Search

Ramani Vijayan,1 Gauhar Afshan,2 Khalid Bashir,3 Mary Cardosa,4 Madhur Chadha,5 Pongparadee Chaudakshetrin,6 Khin Myo Hla,7 Muralidhar Joshi,8 Francis O Javier,9 Asif Gul Kayani,10 Andi Takdir Musba,11 Sasikaan Nimmaanrat,12 Dwi Pantjawibowo,13 Jocelyn C Que,14 Palanisamy Vijayanand15 1Department of Anaesthesiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia; 2Department of Anaesthesiology, The Aga Khan University, Karachi, Pakistan; 3Department of Anaesthesia, Hameed Latif Hospital, Lahore, Pakistan; 4Department of Anaesthesiology, Hospital Selayang, Selangor, Malaysia; 5Department of Pain Medicine, Primus Hospital and Fortis Group of Hospitals, New Delhi, India; 6Pain Management Clinic, Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; 7Department of Physical Medicine & Rehabilitation, Yangon General Hospital, University of Medicine-1, Yangon, Myanmar; 8Department of Anaesthesia & Pain Medicine, Virinchi Hospitals, Hyderabad, India; 9Pain Management Center, St Luke’s Medical Center, Metro Manila, Philippines; 10Department of Anesthesiology, Kulsum International Hospital, Islamabad, Pakistan; 11Department of Anesthesiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; 12Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand; 13Department of Anesthesiology, Intensive Therapy, and Hospital Pain Management, Premier Bintaro Hospital, South Tangerang, Indonesia; 14Center for Pain Medicine, Department of Anesthesiology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines; 15Pain Management Department, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India Background: The supply of controlled drugs is limited in the Far East, despite the prevalence of health disorders that warrant their prescription. Reasons for this include strict regulatory frameworks, limited financial resources, lack of appropriate training amongst the medical profession and fear of addiction in both general practitioners and the wider population. Consequently, the weak opioid tramadol has become the analgesic most frequently used in the region to treat moderate to severe pain.Methods: To obtain a clearer picture of the current role and clinical use of tramadol in Southeast Asia, pain specialists from 7 countries in the region were invited to participate in a survey, using a questionnaire to gather information about their individual use and experience of this analgesic.Results: Fifteen completed questionnaires were returned and the responses analyzed. Tramadol is used to manage acute and chronic pain caused by a wide range of conditions. Almost all the specialists treat moderate cancer pain with tramadol, and every one considers it to be significant or highly significant in the treatment of moderate to severe non-cancer pain. The reasons for choosing tramadol include efficacy, safety and tolerability, ready availability, reasonable cost, multiple formulations and patient compliance. Its safety profile makes tramadol particularly appropriate for use in elderly patients, outpatients, and for long-term treatment. The respondents strongly agreed that tighter regulation of tramadol would reduce its medical availability and adversely affect the quality of pain management. In some countries, there would no longer be any appropriate medication for cancer pain or the long-term treatment of chronic pain.Conclusions: In Southeast Asia, tramadol plays an important part in the pharmacological management of moderate to severe pain, and may be the only available treatment option. If it were to become a controlled substance, the standard of pain management in the region would decline. Keywords: tramadol, questionnaire, indications, efficacy, safety, controlled substance

Abstract: Since it was founded, the International Association for the Study of Pain (IASP) has been at the forefront of improving pain research, education, and effective pain management in both developed and developing countries. As IASP activities progressed, major differences between the practice of pain management, education, and research in developed countries compared with developing countries were identified. This led to areas of focus by IASP that included pain education to address poor knowledge of pain assessment and treatment, prioritization of pain management by governments and official national legislation and programs, and availability of pain treatments (especially potent analgesics). A few pioneering IASP members from developing countries in the early years encouraged more multidisciplinary professionals to join IASP and attend conferences. Inauguration of national and regional chapters was also encouraged, and regular continuing medical education programs were held, especially on topics from IASP conferences and global pain events. Many IASP chapters in developing countries have established collaborations with groups from developed countries, whereas IASP also implemented other innovative approaches including the developing countries working group, educational grants, pain camps, and multidisciplinary pain hubs with toolkits to develop pain experts for regions in the developing world. Thus, the influence of IASP in many developing countries has had a multiplier effect on the progress made in effective pain management, education, and research. Nonetheless, challenges remain and include better integration of pain management, education, and research in national health systems and academic programs for health professionals., (Copyright © 2023 International Association for the Study of Pain.)

A randomized single blind clinical trial was carried out in order to compare the effectiveness of oral morphine syrup and injected morphine in premedication of postpartum tubal sterilization by local anaesthesia. A total of 200 postpartum patients were divided into two groups by systemic random sampling. The first group of 100 patients was premedicated with 30 mgs of syrup morphine orally 90 minutes before operation, and the second group of 100 patients was premedicated with 10 mgs of morphine hydrochloride via the intramuscular route 15 minutes before operation. All patients were given tubal sterilization by first- and second- year residents, using the modified Pomeroy technique. The pain experienced by each patient during the operation was evaluated by verbal and numerical rating scales. The pain scores and the operating time of both groups were analysed by the Mann Whitney U test and pair t test, respectively. The pain scores of the first and second group were 3.644 ± 1.802 and 3.570 ± 1.470, respectively, with no significant difference. The operating time was 10.300 ± 1.904 and 11.200 ± 2.543 minutes in the first and second group, respectively. The effectiveness of oral morphine syrup and intramuscular morphine in premedication for postpartum tubal sterilization was found to give the same results. The cost-effectiveness of oral morphine syrup is greater and it can therefore replace intramuscular morphine in premedication for postpartum tubal sterilization.

Abstract: The burden of pain in low- and middle income countries (LMICs) is high and expected to rise further with their ageing populations. Multidisciplinary pain management approaches based on the biopsychosocial model of pain have been shown to be effective in reducing pain-related distress and disability, but these approaches are still lacking in many LMICs due to various factors, including low levels of awareness about the role of multidisciplinary pain clinics, lack of prioritisation for pain services, and lack of healthcare professionals trained in pain management. The International Association for the Study of Pain (IASP) has several educational programs to promote multidisciplinary pain management in LMICs, in the form of education grants, pain fellowships, pain camps and, most recently, the development of a Multidisciplinary Pain Centre Toolkit. This article describes the various educational programs, focusing on Southeast Asia, that demonstrate how targeted educational programs which include skills training, follow-up and mentorship, can translate into the formation of new multidisciplinary pain management services in settings with limited resources., (Copyright © 2024 International Association for the Study of Pain.)

Approximately 80% of the world's population lives in countries with little or no access to pain management. These countries also have 74% of the world's deaths from cancer and human immunodeficiency virus. Appropriate use of oral opioids can control 80%-90% of cancer pain. However, only 6.7% of the world's medical opioids are available in these low-resource countries. With the Lancet Commission on Global Surgery calling for a significant expansion of surgical services, postoperative pain management will need to be an increasing focus of our attention. There are multiple barriers to providing effective pain management. These include the type and funding of the health care system, the size and educational level of the workforce, the ease of access to effective medications, and the expectations and knowledge base of the community. Some barriers can be addressed by education at the undergraduate level, postgraduate level, and community level. Others will require continued advocacy at government level. Only when we tackle these problems will the considerable neglect of access to effective pain treatment in low- and middle-income countries be lessened.

Background and Purpose: Neuropathic pain (NeuP) associated with traumatic brachial plexus injury (BPI) can be severe, persistent, and resistant to treatment. Moreover, comorbidity associated with NeuP may worsen the pain and quality of life. This study compared persistent NeuP after BPI between patients with and without co-morbid conditions (psychiatric dysfunction and other painful conditions) and tramadol usage as a second-line agent in combination with an antiepileptic and/or antidepressant during a 2-year follow-up., Methods: The medical records of patients diagnosed with BPI referred to a pain center between 2006 and 2010 were reviewed for 2 years retrospectively. Data regarding patient demographics, injury and surgical profiles, characteristics of NeuP and its severity, and treatment received were compared between patients with and without manifesting co-morbid conditions. The NeuP and pain intensity assessments were based on the DN4 questionnaire and a numerical rating scale, respectively., Results: Of the 45 patients studied, 24 patients presented with one of the following co-morbid conditions: myofascial pain (21%), psychiatric disorder (17%), phantom limb pain (4%), complex regional pain syndrome (21%), and insomnia (37%). Tramadol was required by 20 patients with co-morbidity and, 9 patients without co-morbidity (p<0.001). The mean pain score after 2 years was higher in patients with co-morbidity than in those without co-morbidity (p<0.05)., Conclusions: Persistent pain following BPI was more common in patients manifesting other painful conditions or psychiatric co-morbidity. A higher proportion of the patients in the co-morbid group required tramadol as a second-line of agent for pain relief., Competing Interests: The authors have no financial conflicts of interest.

Objective: Thyroid cancer patients treated with 1-131 are potential source of radiation exposure to relatives who are knowingly and willingly exposed to ionizing radiation as a result of providing comfort to patients undergoing I-131 therapy. This study aims to determine radiation dose received by relatives who care for non self-supporting 1-131 patients at Siriraj Hospital., Material and Method: Twenty caregivers of 20 patients underwent I-131 therapy for thyroid cancer with a standard protocol were given specific instructions with regard to radiation safety and provided with electronic digital dosimeter to continuously measure radiation dose received on daily basis, three days in the hospital. On the day patient is released, thyroid uptake estimates were performed to assess internal radiation dose received by caregivers., Results: The 3-day accumulative doses to caregivers to patients receiving 150 mCi (n = 11) and 200 mCi (n = 9) of I-131 ranged from 37 to 333 uSv and 176 to 1,920 pSv respectively depending on the level of supports required. Thyroid uptake estimates in all caregivers were undetectable. Dosimeter indicated a maximum whole-body dose of1.92 mSv was more than the public dose limit of] mSv but within the dose constraint of 5 mSv for caregivers., Discussion: Radiation dose to caregivers of a non self-supporting hospitalized patient undergoing 1-131 therapy were well below the limits recommended by the ICRP. The patients can be comforted with confidence that dose to caregivers will be less than the limit., Conclusion: This study provides guidance for medical practitioners to obtain practical radiation safety concerns associated with hospitalized patients receiving I-131 therapy especially when patient needs assistance.

Thyroid cancer patients treated with high-dose radioactive iodine (3.7-7.4 GBq) are different from other people because after the administration, the radionuclide I-131 is excreted via urine, feces, saliva and breathing, and also via exposure to other patients. Caregivers of the patient may receive higher radiation doses than normal. The purposes of this study were to estimate the total effective dose equivalent from internal and external exposure to caregivers of patients treated with high dose I-131 admitted at Siriraj Hospital, and to compare the estimated dose with the dose constraint of 5 mSv per annum for caregivers. Thirteen caregivers of 13 patients who underwent radioiodine therapy for thyroid cancers following a standard protocol were given specific instructions with regard to radiation safety and were attached to an electronic personal dosimeter and a personal air sampler pump continuously to measure received radiation dose on a daily basis over three days in the hospital. On discharge day, caregivers were asked to perform an in vivo bioassay by the thyroid uptake instrument. The results from the thirteen caregivers were divided into 3 groups. The total effective dose equivalent to caregivers of patients administered 3.7 GBq (n = 1), 5.55 GBq (n = 9), and 7.4 GBq (n = 3) were 0.159 mSv, 0.123 to 0.629 mSv, and 0.631 to 0.718 mSv, respectively. There values were well below 5 mSv per episode as proposed in the IAEA Safety Reports Series No. 63 and the ICRP Publication 103.

Objective: To evaluate the various coexisting soft tissue pathology that made up 'frozen shoulder' and the treatment outcomes. Design: Prospective case series report Methods: All patients with 'frozen shoulder from soft tissue origin were included in this study. A new assessment tool for 'frozen shoulder' was performed integrating the conventional orthopaedic approaches with myofascial pain syndrome by performing only three simple range of movement tests; abduction of shoulder joint (Painful Arch Test), external rotation with abducted shoulder joint and Hand On Scapular Blade Test. Results: Fifty percent (50%) of the patients presented with multiple pathology and sixty six percent (66%) of them revealed multiple structures involvement. Prevalence of MPS and tendinitis were equally high in 'frozen shoulder' (75%). Seventy five percents (75%) of the patients were successfully managed based on this three steps clinical evaluation. Conclusion: The key success of the 'frozen shoulder' management depends on the ability to identify the accurate diagnosis/pathology that made up this complex disorder. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the various coexisting soft tissue pathology that made up "frozen shoulder" and the treatment outcomes. Design: Prospective case series report Methods: All patients with "frozen shoulder from soft tissue origin were included in this study. A new assessment tool for "frozen shoulder" was performed integrating the conventional orthopaedic approaches with myofascial pain syndrome by performing only three simple range of movement tests; abduction of shoulder joint (Painful Arch Test), external rotation with abducted shoulder joint and Hand On Scapular Blade Test. Results: Fifty percent (50%) of the patients presented with multiple pathology and sixty six percent (66%) of them revealed multiple structures involvement. Prevalence of MPS and tendinitis were equally high in "frozen shoulder" (75%). Seventy five percents (75%) of the patients were successfully managed based on this three steps clinical evaluation. Conclusion: The key success of the "frozen shoulder" management depends on the ability to identify the accurate diagnosis/pathology that made up this complex disorder. [ABSTRACT FROM AUTHOR]

Introduction: Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Under -treatment of pain continues to be a major health care problem in Ethiopia. Although it has this problem, it receives limited research attention. This systematic review and meta-analysis will provide valuable insights of prevalence and its factors of healthcare providers' pain management practice in Ethiopia. Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Universal online databases such as PubMed, Cochrane, Google, Google Scholar, SCOPUS, Web of Science and Global Health were used to search for articles. Microsoft Excel for data extraction and STATA17 for data analysis were used. DerSimonian and Laird random-effects model was used to pool the odds ratios across studies and compute the overall pooled prevalence and its predictors. Egger's test with funnel plot symmetry and Cochrane's Q test was used to assess publication bias and heterogeneity respectively. Results: The overall pooled prevalence of health care providers' pain management practice was 39.6% (95% CI: 34.8, 44.5); I2 = 97.0%; P<0.001). Availability of pain management protocol (AOR = 5.1, 95%CI: 3.6, 6.7), Accessibility of analgesia (AOR = 4.5, 95%CI: 1.96, 7.0), higher educational level (AOR = 3.3, 95%CI: 2.5, 4.1), being female (AOR = 1.2, 95% CI: 1.6, 3.1), took training (AOR = 2.7, 95% CI: 1.8, 3.6), decreased work load (AOR = 4.9, 95% CI: -1.9, 11.7), increased work experience (AOR = 3.9, 95% CI: 2.9, 5.1), Being midwifery profession (AOR = 2.5,95% CI: 1.6, 3.4), having good attitude (AOR = 3.9,95%CI: 2.5, 5.4) and being knowledgeable (AOR = 4.2, 95%CI: 2.8, 5.6) of health care providers towards pain management practice were significantly associated in Ethiopia. Conclusion: The overall prevalence of pain management practice among healthcare providers in Ethiopia is low compared with a national target of pain free hospital initiatives in Ethiopia. It needs a call to build health care providers' ongoing education, training, professional development and manageable workload. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and cost-effectiveness of high and low dose regimens of I-131 treatment in patients with hyperthyroidism., Material and Method: One hundred fifty patients with proven hyperthyroidism were randomly allocated into the high (74 patients) and low (76 patients) dose regimen of I-131 treatment. Four patients of the high dose group and one patient of the low dose group were excluded because of lost follow-up. A gland-specific dosage was calculated on the estimated weight of thyroid gland and 24-hour I-131 uptake. The high and low I-131 dose regimens were 150 microCi/gm and 100 microCi/gm, respectively. The first mean radioiodine activity administered to the high and low dose group was 10.2 and 8 mCi, respectively. Repeated treatment was given to 25 patients of the high dose group and 40 patients of the low dose group. Clinical outcome and calculated costs for outpatient attendances, and laboratory tests together with initial and subsequent treatments were evaluated for one year after I-131 treatment. Elimination of hyperthyroidism that resulted in either euthyroidism or hypothyroidism was classified as therapeutic success. The cost effectiveness was also compared., Results: At 6 months after treatment, 45 (64.3%) patients receiving high dose and 59 (78.7%) patients receiving low dose were hyperthyroidism. Clinical outcome at one year showed persistence of hyperthyroidism in 21 (30%) patients of the high dose regimen and 36 (48%) patients of the low dose regimen. At one year post treatment, it was demonstrated that the high dose regimen could eliminate hyperthyroidism in a significantly shorter time than the low dose regimen, i.e., 259.6 days and 305.5 days, respectively, p = 0.008). For the persistent hyperthyroid patients, the average total cost of treatment in the low dose group was significantly higher than that of the high dose group, i.e., 13,422.78 baht and 10,942.79 baht, respectively; p = 0.050)., Conclusion: A high dose regimen of radioactive iodine treatment is more effective than the low dose regimen. The successful outcome of a high dose regimen occurred significantly earlier than that of the low dose regimen. For the persistent hyperthyroid patients, the average total cost in the low dose group was significantly higher than that of the high dose group.

Background: Pain is one of the most frequent and deleterious symptoms for patients with advanced cancer. Pain assessment is important because it is used for detecting severity of disease and the response to treatment. To provide the adequate treatment for pain relief in cancer patients, an assessment tool should be used for pain evaluation. Moreover, suitable tools for pain evaluation should be validated in local language to obtain better pain information., Objective: The objective of the present study was to demonstrate validity and reliability of the Thai version of the Brief Pain Inventory (BPI-T), which is a simple and concise instrument for pain assessment., Material and Method: The available data were obtained from 520 patients with cancer pain. The data included pain severity, which patients reported using Thai version of Brief Pain Inventory (BPI-T). The pain severity and pain information were reported three times with 2-week intervals between each assessment time point., Results: Factor analysis of the Thai version of the Brief Pain Inventory resulted in two factors, pain severity and pain interference, showing valid structures consistent with other language versions of the instrument. Cronbach's alphas, computed for pain interference and pain severity item were 0.88 and 0.89, 0.01 and 0.92, and 0.93 and 0.94, for first, second, and third assessment time, respectively., Conclusion: Thai version of the Brief Pain Inventory is a reliable and valid instrument for cancer pain assessment in Thailand

Objective: To cross-culturally adapt the neuropathic pain diagnostic questionnaire (DN4) to Thai language, Material and Method: Phase 1: Forward and backward translation followed by assessment of semantic equivalence. Phase 2: Testing of the questionnaire in 30 neuropathic pain patients who were seen and diagnosed by experts, followed by modifications to produce a final version., Results: All the Thai translated pain descriptors except 'tingling' got high percentages of understanding among neuropathic pain patients in the first round of testing. After some adaptation of the Thai word for 'tingling' had been made, the new translated word was retested, and all subjects doing the retest understood the word very well., Conclusion: The Thai DN4 questionnaire was systematically translated and validated. This offers a simple Thai neuropathic pain diagnostic tool for clinical use.

Objective: To examine the profile and treatment pattern of patients with neuropathic pain attending Siriraj Pain Clinic., Material and Method: A 2-year retrospective study of the prevalence of neuropathic pain, characteristics of the patients and the use of medical treatment. Records of all the patients that attended Siriraj Pain Clinic from September 1, 2002 until September 30, 2004 were reviewed., Results: One thousand three hundred and thirty patients' records were reviewed. Five hundred and three patients were diagnosed as having neuropathic pain. The prevalence of neuropathic pain at Siriraj Pain Clinic during the survey period was 37.8%. The average age of neuropathic pain patients was 54 years. The most common type of neuropathic pain was peripheral type, nerve compression in particular. The most common concomitant illness was malignant tumor. The majority of patients (71.8%) had one pain location and the most common site was the lower extremity. The main descriptions of neuropathic pain were radiating, electric shock-like, burning, numbing and shooting. Oral medication was the most common method (79%) of pain-relief treatment. Almost all of the patients (93%) had received more than one type of oral medication. The most commonly used medicine was TCA (77.1%), followed by gabapentin (35%), carbamazepine (34%) and tramadol (24.3%). Most of the pain-relief medicines prescribed at this clinic were under the recommended doses for the treatment of neuropathic pain., Conclusion: Characteristics and treatment patterns of neuropathic pain at Siriraj Pain Clinic are similar to those seen in other pain clinics elsewhere in the world. The high prevalence of neuropathic pain in the clinic indicates that this type of pain syndrome is increasingly critical to our clinical practice. More educational programs on neuropathic pain and management are needed for Thai healthcare professionals.

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.

Neural blockade has been used as the single method to anesthetize a part of the body or used in combination with general anesthesia to lessen perioperative pain. Currently, nerve blocks are used for diagnostic, prognostic, therapeutic and prophylactic proposes for management of chronic, acute and cancer pain in a Pain Clinic. Reviewing the records of the 3,349 patients at Siriraj Pain Clinic, we found 2,662 and 687 cases had chronic and acute pain problems respectively, and only 646 patients were treated with anesthetic interventions during 1990 to 1998. They consisted of 317 male and 329 female. The techniques included stellate ganglion block, paravertebral nerve block, celiac plexus block, hypogastric plexus block, mesenteric plexus block, sacral nerve block, epidural steroid, lumbar sympathectomy, first and second thoracic sympatholysis, facet joints injection, sacroiliac joint injection, intravenous regional block with guanethidine or ketanserin, continuous opioid infusion, intravenous lidocaine infusion, and a phentolamine test. The common problems of pain included brachial plexus injury, chronic spinal pain, herpetic neuralgia, ischemic pain, central post-stroke pain, and causalgia. This retrospective review showed that 38 per cent of them reported 50 per cent pain relief with temporary effect. 34 per cent experienced good and satisfactory pain relief while 9 per cent reported excellent pain relief. 17 per cent did not gain benefit from any technique of pain relief and about 2 per cent could not be evaluated due to they did not return for follow-up. One serious complication after thoracic sympatholysis was brachial plexus injury. The neural blockade is proven to be one of the useful adjunct in the management of chronic pain but the selection of the technique is subjected to its critical appraisal.

By injection of eosin dye with latex into 45 cadaveric fingers we were able to demonstrate: (1) a distinct digital pulp arch formed by the ulnar and radial digital arteries over the mid-point of the terminal phalanx in 93% of digits; (2) variations in size of the proper digital arteries to each digit; (3) numerous branches from the pulp arch to the tip of each digit and (4) a constant pattern of dorsal veins over the terminal segment in 89% of digits. [ABSTRACT FROM PUBLISHER]

Background: Low back pain stands as a prevalent contributor to pain-related disability on a global scale. In addressing chronic low back pain (CLBP), there is a growing emphasis on incorporating psychological strategies into the management process. Among these, pain education interventions strive to reshape pain beliefs and mitigate the perceived threat of pain. This randomized controlled trial sought to assess the effects of pain education on various aspects, including pain levels, disability, quality of life, self-efficacy, and prognostic characteristics in individuals grappling with CLBP. Methods: The clinical trial, retrospectively registered with the Clinical Trials Registry of India (CTRI/2021/08/035963), employed a two-arm parallel randomized design. Ninety-two participants with CLBP were randomly assigned to either the standard physiotherapy care with a pain education program or the control group. Both groups underwent a 6-week intervention. Assessment of pain intensity (using NPRS), disability (using RMDQ), self-efficacy (using the general self-efficacy scale), and well-being (using WHO 5I) occurred both before and after the 6-week study intervention. Findings: Post-intervention score comparisons between the groups revealed that the pain education intervention led to a significant reduction in disability compared to the usual standard care at 6 weeks (mean difference 8.2, p < 0.001, effect size Cohen d = 0.75), a decrease in pain intensity (mean difference 3.5, p < 0.001, effect size Cohen d = 0.82), and an improvement in the well-being index (mean difference 13.7, p < 0.001, effect size Cohen d = 0.58). Conclusion: The findings suggest that integrating a pain education program enhances the therapeutic benefits of standard physiotherapy care for individuals dealing with chronic LBP. In conclusion, the clinical benefits of pain education become apparent when delivered in conjunction with standard care physiotherapy during the management of chronic low back pain. [ABSTRACT FROM AUTHOR]

Abstract: For decades, clinicians and researchers have observed bidirectional relationships between child development and the pain experience in childhood. Pain in childhood is an inherently developmental phenomenon, embedded in an iterative, time-dependent process that reflects individual biological, behavioral, social, psychological, and environmental characteristics that unfold across the early life span. Childhood pain can have wide ranging effects on brain development in ways that contribute-for better and worse-to social, emotional, and cognitive well-being in childhood and on into adulthood. Atypical trajectories of development in the context of disorders such as autism, cerebral palsy, ADHD, and mood/anxiety disorders also contribute to unique childhood pain experiences. In this paper, pain will be considered as a determinant of development, and conversely development will be considered as a key determinant of a child's pain experience. We will discuss how intersectional identities (eg, gender, race, socioeconomic status) and associated social, structural, systemic, and physical environments influence the relationship between development and pain. Finally, we will identify what might be needed to think "developmentally" in ways that extend from the "bench side" in the lab to the "curb side" in the community, integrating a developmental perspective into research and clinical practice to achieve health accessibility and equity in pain care for all children across the developmental spectrum., (Copyright © 2024 International Association for the Study of Pain.)

Objectives: This study aimed to compare the effects of trigger point injections and stretching exercises in patients with noncardiac chest pain (NCCP) associated with myofascial pain syndrome. Patients and methods: This prospective randomized controlled trial included 50 patients with noncardiac chest pain and trigger points in the pectoralis muscles between October 2019 and June 2020. The patients were randomly assigned to receive trigger point injections into the pectoralis muscles and exercise (n=25; 15 males, 10 females; mean age: 42.8±9.2 years; range, 25 to 57 years) or only perform exercise (n=25; 11 males, 14 females; mean age: 41.8±11.2 years; range, 18 to 60 years). The primary outcome was pain intensity at the first month and three months after the first treatment session, measured using the Visual Analog Scale from 0 to 100. The secondary outcome was the Nottingham Health Profile score. Results: Treatment with stretching exercises and trigger point injection resulted in significant pain reduction compared to stretching exercises alone, and the reduction was persistent at the three-month follow-up (p<0.001). A between-group comparison showed no significant difference in the Nottingham Health Profile (p=0.522). Complications related to the procedure or severe adverse events attributable to treatment were not reported. Conclusion: Trigger point injection combined with stretching exercises is an efficient treatment for noncardiac chest pain related to myofascial pain syndrome compared to exercise treatment alone. [ABSTRACT FROM AUTHOR]

Objective: Cannabinoid products have been applied for numerous medical conditions, including chronic pain. Thailand was the first country in South East Asia to legalize medical cannabinoids. This study aims to explore prevalence, characters, attitude, side effects of medical cannabinoid use, and pain-related outcome among the chronic cancer and non-cancer pain population at Siriraj Hospital. Materials and Methods: 200 chronic cancer pain and 670 chronic noncancer pain patients were collected by questionnaires and interviews. Data included demographic data, clinical diagnosis, pain treatment, knowledge, attitude, pattern of use, side effects and quality of life of cannabinoid extracts. Results: Prevalence of active cannabis user was 15% in chronic cancer pain and 3.1% in noncancer pain. Oil extract sublingual was the most common form. Pain control was the most common initial reason for usage. No serious side effects were reported. Common side effects were dry oral mucosa, drowsiness, and headache. The most common source was obtained from friends. 36% of the patients believed they had enough understanding of medical cannabis, while 68.5% agreed that it is appropriate to use in Thailand. In cancer patients, the Edmonton Symptom Assessment System (ESAS) subscale for lack of appetite, anxiety, and subscale for a brief pain inventory (BPI) for enjoyment of life were higher among active users. In patients with noncancer pain, only the mood subscale BPI was lower among active users. Conclusion: Medical cannabis usage is common compared with general population in Thai patients with chronic pain and may be associated with increased pain interference and cancer-related symptoms. Nonmedical license prescription and nonmedical license cannabis products were common in Thailand. [ABSTRACT FROM AUTHOR]

Background: Pain is a major public health problem in the Global South, particularly among marginalized communities, such as Somali pastoralists. Yet, the topic of chronic pain has not yet been comprehensively studied in Sub-Saharan Africa, specifically in the Somali region of Ethiopia. Therefore, this study aims to explore the perceptions and notions of chronic pain among Somali pastoralists in this context. Methods: This study used an explorative qualitative design. We performed semi-structured, face-to-face interviews with 20 purposively selected female and male Somali pastoralists with chronic pain. For data analysis, we applied the Framework Method by Gale et al. and explained patterns drawing on the Enactive Approach to Pain proposed by Stilwell and Harman. Findings: Six different themes emerged: (1) "Pain as a symptom of harsh daily life", (2) "Pain descriptions and dimensions", (3) "Temporality of pain", (4) "Pain-related stigma and stoicism" (5) "Mediating role of spirituality", and (6) "Impact of pain on daily life activities". Conclusions: Somali pastoralists described their chronic pain as a multicausal and relational experience. Pastoralists (especially women) commonly refrained from communicating their pain and represented aspects of social stigma and stoicism. The mediating role of spirituality aided pastoralists to make sense of their pain and to ease its impact on their harsh daily life. The findings of this study can contribute to raise awareness of chronic pain issues among pastoralists. They highlight the need for policymakers to prioritize the improvement of pastoralist-specific pain management. Necessary resources and skills should be available within health care facilities. Pain management should be accessible, affordable and culturally acceptable for this population. [ABSTRACT FROM AUTHOR]

This article presents evidence indicating that intracranial pressure (ICP) pulsatility, associated with the heartbeat and breathing, is not just a source of mechanical artefact in electrical recordings, but is "sensed" and plays a role in the brain's information processing. Patch-clamp recording of pressure-activated channels, and detection of Piezo2-protein channel expression in brain neurons, suggest that these channels provide neurons with an intrinsic resonance to ICP pulsatility, which acts to synchronize remote neural networks. Direct measurements in human patients indicate that heartbeat and breathing rhythms generate intracranial forces of tens of millinewtons, exceeding by orders of magnitude the localized forces shown by atomic force microscopy and optical tweezers to activate Piezo channels in isolated neocortical and hippocampal neurons. Additionally, many human touch and proprioceptors, which are also transduced by Piezo channels, show spiking that is phase-locked to heartbeat- and breathing-induced extracranial pressure pulsations. Finally, based on the observation that low-frequency oscillations modulate the phase and amplitude of high-frequency oscillations, body and brain oscillations are proposed to form a single hierarchical system in which the heartbeat is the basic frequency and scaling factor for all other oscillations. Together, these results support the idea that ICP pulsatility may be elemental in modulating the brain's electrical rhythmicity. [ABSTRACT FROM AUTHOR]

Introduction: Cancer incidence and mortality are increasing worldwide, and pain is the most common symptom patients experience. Despite developments in cancer pain management and guidelines, the pain often remains undertreated. Effective pain management ultimately involves overcoming several complex institutional, patient, and healthcare provider-related barriers. Objective: The objective of the study was to explore and describe healthcare providers' perceptions of the cancer pain management barriers at a hospital in Zambia. Method: A descriptive qualitative study was conducted. Data were collected from 10 purposively sampled medical doctors and registered nurses using prepiloted semistructured individual interviews. Interviews were audio recorded and transcribed verbatim. Thematic analysis was done, and trustworthiness was enhanced based on the criteria described by Lincoln and Guba. Ethical principles, as outlined in the Declaration of Helsinki, were adhered to. Results: Three themes emerged, namely patient-related barriers (biographic characteristics, patient knowledge and perceptions), healthcare provider-related barriers (knowledge and perceptions and language barriers), and institution-related barriers (resource limitations and lack of standards and guidelines). Healthcare providers' views that cultural beliefs about cancer being caused by witchcraft and the use of traditional medicine and services are barriers to cancer pain management were unique to this study. Conclusion: Cancer pain management requires a total pain management approach that addresses the barriers to pain management strategies from a patient, healthcare provider, and institutional perspective. The knowledge deficit among patients and healthcare providers is a barrier to cancer pain management and one of the most common challenges reported in the literature. This study further points toward a need to develop culturally competent healthcare providers. [ABSTRACT FROM AUTHOR]

Objective: Neuropathic pain management involves both pharmacological and non-pharmacological interventions. Despite this, no prior research has demonstrated the efficacy of court-type Thai traditional massage (CTTM) for neuropathic pain relief. This study aimed to investigate the potential benefits of CTTM in alleviating neuropathic pain. Materials and Methods: A preliminary single-blind randomized controlled trial was conducted on 28 participants with peripheral neuropathic pain, who were equally assigned to 2 groups. Both groups received standard drug treatment; however, the intervention group additionally received CTTM and hot herbal compression, while the active control group only received HHC. The adjuvant treatments were administered twice weekly for 4 weeks (V1-V8). A follow-up was conducted 4 weeks posttreatment (V9). Outcome measures were assessed at V1, V4, V8, and V9 using a numerical rating scale and the Thai versions of the Neuropathic Pain Symptom Inventory, the Brief Pain Inventory, and the EQ-5L-5D health questionnaire. Results: The data revealed that the intervention and active control groups had statistically significant differences in their pain intensity scores (P < 0.001), total neuropathic pain intensity scores (P = 0.001), and utility of health scores (P = 0.007) during the follow-up period. When comparing outcomes between V1 and V8, the groups exhibited significant differences in pain reduction (P = 0.003) and quality of life (P = 0.027). Conclusion: This study provides initial evidence supporting the potential benefits of CTTM in alleviating peripheral neuropathic pain and improving quality of life. Future research should further investigate the application of CTTM in managing peripheral neuropathic pain conditions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to translate the DN4 questionnaire into Nepalese version and assess its psychometric properties: diagnostic accuracy, internal consistency, and test-retest reliability. Methods: An observational study was conducted in a tertiary level teaching hospital of Kathmandu, Nepal. We included 166 patients with chronic pain visiting a pain clinic over a period of one year. The Nepalese version of the DN4 questionnaire was used for detecting signs and symptoms of neuropathic pain. The English version of the questionnaire was translated into Nepali in accordance with the standard guideline with the help of linguistic experts. The patients who met the inclusion criteria were examined and interviewed twice in an interval of two weeks. The association between the index test and the reference test was analyzed using Chi-square test. Diagnostic accuracy was assessed using sensitivity, specificity, Youden's index, and positive and negative predictive values. We calculated internal consistency using Cronbach's alpha (∝), and test-retest reliability using Cohen's kappa and Intra-class correlation coefficient (ICC). Results: The study showed a significant association between the result of DN4 questionnaire and the gold standard (physician's diagnosis) (p<0.001). The sensitivity and specificity values for the DN4 questionnaire were 75% and 95.3% respectively. Similarly, positive and negative predictive values were 93.8% and 80.4% respectively. Our study showed adequate internal consistency (∝ = 0.710) and a good test-retest reliability (kappa = 0.872, ICC = 0.877). Conclusions: The Nepalese version of DN4 questionnaire is a valid and reliable tool for the identification of signs and symptoms of neuropathic pain. This can be used for screening neuropathic pain signs and symptoms in clinical as well as research settings. [ABSTRACT FROM AUTHOR]

Brachial plexus injury (BPI) occurs commonly in young adults following trauma. This may result in the development of complex regional pain syndrome (CRPS) following injury, which is difficult to treat. We present a group of patients with CRPS secondary to BPI. These patients were managed with neuromodulation of the stellate ganglion (SG) with pulsed radiofrequency (PRF) and followed up for a period of 3 months to assess for pain relief and a decrease in the intake of medications after the intervention. PRF to SG was found to have significant pain relief lasting around three months. [ABSTRACT FROM AUTHOR]

The original French version of the "Douleur Neuropathique en 4 Questions (DN4) questionnaire" is a valid screening tool for the identification of neuropathic pain (NeP). The DN4 has been translated into English, but the reliability of the English version has not yet been investigated. The aim of this study was to investigate the 7-item DN4 questionnaire in regards to short-term reliability before (T0) and immediately after (T1) the clinical examination and long-term reliability one week later (T2). A total of 222 participants (age 56.33 ± 16 years, 56 % female) were recruited from a Pain Management Department and Neurosurgery Spinal Clinic. For T2 measurements, the 7-item DN4 was sent by post with the "Patient Global Impression of Change Scale". The scale detects possible changes of symptoms, scoring from "very much improved" (1) to "very much worse" (7). Only participants whose symptoms had not changed much (scores 3–5) were included in the T0-T2 analysis. Weighted Kappa was used to analyse the reliability of the DN4 total scores and unweighted Kappa for the DN4 classifications. Considering missing data and exclusions, data of 215 participants could be used for the T0-T1 and data of 103 participants for T0-T2 analysis. There was almost perfect agreement for the 7-item DN4 total score between T0-T1 (weighted k: 0.891, CI: 0.758–1.024) and T0-T2 (weighted k: 0.850, CI: 0.657–1.043). Classifications between neuropathic pain and no neuropathic pain showed almost perfect agreement (k: 0.835, CI: 0.755–0.915) for T0-T1 and substantial agreement (k: 0.733, CI: 0.598–0.868) for T0-T2. The English 7-item DN4 is a reliable screening tool for neuropathic pain. #RGS0000001759. [ABSTRACT FROM AUTHOR]

Objectives: Musculoskeletal pain, one of the most common issues faced by older adults, has multidimensional effects including an increased risk of malnutrition. Therefore, this study aimed to investigate the association between pain interference and nutritional status in older adults with chronic musculoskeletal pain. Methods: In this cross-sectional study, data were collected from older adults (age: >60 years) using the brief pain inventory and mini nutritional assessment questionnaire. The correlation between pain interference, pain severity, and nutritional status was assessed using the chi-square test and Spearman's rank correlation. Multiple logistic regression analysis was used to analyze the variables associated with abnormal nutrition status. Results: Overall 241 older adults were recruited in the study. The median (IQR) age of the participants was 70 (11) years, pain severity subscale was 4.2 (1.8), and pain interference subscale was 3.3 (3.1). Abnormal nutritional status was positively correlated with pain interference (Odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.08-1.48; P =.004), pain severity (OR: 1.25; 95% CI: 1.02-1.53; P =.034), age (OR 1.06; 95% CI: 1.01-1.11, P =.011), and hypertension (OR = 2.17; 95% CI: 1.11-4.26; P =.024). Conclusions: This study reports a strong correlation between pain interference and nutritional status. Therefore, pain interference can be a useful pain assessment tool to indicate risk of abnormal nutritional status in older adults. In addition, related factors, including age, underweight, and hypertension, were associated with a higher risk of malnutrition. [ABSTRACT FROM AUTHOR]

Background: Cancer-induced bone pain (CIBP) is considered to have both nociceptive and neuropathic components. However, the prevalence, risk factors, and impact of the neuropathic components are yet poorly understood. Methods: We estimate the prevalence of neuropathic pain (NP) features in patients with CIBP at a tertiary care pain clinic setting using the Douleur Neuropathique 4 questionnaire and evaluate their associated factors and their impact after 4 weeks of treatment using the Brief Pain Inventory questionnaire and the Edmonton Symptom Assessment System. Results: A total of 133 patients were recruited. The estimated prevalence of NP was 30.8% (95% confidence interval: 23.6%-39.1%). Initially, the patients with NP had significantly higher average pain scores (6.00 vs. 5.05, P = 0.006), higher total interference scores (5.84 vs. 4.89, P = 0.033), and symptom distress scores (35.88 vs. 26.52, P = 0.002). After 4 weeks of treatment, patients in both groups reported significantly decreased pain intensity and improved quality of life. However, the patients with NP still reported significantly higher average pain (4.61 vs. 3.58, P = 0.048), trending toward higher total interference scores (3.52 vs. 2.99, P = 0.426), and symptom distress scores (23.30 vs. 20.77, P = 0.524). From multivariate analysis, the independent risk factors for NP were younger age, pain in the extremities, and higher average pain scores. Conclusions: NP are common in patients with CIBP. These conditions negatively affect pain intensity and the patient's quality of life before and after treatment. [ABSTRACT FROM AUTHOR]