Despite significant advantages, approximately 20% of pregnant patients refuse spinal anaesthesia in caesarean section due to fear of spinal needle prick. Studies have shown that the patient's expectation of pain is higher than what they experience in real. The objective was to evaluate the difference between anticipated and actually experienced pain at the spinal needle insertion site in spinal anaesthesia for pregnant women undergoing elective lower segment caesarean section (ELSCS).  The cross-sectional study was conducted in a labour room suite of a tertiary care hospital. P value < 0.01). For the identification of predictors impacting the anticipated and experienced pain, univariate and multivariate regression models were applied. Amsterdam Preoperative Anxiety and Information Scale ≥11 for anticipated pain showed a statistically significant positive correlation in univariate  and multivariable analyses . Thus, anxiety was associated with statistically significant higher anticipated pain.  A total of 50 patients scheduled for ELSCS were included. The median experienced pain at the site of spinal needle insertion was significantly low as compared to anticipated pain ( In conclusion, there is a remarkable difference in the obstetric population between anticipated and actually experienced pain at the site of spinal needle insertion in ELSCS. A caesarean section (CS) is the birth of an infant through incisions in the abdomen (laparotomy) and uterus (hysterectomy) when natural childbirth is likely to cause harm to either the mother or fetus or both . Since tGlobally, spinal anaesthesia (SA) is regarded as a preferred technique in conducting CS . In compStudies have shown that the patient's expectation of pain is higher than what they experience in real. Yano et al. studied predicted and perceived pain in females undergoing elective CS and found overestimated anticipated pain by patients . MogenseOur primary objective was to check the null hypothesis that there was no difference between anticipated and experienced pain at the spinal needle insertion site due to the conduct of spinal anaesthesia for pregnant women undergoing elective lower segment CS.Our secondary objective was to analyse the relationship between preoperative anxiety and pain (both anticipated and experienced) at the site of spinal needle insertion in the same patients.The study was approved from the Institutional Ethics Committee of Aga Khan University Hospital (ERC number 2019-1271-3245). The Aga Khan University Hospital is a tertiary care hospital with a dedicated labour suite which comprises 12 labour rooms, 1 preoperative room, and 2 operating rooms. From 1st April 2019 to 30 September 2019, 688 elective CS were done there. This cross-sectional study was conducted in the labour room suite.The patients with age ≥18 with scheduled elective CS were included. The exclusion criteria were emergency CS, refusal to take part in the study, inability to comprehend the information, patients with contraindication to SA, previous SA experience, patients with a history of chronic back pain, more than two attempts for SA, duration of spinal conduct more than 20 min, and use of cutting spinal needle and its size other than 25 G. The duration of spinal conduct was considered as the time taken from start of skin preparation to withdrawal of the needle. An attempt was defined as from insertion of the introducer needle and spinal needle till complete withdrawal from the skin .Written and informed consent of all patients was taken by the primary researcher who was enrolled in the study as per inclusion criteria. Before the surgical procedure, selected patients were evaluated for preoperative anxiety.For the assessment of anxiety, Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used. The APAIS is a short and reliable tool for the assessment of preoperative anxiety, in which the respondent answers from the 6 items .The patients were informed in detail regarding the conduct of spinal anaesthesia. They explained possible discomfort due to the process of identification of intervertebral space and pain because of local anaesthetic infiltration. They were given a detailed description of spinal anaesthesia including the use of a 25 G needle for local infiltration followed by the insertion of a 20 G introducer needle and 25 G spinal needle (Pencan). All patients were informed regarding the possibility of pain despite local anaesthetic infiltration during introducer and spinal needle insertion and the possibility of more local anaesthesia administration at that site. The Numerical Pain Rating Scale (NPRS) was explained, and the same scale was used to assess anticipated pain by the primary investigator in each patient .None of the patients was given any preoperative anxiolytics. In all patients, spinal anaesthesia was performed by a consultant anaesthesiologist or a resident with a minimum of 2 years of experience. A 20 G intravenous cannula was maintained in the preoperative area. In the operating room after the application of standard monitoring, crystalloid  was administered at 15–20 ml/kg. All patients were positioned in sitting posture and identification of landmarks was done, i.e., third and fourth lumbar vertebral interspace or fourth and fifth lumber intervertebral space. Aseptic measures were practiced including the application of 2% chlorhexidine alcohol antiseptic. The skin and the subsequent layer were infiltrated via a 25 G needle with 2% lignocaine with dose calculation as per body weight (3-4 mg/kg). After the application of local infiltration, a standard 45 second interval was taken to establish the effect of local anaesthetic. Then, with the help of a 20 G introducer needle, the dura layer was pierced with a pencil point 25 G needle (Pencan). After confirmation of free flow of cerebrospinal fluid, 0.5% bupivacaine 10 to 14 mg and fentanyl 10 to 15 micrograms were injected. After completion of spinal anaesthesia, patients were placed supine on the operating table and asked about the intensity of pain experienced as per the NPRS by the primary investigator. The remainder of the procedure was carried out as usual. The segment of the spinal block was confirmed with the application of an ice-cold pack, and if adequate, surgery was commenced. Postoperatively, patients were shifted to the postanaesthesia care unit and the reversal of the spinal block was assessed.STATA version 12.0 was used to compute the sample size for the study proposed by Mogensen et al. which reported that the median anticipated and experienced pain score was 12 (effect size 0.52). At a significance level of 0.05, 42 patients were required to achieve 90% power to detect a 20% difference in numerical pain scale between anticipated and experienced pain. We enrolled 50 patients with adjusting for the 15% dropout.P ≤ 0.05 was considered statistically significant.Data were analysed by Statistical Package for the Social Sciences version 19 . The Kolmogorov–Smirnov test was applied to observe the normality of the outcome which is the pain score. It turned out that numerical variables showed asymmetric behavior. Therefore, for numerical variables, we computed the median with the first and third quartiles. The categorical variables such as comorbid, number of attempts, duration of spinal conduct, and level of anaesthesiologist were computed as frequency and percentage. We applied the Wilcoxon rank-sum test and calculated the effect size (pseudomedian difference) and the 95% confidence interval, in order to determine the difference between anticipated and experienced median pain scores. Simple regression univariate and multivariable analyses were performed to model the pain score (anticipated and experienced) on the basis of predictors. A total of 50 women fulfilling the inclusion criteria were recruited in this study. The median age was 29 years . Most patients underwent spinal anaesthesia in the first attempt (88%). The duration of spinal conduct was also within 10 minutes, in a majority (86%) of cases. SA was performed mostly by the residents (80%). The rest of the details can be seen in P value <0.01). The pseudomedian difference was also statistically significant P value 0.0005) between the anticipated and experienced pain in comparison to the patients in whom a second attempt was made . In regard to the designation of the anaesthesiologist (residents vs. consultants), the median anticipated pain was the same; however, the median experienced pain was lower among the patients in whom the resident placed the spinal anaesthesia. Other variables including age groups, duration of spinal conduct, and APAIS score showed no difference between the subjects.P value <0.01) and APAIS >11 was 4.5 . The patients with APAIS <11 had lower anticipated and experienced median pain scores in comparison to APAIS ≥11. This illustrates that anxiety had a positive correlation with the severity of pain. In both populations, the anticipated pain was higher than the experienced pain.As shown in P value < 0.001) and multivariable analysis . Thus, in patients with increased anxiety, the anticipated pain was higher. There was also a negative correlation of pain when SA was conducted by the residents in comparison to consultants, further verifying our previous finding; however, the difference was not statistically significant in both univariate  and multivariable analyses . The detail of other variables can be seen in A univariate and multivariable regression model was applied to identify the predictors associated with the anticipated and experienced pain. In regard to anticipated pain, the APAIS ≥11 showed a significantly positive correlation in univariate analysis  and multivariable analysis . This shows that APAIS ≥11 was linked more with anticipated pain than experienced pain. The SA by the residents also showed a negative correlation with experienced pain univariate analysis  and multivariable analysis .The key predictors of experienced pain in P < 0.001) for epidural anaesthesia and 1.2-fold more (P=0.031) for spinal anaesthesia as compared to perceived pain [P < 0.0001) [P < 0.01). In terms of NPRS, the anticipated pain in our study was moderate to severe, while the actually experienced pain was classified in the mild category.It is acknowledged that anticipated pain is greater in comparison to actually experienced pain , 16, 17.ved pain . Mogense 0.0001) . Our stuWe included only those patients who underwent spinal anaesthesia with a pencil point 25 G needle along with a 20 G introducer needle. Thus, local infiltration was necessary. Therefore, we measured the anticipated pain of the whole procedure of the spinal block, i.e., from the position and local infiltration until the application of the block. This is in contrast to T. Yano et al. who did not apply local anaesthetic infiltration for the spinal block and measured only spinal needle pain . HoweverAll of the attempted spinal blocks were successful in our study. In our opinion, success rate was due to thorough preoperative counselling and a detailed description of the procedure. Moreover, the spinal block was performed only in the sitting position with the median approach. The paramedian approach is an independent predictor of failed spinal and lateral positions associated with considerable difficulty , 19. As Rhee et al., while identifying factors in patient dissatisfaction and refusal for spinal anaesthesia, revealed that spinal puncture attempts of greater than 3 would result in a dissatisfaction rate and refusal rate of 9.5% and 5.7%, respectively [There was no correlation between pain with the seniority of anaesthesiologist performing the block. Although the anticipated pain was the same from both groups (resident vs. consultants) yet actually experienced pain was less in the resident group. Our hospital is a university teaching hospital. The residents go through a stringent training pathway. Thus, consultants supervise the trainees, and residents are the ones who usually perform the procedure. This can be a possible reason for decreased experienced pain in patients in which residents performed the SA. A similar finding was also observed by Ružman et al. and Atallah et al., who revealed that spinal anaesthesia performed by younger residents was associated with a more first-attempt success rate , 19.We recommend that providing patients with psychological support and thorough information regarding the procedure may help not only to alleviate their needle pain anxiety, but also facilitate consent for spinal anaesthesia. The provision of an information brochure regarding spinal anaesthesia can be a useful adjunct. Many approaches are used to decrease pain at the site of spinal needle insertion, e.g., application of an EMLA  patch, slow infiltration of local anaesthesia in the subcutaneous tissue .Preoperative anxiety is an independent predictor of increased pain . PatientRegarding the limitations of our study, spinal anaesthesia was not performed by one anaesthesiologist. Although the number of spinal blocks applied in the first attempt was considerably high, it shows that all anaesthetists were competent enough regarding experience and the number of performed procedures. However, it can be a limitation as needle handling varies from person to person. The result might have been different if only one anaesthesiologist had performed all spinal blocks. Another limitation was that we were unable to standardize the speed and the pressure of local anaesthetic injection in the subcutaneous tissue. Patients' pain perception can vary with the speed and pressure of the local anaesthetic injection , 24. TheIn conclusion, there is a remarkable difference in the obstetric population between anticipated and actually experienced pain while performing spinal anaesthesia. Based on this study's results, we can counsel the patients about the procedural pain during spinal anaesthesia. This will lead to a less refusal rate of spinal anaesthesia CS. However, further research is needed in a large population group.


A histogram distribution of the two groups, categorized by number of MMEs received, showed no significant differences between the two groups. In this retrospective analysis, we report our experience using BNBs at the time of buccal mucosa graft harvest. While there were no significant differences between the number of MMEs received before and after implementation, further research is needed to assess the blocks’ impact on pain scores.The reduction in opioid use has become a public health priority. We aimed to assess if performing buccal nerve blocks (BNB) at the time of buccal mucosa graft (BMG) harvest impacts post-operative narcotic usage in the inpatient setting. We retrospectively reviewed clinical characteristics and morphine milligram equivalents (MMEs) received for all patients that underwent a BMG urethroplasty at our institution. The primary outcome measure was post-operative MMEs for patients before and after implementing the BNB. We identified 74 patients that underwent BMG urethroplasty, 37 of which were before the implementation of the BNB and 37 of which were after. No other changes were made to the peri-operative pathway between these time points. The mean total MMEs per day, needed post-operatively, was lower in the BNB group (8.8 vs. 5.0,  The opioid epidemic is a growing public health emergency, and physician over prescription of these medications is thought to be contributory. It is estimated that 1–13% of opioid-naïve patients progress to persistent use after surgery, even for minor urologic procedures ,3,4. FurIn response to the growing crisis, surgeons have been encouraged to pursue non-opioid pain management. One such approach involves the use of regional pre-operative nerve blocks and local anesthesia, which are thought to prevent the transition from acute to chronic neuropathic pain, and limit the pro-inflammatory response to surgery ,9,10,11.Despite the growing use of nerve blocks for anesthesia, their use in BMG urethroplasty remains largely unstudied. A recent randomized trial demonstrated reduction in acute post-operative narcotic use following liposomal bupivacaine infiltration to the buccal mucosal harvest site, which is thought to be the foremost source of post-operative pain for these patients ,19.We hypothesized that adding the buccal nerve block would reduce pain, and thus reduce the number of opioid pain medications received by a patient. We reviewed the use of post-operative narcotics before and after this change, to assess its impact on narcotic requirements. Our study contributes to the literature by detailing how buccal nerve blocks can be performed at the time of buccal mucosa graft harvest. In an effort to improve the patient experience, control post-operative pain, and limit the use of post-operative narcotic medications, our institution began performing buccal nerve blocks (BNBs) intra-operatively for all BMG urethroplasties. This change of practice occurred in January 2019. We retrospectively reviewed clinical and procedural characteristics for all patients that underwent urethroplasty at our institution from August 2016 through February 2021. The study included all patients receiving a buccal mucosa graft harvest (BMG) as part of their treatment of urethral strictures. As part of our routine practice, all patients received general anesthesia. Moreover, patients throughout the study, in both groups, that had a perineal incision, received a pudendal nerve block.Beginning in January 2019 we began performing BNB prior to BMG harvest. Blocks are performed by infiltrating 5 cc of a 50/50 mixture of 1% xylocaine and 25% bupivacaine with 4 mg of dexamethasone into the buccal sulcus just distal to the last molar tooth. We then proceed with the harvest. Our technique utilizes hydrodissection with both xylocaine and epinephrine. The harvest site is left open to heal by secondary intention. After harvesting, a gauze soaked with xylocaine and epinephrine is placed on the site and removed prior to leaving the operating room. We divided our patient population into two groups, one before, and one after implementation of the BNB. The primary outcome was morphine milligram equivalents (MMEs), which is the amount of morphine equal to the strength of opioid prescribed. We looked at MMEs in the acute post-operative period, both in the post anesthesia care unit (PACU), and during the inpatient hospital stay. Additionally, we collected data regarding patient demographics, length of stay, graft size, incision location, and documented intra-operative stricture length. Due to the non-normal distribution of MMEs in our data set, we used non-parametric (Mann–Whitney U) testing to detect differences between MMEs given to each group in various phases of post-operative care. We also grouped MMEs to generate a histogram, and performed a Chi-Square analysis to detect differences between these groups. Analysis was conducted in Microsoft Excel. Seventy-four patients underwent urethroplasty with buccal mucosa graft (BMG) harvest at our institution during the study period. Thirty-seven patients had surgery prior to January 2019 and were categorized as “Non-BNB”, indicating they had their surgery before implementation of the buccal nerve block (BNB). The remaining 37 patients were thus in the “BNB” group and received a BNB prior to BMG harvest.Patient demographic factors including age, length of stay, stricture length, graft size, incision location, race, and ethnicity are shown in The mean and median MMEs received in PACU, per day, and throughout the hospital stay for each group are shown in Finally, patient post-operative notes and outpatient records were analyzed for adverse reactions to the blocks. No discernable adverse effects were noted in the BNB group. In an effort to control post-operative pain and limit the need for opioid medications in the post-operative period, we began performing a buccal nerve block (BNB) during buccal mucosa graft (BMG) harvests in January 2019. The buccal nerve is a branch of the mandibular nerve, which branches from the trigeminal nerve and is thought to innervate the buccinator muscles, cheek, gingival mucosa of the retromolar area, and buccal mucosa [p = 0.017), however, there were no significant differences on post-operative day two, or among mean pain scores across the two groups [Prior experience with nerve blocks for urethroplasty is limited. In 2017, Kalava et al. published a case series describing three patients that underwent pudendal blocks prior to urethroplasty using a trans-perineal approach. None of the three patients required narcotic pain medications while inpatient . In 2019Instead of liposomal bupivacaine infiltration, our cohort utilized a BNB of xylocaine, bupivacaine, and dexamethasone. We added dexamethasone because there is evidence it prolongs block efficacy ,24. We sMoreover, it is clear from our data that regardless of whether a BNB was performed, a large group of patients did not require any MMEs post-operatively. Byrne et. al. previously reported on a narcotic-free pathway for urethroplasty, which showed no changes in pain scores, despite a significant reduction in opioids prescribed . As urolOur data is limited by its retrospective nature and the limitations that are inherent to retrospective studies. Even though demographic factors between both cohorts are well matched, there may be other differences in patient-related factors or patient care that influenced the results of our study. Specifically, our change in practice patterns in January 2019 to performing BNBs did not occur in a vacuum. By this time, the public consciousness in the United States began to challenge opioid use as the opioid epidemic became more widely publicized. It is thus possible that conscious or subconscious changes in prescriber patterns contributed to the trends observed in our data. Moreover, a majority of patients in the study did not require any MMEs post-operatively. Although this potentially provides evidence as to the efficacy of nerve blocks, patients that had a high burden of MME requirements had a large influence over our data set. It is possible patients with high narcotic tolerance were skewing the results, however detailed demographic factors, including exposure to opioids pre-procedure, were not available in this retrospective review.Finally, we did not see any adverse events from the BNB. There were no reports of severe reactions, including trouble swallowing, difficulty eating, hematomas, infections, or systemic reactions. Thus, there are minimal downsides to performing BNB at the time of BMG harvest.Despite the limitations in our data set, this study provides evidence that performing buccal nerve blocks intra-operatively is feasible. Our data suggests a possible trend towards lower narcotic requirements for patients receiving a BNB, however it failed to reach statistical significance.Further research is needed to assess patient-reported pain associated with BNBs, as well as prevention of opioid use in the outpatient setting. In a future randomized trial, we hope to answer these questions, as well as provide more robust data on the effect of the BNB on inpatient narcotic usage. Moreover, future studies should look at the use of non-narcotic pain control, both individually and in combination with nerve blocks. In one such study, Ghiasy et. al. conducted a randomized double-blind placebo-controlled trial of gabapentin vs. placebo among 100 patients, and showed that the gabapentin group had decreased pain scores and MME requirements . Going forward, the urologist has clear alternatives for non-narcotic pain management. Given the dangers of opioid prescriptions, both to individual patients and the community at large, every effort should be made to understand the benefit of alternative regimens and transition away from narcotics when possible. The use of BNBs can easily be adopted by other reconstructive urologists.


Objective Acute pain is one of the most common pains experienced by post-cleft lip or cleft surgery patients regardless of the administration of analgesic agents. This current study aimed to evaluate the efficacy of a curcumin patch as an adjuvant analgesic agent on the post-cleft lip and cleft palate surgery patients.Materials and Methods Fifty-five  participants aged 36 months or less are recruited in this pragmatic trial and randomly assigned to a control group, where no curcumin patch was applied; or the experimental group, where the participants wore a curcumin patch with a dosage of 100 mg. All participants (regardless of the group) received a standardized postsurgery analgesic agent immediately after the surgery was completed. A face, leg, activity, cry, and consolability (FLACC) scale was used to evaluate pain levels for three subsequent time points.Statistical Analysis All data were then analyzed by using the Mann–Whitney U test to compare the mean differences between the two groups.Results The results of the current study revealed that there was no significant difference found between the control and the experimental group when mean pain scores were compared for the first evaluation time. Yet, there was a significant difference (p < 0.01) between the two groups' mean pain scores on the second evaluation time.Conclusion Curcumin patch was found to be effective when used as an adjuvant analgesic agent to reduce acute-orofacial postsurgery pain in cleft lip and cleft surgery patients. The latest meta-analysis study performed by Salari et al about the prevalence of cleft lip, cleft palate, as well as cleft lip and palate, revealed that the prevalence of cleft palate based on the 59 studies included in the meta-analysis was 0.33 in every 1,000 live birth ; the prevalence of cleft lip based on the 57 studies included was 0.3 in every 1,000 live birth (95% CI: 0.26–0.34); and the prevalence of cleft lip and palate based on 55 studies included was 0.45 in every 1,000 live birth (95% CI: 0.38–0.52), indicating the high prevalence of these birth defectsConsidering the high prevalence as well as the impact on patients' quality of life, the treatment of cleft lip and/or cleft palate is performed early in life. The course of treatment for cleft lip and/or cleft palate patients consists of several stages, with surgery being the first corrective procedure to go through.Unlike postoperative pain control in adult patients that can involve the usage of opioid analgesics, the usage of opioid analgesics in infants who underwent surgery has been reported for its disadvantages, namely postoperative sedation, respiratory depression, as well as consequent airway compromise.Considering that most of the current postoperative pain control methods consist of invasive procedure(s) with possible additional side effects, ongoing research that evaluates the efficacy of postoperative pain control methods for postlabioplasty and postpalatoplasty patients is currently taking place, including the ones that involve the utilization of natural ingredients. One of the natural ingredients that have been widely evaluated and acknowledged for its analgesic effect is curcumin.Fifty-five  participants aged 36 months old or younger that went through corrective surgery for a cleft lip or cleft palate at Unpad Dental Hospital in Bandung, Indonesia, were recruited for the current study. Prior to the start of the study, ethical clearance was gained from the Universitas Padjadjaran Research Ethics Committee (No. 715/UN6.KEP/EC/2020). To confirm, every procedure and ethical aspect of the current research has been conducted in full accordance with the World Medical Association Declaration of Helsinki. All participants signed informed consent to consent to their participation and any future scientific publication as the result of their participation in the current study.Participants that fulfilled the following inclusion criteria (1) who had completed the cleft lip and/or cleft palate surgery procedure; (2) aged 36 months or less; (3) had no allergic history to curcumin; (4) had an initial pain score of 3 or greater than 3 on a scale of 0–10; (5) did not have any injuries at other parts of the body that have the potential to cause pain, aside from the postoperative wounds, were recruited. Those who (1) consumed additional pain or anti-inflammatory medication in addition to the curcumin patch or the standard analgesic medication prescribed by the doctor in charge and (2) removed the curcumin patch position from the initial location given by the investigator during the study period were excluded from the study.The sampling in this study was performed by using a nonprobability sampling technique with a purposive sampling type. The sample size calculation is performed using the following formula:n1 = n2 = sample sizeZα = type I error = 5% Zβ = 20%, type II error, X1- X2 = minimum difference which is considered significant.S = Because there is no data regarding the standard deviation of the mean difference between patients receiving curcumin and those receiving standard drugs, the researchers suspect that the standard deviation is twice the minimum of the mean difference that is considered significant = 2×10 = 20.Based on the above calculations, the number of participants for each group is 25 participants.The curcumin patch was formulated from a mixture of curcumin extract , hydroxypropyl methylcellulose, ethyl cellulose, polyvinylpyrrolidone, Nipagin, Nipasol, Tween 80, and 95% ethanol. The curcumin patch was in a form of a 6cm×10cm patch . Every All participants in this study followed the postsurgery standardized operational procedures (SOP) for cleft lip or cleft lip surgery patients. According to the SOP, once the surgical procedure was completed, participants who weighed more than 10kg received 100 mg suppository ketoprofen, while participants who weighed less than 10kg received 50 mg. The next dose of ketoprofen was registered 12hours after the first dose.Once the participants completed the operation and received the standard postsurgery analgesic agent, initial pain evaluation by the #1 and #2 field researchers was performed. Participants were then randomly assigned to the control group, where the participants did not receive a curcumin patch; or the treatment group, in which the participants received a 100 mg curcumin patch. The #3 field researcher that was assigned for curcumin placement took a sealed envelope that contained the name of the group the participant was assigned to. Once revealed, this #3 field researcher made a note about which group the patient was assigned to and performed the patch placement procedure. Therefore, the field researchers who were assigned to perform the pain evaluation did not have the knowledge of which group the participant was assigned to.The pain evaluation was performed by two field researchers simultaneously by using the face, leg, activity, cry, and consolability (FLACC) pain scale. The FLACC is a scale that consists of five subsections that are used to assess pain in children aged from 2-month-old to 7-year-old who are unable to communicate their pain. It has been validated and tested for reliability and validity in several previous studies. For each subsection, the pain level is scored as 0, 1, or 2. Therefore, the lowest total scoring would be 0 (zero), while the highest is 10 (ten). Further explanation of the FLACC and the scoring system can be viewed in previous studies.Prior to the main analysis, all data were analyzed by the Kolmogorov–Smirnov normality test. The data were then analyzed by the Mann–Whitney U test to compare the mean differences between the two groups.This current study recruited 55 participants aged between 0 and 36 months old, where most of the participants are males aged between 0 and 18 months . Most oPain evaluation by using FLACC revealed that the mean pain score immediately after the general anesthesia wore off (T0) for both groups from a scale of 0 to 10 was 8.02 (standard deviation [SD] =  1.99), while the pain score in the control group for this evaluation point was 7.54 (SD =  2.12) and the experimental group was 8.52 (SD =  1.76) . The app = 0.005) for the mean pain score  and the second evaluation point . While for the third evaluation point , there was a significant difference  perspective, as well as the parent's perspective would have added additional value to the study.In summary, the current study showed a very promising future for curcumin to be used as an adjuvant analgesic agent for the management of acute orofacial pain due to operative procedures. And considering that our study applied a pragmatic design by following the standardized treatment protocol for acute pain management in postsurgery cleft lip and cleft palate patients, it can be concluded that the external validity of this study is high and therefore, the result is very much applicable in daily practice. Last but not least, considering the direct effect of curcumin on PGE2 found in preclinical studies, it is important to provide further evidence in future clinical studies.


Conclusions: The results obtained in this study demonstrate how REAC ANM manipulation of EBA can lead to improvement in epigenetically conditioned symptoms such as CPHN. These results should prompt further research to expand knowledge and ensure optimized therapeutic outcomes.Background: Chronic post-herpetic neuralgia (CPHN) is a symptomatic condition that afflicts adults and elderly individuals. The chronicity of this symptomatology can be conditioned by the epigenetic modifications induced by the virus on the processes of neurotransmission and sensitivity to pain. The aim of this study is to investigate whether manipulating endogenous bioelectrical activity (EBA), responsible for neurotransmission processes and contributing to the induction of epigenetic modifications, can alleviate pain symptoms. Methods: This manipulation was carried out with the antalgic neuromodulation (ANM) treatment of radioelectric asymmetric conveyer (REAC) technology. Pain assessment before and after treatment was performed using a numerical analog scale (NAS) and a simple descriptive scale (SDS). Results: The results of the analysis showed an over four-point decrease in NAS scale score and over one point decrease in SDS scale score, with a statistical significance for both tests of  Varicella-zoster virus (VZV) is a type of human neurotropic virus that belongs to the alpha herpesvirus family . The firVZV can be reactivated even after many years. The mechanisms that determine both the latency and reactivation of VZV are not yet fully understood, but research has shown that they may be linked to epigenetic mechanisms . These mReactivation from latent VZV results in a clinical and symptomatic picture known as herpes zoster or shingles ,5,6.Shingles is a painful rash consisting of blisters that typically form within 7–10 days and resolve completely within 2–4 weeks. However, in 5–30% of patients , with liNeuropathic pain is a multifaceted condition that results from maladaptive structural changes and a wide range of cell–cell interactions and molecular signaling pathways. This leads to the sensitization of nociceptive pathways, which can cause debilitating pain. These changes can involve various mechanisms, including alterations in ion channels, glial-derived mediators, and epigenetic regulation, among others .In this study, we investigated the efficacy of a specific neurobiological solitonic modulation treatment called antalgic neuromodulation (ANM) . ANM is The aim of this study was to assess whether ANM could effectively reduce pain in patients with CPHN, which can significantly impact their quality of life.The findings of this study suggest that the use of REAC technology can be useful in the treatment of CPHN.The statistical sample size was calculated using GPower software version 3.1.9.4, with the following parameters: effect size of 0.60, alpha probability error of 0.05, power of 0.90, and using the Wilcoxon signed-rank test. Based on these parameters, the sample size calculation yielded a sample size of 27 subjects, which was deemed sufficient to detect statistically significant differences between groups.The inclusion criteria for this study were as follows: men and women aged over 45 years, with a previous diagnosis of herpes zoster and CPHN symptoms present for more than 120 days, with poor or absent sensitivity to antiviral, anti-inflammatory, pain-relieving treatments, and anticonvulsant drugs.The exclusion criteria were concomitant neurological and rheumatological diseases, diabetes, fibromyalgia, psychiatric diseases, and tumor pathologies.This study is part of a project aimed at improving the quality of life of the population of the Brazilian region of Amapá. To ensure a humanitarian approach towards improving the quality of life of the local population, we chose to enroll a larger number of patients in our study than was calculated as necessary to establish the validity of our results. This decision reflects our commitment to maximizing the potential benefits of our research for the community, and to ensuring that as many individuals as possible have access to the latest advances in medical science.In total, 53 subjects aged between 49 and 84 years, with an average of 65.30, of which 31 were male (mean age 64.25) and 22 were female (mean age 66.70) were enrolled between July 2021 and October 2022. The study population was multiracial, and all participants completed the course of therapy.All patients who participated in the study perceived and reported pain essentially localized in the thoracic area along the ribs.Before receiving the treatment (T0), all patients were asked to rate their pain by completing a numerical analog scale (NAS) with a value from 0 to 10, where 0 represents no pain and 10 represents extreme pain . PatientTo compare the two scales, we aligned the initial and final values, with 0 as no pain and 10 as severe-extreme pain, while for the intermediate values, we classified the NAS from 1 to 3 as medium pain, from 4 to 6 as moderate pain, and from 7 to 9 as severe pain.Immediately after collecting the NAS and SDS data, the patients underwent the first ANM treatment (T1).The follow-up (T2) was set at about three months after the end of the treatment cycle. This interval was considered necessary to allow biological time necessary for the remodulation of the epigenetic modifications  that affRadio Electric Asymmetric Conveyer (REAC) technology is a relatively new medical noninvasive technology. It was developed by two Italian researchers Salvatore Rinaldi and Vania Fontani. The REAC technology uses radio electric fields that are asymmetrically conveyed to the body through an asymmetric conveyer probe (ACP).These radio electric fields, using specific administration protocols, are designed to promote the progressive recovery and optimization of the natural endogenous bioelectric activity (EBA) ,18 that The effect of progressive improvement of the EBA is attributed to the solitonic effect ,21, whicA soliton is a type of wave that maintains its shape and amplitude as it propagates through a medium due to its self-reinforcing nature . In the The soliton-like behavior of EBA signals is influenced by the electrical properties of the neuron membrane and the activity of voltage-gated ion channels . When thThis effect has been demonstrated to persist even after a single administration of REAC treatment ,26,27, iAntalgic neuro modulation (ANM) treatment is a solitonic neuromodulation treatment with REAC technology designed to remodel spontaneous spiking activity and the extracellular summation of postsynaptic potentials generated by neuronal population communication, i.e., the so-called local potential fields (LPFs) at the thalamic and cortical levels, particularly in chronic pain . This efThe administration of the ANM involves the positioning of a probe, called an asymmetric conveyer probe (ACP), on the patient’s back to cover the cervical, thoracic and lumbar tracts .The ACP is held in place by an elastic tubular mesh and then connected to the device via a cable. Each treatment session lasts 15 min; the protocol specifies 1–3 treatments sessions per day during the week (Monday–Friday) depending on the logistical availability of the patients. A complete therapeutic cycle consisted of 18 sessions. The administration parameters are established by the manufacturer and cannot be modified by the operator. The device used is the BENE 110 .This study was approved by the Ethical Comity of the Federal University of Amapá, Macapá, with approval code NO. 4.763.000. Since lack of responsiveness to previous treatments for CPHN was a component of the inclusion criteria, we believed, for ethical purposes, that patients could be free to continue taking the previous therapies at their discretion.All participants showed a reduction in NAS scores at T2 compared to T0 .Of the 16 patients who at T0 with NAS had expressed pain at 10, 4 at T2 expressed 7; 6 at T2 expressed 6; 4 at T2 expressed 5; and 2 at T2 expressed 4. Of the 22 patients who at T0 with NAS had expressed pain at 9, 8 at T2 expressed 5, 9 at T2 expressed 4, and 3 at T2 expressed 3. Of the 13 patients who expressed pain at T0 with NAS, 6 at T2 expressed 6; 1 at T2 expressed 5; and 6 at T2 expressed 4.The mean decreases in NAS scores between T0 and T2 was 4.41 points.The analysis of the results obtained using the SDS, calculating the difference of the subjective pain value at T0 and at the T2 follow-up shows an overall improvement in all patients .Of the 16 patients who at T0 with SDS had expressed pain at 4 (extremely severe), 4 at T2 expressed 3 (severe pain) and 12 at T2 expressed 2 (medium pain). Of the 37 patients who at T0 with SDS had expressed pain at 3 (severe pain), 26 at T2 expressed 2 (medium pain); 11 at T2 expressed 1 (medium pain).The mean decrease in SDS score between T0 and T3 was 1.43 points.No patients reported side effects or unwanted effects.The collected data were incorporated into an Excel sheet and subsequently subjected to a statistical analysis using the Statistical Package for Social Science (SPSS) version 22.p < 0.005 was found  and a reduction of more than one point on the Self-Rating Depression Scale (SDS). Notably, these outcomes were achieved in individuals who had been experiencing symptoms for over 120 days, with limited or no response to traditional antiviral medications, anti-inflammatory therapies, pain-relieving treatments, and anticonvulsant drugs.These results highlight the potential of REAC ANM as a viable alternative for the management of chronic post-herpetic neuralgia, particularly in patients who have failed to respond to conventional treatment approaches. By offering significant pain relief to patients who have been suffering for prolonged periods, this innovative technology could help improve their quality of life and overall well-being.The results of this study provide compelling evidence that REAC ANM manipulation of EBA can effectively improve epigenetically conditioned symptoms, such as CPHN. These findings have significant implications for advancing our understanding of the potential benefits of this novel approach in the management of neuropathic pain.In conclusion, the present study sheds new light on the potential of REAC ANM as a promising therapeutic approach for the treatment of chronic neuropathic pain. By encouraging further research, these results pave the way for the development of more effective treatments that can improve the lives of those living with this challenging condition.


Endometriosis is a significant cause of disability that affects 5–10% of reproductive-aged women. Laparoscopy with histological confirmation is the gold standard in establishing the diagnosis as therapeutic management surgery is addressed to a certain category of patients. The objective of this study was to assess patient adherence to follow-up after surgery for endometriosis as the primary endpoint, pain symptoms, quality of life, mental health, and fertility as the secondary endpoints. We have analyzed patients’ adherence to follow-up after surgery for endometriosis after 1, 3, 5, and 7 years. Out of the 2538 total number of surgeries, 453 patients replied just to the first questionnaire (group A), 528 to the first and second (group B), and only 356 carried out the entire follow-up schedule. General health was significantly lower for group A (46.6 vs. 56.4) but with no statistical difference in the post-surgical improvement in both groups. Pain level score improvement was lower for group A (10.5 vs. 18.8), which is statistically significant. In this light, laparoscopy still remains the gold standard in diagnosis only. Furthermore, no malignancy was discovered. The mental component was improved by laparoscopy based on SF-36 in group B. Studies on patient preference for surgery versus alternative treatment are needed. Endometriosis is a gynecological disorder characterized by the growth of endometrial tissue outside of the uterus, which affects 5–10% of reproductive-aged women .There are three types of endometriosis described in the literature: ovarian, superficial peritoneal, and deep infiltrating endometriosis ,4.The pathogenesis of endometriosis is not fully understood, but it is considered to be a hormonally responsive tissue similar to the endometrium. Nevertheless, there is evidence in the literature of symptomatic endometriosis occurring in menopause, where genetic involvement is more likely . It is vThe most widely accepted pathogenic mechanism of endometriosis is menstrual reflux. However, due to the heterogeneity of the disease manifestations, multiple theories and hypotheses have been proposed, including dislocation of the basal endometrium, metaplasia of peritoneal mesothelial cells or endometrial stem cells, lymphatic and hematogenic spread, and exposure to certain agents ,6. PhenoMost commonly, the symptoms consist of pain or infertility, which is also the reason for diagnostic laparoscopic intervention . The preDespite the significant impact of endometriosis symptoms, there are often delays in the diagnosis and treatment of the condition, with women diagnosed during adulthood experiencing a three times longer delay compared to those diagnosed in adolescence in receiving a correct diagnosis. This delay may be due to fear of stigma associated with gynecological complaints or a lack of education .The management of endometriosis can be approached either surgically or medically. Estrogen exposure is a major risk factor for this condition, and current treatments aim to suppress its production . NonsterFor the same reason, alternative diagnostic methods must be sought, even if laparoscopy is the golden standard, along with histopathology. Ultrasound, CT scan (Computer Tomography), and MRI scan (Magnetic Resonance Image) do not bring images specific to endometriosis. Reliable biomarkers are being sought so far, with CA-125 being the most studied, but it is not specific to the pathology. Extended additional studies are needed in this regard ,14,15.The objective of this study was to assess patient adherence to follow-up after surgery for endometriosis as the primary endpoint, with changes in pain symptoms, disease recurrence, quality of life, mental health, and fertility as secondary endpoints. Through this questionnaire, it can be determined to what extent the surgical intervention is useful as therapeutic management or if it remains only the golden standard in the diagnosis of endometriosis, being able to be used in certain cases as therapeutical management. Furthermore, through follow-up, we can detect possible malignancies.Women included in this retrospective analysis of prospectively collected data were managed from June 2009 to June 2019 for pelvic endometriosis.The management of these individuals took place within one of the 15 establishments engaged with the CIRENDO database—a progressive cohort under the North–West Inter Regional Female Cohort for Patients with Endometriosis; NCT02294825—funded by the G4 Group .The CIRENDO database adopted specific inclusion criteria: only women whose diagnosis of endometriosis was substantiated through surgical investigation and histological analysis were incorporated into the database.There were also exclusion criteria to consider any missing details in the electronic database, or an incomplete questionnaire would result in the exclusion of the subject from the study.Data was gathered from both surgical and histological documentation, in addition to self-administered questionnaires filled out prior to surgery. These questionnaires encompassed various aspects such as medical history, sociodemographic information, fertility status, recurring and persistent pain, issues with sexual activities and discomfort during intercourse, gastrointestinal problems, and overall quality of life.Intraoperative findings and immediate postoperative management were recorded using questionnaires filled in by the surgeon. Follow-up self-questionnaires were addressed to patients at 1, 3, 5, and 7 years after the surgery, including questions about endometriosis-related symptoms and fertility outcomes. The roles of data logging, maintaining patient communication, and overseeing patient follow-up were managed by a professional clinical research technician. The forward-looking data collection and interpretation received authorization from French regulatory bodies, namely the CNIL  and the CCTIRS (Comité Consultatif pour le Traitement de l’Information en matière de Recherche dans le domaine de la Santé), prior to being incorporated into the CIRENDO database. Patients were preoperatively informed about the goal and the risks of surgical management of endometriosis. All patients gave written informed consent to participate in the study.The study was approved by the Univ”rsit’ of Medicine, Pharmacy, Science and Technology George E. Palade Targu Mures Institutional Ethics Committee for Non-Interventional Research (no. 2336/17 May 2023).The intensity of pain symptoms was evaluated before surgery and during the follow-up. Questionnaires were used to evaluate chronic pain, dysmenorrhea, dyspareunia, quality of life , mental health, emotional well-being, self-image, and urinary symptoms.A validated language version of Kess (Knowles-Eccersley-Scott-Symptom Questionnaire) and a GastroIntestinal Quality of Life Index CIQLI questionnaire were used for intestinal symptoms and change in bowel habit.Upon completing their surgery, the women were asked to evaluate their overall satisfaction with the provided treatment and determine whether there was a recurrence of pain or the disease by responding to a series of questions.x2 test was used to compare continuous variables. The regression analysis was performed using the Cox regression test. A p value of less than 0.05 was considered statistically significant.Statistical analysis was performed using the Stata 16.0 software . Univariate analysis compared patient characteristics, clinical history, baseline complaints, intraoperative data, and postoperative outcomes. Fischer’s exact test was used to compare qualitative variables and analysis of variance and We have analyzed patients’ adherence to follow-up after surgery for endometriosis after 1, 3, 5, and 7 years. Out of 2538 total surgeries, 453 patients replied just to the first questionnaire, 528 to the first and second, 445 to the first three questionnaires, and 356 carried out the entire follow-up schedule. So, group A includes 445 patients, those who answered the questionnaire before surgery and one year after surgery and then lost the follow-up. Group B includes 528 patients who answered at least two questionnaires after surgery.The mean age of our patient was 32.52, with an SD Standard deviation of 6.87. We have assessed their social background, level of education, medical history, and wish for future pregnancy.Most patients undergoing surgery for endometriosis were employed and in a romantic relationship, with a tendency towards marriage for the group that adhered to the long-term follow-up.Dysmenorrhea and general pelvic pain are common symptoms of endometriosis regardless of age at diagnosis. They took hormonal medication for pain but did not have any improvement. General pelvic pain made it difficult to participate in work or normal daily activities and social life before surgery. Exercise was also impacted more severely than expected. Urinary and gastrointestinal symptoms were also present .All patients answered the same questionnaire before and after the operation and during the follow-up.There were no significant differences in regard to mental status and psychiatric disorders between the evaluated groups.Most patients that answered postoperative questionnaires were diagnosed with stage IV rAFS endometriosis .There was no significant difference in follow-up for patients suffering from primary or secondary infertility.An overall 51.01% of patients desired a pregnancy prior to surgery, with no difference between the groups evaluated.There were no significant differences in obtaining spontaneous or assisted pregnancies and deliveries between the groups at the 1-year postoperative evaluation .Out of those who desired to conceive, 1/5 patients at the 1-year postoperative evaluation, respectively 1/4 patients at the 3-year postoperative evaluation have obtained a pregnancy, which makes the surgical intervention useful to some extent in obtaining pregnancy. However, it is difficult to evaluate without knowing other procedures of assisted human reproduction techniques that could be used by patients during the follow-up period .In the same way, those who were not lost to follow-up showed similar improvement in postoperative symptoms, including in general health and physical condition, but these were without statistical significance, and in the answers to the KESS questionnaire, they reported dissatisfaction . There wHere is the comparison of the two groups to understand what caused the loss of adherence to the follow-up and also to understand the way the surgery brought improvements rather than the diagnosis .We compared patients that were lost to follow-up after one year post-surgery (group A) to patients who adhered throughout the postoperative monitoring (group B) .p < 0.05; pain intensity with no treatment 8.48 vs. 7.89, p < 0.05; pain intensity with treatment 4.84 vs. 4.16, p < 0.05). Moreover, the decrease in intensity of pain reported after surgery between the two groups was significantly higher for patients in group A , on the pain scale 0 meaning no pain and 10 meaning extreme pain. However, patients in group B reported a decrease in pain levels during menstrual cycles during the follow-up , follow-up being important for this reason [During menstrual cycles, pain levels, the need for antalgic treatment, and the association with urinary symptoms were reported to be higher and more frequent before surgery in group A .Pain during intercourse was reported significantly more often in group A compared to group B  , but notOver half of the patients who adhered to follow-up every 1 year for 3 years after surgery had digestive endometriosis involvement . In comparison, 35.67% of patients that were not lost to follow-up had digestive involvement after 7 years of follow-up. Moreover, patients in group A had a higher KESS questionnaire score prior to surgery (12.7 vs. 11.2 with a cut-off at 11 that indicates constipation) with statistical significance and a significantly lower GIQLI score  compared to group B.However, there are no differences for patients with urologic involvement none of the patients from groups A or B developed malignant transformation.The physical functioning segment had a significantly lower score for group A compared to group B before surgery (60.8 vs. 71.7) with lower postoperative improvement (8 vs. 7.6)Role limitations due to physical functioning were reported at 27.6 for group A and 46.4 for group B prior to surgery, with higher postoperative improvement in the case of group A (16.9 vs. 13.7), but with no statistical difference in post-surgical improvement.Pain level score improvement was lower for group A, 10.5 (60.0–49.5 number of patients) vs. 18.8 (67.1–48.3 number of patients), and was statistically significant.There were no differences in the score increase for energy levels between the two groups; however, there were significantly lower scores both before and after surgery for group A.Social functioning was reported to be significantly lower for group A .Role limitations due to emotional involvement before and after surgery had overall lower scores for group A  but with no statistical difference in the post-surgical improvement.SF36 score was used to assess the health status of the patients and to measure the impact the surgery had on their quality of life:Even if the decrease in intensity of pain reported after surgery between the two groups was significantly higher for patients in group A, as the percentage and number of patients and pain level score improvement were lower for group A  and statistically significant, during menstrual cycles or chronic pain. In addition, the physical functioning segment had a significantly lower score for group A compared to group B’s role limitations due to it. General health and social functioning were reported to be significantly lower for group A. Role limitations due to emotional involvement after surgery had overall lower scores for group A. There are no significant differences in urologic symptoms between groups A and B, and no malignancy was discovered.Patient education and medical professional training are necessary to fully understand the nature of this pathology . Our resStudy Limitations: Our study had several limitations, including under sampling of women with infertility, unrevealed rASRM (the revised American Society for Reproductive Medicine) scores, and potential selection bias. Additionally, we did not consider ethnic criteria, economic background, urban/rural residence, or BMI. Furthermore, no studies have provided definitive evidence on when surgery should or should not be performed due to the lack of conclusive data. Furthermore, regarding patient adherence to the follow-up, we can only speculate that patient dissatisfaction is the main reason for the loss of long-term follow-up.In cases of repeat surgery, recurrent pain was the primary indication for re-operation. Our study found that surgery did not significantly improve overall pain levels, especially in group A, where they exceeded group B in the number and percentage of patients 1 year after surgery, but not as pain level scale. There is a gap in long-term pain outcomes.This is confirmed by the lack of follow-up adherence of the patients in group A, probably due to an improvement that does not correspond to their expectations.In addition, the live birth rate was improved in our study, which is confirmed by Matheo Leonardi’s research , but theMental components improved by laparoscopy based on SF-36 and were also better in group B for those who were monitored for a longer period of time, which confirms the data from the literature ,17,18,19Studies on patient preference for surgery versus alternative treatment are needed. In addition, there is a poor correlation between the severity of the symptoms and disease grade .The heterogeneity of the pathology imposes the complexity of therapeutic management ,18, and It is worth noting that malignant transformation is extremely rare in endometriosis, and no cases were described in this study, despite the similar pathogenesis and behavior of endometriosis and cancer. This genetic and epigenetic instability is consistent with the infrequent occurrence of malignant transformation of endometriosis ,22,23,24The clinical guidelines from ESHRE, rASRM, and ACOG (American College of Obstetrics and Gynecology) recommend hormonal treatment as the first-line therapy ,17. HoweThe ESHRE guidelines recommend surgery for drug-resistant pain ,9, and rVarious treatments are currently used, including GnRH analogs or antagonists, anti-inflammatory agents, antiangiogenic agents, agents that induce apoptosis, agents that reduce oxidative stress, and third-generation nonsteroidal anti-inflammatory agents such as letrozole, monoclonal antibodies, and aromatase inhibitors ,9,18,35.A novel therapeutic approach for endometriosis should be based on the disease’s pathogenesis . SeveralHypermethylation of DNA contributes to progesterone resistance, and demethylation agents may be a future research approach ,13,14. FThe scavenging system for iron overload, which is responsible for oxidative stress and inflammation, is being studied as a potential future approach. Retrograde menstruation and bleeding of endometriotic tissue are responsible for the release of hemoglobin into the peritoneal cavity, which has toxic effects with pro-oxidant and pro-inflammatory effects. Continuous delivery of iron to macrophages may overwhelm the capacity of ferritin to store iron. Efforts to scavenge and eliminate Iron could be a potential solution to blocking the progression of endometriosis ,13,15,21All these efforts are justified in reducing the need for surgical re-interventions . EndometSome of the studies showed a slight reduction in health-related quality of life and sexual quality of life after a long-term follow-up ,37. MostCosts should not be the primary concern in management decisions, although they cannot be disregarded. Surgery can remove endometriotic lesions, but it cannot provide a cure for the disease, and safety concerns remain a priority for future interventions ,34.Another concern for the future is finding effective diagnostic methods for endometriosis, as diagnostic laparoscopy with histopathological examination is currently the golden standard, with associated surgical complications. Currently, there is no efficient method to replace surgery apart from imaging techniques such as ultrasound, MRI, CT, and non-specific biomarkers like CA125 ,13,14,15Individualized treatment is crucial in the management of endometriosis, and surgery remains an important therapeutic option in the absence of a more effective method of diagnosis and treatment. To avoid repeat surgeries and optimize cost-effectiveness, treatment decisions should be tailored to the individual patient’s needs. Even if the decrease in intensity of pain reported after surgery between the two groups was significantly higher for patients in group A, a percentage of patients’ pain level score improvement was lower for group A, which was statistically significant (10.5 vs. 18.8), according to the SF36 score. In this light, laparoscopy still remains the golden standard in diagnosis only. There is a gap in long-term pain outcomes. Because of the lack of adherence to follow-up, we can only speculate that patient dissatisfaction was the cause.The mental component was improved by laparoscopy based on SF-36 but in the group of those who were monitored for a longer period of time. No malignancy was reported in both groups. Studies on patient preference for surgery versus alternative treatment are needed.However, making strong recommendations in the absence of high-quality randomized trials can be challenging. Therefore, further research is necessary to develop more effective and personalized treatment strategies for endometriosis.


Background: Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy. In cases where conservative treatment proves ineffective, a new procedure called core decompression of the vertebral body is explored. Core decompression of the vertebral body has the potential to lower and stabilize the intraosseous pressure, resulting in enhanced blood circulation, which contributes to pain reduction. In this trial, we evaluated the efficacy of core decompression of the vertebral body in patients with painful VCFs compared with conventional conservative treatment. Methods: This prospective randomized controlled trial was conducted at a tertiary education hospital between June 2017 and May 2020. The participants were randomly assigned in a 1:1 ratio to one of two treatment groups: the core decompression group and the conservative treatment group. The primary outcome measure was the visual analog scale (VAS) pain score of the back 3 months after the procedure. Secondary outcome measures included the Oswestry Disability Index (ODI) for lumbar disabilities, the European Quality of Life-5 Dimensions (EQ-5D) score for quality of life, and radiographic outcomes such as changes in compression rate. Results: All patients underwent the assigned intervention (48 core decompression and 50 conservative treatments). At both 1 month and 3 months, there were no significant differences between the core decompression group and conservative treatment group in VAS pain score . In addition, there were no significant inter-group differences in ODI and EQ-5D scores throughout the follow-up period . Conclusion: Core decompression of the vertebral body did not demonstrate any significant improvement in pain and disability compared to conventional conservative treatment. Vertebral compression fractures (VCFs) can result in various complications, including chronic back pain, progressive spinal deformity, muscle wasting, pressure ulcers, and sleep disturbances ,2,3,4. AThe underlying mechanisms responsible for pain following VCFs have not been thoroughly investigated. However, increased pressure within the bone (intraosseous pressure) is considered the primary trigger ,11,12,13In this single center, randomized, controlled trial, we evaluated the efficacy of core decompression of the vertebral body in patients with painful VCFs compared with conventional conservative treatment. We hypothesized that patients who undergo core decompression of the vertebral body would report lesser pain and pain-related disabilities than those in the control group.ClinicalTrials.gov (NCT02902250). Before enrollment, written informed consent was obtained from each patient or their legal representatives. The trial was conducted in accordance with the principles of the Declaration of Helsinki. The clinical and radiographic data were monitored by an independent researcher.The participants were enrolled at a tertiary education hospital between June 2017 and May 2020. This trial was approved by the institutional review board of our hospital (B-1502-288-005) and registered at The participants were recruited from the outpatient department of our hospital by a single specialist. The inclusion criteria were as follows: (1) aged ≥ 40 years and voluntarily agreed to participate and (2) diagnosed with one to three painful osteoporotic VCFs between vertebral levels T10 and L5. In all patients with suspected compression fractures, lumbar X-rays and MRI were performed to confirm the fracture and bone marrow edema. Also, in all patients diagnosed with VCFs, bone density scans were performed to confirm osteoporotic VCFs. The exclusion criteria were as follows: (1) previous diagnosis of an inflammatory disease or malignant tumor, (2) presence of a bleeding or coagulation disorder, (3) use of any type of anticoagulant, (4) severe pain other than in the lower back, and (5) deemed unfit for participation in this clinical trial by the researcher.Participants who met the inclusion criteria were randomized into one of two treatment groups at a 1:1 ratio: the core decompression group and the conservative treatment group. The time from fracture to randomization was less than one month. Web-based randomization was employed to achieve concealed allocation. All participants were evaluated for the efficacy and safety of the treatment over a 3-month study period.At baseline, patients scored their back pain using the visual analog scale  and completed self-reported questionnaires, such as the Oswestry Disability Index (ODI) and the 5-level version of the European Quality of Life-5 (EQ-5D). The ODI is a widely used questionnaire designed to assess the level of disability or functional impairment experienced by individuals with low back pain. The EQ-5D score is a standardized instrument used to measure health-related quality of life. It assesses an individual’s general health and well-being and is commonly used in healthcare and clinical research to evaluate the overall health status and quality of life of patients. They also provided their demographic and clinical information. Evaluation measures were performed before randomization and at various times for up to 3 months. The primary outcome measure was the VAS pain score of the back. Secondary outcome measures included ODI and EQ-5D scores.The compression rate and wedge angle of the vertebral body were measured on plain radiographs . The heiAt the first visit, written informed consent, demographic information, medical history, medications, smoking status, and vital signs were obtained, and bone density scan, VAS, ODI, EQ-5D questionnaires, and radiologic examinations were conducted. On day 1 (visit 2), vital signs, VAS, ODI, and adverse event monitoring were performed. Visit 3 (at week 1) included vital signs, VAS, ODI, and adverse event monitoring, The fourth and fifth visits, at weeks 4 and 12, involved vital signs, VAS, ODI, EQ-5D, X-ray, and adverse event monitoring. Adverse events (AEs), vital signs, and physical examination were assessed. An adverse event is defined as a compression rate of 80% or more or a VAS pain score of 8 or higher.The practitioner of core decompression in this trial was an experienced orthopedic surgeon . Patients in the core decompression group were placed in a prone position. The fractured vertebrae were identified and marked under C-arm guidance. Under local anesthesia, a Jamshidi needle was used to perforate the fractured vertebrae. The needle was carefully inserted through the skin and soft tissues layer-by-layer with continuous monitoring through the pedicle using C-arm guidance. The core wire was extracted from the needle and a syringe was connected to the needle. Subsequently, the plunger of the syringe was gradually withdrawn, resulting in the evacuation of blood and intraosseous decompression. Subsequently, the needle was removed and an aseptic dressing was applied to the puncture site.In the conservative treatment group, the patients received a regimen that included bed rest, oral pain medication, use of external braces, and ambulation based on their pain tolerance.In both groups, pain management followed a stepladder approach starting with non-narcotics, low-dose narcotics, and high-dose narcotics. Pain treatment was categorized following the World Health Organization analgesic ladder as 0 (no prescription), 1 , 2 (low-dose narcotics), and 3 (high-dose narcotics). Esomeprazole, a proton pump inhibitor, was used for medication-induced dyspepsia.The degree of effectiveness of core decompression performed in this trial has not been previously reported. Therefore, the required sample size was calculated assuming that an effect similar to that of VP performed in general VCFs can be expected. Considering a minimal clinically significant difference of 1.5 on the VAS, a standard deviation of 2.5 in both groups , and a tracking loss rate of 0.1, a sample size of 49 individuals per group is required.For the primary analyses, we used an intention-to-treat strategy, and treatment effects and confidence intervals were calculated using analysis of covariance (ANCOVA) models with adjustment for baseline values of the outcome measure and age. In addition, we used analysis of variance for repeated measures (RM-ANOVA) to compare the ODI score, EQ-5D score, compression rate, and wedge angle. SPSS  was used for all statistical analyses.From June 2017 to May 2020, a total of 98 patients were enrolled and underwent randomization. Of the 98 patients, 48 and 50 were assigned to the core decompression and conservative treatment group, respectively. Both groups had six patients each who were lost to follow-up before the 3-month assessment . Demograp = 0.970). At 3 months, the mean VAS score in the core decompression group was 29.2 ± 17.0, as compared with 31.1 ± 17.1 in the conservative treatment group  (p < 0.001).The study groups did not differ significantly with respect to the primary outcome (VAS score) at 1 month and 3 months. At 1 month, the mean VAS score in the core decompression group was 43.0 ± 16.8, as compared with 43.4 ± 17.6 in the conservative treatment group  . Both grp = 0.917 and p = 0.704, respectively). This indicates that the ODI and EQ-5D scores did not differ significantly between the core decompression and conservative treatment groups throughout the follow-up period.p = 0.560). Similar results were observed for the wedge angle. At baseline, the wedge angle in the core decompression and conservative treatment groups were 12.2 ± 7.5 and 13.0 ± 7.1, respectively. After 3 months, the wedge angles in the core decompression and conservative treatment groups were 15.8 ± 9.0 and 14.0 ± 7.6, respectively. There were no significant differences between the study groups (p = 0.753).Radiological outcomes are summarized in No serious adverse events, resulting in life-threatening conditions or severe sequelae, were observed.This randomized controlled trial aimed to compare the effectiveness and safety of a newly designed vertebral body core decompression technique with those of conventional conservative treatment in patients with painful VCFs. The results indicated that the core decompression group did not demonstrate a significant difference in pain improvement compared with the conservative treatment group. Moreover, there were no significant differences in the measures of disability and quality of life between the two groups. Additionally, no significant differences were observed in the radiological parameters of the study groups at baseline and 3 months.The core decompression technique employed in this study was based on the principles of the widely used core decompression technique for ONFH . PreviouA few studies have conducted procedures similar to the core decompression performed in this study, referred to as vertebral body perforation, and have reported favorable results. Ogihara et al. demonstrated that vertebral body perforation provides sufficient pain relief in patients with painful lumbar compression fractures . They atThis study has several limitations. First, we were unable to compare the intraosseous pressure of patients in the conservative treatment and core decompression groups, despite recognizing the importance of intraosseous pressure in the pain reduction effect of core decompression. Second, patients’ knowledge of their treatment assignments may have influenced their responses to the questionnaire. Third, the follow-up period was limited to 3 months. Given that pain and disability resulting from vertebral compression fractures can affect a patient’s quality of life over an extended period, a short follow-up duration may not fully capture the long-term effects.In this prospective randomized controlled trial involving patients with osteoporotic VCF, we found no beneficial effects in performing core decompression of the vertebral body compared with that of conservative treatment in patients with painful VCFs.


Acceptance-based pain management interventions have been receiving growing attention in cancer pain care. This study aimed to develop a cancer pain management program based on belief modification to improve the cancer pain experience of Chinese oral cancer survivors and to explore the acceptability and preliminary outcomes of the Cancer Pain Belief Modification Program (CPBMP).A mixed-methods approach was applied to develop and revise the program. The CPBMP was developed and revised using the Delphi technique, and its further improvement was explored with a one-group pre- and post-trial designed with a sample of 16 Chinese oral cancer survivors, and semi-structured interviews. Research instruments included Numeric Rating Scale (NRS), Chinese version of Illness Perception Questionnaire-Revised for Cancer Pain (IPQ-CaCP), and the University of Washington Quality of Life assessment scale (UW-QOL). Descriptive statistics, t-test, and Mann–Whitney U test were used to analyse the data. The semi-structured questions were analysed using content analysis.t = -3.746, p < 0.001); from 140.63 ± 9.02 to 52.75 ± 7.27 ; and the “positive pain beliefs”, “quality of life” scores increased from 55.13 ± 4.54 to 66.00 ± 4.70 ; from 66.97 ± 15.01 to 86.69 ± 8.42 . The qualitative data also indicated that CPBMP was well acceptable.The six-module CPBMP was endorsed by most experts and patients. The expert authority coefficient value was 0.75 in the first round of the Delphi survey and 0.78 in the second round. The “pain intense”, “negative pain beliefs” scores of pre- and post-testing decreased from 5.63 ± 0.48 to 0.81 ± 0.54  in 11/09/2021. (ChiCTR2100051065).The feasibility study has already been registered on the Chinese Clinical Trial Registry (ChiCTR) ( Oral cancer is the most common malignant tumor of the head and neck, including lip cancer, tongue cancer, gum cancer and floor of mouth cancer, which ranks sixth in global cancer incidence . The incIn 2020, the IASP revised the definition of pain, re-emphasizing that pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage . Thus, pStudies –18 have At present, the intervention methods of pain beliefs in patients with chronic pain include second-generation cognitive-behavioral therapy–Cognitive-Behavioral Therapy (CBT), which emphasizes changing cognition, and third-generation cognitive-behavioral therapy– Acceptance and Commitment Therapy(ACT), which is based on acceptance, of which third-generation cognitive-behavioral therapy is currently a hot topic of research in the related field –23. BothLeventhal’s common-sense model of self-regulation (CSM) is a common theoretical model in social psychology . CSM is In this article, we enrich how oral cancer pain belief modification program (CPBMP) was developed and examined by our research team, with reference for pain management of oral cancer patients.A mixed-methods study was used to develop and revise the program. The CPBMP was developed and revised using the literature retrieval, semi-structured interview, and Delphi technique. The further improvement was explored with a one-group pre- and post-trial designed with a sample of 16 Chinese oral cancer survivors, and semi-structured interviews.Electronic databases, including PubMed, Embase, CINAHL, Psych info, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang data, China Science and Technology Journal Database (VIP), Sino Med. Literature inclusion criteria: 1) age ≥ 18 years old cancer pain patients (P); (2) Any form of cancer pain care based on belief modification (I); (3) Control group received routine cancer pain nursing (C); (4) Pain-related outcome indicators (O); (5) study types were randomized controlled trial (RCT) or clinical controlled trial (CCT) (S); (6) Languages ARE limited to Chinese or English. Literature exclusion criteria: literature about the belief modification combined with other measures; repeated published literature; full text of the literature was not available. The search time limit was from the establishment of the database to March 31, 2021. Using Medline as an example, the specific search strategy is shown in Table  age ≥ 18Two review authors Wang RN & Zheng XY according to the PICOs principle and inclusion exclusion criteria, independent retrieval and strict screening of literature are carried out. Studies ranked as irrelevant by both reviewers were excluded. In case of disagreement, it will be discussed and resolved. With a third (Gao J) resolving any disputes. Two review authors (Wang RN & Zheng XY) independently extracted data according to the data extraction form designed in advance, and then cross-checked the data, and checked the original text again to ensure the accuracy of data extraction.Content analysis was used to analyze the literature. A total of 1 462 articles were retrieved according to the inclusion and exclusion criteria, including 709 English articles and 753 Chinese articles. Endnote X8 software was used to remove 348 articles, read 1 114 articles' titles and abstracts, excluded 1 021 articles that did not meet the title, read 93 full texts, and included 20 articles. After snowballing the included articles, 24 articles –55 were Semi-structured, qualitative, in-depth interviews were conducted with eligible participants were in-patients who were initially diagnosed with oral cancer at a tertiary care hospital from March 2021 to May 2021. Purposive sampling was used to select patients who met the inclusion and exclusion criteria and were likely to provide rich information. The inclusion criteria were: (a) older than 18 years; (b) a Numerical Rating Scale (NRS) of at least 3 for chronic pain in the week prior to hospitalization; (c) undergoing a treatment plan of surgery; (d) having received a pathological diagnosis of oral cancer, coupled with an awareness of said diagnosis. Exclusion criteria included: (a) oral cancer recurrence or systemic metastases; (b) having a history of mental illness or currently taking psychiatric drugs; (c) having other diseases that cause pain; (d) being unable to communicate effectively due to disease or treatment; and (e) having previously participated in other research projects similarly.The sample size was based on the repeated occurrence of interviewees' data and no new information appearing in the data analysis. The data reached saturation when the 15th patient was interviewed in this study and no new topics appeared, so the sample size was 15.The interview schedule outlining which was based on the Common-Sense Model of Self-Regulation included (1) How do you feel about pain? ; (2) What do you think when you pain? ; (3) How do you deal with pain? ; (4) How do you feel about the effects of pain management? . The interviews lasted 20 to 40 min. Colaizzi’s 7-step analysis method was used to extract three themes covering ten sub-themes: Pain Cognitive Representations of Oral Cancer, Pain Emotional Representations of Oral Cancer, and Pain Coping Responses. The ten sub-themes include pain identity, pain consequences, pain attributions, pain timelines, pain controllability/curability, and pain coherence, negative emotions, good pain resilience: building a new self, insufficient pain self-management, poor medical interaction.The CPBMP draft was revised by Delphi technique to evaluate the importance and feasibility for pain management in patients with oral cancer. Intentional sampling method was adopted in this study to select experts in oral and maxillofacial medicine, oral radiotherapy, pain and psychology. The inclusion criteria of experts in this study were as follows: (a) working in hospitals or medical colleges; (b) bachelor degree or above, intermediate or above title; (c) Doctors or nurses who have worked in the field of oral and maxillofacial surgery/pain/oral cancer radiation therapy for more than 10 years, or psychologists who have held the national psychological consultant Level 2 or above certificate and have been practicing for more than 8 years.n = 10/ (1–10%) = 12 cases. Finally, 16 patients with oral cavity squamous cell carcinoma were recruited from the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University in August 2021 to January 2023. The inclusion criteria for patients were as follows: (a) inpatients diagnosed with oral cavity squamous cell carcinoma; (b) 18 years of age or older; (c) NRS score of 3 points or greater; (d) patients undergoing surgery and radiotherapy; (e) primary school education or above, good communication and understanding skills; (f) clear consciousness, volunteer to participate in this study.The feasibility of CPBMP was explored with a simple single-group pre- and post-trial and semi-structured in-depth interviews. According to the study , the app16 patients received CPBMP. The CPBMP is shown in Table The draft was evaluated by two rounds Delphi survey. The experts’ suggestions and opinions were collected by Expert Correspondence Questionnaire prepared according to the CPBMP draft content. The questionnaire was composed of four parts. The first part was the instructions of the questionnaire, including the content and purpose of the questionnaire, the requirements for filling in the questionnaire, the way to collect the questionnaire, the time and the acknowledgements. The second part is the questionnaire of basic information of experts, which mainly analyzes the authority degree of experts, involving the basic personal information such as profession, professional title and age. The third part was the main body of the questionnaire, which was mainly aimed at the importance and operability of each item in the pain management plan and revised. Each item was set up with a column of "modification opinions", so as to understand the modification opinions and relevant basis of experts for each item and improve the reliability of expert consultation. The fourth part is the expert judgment basis questionnaire and the familiarity degree questionnaire to understand the experts' familiarity with the content of this study questionnaire and the relevant judgment basis. According to the experts' preferences and actual situation, we choose to communicate with experts by face-to-face letter consultation and email.The authority of experts is expressed by the authority coefficient (Cr). The authority coefficient of experts is mainly determined by the familiarity of experts with the problem and the judgment basis of experts on the problem, which are expressed as Cs and Ca, respectively. (Cr) = (Ca + Cs)/2. It is generally believed that when the degree of expert authority (Cr) reaches 0.7 or above, the research results can be considered reliable and the research results are credible .The basic data of patients was collected by the pain files of oral cancer patients, which consists of the general information questionnaire and the pain file of patients at different treatment stages, Study measures included Numeric Rating Scale (NRS), Chinese version of Illness Perception Questionnaire-Revised for Cancer Pain (IPQ-CaCP), and the University of Washington Quality of Life assessment scale (UW-QOL), which were conducted by a trained full-time master of nursing graduate student within 24 h of admission (T1), 24 h before discharge (T2), 24 h after the end of radiotherapy (T3), and 1 month after the end of radiotherapy (T4).NRS is the most widely used single-dimension assessment scale . A straiThe questionnaire was translated by Guo Shuliu into a self-revised version of the Disease Cognition Questionnaire (IPQ-R) and the Disease Cognition Questionnaire for Slow Pain (IPQ-CP) , 60. It The scale consisted of two parts. The first part included 12 subjective evaluation items related to the disease, including vitality, pain, mood, shoulder function, appearance, anxiety, entertainment, saliva, taste, chewing, speech, and swallowing, which covered 12 problems that patients with head and neck cancer often faced in life. The second part contains three comprehensive questions; In addition, patients chose the items that they thought had the greatest impact on their life. According to the Likert scoring method, the scores of individual items range from 0(very poor) to 100(excellent), and the total score is the sum of each item /12. The score ranges from 0 to 100, and the higher the score, the better the recovery of the patient and the higher the quality of life . We usedThe semi-structured interview was used to understand the patients’ views on CPBMP after intervention. The interview outline includes (a) Do you think CPBMP can help you? Please be specific. (b) What do you think of the overall arrangement of the CPBMP? (c) What do you think are the shortcomings of the CPBMP? What improvements can be made?Data were analyzed using SPSS Statistics for Windows, version 24.0 (IBM Corp.). Descriptive statistics were used to describe demographic data. We used t-test to analyse the pain level, pain beliefs, and quality of life scores, before and after the intervention. The Shapiro–Wilk test was used to test the normality of the total score of patient outcomes and its dimension score before and after the intervention. If the measurement data follow a normal distribution and satisfy the homogeneity of variance, the t-test of two independent samples is used; If the normal distribution is not followed, the Mann–Whitney U-rank sum test is used. Qualitative content analysis was performed to analyse the qualitative data.Through literature research, it was found that the content and methods of pain education were diverse, focusing on the knowledge education of drug analgesia and non-drug analgesia and pain management barriers. The methods included offline oral education, pain knowledge manual education, video education, photo album education and education based on a certain media . Most studies used pain management manuals.The qualitative study also found that oral cancer patients generally had negative pain beliefs, but there were still positive pain beliefs. It is suggested that medical staff should pay attention to the existence of patients' pain beliefs in clinical work, especially the influence of negative beliefs, and take pain acceptance as the entry point to carry out systematic and effective pain management, so that patients' pain control can achieve the desired effect.However, no pain management scheme based on a complete theoretical framework has been constructed, and Yang’s studY  showEd tA total of 15 specialists were included, including 7 cancer care specialists, 2 pain care specialists, 1 pain specialist, 1 psychotherapist, and 4 oral and maxillofacial surgery specialists. The result of experts’ demographic characteristics is shown in Table 16 patients finished the intervention. The oral cancer patients ranged in age from 32 to 74, with an average age of (53.00 ± 13.09) years. The demographic of the sample is shown in Table The expert authority coefficient value was 0.75 in the first round of the Delphi survey and 0.78 in the second round.Deleted “Start from value”.Patients usually only have intuitive feelings or superficial cognition of diseases or symptoms, and it is difficult to raise their cognition to the level of value. .Added “Focus on pain automatic thinking”.Intervention with pain beliefs should probably be gradual and therefore added “Focus on pain automatic thinking”. (expert 6).Merged Items with Overlapping Content.The contents of “Think rationally about analgesics” “Understand oral cancer and cancer pain”, and “Avoid cognitive misunderstanding” were overlapped. (expert 12) Considering the slight differences in emphasis and operability of the items, they were merged into “Understanding pain to avoid cognitive misunderstanding” and “Rational view of analgesics”.In the second round, the experts made no recommendations. We collated and analyzed the data, combined the entry screening threshold value method, and finally did not make any changes.The pain intense, pain beliefs, and quality of life scores for the 16 patients see Fig. , Fig. 5Ft = -3.746, p < 0.001). The average negative pain beliefs score decreased from 140.63 ± 9.02 to 52.75 ± 7.27 . The average positive pain beliefs score increased from 55.13 ± 4.54 to 66.00 ± 4.70 . The average quality of life score increased from 66.97 ± 15.01 to 86.69 ± 8.42 .The average pain intense score at pre- and post-testing decreased from 5.63 ± 0.48 to 0.81 ± 0.54 : “There is a lot of content in this booklet, which is what we want to know. It also teaches us how to accept the pain, which is good, and learning knowledge, and not so painful, the whole person becomes better.”Patients could accept the overall arrangement of the CPBMP, which was reasonable and meaningful. (Participant 5): “The overall arrangement is quite good, it includes pictures, audios, pamphlets, I think it’s quite good. I always felt boring after being sick, there’s nothing to do at home, so I like the intervention. It’s relaxing to practice, and doesn't take a long time.” (Participant 8): “It is simple, and don’t need me to do something complex. I just scan the two-dimensional code to listen to it. I felt quite relaxed. It takes my mind off things and helps me fall asleep faster.”During and after the intervention, the feedback and suggestions of the patients on the CPBMP were obtained. They thought that the number of interventions could be appropriately reduced. (Participant 2): “There’s so many practices that sometimes we don’t have time to do this.” Patients suggested cancelling the questionnaire filling within 24 h of radiotherapy hospitalization to reduce bias. (Participant 7): “I did the questionnaire after surgery, and then went to the radiotherapy department to do it again after half a month’s rest. In fact, I still remember what I filled in last time. I think the interval is too short. I advise that we should cancel the questionnaire filling within 24 h of radiotherapy hospitalization.” After discission with our research team, we didn’t have to accept the advice, because the questionnaire filling was for measurement of the efficacy of the intervention but not the content of CPBMP.The oral cavity is an important functional part of the body, the distribution of blood vessels and nerves is rich, and the feeling is more sensitive. Therefore, oral cancer patients often suffer from severe chronic pain . In the Pain assessment is the basis of pain management. We help patients to establish a pain file in order to fully and dynamically understand the patient’s pain and ensure the development of pain management. We modify the patients’ pain beliefs through belief revision exercises, so as to improve the patients’ acceptance of pain and treat pain with a non-judgmental attitude, thus reducing the level of pain perception, effectively relieve pain and unpleasant emotions caused by pain, and make patients calmer. “Understand pain to avoid cognitive misunderstanding”, and “Accept pain” reflect the importance of paying attention to the beliefs and behaviors of patients with oral cancer pain, and enrich the belief research in the nursing field. CPBMP provides a variety of practice skills for pain acceptance, which is convenient for patients to practice according to their actual situation. In order to meet the continuity of patients’ health management needs, the plan cycle was extended from preoperative to one month after the standardized treatment of oral cancer to achieve the integrity of the management plan and improve the effectiveness and satisfaction of patients’ pain management.Our findings support the acceptability of intervention. In the initial intervention phase, 18 entered the recruitment, and of those, 16 completed the intervention. Two participants withdrew; one due to not receiving postoperative radiotherapy, one owing to refused surgical treatment. The rejection rate of 2/18 (11.1%) may have resulted from the common phenomenon of most patients’ treatment decision-making dilemmas, rather than the attitude and beliefs of pain. During the intervention phase, patients agreed with CPBMP, and believed that CPBMP intervention could help them, reduce their pain, and regulate their own state. Patients could accept the overall arrangement of the CPBMP, which was reasonable and meaningful. In the CPBMP intervention, the Acceptance of Pain manual introduced the main content of each intervention module in simple language and related pictures, provided knowledge related to oral cancer and pain, which was convenient for the study subjects to understand their own disease condition, and helped the intervener to connect and transform different intervention modules. The omission of intervention content and the diversion of topics by the subjects were avoided. At the same time, it is also conducive to the research object to recall the intervention content, correct their bad cognition, regulate the negative emotions and effects caused by pain, and carry out pain self-management, thereby improving the acceptability of CPBMP intervention.The selection of experts and the number of experts is the key to Delphi method. The research subject determines the selection of experts, the number of experts depends on the research scale, and the accuracy of evaluation and prediction improves with the increase of the number of experts . It is gThe results of this study showed that the pain level, pain beliefs, and the quality of life of patients improved after CPBMP intervention, and the difference was statistically significant. Pain belief modification intervention can improve the negative pain beliefs of patients, promote the positive pain beliefs, and reduce the pain intensity. It may be related to the following reasons. Firstly, our study uses the pain acceptance technique to modify and repair individual beliefs and belief systems to improve the pain level of patients. Researchers ask and question the unreasonable pain beliefs of patients with oral cancer to make them realize the unreasonable of their own cognition and think repeatedly. Secondly, we draw lessons from the acceptance commitment therapy (ACT) concept, encourage patients to practice the relevant techniques of acceptance of pain, and hold a non-evaluation attitude towards pain to improve the pain level of patients. Acceptance refers to the willingness of individuals to stay in contact with their own physical feelings, thoughts, and emotions without evaluating, following, avoiding, or changing them . StudiesThis study has several limitations to consider. First, our sample size for the feasibility study is small. We chose 16 oral cancer patients for our study. Second, the time for follow-up is short. However, the main aim of our study was to develop the CPBMP and initially assess its feasibility in the target population, rather than to confirm its efficacy. To confirm its perceived value and further efficacy for oral cancer patients, we will conduct a rigorous RCT with a much larger sample size.This study developed a Cancer Pain Belief Modification Program for patients with oral cancer in China within the framework of the Common-Sense Model of Self-Regulation. A feasibility study was explored to confirm the acceptability of CPBMP. To the best of the authors' knowledge, this is the first study focusing on pain beliefs intervention in patients with oral cancer. It can provide ideas for the pain management of cancer patients.Wang RN completed the study design with Gao J and Zheng XY. Su XX conducted data analysis and Huang XY. interpreted results. Wang RN, Liu HJ and Guo YL contributed to data collection. The manuscript was drafted by Wang RN and edited and approved by Gao J. The author(s) read and approved the final manuscript.