A systematic review and meta-analysis of randomized control trials: efficacy of cognitive behavioral therapies for the management of functional and recurrent abdominal pain disorders in children and adolescents.

Cognitive behavioral therapy (CBT) is effective for pain relief in children and adolescents with functional abdominal pain disorders (FAPDs). However, few studies have focused on the FAPDs specifically and the medium-term or long-term results of CBT. In this meta-analysis, we investigated the efficacy of CBT in pediatric FAPDs and unclassified chronic or recurrent abdominal pain (CAP and RAP, respectively). We searched the PubMed, Embase, and Cochrane Library databases for related randomized controlled trials until August 2021. Eventually, 10 trials with 872 participants were included. The methodological quality of the studies was assessed, and data on two primary and four secondary outcomes of interest were extracted. We used the standardized mean difference (SMD) to measure the same outcome, and precisions of effect sizes were reported as 95% confidence intervals (CIs). We found that CBT had significantly positive effects on reducing pain intensity immediately (SMD: -0.54 [CI: -0.9, -0.19], p = 0.003), 3 months after the intervention (SMD: -0.55; [CI: -1.01, -0.1], p = 0.02) and 12 months after the intervention (SMD: -0.32; [CI: -0.56, -0.08], p = 0.008). CBT also reduced the severity of gastrointestinal symptoms, depression, and solicitousness, improved the quality of life and decreased the total social cost. Future studies should consider uniform interventions in the control group and comparing different CBT delivery methods.

Association between perinatal pain and postpartum depression: A systematic review and meta-analysis.

INTRODUCTION: In recent years, clinical studies have shown that perinatal pain could increase the risk of postpartum depression, while such a conclusion appears controversial. Therefore, we conducted this systematic review and meta-analysis to explore the association between perinatal pain and postpartum depression, and to evaluate the effectiveness of epidural labor analgesia in reducing the risk of postpartum depression. METHODS: PubMed, Web of Science, Embase and Cochrane Library were searched from inception to Jan 30th, 2022. The effect size of the meta-analysis was calculated using odds ratio and 95 % confidence interval. Statistical analysis was performed using Stata 15.0 software. RESULTS: There were 19 studies included with a total of 96,378 patients. Among the included studies, 10 investigated the association between perinatal pain and the risk of postpartum depression, and 9 reported that between labor analgesia and the risk of postpartum depression. The results of meta-analysis showed that perinatal pain increased the risk of postpartum depression [OR = 1.43, 95% CI (1.23, 1.67), p<0.05], and epidural analgesia could reduce the risk of postpartum depression [OR = 0.42, 95% CI (0.33, 0.55), p < 0.05]. LIMITATIONS: Source of heterogeneity in the association between perinatal pain and PPD could not be identified due to the limitations of the original studies. There were mainly cohort studies included in the assessment for effectiveness of epidural analgesia in reducing the incidence of postpartum pain. Therefore, we look forward to more RCTs to confirm our results. CONCLUSION: Perinatal pain is one of the risk factors for postpartum depression, and epidural analgesia could reduce the risk of PPD. This result might provide guidance for clinical practice. However, psychological health counseling should be combined with epidural analgesia for perinatal pain to reduce the risk of PPD.

Knowledge, attitudes, and practices toward cancer pain management amongst healthcare workers (physicians, pharmacists, and nurses): a cross-sectional study from first-tier cities in China.

PURPOSE: China is currently one of the countries with the largest increased number of new cancer cases in the world, but cancer pain management (CPM) is still inadequate. This study uses a questionnaire to demonstrate the status and differences in knowledge, attitude and practice (KAP) of CPM among healthcare workers (HCWs) in developed regions of China, to find deficiencies and priorities for improvement, from which areas and advantages of the role of pharmacists and mobile devices can be explored. METHODS: This study used data from a questionnaire on CPM from March to June 2019. The study population consisted of a total of 515 HCWs in four first-tier developed cities in China. The questionnaire has four major components, analysis of differences in KAP of different occupations through one-way analysis of variance (ANOVA). RESULTS: Among the respondents, the physicians had the highest knowledge scores toward CPM, pharmacists had the lowest practice scores. Around half of the respondents indicated that their hospital or department have a pharmacist participating in CPM. Physicians and nurses were more likely to expect pharmacists to provide drug counseling. The HCWs interviewed most expect that the mobile-based pain management system can automatically screen and mark patients with pain. CONCLUSION: From this study, it can be suggested that pharmacists and nurses in the CPM team should actively promote relevant knowledge. Besides, pharmacists should focus on improving practical ability such as increasing the frequency of pain assessment. Multidisciplinary collaboration and the introduction of mobile devices can improve and refine the CPM.

Multidisciplinary Care for Adults With Chronic Pancreatitis: Incorporating Psychological Therapies to Optimize Outcomes.

ABSTRACT: Chronic pancreatitis (CP) is associated with a high disease burden, extensive negative impact on quality of life, increased rates of depression and anxiety, and significant health care utilization and expenditures. Pain is a hallmark feature of CP, present in up to 90% of patients with this condition, and can lead to high rates of disability, hospitalization, and opioid medication use. Current perspectives on the management of CP have evolved to advocate a multidisciplinary approach which offers new pathways for helping patients manage symptoms. Psychologists play an important role in a multidisciplinary team effort by applying scientifically based psychological principles and techniques to improve pain and adaptation to chronic illness. This review will detail the fundamentals of delivering psychological interventions for adults with CP managed in an outpatient setting. Recommendations for integrating psychological care in multidisciplinary management of CP will be offered. Future directions for psychological care in CP multidisciplinary teams are also discussed.

Postoperative Opioid Utilization and Patient Satisfaction in General Surgery Procedures: A Prospective Observational Study.

BACKGROUND: Wide variation of opioid prescribing persists despite attempts to quantify number of opioids utilized postoperatively. We aim to prospectively determine number of opioids used after common surgery procedures to guide future prescribing. METHODS: A prospective observational trial was performed of opioids prescribed and used postoperatively. Patients filled out pre- and postoperative surveys, and number of opioids utilized was captured at postoperative visit. RESULTS: One-hundred-and-thirteen patients met inclusion. Median opioids prescribed exceeded number of opioids taken for all procedures. Median number of opioids taken postoperatively was fewer than 10 for all categories of procedures: simple skin/soft tissue 2 (IQR 1-4), complex skin/soft tissue 1.5 (IQR 0-14), simple laparoscopy 1 (IQR 0-20) and complex laparoscopy 4 (IQR 0-20), laparotomy 0 (IQR 0-26), and open inguinal hernia 2 (IQR 0-2). Nearly 80% of patients had leftover opioids, and 31% planned to keep them. There was little difference between preoperative and postoperative level of satisfaction with a pain control regimen. DISCUSSION: Postoperatively, patients utilize opioids less frequently than prescribed and often keep leftover pills. Patient pain control satisfaction is unrelated to number of opioids prescribed and taken postoperatively.

What Are Orthopaedic Healthcare Professionals' Attitudes Toward Addressing Patient Psychosocial Factors? A Mixed-Methods Investigation.

BACKGROUND: Integrating psychosocial resources into orthopaedic clinics can reduce psychological distress and opioid use after injury, enhance functional outcomes, and increase patient satisfaction with care. Establishing referral pathways for connecting orthopaedic patients with psychosocial resources requires the active collaboration and buy-in of orthopaedic healthcare professionals. Designing and disseminating psychosocial training materials for orthopaedic healthcare professionals requires a nuanced understanding of orthopaedic healthcare professionals' current attitudes toward addressing psychosocial factors, including any stigma and misconceptions about mental health that exist. QUESTIONS/PURPOSES: (1) What are orthopaedic healthcare professionals' attitudes toward addressing patient psychosocial factors, and how are they related? (2) How do orthopaedic healthcare professionals' beliefs, reasonings, and experiences help to explain these attitudes? (3) How do attitudes differ between physicians and nonphysician healthcare professionals? METHODS: In this multisite, mixed-methods study (that is, a study collecting both quantitative and qualitative data), our team of psychology researchers conducted qualitative focus groups over secure live video with 79 orthopaedic healthcare professionals at three geographically diverse Level I trauma centers. We approached all orthopaedic healthcare professionals within the three trauma centers to participate in the study to collect as many diverse perspectives as possible. Eighty-four percent (79 of 94) of the professionals we approached participated in qualitative data collection (the group of professionals comprised 20 attending surgeons; 28 residents; 10 nurse practitioners, registered nurses, and physician assistants; 13 medical assistants; five physical therapists and social workers; and three research fellows). We also asked participants to complete self-report items that assessed their attitudes toward addressing patients' psychosocial factors (research question 1). The different attitudes identified through the quantitative measurement served as a priori defined themes within which our two independent coders organized the qualitative data and identified beliefs and experiences that explained attitudes (research question 2). We used both quantitative and qualitative data to assess differences between surgeons and residents and nonphysician healthcare professionals (research question 3). RESULTS: We quantitatively identified six underlying attitudes toward addressing psychosocial factors: professional confidence, perceived resource availability, fear of offending patients, fear of negative patient reactions, blame toward patients, and professional role resistance. We observed a strong quantitative correlation between the attitudes of professional confidence and perceived resource availability, and qualitative data revealed how healthcare professionals' willingness to discuss psychosocial issues with patients is shaped by their perception of psychosocial resources available for orthopaedic patients, as well as their perception of their own skills and tools to navigate these conversations. Quantitative data suggested that surgeons and residents endorse higher blame toward patients for psychosocial factors (medium effect size; p = 0.04), which is a stigmatizing attitude that serves as a barrier to integrating psychosocial resources into orthopaedic settings. CONCLUSION: The varying levels of confidence orthopaedic healthcare professionals reported with respect to the topic of discussing psychosocial factors and the misconceptions they endorse regarding psychosocial factors (such as blame toward patients) highlight the need for more specific education for orthopaedic healthcare professionals to help equip them with skills to raise and discuss psychosocial factors with patients in an empathic and destigmatizing manner. CLINICAL RELEVANCE: The strong relationship observed between the attitudes of professional confidence and perceived resource availability suggests that expanding the provision of psychosocial resources in orthopaedic settings and establishing specific, efficient referral processes to connect patients with psychosocial resources will in turn increase orthopaedic healthcare professionals' confidence discussing psychosocial issues with patients.

How Is the Probability of Reporting Various Levels of Pain 12 Months After Noncatastrophic Injuries Associated with the Level of Peritraumatic Distress?

BACKGROUND: Psychological factors have been shown to be consistent predictors of chronic pain in people with musculoskeletal injuries. However, few prognostic studies have considered multiple risk factors including peritraumatic distress. In addition, previous research has not considered that the associations between peritraumatic distress and pain levels can vary across pain outcomes. QUESTION/PURPOSE: To determine whether an easily measurable level of baseline distress is associated with pain levels 1 year after noncatastrophic traumatic injuries when the outcome to be assessed is not normally distributed. METHODS: This was a prospective cohort study. The data were captured from two cohorts in London, Ontario, Canada, and Chicago, IL, USA. Participants were adults with acute noncatastrophic (that is, not treated with surgery or hospitalization) musculoskeletal injuries of any etiology with various injury locations (60% [145 of 241] spinal and 40% [96 of 241] peripheral) that presented to local urgent care centers. Other inclusion criteria included English/French speakers and having no other disorder that would affect their pain levels. In total, between the years 2015 and 2018, 241 participants were recruited based on the inclusion criteria. Ninety-three percent (225 of 241) of participants provided baseline data, and of these, 48% (109 of 225) were lost to follow-up in 1 year. Based on a complete case approach, this study included 116 participants who ranged in age from 18 to 66 years and 69% (80) of whom were women. The Traumatic Injuries Distress Scale (TIDS) was used to evaluate distress at baseline (within 4 weeks of injury). The TIDS is a validated, reliable 12-item risk prognosis screening tool that takes less than 3 minutes to complete with questions regarding uncontrolled pain, negative affect, and intrusion/hyperarousal. The minimum and maximum possible scores are 0 and 24, with higher scores indicating higher levels of distress. The Numeric Pain Rating Scale (NPRS) was used to assess the pain level at baseline and again 12 months postinjury. To complete the NPRS, participants rate the severity of their pain on a scale of 0 to 10, with 0 indicating no pain and 10 indicating the worst pain imaginable. NPRS scores of 1 to 3 indicate mild pain, 4 to 6 indicate moderate pain and 7 or higher indicate severe pain. As a preliminary analysis, to assess whether the participants as a group experienced recovery, a paired samples t-test was used to compare NPRS scores at baseline and 12 months. In all, 52% (60 of 116) of participants reported no pain (NPRS = 0), and mean pain intensity scores improved from 4.8 ± 2.1 at baseline to 1.6 ± 1.6 at 12-month follow-up (p < 0.001). Quantile regression was used to describe the association between baseline distress and pain levels 1 year after the injury. This technique was used because it reveals the relationships at different quantiles of the pain outcome distribution. RESULTS: The results indicate some people (52% [60 of 116]) recovered regardless of their baseline level of distress (30th quantile of the NPRS: ß = 0). However, in those with persisting pain, higher levels of baseline distress are associated with greater levels of pain 12 months after the injury (50th quantile of the NPRS: ß = 0.11; p = 0.01; 70th quantile of the NPRS: ß = 0.27; p < 0.001; 90th quantile of the NPRS: ß = 0.31; p = 0.01). According to this model, with a baseline TIDS score of 5, there is 10% probability that patients will report moderate or greater levels of pain (4 or higher of 10) 12 months later. This probability then increases as the TIDS score increases. For instance, at a score of 13 on the TIDS, the probability of a patient reporting moderate or higher levels of pain increases to 30%, and the probability of reporting severe pain (higher than 6 of 10) is 10%. CONCLUSION: Clinicians and surgeons in orthopaedic settings can screen for the presence of peritraumatic distress using the TIDS, which is an easily administered tool that does not require extensive knowledge of psychology, and by using it they can identify those with higher levels of distress who are more likely to have persistent, long-term pain. A score of 4 or less indicates a low risk of persistent pain, a score between 5 and 12 (endpoints included) indicates moderate risk, and a score of 13 or higher indicates high risk. Future studies should investigate whether certain immediate interventions for peritraumatic distress in the aftermath of trauma can decrease the likelihood that a patient will develop chronic pain after injury. As an analysis technique, quantile regression is useful to assess complex associations in many orthopaedic settings in which a certain outcome is expected to occur in most patients leading to non-normally distributed data. LEVEL OF EVIDENCE: Level II, therapeutic study.

Manejo da dor durante a punção arterial no neonato: estudo descritivo / Manejo del dolor durante la punción arterial en neonatos: estudio descriptivo / Pain management during arterial puncture in newborns: a descriptive study

RESUMO Objetivo descrever as medidas de alívio da dor aplicadas pela equipe de enfermagem durante a punção arterial no neonato e os escores de dor no momento do procedimento. Método estudo descritivo, quantitativo, realizado entre outubro de 2018 e janeiro de 2019, em uma unidade de terapia intensiva neonatal no Noroeste do Paraná, por meio da observação não participantes de 192 punções arteriais, com respectiva mensuração dos escores de dor. O estudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos. Resultados das 192 punções somente 34 foram analisadas quanto às medidas de alívio e escores de dor, os quais se mostraram elevados. As demais punções foram excluídas, devido perda da monitorização durante o procedimento. Conclusão evidenciou-se pouco uso de intervenções relacionadas ao alívio da dor por parte da equipe. O processo de observação constatou a presença de dor intensa.

RESUMEN Objetivo describir las medidas de alivio del dolor aplicadas por el equipo de enfermería durante la punción arterial en neonatos y las escalas de puntuación de dolor en el momento del procedimiento. Método estudio descriptivo, cuantitativo, realizado entre octubre de 2018 y enero de 2019, en una unidad de cuidados intensivos neonatales del noroeste de Paraná, mediante observación no participante de 192 punciones arteriales, con medición respectiva de puntuaciones de dolor. El estudio fue aprobado por el Comité de Ética para la Investigación con Seres Humanos. Resultados de las 192 punciones, solo 34 fueron analizadas en cuanto a las medidas de alivio y puntuaciones de dolor que fueron elevadas. Se excluyeron las otras punciones debido a la pérdida del monitoreo durante el procedimiento. Conclusión el equipo utilizó poco las intervenciones relacionadas con el alivio del dolor. El proceso de observación verificó la presencia de dolor intenso.

ABSTRACT Objective to describe pain relief measures applied by the nursing team during arterial puncture in neonates, and pain scores during the procedure. Method this descriptive, quantitative study was conducted between October 2018 and January 2019 at a neonatal intensive care unit in northwestern Paraná, by non-participant observation of 192 arterial punctures and measurement of the respective pain scores. The study was approved by the human research ethics committee. Results of the 192 punctures, only 34 were examined for relief measures and pain scores; the latter were found to be high. The other punctures were excluded for loss of monitoring during the procedure. Conclusion pain-relief interventions were little used by the team. The observation process found intense pain.

Effects of a Pandemic and Isolation on Alcohol and Psychoactive Medication Use in a Population of Rehabilitation and Pain Patients.

OBJECTIVE: The conjunction of the coronavirus disease lockdown and the use of illicit drugs suggests the potential increase in drug usage and opioid deaths. Because of other studies, we felt the need to examine if the lockdown has caused a change in the drug intake of our population of substance abuse and pain management patients. MATERIALS: Urine drug testing is a strategy to reduce harm to patients in pain management and substance abuse treatment programs. We analyzed trends in the clinical drug testing patterns of urine specimens sent by substance abuse and pain clinics to monitor their patients. These specimens were tested by a national clinical laboratory using LC-MS/MS definitive methods. The time frame of these comparative observations was the past five years, including the time of the pandemic. RESULTS: The only decrease was a 30% reduction in test requests during the second quarter of 2020. Among the patients tested, positivity decreased greatly for the illicit drugs heroin and cocaine but increased for methamphetamine and fentanyl. Use of the antidepressant and anxiolytic drugs remained consistent or declined for some drugs, relative to pre-pandemic patterns. The percent of patients prescribed the opiates morphine and oxycodone decreased, while the use of hydrocodone increased. Positivity for the drug gabapentin increased greatly. The use of alcohol did not increase significantly during the lockdown period. CONCLUSION: In summary, these findings demonstrate relatively consistent drug use, with decreased positivity for high-risk drugs and dangerous drug combinations. We speculate that monitoring of these patients mitigates the possibility of drug misuse and potential overdose and is in concordance with the goals of these monitoring programs.

Identifying the content and context of pain within paediatric rheumatology healthcare professional curricula in the UK: a summative content analysis.

BACKGROUND: The curriculum for professionals working in paediatric rheumatology should include pain but it is unclear to what extent this currently occurs. The aim of this study was to identify pain-related curriculum content and the context in which pain is presented in educational and training documentation for healthcare professionals in this clinical speciality. METHODS: Core curricula documents from UK based professional organisations were identified in partnership with healthcare professionals. Documents were analysed using a summative content analysis approach. Key pain terms were quantified and weighted frequencies were used to explore narrative pain themes. Latent content was interpreted qualitatively to explore the context within which pain terms were positioned. RESULTS: Nine curriculum documents were identified and analysed from doctors, nurses, physiotherapists and occupational therapists specialising in paediatric rheumatology. Pain themes represented a mean percentage of 1.51% of text across all documents. Pain was rarely presented in the context of both inflammatory and non-inflammatory condition types despite being a common feature of each. Musculoskeletal pain was portrayed simply as a 'somatic' symptom, rather than as a complex phenomenon involving biological and psychosocial processes. Content around the assessment and management of pain was vague and inexplicit. CONCLUSION: Current educational and training documentation in paediatric rheumatology do not include core pain topics. Curricula for these healthcare professionals would benefit from updates in contemporary pain theories and examples of in-context, evidence-based pain practices. This should be a priority starting point for optimising patient pain care in paediatric musculoskeletal healthcare.

Pain induced by investigations and procedures commonly administered to older adults in the emergency department: a prospective cohort study.

BACKGROUND: This study aimed to assess the level of pain induced by common interventions performed in older adults consulting to the ED. METHODS: We conducted a prospective multicentre observational cohort study in two academic EDs (Quebec City, Canada) between June 2018 and December 2019. A convenience sample of well-oriented and haemodynamically stable older adults (≥65 years old) who underwent at least two interventions during their ED stay was recruited. The level of pain was assessed using an 11-point Numerous Rating Scale (NRS) and is presented using median and IQR or categorised as no pain (0), mild (1-3), moderate (4-6) or severe pain (7-10). RESULTS: A total of 318 patients were included. The mean age was 77.8±8.0 years old and 54.4% were female . The number of pain assessments per intervention ranged between 22 (urinary catheterisation) and 240 (intravenous catheter). All imaging investigations (X-rays, CT and bedside ultrasound) were associated with a median level of pain of 0. The median level of pain for other interventions was as follows: blood samplings (n=231, NRS 1 (IQR 0-3)), intravenous catheters (n=240, NRS 2 (IQR 0-4)), urinary catheterisations (n=22, NRS 4.5 (IQR 2-6)), cervical collars (n=50, NRS 5 (IQR 0-8)) and immobilisation mattresses (n=34, NRS 5 (IQR 0-8)). Urinary catheterisations (63.8%), cervical collars (56.0%) and immobilisation mattresses (52.9%) frequently induced moderate or severe pain. CONCLUSIONS: Most interventions administered to older adults in the ED are associated with no or low pain intensity. However, urinary catheterisation and spinal motion restriction devices are frequently associated with moderate or severe pain.

Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain-Related Disability: A selfBACK Randomized Clinical Trial.

Importance: Lower back pain (LBP) is a prevalent and challenging condition in primary care. The effectiveness of an individually tailored self-management support tool delivered via a smartphone app has not been rigorously tested. Objective: To investigate the effectiveness of selfBACK, an evidence-based, individually tailored self-management support system delivered through an app as an adjunct to usual care for adults with LBP-related disability. Design, Setting, and Participants: This randomized clinical trial with an intention-to-treat data analysis enrolled eligible individuals who sought care for LBP in a primary care or an outpatient spine clinic in Denmark and Norway from March 8 to December 14, 2019. Participants were 18 years or older, had nonspecific LBP, scored 6 points or higher on the Roland-Morris Disability Questionnaire (RMDQ), and had a smartphone and access to email. Interventions: The selfBACK app provided weekly recommendations for physical activity, strength and flexibility exercises, and daily educational messages. Self-management recommendations were tailored to participant characteristics and symptoms. Usual care included advice or treatment offered to participants by their clinician. Main Outcomes and Measures: Primary outcome was the mean difference in RMDQ scores between the intervention group and control group at 3 months. Secondary outcomes included average and worst LBP intensity levels in the preceding week as measured on the numerical rating scale, ability to cope as assessed with the Pain Self-Efficacy Questionnaire, fear-avoidance belief as assessed by the Fear-Avoidance Beliefs Questionnaire, cognitive and emotional representations of illness as assessed by the Brief Illness Perception Questionnaire, health-related quality of life as assessed by the EuroQol-5 Dimension questionnaire, physical activity level as assessed by the Saltin-Grimby Physical Activity Level Scale, and overall improvement as assessed by the Global Perceived Effect scale. Outcomes were measured at baseline, 6 weeks, 3 months, 6 months, and 9 months. Results: A total of 461 participants were included in the analysis; the population had a mean [SD] age of 47.5 [14.7] years and included 255 women (55%). Of these participants, 232 were randomized to the intervention group and 229 to the control group. By the 3-month follow-up, 399 participants (87%) had completed the trial. The adjusted mean difference in RMDQ score between the 2 groups at 3 months was 0.79 (95% CI, 0.06-1.51; P = .03), favoring the selfBACK intervention. The percentage of participants who reported a score improvement of at least 4 points on the RMDQ was 52% in the intervention group vs 39% in the control group (adjusted odds ratio, 1.76; 95% CI, 1.15-2.70; P = .01). Conclusions and Relevance: Among adults who sought care for LBP in a primary care or an outpatient spine clinic, those who used the selfBACK system as an adjunct to usual care had reduced pain-related disability at 3 months. The improvement in pain-related disability was small and of uncertain clinical significance. Process evaluation may provide insights into refining the selfBACK app to increase its effectiveness. Trial Registration: ClinicalTrials.gov Identifier: NCT03798288.

The Effect of Virtual Reality on Pain and Anxiety During Colonoscopy: A Randomized Controlled Trial.

BACKGROUND: The aim of the study is to evaluate the effect of virtual reality application during a colonoscopy on the pain and anxiety experienced by patients. METHODS: The study was conducted as experimental, randomized, controlled research. The study was carried out between October 15, 2017 and May 20, 2018 in the Endoscopy Unit of a Public Hospital in northern Turkey. The study sample consisted of 60 patients who underwent colonoscopy. The patients were divided into 2 groups by using simple randomization. The patients in the experimental group watched virtual reality applications during colonoscopy, whereas the patients in the control group underwent standard colonoscopy protocol. Colonoscopy was performed on patients in both groups by the same gastroenterologist without the use of anesthesia. The demographic data of both groups, pain levels during and after the procedure, before and after the procedure anxiety levels were evaluated. RESULTS: The mean age of the patients in the experimental group was 56.33 ± 11.81, the mean age of the patients in the control group was 56.20 ± 15.62. There was no statistically significant difference between the pre- and post-operative state anxiety score averages of the patients in the experimental and control groups. There was a statistically significant difference between the trait anxiety scores (P < .000) and pain scores (P < .03) during the procedure between both groups. CONCLUSION: The virtual reality application was found to reduce patients' pain during the colonoscopy procedure. The virtual reality application, an easily available, inexpensive, and non-invasive method, can be used by nurses in pain management during colonoscopy.

Effects of transcranial direct current stimulation on experimental pain perception: A systematic review and meta-analysis.

OBJECTIVE: Many studies have examined the effectiveness of transcranial direct current stimulation (tDCS) on human pain perception in both healthy populations and pain patients. Nevertheless, studies have yielded conflicting results, likely due to differences in stimulation parameters, experimental paradigms, and outcome measures. Human experimental pain models that utilize indices of pain in response to well-controlled noxious stimuli can avoid many confounds present in clinical data. This study aimed to assess the robustness of tDCS effects on experimental pain perception among healthy populations. METHODS: We conducted three meta-analyses that analyzed tDCS effects on ratings of perceived pain intensity to suprathreshold noxious stimuli, pain threshold and tolerance. RESULTS: The meta-analyses showed a statically significant tDCS effect on attenuating pain-intensity ratings to suprathreshold noxious stimuli. In contrast, tDCS effects on pain threshold and pain tolerance were statistically non-significant. Moderator analysis further suggested that stimulation parameters (active electrode size and current density) and experimental pain modality moderated the effectiveness of tDCS in attenuating pain-intensity ratings. CONCLUSION: The effectiveness of tDCS on attenuating experimental pain perception depends on both stimulation parameters of tDCS and the modality of experimental pain. SIGNIFICANCE: This study provides some theoretical basis for the application of tDCS in pain management.

Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. Objective: To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients' treatment preferences and risk of opioid misuse. Design, Setting, and Participants: This study is a secondary analysis of data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Participants included 1302 patients aged 18 to 70 years who presented to the ED with ureter colic or musculoskeletal back and/or neck pain. Interventions: The treatment arm was randomized to receive a patient-facing intervention (not examined in this secondary analysis) and a clinician-facing intervention that consisted of a form containing information about each patient's analgesic treatment preference and risk of opioid misuse. Main Outcomes and Measures: Concordance between patient preference for opioid-containing treatment (assessed before ED discharge) and receipt of an opioid prescription at ED discharge. Results: Among 1302 participants in the Life STORRIED clinical trial, 1012 patients had complete demographic and treatment preference data available and were included in this secondary analysis. Of those, 563 patients (55.6%) self-identified as female, with a mean (SD) age of 40.8 (14.1) years. A total of 455 patients (45.0%) identified as White, 384 patients (37.9%) identified as Black, and 173 patients (17.1%) identified as other races. After controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge (odds ratio [OR], 0.42; 95% CI, 0.27-0.65). When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients (among those who preferred opioids: OR, 0.43 [95% CI, 0.24-0.77]; among those who did not prefer opioids: OR, 0.45 [95% CI, 0.23-0.89]). These disparities were not eliminated in the treatment arm, in which clinicians were given additional data about their patients' treatment preferences and risk of opioid misuse. Conclusions and Relevance: In this secondary analysis of data from a randomized clinical trial, Black patients received different acute pain management than White patients after patient preference was accounted for. These disparities remained after clinicians were given additional patient-level data, suggesting that a lack of patient information may not be associated with opioid prescribing disparities. Trial Registration: ClinicalTrials.gov Identifier: NCT03134092.

Abordaje no farmacológico del dolor en pediatría desde la perspectiva de enfermería: Aplicación de materiales audiovisuales y buzzy® / Non-pharmacological approach to pain in pediatrics from the nursing perspective: Application of audiovisual materials and buzzy®

Objetivo: Evaluacion del abordaje multidisciplinario del dolor pediátrico.Metodo: Revisión sistemática de la bibliografía más actualizada acerca del tema en los buscadores médicos Pubmed, Cuiden, Scielo, Cochrane Library y Cinahl. Aplicando en los motores de búsqueda los términos: “Pain Assessment”, “Pain Measurement” “Pain Management” “Nonpharmacologic treatment”, realizando una acotación a aquellos artículos escritos en castellano e inglés y con fecha de publicación posterior a enero de 2015.Resultados y Discusión: Se ha tratado la identificación de la intensidad del dolor que requiere de un abordaje complejo y no existe un método de evaluación que se muestre superior a otro. Parece por tanto adecuado la aplicación de la combinación del autoregistro por parte del paciente siempre que sea posible, la familia y la aplicación de escalas de aplicación sistematizada por parte de personal cualificado para ello. Para la aplicación de las escalas parece conveniente la utilización según la validación de estas en determinados grupos de pacientes y lo familiarizado que este el personal encargado de registrarlas. El tratamiento farmacológico está siendo desarrollado amplia y eficazmente como medida complementaria a las formas habituales de tratamiento del dolor. Estas medidas en su mayoría de las veces por su fácil aplicación, escaso coste y casi nulo riesgo de iatrogenia se están implementando en la mayoría de las unidades de atención pediátrica. Esta aplicación de medidas exige de la creatividad y capacitación continua del personal que las lleve a cabo y de una correcta evaluación del dolor en cada momento de la asistencia.Conclusión: El control del dolor y la ansiedad que asocia son un desafío de abordaje multidisciplinar en el que la enfermería cumple un gran papel, desde su posición tanto de realizadora de la gran mayoría de procedimientos que pueden desencadenarlo como desde la aplicación de las medidas no farmacológicas.(AU)

Objective: Evaluation of the multidisciplinary approach to pediatric pain.Method: Systematic review of the most up-to-date bibliography on the subject in the medical search engines Pubmed, Cuiden, Scielo, Cochrane Library and Cinahl. Applying in the search engines the terms: “Pain Assessment”, “Pain Measurement” “Pain Management” “Nonpharmacologic treatment”, making a limitation to those articles written in Spanish and English and with a publication date after January 2015.Results and Discussion: The identification of the intensity of pain that requires a complex approach has been discussed and there is no evaluation method that is superior to another. Therefore, the application of the combination of self-registration by the patient whenever possible, the family, and the application of systematized application scales by qualified personnel seems appropriate. For the application of the scales, it seems advisable to use them according to their validation in certain groups of patients and how familiar the personnel in charge of registering them are. Pharmacological treatment is being widely and effectively developed as a complementary measure to the usual forms of pain management. These measures, mostly due to their easy application, low cost and almost zero risk of iatrogenesis, are being implemented in most pediatric care units. This application of measures requires the creativity and continuous training of the personnel who carry them out and a correct assessment of pain at each moment of assistance.Conclusion: The control of pain and associated anxiety are a multidisciplinary approach challenge in which nursing plays a great role, both from its position as the director of the vast majority of procedures that can trigger it and from the application of non-functional measures. pharmacological.(AU)

Knowledge, Attitude, and Practice towards Labor Pain Management and Associated Factors among Skilled Birth Attendants Working at Hospitals Found in Central, West, and North Gondar Zones, Northwest Ethiopia, 2019: A Multicenter Cross-Sectional Study.

Introduction: Delivery of the infant into the arms of a conscious and pain-free mother is the most exciting and rewarding moment in maternal care services. Physical and mental care of women during delivery requires good knowledge and a positive insight to the needs and rights of the mothers. Little was known regarding skilled birth attendants' knowledge, attitude, and practice towards labor pain management in the study area. Hence, the current study aimed at assessing knowledge, attitude, and practice, and associated factors towards labor pain management among skilled birth attendants working at hospitals found in central, west, and north Gondar zones, northwest Ethiopia, 2019. Method: A multicenter institution-based cross-sectional study was conducted from June 1 to 30, 2019. A census sampling technique was used to include a total of 336 skill birth attendants. A pretested standardized self-administered questionnaire was used to collect the data. The data were then entered into Epi Info 7.1.2 and exported to SPSS version 25 for analysis. Multivariable logistic regression analyses were undertaken to identify factors associated with outcome variables. The level of significance of the study was declared based on adjusted odds ratio with 95% confidence interval at a p value of ≤0.05. Result: The proportion of skill birth attendants having good knowledge, a favorable attitude, and a good practice on labor pain relief methods was 47%, 41.96%, and 57.14%, respectively. Age of ≤30 years (AOR = 5.43; 95% CI: 1.25, 23.53), educational status of 2nd degree and above (AOR = 3.56; 95% CI: 1.32, 9.60), working at a private primary hospital (AOR: = 6.55; 95% CI: 2.15, 19.93), and working at a referral hospital (AOR = 2.24 : 95% CI: 1.01, 4.93) are factors significantly associated with good knowledge while having good knowledge on labor pain relief methods (AOR = 2.26; 95% CI: 1.42, 3.60) and working at private primary hospitals (AOR = 7.01; 95% CI: 1.92, 25.65) had statistically significant association with favorable attitude and good practice on labor pain relief methods, respectively. Conclusion and Recommendations. Poor knowledge, unfavorable attitude, and poor practice towards labor pain management were found in this study. Strengthening the capacity of public health facilities and providing continuous professional development (CPD) training for the skilled birth attendants would be helpful in improving knowledge, attitude, and practice towards labor pain management.