Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
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Background: Cancer-related pain is a pervasive symptom affecting the quality of life in patients with malignant tumors. For those with refractory pain, palliative sedation combined with pain management is recommended. Dexmedetomidine (DEX), known for its unique "awake sedation" effect, remains relatively unexplored when used in conjunction with patient-controlled analgesia (PCA) for terminal-stage cancer patients. ⋯ While heart rate, blood oxygen saturation, and respiratory rate remained stable, systolic blood pressure and diastolic blood pressure after 1 h of sedation were significantly lower than presedation levels (p = 0.040 and p = 0.044, respectively). Conclusion: DEX emerges as a promising option for palliative sedation in terminal-stage cancer patients. When used in conjunction with PCA, DEX has been shown to effectively, safely, and stably control refractory pain without inducing adverse effects such as respiratory/circulatory depression.
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Randomized Controlled Trial
Tooth Sensitivity Following Hydrogen Peroxide Bleaching With and Without Ozone: A Randomized Controlled Trial: Tooth Sensitivity Following H2O2 Versus H2O2/Ozone Bleaching.
Aims: The aim of this investigation was to assess bleaching sensitivity following bleaching using either 38% H2O2 only or 38% H2O2 followed by ozone application. Methods: In this randomized controlled clinical investigation, 80 participants (40 females and 40 males) were randomly assigned to two groups (n = 40 each; 20 females and 20 males). The upper anterior teeth were bleached by 38% H2O2 for 20 min followed by ozone application for 60 s (healOzone X4, KaVo Dental, Biberach, Germany) in Group 1 (test group). ⋯ However, less bleaching sensitivity was reported when ozone was applied for 60 s after bleaching with 38% H2O2 (p < 0.001). Female participants reported more bleaching sensitivity regardless the applied bleaching protocol (p < 0.05). Conclusions: Bleaching protocols with 38% hydrogen peroxide were associated with less bleaching sensitivity when followed by ozone application on the teeth.
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Opioid nonadherence represents a significant barrier to cancer pain treatment efficacy. However, there is currently no effective prediction method for opioid adherence in patients with cancer pain. We aimed to develop and validate a machine learning (ML) model and evaluate its feasibility to predict opioid nonadherence in patients with cancer pain. ⋯ The best model obtained in this study, the LR model, had an AUC_ROC of 0.82, accuracy of 0.82, and specificity of 0.71. The DCA showed that clinical interventions for patients at high risk of opioid nonadherence based on the LR model can benefit patients. The strongest predictors for adherence were, in order of importance, beliefs about medicines questionnaire (BMQ)-harm, time since the start of opioid, and BMQ-necessity. Discussion. ML algorithms can be used as an effective means of predicting adherence to opioids in patients with cancer pain, which allows for proactive clinical intervention to optimize cancer pain management. This trial is registered with ChiCTR2000033576.
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Observational Study
Does Postgraduate Education Deepen Temporomandibular Disorders Insights for Dental Professionals?
Objective: This study aims to investigate the impact of postgraduate education on the comprehension of Temporomandibular Disorders (TMDs) among dental professionals. Methods: A cross-sectional observational study was conducted, involving 348 dental professionals, including students and practicing dentists, categorized based on their educational background into two groups: bachelor's degree or lower (Group B) and master's degree or higher (Group M). Questionnaires were utilized to assess attitudes and knowledge across four TMDs-related domains. ⋯ Conclusions: Postgraduate education deepened dental professionals' understanding of TMDs. Students improved more in the domains of "diagnosis" and "treatment and prognosis," whereas practicing dentists enhanced more in the "etiology" domain. To further advance postgraduate education, there is a need for more systematic course designs for TMDs, emphasizing the enhancement of knowledge related to examination methods and treatment options.
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Background: The neuropathic characteristics of pain occurring after an osteoporosis (OP)-related fracture are often under-recognized. The aim of this pilot study is to identify, in patients suffering from pain localized on the site of a previous osteoporotic fracture, the presence of neuropathic characteristics, their medical management, and their impact on quality of life. Methods: This pilot cross-sectional study on consecutive patients in University Hospital, Rheumatology Department, Clermont-Ferrand, France, was approved by the Ethics Committee (IRB number 2023-CF34). ⋯ NCCP patients had more intense pain (NPRS = 5.1 ± 2.9 vs. 2.9 ± 2.7, ES = 0.82 [0.18; 1.44], p=0.019) and impaired sleep compared to patients without NCCP (ES = 0.71 [0.08; 1.33], p=0.043). A remarkable point was that patients had no specific oral or topical treatment for NCCP and were only taking on demand paracetamol and nonsteroidal anti-inflammatory drugs. Conclusions: Future research should focus on the neuropathic characteristics of pain patients with OP, in order to better manage OP-related pain.