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Opioids are important for postoperative analgesia but their use can be associated with numerous side effects. Transcutaneous electrical nerve stimulation (TENS) has been used for acute pain treatment and has dose-dependent analgesic effects, and therefore presents an alternative to intravenous (iv) opioids for postoperative pain relief. The aim of this meta-analysis was to compare high-frequency, high-intensity (HFHI or intense) TENS to iv opioids with regard to postoperative pain intensity, recovery time in the Post Anesthesia Care Unit (PACU) and opioid consumption after elective gynecological surgery.

Purpose: The aim of this study was to describe chronic pain patients' perception of their physical function and treatment factors for improving or maintaining physical function long-term after the completion of an Interdisciplinary Pain Rehabilitation Program (IPRP) and to compare physical function before, directly after and at long-term follow-up (16–20 months after treatment). Materials and methods: Patients with severe nonmalignant chronic pain, participating in an IPRP at a specialist clinic, were eligible for inclusion in a convergent mixed methods study. Quantitative data included aerobic capacity, level of physical activity (PA) and self-efficacy for exercise. Qualitative data were collected through semi-structured interviews. Results: The qualitative analysis resulted in one theme: Orientation change and two categories: Permission to feel self-worth and Reclaiming life, which illuminated factors that enabled a sustained increase in PA. The quantitative data (n = 11) showed a significantly increased maximal oxygen uptake (VO2max) from 2.46 l/min (SD = 0.9) at baseline to 2.63 l/min (SD = 0.9, p =.03) on completion of the program. VO2max was sustained at long-term follow-up (2.56 l/min (SD = 1.0, p =.24). Conclusion: This study indicates that an orientation change process through an IPRP can lead to increased physical function and a sustainable level of PA. Furthermore, it highlights the importance of a person-centered approach to enable sustainable change in patients with chronic pain. [ABSTRACT FROM AUTHOR]

Background: High-frequency, high-intensity transcutaneous electrical nerve stimulation (HFHI TENS, i.e. 80 Hz and 40–60 mA) is an effective, fast-acting pain relief modality after elective surgery, offering pain relief within 5 min. Few studies have explored patients' perspectives on using TENS in the post-anesthesia care unit. This study investigates patients' experiences and perceptions of TENS as a complementary approach to traditional pharmacological pain management in postoperative care. Method: Patients undergoing elective laparoscopic cholecystectomy were offered TENS as an alternative to conventional pain treatment with IV opioids. Twenty participants attended telephone semi-structured telephone interviews a median of 12 days after surgery. Data were analysed using a thematic analysis according to Braun and Clark. Results: Participants expressed that TENS provided reassurance and relaxation, calmed them, and gave them a sense of control over their pain. Participants perceived a greater degree of autonomy as TENS could be administered independently. They conveyed a preference for TENS, which they experienced as a safe and fast-acting alternative to opioids, despite its limitations in managing severe pain and rapid offset upon discontinuation. Conclusion: To our knowledge, this is the first study that describes patients' views on managing postoperative pain using TENS in the post-anesthesia care unit. This study indicates that patients desire alternatives to drugs for pain control in the postoperative setting. TENS has advantages, such as a rapid onset and offset and supporting patient autonomy, as well as drawbacks, such as being ineffective when pain is too severe. TENS could be included within the routine multimodal analgesia framework for person-centred postoperative pain management. Trial registration: The participants in the current study were retrospectively registered and recruited from a randomized controlled trial (RCT; registered at ClinicalTrials.gov: NCT04114149). [ABSTRACT FROM AUTHOR]

Background: Chronic pain (pain > 3 months) is a disabling condition affecting around one fifth of the population. Chronic pain significantly affects a person's psychological and physical health and often interferes with the ability to work. It is one of the most common reasons for extended sick leave and persons with chronic pain often have difficulties returning to work. Interpreting the experiences of currently available is necessary in order to facilitate a return to working life. Therefore, this study aimed to describe and interpret the meaning of support during the return-to-work process for persons on sick leave due to chronic pain. Method: A qualitative interview study was conducted with 14 participants (12 women and 2 men) who experienced sick leave due to chronic pain. The participants were recruited through patient organizations focusing on pain or pain-related conditions. Collected data was analyzed using a phenomenological hermeneutical approach. Results: Have my back as I get back to work was the theme of the analysis, along with six subthemes. Being able to work was important for the participants. However, they often experienced returning to work was a battle for support, dealing with fragmentized backing from the involved stakeholders. Participants with access to collaborative support involving competent care, recognition and the possibility to influence their work felt valuable and capable as persons and workers. Thus, they were provided conditions allowing a successful re-entry into the workplace. Conclusions: Our findings contribute to an enhanced understanding of the importance of stakeholder support in persons with chronic pain re-entering the workplace after an extended break due to sick leave. Through an inclusive, collaborative and flexible approach involving all stakeholders working towards the same goal, a person with chronic pain can feel supported in developing and cultivating the capabilities necessary to manage life and work. [ABSTRACT FROM AUTHOR]

Opioids are important for postoperative analgesia but their use can be associated with numerous side effects. Transcutaneous electrical nerve stimulation (TENS) has been used for acute pain treatment and has dose-dependent analgesic effects, and therefore presents an alternative to intravenous (iv) opioids for postoperative pain relief. The aim of this meta-analysis was to compare high-frequency, high-intensity (HFHI or intense) TENS to iv opioids with regard to postoperative pain intensity, recovery time in the Post Anesthesia Care Unit (PACU) and opioid consumption after elective gynecological surgery. We searched Medline, Embase, Web of Science, Cochrane, Amed and Cinahl for RCTs and quasi-experimental studies (2010–2022), and WHO and ClinicalTrials.gov for ongoing/unpublished studies. Meta-analysis and subsequent Trial Sequential Analysis (TSA) was performed for all stated outcomes. Quality of evidence was assessed according to GRADE. Only three RCTs met the inclusion criteria (362 participants). The surgical procedures involved surgical abortion, gynecologic laparoscopy and hysteroscopy. The applied TENS frequency was 80 Hz and intensity 40–60 mA. There was no difference in pain intensity according to Visual Analogue Scale (VAS) at discharge from PACU between the TENS and opioid group (MD VAS −0.15, 95 % CI −0.38 to 0.09) (moderate level of evidence). Time in PACU was significantly shorter in the TENS group (MD −15.2, 95 % −22.75 to −7.67), and this finding was manifested by TSA (high-level of evidence). Opioid consumption in PACU was lower in the TENS group (MD Morphine equivalents per patient mg −3.42, 95 % −4.67 to −2.17) (high-level of evidence). There was no detectable difference in postoperative pain relief between HFHI TENS and iv opioids after gynecological surgery. Moreover, HFHI TENS decreases recovery time and opioid consumption in PACU. HFHI TENS may be considered an opioid-sparing alternative for postoperative pain relief after gynecological surgery. PROSPERO CRD42021231048. [ABSTRACT FROM AUTHOR]

Active, specific, and professionally led physical exercise is an effective treatment for chronic pain, and self-efficacy is correlated to positive treatment outcomes. At present, there is limited knowledge of self-efficacy for exercise in patients with chronic pain. To evaluate the reliability and aspects of validity of the Swedish version of the Self-Efficacy for Exercise Scale (SEE-SV) in patients with chronic pain. Patients with chronic pain were recruited from a specialist clinic. The Swedish version of the SEE was used. Reliability was evaluated through internal consistency, test-retest, and measurement error (standard error of measurement, SEM and smallest detectable change, SDC). Construct validity was calculated using the correlation between the SEE-SV and other well-established evaluation instruments. Content validity was evaluated both from a patient and a health-care professional perspective. In total, 44 patients, 31 women and 13 men (mean age 40 years), participated in the study. The SEE-SV had good test-retest reliability (intra-class correlation coefficient (ICC) = 0.95) and internal consistency (Cronbach's alpha = 0.97). Regarding measurement error, SEM was 4.9 and SDC 13.5. Moderate correlation was seen between SEE-SV and a pain-specific self-efficacy questionnaire (rs = 0.52). The majority of patients and health-care professionals considered the SEE-SV to be relevant and easy to understand. The SEE-SV showed a good internal consistency, item-to-total correlation, and test-retest reliability (ICC). A relatively high SDC indicates an individual variability of the test results. The content validity was satisfactory. Regarding the construct validity, further studies are needed. [ABSTRACT FROM AUTHOR]

The aim of this prospective cohort study was to evaluate the level of physical activity, self-efficacy and health-related quality of life in patients with chronic pain, at baseline and one year after physiotherapy rehabilitation at a specialist pain clinic. All patients who underwent rehabilitation at the physiotherapy unit at the Pain Centre at Sahlgrenska University Hospital/Östra in Gothenburg during a nine-month period were asked to participate in the study. The participants were evaluated regarding self-efficacy, health-related quality of life (HRQoL) and physical activity during physiotherapy treatment and one year later. Physical activity was measured both subjectively (self-reported physical activity) and objectively (accelerometer). Out of 42 patients who participated in the baseline evaluation, 28 (19 women and nine men) were included in the one-year follow-up. The patients had increased levels of vigorous physical activity at one-year follow-up, without deterioration of pain. There were no significant changes regarding self-efficacy and HRQoL. Levels of physical activity and perceived physical function may be associated to levels of physical activity 1 year after rehabilitation. Patients with chronic pain can increase their level of vigorous physical activity after a period of rehabilitation without deterioration of pain. Physical activity is an important part of rehabilitation for chronic pain patients, but many patients expect more pain after exercise, which they fear may affect performance and maintenance of physical activity. Patients with chronic pain at a specialist clinic increased their level of vigorous physical activity one year after physiotherapist led rehabilitation without deterioration of pain. Levels of physical activity and perceived physical function during rehabilitation may predict levels of physical activity 1 year after rehabilitation. Physiotherapist led rehabilitation seems to be beneficial for long-term improved physical activity in patients with chronic pain [ABSTRACT FROM AUTHOR]

Objective: Prolonged mental fatigue and cognitive impairments are common after a mild traumatic brain injury (TBI). This sets limits for rehabilitation and for regaining the capacity for work and participation in social life. Method: This follow-up study, over a period of approximately 5.5 years was designed to evaluate the effect and safety of methylphenidate treatment for mental fatigue after a mild TBI. A comparison was made between those who had continued, and those who had discontinued the treatment. The effect was also evaluated after a four-week treatment break. Results: Significant improvement in mental fatigue, depression, and anxiety for the group treated with methylphenidate (p <.001) was found, while no significant change was found for the group without methylphenidate. The methylphenidate treatment group also improved their processing speed (p =.008). Withdrawal produced a pronounced and significant deterioration in mental fatigue, depression, and anxiety and a slower processing speed. This indicates that the methylphenidate effect is reversible if discontinued and that continued methylphenidate treatment can be a prerequisite for long-term improvement. The effect was found to be stable and safe over the years. Conclusion: We suggest methylphenidate to be a possible treatment option for patients with post-TBI symptoms including mental fatigue and cognitive symptoms. [ABSTRACT FROM AUTHOR]