Bangladesh Journal of Pain

Effectiveness of Essential Pain Management Programme in Improving Knowledge of Pain Management among Health Care Staff in Bangladesh

Md Mostafa Kamal — 2025-06-30

Background: Lack of knowledge is a major contributing factor of inadequate pain management. Training and pain education of health care staff could play pivotal role in improving knowledge in the assessment and management of pain. The Bangladesh Society for Study of Pain (BSSP), with support from the Australian and New Zealand College of Anaesthetists (ANZCA) and Interplast has been conducting essential pain management (EPM) courses in the country since 2013. The main objective of this study was to evaluate the effectiveness of EPM program in improving health care staffs’ knowledge toward pain management.
Methods: This mixed method study reviewed EPM databases to identify the participants who attended this programme from January to July, 2024. Participants who completed both pre and post-course questionnaires were selected to determine the knowledge gained through EPM workshop. They were also interviewed to explore the utilization of knowledge and perception of the importance of the workshop. The results were presented using tables and/or figures.
Results: A total of 59 participants were included in this study with a response rate of 93.6%. About 75% of the respondents were doctors of different disciplines. More than half (62.7%) had a post-graduate qualification comprising a diploma and master’s degree. The majority of the participants (76.3%) declared that they hadn’t attended any training before EPM. The average mean pre-test and post-test scores were 18.35±1.21 and 22.46±1.38, respectively. The knowledge score increased by about 16% from the pre-test to the post-test score. Nearly all respondents (97%) stated that the workshop helped them in their workplace and 60% of the participants used the knowledge in their daily practice. Most (86.4%) respondents affirmed that the EPM workshop enhanced their knowledge, skills, and confidence in managing patients.
Conclusion: The EPM programme is found to be an effective method of improving knowledge regarding pain management. It has a positive impact on enhancing the confidence and skills of the doctors and nurses which will improve the pain management practice in Bangladesh.

Clinical Safety and Efficacy of Zoledronic Acid in the Treatment of Osteoporosis: A Retrospective Study

Nasreen Boby — 2025-06-30

Background: Zoledronic acid and denosumab now a days represent the most potent antiresorptive agents for the prevention and treatment of osteoporosis. Although same effects on bone resorption, these agents have distinct mechanisms of action. The aim of this study was to evaluate and compare the clinical safety and efficacy of zoledronic acid and denosumab in the treatment of osteoporosis.
Methods: This retrospective study included 385 patients with osteoporosis treated at Dhaka Specialized Pain Management & Research Center Ltd., Bangladesh between January 2023 and December 2024. Patients were divided into two groups. In one group, 294 patients received intravenous zoledronic acid and in another group 91 patients received subcutaneous denosumab. All patients were routinely followed up for up to 12 months. These patients were also monitored for drug-related adverse effects and pain relief after drug administration.
Results: In this study, the mean age of the patients was 57.1±11.8 and most of the patients were female (76.1%). The mean BMI was 23.5±3.1 kg/m2. The baseline BMD in spine T score found -2.51±1.31. The baseline VAS scores were 7.9 ± 1.1 and 7.1 ± 1.3, in zoledronic acid and denosumab group, respectively. After 1 year, the reduction in pain was statistically significant in both groups (p < 0.001), but pain relief was more pronounced in the zoledronic acid group. Both groups experienced mild and self-limiting adverse effects. Flu-like symptoms like fever (95%), myalgia (60%), and headache (5%) were more common in the zoledronic
acid group.
Conclusion: Zoledronic acid is a safe and effective treatment agent for osteoporosis and may offer better pain control compared to denosumab.

Adoption of New Scoring System (PConPUP) for the Timing of Epidural Bolus Dose during the Second Stage of Labour

Afsana Ferdousy — 2025-06-30

Background: Labour epidural analgesia is considered the gold standard technique for relieving labour pain. The impact of epidural analgesia on the second stage of labour considering the progress and outcome is a great concern. The timing of the epidural bolus during the second stage is controversial. This study aimed to evaluate the effectiveness of a new three-point scoring system (PConPUP) to determine the timing of epidural bolus at the second stage of labour.
Methods: This observational study was carried out at the Department of Obstetrics and Gynaecology of Bangladesh Medical University (BMU) and Mohammadpur Fertility Services and Training Centre (MFSTC), Dhaka. Parturients aging 19-35 years, full term (> 37weeks), and cervical dilatation ≥4 cm were included. They were received an epidural bolus dose of 12 ml levobupivacaine-fentanyl (0.1%) when at least two major criteria reached score 2 along with rest criteria score 1 or a total score ≥8. The quality of analgesia, mode of delivery, maternal haemodynamics, and APGAR score were documented.
Result: A total of 44 patients were selected for this study. The average age was 24.69 ± 6.39 years, BMI was 24.42 ± 3.61 Kg/m2, and Gestational age was 38.44±0.23 weeks. Before epidural bolus, cervical dilation was 4.68±0.51 cm, pulse 90.0±1.34 beats/min, SBP 121.90±7.83 mmHg, DBP 74.45±6.09 mmHg, fetal heart rate 137.51±3.61 beats/min, and VAS score was 6.97±1.14. After epidural bolus, VAS score was reduced to 2.15±0.25 and no change of haemodynamics was observed. All parturients gave birth through vaginal delivery, only 6 (14%) needed instrumental delivery. APGAR score of the baby at the 1st and 5th minute were good.
Conclusion: This new scoring system (PConPUP) can be used as a tool to determine the timing of epidural bolus during the second stage of labour.

Outcome of PRP with Radiofrequency Ablation of Genicular Nerve for Grade III Knee Osteoarthritis

Afroza Akter — 2025-06-30

Background: Knee osteoarthritis (OA) is a common problem in middle-aged and elderly patients. There are many non-surgical treatment modalities, including physical therapy and rehabilitation, NSAIDs, intra-articular steroids, hyaluronic acid and platelet rich plasma (PRP). Radiofrequency ablation of the genicular nerve is a new and innovative treatment option for advanced knee OA that has the capacity to decrease pain, improve function, and improve quality of life. This study aimed to observe the outcome of PRP with radiofrequency ablation (RFA) of genicular nerve in advanced knee OA.
Methods: This observational study was carried out at the Dhaka Pain Management and Research Centre. Patients with grade III osteoarthritis who received PRP with radiofrequency ablation of the genicular nerve from January 2023 to December 2024 and completed 12 months of follow-up were included in this study. The primary outcome was to assess the intensity of pain by visual analog scale (VAS) before intervention, after one week, 1, 3, 6, and 12 months. The secondary outcome was to assess functional capacity using the International Knee Documentation Committee (IKDC) scale before intervention, at 1, 3, 6, and 12 months after intervention.
Results: A total of 50 patients were included in this study. The sociodemographic characteristics depicted that the mean age of the patients was 56.2±4.94 years, 36 (72%) patients were female, and the mean BMI was 25.4±2.35 kg/m2. The VAS score and IKDC score before the procedure were 6.60±0.70 and 34.02±4.52, respectively. After receiving PRP and RFA of the genicular nerve, reduction of pain intensity and improvement of functional status were observed. No complications were documented during and after interventions.
Conclusion: PRP with RFA of genicular nerve reduces pain intensity and improve functional status in patients with advanced knee OA. It could be a potential non-surgical alternative for the management of advance knee OA.

Outcome of Multimodal Preemptive Analgesic with Intravenous Paracetamol, Tramadol and Lignocaine Combination on Postoperative Analgesia

Md. Sharif Hossain — 2025-06-30

Background: Post-operative pain management is very important as it is a critical component of perioperative outcomes in different surgeries. Till now, opioid is the only drug used widely, but there are side effects like respiratory depression and longer hospital stays. Preemptive multimodal analgesia may reduce the perioperative analgesic dose and side effects. This study aimed to investigate the effect of preemptive intravenous paracetamol, tramadol, and lignocaine combination on postoperative analgesia.
Methods: This observational study was carried out in the Department of Anaesthesia, Intensive Care and Pain Medicine, Shaheed Suhrawardy Medical College, Dhaka. Patients aged 18-65 years with with ASA-I and ASA-II scheduled for general anesthesia for various surgery were included. All study participants were infused a combination of 15 mg/kg intravenous paracetamol, tramadol 50 mg, and 40 mg lignocaine 10 minutes before surgery. The hemodynamic status, post-operative analgesic consumption, duration of analgesia and any adverse effects were documented.
Results: A total of 60 patients were enrolled in this study. The mean age was 41.5 ± 11.8 years, and the male-to-female ratio was 1:1.8. The average duration of surgery was 83.60± 11.38 minutes. Approximately 35 (58.3%) patients required pethidine at different time periods during the postoperative period. The average total dose was 70.85±12.68 mg. The mean duration of post-operative analgesia was 6.40± 2.38 hours. The hemodynamic status was within the physiological limit during the perioperative period. There were fewer side effects recorded in the post-operative period.
Conclusion: Preemptive multimodal analgesia with a combination of intravenous paracetamol, tramadol and lignocaine is effective in patients undergoing different surgeries under general anaesthesia.

Complex Regional Pain Syndrome (CRPS) Following Distal Radius Fracture and Plaster Immobilization: A Case Report and Review of Literature

Nasreen Boby — 2025-06-30

Complex Regional Pain Syndrome (CRPS) is a rare disorder which may arise after injury to extremities or surgery. It is most commonly associated with fracture followed by immobilization by plaster cast. Our case was a 51-year-old woman who developed CRPS after a distal radius fracture treated with plaster immobilization for three weeks. She presented in pain clinic with persistent pain, swelling, abnormally sweaty and restriction of movement in her left wrist and forearm but showed no signs of allodynia and hyperalgesia. After proper clinical examination her signs and symptoms met Budapest criteria and she was diagnosed as a case of CRPS. Treatment started with multidisciplinary approach- including medication, physiotherapy and cognitive behavioral therapy. On follow-up after 3months, pain and swelling appears within normal limits but she was showing signs of carpal tunnel syndrome or compartment syndrome. Ultrasound of left wrist performed and found median nerve swelling. Then intervention ultrasound guided median nerve hydro dissection was done. This case study highlights the importance of prompt diagnosis and timely initiation of treatment of CRPS following fractures to reduce chronic pain and minimize functional disability.

The Expanding Role of Ultrasound in Pain: A Paradigm Shift from Diagnosis to Treatment

Tolga Ergönenç — 2025-06-30

Ultrasound technology has brought significant progress to pain management in the last twenty years. The development of transducer technology since then has led to a transformation in our ability to view superficial structures with unmatched precision. The advantage of ultrasound in pain medicine stems from its unique combination of advantages that no other imaging modality can match. The real-time imaging capabilities of ultrasound distinguish it from static imaging methods, including MRI and Computed Tomography (CT), because they provide dynamic examination possibilities. Healthcare providers operating in developing nations must consider the core worth of ultrasound technology because it delivers sophisticated imaging solutions that work without MRI or CT equipment. The delivery of high-quality patient care requires standardized training protocols and competency evaluation systems, and quality measurement tools for ultrasound in pain medicine. The implementation of ultrasound technology in pain medicine leads to a total transformation of healthcare delivery, as it establishes an efficient and accessible system for integrated pain management.