-
The Journal of Pain Sep 2017The dorsolateral prefrontal cortex (DLPFC) is a functionally and structurally heterogeneous region and a key node of several brain networks, implicated in cognitive,... (Review)
Review
UNLABELLED
The dorsolateral prefrontal cortex (DLPFC) is a functionally and structurally heterogeneous region and a key node of several brain networks, implicated in cognitive, affective, and sensory processing. As such, the DLPFC is commonly activated in experimental pain studies, and shows abnormally increased function in chronic pain populations. Furthermore, several studies have shown that some chronic pains are associated with decreased left DLPFC gray matter and that successful interventions can reverse this structural abnormality. In addition, studies have indicated that noninvasive stimulation of the left DLPFC effectively treats some chronic pains. In this article, we review the neuroimaging literature regarding the role of the DLPFC and its potential as a therapeutic target for chronic pain conditions, including studies showing the involvement of the DLPFC in encoding and modulating acute pain and studies demonstrating the reversal of DLPFC functional and structural abnormalities after successful interventions for chronic pain. We also review studies of noninvasive brain stimulation of the DLPFC showing acute pain modulation and some effectiveness as a treatment for certain chronic pain conditions. We further discuss the network architecture of the DLPFC, and postulate mechanisms by which DLPFC stimulation alleviates chronic pain. Future work testing these mechanisms will allow for more effective therapies.
PERSPECTIVE
The structure and function of the DLPFC is abnormal in some chronic pain conditions. Upon successful resolution of pain, these abnormalities are reversed. Understanding the underlying mechanisms and the role of this region can lead to the development of an effective therapeutic target for some chronic pain conditions.
Topics: Acute Pain; Chronic Pain; Humans; Neuroimaging; Pain Management; Prefrontal Cortex
PubMed: 28400293
DOI: 10.1016/j.jpain.2017.03.008 -
Journal of Feline Medicine and Surgery Jan 2022
Topics: Acute Pain; Animals; Pain Management
PubMed: 34937454
DOI: 10.1177/1098612X211066266 -
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 -
Clinical Medicine (London, England) Jul 2022Older adults may experience a number of physiological changes that influence how acute pain is perceived, diagnosed and managed by healthcare professionals....
Older adults may experience a number of physiological changes that influence how acute pain is perceived, diagnosed and managed by healthcare professionals. Understanding these differences enables the identification, assessment and treatment of acute pain in older adults. Combining careful selection of pain medications with appropriate titration and monitoring allows the analgesic needs of this group to be met.
Topics: Acute Pain; Aged; Analgesics; Humans; Pain Management; Pain Measurement
PubMed: 35882483
DOI: 10.7861/clinmed.22.4.ac-p -
European Review For Medical and... May 2021The aim of the study was to develop appropriate pain therapy and prevention plans; pain needs to be understood in terms of prevalence and associated predictor factors in...
OBJECTIVE
The aim of the study was to develop appropriate pain therapy and prevention plans; pain needs to be understood in terms of prevalence and associated predictor factors in hospital and primary care. The purpose of our research was to assess the prevalence of chronic, acute, and acute-on-chronic pain, and ascertain the effects of several factors on the likelihood of pain in an Italian Tertiary Care Hospital.
PATIENTS AND METHODS
This is a prevalence study in which the primary outcome was the prevalence rate of chronic pain inpatients. Fisher's exact tests and binomial logistic regression were performed for the prevalence measures, and to ascertain the effects of Hospital Unit, sex, age, surgery and preexisting chronic pain on the likelihood of pain during the hospitalization, respectively.
RESULTS
Chronic pain was reported in one-fifth of inpatients [21.7% (95% CI: 0.1764, 0.2625)], with a high prevalence of pain-related interference on sleep and emotional status. Nearly 70% of chronic pain patients accused acute-on-chronic pain [15.3% (95% CI: 0.1178, 0.1934)]. High pain prevalence rates were assessed at the time of the interview (37.3%; 95% CI: 0.3234, 0.4239) and in the last 24 hours of hospitalization (53.3%; 95% CI: 0.4814, 0.5850). A 2.7 and 2.6 higher odds to suffer from pain during the hospitalization were associated with surgery, and preexisting chronic, respectively.
CONCLUSIONS
This study raises awareness of the necessity to refine pain assessment and management in hospital and outpatient services. The promotion and enhancement of hospital-territory integration are essential for improving pain prescribing practices and increasing patient safety.
Topics: Acute Pain; Aged; Chronic Pain; Female; Hospitalization; Humans; Inpatients; Italy; Male; Middle Aged; Prevalence; Tertiary Care Centers
PubMed: 34109593
DOI: 10.26355/eurrev_202105_25952 -
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 -
Journal of Medical Toxicology :... Sep 2017Epidemic increases in opioid use in the USA and globally highlight the need for effective adjunctive therapies to opioid-based analgesia. Given the shortcomings of... (Review)
Review
Epidemic increases in opioid use in the USA and globally highlight the need for effective adjunctive therapies to opioid-based analgesia. Given the shortcomings of behavioral adjuncts to opioid-based pain treatment, an urgent need exists for pain-related behavioral interventions that resonate with broad patient populations, can be delivered confidentially in any environment, and can incorporate new content automatically. Understanding the potential for automated behavioral therapies like music therapy in modulating the experience of pain may unlock methods to transition patients to lower doses of pharmacologic therapy or provide alternatives to opioids during acute exacerbations of pain. This manuscript describes the neurologic mechanism of action, theoretical basis, and potential applications of personalized music as a smartphone-based mHealth intervention for acute and chronic pain management.
Topics: Acute Pain; Affect; Analgesics, Opioid; Chronic Pain; Combined Modality Therapy; Humans; Mobile Applications; Music Therapy; Opioid-Related Disorders; Pain Management; Pain Measurement; Pain Perception; Pain Threshold; Patient Care Team; Smartphone; Telemedicine; Treatment Outcome
PubMed: 28646359
DOI: 10.1007/s13181-017-0621-9 -
Scientific Reports Apr 2022Few studies have investigated factors associated with acute postsurgical pain (APSP) trajectories, and whether the APSP trajectory can predict chronic postsurgical pain...
Few studies have investigated factors associated with acute postsurgical pain (APSP) trajectories, and whether the APSP trajectory can predict chronic postsurgical pain (CPSP) remains unclear. We aimed to identify the predictors of APSP trajectories in patients undergoing gastrointestinal surgery. Moreover, we hypothesised that APSP trajectories were independently associated with CPSP. We conducted a prospective cohort study of 282 patients undergoing gastrointestinal surgery to describe APSP trajectories. Psychological questionnaires were administered 1 day before surgery. Meanwhile, demographic characteristics and perioperative data were collected. Average pain intensity during the first 7 days after surgery was assessed by a numeric rating scale (NRS). Persistent pain intensity was evaluated at 3 and 6 months postoperatively by phone call interview. CPSP was defined as pain at the incision site or surrounding areas of surgery with a pain NRS score ≥ 1 at rest. The intercept and slope were calculated by linear regression using the least squares method. The predictors for the APSP trajectory and CPSP were determined using multiple linear regression and multivariate logistic regression, respectively. Body mass index, morphine milligram equivalent (MME) consumption, preoperative chronic pain and anxiety were predictors of the APSP trajectory intercept. Moreover, MME consumption and preoperative anxiety could independently predict the APSP trajectory slope. The incidence of CPSP at 3 and 6 months was 30.58% and 16.42% respectively. APSP trajectory and age were predictors of CPSP 3 months postoperatively, while female sex and preoperative anxiety were predictive factors of CPSP 6 months postoperatively. Preoperative anxiety and postoperative analgesic consumption can predict APSP trajectory. In addition, pain trajectory was associated with CPSP. Clinicians need to stay alert for these predictors and pay close attention to pain resolution.
Topics: Acute Pain; Chronic Pain; Digestive System Surgical Procedures; Female; Humans; Infant; Pain Measurement; Pain, Postoperative; Prospective Studies; Risk Factors
PubMed: 35444171
DOI: 10.1038/s41598-022-10504-5 -
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