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Current Pain and Headache Reports Aug 2023We aim to present current understanding and evidence for meditation, mostly referring to mindfulness meditation, for the management of acute pain and potential... (Review)
Review
PURPOSE OF REVIEW
We aim to present current understanding and evidence for meditation, mostly referring to mindfulness meditation, for the management of acute pain and potential opportunities of incorporating it into the acute pain service practice.
RECENT FINDINGS
There is conflicting evidence concerning meditation as a remedy in acute pain. While some studies have found a bigger impact of meditation on the emotional response to a painful stimulus than on the reduction in actual pain intensities, functional Magnet Resonance Imaging has enabled the identification of various brain areas involved in meditation-induced pain relief. Potential benefits of meditation in acute pain treatment include changes in neurocognitive processes. Practice and Experience are necessary to induce pain modulation. In the treatment of acute pain, evidence is emerging only recently. Meditative techniques represent a promising approach for acute pain in various settings.
Topics: Humans; Acute Pain; Meditation; Mindfulness; Pain Management; Brain
PubMed: 37285010
DOI: 10.1007/s11916-023-01119-0 -
European Journal of Pain (London,... Aug 2021Distraction tasks that place continuous, high demand on executive resources have been shown to reduce pain intensity and pain unpleasantness ratings in some healthy...
BACKGROUND
Distraction tasks that place continuous, high demand on executive resources have been shown to reduce pain intensity and pain unpleasantness ratings in some healthy adult samples. We examined the effects of a high-demand 'working memory' 1-back task compared to a low-demand 'motor control' task on pain intensity and unpleasantness ratings in healthy children. Additionally, dispositional mindfulness was examined to explore the mechanisms of distraction on the affective processing of pain.
METHODS
Fifty-seven children (9-13 years old) experienced three randomly presented heat levels (not painful, slightly painful, moderately painful) during two distraction conditions involving different levels of cognitive load (a high load 'working memory' task and a low load 'motor' control task) in counter-balanced order. Children completed measures of dispositional mindfulness, and attentional control and emotional control.
RESULTS
As predicted, children's pain intensity and pain unpleasantness ratings were lower in the high load condition compared to the low load condition. These differences were amplified in the moderately painful heat trials. In contrast with predictions, dispositional mindfulness did not significantly predict the effectiveness of distraction. Dispositional mindfulness was significantly related to measures of children's attentional and emotional control abilities; however, an exploratory serial mediation model did not produce significant indirect or overall effects to suggest a strong influence of mindfulness on the effectiveness of distraction.
CONCLUSIONS
Results demonstrate that distraction that places higher demand on executive resources is more effective for acute pain management for children. Further research is needed to explore cognitive and affective moderators of the effectiveness of distraction for children.
SIGNIFICANCE
This study is one of the first to demonstrate that working-memory engagement can attenuate pain intensity and pain unpleasantness in children aged 9-13. The findings suggest that distraction tasks used in clinical settings for moderately painful medical procedures may benefit more children if they are adequately demanding of cognitive resources.
Topics: Acute Pain; Adolescent; Adult; Attention; Child; Cognition; Humans; Pain Management; Pain Measurement
PubMed: 33756023
DOI: 10.1002/ejp.1770 -
The Journal of Pain Aug 2021Patients undergoing thoracic surgery experience particular challenges for acute pain management. Availability of standardized diagnostic criteria for identification of... (Review)
Review
Patients undergoing thoracic surgery experience particular challenges for acute pain management. Availability of standardized diagnostic criteria for identification of acute pain after thoracotomy and video assisted thoracic surgery (VATS) would provide a foundation for evidence-based management and facilitate future research. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership with the United States Food and Drug Administration, the American Pain Society (APS), and the American Academy of Pain Medicine (AAPM) formed the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) initiative to address absence of acute pain diagnostic criteria. A multidisciplinary working group of pain experts was invited to develop diagnostic criteria for acute thoracotomy and VATS pain. The working group used available studies and expert opinion to characterize acute pain after thoracotomy and VATS using the 5-dimension taxonomical structure proposed by AAAPT (i.e., core diagnostic criteria, common features, modulating factors, impact/functional consequences, and putative mechanisms). The resulting diagnostic criteria will serve as the starting point for subsequent empirically validated criteria. PERSPECTIVE ITEM: This article characterizes acute pain after thoracotomy and VATS using the 5-dimension taxonomical structure proposed by AAAPT (ie, core diagnostic criteria, common features, modulating factors, impact and/or functional consequences, and putative mechanisms).
Topics: Acute Pain; Humans; Pain, Postoperative; Practice Guidelines as Topic; Societies, Medical; Thoracic Surgical Procedures
PubMed: 33848682
DOI: 10.1016/j.jpain.2021.03.148 -
PloS One 2022Untreated pain after surgery leads to poor patient satisfaction, longer hospital length of stay, lower health-related quality of life, and non-compliance with...
Untreated pain after surgery leads to poor patient satisfaction, longer hospital length of stay, lower health-related quality of life, and non-compliance with rehabilitation regimens. The aim of this study is to characterize the structure of acute pain trajectories during the postsurgical hospitalization period and quantify their association with pain at 30-days and 1-year after surgery. This cohort study included 2106 adult (≥18 years) surgical patients who consented to participate in the SATISFY-SOS registry (February 1, 2015 to September 30, 2017). Patients were excluded if they did not undergo invasive surgeries, were classified as outpatients, failed to complete follow up assessments at 30-days and 1-year following surgery, had greater than 4-days of inpatient stay, and/or recorded fewer than four pain scores during their acute hospitalization period. The primary exposure was the acute postsurgical pain trajectories identified by a machine learning-based latent class approach using patient-reported pain scores. Clinically meaningful pain (≥3 on a 0-10 scale) at 30-days and 1-year after surgery were the primary and secondary outcomes, respectively. Of the study participants (N = 2106), 59% were female, 91% were non-Hispanic White, and the mean (SD) age was 62 (13) years; 41% of patients underwent orthopedic surgery and 88% received general anesthesia. Four acute pain trajectory clusters were identified. Pain trajectories were significantly associated with clinically meaningful pain at 30-days (p = 0.007), but not at 1-year (p = 0.79) after surgery using covariate-adjusted logistic regression models. Compared to Cluster 1, the other clusters had lower statistically significant odds of having pain at 30-days after surgery (Cluster 2: [OR = 0.67, 95%CI (0.51-0.89)]; Cluster 3:[OR = 0.74, 95%CI (0.56-0.99)]; Cluster 4:[OR = 0.46, 95%CI (0.26-0.82)], all p<0.05). Patients in Cluster 1 had the highest cumulative likelihood of pain and pain intensity during the latter half of their acute hospitalization period (48-96 hours), potentially contributing to the higher odds of pain during the 30-day postsurgical period. Early identification and management of high-risk pain trajectories can help in ascertaining appropriate pain management interventions. Such interventions can mitigate the occurrence of long-term disabilities associated with pain.
Topics: Acute Pain; Adult; Cohort Studies; Female; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Quality of Life
PubMed: 35687544
DOI: 10.1371/journal.pone.0269455 -
Professioni Infermieristiche Apr 2022The measurement of pain is the fundamental prerequisite for its proper management. Since newborns are unable to communicate verbally, neonatal algometric scales have... (Review)
Review
INTRODUCTION
The measurement of pain is the fundamental prerequisite for its proper management. Since newborns are unable to communicate verbally, neonatal algometric scales have been developed. However, no gold standard has been identified yet.
OBJECTIVE
To identify and classify the most suitable and effective scales for different kinds of pain for term and preterm newborns in different clinical settings.
METHOD
The review was carried out between December 2019 and November 2020 by consulting the PubMed and CINAHL Database, combining Mesh terms and free text with appropriate inclusion and exclusion filters. The references reported in the articles found in the first part of the research were also analyzed, in order to identify further relevant studies.
RESULTS
:Out of 2442 papers initially identified, we included 45 articles, describing 50 pain assessment scales (34 for acute pain, 12 for procedural pain, 24 for prolonged/chronic pain and 19 for pain after surgery). Scales with higher evidence are N-PASS, NFCS, BIIP and PIPP for acute and procedural pain, N-PASS, ALPS-Neo, EDIN and EDIN6 for prolonged/chronic pain, and PIPP, CRIES and COMFORT for pain after surgery.
DISCUSSION
There is no unanimously accepted gold standard scale for neonatal pain. However, some are more suitable and effective: PIPP, NFCS, N-PASS and BIIP for acute pain; N-PASS, ALPS-Neo and EDIN/EDIN6 for chronic and prolonged pain; PIPP, CRIES and COMFORT for postoperative pain. Among all, N-PASS scale is the most complete and fits to different settings.
Topics: Infant, Newborn; Humans; Pain, Procedural; Acute Pain; Chronic Pain; Pain Measurement
PubMed: 36962062
DOI: 10.7429/pi.2022.751017 -
Neuroscience Letters Jan 2020Sickle cell disease is a uniquely complex painful disease, with lifelong episodes of unpredictable acute pain and superimposed chronic pain in adulthood. Both painful... (Review)
Review
Sickle cell disease is a uniquely complex painful disease, with lifelong episodes of unpredictable acute pain and superimposed chronic pain in adulthood. Both painful crises and chronic pain in sickle cell disease lack strong objective pathological correlates and their mechanisms are poorly understood. Opioids have emerged as the standard of care for severe acute pain in sickle cell disease and many patients with chronic pain are maintained on chronic opioid therapy. The strong association between recurrent acute pain and chronic pain in SCD blurs the distinction between acute and chronic opioid management paradigms. In addition, opioid management for SCD is dogged by stigma and concerns regarding addiction. This review aims to synthesize the broad literature on opioids to highlight the clinical complexity of opioid management in sickle cell disease and suggest directions for future research and clinical innovation.
Topics: Acute Pain; Analgesics, Opioid; Anemia, Sickle Cell; Chronic Pain; Humans; Pain Management
PubMed: 31593753
DOI: 10.1016/j.neulet.2019.134534 -
Best Practice & Research. Clinical... Sep 2019It is expected that the number of surgical procedures to diagnose, treat, and palliate cancers will increase in the near future. While many of those interventions can be... (Review)
Review
It is expected that the number of surgical procedures to diagnose, treat, and palliate cancers will increase in the near future. While many of those interventions can be performed with minimally invasive techniques, others require surgical large incisions and in some instances, they involve multiple areas of the body (i.e., tumor resections with flap reconstructions). Pain after major oncological procedures can be severe and many times difficult to treat as patients can present to the operating room with several conditions including preoperative pain (i.e., rapidly growing tumors and painful neuropathies), opioid tolerance, and contraindications to nonopioid analgesics or regional anesthesia. Inadequately treated postoperative pain is associated with activation of the sympathetic system, postoperative complications, large perioperative opioid use, and an increased risk of developing postoperative persistent pain. Furthermore, it has been theorized that poorly treated pain is associated with cancer recurrence and a reduced survival. Lastly, recent research questions the oncological safety of robotic surgery in gynecological procedures and indicates the need of open surgeries, which will be associated with an increased risk in moderate-to-severe postoperative pain. In conclusion, the management of acute postoperative pain in patients with cancer can be challenging.
Topics: Acute Pain; Drug Tolerance; Humans; Neoplasms; Pain Management; Pain, Postoperative
PubMed: 31785721
DOI: 10.1016/j.bpa.2019.07.018 -
Journal of General Internal Medicine Dec 2020Opioid use disorder (OUD), a leading cause of morbidity and mortality in the USA, can be effectively treated with buprenorphine. However, the same pharmacologic... (Review)
Review
Opioid use disorder (OUD), a leading cause of morbidity and mortality in the USA, can be effectively treated with buprenorphine. However, the same pharmacologic properties (e.g., high affinity, partial agonism, long half-life) that make it ideal as a treatment for OUD often cause concern among clinicians that buprenorphine will prevent effective management of acute pain with full agonist opioid analgesics. Because of this concern, many patients are asked to stop buprenorphine preoperatively or at the onset of acute pain, placing them at high risk for both relapse and a difficult transition back to buprenorphine after acute pain has resolved. The purpose of this review is to summarize the existing literature for acute pain and perioperative management in patients treated with buprenorphine for OUD and to provide practical management recommendations for generalist practitioners based on evidence and clinical experience. In short, evidence suggests that sufficient analgesia can be achieved with maintenance of buprenorphine and use of both opioid and non-opioid analgesic options for breakthrough pain. We recommend that clinicians (1) continue buprenorphine in the perioperative or acute pain period for patients with OUD; (2) use a multi-modal analgesic approach; (3) pay attention to care coordination and discharge planning when making an analgesic plan for patients with OUD treated with buprenorphine; and (4) use an individualized approach founded upon shared decision-making. Clinical examples involving mild and severe pain are discussed to highlight important management principles.
Topics: Acute Pain; Analgesics, Opioid; Buprenorphine; Humans; Opiate Substitution Treatment; Opioid-Related Disorders; Pain Management
PubMed: 32827109
DOI: 10.1007/s11606-020-06115-3 -
The Journal of Emergency Medicine Dec 2020
Topics: Acute Pain; Chest Pain; Humans; Thorax
PubMed: 32972787
DOI: 10.1016/j.jemermed.2020.07.034 -
Scandinavian Journal of Pain Apr 2023There appears to be an unwarranted focus on all chronic pain being a "chronification" of acute pain. Despite a plethora of studies on mechanisms to prevent this...
OBJECTIVES
There appears to be an unwarranted focus on all chronic pain being a "chronification" of acute pain. Despite a plethora of studies on mechanisms to prevent this "chronification" following surgery, the positive effects have been minimal. An alternate model to explain chronic pain is presented.
METHODS
Research in PUBMED and accessing data from the HUNTpain examination study.
RESULTS
Data from the HUNT pain examination study reveal that less than 25% of individuals with chronic pain in a general population can relate the onset to an acute event. Another theory explaining the origin of chronic pain is that of priming and the accumulation of events that can be predictors along a continuum before chronic pain is apparent. This theory is presented to refocus for better prevention and treatment of chronic pain.
CONCLUSIONS
"Chronification" cannot explain all cases of chronic/persistent pain. The plastic changes in the pain processing system can be seen as a continuum where at some point where an acute pain event is only one of several possible tipping points on this continuum that changes potential pain to perceived pain.
Topics: Humans; Chronic Pain; Acute Pain
PubMed: 36126651
DOI: 10.1515/sjpain-2022-0100