Search

Background Pain is a significant factor associated with wounds. Its presence can impact on every aspect of an individual, affecting their overall quality of life (QoL) including ability to function, as well as their social and psychological well-being. Holistic approaches that can help to address wound-related pain are vital to improve patient outcomes. Aim We aimed to review the evidence for the holistic management of wound-related pain in individuals with chronic wounds in order to provide recommendations for healthcare professionals in clinical practice. Method The L OVE platform was used for the search as wound and burn are in the same search category. L OVE collects systematic reviews retrieved from the systematic reviews database Epistemonikos and allocates them to specific L OVEs and questions. We conducted our search for reviews related to wounds and burns in November 2022. Retrieved titles and abstracts were exported into Rayyan. The search was organised within Rayyan according to the focus for each chapter to retrieve evidence on pain assessment, physical therapies, patient education, psychological approaches, and complementary and alternative approaches. A systematic approach was used by senior experts in wound and pain management for double-blind screening and application of inclusion criteria (chronic wounds and pain) to agree on articles for review. Sources related to acute wounds (including burn injuries) were excluded. The L OVE search was supplemented by narrative reviews of literature identified from the individual systematic reviews and handsearching of relevant sources. Results Thirty-eight systematic reviews and 27 additional articles were identified providing a total of 65 individual pieces of evidence. The number of reviews and articles included: pain assessment (n=25); physical therapies (n=8); patient education (n=12); psychological approaches (n=2); complementary and alternative approaches (n=18). The literature related to pain assessment highlighted that assessment of wound-related pain is complex and multidimensional. Healthcare providers must determine the most suitable assessment tool for their patients and in doing so consider an individual's ability to respond to the assessment, as there is no one assessment tool to measure pain, as 'one size does not fit all'. In terms of physical therapies, physical exercise is important, although the majority of evidence relates to individuals with venous leg ulcers (VLUs). In relation to management, clinicians need to recognize procedural-related pain, particularly in relation to debridement procedures. There may be a role for topical impregnated dressings and topical anaesthetics in this case. Equally it is important to manage moisture to prevent maceration and reduce the risk of pain from periwound skin irritation (dermatitis). For individuals with malignant fungating wounds (MFW) a combination of therapies to manage symptoms is recommended. Specific research related to patient education and woundrelated pain is lacking, however areas that should be considered include aetiology of the wound and causes of pain, non-pharmacological and pharmacological methods for pain relief, methods for assessing pain relief, as well as impact of pain on QoL. Psychological approaches need to consider the factors associated with pain (attention, cognitions, emotions and emotion regulation and overt behaviour) in order to determine the most appropriate treatment strategy. Evidence to make recommendations for wound-related pain is sparse; however, there may be a role for social models of care and motivation enhancement programmes for individuals with leg ulcers. Additionally, aromatherapy and music therapy may also be helpful. Evidence for other chronic wounds is lacking. There is some evidence to support the role of honey for the management of wound-related pain, specifically the research indicates that the analgesic action may be related to its anti-inflammatory properties. Evidence for traditional Chinese medicine (TCM), plants, low-dose topical steroids and low level-laser therapy was very weak. Conclusion The experience of wound-related pain is complex and needs to take into consideration the psychological and social factors that can impact on an individual's QoL to ensure a holistic approach. Equally the assessment of wound-related pain is complex and multidimensional. Healthcare providers must determine the most suitable assessment tool for their patients and in doing so consider an individual's ability to respond to the assessment. Management of wound-related pain may require both non-pharmacological and pharmacological approaches and can include dressings and devices. A holistic strategy should also incorporate both education (patient and healthcare professional) and psychological approaches to improve patient outcomes. Our review has identified a lack of scientific resources on wound-related pain management to make clear recommendations for effective strategies. What is needed are further prospective studies of patients with woundrelated pain and different types of non-healing wounds. Such research should be cognisant that a phenomenon as complex as pain must also be examined comprehensively. The phenomenon of pain has a high degree of subjective perception and individuals have different coping strategies, and healthcare professionals need to be mindful of this. The main determinants of wound-related pain management cannot solely be based on the wound symptomatology and the process of care (healing), but also need to consider the individuality of the patient and their current needs. [ABSTRACT FROM AUTHOR]

Background and purpose: Primary Sjögren syndrome (pSS) is a chronic, systemic, autoimmune disorder characterized by lymphocytic infiltrates of the exocrine organs, leading to sicca symptoms and parotid enlargement. pSS has been linked to various neurological manifestations, including peripheral neuropathy (PN). We aimed to provide a comprehensive analysis of the currently available evidence regarding pSS‐related PN. Methods: A literature search in the PubMed database was performed, and 49 papers were eligible to be included in this systematic review and meta‐analysis. Results: The pooled prevalence of PN in pSS is estimated to be 15.0% (95% confidence interval = 10.7%–20.7%). The mean age of pSS patients at PN diagnosis is 59 years. Among the patients with pSS and PN, 83% are females. Neuropathic symptoms usually precede or lead to the pSS diagnosis at a 2:1 ratio in patients with pSS‐related PN. The commonest type of pSS‐related PN is distal axonal polyneuropathy (80% of patients with pSS‐related PN), followed by sensory ganglionopathy. Peripheral and cranial mononeuropathies—particularly trigeminal—are also frequent. Risk factors for developing PN include increasing age and presence of vasculitis. Immune‐mediated pathogenetic mechanisms are discussed. Glucocorticoids are the most commonly used treatment option for managing pSS‐related PN, when associated with vasculitis, followed by the use of intravenous immunoglobulin. Conclusions: PN is very common in pSS patients. Evidence on long‐term prognosis of PN in pSS is limited, and further research is needed. Research into the use of immunosuppressive medication in nonvasculitic neuropathies in the context of pSS merits further consideration. [ABSTRACT FROM AUTHOR]

Understanding of the basis of osteoarthritis (OA) has seen some interesting advancements in recent years. It has been observed that cartilage degeneration is preceded by subchondral bone lesions, suggesting a key role of this mechanism within the pathogenesis and progression of OA, as well as the formation of ectopic bone and osteophytes. Moreover, low-grade, chronic inflammation of the synovial lining has gained a central role in the definition of OA physiopathology, and central immunological mechanisms, innate but also adaptive, are now considered crucial in driving inflammation and tissue destruction. In addition, the role of neuroinflammation and central sensitization mechanisms as underlying causes of pain chronicity has been characterized. This has led to a renewed definition of OA, which is now intended as a complex multifactorial joint pathology caused by inflammatory and metabolic factors underlying joint damage. Since this evidence can directly affect the definition of the correct therapeutic approach to OA, an improved understanding of these pathophysiological mechanisms is fundamental. To this aim, this review provides an overview of the most updated evidence on OA pathogenesis; it presents the most recent insights on the pathophysiology of OA, describing the interplay between immunological and biochemical mechanisms proposed to drive inflammation and tissue destruction, as well as central sensitization mechanisms. Moreover, although the therapeutic implications consequent to the renewed definition of OA are beyond this review scope, some suggestions for intervention have been addressed. [ABSTRACT FROM AUTHOR]

Acute lung injury (ALI) is a common and devastating clinical disorder with a high mortality rate and no specific therapy. The pathophysiology of ALI is characterized by increased alveolar/capillary permeability, lung inflammation, oxidative stress and structural damage to lung tissues, which can progress to acute respiratory distress syndrome (ARDS). Adelmidrol (ADM), an analogue of palmitoylethanolamide (PEA), is known for its anti-inflammatory and antioxidant functions, which are mainly due to down-modulating mast cells (MCs) and promoting endogenous antioxidant defense. The aim of this study is to evaluate the protective effects of ADM in a mice model of ALI, induced by intratracheal administration of lipopolysaccharide (LPS) at the dose of 5 mg/kg. ADM 2% was administered by aerosol 1 and 6 h after LPS instillation. In this study, we clearly demonstrated that ADM reduced lung damage and airway infiltration induced by LPS instillation. At the same time, ADM counteracted the increase in MC number and the expression of specific markers of MC activation, i.e., chymase and tryptase. Moreover, ADM reduced oxidative stress by upregulating antioxidant enzymes as well as modulating the Nf-kB pathway and the resulting pro-inflammatory cytokine release. These results suggest that ADM could be a potential candidate in the management of ALI. [ABSTRACT FROM AUTHOR]