Postoperative pain is a prevalent problem, often lasting from days to years. To minimize opioid use and associated risks of dependency, Enhanced Recovery After Surgery (ERAS) protocols increasingly incorporate multimodal analgesics. Sodium channel-selective blockers are a promising non-opioid alternative, yet their application in postoperative pain remains underexplored. This systematic review evaluates their efficacy in managing postoperative, neuropathic, and neuralgia-related pain. A systematic review was conducted using controlled keywords across multiple databases to identify studies on sodium channel-selective blockers published up to 2024. Eligible studies included clinical trials, observational studies, case series, and reports involving patients aged 18 or older. Data were extracted on therapeutic outcomes, dosages, complications, and comparisons with other analgesics. Five studies met the inclusion criteria, involving 804 patients, 81.58% of whom were women. One study addressed postoperative pain, while the remaining five focused on neuropathy- and neuralgia-related pain. All studies reported significant pain reduction in at least one treatment group compared with placebo. In the study on postoperative pain, the sodium channel-selective blocker significantly reduced pain scores without requiring opioid analgesia. Across all studies, only two patients needed concomitant opioid therapy, and one discontinued treatment due to adverse effects. Dosages varied, with no reports of severe complications. Comparative analyses showed that sodium channel-selective blockers were as effective, if not superior, to traditional pain medications in reducing pain intensity. Sodium channel-selective blockers demonstrate significant potential in pain management with minimal opioid reliance. While effective for neuropathic pain, further studies are essential to validate their role in acute postoperative settings and refine their use in multimodal analgesia regimens.
- Keywords
- innovation, pain management, sodium channel-selective analgesics,
- MeSH
- Analgesics therapeutic use MeSH
- Sodium Channel Blockers * therapeutic use MeSH
- Humans MeSH
- Pain Management * methods MeSH
- Neuralgia * drug therapy etiology MeSH
- Analgesics, Opioid therapeutic use administration & dosage MeSH
- Pain, Postoperative * drug therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Systematic Review MeSH
- Names of Substances
- Analgesics MeSH
- Sodium Channel Blockers * MeSH
- Analgesics, Opioid MeSH
In the previous article, the author demonstrated the close relationship between bloodletting practices in medieval Europe and acupuncture in Traditional Chinese Medicine. This study aimed to explore how acupuncture-based treatment was applied in medieval Europe. The author hypothesizes that the physical stimulation of acupuncture points associated with bloodletting was one of the main methods of pain management at that time. The study examined the indications for phlebotomy as depicted in the original illustration from Practica Medicinalis written by the 15th-century Archbishop of Prague, Sigismundus Albicus, supplemented by two other European medieval medical manuscripts. A total of 76 distinct symptoms (corresponding to 25 bloodletting acupuncture points) from the Practica Medicinalis illustration were assembled into four groups: 1) Pain and inflammation symptoms; 2) Symptoms commonly associated with pain and inflammation; 3) General symptoms affecting various organs and functions; and 4) Conditions unrelated to pain or inflammation. Among the 76 symptoms and 25 acupuncture points, only nine symptoms and a single bloodletting point were not associated with the treatment of pain or inflammation. This suggests that acupuncture-based therapy was an effective method for managing pain and inflammation in the Middle Ages and that such treatment could still be valuable from a modern clinical perspective.
- Keywords
- Bloodletting acupuncture, History of medicine, Pain management, Qi flow,
- MeSH
- Acupuncture Points * MeSH
- Acupuncture Therapy * history MeSH
- Pain history MeSH
- History, Medieval MeSH
- Humans MeSH
- Pain Management * history methods MeSH
- Inflammation * history therapy MeSH
- Check Tag
- History, Medieval MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Historical Article MeSH
- Geographicals
- Europe MeSH
BACKGROUND: Adequate postoperative pain treatment is important for quality of life, patient satisfaction, rehabilitation, function, and total opioid consumption, and might lower both the risk of chronic postoperative pain and the costs for society. Prolonged opioid consumption is a well-known risk factor for addiction. Previous studies in upper extremity surgery have shown that total opioid consumption is a third of the amount prescribed, which can be explained by package size. The aim of this study was to examine whether implementation of prepacked takehome analgesia bags reduced the quantity of prescribed and dispensed opioids. MATERIAL AND METHODS: We introduced prepacked take-home analgesia bags for postoperative pain treatment in outpatient surgery. The bags came in two sizes, each containing paracetamol, etoricoxib, and oxycodone. The first 147 patients who received the prepacked analgesia bags were included in the study, and received a questionnaire one month after surgery covering self-assessed pain (visual analog scale of 0-10) and satisfaction (0-5), as well as opioid consumption. Prescription data after introducing the analgesia bags were compared with data before the bags were introduced. RESULTS: Of the 147 patients included in the study, 58 responded. Compared to standard prescription (small bag group: 14 oxycodone immediate release capsules (5 mg), large bag group: additional 28 oxycodone extended release tablets (5 mg), based on the smallest available package), the patients in the small analgesia bag group received 50% less oxycodone and 67% less for the large bag group. Patients with small bags consumed a median of 0.0 mg oxycodone and those with large bags consumed a median of 25.0 mg oxycodone. The median satisfaction was 5.0 (range: 2-5) and the median pain score was acceptable at the first postoperative day. Prescription data showed a significant reduction of 60.0% in the total amount of prescribed opioids after the introduction of prepacked analgesia bags. CONCLUSIONS: The introduction of prepacked analgesia bags dramatically reduced the quantity of opioids prescribed after outpatient hand surgery. Patient satisfaction was high and the postoperative pain level was acceptable. KEY WORDS: analgesia, hand surgery, opioids, outpatint surgery, wrist surgery.
- MeSH
- Ambulatory Surgical Procedures * methods MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Pain Management methods MeSH
- Pain Measurement MeSH
- Analgesics, Opioid * administration & dosage MeSH
- Oxycodone administration & dosage MeSH
- Acetaminophen administration & dosage therapeutic use MeSH
- Pain, Postoperative * prevention & control drug therapy MeSH
- Hand surgery MeSH
- Patient Satisfaction MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Names of Substances
- Analgesics, Opioid * MeSH
- Oxycodone MeSH
- Acetaminophen MeSH
Pain is a complicated subjective entity that is difficult to quantify and treat. Individuals learn the concept of pain through their life experience, and a person's concept of pain perception changes. Although pain usually fulfills an adaptive role, it can have ad-verse effects on quality of life - functional, social and psychological balance. Therefore, it is necessary to respect the communication of the individual experiencing and feeling pain, or to monitor the various symptoms of pain. Today, perioperative pain management is part of the comprehensive care of patients undergoing surgery, and is associated with numerous benefits for the patient and society. Currently, there are enough drugs, dosage forms, treatment modalities available, as well as enough literary data, incl. knowledge about the organization of postoperative pain treatment. Comprehensive care begins even before surgery in specialized outpatient clinics with the proper preparation of the patient for anesthesia and surgery. The treatment of postoperative pain itself is similar to the care of a patient after a surgical procedure, a multidisciplinary team task, in which the attending physician, surgeon, anesthetist and nurses of the postoperative department participate in particular. Part of this extensive collaboration are specialized teams for the treatment of acute postoperative pain, which primarily have a conciliatory, educational and organizational role, and help to provide specialized treatment procedures for pain relief. It is necessary for all specialists to combine basic knowledge and their application in practice.
- Keywords
- Pain, multimodal analgesia, organization of pain management, pain, perioperative analgesia,
- MeSH
- Humans MeSH
- Pain Management * methods MeSH
- Pain, Postoperative * therapy drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Pain and possibilities of its self-treatment - what can be recommended in a pharmacy? Pain is one of the most common health problems for which patients seek help in the pharmacy. Pharmacists and pharmaceutical assistants are the most easily approachable healthcare professionals with deep pharmacotherapeutic knowledge and therefore are able to recommend appropriate pain self-medication including non-pharmacological therapy based on evaluation of patient´s problems and other factors. This article summarizes mainly pharmacological pain treatment options with currently available over-the-counter medicines, also some non-pharmacological recommendations and tries to emphasize rational approach in terms of safety of pharmacotherapy (adverse reactions, dosing). The aim of this article is to provide an evidence-based medicine overview of therapeutic options and a guideline for approach to treatment of all types of pain appropriate for self-medication in the pharmacy.
- Keywords
- Pain, non -opioid analgesics, non-opioid analgesics., pain, self-treatment,
- MeSH
- Analgesics therapeutic use MeSH
- Pain drug therapy MeSH
- Nonprescription Drugs therapeutic use MeSH
- Humans MeSH
- Pain Management methods MeSH
- Self Medication * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Names of Substances
- Analgesics MeSH
- Nonprescription Drugs MeSH
BACKGROUND AND OBJECTIVES: Trigeminal neuralgia affects approximately 2% of patients with multiple sclerosis (MS) and often shows higher rates of pain recurrence after treatment. Previous studies on the effectiveness of stereotactic radiosurgery (SRS) for trigeminal neuralgia did not consider the different MS subtypes, including remitting relapsing (RRMS), primary progressive (PPMS), and secondary progressive (SPMS). Our objective was to investigate how MS subtypes are related to pain control (PC) rates after SRS. METHODS: We conducted a retrospective multicenter analysis of prospectively collected databases. Pain status was assessed using the Barrow National Institute Pain Intensity Scales. Time to recurrence was estimated through the Kaplan-Meier method and compared groups using log-rank tests. Logistic regression was used to calculate the odds ratio (OR). RESULTS: Two hundred and fifty-eight patients, 135 (52.4%) RRMS, 30 (11.6%) PPMS, and 93 (36%) SPMS, were included from 14 institutions. In total, 84.6% of patients achieved initial pain relief, with a median time of 1 month; 78.7% had some degree of pain recurrence with a median time of 10.2 months for RRMS, 8 months for PPMS, 8.1 months for SPMS ( P = .424). Achieving Barrow National Institute-I after SRS was a predictor for longer periods without recurrence ( P = .028). Analyzing PC at the last available follow-up and comparing with RRMS, PPMS was less likely to have PC (OR = 0.389; 95% CI 0.153-0.986; P = .047) and SPMS was more likely (OR = 2.0; 95% CI 0.967-4.136; P = .062). A subgroup of 149 patients did not have other procedures apart from SRS. The median times to recurrence in this group were 11.1, 9.8, and 19.6 months for RRMS, PPMS, and SPMS, respectively (log-rank, P = .045). CONCLUSION: This study is the first to investigate the relationship between MS subtypes and PC after SRS, and our results provide preliminary evidence that subtypes may influence pain outcomes, with PPMS posing the greatest challenge to pain management.
- MeSH
- Pain etiology surgery MeSH
- Humans MeSH
- Neoplasm Recurrence, Local surgery MeSH
- Pain Management methods MeSH
- Trigeminal Neuralgia * radiotherapy surgery MeSH
- Radiosurgery * methods MeSH
- Retrospective Studies MeSH
- Multiple Sclerosis * surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
The use of virtual reality (VR) in medicine is rapidly expanding, particularly in areas like pain management, surgical training, and mental health therapy. This study examines the implementation and effects of the Cold River VR application, a fully immersive tool designed to help manage pain and anxiety during dressing changes for burn trauma patients in a Czech hospital. The Cold River application immerses patients in a peaceful, interactive virtual environment, utilizing eye-tracking technology to engage them without the need for physical controllers, which could interfere with wound care. The study included 67 participants and found that Cold River effectively distracted patients, making the often painful and anxiety-provoking dressing changes more bearable. While stakeholder interviews indicated that the VR application was generally well-received and seen as a valuable tool in reducing patient discomfort, challenges such as lengthy calibration and occasional issues with nausea and headset discomfort were noted. Importantly, the Cold River application increased patient engagement and reduced the psychological burden associated with burn care, though it also highlighted the need for customization based on individual patient preferences and conditions. Overall, the experience with Cold River suggests that immersive VR holds significant potential for improving patient care during burn treatment, particularly when tailored to specific patient needs and contexts.
- Keywords
- Pain, anxiety, burn treatment, stakeholder and patient experiences, virtual reality,
- MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Pain Management methods MeSH
- Young Adult MeSH
- Burns * psychology therapy MeSH
- Aged MeSH
- Anxiety etiology MeSH
- Virtual Reality * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
PURPOSE: Children experience painful invasive procedures very intensely. The aim of health professionals is to help children minimize this traumatic experience. The Simplified Faces Pain Scale (S-FPS) and Simplified Concrete Ordinal Pain Scale (S-COS) tools offer children the possibility of self-assessing their pain. This can then be the basis for tailoring pain relief to the child's individual need. The aim of this study is to present the validation procedure of the S-FPC, S-COS methods. DESIGN AND METHODS: 135 children aged 3-6 years assessed their pain using the self-reported S-FPS and S-COS methods at three consecutive times, and their results were compared with the commonly used Face, Legs, Activity, Cry, Consolability assessment scale. Intra-class correlations (ICC) were used to assess inter-rater agreement. Convergent validity was verified using Spearman's correlation coefficient. RESULTS: This study demonstrated good validity for both the S FPS and S-COS assessment tools. The ICC coefficient showed good inter-rater correlation. Spearman's correlation coefficient showed a strong correlation between the scales. PRACTICE IMPLICATIONS: It is not possible to clearly select a best method of pain assessment in preschool children. To choose the most appropriate method, it is necessary to take into account the child's cognitive development and preferences.
- Keywords
- assessment, child, pain, self-report method,
- MeSH
- Pain * diagnosis psychology MeSH
- Humans MeSH
- Pain Management * MeSH
- Pain Measurement methods MeSH
- Child, Preschool MeSH
- Reproducibility of Results MeSH
- Health Personnel MeSH
- Self Report MeSH
- Check Tag
- Humans MeSH
- Child, Preschool MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVE: This systematic review and meta-analysis aimed to analyze and synthesize the evidence on the effectiveness of virtual reality (VR) interventions in the prevention of pain, fear and anxiety during burn wound care procedures. METHODS: In September and October 2021, PubMed, Scopus, Cochrane Library and Web of Science were searched for relevant randomized controlled and crossover studies. Two independent authors described the following inclusion criteria for the search: patients undergoing burn wound care with applied VR treatment compared to any other or non-VR intervention. From a total of 1171 records, 25 met the inclusion criteria. After full-text screening, seven publications were excluded. The risk of bias was assessed for 18 studies by two independent authors. RevMan 5.4 was used for the statistical analysis, meta-analysis and visual presentation of the results. RESULTS: The meta-analysis showed a significant difference between VR treatment and standard care when analyzing pain outcome during wound care procedures (SMD = -0.49; 95% CI [-0.78, -0.15]; I2 = 41%) and in subgroup analysis when immersive VR was incorporated (SMD = -0.71; 95% CI [-1.07, -0.36]; I2 = 0%). No significant differences were found between VR treatment and standard care for range of motion outcome (SMD = 0.44; 95% CI [-0.23, 1.11]; I2 = 50%). CONCLUSIONS: VR seems to be an effective therapeutic support in burn wound care procedures for reducing pain. However, this systematic review and meta-analysis highlights the need for more research into the use of VR as a distraction method. Studies on larger groups using similar conditions can provide unequivocal evidence of the effectiveness of VR and enable the inclusion of such intervention in standard medical procedures.
- Keywords
- Burns, Pain management, Physiotherapy, Virtual technology,
- MeSH
- Pain MeSH
- Humans MeSH
- Pain Management methods MeSH
- Burns * therapy MeSH
- Virtual Reality Exposure Therapy * MeSH
- Virtual Reality * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
Older people often suffer from different types of ulcers, with the most prevalent being chronic leg ulcers (CLUs) and diabetic foot ulcers. There are major issues in the current medical approach because these ulcers are hard to heal, and, in the case of CLUs, very painful and with a high frequency of relapse. Older people complain of pain more frequently than young people, frequently due to a combination of painful chronic wounds with other comorbidities (e.g. arthritis, peripheral arterial disease, vertebrogenic pain syndrome). However, chronic pain appears to be managed better by older people because the pain sensitivity is downregulated and the pain threshold is higher in older people. Pain management of chronic wounds is often insufficient, especially in older individuals. It is highly important to use non-traumatic wound dressings and pay attention to patients' feelings and fears because pain in chronic ulcers can impair wound healing. Key factors include good preparation for dressing change and adequate analgesia, ideally a combination of topical and oral agents.
- MeSH
- Pain MeSH
- Diabetic Foot * complications MeSH
- Wound Healing MeSH
- Humans MeSH
- Pain Management * MeSH
- Adolescent MeSH
- Bandages adverse effects MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
