in Group B. The multivariate analysis demonstrated spinal metastases with a maximum diameter ≤ 3.0 cm (p = 0.027) and MWA combined with PVP (p = 0.028) were two independent protective factors for LTP. For cement leakage, spinal metastases with vertebral body compression (p = 0.019) was an independent risk factor, while MWA combined with PVP (p = 0.042) was an independent protective factor. MWA combined with PVP for painful spinal metastases from NSCLC performed more sustained pain relief (>6 months) and ultimately improved QoL with lower LTP and cement leakage rates, compared to PVP alone. [ABSTRACT FROM AUTHOR]

Transvaginal oocyte retrieval (TVOR), done for the purpose of assisted ~ reproduction can instigate enormous pain and therefore requires adequate analgesia with the least adverse effects. As the procedure involves retrieving oocytes for in vitro fertilisation, the effect of the anaesthetic drugs on the oocyte quality should also be considered. This review focuses on the various modes of anaesthesia and the anaesthetic drugs which can be administered safely to provide effective analgesia in normal and in special conditions such as women with pre-existing comorbidities. Medline, Embase, PubMed and Cochrane electronic databases were searched according to modified Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. According to this review, conscious sedation appears to be the most preferred mode of anaesthesia in women undergoing TVOR owing to fewer adverse effects, faster recovery, better patient and specialist comfort and the least effect on oocyte quality and embryo development. Combining it with paracervical block resulted in lesser consumption of the anaesthetic drug, which may have a beneficial effect on the oocyte quality. [ABSTRACT FROM AUTHOR]

Background: Endometrial samples are typically obtained by the gynecological procedure known as dilatation and curettage (D & C). Anesthesia is required for the surgery. Although paracervical blocks are frequently employed, the pain they cause is mild to moderate. Objective: The aim of this study was to compare the efficacy of intrauterine instillation of lidocaine, paracervical block, and a combination of the two procedures for their ability to control intra- and post-operative pain during and after endometrial curettage. Patients and Methods: This research was conducted in Ob/Gyn Departments of Menoufia University Hospital and Quesna Central Hospital. 90 women were scheduled for endometrial curettage were divided into three equal groups by random selection: Group 1 (n=30): Lidocaine 2% was administered intra-uterine. Group 2 (n=30): Received paracervical blockage. Group 3 (n=30): Received combined intrauterine lidocaine and paracervical block. Results: The current study showed that mean VAS value of D and C time was statistically higher among lidocaine (4.9 ± 0.76) than in combined intrauterine lidocaine and paracervical block (3.93 ± 0.83). Mean VAS value of D and C time was statistically higher among paracervical block (4.6 ± 1.13) than in combined intrauterine lidocaine and paracervical block (3.93 ± 0.83). Five minutes after the procedure, pain was least after the combined technique (group 3) then after intrauterine lidocaine group (group 1) then after paracervical block (group 2), (VAS:2.6 ± 0.93, 2.9 ± 0.9 and 3.67 ± 0.96 respectively). Conclusion: Greater analgesia was provided by using intrauterine lidocaine in combination with paracervical block than by using either lidocaine or paracervical block alone. [ABSTRACT FROM AUTHOR]

Electrical stimulation of peripheral nerve fibers has always been an attractive field of research. Due to the higher activation threshold, the stimulation of small fibers is accompanied by the stimulation of larger ones. It is therefore necessary to design a specific stimulation theme in order to only activate narrow fibers. There is evidence that stimulating Aδ fibers can activate endogenous pain-relieving mechanisms. However, both selective stimulation and reducing pain by activating small nociceptive fibers are still poorly investigated. In this study, using high-frequency stimulation waveforms (5–20 kHz), computational modeling provides a simple framework for activating narrow nociceptive fibers. Additionally, a model of myelinated nerve fibers is modified by including sodium–potassium pump and investigating its effects on neuronal stimulation. Besides, a modified mathematical model of pain processing circuits in the dorsal horn is presented that consists of supraspinal pain control mechanisms. Hence, by employing this pain-modulating model, the mechanism of the reduction of pain by activating nociceptive fibers is explored. In the case of two fibers with the same distance from the point source electrode, a single stimulation waveform is capable of blocking one large fiber and stimulating another small fiber. Noteworthy, the Na/K pump model demonstrated that it does not have a significant effect on the activation threshold and firing frequency of fiber. Ultimately, results suggest that the descending pathways of Locus coeruleus may effectively contribute to pain relief through stimulation of nociceptive fibers, which will be beneficial for clinical interventions. [ABSTRACT FROM AUTHOR]

The objective of the study is to evaluate the best available evidence on the effectiveness of DN in the management of tendinopathy. Seven randomized control trials were selected following an electronic search in PubMed, Web of Science, Scopus, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants, which investigated the effect of the DN technique on the management of tendinopathies. Only studies in the English language published in peer-reviewed journals between 1999 and 2020 were included. The methodological quality of the studies was assessed using the PEDro scale. The PEDro score of the studies ranged from 5 to 9 with a mean score of 6.7 ± 1.2 (mean ± SD). A total of 357 participants were enrolled in the seven included studies, which were on greater trochanteric pain syndrome, lateral epicondylitis, supraspinatus tendinopathy and Achilles tendinopathy. DN was compared with various interventions, including platelet-rich plasma injection, autologous blood injection and non-steroidal anti-inflammatory medication. All the selected studies reported a significant positive effect of DN on pain intensity and other outcome measures, such as patient-specific functional score, disability index, range of motion and health-related quality of life. The results indicate that DN appears to be as effective as other treatment methods at relieving pain and other symptoms of tendinopathy immediately after treatment and up to 6 months. DN can be considered among the many options available for the management of tendinopathy. [ABSTRACT FROM AUTHOR]

For patients suffering from myofascial pain syndrome (MPS) affecting muscles of mastication, traditional trigger point therapy treatment regimens can prove inconvenient, due to the short duration of pain relief after each injection and expense of repeated visits which are often not covered by insurance. We present a case of a patient treated using an alternative technique that could develop into an additional modality for treating MPS patients who are refractory to conservative treatment. This technique involves identifying and marking the patient's trigger points and surgically cauterizing each location using a Bovie electrosurgical unit. While traditional trigger point injection therapy for myofascial pain syndrome is a well-described technique with acceptable pain relief expected for a period of 8–12 weeks, this technique provided up to 24 months of adequate pain relief in a patient. While further studies are indicated before widespread adoption can be recommended, this patient's response suggests that this technique may be useful in offering longer-term pain relief compared with trigger point injection therapy. [ABSTRACT FROM AUTHOR]

The aim of this research was to evaluate the physiological and behavioural parameters in Saanen goat kids treated with flunixin meglumine compared with no analgesic treatment after cautery disbudding using a device fueled by propane gas. At 7 days of age, 30 goat kids were randomly allocated to three groups: Sham (Sh) control, (i.e., simulating disbudding); Disbudding (Di), using thermal cauterization; Disbudding + Flunixin (DiFl), thermal cauterization + flunixin meglumine (2.2 mg/kg body weight, 15 min before treatment). Each kid was video-recorded for 30 min before and after treatment to evaluate the frequency of head shaking, head scratching, body shaking, grooming, head rubbing, jumping, running, and bleating. Blood samples were taken 30 min after disbudding to evaluate serum cortisol concentrations and white blood cell count. Heart rate (HR) and respiratory rate (RR) were measured using a stethoscope. Liveweight of goat kids was recorded at birth, -24 h and 7 days after treatment, and at 25 days of age. The mean frequency of head shaking and head scratching was higher (p = 0.0001) after disbudding in Di (37.5 ± 47.8 and 33.32 ± 31.2) group compared to Sh (3.42 ± 3.58 and 2.2 ± 1.8) and DiFl, (4.02 ± 2.76 and 4.42 ± 3.72) groups. The frequency of jumping was higher (p = 0.022) for Di (3.74 ± 2.24) than that of DiFl (0.39 ± 0.92). The remaining behaviours did not show differences (p > 0.05). HR and RR were higher (HR: p < 0.0048; RR: p < 0.035) in group Di (HR: 156 ± 13.6; RR: 66 ± 14.8) than in Sh (HR: 138 ± 8.48; RR: 55.6 ± 5.4) and in DiFl (HR: 136 ± 6.38; RR: 52.8 ± 4.13). No differences were detected between live weight, serum cortisol and white blood cell count data (p > 0.05). Results show that flunixin meglumine was effective at reducing pain-related behaviours when given at the time of disbudding. [ABSTRACT FROM AUTHOR]

Background: In preclinical studies, FLASH therapy, in which radiation delivered at ultrahigh dose rates of ≥40 Gy per second, has been shown to cause less injury to normal tissues than radiotherapy delivered at conventional dose rates. This paper describes the protocol for the first-in-human clinical investigation of proton FLASH therapy. Objective: FAST-01 is a prospective, single-center trial designed to assess the workflow feasibility, toxicity, and efficacy of FLASH therapy for the treatment of painful bone metastases in the extremities. Methods: Following informed consent, 10 subjects aged ≥18 years with up to 3 painful bone metastases in the extremities (excluding the feet, hands, and wrists) will be enrolled. A treatment field selected from a predefined library of plans with fixed field sizes (from 7.5 cm Ã-- 7.5 cm up to 7.5 cm Ã-- 20 cm) will be used for treatment. Subjects will receive 8 Gy of radiation in a single fraction-a well-established palliative regimen evaluated in prior investigations using conventional dose rate photon radiotherapy. A FLASH-enabled Varian ProBeam proton therapy unit will be used to deliver treatment to the target volume at a dose rate of ≥40 Gy per second, using the plateau (transmission) portion of the proton beam. After treatment, subjects will be assessed for pain response as well as any adverse effects of FLASH radiation. The primary end points include assessing the workflow feasibility and toxicity of FLASH treatment. The secondary end point is pain response at the treated site(s), as measured by patient-reported pain scores, the use of pain medication, and any flare in bone pain after treatment. The results will be compared to those reported historically for conventional dose rate photon radiotherapy, using the same radiation dose and fractionation. Results: FAST-01 opened to enrollment on November 3, 2020. Initial results are expected to be published in 2022. Conclusions: The results of this investigation will contribute to further developing and optimizing the FLASH-enabled ProBeam proton therapy system workflow. The pain response and toxicity data acquired in our study will provide a greater understanding of FLASH treatment effects on tumor responses and normal tissue toxicities, and they will inform future FLASH trial designs. [ABSTRACT FROM AUTHOR]

Endometriosis is a benign, hormone-responsive chronic disease that affects women of reproductive age; long-term treatment to balance satisfactory tolerability with clinical efficacy is necessary for these patients. The first-line therapy for endometriosis is predominantly medical treatment, in order to improve symptoms or prevent post-surgical disease recurrence. Multiple factors including age and women preference, pain severity, and endometriosis stage must be considered in the choice of the most suitable therapy. Estrogen-progestogins are generally used as first-line hormone therapies among different medical options currently effective for endometriosis management. Several studies have shown that they are able to improve pain symptoms in most patients, are well tolerated, and are inexpensive. Combined hormonal contraception treatment, administered cyclically or continuously, with different types of hormones and route of administration, results in clinically noticeable decrease in dysmenorrhea, noncyclic pelvic pain, dyspareunia, and recurrence rate after surgery, and also in quality of life improvement.

Abstract Ketamine may become an important drug for multimodal analgesia regime again because of its strong analgesic effects and retaining the advantage of spontaneous breathing. The present study was designed to explore the influences of different dosages of S‐ketamine anesthesia induction regimes on psychiatric complications and postoperative prognosis in patients undergoing gynecological operations. In this prospective, triple‐blinded, randomized, controlled study, patients undergoing elective gynecological surgery were randomized to one of three treatment groups: low‐dose S‐ketamine (LDSK) group (a 0.3 mg/kg bolus for anesthesia induction), minimal‐dose S‐ketamine (MDSK) group (a 0.2 mg/kg bolus for anesthesia induction), and placebo (CON) group (a saline bolus for anesthesia induction). The main outcome measures were as follows: intraoperative vital signs, extubation time, anesthesia recovery time and postanesthesia care unit (PACU) stay duration, incidence of psychiatric complications, Ramsay sedation scale (RSS) 1, 2, 24, and 48 h, postoperatively, and overall prognosis. One hundred and eighty female participants were finally included in this study from April 2021 to December 2021. Significant differences were not observed in age, height, weight, American Society of Anesthesiologists physical status classification, or history of mental illness between the groups. No statistically significant differences were discovered with regard to intraoperative vital signs, extubation time and PACU stay duration, incidence of psychiatric complications, and RSS scores at 1, 2, 24, and 48 h postoperatively in the three groups. However, the visual analog scale (VAS) scores of the CON group at 10 min after extubation and at the time point leaving PACU were much higher than that of the LDSK and MDSK groups. The VAS scores at 48 h after surgery in the MDSK group were also lower than that of the CON group and the CON group had received more analgesic drug treatment in the surgical wards consequently. Postoperative nausea and vomiting (PONV) occurrence at 24 and 48 h, postoperatively, increased sharply in the CON group than in the other two experimental groups, which led to an increase in the use of postoperative antiemetic drugs in this group. According to the postoperative satisfaction survey, patients in the CON group had lower medical satisfaction. Our data demonstrate that a small dosage of S‐ketamine anesthesia induction can reduce postoperative pain and the incidence of PONV without increasing hemodynamic fluctuations or psychiatric complications.

Abstract Background Successful pain management after outpatient surgery requires proper education leading to correct decisions on the analgesics use at home. Despite different strategies adopted, up to ½ of patients receive little or no information about the treatment of postoperative pain, 1/3 of them are not able to follow postoperative analgesia instructions. This leads to higher rates of unmet needs in pain treatment, post-discharge emergency calls, and readmissions. Structured educational interventions using psychological empowering techniques may improve postoperative pain management. We hypothesize that preoperative education on use of an improved pain scale to make correct pain management decisions will improve the quality of post-operative pain management at home and reduce analgesics-related side effects. Methods A total of 414 patients scheduled for an outpatient orthopedic surgery (knee/shoulder arthroscopic interventions) are included in this randomized (1:1) controlled trial. Patients in the control arm receive standard information on post-discharge pain management. Patients in the experimental arm receive structured educational intervention based on the rational perception of postoperative pain and discomfort (anchoring and improved pain scale), and the proper use of analgesics. There is no difference in post-discharge analgesics regimen in both arms. Patients are followed for 30 days post-discharge, with the primary outcome expressed as total pain relief score at 5 days. Secondary outcomes include the incidence of severe pain during 30 days, changes in sleep quality (Pittsburg Sleep Quality Assessment), and patients’ perception of postoperative pain management assessed with the International Pain Outcomes questionnaire at day 30 post-discharge. Discussion The developed intervention, based on an improved pain scale, offers the advantages of being non-surgery-specific, is easily administered in a short amount of time, and can be delivered individually or in-group, by physicians or nurses. Trial registration ClinicalTrials.gov NCT03754699 . Registered on November 27, 2018.

In photodynamic therapy (PDT), reactive oxygen species (ROS) are key products that induce cell death, and increasing amount of ROS is a crucial way to enhance PDT efficacy. However, the generated ROS stimulates the transient receptor potential vanilloid 1 channel (TRPV1), which can be activated in the pain pathway and then exacerbate pain. Herein, we utilized arginine−glycine−aspartate (RGD) peptide-modified liposomes for encapsulation Chlorin e6 (Ce6) and capsazepine (Cz), a receptor antagonist of TRPV1, to prepare drug-loaded liposomes, RLCC. Soluble hyaluronic acid microneedle arrays (MNs), which possess sufficient skin penetration capability and excellent biosafety, was applied for in situ delivery of RLCC. With the aid of RGD peptides, the efficiency of intracellular liposomal uptake and the dispersion of drugs in tumor after delivery by MNs were significantly enhanced, showcasing tremendous potential for improving the PDT efficacy. Besides, through the analysis of sciatic nerve signals in mice during PDT, RLCC demonstrated remarkable effectiveness in alleviating pain by significantly reducing nerve impulses. Hence, RLCC demonstrated outstanding effectiveness in PDT and effectively alleviated the associated pain. Overall, this research highlights the potential of utilizing MNs for the in situ delivery of RLCC, facilitating effective PDT while addressing the issue of pain during the treatment. • Soluble hyaluronic acid MNs have excellent biosafety and drug delivery efficiency. • RLCC increases the production of ROS by photosensitizers. • MNs mediated RLCC administration enhances drug distribution in tumor sites. • RLCC effectively alleviates pain during PDT [ABSTRACT FROM AUTHOR]

Pain in photodynamic therapy (PDT), resulting from the stimulation of reactive oxygen species (ROS) and local acute inflammation, is a primary side effect of PDT that often leads to treatment interruption or termination, significantly compromising the efficacy of PDT and posing an enduring challenge for clinical practice. Herein, a ROS-responsive nanomicelle, poly(ethylene glycol)-b-poly(propylene sulphide) (PEG-PPS) encapsulated Ce6 and Lidocaine (LC), (ESCL) was used to address these problems. The tumor preferentially accumulated micelles could realize enhanced PDT effect, as well as in situ quickly release LC due to its ROS generation ability after light irradiation, which owes to the ROS-responsive property of PSS. In addition, PSS can suppress inflammatory pain which is one of the mechanisms of PDT induced pain. High LC-loaded efficiency (94.56 %) owing to the presence of the thioether bond of the PPS made an additional pain relief by inhibiting excessive inflammation besides blocking voltage-gated sodium channels (VGSC). Moreover, the anti-angiogenic effect of LC offers further therapeutic effects of PDT. The in vitro and in vivo anti-tumor results revealed significant PDT efficacy. The signals of the sciatic nerve in mice were measured by electrophysiological study to evaluate the pain relief, results showed that the relative integral area of neural signals in ESCL-treated mice decreased by 49.90 % compared to the micelles without loaded LC. Therefore, our study not only develops a very simple but effective tumor treatment PDT and in situ pain relief strategy during PDT, but also provides a quantitative pain evaluation method. [Display omitted] • ESCL demonstrates excellent drug encapsulation capacity for lidocaine. • The sciatic nerve signal can reflect pain during photodynamic therapy. • ESCL effectively relieves pain during photodynamic therapy. • ESCL enhances the efficacy of photodynamic therapy [ABSTRACT FROM AUTHOR]