The Clinical journal of pain
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Randomized Controlled Trial
The Effect of Adding Dexmedetomidine to Levobupivacaine for Interscalene Block for Postoperative Pain Management After Arthroscopic Shoulder Surgery.
Arthroscopic subacromial decompression may cause substantial postoperative pain. We undertook a randomized controlled trial to examine whether adding dexmedetomidine to the local anesthetic in an interscalene brachial plexus block and subsequent patient-controlled interscalene analgesia (PCIA) regime improved postoperative pain scores, patient satisfaction, rescue analgesic requirement, and local anesthetic consumption. ⋯ Addition of dexmedetomidine to levobupivacaine for interscalene brachial plexus block decreases pain scores and increases patient satisfaction after arthroscopic subacromial decompression.
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Comparative Study
Comparison of Average Weekly Pain Using Recalled Paper and Momentary Assessment Electronic Diary Reports in Children with Arthritis.
The current study investigated the construct validity of a multidimensional pain diary for youth with juvenile idiopathic arthritis and also compared participants' responses on electronic and retrospective diary measures. The purpose of the latter part of this study was to compare absolute agreement, between-person and within-person consistency and judged change in weekly pain between these 2 methods of assessing pain. ⋯ This is one of the few studies to explore the relationship between the measurement methods of pain recall and momentary assessment in adolescents. The poor within-person correlations observed have important implications for research design and practice in pediatric pain.
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Identifying mechanisms that mediate recovery is imperative to improve outcomes in low back pain (LBP). Qualitative studies suggest that guilt may be such a mechanism, but research on this concept is scarce, and reliable instruments to measure pain-related guilt are not available. ⋯ The findings suggest that pain-related guilt is common and is associated with clinical outcomes. Prospective research is needed to examine the role of guilt as a predictor, moderator, and mediator of patients' outcomes.
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Variations of the Analgesia Nociception Index During Propofol Anesthesia for Total Knee Replacement.
The Analgesia Nociception Index (ANI) monitor measures the relative parasympathetic tone as a surrogate for the antinociception/nociception balance during general anesthesia. The aims of this observational study were to test whether ANI could early detect hemodynamic reactivity (HemodR) during propofol anesthesia, measure pain in conscious patients after surgery, and determine ANI predictive thresholds. ⋯ ANI measures during propofol anesthesia are coherent with the evolution of the analgesia/nociception balance, although its performance decreases in awake patients. Further clinical validation should focus on demonstrating the benefit of maintaining ANI over 63 during surgery.
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Immersive virtual reality (IVR) therapy has been explored as an adjunct therapy for the management of acute pain among children and adults for several conditions. Therapeutic approaches have traditionally involved medication and physiotherapy but such approaches are limited over time by their cost and side effects. This review seeks to critically evaluate the evidence for and against IVR as an adjunctive therapy for acute clinical pain applications. ⋯ This review found moderate evidence for the reduction of pain and functional impairment after IVR in patients with acute pain. Further high-quality studies are required for the conclusive judgment of its effectiveness in acute pain, to establish potential benefits for chronic pain, and for safety.