Comparison of analgesic effects of gabapentin and paracetamol post-operatively in patients with hand injury

Objective: Compare the analgesic effects of Gabapentin and Paracetamol post-operatively in patients with hand injury. Methods: This double blind, randomized control trial was conducted at the Department of Plastic Surgery, Dow University of Health Sciences Karachi; during March to August 2019. Fifty participants with hand injury and age ranged 18-60 were enrolled through consecutive sampling; while patients with multiple traumas, psychiatric illnesses, epileptic and pregnant were excluded. Informed written consent was obtained before enrollment of participants. Participants were randomly divided into two groups. Gabapentin (600 mg) and Paracetamol (1000 mg) were provided through anonymous packaging. Pain intensity was assessed using Visual Analogue Scale (VAS) along with self-designed questionnaire which was filled twice post-operatively (first at the time of drug intake once orally allowed and 6 hours later). Computer software SPSS 22 was used for analysis and comparison of results. Results: The analgesic effects of both the groups were analyzed using paired ‘t’ test which revealed statistically significant value i.e. <0.001 for each group. Though; the correlation coefficient was slightly more promising towards Paracetamol group (0.873 and 0.743 for Paracetamol and Gabapentin respectively). While in Gabapentin group there were more change of peaks were observed. Clinically more side effects were found in Gabapentin group. Conclusion: Both the drugs were found to be effective in pain management but Paracetamol had better pain control with relatively less side-effects. Key words: Pain, Hand injury, Gabapentin, Paracetamol. Continuous...

Clinical Practice Guidelines for the Management of Temporomandibular Joint Disorders – A Review

BACKGROUND Temporomandibular joint disorders (TMD) are a group of disorders associated with temporomandibular joints, their associated muscles, and other related structures. TMD present with pain in the joints and related structures which can radiate to the neighbouring areas mimicking ear pains, headaches, neuropathic pain and odontogenic pain. Even though TMDs are more seen in both genders, the ratio of women reporting with TMD is higher (2:1) than men. Pain, the commonest symptom encountered, is usually chronic in duration and mild to severe in intensity. Various other signs and symptoms described are clicking or popping noise, deviation of the mandible, restricted mouth opening and jaw movements. Multiple factors have been reported as an aetiology, however, there is no definite established aetiology to cause TMD. Approaches to the management of TMDs require thorough history taking, clinical and radiological assessment and proper treatment planning. The signs, symptoms, and prevalence of the diseases are also necessary considerations in the treatment planning of TMDs. Traditional approaches in the management of TMDs involve systemic medications, physical therapies, and surgical interventions. The first line of systemic medications to be advised to relieve pain are analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, muscle relaxants, barbiturates like benzodiazepine have been frequently administered. In recent times, extraction of impacted or buccoverted third molar teeth has also proven to be effective in reducing the pain associated with TMDs. The purpose of this study is to provide new clinical practice guidelines to establish a multidisciplinary approach in the management of patients with TMDs and to improve the patient’s quality of life (QoL). KEY WORDS Pain, Temporomandibular Joint Disorder, TMD, Treatment Guidelines

Utilizing Multidisciplinary Medicine in Pain Management: A Narrative Review

BACKGROUND: The role of psychological factors influencing chronic pain has been well documented. This review includes a historical perspective and current examination of the literature on psychological and behavioral health characteristics and their influence on chronic pain. OBJECTIVES: To identify psychological and behavioral health factors involved with chronic pain, as well as the challenges and opportunities of integrating multidisciplinary care into a pain management practice. STUDY DESIGN: Narrative review of peer-reviewed literature examining psychological and behavioral health factors associated with poor clinical outcomes with an emphasis on orthopedics. METHODS: The Medline database was reviewed to identify peer-reviewed research that discussed psychological and behavioral health factors relevant to pain management or orthopedics. RESULTS: The evidence provided suggests that these constructs should receive strong consideration when managing chronic pain. The incorporation of such factors may improve patient care and clinical outcomes and reduce total health care costs. LIMITATIONS: This narrative review is not systematic in nature, but rather focused on the impacts on orthopedics and pain management. CONCLUSIONS: Psychological and behavioral health factors should be an integral component of a pain management practice as there is substantial overlap between depression and anxiety with chronic pain. Positive affect, such as resilience, may act as a buffer and confer some protection against the sequelae of chronic pain. There is evidence that psychological screeners offer further insight into the patient condition and would contribute to the treatment plan. The novel role of a behavioral health navigator in a pain management clinic is worthy of further exploration as it has proved beneficial in other chronic health conditions. KEY WORDS: Pain management, chronic pain, psychological, multidisciplinary, behavioral health navigator, resiliency, opioids

Pain and Chemical Dependency

Pain can mean different things to different people. At the same time, it is a subjective and objective sensation. For the patient experiencing pain, it is an unpleasant sensation that causes undue suffering. Chemical dependency or addiction is characterized by inability to consistently abstain, impairment in behavioral control, and craving; diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and a dysfunctional emotional response. It is a complex chronic disease of brain reward, motivation, memory, and related circuitry. The prevailing view of opioid therapy for chronic pain is a pendulum swinging between opiophobia and opiophilia. The intersection between pain and addiction is also a moving target. Various stakeholders have attempted to find a balance between addressing the crisis of chronic pain in society and not exacerbating the problem of substance abuse. The pain practitioner must recognize the duality that exists between chronic and chemical dependency and must assess risk prior to using controlled substances to manage that pain, and if things go awry, the physician must have an exit strategy. Discharging problem patients merely transfers the problem elsewhere. Offering patients a solution to iatrogenic dependence on controlled substances is a viable and compassionate path for both the patient and the practitioner. This review contains 2 figures, 2 tables, and 20 references. Key Words: pain, opioids, opiophobia, opiophilia, substance abuse, chemical dependency, addiction, chronic pain

The effect of mother’s voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs

Introduction: Arterial blood sampling is a painful procedure, and is frequently performed in PICUs. Listening to mother's voice may be effective in reducing pain during arterial blood sampling in children. This study was aimed to determine the effect of mother’s recorded voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs. Methodology: This study was a single blind randomized clinical trial with crossover design. Fifty children hospitalized in PICUs participated in this study. The participants were selected through “sequential sampling” and randomly allocated into two groups; e.g., Group AB (n = 25) and Group BA (n = 25). Physiological parameters and pain in each child were measured before and during arterial blood sampling with (B) and without (A) listening to their mothers’ voices with a minimum of 24 hrs interval. To measure the pain, COMFORT pain scale was used and the physiological parameters were measured using the monitoring devices connected to the children. Data were analyzed with SPSS version 22, repeated measure test, paired and non-paired t-test, Wilcoxon and Mann-Whitney test. Results: Means of pain scores and physiologic parameters did not show a significant difference before the intervention on the first and second day between the two groups (AB-BA). The results showed the period effect (f = 0.581 and p = 0.89) and carry over effect (f = 0.055, p-value = 0.881) were not significant. Results of paired t-test showed that the mean pain score during arterial blood sampling with (B: 21.82 ± 5.53) and without (A: 22.40 ± 4.76) listening to their mothers’ voices was significantly different (p = 0.002). That is, with the mother’s voice, the children felt a lower level of pain. The SpO2 decline during the sampling was less with the mother’s voice. Additionally, the heart rate declined less during the sampling compared to the rate before the sampling with the mother’s voice; still, the difference was not significant (p > 0.05). Conclusion: Listening to mothers’ recorded voice was effective to alleviate pain during arterial blood sampling in children hospitalized in PICUs. The use of this method to reduce pain during this painful procedure is effective even in the absence of the mother. Key words: Pain; Mother’s voice; Arterial blood sampling; Physiological indices; PICU Citation: Shoghi M, Ahmadi M, Rasouli M. The effect of mother’s voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs. Anaesth. pain intensive care 2021;25(1):40-47.DOI: 10.35975/apic.v25i1.1440 Received: 20 June 2020, Reviewed: 16 September 2020, Accepted: 25 November 2020

Prevention of inflammatory complications in treatment of patients with acute odontogenic purulent periostitis of the jaws

Purpose: to determine the effectiveness of the drug «Tantum Verde®» for the prevention of inflammatory complications in the oral cavity and peri-maxillary soft tissues in patients with acute odontogenic purulent periostitis of the jaws. Methods: 118 patients with acute odontogenic purulent periostitis of the jaws aged from 16 to 65 years were examined (86 people – the main group, 32 people – the control group). Results: on the basis of examinations those patients with acute odontogenic purulent periostitis of the jaws it was found that the drug «Tantum Verde®» used for oral baths after opening subperiostal abscesses has a pronounced antiseptic, anti-inflammatory, analgesic and deodorizing effects. Conclusions: using the drug «Tantum Verde®» made it possible to reduce the number of pyoinflammatory complications and reduce the duration of treatment of patients. During the research was established that the drug «Tantum Verde®» is an effective antimicrobial, analgesic, anti-inflammatory and antipyretic drug and can be recommended for the treatment of patients with acute odontogenic purulent periostitis of the jaws. Key words: pain, inflammation, complications, immunity, periostitis, Tantum Verde®.

Modern solution to the problem of pain relief in newborns with necrotizing enterocolitis

To date, there is no doubt that newborns feel pain. They have short-term and long-term effects of pain, which include disorders of neurological and behavioral development. The perception of pain requires the functioning of the anatomical structures through which the impulse enters the central nervous system, and the neuroendocrine system, which provides the body's response to pain. Diagnosis of pain in newborns is made by assessing the behavioral, physiological and hormonal responses that occur in response to a painful stimulus. Among the three most common pain assessment scales, the PIPP scale is used more often, one of the significant advantages of which is taking into account the degree of maturity and the term of birth of the child, together with the assessment of behavioral responses, physiological parameters (heart rate, oxygen saturation ), the work of facial muscles. Modern strategies for the treatment of acute pain are based on the concept of multimodal analgesia, the main idea of which is to increase the effectiveness of analgesics while reducing the incidence of side effects, using drugs of different groups with different points of application. Interventions to control neonatal pain can be both non-pharmacological and pharmacological. In the case of a relatively stable condition of a patient with necrotizing enterocolitis, the preoperative stage of anesthetic management should be focused on assessing and adjusting the respiratory, circulatory and metabolic status, as well as on the assessment and correction of current hematological and coagulation disorders as an integral part of the above actions. In the case of suspected or therapeutic necrotizing enterocolitis, the main therapeutic interventions should be aimed at creating conditions for the so-called «rest» for the intestine, its decompression and the appointment of broad-spectrum antibiotics. Therefore, anesthetic management of necrotizing enterocolitis is the need to continue the current intensive care and resuscitation, which is especially useful in cases where a critically ill newborn needs vital rescue surgery. No conflict of interest was declared by the author. Key words: pain, newborns, analgesia, necrotizing enterocolitis.

A comparison of low dose ultrasound and far infra-red therapies in patients with mechanical neck pain

Objective: To compare the effect of low-dose continuous ultrasound and far-infrared interventions for reducing pain in patients with mechanical neck pain. Method: The experimental study was conducted from April 2016 to January 2017 at the electrotherapy laboratory of the Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia, and comprised female patients diagnosed with mechanical neck pain. They were divided into two equal groups, with Group A receiving 3 sessions per week of low-dose continuous ultrasound on the cervical region for 7 weeks, and Group B receiving far-infrared treatment on the same patterns. Both groups received stretching, strengthening exercises and transcutaneous electrical nerve stimulation. Pain tolerance was assessed at baseline and post-intervention using digital algometer. Data was analysed using SPSS 17. Results: Of the 30 women with a mean age of 21.36±1.14 years, there were 15(50%) in each of the two groups. There was a significant decrease in post-intervention bilateral values compared to baseline in both groups. Group B showed higher significant values than Group A (p<0.05). Conclusions: Far-Infrared was found to be much better than low-dose continuous ultrasound for reducing pain in patients suffering from mechanical neck pain. Key Words: Pain tolerance, Ultrasound, Infrared, Trigger points, Mechanical neck pain, Algometer. Continuous....

Revised definition of pain by ‘International Association for the Study of Pain’: Concepts, challenges and compromises

A new definition of pain has been formalized and adopted by International Association for the Study of Pain (IASP) in January 2020, which states that pain is “An unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage”. It has been a result of a number of feedbacks from the pain physicians from around the world about their dissatisfaction about the previous definition. In this editorial the author endeavors to give his perspective on the concept of this definition, along with compromises made while incorporating this definition and challenges for future in the revising and updating it. But we must also acknowledge that this definition is a step in the right direction for considering pain as a disease, a standalone health condition, and not only a symptom. Key words: Pain, concepts; Challenges; Pain, definition; IASP; Terminology Citation: Malik NA Revised definition of pain by ‘International Association for the Study of Pain’: Concepts, challenges and compromises. Anaesth. pain intensive care 2020;24(5): Received: 20 June 2020, Reviewed: 24, 28 June 2020, Accepted: 1 July 2020

Opioid Prescription in Switzerland: Appropriate Comedication use in Cancer and Noncancer Pain

Background: In Europe, limited information on the use of opioids is available. Objectives: To assess how guideline recommendations to manage opioid-related adverse events were followed in cancer- and noncancer-related opioid use. Study Design: Analysis of health insurance data of one of the major health insurers in Switzerland. Setting: All opioid claims between 2006 and 2014. Methods: Opioid episodes were cancer-related when cancer treatments were used within ± 3 months of the first opioid claim. Recurrent strong episodes were defined as ≥ 2 opioid claims with at least one strong opioid claim. Episode duration were acute (< 90 days), subacute, or chronic (≥ 120 days/≥ 90 days + ≥ 10 claims). Results: Out of 591,633 opioid episodes 76,968 (13%) were recurrent episodes: 94% were noncancer related (83% in recurrent episodes) and 6% cancer related (17% recurrent). Chronic opioid use was observed in 55% (noncancer) and 58% (cancer) recurrent episodes. Recommended laxatives were used in 50% noncancer and in 67% cancer episodes. Antiemetic drugs were used in 54% noncancer and in 83% cancer episodes. Not recommended coprescription of benzodiazepines was observed in 34% recurrent noncancer and 46% cancer episodes. Limitations: No clinical information was available to assess the indication for opioid use. Conclusions: In this study, opioids were primarily used outside the context of cancer-related treatment. In noncancer-related opioid use, we found a substantial higher proportion without recommended laxative and antiemetic medications. Coprescription of benzodiazepines may increase the risk for opioid overdose and was present in one-third of the noncancer episodes and in almost every second cancer episode. Key words: Pain medications, opioids, nonopioids, benzodiazepines, health insurance claims data, cancer pain, noncancer pain, chronic opioid use, adverse events prevention, guideline recommendations