Pain Research and Management

Background. Pain control is one of the most important aspects that can affect parental satisfaction of the dental care provided for children. Dental local anesthesia has the highest impact on pain sensation of the children. However, there is no scale in the literature to assess parental satisfaction of dental local anesthetic techniques. Objectives. This study was aimed to assess the parental satisfaction with dental local anesthetic techniques for their children through designing a scale that reflects satisfaction and to study the validity and reliability of this scale. Methods. A cross-sectional observational study was conducted on 150 parents (102 mothers and 48 fathers). Two techniques of local anesthesia were used for each child participated in this study (inferior alveolar nerve block and computerized intraosseous anesthesia). The developed scale consisted of 20 items in a 5-point Likert scale. Half of the items were written in a negative format. Internal consistency, validity, and factor analysis were performed in this study. Independent t-test was used to compare between the two techniques of anesthesia, between boys and girls and among fathers and mothers. Results. Parental satisfaction mean values were higher in the computerized intraosseous anesthesia group in comparison to inferior alveolar nerve block ( value <0.05). The T-test showed that there was no difference between boys and girls regarding parental satisfaction ( value >0.05). Furthermore, fathers show lower satisfaction in the computerized interosseous anesthesia group ( value <0.05). Excellent internal consistency of this scale was resulted as Cronbach’s alpha reliability coefficient was 0.985. After factor analysis, seven factor components were retained by using varimax rotation. Conclusions. Findings of this study reported that the designed parental satisfaction of dental local anesthetic techniques scale (PSLAS) is a valid and reliable scale to be used. Moreover, this study showed that parental satisfaction was higher when computerized intraosseous anesthesia was used in comparison to inferior alveolar nerve block.

Background. Lumbar spinal stenosis (LSS) patients have been reported to have neuropathic pain and central sensitivity syndrome (CSS). These associations have been reported in other diseases but are unknown in preoperative LSS patients. We aimed to investigate the association between neuropathic pain and CSS in preoperative LSS patients using the painDETECT and the Central Sensitization Inventory (CSI) questionnaires. Methods. This cross-sectional study was conducted from November 2021 to March 2022. The data were collected regarding demographics and pain, including neuropathic pain, numbness, LSS severity, physical function, quality of life, and CSS. Patients were divided into two groups, patients with acute and chronic pain, and further classified into three categories based on the clinical phenotype of patients in each group. Independent variables included age, gender, type of LSS (bilateral or unilateral symptoms), Numerical Rating Scale of leg pain, CSI, and the Zurich Claudication Questionnaire (ZCQ) for symptom severity and physical function. The dependent variable was painDETECT. Multiple regression analysis using the forced entry method examined the association between painDETECT and CSI. Results. Of the 119 patients with preoperative LSS, 106 were included. The mean age of the participants was 69.9 years, and 45.3% were female. Neuropathic pain was present in 19.8%, and CSS was present in 10.4%. The CSI (β = 0.468, ) and ZCQ for symptom severity (β = 0.304, ) were significantly associated with the painDETECT, explaining 47.8% of the variance in the painDETECT score. Conclusions. There is an association between neuropathic pain and CSS in patients with preoperative LSS using the painDETECT and CSI questionnaires.

Objectives. Failed back surgery syndrome (FBSS) refers to a condition where symptoms such as low back pain, leg pain, and numbness persist or recur after lumbar surgery; it has been reported to occur in 10%–40% of patients who have undergone lumbar surgery. Spinal cord stimulation (SCS) has been reported useful for low back and leg pain due to FBSS. In this study, we studied the efficacy and safety of SCS for FBSS in older adults. Methods. Among FBSS patients who underwent an SCS trial between November 2017 and December 2020, those with at least 50% pain reduction during the trial phase who requested spinal cord stimulator implantation underwent implantation of a stimulator under local anesthesia. The patients were divided into two groups: patients aged <75 years (<75-year-old group) and patients aged ≥75 years (≥75-year-old group). The male/female ratio, symptom duration, operative duration, visual analog scale (VAS) scores before and after one year of surgery, responder rate (RR), complications one year after surgery, and stimulator removal rate were analyzed. Results. There were 27 cases in the <75-year-old group and 46 in the ≥75-year-old group, with no significant differences in male/female ratio, duration of pain, or operative time between the two groups. VAS scores for low back pain, leg pain, and overall pain one year after surgery were improved significantly from respective preoperative scores in both groups . There were no significant differences in low back pain VAS, leg pain VAS, overall pain VAS, RR, complications one year after surgery, or stimulator removal rate between the two groups. Conclusion. SCS reduced pain effectively in both <75-year-old and ≥75-year-old groups with no differences in complications. Therefore, spinal cord stimulator implantation was considered a viable option for FBSS treatment in older adults because it can be performed under local anesthesia and is associated with a low incidence of complications.

Objectives. To evaluate the short-term outcome of treatment by auricular acupressure (AA) on postoperative pain among hip fracture (HF) patients. Methods. A systematic search for randomized controlled trials on this topic was conducted through May 2022 by searching multiple English and Chinese databases. The methodological quality of the included trails was assessed by the Cochrane Handbook tool, and relevant data were extracted and statistically analyzed by RevMan 5.4.1 software. The quality of the evidence supporting each outcome was evaluated by GRADEpro GDT. Results. Fourteen trials with a total of 1390 participants were included in this study. Compared with conventional treatment (CT) alone, the combination of AA and CT had a significantly greater effect on the visual analog scale at 12 h (MD −0.53, 95% CI −0.77 to −0.30), 24 h (MD −0.59, 95% CI −0.92 to −0.25), 36 h (MD −0.07, 95% CI −0.13 to −0.02), 48 h (MD −0.52, 95% CI −0.97 to −0.08), and 72 h (MD −0.72, 95% CI −1.02 to −0.42), amount of analgesics used (MD −12.35, 95% CI −14.21 to −10.48), Harris Hip Score (MD 6.58, 95% CI 3.60 to 9.56), effective rate (OR 6.37, 95% CI 2.68 to 15.15), and adverse events (OR 0.35, 95% CI 0.17 to 0.71). Conclusions. Compared with CT alone, the combination of AA and CRT had a significantly greater effect on postoperative pain in HF patients. However, trails with a rigorous methodology, including standard protocols for AA and multiethnic subjects, are still needed.

Background. A qualitative evaluation study of the prematurely terminated PrEgabalin Lidocaine Capsaicin Neuropathic Pain (PELICAN) study was performed. The PELICAN study aimed to examine pain management for localized neuropathic pain (LNP), as epidemiological figures have shown a high percentage of LNP patients in Belgium. The study compared systemic and topical medications according to pain relief, adverse effects, and several measures of quality of life. Objective. Achieving better study patient recruitment through qualitative research. To investigate and determine the causes of the observed recruitment problems in the PELICAN study, pain centers involved in the study as well as nonrecruiting pain centers were included. Furthermore, it aimed to highlight the positive and negative lessons learned from the conducted study and the number of obstacles the team had to overcome. Methods. A qualitative study, using a mixed methods approach, was performed. Multiple pain centers in Belgium completed an online survey, after which a structured interview was conducted to elaborate the responses in more detail. The broad topics of these meetings were feedback about the study, reviewing survey answers, and actions undertaken to enhance recruitment. Results. Different factors contributed to the low recruitment rate in the PELICAN study, such as limited and late referral from the general practitioners to the Belgian pain centers, insufficient internal referrals from nonpain specialists, lack of specific expertise on LNP in some centers, scarcity of staff, limited reimbursement to administer complex analgesic schemes, overestimation of the patient population, and the reluctance of patients to participate in pain research. Additionally, shortcomings in the implemented study design and the need for more logistical investments were identified. Conclusion. The findings of the qualitative study demonstrate the need for further, more varied LNP research in Belgium, not limited to pharmacological studies. It also sheds important light on the recruitment obstacles that may be faced during these studies. Future studies could support this research by offering better proposals for feasibility and recruitment, for instance, by designing and conducting a compelling pilot study or applying social media during the recruitment phase. Clinical Trials. This trial is registered with NCT03348735. EUDRACT number 2018-003617-17.

Background. Patients with chronic musculoskeletal pain experience not only pain but also abnormal body perception. Such abnormal body perception has been reported to be caused by incongruence between motor intentions and sensory feedback (i.e., sensorimotor incongruence). However, the influence of abnormal body perception with sensorimotor incongruence on pain prognosis in musculoskeletal pain patients has not been investigated. Objective. We aimed at clarifying the influence of abnormal body perception on pain prognosis using an experimental procedure for inducing sensorimotor incongruence in patients with musculoskeletal pain. Methods. We recruited 18 patients within 2 months after limb fracture or ligament injury. In the experiment, patients sat with the intact upper or lower limb reflected in a large mirror aligned with the sagittal plane. A motor task was performed for 20 seconds in each of the congruent and incongruent conditions. In the congruent condition, patients were asked to perform flexion-extension movements with the intact and affected limbs in-phase, while observing the intact limb in the mirror. In the incongruent condition, patients were asked to perform flexion-extension movements antiphase, while observing the intact limb in the mirror. After performing the congruent and incongruent conditions, patients were asked to complete a questionnaire about abnormal body perception. These procedures were conducted within 2 months after the fracture (first), 2 weeks after the first measurement (second), and 4 weeks (third) after the first measurement. Results. Pain, heaviness, and peculiarity were more likely to be experienced in incongruent conditions. Additionally, structural equation modeling indicated that heaviness at the first time point predicted the pain intensity at the second and third time points. Conclusions. Heaviness caused by sensorimotor incongruence may predict pain prognosis in patients with musculoskeletal pain after one month.