Pain physician
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Meta Analysis
Mindfulness Meditation for Fibromyalgia Syndrome: A Systematic Review and Meta-analysis.
The effectiveness of mindfulness meditation (MM) for the treatment of fibromyalgia syndrome (FMS) is unknown and needs to be updated. ⋯ Very low to moderate evidence shows that MM improves quality of life, relieves stress, and relieves insomnia and depression in patients with FMS in the short-term. Notably, the improvement in depression and stress levels continued into the medium-term period. Furthermore, quality of life improvement was discernible at long-term follow-up. This suggests that MM can be used as an adjunct therapy for FMS.International Prospective Register of Systematic Reviews (PROSPERO) Registration Number: CRD42023442356.
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Because of its side effects, a morphine replacement has been searched for in the field of postoperative analgesia. Hydromorphone is a derivative of morphine with no active metabolites. ⋯ There was no significant statistical difference in postoperative analgesic effect between hydromorphone and morphine, as well as side effects, including severe sedation, nausea, and vomiting at 24 hours postoperative. However, the incidence of pruritus was lower in the hydromorphone group at 24 hours postoperative.
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Fibromyalgia is a complex condition that has long puzzled the medical community. Hypotheses to explain the chronic widespread pain associated with the disease have evolved significantly over the years. However, research efforts to identify disease-specific biomarkers and develop effective treatments have been largely unsuccessful. ⋯ Fibromyalgia is likely the result of multiple causative factors, genetic and environmental. To date, no clear, reliable etiological biomarker for fibromyalgia has been identified. The considerable variability among patients suggests the presence of multiple disease subtypes with different pathophysiological mechanisms. Effective treatment therefore requires a multimodal, multidisciplinary approach that targets each individual patient's pathophysiological features. The proposed treatment paradigm attempts to address multiple factors that have been implicated more recently in the development and maintenance of fibromyalgia, such as micro-inflammation, metabolic syndrome, and gut dysbiosis.
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Meta Analysis
Regional Analgesia Techniques Following Thoracic Surgery: A Systematic Review and Network Meta-analysis.
Regional analgesia techniques have become the basis of multimodal analgesia for acute and chronic pain. They are widely used in thoracic surgery, but the best treatment is still uncertain. ⋯ The cTEA and cSAPB techniques are more likely to reduce the cumulative opioid consumption within 24 hours. The cTEA, cSAPB, ESPB techniques were more likely to improve pain at postoperative 6, 12, and 24 hours. Therefore, cTEA, cSAPB, and ESPB are the first choices for pain relief post thoracic surgery, whereas wound infiltration, intercostal block, continuous wound infiltration, and continuous intercostal block were less likely to be effective. We need more high-quality randomized controlled trials with larger sample sizes to validate our results and to determine the ideal regional analgesia technique and the optimal drug formula.
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Acute postoperative pain is one of the most common challenges faced by patients who undergo surgery. Multimodal analgesia has been recommended in recent years to effectively control this condition. Nerve blocks are an important part of multimodal analgesia; a single peripheral nerve block is widely used in clinical practice. To prolong the analgesic duration of a single nerve block, adjuvants with different mechanisms, dosages, or administration routes are added to local anesthetics; however, it is not clear which adjuvant or combination is better. ⋯ Adjuvants with diverse mechanisms of action can variably extend the duration of local anesthetic effects. When utilizing adjuvants in conjunction with local anesthetics, perineural dexmedetomidine (1 mu-g/kg) or intravenous dexamethasone (10 mg) may be preferable, considering their efficacy and side effects. Current research suggests that the combination of perineural dexmedetomidine (1 mu-g/kg) and intravenous dexamethasone (10 mg) is more effective than either dexmedetomidine or dexamethasone alone.