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Southern Medical Journal Apr 2021This study evaluated both randomized and nonrandomized trials of battlefield acupuncture for the treatment of both acute and chronic pain. Studies published between May... (Review)
Review
This study evaluated both randomized and nonrandomized trials of battlefield acupuncture for the treatment of both acute and chronic pain. Studies published between May 2016 and November 2019 were found through PubMed, the Cochrane Library, or Scopus, concerned with the treatment of pain using auricular acupuncture in accordance with battlefield acupuncture protocol. Search terms were AND or AND . Case reports, literature reviews, meta-analyses, and expert opinions were not included. Bias risk was assessed using the . We found 12 studies with a combined sample size of 12,326. All five of the included nonrandomized trials reported positive outcomes, while five of seven of the included randomized trials reached statistical significance in their primary outcome. Six of the randomized trials were considered to have a high risk of bias resulting from the lack of blinding. The one randomized trial with moderate bias risk was a positive study. No severe adverse events were reported. Clinicians may consider battlefield acupuncture as a safe treatment for pain while the evidence base grows; however, we conclude that widespread adoption of battlefield acupuncture will require further high-quality studies drawing from diverse settings and patient populations. In addition, future studies should attempt to achieve blinding.
Topics: Acupuncture, Ear; Acute Pain; Chronic Pain; Humans; Treatment Outcome
PubMed: 33787939
DOI: 10.14423/SMJ.0000000000001232 -
Medicina (Kaunas, Lithuania) Sep 2023In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency... (Review)
Review
In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992-2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management.
Topics: Humans; Pain Management; Acute Pain; Analgesics, Opioid; Analgesia; Emergency Service, Hospital
PubMed: 37893464
DOI: 10.3390/medicina59101746 -
American Family Physician Aug 2023
Topics: Humans; Acute Pain; Pelvic Pain
PubMed: 37590859
DOI: No ID Found -
Current Pain and Headache Reports Sep 2023Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This... (Review)
Review
PURPOSE OF REVIEW
Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD.
RECENT FINDINGS
This narrative review captures a subset of recent advances in the field targeting the literature on patients' risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. To reduce OUD, providers should evaluate both the individual patient's risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.
Topics: Humans; Male; Acute Pain; COVID-19; Opioid-Related Disorders; Analgesics, Opioid; Analgesics; Risk Factors
PubMed: 37392334
DOI: 10.1007/s11916-023-01127-0 -
Journal of Burn Care & Research :... Jul 2023Patients with burns suffer from excruciating pain, thus presenting unique challenges to the hospital staff involved in their care. Any hospital system may be involved in... (Review)
Review
Patients with burns suffer from excruciating pain, thus presenting unique challenges to the hospital staff involved in their care. Any hospital system may be involved in managing smaller and less serious burns, but patients with more complicated issues are often transferred to a burn center. This article will review the pathophysiological evolution of pain immediately after burn injury to emphasize the role of complex inflammatory pathways involved in the progression of burn pain. This review also focuses on managing acute pain using a combined multimodal and regional pain management approach. Finally, we attempt to address the continuum from acute to chronic pain management and the strategies used to minimize and manage the progression to chronic pain. Chronic pain remains a debilitating outcome of burn injury, and this article discusses efforts to mitigate this complication. Available options for pain treatment are important to discuss, as current drug shortages may limit medications that can be used.
Topics: Humans; Adult; Pain Management; Chronic Pain; Burns; Anesthesia, Conduction; Acute Pain
PubMed: 37191659
DOI: 10.1093/jbcr/irad069 -
Regional Anesthesia and Pain Medicine Apr 2020In 2016, individual training programs in regional anesthesiology and acute pain medicine (RA/APM) became eligible for accreditation by the Accreditation Council for... (Review)
Review
INTRODUCTION
In 2016, individual training programs in regional anesthesiology and acute pain medicine (RA/APM) became eligible for accreditation by the Accreditation Council for Graduate Medical Education (ACGME), thereby culminating a process that began 15 years earlier. Herein, we review the origins of regional anesthesia training in the USA, the events leading up to accreditation and the current state of the fellowship.
METHODS
We reviewed pertinent literature on the historical aspects of RA/APM in the USA, related subspecialty training and the formation and current state of RA/APM fellowship training programs. Additionally, a survey was distributed to the directors of the 74 RA/APM fellowships that existed as of 1 January 2017 to gather up-to-date, program-specific information.
RESULTS
The survey yielded a 76% response rate. Mayo Clinic Rochester and Virginia Mason Medical Center likely had the first structured RA/APM fellowships with formalized curriculums and stated objectives, both starting in 1982. Most programs (86%), including ACGME and non-ACGME fellowships, came into existence after the year 2000. Six responding programs have or previously had RA/APM comingled with another subspecialty. Eight current programs originally offered unofficial or part-time fellowships in RA/APM, with fellows also practicing as attending physicians.
DISCUSSION
The history of RA/APM training in the USA is a tortuous one. It began with short 'apprenticeships' under the tutelage of the early proponents of regional anesthesia and continues today with 84 official RA/APM programs and a robust fellowship directors' group. RA/APM programs teach skills essential to the practice and improvement of anesthesiology as a specialty.
Topics: Accreditation; Acute Pain; Anesthesia, Conduction; Anesthesiology; Curriculum; Education; Fellowships and Scholarships; History, 20th Century; History, 21st Century; Humans; Surveys and Questionnaires; United States
PubMed: 32001624
DOI: 10.1136/rapm-2019-100915 -
Journal of Dentistry Aug 2022The effects of hypnosis on acute pain have been discussed recently, resulting in increased attention in the dental/maxillofacial field offering new perspectives,... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION/OBJECTIVES
The effects of hypnosis on acute pain have been discussed recently, resulting in increased attention in the dental/maxillofacial field offering new perspectives, especially in emergency situations, trauma, or acute inflammatory situations where conventional pharmaceuticals are contraindicated due to allergies or intolerance reactions.
DATA
To systematically evaluate and assess the effects of hypnosis on acute dental/facial pain relief. Randomized controlled trials, cohort studies, controlled clinical trials, cross-sectional studies, evaluation, and validation studies, following the PRISMA guidelines, of human subjects of all ages were included.
SOURCES
Five electronic databases (Cochrane, Embase, MEDLINE via PubMed, LILACS, Scopus) were screened for studies published between 1989 - 2021. A NIH quality-assessment-tool was performed.
STUDY SELECTION/RESULTS
27 papers have been included and a meta-analysis was performed. Hypnosis has been reported to reduce intraoperative and postoperative pain as well as the use of analgesics in various dental procedures such as tooth extraction. Highly hypnotizable subjects generally respond better to hypnosis. Different hypnosis techniques were used for pain relief and relaxation. The studies show a large heterogeneity.
CONCLUSION
Although there are only a small number of studies on the subject so far, evidence can be confirmed for the effects of hypnosis on acute pain relief in dental/maxillofacial area. Despite the promising results, further research is needed.
CLINICAL SIGNIFICANCE
Hypnosis offers a possible alternative to conventional pain medications for acute dental and maxillofacial pain, especially in cases of allergies or contraindications; it can be easily applied by a trained practitioner.
Topics: Acute Pain; Cross-Sectional Studies; Humans; Hypersensitivity; Hypnosis; Pain Management
PubMed: 35691451
DOI: 10.1016/j.jdent.2022.104184 -
Deutsches Arzteblatt International Dec 2023More than half of all emergency department patients seek help for acute pain, which is usually of musculoskeletal origin. Acute pain is often inadequately treated even... (Review)
Review
BACKGROUND
More than half of all emergency department patients seek help for acute pain, which is usually of musculoskeletal origin. Acute pain is often inadequately treated even today, particularly in children and in older patients. In this study, we assess the potential role of regional anesthetic methods in improving the treatment of pain in the preclinical and clinical emergency setting.
METHODS
Pain-related reasons for admission were identified and quantified from emergency admission data. A structured literature search was carried out for clinical studies on the treatment of pain in the emergency setting, and a before-and-after comparison of the pain relief achieved with established vs. newer regional anesthetic methods was performed.
RESULTS
43% of emergency patients presented with acute musculoskeletal pain. The literature search yielded 3732 hits for screening; data on entity-specific pain therapy spectra were extracted from 153 studies and presented for the main pain regions. The degree of pain relief obtained through regional anesthetic procedures, on a nominal rating scale from 0 to 10, was 4 to 7 points for acute back and chest wall pain, >6 for shoulder pain, 5 to 7 for hand and forearm injuries, and >4 for hip fractures. These results were as good as, or better than, those obtained by analgesia/sedation with strong opioids.
CONCLUSION
Modern regional anesthetic techniques can improve acute pain management in the emergency department and, to some extent, in the pre-hospital setting as well. Pain relief with these techniques is quantifiably better than with strong opioids in some clinical situations; moreover, there is evidence of further advantages including process optimization and fewer complications. Data for comparative study remain scarce because of a lack of standardization.
Topics: Child; Humans; Aged; Pain Management; Acute Pain; Anesthesia, Conduction; Anesthetics, Local; Emergency Service, Hospital; Analgesics, Opioid; Hospitals
PubMed: 37850298
DOI: 10.3238/arztebl.m2023.0221 -
Paediatric Anaesthesia Sep 2022Providing effective acute pain management to hospitalized children can help improve outcomes, decrease length of stay, and increase patient and parental satisfaction.... (Review)
Review
Providing effective acute pain management to hospitalized children can help improve outcomes, decrease length of stay, and increase patient and parental satisfaction. Error traps (circumstances that lead to erroneous actions or undesirable consequences) can result in inadequately controlled pain, unnecessary side effects, and adverse events. This article highlights five error traps encountered when managing acute pain in children. They include failure to appropriately assess pain, optimally utilize regional anesthesia, select suitable systemic analgesics, identify and treat medication-related side effects, and consider patient characteristics when choosing medication or dosing route. These issues are easily addressed when the clinician is cognizant of ways to anticipate, identify, and mitigate or avoid these errors.
Topics: Acute Pain; Analgesics; Analgesics, Opioid; Child; Humans; Pain Management; Pain Measurement; Syndrome
PubMed: 35751474
DOI: 10.1111/pan.14514 -
Advances in Anesthesia Dec 2023Acute pain can have many etiologies that include surgical procedures, trauma (motor vehicle accident), musculoskeletal injuries (rib fracture) and, burns among others.... (Review)
Review
Acute pain can have many etiologies that include surgical procedures, trauma (motor vehicle accident), musculoskeletal injuries (rib fracture) and, burns among others. Valuable components of a multimodal approach to acute pain management include both opioid and non-opioid medications, procedure specific regional anesthesia techniques (peripheral nerve blocks and neuraxial approaches), and interventional approaches (eg, peripheral nerve stimulation and cryo-neurolysis). Overall, successful acute perioperative pain management requires a multimodal, multidisciplinary approach that involves a coordinated effort between the surgical team, the anesthesia team, nursing, and pharmacy staff using Enhanced Recovery After Surgery (ERAS) protocols.
Topics: Humans; Pain Management; Transcutaneous Electric Nerve Stimulation; Accidents, Traffic; Acute Pain; Anesthesia, Conduction
PubMed: 38251624
DOI: 10.1016/j.aan.2023.06.006