Scandinavian journal of caring sciencesNoora Puusa, Eeva Harju, Maija-Liisa Kalliomäki, Elina Haavisto
AIM: To analyse the use of opioids in children with cancer and the experiences of their family members regarding opioids used in pain management to improve family nursing. DESIGN: An integrative review. METHODS: A systematic literature search was carried out in four databases (CINAHL, MEDLINE, PsycInfo and Scopus) in August 2023, and was subsequently updated to include studies up to the end of 2024. Sixteen peer-reviewed research articles met the inclusion criteria and were included in a quality appraisal and analysis. RESULTS: Of the wide range of opioids used to treat pain in children with cancer, morphine and fentanyl stood out as the most used. The prevalent routes of opioid administration was intravenous and enteral. Limited research has been conducted on the experiences of family members of children with cancer in the context of opioids used for pain management. Furthermore, there is a scarcity of studies that describe the experiences of siblings from the same perspective. Parental experiences were particularly described as concerns about and a desire to refuse opioid use, although satisfaction with opioid use was also described. CONCLUSIONS: Opioids are particularly significant in managing pain among children with cancer. Therefore, the use of opioids in this patient group should be comprehensively studied, and healthcare professionals should receive sufficient training. The experiences of parents conclude that they require sufficient information and guidance on the management of their children's severe pain and the analgesics used to treat it. The notable lack of research regarding the experiences of siblings in connection with the use of opioids for the management of a child's pain addresses the need for further research from these perspectives. More research on experiences during the different phases of cancer treatment is needed. Further research employing qualitative methods will be essential for enhancing family nursing.
Pain practice : the official journal of World Institute of PainÇiğdem Yalçın, Mehmet Alper Salman, Güldane Turhan, Suna Aşkın Turan
OBJECTIVE: Pulsed radiofrequency of the dorsal root ganglion (DRG) is an established treatment for chronic lumbosacral radicular pain, yet comparative evidence on monopolar versus bipolar configurations, particularly regarding quality-of-life outcomes, remains limited. This study aims to compare the analgesic and quality-of-life effects of bipolar versus monopolar pulsed radiofrequency of the lumbosacral DRG. METHODS: We conducted a mixed retrospective and prospective observational review of 143 patients with chronic radicular pain due to lumbosacral disc herniation who underwent DRG pulsed radiofrequency in 2022 and 2023. Patients received either bipolar (n = 79) or monopolar pulsed radiofrequency (n = 64). Pain intensity was recorded using the Numeric Rating Scale at baseline and at 1st, 2nd, and 6th month post-procedure. Quality of life was assessed with Short Form-36 (SF-36) at baseline and 6 months. Any potential complications were recorded to evaluate the safety of procedures. RESULTS: Baseline demographic and clinical characteristics were comparable between groups. All patients exhibited significant reductions in pain scores over time (p < 0.001). However, bipolar pulsed radiofrequency produced significantly greater pain relief at all follow-up points, with mean pain scores at 6 months of 2.32 versus 4.78 in the monopolar group (p < 0.001). At 6 months, bipolar pulsed radiofrequency also resulted in significantly higher SF-36 scores across all eight domains and in total score (583.61 vs. 425.29, p < 0.001). DISCUSSION: Bipolar pulsed radiofrequency of the lumbosacral DRG was associated with greater improvements in pain and quality of life compared with the monopolar modality in patients with chronic lumbosacral radicular pain. These show the potential of bipolar PRF to enhance clinical and functional outcomes in this population.
Pain practice : the official journal of World Institute of PainYoichi Tanaka, Ren Fujii, Tomokazu Hayashi, Takaki Tateishi, Rento Ogata, Kokoro Ota, Kenta Hashimoto, Yuya Sakaguchi, Tsunehiro Otsuka, Daisuke Shimizu
OBJECTIVE: This study aimed to examine the effects of subjective insomnia severity and objective sleep efficiency (SE) on diurnal variation in pain intensity among patients with chronic pain. METHODS: Forty-four community-dwelling patients with chronic pain lasting more than three months were enrolled. Pain intensity was recorded using a visual analog scale at six time points per day over three consecutive days. Subjective sleep was assessed once using the Athens Insomnia Scale (AIS), and objective SE was derived from three days of actigraphy recordings. Linear mixed-effects models included pain intensity as the dependent variable; AIS score, sleep efficiency, time of day, and their interactions as fixed effects, as well as participant ID as a random effect. RESULTS: Significant main effects of time (F = 4.84, p < 0.001) and the AIS score (F = 7.58, p = 0.009) were observed. Significant interactions were found between SE and time of day (F = 3.64, p = 0.003), as well as between the AIS score and time of day (F = 2.55, p = 0.027). Higher AIS scores were associated with greater pain intensity, particularly in the morning. Higher SE was associated with higher pain intensity upon waking but lower pain intensity in the evening. CONCLUSION: In this exploratory study, subjective insomnia severity showed a consistent association with diurnal variation in pain intensity, whereas SE was associated with pain intensity in a time-of-day-dependent manner. These findings, which should be interpreted as hypothesis-generating rather than definitive, suggest that subjective and objective sleep measures capture distinct aspects of time-of-day-dependent pain variation and may inform individualized approaches to pain management, including patient education and rehabilitation planning.
Pain practice : the official journal of World Institute of PainDanilo Donati, Lucia D'Auria, Vincenzo Ricci, Paolo Boccolari, Roberto Tedeschi, Luigi Tarallo
OBJECTIVE: Complex regional pain syndrome (CRPS) is a complex and multifaceted condition in which pain may be neuropathic, nociplastic, nociceptive, or mixed in nature. This review aims to summarize the available pharmacological and non-pharmacological strategies for managing neuropathic pain in CRPS Types I and II. METHODS: Scopus, PubMed, Cochrane Library, and Google Scholar were searched for randomized controlled trials, meta-analyses, case series, and case reports addressing the management of CRPS, with a focus on neuropathic pain. Studies were analyzed from the perspective of pharmacological and non-pharmacological approaches, with attention to differences between CRPS Type I and II. RESULTS: Gabapentin (Level 1 evidence) and physiotherapy (Level 2 evidence) showed the strongest support among the treatments reviewed. Evidence remains limited or inconsistent for other pharmacological options (e.g., anticonvulsants other than gabapentin, opioids, antidepressants, ketamine, botulinum toxin) and for non-pharmacological interventions (e.g., mirror therapy, spinal cord stimulation, acupuncture). No significant differences in treatment efficacy were identified between CRPS Type I and II. CONCLUSION: Given the complex and heterogeneous nature of CRPS, a multimodal, individualized treatment approach is recommended. Further well-structured studies are needed to strengthen the evidence base for the management of neuropathic pain in CRPS.
Pain practice : the official journal of World Institute of PainAlexandre Meurant, Vincent Bonnet, Clément Gakuba, Cédric Villain, Gilles Loggia
BACKGROUND: Optimal perioperative pain management in older adults challenges anesthesiologists due to increased drug sensitivity, altered pharmacokinetics, and limitations of pain assessment tools in cognitively impaired patients. This study evaluated whether a single 60-min structured collaborative training session between a geriatrician and a clinical pharmacist is associated with improved anesthesiologists' clinical reasoning regarding perioperative analgesic management in older adults, as measured by increased concordance with expert opinion on a script concordance test (SCT). METHODS: SCT assessed 20 clinical vignettes covering pain assessment, analgesic selection, and adverse effect management domains. These were submitted to anesthesiologists before and after training. A panel of 13 geriatricians established scoring criteria. Internal consistency was measured using Cronbach's alpha. Paired t-tests and Wilcoxon signed-rank tests compared pre- and post-training scores, with the 95% confidence interval (CI) for the overall change estimated by bootstrap resampling. RESULTS: Seventeen anesthesiologists completed both assessments. Mean SCT scores increased from 45.8 ± 7.4 to 59.5 ± 8.5 post-training (p < 0.001), showing a 29.7% improvement (95% CI, 18.7%-41.7%). Analysis revealed improvements in analgesic prescription (+47.9%; 95% CI, 10.0-28.1 points) and adverse effect management (+26.8%; 95% CI, 9.1-19.0 points), while the change in pain assessment was not statistically significant (-11.6%; 95% CI, -16.6-9.4 points). Internal consistency improved from 0.542 to 0.704. Most participants (89.5%) lacked prior training in prescribing analgesics to older adults, and 73.7% were unfamiliar with clinical guidelines. CONCLUSION: This study suggests that collaborative geriatrician-pharmacist training is associated with improved anesthesiologists' clinical reasoning regarding perioperative analgesic management in older adults, as measured by greater concordance with expert opinion on a script concordance test. The varying effects across domains suggest that distinct competencies may require distinct educational approaches. These findings support further investigation of interprofessional education into anesthesiology training to enhance clinical reasoning in the care of older surgical patients.
Pakistan journal of pharmaceutical sciencesLinlin Chao, Weixing Li, Jinsen Zhang, Zhenyu Cai
BACKGROUND: Chronic non-cancer pain (CNCP) is highly prevalent and often requires analgesic combination therapy due to its complex mechanisms. However, real-world evidence on how different combination regimens correlate with pain relief and treatment modification remains limited, which hampers optimal multimodal analgesia selection. OBJECTIVES: To explore real‑world analgesic combination patterns in CNCP, analyze their associations with pain intensity changes and regimen adjustments and provide evidence for individualized multimodal analgesia. METHODS: This retrospective study included 120 CNCP patients (Jan 2022 to Jan 2024) categorized into three regimens: Dual (NSAIDs + acetaminophen, n=42), Opioid (weak opioid + adjuvant, n=38) and Triple (NSAIDs + opioid + adjuvant, n=40). Numerical Rating Scale (NRS) scores, therapy duration, regimen adjustments and adverse reactions were extracted. Multiple linear regression and binary logistic regression were used to identify factors associated with pain relief and treatment modification. RESULTS: The Triple group achieved the highest pain-relief rate (77.5%) compared with the Opioid (63.2%) and Dual (50.0%) groups (P<0.05). The treatment modification rate was highest in the Dual group (45.2%, mainly escalation; P<0.05). Adverse reactions were more frequent in the Triple group than in the Dual group (P<0.05), but no serious events occurred. Regression analyses identified Triple therapy (B=0.455, 95% CI: 0.260-0.649, P<0.001) and baseline NRS (B=0.607, 95% CI: 0.491-0.723, P<0.001) as independent factors for greater pain relief. Triple therapy (OR=0.256, 95% CI: 0.090-0.729, P=0.011) and longer baseline pain duration (OR=0.917, 95% CI: 0.860-0.978, P=0.009) were independent protective factors against treatment modification. CONCLUSION: CNCP patients exhibit distinct patterns of analgesic combination. Triple therapy was associated with better pain relief persistence and fewer adjustments but higher adverse reaction risks. Therapy selection should be stratified by pain phenotype and patients with moderate‑to‑severe pain may benefit from early standardized combination therapy, which was linked to fewer subsequent regimen adjustments.
Pain practice : the official journal of World Institute of PainSteven Falowski, Jack Smith
INTRODUCTION: Intermittent passive recharge burst therapy is an established therapy to optimize pain relief and mitigate the problems associated with battery life and charging burden. Newer programming parameters have been explored to provide patients with this targeted burst therapy in multiple areas. These areas are programmed separately to optimize pain relief for a complex patient population and those with multi-area pain. This study examined single vs. multi-area passive recharge burst therapy in a neurostimulation naive population during percutaneous SCS trial. METHODS: This study was performed at a single institution by a single trialing physician. Candidates for the study were enrolled on a consecutive basis for any painful condition in the management of chronic intractable pain of the back, trunk and limbs. Subjects were randomized to receive either single area burst therapy or two-area burst therapy-with both subject and physician blinding. Programming was adjusted mid-trial based on optimizing pain relief and could include up to four-area burst. Patient outcomes included VAS, percent pain relief, proceeding to implant, and PROMIS-29 scores. RESULTS: All planned 30 patients completed follow up. The average VAS pain score was 70.2 at baseline and 22.2 at the end of the trial. The average pain relief at mid-trial was 53%, which improved to 67% at the end of the trial with conversion to multi-area programming. There was an overall 87% trial to permanent conversion ratio, with 83% of the patients ending trial on multi-area burst therapy. Analysis of PROMIS-29 scores demonstrates the most significant improvements in pain intensity, pain interference, physical function, sleep, and anxiety. CONCLUSION: Multi-area passive recharge burst has demonstrated a high rate of trial success with significant pain and symptom relief. In addition, there were improvements in pain intensity, pain interference, physical function, sleep, and anxiety. Multi-area passive recharge burst therapy is a viable option to be utilized during a trial to improve patient outcomes and optimize trial success.
Acta anaesthesiologica ScandinavicaAnders Peder Højer Karlsen, Trang Xuan Minh Tran, Christian S Meyhoff, Troels Haxholdt Lunn, Ole Mathiesen, Markus Harboe Olsen
BACKGROUND: Managing postoperative pain while minimising opioid-related adverse drug events (ORADEs) remains a clinical challenge. The OPIAID Zone Tool is a visual scoring system designed to evaluate pain and ORADEs together. It has pain on the x-axis and ORADEs on the y-axis and categorises patients into zones of increased combined symptom burden. We aimed to evaluate the OPIAID Zone Tool, assess its association with postoperative outcomes and explore alternative versions. METHODS: This prospective observational cohort pilot study included 145 adult patients undergoing orthopaedic and abdominal surgery under general anaesthesia with postoperative care in the post-anaesthesia care unit at Bispebjerg Hospital, Denmark. The primary outcome was the OPIAID Zone Tool score (version 0.5). Secondary analyses assessed associations with patient-perceived health (EQ-VAS), quality of recovery (QoR-PACU) and time to discharge readiness in PACU, evaluated using R2, AIC and BIC. RESULTS: Distribution across OPIAID Zones was broad (Zone 0: 13.8%, Zone 1: 6.9%, Zone 2: 22.1%, Zone 3: 18.6%, Zone 4: 20.0%, Zone 5: 18.6%), without clear clustering and with a tendency towards pain-dominant profiles. The OPIAID Zone Tool score was significantly associated with EQ-VAS (R2 = 0.39), QoR-PACU (R2 = 0.35) and PACU discharge readiness (R2 = 0.50), showing stronger overall associations than pain and ORADEs assessed separately. CONCLUSION: The OPIAID Zone Tool (version 0.5) combines pain and ORADE scores into a single metric while simultaneously visualising their distribution across the population. The Zone score was associated with patient-centred outcomes and outperformed pain and ORADEs assessed separately, though a risk of overfitting cannot be ruled out. Further refinement and prospective validation are planned to optimise the tool and confirm its clinical utility. EDITORIAL COMMENT: How high is the quality of the early postoperative analgesia that is being delivered? This study presents a model and instrument for quantifying quality of early postoperative analgesia combining treatments, pain reporting and opioid-related adverse events. The performance of the new instrument is presented with associations to recovery scores and time to post-anaesthesia unit discharge.
Scandinavian journal of painKine Gjesdal, Svetlana Skurtveit, Ane Djuv, Aksel Paulsen, Gabriela Rolova, Cille Sevild, Torgeir Gilje Lid
BACKGROUND: Chronic pain is a global public health issue, severely affecting quality of life, functional capacity, and healthcare resources. Effective management requires adequate health literacy, yet limited health literacy is associated with greater pain burden and poorer outcomes. This underlines the need for interventions that can strengthen patients' health literacy skills. Thus, the aim of the present study was to investigate longitudinal changes in health literacy following participation in a multidisciplinary primary care pain management intervention. METHODS: This longitudinal study reports health literacy outcomes from a multidisciplinary, personalized pain management intervention that was developed in accordance with the Medical Research Council framework. Forty-three participants with chronic non-cancer pain completed the full intervention. Health literacy was measured using the Norwegian version of the Health Literacy Questionnaire (HLQ) at baseline, midpoint, and post-intervention. Changes over time were analyzed using paired-sample t-tests. RESULTS: Statistically significant improvements were observed in five HLQ domains from baseline to midpoint and in eight domains from baseline to post-intervention. "Having sufficient information to manage my health" showed the largest increase among Domains 1-5, whereas "Navigating the healthcare system" showed the largest increase among Domains 6-9 and improved significantly across all time-point comparisons. CONCLUSION: Participants demonstrated improvements in several dimensions of health literacy during participation in the intervention, particularly in domains related to having sufficient information to manage health and active self-management. These findings support further investigation of tailored, multidisciplinary approaches to strengthening health literacy among people with chronic pain. TRIAL REGISTRATION: NCT05828121 Date: 04-25-2023.
Deutsche medizinische Wochenschrift (1946)Michael Brinkers, Giselher Pfau, Jana Bergner, Frank Meyer
BACKGROUND: Pain therapy has obtained a high importance in clinical practice in the meantime and has become indispensable, in particular, with regard to a sufficient perioperative/-interventional case management but also related to a certain approach, specific (problematic) diagnoses, syndromes and special symptomatologies. AIM: To provide a prompt and standardized access to a competently developed compact "Standard Operating Procedure" (SOP) on interdisciplinary pain therapy in tumor patients with a broad profile of (possible) diagnoses at a subspecialized medical center based on i) experiences from long-term clinical practice and ii) current references from the scientific medical literature (not to substitute completely earlier publications and text books). METHOD: Narrative short overview on the "SOP - Pain Therapy in tumor diseases/patients" (provided as QR code at the end). RESULTS (CORNER POINTS): In case of tumor-associated pain, opioids represent the primarily considered group of drugs for an efficient medication. Medication with opioids is limited by hepatic and renal insufficiency, type of opioid (e.g., Tapentadol's effect is not sufficient), further contraindications (e.g., MST in chronic obstructive pulmonary disease [COPD]) and mode of possible drug administration (patients cannot swallow or in lack of consciousness). In patients with tumor-associated pain, it needs to be asked for anxiety. DISCUSSION: A couple of years ago, the interdisciplinary working group at the University Hospital of Magdeburg (Germany) created and established SOP's for postoperative pain therapy in general and abdominal surgery followed by vasculary surgery/medicine in 2024. CONCLUSION: Tumor-associated pain belongs to the type of pain (in addition to birth pang and postoperative pain), which can be approached best. This represents a call to action. It comprises consequent, adequate drug administration with sufficient dosage according to the WHO scheme (WHO I actually not necessary), psychotropics and drug-free procedures.
Persistent pain remains a major unmet need in rheumatoid arthritis (RA), even in patients with adequately controlled inflammatory disease. Cannabinoids have been proposed as potential modulators of pain and inflammation, but their clinical role in RA remains uncertain. To map and critically appraise the available clinical evidence on cannabinoid-related interventions or exposures for pain management in adults with RA. PubMed/MEDLINE, Scopus, the Directory of Open Access Journals, and the Cochrane Central Register of Controlled Trials were searched for studies published from January 1, 1990, to September 10, 2026. Randomized controlled trials and observational studies evaluating cannabinoid-related interventions or exposures in adults with confirmed RA and reporting pain-related outcomes were eligible. Risk of bias was assessed using Cochrane RoB 2 for randomized trials and ROBINS-I for observational studies. Of 593 records identified, three studies met the eligibility criteria: one randomized placebo-controlled trial and two observational studies. In the randomized trial of 58 patients, nabiximols reduced pain on movement by 0.95 points (p = 0.044), pain at rest by 1.04 points (p = 0.018), and improved sleep quality by 1.17 points (p = 0.027); DAS28 decreased by 0.76 points (p = 0.002), while no serious adverse events were reported. Observational studies suggested possible symptomatic benefit but were limited by heterogeneous cannabinoid exposure and serious to critical risk of bias. Current clinical evidence remains insufficient to establish the efficacy or long-term safety of cannabinoids for RA-related pain. Larger, rigorously designed trials using standardized cannabinoid formulations and pain-relevant outcomes are needed.
Japan journal of nursing science : JJNSKayo Ueda, Yukiko Honda, Yuko Masuzawa, Mai Takeshita, Rie Toyomoto, Kumiko Adachi, Hiromi Eto, Yuriko Usui, Rieko Fukuzawa, Tomoko Nishino
AIM: To evaluate the benefits and harms of bathing during the first stage of labor among healthy women with uncomplicated singleton cephalic pregnancies at ≥ 36 weeks' gestation. METHODS: Randomized controlled trials comparing warm-water bathing during the first stage of labor with no bathing were included. MEDLINE (PubMed), Cochrane Database of Systematic Reviews, CENTRAL, and Ichu-shi Web (updated to December 2024) were searched for English- and Japanese-language studies. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias 1.0 tool, and evidence certainty was appraised with GRADE. Random-effects meta-analyses reported risk ratios (RRs) or mean differences with 95% prediction intervals (PIs), and I2 statistics. RESULTS: Nine studies from eight countries (1994-2018; n = 1823) met inclusion criteria. Bathing did not significantly affect regional analgesia use (RR 0.91, 95% PI 0.82-1.01; I2 = 0%), perineal trauma, spontaneous vaginal birth, intact perineum, caesarean section, abnormal fetal heart rate patterns, neonatal infection, or episiotomy. Instrumental vaginal birth was reduced (RR 0.78, 95% PI 0.61-0.98; I2 = 0%). Satisfaction tended to be higher in the bathing group, though evidence was limited to two small heterogeneous trials. CONCLUSIONS: Evidence certainty was low to very low because of risk of bias, imprecision, lack of blinding, and limited woman-reported outcomes. Bathing appears safe for mothers and infants and may reduce instrumental delivery, but a clear analgesic-sparing effect was not shown. Implementation should ensure tub hygiene, water temperature regulation, and regular maternal and fetal monitoring. TRIAL REGISTRATION: Register name: Effect of Bathing for Pain Relief During the First Stage of Labor: A protocol for a systematic review and meta-analysis. Registration DOI: https://doi.org/10.17605/OSF.IO/J9GTS.
African journal of reproductive healthNursel Alp Dal, Kerime D Beydağ, Aysel Doğan
Effective control of pain after cesarean delivery is essential, as poorly managed postoperative pain is a common complication that can impair maternal recovery and early infant care. This prospective, randomized, single-blind controlled trial, conducted in the postpartum unit of Kocaeli University Hospital, Kocaeli, Türkiye, between March 2021 and June 2022, compared the effect of a single neuro-linguistic programming (NLP) session added to standard postoperative care against standard care alone. Seventy-six consenting women were randomized in equal numbers to the intervention (standard care plus NLP) or control (standard care only) group. The primary outcome was pain intensity, measured with the Visual Analogue Scale (VAS) before and after the intervention period. Mean follow-up pain scores were significantly lower in the intervention group (2.37±1.792) than in the control group (6.68±2.068; p<0.001), while baseline pain scores and maternal demographic and obstetric characteristics did not differ significantly between groups. Adding a single NLP session to standard postoperative care effectively reduced pain after cesarean delivery, supporting its use as a non-pharmacological adjunct in postoperative nursing and midwifery practice.
European journal of pain (London, England)Frederik Kirkegaard Kehlet, María Teresa Linares-Fernández, Juan J Amer-Cuenca, Josue Fernandez-Carnero, Hector Beltran-Alacreu, Alfredo Sánchez-Alberca, Danie…
BACKGROUND: A solid foundation in pain science and evidence-based biopsychosocial approaches is essential for quality pain management. Understanding how health professional students' pain knowledge and attitudes evolve during their studies can guide curriculum development. This study compared pain knowledge and attitudes (a) between first- and final-year undergraduate students in Medicine, Nursing, Pharmacy and Physiotherapy, and (b) among final-year students across these disciplines. METHODS: This cross-sectional, observational study recruited students from six Spanish universities. An online survey, which included the Revised Neurophysiology of Pain Questionnaire (RNPQ) to assess pain knowledge and the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) to assess pain attitudes and beliefs, was completed by first- and final-year students. RESULTS: Seven hundred and fifteen students (527 female, 188 male) completed the survey. Comparisons between first and final year students in each discipline showed that Medical and Physiotherapy students improved their scores in both RNPQ (p < 0.001) and HC-PAIRS (p = 0.026 and p < 0.001 respectively). Pharmacy students only showed improvements in RNPQ (RPNQ: p < 0.001; HC-PAIRS: p = 0.313), while Nursing students showed no differences (RPNQ: p = 0.711; HC-PAIRS: p = 0.875). Comparisons between disciplines at final year showed that Physiotherapy and Medicine students scored better than Pharmacy and Nursing students in both RNPQ (p < 0.05) and HC-PAIRS (p < 0.05). CONCLUSIONS: Medical and Physiotherapy students seem to achieve higher pain knowledge and more favourable pain attitudes when compared to Pharmacy and Nursing students. Nursing students did not show improvements in either measure. Our findings highlight the need for longitudinal, interprofessional pain education in Spain. SIGNIFICANCE STATEMENT: This multi-center, cross-sectional observational study with a sample of more than 700 students provides important insight into the level of pain knowledge and attitudes among Medicine, Nursing, Pharmacy and Physiotherapy undergraduate students in Spain. Utilizing validated assessment instruments, it identifies significant discipline-specific and year-level differences, offers meaningful findings on gaps in pain education and implications for curriculum development. The observed discipline-specific disparities underscore the need for longitudinal, interprofessional pain education to equip future health professionals for evidence-based pain management.
Nursing philosophy : an international journal for healthcare professionalsZhuanlian Li, Jiaqi You, Liuhua Zhang, Bangxing Ma, Yinhua Liu
Pain assessment in critical care is organised primarily around patient self-report and numerical scoring, an arrangement that protects the patient's first-person authority. In neurocritical care, however, critically ill patients with stroke may be unable to communicate because of aphasia, impaired consciousness, sedation, mechanical ventilation, or delirium. Under these conditions, the absence of a numerical score may reflect limitations in the systems through which pain is made visible rather than the absence of pain. This paper offers an empirically informed philosophical analysis of what a missing numerical pain score means in neurocritical care and asks how nursing can preserve clinically and ethically meaningful distinctions when a number cannot be responsibly produced. As an empirical point of departure, an extracted adult ischaemic-stroke ICU-stay dataset from MIMIC-IV (6054 ICU stays, 5065 patients) was used, focusing on the first pain score, defined as the earliest documented numerical pain score within the first 24 h after ICU admission among patients with stroke. The empirical material is treated not as epidemiological evidence but as an occasion for conceptual analysis. Of 6054 ICU stays, 2415 (39.9%) had no documented first pain score in the first-24-h structured field. This pattern is not interpreted as evidence that pain was absent, unassessed, or unrecognised in any individual case. Drawing on this finding, the paper develops a five-fold conceptual taxonomy of missingness: absence of pain, absence of self-report, absence of assessment, absence of documentation, and risk of non-recognition. Nursing management is presented as a moral-epistemic practice in which electronic record categories, quality indicators, staffing, education, and workflow shape whether possible pain becomes visible, documentable, auditable, and answerable. The central task is not to force every patient into a number, but to preserve clinically and ethically meaningful differences when a number cannot be responsibly produced.
Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia NursesBurhan Dost, Vikram Rajasekar, Kiran Koneti
Transitional pain describes the clinically important phase in which acute pain resolves or progresses to chronic pain. This phase is particularly relevant after surgery and trauma, where the onset of tissue injury can be identified. Evidence suggests that chronic postsurgical or post-traumatic pain may arise through the interaction of biological, psychological, and social mechanisms, including peripheral and central sensitization, neuroimmune activation, psychological distress, pain catastrophizing, functional avoidance, and prolonged opioid exposure. Transitional Pain Services address this risk period through early identification, multidisciplinary intervention, opioid stewardship, rehabilitation, and psychological support. Current evidence suggests benefits for opioid tapering, pain interference, mood, and function, although stronger trials are needed to confirm whether such services reduce the incidence of chronic pain. Therefore, transitional pain should be understood as a modifiable risk state and a promising target for preventive perioperative pain care.
Journal for specialists in pediatric nursing : JSPNAnna Stålberg, Johanna Granhagen Jungner, Cecilia Bartholdson, Henrik Hjelmgren
PURPOSE: To describe children's experiences of using extended reality (XR) distraction, namely virtual reality (VR) and augmented reality (AR), during needle-related procedures. DESIGN AND METHODS: An exploratory, prospective convergent parallel mixed-methods design was employed. Self-reported measures and structured observations conducted in accordance with a predefined protocol were combined with semi-structured interviews. Data were presented using descriptive statistics and synthesized through thematic analysis. RESULTS: Observations were conducted during 29 venipunctures in children using XR distraction. A majority of the children (90%) reported positive experiences with the use of XR distraction. Numerical Rating Scale pain scores (0-10) were low in both groups, with a mean of 1.26 (SD 1.16) for VR and 1.77 (SD 1.79) for AR. Most procedures (62%) were carried out as planned. No child declined the use of the device. Physical restraint was not observed; however, supportive holding was used in 10% of procedures. Four themes were identified through the interviews: Emotional support and comfort, The artificial world becomes reality, A diversified experience, and Usability aspects influencing user experience. CONCLUSION: When appropriately implemented, XR distraction may reduce pain and anxiety among children during needle-related procedures. However, it is not universally effective, underscoring the importance of a child-centered approach that allows children to select their preferred distraction method. Further research is required to determine optimal implementation strategies, assess cost-effectiveness, and clarify the role of XR distraction in delivering high-quality pediatric care during needle-related procedures. PRACTICE IMPLICATIONS: The demonstrated benefits of XR distraction during needle-related procedures may encourage healthcare professionals to incorporate such tools into clinical practice. Nevertheless, the findings also emphasize the importance of adopting a child-centered approach, recognizing that XR distraction is not suitable for all children.
Acta anaesthesiologica ScandinavicaTórálvur Mohr, Emma Atsuko Tsuchiya, Mette Krag, Bitten Dybdal, Johan Heiberg
BACKGROUND: Clonidine, an alpha-2 receptor agonist, has been explored as a potential analgesic in postoperative pain management, but its efficacy and safety profile remain unclear. The aim of this scoping review was to present the evidence on the use of intravenous clonidine in postoperative pain management. METHODS: This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We searched the following databases: The Cochrane Library, Embase, and MEDLINE for studies investigating the use of intravenous clonidine in postoperative pain management, regardless of comparators or outcomes. Data were summarized and presented descriptively. Risk of bias was assessed using the Risk of Bias 2 tool for randomized trials, while the certainty of evidence was evaluated at the outcome level using a modified Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: We included 10 trials with a total of 646 patients. Most patients were ASA I-II and underwent major elective surgery. The trials varied in clonidine dosage, timing, and combination with other analgesics. All included trials reported outcome data for pain and/or supplemental analgesia with high variability in assessment strategies. The data showed inconsistent effects of clonidine in reducing pain scores and the need for supplemental analgesia. Reported adverse effects were also inconsistent across studies. The overall certainty of evidence was very low for all outcomes. CONCLUSION: Evidence for the use of intravenous clonidine in postoperative pain management is heterogeneous and limited, providing no consistent clinical benefit and underscoring the need for further research. EDITORIAL COMMENT: This scoping review presents the current evidence for intravenous clonidine for post-operative analgesia. So far there is not enough evidence to support a recommendation concerning if or how intravenous clonidine should be used in this context.
Clinical and experimental dental researchQasim Khalid, Abbas Naseem, Waqas Naseem, Adnan Jehangir, Umar Hussain, Maryam Altuhafy, Junad Khan
OBJECTIVES: Orthodontic treatment can be associated with pain, particularly during separator placement, appliance insertion, or activation. Topical anesthetics may offer a simple, locally applied alternative to systemic analgesics, but their effectiveness remains uncertain. The objective of this review was to evaluate the efficacy of topical anesthetics, compared to other treatments or no treatment, in reducing orthodontic pain. MATERIAL AND METHODS: Eligible studies were randomized controlled trials (RCTs) comparing topical anesthetics (gels or patches) with placebo, no treatment, or other active pain-control interventions in orthodontic patients. Five databases (PubMed, Scopus, Cochrane CENTRAL, Embase, Web of Science) were searched up to 14th March 2026, with no language or date restrictions. Data were extracted in duplicate, and the risk of bias was assessed using the ROB-2 tool. Due to heterogeneity, only a qualitative synthesis was performed. RESULTS: Nine RCTs (456 participants, mean age 14-35 years; 36.3% male) conducted in four countries were included. Benzocaine was the most investigated, followed by lidocaine, prilocaine/lidocaine, and menthol. Most studies examined separator-induced pain. Eight of nine trials reported significant reductions in pain intensity with topical anesthetics at one or more time points, particularly within the first 24 to 72 h. Benzocaine consistently showed superior outcomes compared with placebo. Lidocaine and prilocaine/lidocaine provided rapid analgesia, especially in patients with high anxiety or low pain thresholds. Menthol patches also showed significant short-term pain reduction in two studies. Risk of bias was moderate in most trials. CONCLUSION: Topical anesthetics can be effective in reducing short-term orthodontic pain. Their use may reduce reliance on systemic analgesics and improve patient comfort during the initial stages of treatment. However, evidence quality remains limited, and further high-quality RCTs with standardized protocols are needed.
European journal of pain (London, England)Jonas Verbrugghe, Michiel F Reneman, Caitriona Cunningham, Karen Dana Ciccone, Aleksandra Budzisz, Magdalena Kocot-Kępska, Nadia Malliou, Henrik Bjarke Vaegter…
BACKGROUND: Physical activity is a cornerstone of chronic pain management. However, translating general recommendations into practical, clinically meaningful guidance for people living with chronic pain and their healthcare providers remains challenging. Walking represents a promising modality because it is accessible, adaptable, low-cost and easily integrated into daily life. OBJECTIVE: This position paper synthesises evidence on walking as a therapeutic modality for people living with chronic pain, identifies key knowledge gaps and provides a guiding message for healthcare professionals to support clinical communication and patient self-management. METHODS: Narrative synthesis of scientific literature examining walking interventions in chronic musculoskeletal pain conditions. Evidence regarding step counts, progression strategies and behavioural factors influencing engagement in walking was integrated to inform clinically applicable recommendations. RESULTS: Walking interventions demonstrate small-to-moderate improvements in pain, physical function and health-related quality of life. Benefits of walking occur at activity levels below traditional public-health targets, with the largest gains observed when individuals transition from very low to moderate activity levels. Current research does not support universal step-count targets for pain reduction, emphasising instead individualised progression and consistency. Available evidence shows no association between walking participation and worsening pain severity at the population level. Gradual engagement in walking may also provide opportunities to build confidence in one's ability to be physically active. However, walking interventions are frequently delivered alongside education, goal setting, activity monitoring or healthcare professional support, making it difficult to determine the independent contribution of walking to changes in beliefs about movement and activity. CONCLUSIONS: Walking is a generally safe, scalable, evidence-supported strategy for chronic pain management. Rather than fixed targets, gradual progression tailored to individual capacity represents the most evidence-aligned strategy. This paper provides a guiding message to facilitate implementation of walking and physical activity recommendations in routine care. SIGNIFICANCE STATEMENT: This paper translates current evidence on walking and chronic pain into clinically applicable guidance for healthcare professionals and people living with chronic pain. Building on previous EFIC recommendations regarding physical activity, it synthesises evidence across chronic musculoskeletal pain conditions, addresses common barriers such as fear of movement and symptom flare-ups, and provides evidence-informed practical recommendations to support safe, gradual and sustainable walking participation in routine care and self-management.
JMIR research protocolsBarbara Resnick, Elizabeth Galik, Rachel McPherson, Nayeon Kim, Shijun Zhu
BACKGROUND: Pain is a common symptom among older adults in nursing home settings, affecting 30% to 80% of residents living with dementia. Pain is not assessed; the underlying cause is not identified, and treatment is not initiated for a large percentage of residents. Untreated or overtreated pain can lower quality of life, negatively impact function, impair sleep, and increase behavioral and psychological symptoms associated with dementia. OBJECTIVE: The purpose of this National Institute of Aging-funded study is to use our theoretically based approach that includes the social ecological model, social cognitive theory, and the evidence integration triangle to translate the use of the Pain Management Clinical Practice Guideline (Pain Management CPG) into nursing home settings and improve the assessment, diagnosis, and management of pain among residents living with dementia. Our theoretically based approach, combined with the Pain Management CPG, is referred to as PAIN-CPG-EIT (Pain-Clinical Practice Guideline-Using the Evidence Integration Triangle). METHODS: The study is a cluster-randomized clinical trial, with communities assigned to receive treatment with the PAIN-CPG-EIT vs pain education only (EO). The nursing homes have been randomized equally into intervention and control groups. The goal is to recruit a total of 300 residents from 12 nursing homes (25 residents from each community). Implementation of the study is being done via 3 cohorts, with 4 communities included in each cohort. The PAIN-CPG-EIT is implemented by a research nurse facilitator and includes 4 components, namely, component I: establishing and meeting with a stakeholder team; component II: education of the staff; component III: mentoring and motivating the staff to address pain; and component IV: ongoing monitoring of pain management in the community. The EO intervention is also implemented by a research nurse facilitator and consists of component II only, which is education of the staff. RESULTS: Study activities began in September 2023, and recruitment of residents and intervention activities started with cohort 1 in January 2024. Cohort 2 was initiated in February 2025, and cohort 3 was initiated in June 2026 and is currently ongoing. A total of 208 residents have been recruited from the first 10 study sites. All intervention activities have been implemented as intended. The study is expected to be completed by December 2027. CONCLUSIONS: Outcomes are evaluated at baseline, 4 months, and 12 months after implementation of the intervention, and include improvement in the assessment, diagnosis, and management of pain; a decrease in pain; and evidence of more appropriate use of opioids. The findings from this study will provide evidence of the effectiveness of our implementation approach and use of the Pain Management CPG. The theoretically based approach may be useful for the implementation of other CPGs in nursing homes.
Current pain and headache reportsRadhika S Amin, Eliot N Haddad, Raghavan Gopalakrishnan, Sara McCormick, Pavan Tankha, Sara Davin, Rony R Sayegh
PURPOSE OF REVIEW: Chronic ocular pain (COP) is a debilitating condition in which patients experience pain in or around the eyes. It is strongly associated with other pain and psychological conditions. Management options remain limited and available ocular therapies are rarely effective, particularly in patients with central sensitization. As in other pain conditions, psychological and behavioral interventions are important, yet understudied and underutilized in the management of COP. This review explores the literature pertaining to such interventions for COP. RECENT FINDINGS: COP, while previously thought of as dry eye disease, is now accepted as a separate pain entity. It overlaps with other chronic pain conditions and is also associated with depression, anxiety, post-traumatic stress disorder, sleep disturbance, pain catastrophizing, fear avoidance, and somatic symptom burden, which can be conceptualized through a biopsychosocial model. In broader chronic pain populations, cognitive behavioral therapy, mindfulness-based interventions, acceptance and commitment therapy, pain neuroscience education, emotional awareness and expression therapy, and behavioral interventions have demonstrated benefit for pain-related distress, coping, function, and disability. However, evidence supporting such interventions for COP remains limited, and no formal investigation of psychological interventions for COP has been published to date. The reviewed literature provides supportive evidence for psychological and behavioral interventions as mechanism-based adjuncts for COP management within a biopsychosocial framework. Integrating these approaches through multidisciplinary care models emphasizing pain psychology may help address central pain contributors and functional disability. COP-specific trials are needed to define which patients will most benefit, optimal interventions, and implementation models in practice.
BMJ openHannah Louise van Rhoon, Sanne Elisabeth Hoeks, Jorinde A W Polderman, Thomas G de Leeuw, Jan J Van Wijk, Bram Dierckx, Jan Bollen, Simon Van Der Pol, Marly Mm…
INTRODUCTION: Postoperative pain in children and adolescents is frequently reported, despite numerous advancements in pain management strategies. Virtual reality (VR) is a non-pharmacological tool, which has shown to be effective in reducing acute and procedural pain in children and adolescents. However, there are no studies on VR as an adjunctive treatment of postoperative pain management in the paediatric population. The aim of this study is to evaluate the effectiveness of VR in reducing postoperative pain in children and adolescents undergoing major surgery. METHODS AND ANALYSIS: This is a multicentre, prospective, unblinded randomised controlled trial conducted in two tertiary academic children's hospitals in the Netherlands. 159 children and adolescents aged 6-18 undergoing major surgery with expected moderate to severe postoperative pain will be included. Patients will be stratified according to pain treatment and subsequently randomised into two study arms with a 2:1 allocation ratio to receive either (a) VR intervention plus care as usual (CAU) or (b) CAU alone during the first 3 days postoperatively. The primary outcome of this study is the difference between the two intervention groups in rate of change in postoperative pain scores during the first 3 days postoperatively, measured by the Numeric Rating Scale Pain. Secondary outcomes include the immediate- and long-term effects of VR on pain intensity, anxiety, trauma-related symptoms, quality of recovery, opioid and analgesic consumption and incidence of chronic postoperative pain. Analyses will be based on an intention-to-treat approach, employing a linear mixed model to compare the effect of VR to CAU over time. Additional analyses will evaluate usability, user satisfaction, cost-effectiveness and predictors of treatment response. ETHICS AND DISSEMINATION: The Erasmus MC Medical Ethics Review Committee, Rotterdam, the Netherlands granted ethical approval for this study in July 2025. Results from this study will be published as soon as possible after completed data collection in international peer-reviewed scientific journals. CLINICAL TRIAL REGISTRATION: NL-OMON57871.
PloS oneAlp Özel, Umut Ata Uğraş, Muhammet Fatih Uysal, Erhan Renan Uçaroğlu
UNLABELLED: To evaluate the effectiveness of elastic therapeutic taping on postoperative pain, functional mobility, sleep quality, analgesic consumption, and length of hospital stay in patients undergoing coronary artery bypass grafting (CABG) via median sternotomy. In this prospective, randomized, double-blind, placebo- and sham-controlled trial, 195 patients undergoing elective CABG were randomly assigned to elastic therapeutic taping (n = 65), placebo taping without tension (n = 65), or sham taping to a non-related region (n = 65). Elastic therapeutic taping was applied after patients were transferred from the intensive care unit to the cardiovascular surgery ward. Pain at rest and during coughing was assessed using the Visual Analog Scale (VAS) at baseline and 12, 24, and 48 hours. Secondary outcomes were Timed Up and Go (TUG), sleep quality, total analgesic use, and length of hospital stay. Data were analyzed using a prespecified two-way mixed ANOVA with Bonferroni-adjusted post hoc comparisons for the primary pain outcome. Nonparametric secondary outcomes were analyzed using Kruskal-Wallis or Friedman tests, as appropriate. At 48 hours, resting pain was lower in the elastic therapeutic taping group (19.0 ± 10.2) than placebo taping without tension group (37.5 ± 13.7) and sham taping group (41.2 ± 16.2; p = 0.001). The observed between-group reduction in pain exceeded the reported minimal clinically important difference (MCID) of 9.9 mm for acute postoperative pain, indicating a clinically meaningful treatment effect. Coughing pain was also reduced (39.2 ± 17.0 vs. 56.3 ± 17.2 and 59.4 ± 16.8; p = 0.001). Tramadol use was lower with elastic therapeutic taping (50 ± 50 mg vs. 100 ± 50 mg; p = 0.038). Elastic therapeutic taping was associated with a shorter length of hospital stay (4 [3-5] vs. 5 [4-7] days; p = 0.042). Functional mobility (TUG, p = 0.002) and sleep quality (p = 0.001) were also significantly improved in the elastic therapeutic taping group compared with the placebo and sham groups. Elastic therapeutic taping was associated with reduced pain, lower opioid use, improved early recovery, and a shorter length of hospital stay after median sternotomy. TRIAL REGISTRATION: ClinicalTrials.gov NCT06910215.
Critical care (London, England)Chloé Matray, Olivier Duranteau, Anne Bercal, Paul Hebrard de Veyrinas, Mathieu David, Pierre Pasquier, Fabrice Gzil, Antoine Lamblin
BACKGROUND: Modern conflicts have brought about a paradigm shift in military medicine. In Prolonged Field Care, recommendations have so far focused on damage control and care aimed at ensuring survival. But, particularly in large scale combat operation, not all patients will survive, and despite the development of palliative care in the civilian sector, no extension of this approach has yet been envisaged for military medicine. This review aims to identify knowledge gaps in palliative and supportive care in combat situations. METHODS: We conducted a literature review in PubMed, CAIRN, Scopus and Embase, with the last search carried out on 31 December 2025, using triangulation at each stage of the screening process. Studies published since 1900 focusing on frontline palliative and end-of-life care for combatants were included. RESULTS: Of 3,629 unique records, 35 articles were included, ranging from World War II-era accounts to current prolonged field care guidelines. Pain management was the most extensively documented topic. Morphine, a historical mainstay, has been increasingly supplemented by oral transmucosal fentanyl citrate and ketamine. Ketamine was favored in austere settings for its hemodynamic stability and multi-route administration. Other analgesics, such as paracetamol and NSAIDs, were also briefly described. Regional anesthesia was recognized as an analgesic force multiplier, though never described in an explicitly palliative context. For expectant and dying casualties, a limited but consistent body of literature addressed opioid titration and palliative sedation, notably via continuous midazolam infusion. Diverse end-of-life-related symptoms were addressed, including nausea, dyspnea, secretions, and delirium. Non-pharmacological measures, such as thermal regulation, mouth care, disarming, and comfort items, were described as accessible across provider levels. Spiritual care and family communication, though addressed in few sources, emerged as important but under-formalized components. Overall, evidence specific to palliative and end-of-life battlefield care remains sparse and largely extrapolated from curative-care literature. CONCLUSION: Pain management in combat is a well-researched field, but one that is rarely examined in the specific context of end-of-life care. Similarly, there is a notable gap in the literature regarding palliative care in a combat context. Where such topics are addressed, they are often simply a transposition of civilian data. The lack of training and doctrinal guidance prevents the proper integration of this specialized care, which aims to ensure dignity for dying combatants and to reflect the values upon which military medicine is founded. CLINICAL TRIAL NUMBER: The protocol was pre-registered on the Open Science Framework (OSF) on 8 December 2025 (DOI: 10.17605/OSF.IO/U9RSG).
Zhen ci yan jiu = Acupuncture researchRenzhen Zhang, Cui Ma, Tingting Dou, Li Li, Xuejiao Ma, Yuting Wei, Xingke Yan
Chronic pain is often accompanied by negative emotions such as anxiety, depression, and aversion, with structural and functional abnormalities in the limbic system serving as the key pathological basis for this comorbidity. Acupuncture can improve pain-related emotions by modulating multilevel neural centers within the limbic system. At the cortical level, acupuncture can restore the regulatory mechanism of the cortex over pain-related emotions by modulating the neural plasticity of the anterior cingulate cortex, medial cingulate cortex, prefrontal cortex, and insular cortex； at the subcortical level, acupuncture can act on the amygdala and hippocampus to block negative emotions induced by nociceptive information； at the diencephalic level, acupuncture can inhibit the generation of pain-related emotions by down-regulating the abnormal excitability of thalamic paraventricular nucleus neurons, thereby blocking the transmission of pain signals to the limbic system. From a hierarchical perspective of the limbic system, this review elucidated the mechanisms of acupuncture intervention in pain-related emotions, providing a theoretical foundation and reference for clinical research on acupuncture treatment of pain-related emotions.
BMJ openAniello Alfieri, Valentina Cerrone, Sveva Di Franco, Marco Cascella, Rosario De Feo, Ornella Piazza, Maria Pia Bruno, Marco Fiore
INTRODUCTION: Perioperative pain is a major determinant of patients' experience and may influence long-term outcomes. Artificial intelligence (AI) is applied to perioperative datasets to predict acute postoperative pain, opioid requirements, analgesic-related adverse events, chronic postsurgical pain and pain trajectories. However, the evidence is dispersed across perioperative phases, clinical outcomes, data modalities and AI methodologies, while the extent to which current models address validation, interpretability, uncertainty and clinical implementation remains unclear. This scoping review protocol aims to characterise the existing evidence on AI applications related to perioperative pain to identify methodological features that affect its clinical credibility and implementation. METHODS AND ANALYSIS: This protocol will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidance. Eligible studies will include human research evaluating AI methods in relation to pain-related perioperative outcomes, including observational studies, interventional studies and predictive modelling studies. AI approaches include machine learning, deep learning, natural language processing, computer vision, large language models and hybrid or ensemble methods. Searches will be conducted from PubMed/MEDLINE, Embase, the Cochrane Library, medRxiv, arXiv and ClinicalTrials.gov, with supplementary screening of reference lists. Results will be synthesised descriptively. The formal literature searches are planned for September 2026, with completion of study selection, data charting, evidence synthesis and preparation of the final review expected by December 2026. ETHICS AND DISSEMINATION: We will chart ethical aspects reported in included studies, such as governance of retrospective electronic health record use, consent waivers and privacy protections, where available. Findings will be disseminated through submission to a peer-reviewed journal, presentation at scientific meetings and open sharing of search strategies on the Open Science Framework. PROSPERO REGISTRATION NUMBER: This protocol was prospectively registered on the Open Science Framework in March 2026: Cascella M et al 'Artificial intelligence in perioperative pain: a scoping review protocol'. DOI: 10.17605/OSF.IO/SYZH8.
Journal of robotic surgeryOmar Abdelaziz, Ziad G Zayed, Ahmed Mohamed Altukhy, Salem Waleed Salem, Mohamed A Hanafy, Rofida Hamdy, Haytham Abdelrahman, Abdalla M Hadhoud
Although robotic-assisted total knee arthroplasty (RA-TKA) is increasingly adopted for its potential to improve surgical precision, its impact on functional outcomes compared with conventional TKA (C-TKA) remains unclear. Existing syntheses are limited by pooling observational and randomized data, focusing on absolute postoperative scores without evaluating recovery trajectories, and lacking rigorous exploration of heterogeneity. To overcome these limitations, we conducted a methodologically rigorous meta-analysis of randomized controlled trials (RCTs) only, incorporating comprehensive meta-regression, platform-specific subgroup analyses, and assessment of evidence certainty using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. PubMed, Web of Science, Scopus, the Cochrane Library, and Google Scholar (pages 1-50) were comprehensively searched from their inception up to December 27, 2025. Data were pooled using random-effects meta-analysis and Hartung-Knapp adjustments. Meta-regression of different moderators and subgroup analyses by robotic platforms were performed, when feasible, to identify sources of heterogeneity. A total of 24 RCTs encompassing 3,425 patients were included. The pooled analyses demonstrated no significant differences between RA-TKA and C-TKA for change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (MD 0.14; 95% CI - 5.88 to 6.16; p = 0.96), change in functional Knee Society Score (KSS) (MD 0.51; 95% CI - 3.43 to 4.44; p = 0.78), or change in Oxford Knee Score (OKS) (MD 2.07; 95% CI - 6.82 to 10.96; p = 0.51). Although a subgroup analysis revealed a significant improvement in OKS at 6 months only (MD 2.25; p = 0.01), this effect did not reach the minimal clinically important difference (MCID) and was not sustained at other time points. No significant differences were observed for range of motion, change in VAS pain score, KSS satisfaction, or length of hospital stay. Operative time was significantly longer for RA-TKA (MD 22.34 min; 95% CI 13.66 to 31.02; p < 0.01), though this estimate should be interpreted with caution given the very high heterogeneity (I² = 98.53%) and the likelihood that it includes cases performed during the early learning curve of robotic adoption. Trial Sequential Analysis suggested that this finding is unlikely to be attributable to random error, though the required information size was not reached. RA-TKA and C-TKA provide comparable functional improvement, pain relief, and most perioperative outcomes. The most consistent signal is a prolonged operative time with RA-TKA favoring conventional surgery, though the precise magnitude remains uncertain and may be influenced by the learning curve. The certainty of evidence is low to very low across all assessed outcomes, highlighting the need for cautious interpretation. Current evidence does not support the routine adoption of RA-TKA over C-TKA for TKA. Future adequately powered, multicenter RCTs with long-term follow-up and consistent reporting of surgeon experience are required to definitively clarify the role of RA-TKA in contemporary practice.
BMJ openCamille Montaland, Barbara Le Gallo, Antoine Tran, Isabelle Guellec, Louise-Emilie Dumas, Caroline Devos, Aline Joulie, William Lussiez, Eric Fontas, Jennifer …
INTRODUCTION: Peripheral intravenous cannulation (PIVC) is one of the most frequently performed procedures in paediatric emergency and hospital settings and is often associated with significant pain and anxiety in children. Non-pharmacological interventions may complement standard pain management strategies. This trial will evaluate the effectiveness of PARO, an interactive therapeutic robot, in reducing pain and anxiety during PIVC in children. The study aims to provide clinically relevant evidence to support the integration of socially assistive robots into paediatric pain management. METHODS AND ANALYSIS: This will be an open-label, multicentre, randomised controlled superiority trial conducted in five paediatric centres in France. A total of 120 children aged 12 months to 7 years requiring PIVC will be randomly assigned (1:1) to receive either standard pain management alone or standard pain management plus the PARO robot during the procedure. Randomisation will be stratified by age and centre using a centralised electronic system. Due to the nature of the intervention, blinding of participants and outcome assessors will not be feasible.The primary outcome will be the change in pain intensity assessed using the Face, Legs, Activity, Cry, Consolability scale between baseline (15 min before the procedure) and the time of cannulation. Secondary outcomes will include children's distress assessed using the Procedural Restraint Intensity in Children scale, changes in heart rate, number of attempts required for successful cannulation, parental anxiety assessed using the State Trait Anxiety Inventory questionnaire, parental satisfaction and healthcare professional satisfaction. Statistical analysis will be performed on an intention-to-treat basis using analysis of covariance adjusted for stratification factors, with results reported as effect estimates with 95% CIs. ETHICS AND DISSEMINATION: The study has received approval from the French National Agency for Medicines and Health Products Safety and the French Committee for the Protection of Personal Data (CPP Ouest I Tours) on 3 July 2025 (No. 25.02471.000436) and is registered at ClinicalTrials.gov (NCT07299006). Results will be disseminated through publication in peer-reviewed journals, presentation at national and international conferences, and communication to healthcare professionals, stakeholders and participants. TRIAL REGISTRATION NUMBER: NCT07299006.
MedicineYixin Chen, Huamei Yu, Lixian Dang, Lingling Li, Chenyang Li
OBJECTIVE: Chronic pain is a major global public health concern. Pain neuroscience education (PNE), a cognitive intervention grounded in the biopsychosocial model, has been increasingly applied to chronic pain management. However, its knowledge structure and research evolution have not been systematically delineated. This bibliometric study aimed to map the research landscape, identify hot topics and emerging trends, and provide evidence for clinical translation and research planning. METHODS: Publications on PNE in chronic pain were retrieved from the Web of Science Core Collection (2015-2026). A total of 409 articles were analyzed using Microsoft Excel, CiteSpace, VOSviewer, Bibliometrix, and SCImago Graphica to examine publication outputs, collaboration networks, keyword co-occurrence, clustering, burst detection, and citation patterns. RESULTS: Annual publications increased rapidly from 2018 to 2024, peaking in 2024. The United States, Spain, and Belgium were the most productive countries, with strong collaboration between North America and Europe, while Asian and low-and middle-income countries remained peripheral. Jo Nijs team was a central research force. Keyword analysis revealed 3 hotspots: predominant focus on chronic musculoskeletal pain; a shift from single PNE to multimodal regimens combining exercise and cognitive behavioral therapy; methodological validation of assessment tools serving as a critical hub linking research branches. Burst analysis indicated a transition from empirical accumulation to evidence synthesis with personalized interventions for older adults and adolescents as future frontiers. CONCLUSION: PNE research is advancing rapidly, shifting from efficacy validation toward implementation science and precision interventions. Current research shows a geographic imbalance; future efforts should enhance cross-regional knowledge translation. This study provides a clear knowledge map for researchers and evidence-based directions for optimizing pain management systems.
A&A practiceJudith Versloot, Simon Feng, Sara Hoondert, Taryn Araujo, Kathy Kure, Le Giuseppe Faldas, Ilyse Lax, Braeden A Terpou, Lucas Seuren, Karen Conway, Olga Livshit…
BACKGROUND AND OBJECTIVE: Peripheral nerve blocks (PNB) are recognized as best practice for managing pain in older adults with fragility hip fractures. Despite strong evidence, the adoption of PNB pre-operation has been slow due to several implementation barriers. This study addresses this gap by describing the co-design and implementation of a preoperative Mobile PNB Service led by anesthesiology in a Canadian community hospital. We aim to: (1) provide a transferable, anesthesia focused implementation roadmap; (2) identify key implementation activities that enable the delivery of PNBs outside the operating room; and (3) report formative feasibility and evaluation outcomes (blocks delivered, pain levels, adverse events, and opioids administered before and after block delivery. METHODS: The mobile PNB service is comprehensively described to enable replicability following the Template for Intervention Description and Replication (TIDieR) checklist. Key design and implementation activities are identified by matching the activities with theory informed implementation functions from the Behavior Change Wheel (BCW). The formative outcomes were tracked alongside block delivery and abstracted from the patients' chart. RESULTS: The multidisciplinary team led implementation activities primarily targeted enablement, education, and environmental restructuring to support the capability, opportunity, and motivation to deliver nerve blocks. The Mobile PNB Service was implemented feasibly, 76 blocks were delivered (44% Emergency Department (ED) and 56% ward) and safely, no procedure-related adverse events were observed. Early implementation was associated with increased uptake of preoperative PNBs and substantial reductions in patient-reported mean (SD) pain scores following block delivery from 7.1 (2.6) pre-block to 1.0 (2.0) post-block, and reduction in mean (SD) opioid administration following block delivery from 0.64 (0.90 milligrams per hour of oral morphine equivalents pre-block to 0.22 (0.49) milligrams per hour post-block. DISCUSSION: This study provides a replicable, theory-informed roadmap for closing the gap between guideline-recommended PNB and their delivery in non-operating room settings. An anesthesiology-led Mobile PNB Service was successfully implemented by addressing known system- and provider-level barriers using implementation frameworks. These findings underscore the value of theory-guided service design to identify essential components that enable behavior change and expand access to evidence-based analgesia for hip fracture patients.
Far more complex than merely a single system disorder, endometriosis requires a nuanced, patient-centered approach grounded in multidisciplinary care. Nurses play a vital role in this framework, working collaboratively with gynecologists, pain specialists, surgeons, mental health practitioners, and others in both operating room and clinic settings. Nurses' broad presence across the care spectrum uniquely positions them to address both physical and psychosocial challenges associated with endometriosis, contributing significantly to improved patient-centered outcomes. This article discusses nurses' roles as direct care clinicians, treatment coordinators, educators, and advocates, thereby helping to ensure that patients' values, preferences, and lived experiences inform all aspects of care planning and decision-making.
Current pain and headache reportsAbraham Hong, Amanda Okundaye, Fred E Shapiro
PURPOSE OF REVIEW: This review examines the perioperative implications of selected substances in the contemporary unregulated drug supply and outlines a physiology-based approach to preoperative assessment, risk recognition, and postoperative pain management. RECENT FINDINGS: Patients may be exposed intentionally or unknowingly to fentanyl and nitazenes, xylazine and medetomidine, kratom and concentrated 7-hydroxymitragynine products, tianeptine, phenibut, and other psychoactive substances. Clinically important patterns include respiratory depression, prolonged sedation, bradycardia, hypotension, opioid tolerance, withdrawal, and difficult postoperative pain. Polysubstance exposure, uncertain product composition, and limitations of routine toxicology screening may complicate identification of the responsible substance. Perioperative assessment should emphasize specific, nonjudgmental history taking, recognition of physiologic patterns, and individualized risk stratification rather than reliance on identification of a specific substance. Perioperative planning should integrate physiologic findings with the limitations of toxicology testing and distinguish surgical pain from tolerance, withdrawal, opioid-induced hyperalgesia, and delirium. Awareness of a geographically variable and rapidly evolving drug supply is increasingly important for safe perioperative care.
Annals of family medicineHee Joo Ko, Jhia L N Jackson, Ariana Thompson-Lastad, Jesse Wennik, Pamela Swedlow, Maria T Chao
PURPOSE: Social support is associated with improved outcomes for people with chronic pain and is an important but understudied component of biopsychosocial pain care. We sought to explore how group medical visits facilitate 4 distinct types of social support-emotional, appraisal, informational, and instrumental-among primary care patients with chronic pain. METHODS: We collected qualitative data within a randomized trial of integrative group medical visits for chronic pain, focusing on 2 cohorts of English-speaking patients randomized to group medical visits. Data came from 16 observed group medical visits, 2 focus groups, and 12 semistructured interviews. The group medical visit intervention entailed 12 weekly sessions combining clinical care, pain education, mindfulness meditation, therapeutic movement, and facilitated discussion. We analyzed data using team-based flexible coding and codebook thematic analysis. RESULTS: The 26 participating patients were predominantly low-income (80.8% had an annual household income of less than $50,000); 50.0% identified as Black or African American, 15.4% as Hispanic or Latine, and 23.1% as White. On average, they had severe pain with a mean intensity rating of 7.7 out of 10. All 4 social support types emerged through structured program components (curriculum, facilitation strategies, program structure) and interactions among peers and facilitators. Emotional support fostered belonging and countered isolation and stigma. Appraisal support normalized struggles and fostered self-compassion. Informational support combined interactive education with peer-to-peer knowledge exchange. Instrumental support provided concrete assistance. CONCLUSIONS: Our findings illustrate how group medical visits for chronic pain mobilize 4 interwoven and reinforcing forms of social support as core therapeutic processes. They also highlight group medical visits as a potential model for biopsychosocial chronic pain management among primary care patients.
Neurosurgical reviewJuan Pablo Martinez, Jose Alfonso Alvarez-Castro, Maria Lizeth Nieves-Pimienta, Jorge Alejandro Velasco-Calvo, Daniel Aragón-Ortega, Diego Pichardo-Rojas, Mari…
Trigeminal neuralgia (TN) is a chronic pain disorder characterized by recurrent pain. The most common stereotactic radiosurgery (SRS) targets for treatment are proximal and distal; however, there are important discrepancies among authors in the appraisal of the different targets used. A meta-analysis is warranted to evaluate the comparative effectiveness between these targets. Databases were searched until March 6, 2024, to identify studies that compared outcomes for patients with TN treated with SRS between proximal and distal targets. The outcomes included pain relief (PR), pain freedom (PF), facial numbness (FN) and medication de-escalation. Of the 539 screened articles, 6 retrospective cohorts met our inclusion criteria, considering 1055 patients for analysis. Pain relief at 30 days was significantly higher in patients who underwent distal compared to proximal SRS (RR = 1.37, 95%CI: 1.14-1.65; P = 0.001). In pain relief at 90 days, there was no significant difference between targets (RR = 1.11, 95%CI: 0.92-1.34, P = 0.30), nor the rate of PF at last follow-up (RR = 1.24, 95%CI: 0.70-2.20; P = 0.46). The rate of facial numbness did not differ between targets (RR = 1.10, 95%CI: 0.63-1.92, P = 0.75) in both targets. Medication de-escalation rates were not statistically different between targets (RR = 1.29, 95% CI: 0.86-1.94). Our analysis demonstrated significantly greater pain relief at 30 days when distal targeting was used. Given its improved early pain control and comparable safety profile, distal targeting may be preferred when rapid pain relief is a primary treatment objective. However, both targets demonstrated similar efficacy at 90 days and comparable long-term safety outcomes.
MedicineDa-Eun Yoon, Yoonjeong Seo, Heeyoung Moon, Shin Ho Kong, Changwoo Nam, Joowon Hwang, Karam Kim, Man-Heum Kwon, Hyun-Woo Jin, Yeonhee Ryu, In-Seon Lee, Younbyou…
In Traditional East Asian Medicine, acupoints are selected based on clinical symptoms and pattern identification. Since treatment plans target specific diseases and patterns, acupoints may be selected based on clinical indications or pattern-related considerations. This study aimed to examine the associations between acupoint use and deficiency-excess, cold-heat, and dryness-dampness pattern scores. Data were collected from the medical records of 423 outpatients with various pain disorders. Clinicians assigned semi-quantitative scores for deficiency-excess, cold-heat, and dryness-dampness on a -5 to +5 scale as part of the study assessment. Mean scores across the 3 pattern dimensions were calculated for the 30 most frequently prescribed acupoints, followed by hierarchical clustering. Two- to six-cluster solutions were compared using silhouette scores, and a five-cluster partition was retained for descriptive interpretation and further assessed for bootstrap stability. Across the 423 cases, ST36, LR3, and LI4 were the most commonly used acupoints for pain management. These 30 acupoints showed heterogeneous profiles across the 3 pattern dimensions. Hierarchical clustering provided an exploratory five-group representation, although no uniquely optimal cluster solution was identified. Commonly used acupoints showed heterogeneous profiles across clinician-assigned deficiency-excess, cold-heat, and dryness-dampness scores. These findings provide an exploratory description of pattern-related tendencies in real-world acupoint selection. Further prospective studies using standardized pattern assessment and adjustment for disease- and clinician-related factors are required to validate these associations.
Medicina (Kaunas, Lithuania)Sarah Kazemeini, Ryan Shih, Sunny Zhang, Raphael Cohen, Nathaniel LaBarre, Moonis Ghani, George Tsao
Background and Objectives: Postoperative pain and opioid requirements can vary widely, even among patients undergoing similar procedures. This narrative review examines how biological sex, age, frailty, chronic pain, preoperative opioid exposure, and psychological factors may affect postoperative pain, opioid response, and recovery. Materials and Methods: PubMed and Google Scholar were searched from database inception through 18 June 2026. Relevant systematic reviews, meta-analyses, clinical guidelines, randomized trials, and observational studies involving adult surgical patients were included, with a focus on postoperative pain, opioid use, adverse effects, persistent pain, and functional recovery. Human perioperative evidence was prioritized, while experimental and preclinical evidence was used selectively to explain relevant biological mechanisms. Results: The available evidence was heterogeneous across patient populations, surgical procedures, analgesic techniques, and outcome definitions. No single patient characteristic consistently predicts postoperative pain or opioid requirements. Female sex is associated with a greater risk of postoperative nausea and vomiting, but reported differences in pain and opioid efficacy are inconsistent. Older and frail patients may be more susceptible to sedation, respiratory depression, delirium, and other opioid-related adverse effects. Patients with chronic pain or prior opioid exposure often have more difficult postoperative pain control because of tolerance, dependence, or possible opioid-induced hyperalgesia. Anxiety, depression, and pain catastrophizing may also contribute to greater pain and poorer recovery, although their relationship with opioid consumption is less consistent. Conclusions: Perioperative analgesia should be based on the patient's overall clinical picture rather than any single risk factor. The proposed framework is conceptual and has not been clinically validated. Considering these characteristics together may help clinicians select appropriate multimodal treatments, anticipate analgesic needs, monitor for adverse effects, and support recovery.
Medical science monitor : international medical journal of experimental and clinical researchHassan A Moria
BACKGROUND Cooled genicular radiofrequency ablation (CRFA) is used to treat symptomatic knee osteoarthritis (OA), although treatment response may decline over time. This study evaluated 24-month outcomes of CRFA alone versus CRFA combined with intra-articular botulinum toxin type A (BoNT-A). MATERIAL AND METHODS In this retrospective observational comparative-effectiveness cohort study, 90 patients with moderate-to-severe knee OA underwent CRFA alone (n = 50) or CRFA plus intra-articular BoNT-A (n=40). The combination group received BoNT-A at baseline and a planned repeat injection at ~12 months. Pain and function were assessed using the Numerical Rating Scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The primary durability endpoint was the between-group difference in longitudinal NRS trajectories over 24 months, assessed using adjusted mixed-effects modeling. RESULTS Both groups demonstrated substantial early improvement; outcome trajectories diverged after ~12 months. Significant treatment-by-time interactions were observed for NRS (ß=-0.84, 95% confidence interval [CI] -1.21 to -0.47; P=0.0002) and WOMAC outcomes (ß=-6.3, 95% CI -9.4 to -3.2; P=0.0003). At 24 months, mean observed NRS scores were 4.2±2.3 after CRFA alone and 1.8±0.9 after CRFA plus BoNT-A; responder rates were 51.1% and 86.5%, respectively (P=0.0004). CONCLUSIONS In this retrospective observational cohort, a longitudinal treatment pathway combining CRFA with intra-articular BoNT-A was associated with more sustained pain relief and functional improvement over 24 months than CRFA alone. Prospective randomized studies are needed to confirm these findings and clarify the independent contributions of adjunctive and repeat intra-articular BoNT-A.
PloS oneOlivia Young, Katherine O'Connell, Naomi Nero, Melinda C Somers, Paige A Freeburg, Mary Ann Dutton, Abigail A Marsh
Loving-Kindness Meditation (LKM), a contemplative practice that aims to promote social well-being, has also been linked to lower self-reported pain symptoms. However, it remains unknown whether LKM can reduce pain through having a positive impact on social well-being, as well as whether LKM can improve self-reported acute pain and objectively measured acute pain tolerance among a general, healthy population. In this study (ClinicalTrials.gov; NCT04632875), participants (n = 69) completed either a 4-week online LKM training or an active control meditation training (Progressive Muscle Relaxation; PMR), followed by a novel, remote pain induction task: the wall sit test administered over video conference. This study used a two-arm, parallel-group randomized controlled trial design with stratified block randomization and a double-blind baseline session. We hypothesized that, relative to the PMR active control, LKM would improve social well-being, reduce subjective pain reports, and improve acute pain tolerance. Contrary to our hypotheses, the PMR active control training increased perceived social support relative to LKM (p = .028), and neither meditation decreased subjective pain or increased acute pain tolerance over time. Our data were collected during the unique circumstance of the early COVID-19 pandemic, and it is important to interpret our results with consideration of widespread restrictions on in-person social contact and elevated stress during this period. This context may have constrained participants' opportunities for social connection and influenced reports of social support and pain. Nevertheless, our findings add to the current understanding of how meditation, social wellness, and pain may be related.
Current pain and headache reportsMary O'Dell Duplechin, Sydney A Mashaw, Sydney J Schwab, Andre J Mira, Macie A Serio, Shahab Ahmadzadeh, Benjamin C Miller, Sahar Shekoohi, Alan D Kaye
BACKGROUND: Thoracic surgeries and chest wall traumas often result in severe postoperative pain, leading to significant morbidity and prolonged hospital stays. Intercostal nerve blocks have been a common strategy for managing this pain. In this regard, the ESPB is being utilized increasingly as a promising alternative as it offers more extensive pain relief and has a better safety profile. OBJECTIVE: A meta-analysis comparing analgesic efficacy, measured by pain scores and opioid consumption, as well as hospital length of stay and time spent under analgesia, between ESPB and ICNB in patients undergoing thoracic surgeries and chest wall trauma was performed. METHODS: A systematic literature search was conducted across three databases, identifying 2,141 potential studies. After eliminating duplicates (n = 728), the remaining studies were screened in two stages: initially by reviewing abstracts and titles (n = 1,413), followed by a full-text review of the remaining studies (n = 10). These selected studies assessed postoperative pain scores and opioid consumption. Pain was measured using the Numeric Rating Scale (NRS) and Visual Analog Scale (VAS) at 1 h, 24 h, and 48 h postoperatively, while opioid consumption was quantified in intravenous morphine milligram equivalents at 24 and 48 h. RESULTS: The ESPB demonstrated significantly lower pain scores at 1 h (P < 0.00001), 24 h (P < 0.00001), and 48 h (P = 0.0008) postoperatively compared to the ICNB. Postoperative opioid consumption, measured in intravenous morphine milligram equivalents at 24 h (P = 0.10) and 48 h (P = 0.20) showed no significant difference between the two groups. Additionally, there were no significant differences observed in hospital stay duration (P = 0.06) or time spent under analgesia (P = 0.33). CONCLUSION: While ESPB provides superior pain relief at all measured time points postoperatively, there were no significant differences in postoperative opioid consumption, hospital stay, or time under analgesia between ESPB and ICNB. Both techniques effectively manage thoracic pain, but ESPB offers enhanced analgesic effects. Further research is necessary to refine these techniques and establish clearer guidelines for their use in specific clinical contexts.