Cryoneurolysis for the Treatment of Sensory Nerve Pain.

Acute and chronic pain account for high costs both societally and economically, estimated in the United States to be $635 billion. Untreated or undertreated acute pain is associated with substantial morbidity and may become chronic pain. Surgical patients are at an increased risk of long-term opioid use or addiction. Overdose from drugs of abuse, including opioids, is the leading cause of death due to injury in the United States. Traditional pain management strategies for acute and chronic pain have focused on opioid medications, which are often associated with severe side effects. Cryoneurolysis is a minimally invasive, nonsurgical, nonpharmacologic pain management technique that uses cold temperatures to ablate the sensory nerves that cause pain. Because of its safe and reversible nature, cryoneurolysis should be considered as part of a multimodal pain management plan in patients experiencing pain originating from sensory nerves.

Neuropathic Pain Experiences of Spinal Cord Injury Patients.

BACKGROUND: Neuropathic pain (NP) is a common, severe problem that affects spinal cord injury (SCI) patients. Only SCI patients truly understand the impact and extent of this type of pain. PURPOSE: The aim of this study was to understand the NP experienced by SCI patients and the influence of this type of pain on their daily life. METHOD: A qualitative design was used. An interview guide including a semistructured questionnaire and in-depth interviews was conducted with SCI patients with NP in a neurorehabilitation department at a medical center in northern Taiwan. The data were collected using a purposive sampling method. Content analysis was performed on the interview data, which were obtained from 13 SCI patients with NP. RESULTS: Three themes and eight subthemes were identified that described the NP experience of the participants and the influence of NP on their daily life. The three themes included elusive pain (changing and individual pain sensations, erratically haunting threat, and phantom limb sensations), complicated feelings about pain (converting depression into an active attitude toward life, having feelings of anticipation and anxiety about future pain relief, and facing and experiencing pain), and renewed hope (bravely fighting pain and seeking pain relief methods). CONCLUSIONS: This study revealed three important themes of NP experienced by SCI patients, including elusive pain, complicated feelings about pain, and renewed hope. Nurses should understand the nature of NP, provide a thorough pain assessment, and design a proper pain management plan to care effectively for patients with NP.

Advancing Nursing Practice: Management of Neuropathic Pain With Capsaicin 8% Without Physician Supervision.

PURPOSE/AIMS: The purpose of this study was to examine the management of patient's neuropathic pain with capsaicin 8% in a nurse-led clinic when administered by 1 registered advanced nurse practitioner without physician supervision. DESIGN: A longitudinal, single-group, descriptive research design was used to assess pain scores and quality of life 3 times over 3 months after treatment. METHODS: Patients with a diagnosis of neuropathic pain were assessed and treated with capsaicin 8% by 1 advanced nurse practitioner with prescriptive authority in a nurse-led clinic. Pain scores were collected at baseline, and self-assessed pain, activity level, and quality of life were assessed at 1 week, 4 weeks, and 3 months after treatment. Twenty-four patients were recruited, and data were analyzed using Friedman's test. In post hoc analysis, Wilcoxon signed-rank test was used with Bonferroni correction. RESULTS: Pain scores differed from pretreatment to posttreatment at each of the 3 time points, at rest (χ3 = 20.54, P = .001) and on movement (χ3 = 23.644, P = .001), and remained significant after Bonferroni correction. Overall, 62.5% (n = 15) of patients achieved at least a 30% reduction in self-reported pain at rest from pretreatment to 3 months, and 54% (n = 13) achieved the same reduction in pain on movement. Most improvements in patient's quality of life occurred between 1 and 4 weeks. Patient satisfaction was high, with 83% stating that they would be happy to have the treatment repeated. CONCLUSION: Single-dose capsaicin 8% decreased neuropathic pain after being administered in an outpatient setting by an experienced registered advanced nurse practitioner. Further multicenter research led by advanced nurse practitioners is needed to support high-quality, safe treatment of neuropathic pain with high-concentration capsaicin in nurse-led chronic pain clinics.

Acute Neuropathic Pain Assessment in Burn Injured Patients: A Retrospective Review.

PURPOSE: The purpose of the study was to measure the prevalence of acute neuropathic pain in patients with acute burn injuries and the demographic and clinical characteristics of neuropathic pain in this population. We also evaluated the proportion of patients who received twice-daily evaluation of nurses' documentation of neuropathic pain following introduction of a validated neuropathic pain assessment tool embedded within the pain chart. DESIGN: Retrospective, descriptive study. SUBJECTS AND SETTING: The sample comprised 86 patients with second- and third-degree burn injuries. The research setting was a burn injury unit in a provincial center in British Columbia, Canada. METHODS: Medical records over a 1-year prior following introduction of assessment of neuropathic pain into pain charts were retrospectively reviewed, and data collection focused on evidence of nurses undertaking acute neuropathic pain assessment as well as prevalence of report of acute neuropathic pain signs among this patient group. Neuropathic pain was evaluated twice daily using the Douleur Neuropathique 4, a previously validated neuropathic pain assessment tool. RESULTS: Eighty percent of patients cared for received twice-daily neuropathic pain assessment. The prevalence of patients with neuropathic pain based on the Douleur Neuropathique instrument scores was 42%. Males reported neuropathic signs more than female patients, and patients with a greater than 10% body surface burn had a higher prevalence of neuropathic pain. CONCLUSION: Study findings suggest that patients with acute burn injury are at risk of neuropathic pain. We recommend that nurse assessment of neuropathic pain becomes routine during the acute injury phase.

Nurse-led treatment for occipital neuralgia.

Occipital neuralgia is a headache resulting from dysfunction of the occipital nerves. Medically resistant occipital neuralgia is treated by greater occipital nerve injection, which is traditionally performed by neurologists. A nurse-led clinic was developed to try to improve the service. Patient feedback showed that the clinic was positively perceived by patients, with most stating the nurse-led model was more efficient than the previous one, which had been led by consultants.

[Analgesic treatment of cancer pain]. / Le traitement antalgique des douleurs cancéreuses.

Cancer pain can be nociceptive, neuropathic or mixed. It is linked to the tumour, to the metastases and to the treatments for the disease and is managed by multimodal analgesia corresponding to the pain relief drugs of the WHO's pain ladder, antidepressants, antiepileptic drugs and local anaesthetics.

Strategies to reduce or eliminate wound pain.

Wound pain is often underestimated and poorly managed. This article explains the different types of pain and how to assess wound pain, and gives practical advice on how to manage or minimise the pain experienced by patients with wounds.

Neuropathic pain referrals to a multidisciplinary pediatric cancer pain service.

Neuropathic pain (NP) in children with cancer is not well characterized. In a retrospective review of patient data from a 3.5-year period, we describe the prevalence of NP and the characteristics, duration of follow-up, and interventions provided for NP among patients referred to a pediatric oncology center's pain management service. Fifteen percent (66/439) of all referrals to our pain service were for NP (56/323 patients [17%]; 34 male, 22 female). The NP patient group had 1,401 clinical visits (778 inpatient visits [55.5%] and 623 outpatient visits [44.5%]). Patients with NP had a significantly greater mean number of pain visits per consultation (p = .008) and significantly more days of pain service follow-up (p < .001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacologic management of NP was complex, often comprising three medications. Nonpharmacologic approaches were used for 57.6% of NP referrals. Neuropathic pain is less frequently encountered than non-NP in children with cancer; nevertheless, it is more difficult to treat, requiring longer follow-up, more clinical visits, complex pharmacologic management, and the frequent addition of nonpharmacologic interventions.

Nurse screening for neuropathic pain in postoperative patients.

This study was designed to audit nurse assessment and documentation for neuropathic pain in postoperative patients. The audit focused on recorded signs of neuropathic pain in the immediate postoperative period. Nurses were educated on how to screen patients for neuropathic signs using the validated and reliable 7-item DN4. Data were obtained from 450 patient charts from the thoracic, orthopaedic and spinal units. Of the 450 patient charts reviewed, 423 included a record of nurse screening of neuropathic pain signs. Screening by nurses found 24% (n=102) of the patients reported between one and four signs of neuropathic pain within the first 3 days following their surgery. This study demonstrated that the incorporation of the 7-item DN4 neuropathic pain assessment tool within the generic pain chart enabled nurses to regularly screen postoperative patients for signs of neuropathic pain in the immediate postoperative period.

The effects of music therapy on pain in patients with neuropathic pain.

The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity.

The journey to chronic pain: a grounded theory of older adults' experiences of pain associated with leg ulceration.

This study aimed to develop a grounded theory to describe and explain the experience of pain and its impact, as reported by the individuals who had pain associated with chronic leg ulceration. The Strauss and Corbin grounded theory approach was used. In-depth interviews were undertaken with 11 people aged ≥ 65 years from Leeds in the north of England. All participants were cared for by home care nurses and had painful leg ulceration. The emergent grounded theory centered on a core category of "The journey to chronic pain." The theory suggested a trajectory consisting of three phases that the patient experiences, where the end result is a chronic pain syndrome. In phase 1, leg ulcer pain has predominantly acute nociceptive properties, and if this is not managed effectively, or ulcers do not heal, persistent pain may develop with both nociceptive and neuropathic properties (i.e., phase 2). If phase 2 pain is not managed effectively, patients may then develop refractory long-term pain (phase 3). Those who progress to phase 3 tend to experience negative consequences such as insomnia, depression, and suicidal ideation. Only when health care professionals understand and acknowledge the persistent and long-term nature of the pain in this patient group can the pain be managed effectively.

Psychologic and biologic factors associated with fatigue in patients with persistent radiculopathy.

Fatigue is a common symptom associated with neuropathic pain (NP) and can have negative consequences on psychosocial functioning, physical endurance, and quality of life. Recent evidence indicates that immune activation modulated through the increased release of proinflammatory cytokines can predict fatigue in some patient populations. Although earlier studies have shown that immune activation is a pathophysiologic feature of NP, there have been no studies to examine the relationship between immune activation and fatigue in persons with NP. Therefore, the purpose of this exploratory study was to: 1) determine the relationships among fatigue, pain, psychosocial factors, and selected biologic markers of immune activation (interleukin [IL] 6 and soluble IL-6 receptor [sIL-6R]) in participants with persistent radiculopathy; and 2) determine the differences in these variables based on fatigue severity. Participants (n = 80) were classified according to their level of fatigue as low (27.5%), moderate (32.5%), or high (40%), and significant differences were found between fatigue categories (p = .001). Multivariate analyses of variance revealed that individuals with moderate to high levels of fatigue differed from those with the lowest levels of fatigue in psychologic distress, depressive symptoms, IL-6, and sIL-6R, whereas the differences between moderate and high levels of fatigue were significant for psychologic distress and sIL-6R only. The findings suggest that immune activation affects fatigue severity and possibly other behavioral responses, offering important information when providing care to patients with persistent radiculopathy. The integration of biobehavioral nursing interventions in pain management may have a greater impact on quality of life than treatment focused only on pain.

Acceptance of chronic neuropathic pain in spinal cord injured persons: a qualitative approach.

Chronic neuropathic pain (CNP) in spinal cord injury (SCI) is a significant problem that has physical, functional, and psychosocial repercussions beyond the consequences of SCI. The notion that acceptance may be a viable alternative to suffering when resolution of pain is unattainable was explored. Studies indicate that acceptance of pain is associated with lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily active time, and improved work status in patients who have other types of chronic pain. This exploratory qualitative study examined acceptance of pain in SCI individuals who have CNP. Grounded theory was used to develop a conceptual framework to describe acceptance in people with CNP and SCI. Data were obtained from in-depth interviews with seven SCI individuals. Six phases were identified, including: "comprehending the perplexity of CNP," "seeking pain resolution," "acknowledging pain permanence," "redefining core values," "learning to live with the pain," and "integrating pain." Two driving forces, "increasing independence" and "evolving pain view," were noted to move the process of acceptance forward. The findings in this study suggest that acceptance of pain appeared to be beneficial in terms of reducing suffering and facilitating a more satisfying and fulfilling life in these SCI individuals. A decreased emphasis on continued searching for a cure for CNP and movement toward a self-management approach was associated with increased pain coping for these SCI individuals. Clinical implications suggest that early intervention to facilitate effective coping and an exploration of the notion of acceptance could be beneficial.

Peripheral neuropathy: evidence-based treatment of a complex disorder.

Peripheral neuropathy (PN) is a common and often progressive condition frequently seen in primary care. The chronic pain associated with PN, or neuropathic pain, can significantly diminish patients' quality of life and be challenging to treat.

A meta-synthesis of research on leg ulceration and neuropathic pain component and sequelae.

Leg ulceration represents a substantial health problem, and pain is likely to be an associated symptom. The aim of this meta-synthesis was to undertake a systematic review of qualitative studies investigating the experience of chronic painful leg ulceration. This study undertook the meta-synthesis approach described by Sandelowski and Barroso (2003), which is a synthesis and re-interpretation of the findings from several qualitative studies. Findings were extracted and synthesized. The overarching theme was that patients with chronic leg ulceration suffer from persistent pain with associated sequelae. Word descriptors used by participants also suggested that patients have neuropathic pain. In addition, findings from the meta-synthesis suggested that pain associated with chronic leg ulcer may have a neuropathic pain component. Pain associated with leg ulceration is likely to have nociceptive properties as well as neuropathic properties. If neuropathic pain is not identified and managed effectively, patients are at risk of developing a chronic pain condition with associated sequelae, such as poor sleep, depression and suicidal ideation. It is proposed that early identification and management may enable appropriate pain management which may prevent or reduce the associated risks.