Pain control according to the periprostatic nerve block site in magnetic resonance imaging/transrectal targeted prostate biopsy

We analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site. We collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 min after biopsy. For all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039). Base and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.

Localized peripheral neuropathic pain: topical treatment with lidocaine 700 mg medicated plaster in routine clinical practice

Aim: To provide real-world evidence for the effectiveness and tolerability of lidocaine 700 mg medicated plaster (LMP) in localized peripheral neuropathic pain (l-PNP) treatment compared with first-line oral medications (OM). Patients & methods: This was a noninterventional, retrospective 6-month cohort study in patients refractory to at least one recommended OM, using anonymized medical care data from the German Pain eRegistry. Treatment groups were matched by propensity scoring, considering seven predefined confounding factors. The primary effectiveness end point was the absolute change in average pain intensity index from baseline at weeks 4, 12 and 24 of treatment and over the treatment period. Results: A total of 3081 datasets were retained per treatment group. LMP provided superior pain reductions and significantly greater improvements in pain-related impairments of daily living and quality of life with significantly better tolerability (p < 0.001 for all parameters) than OM. Conclusion: These real-world data confirm the effectiveness and good tolerability of LMP for l-PNP treatment under routine medical care.

PSYCHO-EMOTIONAL ASPECTS IN THE FORMATION OF PAIN SYNDROME CHARACTERISTICS IN PATIENTS WITH MULTIPLE SCLEROSIS

Introduction: Pain syndromes, anxiety, and depression are common syndromes in multiple sclerosis (MS). Comorbidity of pain and depression or pain and anxiety exists in up to one-third of MS patients. Based on the biopsychosocial model of pain, given the high prevalence of these symptoms and their frequent combination in MS, which is significantly higher than in the general population, we can hypothesize the relationship between the characteristics of pain and anxiety and depression in patients with MS. Objectives: To assess the prevalence of anxiety and depression among MS patients with pain syndromes and analyze the relationship between anxiety and depression with pain syndromes' characteristics in patients with MS. Methods: Data were collected prospectively at Lviv Regional Multiple Sclerosis Center. 120 randomly selected patients with a confirmed diagnosis of multiple sclerosis were examined. 104 of them had pain syndromes during the last month. Complaints and medical history, analysis of medical records, neurological and general medical examination of the patients were collected. Depressive symptoms and anxiety were assessed in all patients using the Hospital Anxiety and Depression Scale (HADS) questionnaire. In patients with pain syndromes, the Visual analogue scale (VAS), Short-form McGill Pain Questionnaire 2 (SF-MPQ-2), Pain Detect were used to assess pain characteristics. Results: The levels of anxiety and depression were higher in the group of MS patients with pain. The level of anxiety was 9.0 [6,0; 12,75] in the group with pain and 7.0 [4,0; 9,25] in the group without pain (p=0.04). The level of depression was 7.0 [4,0; 10,0] in the group with pain and 4.0 [1,75; 6,0] in the group without pain (p<0,01). It was found that part of MS patients with pain syndromes with anxiety was 36.5%, and 29.8% had a subclinical level of anxiety; part of MS patients with pain syndromes with depression was 19.23%. The proportion of patients with anxiety was highest in patients with neuropathic pain: 56.3% ± 8.8% vs. 22.4% ± 6.0% with nociceptive, p<0.01. A similar situation is observed in patients with depression. The share of patients with depression was higher in the group with neuropathic pain 37.5% ± 8.6%, compared to 14.3% ± 5.0% with nociceptive, p=0.02. The proportion of patients with MS without signs of anxiety and depression is significantly higher among patients with nociceptive pain (p<0,05). Also, the correlational relationship between the level of anxiety and depression with the level of the neuropathic type of pain manifestation was found (r=0,40; p<0,01 and r=0,30; p<0,01). Levels of anxiety and depression correlated with the average pain intensity per month (r = 0,21; p=0,03) and did not have a statistically significant relationship with pain intensity at the time of examination and the strongest pain for the last month. The anxiety and depression had correlations with all components of the structure of pain syndromes (according to sfMPQ-2), but the most pronounced direct correlation was found between anxiety and the affective component of pain (r=0,57; p<0,01). It was also found that the level of anxiety was proved to be higher in patients who have 2-3 pain syndromes, than in patients with one pain syndrome: 12.0 [8,0; 14,0] points against 8.0 [5,0; 11,0] points, p<0.01. Besides, this localization of pain in the arms, shoulders and back was related to higher levels of anxiety (r=0.22; p=0.03). Conclusion: Pain syndromes, anxiety, and depression are widespread among patients with MS and there is a relationship between them. MS patients with pain have higher levels of anxiety and depression than MS patients without pain. It is also noteworthy that among MS patients with pain syndromes, high levels of anxiety are detected. Anxiety and depression also have a pronounced relationship with a neuropathic component of pain in patients with MS. Besides this, the presence of more than one pain syndrome, high average pain intensity per month is associated with higher levels of anxiety and depression. The localization of pain in the arms, shoulders and back is related to higher anxiety levels. These discoveries, combined with modern neuroimaging technologies used in the next step of our study, will provide a better understanding of both pain and its structure, as well as anxiety and depression

Gambaran Penurunan Nyeri pada Penderita Plantar Fasciitis Sebelum dan Sesudah Pemberian Modalitas Ultrasound : Literature Review

Plantar fasciitis is an example of one of the problems in the field of musculoskeletal physiotherapy. It is estimated that 10% of the general population will develop plantar fasciitis in their lifetime. The highest incidence of plantar fasciitis is between the ages of 40 and 65 years. Ultrasound modality is a therapeutic tool that helps increase blood vessels, aims to repair damaged tissue, the frequency used in therapy is between 1-3 MHz. This literature review study aims to determine the description of ultrasound modality to reduce plantar pain in plantar fasciitis patients. The selection of articles in this study used the PICO mnemonic. This article search used literature search through Google Scholar (2), PubMed (1), Science Direct (1) dan Sage Journal (1). Inclusion and exclusion criteria according to keywords, published from 2010-2021, articles in full text and not a systematic review. The results of a literature review of 5 articles showed that the ultrasound modality was proven to reduce plantar pain with an average pain reduction using the Visual Analogue Scale (VAS) before and before intervention with a pre-test value of 6.06 and a post-test of 3.33 and got the average difference in pain reduction is 2.73. The literature review study shows that women are more dominant in experiencing plantar fasciitis in the number of 117 people (62.6%), the average age of those experiencing plantar fasciitis is 49.8 years. This research can be used as a basis for the development of the physiotherapy profession, on the problem of reducing plantar pain in plantar fasciitis patients with ultrasound modality intervention.Keywords: Pain; plantar fasciitis; ultrasound AbstrakPlantar fasciitis merupakan contoh dari salah satu kasus masalah dibidang fisioterapi musculoskeletal. Diperkirakan 10% dari populasi umum akan menderita plantar fasciitis dalam hidupnya. Insiden plantar fasciitis tertinggi adalah diantara rentang usia 40 dan 65 tahun. Modalitas ultrasound merupakan alat terapi yang membantu meningkatkan pembuluh darah, bertujuan untuk memperbaiki jaringan yang mengalami kerusakan, frekuensi yang digunakan dalam terapi antara 1-3 MHz Penelitian literature review ini bertujuan untuk mengetahui gambaran modalitas ultrasound terhadap penurunan nyeri pada plantaris pada penderita plantar fasciitis. Pemilihan artikel pada penelitian ini menggunakan mnemonic PICO. Penelusuran artikel ini menggunakan penelusuran literature melalui Google Scholar (2), PubMed (1), Science Direct (1) dan Sage Journal (1). Kriteria inklusi dan eksklusi sesuai dengan kata kunci, dipublikasi dari rentan waktu 2010-2021, artikel dalam teks lengkap dan bukan systematic review. Hasil literature review 5 artikel menunjukan bahwa modalitas ultrasound terbukti mengurangi nyeri pada plantaris dengan hasil rata- rata penurunan nyeri dengan alat ukur Visual Analogue Scale (VAS) Sebelum dan sesudah intervensi dengan nilai pre test 6,06 dan post test 3,33 dan mendapatkan rata-rata selisih penurunan nyeri 2,73. Studi literature review menunjukan perempuan lebih mendominasi mengalami plantar fasciitis sejumlah 117 orang (62,6%), rata-rata usia yang mengalami plantar fasciitis usia 49,8 tahun. Study literatur review menunjukan bahwa modalitas ultrasound berpengaruh terhadap penurunan nyeri plantaris pada penderita plantar fasciitis. Penelitian ini dapat digunakan sebagai dasar dari pengembangan profesi fisioterapi, pada masalah penurunan nyeri pada plantaris pada penderitas plantar fasciitis dengan intervensi modalitas ultrasound.Kata kunci : Nyeri; plantar fasciitis; ultrasound

Literature Review : Penerapan Metode Kompres Hangat Dalam Menurunkan Intensitas Nyeri Ibu Bersalin Kala 1 Fase Aktif

The unproper handied labour pain may ancrease blood pressure as well as oxygen demand, and decrease uterine contraction. Warm compress is a method that can be applied to reduce the intensity of pain during labour. this scientific report was written to describe the application of warm compresses to reduce the intensity of maternal pain during the first active phase of labour based on a literature review. this literature review was constructed by analyzing 3 articles takeen from Google Scholar with "labour pain", "firts active phase" and "warm compresses" the keywords, in the form of fulltext articles, and published during 2011 - 2021. From 78 respondent, 66.6% of them aged >25 years old, 58% were multipara, and 60.4% finished secondary education. The result showed that the average pain scale before the intervention was 5,3. Therefore, it can be concluded that warm compresses can reduce labour pain during the firts active phse. hence, health workers are suggested to give warm compresses to reduce the intensity of labour pain during the firts active phase.Keywords: Labour Pain; Warm Compresses; Stage 1 Active Phase AbstrakNyeri persalinan yang tidak ditangani dengan tepat dapat menyebabkan peningkatan tekanan darah, peningkatan kebutuhan oksigen dan penurunan kotraksi uterus. Metode kompres hangat merupakan salah satu intevensi yang dapat menurunkan intensitas nyeri pada ibu bersalin. Penulisan karya tulis ilmiah ini bertujuan untuk mengambarkan penerapan kompres hangat terhadap intensitas nyeri ibu bersalin kala 1 fase aktif berdasarkan literature review. Desain karya tulis ilmiah ini adalah Literature Review, dengan menganalisis 3 artikel yang diambil dari laman google scholar dengan kata kunci “nyeri persalinan”, “kala 1 fase aktif” dan “kompres hangat”, berupa artikel fulltext artikel terbit pada tahun 2011-2021 . Hasil analisa karakteristik responden berjumlah 78, 66,6% responden berusia >25 tahun, 58% paritas Multipara, dan 60,4% pendidikan menegah. Rata-rata skala nyeri sebelum intervensi 7,9 dan setelah intervensi 5,3. Kesimpulanya adalah kompres hangat dapat menurunkan nyeri pada ibu bersalin kala 1 fase aktif. Saran bagi tenaga kesehatan adalah memberikan kompres hangat untuk menggurangi intensitas nyeri bersalin kala 1 fase aktif.Kata kunci: Nyeri Persalinan; Kompres hangat; Kala 1 Fase Aktif

Literature Review : Penerapan Terapi Musik Klasik Dalam Menurunkan Nyeri Pada Pasien Kanker

Cancer is a malignant disease caused by the growth of abnormal body cells and causes tissue damage that can cause pain. One therapy that can be used to cut pain is classical music therapy. The purpose of this scientific paper is to describe the application of classical music therapy in reducing pain in cancer patients. The writing method uses a literature review of three articles obtained from Google Scholar with the keywords “cancer”, “pain”, and “classical music therapy”, in the form of full text articles published in 2014-2020. The results of the literature review from the three articles showed that the average pain before being given classical music therapy was 5.23 and after being given classical music therapy the average pain was 3.82 with a p value < 0.05. Therefore, it can be concluded that classical music therapy can reduce pain of cancer patients. This result can be used as a consideration for the nurses to apply classical music therapy to cancer patients who experience pain.Keywords:Cancer; Pain; Classical Music Therapy. AbstrakKanker adalah penyakit ganas yang disebabkan oleh pertumbuhan sel-sel tubuh yang abnormal serta menyebabkan kerusakan jaringan sehingga dapat menimbulkan nyeri. Salah satu terapi yang dapat digunakan untuk mengurangi nyeri adalah terapi musik klasik. Tujuan dari karya tulis ilmiah ini adalah untuk mengetahui gambaran penerapan terapi musik klasik dalam menurunkan nyeri pada pasien kanker. Metode penulisan menggunakan literature review dari tiga artikel yang didapatkan dari google scholar dengan kata kunci “kanker”, “nyeri”, dan “terapi musik klasik”, berupa artikel fulltex terbit tahun 2014-2020. Hasil literature review dari ketiga artikel menunjukkan rata-rata nyeri sebelum diberikan terapi musik klasik 5,23 dan setelah diberikan terapi musik klasik rata-rata nyeri menjadi 3,82 dengan p value < 0,05. Simpulan dari literature review ini menunjukkan bahwa terapi musik klasik dapat menurunkan nyeri pada pasien kanker. Saran bagi profesi keperawatan dapat menerapkan terapi musik klasik pada pasien kanker yang mengalami nyeri.Kata kunci: Kanker; Nyeri; Terapi Musik Klasik

Literature Review : Pengaruh Terapi Distraksi Musik Klasik Terhadap Intensitas Nyeri Pada Pasien Post Operasi Hernia

Hernia is the expulsion Of body contents through the weakest part Of a Wall Of the abdominal cavity. Handling is done by surgery. The surgical procedures will cause pain. One of the non-pharmacological therapies to treat pain in post-hernia surgery patients is classical music distraction therapy. This study aims to describe the effect of classical music distraction therapy on reducing pain intensity in post hernia surgery patients. The design of this scientific paper used a literature review with a total of 3 articies taken from the Googie Scholar page with the keywords a pain, post hemia surgery, classical music therapy" in the form of full-text articles published in 2014-2018. The results showed that the average value before being given therapy was 5.11 and after being given therapy, the average pain was 3.11 with a p-value <0.05. Therefore it can be concluded that there is an effect of giving classical music distraction techniques to reducing pain intensitu in post hernia surgery patients. This result can be used as a consideration for nurses to apply classical music distraction therapy to reduce pain in post hernia surgery patients.Keywords: Pain; Post Hernia Surgery; Classical Music Therapy AbstrakHernia yaitu keluarnya isi tubuh melewati bagian terlemah dari suatu dinding rongga perut. Penanganan yang dilakukan yaitu dengan pembedahan, dan prosedur pembedahan akan menimbulkan rasa nyeri. Salah satu terapi non farmakologi untuk mengatasi nyeri pada pasien post operasi hernia adalah terapi distraksi music klasik. Penelitian ini bertujuan untuk menggambarkan pengaruh terapi distraksi musik klasik terhadap penurunan intensitas nyeri pada pasien post operasi hernia. Desain karya tulis ilmiah ini menggunakan literature review dengan jumlah 3 artikel yang diambil dari laman google scholar dengan kata kunci “nyeri, post operasi hernia, terapi musik klasik” berupa artikel fulltex dengan tahun terbit 2014-2018. Hasil analisa dari literature review 3 artikel didapatkan nilai rata-rata sebelum diberikan terapi adalah 5,11 dan setelah diberikan terapi rata-rata nyeri menjadi 3,11 dengan p-value <0,05. Simpulan dari literature review ini yaitu terdapat pengaruh pemberian teknik distraksi music klasik terhadap penurunan intensitas nyeri pada pasien post operasi hernia. Saran bagi perawat dapat menerapkan terapi distraksi musik klasik untuk menurunkan nyeripasien post operasi hernia.Kata kunci: : Nyeri; Post Operasi Hernia; Terapi Musik Klasik

Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population

Purpose: Stable angina is ischemic chest pain on exertion or with emotional stress. Despite guideline-directed therapy, up to 30% of patients have suboptimal pain relief. The aims of this study were to: (1) determine the feasibility and acceptability of a randomized controlled trial (RCT) of acupuncture; and (2) evaluate preliminary efficacy of acupuncture with respect to reduction of pain and increased functional status and health-related quality of life (HRQoL). Methods: Participants with stable angina for ⩾1 month received either a standardized acupuncture protocol, twice per week for 5 weeks, or an attention control protocol. Measures included the McGill Pain Questionnaire (average pain intensity (API), pain now) and the Seattle Angina Questionnaire–7 (functional status, symptoms, and HRQoL). Feasibility was defined as ⩾80% recruitment, ⩾75% retention following enrollment, and ⩾80% completion. Descriptive statistics and mixed-effects linear regression were used for analysis. Results: The sample (n = 24) had a mean age of 59 ± 12 years, was predominantly female (63%), and represented minority groups (8% White, 52% Black, 33% Hispanic, and 8% Other). Feasibility was supported by 79% retention and 89% completion rates. The recruitment rate (68%) was slightly lower than expected. Acceptability scores were 87.9% for the acupuncture group and 51.7% for the control group. Outcomes were significantly better for the acupuncture versus control groups (API, b = −2.1 (1.1), p = 0.047; functional status, b = 27.6 (7.2), p < 0.001; and HRQoL, b = 38.8 (11.9), p = 0.001). Conclusions and implications: Acupuncture was feasible and acceptable in our diverse sample. We were slightly under the recruitment target of 80%, but participants who started the study had a high likelihood of completing it. Acupuncture shows promise for stable angina, but its effectiveness needs to be confirmed by a larger, adequately powered RCT. Trial registration number: NCT02914834 (ClinicalTrials.gov).

Prediction of chronic postsurgical pain in adults: a protocol for multivariable prediction model development

IntroductionChronic postsurgical pain (CPSP) is a condition that affects an estimated 10%–50% of adults, depending on the surgical procedure. CPSP often interferes with activities of daily living and may have a negative impact on quality of life, emotional and physical well-being. Clinical prediction models can help clinicians target preventive strategies towards patients at high-risk of CPSP. Therefore, the objective of this study is to develop a clinically applicable and generalisable prediction model for CPSP in adults.Methods and analysisThis research will be a prospective single-centre observational cohort study in Denmark spanning approximately 1 year or until a predefined number of patients are recruited (n=1526). Adult patients aged 18 years and older scheduled to undergo surgery will be recruited at Aarhus University Hospital. The primary outcome is CPSP 3 months after surgery defined as average pain intensity at rest or on movement ≥3 on numerical rating scale (NRS) within the past week, and/or average pain interference ≥3 on NRS among any of seven short-form Brief Pain Inventory items in the past week (general activity, mood, walking ability, normal work (including housework), relations with other people, sleep and enjoyment of life). Logistic regression will be used to conduct multivariate analysis. Predictive model performance will be evaluated by discrimination, calibration and model classification.Ethics and disseminationThis research has been approved by Central Region Denmark and will be conducted in accordance with the Danish Data Protection Act and Declaration of Helsinki. Study findings will be disseminated through conference presentations and peer-reviewed publication. A CPSP risk calculator (CPSP-RC) will be developed based on predictors retained in the final models. The CPSP-RC will be made available online and as a mobile application to be easily accessible for clinical use and future research including validation and clinical impact assessments.Trial registration numberNCT04866147.

Comparison between Aquacel and Aquacel Foam dressing on split-thickness skin graft donor site

Objective: To compare the effectiveness of two commonly used moist dressings, Aquacel and Aquacel Foam (both ConvaTec Ltd., UK), in managing split-thickness skin graft (STSG) donor site wounds. Method: Patients undergoing STSG harvesting for reconstruction were eligible for this quasi-experimental study. After reconstruction surgery, the Aquacel (A) or Aquacel Foam (AF) dressings were applied on the donor site wound. The STSG donor site was assessed by two trained research nurses daily. Clinical outcomes including pain on dressing removal, use of intravenous analgesics, signs and symptoms of wound infection, incidence of exudate leakage and percentage healed were recorded in a standardised form. Cost of the dressing change was retrieved from the hospital billing system. Results: Of 50 patients recruited, 25 received dressing A and 25 received the AF dressing for their STSG donor site wound. The average pain score on dressing removal was significantly lower in the AF dressing group compared with the A dressing group (0.8±0.8 versus 3.1±1.5, respectively (p=0.04)). Regression analysis demonstrated that compared with dressing A, the AF dressing was associated with a lower average pain score (beta: –2.27, standard error: 0.33; p<0.001), lower likelihood of pro re nata (PRN) intravenous analgesic use (odds ratio (OR)=0.21, 95% confidence interval: 0.06–0.71; p=0.01) and lower likelihood of exudate leakage (OR=0.11, p=0.01). The differences in time to wound healing, infection and cost were not statistically significant between the two groups. Conclusion: In this study, the AF dressing demonstrated superior performance in pain response on dressing removal for STSG donor site wounds compared with dressing A. Large-scale randomised controlled trials should be conducted to confirm the findings.