Effects of pregabalin combined with tramadol/paracetamol on acute pain in patients with CT-guided puncture localization of pulmonary nodules.

OBJECTIVE: To investigate the effects of pregabalin combined with tramadol/paracetamol on acute pain in patients with CT-guided puncture localization of pulmonary nodules. MATERIALS AND METHODS: In this randomized, placebo-controlled and single-center study, 120 patients were allocated randomly to four groups: the control group (Group P), the pregabalin-placebo group (Group BP), the tramadol/paracetamol-placebo group (Group AP), and the pregabalin-tramadol/paracetamol group (Group AB). The primary outcome was the NRS (Numerical Rating Scale) score. Other outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2), the incidence of moderate to severe pain, the analgesia recovery ratio, the incidence of adverse drug reactions and patients' satisfaction. RESULTS: No significant interaction was detected between the interventions (P = 0.752). The NRS score of the Taking pregabalin group and the Taking tramadol/paracetamol group were significantly lower than those of the Not-taking pregabalin group and the Not-taking tramadol/paracetamol group respectively (P < 0.05). There was significant difference in the NRS scores among the four groups (P < 0.001). The NRS score of Group AB was significantly lower than that of Group P (P < 0.001), Group BP (P < 0.001) and Group AP (P = 0.001). At the same time, the NRS scores of Group BP (P < 0.001) and Group AP (P < 0.001) were significantly lower than those of Group P, but there was no significant difference between Group BP and Group AP (P = 1.000). The SBP, DBP, HR, the incidence of moderate to severe pain and the analgesia recovery ratio of Group AB were significantly lower than those of Group P (P < 0.05), while the SpO2 and the number of people who were very satisfied were significantly higher than those of Group P (P < 0.05). There was no significant difference in the incidence of adverse drug reactions among the four groups (P = 0.272). CONCLUSIONS: The combination or single use of pregabalin and tramadol/paracetamol can effectively relieve the acute pain after localization. Pregabalin combined with tramadol/paracetamol has the best analgesic effect and significantly reduces the hemodynamic fluctuations, with high safety and low incidence of adverse drug reactions, which has a certain clinical popularization and application value.

Can we use biomarkers to identify those at risk of acute pain from sickle cell disease?

INTRODUCTION: Acute pain episodes, also known as vaso-occlusive crises (VOC), are a major symptom of sickle cell disease (SCD) and lead to frequent hospitalizations. The diagnosis of VOC can be challenging, particularly in adults with SCD, 50% of whom have chronic pain. Several potential biomarkers have been proposed for identifying individuals with VOC, including elevation above the baseline of various vascular growth factors, cytokines, and other markers of inflammation. However, none have been validated to date. AREAS COVERED: We summarize prospective biomarkers for the diagnosis of acute pain in SCD, and how they may be involved in the pathophysiology of a VOC. Previous and current strategies for biomarker discovery, including the use of omics techniques, are discussed. EXPERT OPINION: Implementing a multi-omics-based approach will facilitate the discovery of objective and validated biomarkers for acute pain.

[Management of acute and chronic anal pain]. / Prise en charge des douleurs anales aiguës et chroniques.

Anal pain can be acute (most commonly related to anal fissure, perianal abcess or fistula, perianal vein thrombosis) or chronic (functional or neuropathic) including levator ani syndrome, proctalgia fugax, pudendal nevralgia and coccygodynia. History and clinical examination are keys to diagnose acute causes. Diagnosis of chronic anal pain on the other hand is more challenging and based on thorough history and analysis of symptoms. The aim of this article is to discuss the main etiologies and treatments of acute and chronic anal pain, including an update on the management and treatment of hemorrhoidal disease and postoperative pain management.

La douleur anale peut être de survenue aiguë (le plus fréquemment en lien avec une fissure anale, un abcès ou fistule anale, ou une thrombose des veines périanales) ou chronique (fonctionnelle ou neuropathique), comportant le syndrome du releveur de l'anus, la proctalgia fugax, la névralgie du pudendal et les coccygodynies. Le diagnostic d'une douleur anale aiguë est rapidement posé grâce à l'anamnèse et surtout l'examen clinique. Les causes chroniques sont en revanche plus difficiles à diagnostiquer et nécessitent un interrogatoire détaillé avec une analyse approfondie des symptômes. Le but de cet article est d'explorer le traitement des étiologies de douleur anale aiguë, de pouvoir reconnaître une grande part des douleurs anales chroniques, sans oublier une mise à jour sur la maladie hémorroïdaire avec la prévention et gestion des douleurs postopératoires.

Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis.

BACKGROUND: Practice guidelines recommend nonpharmacologic and nonopioid therapies as first-line pain treatment for acute pain. However, little is known about their utilization generally and among individuals with opioid use disorder (OUD) for whom opioid and other pharmacologic therapies carry greater risk of harm. OBJECTIVE: To determine the association between a pre-existing OUD diagnosis and treatment of acute low back pain (aLBP). DESIGN: Retrospective cohort study using 2016-2019 Medicare data. PARTICIPANTS: Fee-for-service Medicare beneficiaries with a new episode of aLBP. MAIN MEASURES: The main independent variable was OUD diagnosis measured prior to the first LBP claim (i.e., index date). Using multivariable logistic regressions, we assessed the following outcomes measured within 30 days of the index date: (1) nonpharmacologic therapies (physical therapy and/or chiropractic care), and (2) prescription opioids. Among opioid recipients, we further assessed opioid dose and co-prescription of gabapentin. Analyses were conducted overall and stratified by receipt of physical therapy, chiropractic care, opioid fills, or gabapentin fills during the 6 months before the index date. KEY RESULTS: We identified 1,263,188 beneficiaries with aLBP, of whom 3.0% had OUD. Two-thirds (65.8%) did not receive pain treatments of interest at baseline. Overall, nonpharmacologic therapy receipt was less prevalent and opioid and nonopioid pharmacologic therapies were more common among beneficiaries with OUD than those without OUD. Beneficiaries with OUD had lower odds of receiving nonpharmacologic therapies (aOR = 0.62, 99%CI = 0.58-0.65) and higher odds of prescription opioid receipt (aOR = 2.24, 99%CI = 2.17-2.32). OUD also was significantly associated with increased odds of opioid doses ≥ 90 morphine milligram equivalents/day (aOR = 2.43, 99%CI = 2.30-2.56) and co-prescription of gabapentin (aOR = 1.15, 99%CI = 1.09-1.22). Similar associations were observed in stratified groups though magnitudes differed. CONCLUSIONS: Medicare beneficiaries with aLBP and OUD underutilized nonpharmacologic pain therapies and commonly received opioids at high doses and with gabapentin. Complementing the promulgation of practice guidelines with implementation science could improve the uptake of evidence-based nonpharmacologic therapies for aLBP.

Statistical modeling of acute and chronic pain patient-reported outcomes obtained from ecological momentary assessment.

ABSTRACT: Ecological momentary assessment (EMA) allows for the collection of participant-reported outcomes (PROs), including pain, in the normal environment at high resolution and with reduced recall bias. Ecological momentary assessment is an important component in studies of pain, providing detailed information about the frequency, intensity, and degree of interference of individuals' pain. However, there is no universally agreed on standard for summarizing pain measures from repeated PRO assessment using EMA into a single, clinically meaningful measure of pain. Here, we quantify the accuracy of summaries (eg, mean and median) of pain outcomes obtained from EMA and the effect of thresholding these summaries to obtain binary clinical end points of chronic pain status (yes/no). Data applications and simulations indicate that binarizing empirical estimators (eg, sample mean, random intercept linear mixed model) can perform well. However, linear mixed-effect modeling estimators that account for the nonlinear relationship between average and variability of pain scores perform better for quantifying the true average pain and reduce estimation error by up to 50%, with larger improvements for individuals with more variable pain scores. We also show that binarizing pain scores (eg, <3 and ≥3) can lead to a substantial loss of statistical power (40%-50%). Thus, when examining pain outcomes using EMA, the use of linear mixed models using the entire scale (0-10) is superior to splitting the outcomes into 2 groups (<3 and ≥3) providing greater statistical power and sensitivity.

Challenges of acute pain management in older patients.

Adequate management of acute pain in the older population is crucial. However, it is inherently complex because of multiple physiological changes that significantly impact both the pharmacokinetics and pharmacodynamics of medications. Current guidelines promote paracetamol as the first-line analgesic for acute pain in older adults, whereas opioids are advised cautiously for moderate to severe acute pain. However, opioids come with a significant array of side effects, which can be more pronounced in older individuals. Ketamine administered via intranasal (IN) and nebulised inhalation in the emergency department for managing acute pain in older patients shows promising potential for improving pain management and reducing opioid reliance Kampan, Thong-on, Sri-on (2024, Age Ageing, 53, afad255). Nebulised ketamine appears superior in terms of adverse event incidence. However, the adoption of IN or nebulised ketamine in older adult acute pain management remains unclear because of the lack of definitive conclusions and clear guidelines. Nevertheless, these modalities can be valuable options for patients where opioid analgesics are contraindicated or when intravenous morphine titration is impractical or contraindicated. Here, we review these concepts, the latest evidence and propose avenues for research.

The acute pain crisis in sickle cell disease: What can be done to improve outcomes?

The acute pain crisis (APC) is the commonest complication of sickle cell disease (SCD). Severe episodes may require treatment in hospital with strong opioid analgesic drugs, combined with additional supportive care measures. Guidelines for APC management have been produced over the past two decades gathering evidence from published studies, expert opinion, and patient perspective. Unfortunately, reports from multiple sources indicate that guidelines are often not followed, and that acute care in emergency departments and on acute medical wards is suboptimal. It is important to understand what leads to this breakdown in health care, and to identify evidence-based interventions which could be implemented to improve care. This review focuses on recently published articles as well as information about on-going clinical trials. Aspects of care which could potentially make a difference to patient experience include availability and accessibility of individual care plans agreed between patient and treating specialist, innovative means of delivering initial opioids to reduce time to first analgesia, and availability of a specialist unit away from the ED, where expert care can be delivered in a more compassionate environment. The current evidence of improved outcomes and health economic advantage with these interventions is inadequate, and this is hampering their implementation into health care systems.

Effects of foam roller on pain intensity in individuals with chronic and acute musculoskeletal pain: a systematic review of randomized trials.

OBJECTIVE: To analyze the effects of using foam roller on pain intensity in individuals with chronic and acute musculoskeletal pain. METHODS: This systematic review was registered in the National Institute for Health Research's prospective online registry of systematic reviews (PROSPERO) under CRD42023456841. The databases Pubmed, Medline (via Ovid), Embase, BVS, and PEDro (Physiotherapy Evidence Database) were consulted to carry out this systematic review. Notably, the records of clinical trials characterized as eligible were manually searched. The search terms were: (foam rolling OR foam rolling vibration) AND (acute musculoskeletal pain) AND (chronic musculoskeletal pain). The search was performed until August 22, 2023. For the analysis of the methodological quality, the PEDro scale was used for each of the manuscripts included in the systematic review. Due to the heterogeneity in the studies included in this systematic review, performing a meta-analysis of the analyzed variables was impossible. RESULTS: Only six manuscripts were eligible for data analysis. The type of FR used was non-vibrational, being applied by a therapist in only one of the manuscripts. With an application time ranging from at least 45 s to 15 min, the non-vibrational FR was applied within a day up to six weeks. Using the PEDro scale, scores were assigned that varied between 4 and 8 points, with an average of 6 ± 1.29 points. Only two randomized clinical trials found a significant benefit in pain intensity of adding FR associated with a therapeutic exercise protocol in individuals with patellofemoral pain syndrome and chronic neck pain. CONCLUSION: The results of this systematic review do not elucidate or reinforce the clinical use of FR in pain intensity in individuals with chronic and acute musculoskeletal pain.

A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery: Associations With Psychological and Medical Factors and Chronic Postsurgical Pain.

BACKGROUND: Understanding the association of acute pain intensity and opioid consumption after cardiac surgery with chronic postsurgical pain (CPSP) can facilitate implementation of personalized prevention measures to improve outcomes. The objectives were to (1) examine acute pain intensity and daily mg morphine equivalent dose (MME/day) trajectories after cardiac surgery, (2) identify factors associated with pain intensity and opioid consumption trajectories, and (3) assess whether pain intensity and opioid consumption trajectories are risk factors for CPSP. METHODS: Prospective observational cohort study design conducted between August 2012 and June 2020 with 1-year follow-up. A total of 1115 adults undergoing cardiac surgery were recruited from the preoperative clinic. Of the 959 participants included in the analyses, 573 completed the 1-year follow-up. Main outcomes were pain intensity scores and MME/day consumption over the first 6 postoperative days (PODs) analyzed using latent growth mixture modeling (GMM). Secondary outcome was 12-month CPSP status. RESULTS: Participants were mostly male (76%), with a mean age of 61 ± 13 years. Three distinct linear acute postoperative pain intensity trajectories were identified: "initially moderate pain intensity remaining moderate" (n = 62), "initially mild pain intensity remaining mild" (n = 221), and "initially moderate pain intensity decreasing to mild" (n = 251). Age, sex, emotional distress in response to bodily sensations, and sensitivity to pain traumatization were significantly associated with pain intensity trajectories. Three distinct opioid consumption trajectories were identified on the log MME/day: "initially high level of MME/day gradually decreasing" (n = 89), "initially low level of MME/day remaining low" (n = 108), and "initially moderate level of MME/day decreasing to low" (n = 329). Age and emotional distress in response to bodily sensations were associated with trajectory membership. Individuals in the "initially mild pain intensity remaining mild" trajectory were less likely than those in the "initially moderate pain intensity remaining moderate" trajectory to report CPSP (odds ratio [95% confidence interval, CI], 0.23 [0.06-0.88]). No significant associations were observed between opioid consumption trajectory membership and CPSP status (odds ratio [95% CI], 0.84 [0.28-2.54] and 0.95 [0.22-4.13]). CONCLUSIONS: Those with moderate pain intensity right after surgery are more likely to develop CPSP suggesting that those patients should be flagged early on in their postoperative recovery to attempt to alter their trajectory and prevent CPSP. Emotional distress in response to bodily sensations is the only consistent modifiable factor associated with both pain and opioid trajectories.

Development of an Acute Pain Assessment Tool for Patients in Post-anesthesia Care Units.

BACKGROUND: Post-operative pain is a common form of acute pain. Objective pain assessment in post-anesthesia care units after surgery is useful regardless of the patient's condition. AIMS: This study aimed to develop and evaluate an acute pain assessment tool for patients in post-anesthesia care units. DESIGN: This was a cross-sectional observational study comprising two stages: scale development and psychometric evaluation. SETTINGS:  . PARTICIPANTS/SUBJECTS:  . METHODS: Scale items were developed based on a literature review and content validity by experts. The validity and interrater reliability of the pain scale were evaluated using data from 218 patients admitted to the post-anesthesia care unit at a university hospital. A receiver operating characteristic curve was used to identify the sensitivity and specificity for determining the cutoff point for acute pain. RESULTS: We developed an objective acute pain scale, called the APA5, which ranges from 0-10 and comprises behavioral (facial and verbal expressions and body movement) and physiological (changes in heart rate and blood pressure) responses. The APA5 is valid and reliable for assessing acute pain in the recovery room. Sensitivity and specificity were acceptable when the cutoff was 2 out of 10 points. CONCLUSIONS: The APA5 is an easy and simple tool for measuring pain in patients in post-anesthesia care units who have difficulties with self-reporting.

Reconceptualizing Acute Pain Management in the 21st Century.

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.

Tendinitis cálcica atraumática de tendón extensor común del dedo medio: un caso infrecuente de dolor metacarpofalángico / Atraumatic calcium tendonitis of common extensor tendon of the middle finger: a rare case of metacarpophalangeal pain

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

Validity and reliability of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS) in Turkish: prospective study

ABSTRACT BACKGROUND: Using pain scales helps nurses in making early diagnoses and in assessing and managing pain symptoms and findings when developing a nursing care plan. OBJECTIVE: To determine the validity and reliability of the Turkish form of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). DESIGN AND SETTING: Prospective study conducted in Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. METHODS: 145 newborns in the 26th to 42nd gestational weeks that were receiving treatment and care in the neonatal intensive care unit were included in this study. A total of 1740 pain assessments were made by two independent observers on these 145 newborns. The research data was collected using a newborn description form, NIAPAS and the Neonatal Infant Pain Scale (NIPS). RESULTS: The scope validity index of NIAPAS was found to be between 0.90 and 1.00 and its Cronbach's alpha coefficient was 0.914. Correlations between characteristics and total scores (r = 0.20-0.82) were found to be sufficiently high. In an assessment on concurrency validity, there was a strong positive relationship between NIAPAS and NIPS scores (r = 0.73-0.82; P < 0.000). From kappa analysis (0.73-0.99) and intraclass correlation (r = 0.75-0.96), it was determined that there was concordance between the observers. CONCLUSION: NIAPAS was found to be a valid and reliable scale for evaluating acute pain in newborns.

PainAPPle. Validación y evaluación de una aplicación electrónica para el manejo del dolor agudo en pacientes pediátricos / PainAPPle. Validation and evaluation of an electronic application for the management of acute pain in pediatric patients

INTRODUCCIÓN: La versión digital de las escalas de valoración recomendadas para el paciente pediátrico podría contribuir a su mejora y a implementar los indicadores de calidad descritos para el manejo del dolor agudo. MATERIAL Y MÉTODOS: Desarrollo de una aplicación electrónica (PainAPPle) que incorpora versiones de las escalas de valoración del dolor y efectos secundarios validados para cada edad, así como las estrategias terapéuticas aceptadas para el manejo del dolor agudo en pacientes pediátricos. Validación psicométrica (validez y fiabilidad) de las escalas incorporadas en 44 pacientes de 4 a 18 años de la unidad de dolor agudo, aplicándoles ambos formatos (papel y electrónico) de todas las escalas en dos mediciones con 30 min de diferencia. Evaluación de los datos recogidos por PainAPPle en pacientes pediátricos a cargo de dicha unidad. RESULTADOS: La fiabilidad se estudió analizando la correlación (Spearman mayor de 0,5, p < 0,001) que obtuvimos para las distintas escalas en dos momentos con 30 min de diferencia, en los mismos pacientes. Para la validez se analizó la correlación (Spearman mayor de 0,5, p < 0,001) entre los valores de las escalas en papel (regla de oro) y en PainAPPle tanto en el minuto 0 como en el minuto 30. Los niveles de concordancia obtenidos teniendo en cuenta el punto de corte de las escalas que obligaría a un tratamiento fueron también estadísticamente significativos (p < 0,005). CONCLUSIONES: PainAPPle es un instrumento validado para el manejo del dolor agudo en pacientes pediátricos. Los datos recogidos permiten aplicar los indicadores de calidad descritos para el manejo del dolor agudo postoperatorio

INTRODUCTION: The digital version of the assessment scales recommended for the pediatric patient could contribute to its improvement and to implement the quality indicators described for the management of acute pain. MATERIAL AND METHODS: Psychometric validation (validity and reliability) of pain assessment and treatment side effects scales incorporated in the electronic application PainAPPle. For this, both formats (paper and electronic) of all the scales were applied in two measurements with 30 minutes of difference in 44 patients from 4 to 18 years of the Acute Pain Unit in the immediate postoperative period. In addition, the data collected by PainAPPle was evaluated by retrospectively applying the quality indicators described for the management of acute postoperative pain. RESULTS: Reliability was studied analyzing the high correlation (Spearman greater than 0.5, P<.001) that we obtained for the values of each scale in two moments with 30minutes of difference, in the same patients. For validity, the high correlation (Spearman greater than 0.5, P<.001) between the values of the paper scales (gold rule) and PainAPPle at both minute 0 and 30 was analyzed. Concordance obtained taking into account the cut-off point of the scales that would force a treatment were also statistically significant (P<.005). CONCLUSIONS: PainAPPle is a validated instrument for the management of acute pain in pediatric patients. The collected data allow to apply the quality indicators described for the management of acute postoperative pain

Analgesia Nociception Index: assessment of acute postoperative pain / Índice de Analgesia/Nocicepção: avaliação da dor aguda pós-operatória

Abstract Background and objectives Patient self-rating based scales such as Numerical Rating Scale, Visual Analog Scale that is used for postoperative pain assessment may be problematic in geriatric or critically ill patients with communication problems. A method capable of the assessment of pain in objective manner has been searched for years. Analgesia nociception index, which is based on electrocardiographic data reflecting parasympathetic activity, has been proposed for this. In this study we aimed to investigate the effectiveness of analgesia nociception index as a tool for acute postoperative pain assessment. Our hypothesis was that analgesia nociception index may have good correlation with Numerical Rating Scale values. Methods A total of 120 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing any surgical procedure under halogenated-based anesthesia with fentanyl or remifentanil were enrolled for the study. At the 15th minute of arrival to the Postoperative Care Unit the patients' pain was rated on a 0-10 point Numerical Rating Scale. The patients' heart rate, blood pressure, and analgesia nociception index scores were simultaneously measured at that time. The correlation between analgesia nociception index, heart rate, blood pressure and Numerical Rating Scale was examined. Results The study was completed with 107 patients, of which 46 were males (43%). Mean (SD) analgesia nociception index values were significantly higher in patients with initial Numerical Rating Scale ≤3, compared with Numerical Rating Scale >3 (69.1 [13.4] vs. 58.1 [12.9] respectively, p < 0.001). A significant negative linear relationship (r 2 = -0.312, p = 0.001) was observed between analgesia nociception index and Numerical Rating Scale. Conclusion Analgesia nociception index measurements at postoperative period after volatile agent and opioid-based anesthesia correlate well with subjective Numerical Rating Scale scores.

Resumo Justificativa e objetivo As escalas baseadas na autoavaliação de pacientes, como a Escala Visual Numérica e a Escala Visual Analógica, que são usadas para avaliar a dor pós-operatória podem ser problemáticas em pacientes geriátricos ou em estado crítico com problemas de comunicação. Portanto, um método capaz de avaliar a dor de maneira objetiva vem sendo pesquisado há anos. O índice de analgesia/nocicepção, baseado em dados eletrocardiográficos que refletem a atividade parassimpática, tem sido proposto para tal avaliação. Neste estudo, objetivamos investigar a eficácia do índice de analgesia/nocicepção como uma ferramenta para a avaliação da dor pós-operatória aguda. Nossa hipótese foi que o índice de analgesia/nocicepção pode ter boa correlação com os valores da Escala de Classificação Numérica. Métodos Um total de 120 pacientes com estado físico ASA I e II, submetidos a qualquer procedimento cirúrgico com o uso de anestésicos halogenados associados a fentanil ou remifentanil, foi incluído no estudo. No 15º minuto após a chegada à sala de recuperação pós-anestesia, a dor dos pacientes foi avaliada em uma escala numérica de 0-10 pontos. Os escores de frequência cardíaca, pressão arterial e o índice de analgesia/nocicepção dos pacientes foram medidos simultaneamente naquele momento. A correlação entre o índice de analgesia/nocicepção, frequência cardíaca, pressão arterial e a Escala Visual Numérica foi avaliada. Resultados O estudo foi concluído com 107 pacientes, dos quais 46 eram do sexo masculino (43%). Os valores da média (DP) do índice de analgesia/nocicepção foram significativamente maiores nos pacientes com valor inicial na Escala Visual Numérica ≤ 3, em comparação com valor na mesma escala > 3 (69,1 [13,4] vs. 58,1 [12,9], respectivamente, p < 0,001). Uma relação linear negativa significativa (r2 = -0,312, p = 0,001) foi observada entre o índice de analgesia/nocicepção e a Escala Visual Numérica. Conclusão As mensurações do índice de analgesia/nocicepção no pós-operatório após anestesia com agentes halogenados e opioides mostraram boa correlação com os escores subjetivos da Escala Visual Numérica.

Percepción del dolor según el modo de punción de la fístula arteriovenosa en pacientes sometidos a hemodiálisis. Revisión sistemática / Pain perception according to manner of arteriovenous fistula cannulation in patients undergoing hemodialysis. Systematic review

Objetivo: Valorar la posible asociación entre la forma de punción de la fístula arteriovenosa y el dolor que siente el paciente por la inserción de la aguja. Metodología: Se ha seguido la declaración PRISMA para revisiones sistemáticas. Se han consultado 6 bases de datos; Medline, Scopus, Cuiden, CINAHL, SciELO, y Cochrane PLUS. Además, se realizó una búsqueda secundaría manual para detectar literatura gris no encontrada en las bases de datos o mediantes las estrategias definidas. Criterios de inclusión; estudios de nivel de evidencia 1 en la escala Scottish Intercollegiate Guidelines Network, publicados en los últimos 10 años, idiomas español/inglés, y temática relacionada con las técnicas utilizadas en hemodiálisis para el abordaje de la fistula. Los artículos se evaluaron de forma crítica para detectar cualquier riesgo de sesgo mediante el instrumento CASPe y el manual Cochrane para Revisiones Sistemáticas de Intervenciones. Resultados: Se identificaron un total de 150 resultados, seleccionándose finalmente 9 estudios. Los resultados han sido muy heterogéneas, encontrándose resultados para el dolor, tasas de infección, número de intentos de canalización, flujo sanguíneo, presión venosa, tiempo de hemostasia, seguridad, dilataciones aneurismáticas, estética del brazo portador de la fístula y calidad de vida del paciente. Conclusiones: La evidencia no respalda el uso preferencial de la técnica del ojal sobre la canalización tradicional. Por tanto, se necesita mejorar el rigor metodológico y un mayor tamaño muestral para dilucidar que técnica da mejores prestaciones respecto al dolor, permitiendo por tanto mejorar la calidad de vida de los pacientes de hemodiálisis

Aims: To assess the possible association between the manner of arteriovenous fistula cannulation and the patient pain related to the insertion of the needle for the hemodialysis session. Methodology: The PRISMA statement for systematic reviews has been followed. Six databases have been consulted: Medline, Scopus, Cuiden, CINAHL, SciELO, and Cochrane PLUS. In addition, a secondary manual search was performed to detect grey literature not found in databases or through defined strategies. Inclusion criteria: studies of level of evidence 1 on the Scottish Intercollegiate Guidelines Network scale, published in the last 10 years, Spanish/English languages, and topics related to the techniques used to canalize the hemodialysis fistula. The articles were critically evaluated to detect any risk of bias using the CASPe instrument and the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 150 results were identified, 9 of which were finally selected. The results have been very heterogeneous, finding results for pain, infection rates number of attempts of channalization, blood flow, venous pressure, time of hemostasis, safety, aneurysmal dilations, esthetics of the fistula-carrying arm and quality of life of the patient. Conclusions: The evidence does not support the preferential use of the buttonhole technique over traditional channeling. Therefore, it is necessary to improve the methodological quality and a larger sample size to elucidate which technique gives better benefits with respect to pain, thus allowing to improve the quality of life of hemodialysis patients

Dolor postoperatorio, analgesia y presencia de factores de riesgo para dolor crónico en pacientes hospitalizados de un hospital público de Santiago de Chile / Postoperative pain, analgesia and presence of risk factors for chronic postoperative pain in hospitalized patients of a public hospital of Santiago de Chile

INTRODUCCIÓN: el dolor postoperatorio es un importante problema de salud pública, con una elevada incidencia según publicaciones internacionales. el dolor crónico postoperatorio (DCPO) se desarrolla posterior a una cirugía y persiste por más de dos meses, excluyendo otras causas y problemas preexistentes. se han descrito factores de riesgo demográficos, psicosociales y médicos para el desarrollo de dolor crónico postoperatorio (DCPO), siendo el más importante el dolor postoperatorio agudo elevado. actualmente, en Chile se carece de datos locales sobre dolor postoperatorio agudo y crónico. OBJETIVO: evaluar la intensidad del dolor agudo en pacientes post-operados y las medidas analgésicas utilizadas, esto en el contexto de la identificación de los factores de riesgo para el desarrollo de DCPO en pacientes hospitalizados en el servicio de cirugía de un hospital de alta complejidad. MATERRIALES Y MÉTODOS: se realizó un estudio observacional descriptivo de corte transversal retrospectivo. La muestra incluyó a 100 pacientes post-operados seleccionados en forma aleatoria del área de cirugía del Hospital del Salvador entre los meses de septiembre y octubre de 2017. Se realizó una revisión de protocolos operatorios, evoluciones e indicaciones médicas y se registraron edad, sexo, dolor postoperatorio según la escala numérica del dolor (EN) y factores de riesgo de DCPO (cirugía con riesgo de daño nervioso, revisional, abierta, malla, complicaciones postoperatorias, dolor postoperatorio sobre 5, según EN), además del tiempo operatorio. Se realizó un registro electrónico en planilla de excel (Microsoft® Excel® 2011) pre-codificada y diseñada para este fin, resguardando la identidad de los participantes. Los datos obtenidos se expresaron como promedios (con desviación estándar) y medianas. RESULTADOS: se encontró una incidencia de 44% de dolor postoperatorio, con intensidad promedio de 4,4 ± 1,64 puntos entre los pacientes que presentaron dolor en algún grado. el 93% de los pacientes con dolor presentó dolor moderado a severo. en el 98% del total de pacientes se indicó terapia analgésica; de éstos, el 47,95% solo tuvo indicación de antiinflamatorios no esteroidales (AINEs), 39,79% AINEs y paracetamol, 7,14% solo paracetamol y 5,10% otras combinaciones. el 95% de los pacientes presentó uno o más factores de riesgo para DCPO, y el 11%, cuatro o más. DISCUSIÓN: el conocimiento de la incidencia e intensidad local de dolor postoperatorio es un primer paso para optimizar su manejo. la identificación de la población en riesgo de desarrollar DCPO podría permitir implementar a futuro medidas preventivas, que mejoren la calidad de vida de los pacientes postoperados

INTRODUCTION: postoperative pain is an important public health issue, with a high incidence reported in international literature. chronic postoperative pain (CPOP) is developed posterior to a surgical intervention and persists over two months, excluding other causes and preexisting problems. several risk factors for CPOP have been mentioned, including demographic, psicosocial and medical ones; the most relevant being high acute postoperative pain. nowadays, Chile lacks local data of acute and chronic postoperative pain. OBJECTIVES: assess the intensity of acute postoperative pain and the analgesia used, in the context of the identification of risk factors for CPOP in a surgery department of a high complexity hospital. MATERIALS AND METHODS: an observational descriptive tranversal restrospective study was used. the sample was constituted by 100 postsurgical patients selected randomly from the surgical department of the Hospital del Salvador between september and october 2017. a revision of surgical protocols and medical charts was made; age, sex, postsurgical pain according to numeric pain scale (NPS) and risk factors for CPOP (surgery with risk of nervous damage, second look, open, use of mesh, postsurgical complications, postsurgical pain above 5 according to NPS) were registered, besides surgical time. the record was made on an precoded excel sheet (Microsoft® Excel® 2011), designed for this purpose. the identity of the patients was kept anonymous. the data obtained was expressed as mean (with standard deviation) and median. RESULTS: an incidence of 44% of postsurgical pain was found, with mean intensity of 4.4 ± 1.64points between patients that presented any degree of pain.93% from the patients with pain presented moderate to severe pain. 98% from the total of patients had analgesia, from them 47.95% only had non-steroidal antiinflamatory drugs (NSAIDs), 39.79% NSAIDs and acetaminophen, 7.14% only acetaminophen and 5.10% other combinations. 95% of patients had one or more risk factors for CPOP, and 11% four or more of them. DISCUSSION: the knowledge of the incidence and intensity of postsurgical pain is the first step in order to optimize its manage. the identification of the population at risk to develop CPOP could allow the implementation of preventive measures that may improve the quality of life of postsurgical patients.

Lactancia materna para control del dolor agudo en lactantes: ensayo clínico controlado, ciego simple / Breastfeeding for acute pain control on infants: a randomized controlled trial

Objetivo: determinar la eficacia de la lactancia materna (LM) para el manejo del dolor agudo después de la vacunación en lactantes menores de 6 meses al compararse con el sucedáneo de la leche (SL) y no aplicar ninguna maniobra. Métodos: se realizó un ensayo clínico controlado aleatorizado, ciego simple en fase III en lactantes menores de 6 meses de edad. Se incluyeron 3 grupos: LM, SL y sin aplicar analgesia (control). El dolor se midió a través del tiempo de llanto y una escala de dolor pediátrico. En el análisis estadístico se utilizaron las pruebas de Kruskal Wallis y U de Mann Whitney para variables cuantitativas y para variables cualitativas se aplicó la prueba de Chi2. Se utilizó Kaplan Meier para analizar el tiempo de llanto total. Resultados: se analizaron un total de 144 pacientes, 48 por grupos. El grupo de LM tuvo menor tiempo de llanto (p = 0,007) y menor calificación de dolor a los 90 (p = 0,006) y 120 (p = 0,003) segundos comparado con los otros 2 grupos. Mientras que entre el grupo SL y el grupo control no hubo diferencia significativa en la duración del llanto ni la escala de dolor. Conclusiones: la lactancia materna es efectiva para el manejo del dolor agudo después de la vacunación en lactantes menores de 6 meses de edad en comparación al sucedáneo de leche y no aplicar analgesia (AU)

Objective: To determine the effectiveness of breastfeeding (BF) for the management in acute pain after vaccination in infants under 6 months of age when compared to the milk substitute (MS) and not to apply any maneuver. Methods: A controlled, single-blind phase III clinical trial was conducted on infants under 6 months old to evaluate the effectiveness of BF in acute pain by vaccination. Divided in 3 groups: BF, milk substitutes (MS), and without applying any analgesic maneuver (control). Pain was measured by crying time and pediatric pain scale. Statistical analysis was performed using the Kruskal Wallis and Mann-Whitney U for quantitative variables. For qualitative data, Chi2 was applied Kaplan Meier was used to analyze the total time crying. Results: A total of 144 patients were recruited, divided in groups of 48 patients. The group of BF had fewer crying time (p = 0.007) and pain rating at 90 (p = 0.006) and 120 (p = 0.003) seconds compared with other groups. There was no signifi cant difference in the crying time (p = 0.396) and the pain scale between the group receiving MR and control. Conclusions: Breastfeeding is effective in management of acute pain by vaccination in infants under six months of age compared to milk substitute and control (AU)