Pain Management Nursing最新文献

{"title":"Validity, Diagnostic Accuracy and Clinical Utility of Persian CPOT-Neuro in Brain-Injured Patients.","authors":"Melika Kavyanicherati, Saeed Barzegari, Hamid Sharif-Nia, Roghieh Nazari","doi":"10.1016/j.pmn.2026.03.019","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.03.019","url":null,"abstract":"<p><strong>Purpose: </strong>Effective pain management in intensive care units (ICUs) is essential, particularly for braininjured patients who are often unable to self-report pain. This study aimed to translate, culturally adapt, and validate the Persian version of the Critical Pain Observational Tool-Neuro (CPOT-Neuro) in braininjured patients and evaluate its diagnostic accuracy and clinical utility.</p><p><strong>Design: </strong>Prospective diagnostic accuracy.</p><p><strong>Methods: </strong>This study was conducted in northern Iran from 2023 to 2024. After translating and culturally adapting the CPOT-Neuro, its reliability was assessed via inter-rater and intra-rater agreement. Discriminative validity was evaluated by enrolling 132 brain-injured patients and comparing CPOT-Neuro scores before, during, and after nociceptive and non-nociceptive procedures. Criterion validity was evaluated by correlating CPOT-Neuro scores with patients' self-reported pain (when communicable). Diagnostic accuracy was examined using receiver operating characteristic (ROC) curve analysis, and clinical utility calculated using Mitchell's formula.</p><p><strong>Results: </strong>A strong positive correlation was observed between self-reported pain and CPOT-Neuro scores during nociceptive procedures (rs = 0.79, p < 0.001). The CPOT-Neuro demonstrated excellent discriminative validity, with significantly higher scores during nociceptive procedures versus rest periods (Wilcoxon Z = -9.43, p < 0.001). Inter-rater reliability during nociceptive procedures (ICC [2,1] = 0.87, 95% CI [0.69-0.95] p < 0.001) and intra-rater reliability (ICC[3,1] = 0.90, 95% CI [0.76-0.96] p < 0.001) were excellent. The Persian CPOT-Neuro revealed AUCs of 0.85 (cutoff ≥1: 94% sensitivity, 62% specificity), 0.89 (cutoff ≥3: 73% sensitivity, 91% specificity), and 0.94 (cutoff ≥5: 62% sensitivity, 98% specificity), establishing reliable cutoffs for pain-free, mild, and moderate pain identification. Positive clinical utility of Persian CPOT-Neuro for pain detection was excellent (0.85), while negative clinical utility was poor (0.48).</p><p><strong>Conclusions: </strong>The Persian CPOT-Neuro demonstrates strong validity, reliability, diagnostic accuracy, andexcellent positive clinical utility for pain assessment in brain-injured patients, though it's negative clinical utility is limited. It is a promising tool for pain diagnosis in this population. The poor negative clinical utility suggests that a score below the cutoff should not be used in isolation to rule out pain, emphasizing the need for continued clinical vigilance.</p><p><strong>Implications for clinical practice: </strong>By embedding CPOT-Neuro into routine ICU workflows, nurses can advance evidence-based, patient-centered care and mitigate the adverse outcomes of unrelieved pain in this vulnerable population.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Reality for Dual Relief of Pain and Sleep Disturbance in Burn Patients: A Randomized Clinical Trial.","authors":"Rasool Paygozar, Noorollah Tahery, Farshid Mohammad Mousaei","doi":"10.1016/j.pmn.2026.02.003","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.02.003","url":null,"abstract":"<p><strong>Purpose: </strong>Pain during dressing changes and sleep disturbances are among the most distressing challenges faced by burn patients, profoundly affecting recovery and quality of life. This randomized controlled trial examined the efficacy of virtual reality (VR) as a nonpharmacological intervention for alleviating procedural pain and improving sleep quality in patients with 25%-60% total body surface area burns.</p><p><strong>Design: </strong>Single-center, parallel-group, randomized controlled trial.</p><p><strong>Methods: </strong>Sixty patients admitted to Taleghani Burn and Trauma Hospital in Ahvaz were randomly assigned to a VR group (n = 30) or a control group (n = 30). The VR group received immersive virtual reality distraction during dressing changes, while the control group received standard care. Pain intensity was measured using the visual analog scale (VAS) before and immediately after the procedure, and sleep quality was assessed via the Pittsburgh Sleep Quality Index (PSQI) at baseline and 24 hours postintervention.</p><p><strong>Results: </strong>The VR group showed dramatic improvement in sleep quality (PSQI: 18.63 ± 1.25 → 11.37 ± 1.59; Δ = -7.27 ± 1.68) and significant pain reduction (VAS: 8.73 ± 0.64 → 7.33 ± 0.71; Δ= -1.40 ± 0.86). In contrast, the control group showed no meaningful improvement. Between-group differences in change scores were highly significant (p < .001 for both outcomes).</p><p><strong>Conclusions: </strong>VR is a highly effective, nonpharmacological intervention that concurrently alleviates procedural pain and improves global sleep quality in burn patients.</p><p><strong>Clinical implications: </strong>The magnitude of sleep improvement exceeds the minimal clinically important difference (MCID = 2-3), supporting VR's integration into standard burn care protocols as a safe, nonpharmacological adjunct.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Pain Neuroscience Education and Progressive Muscle Relaxation for Post-Thoracoscopic Pain.","authors":"Xueqin Wang, Wenyan Li, Fan Wang, Yang Liu, Qing Zhao, Jinchun Liu, Yu Zhu","doi":"10.1016/j.pmn.2026.03.024","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.03.024","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study was to evaluate whether combining pain neuroscience education (PNE) with progressive muscle relaxation (PMR) could reduce acute pain after thoracoscopic lung resection, alleviate psychological distress, and decrease rescue analgesic use.</p><p><strong>Methods: </strong>In this randomized controlled trial, 58 patients were allocated to either an experimental group (PNE + PMR) or a control group (conventional treatment). Postoperative pain intensity, central sensitization, pain catastrophizing, quality of recovery, and rescue analgesic use were assessed and compared between groups.</p><p><strong>Results: </strong>Baseline demographic characteristics did not differ significantly between groups. Compared with controls, patients in the experimental group reported lower postoperative pain, reduced central sensitization and pain catastrophizing, and less frequent use of rescue analgesics. No significant differences in overall recovery quality were observed.</p><p><strong>Conclusion: </strong>PNE combined with PMR is a feasible non-pharmacological strategy within multimodal analgesia protocols. This approach may enhance perioperative pain control and psychological well-being while reducing reliance on opioids, thereby contributing to improved patient outcomes.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain and Cognitive Frailty in Chinese Elders: Mediation by Daily Living Activities.","authors":"Xiaoyan Li, Xinru Wang, Junpeng Li, Qinghua Zhu, Songyi Li, Zhihua Shi, Yanyan Zhu, Sha Sha, Lili Ji","doi":"10.1016/j.pmn.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.04.001","url":null,"abstract":"<p><strong>Background: </strong>Pain is highly prevalent among older adults and represents a significant risk factor for cognitive frailty, but the underlying mechanism remains insufficiently understood.</p><p><strong>Objective: </strong>To examine the mediating effects of basic, instrumental, and advanced activities of daily living (ADL) in the relationship between pain and cognitive frailty in community-dwelling older adults.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 710 Chinese adults aged 60 and above. Pain was measured using the Revised Faces Pain Scale. Cognitive frailty, defined by the FRAIL scale, subjective cognitive decline, and Short Portable Mental Status Questionnaire, was subclassified into reversible cognitive frailty (RCF) and potentially RCF (PRCF) subtypes. Katz Index for basic ADL, the Lawton Scale for instrumental ADL, and the advanced ADL scale (AADL). Parallel mediation models were tested using logistic regression, Z-test, and bootstrapping, while adjusting for covariates.</p><p><strong>Results: </strong>Pain was significantly associated with both subtypes of cognitive frailty (RCF: OR = 3.75, 95% CI [2.36, 5.97]; PRCF: OR = 7.60, 95% CI [4.10, 14.06]). AADL, rather than basic ADL and instrumental ADL, partially mediated this association for both RCF and PRCF. Both the Z-test and bootstrapping method confirmed the indirect effect (estimate = 0.316, SE = 0.095, 95% CI [0.157, 0.533]).</p><p><strong>Conclusions: </strong>AADL played a key mediating role in the link between pain and cognitive frailty. Interventions targeting AADL may be crucial for preventing cognitive frailty in older adults experiencing pain.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Challenges of Artificial Intelligence in Scholarly Writing.","authors":"Elaine L Miller, Cecile Evans","doi":"10.1016/j.pmn.2026.04.003","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.04.003","url":null,"abstract":"","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a Nurse-Led Telehealth Aftercare Program on Pain and Physical Role Functioning of Adult Burn Survivors: A Randomized Controlled Trial.","authors":"Jonathan Bayuo, Frances Kam Yuet Wong, Loretta Yuet Foon Chung","doi":"10.1016/j.pmn.2026.03.021","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.03.021","url":null,"abstract":"<p><strong>Background: </strong>Burn-related pain remains a significant global health issue that is often challenging to manage. It becomes more complex once a patient with burns is discharged but is unable to return to use available medical review services because of long travel distances and/or financial constraints. Poorly managed pain can adversely impact on the burn survivor's physical performance capacity, leading to poor recovery outcomes. In response to these critical gaps, this study examined the effects of a nurse-led telehealth aftercare program on pain and physical role functioning outcomes of adult burn survivors.</p><p><strong>Design: </strong>A randomized controlled trial approach was used.</p><p><strong>Methods: </strong>Sixty adult burn survivors were assigned randomly to intervention and control groups. Adult burn survivors in the intervention arm received the telehealth program via WeChat for 8 weeks. To ascertain the sustained effects of the intervention, a 4-week period was included. Data were obtained at three time points: baseline (T0), postintervention (T1), and follow-up (T2). The generalized estimating equation was used as the main statistical analytical test with a Bonferroni corrected p value of .017.</p><p><strong>Results: </strong>The participants included 48 men and 12 women with a mean age of 37.88 years. Pain intensity demonstrated time and group effects, but not interaction effects, at T1 and T2. Pain interference showed a statistically significant interaction effect at T2 only. Physical role functioning showed improvement at both T1 and T2.</p><p><strong>Conclusions: </strong>This study provides evidence regarding the impact of aftercare support and the possibility of delivering such innovative programs via telehealth. Further work is warranted to integrate aftercare support in the burn-management process.</p><p><strong>Clinical implications: </strong>Considering the long-standing nature of post-burn sequelae, ongoing aftercare support is crucial to supporting burn survivors on their recovery journey. Delivering aftercare support via telehealth is possible and potentially safe.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Buzzy^Ⓡ and Pikluc^Ⓡ for Pain Relief in Pediatric Intramuscular Injections: A Randomized Equivalence Trial.","authors":"Jefferson Wildes da Silva Moura, Mari Takashima, Sabrina de Souza, Thiago Lopes Silva, Aline de Souza Bitencourt, Kaili da Silva Medeiros, Henrik Hjelmgren, Luciano Marques Dos Santos, Amanda Ullman, Patrícia Kuerten Rocha","doi":"10.1016/j.pmn.2026.03.016","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.03.016","url":null,"abstract":"<p><strong>Objective: </strong>To compare three devices: Buzzy^Ⓡ 15 seconds (intervention 1), Pikluc^Ⓡ (intervention 2) and Buzzy^Ⓡ 30 seconds (control group) for non-pharmacological, non-invasive pain relief in children during intramuscular injections.</p><p><strong>Method: </strong>This was a three-arm, non-masked, parallel-group, randomized equivalence clinical trial in children aged 1-11 years (stratified by: 1-3 and 4-11 years) at two Brazilian Pediatric Emergency Units. The primary outcome is pain, measured by observer-reported pain using the Face, Legs, Activity, Cry, Consolability Scale for children aged 1-3 years and by self-reported pain using the Faces Pain Scale - Revised for children aged 4-11 years. The secondary outcome is pain (parent- and observer-reported) and distress. The study is registered in the Brazilian Clinical Trials Registry under the number RBR-57m3wnw.</p><p><strong>Results: </strong>Of 170 participants, 54 were allocated intervention 1, 60 intervention 2, 56 control group. For ages 1-3 years, all comparisons were equivalent: Pikluc^Ⓡ vs. Buzzy^Ⓡ 30 seconds (mean score difference [MSD] -0.457; 95% CI: -1.191, 0.277), Buzzy^Ⓡ 15 seconds vs. Pikluc^Ⓡ (MSD 0.296; 95% CI: -0.438, 1.030), and Buzzy^Ⓡ 15 seconds vs. Buzzy^Ⓡ 30 seconds (MSD -0.161; 95% CI: -0.912, 0.590). For ages 4-11 years, the primary outcome (self-reported pain) did not show equivalence for any comparison, while observer-reported assessments (secondary outcomes) suggested equivalence for Pikluc^Ⓡ vs. Buzzy^Ⓡ 30 seconds and for Buzzy^Ⓡ 15 seconds vs. Buzzy^Ⓡ 30 seconds.</p><p><strong>Conclusions: </strong>In children aged 1-3 years, equivalent pain relief was shown across all devices during intramuscular injections. For children aged 4-11 years, there were inconsistencies between observer, parent and self-reported assessments.</p><p><strong>Clinical implications: </strong>For children aged 1-3 years, both Pikluc^Ⓡ and Buzzy^Ⓡ devices can be used during intramuscular injections, with Pikluc^Ⓡ offering immediate application and Buzzy^Ⓡ 15 seconds showing similar effects to 30 seconds application.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Perception and Satisfaction with Cancer-Related Pain Management in Patients and Family Caregivers.","authors":"Ching-Hui Cheng, Hui-Chin Lin, Shu-Yuan Liang","doi":"10.1016/j.pmn.2026.03.023","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.03.023","url":null,"abstract":"<p><strong>Background: </strong>Family members play a crucial role in the care of patients with cancer. Ensuring consistency between the perceptions of patients and their family members regarding pain and its treatment outcomes facilitates the administration of analgesics by the family members at home, thereby influencing the effectiveness of pain management.</p><p><strong>Purpose: </strong>This study explored the perceptions of patients with cancer and their primary family caregivers toward cancer-related pain and satisfaction with pain management. It examined the differences between patients and family members in terms of pain perception, pain relief, pain interference, and satisfaction with pain management.</p><p><strong>Methods: </strong>In this cross-sectional comparative study, convenience sampling was used to recruit 40 dyads of patients with cancer-related pain and their primary family caregivers from the inpatient wards of an oncology medical center. The main research instruments used were the Short-Form Brief Pain Inventory and the American Pain Society Patient Outcome Questionnaire.</p><p><strong>Results: </strong>Significant differences were observed between patients and family members in terms of the perceptions of least pain (t = -5.20, p < .001), pain at the time of interview (t = -5.57, p < .001), average pain (t = -2.50, p < .05), and pain interference (t = -4.21, p < .001), with family members consistently reporting higher levels of pain. No significant differences were observed in terms of satisfaction with pain management provided by nurses (p > .05) or physicians (p > .05).</p><p><strong>Conclusion: </strong>Pain is a subjective experience. In home care settings, family members may overestimate the patient's level of pain and pain interference.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nurse-Led Pain Service After Major Abdominal Surgery.","authors":"Josephine Zachodnik, Marianne Krogsgaard, Anja Geisler","doi":"10.1016/j.pmn.2026.03.018","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.03.018","url":null,"abstract":"<p><strong>Purpose: </strong>This project aimed to improve epidural catheter (EC) utilization, reduce opioids, and enhance postoperative outcomes through bedside education facilitated by a nurse-led pain service within the standardized emergency abdominal surgery program.</p><p><strong>Design: </strong>This is a nurse-led, single-group, post-test-only quality-improvement project. A specialized pain nurse provided daily ward visits, including targeted education for staff caring for OMEGA patients with an EC. Data was collected from October 2019 to November 2020. Outcomes included: the proportion of patients achieving adequate pain control Numeric Rating Scale (NRS ≤3) on postoperative days (POD) 1-5, daily use of analgesics, mobilization, side effects, and length of stay.</p><p><strong>Results: </strong>A total of 110 patients were included. Adequate pain control was achieved in 76%-94% of patients at rest and 76%-82% during mobilization (POD 1-5). Median opioid consumption remained low (POD 0: 10 mg IV morphine equivalents; POD 1-5: 0-6.7 mg). EC use declined postoperatively (POD 1: 95%; POD 5: 10%). Mobilization rates increased progressively (POD 1: 64%; POD 5: 91%). A few opioid-related side effects were detected. The median length of stay was 6 days.</p><p><strong>Conclusion: </strong>This nurse-led quality improvement project describes the implementation of a structured, nurse-led pain service for patients undergoing major emergency abdominal surgery. The project provides descriptive insight into postoperative pain management practices, including epidural catheter management, opioid use, and mobilization, and highlights variability in adherence to the multimodal analgesic regimen.</p><p><strong>Clinical implications: </strong>The findings underscore the importance of structured support and targeted education for surgical ward nurses involved in epidural catheter management and postoperative pain care. Strengthening nursing competencies and implementation support may contribute to more consistent application of multimodal pain management practices in emergency surgical settings.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Hypoglycemia Associated With High-Dose Methadone in a Patient With ESRD: A Case Report and Review.","authors":"Jay Patel, Emily Tyler, Jesse Burton, Khusi Patel","doi":"10.1016/j.pmn.2026.03.020","DOIUrl":"https://doi.org/10.1016/j.pmn.2026.03.020","url":null,"abstract":"<p><p>Methadone is a synthetic opioid widely used in addiction medicine and pain management. Although effective, high-dose methadone has been associated with rare but clinically significant hypoglycemia. This case report describes a 49-year-old man with end-stage renal disease (ESRD) on hemodialysis who developed severe hypoglycemia while receiving high-dose methadone. Laboratory evaluation was consistent with endogenous hyperinsulinemia. Upon dose reduction, hypoglycemic episodes resolved without recurrence. This report highlights the need for cautious dosing and routine glucose monitoring in patients receiving moderate to high methadone doses, particularly those with renal impairment or other risk factors.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}