Objective. To assess the feasibility of determining intraoperative fentanyl dosage considering preoperative evaluation of pain sensitivity to standardized stimuli. Material and methods. A prospective single-center pilot study enrolled 44 patients (ASA II-III) undergoing elective thoracic and abdominal surgeries. A standardized anesthesia protocol (propofol, fentanyl, sevoflurane) with multimodal analgesia (ibuprofen, paracetamol) was employed. Pain sensitivity was assessed during venous catheter insertion using a numerical rating scale (NRS) (0-10). Intraoperative fentanyl requirements were adjusted according to the qNOX index (target range 40-60). Postoperative evaluation included pain intensity (NRS at 8 time points), cortisol and cognitive function (MOCA, TMT, MMSE). Results. Ther was a strong correlation between preoperative pain sensitivity and intraoperative fentanyl requirements (Spearman’s correlation coefficient 0.7, p<0.05). Furthermore, when patients were divided into three groups depending on pain following standard stimulus, we found significant differences in intraoperative fentanyl requirements (Kruskal-Wallis test, p=0.0011). Cognitive impairments were minimal and rapidly regressed. Cortisol demonstrated no correlation with preoperative pain sensitivity. Conclusion. Preoperative pain sensitivity may be a predictor of intraoperative analgesic requirements. This personalized approach reduces postoperative pain and cognitive dysfunction, as well as demonstrates clinical potential.
Objective. To evaluate the influence of central sensitivity syndrome (CSS) on symptoms of chronic nonspecific low back pain (LBP) in patients with spinal osteoarthritis. Material and methods. Patients with chronic nonspecific LBP (n=120) and spinal osteoarthritis (OA) were divided into two equal groups (n=60). The 1st group included patients with clinically insignificant CSS (CSI score <35). The 2nd group included patients with clinically significant CSS (CSI score ≥35). Both groups were compared regarding duration of disease and exacerbation; LBP intensity; degree of disability; risk of LBP chronicity; number of descriptors of various painful sensations and associated affective reactions. Results. Both groups were comparable regarding anthropometric parameters; duration of disease and exacerbation; back and leg pain intensity. The following parameters (median) were lower in the 1st group: total CSI score (22 vs 47 points); disability according to the Roland-Morris Disability Questionnaire (10 vs 13.5 points); risk of chronicity according to the Keele STarT Back Tool (4 vs 7 points); SF-MPQ-2 total score (41 vs 67 points). Patients in the 2nd group often complained on symptoms typical for chronic fatigue syndrome, fibromyalgia, and clinical depression. Conclusion. Central sensitivity syndrome limits daily activities of patients with chronic low back pain and exacerbates its course. Patients with chronic low back pain and clinically significant central sensitivity syndrome predominantly demonstrate symptoms typical for chronic fatigue syndrome, fibromyalgia, and depression. In such cases, low back pain may be one of the symptoms of these conditions.
Objective. To explore nurses’ knowledge and attitudes towards pain management in hospitals in Saudi Arabia’s Eastern region. Material and methods. A descriptive cross-sectional study was conducted among 389 nurses across three hospitals in June and July 2024 using a validated questionnaire. The questionnaire assessed nurses’ sociodemographic information, knowledge, and attitudes toward pain management. Reliability and feasibility were confirmed through pilot testing, and ethical approval was obtained. Data were analyzed using SPSS v. 25. Results. While most nurses had some pain management training, significant knowledge gaps existed (mean score 16.22/30). Attitudes were generally positive (mean score 3.76 on a 5-point Likert scale), with experience and age positively correlating with knowledge. Renal dialysis unit nurses had the highest knowledge mean score, while medical and surgical nurses held the least favorable views. Conclusion. Despite some training, many nurses lack sufficient knowledge of pain management. Enhanced education programs are needed, particularly for less experienced staff and those in high-demand departments.
Objective. To develop an algorithm for identifying clinical and pathophysiological phenotypes of chronic postamputation pain. Material and methods. A questionnaire was developed for examination of patients. This questionnaire includes sections for collecting anamnestic data, entering neurological examination data. Pain intensity was assessed according to numeric rating scale (NRS). The following questionnaires and scales were used for psychometric examination: the Hospital Anxiety and Depression Scale (HADS), the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder, the Pain Catastrophizing Scale (PCS), and the Central Sensitization Inventory (CSI). To differentiate nociceptive and neuropathic pain in the stump, a questionnaire for diagnosis of neuropathic pain (DN4) was used. The Second Short Form of the McGill Pain Questionnaire (SF-MPQ-2) was used to accurately determine descriptors of postamputation pain and intensity of symptoms. The “Budapest Criteria” adapted by the International Association for the Study of Pain (2021) were used to make the diagnosis of complex regional pain syndrome. Results. Eighty-two patients were examined. Of these, 70 (85%) patients had phantom limb pain, 40 (49%) — stump pain, 32 (39%) — combination of stump pain and phantom pain syndrome, 2 (2%) — complex regional pain syndrome according to the “Budapest Criteria”. Other 19 (23%) patients had neuroma. Conclusion. The mechanism of formation and maintenance of chronic postamputation pain is extremely complex and involves various levels of somatosensory system. This causes various pain syndromes and makes necessary to determine clinical phenotypes of postamputation pain. This is important to personalize treatment approaches taking into account pathogenetic features of pain syndrome. Original algorithm makes it possible to identify postamputation pain phenotypes in clinical practice.
Pain syndrome (PS) poses a serious challenge in children and adolescents admitted in ICUs. This review describes the outcomes of analgesic ketamine administration in pediatric patients with various PS. It discusses the advantages and disadvantages of this drug for pain relief in childhood. The mechanisms of analgesic effect through the effect on NMDA and opiate receptors are described. Pharmacokinetics of ketamine is described. The main dosages and routes of administration for PS relief in children and adolescents are indicated. The authors analyze clinical data on ketamine versus other analgesics for relief of intraoperative and postoperative pain, PS associated with cancer and chronic PS. Pediatric anesthesiologists should consider this analgesic for PS relief in children and adolescents.
