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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 -
Advances in Clinical and Experimental... 2015Pain management originated at the turn of the 1960s and 70s in the United States, and spread to Western Europe almost a decade later. It is estimated today that a lack... (Review)
Review
Pain management originated at the turn of the 1960s and 70s in the United States, and spread to Western Europe almost a decade later. It is estimated today that a lack of adequate pain management affects 80% of the global population, and is a serious problem in over 150 countries. At the national level, the greatest burden of inadequate pain management is borne by the elderly, pregnant and breastfeeding women, children, people coping with addictions to harmful substances, and the mentally ill. In spite of enormous progress, there are still significant barriers to comprehensive pain management. Pain management should be considered a priority. It is an interdisciplinary task requiring the cooperation of the whole medical staff. The current review of literature revealed a number of factors limiting the possibility of achieving effective pain management, related to healthcare systems, medical staff and patients.
Topics: Acute Pain; Clinical Competence; Female; Health Services Needs and Demand; Humans; Internationality; Pain Management; Pain, Postoperative; Physician-Nurse Relations; Pregnancy
PubMed: 26768644
DOI: 10.17219/acem/26394 -
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 -
American Journal of Physiology.... Jul 2018Sickle cell disease (SCD) is a genetic disorder associated with hemolytic anemia, end-organ damage, reduced survival, and pain. One of the unique features of SCD is... (Review)
Review
Sickle cell disease (SCD) is a genetic disorder associated with hemolytic anemia, end-organ damage, reduced survival, and pain. One of the unique features of SCD is recurrent and unpredictable episodes of acute pain due to vasoocclusive crisis requiring hospitalization. Additionally, patients with SCD often develop chronic persistent pain. Currently, sickle cell pain is treated with opioids, an approach limited by adverse effects. Because pain can start at infancy and continue throughout life, preventing the genesis of pain may be relatively better than treating the pain once it has been evoked. Therefore, we provide insights into the cellular and molecular mechanisms of sickle cell pain that contribute to the activation of the somatosensory system in the peripheral and central nervous systems. These mechanisms include mast cell activation and neurogenic inflammation, peripheral nociceptor sensitization, maladaptation of spinal signals, central sensitization, and modulation of neural circuits in the brain. In this review, we describe potential preventive/therapeutic targets and their targeting with novel pharmacologic and/or integrative approaches to ameliorate sickle cell pain.
Topics: Acute Pain; Analgesics; Anemia, Sickle Cell; Animals; Chronic Pain; Disease Models, Animal; Humans; Molecular Targeted Therapy; Pain Management; Pain Perception; Pain Threshold; Risk Factors; Signal Transduction; Treatment Outcome
PubMed: 29590553
DOI: 10.1152/ajpregu.00021.2018 -
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 -
Pain Medicine (Malden, Mass.) Nov 2020Low back pain is one of the most common reasons for which people visit their doctor. Between 12% and 15% of the US population seek care for spine pain each year, with... (Review)
Review
OBJECTIVE
Low back pain is one of the most common reasons for which people visit their doctor. Between 12% and 15% of the US population seek care for spine pain each year, with associated costs exceeding $200 billion. Up to 80% of adults will experience acute low back pain at some point in their lives. This staggering prevalence supports the need for increased research to support tailored clinical care of low back pain. This work proposes a multidimensional conceptual taxonomy.
METHODS
A multidisciplinary task force of the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) with clinical and research expertise performed a focused review and analysis, applying the AAAPT five-dimensional framework to acute low back pain.
RESULTS
Application of the AAAPT framework yielded the following: 1) Core Criteria: location, timing, and severity of acute low back pain were defined; 2) Common Features: character and expected trajectories were established in relevant subgroups, and common pain assessment tools were identified; 3) Modulating Factors: biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: domains of impact were outlined and defined; 5) Neurobiological Mechanisms: putative mechanisms were specified including nerve injury, inflammation, peripheral and central sensitization, and affective and social processing of acute low back pain.
CONCLUSIONS
The goal of applying the AAAPT taxonomy to acute low back pain is to improve its assessment through a defined evidence and consensus-driven structure. The criteria proposed will enable more rigorous meta-analyses and promote more generalizable studies of interindividual variation in acute low back pain and its potential underlying mechanisms.
Topics: Acute Pain; Adult; Humans; Low Back Pain; Lower Extremity; Pain Measurement
PubMed: 32914195
DOI: 10.1093/pm/pnaa239 -
Pain Medicine (Malden, Mass.) Mar 2021Define and contrast acute pain trajectories vs. the aggregate pain measurements, summarize appropriate linear and nonlinear statistical analyses for pain trajectories at...
OBJECTIVE
Define and contrast acute pain trajectories vs. the aggregate pain measurements, summarize appropriate linear and nonlinear statistical analyses for pain trajectories at the patient level, and present methods to classify individual pain trajectories. Clinical applications of acute pain trajectories are also discussed.
SETTING
In 2016, an expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM) established an initiative to create a pain taxonomy, named the ACTTION-APS-AAPM Pain Taxonomy (AAAPT), for the multidimensional classification of acute pain. The AAAPT panel commissioned the present report to provide further details on analysis of the individual acute pain trajectory as an important component of comprehensive pain assessment.
METHODS
Linear mixed models and nonlinear models (e.g., regression splines and polynomial models) can be applied to analyze the acute pain trajectory. Alternatively, methods for classifying individual pain trajectories (e.g., using the 50% confidence interval of the random slope approach or using latent class analyses) can be applied in the clinical context to identify different trajectories of resolving pain (e.g., rapid reduction or slow reduction) or persisting pain. Each approach has advantages and disadvantages that may guide selection. Assessment of the acute pain trajectory may guide treatment and tailoring to anticipated symptom recovery. The acute pain trajectory can also serve as a treatment outcome measure, informing further management.
CONCLUSIONS
Application of trajectory approaches to acute pain assessments enables more comprehensive measurement of acute pain, which forms the cornerstone of accurate classification and treatment of pain.
Topics: Acute Pain; Humans; Pain Measurement
PubMed: 33735384
DOI: 10.1093/pm/pnaa440 -
Lancet (London, England) Jan 2016Pain is common in children presenting to emergency departments with episodic illnesses, acute injuries, and exacerbation of chronic disorders. We review recognition and... (Review)
Review
Pain is common in children presenting to emergency departments with episodic illnesses, acute injuries, and exacerbation of chronic disorders. We review recognition and assessment of pain in infants and children and discuss the manifestations of pain in children with chronic illness, recurrent pain syndromes, and cognitive impairment, including the difficulties of pain management in these patients. Non-pharmacological interventions, as adjuncts to pharmacological management for acute anxiety and pain, are described by age and development. We discuss the pharmacological management of acute pain and anxiety, reviewing invasive and non-invasive routes of administration, pharmacology, and adverse effects.
Topics: Acute Pain; Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Anxiety; Child; Emergency Medicine; Emergency Service, Hospital; Humans; Pain Management; Pediatrics; Stress, Psychological
PubMed: 26095580
DOI: 10.1016/S0140-6736(14)61686-X -
The Journal of Pain 2020Abdominal and peritoneal pain after surgery is common and burdensome, yet the lack of standardized diagnostic criteria for this type of acute pain impedes basic,...
Abdominal and peritoneal pain after surgery is common and burdensome, yet the lack of standardized diagnostic criteria for this type of acute pain impedes basic, translational, and clinical investigations. The collaborative effort among the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, American Pain Society, and American Academy of Pain Medicine Pain Taxonomy (AAAPT) provides a systematic framework to classify acute painful conditions. Using this framework, a multidisciplinary working group reviewed the literature and developed core diagnostic criteria for acute abdominal and peritoneal pain after surgery. In this report, we apply the proposed AAAPT framework to 4 prototypical surgical procedures resulting in abdominal and peritoneal pain as examples: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection. These diagnostic criteria address the 3 most common surgical procedures performed in the United States, capture diverse surgical approaches, and may also be applied to other surgical procedures resulting in abdominal and peritoneal pain. Additional investigation regarding the validity and reliability of this framework will facilitate its adoption in research that advances our comprehension of mechanisms, deliver better treatments, and help prevent the transition of acute to chronic pain after surgery in the abdominal and peritoneal region. PERSPECTIVE: Using AAAPT, we present key diagnostic criteria for acute abdominal and peritoneal pain after surgery. We provide a systematic classification using 5 dimensions for abdominal and peritoneal pain that occurs after surgery, in addition to 4 specific surgical procedures: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection.
Topics: Abdominal Pain; Acute Pain; Congresses as Topic; Consensus; Female; Humans; Male; Pain Measurement; Pain, Postoperative; Peritoneum; Public-Private Sector Partnerships; Societies, Medical; United States
PubMed: 32006701
DOI: 10.1016/j.jpain.2020.01.004 -
Journal of Feline Medicine and Surgery Jan 2019Pain assessment has gained much attention in recent years as a means of improving pain management and treatment standards. It has become an elemental part of feline... (Review)
Review
PRACTICAL RELEVANCE
Pain assessment has gained much attention in recent years as a means of improving pain management and treatment standards. It has become an elemental part of feline practice with ultimate benefit to feline health and welfare. Currently pain assessment involves mostly the investigation of sensory-discriminative (intensity, location and duration) and affective-motivational (emotional) domains of pain. Specific behaviors associated with acute pain have been identified and constitute the basis for its assessment in cats.
RECENT ADVANCES
The publication of pain scales with reported validation - the UNESP-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale - and species-specific studies have advanced our knowledge on the subject. Facial expressions have also been shown to be different between painful and non-painful cats, and very recently the Feline Grimace Scale has been validated as a tool for acute pain assessment.
CLINICAL CHALLENGES
Despite recent advances, several challenges still exist. For instance, the effects of disease and sedation on pain scoring/ assessment are unknown. Also, specific painful conditions (eg, dental pain) have not been systematically investigated. The development and validation of instruments for pain assessment by cat owners is warranted, as these tools are currently lacking.
AIMS
This article reviews the use, advantages, disadvantages and limitations of the two validated pain scales, and presents a practical, stepwise approach to feline pain recognition and assessment using a dynamic and interactive process. The authors also offer perspectives regarding current challenges and future directions.
Topics: Acute Pain; Animals; Cat Diseases; Cats; Pain Management; Pain Measurement
PubMed: 30320529
DOI: 10.1177/1098612X18808103