Articles: pain.
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A recent Lancet Commission raised concerns about the management of child and adolescent pain. We aimed to undertake a comprehensive review of qualitative research to understand children and adolescent pain experiences across contexts. We used the 7 stages of meta-ethnography to synthesise findings. ⋯ We report 6 themes focusing on transition to adulthood: (1) I want to stay within the safety of home; (2) don't exclude me from my own care; (3) it might hurt but it's for my own good; (4) I rely on others but I want some independence; (5) I am no longer a child but I am not an adult yet; and (6) I wasn't prepared for the transfer to adult health care. Our findings focus on the complex transition into adulthood and the importance of creating a genuine healthcare partnership with young people by acknowledging their perspectives, creating a safe and supportive environment, and preparing them for the transition to adult pain care. Arts-based methods have the potential to make findings from qualitative evidence syntheses accessible and impactful for compassionate health care.
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Randomized Controlled Trial
Independent effects of transcranial direct current stimulation and social influence on pain.
Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulatory technique with the potential to provide pain relief. However, tDCS effects on pain are variable across existing studies, possibly related to differences in stimulation protocols and expectancy effects. We investigated the independent and joint effects of contralateral motor cortex tDCS (anodal vs cathodal) and socially induced expectations (analgesia vs hyperalgesia) about tDCS on thermal pain. ⋯ The observed additive effects provide novel evidence that tDCS and socially induced expectations operate through independent processes. They extend clinical tDCS studies by showing tDCS effects on controlled nociceptive pain independent of expectancy effects. In addition, they show that social suggestions about neurostimulation effects can elicit potent placebo effects.
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Randomized Controlled Trial Comparative Study
Comparison between thoracic epidural analgesia VS patient controlled analgesia on chronic postoperative pain after video-assisted thoracoscopic surgery: A prospective randomized controlled study.
To test the hypothesis that thoracic epidural anesthesia and analgesia (TEA) reduces the incidence of chronic postoperative pain (CPSP) after video-assisted thoracoscopic surgery (VATS). ⋯ A total of 231 patients were analyzed, including 114 in the PCIA group and 117 in the EPI group. Sixty-six patients (56.4 %) in the PCIA group and 33 patients (28.9 %) in the EPI group experienced chronic pain at 3 months postoperatively. The odds ratio (OR) was 0.31 (95 % confidence interval [CI], 0.18 to 0.54; P < 0.0001). After adjusting for confounding factors, the adjusted OR was 0.28 (95 % CI, 0.16 to 0.50, P < 0.001). Six months postoperatively, 50 (42.7 %) and 17 (14.9 %) patients in the PCIA and EPI groups, respectively, were diagnosed with CPSP (P < 0.0001).
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Review Historical Article
Experiencing pain: perspectives of Patrick D. Wall-founding editor of the journal PAIN.
Pain is a sensory and emotional experience. How did Pat Wall, founding editor of the journal PAIN and recognized pain guru, view the relation between the brain and the experience of pain? He was certain what it is not. It is not impulses in peripheral nociceptors that light up neurons in a central pain nucleus. ⋯ Pain signatures are modulated in many ways: suppressed by gate control and descending brain pathways, augmented by peripheral and central sensitization, and massaged by abundant central feedback and feedforward loops. Pain experience is a complex function of a conscious brain. Ultimately, to understand pain is to understand conscious perception.
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Persistent breast cancer treatment-related pain affects up to 40% of patients, decreasing their quality of life (QoL). While current research typically utilizes correlation and regression analysis to identify biopsychosocial phenotypes contributing to this pain, this study employs cluster analysis to identify qualitatively different phenotypes based on somatosensory and psychosocial characteristics both before and one week post-breast cancer surgery. Further, it investigates how these phenotypes are related to pain intensity one year post-surgery and examines the evolution of phenotype membership from pre- to post-surgery. ⋯ PERSPECTIVE: This secondary analysis, utilizing cluster analysis, reveals five distinct phenotype based on somatosensory and psychosocial characteristics both before and post-breast cancer surgery. Higher psychosocial distress and lower quality of life correlated with elevated pain intensity one year post-surgery, emphasizing the need to address patients' mental health perioperatively. TRIAL REGISTRATION: clinicaltrials.gov (NCT03351075).