Search

Objective: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain in patients undergoing modified radical mastectomy for breast cancer., Methods: A total of 140 female patients scheduled for unilateral modified radical mastectomy for breast cancer undergoing general anesthesia were randomized into a TEAS group (70 cases) and a sham TEAS group (70 cases, 2 cases dropped out). Patients in both groups received TEAS or sham TEAS at bilateral Neiguan (PC6), Zusanli (ST36), and Danzhong (CV17), respectively, from 30 min before anesthesia induction until the end of surgery, and on 1st, 2nd, and 3rd days after surgery for 30 min a time, once a day. On 1st, 2nd, and 3rd days after surgery, the pain visual analogue scale (VAS) score was observed; on 3, 6, 12 months after surgery, the incidence rate of chronic pain was observed; before surgery, and on 1st, 3rd, and 7th days after surgery, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were detected; the number of analgesia pump press, rescue analgesia, and the occurrence of adverse reaction after surgery were recorded in the two groups., Results: In the TEAS group, the VAS scores on 1st and 2nd days after surgery, and the incidence rates of chronic pain on 3 and 6 months after surgery were lower than those in the sham TEAS group ( P <0.05). On 1st, 3rd, and 7th days after surgery, the serum levels of TNF-α, IL-6, and IL-10 were increased compared with those before surgery in both groups ( P <0.05, P <0.01); the above indexes in the TEAS group were lower than those in the sham TEAS group ( P <0.05). The number of analgesia pump press and the incidence rate of rescue analgesia after surgery in the TEAS group were lower than those in the sham TEAS group ( P <0.05). There was no statistically significant difference in the incidence of adverse reactions after surgery between the two groups ( P >0.05)., Conclusion: TEAS can effectively improve both the postoperative acute pain and chronic pain in patients undergoing modified radical mastectomy for breast cancer, the mechanism may relate to inhibiting the inflammatory reaction.

Perioperative skills-based interventions may support non-pharmacological management of pain and opioid reduction after surgery. Such interventions may target and enhance predictors for surgical recovery and possibly reduce chronic postsurgical pain. Existing meta-analyses are limited by inclusion of studies that are either non-surgical or with outcomes occurring only in the hours after surgery. Lacking is a scoping review of studies testing perioperative skills-based interventions for postsurgical pain relief and opioid reduction in the days and months after surgery. We reviewed the efficacy of perioperative behavioral interventions; over what time frame and in which surgical populations efficacy evidence exists; and whether such interventions can prevent chronic postsurgical pain. 20 randomized trials were included, with the following intervention types: hypnosis, relaxation therapy, stress management training, mindfulness, mixed-type skills interventions (mind-body skills, preoperative pain self-management, empowered relief for surgery); cognitive behavioral-therapy (CBT); and mindfulness-based CBT. We summarize study methods, treatment specifics, and analgesic effects. No studies were designed to test intervention efficacy for preventing chronic postsurgical pain. Only two studies used active controls as the study comparator. Two studies showed positive effects on postsurgical opioid use. No studies tested whether the interventions enhanced time to pain cessation after surgery. Four studies demonstrated durable analgesic effects at 3-12 months after surgery. We describe the real-world practicality of intervention integration into the perioperative pathway and provide dissemination and implementation methodologies that may increase intervention uptake and therefore fulfill calls from national agencies to better integrate behavioral pain treatments into perioperative care., Competing Interests: Competing interests: BDD receives royalties for four pain treatment books she has authored or coauthored. She is the principal investigator for two pain research awards from the Patient-Centered Outcomes Research Institute, one of which is investigating Empowered Relief for chronic pain treatment, and for an NIH grant involving Empowered Relief for chronic pain. Empowered Relief is copyrighted and trade marked by Stanford University and BDD receives no revenue from the Stanford hosted Empowered Relief CME instructor certification workshops. BDD is a former member of the Board of Directors for the American Academy of Pain Medicine, is on the Board of Directors for the Institute for Brain Potential and is on the Medical Advisory Board for the Facial Pain Association. BDD is a scientific member of the NIH Interagency Pain Research Coordinating Committee, a former member of the Centers for Disease Control and Prevention Opioid Workgroup (2020–2021), and a member of the Pain Advisory Group of the American Psychological Association. Other authors have no conflicts of interest and no disclosures., (© American Society of Regional Anesthesia & Pain Medicine 2025. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ Group.)

Chronic postsurgical pain (CPSP) is a cause of new chronic pain, with a wide range of reported incidence. Previous longitudinal studies suggest that development of CPSP may depend more on the constellation of risk factors around a patient (pre-existing pain phenotype) rather than on the extent of surgical injury itself. The biopsychosocial model of pain outlines a broad array of factors that modulate the severity, longevity, and impact of pain. Biological variables associated with CPSP include age, sex, baseline pain sensitivity, and opioid tolerance. Psychological factors, including anxiety, depression, somatization, sleep disturbance, catastrophizing, and resilience, and social factors, like education and social support, may also importantly modulate CPSP. Prevention efforts have targeted acute pain reduction using multimodal analgesia (regional anesthesia and intraoperative analgesic adjuvant medications). However, studies that do not measure or take phenotypic risk factors into account (either using them for enrichment or statistically as effect modifiers) likely suffer from underpowering, and thus, fail to discern subgroups of patients that preventive measures may be most helpful to. Early preoperative identification of a patient's pain phenotype allows estimation of their constellation of risk factors and may greatly enhance successful, personalized prevention of postoperative pain. Effective preoperative employment of behavioral interventions like cognitive-behavioral therapy, stress reduction, and physical and mental prehabilitation may particularly require knowledge of a patient's pain phenotype. Preoperative assessment of patients' pain phenotypes will not only inform high-quality personalized perioperative care clinically, but it will enable enriched testing of novel therapies in future scientific studies., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background/importance: Chronic postsurgical pain (CPSP) is a significant, often debilitating outcome of surgery, impacting patients' quality of life and placing a substantial burden on healthcare systems worldwide. CPSP (pain persisting for more than 3 months postsurgery) leads to both physical and psychological distress. Recognized as a distinct chronic pain entity in International Classification of Diseases, 11th Revision, CPSP enables better reporting and improved management strategies. Despite advancements in surgical care, CPSP remains prevalent, affecting 5%-85% of patients, with higher rates following thoracotomies, amputations, mastectomies and joint replacements., Objective: The acute to chronic pain transition involves complex interactions between peripheral and central mechanisms, with central sensitization playing a key role. Identifying high-risk patients is crucial for prevention, with factors such as surgical type, nerve injury, neuropathic elements in acute postoperative pain, and psychosocial conditions being significant contributors., Evidence Review: Current pain management strategies, including multimodal therapy and regional anesthesia, show limited effectiveness in preventing CPSP. Neuromodulation interventions, though promising, are not yet established as preventive modalities., Findings: Transitional pain services (TPSs) offer a comprehensive, multidisciplinary approach to managing CPSP and reducing opioid dependence, addressing both physical and psychosocial aspects of functional recovery. While promising results have been seen in Canada and Finland, TPSs are not yet widely implemented in Europe. There is also growing interest in pain biomarkers, through initiatives such as the A2CPS program, aiming to improve CPSP prediction and develop targeted interventions., Conclusions: Future research should focus on large-scale studies integrating various factors to facilitate CPSP prediction, refine prevention strategies and reduce its long-term impact., Competing Interests: Competing interests: The authors declare no conflict of interest regarding the submitted work. The manuscript has been submitted by the group of authors on behalf of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). EM and ARS serve as President and Member of the ESRA Executive Board respectively. JAA is Past President of the ESRA–European Diploma of Regional Anaesthesia (ESRA-DRA). ARS and PL are members of the PROSPECT ESRA Working Group. Outside the submitted manuscript, EM has received speakers’ fees from MENARINI Hellas, whereas the rest of the authors (JAA, ARS and PL) have no conflicts of interest to declare., (© American Society of Regional Anesthesia & Pain Medicine 2025. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ Group.)

Background: Poorly controlled pain during the acute postoperative period is associated with the development of persistent or 'chronic' pain lasting months or years after surgery. Relatively small trials suggest that local anesthetic-based peripheral nerve blocks lasting hours or a few days may decrease persistent postsurgical pain for some surgical procedures, but definitive data is lacking. Two possible alternatives-percutaneous cryoneurolysis and peripheral nerve stimulation-are analgesic modalities with the potential to provide weeks or months of pain relief following surgery. This increase in analgesic duration raises the possibility of decreased transition from acute to chronic postsurgical pain., Objective: This review aims to summarize the available evidence involving the use of percutaneous cryoneurolysis and peripheral nerve stimulation within the immediate perioperative period and its effects on decreasing chronic postoperative pain., Findings: Two randomized trials (n=66 and 16) comparing active percutaneous peripheral nerve stimulation to sham stimulation and two randomized trials (n=60 and 7) comparing percutaneous cryoneurolysis to a sham procedure for postoperative pain are described in this review. In each trial, participants were followed for at least three months., Conclusion: This review describes percutaneous cryoneurolysis and peripheral nerve stimulation for perioperative analgesia as well as the available evidence supporting their use to prevent persistent postsurgical pain., Competing Interests: Competing interests: JJF and BMI have received funding and/or product from Epimed International (Dallas, Texas, USA), SPR Therapeutics (Cleveland, Ohio, USA), InfuTronix (Natick, Massachusetts, USA), Masimo (Irvine, California, USA), Varian Medical Systems (Palo Alto, California, USA) and Avanos Medical (Irvine, California, USA) for various laboratory and clinical research studies, some of which are included in the present review., (© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Despite humanity's long experience with amputations, postamputation pain remains a highly prevalent, incompletely understood, and clinically challenging condition. There are two main types of postamputation pain: residual limb pain (including but not limited to the "stump") and phantom limb pain. Despite considerable overlap between the two, they also have distinct clinical features, risk factors, and pathophysiological mechanisms. Central, peripheral, and spinal mechanisms may all contribute to the protean manifestations of persistent postamputation pain; an improved understanding of these mechanisms will be essential to identify the most promising interventions for the prevention and treatment of postamputation pain. Although there are currently no standardized prevention or treatment recommendations for any type of postamputation pain, an evidence-based, multimodal strategy including pharmacological agents, nonsurgical procedures, surgery, complementary and integrative techniques, and assistive technologies may prevent the development of chronic postamputation pain after amputation and/or optimize treatment outcomes., Competing Interests: Competing interests: SPC has served as a consultant to SPR, which manufactures a peripheral nerve stimulation system studied in PAP. All other authors report no relevant competing interests or financial disclosures., (© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Fascial plane blocks of the posterior thoracic wall (erector spinae plane [ESP] and intertransverse plane [ITP]) may offer advantages for high-risk patients requiring open abdominal surgery in whom thoracic epidural analgesia (TEA) combined with general anesthesia (GA) may be relatively contraindicated. As a primary anesthesia method, ESP/ITP (paravertebral by proxy) blocks proved effective in a case of open gastrectomy by avoiding airway intervention, mechanical ventilation, and effectively managing visceral pain. This article highlights the use of ESP/ITP blocks in a high-risk patient for whom GA and TEA posed substantial risks, with the patient who experienced favorable perioperative outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 International Anesthesia Research Society.)

Purpose: The aim of this study was to determine the effect of transcutaneous electrical nerve stimulation (TENS) on pain, functionality, quality of life, and analgesic consumption in patients undergoing TKR., Design: A single center, randomized controlled trial., Methods: A total of 52 participants were randomly assigned to the intervention (n = 26) and control (n = 26) groups. The intervention group was exposed to conventional TENS. Data were collected with a Patient Identification Form, the Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Quality of Life Scale (SF-36), and the Analgesic Tracking Form., Results: VAS and WOMAC scores significantly decreased in the intervention group, over time, while they increased in the control group. SF-36 scores significantly increased in the intervention group over time. It was determined that analgesic consumption was significantly lower in the intervention group than in the control group., Conclusions: TENS significantly reduced pain and increased functionality and quality of life. Our findings suggest that TENS may be an effective adjunctive analgesic therapy in patients receiving TKR; however, more testing is needed in larger and more heterogeneous populations., Clinical Implications: Nurses can provide effective postoperative pain control in patients undergoing TKR, increase functionality, accelerate the healing process, and improve their quality of life by using TENS, a non-pharmacological treatment method, in the perioperative period., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Literature regarding nonpharmacological interventions (NPI) for PMPS or CP after mastectomy is scarce and not fully appraised, therefore we conducted this systematic review to explore the current panorama of treatment options., Methods: A systematic review to assess the existing evidence regarding nonpharmacological approaches for PMPS. We reviewed the following databases: PubMed-MEDLINE, Embase, and Ovid (including the Cochrane Database for Clinical studies) using the following search terms: CP, mastectomy, and PMPS, and adjusted the terms depending on the database used. We included observational studies including case reports, cross sectional studies, cohort studies, and clinical trials (randomized or not) that included a NPI to treat PMPS., Results: Total 1061 records were identified. After duplicate elimination, 863 records were screened for eligibility. A total of 717 records were excluded using our criteria, 138 records were sought for retrieval, and 117 full text records were assessed. Finally, 30 studies were included: seven case series, one cross-sectional study, two cohort studies, one case-control study, five nonrandomized clinical trials, ten randomized clinical trials (RCT), one qualitative study, and three systematic reviews of the literature, including two meta analyses, were included., Discussion: Findings suggest that there is a great response of patients to some NPI. Regarding surgical interventions, autologous fat grafting and lymph node transplantation showed to have the greatest benefit for patients in terms of quality of life and reduced pain scores. Pulsed radiofrequency demonstrated the highest quality of evidence for energy related procedures. Within the physical therapy interventions, transcutaneous electric nerve stimulation and dry needling showed the greatest benefit. Finally, virtual reality demonstrated the greatest benefit in educational interventions., Competing Interests: Disclosure The authors have stated that they have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Aromatherapy, a non-pharmacological intervention involving essential oils, has been suggested as a complementary therapy for perioperative discomfort. This study seeks to systematically examine the efficacy of aromatherapy in alleviating pain and other discomforts in mothers undergoing cesarean sections., Methods: A systematic search of PubMed, the Cochrane Library, and Embase was conducted from inception to September 2024. Inclusion criteria involved mothers undergoing cesarean section, aromatherapy as an intervention, and outcomes such as pain, anxiety, nausea and vomiting. Subgroup analyses explored the effects of distinct control groups, essential oil, dosage, number of sessions, and session length of aroma preparations. Statistical analysis was conducted using RevMan 5.3, with heterogeneity assessed using the Q test and I 2 statistic., Results: Seventeen studies involving 1490 participants were included. Aromatherapy significantly reduced post-cesarean pain (SMD = -1.19, 95 % CI [-1.93, -0.45], p = 0.002). Chamomile oil, low dosage (≤2 drops), single session and sessions lasting 20 min or less were more effective in relieving pain. Aromatherapy significantly decreased nausea incidence (RR = 0.52, 95 % CI [0.33, 0.81], p = 0.004), reduced analgesic requirements (RR = 0.60, 95 % CI [0.49, 0.73], p < 0.00001), and improved patient satisfaction (RR = 1.64, 95 % CI [1.26, 2.12], p = 0.0002)., Conclusion: Aromatherapy effectively reduces post-cesarean pain, nausea, analgesic use, and improves patient satisfaction. Chamomile oil, low doses (≤2 drops), single session and short length (≤20 min) seems to be the most effective method for alleviating post-cesarean pain., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Preoperative state anxiety is a known predisposing factor for enhanced postoperative pain and hindered recovery following total knee or hip replacement. Acupuncture administered preoperatively has been associated with reduced anxiety in surgical studies, yet evidence of its efficacy in the orthopedic surgical setting is limited. Objective: This study investigated the effects of preoperative acupuncture on preoperative anxiety and pain and compared acute postoperative pain between acupuncture and control patient groups. Design: Parallel-arm, open-label, randomized controlled trial. Setting: Bone and Joint Institute, Hartford Hospital, Hartford, CT. Participants: Sixty middle-aged and elderly men and women with clinically validated preoperative anxiety undergoing elective total hip or knee replacement. Intervention: One-to-one randomization to preoperative acupuncture ( n = 30) or no acupuncture treatment ( n = 30) on the day of surgery. Coprimary outcomes: Anxiety before and after preoperative acupuncture using the visual analog scale and postsurgical pain using the numeric pain scale. Secondary outcomes: Incidence of acupuncture-related complications, pain before and after acupuncture, nausea and vomiting incidence, opioid consumption, anxiolytics and antiemetics use, and patient satisfaction. Results: Patients reported lower anxiety and pain preoperatively following acupuncture compared with before treatment (both p < 0.001). Postoperatively, the acupuncture group reported lower pain in the first 3 h than the control group, although this difference was not statistically significant. No significant differences in postoperative complications or patient satisfaction were observed between the study groups. Most patients were satisfied with the acupuncture treatment and reported a likelihood of considering preoperative acupuncture for future surgeries. Conclusions: These preliminary findings support that preoperative acupuncture is a safe and effective means to reduce perioperative anxiety and pain in patients undergoing total hip or knee replacement surgery. Additional studies should be conducted to best determine the value of preoperative acupuncture in total hip or knee patients presenting with surgically related anxiety. Clinical Trial Registration: ClinicalTrials.gov (10/31/2023, NCT06099223).

Introduction: Acupuncture's role in surgical and postoperative contexts is gaining traction. However, the evidence remains patchy and is often of low-grade quality, particularly in the context of postintestinal surgery. Purpose: To assess acupuncture's efficacy in pain relief and functional recovery after abdominal surgery. Methods: We searched PubMed, Cochrane, Web of Science, and Google Scholar for randomized trials using manual acupuncture as the main intervention. Outcomes included postoperative pain, analgesic use, nausea, gastrointestinal (GI) regeneration, and length of hospital stay. For risk of bias assessment Cochrane risk of bias tool 2 was employed. Registered with PROSPERO: CRD42022311718. Results: Of 700 records till May 2023, 8 trials (551 patients; 16-200/trial) were included. Due to factors such as varying experimental settings and unpublished protocols, there was high risk of bias and heterogeneity, making meta-analysis unfeasible. Safety data were documented sufficiently by two trials. However, acupuncture showed marked benefits in pain relief, less analgesic use, fewer nausea cases, and improved GI recovery. One study reported reduced hospitalization time. Conclusion: Due to the varied methodologies and potential biases in existing studies, the definitive effectiveness of acupuncture remains unclear. To confirm the potential benefits of acupuncture as suggested by the reviewed studies, it's imperative to have more standardized study protocols, well-defined interventions and controls, and objective measures of efficacy.

Background: Postmastectomy pain syndrome (PMPS) is a chronic condition that significantly impacts breast cancer survivors, marked by persistent neuropathic pain that is often unresponsive to conventional therapies. Spinal cord stimulation (SCS) has emerged as a promising intervention for managing this type of pain. This study aimed to assess the clinical efficacy of SCS in managing PMPS and identify patient-specific factors impacting treatment outcomes., Materials and Methods: This retrospective observational study analyzed 78 female patients who underwent SCS implantation between January and October 2023. The efficacy of SCS was assessed by evaluating changes in visual analog scale (VAS) pain scores from baseline to six months after implantation. The influence of factors such as age, body mass index (BMI), prior treatments, and psychologic health on treatment success was explored using binary logistic regression., Results: Six months after implantation, 61 patients (78.2%) reported significant pain relief, with a decrease in VAS scores by ≥4 points. Statistical analysis revealed several predictors of positive outcomes: younger age (hazard ratio [HR] = 0.882, 95% CI: 0.802-0.970, p = 0.009), lower BMI (HR = 0.659, 95% CI: 0.487-0.891, p = 0.007), and psychologic treatment (HR = 0.015, 95% CI: 0.001-0.377, p = 0.011). Conversely, prior radiotherapy was associated with less favorable outcomes (HR = 2.139, 95% CI: 1.219-5.808, p = 0.029). The receiver operating characteristic curve analysis confirmed the model's accuracy (area under the curve = 0.927)., Conclusions: SCS is an effective treatment for PMPS, with age, BMI, psychologic treatments, and prior radiotherapy being significant predictors of outcomes. Tailoring treatment plans to these factors can potentially enhance pain management for patients with PMPS., Competing Interests: Conflict of Interest The authors reported no conflict of interest., (Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)

Aim: This systematic review and meta-analysis aimed to evaluate the effect of technology-based interventions on the pain of paediatric surgery patients., Background: Recently, the number of technology-based interventions involving multimodal nonpharmacological methods tailored to pain management in paediatric surgery patients has increased. It is crucial to determine the effectiveness of these interventions., Design: A systematic review and meta-analysis of randomized controlled trials following Cochrane methods was conducted., Review Methods: We performed a literature search in the Web of Science, PubMed, CINAHL, Science Direct, MEDLINE, ProQuest and Cochrane Library databases. Two independent researchers screened the literature using specific keywords and selected randomized controlled trials based on the inclusion and exclusion criteria. Each researcher extracted data and assessed the risk of bias in the randomized controlled trials using the Cochrane bias risk assessment tool., Result: We conducted a meta-analysis on 14 randomized controlled trials included in the study. The results showed that technology-based interventions reduced pain scores in paediatric surgery patients. Cochran's Q test results pointed to a high level of heterogeneity among the randomized controlled trials., Conclusion: A meta-analysis result of 14 randomized controlled trials showed that technology-based interventions are effective methods for reducing pain in paediatric surgery patients., Registration Number: CRD42021226666., (© 2025 The Author(s). International Journal of Nursing Practice published by John Wiley & Sons Australia, Ltd.)

Patients undergoing lower-limb orthopedic surgery may experience multiple postoperative complications. Although peripheral nerve stimulation (PNS) is a promising non-pharmacological approach that has been used in lower-limb postoperative recovery, the clinical efficacy of PNS remains inconclusive. This study systematically searched three databases (PubMed, Embase, and Cochrane Library) for randomized controlled trials (RCTs) that examined the treatment effects of PNSs in patients who underwent lower-limb orthopedic surgery up to September 29, 2023. Two investigators independently identified studies, extracted data, and conducted meta-analyses with Review Manager 5.4. The outcomes were pain relief (measured by reductions in pain intensity and analgesic consumption) and functional improvements (range of motion [ROM] and length of hospitalization [LOH]). A total of 633 patients including 321 in the experimental groups and 312 in the control groups from eight RCTs were included. PNS showed no significant effect on pain intensity, while analgesic consumption was marginally significantly reduced in the experimental group. Furthermore, no significant differences were observed regarding functional improvements in ROM or LOH after the intervention. Although PNS had no significant effect on pain relief or functional improvements, the intervention exhibited a marginally significant reduction in analgesic consumption. Future trials should be conducted with larger sample sizes, longer follow-up periods, and more varied stimulation parameters., (© 2024 The Author(s). PsyCh Journal published by Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.)

Purpose of Review: Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related to the high dose opioids which have traditionally been used perioperatively in cardiac surgery have led to the adoption of alternative analgesic strategies. This review aims to highlight current evidence-based approaches to managing pain after cardiac surgery., Recent Findings: Current evidence and international guidelines support the use of multimodal analgesics for managing perioperative pain after cardiac surgery. Regional anaesthesia in the form of fascial plane blocks, such as the erector spinae plane and parasternal intercostal plane blocks, are effective and safe techniques for anticoagulated cardiac surgery patients. Transitional pain services are multidisciplinary programmes that bridge the gap between inpatient and outpatient care for these patients., Summary: This paper reviews advancements in perioperative pain management for cardiac surgery patients, emphasising the shift from high-dose opioids to multimodal analgesia and regional anaesthetic techniques, and highlighting the role of multidisciplinary transitional pain services., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Back pain is increasingly common, leading to more spine surgeries. While most people experience pain relief and improved function after surgery, many continue to suffer from chronic post-surgical pain (CPSP) with limited functional improvement. CPSP is often treated with opioids, raising concerns about misuse, poor functional outcomes, and broader public health impacts. Therefore, perioperative interventions are needed to enhance outcomes and reduce the risk of opioid misuse after surgery., Objective: This article outlines a study protocol evaluating the feasibility, acceptability, and preliminary efficacy of a brief, perioperative Acceptance and Commitment Therapy (ACT) intervention aimed at improving pain and reducing opioid use after spine surgery., Design: In this pilot randomized controlled trial, participants scheduled for spine surgery (anticipated N = 100) are assigned to the ACT intervention or a treatment-as-usual group., Intervention: The ACT intervention is a 5-h, single-session, virtual workshop with a booster call two weeks post-workshop or post-surgery, whichever is later., Outcome Measures: The primary outcome is patient-reported treatment helpfulness immediately after the intervention. Secondary outcomes include patient-reported treatment credibility and expectancy post-intervention, treatment helpfulness at 1 month post-surgery, and pain interference, pain intensity and opioid use at 1, 3, and 6 months post-surgery., Conclusion: This pilot trial examines a novel, brief ACT intervention aimed at preventing CPSP and reducing opioid dependence. If successful, feasibility and preliminary efficacy results will be utilized to inform a future, full-scale randomized trial of this intervention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Transcutaneous Electrical Acupoint Stimulation (TEAS) is a noninvasive technique that involves the application of electrical stimulation to specific acupoints on the skin. This meta-analysis aimed to evaluate the clinical efficacy of TEAS in alleviating postoperative pain after gynecological surgeries., Method: A systematic search of multiple electronic databases was carried out to identify relevant studies that investigated the use of TEAS for postoperative pain management in gynecological surgery settings., Results: After screening and data extraction, a total of 10 randomized controlled trials (RCTs) were included in the meta-analysis. The results of the meta-analysis showed that TEAS was associated with reduction in postoperative pain intensity compared to control interventions, such as sham stimulation or conventional analgesics. However, this reduction was statistically insignificant (p > .05). Additionally, TEAS was found to be effective in reducing the consumption of analgesic medications and improving patient satisfaction with pain management. The assessment of certainty of evidence revealed a grading of low to moderate., Conclusions: Overall, the findings of this meta-analysis suggest that TEAS may be a promising adjunctive therapy for alleviating postoperative pain in gynecological surgery patients. However, caution should be exercised when interpreting the results and making clinical recommendations based on the low to moderate quality of the current evidence. Further high-quality studies are needed to confirm these results and establish optimal treatment protocols for TEAS in this patient population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Lower limb fractures cause local pain, swelling, ecchymosis, and dysfunction. Clinically, incision and reduction surgery are often employed to treat lower limb fractures. However, postoperative pain can be intense, leading to adverse emotions that hinder subsequent recovery., Methods: A total of 99 postoperative patients with lower limb fractures were randomly divided into 3 groups: the control group (routine care, 33 patients), the auricular acupressure group (routine care plus auricular acupressure, 33 patients), and the combined group (routine care, auricular acupressure, and emotional freedom techniques [EFT], 33 patients). Pain levels were measured using the visual analog scale (VAS), and anxiety levels were measured using the self-rating anxiety scale (SAS) at various time points post-intervention. Patient satisfaction with nursing care was also evaluated at the end of the intervention., Results: The VAS scores in the combined group were significantly lower than those in the auricular acupressure and control groups at 4, 12, 24, and 48 hours post-intervention (P < .05). Additionally, the SAS scores in the combined group were significantly lower than those in the auricular acupressure and control groups at 72 hours post-intervention (P < .05). The combined group also reported significantly higher satisfaction with nursing care compared to the other 2 groups at the end of the intervention (P < .05)., Conclusion: Auricular acupressure combined with EFT effectively reduces pain levels, alleviates anxiety, and increases patient satisfaction with nursing care in postoperative patients with lower limb fractures., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: Blood loss and pain management are significant concerns in total knee arthroplasty (TKA). Tranexamic acid (TA) and cryotherapy have been used separately to address these issues, but their comparative effectiveness is not well studied. This study aimed to evaluate the efficacy of intravenous TA and cryotherapy in reducing blood loss and improving clinical outcomes after TKA., Methods: A randomized controlled trial with 76 patients assigned to three groups: Group 1 received pre- and postoperative cryotherapy, Group 2 received intravenous tranexamic acid (TA), and Group 3 (control) received a standard cold pack. Hemoglobin (Hb), hematocrit (Hct), prothrombin time, international normalized ratio (INR), knee flexion and extension angles, and visual analog scale (VAS) pain scores were monitored preoperatively and postoperatively at 6, 24, and 48 h., Results: The mean age of patients was 65 ± 7 years. The tranexamic acid group showed significantly lower blood loss compared to the control group (p < 0.001). Knee flexion and extension angles were significantly better in the cryotherapy group compared to the control group (p < 0.001). VAS pain scores were significantly lower in the cryotherapy group at all time points compared to both the tranexamic acid and control groups (p < 0.001)., Conclusion: Both tranexamic acid and cryotherapy are effective in reducing blood loss and improving clinical outcomes following TKA. Tranexamic acid significantly reduces blood loss, while cryotherapy effectively manages postoperative pain and range of motion. These methods can enhance patient recovery after TKA., Competing Interests: Declarations. Conflict of interest: The authors declare no conflict of interest. Ethics committee approval: The study protocol was approved by the local ethics committee (No: 2024/129). The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent: Informed consent was obtained from all individual participants included in the study., (© 2025. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Anal fistula surgery often leads to postoperative pain, which can hinder recovery and negatively impact patients' quality of life. This prospective, randomised, controlled trial (RCT) aims to investigate the efficacy of acupuncture in alleviating postoperative pain and reducing the usage of analgesic medications following anal fistula surgery., Methods: This single-centre, patient-blinded, assessor-blinded, placebo-controlled randomised controlled trial (RCT) will be conducted at a tertiary referral hospital. A total of 66 patients with low simple anal fistula will be randomised at a 1:1 ratio to receive either acupuncture or sham acupuncture. The primary outcome is the difference in the numerical rating scale (NRS) pain score before and after acupuncture at 6 hours post surgery. The secondary outcomes include postoperative analgesic usage (Day 0 to Day 7), complications (including infection, urinary retention, and bleeding from Day 0 to Day 7, as well as delayed wound healing and recurrence within 3 months post surgery), sleep quality (PSQI from Day 0 to Day 7), psychological state (SDS and SAS on Day 0, Day 1, and Day 7), and overall recovery quality (QoR-15 on Day 1, Day 3, and Day 7). The statistical analysis of this trial will be conducted using SPSS software, validating the normality of data and the homogeneity of variance, and employing t-tests, Mann-Whitney U tests, chi-square tests, and repeated measures ANOVA to analyze baseline data, primary and secondary outcome indicators., Discussion: This study aims to contribute to the expanding evidence base regarding the role of acupuncture in postoperative pain management. Through a comprehensive assessment of pain relief, analgesic usage, and other recovery-related outcomes, our findings will establish a foundation for standardizing acupuncture protocols specifically tailored for anal fistula surgery patients. The strengths of this trial are rooted in its rigorous randomised controlled trial (RCT) design, comprehensive outcome measures, and focused examination of a clinically significant issue. Ultimately, the findings of this trial have the potential to offer valuable insights into the utility of acupuncture as an adjunctive therapy for postoperative pain management among anal fistula patients, thereby informing future clinical practice and research directions., Trial Registration: This study was registered in the China Clinical Trial Registry on June 1, 2024, with registration number: ChiCTR2400085178., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

To optimize the efficacy of analgesia for patients receiving laparoscopic inguinal hernia repair, peri-operative pain neuroscience education (PNE) as a pain-specific cognitive therapy was incorporated into multi-modal analgesia. A randomized controlled trial was conducted to compare conventional analgesia (group CA) and the addition of pain neuroscience education into it (group PNE) in patients receiving laparoscopic inguinal hernia repair. Characteristics of peri-operative pain was evaluated with Douleur Neuropathique 4 questionnaire (DN-4), central sensitization inventory (CSI), pain catastrophizing scale (PCS) post-operatively and pressure pain threshold. Post-operative quality of recovery was measured with EuroQol five dimensions questionnaire (EQ-5D-5L). The incidence of chronic post-operative pain was also recorded. A total of 184 patients consented to participate in this study and finished follow-up. Compared with those receiving conventional analgesia (group CA, N = 91), patients in group PNE (N = 93) reported reduced incidence of moderate-to-severe pain and less dosages of opioid during hospitalization (p < 0.05). Catastrophing, sensitization related to pain were reduced in group PNE (p < 0.05). Quality of recovery was improved till 1 month after surgery (p < 0.05). The addition of pain neuroscience education improved analgesic effect and quality of recovery for patients undergoing laparoscopic inguinal hernia repair. It also helped reduce sensitization and catastrophic of acute surgical pain. This psychologically-oriented analgesic approach merits future research and application for these patients., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval: Ethics approval was received from the Instutional Review Board of The First Affiliated Hospital of Chongqing Medical University (IRB number: 2022-068)., (© 2025. The Author(s).)

Introduction: Osseointegration is an innovative procedure to attach an external prosthetic device directly to the skeleton. The technique has been shown to improve physical function and quality of life relative to conventional socket prosthetic devices. While much of the research in osseointegration has focused on functional outcomes, less is known regarding perioperative pain management. The purpose of this study was to describe perioperative and postoperative pain management approaches received by patients undergoing osseointegration procedures at a tertiary medical center., Materials and Methods: This retrospective study was determined to be exempt from Institutional Review Board review by the Walter Reed National Military Medical Center Department of Research Programs. Perioperative and postoperative pain management approaches received by 41 patients who underwent 76 staged osseointegration procedures from 2016 to 2021 at Walter Reed National Military Medical Center were described., Results: Pain management approaches included perioperative ketamine (51% stage I, 55% stage II), epidurals (76% stage I, 77% stage II) with a median of 3-4 days across stages, peripheral nerve catheters (27% stage I, 16% stage II), and/or single-shot peripheral nerve block (<10% across stages). The median morphine equivalent dose provided during surgery was 65 mg across both stages, with 56% and 54% of patients also requiring opioid medication in the post-anesthesia care unit. In 11 of 76 (15%) procedures, patients required an increase in the rate or concentration of epidural or peripheral nerve catheter infusion. In six (8%) unique recovery periods, patients experienced a dislodged catheter. In 27 of 76 (36%) unique recovery periods, patients experienced a significant increase in postoperative pain requiring acute pain service intervention in the form of catheter adjustment, intravenous pain medications, and/or the addition of intravenous patient-controlled analgesia. Adequate pain control was achieved with minimal epidural or peripheral nerve catheter trouble-shooting and a bolus for 24 patients (89% requiring intervention). Summed 24-hour pain scores (SPI24) did not vary across stages. SPI24 was positively correlated with opioid doses received. Patients with single, relative to multiple, limb amputations had similar SPI24 values (P > .05)., Conclusions: Variability in pain management requirements calls forth opportunities to optimize osseointegration analgesia care and future research. As osseointegration becomes more accessible, the need for optimizing pain management through patient-centered research becomes more salient., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Transcutaneous electrical stimulation after breast cancer surgery has been utilized for various purposes, but the full efficacy of this treatment approach on postoperative symptoms remains unclear., Aim: This study aimed to answer the question: Does transcutaneous electrical nerve stimulation significantly impact postoperative patient outcomes in individuals undergoing breast cancer surgery?, Methods: A systematic review of randomized controlled trials was conducted. Because of the limited number of studies included, it was not feasible to perform a meta-analysis. English-language publications from 2013 and 2024 that investigated the effects of transcutaneous electrical stimulation in breast cancer surgery patients were included. Electronic databases such as Web of Science, PubMed, Scopus, EBSCO, ScienceDirect, Cochrane Central Register of Controlled Trials, and Wiley Online Library were searched. Two independent investigators assessed the studies using the revised JBI risk of bias tool. Data from randomized trials were extracted by two researchers using the Cochrane data collection tool., Results: Our comprehensive literature review identified 251 studies. After rigorous assessment, 12 articles met our inclusion criteria. Title and abstract screening excluded seven studies that did not involve surgery, used treatments other than TENS, included acupuncture, or did not measure pain outcomes. Among these, five studies involving 776 patients examined the effects of transcutaneous electrical stimulation on pain management in breast cancer surgery. In all of the studies reviewed, transcutaneous electrical stimulation had a beneficial effect on postoperative pain., Conclusion: Transcutaneous electrical stimulation has significantly alleviated pain associated with breast cancer surgery. This therapeutic modality has improved patient satisfaction with analgesia by relieving pain; reducing analgesic use; reducing postoperative nausea and vomiting; increasing blood levels of IL-2, IFN-γ, and IL-2/IL-4 ratio; and reducing skin sensitivity. Transcutaneous electrical stimulation devices may improve postoperative patient outcomes and enhance the recovery process in people undergoing breast cancer surgery. The results of this study are limited by heterogeneity and the small number of included studies. Future research should prioritize standardization of intervention procedures and investigation of the long-term effects of TENS in postoperative care., Registration: This study was registered in the PROSPERO registration system under the number CRD42024523558., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s).)

Background and Aim: Removing the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023., Methods: This was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups: 1- control group, 2- respiratory relaxation group, 3- foot reflex massage group, and 4- a combination of respiratory relaxation and reflexology massage. To collect data, two demographic questionnaires, and a visual analog scale were used., Results: The participants of the four groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively). The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the four groups of study (P = 0.15, 0.54 respectively); However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008)., Conclusion: The results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients' average pain., Competing Interests: Declarations. Ethical approval: The study protocol was approved by the Ethics Committee of Rafsanjan University of Medical Sciences (Code: IR.RUMS.REC.1401.236). Besides, it was registered at the Iranian Registry of Clinical Trial (Code: IRCT20190714044196N1). Consent for publication: All authors declare their full consent for publishing their article in the Journal of Cardiothoracic Surgery. Limitations and recommendations: One of the study’s limitations was the limited number of patients in the study setting. For further research, we can propose using multi-center sampling methods in order to reach a bigger sample size. Another limitation was the limited number of similar studies to compare and support the results. Future studies are recommended to investigate other non-pharmacological methods of complementary and alternative medicine on anxiety caused by chest tube removal and, on average pain in other surgeries and with other variables rather than pain. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: High-frequency, high-intensity transcutaneous electrical nerve stimulation (HFHI TENS, i.e. 80 Hz and 40-60 mA) is an effective, fast-acting pain relief modality after elective surgery, offering pain relief within 5 min. Few studies have explored patients' perspectives on using TENS in the post-anesthesia care unit. This study investigates patients' experiences and perceptions of TENS as a complementary approach to traditional pharmacological pain management in postoperative care., Method: Patients undergoing elective laparoscopic cholecystectomy were offered TENS as an alternative to conventional pain treatment with IV opioids. Twenty participants attended telephone semi-structured telephone interviews a median of 12 days after surgery. Data were analysed using a thematic analysis according to Braun and Clark., Results: Participants expressed that TENS provided reassurance and relaxation, calmed them, and gave them a sense of control over their pain. Participants perceived a greater degree of autonomy as TENS could be administered independently. They conveyed a preference for TENS, which they experienced as a safe and fast-acting alternative to opioids, despite its limitations in managing severe pain and rapid offset upon discontinuation., Conclusion: To our knowledge, this is the first study that describes patients' views on managing postoperative pain using TENS in the post-anesthesia care unit. This study indicates that patients desire alternatives to drugs for pain control in the postoperative setting. TENS has advantages, such as a rapid onset and offset and supporting patient autonomy, as well as drawbacks, such as being ineffective when pain is too severe. TENS could be included within the routine multimodal analgesia framework for person-centred postoperative pain management., Trial Registration: The participants in the current study were retrospectively registered and recruited from a randomized controlled trial (RCT; registered at ClinicalTrials.gov: NCT04114149)., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Helsinki Declaration 1975, as revised in 2013 (23). The Regional Ethics Review Board in Gothenburg and the Swedish Ethical Review Authority approved the study (registration number 954 − 18, supplementary applications registry numbers 2021–03306 and 2023-01979-02). All participants gave oral and written consent to participate after receiving oral and written information about the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Management of acute and chronic pain following surgery remains a critical patient management challenge, with poor pain management associated with negative patient satisfaction, increased opioid consumption and a high incidence of adverse events. Chest surgery specifically carries a high incidence of significant early and chronic post operative pain. The high incidence, prolonged duration of pain, and adverse effects associated with chronic opioid analgesia, has given rise to the need for non-opioid pain management strategies. Cryoneurolysis, also known as cryoanalgesia, has emerged as a promising option for both acute and chronic pain management. While cryoneurolysis was first developed over fifty years ago, its utilization was limited by technical implementation challenges and limitations in identifying target structures percutaneously. Advances both in cryoneurolysis delivery devices as well as ultrasound have reinvigorated interest in the technique, with recent studies highlighting the advantages of cryoneurolysis, including its favorable side effect profile, long duration of efficacy and relative technical simplicity. The purpose of this review is to examine techniques for cryoneurolysis, and explore recent evidence for safety and efficacy of the technique following different surgical procedures., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Post-laparoscopic shoulder pain (PLSP) can slow patient recovery and extend hospital stays, making its management crucial for patients undergoing laparoscopic surgery. Current consensus guidelines say little about how to prevent or manage PLSP. In this context, a multimodal approach to PLSP management that maybe extend beyond the pharmaceutical interventions currently employed. A variety of devices comprising both invasive and noninvasive approaches are available to patients, serving as adjuvants to analgesics. In this review, we explore the potential causes of PLSP. Additionally, by searching relevant databases and reviewing existing literature, we provide a comprehensive summary of current PLSP management strategies excluding analgesics., Recent Findings: A total of 30 articles were reviewed. The review identified a number of different treatments for PLSP, including trendelenburg position, discharge of residual gas, pulmonary recruitment manoeuvre, low-pressure pneumoperitoneum and phrenic nerve block, among others. However, the inconsistencies in the study designs resulted in disparate conclusions. While the current studies provide valuable insights, there is a clear need for further research in this area., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests. Human and Animal Rights: All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines)., (© 2024. The Author(s).)

Approximately 1 in 10 patients undergoing surgery is considered at high risk for poor pain and opioid-related outcomes due to chronic pain or persistent opioid use prior to surgery, leading to increased hospital lengths of stay, emergency department visits, hospital readmissions, and worse long-term outcomes. Multidisciplinary transitional pain services (TPSs) have been shown to effectively identify and optimize high-risk patients before surgery, leading to a reduction in healthcare utilization. We conducted a series of semistructured interviews, a literature search, and a financial analysis to develop a reproducible business case for establishing a TPS. These interviews involved discussions with clinicians and administrators at Michigan Medicine, as well as leaders of TPS initiatives at peer institutions across the USA and Canada. The aim was to understand possible operational structures and potential sources of revenue and cost savings that needed inclusion in our model. Subsequently, the authors developed a modifiable financial modeling tool, which is freely available for download and adaptable to any healthcare institution. The model suggests that the primary source of cost savings can be attributed to a reduction in length of stay. Furthermore, several operational options exist for incorporating a TPS that performs at breakeven or positive net profit. This tool and these findings are important for informing health systems of operational and financial considerations when implementing a TPS program. Future research should evaluate this financial tool's reproducibility in community health system contexts., Competing Interests: Competing interests: CMB is a consultant for Heron Therapeutics, Vertex Pharmaceuticals, Benter Foundation and Alosa Health, and he provides expert medical testimony. AE provides expert medical review and testimony. There are otherwise no disclosures., (© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Percutaneous auricular nerve stimulation (neuromodulation) is an analgesic technique involving the percutaneous implantation of multiple leads at various points on/around the ear followed by the delivery of electric current using an external pulse generator. A device is currently available within the USA cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. The current randomized, controlled pilot study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent definitive clinical trial and (2) estimate the treatment effect of auricular neuromodulation on postoperative pain and opioid consumption following total knee arthroplasty., Methods: Within the recovery room following primary, unilateral, total knee arthroplasty, an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) was applied using three percutaneous leads and one ground electrode. Participants were randomized to 5 days of either electrical stimulation or sham stimulation in a double-masked fashion. Participants were discharged with the stimulator in situ and removed the disposable devices at home. The dual primary treatment effect outcome measures were the cumulative opioid use (oral oxycodone) and the mean of the "average" daily pain measured with the Numeric Rating Scale for the first 5 postoperative days., Results: During the first five postoperative days, oxycodone consumption in participants given active stimulation (n=15) was a median (IQR) of 4 mg (2-12) vs 13 mg (5-23) in patients given sham (n=15) treatment (p=0.039). During this same period, the average pain intensity in patients given active stimulation was a median (IQR) of 2.5 (1.5-3.3) vs 4.0 (3.6-4.8) in those given sham (p=0.014). Awakenings due to pain over all eight postoperative nights in participants given active stimulation was a median (IQR) of 5 (3-8) vs 11 (4-14) in those given sham (p<0.001). No device-related localized cutaneous irritation, systemic side effects, or other adverse events were identified., Conclusions: Percutaneous auricular neuromodulation reduced pain scores and opioid requirements during the initial week after total knee arthroplasty. Given the ease of application as well as the lack of systemic side effects and reported complications, a definitive clinical trial appears warranted., Trial Registration Number: NCT05521516., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2025. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ Group.)

Aim: Electronic bidets can be a substitute for sitz baths, but no study has examined the use of electronic bidets to manage anal problems., Methods: A randomized, controlled, single-blind, multicenter, parallel group trial was performed. Patients who underwent hemorrhoidectomy were randomly assigned (1:1) to use the electronic bidet or warm sitz baths for 7 days after hemorrhoidectomy. The primary endpoint was the difference in the anal pain VAS score for 7 days posthemorrhoidectomy., Results: Patients were assigned to the electronic bidet (51) or sitz bath (50) groups. Twenty-six patients dropped out after randomization, and the final analysis included 34 patients in the electronic bidet group and 41 in the sitz bath group. The VAS score for anal pain 7 days posthemorrhoidectomy did not differ between the electronic bidet and sitz bath groups (38.3 ± 21.9 vs. 42.0 ± 21.1, p = 0.453). The upper limit of the 95% confidence interval of the VAS score in the electronic bidet group (81.22) was greater than the margin of noninferiority (46.20)., Conclusion: The VAS scores after hemorrhoidectomy did not differ between the electronic bidet and sitz bath groups, but the noninferiority of the electronic bidet to sitz baths for anal pain 7 days posthemorrhoidectomy was not verified., Trial Registration: The trial was registered on ClinicalTrials.gov (Registration number: NCT02353156, date: 02/02/2015)., Competing Interests: Declarations. Ethics approval and consent to participate: The experimental protocol was established according to the ethical guidelines of the Helsinki Declaration and was approved by the institutional review board (IRB) of Seoul National University Hospital (1412-080-633). Written informed consent was obtained from individual participants or their guardians. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Reflexology is a method used to control the pain and anxiety associated with chest tube removal in patients undergoing cardiovascular surgery., Primary Study Objective: This study aimed to identify the effect of foot reflexology applied before chest tube removal on pain and anxiety levels in patients with coronary artery bypass graft surgery., Methods/design: This study was a randomized controlled clinical trial., Setting: This study was conducted in the cardiovascular surgery intensive care unit of the Baskent University Ankara Hospital., Participants: Patients, who underwent coronary artery bypass graft surgery, were randomly assigned either to the reflexology group or the control group (n = 28 individuals/group)., Intervention: The reflexology group received foot reflexology for 30 minutes in two sessions (first postoperative day and before chest tube removal)., Primary Outcome Measures: The primary outcomes of the surgery were pain, evaluated using a Numeric Pain-Rating Scale; and anxiety, evaluated using the Profile of Mood States Scale Tension-Anxiety Subscale. Pain and anxiety were determined on the first (before and after the reflexology) and second postoperative days (before and after the reflexology and immediately, 15 min, 1 hour (only pain level) after chest tube removal)., Results: The mean pain scores of the control and intervention groups were similar during chest tube removal, 15 minutes after, and 1 hour after (P > .05). Although mean anxiety scores were comparable after chest tube removal in both groups (P > .05), a significant difference was found 15 minutes later (P < .05). The increase in pain (P = .0001) and anxiety (P = .032) levels before and after the removal was significantly less in the intervention group compared to the control group, based on pain and anxiety scores., Conclusion: Foot reflexology significantly reduced the increase in pain and anxiety during chest tube removal in patients with coronary artery bypass graft surgery.

Introduction: Randomized controlled trials and meta-analyses have provided evidence of the positive effects of perioperative music interventions on pain, anxiety, and stress. However, the cost-effectiveness is unknown. The objective of this study was to analyze the cost-effectiveness of the implementation of a music intervention in the perioperative care of patients undergoing colorectal surgery., Methods: A post hoc analysis was performed on patients included in the Implementation of Music Intervention in the PeRiOperatiVe standard care study: a clinical implementation study comparing the effects of perioperative music interventions (post-implementation group, N = 50) to standard care in colorectal surgery (pre-implementation group, N = 50). Main outcomes analyzed were postoperative pain scores and healthcare costs. Propensity score matching with inverse probability weighting was applied. Incremental costs and cumulative pain score differences were estimated using bootstrap analysis with 1000 replications., Results: Median age of the entire patient population was 62.5. Mean sum of postoperative pain scores on postoperative days 0 to 3 was 9.8 (range 0-40) (95% confidence interval [CI] 8.3-11.4) and 9.9 (95% CI; 7.0-12.9) in the pre- and post-implementation group, respectively (P = 0.970). The total costs were not significantly different between the pre- and post-implementation group in the entire group (€7000 versus €8,070, mean difference of €1070 (bootstrap 95% CI - €1190 - €3336), P = 0.353). Incremental costs were €1288 and €5030 (intention-to-treat and per protocol analysis, respectively) per clinically relevant decrease in pain during postoperative day 0-3., Conclusions: The implementation of music intervention does not lead to a significant difference in costs. These results can aid clinicians considering the implementation of perioperative music., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Postoperative pain is one of the most common problems after caesarean section (CS). Pain reduction and effective mobilisation after CS positively affect maternal and infant health., Aim: This study aimed to determine the effects of acupressure applied to women after CS on pain intensity and first mobilisation distance., Methods: The sample of this prospective, two-armed (1:1), double-blind randomised controlled clinical trial consisted of 64 women undergoing CS (32 acupressure and 32 placebo acupressure group). The data were analysed using descriptive statistics, chi-square test, independent-groups t-test, Mann-Whitney U test, repeated-measures two-way analysis of variance (ANOVA) and simple main-effects analysis., Results: Findings showed statistically significant group effects (F = 19.32, p<.001), time effects (F = 27.67, p<.001), and group- and time-interaction effects (F = 26.60, p<.001) on postoperative pain after CS. In the acupressure group, the VAS scores were lower at 1 min, 2 h and 4 h after the intervention compared to before the intervention (p<.001; p<.001; p=.001, respectively). In the placebo group, the VAS score at 1 min after the application decreased, increasing at 2 h and 4 h, but these changes were not significant (p>.05). The first mobilisation distance of the acupressure group was significantly longer than that of the placebo group (p<.001)., Conclusion: Acupressure applied to the SP6, P6 and LI4 points was an effective nursing intervention for pain control and mobilisation after CS. Considering the significant impact of pain after CS on maternal and infant health, nurses should include acupressure, which is easy to apply, cost-effective, and efficacious, in postpartum care., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Controlling acute pain for individuals undergoing orthopedic surgery is highly desirable as it is related to various treatment outcomes. Immersive, virtual reality hypnosis (VRH) is one potential treatment modality to aid in pain management. This three-arm, randomized clinical trial evaluated the efficacy of two hypnosis interventions for reducing post-surgical pain and anxiety in addition to evaluating the effects on sleep quality, mental health, and physical functioning. Results indicated no statistically significant main effects associated with intervention groups for pre-post change scores of pain intensity (F(3, 177) = 0.35, p  = .71, partial η2 = .004), anxiety (F(3, 177) = 0.20, p = .81, partial η2 = .002) or sleep quality (F(3, 175) = 0.81, p  = .45, partial η2 = .009). Additionally, there were no statistically significant group effects of treatment condition on mental health (F(2, 162) = .71, p  = .49, η2 = .009) or physical functioning (F(2, 165) = .43, p  = .65, η2 = .005). Issues and future directions for this line of research are discussed.

Purpose of Review: Peripheral nerve blocks are performed using local anesthetics that are commonly performed prior to surgery to either be the sole anesthetic and/or for postoperative pain management. Interscalene blocks are a specific type of nerve block that targets the superior and middle trunks of the brachial plexus inhibiting transmission of pain signals from the upper extremities to the central nervous system making them useful in mitigating pain following surgeries involving the shoulder, upper arm, and elbow., Recent Findings: Previously, interscalene blocks were performed with a nerve stimulator, which is an instrument designed to generate a twitch in surrounding muscles to verify the anesthetic block was placed in the correct location. However, this approach with a nerve stimulator alone is being done less frequently as physicians now often employ ultrasound either by itself or in conjunction with a nerve stimulator to in the block. Several clinical studies have shown that the use of ultrasound leads to improved safety and effectiveness of the interscalene block as compared to performing the block using a nerve stimulator alone. Clinical studies comparing interscalene blocks done with ultrasound versus ultrasound in conjunction with a nerve stimulator have shown the combination to be slightly safer and more efficacious with reduced side effects, though the difference in these metrics between the two is small. Interscalene blocks are highly effective for postoperative pain related to shoulder and upper extremity surgeries. Ultrasound guided blocks are more effective with reduced adverse effects when compared to nerve stimulation alone. The combination of both ultrasound and nerve stimulation allows for increased efficacy and decreaed side effects in limited clinical investigations. Therefore, more studies are needed to further compare and determine best practice interscalene techniques for shoulder and upper extremity surgeries., Competing Interests: Declarations. Human and Animal Rights and Informed Consent: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Competing Interests: ADK and CLR are section editors for CPHR., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: This randomized clinical trial aimed to evaluate the effect of intracanal cryotherapy with 2-4 °C normal saline irrigation on post-operative pain after single-visit non-surgical root canal retreatment., Methods: Forty-six single-rooted, single-canal teeth requiring non-surgical root canal retreatment were randomly assigned to two groups (n = 23): a cryotherapy group and a control group. All the treatments were completed during a single visit. A combination of nickel-titanium and stainless-steel files was used for the removal of gutta-percha and root canal preparation, and irrigation was performed using 5.25% NaOCl and 17% EDTA. The cryotherapy group had a final irrigation temperature of 2-4 °C for 5 min before root canal obturation, whereas the control group received irrigation at room temperature. Post-operative pain levels were assessed via the Numerical Rating Scale at 6, 18, 24, 48, 72, and 168 h (up to 7 days). The number of analgesics consumed at the same intervals was also recorded. Statistical analysis was performed using the Chi-Square test, Mann-Whitney test, and Independent Samples test, with the significance level set at 0.05., Results: There was a statistically significant difference in post-operative pain between the cryotherapy group and the control group at 6 h after treatment (P < 0.05). However, post-operative pain levels were not significantly different at 18, 24, 48, 72, or 168 h after treatment (P > 0.05). Additionally, there was no statistically significant difference between the groups in terms of analgesic intake (P > 0.05)., Conclusion: Intracanal cryotherapy can effectively reduce short-term post-operative pain, but it has no effect on long-term pain or the need for analgesics., Competing Interests: Declarations. Ethics approval and consent to participate: This retrospective study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Research Ethics Committee of the School of Dentistry- Tehran University of Medical Sciences (IR.TUMS.DENTISTRY.REC.1401.072). This study is registered on the Iranian Registry of Clinical Trials website at www.irct.ir (IRCT20211231053574N1-19/12/2022) and informed consent to participate was obtained from all of the participants in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Acute postoperative pain is often reported after repair of inguinal hernia and can negatively impact patient satisfaction and clinical outcomes. This includes delayed wound healing, longer hospitalization, and increased health care costs. Non-pharmacological techniques like Progressive Muscle Relaxation (PMR) and Rhythmic Breathing (RB) have been suggested as possible interventions for managing this type of pain. The purpose of this study was to examine the effects of PMR and RB on postoperative pain following repair of inguinal hernia., Methods: This parallel randomized controlled trial was conducted to examine 120 patients in the age range of 18 to 75 years with inclusion criteria: Repair of Inguinal Hernia under general anesthesia and no addiction to drugs and narcotics. These patients were randomly assigned to one of three groups: the RB group, PMR group, or the control group (which received standard care). The RB and PMR interventions were administered at 3, 6, 12, and 24 h after surgery. The primary outcome measure was the intensity of pain at the surgical site, assessed using the Visual Analog Scale (VAS). The secondary outcome measure was the amount of rescue analgesic (Pethidine). The one-way analysis of variance, Chi-square, post-hoc test, and repeated measures ANOVA were used for data analysis., Results: Following the interventions, participants in both the RB and PMR groups exhibited significantly lower levels of acute pain after inguinal hernia repair compared to the control group across all four time periods, except at 12 h postoperatively in the RB group. However, there was no statistically significant difference between the RB and PMR groups. Additionally, the amount of pethidine consumed in the control group was significantly higher compared to the two experimental groups., Conclusions: Based on the results, both RB and PMR were found to be effective techniques in reducing patients' pain. Therefore, it is recommended that healthcare team members, particularly nurses, actively learn and teach both RB and PMR., Trial Registration: Registered in the Iranian registry of clinical trials ( www.irct.ir ) in 31/01/2023 with the following code: IRCT20200206046395N2., Competing Interests: Declarations. Ethics approval and consent to participate: This clinical trial was registered after being reviewed and approved by the Ethics Committee of Shahroud University of Medical Sciences (Identifier: SHMU.REC.1401.186). It was also recorded in irct.ir (IRCT20200206046395N2). After providing clear explanations about the protocol, objectives, potential benefits, and possible risks of participating in the research, eligible volunteers, were given the informed consent form to sign. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To investigate the effect of electroacupuncture pretreatment on the quality of recovery in the patients undergoing laparoscopic gastrointestinal surgery., Methods: Sixty patients for elective laparoscopic resection of gastrointestinal tumors under general anesthesia were randomly assigned to either an observation group or a control group, with 30 patients in each group. In the control group, the routine inhalation-intravenous combined general anesthesia was adopted. On the basis of the control group, in the observation group, 30 min before anesthesia induction, electroacupuncture was applied to bilateral Neiguan (PC 6) and Neimadian (Extra) for 30 min, using disperse-dense wave and at 2 Hz/100 Hz. The recovery time of spontaneous breathing, awakening time, extubation time, and the post-anesthesia care unit (PACU) stay time were compared between the two groups. Mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO 2 ) were recorded at multiple time points: before electroacupuncture (T0), before extubation (T1), immediately after extubation (T2), 5 minutes (T3) and 10 minutes (T4) after extubation, and upon discharge from PACU (T5). The visual analogue scale (VAS) score for pain and Ramsay sedation score at T3, T4 and T5 were observed; and the incidence of agitation, nausea and vomiting at T5 was evaluated in the two groups. At T0 and T5, the serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and cortisol were determined in the two groups., Results: In the observation group, the recovery time of spontaneous breathing, awakening time, extubation time, and PACU stay time were shorter ( P <0.001), MAP and HR at T2 were lower ( P <0.01, P <0.05), the VAS scores for pain at T3, T4, and T5 dropped ( P <0.001, P <0.01), and the Ramsay sedation score at T3 reduced ( P <0.05) compared with those in the control group. The incidence of nausea and vomiting was lower in the observation group when compared with that in the control group ( P <0.05). In comparison with the indexes at T0, the serum levels of TNF-α, IL-6, and cortisol increased at T5 in both groups ( P <0.01); and these indexes at T5 in the observation group were lower than those in the control group ( P <0.01, P <0.05)., Conclusion: Electroacupuncture pretreatment can enhance the quality of recovery in the patients undergoing laparoscopic gastrointestinal tumor surgery, shorten the time for spontaneous breathing recovery, awakening, extubation and PACU stay, and attenuate postoperative pain and stress response.

Background: Rotator cuff repair (RCR) is one of the most prevalent procedures to manage rotator cuff tears (RCT). Postoperative shoulder pain is a common complication following RCR and may be aggravated by activation of myofascial trigger points (MTrP) associated with the injury to the soft tissues surrounding the surgical incision. This study aimed to describe a preliminary, randomized, sham-controlled trial to evaluate the effectiveness of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) as a muscle treatment approach along with 10 sessions of multimodal rehabilitation protocol (MRh) consisting of therapeutic exercise, manual therapy, and electrotherapy on postoperative shoulder pain, range of motion (ROM), strength, and functional outcome scores for patients following RCR surgery., Methods: Forty-six patients aged 40-75 following RCR surgery were recruited and randomly allocated into 2 groups: (1) MTrP-DN plus MRh (experimental group), and (2) sham dry needling (S-DN) plus MRh (control group). This trial had a 4-week intervention period. The primary outcome was the Numeric Pain Rating Scale (NPRS) for postoperative shoulder pain. Secondary outcomes were the Shoulder Pain and Disability Index (SPADI), ROM, and strength. The mentioned outcomes were measured at baseline and week 4. In the current study, adverse events were recorded as well., Results: No statistically significant differences were observed between groups when adding MTrP-DN to MRh for postoperative shoulder pain after 4 weeks of intervention (mean difference 0.32, [95% CI -0.41,1.05], p = 0.37). However, this trial found a small effect size for postoperative shoulder pain. No significant between-group differences were detected in any of the secondary outcomes (p > 0.05) either. We found significant within-group changes in all studied outcome measures. (p < 0.001). This study also reported minor adverse events. following the needling approach., Conclusion: The lack of statistically significant differences in the outcomes and small clinical significance in shoulder pain highlights the complexity of pain management, suggesting that alternative methodologies may be needed for meaningful clinical benefits. Future studies should consider different control groups, long-term follow ups, larger sample sizes, and more MTrP-DN sessions to better understand their potential impact., Trial Registration: This trial was registered at ( https://www.irct.ir ), (IRCT20211005052677N1) on 19/02/2022., Competing Interests: Declarations. Ethics approval and consent to participate: This trial was approved by the Ethics Committee of Iran University of Medical Sciences (Reference number: IR.IUMS.REC.1400.653) and the informed consent form was designed according to the standards of this committee. All participants were informed about the intervention procedure and possible adverse events before the commencement of the trial. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The impact of acupuncture on knee function and pain intensity following knee replacement remains controversial. Therefore, we categorized the postsurgery recovery period into 3 phases: short-term (≤2 weeks), intermediate-term (2 weeks-3 months), and long-term (>3 months), and then assessed the effectiveness of acupuncture in improving function and alleviating pain at different stages following knee replacement. This meta-analysis included randomized controlled trials that compared acupuncture intervention with either no treatment or a sham group after knee replacement. Six databases were searched from inception to December 31, 2023, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and 2 Chinese databases (Chinese National Knowledge Infrastructure and WanFang Data). A total of 23 studies comprising 1,464 participants were included. Significant improvement of active range of motion was observed on day 7 and week 2 after operation. Lower pain intensity at rest was noted in patients receiving acupuncture in short-term periods after operation (12 hours, day 1, day 2, day 5, and week 2). A reduction in pain intensity during movement with acupuncture was observed on postoperative day 1 and day 7. Auricular acupuncture did not show not significant effectiveness in improving range of motion and pain intensity. For conventional acupuncture, the combination of distal and local point selection was found to be the most effective. Early application of acupuncture, in conjunction with physical therapy, starting before postoperative day 1 or day 2, was recommended. Further high-quality researches are warranted to validate the findings in this meta-analysis. PERSPECTIVE: This article demonstrates that acupuncture has short-term effects (≤2 weeks) on improving active range of motion and reducing pain during rest and during movement following knee replacement surgery. The findings support the early application of acupuncture in hospital settings after knee replacement. REGISTRATION ID: The study was registered on PROSPERO (CRD42024503479)., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Chronic postsurgical neuropathic pain (CPSNP) and related static mechanical allodynia (SMA) is recognised as a significant long-term complication after breast cancer surgery (BCS). This study investigates the effectiveness of a novel laser acupuncture technique in treating CPSNP and SMA post-BCS whilst patients underwent standard cancer treatments., Methods: Thirty patients with significant breast area CPSNP and SMA (DN4 ≥ 4) were treated with 60Milliwatt, 658nm laser acupuncture at Austin Hospital between January 2021 and 2024. Patient data was analysed retrospectively: 29 with CPSNP, 22 with SMA. The cohort had exposures to pain aggravating cancer therapies (e.g. chemotherapy, radiotherapy and antihormonal medications). An online patient questionnaire assessed treatment outcomes qualitatively., Results: Patients received an average of 6·4 treatments and their average CPSNP showed significant reduction from 6·86 to 1.29 (P < .001), with a mean 5.57 point decrease (95% CI, 4.90-6.24). Average SMA showed significant reduction from an average of 6.77-1.75 (P < .001), with a mean 5.02-point decrease (95% CI, 4.09-5.96). Pain reductions occurred despite NP aggravating treatment and ongoing usage by 40% of the cohort. 92% of patients reported acute reductions in SMA in the online questionnaire., Conclusion: The significant pain reductions observed may indicate effectiveness of laser acupuncture in reducing both CPSNP and SMA in breast cancer patients post-BCS., Competing Interests: Disclosure None declared., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Background: Postoperative pain and agitation is an ongoing issue among patients undergoing total knee replacement (TKR). Use of complementary therapies such as music may improve outcomes when combined with medical therapy., Aim: The purpose of this quality improvement (QI) initiative was to evaluate postoperative use of classical music among adult patients who have undergone TKR on reported agitation, pain, and opioid use., Design: A prospective evidence-based QI initiative., Setting: A midwestern hospital post-anesthesia care unit., Participants: Postoperative patients who had undergone TKR., Methods: Classical piano music was played postoperatively using an MP3 device. Adult patients who were undergoing TKR were consecutively offered music during their recovery period in the PACU. Agitation was measured using the Richmond Agitation Sedation Score (RASS). Patient perceived pain was measured on a scale of 0-10 with 0 being no pain and 10 being extreme pain. Opioid use was measured using the morphine milligram equivalents (MME)., Findings: A total of (n=40) patients received music and (n=50) patients received standard care without music. RASS was significantly lower in the music group than in the baseline non-music group X 2 (1, N = 89) = 17.8, p < .001. Patient reported pain scores were significantly lower in the music group, 3.98(SD = 2.71), compared to the baseline non-music group, 6.27(SD = 2.60). Opioid use was also significantly decreased in the music group to MME 9.51(SD = 8.62) compared to the baseline non-music group 13.38 (SD = 9.71)., Conclusion: Music is an effective nonpharmacologic intervention in decreasing agitation, pain, and opioid use among patients undergoing TKR. These findings provide evidence for nurses to incorporate music as an adjunctive approach to enhance the patient's experience and improve outcomes., Competing Interests: Declaration of competing interest The authors declare no conflict of interest. Declaration of Generative AI and AI-assisted technologies were not used by the authors in the writing process of this manuscript., (Copyright © 2024 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Introduction: Using a human factors engineering approach, the Johns Hopkins Personalized Pain Program adopted telemedicine for perioperative pain management in response to the COVID-19 pandemic. This study examines the impact of telemedicine adoption on the quality and outcomes of perioperative pain management., Methods: A mixed-methods study with a convergent parallel design was conducted. From June 2017 to December 2021, 902 patients participated in the Personalized Pain Program. Quantitative data on daily opioid consumption, pain severity and interference, physical and mental health status, and patient satisfaction and engagement were continuously collected with all patients using chart review and patient surveys. Beginning 23 March 2020, the Personalized Pain Program transitioned to telemedicine. A pre-post quasi-experimental design was used to examine the impact of telemedicine. In addition, qualitative interviews were conducted with 3 clinicians and 17 patients to explore their experience with telemedicine visits., Results: The monthly number of new patients seen in the Personalized Pain Program did not significantly change before and after telemedicine adoption. Compared to patients having in-person visits before the pandemic, patients having telemedicine visits during the pandemic achieved comparable improvements in daily opioid consumption, pain severity and interference, and physical health status. While telemedicine helped overcome many challenges faced by the patients, the limitations of telemedicine were also discussed., Conclusion: The COVID-19 pandemic stimulated the use of telemedicine. To facilitate telemedicine adoption beyond the pandemic, future research is needed to examine best practices for telemedicine adoption and provide additional evidence on the effectiveness of telemedicine., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The ESPA Pain Management Ladder Initiative is a clinical practice advisory based upon expert consensus supported by the current literature to help ensure a basic standard of perioperative pain management for all children. In 2018 the perioperative pain management of six common pediatric surgical procedures was summarised. The current Pain Management Ladder recommendations focus on five more complex pediatric surgical procedures and suggest basic, intermediate, and advanced pain management methods. The aim of this paper is to encourage best possible pain management practice and to support institutions to create their own pain management concepts according to their financial and human resources due to the diversity of clinical settings in Europe. Furthermore, the authors underline that these recommendations are intended for inpatients only., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Cryotherapy, a therapeutic technique involving localized cooling of the body, has gained popularity for postsurgical rehabilitation. It induces a reduction in cellular metabolism, vasoconstriction, and pain relief, making it an attractive option for managing postoperative (PO) shoulder pain. This systematic review aimed to assess the effectiveness of cryotherapy in PO shoulder patients, focusing on pain, range of motion, functionality, and temperature changes. The review included six randomized clinical trials, involving a total of 233 patients who underwent various shoulder surgeries. Cryotherapy was applied using different methods, including Cryo/Cuff, Cryoton ® , Polar Care 300, and ice packs. Results indicated that cryotherapy was generally effective in reducing PO shoulder pain. However, one study found no significant difference in pain outcomes between the cryotherapy group and control group. Furthermore, three studies demonstrated a decrease in intra-articular and skin temperatures with cryotherapy application. A risk of bias analysis revealed some concerns in the overall risk of bias for five studies, with one study considered to have a high risk of bias. Although publication bias assessment was not conducted due to the limited number of included studies, it was noted that the studies exhibited heterogeneity in terms of population, intervention methods, and outcome measures. In conclusion, cryotherapy appears to be a promising adjunctive treatment for PO shoulder pain, although the existing evidence has some limitations, including small sample sizes and methodological concerns. More high-quality studies are needed to establish the full extent of cryotherapy's effectiveness in PO shoulder rehabilitation, especially regarding its impact on functionality and range of motion.

The aim of this study is to describe a protocol for evaluating the effects of transcutaneous electrical nerve stimulation (TENS) on pain following breast augmentation surgery. Fifty-four women will be randomly allocated into two groups: active TENS and placebo. Pain will be assessed at rest and during movement, before and immediately after TENS application. Secondary outcomes include pain one-hour post-treatment, respiratory muscle strength, patient satisfaction, and analgesic use in the first four hours post-surgery. The results of this clinical trial could enhance the management of post-operative pain in breast augmentation surgery using non-pharmacological interventions, potentially reducing costs and improving patient experience.Clinical Trial Registration: RBR-96h3k97.

Aims: Post-mastectomy pain syndrome is a common postoperative complication that can impact patient quality of life and function. The aim of this systematic review is to evaluate the effectiveness of cryoneurolysis as an intervention for the management of post-mastectomy pain., Methods: A prospero-registered systematic review was performed following PRISMA 2020 guidelines. An initial screening consisted of 53 articles imported from the following databases: PubMed, Embase, Web of Science, Cochrane, and Scopus. Google Scholar and WorldCat were also searched to pull any further articles., Results: Three clinical trials, one case series, and one case report were included. Primary outcome measure of patient reported pain score (VAS or NRS) showed clinically significant reduction in pain in all five studies. Three of the studies also reported reduction in opioid use with cryoneurolysis intervention. A pooled effect size of Hedges g = -0.963, (95% CI [-1.55, -0.373]), with heterogeneity (I 2  = 0.70)., Conclusion: Cryoneurolysis intervention shows promising and clinically significant relief in post-mastectomy pain in patients and further studies are encouraged.

Objective: The objective of this study was to evaluate the effects of comfort care on perioperative outcomes and postoperative recovery of breast cancer patients. Evaluating comfort care is important in the context of breast cancer surgery because it can potentially alleviate pain, improve patient comfort, enhance postoperative recovery, and reduce complications, ultimately leading to better patient outcomes., Methods: Between March 2020 and December 2021, 78 patients undergoing breast cancer surgery at our hospital were randomly assigned to receive either routine nursing (routine group) or comfort care (experimental group). The comfort care intervention included various components such as health education, preoperative care, intraoperative care, postoperative care, pain care, and psychological care. The routine group received standard nursing care following medical advice., Results: The patient characteristics between the two groups were comparable. Comfort care resulted in significantly higher visual analog scale (VAS) scores, indicating reduced pain, and better improvement in functional recovery of the upper limb compared to routine nursing. Comfort care was also associated with better postoperative recovery, as evidenced by lower self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores. The experimental group had a significantly lower incidence of complications compared to the routine group. Additionally, the experimental group reported better 24-hour comfort and higher nursing satisfaction., Conclusion: In conclusion, comfort care effectively reduces postoperative pain, promotes postoperative recovery, improves patient emotions, lowers the incidence of complications, and enhances comfort and care satisfaction in breast cancer patients undergoing radical surgery. These findings highlight the importance of incorporating comfort care interventions in the perioperative management of breast cancer patients. Further research and implementation of comfort care strategies may have implications for improving clinical practice and patient outcomes in the future.