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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Pain Management".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 13719

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Special Issue Editor

Prof. Dr. Jeffrey Jianhong Huang

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Guest Editor

Moffitt Cancer Center, Magnolia Campus, Tampa, FL 33612, USA
Interests: anesthesiology; pain management; enhanced recovery after surgery (ERAS); anesthesia and cancer recurrence; anesthesia outcomes

Special Issue Information

Dear Colleagues,

Pain has a substantial impact on the well-being of older individuals residing in both community and nursing home settings. In the former, over 50% are affected, while in the latter, this figure rises to over 80%. Unfortunately, persistent pain is frequently underdiagnosed and inadequately addressed. This condition not only curtails functional capabilities but also leads to a diminished quality of life, sleep disturbances, social isolation, depression, heightened healthcare costs, and increased resource consumption. Consequently, opioid abuse and behavioral shifts in patients have arisen, posing fresh clinical challenges for healthcare providers and affecting not only patients but also their families.

Healthcare professionals engage in comprehensive patient assessment, pain evaluation, diagnosis, pain treatment, non-pharmacological interventions, and the management of adverse effects stemming from pharmacological treatments. The timely and effective evaluation of pain, as well as its careful management, can substantially alleviate suffering while preserving and enhancing one's quality of life.

Our current Special Issue represents an exceptional opportunity to contribute to this groundbreaking field of pain. We encourage submissions encompassing various critical areas, including but not limited to acute pain, regional anesthesia for acute pain, chronic pain, cancer pain, interventional pain techniques, opioid management, non-pharmacological therapy for pain, pain management for pediatric patients, pain management for geriatric patients, and pain management for female patients. Submissions from around the world are welcome. Manuscripts may take the form of literature reviews (systematic literature reviews, meta-analyses, narrative reviews, and perspective articles) or original research (trials, cohort studies, experimental laboratory work, case–control studies), as long as they exhibit high quality and a strong focus on pain management. Please note that case reports and study protocols will not be considered. The scope of this issue is intentionally broad to encourage coverage of a diverse range of topics and viewpoints related to pain management.

Prof. Dr. Jeffrey Jianhong Huang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

acute pain
regional anesthesia for acute pain
chronic pain
cancer pain
interventional pain techniques
opioid management
non pharmaceutics therapy for pain
pain management for pediatric patients
pain management for geriatric patients
pain management for women patients

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Published Papers (8 papers)

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Research

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14 pages, 203 KiB

Open AccessArticle

Substance Use and Chronic Pain Management: Understanding the Learning Needs of Primary Care Clinicians Through Project ECHO

by Joanna G. Katzman, Brandon J. Warrick, Mikiko Takeda, Snehal Bhatt, Radhika P. Grandhe, Vanessa Jacobsohn and Laura E. Tomedi

Healthcare 2025, 13(8), 873; https://doi.org/10.3390/healthcare13080873 - 11 Apr 2025

Viewed by 142

Abstract

Background: In 2022, more than 107,000 people died in the US from an opioid overdose. The Opioid Rapid Response and Pain (ORRP) ECHO was developed to educate primary care clinicians on best practices in pain and substance use management consistent with the 2016 Guideline for Prescribing Opioids for Chronic Pain. Methods: Six 1 h virtual sessions consisting of didactics and case discussions focusing on pain and substance use were delivered by a multidisciplinary hub team to four diverse US regions. The authors utilized qualitative analyses, including a modified Delphi Technique and thematic analysis, to assess participant questions during the sessions, focus groups with participants, and post-session survey responses for ORRP ECHO training between 14 October 2021 and 15 November 2022. Results: One hundred and eighteen primary care clinicians performed 627 chat responses and were eligible to receive 648 continuing education unit credits. The majority of chat questions were related to Patient-Centered Care (28%, 170 total responses) and Knowledge (27%, 178 total responses). The focus groups revealed five core themes: (1) there was a clear need for the ECHO trainings, (2) the program fostered a unique and supportive community, (3) the content was applicable, (4) the administration of the program was effective, and (5) it had a meaningful impact on practice. The participants who completed the post-session surveys reported that they would apply their knowledge (range across cohorts: 85.7% to 100.0% of survey respondents agreed or strongly agreed) and communication skills gained (range: 71.4% to 98.6%). Conclusions: Through didactics and interactive case discussions, the ECHO model holds promise as a useful training model to support the appropriate use of clinical practice guidelines by informing individualized, patient-centered care and clinical judgment. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

8 pages, 783 KiB

Open AccessArticle

Safety and Preliminary Efficacy of Cervical Paraspinal Interfascial Plane Block for Postoperative Pain after Pediatric Chiari Decompression

by Jared M. Pisapia, Tara M. Doherty, Liana Grosinger, Audrey Huang, Carrie R. Muh, Apolonia E. Abramowicz and Jeff L. Xu

Healthcare 2024, 12(14), 1426; https://doi.org/10.3390/healthcare12141426 - 17 Jul 2024

Cited by 1 | Viewed by 1730

Abstract

Background: Surgery for lesions of the posterior fossa is associated with significant postoperative pain in pediatric patients related to extensive manipulation of the suboccipital musculature and bone. In this study, we assess the preliminary safety, effect on neuromonitoring, and analgesic efficacy of applying a cervical paraspinal interfascial plane block in pediatric patients undergoing posterior fossa surgery. Methods: In this prospective case series, we enrolled five patients aged 2–18 years undergoing surgery for symptomatic Chiari type I malformation. An ultrasound-guided cervical cervicis plane (CCeP) block was performed prior to the incision. A local anesthetic agent (bupivacaine) and a steroid adjuvant (dexamethasone) were injected into the fascial planes between the cervical semispinalis capitis and cervical semispinalis cervicis muscles at the level of the planned suboccipital decompression and C1 laminectomy. Motor-evoked and somatosensory-evoked potentials were monitored before and after the block. Patients were assessed for complications from the local injection in the intraoperative period and for pain in the postoperative period. Results: No adverse events were noted intraoperatively, and there were no changes in neuromonitoring signals. Pain scores were low in the immediate postoperative period, and rescue medications were minimal. No complaints of incisional pain or need for narcotics were noted at the time of the 3-month postsurgical follow-up. Conclusions: In this study, we demonstrate the preliminary safety and analgesic efficacy of a novel application of a CCeP block to pediatric patients undergoing suboccipital surgery. Larger studies are needed to further validate the use of this block in children. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

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8 pages, 492 KiB

Open AccessCommunication

An Overview of Opioid Prescription Patterns among Non-Opioid Users Following Emergency Department Admission

by Miriam Zeino, Romain Léguillon, Pauline Brevet, Baptiste Gerard, Catherine Chenailler, Johanna Raymond, Lucas Bibaut, Sophie Pouplin, Luc Marie Joly, Rémi Varin and Eric Barat

Healthcare 2024, 12(11), 1138; https://doi.org/10.3390/healthcare12111138 - 3 Jun 2024

Viewed by 1012

Abstract

The evolving landscape of opioid prescription practices necessitates a comprehensive understanding of emerging patterns, particularly among new opioid users discharged from emergency departments. This study delves into the intricate realm of opioid utilization by elucidating the prevalence of their prescriptions. A retrospective analysis of electronic health records was conducted, including a cohort of 71 patients who received opioid prescriptions upon discharge from emergency departments from 1 January 2022 to 30 June 2022. Demographic characteristics and prescription details were systematically examined. This study illuminates tramadol’s prominence, with 84% of prescriptions and a Defined Daily Dose (DDD) morphine equivalent of 60 mg, as the primary choice as a new opioid, a finding that draws attention due to the closely aligned dosages with morphine equivalents. This discovery prompts a critical reassessment of tramadol’s therapeutic role, considering its multifaceted nature encompassing serotonergic effects and heightened fall risks. This study advocates for a nuanced and vigilant approach to tramadol prescription, cognizant of its potential risks and therapeutic implications, and highlights the imperative of optimizing data quality and traceability within electronic health records to enhance patient care and facilitate future research endeavors. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

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13 pages, 763 KiB

Open AccessArticle

Opioid Treatment in Primary Care: Knowledge and Practical Use of Opioid Therapy

by Aleksander Michał Biesiada, Aleksandra Ciałkowska-Rysz and Agnieszka Mastalerz-Migas

Healthcare 2024, 12(2), 217; https://doi.org/10.3390/healthcare12020217 - 16 Jan 2024

Viewed by 1534

Abstract

Background: Primary care physicians play a key role in initiating opioid therapy. However, knowledge gaps in opioid use and pain management are significant barriers to providing optimal care. This research study aims to investigate the educational needs of primary care physicians regarding opioid therapy and opioid use in pain management. Methods: A computer-assisted web interview (CAWI) protocol was used to collect data from primary care physicians. Drug selection criteria, knowledge of opioid substitutes and dosage, and practical use of opioid therapy were evaluated. Results: While 84% of participating physicians (724 respondents) reported initiating opioid treatment, only a minority demonstrated accurate opioid dosage calculations. Significant discrepancies between physicians’ self-perceived knowledge and their clinical skills in opioid prescribing and pain management were observed. In total, 41% of physicians incorrectly indicated dose conversion rates for tramadol (the most frequently used drug according to 65% of responders). Conclusions: Targeted educational programs are essential to bridge the knowledge gap and increase physicians’ competence in pain management. The proper self-assessment of one’s own skills may be the key to improvement. Further research should focus on developing specialized educational courses and decision-support tools for primary care physicians and examining the impact of interprofessional pain management teams on patient outcomes. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

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10 pages, 794 KiB

Open AccessArticle

Pain Prevalence and Satisfaction with Pain Management in Inpatients: A Cross-Sectional Study

by Ángel Becerra-Bolaños, Annette Armas-Domínguez, Lucía Valencia, Pedro Jiménez-Marrero, Sergio López-Ruiz and Aurelio Rodríguez-Pérez

Healthcare 2023, 11(24), 3191; https://doi.org/10.3390/healthcare11243191 - 18 Dec 2023

Cited by 5 | Viewed by 2173

Abstract

Background: Pain in hospitalized adults is underestimated and undervalued. The aim of this study was to evaluate pain prevalence and satisfaction with the hospital’s pain management among patients attending a tertiary university hospital. Predictor factors of pain were also studied. Methods: A prospective, cross-sectional study was carried out through a structured questionnaire given on one day to all hospitalized patients in a university hospital. Clinical data, such as personal history and analgesic treatment, were collected from medical records. Other variables related to pain (including intensity rated by the visual analogue scale as well as location and patient satisfaction measured by the numerical rating scale) were also obtained. Results: Of the 274 surveyed patients, pain prevalence was 52.9%, with an average intensity of 5.3 ± 2.8 according to VAS. The overall satisfaction was 87.2%, and 72.6% had already been prescribed at least one analgesic. Patients receiving analgesics showed higher pain intensity (VAS 3.6 ± 3.4) than those without treatment (VAS 1.1 ± 2.1) (p < 0.001). However, patients with treatment showed more satisfaction (NRS 7.8 ± 2 vs. 5.3 ± 1.4, p < 0.001). Conclusions: The prevalence of pain in hospitalized patients was high, despite the fact that patient satisfaction was also very high. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

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23 pages, 7256 KiB

Open AccessArticle

Effectiveness and Safety of Progressive Loading–Motion Style Acupuncture Treatment for Acute Low Back Pain after Traffic Accidents: A Randomized Controlled Trial

by Seung-Yoon Hwangbo, Young-Jun Kim, Dong Guk Shin, Sang-Joon An, Hyunjin Choi, Yeonsun Lee, Yoon Jae Lee, Ju Yeon Kim and In-Hyuk Ha

Healthcare 2023, 11(22), 2939; https://doi.org/10.3390/healthcare11222939 - 10 Nov 2023

Cited by 1 | Viewed by 1979

Abstract

Background: Traffic injuries include acute low back pain (LBP) needing active treatment to prevent chronicity. This two-armed, parallel, assessor-blinded, randomized controlled trial evaluated the effectiveness and safety of progressive loading–motion style acupuncture treatment (PL-MSAT) for acute LBP following traffic accidents. Methods: Based on an effect size of 1.03, 104 participants were recruited and divided in a 1:1 ratio into PL-MAST and control groups using block randomization. Both groups underwent integrative Korean medicine treatment (IKMT) daily; only the PL-MSAT group underwent three PL-MSAT sessions. The outcomes were assessed before and after the treatment sessions and at 1 and 3 months post-discharge. The primary outcome was the difference in the numeric rating scale (NRS) for LBP. The secondary outcomes included a visual analog scale for LBP, leg pain status, the Oswestry disability index, lumbar active range of motion (ROM), quality of life, Patient Global Impression of Change, and Post-Traumatic Stress Disorder Checklist adverse events. Results: In the modified intention-to-treat analysis, 50 and 51 participants were included in the PL-MSAT and control groups. On Day 4, the mean LBP NRS score was 3.67 (3.44–3.90) in the PL-MSAT group, indicating a significantly lower NRS 0.77 (0.44–1.11) compared to 4.44 (4.20–4.68) for the control group (p < 0.001). The PL-MSAT group exhibited greater ROM flexion (−5.31; −8.15 to −2.48) and extension (−2.09; −3.39 to −0.80). No significant differences were found for the secondary outcomes and follow-ups. Conclusions: Compared with IKMT alone, PL-MSAT plus IKMT showed significantly better outcomes for reducing pain and increasing the ROM in acute LBP. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

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Review

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11 pages, 215 KiB

Open AccessReview

Consciousness Research Through Pain

by Dong Ah Shin and Min Cheol Chang

Healthcare 2025, 13(3), 332; https://doi.org/10.3390/healthcare13030332 - 6 Feb 2025

Viewed by 983

Abstract

Background/Objectives: Consciousness is a complex and elusive phenomenon encompassing self-awareness, sensory perception, emotions, and cognition. Despite significant advances in neuroscience, understanding the neural mechanisms underlying consciousness remains challenging. Pain, as a subjective and multifaceted experience, offers a unique lens for exploring consciousness by integrating sensory inputs with emotional and cognitive dimensions. This study examines the relationship between consciousness and pain, highlighting the potential of pain as a model for understanding the interplay between subjective experience and neural activity. Methods: Literature review. Results: Key theories of consciousness, such as the Global Workspace Theory and the Integrated Information Theory, provide diverse frameworks for interpreting the emergence of consciousness. Similarly, pain research emphasizes the role of subjective interpretation and emotional context in shaping sensory experiences, reflecting broader challenges in consciousness studies. The limitations of current methodologies, particularly the difficulty of objectively measuring subjective phenomena, like pain and consciousness, are also addressed. This highlights the importance of neural correlates, with a particular focus on brain regions, such as the anterior cingulate cortex and the insula, which bridge sensory and emotional experiences. By analyzing the shared attributes of pain and consciousness, this study underscores the potential for pain to serve as a measurable proxy in consciousness research. Conclusions: Ultimately, it contributes to unraveling the neural and philosophical underpinnings of consciousness, offering implications for mental health treatment and advancements in artificial intelligence. This study fills a critical gap by leveraging pain as a measurable and reproducible model for exploring the neural and subjective mechanisms of consciousness. By combining theoretical frameworks with empirical evidence, it offers novel insights into how consciousness emerges from neural processes. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

Other

Jump to: Research, Review

38 pages, 611 KiB

Open AccessSystematic Review

The Efficacy of Ketamine for Acute and Chronic Pain in Patients with Cancer: A Systematic Review of Randomized Controlled Trials

by Leila Azari, Homa Hemati, Ronia Tavasolian, Sareh Shahdab, Stephanie M. Tomlinson, Margarita Bobonis Babilonia, Jeffrey Huang, Danielle B. Tometich, Kea Turner, Kimia Saleh Anaraki, Heather S. L. Jim and Amir Alishahi Tabriz

Healthcare 2024, 12(16), 1560; https://doi.org/10.3390/healthcare12161560 - 6 Aug 2024

Cited by 3 | Viewed by 2556 | Correction

Abstract

Managing cancer-related pain poses significant challenges, prompting research into alternative approaches such as ketamine. This systematic review aims to analyze and summarize the impact of ketamine as an adjuvant to opioid therapy for cancer-related pain. We conducted a literature review in MEDLINE, EMBASE, and Scopus from 1 January 1982 to 20 October 2023. Abstracts were screened against inclusion criteria, and eligible studies underwent a full-text review. Data was extracted from the included studies, and a framework analysis approach summarized the evidence regarding ketamine’s use in patients with cancer. A total of 21 randomized clinical trials were included, and the quality of all the included studies was good or fair. Significant improvements in pain scores and reduced morphine consumption were consistently observed with intravenous ketamine administration for postoperative pain control, particularly when combined with other analgesics such as morphine. Ketamine was less effective when used as an analgesic for chronic pain management, with several studies on neuropathic pain or chemotherapy-induced neuropathy finding minimal significant effect on reduction of pain scores or morphine requirements. The efficacy of ketamine in pain management appears to depend on factors such as dosage, route of administration, and patient population. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

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