Objective:To develop and validate a Chinese assessment scale for patients with zoster-associated pain (ZAP) to suitable for China's national conditions.Methods:Descriptive study. According to the common clinical features of ZAP, the preliminary scale entries of the Chinese scale were developed, based on the consensus of domestic experts in the field of herpes zoster, clinical diagnosis and treatment guidelines, and referring to the international scale production process, then the pre-scale was formed after review by pain experts and pre-test revision. A clinical investigation was conducted on 145 patients diagnosed with ZAP in the Pain Department of Shandong Provincial Hospital from March 20, 2024 to November 21, 2024. A pre-scaled questionnaire, item analyses such as the crucial ratio technique, the correlation coefficient method, and the discrete trend method were used to screen the items and create a preliminary version of the scale. Further reliability and validity test were conducted.Results:The validity and reliability of the scale were positive, with standardized Cronbach's α 0.857 (>0.7), the Kaiser-Meyer-Olkin(KMO) value 0.781 (>0.6), χ2=914.521 and P<0.001 of Bartlett spherical test. The exploratory factor analysis extracting five common factors with a cumulative variance contribution was 70.169% (>50%) and factor loadings ranging were between 0.529 and 0.920 for each entry; and validated factor analysis showed χ2/ df=1.902, root mean square error of approximation (RMSEA)=0.079 (<0.08), comparative fit index (CFI)=0.915 (>0.90), and incremental fit index (IFI)=0.917 (>0.90). The final Chinese assessment scale for patients with ZAP consists of three parts: the first part with 15 non-quantitative entries; the second part containing 5 dimensions and 17 quantitative entries; and the third part containing 3 quantitative entries for patients in the acute phase. Conclusion:This Chinese assessment scale for ZAP has good reliability, validity and applicability.
Background: Chronic cancer-related pain can seriously damage physical and mental health of cancer patients. Eliminating cancer pain is basic right of cancer patients, controlling and eliminating cancer pain is the responsibility of medical staff. Objective: To further enhance the diagnosis and treatment capabilities for chronic cancer-related pain management, the Chinese Clinical Guideline for Chronic Cancer-Related Pain convened an expert panel to develop the guideline. Main ideas: Based on high quality evidence of medical researches on the diagnosis and treatment of chronic cancer-related pain published domestically and internationally in the past 10 years, the expert group has formed recommendations for common treatment methods through rigorous argumentation and expert voting, to provide references for standardized diagnosis and treatment of chronic cancer-related pain. This guideline adopts GRADE methodology to evaluate the level of evidence and strength of recommendation for the treatments of chronic cancer-related pain. This guideline gives treatment recommendations for different types of chronic cancer-related pain in International Classification of Diseases-11, as well as for breakthrough cancer pain. Conclusion: Although there are many treatments to relieve chronic cancer-related pain, it is still a global medical challenge. According to the characteristics of cancer-related pain, stepped and personalized treatment is the key to relieve pain.
Knee osteoarthritis is the most common form of arthritis, with a global prevalence of 3.8%, higher in white women and lower in Asians and blacks. Knee osteoarthritis affects the lives and work of approximately 30 million people, about half of them have severe or terminal joint lesions. However, various treatment modalities, including non-surgical treatment such as injection therapy, provide only temporary pain relief with little or no improvement in patient function. Based on his own experience, the author described the development of the radiofrequency ablation, the latest research and clinical data of radiofrequency ablation for persistent pain after total knee arthroplasty, and introduced the advantages of cold radiofrequency ablation in detail.
Digital therapeutics (DTx) deliver evidence-based therapeutic interventions to patients, which are driven by high quality software programs to treat, manage, or prevent a disease or disorder. DTx can be used independently or in concert with medications, devices, and other therapies to optimize patient care and health outcomes. DTx can effectively improve patient compliance and medical accessibility, reduce patient time costs and economic burden, and is a supplement and optimization to traditional therapies. At present, many mature DTx products have been applied in chronic pain at home and abroad, such as Hinge Health, AppliedVR, XRHealth, IntelliHab, Shukang, which have significant effects and broad prospects.
The interaction of biological-psychological-social elements is the core factor for the persistence of symptoms in patients with chronic low back pain, and also affect their rehabilitation outcomes. Therefore, the latest clinical guidelines recommend the use of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain to achieve holistic rehabilitation. Compared with the biomedical model of a single rehabilitation intervention, multidisciplinary rehabilitation can effectively relieve the pain, improve the physical and mental dysfunction, enhance work ability and quality of life, and finally enable the patients to return to society.
Vascular endothelial growth factor (VEGF) is a kind of cytokines that has a specific effect on vascular endothelial cells. VEGF-A is one of the most important members of VEGF, and it is widely expressed in the nervous system. VEGF-A primarily binds to VEGFR1 and VEGFR2 to play a biological role, participating in the proliferation and differentiation of the vascular system and directly affecting the growth and function of neurons. The research hotspot has been the VEGF-A in pathological angiogenesis which is related to tumors, intraocular neovascularization, and other diseases. However, in recent years, more and more attention has been paid to the role of the VEGF family in neuroprotection and nociceptive perception. The role of VEGF-A in the pathophysiology of chronic pain is yet not fully understood. Therefore, this paper reviews the molecular mechanisms of VEGF-A regulation in chronic pain.
Herpes zoster (HZ) is a painful vesicular rash with reactivation of the varicella zoster virus. This article reviewed the minimally invasive treatment and prevention of HZ, to provide theoretical support for the effective treatment and prevention of HZ.
Scapulohumeral periarthritis, a common shoulder joint disease, mainly manifested in pain and limited mobility. Although it is a self-limiting disease, the severe pain and limited mobility seriously affect the patient's life and work during the onset. With the change of people's lifestyle, the incidence rate of the disease is gradually rising, and effective treatment is particularly important. There are various methods for treating scapulohumeral periarthritis, including conservative treatment, minimally invasive surgery, traditional Chinese medicine therapy, and one or combined method can be selected. This article reviews the efficacy of various treatment methods for the treatment of scapulohumeral periarthritis.
Objective:To investigate the effect of ketorolac tromethamine patient-controlled intravenous analgesia (PCIA) combined with iliac fascia block on postoperative analgesia and inflammatory factors in diabetic patients undergoing total hip joint replacement.Methods:Ninety diabetic mellitus patients received total hip joint replacement in Second Hospital of Shanxi Medical University from May 2021 to September 2021 were collected and randomly divided into the block group (group A), the ketorolac tromethamine group (group B) and the combination group (group C) ( n=30 each). In the block group, iliac fascia block with 30 ml of 0.25% ropivacaine was performed after the operation. In the ketorolac tromethamine group, PCIA was performed (ketorolac tromethamine 1.8 mg/ml, sufentanil 1.0 μg/ml and normal saline mixture, background infusion dose 2 ml/h, single pressing dose of PCA 0.5 ml, and locking time 15 min) for 48 hours. In the combination group, patients were firstly given iliac fascia block in the same way as group A at the end of the operation, and then received PCIA pump in the same way as group B. The BP and HR were measured before starting analgesia (T0), 24 hours after analgesia (T1) and 48 hours after analgesia (T2). The level of IL-1β, IL-6 and TNF-α in plasma at the time of T0, T1 and T2 were measured. The visual analogue scale (VAS) and blood glucose level were compared during the three groups at the time of T0, T1 and T2. Results:The VAS were significantly lower at T1 and T2 in the combination group (2.1±0.6, 2.0±0.5) than those in the block group (3.6±0.9, 3.8±0.8) and in the Ketorolac tromethamine group (3.0±0.7, 3.1±0.7) (all P<0.05). The MAP (86±7, 83±7) mmHg and HR (83±7, 82±8) beats/min were significantly lower at T1 and T2 in the combination group than MAP (94±4, 90±6) mm Hg and HR (95±7, 92±6) beats/min in the block group (all P<0.05), the MAP (83±7 mm Hg) and HR (82±8 beats/min) were significantly lower at T2 in the combination group than MAP (86±8 mm Hg) and HR (88±6 beats/min) in the ketorolac tromethamine group (all P<0.05). The blood glucose levels (10.2±0.7, 9.2±0.6) mmol/L were significantly lower at T1 and T2 in the combination group than those in the block group (12.6±1.0, 12.6±1.0) mmol/L and the ketorolac tromethamine group (12.0±0.8, 10.9±0.8) mmol/L (all P<0.05). The serum levels of IL-1β (12.0±0.3, 9.1±1.2) pg/mL, IL-6 (63.0±6.9, 53.3±5.2) pg/ml and TNF-α (113.6±9.1, 93.4±6.2) pg/ml were significantly lower at T1 and T2 in the combination group than IL-1β (15.3±1.3, 12.0±0.3) pg/ml, IL-6 (88.9±6.2, 75.4±8.1) pg/mland TNF-α (162.2±11.2, 123.5±10.5) pg/ml in the block group and IL-1β (13.6±1.2, 11.0±0.7) pg/ml, IL-6 (80.3±7.3, 65.3±5.8) pg/ml and TNF-α (142.2±11.3, 110.4±9.3) pg/ml in the ketorolac tromethamine group (all P<0.05). Conclusion:PCIA with ketorolac tromethamine combined with iliac fascia block can obtain satisfactory analgesic effect, maintain the stability of hemodynamics, and also reduce the blood glucose level and the expression of inflammatory factors, reduce the adverse reactions caused by stress response and blood glucose fluctuation in patients with diabetic mellitus, so as to improve the prognosis of the patients.
Objective:To explore the effect of virtual reality technology on rehabilitation exercise in patients after total knee replacement.Methods:Forty-two patients after total knee arthroplasty (TKA) admitted to the Rehabilitation Department of Yinchuan Second People's Hospital from October 2021 to October 2022 were collected, aged 62-78 years, 28 males and 14 females. The patients were divided into two groups by random number table method, the passive exercise group ( n=21) and the virtual exercise group ( n=21). The patients in the passive movement group performed continuous passive movement machine (CPM) for rehabilitation exercise, and in the virtual movement group wore virtual reality (VR) technology headset glasses, immersed in the virtual scene and performed the CPM rehabilitation exercise. On the 7th and 14th day after the rehabilitation exercise, numerical rating scale (NRS), knee function score (AKS), Beck anxiety inventory (BAI), kinesiophobia score (TSK) and activity of daily living scale (ADL) were compared in the two groups. Results:NRS score, BAI score and TSK score in the two groups were significantly decreased on the 7th and 14th day after the rehabilitation exercise. On the 7th and 14th day after rehabilitation exercise, NRS were significantly lower (5.2±0.7) and (3.1±0.8) in the virtual exercise group than those in the passive exercise group (6.2±0.9) and (4.4±0.7)(all P<0.05); BAI scores were significantly lower (25.4±2.3) and (14.2±2.3) in the virtual exercise group than those in the passive exercise group (28.8±2.4) and (19.5±2.7) (all P<0.05); and TSK scores, ASK scores and ADL scores were also better in the virtual exercise group than those in the passive exercise group (all P<0.05). Conclusion:Both passive motion and virtual motion rehabilitation exercise can reduce the pain and anxiety of TKA patients during rehabilitation exercise, but VR technology is better.
Pain management has always been challenging in the emergency department, and is often the problem of insufficient analgesia. This paper reviews the ultrasound-guided regional nerve block for pain treatment in the emergency room, mainly introduces the application status of this technology, and expounds its progress for pain relief in upper and lower limbs, trunk, face and neck, and discusses the potential risks and adverse event.
Nerve block is an important intervention method for early and medium-term knee osteoarthritis (KOA) patients with pain. At present, the main block methods include femoral nerve block, adductor canal block, genicular nerve block and infiltration between the popliteal artery and capsule of the knee. With the progress of ultrasound imaging technology, combination of the nerve block and ultrasound will play a pivotal role in the treatment of KOA in the future.
Ketamine is a racemic mixture of (R-) and (S+) isomers. S+ketamine, the pure dextrorotatory enantiomer of ketamine, mainly has an effect on analgesia and anesthesia, and is twice as potent as ketamine with fewer adverse reactions. S+ketamine should replace ketamine in order to seek the advantages and avoid disadvantages, for critically ill shock patients, especially for the wounded with hemodynamically unstable. S+ketamine is also an indispensable medicine in wartime and disaster relief.
With the development of minimal invasive technology, spinal endoscopic has gradually become the main treatment option for lumbar disc herniation. Combining with the advantages of different spinal endoscopic and choosing the most suitable operative approach can improve the surgical result and reduce the complications. This article reviews the application progress of spine endoscopic in different operative approach for treatment of lumbar disc herniation.
Objective:To observe the analgesic efficacy of fascia iliaca compartment block with dexmedetomidine and ropivacaine under general anesthesia for pediatric patients with femoral fracture.Methods:Sixty-four children, 6-10 years old, ASA ⅠorⅡ, underwent open reduction and internal fixation for femoral fracture under general anesthesia combined with fascia iliaca comparment block from July 2020 to December 2021, were collected. The children were randomly divided into dexmedetomidine and ropivacaine group (group DR, n=32) and ropivacaine alone group (group R, n=32). The children received iliofascia compartment block with 0.25% ropivacaine 0.5 ml/kg combined with 1 μg/kg dexmedetomidine in the group DR, and received 0.25% ropivacaine 0.5 ml/kg in the group R respectively. FLACC pain scores were recorded at 2, 6, 12, 18, 24 h after the operation. The duration of block and the dose of tramadol within 24 h after the operation were observed, and the occurrence of agitation and adverse reactions (nerve injury, bradycardia, nausea and vomiting, excessive sedation) during the recovery period were recorded. Results:Compared with the group R, FLACC score was lower in the group DR at 6 h (Wald χ2=33.09, P<0.001), 12 h (Wald χ2=50.02, P<0.001) and 18 h (Wald χ2=42.00, P<0.001) after the operation. The duration of block was significantly longer in the group DR than that in the group R ( Z=-6.66, P<0.001). Compared with the group R, the number of patients requiring tramadol for relief pain at 24 h after the operation in the group DR was fewer ( χ2=4.63, P=0.031), and the dosage of tramadol was also lower ( t=6.54, P<0.001). The incidence of agitation, nausea and vomiting were less in the group DR than that in the group R (3 cases vs. 11 cases, χ2=5.96, P=0.015), (2 cases vs. 9 cases, χ2=5.46, P=0.020) respectively. The incidence of bradycardia was identical between the two groups ( P>0.05). Conclusion:Dexmedetomidine 1 μg/kg combined with ropivacaine for fascia iliaca compartment block during general anesthesia can reduce the agitation in recovery period, provide longer postoperative analgesia, lower the incidence of adverse reactions.
One patient with postherpetic neuralgia (PHN) in the right occipital region of head was treated by electrical stimulation on the occipital nerves. After 10 days treatment the pain was obviously relieved. Peripheral nerve electrical stimulation was a better choice for intractable PHN in the occipital region.
Objective:To study the efficacy of arc-edge needle in the treatment of chronic gluteal epithelial nerve entrapment syndrome.Methods:From January 2016 to January 2020, 86 patients with chronic gluteal epithelial nerve entrapment syndrome were collected, 52 males and 34 females, age 25 to 76 years old, the course of disease 1 to 38 months, in the Painology Department of Henan Province Hospital of Traditional Chinese Medicine. All patients were treated with arc-edge needle once, without other drug treatment. The visual analogue scale (VAS) before and at 1 week, 2 weeks, 3 weeks and 24 weeks after the treatment were recorded, and the Wangxuechang disease efficacy score (WDES) at 24 weeks after the treatment.Results:After the treatment, the VAS were significantly lower than those before the treatment, and continue to decrease at the other time points ( P<0.05). At the 24 weeks follow-up, the total efficacy score (WDES) was 98.8% (85/86 cases). Conclusion:The arc-edge needle is effective to treatment of chronic gluteal epithelial nerve entrapment syndrome.
Objective:To evaluate the trigeminal ganglion block combined with general anesthesia for percutaneous microballon compression (PMC) in patients with primary trigeminal neuralgia.Methods:Forty patients with primary trigeminal neuralgia, aged 60-80 years old, visual analogue scale (VAS) 7-10, in the Department of Painology, Qingdao Muninicipal Hospital from October 1, 2019 to October 1, 2022, were collected. All patients were randomly divided into the general anesthesia group and the compound anesthesia group by the randomization table, with 20 patients in each group. Patients received PMC under the general anesthesia in the general anesthesia group, while received PMC under trigeminal ganglion block combined with general anesthesia in the compound anesthesia group. Mean arterial pressure, heart rate, and adverse effects were recorded at admission, after anesthetic induction, during the needle puncture into the foramen ovale, during trigeminal ganglion compression by the balloon, 1 minute after the end of the PMC procedure, awakening and 6 hours after the treatment. VAS was recorded before the treatment, awakening from anesthesia, 3 days and 1 month after the treatment. Total amount of analgesic medication (sufentanil) and the time of awakening were recorded.Results:There was no statistically significant difference in VAS between the two groups at admission, 3 days and 1 month after the treatment (all P>0.05). After awakening from anesthesia, VAS was lower in the combined anesthesia group than that in the general anesthesia group ( P<0.05). After puncture, compression, 1 minute after the treatment, and awakening, the mean arterial pressure and heart rate were lower in the combined anesthesia group than those in the general anesthesia group (all P<0.05). Four patients developed arrhythmia in the general anesthesia group, none in the compound anesthesia group ( P<0.05). Sufentanil used was less in the compound anesthesia group than that in the general anesthesia group[(24.3±3.7) μg vs. (35.3±4.4) μg, t=8.44, P<0.001].The awakening time was shorter in the compound anesthesia group than that in the general anesthesia group [(16.5±3.5) min vs. (28.7±5.6) min, t=8.28, P<0.001]. Conclusion:Percutaneous microballon compression under the general anesthesia or general anesthesia combined with trigeminal ganglion block are all effective, but the latter has a higher efficacy and safety.
There are many treatment methods to treat the frozen shoulder, involving departments of painology, anesthesiology, rehabilitation, bone and joint surgery and traditional Chinese medicine. In order to better carry out the clinical diagnosis and treatment of frozen shoulder, the basic and clinical experts from various disciplines, referenced the latest domestic and foreign literature, combined with their professional characteristics and experience, focused on the anatomy and clinical manifestations, diagnosis and treatment of frozen shoulder, and compiled this multidisciplinary cooperation consensus.
Intensive silver needle therapy is a widely used method for chronic musculoskeletal pain caused by soft tissue damage and its associated visceral related symptoms in Department of Painolgy. However, due to the non-strict indication and non-standard operation in the implementation process, the clinical efficacy is not satisfied and complications often occur. In order to further standardize the silver needle therapy to guide the clinical application, this expert consensus are composed including the physical properties of the silver needle, treatment principles, indications and contraindications, routine diagnosis and treatment procedures, acupuncture site methods, precautions, and adverse reactions.
