Efficacy of aromatherapy for reducing pain during labor: a randomized controlled trial.

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Tanvisut, Rajavadi; Traisrisilp, Kuntharee; Tongsong, Theera

2018-05-01

Many strategies for labor pain management have been studied, including aromatherapy, which is a noninvasive, alternative medicine used as an adjunct for labor pain control. Nevertheless, the results were contradictory. Therefore, we conducted this study to determine the effectiveness of aromatherapy for reducing pain during labor. A randomized controlled trial was carried out on Thai laboring primigravidae who were a low-risk singleton pregnancy undergoing vaginal delivery. All participants, both study and control group, received standard obstetric care. Aromatherapy was only provided to the study group during the first stage of labor. The women rated their pain intensity by rating scales at different stages of labor. The primary outcome was pain scores and the secondary outcomes were necessity of painkiller usage, labor time, aromatherapy-associated complications, route of delivery, and Apgar scores. A total of 104 women were recruited, 52 in each group. Baseline characteristics and baseline pain scores were comparable. The median pain score of latent and early active phase was lower in the aromatherapy group, 5 vs 6 and 7 vs 8, respectively. The mean differences of pain scores between latent and early active phase and the baseline were significantly lower in the aromatherapy group, 1.88 vs 2.6 (p = 0.010) and 3.82 vs 4.39 (p = 0.031), respectively. Late active phase pain scores and other perinatal outcomes were not significantly different. Aromatherapy is helpful in reducing pain in latent and early active phase, and can probably be used as an adjunctive method for labor pain control without serious side effects.

Can Indian classical instrumental music reduce pain felt during venepuncture?

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Balan, Rajiv; Bavdekar, S B; Jadhav, Sandhya

2009-05-01

Local anesthetic agent is not usually used to reduce pain experienced by children undergoing venepuncture. This study was undertaken to determine comparative efficacy of local anesthetic cream, Indian classical instrumental music and placebo, in reducing pain due to venepuncture in children. Children aged 5-12 yr requiring venepuncture were enrolled in a prospective randomized clinical trial conducted at a tertiary care center. They were randomly assigned to 3 groups: local anesthetic (LA), music or placebo (control) group. Eutactic mixture of local anesthetic agents (EMLA) and Indian classical instrumental music (raaga-Todi) were used in the first 2 groups, respectively. Pain was assessed independently by parent, patient, investigator and an independent observer at the time of insertion of the cannula (0 min) and at 1- and 5 min after the insertion using a Visual Analog Scale (VAS). Kruskal- Wallis and Mann-Whitney U tests were used to assess the difference amongst the VAS scores. Fifty subjects were enrolled in each group. Significantly higher VAS scores were noted in control (placebo) group by all the categories of observers (parent, patient, investigator, independent observer) at all time points. The VAS scores obtained in LA group were lowest at all time points. However, the difference between VAS scores in LA group were significantly lower than those in music group only at some time-points and with some categories of observers (parent: 1 min; investigator: 0-, 1-, 5 min and independent observer: 5 min). Pain experienced during venepuncture can be significantly reduced by using EMLA or Indian classical instrumental music. The difference between VAS scores with LA and music is not always significant. Hence, the choice between EMLA and music could be dictated by logistical factors.

Educational outreach to reduce immunization pain in office settings.

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Schechter, Neil L; Bernstein, Bruce A; Zempsky, William T; Bright, Nancy S; Willard, Alice K

2010-12-01

The goal was to examine the impact of a teaching module on immunization pain reduction practices in pediatric offices 1 and 6 months after the intervention. Fourteen practices were selected randomly to receive a 1-hour teaching session on immunization pain reduction techniques, and 13 completed the study. Before the intervention, telephone interviews were conducted with parents concerning their children's recent immunization experiences. At 1 and 6 months after the intervention, parents of children who had recent immunizations were interviewed by using the same questionnaires. Clinicians also were surveyed at baseline and at 6 months. A total of 839 telephone interviews and 92 clinician surveys were included. Significant changes from baseline were identified at 1 and 6 months after the intervention. At 1 month, parents were more likely to report receiving information (P = .04), using strategies to reduce pain (P hour teaching session had measurable effects on the use of pain-reducing strategies at 1 and 6 months after the intervention. This research supports the hypothesis that small-group teaching sessions at the site of care can be associated with changes in practice behaviors.

Low-dose vaporized cannabis significantly improves neuropathic pain.

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Wilsey, Barth; Marcotte, Thomas; Deutsch, Reena; Gouaux, Ben; Sakai, Staci; Donaghe, Haylee

2013-02-01

We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling medium-dose (3.53%), low-dose (1.29%), or placebo cannabis with the primary outcome being visual analog scale pain intensity. Psychoactive side effects and neuropsychological performance were also evaluated. Mixed-effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the 2 active dose groups' results (P > .7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo versus low-dose, 2.9 for placebo versus medium-dose, and 25 for medium- versus low-dose. As these NNTs are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well tolerated, and neuropsychological effects were of limited duration and readily reversible within 1 to 2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. In general, the effect sizes on cognitive testing were consistent with this minimal dose. As a result, one might not anticipate a significant impact on daily functioning. Published by Elsevier Inc.

Root Canal Therapy Reduces Multiple Dimensions of Pain: A National Dental PBRN Study

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Law, Alan S.; Nixdorf, Donald R.; Rabinowitz, Ira; Reams, Gregory J.; Smith, James A.; Torres, Anibal V.; Harris, D. Robert

2014-01-01

Background Initial orthograde root canal therapy (RCT) is used to treat dentoalveolar pathosis. The affect RCT has on pain intensity has been frequently reported, but the affect on other dimensions of pain has not. Also, the lack of large prospective studies involving diverse groups of patients and practitioners that are not involved in data collection suggest that there are multiple opportunities for bias to be introduced when this data is systematically aggregated. Method This prospective observational study assessed pain intensity, duration, and its interference with daily activities among RCT patients. Sixty-two practitioners (46 general dentists, 16 endodontists) in the National Dental Practice-Based Research Network enrolled patients requiring RCT. Patient reported data were collected before, immediately following, and one week after treatment using the Graded Chronic Pain Scale. Results Enrollment of 708 patients was completed over 6 months with 655 patients (93%) providing one-week follow-up data. Prior to treatment, patients reported a mean (±standard deviation) worst pain intensity of 5.3±3.8 (0-10 scale), 50% had “severe” pain (≥7), and mean days in pain and days pain interfered with activities were 3.6±2.7 and 0.5±1.2, respectively. Following treatment, patients reported a mean worst pain intensity of 3.0±3.2, 19% had “severe” pain, and mean days in pain and days with pain interference were 2.1±2.4 and 0.4±1.1, respectively. All changes were statistically significant (ppain, significantly reducing pain intensity, duration, and related interference. Further research is needed to reduce the proportion of patients reporting “severe” post-operative pain. PMID:25190605

Equipment-based Pilates reduces work-related chronic low back pain and disability: A pilot study.

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Stieglitz, Dana Duval; Vinson, David R; Hampton, Michelle De Coux

2016-01-01

This study investigated effectiveness of an equipment-based Pilates protocol for reducing pain and disability in individuals with work-related chronic low back pain (CLBP). Twelve workers with non-specific CLBP participated in a quasi-experimental, one-group, pretest-posttest pilot study of supervised 6-week equipment-based Pilates exercise. Pain severity was assessed using a 100-mm visual analog scale (VAS). Physical function was assessed using the Oswestry disability index (ODI). The Pilates intervention significantly reduced pain (mean decrease in VAS 30.75 ± 20.27, p Pilates exercise reduced pain and disability in workers with CLBP. Further research is needed to investigate Pilates exercise for rehabilitation of work-related injuries in large populations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Acupuncture Reduces Breast Cancer Joint Pain | Division of Cancer Prevention

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In the largest, most rigorous study of its kind, acupuncture was found to significantly reduce the debilitating joint pain experienced by tens of thousands of women each year while being treated for early stage breast cancer with aromatase inhibitors (AIs). |

Comparative Survey of Holding Positions for Reducing Vaccination Pain in Young Infants

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Hui-Chu Yin

2017-01-01

Full Text Available Background. Infant holding position may reduce vaccination pain. However, the optimal position for young infants remains controversial. Objectives. To compare the effectiveness of holding infants in the supine position and the effectiveness of holding infants in upright position for relieving acute pain from vaccine injection. Methods. This prospective cohort study enrolled 6–12-week-old healthy infants. We examined infant pain responses by evaluating the following three categories: (1 crying, (2 irritability, and (3 facial expression. Results. In total, 282 infants were enrolled, with 103 and 179 held in the supine and upright positions, respectively. At 30 s after vaccination, the infants in the supine position showed a larger decrease in crying (p<0.001, irritability (p=0.002, and pained facial expression (p=0.001 than did those in the upright position. However, there was no significant difference in pain response between two groups at 180 s after intervention. Conclusion. In 2-month-old infants, the supine position may reduce acute pain more effectively than does the upright position. Our findings provide a clinical strategy for relieving vaccination pain in young infants.

Efficacy of tramadol and butorphanol pretreatment in reducing pain on propofol injection: A placebo-controlled randomized study

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Arvinderpal Singh

2016-01-01

Conclusion: Pretreatment with both butorphanol and tramadol significantly reduced pain on propofol injection; however, they exhibited comparable efficacy among each other. Thus, either of these two drugs can be considered for pretreatment to reduce propofol injection pain.

Reducing Postoperative Pain from Tonsillectomy Using Monopolar Electrocautery by Cooling the Oropharynx

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Vieira, Lucas

2014-01-01

Full Text Available Objective Evaluate intraoperative cooling of the oropharynx to reduce postoperative pain in tonsillectomy using monopolar electrocautery. Methods Sixty-six patients, age 1 to 12 years, were selected for the study, 33 in the control group and 33 in the experimental group. After randomization, patients underwent subcapsular dissection and hemostasis with monopolar electrocautery. Patients in the experimental group had the oropharynx cooled after tonsil dissection and hemostasis for 10 minutes. The procedure was done through the oral cavity by irrigation with 500 mL of 0.9% saline, in temperatures between 5°C and 10°C, for 5 minutes. The evaluation of postoperative pain was made with the pain visual analog scale (VAS for 10 days. As complementary data on the evaluation of pain, we recorded daily use of ketoprofen for pain relief. Results Pain after tonsillectomy assessed by VAS was significantly lower in the experimental group at days 0, 5, and 6 (p < 0.05. There were no differences in the use of ketoprofen between the groups. Conclusion Cooling of the oropharynx after tonsillectomy promotes clinically significant reduction in postoperative pain, without additional complications.

Viewing pictures of a romantic partner reduces experimental pain: involvement of neural reward systems.

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Younger, Jarred; Aron, Arthur; Parke, Sara; Chatterjee, Neil; Mackey, Sean

2010-10-13

The early stages of a new romantic relationship are characterized by intense feelings of euphoria, well-being, and preoccupation with the romantic partner. Neuroimaging research has linked those feelings to activation of reward systems in the human brain. The results of those studies may be relevant to pain management in humans, as basic animal research has shown that pharmacologic activation of reward systems can substantially reduce pain. Indeed, viewing pictures of a romantic partner was recently demonstrated to reduce experimental thermal pain. We hypothesized that pain relief evoked by viewing pictures of a romantic partner would be associated with neural activations in reward-processing centers. In this functional magnetic resonance imaging (fMRI) study, we examined fifteen individuals in the first nine months of a new, romantic relationship. Participants completed three tasks under periods of moderate and high thermal pain: 1) viewing pictures of their romantic partner, 2) viewing pictures of an equally attractive and familiar acquaintance, and 3) a word-association distraction task previously demonstrated to reduce pain. The partner and distraction tasks both significantly reduced self-reported pain, although only the partner task was associated with activation of reward systems. Greater analgesia while viewing pictures of a romantic partner was associated with increased activity in several reward-processing regions, including the caudate head, nucleus accumbens, lateral orbitofrontal cortex, amygdala, and dorsolateral prefrontal cortex--regions not associated with distraction-induced analgesia. The results suggest that the activation of neural reward systems via non-pharmacologic means can reduce the experience of pain.

Evaluation of a program to reduce back pain in nursing personnel

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Neusa Maria C Alexandre

2001-08-01

Full Text Available OBJECTIVE: To evaluate the effectiveness of a program designed to reduce back pain in nursing aides. METHODS: Female nursing aides from a university hospital who had suffered episodes of back pain for at least six months were included in the study. Participants were randomly divided into a control group and an intervention group. The intervention program involved a set of exercises and an educational component stressing the ergonomic aspect, administered twice a week during working hours for four months. All subjects answered a structured questionnaire and the intensity of pain was assessed before and after the program using a visual analogue scale (VAS. Student's t-test or the Wilcoxon Rank Sum Test for independent samples, and Chi-square test or the Exact Fisher test for categorical analysis, were used. The McNemar test and the Wilcoxon matched pairs test were used to compare the periods before and after the program. RESULTS: There was a statistically significant decrease in the frequency of cervical pain in the last two months and in the last seven days in the intervention group. There was also a reduction in cervical pain intensity in the two periods (2 months, 7 days and lumbar pain intensity in the last 7 days. CONCLUSIONS: The results suggest that a program of regular exercise with an emphasis on ergonomics can reduce musculoskeletal symptoms in nursing personnel.

Evaluation of a program to reduce back pain in nursing personnel

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Alexandre Neusa Maria C

2001-01-01

Full Text Available OBJECTIVE: To evaluate the effectiveness of a program designed to reduce back pain in nursing aides. METHODS: Female nursing aides from a university hospital who had suffered episodes of back pain for at least six months were included in the study. Participants were randomly divided into a control group and an intervention group. The intervention program involved a set of exercises and an educational component stressing the ergonomic aspect, administered twice a week during working hours for four months. All subjects answered a structured questionnaire and the intensity of pain was assessed before and after the program using a visual analogue scale (VAS. Student's t-test or the Wilcoxon Rank Sum Test for independent samples, and Chi-square test or the Exact Fisher test for categorical analysis, were used. The McNemar test and the Wilcoxon matched pairs test were used to compare the periods before and after the program. RESULTS: There was a statistically significant decrease in the frequency of cervical pain in the last two months and in the last seven days in the intervention group. There was also a reduction in cervical pain intensity in the two periods (2 months, 7 days and lumbar pain intensity in the last 7 days. CONCLUSIONS: The results suggest that a program of regular exercise with an emphasis on ergonomics can reduce musculoskeletal symptoms in nursing personnel.

Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review

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Juliano Bergamaschine Mata Diz

2017-01-01

Full Text Available Question: Among people with myofascial pain, does exercise reduce the intensity of the pain and disability? Design: Systematic review of randomised and quasi-randomised controlled trials. Participants: People with myofascial pain of any duration. Intervention: Exercise versus minimal or no intervention and exercise versus other intervention. Outcome measures: Pain intensity and disability. Results: Eight studies involving 255 participants were included. Pooled estimates from six studies showed statistically significant effects of exercise when compared with minimal or no intervention (support and encouragement or no treatment on pain intensity at short-term follow-up. The weighted mean difference in pain intensity due to exercise was –1.2 points (95% CI –2.3 to –0.1 on a 0 to 10 scale. Pooled estimates from two studies showed a non-significant effect of exercise when compared with other interventions (electrotherapy or dry needling on pain intensity at short-term follow-up. The weighted mean difference in pain intensity due to exercise instead of other therapies was 0.4 points (95% CI –0.3 to 1.1 on a 0 to 10 scale. Individual studies reported no significant effects of exercise on disability compared with minimal intervention (–0.4, 95% CI –1.3 to 0.5 and other interventions (0.0, 95% CI –0.8 to 0.8 at short-term follow-up. Sensitivity analysis suggested that combining stretching and strengthening achieves greater short-term effects on pain intensity compared with minimal or no intervention (–2.3, 95% CI –4.1 to –0.5. Conclusion: Evidence from a limited number of trials indicates that exercise has positive small-to-moderate effects on pain intensity at short-term follow-up in people with myofascial pain. A combination of stretching and strengthening exercises seems to achieve greater effects. These estimates may change with future high-quality studies. [Mata Diz JB, de Souza JRLM, Leopoldino AAO, Oliveira VC (2016 Exercise

Home Cervical Traction to Reduce Neck Pain in Fighter Pilots.

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Chumbley, Eric M; O'Hair, Nicole; Stolfi, Adrienne; Lienesch, Christopher; McEachen, James C; Wright, Bruce A

2016-12-01

Most fighter pilots report cervical pain during their careers. Recommendations for remediation lack evidence. We sought to determine whether regular use of a home cervical traction device could decrease reported cervical pain in F-15C pilots. An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, controlled crossover study was undertaken with 21 male F-15C fighter pilots between February and June 2015. Of the 21 subjects, 12 completed 6 wk each of traction and control, while logging morning, postflying, and post-traction pain. Pain was compared with paired t-tests between the periods, from initial pain scores to postflying, and postflying to post-traction. In the traction phase, initial pain levels increased postflight, from 1.2 (0.7) to 1.6 (1.0) Subsequent post-traction pain levels decreased to 1.3 (0.9), with a corresponding linear decrease in pain relative to pain reported postflight. The difference in pain levels after traction compared to initial levels was not significant, indicating that cervical traction was effective in alleviating flying-related pain. Control pain increased postflight from 1.4 (0.9) to 1.9 (1.3). Daily traction phase pain was lower than the control, but insignificant. To our knowledge, this is the first study of home cervical traction to address fighter pilots' cervical pain. We found a small but meaningful improvement in daily pain rating when using cervical traction after flying. These results help inform countermeasure development for pilots flying high-performance aircraft. Further study should clarify the optimal traction dose and timing in relation to flying.Chumbley EM, O'Hair N, Stolfi A, Lienesch C, McEachen JC, Wright BA. Home cervical traction to reduce neck pain in fighter pilots. Aerosp Med Hum Perform. 2016; 87(12):1010-1015.

Reduced pain and inflammation in juvenile and adult rats fed a ketogenic diet.

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David N Ruskin

2009-12-01

Full Text Available The ketogenic diet is a high-fat, low-carbohydrate regimen that forces ketone-based rather than glucose-based cellular metabolism. Clinically, maintenance on a ketogenic diet has been proven effective in treating pediatric epilepsy and type II diabetes, and recent basic research provides evidence that ketogenic strategies offer promise in reducing brain injury. Cellular mechanisms hypothesized to be mobilized by ketone metabolism and underlying the success of ketogenic diet therapy, such as reduced reactive oxygen species and increased central adenosine, suggest that the ketolytic metabolism induced by the diet could reduce pain and inflammation. To test the effects of a ketone-based metabolism on pain and inflammation directly, we fed juvenile and adult rats a control diet (standard rodent chow or ketogenic diet (79% fat ad libitum for 3-4 weeks. We then quantified hindpaw thermal nociception as a pain measure and complete Freund's adjuvant-induced local hindpaw swelling and plasma extravasation (fluid movement from the vasculature as inflammation measures. Independent of age, maintenance on a ketogenic diet reduced the peripheral inflammatory response significantly as measured by paw swelling and plasma extravasation. The ketogenic diet also induced significant thermal hypoalgesia independent of age, shown by increased hindpaw withdrawal latency in the hotplate nociception test. Anti-inflammatory and hypoalgesic diet effects were generally more robust in juveniles. The ketogenic diet elevated plasma ketones similarly in both age groups, but caused slowed body growth only in juveniles. These data suggest that applying a ketogenic diet or exploiting cellular mechanisms associated with ketone-based metabolism offers new therapeutic opportunities for controlling pain and peripheral inflammation, and that such a metabolic strategy may offer significant benefits for children and adults.

From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain.

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Mischkowski, Dominik; Crocker, Jennifer; Way, Baldwin M

2016-09-01

Simulation theories of empathy hypothesize that empathizing with others' pain shares some common psychological computations with the processing of one's own pain. Support for this perspective has largely relied on functional neuroimaging evidence of an overlap between activations during the experience of physical pain and empathy for other people's pain. Here, we extend the functional overlap perspective to the neurochemical level and test whether a common physical painkiller, acetaminophen (paracetamol), can reduce empathy for another's pain. In two double-blind placebo-controlled experiments, participants rated perceived pain, personal distress and empathic concern in response to reading scenarios about another's physical or social pain, witnessing ostracism in the lab, or visualizing another study participant receiving painful noise blasts. As hypothesized, acetaminophen reduced empathy in response to others' pain. Acetaminophen also reduced the unpleasantness of noise blasts delivered to the participant, which mediated acetaminophen's effects on empathy. Together, these findings suggest that the physical painkiller acetaminophen reduces empathy for pain and provide a new perspective on the neurochemical bases of empathy. Because empathy regulates prosocial and antisocial behavior, these drug-induced reductions in empathy raise concerns about the broader social side effects of acetaminophen, which is taken by almost a quarter of adults in the United States each week. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Expectations contribute to reduced pain levels during prayer in highly religious participants.

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Jegindø, Else-Marie Elmholdt; Vase, Lene; Skewes, Joshua Charles; Terkelsen, Astrid Juhl; Hansen, John; Geertz, Armin W; Roepstorff, Andreas; Jensen, Troels Staehelin

2013-08-01

Although the use of prayer as a religious coping strategy is widespread and often claimed to have positive effects on physical disorders including pain, it has never been tested in a controlled experimental setting whether prayer has a pain relieving effect. Religious beliefs and practices are complex phenomena and the use of prayer may be mediated by general psychological factors known to be related to the pain experience, such as expectations, desire for pain relief, and anxiety. Twenty religious and twenty non-religious healthy volunteers were exposed to painful electrical stimulation during internal prayer to God, a secular contrast condition, and a pain-only control condition. Subjects rated expected pain intensity levels, desire for pain relief, and anxiety before each trial and pain intensity and pain unpleasantness immediately after on mechanical visual analogue scales. Autonomic and cardiovascular measures provided continuous non-invasive objective means for assessing the potential analgesic effects of prayer. Prayer reduced pain intensity by 34 % and pain unpleasantness by 38 % for religious participants, but not for non-religious participants. For religious participants, expectancy and desire predicted 56-64 % of the variance in pain intensity scores, but for non-religious participants, only expectancy was significantly predictive of pain intensity (65-73 %). Conversely, prayer-induced reduction in pain intensity and pain unpleasantness were not followed by autonomic and cardiovascular changes.

Acoustic noise in functional magnetic resonance imaging reduces pain unpleasantness ratings.

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Boyle, Y; Bentley, D E; Watson, A; Jones, A K P

2006-07-01

Functional magnetic resonance imaging (fMRI) is increasingly used in cognitive studies. Unfortunately, the scanner produces acoustic noise during the image acquisition process. Interference from acoustic noise is known to affect auditory, visual and motor processing, raising the possibility that acoustic interference may also modulate processing of other sensory modalities such as pain. With the increasing use of fMRI in the investigation of the mechanisms of pain perception, particularly in relation to attention, this issue has become highly relevant. Pain is a complex experience, composed of sensory-discriminative, affective-motivational and cognitive-evaluative components. The aim of this experiment was to assess the effect of MRI scanner noise, compared to white noise, on the affective (unpleasantness) and the sensory-discriminative (localisation) components of pain. Painful radiant heat from a CO(2) laser was delivered to the skin of the right forearm in 24 healthy volunteers. The volunteers attended to either pain location or pain unpleasantness during three conditions: i) no noise, ii) exposure to MRI scanner noise (85 dB) or iii) exposure to white noise (85 dB). Both MRI scanner noise and white noise significantly reduced unpleasantness ratings (from 5.1 +/- 1.6 in the control condition to 4.7 +/- 1.5 (P = 0.002) and 4.6 +/- 1.6 (P white noise respectively), whereas the ability to localise pain was not significantly affected (from 85.4 +/- 9.2% correct in the control condition to 83.1 +/- 10.3% (P = 0.06) and 83.9 +/- 9.5% (P = 0.27) with MRI scanner and white noise respectively). This phenomenon should be taken into account in the design of fMRI studies into human pain perception.

Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain

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Wilsey, Barth; Marcotte, Thomas D.; Deutsch, Reena; Gouaux, Ben; Sakai, Staci; Donaghe, Haylee

2013-01-01

We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling either medium dose (3.53%), low dose (1.29%), or placebo cannabis with the primary outcome being VAS pain intensity. Psychoactive side-effects, and neuropsychological performance were also evaluated. Mixed effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the two active dose groups’ results (p>0.7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo vs. low dose, 2.9 for placebo vs. medium dose, and 25 for medium vs. low dose. As these NNT are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being, for all intents and purposes, as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well-tolerated, and neuropsychological effects were of limited duration and readily reversible within 1–2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. PMID:23237736

Dextromethorphan Reduces Postoperative Pain of Post Partum Tubal Ligation under General Anesthesia

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N. Manochehrian

2009-04-01

Full Text Available Introduction & Objective: Postoperative pain has harmful effects in many systems. Dextromethorphan reduces postoperative pain in post partum tubal ligation under general anesthesia. Materials & Methods: In this research 40 patients with ASA class I and II in double blind randomized clinical trial were studied in two groups. 90 minutes before surgery the patients received 90 mg dextromethorphan or placebo (oral. The patients induced general anesthesia with thiopental (5mg/kg, fentanyl 1.5 g/kg and succinylcholin(1-1.5 mg/kg and maintenance with halothane and N2O 50%. Patients were observed studied for analgesic requirement, nausea, vomiting, urinary retention and respiratory depression in recovery and 2,4,8 and 24 hours after surgery. Results: There was no significant difference in age, education, . . . Pain in recovery, 2 and 4 hours after surgery in dextromethorphan was less than placebo group. The analgesic requirement (pethidine in dextromethophan was less than placebo group.Conclusion: Administration of 90 mg dextromethorphan 90 minutes before the surgery under GA reduces pain in recovery time , 2 and 4 hours after the surgery.

Music reduces pain and increases functional mobility in fibromyalgia

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Garza-Villarreal, Eduardo A.; Wilson, Andrew D; Vase, Lene

2014-01-01

task (not during), therefore the effect cannot be explained merely by motor entrainment to a fast rhythm. Cognitive and emotional mechanisms seem to be central to music-induced analgesia. Our findings encourage the use of music as a treatment adjuvant to reduce chronic pain in FM and increase......The pain in Fibromyalgia (FM) is difficult to treat and functional mobility seems to be an important comorbidity in these patients that could evolve into a disability. In this study we wanted to investigate the analgesic effects of music in FM pain. Twenty-two FM patients were passively exposed...... to (1) self-chosen, relaxing, pleasant music, and to (2) a control auditory condition (pink noise). They rated pain and performed the “timed-up & go task (TUG)” to measure functional mobility after each auditory condition. Listening to relaxing, pleasant, self-chosen music reduced pain and increased...

Intraperitoneal injection of Bupivacaine and Lidocaine in reducing postoperative pain in gynecologic laparoscopic surgeries: a comparative study

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Alleyassin A

2007-08-01

Full Text Available Background: As less invasive surgical procedures, such as laparoscopy, become more common, patients can go home soon after the surgery. However, some pain is accompanied by such procedures due to peritoneal stretching, diaphragmatic irritation, or, to a lesser extent, abdominal puncture. It is important to reduce the level of pain to the point that narcotics are not necessary. The administration of opioids for pain after abdominal surgeries is common. The receptors involved seem to be susceptible to blockade with low-dose local anesthesia, although this is subject to some controversy. In this study, we assess and compare the effectiveness of intraperitoneal Bupivacaine and Lidocaine in pain reduction after diagnostic gynecologic laparoscopy in infertility patients. Methods: In this randomized clinical trial, 150 patients admitted to Dr. Shariati Hospital for diagnostic gynecologic laparoscopy were entered into three randomized groups. Group B received Bupivacaine after the diagnostic laparoscopic procedure, group L received Lidocaine and group C, the control group, received a placebo after the surgery, all administered intraperi- toneally. Postsurgerical pain was assessed using the numeric visual analogue scale at 6 and 24 hours after surgery. Results: In group B, the pain scores at 6 and 24 hours after surgery were significantly less than those of group L. Conclusions: Administration of Bupivacaine after diagnostic gynecologic laparoscopic procedures is more effective in pain control than Lidocaine. The effect of this drug is temporary, yet it significantly decreases early postoperative pain, reducing the need for additional postoperative analgesics. Furthermore, the time at which patients can be discharged from the hospital is significantly reduced.

Listening to music does not reduce pain during sigmoidoscopy.

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Meeuse, Jan J; Koornstra, Jan Jacob; Reyners, An K L

2010-08-01

Up to 40% of the sigmoidoscopies are considered painful by patients. Nonpharmacological intervention would be attractive, as sedation and analgesia carry the risk of side-effects and increase procedure-related costs. Music might have the potential of pain reduction, but its effect during sigmoidoscopy has not been established yet. To study whether listening to music reduces experienced pain during sigmoidoscopy. Consecutive patients, above 18 years of age, undergoing sigmoidoscopy without sedation or analgesia and who gave their informed consent were included in this study. Patients in the music group listened to their preferred music (classical, jazz, English or Dutch Popular) during the sigmoidoscopy. The control group received care as usual. The outcome measures were pain intensity during sigmoidoscopy (measured with a 100-mm-long visual analogue scale) and the proportion of patients with at least moderate pain during sigmoidoscopy (pain intensity score of 50 mm or higher). The music groups consisted of 153 patients, the control group of 154 patients. The mean pain intensity + or - standard deviation was 36 + or - 27 mm in the music group and 40 + or - 29 in the control group (P=0.27) during sigmoidoscopy. The proportion of patients with at least moderate pain during sigmoidoscopy was 29 and 37% in the respective groups (P=0.12). Listening to music by patients did not reduce pain intensity during sigmoidoscopy. As a consequence, music during sigmoidoscopy is not recommended for this purpose.

Pre-emptive tramadol could reduce pain after ureteroscopic lithotripsy.

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Mimić, Ana; Denčić, Nataša; Jovičić, Jelena; Mirković, Jelena; Durutović, Otaš; Milenković-Petronić, Dragica; Lađević, Nebojša

2014-09-01

Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement. The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (ppain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain.

Does Liposomal Bupivacaine (Exparel) Significantly Reduce Postoperative Pain/Numbness in Symptomatic Teeth with a Diagnosis of Necrosis? A Prospective, Randomized, Double-blind Trial.

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Glenn, Brandon; Drum, Melissa; Reader, Al; Fowler, Sara; Nusstein, John; Beck, Mike

2016-09-01

Medical studies have shown some potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA), a slow-release bupivacaine solution, to extend postoperative benefits of numbness/pain relief for up to several days. Because the Food and Drug Administration has approved Exparel only for infiltrations, we wanted to evaluate if it would be effective as an infiltration to control postoperative pain. The purpose of this study was to compare an infiltration of bupivacaine with liposomal bupivacaine for postoperative numbness and pain in symptomatic patients diagnosed with pulpal necrosis experiencing moderate to severe preoperative pain. One hundred patients randomly received a 4.0-mL buccal infiltration of either bupivacaine or liposomal bupivacaine after endodontic debridement. For postoperative pain, patients were given ibuprofen/acetaminophen, and they could receive narcotic pain medication as an escape. Patients recorded their level of numbness, pain, and medication use the night of the appointment and over the next 5 days. Success was defined as no or mild postoperative pain and no narcotic use. The success rate was 29% for the liposomal group and 22% for the bupivacaine group, with no significant difference (P = .4684) between the groups. Liposomal bupivacaine had some effect on soft tissue numbness, pain, and use of non-narcotic medications, but it was not clinically significant. There was no significant difference in the need for escape medication. For symptomatic patients diagnosed with pulpal necrosis experiencing moderate to severe preoperative pain, a 4.0-mL infiltration of liposomal bupivacaine did not result in a statistically significant increase in postoperative success compared with an infiltration of 4.0 mL bupivacaine. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Drug Reduces Cancer Treatment-Related Joint Pain

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A Cancer Currents blog post about a clinical trial demonstrating that duloxetine (Cymbalta®) may reduce joint pain caused by aromatase inhibitors in women being treated for early-stage breast cancer.

EFFECTIVENESS OF MC KENZIE EXERCISES IN REDUCING NECK AND BACK PAIN AMONG MADRASSA STUDENTS

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Saima Aziz

2016-02-01

Full Text Available Background: In this advanced era, neck and back pain has become a common musculoskeletal problem. These symptoms have a high prevalence in the community and now they are affecting even our adolescents leaving a major impact on youth’s functional and educational activities. Nevertheless, the burden of these musculoskeletal pains, which relates not only to its prevalence but also to increase in physiological and psychological stress among them, distressing their creativity. Madrassa students have a daily exposure to neck and back pain due to poor posture. The McKenzie method is a popular treatment for back and neck pain among physical therapists. So, the intention of this study is to test the effectiveness of McKenzie exercises in neck and back pain, because hardly any data is available on McKenzie technique and its outcome in Pakistan. The objective of the study is to determine the effectiveness of McKenzie exercises in reducing neck and back pain among madrassa students. Methods: The students were recruited from Madrassa Darul Akram (Baldia town and Jamia Ashraf-ul-madrassa (Gulshan-e-Iqbal Karachi. One sixty three students aged between 12–18 years of both genders who were fulfilling the inclusion criteria were selected from Madrassa Darul Akram (Baldia town and Jamia Ashraf-ul-madrassa (Gulshane-Iqbal. The participants received McKenzie exercises programs intervention for three consecutive weeks. Outcome Measure: Neck Disability Index (NDI, Modified Oswestry Low Back Pain Disability Index (ODI and Numeric Pain Rating Scale (NPRS Results: The present study showed significant results in all three scales in both genders (p<0.001.Among sections, the Hafiz students revealed greater score in all 3 scales before treatment as compared to ‘Alim/Alima’ and ‘Nazra’ students and after treatment showed significant results in all 3 domains (p<0.001. Conclusion: Findings of this study revealed that madrassa students were more prone to develop neck

The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis

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Sheafer, Heather; Tepper, Deborah

2016-01-01

Background. Aromatherapy refers to the medicinal or therapeutic use of essential oils absorbed through the skin or olfactory system. Recent literature has examined the effectiveness of aromatherapy in treating pain. Methods. 12 studies examining the use of aromatherapy for pain management were identified through an electronic database search. A meta-analysis was performed to determine the effects of aromatherapy on pain. Results. There is a significant positive effect of aromatherapy (compared to placebo or treatments as usual controls) in reducing pain reported on a visual analog scale (SMD = −1.18, 95% CI: −1.33, −1.03; p aromatherapy is more consistent for treating nociceptive (SMD = −1.57, 95% CI: −1.76, −1.39, p aromatherapy is most effective in treating postoperative pain (SMD = −1.79, 95% CI: −2.08, −1.51, p aromatherapy can successfully treat pain when combined with conventional treatments. PMID:28070420

Interpersonal issues between pain physician and patient: strategies to reduce conflict.

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Diesfeld, Kate

2008-11-01

This article analyzes scholarship on the interpersonal challenges that pain physicians face, with an emphasis on strategies to reduce conflicts within therapeutic relationships. Scholarship on the dilemmas pain physicians face suggests that 1) there are unique and perhaps unrecognized features of pain medicine that generate stress; 2) interpersonal conflict may contribute to stress; and 3) clinicians' biases may interfere with the doctor-patient relationship and with the best practice of pain medicine. Application of a framework based on clinicians' beliefs and Papadimos' reflections on justice and temperance may reduce such conflicts. The challenges of pain medicine may be complicated by the clinician's undisclosed attitudes regarding their roles and their perceptions of pain sufferers. A strategy for physicians to examine their beliefs within a supportive environment may aid physicians caring for people with chronic pain. Papadimos' reflections upon the virtues of justice and tolerance guide this analysis.

Neck arthritis pain is reduced and range of motion is increased by massage therapy.

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Field, Tiffany; Diego, Miguel; Gonzalez, Gladys; Funk, C G

2014-11-01

The literature on the effects of massage therapy on neck arthritis pain is mixed depending on the dose level, and it is also based on self-report. In the present study an attempt was made to enhance the effects of weekly massage therapy by having the participants massage themselves daily. And in addition to self-reports on pain, range of motion (ROM) and the associated ROM pain were assessed before and after the first massage session and pre-post the last session one month later. Staff and faculty members at a medical school who were eligible for the study if they had neck arthritis pain were randomly assigned to a massage or a waitlist control group (N = 24 per group). The massage group received moderate pressure massages weekly by a massage therapist plus daily self-massages. The waitlist control group received the same schedule massages one month after being control subjects. The massage group showed significant short-term reductions after the first and last day massages in self-reported pain and in ROM-associated pain as well as an increase in ROM. Comparisons between the massage group (N = 23) and the control group (N = 14) on the last versus the first day data suggested significantly different changes including increased ROM and reduced ROM-associated pain for the massage group and reduced ROM and increased ROM-associated pain for the control group. These changes occurred specifically for flexion and right and left lateral flexion motions. These data highlight the importance of designing massage therapy protocols that target the most affected neck muscle groups and then assessing range of motion and related pain before and after the massage therapy. Comparisons with other studies also suggest that moderate pressure may contribute to the massage effects, and the use of daily self-massages between sessions may sustain the effects and serve as a cost-effective therapy for individuals with neck arthritis pain. Copyright © 2014. Published by Elsevier Ltd.

Use of Temporary Implantable Biomaterials to Reduce Leg Pain and Back Pain in Patients with Sciatica and Lumbar Disc Herniation

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Gere S. diZerega

2010-05-01

Full Text Available The principle etiology of leg pain (sciatica from lumbar disc herniation is mechanical compression of the nerve root. Sciatica is reduced by decompression of the herniated disc, i.e., removing mechanical compression of the nerve root. Decompression surgery typically reduces sciatica more than lumbar back pain (LBP. Decompression surgery reduces mechanical compression of the nerve root. However, decompression surgery does not directly reduce sensitization of the sensory nerves in the epidural space and disc. In addition, sensory nerves in the annulus fibrosus and epidural space are not protected from topical interaction with pain mediators induced by decompression surgery. The secondary etiology of sciatica from lumbar disc herniation is sensitization of the nerve root. Sensitization of the nerve root results from a mechanical compression, b exposure to cellular pain mediators, and/or c exposure to biochemical pain mediators. Although decompression surgery reduces nerve root compression, sensory nerve sensitization often persists. These observations are consistent with continued exposure of tissue in the epidural space, including the nerve root, to increased cellular and biochemical pain mediators following surgery. A potential contributor to lumbar back pain (LBP is stimulation of sensory nerves in the annulus fibrosus by a cellular pain mediators and/or b biochemical pain mediators that accompany annular tears or disruption. Sensory fibers located in the outer one-third of the annulus fibrosus increase in number and depth as a result of disc herniation. The nucleus pulposus is comprised of material that can produce an autoimmune stimulation of the sensory nerves located in the annulus and epidural space leading to LBP. The sensory nerves of the annulus fibrosus and epidural space may be sensitized by topical exposure to cellular and biochemical pain mediators induced by lumbar surgery. Annulotomy or annular rupture allows the nucleus pulposus

Comparing the use of Memantine with Dextromethorphan and Placebo to Reduce Pain before Orthopedic Surgery

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Mehrdad Taheri

2017-12-01

Full Text Available Introduction: To compare the use of Memantine with Dextromethorphan and placebo to reduce pain after orthopedic surgery.Materials and Methods: The present study was a double-blind clinical trial including180 patients undergoing elective orthopedic surgery of the lower limbs. Patients were divided randomly into three groups of 60 patients each. The first group (Group M received 30 mg Memantine orally, the second group (Group D received 45 mg of Dextromethorphan and the third group (Group P received only placebo, two and a half hours before the operation. The intensity of pain (VAS score, sedation score, and nausea and vomiting were recorded postoperatively.Results: In this study, 60 patients were enrolled in each group. The total VAS (Visual Analogue Scale score was significantly lower among patients receiving Memantine and the satisfaction was significantly higher compared to the Dextromethorphan and placebo groups (P-value <0.001.Conclusion: The present study results indicate that Memantine has a relatively better outcome compared to Dextromethorphan or placebo in reducing the post surgical pain among patients undergoing orthopedic surgeries. It also reduced the need for post surgical opioid use and improved the patients’ satisfaction.  

Combined inhibition of monoacylglycerol lipase and cyclooxygenases synergistically reduces neuropathic pain in mice

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Crowe, Molly S; Leishman, Emma; Banks, Matthew L; Gujjar, Ramesh; Mahadevan, Anu; Bradshaw, Heather B; Kinsey, Steven G

2015-01-01

Background and Purpose Neuropathic pain is commonly treated with GABA analogues, steroids or non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs inhibit one or more COX isozymes but chronic COX inhibition paradoxically increases gastrointestinal inflammation and risk of unwanted cardiovascular events. The cannabinoids also have analgesic and anti-inflammatory properties and reduce neuropathic pain in animal models. The present study investigated the analgesic effects of inhibiting both monoacylglycerol lipase (MAGL) and COX enzymes, using low doses of both inhibitors. Experimental Approach Mice subjected to chronic constriction injury (CCI) were tested for mechanical and cold allodynia after administration of the MAGL inhibitor, JZL184, or the non-selective COX inhibitor diclofenac. Then, both drugs were co-administered at fixed dose proportions of 1:3, 1:1 and 3:1, based on their ED50 values. PGs, endocannabinoids and related lipids were quantified in lumbar spinal cord. Key Results Combining low doses of JZL184 and diclofenac synergistically attenuated mechanical allodynia and additively reduced cold allodynia. The cannabinoid CB1 receptor antagonist, rimonabant, but not the CB2 receptor antagonist, SR144528, blocked the analgesic effects of the JZL184 and diclofenac combination on mechanical allodynia, implying that CB1 receptors were primarily responsible for the anti-allodynia. Diclofenac alone and with JZL184 significantly reduced PGE2 and PGF2α in lumbar spinal cord tissue, whereas JZL184 alone caused significant increases in the endocannabinoid metabolite, N-arachidonoyl glycine. Conclusions and Implications Combining COX and MAGL inhibition is a promising therapeutic approach for reducing neuropathic pain with minimal side effects. PMID:25393148

Topical Mannitol Reduces Capsaicin-Induced Pain: Results of a Pilot-Level, Double-Blind, Randomized Controlled Trial.

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Bertrand, Helene; Kyriazis, Marylene; Reeves, K Dean; Lyftogt, John; Rabago, David

2015-11-01

Capsaicin specifically activates, and then gradually exhausts, the transient receptor potential vanilloid type 1 (TRPV1) receptor, a key receptor in neuropathic pain. Activation of the TRPV-1 receptor is accompanied by burning pain. A natural substance or medication that can reduce the burning pain resulting from capsaicin application may have therapeutic potential in neuropathic pain. To assess the pain-relieving effects of a mannitol-containing cream in a capsaicin-based pain model. Randomized, placebo-controlled, double-blind clinical trial. Outpatient pain clinic. Twenty-five adults with pain-free lips. Capsaicin .075% cream was applied to both halves of each participant's upper lip, inducing pain via stimulation of the transient receptor potential vanilloid 1 (TRPV1, capsaicin) receptor, then removed after 5 minutes or when participants reported a burning pain of 8/10, whichever came first. A cream containing mannitol and the same cream without mannitol (control) were then immediately applied, 1 on each side of the lip, in an allocation-masked manner. Participants self-recorded a numeric rating scale (NRS, 0-10) pain score for each side of the lip per minute for 10 minutes. A t-test was performed to evaluate the pain score change from baseline between each side of the lip at each recording. Area under the curve (AUC) analysis was used to determine the overall difference between groups. Participants reached a capsaicin-induced pain level of 7.8 ± 1.0 points in 3.3 ± 1.6 minutes that was equal on both sides of the lip. Both groups reported progressive diminution of pain over the 10-minute study period. However, participants reported significantly reduced pain scores on the mannitol cream half-lip compared to control at 3 through 10 minutes (P < .05) and in AUC analysis (P < .001). Mannitol cream reduced self-reported pain scores in a capsaicin pain model more rapidly than a control cream, potentially via a TRPV1 receptor effect. Copyright © 2015 American

Reduced Pain and Anxiety with Music and Noise-Canceling Headphones During Shockwave Lithotripsy.

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Karalar, Mustafa; Keles, Ibrahim; Doğantekin, Engin; Kahveci, Orhan Kemal; Sarici, Hasmet

2016-06-01

We assessed the effects of music and noise-canceling headphones (NCHs) on perceived patient pain and anxiety from extracorporeal shockwave lithotripsy (SWL). Patients with renal calculi scheduled for SWL were prospectively enrolled. All 89 patients between the ages of 19 and 80 years were informed about this study and then randomized into three groups: Group 1 (controls), no headphones and music; Group 2, music with NCHs (patients listened to Turkish classical music with NCHs during SWL); and Group 3, music with non-NCHs (patients listened to Turkish classical music with non-NCHs during SWL). Hemodynamic and respiratory parameters were recorded before and just after the SWL session. All patient visual analog scale (VAS) and State-Trait Anxiety Inventory (STAI) scores were recorded just after the SWL procedure. There were significant differences in VAS scores among the groups (5.1, 3.6, and 4.5, respectively, p < 0.001), including between Groups 2 and 3 (p = 0.018). There were also significant differences in STAI-State anxiety scores among the groups (43.1, 33.5, and 38.9, respectively, p = 0.001), including between Groups 2 and 3 (p = 0.04). Music therapy during SWL reduced pain and anxiety. Music therapy with NCHs was more effective for pain and anxiety reduction. To reduce pain and anxiety, nonpharmacologic therapies such as music therapy with NCHs during SWL should be investigated further and used routinely.

Voluntary wheel running delays disease onset and reduces pain hypersensitivity in early experimental autoimmune encephalomyelitis (EAE).

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Benson, Curtis; Paylor, John W; Tenorio, Gustavo; Winship, Ian; Baker, Glen; Kerr, Bradley J

2015-09-01

Multiple sclerosis (MS) is classically defined by motor deficits, but it is also associated with the secondary symptoms of pain, depression, and anxiety. Up to this point modifying these secondary symptoms has been difficult. There is evidence that both MS and the animal model experimental autoimmune encephalomyelitis (EAE), commonly used to study the pathophysiology of the disease, can be modulated by exercise. To examine whether limited voluntary wheel running could modulate EAE disease progression and the co-morbid symptoms of pain, mice with EAE were allowed access to running wheels for 1h every day. Allowing only 1h every day of voluntary running led to a significant delay in the onset of clinical signs of the disease. The development of mechanical allodynia was assessed using Von Frey hairs and indicated that wheel running had a modest positive effect on the pain hypersensitivity associated with EAE. These behavioral changes were associated with reduced numbers of cFOS and phosphorylated NR1 positive cells in the dorsal horn of the spinal cord compared to no-run EAE controls. In addition, within the dorsal horn, voluntary wheel running reduced the number of infiltrating CD3(+) T-cells and reduced the overall levels of Iba1 immunoreactivity. Using high performance liquid chromatography (HPLC), we observed that wheel-running lead to significant changes in the spinal cord levels of the antioxidant glutathione. Oxidative stress has separately been shown to contribute to EAE disease progression and neuropathic pain. Together these results indicate that in mice with EAE, voluntary motor activity can delay the onset of clinical signs and reduce pain symptoms associated with the disease. Copyright © 2015 Elsevier Inc. All rights reserved.

Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial.

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Alpayci, Mahmut; İlter, Server

2017-09-01

The aim of this study was to investigate whether isometric neck extension exercise restores physiological cervical lordosis and reduces pain. Sixty-five patients with loss of cervical lordosis were randomly assigned to exercise (27 women, 7 men; mean age, 32.82 ± 8.83 yrs) and control (26 women, 5 men; mean age, 33.48 ± 9.67 yrs) groups. Both groups received nonsteroidal anti-inflammatory drugs for 10 days. The exercise group received additional therapy as a home exercise program, which consisted of isometric neck extension for 3 mos. Neck pain severity and cervical lordosis were measured at baseline and at 3 mos after baseline. Compared with baseline levels, cervical lordosis angle was significantly improved in the exercise group (P cervical lordosis angle returned to physiological conditions (85.2% vs. 22.5%; P pain intensity was significantly reduced in both groups compared with baseline levels (for all, P pain was about twice in the exercise group compared with the control group (P cervical lordosis and pain.

Hypnotic analgesia reduces brain responses to pain seen in others.

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Braboszcz, Claire; Brandao-Farinelli, Edith; Vuilleumier, Patrik

2017-08-29

Brain responses to pain experienced by oneself or seen in other people show consistent overlap in the pain processing network, particularly anterior insula, supporting the view that pain empathy partly relies on neural processes engaged by self-nociception. However, it remains unresolved whether changes in one's own pain sensation may affect empathic responding to others' pain. Here we show that inducing analgesia through hypnosis leads to decreased responses to both self and vicarious experience of pain. Activations in the right anterior insula and amygdala were markedly reduced when participants received painful thermal stimuli following hypnotic analgesia on their own hand, but also when they viewed pictures of others' hand in pain. Functional connectivity analysis indicated that this hypnotic modulation of pain responses was associated with differential recruitment of right prefrontal regions implicated in selective attention and inhibitory control. Our results provide novel support to the view that self-nociception is involved during empathy for pain, and demonstrate the possibility to use hypnotic procedures to modulate higher-level emotional and social processes.

Intraoperative ketamine reduces immediate postoperative opioid consumption after spinal fusion surgery in chronic pain patients with opioid dependency: a randomized, blinded trial.

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Nielsen, Rikke Vibeke; Fomsgaard, Jonna Storm; Siegel, Hanna; Martusevicius, Robertas; Nikolajsen, Lone; Dahl, Jørgen Berg; Mathiesen, Ole

2017-03-01

Perioperative handling of surgical patients with opioid dependency represents an important clinical problem. Animal studies suggest that ketamine attenuates central sensitization and hyperalgesia and thereby reduces postoperative opioid tolerance. We hypothesized that intraoperative ketamine would reduce immediate postoperative opioid consumption compared with placebo in chronic pain patients with opioid dependency undergoing lumbar spinal fusion surgery. Primary outcome was morphine consumption 0 to 24 hours postoperatively. Secondary outcomes were acute pain at rest and during mobilization 2 to 24 hours postoperatively (visual analogue scale), adverse events, and persistent pain 6 months postoperatively. One hundred fifty patients were randomly assigned to intraoperative S-ketamine bolus 0.5 mg/kg and infusion 0.25 mg·kg·h or placebo. Postoperatively, patients received their usual opioids, paracetamol and IV patient-controlled analgesia with morphine. In the final analyses, 147 patients were included. Patient-controlled analgesia IV morphine consumption 0 to 24 hours postoperatively was significantly reduced in the ketamine group compared with the placebo group: 79 (47) vs 121 (53) mg IV, mean difference 42 mg (95% confidence interval -59 to -25), P ketamine group 6 and 24 hours postoperatively. There were no significant differences regarding acute pain, nausea, vomiting, hallucinations, or nightmares. Back pain at 6 months postoperatively compared with preoperative pain was significantly more improved in the ketamine group compared with the placebo group, P = 0.005. In conclusion, intraoperative ketamine significantly reduced morphine consumption 0 to 24 hours after lumbar fusion surgery in opioid-dependent patients. The trend regarding less persistent pain 6 months postoperatively needs further investigation.

Transcutaneous Electrical Nerve Stimulation (TENS) reduces pain, fatigue, and hyperalgesia while restoring central inhibition in primary fibromyalgia

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Dailey, Dana L; Rakel, Barbara A; Vance, Carol GT; Liebano, Richard E; Anand, Amrit S; Bush, Heather M; Lee, Kyoung S; Lee, Jennifer E; Sluka, Kathleen A

2014-01-01

Because TENS works by reducing central excitability and activating central inhibition pathways, we tested the hypothesis that TENS would reduce pain and fatigue and improve function and hyperalgesia in people with fibromyalgia who have enhanced central excitability and reduced inhibition. The current study used a double-blinded randomized, placebo controlled cross-over design to test effects of a single treatment of TENS in people with fibromyalgia. Three treatments were assessed in random order: active TENS, placebo TENS, no TENS. The following measures were assessed before and after each TENS treatment: pain and fatigue at rest and movement, pressure pain thresholds (PPTs), 6 minute walk test (6MWT), range of motion (ROM), five time sit to stand test (FTSTS), and single leg stance (SLS). Conditioned pain modulation (CPM) was completed at end of testing. There was a significant decrease in pain and fatigue with movement for active TENS compared to placebo and no TENS. PPTs increased at site of TENS (spine) and outside site of TENS (leg) when compared to placebo TENS or no TENS. During Active TENS CPM was significantly stronger compared to placebo TENS and no TENS. No changes in functional tasks were observed with TENS. Thus, the current study suggests TENS has short-term efficacy in relieving symptoms of fibromyalgia while the stimulator is active. Future clinical trials should examine the effects of repeated daily delivery of TENS, similar to how TENS is used clinically, on pain, fatigue, function and quality of life in individuals with fibromyalgia. PMID:23900134

Comparison Efficacy of Topical Piroxicam Gel and Lidocaine with Intravenous Pethidine in Reducing Pain during ESWL

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F Mohammad Alibeigi

2011-06-01

Full Text Available Introduction & Objective: ESWL is a non-invasive method of breaking stones, using acoustic shock waves. Shock waves cause temporary deep visceral pain and discomfort in entry therefore, administration of sedatives is necessary. The purpose of this study was to compare the effect of topical lidocaine and piroxicam gel with intravenous pethidine in reducing pain during ESWL. Materials & Methods: This clinical trial study was performed on 159 patients who referred to Ayatollah Kashani Hospital in Shahrkord for ESWL in 2009. Patients were randomly divided into three-groups. For the first group, intravenous pethidine (0.5 mg/kg alone was administered. The second group received topical piroxicam, and the third group received topical lidocaine in the area of flank for half an hour before ESWL. During the operation, those patients who had unbearable pain, received another 0.5 mg/kg of pethidine. Data was collected using MC Gill questionnaires and analyzed using the SPSS software, using parametric, nonparametric methods and Dunn's Multiple Comparisons tests. Results: The mean of pain scores in the first group (pethidine was 6.2 ± 6.9 while these scores were 3.2 ± 2 .7 and 3.9 ± 3.1 for the second (piroxicam gel and third group (lidocaine gel respectively. The differences in the mean score of pain was significant in the pethidine group compared to the other groups (P <0.05. The average pethidin consumption were 24 ± 16 mg for the first group (pethidine, 10 ± 13 mg for the second group (piroxicam gel, and 5 ± 9 mg for the third group (lidocaine gel. The mean difference was significant in pethidine treated group in comparison with other two groups (P < 0.05. Conclusion: The use of topical piroxicam or lidocaine reduces pain in patients after ESWL It also reduces the need for sedative drugs.

Efficacy of port-site and intraperitoneal application of bupivacaine in reducing early post-laparoscopic cholecystectomy pain

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Ahmad, J.; Khan, Z.A.; Khan, A.

2015-01-01

The aim of this study was to assess the analgesic efficacy of Bupivacaine application at port-site and intraperitoneal infiltration in patients with laparoscopic cholecystectomy. Study Design: Randomized Controlled Clinical Trial. Place and Duration: The study was conducted at Rehman Medical Institute (RMI) Peshawar, Pakistan from June 2009 to June 2012. Materials and Methods: Patients who underwent elective laparoscopic cholecystectomy during the study period were included in the study. Eighty patients were randomized into two groups, study group and control group. The study group received 40 ml of 0.25% bupivacaine intraoperatively as intraperitoneal infiltration and local infiltration at the port sites. Pain assessment was done using visual analogue pain score (VAS) of 0-10 at fixed intervals during the first 24 hours post surgery. Results: The mean VAS score in the study group was less as compared to the control group throughout the 24 hours assessment period, however this difference was statistically significant (p<0.001) only during the first three assessments at 1 hour, 4 hours and 8 hours post surgery. The analgesia requirement was also significantly (p<0.001) decreased in the study group. Conclusion: Port site and intraperitoneal application of local anesthetic bupivacaine significantly reduced pain during the first 8 hours post surgery and total analgesia requirement was also significantly reduced. It is a simple and easily applicable technique which increases patient comfort and can be safely used to decrease post operative pain in patients undergoing laparoscopic cholecystectomy. (author)

Inhibition of TRPM8 channels reduces pain in the cold pressor test in humans.

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Winchester, Wendy J; Gore, Katrina; Glatt, Sophie; Petit, Wendy; Gardiner, Jennifer C; Conlon, Kelly; Postlethwaite, Michael; Saintot, Pierre-Philippe; Roberts, Sonia; Gosset, James R; Matsuura, Tomomi; Andrews, Mark D; Glossop, Paul A; Palmer, Michael J; Clear, Nicola; Collins, Susie; Beaumont, Kevin; Reynolds, David S

2014-11-01

The transient receptor potential (subfamily M, member 8; TRPM8) is a nonselective cation channel localized in primary sensory neurons, and is a candidate for cold thermosensing, mediation of cold pain, and bladder overactivity. Studies with TRPM8 knockout mice and selective TRPM8 channel blockers demonstrate a lack of cold sensitivity and reduced cold pain in various rodent models. Furthermore, TRPM8 blockers significantly lower body temperature. We have identified a moderately potent (IC50 = 103 nM), selective TRPM8 antagonist, PF-05105679 [(R)-3-[(1-(4-fluorophenyl)ethyl)(quinolin-3-ylcarbonyl)amino]methylbenzoic acid]. It demonstrated activity in vivo in the guinea pig bladder ice water and menthol challenge tests with an IC50 of 200 nM and reduced core body temperature in the rat (at concentrations >1219 nM). PF-05105679 was suitable for acute administration to humans and was evaluated for effects on core body temperature and experimentally induced cold pain, using the cold pressor test. Unbound plasma concentrations greater than the IC50 were achieved with 600- and 900-mg doses. The compound displayed a significant inhibition of pain in the cold pressor test, with efficacy equivalent to oxycodone (20 mg) at 1.5 hours postdose. No effect on core body temperature was observed. An unexpected adverse event (hot feeling) was reported, predominantly periorally, in 23 and 36% of volunteers (600- and 900-mg dose, respectively), which in two volunteers was nontolerable. In conclusion, this study supports a role for TRPM8 in acute cold pain signaling at doses that do not cause hypothermia. Copyright © 2014 by The American Society for Pharmacology and Experimental Therapeutics.

Improved Function and Reduced Pain after Swimming and Cycling Training in Patients with Osteoarthritis.

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Alkatan, Mohammed; Baker, Jeffrey R; Machin, Daniel R; Park, Wonil; Akkari, Amanda S; Pasha, Evan P; Tanaka, Hirofumi

2016-03-01

Arthritis and its associated joint pain act as significant barriers for adults attempting to perform land-based physical activity. Swimming can be an ideal form of exercise for patients with arthritis. Yet there is no information on the efficacy of regular swimming exercise involving patients with arthritis. The effect of a swimming exercise intervention on joint pain, stiffness, and physical function was evaluated in patients with osteoarthritis (OA). Using a randomized study design, 48 sedentary middle-aged and older adults with OA underwent 3 months of either swimming or cycling exercise training. Supervised exercise training was performed for 45 min/day, 3 days/week at 60-70% heart rate reserve for 12 weeks. The Western Ontario and McMaster Universities Arthritis Index was used to measure joint pain, stiffness, and physical limitation. After the exercise interventions, there were significant reductions in joint pain, stiffness, and physical limitation accompanied by increases in quality of life in both groups (all p swimming and cycling training. Regular swimming exercise reduced joint pain and stiffness associated with OA and improved muscle strength and functional capacity in middle-aged and older adults with OA. Additionally, the benefits of swimming exercise were similar to the more frequently prescribed land-based cycling training. clinicaltrials.gov NCT01836380.

Participatory ergonomics to reduce exposure to psychosocial and physical risk factors for low back pain and neck pain: results of a cluster randomised controlled trial.

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Driessen, Maurice T; Proper, Karin I; Anema, Johannes R; Knol, Dirk L; Bongers, Paulien M; van der Beek, Allard J

2011-09-01

This study investigated the effectiveness of the Stay@Work participatory ergonomics programme to reduce workers' exposure to psychosocial and physical risk factors. 37 departments (n=3047 workers) from four Dutch companies participated in this cluster randomised controlled trial; 19 (n=1472 workers) were randomised to an intervention group (participatory ergonomics) and 18 (n=1575 workers) to a control group (no participatory ergonomics). During a 6 h meeting guided by an ergonomist, working groups devised ergonomic measures to reduce psychosocial and physical workload and implemented them within 3months in their departments. Data on psychosocial and physical risk factors for low back pain and neck pain were collected at baseline and after 6 months. Psychosocial risk factors were measured using the Job Content Questionnaire and physical risk factors using the Dutch Musculoskeletal Questionnaire. Intervention effects were studied using multilevel analysis. Intervention group workers significantly increased on decision latitude (0.29 points; 95% CI 0.07 to 0.52) and decision authority (0.16 points; 95% CI 0.04 to 0.28) compared to control workers. However, exposure to awkward trunk working postures significantly increased in the intervention group (OR 1.86; 95% CI 1.15 to 3.01) compared to the control group. No significant differences between the intervention and control group were found for the remaining risk factors. After 6months, loss to follow-up was 35% in the intervention group and 29% in the control group. Participatory ergonomics was not effective in reducing exposure to psychosocial and physical risk factors for low back pain and neck pain among a large group of workers. ISRCTN27472278.

Knee osteoarthritis pain in the elderly can be reduced by massage therapy, yoga and tai chi: A review.

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Field, Tiffany

2016-02-01

This is a review of recently published research, both empirical studies and meta-analyses, on the effects of complementary therapies including massage therapy, yoga and tai chi on pain associated with knee osteoarthritis in the elderly. The massage therapy protocols have been effective in not only reducing pain but also in increasing range of motion, specifically when moderate pressure massage was used and when both the quadriceps and hamstrings were massaged. The yoga studies typically measured pain by the WOMAC. Most of those studies showed a clinically significant reduction in pain, especially the research that focused on poses (e.g. the Iyengar studies) as opposed to those that had integrated protocols (poses, breathing and meditation exercises). The tai chi studies also assessed pain by self-report on the WOMAC and showed significant reductions in pain. The tai chi studies were difficult to compare because of their highly variable protocols in terms of the frequency and duration of treatment. Larger, randomized control trials are needed on each of these therapies using more standardized protocols and more objective variables in addition to the self-reported WOMAC pain scale, for example, range-of-motion and observed range-of-motion pain. In addition, treatment comparison studies should be conducted so, for example, if the lower-cost yoga and tai chi were as effective as massage therapy, they might be used in combination with or as supplemental to massage therapy. Nonetheless, these therapies are at least reducing pain in knee osteoarthritis and they do not seem to have side effects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Perspectives on the clinical significance of functional pain syndromes in children

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Basch MC

2015-10-01

Full Text Available Molly C Basch,1,2 Erika T Chow,1,3 Deirdre E Logan,1,4 Neil L Schechter,4 Laura E Simons1,2,4 1Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 2Boston Children's Hospital, Center for Pain and the Brain, PAIN Research Group, 3Boston University School of Medicine, Boston University, 4Department of Psychiatry, Harvard Medical School, Boston, MA, USA Abstract: Functional pain syndromes (FPS characterize a subset of individuals who experience pain and related symptoms and disability without clear structural or disease etiology. In the pediatric population, FPS hold high clinical importance due to significant prevalence rates and potential to persist into adulthood. Although extensive research has been executed to disambiguate FPS, the syndromes that fall within its spectrum remain conceptually complex and sometimes ill-defined. This paper provides an overview of available research on the classification and multifaceted etiology of FPS in youth and their effects on interpersonal, psychological, and familial function. Vital aspects of a successful multidisciplinary approach to treating this population are described; however, it is evident that future research requires more longitudinal studies. Keywords: overlapping chronic pain, functional pain, primary pain disorders, pediatrics, biopsychosocial model

Tramadol versus Celecoxib for reducing pain associated with outpatient hysteroscopy: a randomized double-blind placebo-controlled trial.

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Hassan, A; Wahba, A; Haggag, H

2016-01-01

Which is better, Tramadol or Celecoxib, in reducing pain associated with outpatient hysteroscopy? Both Tramadol and Celecoxib are effective in reducing pain associated with outpatient hysteroscopy but Celecoxib may be better tolerated. Pain is the most common cause of failure of outpatient hysteroscopy. A systematic review and meta-analysis showed that local anaesthetics were effective in reducing pain associated with hysteroscopy but there was insufficient evidence to support the use of oral analgesics, opioids and non-steroidal anti-inflammatory drugs, to reduce hysteroscopy-associated pain and further studies were recommended. This was a randomized double-blind placebo-controlled trial with balanced randomization (allocation ratio 1:1:1) conducted in a university hospital from May 2014 to November 2014. Two hundred and ten women who had diagnostic outpatient hysteroscopy were randomly divided into three equal groups: Group 1 received oral Tramadol 100 mg, group 2 received Celecoxib 200 mg and group 3 received an oral placebo. All the drugs were given 1 h before the procedure. A patient's perception of pain was assessed during the procedure, immediately afterwards and 30 min after the procedure with the use of a visual analogue scale (VAS). There was a significant difference in the pain scores among the groups during the procedure, immediately afterwards and 30 min after the procedure (Ppain scores when compared with the placebo during the procedure (mean difference = 1.54, 95% confidence interval (CI) (0.86, 2.22), P pain scores than the placebo during the procedure (mean difference = 1.28, 95% CI (0.62, 1.94), P pain scores between Tramadol and Celecoxib at any time. Time until no pain differed significantly among the groups (P = 0.01); it was shorter with both Tramadol and Celecoxib groups when compared with placebo (P = 0.002 and 0.046, respectively). The procedure failed to be completed in one patient in the placebo group but no failure to complete the

Cortisol reduces recall of explicit contextual pain memory in healthy young men.

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Schwegler, Kyrill; Ettlin, Dominik; Buser, Iris; Klaghofer, Richard; Goetzmann, Lutz; Buddeberg, Claus; Alon, Eli; Brügger, Mike; de Quervain, Dominique J-F

2010-09-01

Remembering painful incidents has important adaptive value but may also contribute to clinical symptoms of posttraumatic stress disorder and chronic pain states. Because glucocorticoids are known to impair memory retrieval processes, we investigated whether cortisol affects recall of previously experienced pain in healthy young men. In a double-blind, placebo-controlled crossover study, 20 male participants were presented pictures, half of them combined with a heat-pain stimulus. The next day, the same pictures were shown in the absence of pain. Cortisol (20 mg) administered 1h before retention testing reduced recall of explicit contextual pain memory, whereas it did not affect pain threshold or pain tolerance. Copyright 2010 Elsevier Ltd. All rights reserved.

Xiaozhi decoction reduced posthemorrhoidectomy pain and analgesic medication consumption: a prospective study

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Shen JB

2017-01-01

Full Text Available Jianbin Shen,1,* Xiagang Luo,2,* Xiao Zhou,3 Chengwu Tang,1 Huanyu Ju,2 Yongqiang Xu,1 Lianjin Qin1 1Department of General Surgery, First People’s Hospital Affiliated to Huzhou Normal College, Huzhou, Zhejiang, 2Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 3Department of Orthopedics, People’s Hospital of Zhangqiu, Jinan, Shandong, People’s Republic of China *These authors contributed equally to this work Objective: The aim of this study was to investigate the effect of Xiaozhi decoction (XZD on posthemorrhoidectomy pain and analgesic medication consumption.Methods: From May 2013 to March 2015, 315 patients who underwent open hemorrhoidectomy in our hospital were enrolled in this study, of whom, 160 patients were randomly assigned to accept sitz bath with warm water after hemorrhoidectomy (control group and 155 patients were randomly assigned to accept sitz bath with XZD (XZD group after hemorrhoidectomy. Postoperative pain at 12 hours after surgery and on postoperative days (PODs 1, 2, 7, 14 and 28 was evaluated by Visual Analog Scale (VAS. Pain on defecation on PODs 1, 2, 7, 14 and 28 was also recorded using the VAS. The consumption of analgesics was also analyzed.Results: No significant difference was found in baseline characteristics between the two groups. Postoperative pain score of the XZD group was significantly lower on POD 2 (6.04±1.11 vs 6.33±1.14, P=0.0229, POD 7 (3.35±0.75 vs 4.22±0.87, P=0.0000 and POD 14 (2.87±0.64 vs 3.64±0.77, P=0.0000 than that of the control group. Similarly, patients in the XZD group experienced significantly less pain on defecation on POD 2 (5.02±1.34 vs 5.43±1.56, P=0.0130, POD 7 (3.08±1.17 vs 3.52±1.29, P=0.0017 and POD 14 (2.31±0.85 vs 2.68±0.99, P=0.0004. Patients in the XZD group consumed significantly less analgesic medication on POD 2 (P=0.0136, POD 7 (P=0.0074 and POD 14 (P=0.0046 than the control group. Conclusion

The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis

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Shaheen E. Lakhan

2016-01-01

Full Text Available Background. Aromatherapy refers to the medicinal or therapeutic use of essential oils absorbed through the skin or olfactory system. Recent literature has examined the effectiveness of aromatherapy in treating pain. Methods. 12 studies examining the use of aromatherapy for pain management were identified through an electronic database search. A meta-analysis was performed to determine the effects of aromatherapy on pain. Results. There is a significant positive effect of aromatherapy (compared to placebo or treatments as usual controls in reducing pain reported on a visual analog scale (SMD = −1.18, 95% CI: −1.33, −1.03; p<0.0001. Secondary analyses found that aromatherapy is more consistent for treating nociceptive (SMD = −1.57, 95% CI: −1.76, −1.39, p<0.0001 and acute pain (SMD = −1.58, 95% CI: −1.75, −1.40, p<0.0001 than inflammatory (SMD = −0.53, 95% CI: −0.77, −0.29, p<0.0001 and chronic pain (SMD = −0.22, 95% CI: −0.49, 0.05, p=0.001, respectively. Based on the available research, aromatherapy is most effective in treating postoperative pain (SMD = −1.79, 95% CI: −2.08, −1.51, p<0.0001 and obstetrical and gynecological pain (SMD = −1.14, 95% CI: −2.10, −0.19, p<0.0001. Conclusion. The findings of this study indicate that aromatherapy can successfully treat pain when combined with conventional treatments.

Risk factors associated with reduced work productivity among people with chronic knee pain.

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Agaliotis, M; Fransen, M; Bridgett, L; Nairn, L; Votrubec, M; Jan, S; Heard, R; Mackey, M

2013-09-01

To determine the burden and risk factors associated with reduced work productivity among people with chronic knee pain. A longitudinal study, nested within a randomised controlled trial (RCT) evaluating the long-term effects of dietary supplements, was conducted among people with chronic knee pain in paid employment (n = 360). Participants recorded days off work (absenteeism) and reduced productivity while at work (presenteeism) for seven days every two months over a 12-month period in a study specific diary. Examined risk factors included knee pain severity, occupational group, radiographic disease severity, physical activity, body mass index (BMI), health-related quality of life (SF-12) and co-morbidity. Over the 12-month follow up period, 50 (14%) participants reported one or more days off work due to knee problems, while 283 (79%) reported reduced productivity while at work (presenteeism absenteeism was having an SF-12 Mental Component Summary (MCS) score labour (OR: 2.23 [1.09-4.59]) or manual labour (OR: 6.40 [1.44-28.35]) or a high maximum knee pain (4-6 out of 10) (OR: 2.29 [1.17-4.46]). This longitudinal study found that among this cohort of people with chronic knee pain, the burden of reduced work productivity is mainly attributable to presenteeism rather absenteeism. This study demonstrated that effective strategies to increase work productivity should focus on reducing knee pain or physical disability especially among workers in manual or semi-manual labour. © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Comparison of lbuprofen with Acupuncture in Reducing Knee Osteoarthritis Pain

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MR Emad

2008-01-01

Full Text Available ABSTRACT: Introduction & Objective: Osteoarthritis is the most common joint disease of humans. Acupuncture is one of the treatments for osteoarthritis. This study aimed to compare lbuprofen with acupuncture in the pain reduction in knee osteoarthritis. Materials & Methods: This is a clinical trial which was performed in Shiraz Medical School Clinics in 2007. Forty six patients with chronic pain due to the knee osteoarthritis were recruited using strict inclusion and exclusion criteria. All the patients were randomly divided into two groups (A and B who received lbuprofen (1200 mg/day or acupuncture (2 sessions per week for 2 weeks, respectively. Evaluating measuring tools were pain intensity (based on VAS, ROM (based on degree and morning stiffness of the knee joint. Collected data were analyzed by Chi-Square test, using SPSS software. Results: Pain intensity at baseline, after the course of treatment and 3 weeks after the treatment in group A was 7.29 ± 0.61, 4.20±0.93 and 5.20± 1.32 cm, respectively while these figures for group B were 7.35±0.82, 3.43±0.96 and 4.93±1.32 cm, respectively (p<0.005. Also knee ROM degree in group A was 21.54±7.46, 13.08±5.60 and 15.38±3.2 and for group B was 20.36±7.19, 12.40±5.78 and 10.36±5.30, respectively (p=0.003. Knee morning stiffness improved more in group B. Conclusion: Result of this study showed that both modalities significantly reduced the pain in patients with knee osteoarthritis and improved ROM while morning stiffness improved more in group B.

Intraoperative Sensorcaine significantly improves postoperative pain management in outpatient reduction mammaplasty.

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Culliford, Alfred T; Spector, Jason A; Flores, Roberto L; Louie, Otway; Choi, Mihye; Karp, Nolan S

2007-09-15

Breast reduction is one of the most frequently performed plastic surgical procedures in the United States; more than 160,500 patients underwent the procedure in 2005. Many outpatient reduction mammaplasty patients report the greatest postoperative discomfort in the first 48 hours. The authors' investigated the effect of intraoperative topical application of the long-acting local anesthetic agent bupivacaine (Sensorcaine or Marcaine) on postoperative pain, time to postanesthesia care unit discharge, and postoperative use of narcotic medication. In a prospective, randomized, single-blind trial, intraoperative use of Sensorcaine versus placebo (normal saline) was compared. Postoperative pain was quantified using the visual analogue scale, and time to discharge from the postanesthesia care unit was recorded. Patients documented their outpatient pain medication usage. Of the 37 patients enrolled in the study, 20 were treated with intraoperative topical Sensorcaine and 17 received placebo. Patients treated with Sensorcaine were discharged home significantly faster (2.9 hours versus 3.8 hours, p = 0.002). The control arm consistently had higher pain scores in the postanesthesia care unit (although not statistically significant) than the Sensorcaine group using the visual analogue scale system. Furthermore, patients receiving Sensorcaine required significantly less narcotic medication while recovering at home (mean, 3.5 tablets of Vicodin) than the control group (mean, 6.4 tablets; p = 0.001). There were no complications resulting from Sensorcaine usage. This prospective, randomized, single-blind study demonstrates that a single dose of intraoperative Sensorcaine provides a safe, inexpensive, and efficacious way to significantly shorten the length of postanesthesia care unit stay and significantly decrease postoperative opioid analgesic use in patients undergoing ambulatory reduction mammaplasty.

Time to significant pain reduction following DETP application vs placebo for acute soft tissue injuries.

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Yanchick, J; Magelli, M; Bodie, J; Sjogren, J; Rovati, S

2010-08-01

Nonsteroidal anti-inflammatory drugs (NSAIDs) provide fast and effective acute pain relief, but systemic administration has increased risk for some adverse reactions. The diclofenac epolamine 1.3% topical patch (DETP) is a topical NSAID with demonstrated safety and efficacy in treatment of acute pain from minor soft tissue injuries. Significant pain reduction has been observed in clinical trials within several hours following DETP application, suggesting rapid pain relief; however, this has not been extensively studied for topical NSAIDs in general. This retrospective post-hoc analysis examined time to onset of significant pain reduction after DETP application compared to a placebo patch for patients with mild-to-moderate acute ankle sprain, evaluating the primary efficacy endpoint from two nearly identical studies. Data from two double-blind, randomized, parallel-group, placebo-controlled studies (N = 274) of safety and efficacy of the DETP applied once daily for 7 days for acute ankle sprain were evaluated post-hoc using statistical modeling to estimate time to onset of significant pain reduction following DETP application. Pain on active movement on a 100 mm Visual Analog Scale (VAS) recorded in patient diaries; physician- and patient-assessed tolerability; and adverse events. DETP treatment resulted in significant pain reduction within approximately 3 hours compared to placebo. Within-treatment post-hoc analysis based on a statistical model suggested significant pain reduction occurred as early as 1.27 hours for the DETP group. The study may have been limited by the retrospective nature of the analyses. In both studies, the DETP was well tolerated with few adverse events, limited primarily to application site skin reactions. The DETP is an effective treatment for acute minor soft tissue injury, providing pain relief as rapidly as 1.27 hours post-treatment. Statistical modeling may be useful in estimating time to onset of pain relief for comparison of topical

Topical combinations aimed at treating microvascular dysfunction reduce allodynia in rat models of CRPS-I and neuropathic pain.

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Ragavendran, J Vaigunda; Laferrière, André; Xiao, Wen Hua; Bennett, Gary J; Padi, Satyanarayana S V; Zhang, Ji; Coderre, Terence J

2013-01-01

Growing evidence indicates that various chronic pain syndromes exhibit tissue abnormalities caused by microvasculature dysfunction in the blood vessels of skin, muscle, or nerve. We tested whether topical combinations aimed at improving microvascular function would relieve allodynia in animal models of complex regional pain syndrome type I (CRPS-I) and neuropathic pain. We hypothesized that topical administration of either α(2)-adrenergic (α(2)A) receptor agonists or nitric oxide (NO) donors combined with either phosphodiesterase (PDE) or phosphatidic acid (PA) inhibitors would effectively reduce allodynia in these animal models of chronic pain. Single topical agents produced significant dose-dependent antiallodynic effects in rats with chronic postischemia pain, and the antiallodynic dose-response curves of PDE and PA inhibitors were shifted 2.5- to 10-fold leftward when combined with nonanalgesic doses of α(2)A receptor agonists or NO donors. Topical combinations also produced significant antiallodynic effects in rats with sciatic nerve injury, painful diabetic neuropathy, and chemotherapy-induced painful neuropathy. These effects were shown to be produced by a local action, lasted up to 6 hours after acute treatment, and did not produce tolerance over 15 days of chronic daily dosing. The present results support the hypothesis that allodynia in animal models of CRPS-I and neuropathic pain is effectively relieved by topical combinations of α(2)A or NO donors with PDE or PA inhibitors. This suggests that topical treatments aimed at improving microvascular function may reduce allodynia in patients with CRPS-I and neuropathic pain. This article presents the synergistic antiallodynic effects of combinations of α(2)A or NO donors with PDE or PA inhibitors in animal models of CRPS-I and neuropathic pain. The data suggest that effective clinical treatment of chronic neuropathic pain may be achieved by therapies that alleviate microvascular dysfunction in affected

The effects of compensatory workplace exercises to reduce work-related stress and musculoskeletal pain

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Fabiana Cristina Taubert de Freitas-Swerts

2014-08-01

Full Text Available OBJECTIVES: to assess the effect of a compensatory workplace exercise program on workers with the purpose of reducing work-related stress and musculoskeletal pain.METHOD: quasi-experimental research with quantitative analysis of the data, involving 30 administrative workers from a Higher Education Public Institution. For data collection, questionnaires were used to characterize the workers, as well as the Workplace Stress Scale and the Corlett Diagram. The research took place in three stages: first: pre-test with the application of the questionnaires to the subjects; second: Workplace Exercise taking place twice a week, for 15 minutes, during a period of 10 weeks; third: post-test in which the subjects answered the questionnaires again. For data analysis, the descriptive statistics and non-parametric statistics were used through the Wilcoxon Test.RESULTS: work-related stress was present in the assessed workers, but there was no statistically significant reduction in the scores after undergoing Workplace Exercise. However, there was a statistically significant pain reduction in the neck, cervical, upper, middle and lower back, right thigh, left leg, right ankle and feet.CONCLUSION: the Workplace Exercise promoted a significant pain reduction in the spine, but did not result in a significant reduction in the levels of work-related stress.

Modest Amounts of Voluntary Exercise Reduce Pain- and Stress-Related Outcomes in a Rat Model of Persistent Hind Limb Inflammation.

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Pitcher, Mark H; Tarum, Farid; Rauf, Imran Z; Low, Lucie A; Bushnell, Catherine

2017-06-01

Aerobic exercise improves outcomes in a variety of chronic health conditions, yet the support for exercise-induced effects on chronic pain in humans is mixed. Although many rodent studies have examined the effects of exercise on persistent hypersensitivity, the most used forced exercise paradigms that are known to be highly stressful. Because stress can also produce analgesic effects, we studied how voluntary exercise, known to reduce stress in healthy subjects, alters hypersensitivity, stress, and swelling in a rat model of persistent hind paw inflammation. Our data indicate that voluntary exercise rapidly and effectively reduces hypersensitivity as well as stress-related outcomes without altering swelling. Moreover, the level of exercise is unrelated to the analgesic and stress-reducing effects, suggesting that even modest amounts of exercise may impart significant benefit in persistent inflammatory pain states. Modest levels of voluntary exercise reduce pain- and stress-related outcomes in a rat model of persistent inflammatory pain, independently of the amount of exercise. As such, consistent, self-regulated activity levels may be more relevant to health improvement in persistent pain states than standardized exercise goals. Published by Elsevier Inc.

Does wound infi ltration of tramadol reduce postoperative pain in laparoscopic or open herniorrhaphy?

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Remziye Sıvacı

2012-09-01

Full Text Available Introduction: The laparoscopic approach may be associated with more postoperative pain initially. The aim of this study was to evaluate the effects of administered tramadol at wound closure on postoperative painand analgesic requirements under spinal anesthesia in laparoscopic inguinal herniorrhaphy (LH or tension free open inguinal herniorrhaphy (TFOH.Methods: Twenty patients were randomly divided into two groups (n= 10 in each as LH or TFOH. Patients received infiltration of 200 mg tramadol with 40 mL of 0.9% saline solution at wound closure procedure. Postoperative pain was assessed with a Visual Analog Scale (VAS at 3, 6, 12, and 24 hours postoperatively. Additional requirements of tramadol for postoperative pain releif were registered.Results: VAS scores at postoperative 12 and 24 hours were signifi cantly higher according to 3rd hour VAS scores in both groups. The VAS scores at 12 hours after operation signifi cantly lower in LH group than inTFOH group (1.5 ± 0.97 vs 5.1 ± 0.99. Additional requirements of tramadol for postoperative pain releif were significantly lower in LH group.Conclusion: We conclude that wound infi ltration of 200 mg tramadol reduce postoperative pain in LH group.

Intradiscal and intra-articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain

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Kirchner, Fernando; Anitua, Eduardo

2016-01-01

Context: Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge. Aims: The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF-Endoret) infiltrations (one intradiscal, one intra-articular facet, and one transforaminal epidural injection) under fluoroscopic guidance-control in patients with chronic LBP. PRGF-Endoret which has been shown to be an efficient treatment to reduce joint pain. Settings and Design: The study was designed as an observational retrospective pilot study. Eighty-six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012. Subjects and Methods: One intradiscal, one intra-articular facet, and one transforaminal epidural injection of PRGF-Endoret under fluoroscopic guidance-control were carried out in 86 patients with chronic LBP in the operating theater setting. Statistical Analysis Used: Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow-up time points on pain reduction after treatment. Results: Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF-Endoret injections showed a statistically significant drop from 8.4 ± 1.1 before the treatment to 4 ± 2.6, 1.7 ± 2.3, and 0.8 ± 1.7 at 1, 3, and 6 months after the treatment, respectively, with respect to all the time evaluations (P PRGF in patients with chronic LBP resulted in significant pain reduction assessed by VAS. PMID:27891035

The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review.

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Morris, Linzette Deidré; Louw, Quinette Abegail; Grimmer-Somers, Karen

2009-01-01

To systematically review the current evidence for the effectiveness of Virtual Reality (VR), in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. A comprehensive search was conducted between December 2007 and January 2008, and updated in January 2009, before publication. Computerized bibliographic databases were individually searched using specifically developed search strategies to identify eligible studies. Nine studies were deemed eligible for inclusion in this review. Wound dressing changes was the most common procedure during which VR was trialed. Pain was the primary outcome measure in all of the studies included. Anxiety was a secondary outcome measure in 3 of the 9 included studies. VR, in conjunction with pharmacologic analgesics, significantly reduced pain experienced by burn injury patients during wound dressing changes and physiotherapy. There is equivocal evidence for the effect of VR in conjunction with pharmacologic analgesics on reducing anxiety in burn injury patients during wound dressing changes and physiotherapy. This is the first known systematic review to report on the effectiveness of VR, in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. Used as an adjunct to the current burn pain management regimens, VR could possibly assist health professionals in making the rehabilitation process for burn patients less excruciating, thereby improving functional outcomes. Further research investigating the effect of VR on anxiety in burn injury patients is warranted.

Investigating Efficacy of Melatonin and Gabapentin in Reducing Anxiety and Pain of Lumbar Puncture in Children

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R Fallah

2013-10-01

Full Text Available Introduction: The lumbar puncture is one of the most important diagnostic and therapeutic procedures within children which child’s non-cooperativeness and procedural sedation are regarded necessary to conduct it. This study aimed to compare efficacy and safety of melatonin and gabapentin in reducing anxiety and pain of lumbar puncture in children. Methods: In a parallel single-blinded randomized clinical trial, sixty children aged 6 months -7 years, were evaluated in Pediatric Ward of Shahid Sadoughi Hospital, in Yazd (Iran in 2012. The children were distributedrandomly into two groups (30 children in each group. In group one, they received 0.3 mg/kg/dose of melatonin and theother group received 15 mg/kg/dose of gabapentin. Primary endpoints were success rate in reducing anxiety (anxiety score of≥ four and reducing pain when the needle was inserted to skin for lumbarpuncture (pain score of less than four. The clinicalside effects were investigated as well. Results: Twenty two girls (36.7% and 38 boys (63.3% with mean age of 2.79 ± 1.92 years were evaluated. Anxiety reduction (achieving the anxiety score of ≥ four was obtained in 43.3% in melatonin and in 36.7% in gabapentin groups, respectively and both drugs were equally effective in anxiety reduction (p.value = 0.598.Pain reduction ( achieving the pain score of less than four was obtained in 23.3% in melatonin and in 50% in gabapentin groups, respectively and thus, gabapentin wasproved to be more effective in pain reduction (p.value = 0.032.Mild side effects were observed in 10% of melatonin group and in 16.7% of gabapentin group. No statistically significant differences were seen from viewpoint of safety between the two drugs (p.value=0.448. Conclusion: Melatonin and gabapentin were not effective drugs in anxiety reduction for lumbar puncture of children. However, gabapentin is a safe and effective drug in pain reduction in painful diagnostic therapeutic procedures.

Pregabalin reduces acute inflammatory and persistent pain associated with nerve injury and cancer in rat models of orofacial pain.

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Hummig, Wagner; Kopruszinski, Caroline Machado; Chichorro, Juliana Geremias

2014-01-01

To assess the analgesic effect of pregabalin in orofacial models of acute inflammatory pain and of persistent pain associated with nerve injury and cancer, and so determine its effectiveness in controlling orofacial pains having different underlying mechanisms. Orofacial capsaicin and formalin tests were employed in male Wistar rats to assess the influence of pregabalin (or vehicle) pretreatment in acute pain models, and the results from these experiments were analyzed by one-way analysis of variance (ANOVA) followed by Newman Keuls post-hoc test. Pregabalin (or vehicle) treatment was also tested on the facial heat hyperalgesia that was evaluated in rats receiving injection of the inflammatory irritant carrageenan into the upper lip, as well as after constriction of the infraorbital nerve (a model of trigeminal neuropathic pain), or after inoculation of tumor cells into the facial vibrissal pad; two-way repeated measures ANOVA followed by Newman-Keuls post-hoc test was used to analyze data from these experiments. Facial grooming induced by capsaicin was abolished by pretreatment with pregabalin at 10 and 30 mg/kg. However, pregabalin failed to modify the first phase of the formalin response, but reduced the second phase at both doses (10 and 30 mg/kg). In addition, treatment of rats with pregabalin reduced the heat hyperalgesia induced by carrageenan, as well as by nerve injury and facial cancer. Pregabalin produced a marked antinociceptive effect in rat models of facial inflammatory pain as well as in facial neuropathic and cancer pain models, suggesting that it may represent an important agent for the clinical control of orofacial pain.

A study of ′cough trick′ technique in reducing vaccination prick pain in adolescents

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Vikram S. Kumar

2014-01-01

Full Text Available Background: The ′cough trick′ (CT technique is used in reducing intramuscular prick (IMP pain during vaccinations and also for brief painful procedures like subcutaneous injection, intravenous cannulation, and so forth. We present the utility study of this technique in male adolescents. Materials and Methods: A Randomized Crossover Volunteer Study of 50 early adolescent male children (age 11-13 receiving immunizations was performed. Participants were recruited from four outpatient pediatric clinics. The strategy required a single "warm-up" cough of moderate force, followed by a second cough that coincided with needle puncture. The principle outcome was self-reported pain. Results: Paired ′t′ test revealed that the procedure was effective at a statistically and clinically significant level for participants. Children found the procedure acceptable and effective. Conclusions: The results of this study suggest that the CT can be an effective strategy for the reduction of pain for male adolescent children undergoing routine immunizations. However, additional research is needed with a larger sample size with different age groups and also including girl children.

CUTANEUS STIMULATION: SLOW-STROKE BACK MASSAGE REDUCES THE INTENSITY OF OSTEOARTRITIS PAIN OF ELDERLY

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Mira Triharini

2017-04-01

Full Text Available Introduction: Osteoarthritis disease is the result of both mechanical and biological process which lead come to unstable degradation and synthesis of condrozyte cartilage and extracellular matrix. The risk factor of this instability is aging process. The aging process stimulates osteophytes formation and degradation of cartilage, and emerged pain as primary clinical symptom. One of the non pharmacological ways to cope this pain is by applying cutaneus stimulation through slow-stroke back massage method. The objective of this study was to analyze the effect of applying cutaneus stimulation with slow-stroke back massage method to osteoarthritis’s pain intensity. Method: Pre experimental design with one group pre test-post test approach was used in this study. The subject of this study were elderly above 50 years old living in Panti Werdha Hargo Dedali Surabaya, 15 participants were involved using purpose sampling technique. This study started on January 29th until February 6th, 2010. Data were collected by interview and observation and analyzed by WIlcoxcon Signed Rank Test α = 0.05, p value <α. Result: The Result showed that the message intervention was significantly affect the elder’s level of osteoarthritis pain in Panti Werdha Hargo Dedali Surabaya (p = 0.003. Discussion: It can be concluded that gives stimulation cutaneus: slow-stroke back massage reduce osteoathritis pain intensity. Slow-stroke back massage increase level of endorphin, so that pain reduction and individual pain perception will decrease.

Biosorbable poly-L-lactide rib-connecting pins may reduce acute pain after thoracotomy.

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Iwasaki, A; Hamatake, D; Shirakusa, T

2004-02-01

Conventional thoracotomy is currently used as a standard procedure, and is often required to treat numerous diseases. Additionally, rib resections are occasionally required to maintain an adequate field of view for surgery. The benefits of using rib pins for chest closure following such procedures have not yet been established. This study sought to evaluate the usefulness of rib pins in reducing acute postoperative pain. Thirty-three consecutive patients with lung cancer underwent lobectomies using the posterolateral approach. The patients were rib-resected and reconstructed with two techniques: 21 patients with absorbable rib pins (ARP group) and 12 patients by ligation with absorbable sutures (LAS group). Intensity of pain was assessed during the 3 days immediately following surgery. The two groups were assessed using the visual analogue scale (VAS) as a pain scale, amounts consumed of patient-controlled analgesics (PCA), and additional chest x-rays. On the first day following surgery, the mean VAS intensity of the ARP group for patient motion was 2.71 +/- 2.14, compared to 5.33 +/- 2.99 in the LAS group. After three days, the mean score for the ARP group was 1.98 +/- 1.89, compared to 4.60 +/- 1.97 in the LAS group. Scores in the ARP group were significantly lower than in the LAS group one day and three days following thoracotomy. The LAS group (55.0 +/- 15.9 times) made more frequent requests than the ARP group (16.1 +/- 10.3 times). The PCA requirement was also significantly lower in the ARP group. Excessive derangement of the rib (grade 2) was found in one case (4.7 %) in the ARP group compared to five cases (41.6 %) in the LAS group. Rib shifts were seen in numerous cases in the LAS group compared to the ARP group as measured by chest x-rays. Use of absorbable rib pins reduced postoperative pain and may improve long-term prospects for the post-thoracotomy course.

Pre-emptive penile ring block with sucrose analgesia reduces pain response to neonatal circumcision.

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Roman-Rodriguez, Christian F; Toussaint, Thomas; Sherlock, Douglas J; Fogel, Joshua; Hsu, Chaur-Dong

2014-04-01

To compare retrospective use of oral sucrose (SUC) vs oral sucrose plus lidocaine ring block (SUC + RB) in the management of pain during neonatal circumcision. A retrospective review of medical records of newborns circumcised using the "Neonatal Infant Pain Scale" was done. With regard to pain, the SUC group had a significantly greater percentage of those with pain than the SUC + RB group at 1 minute (77.7% vs 69.4%; P = .01) and 5 minutes (65.7% vs 55.7%; P = .004). There was no significant pain difference at 30 minutes. In the multivariate logistic regression analyses, those in the SUC group had significantly greater odds for pain at 1 minute than those in the SUC + RB group (odds ratio 1.45, 95% confidence interval 1.04-2.02; P = .03). No significant difference was noted at 5 minutes. Each of the SUC and SUC + RB groups had significant decreases in pain percentages at 5 minutes and 30 minutes (P analgesia. In addition, for post-term neonates, we recommend greater focus on pain levels, including considering higher dosages of pain medications. Copyright © 2014 Elsevier Inc. All rights reserved.

The Edible Brown Seaweed Ecklonia cava Reduces Hypersensitivity in Postoperative and Neuropathic Pain Models in Rats

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Jae Goo Kim

2014-06-01

Full Text Available The current study was designed to investigate whether edible brown seaweed Ecklonia cava extracts exhibits analgesic effects in plantar incision and spared nerve injury (SNI rats. To evaluate pain-related behavior, we performed the mechanical withdrawal threshold (MWT and thermal hypersensitivity tests measured by von Frey filaments and a hot/cold plate analgesia meter. Pain-related behavior was also determined through analysis of ultrasonic vocalization. The results of experiments showed MWT values of the group that was treated with E. cava extracts by 300 mg/kg significantly increased; on the contrary, number of ultrasonic distress vocalization of the treated group was reduced at 6 h and 24 h after plantar incision operation (62.8%, p < 0.05. Moreover, E. cava 300 mg/kg treated group increased the paw withdrawal latency in hot-and cold-plate tests in the plantar incision rats. After 15 days of continuous treatment with E. cava extracts at 300 mg/kg, the treated group showed significantly alleviated SNI-induced hypersensitivity response by MWT compared with the control group. In conclusion, these results suggest that E. cava extracts have potential analgesic effects in the case of postoperative pain and neuropathic pain in rats.

Frutalin reduces acute and neuropathic nociceptive behaviours in rodent models of orofacial pain.

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Damasceno, Marina B M V; de Melo Júnior, José de Maria A; Santos, Sacha Aubrey A R; Melo, Luana T M; Leite, Laura Hévila I; Vieira-Neto, Antonio E; Moreira, Renato de A; Monteiro-Moreira, Ana Cristina de O; Campos, Adriana R

2016-08-25

Orofacial pain is a highly prevalent clinical condition, yet difficult to control effectively with available drugs. Much attention is currently focused on the anti-inflammatory and antinociceptive properties of lectins. The purpose of this study was to evaluate the antinociceptive effect of frutalin (FTL) using rodent models of inflammatory and neuropathic orofacial pain. Acute pain was induced by formalin, glutamate or capsaicin (orofacial model) and hypertonic saline (corneal model). In one experiment, animals were pretreated with l-NAME and naloxone to investigate the mechanism of antinociception. The involvement of the lectin domain in the antinociceptive effect of FTL was verified by allowing the lectin to bind to its specific ligand. In another experiment, animals pretreated with FTL or saline were submitted to the temporomandibular joint formalin test. In yet another, animals were submitted to infraorbital nerve transection to induce chronic pain, followed by induction of thermal hypersensitivity using acetone. Motor activity was evaluated with the rotarod test. A molecular docking was performed using the TRPV1 channel. Pretreatment with FTL significantly reduced nociceptive behaviour associated with acute and neuropathic pain, especially at 0.5 mg/kg. Antinociception was effectively inhibited by l-NAME and d-galactose. In line with in vivo experiments, docking studies indicated that FTL may interact with TRPV1. Our results confirm the potential pharmacological relevance of FTL as an inhibitor of orofacial nociception in acute and chronic pain mediated by TRPA1, TRPV1 and TRPM8 receptor. Copyright © 2016. Published by Elsevier Ireland Ltd.

A hip abduction exercise prior to prolonged standing increased movement while reducing cocontraction and low back pain perception in those initially reporting low back pain.

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Viggiani, Daniel; Callaghan, Jack P

2016-12-01

Persons who develop low back pain from prolonged standing exhibit increased muscle cocontraction, decreased movement and increased spine extension. However, it is unclear how these factors relate to pain development. The purpose of this study was to use hip abductor fatigue to manipulate muscle activity patterns and determine its effects on standing behaviours and pain development. Forty participants stood for two hours twice, once following a hip abductor fatigue exercise (fatigue), and once without exercise beforehand (control). Trunk and gluteal muscle activity were measured to determine cocontraction. Lumbo-pelvic angles and force plates were used to assess posture and movement strategies. Visual analog scales differentiated pain (PDs) and non-pain developers (NPDs). PDs reported less low back pain during the fatigue session, with females having earlier reductions of similar scale than males. The fatigue session reduced gluteal and trunk cocontraction and increased centre of pressure movement; male and female PDs had opposing spine posture compensations. Muscle fatigue prior to standing reduced cocontraction, increased movement during standing and reduced the low back pain developed by PDs; the timing of pain reductions depended on spine postures adopted during standing. Copyright © 2016 Elsevier Ltd. All rights reserved.

A randomized trial of nature scenery and sounds versus urban scenery and sounds to reduce pain in adults undergoing bone marrow aspirate and biopsy.

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Lechtzin, Noah; Busse, Anne M; Smith, Michael T; Grossman, Stuart; Nesbit, Suzanne; Diette, Gregory B

2010-09-01

Bone marrow aspiration and biopsy (BMAB) is painful when performed with only local anesthetic. Our objective was to determine whether viewing nature scenes and listening to nature sounds can reduce pain during BMAB. This was a randomized, controlled clinical trial. Adult patients undergoing outpatient BMAB with only local anesthetic were assigned to use either a nature scene with accompanying nature sounds, city scene with city sounds, or standard care. The primary outcome was a visual analog scale (0-10) of pain. Prespecified secondary analyses included categorizing pain as mild and moderate to severe and using multiple logistic regression to adjust for potential confounding variables. One hundred and twenty (120) subjects were enrolled: 44 in the Nature arm, 39 in the City arm, and 37 in the Standard Care arm. The mean pain scores, which were the primary outcome, were not significantly different between the three arms. A higher proportion in the Standard Care arm had moderate-to-severe pain (pain rating ≥4) than in the Nature arm (78.4% versus 60.5%), though this was not statistically significant (p = 0.097). This difference was statistically significant after adjusting for differences in the operators who performed the procedures (odds ratio = 3.71, p = 0.02). We confirmed earlier findings showing that BMAB is poorly tolerated. While mean pain scores were not significantly different between the study arms, secondary analyses suggest that viewing a nature scene while listening to nature sounds is a safe, inexpensive method that may reduce pain during BMAB. This approach should be considered to alleviate pain during invasive procedures.

Investigating the Effect of Extracorporeal Shock Wave Therapy on reducing Chronic Pain in Patients with Pes Anserine Bursitis: A Randomized, Clinical- Controlled Trial

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Saeid Khosrawi

2017-01-01

Full Text Available Background: Knee pain, is one of the most common causes of patients' referring to physiatric clinics, and several factors, are involved in its creation. One of these factors is pes anserine bursitis (PAB for which various treatment methods are used. This study aims to investigate the effect of this method on reducing chronic pain in these patients. Materials and Methods: This clinical trial was conducted in 2013- 2014 on patients with PAB referring to academic, physical medicine clinics. The patients with chronic PAB (pain duration more than 3 months, who were refractory to conservative treatments, were randomly divided into two 20-member experimental groups (extracorporeal shock wave therapy [ESWT] and sham ESWT. Pain scores of all patients were measured using the Visual Analog Scale (VAS and McGill Pain Questionnaire (MPQ (total and present pain indexes [TPIs and PPIs] before intervention, immediately after intervention (3rd week, and after 8 weeks. The pain scores were then compared and statistically analyzed. Results: In the ESWT group, the mean patient pain score of the VAS and TPI in MPQ were significantly lower than in the sham ESWT group immediately after intervention (3rd week: P=0.02, P= 0.04 respectively; and 8 weeks after the end of treatment: P=0.01, P= 0.000. Moreover, the PPI in both groups had significantly decreased over time, although in ESWT group this decrement was significantly more than sham ESWT group (P < 0.001. Conclusion: The results showed that ESWT could be effective in reducing the pain and treating PAB.

Risk factors of significant pain syndrome 90 days after minor thoracic injury: trajectory analysis.

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Daoust, Raoul; Emond, Marcel; Bergeron, Eric; LeSage, Natalie; Camden, Stéphanie; Guimont, Chantal; Vanier, Laurent; Chauny, Jean-Marc

2013-11-01

The objective was to identify the risk factors of clinically significant pain at 90 days in patients with minor thoracic injury (MTI) discharged from the emergency department (ED). A prospective, multicenter, cohort study was conducted in four Canadian EDs from November 2006 to November 2010. All consecutive patients aged 16 years or older with MTI were eligible at discharge from EDs. They underwent standardized clinical and radiologic evaluations at 1 and 2 weeks, followed by standardized telephone interviews at 30 and 90 days. A pain trajectory model characterized groups of patients with different pain evolutions and ascertained specific risk factors in each group through multivariate analysis. In this cohort of 1,132 patients, 734 were eligible for study inclusion. The authors identified a pain trajectory that characterized 18.2% of the study population experiencing clinically significant pain (>3 of 10) at 90 days after a MTI. Multivariate modeling found two or more rib fractures, smoking, and initial oxygen saturation below 95% to be predictors of this group of patients. To the authors' knowledge, this is the first prospective study of trajectory modeling to detect risk factors associated with significant pain at 90 days after MTI. These factors may help in planning specific treatment strategies and should be validated in another prospective cohort. © 2013 by the Society for Academic Emergency Medicine.

Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review

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Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

2014-01-01

INTRODUCTION: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. METHODS: A systematic review was conducted...... formation and physical function. RESULTS: A total of 50 publications were identified; 42 publications were excluded leaving eight publications counting a total of 578 patients for analysis. Generally, the scientific quality of the studies was poor. Use of abdominal binder revealed a non-significant tendency...... to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases...

Smartphone-based Music Listening to Reduce Pain and Anxiety Before Coronarography: A Focus on Sex Differences.

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Guétin, Stéphane; Brun, Luc; Deniaud, Maelle; Clerc, Jean-Michel; Thayer, Julian F; Koenig, Julian

2016-07-01

Background • Music Care is a smartphone-based application providing a musical intervention for the management of pain and anxiety in a clinical setting. Coronarography is a medical procedure frequently associated with examination anxiety. Objectives • The study intended to perform an initial evaluation of the application for use with patients undergoing a coronarography. Design • The research team performed an uncontrolled, observational study. Setting • The study took place at Nouméa General Hospital in Nouméa, New Caledonia, France. Participants • Participants were 35 patients, 17 women and 18 men, who were undergoing a coronarography between November 2010 and April 2011 at the Nouméa General Hospital. Intervention • Participants listened to a standardized musical sequence of adjustable length by choosing a preferred style of music (eg, classic rock or folk music) from a variety of choices that the research team had chosen to include in the application. Outcome Measures • Before and after listening to the music, all participants were asked to rate their anxiety and pain on an 11-item, visual analogue scale and to complete a questionnaire on their satisfaction with use of the application. Results • The paired sample t test revealed a significant reduction in participants' anxiety (t33 = 4.12, P music. No significant reduction in self-reported pain occurred; however, only a few participants reported pain associated with the procedure. No significant sex differences existed. Women and men both showed reduced anxiety after listening to music as well as reported a high level of satisfaction in using the Music Care application. Conclusions • The smartphone-based Music Care application is an easy-to-use tool to reduce anxiety in patients undergoing coronarography. Future large-scale, controlled trials are necessary to compare its effectiveness with other interventions. Both women and men can benefit from the use of the application.

Music can effectively reduce pain perception in women rather than men.

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Ghaffaripour, Sina; Mahmoudi, Hilda; Sahmeddini, Mohammad Ali; Alipour, Abbas; Chohedri, Abdolhamid

2013-01-01

Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music (Iranian folkloric and preferred music) on pain tolerance and pain rating in cold pressor test. A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music (F (1,48) =25.44, p=0.0001) and no music (F(1,48)=3.51, p=0.0001) conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females (F(1,48)=5.53, p=0.023). The results also indicated that pain ratings, regardless of sex, were different in three musical conditions (F(1.7,81.34)=15.37, p=0.0001). Music distracted attention from pain and Women can be impressed and distracted more easily by music.

Reduction of voltage gated sodium channel protein in DRG by vector mediated miRNA reduces pain in rats with painful diabetic neuropathy.

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Chattopadhyay, Munmun; Zhou, Zhigang; Hao, Shuanglin; Mata, Marina; Fink, David J

2012-03-22

Painful neuropathy is a common complication of diabetes. Previous studies have identified significant increases in the amount of voltage gated sodium channel isoforms Na(V)1.7 and Na(V)1.3 protein in the dorsal root ganglia (DRG) of rats with streptozotocin (STZ)-induced diabetes. We found that gene transfer-mediated release of the inhibitory neurotransmitters enkephalin or gamma amino butyric acid (GABA) from DRG neurons in diabetic animals reduced pain-related behaviors coincident with a reduction in Na(V)1.7 protein levels in DRG in vivo. To further evaluate the role of Na(V)α subunit levels in DRG in the pathogenesis of pain in diabetic neuropathy, we constructed a non-replicating herpes simplex virus (HSV)-based vector expressing a microRNA (miRNA) against Na(V)α subunits. Subcutaneous inoculation of the miRNA-expressing HSV vector into the feet of diabetic rats to transduce DRG resulted in a reduction in Na(V)α subunit levels in DRG neurons, coincident with a reduction in cold allodynia, thermal hyperalgesia and mechanical hyperalgesia. These data support the role of increased Na(V)α protein in DRG in the pathogenesis of pain in diabetic neuropathy, and provide a proof-of-principle demonstration for the development of a novel therapy that could be used to treat intractable pain in patients with diabetic neuropathy.

The interactions between pain, pain-related fear of movement and productivity

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Sell, L; Lund, H L; Holtermann, A

2014-01-01

BACKGROUND: Employees with physically heavy work have an increased risk of musculoskeletal disorders leading to reduced work ability. AIMS: To investigate if a high level of musculoskeletal pain or pain-related fear of movement was associated with low productivity among employees with physically....... CONCLUSIONS: Despite the fact that musculoskeletal pain increases the risk of reduced work ability significantly, musculoskeletal pain and pain-related fear of movement were associated with low productivity only among employees with good work ability....... heavy work and differing work ability levels. METHODS: The study was conducted at a Danish production site and employees with physically heavy work in the production line were included in the study. Work ability was assessed with the Work Ability Index (WAI), pain-related fear of movement with the Tampa...

Modeling subjective well-being in individuals with chronic pain and a physical disability: the role of pain control and pain catastrophizing.

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Furrer, Angela; Michel, Gisela; Terrill, Alexandra L; Jensen, Mark P; Müller, Rachel

2017-10-23

To investigate the associations between subjective well-being and pain intensity, pain interference, and depression in individuals with physical disabilities. We hypothesized that (1) pain control and (2) pain catastrophizing mediate the effects of subjective well-being on pain intensity, pain interference, and depression. Analyses of cross-sectional data from 96 individuals diagnosed with spinal cord injury, multiple sclerosis, neuromuscular disease, or post-polio syndrome, with average pain intensity of ≥4 (0-10) on at least half the days in the past month. Two models tested study hypotheses using structural equation. Both models showed acceptable model fit. Pain catastrophizing significantly mediated the effect of subjective well-being on pain intensity and pain interference, but not on depression. Pain control did not significantly mediate the effect of subjective well-being on pain intensity, pain interference, or depression. Path coefficients showed significant direct effects of subjective well-being on pain control (β = 0.39), pain catastrophizing (β = -0.61), pain interference (β = -0.48; -0.42), and depression (β = -0.75; -0.78). This study supports the potential of enhancing subjective well-being and lowering pain catastrophizing for reducing pain intensity, pain interference, and depressive symptoms in individuals with chronic pain and a physical disability. The findings indicate that true experiments to test for causal associations are warranted. Implications for rehabilitation The majority of individuals with physical disabilities report having persistent moderate-to-severe pain that may negatively limit daily activities and quality of life. The present cross-sectional study indicates that individuals who reported greater subjective well-being showed significantly lower pain intensity via the mediating effect of lower pain catastrophizing. Since sample size and respective power are low, these findings should be taken as first

A randomized controlled pilot study feasibility of a tablet-based guided audio-visual relaxation intervention for reducing stress and pain in adults with sickle cell disease.

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Ezenwa, Miriam O; Yao, Yingwei; Engeland, Christopher G; Molokie, Robert E; Wang, Zaijie Jim; Suarez, Marie L; Wilkie, Diana J

2016-06-01

To test feasibility of a guided audio-visual relaxation intervention protocol for reducing stress and pain in adults with sickle cell disease. Sickle cell pain is inadequately controlled using opioids, necessitating further intervention such as guided relaxation to reduce stress and pain. Attention-control, randomized clinical feasibility pilot study with repeated measures. Randomized to guided relaxation or control groups, all patients recruited between 2013-2014 during clinical visits, completed stress and pain measures via a Galaxy Internet-enabled Android tablet at the Baseline visit (pre/post intervention), 2-week posttest visit and also daily at home between the two visits. Experimental group patients were asked to use a guided relaxation intervention at the Baseline visit and at least once daily for 2 weeks. Control group patients engaged in a recorded sickle cell discussion at the Baseline visit. Data were analysed using linear regression with bootstrapping. At baseline, 27/28 of consented patients completed the study protocol. Group comparison showed that guided relaxation significantly reduced current stress and pain. At the 2-week posttest, 24/27 of patients completed the study, all of whom reported liking the study. Patients completed tablet-based measures on 71% of study days (69% in control group, 72% in experiment group). At the 2-week posttest, the experimental group had significantly lower composite pain index scores, but the two groups did not differ significantly on stress intensity. This study protocol appears feasible. The tablet-based guided relaxation intervention shows promise for reducing sickle cell pain and warrants a larger efficacy trial. The ClinicalTrials.gov Identifier is: NCT02501447. © 2016 John Wiley & Sons Ltd.

Antibiotics are not useful to reduce pain associated with irreversible pulpitis.

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Hoskin, Eileen; Veitz-Keenan, Analia

2016-09-01

.45 (SD4.42) in the placebo group; mean difference 2.45 (95%CI -1.23 to 6.13; P value = 0.19). The study did not address adverse events.ConclusionsThere is insufficient evidence to accept or refute the benefit of using penicillin to control pain intensity associated with irreversible pulpitis. This study primarily found that antibiotics given preoperatively (before definitive root canal therapy) do not appear to significantly reduce toothache caused by irreversible pulpitis. Between the two groups, those taking the antibiotics and those taking the placebo, there was no statistical difference in the amount of oral analgesics taken to relieve the pain.

Pulsed Dose Radiofrequency Before Ablation of Medial Branch of the Lumbar Dorsal Ramus for Zygapophyseal Joint Pain Reduces Post-procedural Pain.

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Arsanious, David; Gage, Emmanuel; Koning, Jonathon; Sarhan, Mazin; Chaiban, Gassan; Almualim, Mohammed; Atallah, Joseph

2016-01-01

One of the potential side effects with radiofrequency ablation (RFA) includes painful cutaneous dysesthesias and increased pain due to neuritis or neurogenic inflammation. This pain may require the prescription of opioids or non-opioid analgesics to control post-procedural pain and discomfort. The goal of this study is to compare post-procedural pain scores and post-procedural oral analgesic use in patients receiving continuous thermal radiofrequency ablation versus patients receiving pulsed dose radiofrequency immediately followed by continuous thermal radiofrequency ablation for zygopophaseal joint disease. This is a prospective, double-blinded, randomized, controlled trial. Patients who met all the inclusion criteria and were not subject to any of the exclusion criteria were required to have two positive diagnostic medial branch blocks prior to undergoing randomization, intervention, and analysis. University hospital. Eligible patients were randomized in a 1:1 ratio to either receive thermal radiofrequency ablation alone (standard group) or pulsed dose radiofrequency (PDRF) immediately followed by thermal radiofrequency ablation (investigational group), all of which were performed by a single Board Certified Pain Medicine physician. Post-procedural pain levels between the two groups were assessed using the numerical pain Scale (NPS), and patients were contacted by phone on post-procedural days 1 and 2 in the morning and afternoon regarding the amount of oral analgesic medications used in the first 48 hours following the procedure. Patients who received pulsed dose radiofrequency followed by continuous radiofrequency neurotomy reported statistically significantly lower post-procedural pain scores in the first 24 hours compared to patients who received thermal radiofrequency neurotomy alone. These patients also used less oral analgesic medication in the post-procedural period. These interventions were carried out by one board accredited pain physician at one

Dexmedetomidine reduces pain associated with rocuronium injection without causing a decrease in BIS values: a dose-response study.

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Joo, Jin; Baek, Jungwon; Lee, Jaemin

2014-09-01

To examine whether dexmedetomidine reduces the injection pain of propofol and rocuronium and to investigate whether the decrease in injection pain is associated with the known sedative action of dexmedetomidine. Randomized, double-blind, placebo-controlled clinical comparison study. Patients undergoing general anesthesia with intubation received 40 mg of 1% lidocaine (lidocaine group; n = 28), 0.25 μg/kg of dexmedetomidine (low-dose group; n = 27), 0.5 μg/kg of dexmedetomidine (subclinical dose group; n = 28), 1.0 μg/kg of dexmedetomidine (clinical dose group, n = 27), or normal saline (saline group; n = 28) before anesthetic induction. Pain associated with propofol and rocuronium injection was assessed using a 10-point verbal analog scale (VAS) and a 4-point withdrawal movement scale, respectively. The BIS value was measured 60 seconds after administration of the study drug, and at the time of rocuronium injection and intubation. The overall incidence of withdrawal movements due to rocuronium decreased significantly as the dose of dexmedetomidine increased (92.8%, 85.2%, 78.6%, and 51.9% in the saline, low-dose, subclinical dose, and clinical dose groups, respectively; P = 0.001). There was no significant difference in BIS values among the groups 60 seconds after study drug administration or at the time of rocuronium injection. Dexmedetomidine reduced pain associated with rocuronium injection in a dose-dependent manner. This effect was not associated with the decrease in BIS value. Copyright © 2014 Elsevier Inc. All rights reserved.

"Do unto others"? Distinct psychopathy facets predict reduced perception and tolerance of pain.

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Brislin, Sarah J; Buchman-Schmitt, Jennifer M; Joiner, Thomas E; Patrick, Christopher J

2016-07-01

Recent research has sought to understand how individuals high in psychopathic traits perceive pain in others (Decety, Skelly, & Kiehl, 2013; Marsh et al., 2013). Perception of pain in others is presumed to act as a prosocial signal, and underreactivity to others' pain may contribute to engagement in exploitative-aggressive behaviors among individuals high in psychopathic traits (Jackson, Meltzoff, & Decety, 2005). The current study tested for associations between facets of psychopathy as defined by the triarchic model (Patrick, Fowles, & Krueger, 2009) and decreased sensitivity to pain in 105 undergraduates tested in a laboratory pain assessment. A pressure algometer was used to index pain tolerance, and participants also rated their perceptions of and reactivity to the algometer-induced pain during the assessment and again 3 days later. A unique positive relationship was found between pain tolerance and the meanness facet of psychopathy, which also predicted reduced fear of painful algometer stimulation. Other psychopathy facets (boldness, disinhibition) showed negative relations with fear of pain stimulation during testing and at follow-up. Findings from this study extend the nomological network surrounding callousness (meanness) and suggest that increased pain tolerance may be a mechanism contributing to insensitivity to expressions of discomfort in others. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Role of oral tramadol 50 mg in reducing pain associated with outpatient hysteroscopy: A randomised double-blind placebo-controlled trial.

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Hassan, AbdelGany; Haggag, Hisham

2016-02-01

Several drugs have been used to reduce hysteroscopy-associated pain. Although the Royal College of Obstetricians and Gynaecologists has recommended against the use of opiates in outpatient hysteroscopy, we wished to investigate if opioids can be used if the appropriate opioid was given in the appropriate dose. To study the effectiveness of tramadol 50 mg in reducing pain associated with outpatient hysteroscopy. A prospective randomised double-blind placebo-controlled trial conducted in the outpatient hysteroscopy clinic at Cairo University Hospital. Main outcome measures were the severity of pain during the procedure, immediately after the procedure and 30 minutes later assessed by a visual analogue scale (VAS). VAS of 0 indicates no pain and VAS of 10 indicates the worst possible pain. A total of 140 women who had diagnostic outpatient hysteroscopy were randomised to receive oral tramadol 50 mg or placebo one h before performing outpatient hysteroscopy. There was no difference between the groups in the age, parity, duration of the procedures or indications of hysteroscopy. The median pain score was significantly lower in the tramadol group during the procedure (5 vs 6; P = 0.013), immediately after the procedure (3 vs 4; P pain evoked by the procedure and the drug was well tolerated by women. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia.

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Eslamian, Laleh; Jalili, Zorvan; Jamal, Ashraf; Marsoosi, Vajiheh; Movafegh, Ali

2012-06-01

It is reported that following abdominal surgery, transversus abdominis plane (TAP) block can reduce postoperative pain. The primary outcome of this study was the evaluation of the efficacy of TAP block on pain intensity following cesarean delivery with Pfannenstiel incision. Fifty pregnant women were randomized blindly to receive either a TAP block with 15 ml 0.25% bupivacaine in both sides (group T, n = 25) or no blockade (group C, n = 25) at the end of the surgery, which was performed with a Pfannenstiel incision under general anesthesia. The pain intensity in the patients was assessed by a blinded investigator at the time of discharge from recovery and at 6, 12, and 24 h postoperatively, with a visual analogue scale (VAS) for pain. The women in the TAP block group had significantly lower VAS pain scores at rest and during coughing and consumed significantly less tramadol than the women in group C [50 mg (0-150) vs. 250 mg (0-400), P = 0.001]. There was a significantly longer time to the first request for analgesic in the TAP block group [210 min (0-300) vs. 30 min (10-180) in group C, P = 0.0001]. Two-sided TAP block with 0.25% bupivacaine in parturients who undergo cesarean section with a Pfannenstiel incision under general anesthesia can decrease postoperative pain and analgesic consumption. The time to the first analgesic rescue was longer in the parturients who received the TAP block.

Effects of Massage in Reducing the Pain and Anxiety of the Cardiac Surgery Critically Ill-a Randomized Controlled Trial.

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Boitor, Madalina; Martorella, Géraldine; Maheu, Christine; Laizner, Andréa Maria; Gélinas, Céline

2018-03-30

To evaluate the effectiveness of hand massage on the pain and anxiety of the cardiac surgery critically ill. A three-arm randomized controlled trial. This study was conducted in a medical-surgical intensive care unit in Canada. Adult patients who underwent elective cardiac surgery, who were able to speak French/English and to self-report symptoms, without a high risk of postoperative complications were eligible. Patients were randomly allocated to standard care plus either two 20-minute hand massages (experimental), two 20-minute hand holdings (active control), or two 20-minute rest periods (passive control/standard care). Pain intensity, pain unpleasantness, anxiety, muscle tension, and vital signs were evaluated before, after, and 30 minutes later for each intervention. From the 83 patients recruited, 60 were randomized (20 massage, 19 hand holding, 21 standard care). After controlling for baseline scores, the massage group reported significantly lower pain intensity, pain unpleasantness, and anxiety for the first data collection set compared with both hand holding and standard care (analysis of covariance, P < 0.02), with an average decrease of two points on a 0-10 scale. No statistically significant differences were noted between hand holding and standard care for any of the symptoms. Similar results were observed for the second data collection set (N = 43). Patients had decreased muscle tension post massage. Vital signs did not differ significantly between groups. Findings suggest that a 20-minute hand massage in addition to routine postoperative pain management can concomitantly reduce pain intensity, pain unpleasantness, and anxiety by two points on average on a 0-10 scale.

Efficacy of tramadol and butorphanol pretreatment in reducing pain on propofol injection: A placebo-controlled randomized study.

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Singh, Arvinderpal; Sharma, Geeta; Gupta, Ruchi; Kumari, Anita; Tikko, Deepika

2016-01-01

Pain of propofol injection has been recalled by many patients as the most painful part of the induction of anesthesia. Tramadol and butorphanol are commonly used analgesics for perioperative analgesia in anesthesia practice. However, their potential to relieve propofol injection pain still needs to be explored. A randomized, double-blind, placebo-controlled study was conducted on 90 American Society of Anesthesiologists I and II adult patients undergoing elective surgery under general anesthesia with propofol as an induction agent. Consecutive sampling technique with random assignment was used to allocate three groups of 30 patients each. Group I patients received an injection of normal saline 3 ml intravenously (placebo) while Group II and Group III patients received injection of tramadol 50 mg and butorphanol 1 mg intravenously, respectively. Before induction of anesthesia patients were asked about the intensity of pain on propofol injection by using visual analog scale (VAS) before the loss of consciousness. Descriptive statistics and analysis of variance with Chi-square test were used to analyze the data. The value of P pain in Group I was observed in 80% of the patients, while it was observed in 23.33% and 20% of patients in Group II and III, respectively. Mean VAS scores were 2.27 ± 1.51, 1.14 ± 1.74, and 1.03 ± 1.72 in Group I, II, and Group III patients, respectively. The incidence of pruritus was 10% and 6.7% and erythema in 13.2% and 6.7% in Group II and III, respectively. Pretreatment with both butorphanol and tramadol significantly reduced pain on propofol injection; however, they exhibited comparable efficacy among each other. Thus, either of these two drugs can be considered for pretreatment to reduce propofol injection pain.

Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain

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Brooks Joanna

2013-01-01

Full Text Available Abstract Background Previous research has demonstrated that the significant others of individuals with persistent back pain may have important influences on work participation outcomes. The aim of this study was to extend previous research by including individuals who have remained in work despite persistent back pain in addition to those who had become incapacitated for work, along with their significant others. The purpose of this research was to explore whether the illness beliefs of significant others differed depending on their relative’s working status, and to make some preliminary identification of how significant others may facilitate or hinder work participation for those with persistent back pain. Methods Interviews structured around the Illness Perception Questionnaire (chronic pain version were conducted with back pain patients recruited from a hospital pain management clinic along with their significant others. Some patients had remained in work despite their back pain; others had ceased employment. Data were analysed using template analysis. Results There were clear differences between beliefs about, and reported responses to, back pain symptoms amongst the significant others of individuals who had remained in employment compared with the significant others of those who had ceased work. Three overarching themes emerged: perceived consequences of back pain, specific nature of employment and the impact of back pain on patient identity. Conclusions Significant others of employed individuals with back pain focused on the extent to which activity could still be undertaken despite back pain symptoms. Individuals out of work due to persistent back pain apparently self-limited their activity and were supported in their beliefs and behaviours by their significant others. To justify incapacity due to back pain, this group had seemingly become entrenched in a position whereby it was crucial that the individual with back pain was perceived

Comparison thoracic epidural and intercostal block to improve ventilation parameters and reduce pain in patients with multiple rib fractures.

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Hashemzadeh, Shahryar; Hashemzadeh, Khosrov; Hosseinzadeh, Hamzeh; Aligholipour Maleki, Raheleh; Golzari, Samad E J; Golzari, Samad

2011-01-01

Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may require such high dose that they produce respiratory depression, especially in elderly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or intercostal block with 0.25% bupivacaine. The patients were assessed through ICU and hospital stay length, ventilation function tests. Pain score among the patients was measured with verbal rating scale, before and after administration of the analgesia. We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P pain at rest and pain caused by coughing and deep breathing in group A compared group B... ICU and hospital stay markedly reduced in Group A. thoracic epidural analgesia is superior to intercostals block regarding pain relief of rib fractures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

Comparison of granisetron and lidocaine on reducing injection pain of etomidate: a controlled randomized study

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Alireza Saliminia

Full Text Available Abstract Background and objectives Reducing pain on injection of anesthetic drugs is of importance to every anesthesiologist. In this study we pursued to define if pretreatment by granisetron reduces the pain on injection of etomidate similar to lidocaine. Methods Thirty patients aged between 18 and 50 years of American Society of Anesthesiologists physical status class I or II, whom were candidates for elective laparoscopic cholecystectomy surgery were enrolled in this study. Two 20 gauge cannulas were inserted into the veins on the dorsum of both hands and 100 mL of normal saline was administered during a 10 min period from each cannula. Using an elastic band as a tourniquet, venous drainage of both hands was occluded. 2 mL of granisetron was administered into one hand and 2 mL of lidocaine 2% at the same time into the other hand. One minute later the elastic band was opened and 2 mL of etomidate was administered to each hand with equal rates. The patients were asked to give a score from 0 to 10 (0 = no pain, 10 = severe pain to each the pain sensed in each hand. Results Two patients were deeply sedated after injection of etomidate and unable to answer any questions. The mean numerical rating score for injection pain of intravenously administered etomidate after intravenous granisetron was 2.3 ± 1.7, which was lower when compared with pain sensed due to intravenously administered etomidate after administration of lidocaine 2% (4.6 ± 1.8, p < 0.05. Conclusion The result of this study demonstrated that, granisetron reduces pain on injection of etomidate more efficiently than lidocaine.

Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement After Colorectal Surgery.

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Stokes, Audrey L; Adhikary, Sanjib D; Quintili, Ashley; Puleo, Frances J; Choi, Christine S; Hollenbeak, Christopher S; Messaris, Evangelos

2017-02-01

Enhanced recovery protocols frequently use multimodal postoperative analgesia to improve postoperative outcomes in patients undergoing colorectal surgery. The purpose of this study was to evaluate liposomal bupivacaine use in transversus abdominis plane blocks on postoperative pain scores and opioid use after colorectal surgery. This was a retrospective cohort study comparing outcomes between patients receiving nonliposomal anesthetic (n = 104) and liposomal bupivacaine (n = 303) blocks. The study was conducted at a single tertiary care center. Patients included those identified within an institutional database as inpatients undergoing colorectal procedures between 2013 and 2015 who underwent transversus abdominis plane block for perioperative analgesia. The study measured postoperative pain scores and opioid requirements. Patients receiving liposomal bupivacaine had significantly lower pain scores for the first 24 to 36 postoperative hours. Pain scores were similar after 36 hours. The use of intravenous opioids among the liposomal bupivacaine group decreased by more than one third during the hospitalization (99.1 vs 64.5 mg; p = 0.040). The use of ketorolac was also decreased (49.0 vs 18.3 mg; p bupivacaine group but did not achieve statistical significance. The study was limited by its retrospective, single-center design and heterogeneity of block administration. Attenuated pain scores observed with liposomal bupivacaine use were associated with significantly lower intravenous opioid and ketorolac use, suggesting that liposomal bupivacaine-containing transversus abdominis plane blocks are well aligned with the opioid-reducing goals of many enhanced recovery protocols.

Effectiveness of off-the-shelf, extra-depth footwear in reducing foot pain in older people: a randomized controlled trial.

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Menz, Hylton B; Auhl, Maria; Ristevski, Sonja; Frescos, Nicoletta; Munteanu, Shannon E

2015-04-01

Foot pain is highly prevalent in older people and in many cases is associated with inappropriate footwear. This study evaluated the effectiveness of off-the-shelf, extra-depth footwear in reducing foot pain. Community-dwelling older people with disabling foot pain (72 men and 48 women aged 65 to 96 years; mean age 82 [SD 8]) were randomly allocated to an intervention group (n = 59) or control group (n = 61). The intervention group was provided with off-the-shelf, extra-depth footwear. Participants in the control group received their footwear at the completion of the study. Both groups continued to receive usual podiatry care for the study period. The primary outcome measure was the Foot Health Status Questionnaire (FHSQ), measured at baseline and 16 weeks. There was a significant improvement in the FHSQ pain domain (ANCOVA-adjusted mean difference 11.5 points, 95% confidence interval 4.2 to 18.8, p = .002) and FHSQ function domain (10.0 points, 0.9 to 19.1, p = .032) in the intervention group compared to the control group. The intervention group also developed fewer keratotic lesions (mean difference -1.4, -2.5 to -0.2, p = .021), were less likely to report the use of co-interventions (relative risk [RR] 0.74, 0.56 to 0.98, p = .026) and were more likely to report that their foot pain had moderately or markedly improved during the study (RR = 7.93, 2.51 to 25.00, p footwear significantly reduces foot pain, improves foot function and is associated with the development of fewer keratotic lesions in older people. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Hypnosis can reduce pain in hospitalized older patients: a randomized controlled study.

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Ardigo, Sheila; Herrmann, François R; Moret, Véronique; Déramé, Laurence; Giannelli, Sandra; Gold, Gabriel; Pautex, Sophie

2016-01-15

Chronic pain is a common and serious health problem in older patients. Treatment often includes non pharmacological approaches despite a relatively modest evidence base in this population. Hypnosis has been used in younger adults with positive results. The main objective of this study was to measure the feasibility and efficacy of hypnosis (including self hypnosis) in the management of chronic pain in older hospitalized patients. A single center randomized controlled trial using a two arm parallel group design (hypnosis versus massage). Inclusion criteria were chronic pain for more than 3 months with impact on daily life activities, intensity of > 4; adapted analgesic treatment; no cognitive impairment. Brief pain inventory was completed. Fifty-three patients were included (mean age: 80.6 ± 8.2--14 men; 26 hypnosis; 27 massage. Pain intensity decreased significantly in both groups after each session. Average pain measured by the brief pain index sustained a greater decrease in the hypnosis group compared to the massage group during the hospitalisation. This was confirmed by the measure of intensity of the pain before each session that decreased only in the hypnosis group over time (P = 0.008). Depression scores improved significantly over the time only in the hypnosis group (P = 0.049). There was no effect in either group 3 months post hospitals discharge. Hypnosis represents a safe and valuable tool in chronic pain management of hospitalized older patients. In hospital interventions did not provide long term post discharge relief. ISRCTN15615614; registered 2/1/2015.

A cross-cultural perspective of medical clowning: comparison of its effectiveness in reducing pain and anxiety among hospitalized Bedouin and Jewish Israeli children.

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Gilboa-Negari, Zehavit; Abu-Kaf, Sarah; Huss, Ephrat; Hain, Gavriel; Moser, Asher

2017-01-01

Medical clowning has proven effective for reducing pain, anxiety, and stress, however, its differential effects on children from different cultures have not yet been researched. This study evaluated the effects of medical-clowning intervention on anxiety and pain among Jewish and Bedouin children, and anxiety among their parents, in southern Israel. The study was conducted in hospital pediatric departments and employed a pre-post design involving quantitative and qualitative methods. The study included 89 children whose ages ranged from 7.5 to 12 years (39 Jewish and 50 Bedouin) and 69 parents (19 Jewish and 50 Bedouin). Questionnaires assessing pain, anxiety, and demographics were used at the pre-intervention stage and pain, anxiety, and enjoyment of different aspects of the intervention were evaluated following the intervention. The intervention stage lasted for 8-10 minutes and included the use of word play, body language, and making faces, as well as the use of props brought by the clown. Semi-structured interviews were also conducted at the post-intervention stage. The intervention reduced pain and anxiety among both groups of children and reduced anxiety among both groups of parents. However, anxiety levels were reduced more significantly among Bedouin children. The nonverbal components of the clowns' humor were most central, but it was the verbal components that mediated the reduction in anxiety among the Bedouin children. This study underscored the effectiveness and importance of medical clowning in reducing pain and anxiety among children in different cultural contexts. Moreover, the issue of culturally appropriate humor was underscored and implications for intercultural clown training are discussed.

Randomized controlled trial of topical EMLA and vapocoolant spray for reducing pain during wDPT vaccination.

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Gupta, Navratan Kumar; Upadhyay, Amit; Dwivedi, Ajeet Kumar; Agarwal, Astha; Jaiswal, Vijay; Singh, Abhishek

2017-06-01

Intramuscular vaccination is among the most common source of iatrogenic pain in infants. Vapocoolant sprays are rapid-acting alternative to topical anesthetics. They provide transient anesthesia via evaporation induced skin cooling, and reduce pain due to vaccine injection in children and adults. The objective was to compare the synergistic analgesic effect of eutectic mixture of local anesthetics (EMLA) with breastfeeding (EB group) and vapocoolant spay with breastfeeding (VB group) to that of only breastfeeding (BO group) during whole cell diptheria, pertussis and tetanus (wDPT) vaccination. A double blind randomized controlled trial was done to include infants up to 3 months of age who came for their first wDPT vaccination. The primary outcome variable was the duration of cry after vaccination. Secondary outcome variables were Modified Facial Coding Score, Neonatal Infant Pain Scale and latency of onset of cry. Of the 201 eligible participants, 111 babies were excluded and remaining 90 babies were randomized into three groups of thirty each. The groups did not differ significantly in baseline characteristics. Median (interquartile range, IQR) of duration of cry was lesser [35.86 (21.07-107.75) seconds] in babies receiving EMLA cream with breast feeding (EB group) and in babies receiving vapocoolant spray with breast feeding (VB group) [32.58 (21.25-106.21) seconds] as compared to babies receiving only breast feeding (BO group) [67.5 (27.6-180) seconds] (P=0.147). Difference in median (IQR) of latency of cry was not statistically significant. Modified Facial Coding Score and Neonatal Infant Pain Scale at 1 minute and 3 minutes was significantly lower in the EB and VB group, as compared to the BO group (Pcry in infants up to 3 months of age. However, they are able to show reduction in pain score and further studies are warranted to assess their efficacy as pain relief measures in infants and children.

Women with provoked vestibulodynia experience clinically significant reductions in pain regardless of treatment: results from a 2-year follow-up study.

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Davis, Seth N P; Bergeron, Sophie; Binik, Yitzchak M; Lambert, Bernard

2013-12-01

Provoked vestibulodynia (PVD) is a prevalent genital pain syndrome that has been assumed to be chronic, with little spontaneous remission. Despite this assumption, there is a dearth of empirical evidence regarding the progression of PVD in a natural setting. Although many treatments are available, there is no single treatment that has demonstrated efficacy above others. The aims of this secondary analysis of a prospective study were to (i) assess changes over a 2-year period in pain, depressive symptoms, and sexual outcomes in women with PVD; and (ii) examine changes based on treatment(s) type. Participants completed questionnaire packages at Time 1 and a follow-up package 2 years later. Visual analog scale of genital pain, Global Measure of Sexual Satisfaction, Female Sexual Function Index, Beck Depression Inventory, Dyadic Adjustment Scale, and sexual intercourse attempts over the past month. Two hundred thirty-nine women with PVD completed both time one and two questionnaires. For the sample as a whole, there was significant improvement over 2 years on pain ratings, sexual satisfaction, sexual function, and depressive symptoms. The most commonly received treatments were physical therapy, sex/psychotherapy, and medical treatment, although 41.0% did not undergo any treatment. Women receiving no treatment also improved significantly on pain ratings. No single treatment type predicted better outcome for any variable except depressive symptoms, in which women who underwent surgery were more likely to improve. These results suggest that PVD may significantly reduce in severity over time. Participants demonstrated clinically significant pain improvement, even when they did not receive treatment. Furthermore, the only single treatment type predicting better outcomes was surgery, and only for depressive symptoms, accounting for only 2.3% of the variance. These data do not demonstrate the superiority of any one treatment and underscore the need to have control groups in

‘Do Unto Others’?: Distinct Psychopathy Facets Predict Reduced Perception and Tolerance of Pain

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Brislin, Sarah J.; Buchman-Schmitt, Jennifer M.; Joiner, Thomas E.; Patrick, Christopher J.

2016-01-01

Recent research has sought to understand how individuals high in psychopathic traits perceive pain in others (Decety, Skelly, & Kiehl, 2013; Marsh et al., 2013). Perception of pain in others is presumed to act as a prosocial signal, and underreactivity to others’ pain may contribute to engagement in exploitative-aggressive behaviors among individuals high in psychopathic traits (Jackson, Meltzoff, & Decety; 2005). The current study tested for associations between facets of psychopathy as defined by the triarchic model (Patrick, Fowles, & Krueger, 2009) and decreased sensitivity to pain in 105 undergraduates tested in a laboratory pain assessment. A pressure algometer was used to index pain tolerance, and participants also rated their perceptions of and reactivity to the algometer-induced pain during the assessment and again three days later. A unique positive relationship was found between pain tolerance and the meanness facet of psychopathy, which also predicted reduced fear of painful algometer stimulation. Other psychopathy facets (boldness, disinhibition) showed negative relations with fear of pain stimulation during testing and at follow-up. Findings from this study extend the nomological network surrounding callousness (meanness) and suggest that increased pain tolerance may be a mechanism contributing to insensitivity to expressions of discomfort in others. PMID:26950545

Differential effect of ketamine and lidocaine on spontaneous and mechanical evoked pain in patients with nerve injury pain

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Gottrup, Hanne; Bach, Flemming Winther; Juhl, Gitte Irene

2006-01-01

ketamine, an N-methyl-D-aspartate receptor antagonist and lidocaine, a sodium channel blocker, on spontaneous pain, brush-evoked pain, and pinprick-evoked pain in patients with nerve injury pain. METHODS: Twenty patients participated in two randomized, double-blinded, placebo-controlled, crossover...... experiments in which they, on four different days, received a 30-minute intravenous infusion of ketamine (0.24 mg/kg), lidocaine (5 mg/kg), or saline. Ongoing pain, pain evoked by brush and repetitive pinprick stimuli, and acetone was measured before, during, and after infusion. RESULTS: Ketamine...... significantly reduced ongoing pain and evoked pain to brush and pinprick, whereas lidocaine only reduced evoked pain to repetitive pinprick stimuli. In individual patients, there was no correlation between the pain-relieving effect of lidocaine and ketamine on ongoing or mechanically evoked pains. CONCLUSIONS...

The impact of a pulmonary recruitment maneuver to reduce post-laparoscopic shoulder pain: A randomized controlled trial.

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Ryu, Kyoungho; Choi, Wonjun; Shim, Jaegeum; Song, Taejong

2017-01-01

A pulmonary recruitment maneuver (PRM) can effectively reduce post-laparoscopic shoulder pain (PLSP). However, a high-pressure PRM may cause pulmonary barotrauma. This study aimed to evaluate the efficacy and safety of a PRM using two different maximum inspiratory pressures (40 and 60cmH 2 O) for reducing PLSP. Patients undergoing gynecologic laparoscopy were randomly allocated to a control group (n=30), a 40 cmH 2 O PRM group (n=30), and a 60 cmH 2 O PRM group (n=30). In the control group, residual carbon dioxide was removed by passive exsufflation through the port site. In the two intervention groups, the PRM consisting of five manual pulmonary inflations was performed at the end of surgery with a maximum pressure of 40 cmH 2 O or 60 cmH 2 O, respectively. Shoulder pain and wound pain were recorded using a visual analogue scale at 24 and 48h postoperatively. Wound pain scores at 24 and 48h post-surgery were not different between the three groups. The PLSP scores in the two intervention groups were significantly lower than that seen in the control group at 24 and 48h postoperatively (P=0.006 and P<0.001, respectively). However, there were no statistically significant differences in the PLSP scores between the two intervention groups. A low-pressure PRM (40cmH 2 O) is as effective as a high-pressure PRM (60cmH 2 O) for removing residual gas from the peritoneal cavity. PRM using a maximal inspiratory pressure of 40cmH 2 O is safe and efficacious for the reduction of PLSP. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated.

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Boneti, Cristiano; Arentz, Candy; Klimberg, V Suzanne

2010-10-01

Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain. An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics. Average age of the study group was 53.4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases. Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.

Intra-articular laser treatment plus Platelet Rich Plasma (PRP) significantly reduces pain in many patients who had failed prior PRP treatment

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Prodromos, Chadwick C.; Finkle, Susan; Dawes, Alexander; Dizon, Angelo

2018-02-01

INTRODUCTION: In our practice Platelet Rich Plasma (PRP) injections effectively reduce pain in most but not all arthritic patients. However, for patients who fail PRP treatment, no good alternative currently exists except total joint replacement surgery. Low level laser therapy (LLLT) on the surface of the skin has not been helpful for arthritis patients in our experience. However, we hypothesized that intra-articular laser treatment would be an effective augmentation to PRP injection and would increase its efficacy in patients who had failed prior PRP injection alone. METHODS: We offered Intra-articular Low Level Laser Therapy (IAL) treatment in conjunction with repeat PRP injection to patients who had received no benefit from PRP injection alone at our center. They were the treatment group. They were not charged for PRP or IAL. They also served as a historical control group since they had all had failed PRP treatment alone. 28 patients (30 joints) accepted treatment after informed consent. 22 knees, 4 hips, 2 shoulder glenohumeral joints and 1 first carpo-metacarpal (1st CMC) joint were treated RESULTS: All patients were followed up at 1 month and no adverse events were seen from the treatment. At 6 months post treatment 46% of patients had good outcomes, and at 1 year 17% still showed improvement after treatment. 11 patients failed treatment and went on to joint replacement. DISCUSSION: A single treatment of IAL with PRP salvaged 46% of patients who had failed PRP treatment alone, allowing avoidance of surgery and good pain control.

Effect of Patient Education on Reducing Medication in Spinal Cord Injury Patients With Neuropathic Pain.

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Shin, Ji Cheol; Kim, Na Young; Chang, Shin Hye; Lee, Jae Joong; Park, Han Kyul

2017-08-01

To determine whether providing education about the disease pathophysiology and drug mechanisms and side effects, would be effective for reducing the use of pain medication while appropriately managing neurogenic pain in spinal cord injury (SCI) patients. In this prospective study, 109 patients with an SCI and neuropathic pain, participated in an educational pain management program. This comprehensive program was specifically created, for patients with an SCI and neuropathic pain. It consisted of 6 sessions, including educational training, over a 6-week period. Of 109 patients, 79 (72.5%) initially took more than two types of pain medication, and this decreased to 36 (33.0%) after the educational pain management program was completed. The mean pain scale score and the number of pain medications decreased, compared to the baseline values. Compared to the non-response group, the response group had a shorter duration of pain onset (p=0.004), and a higher initial number of different medications (ppain management program, can be a valuable complement to the treatment of spinal cord injured patients with neuropathic pain. Early intervention is important, to prevent patients from developing chronic SCI-related pain.

Localized Sympathectomy Reduces Mechanical Hypersensitivity by Restoring Normal Immune Homeostasis in Rat Models of Inflammatory Pain.

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Xie, Wenrui; Chen, Sisi; Strong, Judith A; Li, Ai-Ling; Lewkowich, Ian P; Zhang, Jun-Ming

2016-08-17

Some forms of chronic pain are maintained or enhanced by activity in the sympathetic nervous system (SNS), but attempts to model this have yielded conflicting findings. The SNS has both pro- and anti-inflammatory effects on immunity, confounding the interpretation of experiments using global sympathectomy methods. We performed a "microsympathectomy" by cutting the ipsilateral gray rami where they entered the spinal nerves near the L4 and L5 DRG. This led to profound sustained reductions in pain behaviors induced by local DRG inflammation (a rat model of low back pain) and by a peripheral paw inflammation model. Effects of microsympathectomy were evident within one day, making it unlikely that blocking sympathetic sprouting in the local DRGs or hindpaw was the sole mechanism. Prior microsympathectomy greatly reduced hyperexcitability of sensory neurons induced by local DRG inflammation observed 4 d later. Microsympathectomy reduced local inflammation and macrophage density in the affected tissues (as indicated by paw swelling and histochemical staining). Cytokine profiling in locally inflamed DRG showed increases in pro-inflammatory Type 1 cytokines and decreases in the Type 2 cytokines present at baseline, changes that were mitigated by microsympathectomy. Microsympathectomy was also effective in reducing established pain behaviors in the local DRG inflammation model. We conclude that the effect of sympathetic fibers in the L4/L5 gray rami in these models is pro-inflammatory. This raises the possibility that therapeutic interventions targeting gray rami might be useful in some chronic inflammatory pain conditions. Sympathetic blockade is used for many pain conditions, but preclinical studies show both pro- and anti-nociceptive effects. The sympathetic nervous system also has both pro- and anti-inflammatory effects on immune tissues and cells. We examined effects of a very localized sympathectomy. By cutting the gray rami to the spinal nerves near the lumbar sensory

Comparison Thoracic Epidural and Intercostal Block to Improve Ventilation Parameters and Reduce Pain in Patients with Multiple Rib Fractures

Directory of Open Access Journals (Sweden)

Raheleh Aligholipour Maleki

2011-08-01

Full Text Available Introduction: Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may re-quire such high dose that they produce respiratory depression, especially in el-derly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. Methods: sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or inter-costal block with %0.25 bupivacaine. The patients were assessed through ICU and hos-pital stay length, ventilation function tests. Pain score among the patients was meas-ured with verbal rating scale, before and after administration of the analgesia. Results: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P < 0.004. Changes in the visual Analogue Scale were associated with marked improvement re-garding pain at rest and pain caused by coughing and deep breathing in group A com-pared group B... ICU and hospital stay markedly reduced in Group A. Conclusion: tho-racic epidural analgesia is superior to intercostals block regarding pain relief of rib frac-tures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

Effect of pain chronification and chronic pain on an endogenous pain modulation circuit in rats.

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Miranda, J; Lamana, S M S; Dias, E V; Athie, M; Parada, C A; Tambeli, C H

2015-02-12

We tested the hypothesis that chronic pain development (pain chronification) and ongoing chronic pain (chronic pain) reduce the activity and induce plastic changes in an endogenous analgesia circuit, the ascending nociceptive control. An important mechanism mediating this form of endogenous analgesia, referred to as capsaicin-induced analgesia, is its dependence on nucleus accumbens μ-opioid receptor mechanisms. Therefore, we also investigated whether pain chronification and chronic pain alter the requirement for nucleus accumbens μ-opioid receptor mechanisms in capsaicin-induced analgesia. We used an animal model of pain chronification in which daily subcutaneous prostaglandin E2 (PGE2) injections into the rat's hind paw for 14 days, referred to as the induction period of persistent hyperalgesia, induce a long-lasting state of nociceptor sensitization referred to as the maintenance period of persistent hyperalgesia, that lasts for at least 30 days following the cessation of the PGE2 treatment. The nociceptor hypersensitivity was measured by the shortening of the time interval for the animal to respond to a mechanical stimulation of the hind paw. We found a significant reduction in the duration of capsaicin-induced analgesia during the induction and maintenance period of persistent mechanical hyperalgesia. Intra-accumbens injection of the μ-opioid receptor selective antagonist Cys(2),Tyr(3),Orn(5),Pen(7)amide (CTOP) 10 min before the subcutaneous injection of capsaicin into the rat's fore paw blocked capsaicin-induced analgesia. Taken together, these findings indicate that pain chronification and chronic pain reduce the duration of capsaicin-induced analgesia, without affecting its dependence on nucleus accumbens μ-opioid receptor mechanisms. The attenuation of endogenous analgesia during pain chronification and chronic pain suggests that endogenous pain circuits play an important role in the development and maintenance of chronic pain. Copyright © 2014 IBRO

Arthroscopic treatment of impingement of the ankle reduces pain and enhances function

DEFF Research Database (Denmark)

Rasmussen, S; Hjorth Jensen, C

2002-01-01

A consecutive series of 105 patients with a median age of 35 (16-62) years who were operated on with arthroscopic resection for impingement of the ankle using standardized technique without distraction is presented. All patients complained of painful dorsiflexion and had failed to respond to cons...... synovectomy and intravenous antibiotics. In one patient persistent symptoms were recorded. Ankle arthroscopy yielded good results in the treatment of anterior impingement of the ankle as it effectively reduced pain and enhanced function....... of pain. Gait was improved in 30/41 patients and 22 resumed sporting activities. The results were graded excellent in 67, good in 25, fair in six and poor in seven patients. There were four deep infections and one synovial fistula in this series. The deep infections all responded well to arthroscopic...

Neonatal pain

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Walker, Suellen M

2014-01-01

Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

Piracetam for reducing the incidence of painful sickle cell disease crises.

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Al Hajeri, Amani; Fedorowicz, Zbys

2016-02-12

Sickle cell disease is one of the most common genetic disorders. Sickle cell crises in which irregular and dehydrated cells contribute to blocking of blood vessels are characterised by episodes of pain. Treatment is mainly supportive and symptomatic. In vitro studies with piracetam indicate that it has the potential for inhibition and a reversal of the process of sickling of erythrocytes. This is an update of a previously published Cochrane review. To assess the effectiveness of piracetam for reducing the incidence of painful sickle cell disease crises. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Last search of the Group's Haemoglobinopathies Trials Register: 21 September 2015. Randomised controlled trials comparing orally administered piracetam to placebo or standard care in people, of all ages and both sexes, with sickle cell disease. Two authors independently assessed trial quality and extracted data. Trial authors were contacted for additional information. Adverse effects data were collected from the trials. Three trials involving 169 participants were included in the review. A limited amount of data addressing some of the primary and some of the secondary outcomes were provided, but data were incomplete and based on un-validated assumptions used in the evaluation of outcomes. One trial reported a reduction in the number of pain crises and their severity with active intervention than placebo but presented no data to confirm these results. A second trial presented a monthly global pain score based on the number of sickle cell crises and severity of pain but included no separate data for these primary outcomes. Although there was no significant difference between the piracetam and placebo periods for the number of days of

Pharmacological and non-pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults.

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Prabhakar, Hemanshu; Singh, Gyaninder Pal; Ali, Zulfiqar; Kalaivani, Mani; Smith, Martha A

2016-02-12

. We used a fixed-effect model where there was no evidence of significant heterogeneity between studies and a random-effects model if heterogeneity was likely. We included 66 studies with 7840 participants in the review, though most analyses were based on data from fewer participants. In total there are 17 studies awaiting classification. No studies were at a low risk of bias. We noted substantial statistical and clinical heterogeneity between trials. Most of the studies reported the primary outcome pain as assessed by verbal response from participants in an awake state but some trials reported withdrawal of the injected limb as a proxy for pain after induction of anaesthesia in response to rocuronium administration. Few studies reported adverse events and no study reported heart rate and blood pressure changes after administration of rocuronium. Lidocaine was the most commonly studied intervention drug, used in 29 trials with 2256 participants. The risk ratio (RR) of pain on injection if given lidocaine compared to placebo was 0.23 (95% confidence interval (CI) 0.17 to 0.31; I² = 65%, low quality of evidence). The RR of pain on injection if fentanyl and remifentanil were given compared to placebo was 0.42 (95% CI 0.26 to 0.70; I² = 79%, low quality of evidence) and (RR 0.10, 95% CI 0.04 to 0.26; I² = 74%, low quality of evidence), respectively. Pain on injection of intervention drugs was reported with the use of lidocaine and acetaminophen in one study. Cough was reported with the use of fentanyl (one study), remifentanil (five studies, low quality evidence) and alfentanil (one study). Breath holding and chest tightness were reported with the use of remifentanil in two studies (very low quality evidence) and one study (very low quality evidence), respectively. The overall rate of complications was low. The evidence to suggest that the most commonly investigated pharmacological interventions reduce pain on injection of rocuronium is of low quality due to risk of

Modulation of itch by conditioning itch and pain stimulation in healthy humans

DEFF Research Database (Denmark)

Andersen, Hjalte Holm; van Laarhoven, Antoinette I. M.; Elberling, Jesper

2017-01-01

Little is known about endogenous descending control of itch. In chronic pain, descending pain inhibition is reduced as signified by lowered conditioned pain modulation (CPM). There are indications that patients with chronic itch may also exhibit reduced endogenous descending inhibition of itch......-evoked itch, while the test stimuli were electrical stimulation paradigms designed to evoke itch or pain. Pain was significantly reduced (CPM-effect) by the conditioning pain stimulus (p

Intra-Articular Corticosteroids in Addition to Exercise for Reducing Pain Sensitivity in Knee Osteoarthritis

DEFF Research Database (Denmark)

Soriano-Maldonado, Alberto; Klokker, Louise; Bartholdy, Cecilie

2016-01-01

OBJECTIVE: To assess the effects of one intra-articular corticosteroid injection two weeks prior to an exercise-based intervention program for reducing pain sensitivity in patients with knee osteoarthritis (OA). DESIGN: Randomized, masked, parallel, placebo-controlled trial involving 100 particip......OBJECTIVE: To assess the effects of one intra-articular corticosteroid injection two weeks prior to an exercise-based intervention program for reducing pain sensitivity in patients with knee osteoarthritis (OA). DESIGN: Randomized, masked, parallel, placebo-controlled trial involving 100...... the injections all participants undertook a 12-week supervised exercise program. Main outcomes were changes from baseline in pressure-pain sensitivity (pressure-pain threshold [PPT] and temporal summation [TS]) assessed using cuff pressure algometry on the calf. These were exploratory outcomes from a randomized....... The mean group difference in changes from baseline at week 14 was 0.6 kPa (95% CI: -1.7 to 2.8; P = 0.626) for PPT and 384 mm×sec (95% CI: -2980 to 3750; P = 0.821) for TS. CONCLUSIONS: These results suggest that adding intra-articular corticosteroid injection 2 weeks prior to an exercise program does...

Intelligent Physical Exercise Training proves effective in enhancing muscle strength and reducing musculoskeletal pain in a workplace setting

DEFF Research Database (Denmark)

Dalager, Tina; Justesen, Just Bendix; Sjøgaard, Gisela

intensity IPET every week within working hours for one year. The training program was based on baseline health check measures of muscle strength, musculoskeletal pain (self-reported on a 0-9 numeric box scale), cardiorespiratory fitness and health risk indicators, as well as functional capacity including...... compared with REF (~ 20 %). Discussion: High intensity IPET during working hours significantly reduced musculoskeletal pain in neck and shoulders as well as increased muscle strength among office workers. Of note is the large proportion of employees in TG who had pain reductions of ≥1, which is considered...... workers based on health checks and to assess the effect on musculoskeletal health (Sjøgaard G et al. BMC Public Health 2014, 14:652). Methods: Office workers were at each of 6 companies randomized 1:1 to a training group, TG (N=194) or a reference group, REF (N=195). TG received one-hour supervised high...

Pain-related worry in patients with chronic orofacial pain.

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Davis, C Ervin; Stockstill, John W; Stanley, William D; Wu, Qiang

2014-07-01

Pain-related worry is distinct from, but related to, pain catastrophizing (PC) and anxiety. Worry and its relationship with other variables have been studied in people with chronic pain but not in people with chronic orofacial pain. The authors explored the prevalence of trait, general and pain-related worry and the association of worry with higher pain levels and other variables. The authors assessed people who had a diagnosis of chronic orofacial pain by using nonpain-related trait worry, state anxiety, trait anxiety, PC and pain measures. The participants' answers to an open-ended question about what they were most worried about led to the identification of worry domains, including worry about pain. The authors found that worrying about pain was related significantly to worst and least pain levels, pain interference and pain duration, as well as moderated trait worry in predicting pain interference. Although trait worry was not correlated directly with pain, when moderated by PC, it made substantial contributions in predicting pain interference. Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping.

Reducing neonatal pain during routine heel lance procedures.

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Morrow, Carla; Hidinger, Andrea; Wilkinson-Faulk, Debbie

2010-01-01

To measure the difference in pain scores for newborns who were held and swaddled while undergoing routine heel lance procedures compared to newborns who were lying on their backs and not swaddled during heel lance. Additionally, we sought to compare the total amount of time it took to collect the specimens in each group. A total of 42 neonates recruited from a large tertiary hospital were enrolled in a randomized controlled trial. Infants in the experimental group (n = 22) were swaddled and held in an upright position during routine heel lance procedures while neonates in the control group (n = 20) remained in a standard care position. Pain was measured with the Neonatal Inventory Pain Scale (NIPS) at two points in time for each group (just before the heel lance procedure and at the completion of the heel lance). Total collection time was measured using a stopwatch accurate to 1/100th of a second. Specimen quality was measured based on the number of rejected specimens for each group. Descriptive statistics and t tests were used to analyze the data. The mean NIPS score for neonates who were swaddled and held during the procedure (experimental group) was significantly lower (M = 1.3, SD = .9) than the score for infants in the standard position (control group) (M = 2.7, SD = 1.3), t (40) = -4.48, p lance procedures offers nurses a nonpharmacologic method of neonatal pain reduction for heel sticks. This technique can be easily implemented on any unit independent of facility protocols. Furthermore, the technique is not associated with any cost or policy development, making it more likely that nurses can use it in practice.

APP/SOD1 overexpressing mice present reduced neuropathic pain sensitivity.

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Kotulska, Katarzyna; Larysz-Brysz, Magdalena; LePecheur, Marie; Marcol, Wiesław; Olakowska, Edyta; Lewin-Kowalik, Joanna; London, Jacqueline

2011-07-15

There are controversies regarding pain expression in mentally disabled people, including Down syndrome patients. The aim of this study was to examine neuropathic pain-related behavior and peripheral nerve regeneration in mouse model of Down syndrome. Sciatic nerves of double transgenic mice, overexpressing both amyloid precursor protein (APP) and Cu/Zn superoxide dismutase (SOD1) genes, and FVB/N wild type mice were transected and immediately resutured. Evaluation of autotomy and functional recovery was carried out during 4-week follow-up. We found markedly less severe autotomy in transgenic animals, although the onset of autotomy was significantly delayed in control mice. Interestingly, neuroma formation at the injury site was significantly more prominent in transgenic animals. Sciatic function index outcome was better in transgenic mice than in wild-type group. Histological evaluation revealed no statistically significant differences in the number of GAP-43-positive growth cones and macrophages in the distal stump of the transected nerve between groups. However, in transgenic animals, the regenerating axons were arranged more chaotically. The number of Schwann cells in the distal stump of the transected nerves was significantly lower in transgenic mice. The number of surviving motoneurons was markedly decreased in transgenic group. We measured also the atrophy of denervated muscles and found it decreased in APP/SOD1 overexpressing mice. Taken together, in this model of Down syndrome, we observed increased neuroma formation and decreased autotomy after peripheral nerve injury. Our findings suggest that APP/SOD1 overexpressing mice are less sensitive for neuropathic pain associated with neuroma. Copyright © 2011 Elsevier Inc. All rights reserved.

Oxytocin reduces neural activity in the pain circuitry when seeing pain in others

NARCIS (Netherlands)

Bos, P.A.; Montoya, E.R.; Hermans, E.; Keysers, C.; Honk, J. van

2015-01-01

Our empathetic abilities allow us to feel the pain of others. This phenomenon of vicarious feeling arises because the neural circuitry of feeling pain and seeing pain in others is shared. The neuropeptide oxytocin (OXT) is considered a robust facilitator of empathy, as intranasal OXT studies have

Oxytocin reduces neural activity in the pain circuitry when seeing pain in others

NARCIS (Netherlands)

Bos, Peter A; Montoya, Estrella R; Hermans, Erno J; Keysers, C.; van Honk, Jack

Our empathetic abilities allow us to feel the pain of others. This phenomenon of vicarious feeling arises because the neural circuitry of feeling pain and seeing pain in others is shared. The neuropeptide oxytocin (OXT) is considered a robust facilitator of empathy, as intranasal OXT studies have

Clinical use of virtual reality distraction system to reduce anxiety and pain in dental procedures.

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Wiederhold, Mark D; Gao, Kenneth; Wiederhold, Brenda K

2014-06-01

Virtual reality (VR) has been used by clinicians to manage pain in clinical populations. This study examines the use of VR as a form of distraction for dental patients using both subjective and objective measures to determine how a VR system affects patients' reported anxiety level, pain level, and physiological factors. As predicted, results of self-evaluation questionnaires showed that patients experienced less anxiety and pain after undergoing VR treatment. Physiological data reported similar trends in decreased anxiety. Overall, the favorable subjective and objective responses suggest that VR distraction systems can reduce discomfort and pain for patients with mild to moderate fear and anxiety.

Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life.

Science.gov (United States)

Lambeek, Ludeke C; van Mechelen, Willem; Knol, Dirk L; Loisel, Patrick; Anema, Johannes R

2010-03-16

To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain. Population based randomised controlled trial. Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals). 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain. Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles. The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status. The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly. The integrated care programme substantially reduced disability due to chronic low back pain in private and working life. Trial registration Current Controlled Trials ISRCTN28478651.

Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development.

Science.gov (United States)

Mooney-Leber, Sean M; Brummelte, Susanne

2017-02-07

Advances in neonatal intensive care units (NICUs) have drastically increased the survival chances of preterm infants. However, preterm infants are still exposed to a wide range of stressors during their stay in the NICU, which include painful procedures and reduced maternal contact. The activation of the hypothalamic-pituitary-adrenal (HPA) axis, in response to these stressors during this critical period of brain development, has been associated with many acute and long-term adverse biobehavioral outcomes. Recent research has shown that Kangaroo care, a non-pharmacological analgesic based on increased skin-to-skin contact between the neonate and the mother, negates the adverse outcomes associated with neonatal pain and reduced maternal care, however the biological mechanism remains widely unknown. This review summarizes findings from both human and rodent literature investigating neonatal pain and reduced maternal care independently, primarily focusing on the role of the HPA axis and biobehavioral outcomes. The physiological and positive outcomes of Kangaroo care will also be discussed in terms of how dampening of the HPA axis response to neonatal pain and increased maternal care may account for positive outcomes associated with Kangaroo care. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

Lipoxin A4 inhibits microglial activation and reduces neuroinflammation and neuropathic pain after spinal cord hemisection.

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Martini, Alessandra Cadete; Berta, Temugin; Forner, Stefânia; Chen, Gang; Bento, Allisson Freire; Ji, Ru-Rong; Rae, Giles Alexander

2016-04-08

Spinal cord injury (SCI) is a severe neurological disorder with many disabling consequences, including persistent neuropathic pain, which develops in about 40 % of SCI patients and is induced and sustained by excessive and uncontrolled spinal neuroinflammation. Here, we have evaluated the effects of lipoxin A4 (LXA4), a member of a unique class of endogenous lipid mediators with both anti-inflammatory and analgesic properties, on spinal neuroinflammation and chronic pain in an experimental model of SCI. Spinal hemisection at T10 was carried out in adult male CD1 mice and Wistar rats. To test if LXA4 can reduce neuroinflammation and neuropathic pain, each animal received two intrathecal injections of LXA4 (300 pmol) or vehicle at 4 and 24 h after SCI. Sensitivity to mechanical stimulation of the hind paws was evaluated using von Frey monofilaments, and neuroinflammation was tested by measuring the mRNA and/or protein expression levels of glial markers and cytokines in the spinal cord samples after SCI. Also, microglia cultures prepared from murine cortical tissue were used to assess the direct effects of LXA4 on microglial activation and release of pro-inflammatory TNF-α. LXA4 treatment caused significant reductions in the intensity of mechanical pain hypersensitivity and spinal expression levels of microglial markers and pro-inflammatory cytokines induced by SCI, when compared to rodents receiving control vehicle injections. Notably, the increased expressions of the microglial marker IBA-1 and of the pro-inflammatory cytokine TNF-α were the most affected by the LXA4 treatment. Furthermore, cortical microglial cultures expressed ALX/FPR2 receptors for LXA4 and displayed potentially anti-inflammatory responses upon challenge with LXA4. Collectively, our results suggest that LXA4 can effectively modulate microglial activation and TNF-α release through ALX/FPR2 receptors, ultimately reducing neuropathic pain in rodents after spinal cord hemisection. The dual anti

The influence of 'significant others' on persistent back pain and work participation: A qualitative exploration of illness perceptions

Directory of Open Access Journals (Sweden)

King Nigel

2011-10-01

Full Text Available Abstract Background Individual illness perceptions have been highlighted as important influences on clinical outcomes for back pain. However, the illness perceptions of 'significant others' (spouse/partner/close family member are rarely explored, particularly in relation to persistent back pain and work participation. The aim of this study was to initiate qualitative research in this area in order to further understand these wider influences on outcome. Methods Semi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with a convenience sample of UK disability benefit claimants, along with their significant others (n = 5 dyads. Data were analysed using template analysis. Results Significant others shared, and perhaps further reinforced, claimants' unhelpful illness beliefs including fear of pain/re-injury associated with certain types of work and activity, and pessimism about the likelihood of return to work. In some cases, significant others appeared more resigned to the permanence and negative inevitable consequences of the claimant's back pain condition on work participation, and were more sceptical about the availability of suitable work and sympathy from employers. In their pursuit of authenticity, claimants were keen to stress their desire to work whilst emphasising how the severity and physical limitations of their condition prevented them from doing so. In this vein, and seemingly based on their perceptions of what makes a 'good' significant other, significant others acted as a 'witness to pain', supporting claimants' self-limiting behaviour and statements of incapacity, often responding with empathy and assistance. The beliefs and responses of significant others may also have been influenced by their own experience of chronic illness, thus participants lives were often intertwined and defined by illness. Conclusions The findings from this exploratory study reveal how

Knee arthritis pain is reduced and range of motion is increased following moderate pressure massage therapy.

Science.gov (United States)

Field, Tiffany; Diego, Miguel; Gonzalez, Gladys; Funk, C G

2015-11-01

The literature on massage therapy effects on knee pain suggests that pain was reduced based on self-report, but little is known about range of motion (ROM) effects. Medical School staff and faculty who had knee arthritis pain were randomly assigned to a moderate pressure massage therapy or a waitlist control group (24 per group). Self-reports included the WOMAC (pain, stiffness and function) and the Pittsburgh Sleep Quality Index. ROM and ROM-related pain were assessed before and after the last sessions. The massage group showed an immediate post-massage increase in ROM and a decrease in ROM-associated pain. On the last versus the first day of the study, the massage group showed greater increases in ROM and decreases in ROM-related pain as well as less self-reported pain and sleep disturbances than the waitlist control group. These data highlight the effectiveness of moderate pressure massage therapy for increasing ROM and lessening ROM-related pain and long-term pain and sleep disturbances. Copyright © 2015 Elsevier Ltd. All rights reserved.

Swimming Training Reduces Neuroma Pain by Regulating Neurotrophins.

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Tian, Jinge; Yu, Tingting; Xu, Yongming; Pu, Shaofeng; Lv, Yingying; Zhang, Xin; DU, Dongping

2018-01-01

Neuroma formation after peripheral nerve transection leads to severe neuropathic pain in amputees. Previous studies suggested that physical exercise could bring beneficial effect on alleviating neuropathic pain. However, the effect of exercise on neuroma pain still remained unclear. In addition, long-term exercise can affect the expression of neurotrophins (NT), such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), which play key roles in nociceptor sensitization and nerve sprouting after nerve injury. Here, we investigated whether long-term swimming exercise could relieve neuroma pain by modulating NT expression. We used a tibial neuroma transposition (TNT) rat model to mimic neuroma pain. After TNT surgery, rats performed swimming exercise for 5 wk. Neuroma pain and tactile sensitivities were detected using von Frey filaments. Immunofluorescence was applied to analyze neuroma formation. NGF and BDNF expressions in peripheral neuroma, dorsal root ganglion, and the spinal cord were measured using enzyme-linked immunosorbent assay and Western blotting. TNT led to neuroma formation, induced neuroma pain, and mechanical allodynia in hind paw. Five-week swimming exercise inhibited neuroma formation and relieved mechanical allodynia in the hind paw and neuroma pain in the lateral ankle. The analgesic effect lasted for at least 1 wk, even when the exercise ceased. TNT elevated the expressions of BDNF and NGF in peripheral neuroma, dorsal root ganglion, and the spinal cord to different extents. Swimming also decreased the elevation of NT expression. Swimming exercise not only inhibits neuroma formation induced by nerve transection but also relieves pain behavior. These effects might be associated with the modulation of NT.

Effects of vicarious pain on self-pain perception: investigating the role of awareness

Science.gov (United States)

Terrighena, Esslin L; Lu, Ge; Yuen, Wai Ping; Lee, Tatia MC; Keuper, Kati

2017-01-01

The observation of pain in others may enhance or reduce self-pain, yet the boundary conditions and factors that determine the direction of such effects are poorly understood. The current study set out to show that visual stimulus awareness plays a crucial role in determining whether vicarious pain primarily activates behavioral defense systems that enhance pain sensitivity and stimulate withdrawal or appetitive systems that attenuate pain sensitivity and stimulate approach. We employed a mixed factorial design with the between-subject factors exposure time (subliminal vs optimal) and vicarious pain (pain vs no pain images), and the within-subject factor session (baseline vs trial) to investigate how visual awareness of vicarious pain images affects subsequent self-pain in the cold-pressor test. Self-pain tolerance, intensity and unpleasantness were evaluated in a sample of 77 healthy participants. Results revealed significant interactions of exposure time and vicarious pain in all three dependent measures. In the presence of visual awareness (optimal condition), vicarious pain compared to no-pain elicited overall enhanced self-pain sensitivity, indexed by reduced pain tolerance and enhanced ratings of pain intensity and unpleasantness. Conversely, in the absence of visual awareness (subliminal condition), vicarious pain evoked decreased self-pain intensity and unpleasantness while pain tolerance remained unaffected. These findings suggest that the activation of defense mechanisms by vicarious pain depends on relatively elaborate cognitive processes, while – strikingly – the appetitive system is activated in highly automatic manner independent from stimulus awareness. Such mechanisms may have evolved to facilitate empathic, protective approach responses toward suffering individuals, ensuring survival of the protective social group. PMID:28831270

Innovative Technology Using Virtual Reality in the Treatment of Pain: Does It Reduce Pain via Distraction, or Is There More to It?

Science.gov (United States)

Gupta, Anita; Scott, Kevin; Dukewich, Matthew

2018-01-01

Virtual reality (VR) is an exciting new technology with almost endless possible uses in medicine. One area it has shown promise is pain management. This selective review focused on studies that gave evidence to the distraction or nondistraction mechanisms by which VR leads to the treatment of pain. The review looked at articles from 2000 to July 29, 2016, focusing on studies concerning mechanisms by which virtual reality can augment pain relief. The data was collected through a search of MEDLINE and Web of Science using the key words of "virtual reality" and "pain" or "distraction." Six studies were identified: four small randomized controlled studies and two prospective/pilot studies. The search results provided evidence that distraction is a technique by which VR can have benefits in the treatment of pain. Both adult and pediatric populations were included in these studies. In addition to acute pain, several studies looked at chronic pain states such as headaches or fibromyalgia. These studies also combined VR with other treatment modalities such as biofeedback mechanisms and cognitive behavioral therapy. These results demonstrate that in addition to distraction, there are novel mechanisms for VR treatment in pain, such as producing neurophysiologic changes related to conditioning and exposure therapies. If these new mechanisms can lead to new treatment options for patients with chronic pain, VR may have the ability to help reduce opioid use and misuse among chronic pain patients. More studies are needed to reproduce results from prospective/pilot studies in large randomized control studies. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Reduce chest pain using modified silicone fluted drain tube for chest drainage after video-assisted thoracic surgery (VATS) lung resection.

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Li, Xin; Hu, Bin; Miao, Jinbai; Li, Hui

2016-02-01

The aim of this study was to assess the feasibility, efficacy and safety of a modified silicone fluted drain tube after video-assisted thoracic surgery (VATS) lung resection. The prospective randomized study included 50 patients who underwent VATS lung resection between March 2015 and June 2015. Eligible patients were randomized into two groups: experimental group (using the silicone fluted drain tubes for chest drainage) and control group (using standard drain tubes for chest drainage). The volume and characteristics of drainage, postoperative (PO) pain scores and hospital stay were recorded. All patients received standard care during hospital admission. In accordance with the exit criteria, three patients were excluded from study. The remaining 47 patients included in the final analysis were divided into two groups: experiment group (N=24) and control group (N=23). There was no significant difference between the two groups in terms of age, sex, height, weight, clinical diagnosis and type of surgical procedure. There was a trend toward less PO pain in experimental group on postoperative day (POD) 1, with a statistically significant difference. Patients in experimental group had a reduced occurrence of fever [temperature (T) >37.4 °C] compared to the control group. The silicone fluted drain tube is feasible and safe and may relieve patient PO pain and reduce occurrence of fever without the added risk of PO complications.

Using a New Measurement to Evaluate Pain Relief Among Cancer Inpatients with Clinically Significant Pain Based on a Nursing Information System: A Three-Year Hospital-Based Study.

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Wang, Wei-Yun; Chu, Chi-Ming; Sung, Chun-Sung; Ho, Shung-Tai; Wu, Yi-Syuan; Liang, Chun-Yu; Wang, Kwua-Yun

2016-11-01

Developing a new measurement index is the first step in evaluating pain relief outcomes. Although the percentage difference in pain intensity (%PID) is the most popular indicator, this indicator does not take into account the goal of pain relief. Therefore, the aims of this study were to develop a pain relief index (PRI) for outcome evaluation and to examine the index using demographic characteristics of cancer inpatients with clinically significant pain. Retrospective cohort study. A national hospital. All cancer inpatients. Pain intensity was assessed using a numerical rating scale, a faces pain scale or the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Tool. Using a nursing information system, a pain score database containing data from 2011 through 2013 was analyzed. Cancer patients representing 93,812 hospitalizations were considered in this study. We focused on cancer patients for whom the worst pain intensity (WPI) was ≥ 4 points. PRI values of -62.02% to -72.55% were observed in the WPI ≥ 7 and 4 ≤ WPI ≤ 6 groups. Significant (P 65 years old, those who were admitted to the medicine or gynecology and those who had a hospital stay > 30 days. This hospital-based study demonstrated that the PRI is an effective and valid measure for evaluating outcome data using an electronic nursing information system. We will further define the meaningful range of percentage difference in PRI from various perspectives. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage.

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De Bonis, Maria; Torricelli, Michela; Leoni, Licia; Berti, Paolo; Ciani, Valentina; Puzzutiello, Rosa; Severi, Filiberto Maria; Petraglia, Felice

2012-06-01

To compare the effectiveness of carbetocin with oxytocin with respect to maintain adequate uterine tone and to reduce the incidence and severity of postpartum haemorrhage. Moreover safety, adverse effects and the need of additional medications were evaluated. Prospective controlled clinical trial. We compared the effect of a single dose of carbetocin (n = 55) with oxytocin infusion (n = 55) in a women population undergoing to elective caesarean section with regional subarachnoid anaesthesia with at least one risk factor for postpartum haemorrhage. The mean ± SD of postoperative pain in the day of surgery in carbetocin group was significantly lower than in oxytocin group and remained significant till the third day after caesarean section. In the day of surgery and the first day after surgery, women of carbetocin group who needed analgesic drugs were significantly lower than women of oxytocin group. The differences of diuresis and of diuretic drugs need were not statistically significant between the two groups. A single carbetocin injection is efficacious and safe on the maintenance of uterine tone and on the limitation of blood losses, in peri- and in postoperative period. In addition, carbetocin was able to reduce pain perception during postoperative days improving quality life of women.

Transcutaneous electrical nerve stimulation (TENS reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial

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Licia Santos Santana

2016-01-01

Full Text Available Questions: In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Design: Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Participants: Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4 cm, and without the use of any medications from hospital admission until randomisation. Intervention: The principal investigator applied TENS to the experimental group for 30 minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. Outcome measures: The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. Results: After the intervention, a significant mean difference in change in pain of 15 mm was observed favouring the experimental group (95% CI 2 to 27. The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0 hours (95% CI 4.1 to 5.9 longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. Conclusion: TENS produces a significant decrease in pain during labour and postpones the need for pharmacological

Effectiveness of Low-Level Laser Therapy in Reducing Orthodontic Pain: A Systematic Review and Meta-Analysis

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Deana, Naira Figueiredo; Zaror, Carlos; Sandoval, Paulo

2017-01-01

Objectives To assess the effectiveness of low-level laser therapy (LLLT) in reducing orthodontic pain after the application of orthodontic force (OF). Methods A systematic search was conducted in the MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science, and EBSCOhost databases. The study included randomized clinical trials (RCT) which analysed the effectiveness of LLLT in reducing orthodontic pain assessed at 24 and 72 hrs after the application of OF. The risk of bias of the eligible trials was assessed using the Cochrane Collaboration's risk of bias tool. Standard mean difference was calculated and pooled by meta-analysis using random effect models. Results Of 467 identified articles, 20 RCT were finally included. In the risk of bias assessments, 13 studies presented a high risk, 5 an unclear risk, and 2 a low risk. The meta-analysis showed that in patients treated with laser versus placebo there was a difference in favour of LLLT in spontaneous pain 24 and 72 hrs after the installation of light archwires and spontaneous pain and chewing pain 24 and 72 hrs after the installation of elastomeric separators. Conclusions LLLT proved to be effective in promoting a reduction in spontaneous and chewing pain after the application of OF; however, the poor quality of the evidence requires these results to be treated with caution. PMID:29089818

Reducing risk of spinal haematoma from spinal and epidural pain procedures.

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Breivik, Harald; Norum, Hilde; Fenger-Eriksen, Christian; Alahuhta, Seppo; Vigfússon, Gísli; Thomas, Owain; Lagerkranser, Michael

2018-04-25

Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory. We searched recent guidelines, PubMed (MEDLINE), SCOPUS and EMBASE for new and relevant randomised controlled trials (RCT), case-reports and original articles concerning benefits of neuraxial blocks, risks of SH due to anti-haemostatic drugs, patient-related risk factors, especially renal impairment with delayed excretion of antihaemostatic drugs, and specific risk factors related to the neuraxial pain procedures. Epidural and spinal analgesic techniques, as well as their combination provide superior analgesia and reduce the risk of postoperative and obstetric morbidity and mortality. Spinal pain procedure can be highly effective for cancer patients, less so for chronic non-cancer patients. We did not identify any RCT with SH as outcome. We evaluated risks and recommend precautions for SH when patients are treated with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients' comorbidities may increase risks, and when procedure-specific risk factors are present. Inserting and withdrawing epidural catheters appear to have similar risks for initiating a SH. Invasive neuraxial pain procedures, e.g. spinal cord stimulation, have higher risks of bleeding than traditional neuraxial blocks. We recommend robust monitoring routines and treatment protocol to ensure early diagnosis and effective treatment of SH should this rare but potentially serious complication occur. When neuraxial analgesia is considered for a patient on anti

The Clinical Effects of Aromatherapy Massage on Reducing Pain for the Cancer Patients: Meta-Analysis of Randomized Controlled Trials

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Ting-Hao Chen

2016-01-01

Full Text Available Purpose. Aromatherapy massage is an alternative treatment in reducing the pain of the cancer patients. This study was to investigate whether aromatherapy massage could improve the pain of the cancer patients. Methods. We searched PubMed and Cochrane Library for relevant randomized controlled trials without language limitations between 1 January 1990 and 31 July 2015 with a priori defined inclusion and exclusion criteria. The search terms included aromatherapy, essential oil, pain, ache, cancer, tumor, and carcinoma. There were 7 studies which met the selection criteria and 3 studies were eventually included among 63 eligible publications. Results. This meta-analysis included three randomized controlled trials with a total of 278 participants (135 participants in the massage with essential oil group and 143 participants in the control (usual care group. Compared with the control group, the massage with essential oil group had nonsignificant effect on reducing the pain (standardized mean difference = 0.01; 95% CI [-0.23,0.24]. Conclusion. Aromatherapy massage does not appear to reduce pain of the cancer patients. Further rigorous studies should be conducted with more objective measures.

Relaxation and guided imagery do not reduce stress, pain and unpleasantness for 11- to 12-year-old girls during vaccinations.

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Nilsson, Stefan; Forsner, Maria; Finnström, Berit; Mörelius, Evalotte

2015-07-01

Relaxation and guided imagery is a distraction technique known to reduce discomfort during paediatric medical procedures. We examined whether its use decreased the stress experienced by 11- to 12-year-old girls receiving the human papilloma virus vaccination, as well as the intensity and unpleasantness of any pain. A randomised crossover trial was conducted with 37 girls. During the first vaccination, each girl was randomised to receive either relaxation and guided imagery or standard care. They then received the other form of care during the second vaccination. Salivary cortisol was measured before each vaccination, and 30 minutes after it was administered. The girls reported pain intensity and pain unpleasantness before and directly after each vaccination and stress after each vaccination. On a group level, relaxation and guided imagery did not decrease cortisol levels, self-reported stress, pain intensity and pain unpleasantness. Salivary cortisol levels decreased significantly in both groups during the second vaccination. Relaxation and guided imagery did not prove beneficial during the vaccination of 11- to 12-year-old girls and is not recommended as a regular nursing intervention. However, further research is needed into effective techniques to help children who experience pain unpleasantness in connection with needle procedures. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Differentiation of pain ratings in combat-related posttraumatic stress disorder.

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Kraus, Anja; Geuze, Elbert; Schmahl, Christian; Greffrath, Wolfgang; Treede, Rolf-Detlef; Bohus, Martin; Vermetten, Eric

2009-06-01

Although posttraumatic stress disorder (PTSD) is associated with chronic pain, preliminary evidence suggests reduced experimental pain sensitivity in this disorder. The questions addressed in the present study were whether pain perception would also be reduced in PTSD patients who are not suffering from chronic pain symptoms, and whether a reduction in pain sensitivity would also be present in combat veterans who did not develop PTSD. For this, we determined thermal detection and pain thresholds in 10 male combat-related PTSD patients, 10 combat control subjects (no PTSD) and 10 healthy controls without combat experience. All subjects were pain free. First, we measured thermal sensory thresholds with ramped heat and cold stimuli using the method of limits. Ramped thermal sensory stimulation revealed no deficits for the detection of (non-noxious) f2.1thermal stimuli between groups. In contrast, heat and cold pain thresholds in both combat groups (PTSD and combat controls) were significantly increased compared to healthy controls. However, these stimuli could not distinguish between the two groups due to ceiling effects. When using longer-lasting heat stimulation at different temperatures (30s duration; method of fixed stimuli), we found significantly lower frequency of pain reports in PTSD patients compared with both combat and healthy controls, as well as significantly lower pain ratings. Our results suggest an association of PTSD with reduced pain sensitivity, which could be related to PTSD-related (neuro-)psychological alterations or to a pre-existing risk factor for the disorder.

Music for reducing the anxiety and pain of patients undergoing a biopsy: A meta-analysis.

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Song, Mingzhi; Li, Nanyang; Zhang, Xianbin; Shang, Yuru; Yan, Litao; Chu, Jin; Sun, Ran; Xu, Yun

2018-05-01

This study aimed to evaluate the efficacy of music therapy for reducing the anxiety and pain of patients who underwent a biopsy. Music can affect human anxiety and pain by triggering a neuroendocrine effect. Clinical study results indicated that music can influence the anxiety and pain caused by invasive procedures. There is no effective solution for anxiety and pain arising from a biopsy. Although researchers in this field have different views, music still holds promise in reducing the anxiety and pain in patients undergoing the biopsy. Systematic review and meta-analysis of randomized controlled trials. Systematic searches were conducted in PubMed, Embase, Medline and Cochrane databases for studies reported in the English language. The review period covered 2000 - December 2016. The outcome measure of interest was anxiety and pain. This review followed Cochrane methods. Studies were selected according to the PICOS framework. The methodological quality of studies was assessed with the Cochrane risk of bias tool. A systematic review of effectiveness was conducted by using GRADE approach. Nine randomized controlled trials with a total of 326 participants in the music intervention group and 323 controls met the inclusion criteria. Music had a tendency towards decreasing systolic blood pressure before the biopsy, State-Trait Anxiety Inventory scores after the biopsy, diastolic blood pressure after the biopsy and heart rate after the biopsy. Similarly, music also tended to be more effective for controlling pain after the biopsy. There was moderate quality evidence for the outcome: State-Trait Anxiety Inventory scores after the biopsy; and low- or very low-quality evidence for other outcomes. Music can be used for patients before and during the biopsy procedure. This approach may be performed by nurses to promote the recovery of patients after the biopsy. © 2017 John Wiley & Sons Ltd.

Oral Flurbiprofen Spray for Posttonsillectomy Pain.

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Muderris, Togay; Gul, Fatih; Yalciner, Gokhan; Babademez, Mehmet Ali; Bercin, Sami; Kiris, Muzaffer

2016-07-01

Tonsillectomy is still one of the most common surgical procedures, but there exists no standard guideline for pain management after tonsillectomy. Our aim is to determine whether oral spray of flurbiprofen reduces pain and has an influence on other morbid outcomes following tonsillectomy. Prospective, double-blind, randomized, placebo controlled. Patients at Ataturk Training and Research Hospital, Ankara, Turkey. This study was performed on 84 patients (45 in flurbiprofen group, 39 in placebo group) who underwent tonsillectomy. The patients were randomly chosen, and each used oral spray of flurbiprofen 3 times daily or placebo solution at the same regimen. Efficacy was assessed by changes in Numeric Pain Rating Scale. Data were collected at postoperative days 1, 3, 5, and 7 for pain, bleeding, and healing. Data for Mallampati scores were also collected. There were no significant difference between groups with respect to the demographic data. The flurbiprofen group had statistically significant lower pain scores at days 1, 3, 5, and 7 (P = .000, P = .002, P = .001, P = .000, respectively). On days 3 and 7, pain scores were significantly different between different Mallampati groups (P = .049, P = .015, respectively). The flurbiprofen group required less analgesic than the placebo group during the study period on days 1, 3, 5, and 7 (P = .001, P = .001, P = .03, P = .001, respectively). Healing and side effects were not significantly different between the groups. In this study, topical use of flurbiprofen may reduce posttonsillectomy pain without any evidence of additional complications. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Efficacy of Rhus coriaria (sumac) juice in reducing muscle pain during aerobic exercise.

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Alghadir, A H; Gabr, S A

2016-06-01

The main target of this study was to measure the influence of sumac juice drink on muscle indices and pain during an acute, intense exercise for 30 days. Forty healthy volunteers (15-25 years) were involved in aerobic exercise program for 4 weeks. Participants ingested sumac juice or placebo drink twice daily for 30 days. All participants were subjected for the evaluation of pain and estimation of serum: creatine kinase (CK), lactic acid dehydrogenase (LDH), troponin I, hydroxyproline (hyp), total antioxidant capacity (TAC), and in vitro antioxidant activity of sumac juice using pre-validated visual analog scale, colorimetric and immunoassays. The participants of both groups, placebo and sumac, showed an increment in pain scores both during exercise and post-exercise intervals. However, the sumac juice group showed a significant smaller increase in the pain scores compared to the placebo group. Participants in the sumac juice group were more willing to use the drink in the future. They achieved a higher satisfaction of sumac juice in ameliorating and the reduction of pain. Also, the sumac group showed a significant enhancement in the level of CK, LDH, troponin I, hyp, along with significant increase in serum (TAC) compared to the placebo group. The protective activity of muscle may relate to the antioxidant activity of phenolic component(s) in sumac juice as measured by 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging (87.9%) and β-carotene-linoleic acid (68.7%) assays. These data suggest that oral administration of sumac juice may have a beneficial effect on muscle performance among athletes.

The Impact of Virtual Reality on Chronic Pain.

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Jones, Ted; Moore, Todd; Choo, James

2016-01-01

The treatment of chronic pain could benefit from additional non-opioid interventions. Virtual reality (VR) has been shown to be effective in decreasing pain for procedural or acute pain but to date there have been few studies on its use in chronic pain. The present study was an investigation of the impact of a virtual reality application for chronic pain. Thirty (30) participants with various chronic pain conditions were offered a five-minute session using a virtual reality application called Cool! Participants were asked about their pain using a 0-10 visual analog scale rating before the VR session, during the session and immediately after the session. They were also asked about immersion into the VR world and about possible side effects. Pain was reduced from pre-session to post-session by 33%. Pain was reduced from pre-session during the VR session by 60%. These changes were both statistically significant at the p virtual reality session. All participants (100%) reported a decrease in pain to some degree between pre-session pain and during-session pain. The virtual reality experience was found here to provide a significant amount of pain relief. A head mounted display (HMD) was used with all subjects and no discomfort was experienced. Only one participant noted any side effects. VR seems to have promise as a non-opioid treatment for chronic pain and further investigation is warranted.

Pain-related psychological distress, self-rated health and significance of neuropathic pain in Danish soldiers injured in Afghanistan

DEFF Research Database (Denmark)

Duffy, J R; Warburg, Finn; Koelle, S-F T

2015-01-01

BACKGROUND: Pain and mental health concerns are prevalent among veterans. While the majority of research has focused on chronic pain as an entity, there has been little work directed towards investigating the role of neuropathic pain in relation to psychological comorbidity. As such, we...... hypothesised that participants with signs of neuropathic pain would report higher levels of psychological distress and diminished self-rated health compared to those without a neuropathic component. METHODS: A retrospective review of standardised questionnaires (PainDETECT Questionnaire, Post-traumatic Stress...... pain. RESULTS: Fifty-three participants were included. The Post-traumatic Stress Disorder Checklist-Civilian score was in median (interquartile range) 26 (22-31), the Hospital Anxiety and Depression Scale score was 4 (2-6.5) and 2 (1-5) for anxiety and depression respectively. Evidence of neuropathic...

Effects of gabapentin on experimental somatic pain and temporal summation

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Arendt-Nielsen, Lars; Frøkjaer, Jens Brøndum; Staahl, Camilla

2007-01-01

at 2 Hz); (2) stimulus-response function relating pain intensity scores (visual analog scale, VAS) to increasing current intensities for electrical skin and muscle stimuli (single and repeated, determined at baseline); and (3) the pain intensity (VAS) and pain areas after intramuscular injection......, was to examine the effect of a single dose of 1200 mg gabapentin on multi-modal experimental cutaneous and muscle pain models. METHODS: The following pain models were applied: (1) pain thresholds to single and repeated cutaneous and intramuscular electrical stimulation (temporal summation to 5 stimuli delivered...... reduced the area under the pain intensity curve to hypertonic saline injections in the muscle (P = .02); and (3) significantly reduced the area of pain evoked by hypertonic saline (P = .03). CONCLUSIONS: Gabapentin reduces temporal summation of skin stimuli at pain threshold intensities; this may have...

Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy

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Hristovska, Ana-Marija; Kristensen, Billy B; Rasmussen, Marianne A

2014-01-01

: Thirty-seven patients undergoing vaginal hysterectomy. METHODS: Patients received high-volume (50 mL) ropivacaine 0.50% (n = 20) or saline (n = 17) infiltration using a systematic technique ensuring uniform delivery to all tissues incised, handled or instrumented during the procedure. MAIN OUTCOME...... MEASURES: Pain, nausea, vomiting and opioid requirements were assessed for 32 h as well as time spent in the post-anesthesia care unit and time to first mobilization. RESULTS: Pain at rest was significantly reduced after one, four and eight hours in the ropivacaine group (p ≤ 0.001-0.01). Pain during...... coughing was significantly reduced after one and four hours (p ≤ 0.001 and p ≤ 0.003), and pain during movement was significantly reduced after four hours (p ≤ 0.02). Opioid requirements and time spent in the post-anesthesia care unit were significantly reduced in the ropivacaine group (p

Pain Amplification Syndrome: A Biopsychosocial Approach.

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Namerow, Lisa B; Kutner, Emily C; Wakefield, Emily C; Rzepski, Barbara R; Sahl, Robert A

2016-08-01

Pediatric neurologists frequently encounter patients who present with significant musculoskeletal pain that cannot be attributed to a specific injury or illness, which can often be defined as pain amplification syndrome (PAS). PAS in children and adolescents is the result of a heightened pain sensitivity pathway, which is intensified by significant biological, psychological, and social contributors. Appropriate assessment and multimodal intervention of PAS are crucial to treatment success, including neurology and behavioral health collaborative treatment plans to restore patient function and reduce pain perception. Pediatric neurologists are imperative in the identification of patients with PAS, providing the family assurance in diagnosis and validation of pain, and directing patients to the appropriate multidisciplinary treatment pathway. Copyright © 2016 Elsevier Inc. All rights reserved.

Atypical electrophysiological activity during pain observation in amputees who experience synaesthetic pain.

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Fitzgibbon, Bernadette M; Enticott, Peter G; Giummarra, Melita J; Thomson, Richard H; Georgiou-Karistianis, Nellie; Bradshaw, John L

2012-03-01

There are increasing reports of people experiencing pain when observing pain in another. This describes the phenomenon of synaesthetic pain which, until recently, had been primarily reported in amputees with phantom pain. In the current study, we used electroencephalography (EEG) to investigate how amputees who experience synaesthetic pain process pain observed in another. Participants were grouped according to amputees who experience phantom and synaesthetic pain (n=8), amputees who experience phantom pain but not synaesthetic pain (n=10) and healthy controls (n=10). Participants underwent EEG as they observed still images of hands and feet in potentially painful and non-painful situations. We found that pain synaesthetes showed some reduced event-related potential (ERP) components at certain electrode sites, and reduced theta- and alpha band power amplitude at a central electrode. The finding of reduced ERP amplitude and theta band power may reflect inhibition of the processing of observed pain (e.g. avoidance/guarding as a protective strategy), and reduced alpha band power may indicate a disinhibition in control processes that may result in synaesthetic pain. These results provide the first documentation of atypical neurophysiological activity in amputees who experience synaesthetic pain when processing pain in another. © The Author (2011). Published by Oxford University Press.

Sympathetic Blocks Provided Sustained Pain Relief in a Patient with Refractory Painful Diabetic Neuropathy

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Jianguo Cheng

2012-01-01

Full Text Available The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic intervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic nerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological treatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies. A series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic paravertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy cases, consequent to extensive involvement of the intercostal nerves. These blocks provided sustained and significant pain relief and improvement of quality of life over a period of more than two years. We thus provided the first clinical evidence supporting the notion that sympathetic nervous system plays a critical role in painful diabetic neuropathy and sympathetic blocks can be an effective management modality of painful diabetic neuropathy. We concluded that the sympathetic nervous system is a valuable therapeutic target of pharmacological and interventional modalities of treatments in painful diabetic neuropathy patients.

Use of remifentanil to reduce propofol injection pain and the required propofol dose in upper digestive tract endoscopy diagnostic tests.

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Uliana, Gustavo Nadal; Tambara, Elizabeth Milla; Baretta, Giorgio Alfredo Pedroso

2015-01-01

The introduction of propofol (2,6-diisopropylphenol) as a sedative agent has transformed the area of sedation for endoscopic procedures. However, a major drawback of sedation with the use of propofol is its high incidence of injection pain. The most widely used technique in reducing propofol injection pain is through the association of other drugs. The aim of this study was to evaluate the effect of remifentanil-propofol combination on the incidence of propofol injection pain and its influence on the total dose of propofol required for sedation in upper digestive tract endoscopy (UDE) diagnostic tests. One hundred and five patients undergoing upper digestive tract endoscopy were evaluated and randomly divided into 3 groups of 35 patients each. The Control Group received propofol alone; Study-group 1 received remifentanil at a fixed dose of 0.2mg/kg combined with propofol; Study-group 2 received remifentanil at a fixed dose of 0.3mg/kg combined with propofol. The incidence of propofol injection pain and the total dose of propofol required for the test were evaluated. The sample was very similar regarding age, weight, height, sex, and physical status. Statistical analysis was performed according to the nature of the evaluated data. Student's t-test was used to compare the mean of age, weight, height (cm), and dose (mg/kg) variables between groups. The χ(2) test was used to compare sex, physical status, and propofol injection pain between groups. The significance level was αpain and total dose of propofol (mg/kg) used. However, there were no statistical differences between the two study groups for these parameters. We conclude that the use of remifentanil at doses of 0.2mg/kg and 0.3mg/kg was effective for reducing both the propofol injection pain and the total dose of propofol used. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients

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Jørgensen, Tanja Schjødt; Graven-Nielsen, Thomas; Ellegaard, Karen

2014-01-01

Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded...... muscles (control site). Results. Significantly increased PPTs were found following intra-articular injection, at both the knee (P effects were sustained for two weeks, and at some points the effect was even greater at two weeks (P 

Relationship of musculoskeletal pain and well-being at work - Does pain matter?

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Malmberg-Ceder, Kirsi; Haanpää, Maija; Korhonen, Päivi E; Kautiainen, Hannu; Soinila, Seppo

2017-04-01

crude analysis, work engagement (UWES-9) was similar in women without pain and those with musculoskeletal pain (4.96 vs. 4.79; p=0.091). After adjustment for age, education years, BMI, working hours and financial satisfaction, the difference between the groups became statistically significant (p=0.036). Still, there was no difference between the groups of no-pain and low burden of pain (p=0.21, after adjustment). Work engagement was significantly lower in the groups of medium (p=0.024, after adjusted) and high (pengagement musculoskeletal pain per se did not enter in the model to explain work engagement. Work and family stress, type D personality and duration of sick leave due to pain reduced work engagement, whereas financial satisfaction, moderate and high leisure time physical activity and higher BMI improved it. Among women with musculoskeletal pain psychosocial and lifestyle factors significantly correlate with work engagement, while the pain itself does not. Special attention should be paid to the psychosocial aspects in female employees with musculoskeletal pain to improve work well-being and maintain work ability. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Cervical flexor muscle training reduces pain, anxiety, and depression levels in patients with chronic neck pain by a clinically important amount: A prospective cohort study.

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Nazari, Goris; Bobos, Pavlos; Billis, Evdokia; MacDermid, Joy C

2018-03-14

Neck pain is the fourth leading cause of disability in the United States and exerts an important socio-economic burden around the world. The aims of this study were to determine the effectiveness of deep and superficial flexor muscle training in addition to home-based exercises in reducing chronic neck pain and anxiety/depression levels. This was a prospective cohort study. Patients between 18 and 65 years old with chronic neck pain were eligible to participate if they had disability levels at least 5 out of 50 on the Neck Disability Index. Patients were divided into three groups: Group A received deep neck flexor and home-based exercises; Group B received superficial muscle and home-based exercises; and Group C received home-based exercises only. The Numeric Pain Rating Scale (NPRS), Neck Disability Index, and Hospital Anxiety and Depression Scale were administered at baseline and 7 weeks later. The highest improvements in pain intensity levels were observed in Group A with 4.75 (1.74) NPRS points, and the lowest were in Group C with 1.00 (1.10). The highest reductions in anxiety and depression levels were noted in Group A (2.80) and Group B (1.65), respectively. The highest improvements in pain intensity levels were observed among Groups A versus C with 2.80 (0.52) NPRS. The highest reductions in anxiety and depression levels were noted among Groups A versus C with 1.75 (1.10) points and Groups B versus C with 1.60 (0.90) points, respectively. Deep and superficial flexor muscle training along with home-based exercises is likely to reduce chronic neck pain and anxiety/depression levels by a clinically relevant amount. Future larger scaled randomized controlled trials are warranted to further support these findings. Copyright © 2018 John Wiley & Sons, Ltd.

Interactive cervical motion kinematics: sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain.

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Sarig Bahat, Hilla; Chen, Xiaoqi; Reznik, David; Kodesh, Einat; Treleaven, Julia

2015-04-01

Chronic neck pain has been consistently shown to be associated with impaired kinematic control including reduced range, velocity and smoothness of cervical motion, that seem relevant to daily function as in quick neck motion in response to surrounding stimuli. The objectives of this study were: to compare interactive cervical kinematics in patients with neck pain and controls; to explore the new measures of cervical motion accuracy; and to find the sensitivity, specificity, and optimal cutoff values for defining impaired kinematics in those with neck pain. In this cross-section study, 33 patients with chronic neck pain and 22 asymptomatic controls were assessed for their cervical kinematic control using interactive virtual reality hardware and customized software utilizing a head mounted display with built-in head tracking. Outcome measures included peak and mean velocity, smoothness (represented by number of velocity peaks (NVP)), symmetry (represented by time to peak velocity percentage (TTPP)), and accuracy of cervical motion. Results demonstrated significant and strong effect-size differences in peak and mean velocities, NVP and TTPP in all directions excluding TTPP in left rotation, and good effect-size group differences in 5/8 accuracy measures. Regression results emphasized the high clinical value of neck motion velocity, with very high sensitivity and specificity (85%-100%), followed by motion smoothness, symmetry and accuracy. These finding suggest cervical kinematics should be evaluated clinically, and screened by the provided cut off values for identification of relevant impairments in those with neck pain. Such identification of presence or absence of kinematic impairments may direct treatment strategies and additional evaluation when needed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mindfulness meditation–based pain relief: a mechanistic account

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Zeidan, Fadel; Vago, David

2016-01-01

Pain is a multidimensional experience that involves sensory, cognitive, and affective factors. The constellation of interactions between these factors renders the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast-acting nonpharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. The present review delineates findings from recent studies demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms—an important consideration for the millions of chronic pain patients seeking narcotic-free, self-facilitated pain therapy. PMID:27398643

Biobehavioral pain profile in individuals with chronic spine pain.

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Matteliano, Deborah; Scherer, Yvonne Krall; Chang, Yu-Ping

2014-03-01

Pain in the spine is the most frequently described pain problem in primary care, afflicting at least 54 million Americans. When spinal pain becomes chronic, the prognosis for recovery is poor, often leading to disability and reduced quality of life. Clinical treatment is inadequate, often focusing on physical pathology alone. To improve treatment outcomes for chronic pain as recommended by current guidelines, the Biobehavioral Pain Profile (BPP), which includes six pain response subscales, was developed to guide cognitive behavioral therapy (CBT). The purpose of this study was to describe the BPP in 100 individuals with chronic spine pain and examine the associations between the BPP and important clinical outcomes, including chronic pain, disability, and quality of life. Participants reported a high level of pain, a low quality of life, and a high level of disability despite receiving treatment with opioids. Scores on BPP subscales including evaluating loss of control, past and current experience, physiologic responsivity, and thoughts of disease progression were elevated, indicating a need for CBT. Five of the six BPP subscales had a significant association with quality of life, chronic pain, and disability with the thought of disease progression being a strong factor for most of the clinical outcome variables. By identifying BPP, clinicians can provide appropriate treatments to improve individuals' quality of life and prevent further disability. Further study using the BPP to guide CBT is needed. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Functional Abdominal Pain: "Get" the Function, Loose the Pain.

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Draeger-Muenke, Reinhild

2015-07-01

Functional abdominal pain is a mind-body, psychosocial, and self-reinforcing experience with significant consequences for the sufferer and the surrounding support network. The occurrence of unpredictable symptoms and their severity add an element of dread and feeling out-of-control to daily life and often reduce overall functioning in a downward spiral. Two clinical presentations of functional abdominal pain are offered in this article (composites to protect confidentiality) dealing with abdominal pain syndrome and abdominal migraines. The treatment demonstrates the use of hypnotic principles for self-regulation, exploration, and meaning-making. Hypnosis treatment is conducted in combination with mindfulness-based interventions and Traditional Chinese Medicine's (TCM) teachings regarding abdominal health and illness. The clinical examples illustrate medical findings that suggest children with early life stress and an early onset of gastrointestinal somatization may not simply outgrow their functional abdominal pain but may suffer into adulthood.

Benfotiamine relieves inflammatory and neuropathic pain in rats.

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Sánchez-Ramírez, Gabriela M; Caram-Salas, Nadia L; Rocha-González, Héctor I; Vidal-Cantú, Guadalupe C; Medina-Santillán, Roberto; Reyes-García, Gerardo; Granados-Soto, Vinicio

2006-01-13

Benfotiamine has shown therapeutic efficacy in the treatment of painful diabetic neuropathy in human beings. However, so far there is no evidence about the efficacy of this drug in preclinical models of pain. The purpose of this study was to assess the possible antinociceptive and antiallodynic effect of benfotiamine in inflammatory and neuropathic pain models in the rat. Inflammatory pain was induced by injection of formalin in non-diabetic and diabetic (2 weeks) rats. Reduction of flinching behavior was considered as antinociception. Neuropathic pain was induced by either ligation of left L5/L6 spinal nerves or administration of streptozotocin (50 mg/kg, i.p.) in Wistar rats. Benfotiamine significantly reduced inflammatory (10-300 mg/kg) and neuropathic (75-300 mg/kg) nociception in non-diabetic and diabetic rats. Results indicate that oral administration of benfotiamine is able to reduce tactile allodynia from different origin in the rat and they suggest the use of this drug to reduce inflammatory and neuropathic pain in humans.

R-Flurbiprofen Reduces Neuropathic Pain in Rodents by Restoring Endogenous Cannabinoids

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Marian, Claudiu; Häussler, Annett; Wijnvoord, Nina; Ziebell, Simone; Metzner, Julia; Koch, Marco; Myrczek, Thekla; Bechmann, Ingo; Kuner, Rohini; Costigan, Michael; Dehghani, Faramarz; Geisslinger, Gerd; Tegeder, Irmgard

2010-01-01

Background R-flurbiprofen, one of the enantiomers of flurbiprofen racemate, is inactive with respect to cyclooxygenase inhibition, but shows analgesic properties without relevant toxicity. Its mode of action is still unclear. Methodology/Principal Findings We show that R-flurbiprofen reduces glutamate release in the dorsal horn of the spinal cord evoked by sciatic nerve injury and thereby alleviates pain in sciatic nerve injury models of neuropathic pain in rats and mice. This is mediated by restoring the balance of endocannabinoids (eCB), which is disturbed following peripheral nerve injury in the DRGs, spinal cord and forebrain. The imbalance results from transcriptional adaptations of fatty acid amide hydrolase (FAAH) and NAPE-phospholipase D, i.e. the major enzymes involved in anandamide metabolism and synthesis, respectively. R-flurbiprofen inhibits FAAH activity and normalizes NAPE-PLD expression. As a consequence, R-Flurbiprofen improves endogenous cannabinoid mediated effects, indicated by the reduction of glutamate release, increased activity of the anti-inflammatory transcription factor PPARγ and attenuation of microglia activation. Antinociceptive effects are lost by combined inhibition of CB1 and CB2 receptors and partially abolished in CB1 receptor deficient mice. R-flurbiprofen does however not cause changes of core body temperature which is a typical indicator of central effects of cannabinoid-1 receptor agonists. Conclusion Our results suggest that R-flurbiprofen improves the endogenous mechanisms to regain stability after axonal injury and to fend off chronic neuropathic pain by modulating the endocannabinoid system and thus constitutes an attractive, novel therapeutic agent in the treatment of chronic, intractable pain. PMID:20498712

R-flurbiprofen reduces neuropathic pain in rodents by restoring endogenous cannabinoids.

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Philipp Bishay

Full Text Available BACKGROUND: R-flurbiprofen, one of the enantiomers of flurbiprofen racemate, is inactive with respect to cyclooxygenase inhibition, but shows analgesic properties without relevant toxicity. Its mode of action is still unclear. METHODOLOGY/PRINCIPAL FINDINGS: We show that R-flurbiprofen reduces glutamate release in the dorsal horn of the spinal cord evoked by sciatic nerve injury and thereby alleviates pain in sciatic nerve injury models of neuropathic pain in rats and mice. This is mediated by restoring the balance of endocannabinoids (eCB, which is disturbed following peripheral nerve injury in the DRGs, spinal cord and forebrain. The imbalance results from transcriptional adaptations of fatty acid amide hydrolase (FAAH and NAPE-phospholipase D, i.e. the major enzymes involved in anandamide metabolism and synthesis, respectively. R-flurbiprofen inhibits FAAH activity and normalizes NAPE-PLD expression. As a consequence, R-Flurbiprofen improves endogenous cannabinoid mediated effects, indicated by the reduction of glutamate release, increased activity of the anti-inflammatory transcription factor PPARgamma and attenuation of microglia activation. Antinociceptive effects are lost by combined inhibition of CB1 and CB2 receptors and partially abolished in CB1 receptor deficient mice. R-flurbiprofen does however not cause changes of core body temperature which is a typical indicator of central effects of cannabinoid-1 receptor agonists. CONCLUSION: Our results suggest that R-flurbiprofen improves the endogenous mechanisms to regain stability after axonal injury and to fend off chronic neuropathic pain by modulating the endocannabinoid system and thus constitutes an attractive, novel therapeutic agent in the treatment of chronic, intractable pain.

An Educational Intervention to Reduce Pain and Improve Pain Management for Malawian People Living With HIV/AIDS and Their Family Carers: A Randomized Controlled Trial.

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Nkhoma, Kennedy; Seymour, Jane; Arthur, Antony

2015-07-01

Advances being made in improving access to HIV drugs in resource-poor countries mean HIV patients are living longer, and, therefore, experiencing pain over a longer period of time. There is a need to provide effective interventions for alleviating and managing pain. To assess whether a pain educational intervention compared with usual care reduces pain severity and improves pain management in patients with HIV/AIDS and their family carers. This was a randomized, parallel group, superiority trial conducted at HIV and palliative care clinics of two public hospitals in Malawi. A total of 182 adults with HIV/AIDS (Stage III or IV) and their family carers participated; carer participants were those individuals most involved in the patient's unpaid care. The educational intervention comprised a 30 minute face-to-face meeting, a leaflet, and a follow-up telephone call at two weeks. The content of the educational intervention covered definition, causes, and characteristics of pain in HIV/AIDS; beliefs and myths about pain and pain medication; assessment of pain; and pharmacological and nonpharmacological management. The primary outcome was average pain severity measured by the Brief Pain Inventory-Pain Severity subscale. Assessments were recorded at baseline before randomization and at eight weeks after randomization. Of the 182 patient/carer dyads randomly allocated, 157 patient/carer dyads completed the trial. Patients in the intervention group experienced a greater decrease in pain severity (mean difference = 21.09 points, 95% confidence interval = 16.56-25.63; P HIV/AIDS and their family carers. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Effectiveness of Biomodulator in treating chronic pain and reducing medications pain and reducing medications

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2017-01-12

care Nursing Competencies and Practice: Patient outcomes Quality and safety Translate research into practice/evidence-based practice...Preparing tomorrow’s leaders Care of the caregiver Other: Army Nurse Corps High Priority Research Topic: Evaluation of CAM for Pain and Well-Being... care + PEMF participants that cannot be fully explained; and it is in contrast to small, clinically insignificant decreases in reported depression

Respiratory muscle endurance training reduces chronic neck pain: A pilot study.

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Wirth, B; Ferreira, T Duarte; Mittelholzer, M; Humphreys, B K; Boutellier, U

2016-11-21

Patients with chronic neck pain show also respiratory dysfunctions. To investigate the effects of respiratory muscle endurance training (RMET) on chronic neck pain. In this pilot study (single-subject design: 3 baseline measurements, 4 measurements during RMET), 15 neck patients (49.3 ± 13.7 years; 13 females) conducted 20 sessions of home-based RMET using a SpiroTiger® (normocapnic hyperpnoea). Maximal voluntary ventilation (MVV), maximal inspiratory (Pimax) and expiratory (Pemax) pressure were measured before and after RMET. Neck flexor endurance, cervical and thoracic mobility, forward head posture, chest wall expansion and self-assessed neck disability [Neck Disability Index (NDI), Bournemouth questionnaire] were weekly assessed. Repeated measure ANOVA (Bonferroni correction) compared the first and last baseline and the last measurement after RMET. RMET significantly increased MVV (p= 0.025), Pimax (p= 0.001) and Pemax (pneck pain. The underlying mechanisms, including blood gas analyses, need further investigation in a randomized controlled study.

A cross-cultural perspective of medical clowning: comparison of its effectiveness in reducing pain and anxiety among hospitalized Bedouin and Jewish Israeli children

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Gilboa-Negari Z

2017-07-01

Full Text Available Zehavit Gilboa-Negari,1 Sarah Abu-Kaf,2 Ephrat Huss,1 Gavriel Hain,3 Asher Moser4 1Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 2Conflict Management and Resolution Program, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 3Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel; 4Department of Pediatric Oncology, Soroka University Medical Center, Beer-Sheva, Israel Purpose: Medical clowning has proven effective for reducing pain, anxiety, and stress, however, its differential effects on children from different cultures have not yet been researched. This study evaluated the effects of medical-clowning intervention on anxiety and pain among Jewish and Bedouin children, and anxiety among their parents, in southern Israel. Patients and methods: The study was conducted in hospital pediatric departments and employed a pre–post design involving quantitative and qualitative methods. The study included 89 children whose ages ranged from 7.5 to 12 years (39 Jewish and 50 Bedouin and 69 parents (19 Jewish and 50 Bedouin. Questionnaires assessing pain, anxiety, and demographics were used at the pre-intervention stage and pain, anxiety, and enjoyment of different aspects of the intervention were evaluated following the intervention. The intervention stage lasted for 8–10 minutes and included the use of word play, body language, and making faces, as well as the use of props brought by the clown. Semi-structured interviews were also conducted at the post-intervention stage. Results: The intervention reduced pain and anxiety among both groups of children and reduced anxiety among both groups of parents. However, anxiety levels were reduced more significantly among Bedouin children. The nonverbal components of the clowns’ humor were most central, but it was the verbal components that mediated the reduction in anxiety among the Bedouin children. Conclusion: This study underscored

Sucralfate significantly reduces ciprofloxacin concentrations in serum.

OpenAIRE

Garrelts, J C; Godley, P J; Peterie, J D; Gerlach, E H; Yakshe, C C

1990-01-01

The effect of sucralfate on the bioavailability of ciprofloxacin was evaluated in eight healthy subjects utilizing a randomized, crossover design. The area under the concentration-time curve from 0 to 12 h was reduced from 8.8 to 1.1 micrograms.h/ml by sucralfate (P less than 0.005). Similarly, the maximum concentration of ciprofloxacin in serum was reduced from 2.0 to 0.2 micrograms/ml (P less than 0.005). We conclude that concurrent ingestion of sucralfate significantly reduces the concentr...

Complementary and alternative therapies for back pain II.

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Furlan, Andrea D; Yazdi, Fatemeh; Tsertsvadze, Alexander; Gross, Anita; Van Tulder, Maurits; Santaguida, Lina; Cherkin, Dan; Gagnier, Joel; Ammendolia, Carlo; Ansari, Mohammed T; Ostermann, Thomas; Dryden, Trish; Doucette, Steve; Skidmore, Becky; Daniel, Raymond; Tsouros, Sophia; Weeks, Laura; Galipeau, James

2010-10-01

Back and neck pain are important health problems with serious societal and economic implications. Conventional treatments have been shown to have limited benefit in improving patient outcomes. Complementary and Alternative Medicine (CAM) therapies offer additional options in the management of low back and neck pain. Many trials evaluating CAM therapies have poor quality and inconsistent results. To systematically review the efficacy, effectiveness, cost-effectiveness, and harms of acupuncture, spinal manipulation, mobilization, and massage techniques in management of back, neck, and/or thoracic pain. MEDLINE, Cochrane Central, Cochrane Database of Systematic Reviews, CINAHL, and EMBASE were searched up to 2010; unpublished literature and reference lists of relevant articles were also searched. study selection: All records were screened by two independent reviewers. Primary reports of comparative efficacy, effectiveness, harms, and/or economic evaluations from randomized controlled trials (RCTs) of the CAM therapies in adults (age ≥ 18 years) with back, neck, or thoracic pain were eligible. Non-randomized controlled trials and observational studies (case-control, cohort, cross-sectional) comparing harms were also included. Reviews, case reports, editorials, commentaries or letters were excluded. Two independent reviewers using a predefined form extracted data on study, participants, treatments, and outcome characteristics. 265 RCTs and 5 non-RCTs were included. Acupuncture for chronic nonspecific low back pain was associated with significantly lower pain intensity than placebo but only immediately post-treatment (VAS: -0.59, 95 percent CI: -0.93, -0.25). However, acupuncture was not different from placebo in post-treatment disability, pain medication intake, or global improvement in chronic nonspecific low back pain. Acupuncture did not differ from sham-acupuncture in reducing chronic non-specific neck pain immediately after treatment (VAS: 0.24, 95 percent CI: -1

Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience

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Fabio Caviggioli

2016-01-01

Full Text Available Introduction. Pain syndromes affect women after conservative and radical breast oncological procedures. Radiation therapy influences their development. We report autologous fat grafting therapeutical role in treating chronic pain in irradiated patients. Materials and Methods. From February 2006 to November 2014, we collect a total of 209 patients who meet the definition of “Postmastectomy Pain Syndrome” (PMPS and had undergone mastectomy with axillary dissection (113 patients or quadrantectomy (96 patients. Both procedures were followed by radiotherapy. We performed fat grafting following Coleman’s procedure. Mean amount of adipose tissue injected was 52 cc (±8.9 cc per breast. Seventy-eight in 209 patients were not treated surgically and were considered as control group. Data were gathered through preoperative and postoperative VAS questionnaires; analgesic drug intake was recorded. Results. The follow-up was at 12 months (range 11.7–13.5 months. In 120 treated patients we detected pain decrease (mean ± SD point reduction, 3.19 ± 2.86. Forty-eight in 59 patients stopped their analgesic drug therapy. Controls reported a mean ± SD decrease of pain of 1.14 ± 2.72. Results showed that pain decreased significantly in patients treated (p<0.005, Wilcoxon rank-sum test. Conclusion. Our 8-year experience confirms fat grafting effectiveness in decreasing neuropathic pain.

Pain, music creativity and music therapy in palliative care.

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O'Callaghan, C C

1996-01-01

An analysis of the music therapy literature yields numerous reports to support the role of music in the alleviation of pain in palliative care. Four theoretical perspectives that support why many patients report reduced pain sensation after music therapy include: the psychological relationship between music and pain; the psychophysiological theory; spinal mechanisms involved in pain modulation; and the role of endorphins. Considerations significant to the use of music in pain relief include how music, used inappropriately, can aggravate pain sensation. Case studies, which include the use of creative music therapy techniques, point to the efficacy of music therapy in alleviating the pain experiences of both palliative care patients and their significant others.

Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: A systematic review and meta-analysis.

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Tian, Kewei; Cheng, Huiguang; Zhang, Jiangtao; Chen, Ke

2018-04-01

To evaluate the efficacy and safety of intra-articular methylprednisolone for reducing pain in patients with knee osteoarthritis. We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11), and the Cochrane Library (1900-2017.11) for randomized clinical trials comparing the use of methylprednisolone to treat knee osteoarthritis. The primary outcomes are Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and WOMAC function scores. Each outcome was combined and calculated using the statistical software STATA 12.0. Fixed/random effect model was adopted based on the heterogeneity tested by I statistic. A total of 739 patients were analyzed across 4 randomized controlled trials (RCTs). The present meta-analysis revealed that there were significant differences between groups regarding the WOMAC pain scores at 4 weeks (WMD = -1.384, 95% CI: -1.975 to -0.793, P = .000), 12 weeks (WMD = -1.587, 95% CI: -2.489 to -0.685, P = .001), and 24 weeks (WMD = -1.563, 95% CI: -2.245 to -0.881, P = .000). Significant differences were identified in terms of physical function at 4 weeks (WMD = -7.925, 95% CI: -13.359 to -2.491, P = .004), 12 weeks (WMD = -7.314, 95% CI: -13.308 to -1.320, P = .117), and 24 weeks (WMD = -6.484, 95% CI: -11.256 to -1.711, P = .008). Intra-articular methylprednisolone injection was associated with an improved pain relief and physical function in patients with knee osteoarthritis. Additionally, no severe adverse effects were observed. Due to the limited quality of the evidence currently available, higher quality RCTs were required.

Pain-relevant anxiety affects desire for pain relief, but not pain perception

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Adriana Banozic

2017-01-01

Full Text Available Background: Pain context plays a significant role in the perception of pain. Despite recent interest in vicarious learning and anxiety in pain modulation, there have been no attempts to explore pain modulation by specific environmental cues. Aims: Therefore, the present study evaluated pain responses in the condition that was attributed as either anxiety relevant (AR or anxiety irrelevant. Materials and Methods: Participants were exposed to both conditions through social observational learning. Pain perception was assessed by means of a visual analog scale ranging from 0 = no pain to 10 = maximum imaginable pain. State anxiety, empathy, expectancy, and desire for pain relief were also measured at both neutral and emotionally inducing conditions. Results: No effect of relevancy of anxiety for the pain context on any of the pain-related constructs was found. However, participants in the AR condition reported an increased desire for pain relief. Maximizing similarities between observed and experienced pain context did not enhance observational learning effects in the emotionally inducing condition regardless of its relevance, but significant changes were found in comparison to the affectively neutral group. Conclusions: These results could have potentially significant clinical implications suggesting that even though observing painful procedures does not increase pain it could affect medication usage.

The effects of therapeutic touch on pain.

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Monroe, Carolyn Magdalen

2009-06-01

To better understand how Therapeutic Touch can be used in today's health care arena, this integrative literature review will examine current research that will help answer the question, Does Therapeutic Touch reduce pain? An extensive search was conducted of the online databases MEDLINE, CINAHL, Cochrane Library, EMBASE, PsychLIT, and PubMed to retrieve research articles published from 1997 to 2007. Seven studies that were conducted between 1997 and 2004 were found and only five of the seven were included as pertinent evidence to answer the question. All of the research that was reviewed to answer whether Therapeutic Touch could significantly reduce pain revealed a majority of statistically significant positive results for implementing this intervention. Because there are no identified risks to Therapeutic Touch as a pain relief measure, it is safe to recommend despite the limitations of current research. Therapeutic Touch should be considered among the many possible nursing interventions for the treatment of pain.

The effect of medical clowning on reducing pain, crying, and anxiety in children aged 2-10 years old undergoing venous blood drawing--a randomized controlled study.

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Meiri, N; Ankri, A; Hamad-Saied, M; Konopnicki, M; Pillar, G

2016-03-01

Recently, the utilization of medical clowns to reduce anxiety, stress, and even pain associated with hospitalization has become popular. However, the scientific basis of this benefit and outcome is scant. Venipuncture and IV cannulation are very common sources of pain in ill children. To reduce pain, one common approach is to apply a local anesthetic prior to the procedure. In the current study, we sought to compare the utilization of medical clowning in this process with two control groups: (1) local anesthetic cream (EMLA®, Astrazeneca, London, UK) applied prior to the procedure (active control) and (2) the procedure performed with neither clown nor EMLA (control group). We hypothesized that a medical clown will reduce pain, crying, and anxiety in children undergoing this procedure.Children aged 2-10 years who required either venous blood sampling or intravenous cannulation were recruited and randomly assigned to one of the three groups. Outcome measures consisted of the duration of the whole procedure (measured objectively by an independent observer), the duration of crying (measured objectively by an independent observer), subjective assessment of pain level (a commonly used validated scale), and anxiety level regarding future blood exams (by questionnaire). Analysis of variance (ANOVA) was used to compare between the groups. p children participated. Mean age was 5.3 ± 2.5 years (range 2-10 years). The duration of crying was significantly lower with clown than in the control group (1.3 ± 2.0 vs 3.8 ± 5.4 min, p = 0.01). With EMLA, this duration was 2.4 ± 2.9 min. The pain magnitude as assessed by the child was significantly lower with EMLA than in the control group (2.9 ± 3.3 vs 5.3 ± 3.8, p = 0.04), while with clown it was 4.1 ± 3.5, not significant when compared with the other two modalities. Hence, duration of crying was shortest with clown while pain assessment was lowest with EMLA. Furthermore, with clown

Music reduces pain and increases resting state fMRI BOLD signal amplitude in the left angular gyrus in fibromyalgia patients

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Eduardo A. Garza-Villarreal

2015-07-01

Full Text Available Music reduces pain in fibromyalgia (FM, a chronic pain disease, but the functional neural correlates of music-induced analgesia are still largely unknown. We recruited FM patients (n = 22 who listened to their preferred relaxing music and an auditory control (pink noise for 5 minutes without external noise from fMRI image acquisition. Resting state fMRI was then acquired before and after the music and control conditions. A significant increase in the amplitude of low frequency fluctuations of the BOLD signal was evident in the left angular gyrus after listening to music, which in turn, correlated to the analgesia reports. The post-hoc seed-based functional connectivity analysis of the left angular gyrus showed found higher connectivity after listening to music with right dorsolateral prefrontal cortex, the left caudate, and decreased connectivity with right anterior cingulate cortex, right supplementary motor area, precuneus and right precentral gyrus. Pain intensity analgesia was correlated (r = .61 to the connectivity of the left angular gyrus with the right precentral gyrus. Our results show that music-induced analgesia in FM is related to top-down regulation of the pain modulatory network by the default-mode network.

Osteoprotegerin reduces the development of pain behaviour and joint pathology in a model of osteoarthritis.

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Sagar, Devi Rani; Ashraf, Sadaf; Xu, Luting; Burston, James J; Menhinick, Matthew R; Poulter, Caroline L; Bennett, Andrew J; Walsh, David A; Chapman, Victoria

2014-08-01

Increased subchondral bone turnover may contribute to pain in osteoarthritis (OA). To investigate the analgesic potential of a modified version of osteoprotegerin (osteoprotegerin-Fc (OPG-Fc)) in the monosodium iodoacetate (MIA) model of OA pain. Male Sprague Dawley rats (140-260 g) were treated with either OPG-Fc (3 mg/kg, subcutaneously) or vehicle (phosphate-buffered saline) between days 1 and 27 (pre-emptive treatment) or days 21 and 27 (therapeutic treatment) after an intra-articular injection of MIA (1 mg/50 µl) or saline. A separate cohort of rats received the bisphosphonate zoledronate (100 µg/kg, subcutaneously) between days 1 and 25 post-MIA injection. Incapacitance testing and von Frey (1-15 g) hind paw withdrawal thresholds were used to assess pain behaviour. At the end of the study, rats were killed and the knee joints and spinal cord removed for analysis. Immunohistochemical studies using Iba-1 and GFAP quantified levels of activation of spinal microglia and astrocytes, respectively. Joint sections were stained with haematoxylin and eosin or Safranin-O fast green and scored for matrix proteoglycan and overall joint morphology. The numbers of tartrate-resistant acid phosphatase-positive osteoclasts were quantified. N=10 rats/group. Pre-emptive treatment with OPG-Fc significantly attenuated the development of MIA-induced changes in weightbearing, but not allodynia. OPG-Fc decreased osteoclast number, inhibited the formation of osteophytes and improved structural pathology within the joint similarly to the decrease seen after pretreatment with the bisphosphonate, zoledronate. Therapeutic treatment with OPG-Fc decreased pain behaviour, but did not improve pathology in rats with established joint damage. Our data suggest that early targeting of osteoclasts may reduce pain associated with OA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effects of vicarious pain on self-pain perception: investigating the role of awareness

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Terrighena EL

2017-07-01

Full Text Available Esslin L Terrighena,1,2 Ge Lu,1 Wai Ping Yuen,1 Tatia M C Lee,1–4 Kati Keuper1,2,5 1Department of Psychology, Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; 2Laboratory of Social Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong; 3The State Key Laboratory of Brain and Cognitive Sciences, Hong Kong; 4Institute of Clinical Neuropsychology, The University of Hong Kong, Hong Kong; 5Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany Abstract: The observation of pain in others may enhance or reduce self-pain, yet the boundary conditions and factors that determine the direction of such effects are poorly understood. The current study set out to show that visual stimulus awareness plays a crucial role in ­determining whether vicarious pain primarily activates behavioral defense systems that enhance pain sensitivity and stimulate withdrawal or appetitive systems that attenuate pain sensitivity and stimulate approach. We employed a mixed factorial design with the between-subject factors exposure time (subliminal vs optimal and vicarious pain (pain vs no pain images, and the within-subject factor session (baseline vs trial to investigate how visual awareness of vicarious pain images affects subsequent self-pain in the cold-pressor test. Self-pain tolerance, intensity and unpleasantness were evaluated in a sample of 77 healthy participants. Results revealed ­significant interactions of exposure time and vicarious pain in all three dependent measures. In the presence of visual awareness (optimal condition, vicarious pain compared to no-pain elicited overall enhanced self-pain sensitivity, indexed by reduced pain tolerance and enhanced ratings of pain intensity and unpleasantness. Conversely, in the absence of visual awareness (subliminal condition, vicarious pain evoked decreased self-pain intensity and unpleasantness while pain tolerance remained unaffected. These

The significance of preoperative shoulder arthrography in painful arc patients

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Myllylae, V.; Jalovaara, P.; Pyhtinen, J.; Oulu Univ.

1984-01-01

Preoperative shoulder arthrography was performed on 34 patients with painful arc syndromes. Rotator cuff rupture was diagnosed in 20 cases. Out of these the arthrography correctly showed rupture in 17 cases, while in one case rupture was not seen and two examinations were unsuccessful. Rotator cuff rupture was found in 14 cases at operation. Of these, arthrography had been negative in eight cases and in six cases the rupture had merely been suspected. Sensitivity of shoulder arthrography in showing rotator cuff rupture was thus 85%, specificity 57% and accuracy 74%. The biceps tendon was intact in all cases with rotator cuff rupture. S-called ''bicipital leakage'' was seen in four cases, but its significance remains unclear. (orig.) [de

Does advanced cryotherapy reduce pain and narcotic consumption after knee arthroplasty?

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Thienpont, Emmanuel

2014-11-01

Cryotherapy has been used to enhance recovery after orthopaedic surgery. Several cooling devices are available but few can guarantee a fixed temperature during a prolonged time and therefore have been criticized. The arrival of new advanced cryotherapy devices made it possible to test the effect of prolonged cooling on rehabilitation after joint replacement. The hypotheses of this randomized controlled trial (RCT) were that advanced cryotherapy devices compared with cold packs result in (1) better postoperative pain control resulting in a lower consumption of narcotics; (2) better early ROM; and (3) less postoperative bleeding and swelling. A priori sample size calculation had determined that to detect a difference of 2 points on the VAS, a sample size of 50 subjects per group at followup would be required, given a study power of 80%. One hundred sixteen patients were included and randomly allocated to receive advanced cryotherapy (n=58) or use of cold packs (n=58). The primary outcomes for the study were to evaluate pain with the VAS and analgesics consumption. Secondary outcomes were postoperative ROM, swelling, and blood loss. One hundred (50 in each group) patients had complete data available for analysis. No statistically significant differences in VAS, need for analgesics, nor in secondary outcomes were observed, except for substantially reduced flexion at 6 weeks in the advanced cryotherapy group (114° versus 120°). Advanced cryotherapy with a continuous temperature for a prolonged period does not deliver expected results of superior early recovery after knee arthroplasty. Greater sample sizes are required to fully determine significant differences between the two techniques for these study parameters. Immobilization of the knee in extension during the prolonged cryotherapy session resulted in lower active flexion at 6 weeks after surgery for the advanced cryotherapy group. Advanced cryotherapy should not be used in fast track knee arthroplasty if the

Reduced basal ganglia μ-opioid receptor availability in trigeminal neuropathic pain: A pilot study

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DosSantos Marcos

2012-09-01

Full Text Available Abstract Background Although neuroimaging techniques have provided insights into the function of brain regions involved in Trigeminal Neuropathic Pain (TNP in humans, there is little understanding of the molecular mechanisms affected during the course of this disorder. Understanding these processes is crucial to determine the systems involved in the development and persistence of TNP. Findings In this study, we examined the regional μ-opioid receptor (μOR availability in vivo (non-displaceable binding potential BPND of TNP patients with positron emission tomography (PET using the μOR selective radioligand [11C]carfentanil. Four TNP patients and eight gender and age-matched healthy controls were examined with PET. Patients with TNP showed reduced μOR BPND in the left nucleus accumbens (NAc, an area known to be involved in pain modulation and reward/aversive behaviors. In addition, the μOR BPND in the NAc was negatively correlated with the McGill sensory and total pain ratings in the TNP patients. Conclusions Our findings give preliminary evidence that the clinical pain in TNP patients can be related to alterations in the endogenous μ-opioid system, rather than only to the peripheral pathology. The decreased availability of μORs found in TNP patients, and its inverse relationship to clinical pain levels, provide insights into the central mechanisms related to this condition. The results also expand our understanding about the impact of chronic pain on the limbic system.

Lidocaine patches reduce pain in trauma patients with rib fractures.

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Zink, Karen A; Mayberry, John C; Peck, Ellen G; Schreiber, Martin A

2011-04-01

Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.

Intraoperative low-dose ketamine infusion reduces acute postoperative pain following total knee replacement surgery: a prospective, randomized double-blind placebo-controlled trial.

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Cengiz, Pelin; Gokcinar, Derya; Karabeyoglu, Isil; Topcu, Hulya; Cicek, Gizem Selen; Gogus, Nermin

2014-05-01

To evaluate the effect of intraoperative low-dose ketamine with general anesthesia on postoperative pain after total knee replacement surgery. A randomized, double-blind comparative study. Ankara Numune Training and Research Hospital, Turkey, from January and June 2011. Sixty adults undergoing total knee arthroplasty were enrolled in this study. The patients were randomly allocated into two groups of equal size to receive either racemic ketamine infusion (6 μg/kg/minute) or the same volume of saline. A visual analogue scale (VAS) was used to measure each patient's level of pain at 1, 3, 6, 12, and 24 hours after surgery. Time to first analgesic request, postoperative morphine consumption and the incidence of side effects were also recorded. Low-dose ketamine infusion prolonged the time to first analgesic request. It also reduced postoperative cumulative morphine consumption at 1, 3, 6, 12, and 24 hours postsurgery (p < 0.001). Postoperative VAS scores were also significantly lower in the ketamine group than placebo, at all observation times. Incidences of side effects were similar in both study groups. Intraoperative continuous low-dose ketamine infusion reduced pain and postoperative analgesic consumption without affecting the incidence of side effects.

Abnormal pain perception in patients with Multiple System Atrophy.

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Ory-Magne, F; Pellaprat, J; Harroch, E; Galitzsky, M; Rousseau, V; Pavy-Le Traon, A; Rascol, O; Gerdelat, A; Brefel-Courbon, C

2018-03-01

Patients with Parkinson's disease or Multiple System Atrophy frequently experience painful sensations. The few studies investigating pain mechanisms in Multiple System Atrophy patients have reported contradictory results. In our study, we compared pain thresholds in Multiple System Atrophy and Parkinson's disease patients and healthy controls and evaluated the effect of l-DOPA on pain thresholds. We assessed subjective and objective pain thresholds (using a thermotest and RIII reflex), and pain tolerance in OFF and ON conditions, clinical pain, motor and psychological evaluation. Pain was reported in 78.6% of Multiple System Atrophy patients and in 37.5% of Parkinson's disease patients. In the OFF condition, subjective and objective pain thresholds were significantly lower in Multiple System Atrophy patients than in healthy controls (43.8 °C ± 1.3 vs 45.7 °C ± 0.8; p = 0.0005 and 7.4 mA ± 3.8 vs 13.7 mA ± 2.8; p = 0.002, respectively). They were also significantly reduced in Multiple System Atrophy compared to Parkinson's disease patients. No significant difference was found in pain tolerance for the 3 groups and in the effect of l-DOPA on pain thresholds in Multiple System Atrophy and Parkinson's disease patients. In the ON condition, pain tolerance tended to be reduced in Multiple System Atrophy versus Parkinson's disease patients (p = 0.05). Multiple System Atrophy patients had an increase in pain perception compared to Parkinson's disease patients and healthy controls. The l-DOPA effect was similar for pain thresholds in Multiple System Atrophy and Parkinson's disease patients, but tended to worsen pain tolerance in Multiple System Atrophy. Copyright © 2017 Elsevier Ltd. All rights reserved.

A comprehensive protocol to diagnose and treat pain of muscular origin may successfully and reliably decrease or eliminate pain in a chronic pain population.

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Marcus, Norman J; Gracely, Edward J; Keefe, Kelly O

2010-01-01

A comprehensive protocol is presented to identify muscular causes of regional pain syndromes utilizing an electrical stimulus in lieu of palpation, and combining elements of Prolotherapy with trigger point injections. One hundred seventy-six consecutive patients were evaluated for the presence of muscle pain by utilizing an electrical stimulus produced by the Muscle Pain Detection Device. The diagnosis of "Muscle Pain Amenable to Injection" (MPAI), rather than trigger points, was made if pain was produced for the duration of the stimulation. If MPAI was found, muscle tendon injections (MTI) were offered to patients along with post-MTI physical therapy, providing neuromuscular electrical stimulation followed by a validated exercise program [1]. A control group, evaluated 1 month prior to their actual consultation/evaluation when muscle pain was identified but not yet treated, was used for comparison. Forty-five patients who met criteria completed treatment. Patients' scores on the Brief Pain Inventory decreased an average of 62%; median 70% (P < 0.001) for pain severity and 68%; median 85% (P < 0.001) for pain interference one month following treatment. These changes were significantly greater (P < 0.001) than those observed in the untreated controls. A protocol incorporating an easily reproducible electrical stimulus to diagnose a muscle causing pain in a region of the body followed by an injection technique that involves the entirety of the muscle, and post injection restoration of muscle function, can successfully eliminate or significantly reduce regional pain present for years.

Is TENS purely a placebo effect? A controlled study on chronic low back pain.

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Marchand, S; Charest, J; Li, J; Chenard, J R; Lavignolle, B; Laurencelle, L

1993-07-01

Although high-frequency low-intensity transcutaneous electric nerve stimulation (TENS) has been extensively used to relieve low back pain, experimental studies of its effectiveness have yielded contradictory findings mainly due to methodological problems in pain evaluation and placebo control. In the present study, separate visual analog scales (VAS) were used to measure the sensory-discriminative and motivational-affective components of low back pain. Forty-two subjects were randomly assigned to 1 of 3 groups: TENS, placebo-TENS, and no treatment (control). In order to measure the short-term effect of TENS, VAS pain ratings were taken before and after each treatment session. Also, to measure long-term effects, patients rated their pain at home every 2 h throughout a 3-day period before and 1 week, 3 months and 6 months after the treatment sessions. In comparing the pain evaluations made immediately before and after each treatment session, TENS and placebo-TENS significantly reduced both the intensity and unpleasantness of chronic low back pain. TENS was significantly more efficient than placebo-TENS in reducing pain intensity but not pain unpleasantness. TENS also produced a significant additive effect over repetitive treatment sessions for pain intensity and relative pain unpleasantness. This additive effect was not found for placebo-TENS. When evaluated at home, pain intensity was significantly reduced more by TENS than placebo-TENS 1 week after the end of treatment, but not 3 months and 6 months later. At home evaluation of pain unpleasantness in the TENS group was never different from the placebo-TENS group.(ABSTRACT TRUNCATED AT 250 WORDS)

Systemic Exercise-Induced Hypoalgesia Following Isometric Exercise Reduces Conditioned Pain Modulation.

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Alsouhibani, Ali; Vaegter, Henrik Bjarke; Hoeger Bement, Marie

2018-04-03

Physically active individuals show greater conditioned pain modulation (CPM) compared with less active individuals. Understanding the effects of acute exercise on CPM may allow for a more targeted use of exercise in the management of pain. This study investigated the effects of acute isometric exercise on CPM. In addition, the between-session and within-session reliability of CPM was investigated. Experimental, randomized crossover study. Laboratory at Marquette University. Thirty healthy adults (19.3±1.5 years, 15 males). Subjects underwent CPM testing before and after isometric exercise (knee extension, 30% maximum voluntary contraction for three minutes) and quiet rest in two separate experimental sessions. Pressure pain thresholds (PPTs) at the quadriceps and upper trapezius muscles were assessed before, during, and after ice water immersions. PPTs increased during ice water immersion (i.e., CPM), and quadriceps PPT increased after exercise (P CPM decreased similarly following exercise and quiet rest (P > 0.05). CPM within-session reliability was fair to good (intraclass correlation coefficient [ICC] = 0.43-0.70), and the between-session reliability was poor (ICC = 0.20-0.35). Due to the variability in the systemic exercise-induced hypoalgesia (EIH) response, participants were divided into systemic EIH responders (N = 9) and nonresponders (N = 21). EIH responders experienced attenuated CPM following exercise (P = 0.03), whereas the nonresponders showed no significant change (P > 0.05). Isometric exercise decreased CPM in individuals who reported systemic EIH, suggesting activation of shared mechanisms between CPM and systemic EIH responses. These results may improve the understanding of increased pain after exercise in patients with chronic pain and potentially attenuated CPM.

Nicoboxil/nonivamide cream effectively and safely reduces acute nonspecific low back pain – a randomized, placebo-controlled trial

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Blahova Z

2016-12-01

Full Text Available Zuzana Blahova,1 Janina Claudia Holm,1 Thomas Weiser,2 Erika Richter,2 Matthias Trampisch,2 Elena Akarachkova3 1Boehringer Ingelheim RCV GmbH & Co KG, Vienna, Austria; 2Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany; 3I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Background/objective: Low back pain affects many patients and has a high socioeconomic impact. Topical capsaicinoids have been used for decades to treat musculoskeletal pain. This study investigated the effects of the fixed dose combination (FDC of nonivamide (a capsaicinoid and nicoboxil (a nicotinic acid ester cream in the treatment of acute nonspecific low back pain.Materials and methods: This phase III randomized, double-blind, placebo-controlled, multinational, multi-center trial investigated efficacy, safety, and tolerability of topical nicoboxil 1.08%/nonivamide 0.17% (Finalgon® cream in treatment of acute nonspecific low back pain with the endpoints: pain intensity (PI difference between pre-dose baseline and 8 hours after first application and the end of treatment, mobility score, and efficacy score.Results: Patients (n=138, 21–65 years of age, were treated for up to 4 days with FDC or placebo cream. Mean baseline PI was 6.8 on a 0–10 point numerical rating scale. After 8 hours, pain was more reduced with the FDC than with placebo (adjusted means: 2.824 vs. 0.975 points; p<0.0001. On the last treatment day, mean pain reduction by the FDC was stronger than with placebo (adjusted means: 5.132 vs. 2.174 points; p<0.0001. Mobility on Day 1 was in favor of the FDC when compared to placebo (odds ratio [95% confidence interval {CI}]: 7.200 [3.609, 14.363], p<0.0001. At the end of treatment, patients treated with the FDC rated efficacy significantly higher than placebo (odds ratio [95% CI]: 11.370 [5.342, 24.199], p<0.0001. Both treatments were tolerated well. No serious adverse events were reported.Conclusion: Nicoboxil

Can live music therapy reduce distress and pain in children with burns after wound care procedures? A randomized controlled trial.

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van der Heijden, Marianne J E; Jeekel, Johannes; Rode, Heinz; Cox, Sharon; van Rosmalen, Joost; Hunink, Myriam G M; van Dijk, Monique

2018-06-01

Burn wound care procedures are very painful and lead to distress. Live music therapy has shown beneficial effects on distress and pain in specific pediatric patient populations. In this study we measured whether live music therapy has beneficial effects in terms of less distress and pain in children with burns after wound care procedures. This randomized assessor-blinded controlled trial (RCT) took place at the burns unit of the Red Cross War Memorial Children's Hospital, Cape Town, South Africa. It included newly admitted inpatients between the ages of 0 and 13 years undergoing their first or second wound care procedures. Excluded were children with a hearing impairment or low level of consciousness. The intervention group received one live music therapy session directly after wound care in addition to standard care. The control group received standard care only. The primary outcome was distress measured with the Observational Scale of Behavioral Distress-revised (OSBD-r). The secondary outcome was pain measured with the COMFORT-behavioral scale (COMFORT-B). In addition, in children older than 5 years self-reported distress with the validated Wong-Baker scale (FACES) and pain with the Faces Pain Scale-Revised (FPS-R) were measured. Patients in both groups were videotaped for three minutes before wound care; during the music therapy or the control condition; and for two minutes thereafter. Two researchers, blinded to the study condition, independently scored the OSBD-r and the COMFORT-B from the video footage before and after music therapy. We included 135 patients, median age 22.6 months (IQR 15.4-40.7 months). Change scores did not significantly differ between the intervention and the control groups for either distress (p=0.53; d=0.11; 95% CI -0.23 to 0.45) or pain (p=0.99; d=0.04; 95% CI -0.30 to 0.38). Self-reported distress in a small group of children (n=18) older than 5 years indicated a significant reduction in distress after live music therapy (p=0

A performance improvement prescribing guideline reduces opioid prescriptions for emergency department dental pain patients.

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Fox, Timothy R; Li, James; Stevens, Sandra; Tippie, Tracy

2013-09-01

In an effort to reduce prescription opioid abuse originating from our institution, we implement and measure the effect of a prescribing guideline on the rate of emergency department (ED) opioid prescriptions written for patients presenting with dental pain, a complaint previously associated with drug-seeking behavior. After implementing a departmental guideline on controlled substance prescriptions, we performed a structured before-and-after chart review of dental pain patients aged 16 and older. Before the guideline, the rate of opioid prescription was 59% (302/515). After implementation, the rate was 42% (65/153). The absolute decrease in rates was 17% (95% confidence interval 7% to 25%). Additionally, in comparing the 12-month period before and after implementation, the dental pain visit rate decreased from 26 to 21 per 1,000 ED visits (95% confidence interval of decrease 2 to 9 visits/1,000). A performance improvement program involving a departmental prescribing guideline was associated with a reduction in the rate of opioid prescriptions and visits for ED patients presenting with dental pain. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Treatment with 4Jointz reduces knee pain over 12 weeks of treatment in patients with clinical knee osteoarthritis: a randomised controlled trial.

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Laslett, L L; Quinn, S J; Darian-Smith, E; Kwok, M; Fedorova, T; Körner, H; Steels, E; March, L; Jones, G

2012-11-01

To assess the efficacy of thrice daily topical 4Jointz utilizing Acteev technology (a combination of a standardized comfrey extract and a pharmaceutical grade tannic acid, 3.5 g/day) on osteoarthritic knee pain, markers of inflammation and cartilage breakdown over 12 weeks. Adults aged 50-80 years (n = 133) with clinical knee OA were randomised to receive 4Jointz or placebo in addition to existing medications. Pain and function were measured using a visual analogue scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) scale at baseline, 4, 8 and 12 weeks. Inflammation was measured analysing IL-6 expression and CTX-2 presence as representative for cartilage breakdown using ELISA, at baseline and 12 weeks. Pain scores significantly reduced in the group who received 4Jointz compared to the group who received placebo after 12 weeks using both the VAS (-9.9 mm, P = 0.034) and the KOOS pain scale (+5.7, P = 0.047). Changes in IL-6 and CTX-2 were not significant (-0.04, P = 0.5; -0.01, P = 0.68). Post-hoc analyses suggested that treatment may be most effective in women (VAS -16.8 mm, P = 0.008) and those with milder radiographic osteoarthritis (OA) (VAS -16.1 mm, P = 0.009). Rates of adverse events were similar in both groups, excepting local rash that was more common amongst participants receiving 4Jointz (21% vs 1.6%, IRR 13.2, P = 0.013), but only 26% (n = 4) of participants with rashes discontinued treatment. There were no changes in systemic blood results. Topical treatment using 4Jointz reduced pain but had no effect on inflammation or cartilage breakdown over 12 weeks of treatment. Australia and New Zealand Clinical Trials registry ACTRN12610000877088. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial.

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Malfliet, Anneleen; Kregel, Jeroen; Coppieters, Iris; De Pauw, Robby; Meeus, Mira; Roussel, Nathalie; Cagnie, Barbara; Danneels, Lieven; Nijs, Jo

2018-04-16

Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain. Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months. Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy). Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health). There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical

A comparative study of collagen dressing versus petrolatum gauze dressing in reducing pain at the donor area

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B A Ramesh

2017-01-01

Full Text Available Background: Skin graft is one of the commonly done procedures by plastic surgeons, dermato surgeons and general surgeons. Pain at the donor area is a common complaint by the patient. The skin graft donor site area is usually covered with petrolatum dressing dermatosurgeons. Aim: This study was done to compare collagen dressing with petroleum gauze dressing in control of post-operative pain on skin graft donor area. Materials and Methods: The study was done on forty patients, twenty as study group who received collagen dressing and twenty as control group who received petroleum gauze dressing. The procedure was randomly selected by permutated block size of four. The post-operative pain was assessed with numerical pain rating scale 0 to 10. Nursing staff did the recording of pain scale. The nursing staff was not aware whether patient had collagen or petroleum gauze dressing. Statistics: Statistical analysis used was independent 't'-test (two-sample test and Levene's test. Results: Statistics proved that study group (collagen dressing had lesser pain than control group (petroleum gauze dressing. Conclusion: The collagen sheet dressing on skin graft donor area reduces pain in post-operative period.

Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection.

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Jhang, Jia-Fong; Kuo, Hann-Chorng

2015-06-18

Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months' duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.

Elite level rhythmic gymnasts have significantly more and stronger pain than peers of similar age: a prospective study.

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Sabeti, Manuel; Jeremian, Lusine; Graf, Alexandra; Kandelhart, Robert

2015-01-01

Rhythmic gymnastics (RG) unites aesthetic, ballet-like motion, and all aspects of gymnastics. To reach elite level, girls begin at early age the intensive training. To date it is unclear if such demanding training influences the incidence and intensity of painful overuse injuries. The purpose of this study is to analyze anatomical painful regions and pain intensity in elite level rhythmic gymnasts (elRG) and compare results with an age-matched control group (CG). This prospective field study was carried out at the European Championship in RG 2013 (218 participating athletes, Vienna, Austria). Volunteering athletes were interviewed according to a preformed questionnaire. As CG secondary school pupils without any competitive sports experience were analyzed accordingly. Overall, 243 young females (144 elRG/66 % of all participants and 99 CG) were observed. ElRGs were significantly (s.) smaller, lighter, and had s. stronger pain (p < 0.001). A total of 72 % of athletes reported to have at least one painful body region compared with 52 % of CG (p < 0.001). ElRG had nearly three times more serious injuries than the CG. In all 23 % off all elRG reported to have had no access to professional medical care. ElRGs were s. more frequently (25 vs 9 %) affected at the lumbar spine and the ankle joint (17.4 vs 7 %). To our knowledge, this trial analyzes the largest cohort of elRG to date. Hence, it is clearly alluded that intensive training in RG is a significant factor causing more and stronger pain than in a CG.

High frequency migraine is associated with lower acute pain sensitivity and abnormal insula activity related to migraine pain intensity, attack frequency, and pain catastrophizing

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Vani A Mathur

2016-09-01

Full Text Available Migraine is a pain disorder associated with abnormal brain structure and function, yet the effect of migraine on acute pain processing remains unclear. It also remains unclear whether altered pain-related brain responses and related structural changes are associated with clinical migraine characteristics. Using fMRI and three levels of thermal stimuli (non-painful, mildly painful, and moderately painful, we compared whole-brain activity between 14 migraine patients and 14 matched controls. Although, there were no significant differences in pain thresholds and pre-scan pain ratings to mildly painful thermal stimuli, patients had aberrant suprathreshold nociceptive processing. Compared to controls, patients had reduced activity in pain modulatory regions including left dorsolateral prefrontal, posterior parietal, and middle temporal cortices and, at a lower-threshold, greater activation in the right mid-insula to moderate pain versus mild pain. We also found that pain-related activity in the insula was associated with clinical variables in patients, including associations between: bilateral anterior insula and pain catastrophizing (PCS; bilateral anterior insula and contralateral posterior insula and migraine pain intensity; and bilateral posterior insula and migraine frequency at a lower-threshold. PCS and migraine pain intensity were also negatively associated with activity in midline regions including posterior cingulate and medial prefrontal cortices. Diffusion tensor imaging revealed a negative correlation between fractional anisotropy (a measure of white matter integrity; FA and migraine duration in the right mid-insula and a positive correlation between left mid-insula FA and PCS. In sum, while patients showed lower sensitivity to acute noxious stimuli, the neuroimaging findings suggest enhanced nociceptive processing and significantly disrupted modulatory networks, particularly involving the insula cortex, associated with indices of

Endogenous Opioid Inhibition of Chronic Low Back Pain Influences Degree of Back Pain Relief Following Morphine Administration

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Bruehl, Stephen; Burns, John W.; Gupta, Rajnish; Buvanendran, Asokumar; Chont, Melissa; Schuster, Erik; France, Christopher R.

2014-01-01

Background and Objectives Factors underlying differential responsiveness to opioid analgesic medications used in chronic pain management are poorly understood. We tested whether individual differences in endogenous opioid inhibition of chronic low back pain were associated with magnitude of acute reductions in back pain ratings following morphine administration. Methods In randomized, counterbalanced order over three sessions, 50 chronic low back pain patients received intravenous naloxone (8mg), morphine (0.08 mg/kg), or placebo. Back pain intensity was rated pre-drug and again after peak drug activity was achieved using the McGill Pain Questionnaire-Short Form (Sensory and Affective subscales, VAS intensity measure). Opioid blockade effect measures to index degree of endogenous opioid inhibition of back pain intensity were derived as the difference between pre-to post-drug changes in pain intensity across placebo and naloxone conditions, with similar morphine responsiveness measures derived across placebo and morphine conditions. Results Morphine significantly reduced back pain compared to placebo (MPQ-Sensory, VAS; P effects of opioid blockade on back pain intensity. However, individual differences in opioid blockade effects were significantly associated with degree of acute morphine-related reductions in back pain on all measures, even after controlling for effects of age, sex, and chronic pain duration (P morphine. Conclusions Morphine appears to provide better acute relief of chronic back pain in individuals with lower natural opioidergic inhibition of chronic pain intensity. Possible implications for personalized medicine are discussed. PMID:24553304

Preoperative oral dextromethorphan does not reduce pain or morphine consumption after open cholecystectomy

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Mahmoodzadeh Hossein

2009-01-01

Full Text Available Background: Dextromethorphan, the D-isomer of the codeine analog levorphanol, is a weak, noncompetitive N-Methyl-D-Aspartate (NMDA receptor antagonist. It has been suggested that NMDA receptor antagonists induce preemptive analgesia when administered before tissue injury occurs, thus decreasing the subsequent sensation of pain. Materials and Methods: The study was conducted in the Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, between February 2005 and December 2006. In this study, 72 patients scheduled for elective cholesyctectomy were randomized into three groups to receive either oral dextromethorphan 45 mg (Group D45 = 24, dextromethorphan 90 mg (Group D90 = 24, or placebo (Group C, n = 24, as premedication, 120 minutes before surgery. A visual analog scale (VAS for pain of each patient was measured at arrival in the ward and six and 24 hours after surgery. Results: The demographic characteristics of patients, ASA physical status class, duration of surgery, and the basal VAS pain score were similar in the two groups. There was no significant difference in the mean of the VAS pain scores measured over time or morphine consumption among the three groups. Conclusion: Dextromethorphan 45 mg and 90 mg, administrated orally, two hours before surgery, had no effect on postoperative morphine requirement and pain intensity.

Computer tablet distraction reduces pain and anxiety in pediatric burn patients undergoing hydrotherapy: A randomized trial.

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Burns-Nader, Sherwood; Joe, Lindsay; Pinion, Kelly

2017-09-01

Distraction is often used in conjunction with analgesics to minimize pain in pediatric burn patients during treatment procedures. Computer tablets provide many options for distraction items in one tool and are often used during medical procedures. Few studies have examined the effectiveness of tablet distraction in improving the care of pediatric burn patients. This study examines the effectiveness of tablet distraction provided by a child life specialist to minimize pain and anxiety in pediatric burn patients undergoing hydrotherapy. Thirty pediatric patients (4-12) undergoing hydrotherapy for the treatment of burns participated in this randomized clinical trial. The tablet distraction group received tablet distraction provided by a child life specialist while those in the control group received standard care. Pain was assessed through self-reports and observation reports. Anxiety was assessed through behavioral observations. Length of procedure was also recorded. Nurses reported significantly less pain for the tablet distraction group compared to the control group. There was no significant difference between groups on self-reported pain. The tablet distraction group displayed significantly less anxiety during the procedure compared to the control group. Also, the tablet distraction group returned to baseline after the procedure while those in the control group displayed higher anxiety post-procedure. There was no difference in the length of the procedure between groups. These findings suggest tablet distraction provided by a child life specialist may be an effective method for improving pain and anxiety in children undergoing hydrotherapy treatment for burns. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculuskeletal pain patients with high pain sensitivity

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Vægter, Henrik Bjarke; Handberg, Gitte; Graven-Nielsen, Thomas

2016-01-01

OBJECTIVES: In chronic pain patients, impaired conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) have been reported. No studies have compared CPM and EIH in chronic musculoskeletal pain patients with high pain sensitivity (HPS) and low pain sensitivity (LPS). MATERIALS.......005). Pain tolerance increased after the cold pressor test and exercise in both groups (PCPM and EIH were partly impaired in chronic pain patients with high versus less pain sensitivity, suggesting that the CPM and EIH responses depend on the degree of pain sensitivity. This has clinical...

Modulation of Itch by Conditioning Itch and Pain Stimulation in Healthy Humans.

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Andersen, Hjalte H; van Laarhoven, Antoinette I M; Elberling, Jesper; Arendt-Nielsen, Lars

2017-12-01

Little is known about endogenous descending control of itch. In chronic pain, descending pain inhibition is reduced as signified by lowered conditioned pain modulation. There are indications that patients with chronic itch may also exhibit reduced endogenous descending inhibition of itch and pain. This study aimed to investigate whether and the extent to which itch can be modulated by conditioning itch and pain stimuli. Twenty-six healthy volunteers participated. The study consisted of 5 conditions designed to systematically assess endogenous modulation of itch or pain: 1) itch-induced modulation of contralateral itch, 2) pain-induced modulation of contralateral itch, 3) pain-induced modulation of ipsilateral itch, 4) pain-induced modulation of contralateral pain, and 5) itch-induced modulation of contralateral pain. Conditioning stimuli were cold pressor-induced pain and histamine-evoked itch, whereas the test stimuli were electrical stimulation paradigms designed to evoke itch or pain. Pain was significantly reduced (conditioned pain modulation-effect) by the conditioning pain stimulus (P modulation-effect) by contra- as well as ipsilateral applied conditioning pain (both P modulation of itch as well as pain in humans. Future studies addressing potential aberrations in pain-evoked descending modulation of itch in chronic itch patients are warranted. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.

Feasibility and potential effect of a low-cost virtual reality system on reducing pain and anxiety in adult burn injury patients during physiotherapy in a developing country.

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Morris, Linzette Deidré; Louw, Quinette Abegail; Crous, Lynette Christine

2010-08-01

The purpose of this study was to ascertain the feasibility and potential effect of a low-cost VR system (eMagin Z800 3DVisor), used in conjunction with pharmacological analgesia, on reducing pain and anxiety in adult burn patients undergoing physiotherapy treatment, compared to pharmacologic analgesia alone at a South African hospital. Single-blind, within-subject study design. Pain and anxiety outcome measures were measured by a blinded assessor using the Numeric Pain Rating Scale and Burn Specific Pain and Anxiety Scale. Box-and-whisker plot method, Chi-square tests as well as the Student's paired t-test were used to analyze data. Eleven eligible adult burn patients consented to participate in this study (3 female, 8 male; median age 33 years: range 23-54 years). A marginal (p=0.06) to insignificant (p=0.13) difference between the two sessions (analgesia with VR and analgesia without VR) in reducing pain was found. No significant difference (p=0.58) was found between the two sessions (analgesia with VR and analgesia without VR) for anxiety. There seems to be a trend that the low-cost VR system, when added to routine pharmacological analgesics, is a safe technique and could be of considerable benefit if implemented into the pain management regime of burn units at a South African hospital.

Improvement of burn pain management through routine pain monitoring and pain management protocol.

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Yang, Hyeong Tae; Hur, Giyeun; Kwak, In-Suk; Yim, Haejun; Cho, Yong Suk; Kim, Dohern; Hur, Jun; Kim, Jong Hyun; Lee, Boung Chul; Seo, Cheong Hoon; Chun, Wook

2013-06-01

Pain management is an important aspect of burn management. We developed a routine pain monitoring system and pain management protocol for burn patients. The purpose of this study is to evaluate the effectiveness of our new pain management system. From May 2011 to November 2011, the prospective study was performed with 107 burn patients. We performed control group (n=58) data analysis and then developed the pain management protocol and monitoring system. Next, we applied our protocol to patients and performed protocol group (n=49) data analysis, and compared this to control group data. Data analysis was performed using the Numeric Rating Scale (NRS) of background pain and procedural pain, Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Rating Scale (HDRS), State-Trait Anxiety Inventory Scale (STAIS), and Holmes and Rahe Stress Scale (HRSS). The NRS of background pain for the protocol group was significantly decreased compared to the control group (2.8±2.0 versus 3.9±1.9), and the NRS of procedural pain of the protocol group was significantly decreased compared to the control group (4.8±2.8 versus 3.7±2.5). CAPS and HDRS were decreased in the protocol group, but did not have statistical significance. STAIS and HRSS were decreased in the protocol group, but only the STAIS had statistical significance. Our new pain management system was effective in burn pain management. However, adequate pain management can only be accomplished by a continuous and thorough effort. Therefore, pain control protocol and pain monitoring systems need to be under constant revision and improvement using creative ideas and approaches. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Differential pain modulation in patients with peripheral neuropathic pain and fibromyalgia.

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Gormsen, Lise; Bach, Flemming W; Rosenberg, Raben; Jensen, Troels S

2017-12-29

Background The definition of neuropathic pain has recently been changed by the International Association for the Study of Pain. This means that conditions such as fibromyalgia cannot, as sometimes discussed, be included in the neuropathic pain conditions. However, fibromyalgia and peripheral neuropathic pain share common clinical features such as spontaneous pain and hypersensitivity to external stimuli. Therefore, it is of interest to directly compare the conditions. Material and methods In this study we directly compared the pain modulation in neuropathic pain versus fibromyalgia by recording responses to a cold pressor test in 30 patients with peripheral neuropathic pain, 28 patients with fibromyalgia, and 26 pain-free age-and gender-matched healthy controls. Patients were asked to rate their spontaneous pain on a visual analog scale (VAS (0-100 mm) immediately before and immediately after the cold pressor test. Furthermore the duration (s) of extremity immersion in cold water was used as a measure of the pain tolerance threshold, and the perceived pain intensity at pain tolerance on the VAS was recorded on the extremity in the water after the cold pressor test. In addition, thermal (thermo tester) and mechanical stimuli (pressure algometer) were used to determine sensory detection, pain detection, and pain tolerance thresholds in different body parts. All sensory tests were done by the same examiner, in the same room, and with each subject in a supine position. The sequence of examinations was the following: (1) reaction time, (2) pressure thresholds, (3) thermal thresholds, and (4) cold pressor test. Reaction time was measured to ensure that psychomotoric inhibitions did not influence pain thresholds. Results Pain modulation induced by a cold pressor test reduced spontaneous pain by 40% on average in neuropathic pain patients, but increased spontaneous pain by 2.6% in fibromyalgia patients. This difference between fibromyalgia and neuropathic pain patients was

The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance.

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Algafly, Amin A; George, Keith P

2007-06-01

To determine the impact of the application of cryotherapy on nerve conduction velocity (NCV), pain threshold (PTH) and pain tolerance (PTO). A within-subject experimental design; treatment ankle (cryotherapy) and control ankle (no cryotherapy). Hospital-based physiotherapy laboratory. A convenience sample of adult male sports players (n = 23). NCV of the tibial nerve via electromyogram as well as PTH and PTO via pressure algometer. All outcome measures were assessed at two sites served by the tibial nerve: one receiving cryotherapy and one not receiving cryotherapy. In the control ankle, NCV, PTH and PTO did not alter when reassessed. In the ankle receiving cryotherapy, NCV was significantly and progressively reduced as ankle skin temperature was reduced to 10 degrees C by a cumulative total of 32.8% (pCryotherapy led to an increased PTH and PTO at both assessment sites (pcryotherapy can increase PTH and PTO at the ankle and this was associated with a significant decrease in NCV. Reduced NCV at the ankle may be a mechanism by which cryotherapy achieves its clinical goals.

Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial.

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Kayo, Andrea Harumi; Peccin, Maria Stella; Sanches, Carla Munhoz; Trevisani, Virgínia Fernandes Moça

2012-08-01

The purpose of this study was to evaluate and compare the effectiveness of muscle-strengthening exercises (MS) and a walking program (WA) in reducing pain in patients with fibromyalgia. Ninety women, 30-55 years of age, diagnosed with fibromyalgia according to the American College of Rheumatology 1990 criteria, were randomized into 3 groups: WA Group, MS Group, and control group. Pain (visual analog scale) was evaluated as the primary outcome. Physical functioning (Fibromyalgia Impact Questionnaire, FIQ), health-related quality of life (Short-Form 36 Health Survey, SF-36), and use of medication were evaluated as secondary outcomes. Assessments were performed at baseline, 8, 16, and 28 weeks. Intention-to-treat and efficacy analyses were conducted. Sixty-eight patients completed the treatment protocol. All 3 groups showed improvement after the 16-week treatment compared to baseline. At the 28-week follow-up, pain reduction was similar for the WA and MS groups (P = 0.39), but different from the control group (P = 0.01). At the end of the treatment, 80% of subjects in the control group took pain medication, but only 46.7% in the WA and 41.4% in the MS groups. Mean FIQ total scores were lower for the WA and MS groups (P = 0.96) compared with the control group (P < 0.01). Patients in the WA and MS groups reported higher scores (better health status) than controls in almost all SF-36 subscales. MS was as effective as WA in reducing pain regarding all study variables; however, symptoms management during the follow-up period was more efficient in the WA group.

5-HT modulation of pain perception in humans.

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Martin, Sarah L; Power, Andrea; Boyle, Yvonne; Anderson, Ian M; Silverdale, Monty A; Jones, Anthony K P

2017-10-01

Although there is clear evidence for the serotonergic regulation of descending control of pain in animals, little direct evidence exists in humans. The majority of our knowledge comes from the use of serotonin (5-HT)-modulating antidepressants as analgesics in the clinical management of chronic pain. Here, we have used an acute tryptophan depletion (ATD) to manipulate 5-HT function and examine its effects of ATD on heat pain threshold and tolerance, attentional manipulation of nociceptive processing and mood in human volunteers. Fifteen healthy participants received both ATD and balanced amino acid (BAL) drinks on two separate sessions in a double-blind cross-over design. Pain threshold and tolerance were determined 4 h post-drink via a heat thermode. Additional attention, distraction and temperature discrimination paradigms were completed using a laser-induced heat pain stimulus. Mood was assessed prior and throughout each session. Our investigation reported that the ATD lowered plasma TRP levels by 65.05 ± 7.29% and significantly reduced pain threshold and tolerance in response to the heat thermode. There was a direct correlation between the reduction in total plasma TRP levels and reduction in thermode temperature. In contrast, ATD showed no effect on laser-induced pain nor significant impact of the distraction-induced analgesia on pain perception but did reduce performance of the painful temperature discrimination task. Importantly, all findings were independent of any effects of ATD on mood. As far as we are aware, it is the first demonstration of 5-HT effects on pain perception which are not confounded by mood changes.

Intraoperative Low-Dose Ketamine Infusion Reduces Acute Postoperative Pain Following Total Knee Replacement Surgery: A Prospective, Randomized Double-Blind Placebo-Controlled Trial

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Pelin Cengiz, P.; Gokcinar, D.; Karabeyoglu, I.; Topcu, H.; Cicek, G. S.; Gogus, N.

2014-01-01

Objective: To evaluate the effect of intraoperative low-dose ketamine with general anesthesia on postoperative pain after total knee replacement surgery. Study Design: A randomized, double-blind comparative study. Place and Duration of Study: Ankara Numune Training and Research Hospital, Turkey, from January and June 2011. Methodology: Sixty adults undergoing total knee arthroplasty were enrolled in this study. The patients were randomly allocated into two groups of equal size to receive either racemic ketamine infusion (6.25 g/kg/minute) or the same volume of saline. A visual analogue scale (VAS) was used to measure each patient's level of pain at 1, 3, 6, 12, and 24 hours after surgery. Time to first analgesic request, postoperative morphine consumption and the incidence of side effects were also recorded. Results: Low-dose ketamine infusion prolonged the time to first analgesic request. It also reduced postoperative cumulative morphine consumption at 1, 3, 6, 12, and 24 hours postsurgery (p < 0.001). Postoperative VAS scores were also significantly lower in the ketamine group than placebo, at all observation times. Incidences of side effects were similar in both study groups. Conclusion: Intraoperative continuous low-dose ketamine infusion reduced pain and postoperative analgesic consumption without affecting the incidence of side effects. (author)

Physical activity, pain responses to heat stimuli, and conditioned pain modulation in postmenopausal women.

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Adrian, Amanda L; O'Connor, Patrick J; Ward-Ritacco, Christie L; Evans, Ellen M

2015-08-01

Postmenopausal women (PMW) are at high risk for disabling pain and physical inactivity. This study sought to enhance the understanding of relationships between physical activity (PA) and pain among PMW using heat pain sensitivity test and conditioned pain modulation test. We hypothesized that, compared with active women, (i) inactive women would report higher pain intensity and pain unpleasantness ratings; (ii) inactive women in disabling pain would report higher pain intensity and pain unpleasantness at high, but not low, stimulus intensities; and (iii) inactive women would have less modulation. Sixty-eight PMW rated the pain intensity and pain unpleasantness of hot stimuli presented to the thenar eminence of the hand. A subset of 31 women rated the pain intensity of a test stimulus (noxious heat) and a conditioning stimulus (cold water) as part of the conditioned pain modulation task. PA was assessed objectively with accelerometry. Mixed-model analysis of variance (2 × 4 × 2; PA × Temperature × Pain Status) showed that inactive women in disabling pain rated pain unpleasantness higher than active women in disabling pain (F3,192 = 3.526, ∂η = 0.052, P = 0.016). Significantly lower pain unpleasantness ratings were found at the highest stimulus intensity (49°C) only for active women in disabling pain compared with inactive women in disabling pain (t11 = 2.523, P = 0.028). The other hypotheses were not supported. PA is associated with a reduced sensitivity to the unpleasantness of painful high-intensity heat stimuli among women in disabling pain.

Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids.

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Zeidan, Fadel; Adler-Neal, Adrienne L; Wells, Rebecca E; Stagnaro, Emily; May, Lisa M; Eisenach, James C; McHaffie, John G; Coghill, Robert C

2016-03-16

Mindfulness meditation, a cognitive practice premised on sustaining nonjudgmental awareness of arising sensory events, reliably attenuates pain. Mindfulness meditation activates multiple brain regions that contain a high expression of opioid receptors. However, it is unknown whether mindfulness-meditation-based analgesia is mediated by endogenous opioids. The present double-blind, randomized study examined behavioral pain responses in healthy human volunteers during mindfulness meditation and a nonmanipulation control condition in response to noxious heat and intravenous administration of the opioid antagonist naloxone (0.15 mg/kg bolus + 0.1 mg/kg/h infusion) or saline placebo. Meditation during saline infusion significantly reduced pain intensity and unpleasantness ratings when compared to the control + saline group. However, naloxone infusion failed to reverse meditation-induced analgesia. There were no significant differences in pain intensity or pain unpleasantness reductions between the meditation + naloxone and the meditation + saline groups. Furthermore, mindfulness meditation during naloxone produced significantly greater reductions in pain intensity and unpleasantness than the control groups. These findings demonstrate that mindfulness meditation does not rely on endogenous opioidergic mechanisms to reduce pain. Endogenous opioids have been repeatedly shown to be involved in the cognitive inhibition of pain. Mindfulness meditation, a practice premised on directing nonjudgmental attention to arising sensory events, reduces pain by engaging mechanisms supporting the cognitive control of pain. However, it remains unknown if mindfulness-meditation-based analgesia is mediated by opioids, an important consideration for using meditation to treat chronic pain. To address this question, the present study examined pain reports during meditation in response to noxious heat and administration of the opioid antagonist naloxone and placebo saline. The results

Dynamic Changes in Nociception and Pain Perception After Spinal Cord Stimulation in Chronic Neuropathic Pain Patients.

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Biurrun Manresa, José A; Sörensen, Jan; Andersen, Ole K; Arendt-Nielsen, Lars; Gerdle, Björn

2015-12-01

Patients with an implanted spinal cord stimulation (SCS) system for pain management present an opportunity to study dynamic changes in the pain system in a situation where patients are not stimulated (ie, experiencing severe pain) compared with a situation in which patients have just been stimulated (ie, pain free or greatly reduced pain). The aims of this study were (1) to determine if there are differences in nociceptive withdrawal reflex thresholds (NWR-T) and electrical pain thresholds (EP-T) before and after SCS; and (2) to establish if these differences are related to psychological factors associated with chronic pain. Seventeen volunteers with chronic neuropathic pain participated in the experiment. Electrical stimuli were applied to assess the NWR-T and the EP-T. In addition, psychological factors (ie, pain characteristics, depression, anxiety, and disability indexes) were also recorded. The NWR-T and EP-T were assessed with the SCS system off (at least 8 h before the experiment), and then reassessed 1 hour after the SCS system was turned on. Ongoing pain intensity ratings decreased (P=0.018), whereas the NWR-T increased (P=0.028) after the SCS was turned on, whereas no significant difference was found for EP-T (P=0.324). Psychological factors were significant predictors for EP-T but not for NWR-T. The results of this study suggest that pain relief after SCS is partially mediated by a decrease in the excitability of dorsal horn neurons in the spinal cord.

Increased multiple sclerosis relapses related to lower prevalence of pain

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José Vinícius Martins da Silva

2015-07-01

Full Text Available Objective The study aims to investigate the presence of pain amongst multiple sclerosis (MS patients. Method One hundred MS patients responded to questionnaires evaluating neuropathic and nociceptive pain, depression and anxiety. Statistical analysis was performed using the Mann–Whitney U, Chi-Square and two-tailed Fisher’s exact tests and multivariate logistic regression. Results Women had a statistically higher prevalence of pain (p = 0.037, and chances of having pain after the age of 50 reduced. Women with pain had a statistically significant lower number of relapses (p = 0.003, restricting analysis to those patients with more than one relapse. After the second relapse, each relapse reduced the chance of having pain by 46%. Presence of pain was independent of Expanded Disability Status Scale (EDSS anxiety, and depression. Conclusion Our findings suggest a strong inverse association between relapses and pain indicating a possible protective role of focal inflammation in the control of pain.

Nonpainful remote electrical stimulation alleviates episodic migraine pain.

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Yarnitsky, David; Volokh, Lana; Ironi, Alon; Weller, Boaz; Shor, Merav; Shifrin, Alla; Granovsky, Yelena

2017-03-28

To evaluate the efficacy of remote nonpainful electrical upper arm skin stimulation in reducing migraine attack pain. This is a prospective, double-blinded, randomized, crossover, sham-controlled trial. Migraineurs applied skin electrodes to the upper arm soon after attack onset for 20 minutes, at various pulse widths, and refrained from medications for 2 hours. Patients were asked to use the device for up to 20 attacks. In 71 patients (299 treatments) with evaluable data, 50% pain reduction was obtained for 64% of participants based on best of 200-μs, 150-μs, and 100-μs pulse width stimuli per individual vs 26% for sham stimuli. Greater pain reduction was found for active stimulation vs placebo; for those starting at severe or moderate pain, reduction (1) to mild or no pain occurred in 58% (25/43) of participants (66/134 treatments) for the 200-μs stimulation protocol and 24% (4/17; 8/29 treatments) for placebo ( p = 0.02), and (2) to no pain occurred in 30% (13/43) of participants (37/134 treatments) and 6% (1/17; 5/29 treatments), respectively ( p = 0.004). Earlier application of the treatment, within 20 minutes of attack onset, yielded better results: 46.7% pain reduction as opposed to 24.9% reduction when started later ( p = 0.02). Nonpainful remote skin stimulation can significantly reduce migraine pain, especially when applied early in an attack. This is presumably by activating descending inhibition pathways via the conditioned pain modulation effect. This treatment may be proposed as an attractive nonpharmacologic, easy to use, adverse event free, and inexpensive tool to reduce migraine pain. NCT02453399. This study provides Class III evidence that for patients with an acute migraine headache, remote nonpainful electrical stimulation on the upper arm skin reduces migraine pain. © 2017 American Academy of Neurology.

Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain.

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Cheing, G L; Hui-Chan, C W

1999-03-01

To investigate to what extent a single 60-minute session of transcutaneous electrical nerve stimulation (TENS) would modify chronic clinical pain, acute experimental pain, and the flexion reflex evoked in chronic low back pain patients. Thirty young subjects with chronic low back pain were randomly allocated to two groups, receiving either TENS or placebo stimulation to the lumbosacral region for 60 minutes. The flexion reflex was elicited by an electrical stimulation applied to the subject's right sole and recorded electromyographically from the biceps femoris and the tibialis anterior muscles. Subjective sensation of low back pain and the electrically induced pain were measured by two separate visual analog scales, termed VAS(LBP) and VAS(FR), respectively. Data obtained before, during, and 60 minutes after TENS and placebo stimulations were analyzed using repeated measures ANOVA. The VAS(LBP) score was significantly reduced to 63.1% of the prestimulation value after TENS (pTENS protocol had different degrees of antinociceptive influence on chronic and acute pain in chronic low back pain patients.

What Do the Parents of Children Who Have Chronic Pain Expect from Their First Visit to a Pediatric Chronic Pain Clinic?

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Kathy Reid

2010-01-01

Full Text Available BACKGROUND: Chronic pain in childhood is increasingly recognized as a significant clinical problem. Best-practice management of pediatric chronic pain in a multidisciplinary pain clinic involves a variety of treatment modalities. It is important that parents of children treated in these settings understand the different treatment options available for their children. By involving parents more effectively, care providers may more efficiently address unmet treatment needs and improve tailoring of treatment programs aimed at increasing function, reducing pain-related disability and improving quality of life.

Effects of Flotation-REST on Muscle Tension Pain

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Anette Kjellgren

2001-01-01

Full Text Available The purpose of the present study was to investigate whether the floating form of the restricted environmental stimulation technique (REST may be applied within the field of pain relief. Flotation-REST consists of a procedure whereby an individual is immersed in a tank filled with water of an extremely high salt concentration. Thirty-seven patients (14 men and 23 women suffering from chronic pain consisting of aching muscles in the neck and back area participated in the study. They were randomly assigned to either a control group (17 participants or an experimental group (20 participants. The experimental group received nine opportunities to use the flotation-REST technique in the water tank over a three-week period. The results indicated that the most severe perceived pain intensity was significantly reduced, whereas low perceived pain intensity was not influenced by the floating technique. Further, the results indicated that circulating levels of the noradrenaline metabolite 3-methoxy-4-hydroxyphenylethyleneglycol were reduced significantly in the experimental group but not in the control group following treatment, whereas endorphin levels were not affected by flotation. Flotation-REST treatment also elevated the participants' optimism and reduced the degree of anxiety or depression; at nighttime, patients who underwent flotation fell asleep more easily. The present findings describe possible changes, for the better, in patients presenting with chronic pain complaints.

Effects of flotation-REST on muscle tension pain.

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Kjellgren, A; Sundequist, U; Norlander, T; Archer, T

2001-01-01

The purpose of the present study was to investigate whether the floating form of the restricted environmental stimulation technique (REST) may be applied within the field of pain relief. Flotation-REST consists of a procedure whereby an individual is immersed in a tank filled with water of an extremely high salt concentration. Thirty-seven patients (14 men and 23 women) suffering from chronic pain consisting of aching muscles in the neck and back area participated in the study. They were randomly assigned to either a control group (17 participants) or an experimental group (20 participants). The experimental group received nine opportunities to use the flotation-REST technique in the water tank over a three-week period. The results indicated that the most severe perceived pain intensity was significantly reduced, whereas low perceived pain intensity was not influenced by the floating technique. Further, the results indicated that circulating levels of the noradrenaline metabolite 3-methoxy-4-hydroxyphenylethyleneglycol were reduced significantly in the experimental group but not in the control group following treatment, whereas endorphin levels were not affected by flotation. Flotation-REST treatment also elevated the participants' optimism and reduced the degree of anxiety or depression; at nighttime, patients who underwent flotation fell asleep more easily. The present findings describe possible changes, for the better, in patients presenting with chronic pain complaints.

Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia.

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Gerhardt, Andreas; Eich, Wolfgang; Treede, Rolf-Detlef; Tesarz, Jonas

2017-03-01

Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPM might influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P pain modulation in CLP was significantly higher than that in CWP and FMS (P painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = -0.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP or CWP (P values pain inhibition seem to be more indicated the higher the pain extent.

Lack of endogenous modulation and reduced decay of prolonged heat pain in older adults.

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Riley, Joseph L; King, Christopher D; Wong, Fong; Fillingim, Roger B; Mauderli, Andre P

2010-07-01

This study supports the hypothesis that healthy older adults exhibit decreased endogenous pain inhibition compared to younger healthy controls. Twenty-two older adults (56-77years of age) and 27 controls aged 20-49 participated in five experimental sessions following a training session. Each experimental session consisted of five 60-s trials in which the experimental heat stimulus was presented to the thenar eminence of the left palm with or without a conditioning stimulus (cold-water immersion of the foot). The temperature for the palm (44-49 degrees C) and foot (8-16 degrees C) was customized for each subject. The intensity of experimental pain produced by the contact thermode was continuously measured during the 60-s trial with an electronic visual analogue scale. No significant associations were found between subjects rating of concentration and the overall inhibitory effect. Older subjects failed to demonstrate conditioned pain modulation (CPM) and showed facilitation in the trials using painful concurrent immersion of the foot. A novel aspect of the study was that we recorded "pain offset" (i.e., after-sensations) and found that ratings for the older sample decreased at a slower rate than observed for the group of younger adults suggesting increased central sensitization among the older sample. Decrements in CPM could contribute to the greater prevalence of pain in older age. Since a number of neurotransmitter systems are involved in pain modulation, it is possible age-related differences in CPM are due to functional changes in these systems in a number of areas within the neuroaxis. Copyright 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Efficacy and speed of onset of pain relief of fast-dissolving paracetamol on postsurgical dental pain: two randomized, single-dose, double-blind, placebo-controlled clinical studies.

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Yue, Yong; Collaku, Agron; Brown, Jean; Buchanan, William L; Reed, Kenneth; Cooper, Stephen A; Otto, James

2013-09-01

Paracetamol (APAP), also known as acetaminophen, is the most commonly used over-the-counter analgesic for the treatment of mild-to-moderate pain. However, the speed of onset of pain relief is limited mainly to the standard, immediate-release formulation. Efficacy and speed of onset of pain relief are critical in acute pain situations such as postsurgical dental pain, because reducing pain can improve clinical outcome and reduce the risk of transition from acute pain to more chronic pain. Efficacy and rapid onset also reduce the risk of excessive dosing with the analgesic. We sought to investigate the dose-response efficacy and speed of onset of pain relief of a fast-dissolving APAP formulation compared with lower doses of APAP and placebo in dental patients after impacted third molar extraction. Two single-center, single-dose, randomized, placebo-controlled, double-blind, double-dummy, parallel-group studies (Study I and Study II) were conducted to evaluate the efficacy and speed of onset of pain relief of different doses of a fast-dissolving APAP tablet (FD-APAP), standard APAP, and placebo in patients with postsurgical dental pain following third molar extraction. In Study I, a single dose of FD-APAP 1000 mg, FD-APAP 500 mg, or placebo was given to 300 patients; in Study II, a single dose of FD-APAP 1000 mg, standard APAP 650 mg, or placebo was given to 401 patients. All 701 patients from both studies were included in the analysis and safety assessment. FD-APAP 1000 mg demonstrated significantly greater effect compared with FD-APAP 500 mg, APAP 650 mg, and placebo for all efficacy measurements, including sum of pain relief and pain intensity difference, total pain relief, sum of pain intensity difference, pain intensity difference, and pain relief score during 6 hours after the dose. Onset of confirmed first perceptible relief in subjects treated with FD-APAP 1000 mg was 15 minutes, which was 32% and 25% significantly shorter than onset of pain relief of FD

Predicting postoperative pain by preoperative pressure pain assessment.

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Hsu, Yung-Wei; Somma, Jacques; Hung, Yu-Chun; Tsai, Pei-Shan; Yang, Chen-Hsien; Chen, Chien-Chuan

2005-09-01

The goal of this study was to evaluate whether preoperative pressure pain sensitivity testing is predictive of postoperative surgical pain. Female subjects undergoing lower abdominal gynecologic surgery were studied. A pressure algometer was used preoperatively to determine the pressure pain threshold and tolerance. A visual analog scale (VAS) was used to assess postoperative pain. A State-Trait Anxiety Inventory was used to assess patients' anxiety. Subjects received intravenous patient-controlled analgesia for postoperative pain control. The preoperative pain threshold and tolerance were compared with the postoperative VAS pain score and morphine consumption. Forty women were enrolled. Their preoperative pressure pain threshold and tolerance were 141 +/- 65 kPa and 223 +/- 62 kPa, respectively. The VAS pain score in the postanesthesia care unit and at 24 h postoperatively were 81 +/- 24 and 31 +/- 10, respectively. Highly anxious patients had higher VAS pain scores in the postanesthesia care unit (P pain tolerance was significantly correlated with the VAS at 24 h postoperatively (P pain tolerance after fentanyl administration (mean, 272 +/- 68 kPa) correlated significantly with morphine consumption in the first 24 h postoperatively (P pain tolerance is significantly correlated with the level of postoperative pain. Pain tolerance assessment after fentanyl was administered and fentanyl sensitivity predicted the dose of analgesics used in the first 24 h after surgery. The algometer is thus a simple, useful tool for predicting postoperative pain and analgesic consumption.

Effects on musculoskeletal pain from "Take a Stand!" - a cluster-randomized controlled trial reducing sitting time among office workers

DEFF Research Database (Denmark)

Danquah, Ida Høgstedt; Kloster, Stine; Holtermann, Andreas

2017-01-01

Objectives Prolonged sitting at work has been found to increase risk for musculoskeletal pain. The office-based intervention "Take a Stand!" was effective in reducing sitting time at work. We aimed to study the effect of the intervention on a secondary outcome: musculoskeletal pain. Methods Take...... a Stand! included 19 offices (317 workers) at four workplaces cluster randomized to intervention or control. The multicomponent intervention lasted three months and included management support, environmental changes, and local adaptation. Control participants behaved as usual. Musculoskeletal pain...

Listening to music does not reduce pain during sigmoidoscopy

NARCIS (Netherlands)

Meeuse, Jan J.; Koornstra, Jan Jacob; Reyners, An K. L.

Objective Up to 40% of the sigmoidoscopies are considered painful by patients. Nonpharmacological intervention would be attractive, as sedation and analgesia carry the risk of side-effects and increase procedure-related costs. Music might have the potential of pain reduction, but its effect during

Intraoperative ketamine reduces immediate postoperative opioid consumption after spinal fusion surgery in chronic pain patients with opioid dependency

DEFF Research Database (Denmark)

Nielsen, Rikke Vibeke; Fomsgaard, Jonna Storm; Siegel, Hanna

2017-01-01

Perioperative handling of surgical patients with opioid dependency represents an important clinical problem. Animal studies suggest that ketamine attenuates central sensitization and hyperalgesia and thereby reduces postoperative opioid tolerance. We hypothesized that intraoperative ketamine would...... to 24 hours postoperatively (visual analogue scale), adverse events, and persistent pain 6 months postoperatively. One hundred fifty patients were randomly assigned to intraoperative S-ketamine bolus 0.5 mg/kg and infusion 0.25 mg·kg·h or placebo. Postoperatively, patients received their usual opioids......, paracetamol and IV patient-controlled analgesia with morphine. In the final analyses, 147 patients were included. Patient-controlled analgesia IV morphine consumption 0 to 24 hours postoperatively was significantly reduced in the ketamine group compared with the placebo group: 79 (47) vs 121 (53) mg IV, mean...

Vibration for Pain Reduction in a Plastic Surgery Clinic.

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Eichhorn, Mitchell George; Karadsheh, Murad Jehad; Krebiehl, Johanna Ruth; Ford, Dawn Marie; Ford, Ronald D

2016-01-01

Patients can experience significant pain during routine procedures in the plastic surgery clinic. Methods for clinical pain reduction are often impractical, time-consuming, or ineffective. Vibration is a safe, inexpensive, and highly applicable modality for pain reduction that can be readily utilized for a wide variety of procedures. This study evaluated the use of vibration as a viable pain-reduction strategy in the clinical plastic surgery setting. Patients requiring at least 2 consecutive procedures that are considered painful were enrolled in the study. These included injections, staple removal, and suture removal. In the same patient, one half of the procedures were performed without vibration and the other half with vibration. After completing the procedures, the patients rated their pain with vibration and without vibration. The patient and the researcher also described the experience with a short questionnaire. Twenty-eight patients were enrolled in the study. Patients reported significantly less pain on the Numeric Rating Scale pain scale when vibration was used compared with the control group (p reduction. It significantly reduces the pain experienced by patients during minor office procedures. Given its practicality and ease of use, it is a welcome tool in the plastic surgery clinic.

Magnesium sulfate reduces formalin-induced orofacial pain in rats with normal magnesium serum levels.

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Srebro, Dragana P; Vučković, Sonja M; Dožić, Ivan S; Dožić, Branko S; Savić Vujović, Katarina R; Milovanović, Aleksandar P; Karadžić, Branislav V; Prostran, Milica Š

2018-02-01

In humans, orofacial pain has a high prevalence and is often difficult to treat. Magnesium is an essential element in biological a system which controls the activity of many ion channels, neurotransmitters and enzymes. Magnesium produces an antinociceptive effect in neuropathic pain, while in inflammatory pain results are not consistent. We examined the effects of magnesium sulfate using the rat orofacial formalin test, a model of trigeminal pain. Male Wistar rats were injected with 1.5% formalin into the perinasal area, and the total time spent in pain-related behavior (face rubbing) was quantified. We also spectrophotometrically determined the concentration of magnesium and creatine kinase activity in blood serum. Magnesium sulfate administered subcutaneously (0.005-45mg/kg) produced significant antinociception in the second phase of the orofacial formalin test in rats at physiological serum concentration of magnesium. The effect was not dose-dependent. The maximum antinociceptive effect of magnesium sulfate was about 50% and was achieved at doses of 15 and 45mg/kg. Magnesium did not affect increase the levels of serum creatine kinase activity. Preemptive systemic administration of magnesium sulfate as the only drug can be used to prevent inflammatory pain in the orofacial region. Its analgesic effect is not associated with magnesium deficiency. Copyright © 2017 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier B.V. All rights reserved.

Does Eccentric Exercise Reduce Pain and Improve Strength in Physically Active Adults With Symptomatic Lower Extremity Tendinosis? A Systematic Review

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Wasielewski, Noah J; Kotsko, Kevin M

2007-01-01

Objective: To critically review evidence for the effectiveness of eccentric exercise to treat lower extremity tendinoses. Data Sources: Databases used to locate randomized controlled trials (RCTs) included PubMed (1980–2006), CINAHL (1982–2006), Web of Science (1995–2006), SPORT Discus (1980–2006), Physiotherapy Evidence Database (PEDro), and the Cochrane Collaboration Database. Key words included tendon, tendonitis, tendinosis, tendinopathy, exercise, eccentric, rehabilitation, and therapy. Study Selection: The criteria for trial selection were (1) the literature was written in English, (2) the research design was an RCT, (3) the study participants were adults with a clinical diagnosis of tendinosis, (4) the outcome measures included pain or strength, and (5) eccentric exercise was used to treat lower extremity tendinosis. Data Extraction: Specific data were abstracted from the RCTs, including eccentric exercise protocol, adjunctive treatments, concurrent physical activity, and treatment outcome. Data Synthesis: The calculated post hoc statistical power of the selected studies (n = 11) was low, and the average methodologic score was 5.3/10 based on PEDro criteria. Eccentric exercise was compared with no treatment (n = 1), concentric exercise (n = 5), an alternative eccentric exercise protocol (n = 1), stretching (n = 2), night splinting (n = 1), and physical agents (n = 1). In most trials, tendinosis-related pain was reduced with eccentric exercise over time, but only in 3 studies did eccentric exercise decrease pain relative to the control treatment. Similarly, the RCTs demonstrated that strength-related measures improved over time, but none revealed significant differences relative to the control treatment. Based on the best evidence available, it appears that eccentric exercise may reduce pain and improve strength in lower extremity tendinoses, but whether eccentric exercise is more effective than other forms of therapeutic exercise for the resolution

Pain-mediated affect regulation is reduced after dialectical behavior therapy in borderline personality disorder: a longitudinal fMRI study.

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Niedtfeld, Inga; Schmitt, Ruth; Winter, Dorina; Bohus, Martin; Schmahl, Christian; Herpertz, Sabine C

2017-05-01

Borderline Personality Disorder (BPD) is characterized by affective instability, but self-injurious behavior appears to have an emotion-regulating effect. We investigated whether pain-mediated affect regulation can be altered at the neural level by residential Dialectical Behavior Therapy (DBT), providing adaptive emotion regulation techniques. Likewise, we investigated whether pain thresholds or the appraisal of pain change after psychotherapy. We investigated 28 patients with BPD undergoing DBT (self-referral), 15 patients with treatment as usual and 23 healthy control subjects at two time points 12 weeks apart. We conducted an fMRI experiment eliciting negative emotions with picture stimuli and induced heat pain to investigate the role of pain in emotion regulation. Additionally, we assessed heat and cold pain thresholds.At first measurement, patients with BPD showed amygdala deactivation in response to painful stimulation, as well as altered connectivity between left amygdala and dorsal anterior cingulate cortex. These effects were reduced after DBT, as compared with patients with treatment as usual. Pain thresholds did not differ between the patient groups. We replicated the role of pain as a means of affect regulation in BPD, indicated by increased amygdala coupling. For the first time, we could demonstrate that pain-mediated affect regulation can be changed by DBT. © The Author (2017). Published by Oxford University Press.

Quality of life and neck pain in nurses

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Lucy Joslin

2014-04-01

Full Text Available Objectives: To investigate the association between neck pain and psychological stress in nurses. Material and Methods: Nurses from the Avon Orthopaedic Centre completed 2 questionnaires: the Short Form-36 (SF-36 and 1 exploring neck pain and associated psychological stress. Results: Thirty four nurses entered the study (68% response. Twelve (35.3% had current neck pain, 13 (38.2% reported neck pain within the past year and 9 (26.5% had no neck pain. Subjects with current neck pain had significantly lower mental health (47.1 vs. 70.4; p = 0.002, physical health (60.8 vs. 76.8; p = 0.010 and overall SF-36 scores (56.8 vs. 74.9; p = 0.003. Five (41.7% subjects with current neck pain and 5 (38.5% subjects with neck pain in the previous year attributed it to psychological stress. Conclusions: Over 1/3 of nurses have symptomatic neck pain and significantly lower mental and physical health scores. Managing psychological stress may reduce neck pain, leading to improved quality of life for nurses, financial benefits for the NHS, and improved patient care.

Electronic Gaming as Pain Distraction

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Eleanor Jameson

2011-01-01

Full Text Available The current study investigated whether active distraction reduces participants’ experience of pain more than passive distraction during a cold pressor task. In the first experiment, 60 participants were asked to submerge their hand in cold (2°C water for as long as they could tolerate. They did this with no distraction, and then with active (electronic gaming system and passive (television distraction, in randomly assigned order. Tolerance time, pain intensity ratings and task absorption ratings were measured for each condition. A second experiment attempted to control for participants’ expectations about the effects of distraction on pain. Forty participants underwent the same experimental procedure, but were given verbal suggestions about the effects of distraction by the experimenter before each distraction condition. Participants in both experiments had a significantly higher pain tolerance and reported less pain with the active distraction compared with passive or no distraction. Participants reported being more absorbed, and were significantly more willing to do the task again when they had the active distraction compared with both passive distraction and no distraction. They also had more enjoyment, less anxiety and greater reduction in pain with active distraction than with passive distraction. There was no effect of suggestion. These experiments offer further support for the use of electronic games as a method of pain control.

Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.

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Dräger, Dagmar; Budnick, Andrea; Kuhnert, Ronny; Kalinowski, Sonja; Könner, Franziska; Kreutz, Reinhold

2017-10-01

Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543. © 2016 Japan Geriatrics Society.

IL-10 mediated by herpes simplex virus vector reduces neuropathic pain induced by HIV gp120 combined with ddC in rats.

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Zheng, Wenwen; Huang, Wan; Liu, Shue; Levitt, Roy C; Candiotti, Keith A; Lubarsky, David A; Hao, Shuanglin

2014-07-30

HIV-associated sensory neuropathy affects over 50% of HIV patients and is a common peripheral nerve complication of HIV infection and highly active antiretroviral therapy (HAART). Evidence shows that painful HIV sensory neuropathy is influenced by neuroinflammatory events that include the proinflammatory molecules, MAP Kinase, tumor necrosis factor-α (TNFα), stromal cell-derived factor 1-α (SDF1α), and C-X-C chemokine receptor type 4 (CXCR4). However, the exact mechanisms of painful HIV sensory neuropathy are not known, which hinders our ability to develop effective treatments. In this study, we investigated whether inhibition of proinflammatory factors reduces the HIV-associated neuropathic pain state. Neuropathic pain was induced by peripheral HIV coat protein gp120 combined with 2',3'-dideoxycytidine (ddC, one of the nucleoside reverse transcriptase inhibitors (NRTIs)). Mechanical threshold was tested using von Frey filament fibers. Non-replicating herpes simplex virus (HSV) vectors expressing interleukin 10 (IL10) were inoculated into the hindpaws of rats. The expression of TNFα, SDF1α, and CXCR4 in the lumbar spinal cord and L4/5 dorsal root ganglia (DRG) was examined using western blots. IL-10 expression mediated by the HSV vectors resulted in a significant elevation of mechanical threshold. The anti-allodynic effect of IL-10 expression mediated by the HSV vectors lasted more than 3 weeks. The area under the effect-time curves (AUC) in mechanical threshold in rats inoculated with the HSV vectors expressing IL-10, was increased compared with the control vectors, indicating antinociceptive effect of the IL-10 vectors. The HSV vectors expressing IL-10 also concomitantly reversed the upregulation of p-p38, TNFα, SDF1α, and CXCR4 induced by gp120 in the lumbar spinal dorsal horn and/or the DRG at 2 and/or 4 weeks. The blocking of the signaling of these proinflammatory molecules is able to reduce HIV-related neuropathic pain, which provide a novel

An improved behavioural assay demonstrates that ultrasound vocalizations constitute a reliable indicator of chronic cancer pain and neuropathic pain

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Selvaraj Deepitha

2010-03-01

Full Text Available Abstract Background On-going pain is one of the most debilitating symptoms associated with a variety of chronic pain disorders. An understanding of mechanisms underlying on-going pain, i.e. stimulus-independent pain has been hampered so far by a lack of behavioural parameters which enable studying it in experimental animals. Ultrasound vocalizations (USVs have been proposed to correlate with pain evoked by an acute activation of nociceptors. However, literature on the utility of USVs as an indicator of chronic pain is very controversial. A majority of these inconsistencies arise from parameters confounding behavioural experiments, which include novelty, fear and stress due to restrain, amongst others. Results We have developed an improved assay which overcomes these confounding factors and enables studying USVs in freely moving mice repetitively over several weeks. Using this improved assay, we report here that USVs increase significantly in mice with bone metastases-induced cancer pain or neuropathic pain for several weeks, in comparison to sham-treated mice. Importantly, analgesic drugs which are known to alleviate tumour pain or neuropathic pain in human patients significantly reduce USVs as well as mechanical allodynia in corresponding mouse models. Conclusions We show that studying USVs and mechanical allodynia in the same cohort of mice enables comparing the temporal progression of on-going pain (i.e. stimulus-independent pain and stimulus-evoked pain in these clinically highly-relevant forms of chronic pain.

Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results.

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Huber, Stephan; Priebe, Janosch A; Baumann, Kaja-Maria; Plidschun, Anne; Schiessl, Christine; Tölle, Thomas R

2017-12-04

Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases. The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP. Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines. Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects. This retrospective study showed that in a pre

Increase in vastus medialis cross-sectional area is associated with reduced pain, cartilage loss, and joint replacement risk in knee osteoarthritis.

Science.gov (United States)

Wang, Yuanyuan; Wluka, Anita E; Berry, Patricia A; Siew, Terence; Teichtahl, Andrew J; Urquhart, Donna M; Lloyd, David G; Jones, Graeme; Cicuttini, Flavia M

2012-12-01

Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross-sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA). One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs). After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = -0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient -10.9 [95% CI -19.5, -2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient -16.8 [95% CI -28.9, -4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]). In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement. Copyright © 2012 by the American College of Rheumatology.

Mechanisms of Osteoarthritic Pain. Studies in Humans and Experimental Models

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Annett Eitner

2017-11-01

Full Text Available Pain due to osteoarthritis (OA is one of the most frequent causes of chronic pain. However, the mechanisms of OA pain are poorly understood. This review addresses the mechanisms which are thought to be involved in OA pain, derived from studies on pain mechanisms in humans and in experimental models of OA. Three areas will be considered, namely local processes in the joint associated with OA pain, neuronal mechanisms involved in OA pain, and general factors which influence OA pain. Except the cartilage all structures of the joints are innervated by nociceptors. Although the hallmark of OA is the degradation of the cartilage, OA joints show multiple structural alterations of cartilage, bone and synovial tissue. In particular synovitis and bone marrow lesions have been proposed to determine OA pain whereas the contribution of the other pathologies to pain generation has been studied less. Concerning the peripheral neuronal mechanisms of OA pain, peripheral nociceptive sensitization was shown, and neuropathic mechanisms may be involved at some stages. Structural changes of joint innervation such as local loss and/or sprouting of nerve fibers were shown. In addition, central sensitization, reduction of descending inhibition, descending excitation and cortical atrophies were observed in OA. The combination of different neuronal mechanisms may define the particular pain phenotype in an OA patient. Among mediators involved in OA pain, nerve growth factor (NGF is in the focus because antibodies against NGF significantly reduce OA pain. Several studies show that neutralization of interleukin-1β and TNF may reduce OA pain. Many patients with OA exhibit comorbidities such as obesity, low grade systemic inflammation and diabetes mellitus. These comorbidities can significantly influence the course of OA, and pain research just began to study the significance of such factors in pain generation. In addition, psychologic and socioeconomic factors may aggravate

Reduced acute nociception and chronic pain in Shank2 ?/? mice

OpenAIRE

Ko, Hyoung-Gon; Oh, Seog-Bae; Zhuo, Min; Kaang, Bong-Kiun

2016-01-01

Autism spectrum disorder is a debilitating mental illness and social issue. Autism spectrum disorder patients suffer from social isolation, cognitive deficits, compulsive behavior, and sensory deficits, including hyposensitivity to pain. However, recent studies argued that autism spectrum disorder patients show physiological pain response and, in some cases, even extremely intense pain response to harmless stimulation. Recently, Shank gene family was reported as one of the genetic risk factor...

LAVENDER (LAVANDULA ANGUSTIFOLIA) AROMATHERAPY AS AN ALTERNATIVE TREATMENT IN REDUCING PAIN IN PRIMIPAROUS MOTHERS IN THE ACTIVE FIRST STAGE OF LABOR

OpenAIRE

Hilda Yani Karo Karo; Noor Pramono; Sri Wahyuni; Imam Djamaluddin Mashoedi; Leny Latifah

2017-01-01

Background: Labor and childbirth is an extremely painful process. Aromatherapy is considered as one of the nonpharmacological methods to reduce labor pain. Objective: To determine the effect of Lavender (Lavandula Angustifolia) aromatherapy on the level of pain in primipara in the first stage of labor. Methods: A quasy-experimental research with pretest and posttest design with control group conducted between October until November 2016. Forthy respondents selected using consecutive sa...

The Effects of Patellar Taping on Dynamic Balance and Reduction of Pain in Athletic Women with Patellofemoral Pain Syndrome(PFPS

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N Khoshraftare Yazdi

2012-08-01

Full Text Available Introduction: Patellofemoral pain syndrome(PFPS is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who attend to the sport medical clinics. Patellofemoral is more common among female athletes especially adolescents and young adults. Patellar taping provides an effective treatment in alleviating the symptoms of a high proportion of subjects who suffer from PFPS, though the mechanisms of pain reduction have not completely been established following its application. The purpose of this study was to investigate the effects of taping on dynamic balance and reduction of pain in athletic women with patellofemoral pain syndrome. Methods: Fifteen female athletes with patellofemoral pain syndrome participated in the study. Therefore, dynamic balance was assessed using a SEBT(Star Excursion Balance Test before and after application of patellar taping. The severity of pain was measured by VAS(Visual Analog Scale. Results: The results of variance analysis by VAS(p<0/008 in repeated measure indicated a statistically significant improvement in pain and in knee function in anterior, anteromedial, medial, posteromedial and anterolateral directions(p<0/05. Conclusion: The study results confirmed a significant improvement in reducing pain and increasing function (dynamic balance of female athletes with patellofemoral pain syndrome after patellar taping.

Electroacupuncture in conscious free-moving mice reduces pain by ameliorating peripheral and central nociceptive mechanisms

Science.gov (United States)

Wang, Ying; Lei, Jianxun; Gupta, Mihir; Peng, Fei; Lam, Sarah; Jha, Ritu; Raduenz, Ellis; Beitz, Al J.; Gupta, Kalpna

2016-01-01

Integrative approaches such as electroacupuncture, devoid of drug effects are gaining prominence for treating pain. Understanding the mechanisms of electroacupuncture induced analgesia would benefit chronic pain conditions such as sickle cell disease (SCD), for which patients may require opioid analgesics throughout life. Mouse models are instructive in developing a mechanistic understanding of pain, but the anesthesia/restraint required to administer electroacupuncture may alter the underlying mechanisms. To overcome these limitations, we developed a method to perform electroacupuncture in conscious, freely moving, unrestrained mice. Using this technique we demonstrate a significant analgesic effect in transgenic mouse models of SCD and cancer as well as complete Freund’s adjuvant-induced pain. We demonstrate a comprehensive antinociceptive effect on mechanical, cold and deep tissue hyperalagesia in both genders. Interestingly, individual mice showed a variable response to electroacupuncture, categorized into high-, moderate-, and non-responders. Mechanistically, electroacupuncture significantly ameliorated inflammatory and nociceptive mediators both peripherally and centrally in sickle mice correlative to the antinociceptive response. Application of sub-optimal doses of morphine in electroacupuncture-treated moderate-responders produced equivalent antinociception as obtained in high-responders. Electroacupuncture in conscious freely moving mice offers an effective approach to develop a mechanism-based understanding of analgesia devoid of the influence of anesthetics or restraints. PMID:27687125

Music reduces pain and increases resting state fMRI BOLD signal amplitude in the left angular gyrus in fibromyalgia patients

DEFF Research Database (Denmark)

Garza-Villarreal, Eduardo A; Jiang, Zhiguo; Vuust, Peter

2015-01-01

, correlated to the analgesia reports. The post-hoc seed-based functional connectivity analysis of the lAnG showed found higher connectivity after listening to music with right dorsolateral prefrontal cortex (rdlPFC), the left caudate (lCau), and decreased connectivity with right anterior cingulate cortex (r......Music reduces pain in fibromyalgia (FM), a chronic pain disease, but the functional neural correlates of music-induced analgesia (MIA) are still largely unknown. We recruited FM patients (n = 22) who listened to their preferred relaxing music and an auditory control (pink noise) for 5 min without...... external noise from fMRI image acquisition. Resting state fMRI was then acquired before and after the music and control conditions. A significant increase in the amplitude of low frequency fluctuations of the BOLD signal was evident in the left angular gyrus (lAnG) after listening to music, which in turn...

Evaluation of pain intensity measurement during the removal of wound dressing material using 'the PainVision™ system' for quantitative analysis of perception and pain sensation in healthy subjects.

Science.gov (United States)

Matsumura, Hajime; Imai, Ryutaro; Gondo, Masahide; Watanabe, Katsueki

2012-08-01

Reducing pain caused by the removal of adhesive wound dressing materials is very important in clinical practice and is also one of the factors to consider when choosing dressing materials. A visual analogue scale is the most popular method for assessing pain, but it is subjective and is difficult to evaluate quantitatively or statistically. Recently, a new method for the quantitative measurement of pain intensity using a painless electrical stimulation system, PainVision™, has been developed. In this study, we evaluated pain intensity during the removal of wound dressing materials in healthy volunteers by comparing pain during the removal of wound dressing materials, which use acrylic pressure-sensitive adhesive and pain during the removal of materials, which use soft silicone adhesive, as evaluated using the PainVision™ system. Pain intensity was significantly lower with the dressing materials, which use soft silicone adhesive when measured with the PainVision™ system. The PainVision™ system promises to be useful for the quantitative assessment of pain caused by the removal of adhesive wound dressing materials. Further studies are needed to determine whether the PainVision™ system is also effective in measuring pain caused by the removal of wound dressing materials in actual wounds. © 2012 The Authors. © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Statistical significance versus clinical importance: trials on exercise therapy for chronic low back pain as example.

NARCIS (Netherlands)

van Tulder, M.W.; Malmivaara, A.; Hayden, J.; Koes, B.

2007-01-01

STUDY DESIGN. Critical appraisal of the literature. OBJECIVES. The objective of this study was to assess if results of back pain trials are statistically significant and clinically important. SUMMARY OF BACKGROUND DATA. There seems to be a discrepancy between conclusions reported by authors and

Suprascapular block in the therapy of chronic pain in the shoulder and the shoulder joint: Suprascapular block

Directory of Open Access Journals (Sweden)

Palibrk Ivan

2016-01-01

Full Text Available Introduction: Chronic pain in the shoulder and the shoulder joint is a very common pathology in modern human population. The etiology of chronic pain is often unknown, although the trauma, degenerative diseases, inflammation, tumors and neurological disease appear as common etiologic factors. Patients with this pain had a significantly reduced quality of life.1,2 Method: During the two years, twelve patients diagnosed painful shoulder syndrome. Eleven of the twelve patients involved in the study had started physical therapy. Under the physical treatment pain intensity decreased, but not completely. Hand had reduced mobility. We applied a suprascapular block. We used 1 ml (7 mg betamethasone. Results: Suprascapular block was applied to the eleven patients in physical therapy. After three days of application, the pain was significantly reduced, by 50% in seven patients. Mobility of the hand was greatly improved. In three of the remaining four patients the block was repeated after one month. The pain was significantly smaller after that. Physical therapy is done all the time. Conclusion: The treatment of chronic pain in the shoulder and the shoulder joint is multidisciplinary. In some cases, the use of corticosteroids suprascapular block is very useful.

EFFICACY OF YOGA ON LOW BACK PAIN AND DISABILITY IN PRIMI GRAVIDAS

Directory of Open Access Journals (Sweden)

Prem Kumar B N

2016-04-01

Full Text Available Background: Low back pain is the most undesirable phase of women. Every pregnant woman would suffer from low back pain with mild or severe intensity. Various methods and forms of treatment have been practised to relive low back pain during child bearing phase without causing any harm to the developing foetus. This study has focussed on yoga to relieve the pain and disabilities due to low back pain in primi gravida women. Objective: To evaluate the effectiveness of yoga postures in reducing the low back pain and disability due to low back pain in second trimester of prima gravidas. Methods: Primi gravida women with low back pain were randomised to 2 groups, group-1 and group-2. The study was conducted for 8weeks and included 70 patients with 35 in group-1 and 30 in group-2. There were 5 drop outs. The selection criteria were based on patients suffering from low back pain which was further restricting their normal daily activities. The pain was assessed with VAS score of 0-10 with mean of 5.6 and 6.2 respectively in experimental and control group respectively before the treatment and disabilities were assessed with MODI with mean score 52% and 57 % respectively before treatment. The Group-1 was treated with yoga postures and group-2 by gynaecologists’ advice with acetaminophen, external topical gel and moist heat modalities. Results: The study concluded that there was significant reduction of pain on VAS score (p<0.001 and reduced disabilities on MODI (p<0.001 in both the groups. The statistical analysis showed there was significance within the interventional group and also within control group. Whereas the analysis done between the groups showed high significance of the interventional group having better recovery than the control group at the end of 8 weeks. Conclusion: Yoga postures had higher benefits in alleviating the low back pain and reducing disabilities related to low back pain in primi gravidas.

ABDOMINAL DRAWING IN MANEUVER: EFFECT ON GAIT PARAMETERS AND PAIN REDUCTION IN PATIENTS WITH CHRONIC LOW BACK PAIN

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Paramasivan Mani

2016-08-01

Full Text Available Background: Back pain is the common musculoskeletal condition with a high prevalence of up to 80% among the general and work force population at some times in their lives.Muscular injury, fatigue, or facet or disc degeneration can compromise the stabilizing effects resulting in shearing forces that cause pain.Abdominal drawing in maneuver is used to facilitate the re-education of neuromuscular control mechanisms provided by local stabilizing muscles. Objective of the study is to measure the gait parameters and pain control before and after abdominal drawing in maneuver in patient with chronic mechanical low back pain. Methods: Total number of 30 consecutive patients and they were divided into two groups by purposive sampling. Group A is subjects with low back pain and Group B is subjects without low back pain. Outcome measures were average step cycle, average step length, coefficient of variation, time on each foot, Ambulation index measured with Biodex gait trainer. Pain is measured with Revised-Oswestry low back pain questionnaire. Results: Significant difference between gait parameters were observed in both low back pain group and the group without low back pain group with abdominal drawing in maneuver and the changes without abdominal drawing in maneuver was minimal. There was no significant difference found between both groups with or without abdominal drawing in maneuver. Conclusion: Gait parameters and Pain control can be improved by training with abdominal drawing in maneuver thereby it reduces pain and improves gait symmetry in subjects with low back pain.

Chronic pain, work performance and litigation.

Science.gov (United States)

Blyth, Fiona M; March, Lyn M; Nicholas, Michael K; Cousins, Michael J

2003-05-01

The overall population impact of chronic pain on work performance has been underestimated as it has often been described in terms of work-related absence, excluding more subtle effects that chronic pain may have on the ability to work effectively. Additionally, most studies have focussed on occupational and/or patient cohorts and treatment seeking, rather than sampling from the general population. We undertook a population-based random digit dialling computer-assisted telephone survey with participants randomly selected within households in order to measure the impact of chronic pain on work performance. In addition, we measured the association between pain-related disability and litigation. The study took place in Northern Sydney Health Area, a geographically defined urban area of New South Wales, Australia, and included 484 adults aged 18 or over with chronic pain. The response rate was 73.4%. Working with pain was more common (on an average 83.8 days in 6 months) than lost work days due to pain (4.5 days) among chronic pain participants in full-time or part-time employment. When both lost work days and reduced-effectiveness work days were summed, an average of 16.4 lost work day equivalents occurred in a 6-month period, approximately three times the average number of lost work days. In multiple logistic regression modelling with pain-related disability as the dependent variable, past or present pain-related litigation had the strongest association (odds ratio (OR)=3.59, P=0.001). In conclusion, chronic pain had a larger impact on work performance than has previously been recognised, related to reduced performance while working with pain. A significant proportion were able to work effectively with pain, suggesting that complete relief of pain may not be an essential therapeutic target. Litigation (principally work-related) for chronic pain was strongly associated with higher levels of pain-related disability, even after taking into account other factors

Transcutaneous Electrical Nerve Stimulation (TENS) reduces pain, fatigue, and hyperalgesia while restoring central inhibition in primary fibromyalgia

OpenAIRE

Dailey, Dana L; Rakel, Barbara A; Vance, Carol GT; Liebano, Richard E; Anand, Amrit S; Bush, Heather M; Lee, Kyoung S; Lee, Jennifer E; Sluka, Kathleen A

2013-01-01

Because TENS works by reducing central excitability and activating central inhibition pathways, we tested the hypothesis that TENS would reduce pain and fatigue and improve function and hyperalgesia in people with fibromyalgia who have enhanced central excitability and reduced inhibition. The current study used a double-blinded randomized, placebo controlled cross-over design to test effects of a single treatment of TENS in people with fibromyalgia. Three treatments were assessed in random or...

Quality of life considerations and pain management in hidradenitis suppurativa

DEFF Research Database (Denmark)

Jemec, Gregor Be

2017-01-01

perceived as unclean and stigmatizing by the patients, but also cause pain and scarring making this inflammatory skin disorder unique. It is obvious that the disease has a significant negative impact on the patients' quality of life (QOL). The impact is influenced not only by the pain which is a significant...... independent contributor to the patients' life quality, but by the clinically significant comorbidity associated with HS. In particular, the psychological comorbidities of depression and anxiety both further compound QOL impairment and pain. It is strongly recommended that these factors be taken into account...... when planning a treatment strategy for patients with HS, and that specific steps are taken to manage pain and comorbidities associated with the reduced QOL generally experienced by this group of patients. Basic pain management includes anti-inflammatory treatments as well as local- and central...

Analgesic effect of clobazam in chronic low-back pain but not in experimentally induced pain.

Science.gov (United States)

Schliessbach, J; Vuilleumier, P H; Siegenthaler, A; Bütikofer, L; Limacher, A; Juni, P; Zeilhofer, H U; Arendt-Nielsen, L; Curatolo, M

2017-09-01

Chronic pain is frequently associated with hypersensitivity of the nervous system, and drugs that increase central inhibition are therefore a potentially effective treatment. Benzodiazepines are potent modulators of GABAergic neurotransmission and are known to exert antihyperalgesic effects in rodents, but translation into patients are lacking. This study investigates the effect of the benzodiazepine clobazam in chronic low-back pain in humans. The aim of this study is to explore the effect of GABA modulation on chronic low-back pain and on quantitative sensory tests. In this double-blind cross-over study, 49 patients with chronic low-back pain received a single oral dose of clobazam 20 mg or active placebo tolterodine 1 mg. Pain intensity on the 0-10 numeric rating scale and quantitative sensory tests were assessed during 2 h after drug intake. Pain intensity in the supine position was significantly reduced by clobazam compared to active placebo (60 min: 2.9 vs. 3.5, p = 0.008; 90 min: 2.7 vs. 3.3, p = 0.024; 120 min: 2.4 vs. 3.1, p = 0.005). Pain intensity in the sitting position was not significantly different between groups. No effects on quantitative sensory tests were observed. This study suggests that clobazam has an analgesic effect in patients with chronic low-back pain. Muscle relaxation or sedation may have contributed to the effect. Development of substances devoid of these side effects would offer the potential to further investigate the antihyperalgesic action of GABAergic compounds. Modulation of GABAergic pain-inhibitory pathways may be a potential future therapeutic target. © 2017 European Pain Federation - EFIC®.

Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia

Science.gov (United States)

Emerson, Nichole M.; Farris, Suzan R.; Ray, Jenna N.; Jung, Youngkyoo; McHaffie, John G.; Coghill, Robert C.

2015-01-01

Mindfulness meditation reduces pain in experimental and clinical settings. However, it remains unknown whether mindfulness meditation engages pain-relieving mechanisms other than those associated with the placebo effect (e.g., conditioning, psychosocial context, beliefs). To determine whether the analgesic mechanisms of mindfulness meditation are different from placebo, we randomly assigned 75 healthy, human volunteers to 4 d of the following: (1) mindfulness meditation, (2) placebo conditioning, (3) sham mindfulness meditation, or (4) book-listening control intervention. We assessed intervention efficacy using psychophysical evaluation of experimental pain and functional neuroimaging. Importantly, all cognitive manipulations (i.e., mindfulness meditation, placebo conditioning, sham mindfulness meditation) significantly attenuated pain intensity and unpleasantness ratings when compared to rest and the control condition (p Mindfulness meditation reduced pain intensity (p = 0.032) and pain unpleasantness (p Mindfulness meditation also reduced pain intensity (p = 0.030) and pain unpleasantness (p = 0.043) ratings more than sham mindfulness meditation. Mindfulness-meditation-related pain relief was associated with greater activation in brain regions associated with the cognitive modulation of pain, including the orbitofrontal, subgenual anterior cingulate, and anterior insular cortex. In contrast, placebo analgesia was associated with activation of the dorsolateral prefrontal cortex and deactivation of sensory processing regions (secondary somatosensory cortex). Sham mindfulness meditation-induced analgesia was not correlated with significant neural activity, but rather by greater reductions in respiration rate. This study is the first to demonstrate that mindfulness-related pain relief is mechanistically distinct from placebo analgesia. The elucidation of this distinction confirms the existence of multiple, cognitively driven, supraspinal mechanisms for pain

Pain education combined with neck- and aerobic training is more effective at relieving chronic neck pain than pain education alone--A preliminary randomized controlled trial.

Science.gov (United States)

Brage, K; Ris, I; Falla, D; Søgaard, K; Juul-Kristensen, B

2015-10-01

To evaluate the effect of training and pain education vs pain education alone, on neck pain, neck muscle activity and postural sway in patients with chronic neck pain. Twenty women with chronic neck pain were randomized to receive pain education and specific training (neck-shoulder exercises, balance and aerobic training) (INV), or pain education alone (CTRL). Effect on neck pain, function and Global Perceived Effect (GPE) were measured. Surface electromyography (EMG) was recorded from neck flexor and extensor muscles during performance of the Cranio-Cervical Flexion Test (CCFT) and three postural control tests (two-legged: eyes open and closed, one-legged: eyes open). Sway parameters were calculated. Fifteen participants (CTRL: eight; INV: seven) completed the study. Per protocol analyses showed a larger pain reduction (p = 0.002) for the INV group with tendencies for increased GPE (p = 0.06), reduced sternocleidomastoid activity during the CCFT (p = 0.09), reduced sway length (p = 0.09), and increased neck extensor activity (p = 0.02) during sway compared to the CTRL group. Pain education and specific training reduce neck pain more than pain education alone in patients with chronic neck pain. These results provide encouragement for a larger clinical trial to corroborate these observations. Copyright © 2015 Elsevier Ltd. All rights reserved.

The relation between pain extent and quality-of-life, psychological factors and neck funktion in patients with chronic neck pain

DEFF Research Database (Denmark)

Ris Hansen, Inge; Barbero, Marco; Falla, Deborah

factors and/or decreased function of the involved body parts. Purpose: To study the relation between pain extent with 1) quality of life, 2) kinesiophobia, depression, 3) cervical muscle function and mobility and additionally the relation of pain extent with the origin of pain being traumatic or non...... of Kinesiophobia (TSK), Beck Depression Inventory-II (BDI-ll), Neck Disability Index (NDI) and clinical tests: Craniocervical Flexion Test (CCFT), Cervical Extension Test (CE), and Cervical Range of Motion (CROM). Results: Significant positive correlations were observed between pain extent and NDI (r = 0.33; p... to the origin being traumatic or non-traumatic. Conclusion: Pain extent extracted from pain drawings are moderately correlated with patient-reported neck function, and weakly correlated with depression, kinesiophobia and cervical clinical tests. In clinical decision-making, pain extent may indicate reduced neck...

Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

Directory of Open Access Journals (Sweden)

Burns LC

2015-01-01

predictor of chronic pain persisting ≥3 months following TKA in five of the studies assessed. Limitations of studies included lack of large-scale data, absence of standardized pain measurements, inadequate multivariate adjustment, such as failure to control for analgesic use and other relevant covariates, and failure to report non-significant parameter estimates. Conclusion: This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA. Directions for future research include larger, well-controlled studies with standard pain outcomes, identification of clinically-relevant catastrophizing cut-offs that predict pain outcomes, investigation of other psychosocial risk factors, and assessment of interventions aimed to reduce pain catastrophizing on chronic pain outcomes following TKA surgery. Keywords: pain catastrophizing, total knee arthroplasty, total knee replacement, knee arthroplasty, risk factors, chronic pain

The genetic influence on the cortical processing of experimental pain and the moderating effect of pain status.

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Helen Vossen

Full Text Available BACKGROUND: Research suggests that the COMT Val(158Met, BDNF Val(66Met and OPRM1 A(118G polymorphisms moderate the experience of pain. In order to obtain experimental confirmation and extension of findings, cortical processing of experimentally-induced pain was used. METHOD: A sample of 78 individuals with chronic low back pain complaints and 37 healthy controls underwent EEG registration. Event-Related Potentials were measured in response to electrical nociceptive stimuli and moderation by COMT Val(158Met, BDNF Val(66Met and OPRM1 A(118G polymorphisms was assessed. RESULTS: Genetic variation did not have a direct effect on cortical processing of experimental pain. However, genetic effects (COMT Val(158Met and BDNF Val(66Met on experimental pain were moderated by the presence of chronic pain. In the presence of chronic pain, the COMT Met allele and the BDNF Met allele augmented cortical pain processing, whilst reducing pain processing in pain-free controls. No significant effects were found concerning the OPRM1 A(118G polymorphism. CONCLUSIONS: The current study suggests that chronic experience of pain enhances genetic sensitivity to experimentally induced mildly painful stimuli, possibly through a process of epigenetic modification.

Brunkow exercises and low back pain

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Emela Mujić Skikić

2004-11-01

Full Text Available Brunkow exercises starting with dynamic contraction of hands and feet with fixed point on the wrist or/and heal. Dynamic contraction from the beginning, transferring through kinetic chain, leads to isometric contraction of the group of muscles, which has to be included in the exercise. Starting positions determine the group of muscles to be trained. The purpose of this study is to investigate influence of Brunkow exercises on spinal motion improvement and pain relief and to evaluate use of Brunkow exercises, as a routine method for lower back pain in Physical Medicine and Rehabilitation Centres. Thirty-four patients with symptoms of low back pain were included in study. Patients received a mean of 14.9 treatments with standard deviation of 8.96. All patients were assessed before and after the treatment for spinal mobility and flexibility as well as pain intensity. All parameters for spinal movements showed statistically significant improvement in patients with low back pain who practiced Brunkow exercise program at the end of treatment in relations to pre-treatment values, with significant difference of p<0.01 for all motions. Pain was reduced on VAS for X=1.,7 with S.D. 1.97. Difference Test was t=6.020 with significant difference p<0.01. Flexibility of spine increased, so average difference in values before and after treatment for Shober test was 0.5 cm with SD 0.65. Difference test was t=3.794 with significant difference p<0.01. Brunkow exercises for low back pain are beneficial treatment for increasing flexibility and mobility of spine and improving the pain.

Pain management in sickle cell disease: What remedy to reduce the ...

African Journals Online (AJOL)

Sickle cell disease is an inherited disorder, the hallmark of which is recurrent acute painful crises requiring opioid therapy. These acute painful episodes when superimposed on chronic pain could last for years especially in association with comorbidities like osteonecrosis, chronic leg ulcers, cholelithiasis or stuttering ...

Is physiotherapy integrated virtual walking effective on pain, function, and kinesiophobia in patients with non-specific low-back pain? Randomised controlled trial.

Science.gov (United States)

Yilmaz Yelvar, Gul Deniz; Çırak, Yasemin; Dalkılınç, Murat; Parlak Demir, Yasemin; Guner, Zeynep; Boydak, Ayşenur

2017-02-01

According to literature, virtual reality was found to reduce pain and kinesiophobia in patients with chronic pain. The purpose of the study was to investigate short-term effect of the virtual reality on pain, function, and kinesiophobia in patients with subacute and chronic non-specific low-back pain METHODS: This randomised controlled study in which 44 patients were randomly assigned to the traditional physiotherapy (control group, 22 subjects) or virtual walking integrated physiotherapy (experimental group, 22 subjects). Before and after treatment, Visual Analog Scale (VAS), TAMPA Kinesiophobia Scale (TKS), Oswestry Disability Index (ODI), Nottingham Health Profile (NHP), Timed-up and go Test (TUG), 6-Minute Walk Test (6MWT), and Single-Leg Balance Test were assessed. The interaction effect between group and time was assessed by using repeated-measures analysis of covariance. After treatment, both groups showed improvement in all parameters. However, VAS, TKS, TUG, and 6MWT scores showed significant differences in favor of the experimental group. Virtual walking integrated physiotherapy reduces pain and kinesiophobia, and improved function in patients with subacute and chronic non-specific low-back pain in short term.

Evaluation of pain management interventions for neonatal circumcision pain.

Science.gov (United States)

Joyce, B A; Keck, J F; Gerkensmeyer, J

2001-01-01

The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics (EMLA) on pain responses of neonates undergoing circumcision. A randomized, double-blind experimental design was used with 23 neonates. Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate, respiratory rate, oxygen saturation levels, salivary cortisol levels, and length of cry. Each infant's state was examined for a potential contribution to the pain response. Infant state, salivary cortisol levels, and respiratory rates were not significant. Pain ratings had considerable variability for all treatment conditions, but both single treatment groups had less pain by the end of the procedure. The heart rate was significantly lower for the EMLA group and remained stable for the music group. Oxygen saturation differences were statistically significant for the music group (P =.02) and approached significance for the EMLA group. Preliminary support was provided for the efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision. Further study is warranted. Neonates deserve interventions that will provide them with a less painful start in life.

Nursing Music Protocol and Postoperative Pain.

Science.gov (United States)

Poulsen, Michael J; Coto, Jeffrey

2018-04-01

Pain has always been a major concern for patients and nurses during the postoperative period. Therapies, medicines, and protocols have been developed to improve pain and anxiety but have undesirable risks to the patient. Complementary and alternative medicine therapies have been studied but have not been applied as regular protocols in the hospital setting. Music is one type of complementary and alternative medicine therapy that has been reported to have favorable results on reducing postoperative pain, anxiety, and opioid usage. However, music lacks a protocol that nurses can implement during the perioperative process. This paper is an in-depth literature review assessing a best practice recommendation and protocol that establishes a consensus in the use of music therapy. The results suggest that music therapy may consist of calming, soft tones of 60-80 beats per minute for at least 15-30 minutes at least twice daily during the pre- and postoperative periods. It is suggested that music only be used in conjunction with standards of care and not as the primary intervention of pain or anxiety. This evidence suggests that proper use of music therapy can significantly reduce surgical pain. Implementing these protocols and allowing the freedom of nursing staff to use them may lead to greater reductions in surgical pain and anxiety and a reduction in opioid use. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Ketamine in the treatment of acute pain.

Science.gov (United States)

Brinck, Elina; Kontinen, Vesa

2017-01-01

Ketamine is an old anesthetic agent that relieves pain by reducing central sensitization in the central nervous system. This is advantageous for patients suffering from severe pain prior to surgery or are using a strong opioid. The S enantiomer of ketamine used for anesthesia is more powerful than racemic ketamine. The ideal dose of ketamine for pain relief is not yet known, and its adverse effects on the central nervous system, including hallucinations, sedation, and diplopia have limited its use in pain management. The significance of these effects at low doses is probably less than expected, particularly if benzodiazepines or an alpha-2 agonist, such as dexmedetomidine, are administered in addition to ketamine.

Factors related to pain during routine photodynamic therapy

DEFF Research Database (Denmark)

Miller, I M; Nielsen, J S; Lophaven, S

2011-01-01

between pain-reducing intervention and diagnosis, pre-treatment, gender or age was found. CONCLUSIONS: Pain-reducing intervention was required in 44% of the PDT treatments. Intervention was particularly required when treating lesions in areas suited for PDT therapy for cosmetic reasons such as the scalp......BACKGROUND: Pain may be a limiting factor in the use of photodynamic therapy (PDT). The consequences of the pain i.e. the resources spent on pain-intervention during routine PDT therapy are poorly described. OBJECTIVES: To describe the consequences of pain during PDT by describing the use of pain......-reducing interventions in routine use. We studied the frequency as well as level of pain-reducing intervention. METHODS: Descriptive data from PDT treated patients. The level of pain-reducing intervention was graded 0, no intervention; +, cold water spray and ++, pause or nerve block. RESULTS: Data from 983 PDT...

Meditation reduces pain-related neural activity in the anterior cingulate cortex, insula, secondary somatosensory cortex, and thalamus

Science.gov (United States)

Nakata, Hiroki; Sakamoto, Kiwako; Kakigi, Ryusuke

2014-01-01

Recent studies have shown that meditation inhibits or relieves pain perception. To clarify the underlying mechanisms for this phenomenon, neuroimaging methods, such as functional magnetic resonance imaging, and neurophysiological methods, such as magnetoencephalography and electroencephalography, have been used. However, it has been difficult to interpret the results, because there is some paradoxical evidence. For example, some studies reported increased neural responses to pain stimulation during meditation in the anterior cingulate cortex (ACC) and insula, whereas others showed a decrease in these regions. There have been inconsistent findings to date. Moreover, in general, since the activities of the ACC and insula are correlated with pain perception, the increase in neural activities during meditation would be related to the enhancement of pain perception rather than its reduction. These contradictions might directly contribute to the ‘mystery of meditation.’ In this review, we presented previous findings for brain regions during meditation and the anatomical changes that occurred in the brain with long-term meditation training. We then discussed the findings of previous studies that examined pain-related neural activity during meditation. We also described the brain mechanisms responsible for pain relief during meditation, and possible reasons for paradoxical evidence among previous studies. By thoroughly overviewing previous findings, we hypothesized that meditation reduces pain-related neural activity in the ACC, insula, secondary somatosensory cortex, and thalamus. We suggest that the characteristics of the modulation of this activity may depend on the kind of meditation and/or number of years of experience of meditation, which were associated with paradoxical findings among previous studies that investigated pain-related neural activities during meditation. PMID:25566158

Reduced thoracolumbar fascia shear strain in human chronic low back pain

Directory of Open Access Journals (Sweden)

Konofagou Elisa E

2011-09-01

Full Text Available Abstract Background The role played by the thoracolumbar fascia in chronic low back pain (LBP is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP. Methods We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity. Results Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p Conclusion Thoracolumbar fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in altered connective tissue function.

Central Pain Syndrome

Science.gov (United States)

... such as neurontin (gabapentin) can be useful. Lowering stress levels appears to reduce pain. View Full Treatment Information Definition Central pain syndrome is a neurological condition caused ...

Impact of a pain protocol including hypnosis in major burns.

Science.gov (United States)

Berger, Mette M; Davadant, Maryse; Marin, Christian; Wasserfallen, Jean-Blaise; Pinget, Christophe; Maravic, Philippe; Koch, Nathalie; Raffoul, Wassim; Chiolero, René L

2010-08-01

Pain is a major issue after burns even when large doses of opioids are prescribed. The study focused on the impact of a pain protocol using hypnosis on pain intensity, anxiety, clinical course, and costs. All patients admitted to the ICU, aged >18 years, with an ICU stay >24h, accepting to try hypnosis, and treated according to standardized pain protocol were included. Pain was scaled on the Visual Analog Scale (VAS) (mean of daily multiple recordings), and basal and procedural opioid doses were recorded. Clinical outcome and economical data were retrieved from hospital charts and information system, respectively. Treated patients were matched with controls for sex, age, and the burned surface area. Forty patients were admitted from 2006 to 2007: 17 met exclusion criteria, leaving 23 patients, who were matched with 23 historical controls. Altogether patients were 36+/-14 years old and burned 27+/-15%BSA. The first hypnosis session was performed after a median of 9 days. The protocol resulted in the early delivery of higher opioid doses/24h (ppatient. A pain protocol including hypnosis reduced pain intensity, improved opioid efficiency, reduced anxiety, improved wound outcome while reducing costs. The protocol guided use of opioids improved patient care without side effects, while hypnosis had significant psychological benefits.

Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomised clinical trial

DEFF Research Database (Denmark)

de Vos, Cecile C; Meier, Kaare; Zaalberg, Paul Brocades

2014-01-01

Painful diabetic neuropathy (PDN) is a peripheral neuropathic pain condition that is often difficult to relieve. Spinal cord stimulation (SCS) is a proven effective therapy for various types of mixed neuropathic conditions, yet effectiveness of SCS treatment for PDN is not well established. To our......D questionnaires also showed that patients in the SCS group, unlike those in the control group, experienced reduced pain and improved health and quality of life after 6 months of treatment. In patients with refractory painful diabetic neuropathy, spinal cord stimulation therapy significantly reduced...

The Effects of Workplace Physical Activity Programs on Musculoskeletal Pain: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Moreira-Silva, Isabel; Teixeira, Pedro M; Santos, Rute; Abreu, Sandra; Moreira, Carla; Mota, Jorge

2016-05-01

This article reviews the effectiveness of physical activity (PA) interventions at the workplace to reduce musculoskeletal pain among employees and assesses the effect size of these programs using meta-analysis. Four databases (i.e., PubMed, EBSCO, Web of Science, and Cochrane) were searched for research trials, which included comparison groups of employees that assessed PA programs, musculoskeletal pain, and health-related behaviors, published between January 1990 and March 2013. The meta-analysis estimates of standardized mean differences (Hedges' g) present significant evidence of less general pain (g = -.40 with a 95% confidence interval [CI] = [-0.78, -0.02]) and neck and shoulder pain (g = -.37 with a 95% CI = [-0.63, -0.12]) in intervention groups. The few studies of low back pain and arm, elbow, wrist, hand, or finger pain did not present sufficient statistically significant evidence. Consistent evidence demonstrates that workplace PA interventions significantly reduce general musculoskeletal pain and neck and shoulder pain. More studies are needed to determine the effectiveness of work-related PA interventions for arm, elbow, wrist, hand or finger, and low back pain. © 2016 The Author(s).

Listening to music during electromyography does not influence the examinee's anxiety and pain levels.

Science.gov (United States)

Abraham, Alon; Drory, Vivian E

2014-09-01

Listening to music is a low-cost intervention that has demonstrated ability to reduce pain and anxiety levels in various medical procedures. Subjects undergoing electrophysiological examinations were randomized into a music-listening group and a control group. Visual analog scales were used to measure anxiety and pain levels during the procedure. Thirty subjects were randomized to each group. No statistically significant difference was found in anxiety or pain levels during the procedure between groups. However, most subjects in the music-listening group reported anxiety and pain reduction and would prefer to hear music in a future examination. Although listening to music during electrophysiological examinations did not reduce anxiety or pain significantly, most subjects felt a positive effect and would prefer to hear music; therefore, we suggest that music may be offered optionally in the electromyography laboratory setting. © 2014 Wiley Periodicals, Inc.

Novel orally available salvinorin A analog PR-38 inhibits gastrointestinal motility and reduces abdominal pain in mouse models mimicking irritable bowel syndrome.

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Sałaga, M; Polepally, P R; Sobczak, M; Grzywacz, D; Kamysz, W; Sibaev, A; Storr, M; Do Rego, J C; Zjawiony, J K; Fichna, J

2014-07-01

The opioid and cannabinoid systems play a crucial role in multiple physiological processes in the central nervous system and in the periphery. Selective opioid as well as cannabinoid (CB) receptor agonists exert a potent inhibitory action on gastrointestinal (GI) motility and pain. In this study, we examined (in vitro and in vivo) whether PR-38 (2-O-cinnamoylsalvinorin B), a novel analog of salvinorin A, can interact with both systems and demonstrate therapeutic effects. We used mouse models of hypermotility, diarrhea, and abdominal pain. We also assessed the influence of PR-38 on the central nervous system by measurement of motoric parameters and exploratory behaviors in mice. Subsequently, we investigated the pharmacokinetics of PR-38 in mouse blood samples after intraperitoneal and oral administration. PR-38 significantly inhibited mouse colonic motility in vitro and in vivo. Administration of PR-38 significantly prolonged the whole GI transit time, and this effect was mediated by µ- and κ-opioid receptors and the CB1 receptor. PR-38 reversed hypermotility and reduced pain in mouse models mimicking functional GI disorders. These data expand our understanding of the interactions between opioid and cannabinoid systems and their functions in the GI tract. We also provide a novel framework for the development of future potential treatments of functional GI disorders. Copyright © 2014 by The American Society for Pharmacology and Experimental Therapeutics.

Effect of orthodontic pain on quality of life of patients undergoing orthodontic treatment.

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Banerjee, Sujoy; Banerjee, Rajlakshmi; Shenoy, Usha; Agarkar, Sanket; Bhattacharya, Sangeeta

2018-01-01

Pain is an important aspect of oral health-related quality of life (OHRQOL). Understanding how patients' pain experiences during their treatment affect their quality of life (QOL) is important and the absence of pain/discomfort is important for achieving a high QOL. The objective of this study was to assess the relationship between pain and OHRQOL among patients wearing fixed orthodontic appliances and to evaluate whether patient motivation and counseling had an effect on the pain and discomfort. The McGill-Short-Form with visual analog scale and present pain intensity and Oral Health Impact Profile-14 indices were used to determine the intensity and severity of pain and to evaluate the QOL of 200 adolescents undergoing fixed orthodontic treatment during different phases of treatment. There was a significant correlation found between pain and the QOL of patients undergoing orthodontic treatment. Overall score of OHRQOL increased significantly (mean 43.5 ± 10.9) in the initial phase of treatment where the incidence of severe to moderate pain was reported in 80% patients. Ninety-five percent patients felt pain or discomfort. After 1 day of appliance placement, more than 85% of patients experienced severe to mild pain whereas 9% of patients suffered very severe pain. Pain reduced over a week, and at the end of a month, 10.5% patients had moderate pain whereas majority, i.e., 58% of patients complained of only mild pain (P orthodontic treatment and has a significant effect on the QOL of orthodontic patients, especially during the initial phases of treatment. Patient motivation and counseling by the orthodontist have a profounding effect in reducing the pain and discomfort, improving the QOL, and an overall improvement in the patient compliance affecting the successful outcome of the treatment.

Treatment of Severe Cancer Pain by Transdermal Fentanyl

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Dženita Ljuca

2010-05-01

Full Text Available The goal of research was to determine the frequency, intensity, time of occurrence, duration and causes of breakthrough pain (BTP in patients whose carcinoma pain was treated by transdermal fentanyl. (TDF. A prospective study was conducted in a hospice for recumbent patients of the Centre for Palliative Care (hospice University Clinical Centre Tuzla from October 2009 to December 2010. 33 patients in terminal stage of carcinoma, who had been treated by transdermal fentanyl due to their excruciating pain (7-10 mark on numerica! scale with initial dosage of 25 μg as a strong opiate analgesic, were monitored within the time period of 10 days. In the statistics we used the even T - test, the Wilcox test and Mann -Whitney test. The difference was seen to be significant at p < 0,05. Treatment by transdermal fentanyl significantly reduces the intensity of strong carcinoma pain (p < 0.0001, with a frequent requirement for dose increase with bone metastasis. The intensity of BTP is higher compared to the pain experienced upon reception. The frequency and intensity of BTP are significantly reduced already in the second day of treatment by transdermal fentanyl (p = 0,0024. The BTP is most intense in patients with neck and head tumours (9,26 ± 0,66, and most frequent with abdomen and pelvic tumour. The biggest number of BTP (68.3 % occurs within first three days of treatment. BTP most frequently occurs in the evening or at night (between 18:00 and 06:00 h in 62,2 % of the cases, with the duration of usually less than 15 minutes (65,2% of the cases. In 61,6 % cases the occurrence of BTP is related to physical activities or psychosocial incidents, while the cause is undetermined in 38,4 % of examinees.BTP is most frequent within first three days of treatment by TDF. Using the optimal dosage a good control of carcinoma pain is enabled, regardless of the occurrence of bone metastasis, while it also helps reduce the frequency and intensity of BTP.

Effectiveness of non-pharmacological measures for reducing pain and fear in children during venipuncture in the emergency department: a vibrating cold devices versus distraction.

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García-Aracil, Noelia; Ramos-Pichardo, Juan Diego; Castejón-de la Encina, María Elena; José-Alcaide, Lourdes; Juliá-Sanchís, Rocío; Sanjuan-Quiles, Ángela

2018-06-01

To assess the effectiveness of a physical method of managing pain and fear in children and anxiety in the accompanying adult during venous puncture in the emergency department. Quasi-experimental study of 3 groups: one group used a combination of directed distraction by means of a vibration device with ice pack, a second group received only distraction, and no strategy was used in the third. Pain and adult anxiety were similar in the 2 groups in which a pain management strategy was applied. Pain and adult anxiety were greater when no strategy was adopted. We detected no differences in the level of the children's fear. Directed distraction can be useful for managing pain in children and it reduces the anxiety experienced by accompanying adults. The use of a vibration device with ice does not add benefits. Fear is not reduced by any of these measures.

A randomized controlled trial to assess the pain associated with the debond of orthodontic fixed appliances

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Mangnall, Louise A R; Dietrich, Thomas; Scholey, John M

2013-01-01

Objective: To determine patient experience of pain during treatment with fixed orthodontic appliances, expectations of pain during debond and whether biting on a soft acrylic wafer during debond decreases pain experience. Design: Multicentre randomized controlled trial. Setting: Three UK hospital based orthodontic departments: Mid-Staffordshire NHS Foundation Trust, Birmingham Dental Hospital and University Hospital of North Staffordshire. Materials and methods: Ninety patients were randomly allocated to either the control (n = 45) or wafer group (n = 45). A visual analogue scale-based questionnaire was completed pre-debond to determine pain experience during treatment and expectations of pain during debond. The appliances were debonded and those in the wafer group bit on a soft acrylic wafer. A second questionnaire was completed post-debond to assess the pain experienced. Results: Biting on an acrylic wafer significantly reduced the pain experienced when debonding the posterior teeth (P≤0·05). Thirty-nine per cent found the lower anterior teeth the most painful. The expected pain was significantly greater than that actually experienced (P≤0·0001). Greater pain during treatment correlated with increased expectations and increased actually experienced pain (P≤0·0001). Conclusions: Biting on a soft acrylic wafer during debond of the posterior teeth reduces the pain experienced. The lower anterior teeth are the most painful. The pain expected is significantly greater than actually experienced. Patients who had greater pain during treatment expected and experienced greater pain at debond. PMID:24009318

Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition

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Becker, Susanne; Gandhi, Wiebke; Kwan, Saskia; Ahmed, Alysha-Karima; Schweinhardt, Petra

2015-01-01

When in pain, pain relief is much sought after, particularly for individuals with chronic pain. In analogy to augmentation of the hedonic experience ("liking") of a reward by the motivation to obtain a reward ("wanting"), the seeking of pain relief in a motivated state might increase the experience of pain relief when obtained. We tested this hypothesis in a psychophysical experiment in healthy human subjects, by assessing potential pain-inhibitory effects of pain relief "won" in a wheel of fortune game compared with pain relief without winning, exploiting the fact that the mere chance of winning induces a motivated state. The results show pain-inhibitory effects of pain relief obtained by winning in behaviorally assessed pain perception and ratings of pain intensity. Further, the higher participants scored on the personality trait novelty seeking, the more pain inhibition was induced. These results provide evidence that pain relief, when obtained in a motivated state, engages endogenous pain-inhibitory systems beyond the pain reduction that underlies the relief in the first place. Consequently, such pain relief might be used to improve behavioral pain therapy, inducing a positive, perhaps self-amplifying feedback loop of reduced pain and improved functionality.

The relationship between pain, disability, guilt and acceptance in low back pain: a mediation analysis.

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Serbic, Danijela; Pincus, Tamar

2017-08-01

Pain-related guilt is a common yet unexplored psychological factor in low back pain (LBP). It has recently been linked to greater depression, anxiety and disability in LBP, hence an understanding of how it can be managed in the presence of pain and disability is necessary. Since acceptance of pain has been shown to be associated with improved outcomes in chronic pain, we examined whether it might also help reduce guilt in people with LBP. To this end, a series of mediation analyses were conducted on data from 287 patients with chronic LBP, in which acceptance of pain was tested as a mediator of the relationship between pain/disability and guilt. Results showed that acceptance of pain reduced the impact of pain/disability on pain-related guilt in all mediation analyses. Pain-related guilt might be a potential target for acceptance based interventions, thus this relationship should be further tested using longitudinal designs.

Comparison of relaxation with counterpressure massage techniques for reduce pain first stage of labor

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Lisa, U. F.; Jalina, M.; Marniati

2017-09-01

Based on interviews of so me mother who entered the first stage of labor lack of care from health workers to the effort to reducing the acuteof labor. Health care workers appertain hospital in effective in implement maternity nursing interventions in reducing acute the first stage of labor. The reducing acute have two method are pharmacological and non-pharmacological. In this case, has several techniques there are: relaxation and counterpressure massage techniques that capable to reducing acute first stage of labor. The of non-pharmacological is one of authority which must be implemented by midwives especially breathing relaxation techniquesand massage. The research is Quasi Exsperimen with pretes-posttest design. The statistic test has T test paired and unpairedt test. To indicatea reducing the level of acute before and after given relaxation technique result p-value pain. Therefore, the health of workers, especially for a study to apply relaxation and massage to provide of mother care, mainly to the primigravida who in experienced in process of labor.

The Relationship between Fear of Movement and Pain Intensity with Physical Disability in Chronic Lew-Back Pain Patients

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Taher Afshar-Nezhad

2010-07-01

Full Text Available Objective: There is growing evidence for the idea that fear of movement may be as disabling as pain intensity in chronic low back pain patients (CLBP. The purpose of the present paper is to investigate the relation between fear of movement and pain intensity with physical disability in chronic low back pain patients and the role of pain duration, gender and age differences in these relations. Materials & Methods: In this analytical and cross-sectional study, 194 patients with chronic low back pain for more than three months, referred to seven rehabilitation clinics in Rasht city during four months, were selected consecutively. Data were collected by Numerical Rating Scale, Roland–Morris Disability Questionnaire, Tampa Scale for Kinesiophobia and Demographic questionnaire and analyzed by Pearson Correlation Coefficient and Multi Regression. Results: Significant correlations were found between physical disability with fear of movement, pain intensity and age (P<0.001 and also pain duration (P=0.036. These relations were not different between males and females. In first Regression model, fear of movement and pain intensity, were the strongest predictors of physical disability. No differences were found between these factors. Then, prediction model was prepared adding age, sex and pain duration. Multiple regression analyses revealed that the fear of movement and pain intensity were superior in predicting disability. Among demographic variables, only the Beta Coefficient for age was significant in predicting disability (P=0.002. Conclusion: Fear of movement, pain intensity and age are important factors influencing physical disability in individuals suffering a chronic low back pain. Thus, for minimizing physical disability, alone with reducing pain intensity, patients showing fear of movement can be offered interventions that focus on reduction of the fear.

Pain perception and low back pain functional disability after a 10-week core and mobility training program: A pilot study.

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Lima, Vicente Pinheiro; de Alkmim Moreira Nunes, Rodolfo; da Silva, Jurandir Baptista; Paz, Gabriel Andrade; Jesus, Marco; de Castro, Juliana Brandão Pinto; Dantas, Estélio Henrique Martin; de Souza Vale, Rodrigo Gomes

2018-03-02

The aim of this study was to evaluate the effects of a 10-week core and mobility training program on pain perception and low back disability score in professors, students and employees of a university. Twenty-four individuals of a university who previously reported pain and low back disability were randomly assigned to an experimental group (EG; n= 8) that received 2 weekly sessions of 50 minutes of core and mobility training for 10 weeks; or to a control group (CG; n= 16). Both groups received a guideline to adopt ergonomic postures during work and activities of daily living. The visual analog pain scale (VAS) and the Roland-Morris questionnaire (RMQ) were applied pre and post intervention. Significant reductions in the pain intensity perception (p= 0.014) and low back functional disability (p= 0.011) were noted in the EG pre and post measures. However, no significant difference was observed in the CG. Thus, there was a significant difference between the EG and the CG in the post-intervention measures (p= 0.001). Core and mobility training and home-ergonomic instructions were effective to reduce the pain intensity perception and low back functional disability in the EG.

A recovery room-based acute pain service.

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Leykin, Y; Pellis, T; Ambrosio, C; Zanette, G; Malisano, A; Rapotec, A; Casati, A

2007-04-01

Despite routine postoperative pain management improves recovery and reduces postoperative morbidity and overall costs, and the availability of a large armamentarium of analgesic techniques and drugs, a significant portion of patients do not receive adequate postoperative pain control. We describe a recovery room (RR) based acute pain service model. Guidelines on postoperative pain and therapeutic protocols were instituted in January 1999. The analgesic endpoint was a visual analogic scale (VAS) below 4 for all surgical patients for the first 48-72 h. The RR, run by one anesthesiologist and 2 nurses and one assistant, acted as a coordination centre. Discharge from the RR was subject to achieving effective analgesia. Nurses of each ward monitored VAS along with vital signs, administered rescue doses if necessary, and reported to the RR nurse when needed. RR nurses monitored the patient at least twice daily and reported to the anesthesiologist. We have distributed an anonymous questionnaire, within surgical wards, to both surgeons and nurses to evaluate their perception of pain management and of this acute pain service (APS) model. VAS was maintained significantly process confirmed the desire of all professional figures to be informed and involved in acute pain management as part of a coordinated and systematic approach to the surgical patient. A RR-based APS can effectively act as coordinating centre for acute pain treatment without adjunctive personnel.

Bone pain caused by swelling of mouse ear capsule static xylene and effects on rat models of cervical spondylosis

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Zhang, Xuhui; Xia, Lei; Hao, Shaojun; Chen, Weiliang; Guo, Junyi; Ma, Zhenzhen; Wang, Huamin; Kong, Xuejun; Wang, Hongyu; Zhang, Zhengchen

2018-04-01

To observe the effect of intravenous bone pain Capsule on the ear of mice induced by xylene, swelling of rat models of cervical spondylosis. Weighing 18 ˜ 21g 50 mice, male, were randomly divided into for five groups, which were fed with service for bone pain static capsule suspension, Jingfukang granule suspension 0.5%CMC liquid and the same volume of. Respectively to the mice ear drop of xylene 0.05 ml, 4h after cervical dislocation, the mice were sacrificed and the cut two ear, rapid analytical balance weighing, and calculate the ear swelling degree and the other to take the weight of 200 - 60 250g male SD rats, were randomly divided into for 6 groups, 10 rats in each group, of which 5 groups made cervical spondylosis model. Results: with the blank group than bone pain static capsule group and Jingfukang granule group can significantly reduce mouse auricular dimethylbenzene swelling, significantly reduce ear swelling degree (P cervical spondylosis. With the model group ratio, large, medium and small dose of bone pain static capsule group, Jingfukang granule group (P pain static capsule group, Jingfukang granule group can significantly reduce the rat X-ray scores (P pain static capsule can significantly reduce mouse auricular dimethylbenzene swelling. The bone pain capsule has a good effect on the rat model of cervical spondylosis.

[High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer : Evaluation with the pain sensation scale (SES)].

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Marinova, M; Strunk, H M; Rauch, M; Henseler, J; Clarens, T; Brüx, L; Dolscheid-Pommerich, R; Conrad, R; Cuhls, H; Radbruch, L; Schild, H H; Mücke, M

2017-02-01

High-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer. Evaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries. In this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6 stage III, 12 stage IV according to UICC and 2 with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS). The average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3 % compared to the mean baseline score (n = 15, 75 %) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (n = 2) or the analgesic dosage could be reduced (n = 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1 week after HIFU, p pain scales). US-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.

Influence of intramuscular granisetron on experimentally induced muscle pain by acidic saline.

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Louca, S; Ernberg, M; Christidis, N

2013-06-01

The aim of this study was to investigate whether intramuscular administration of the 5-HT(3) receptor antagonist granisetron reduces experimental muscle pain induced by repeated intramuscular injections of acidic saline into the masseter muscles. Twenty-eight healthy and pain-free volunteers, fourteen women and fourteen men participated in this randomized, double-blind and placebo-controlled study. After a screening examination and registration of the baseline pressure-pain threshold (PPT), the first simultaneous bilateral injections of 0·5 mL acidic saline (9 mg mL(-1) , pH 3·3) into the masseter muscles were performed. Two days later, PPT and pain (VAS) were re-assessed. The masseter muscle was then pre-treated with 0·5 mL granisetron (Kytril(®) 1 mg mL(-1) pH 5·3) on one side and control substance (isotonic saline, 9 mg mL(-1) pH 6) on the contralateral side. Two minutes thereafter a bilateral simultaneous injection of 0·5 mL acidic saline followed. The evoked pain intensity, pain duration, pain area and PPT were assessed. The volunteers returned 1 week later to re-assess VAS and PPT. On the side pre-treated with granisetron, the induced pain had significantly lower intensity and shorter duration (P granisetron on pain duration was significant only in women (P granisetron has a pain-reducing effect on experimentally induced muscle pain by repeated acidic saline injection. © 2013 John Wiley & Sons Ltd.

Pain relief by touch: a quantitative approach.

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Mancini, Flavia; Nash, Thomas; Iannetti, Gian Domenico; Haggard, Patrick

2014-03-01

Pain relief by touch has been studied for decades in pain neuroscience. Human perceptual studies revealed analgesic effects of segmental tactile stimulation, as compared to extrasegmental touch. However, the spatial organisation of touch-pain interactions within a single human dermatome has not been investigated yet. In 2 experiments we tested whether, how, and where within a dermatome touch modulates the perception of laser-evoked pain. We measured pain perception using intensity ratings, qualitative descriptors, and signal detection measures of sensitivity and response bias. Touch concurrent with laser pulses produced a significant analgesia, and reduced the sensitivity in detecting the energy of laser stimulation, implying a functional loss of information within the ascending Aδ pathway. Touch also produced a bias to judge laser stimuli as less painful. This bias decreased linearly when the distance between the laser and tactile stimuli increased. Thus, our study provides evidence for a spatial organisation of intrasegmental touch-pain interactions. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Learned control over spinal nociception in patients with chronic back pain.

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Krafft, S; Göhmann, H-D; Sommer, J; Straube, A; Ruscheweyh, R

2017-10-01

Descending pain inhibition suppresses spinal nociception, reducing nociceptive input to the brain. It is modulated by cognitive and emotional processes. In subjects with chronic pain, it is impaired, possibly contributing to pain persistence. A previously developed feedback method trains subjects to activate their descending inhibition. Participants are trained to use cognitive-emotional strategies to reduce their spinal nociception, as quantified by the nociceptive flexor reflex (RIII reflex), under visual feedback about their RIII reflex size. The aim of the present study was to test whether also subjects with chronic back pain can achieve a modulation of their descending pain inhibition under RIII feedback. In total, 33 subjects with chronic back pain received either true (n = 18) or sham RIII feedback (n = 15), 15 healthy control subjects received true RIII feedback. All three groups achieved significant RIII suppression, largest in controls (to 76 ± 26% of baseline), intermediate in chronic back pain subjects receiving true feedback (to 82 ± 13%) and smallest in chronic back pain subjects receiving sham feedback (to 89 ± 14%, all p chronic pain subjects receiving true feedback significantly improved their descending inhibition over the feedback training, quantified by the conditioned pain modulation effect (test pain reduction of baseline before training: to 98 ± 26%, after: to 80 ± 21%, p chronic back pain can achieve a reduction of their spinal nociception and improve their descending pain inhibition under RIII feedback training. Subjects with chronic back pain can learn to control their spinal nociception, quantified by the RIII reflex, when they receive feedback about the RIII reflex. © 2017 European Pain Federation - EFIC®.

Adoptive transfer of M2 macrophages reduces neuropathic pain via opioid peptides.

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Pannell, Maria; Labuz, Dominika; Celik, Melih Ö; Keye, Jacqueline; Batra, Arvind; Siegmund, Britta; Machelska, Halina

2016-10-07

During the inflammation which occurs following nerve damage, macrophages are recruited to the site of injury. Phenotypic diversity is a hallmark of the macrophage lineage and includes pro-inflammatory M1 and anti-inflammatory M2 populations. Our aim in this study was to investigate the ability of polarized M0, M1, and M2 macrophages to secrete opioid peptides and to examine their relative contribution to the modulation of neuropathic pain. Mouse bone marrow-derived cells were cultured as unstimulated M0 macrophages or were stimulated into an M1 phenotype using lipopolysaccharide and interferon-γ or into an M2 phenotype using interleukin-4. The macrophage phenotypes were verified using flow cytometry for surface marker analysis and cytokine bead array for cytokine profile assessment. Opioid peptide levels were measured by radioimmunoassay and enzyme immunoassay. As a model of neuropathic pain, a chronic constriction injury (CCI) of the sciatic nerve was employed. Polarized M0, M1, and M2 macrophages (5 × 10 5 cells) were injected perineurally twice, on days 14 and 15 following CCI or sham surgery. Mechanical and heat sensitivity were measured using the von Frey and Hargreaves tests, respectively. To track the injected macrophages, we also transferred fluorescently stained polarized cells and analyzed the surface marker profile of endogenous and injected cells in the nerves ex vivo. Compared to M0 and M1 cells, M2 macrophages contained and released higher amounts of opioid peptides, including Met-enkephalin, dynorphin A (1-17), and β-endorphin. M2 cells transferred perineurally at the nerve injury site reduced mechanical, but not heat hypersensitivity following the second injection. The analgesic effect was reversed by the perineurally applied opioid receptor antagonist naloxone methiodide. M2 cells did not affect sensitivity following sham surgery. Neither M0 nor M1 cells altered mechanical and heat sensitivity in CCI or sham-operated animals. Tracing the

Efficacy of workplace interventions for shoulder pain: A systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Veronique Lowry

2017-06-01

Full Text Available Objective: To perform a systematic review and meta-analysis of randomized controlled trials on the efficacy of workplace-based interventions to prevent or treat shoulder pain. Data sources: A systematic review of 4 databases was performed up to January 2016. Study selection: Randomized controlled trials were included if the intervention under study was a workplace-based intervention performed to prevent or reduce shoulder pain and disability in workers. Data extraction: The methodological quality of the studies was evaluated and meta-analyses were conducted. Pooled mean differences and risk ratios were calculated. Data synthesis: Data from 4 studies on strengthening exercises performed in the workplace for workers with shoulder pain (n = 368 were pooled. A statistically significant reduction in pain intensity was observed compared with different control interventions (mean differences (scale out of 10 1.31 (95% confidence interval (95% CI 0.86–1.76. Pooled data from 5 studies on the efficacy of workstation modifications (n = 2,148 showed a statistically significant reduction in the prevalence of shoulder pain with a risk ratio of 1.88 (95% CI 1.20–2.96 compared with different control interventions. Conclusion: Low-grade evidence exists that a workplace exercise programme may reduce the intensity of shoulder pain, and that workstation modifications may reduce the prevalence of shoulder pain.

Intraarticular Pulsed Radiofrequency to Treat Refractory Lumbar Facet Joint Pain in Patients with Low Back Pain.

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Chang, Min Cheol; Cho, Yun-Woo; Ahn, Da Hyun; Do, Kyung Hee

2018-04-01

Many treatment techniques have been used for refractory lumbar facet joint pain; however, their efficacy has been controversial. In this study, we investigated the clinical efficacy and safety of intra-articular pulsed radiofrequency for the treatment of refractory lumbar facet joint pain in patients with low back pain. Twenty patients with refractory lumbar facet joint pain were recruited, and each patient was treated via intra-articular pulsed radiofrequency. The treatment effects were measured with a numerical rating scale, and the technical accuracy of intra-articular pulsed radiofrequency treatment was evaluated independently by 2 radiologists. Any adverse events or complications also were checked. We performed intra-articular pulsed radiofrequency treatment at 48 levels of the lumbar facet joints in 20 patients (5 men and 15 women; mean age, 64.50 ± 10.65 years) with refractory lumbar facet joint pain. Pain scores were significantly reduced at 1 month, 3 months, and 6 months after treatment (P radiofrequency results in all 20 patients, without any serious adverse effects. Treatment using intra-articular pulsed radiofrequency is an alternative to other techniques in patients with refractory lumbar facet joint pain. Copyright © 2018 Elsevier Inc. All rights reserved.

Evaluation of reduced-dose CT for acute non-traumatic abdominal pain: evaluation of diagnostic accuracy in comparison to standard-dose CT.

Science.gov (United States)

Othman, Ahmed E; Bongers, Malte Niklas; Zinsser, Dominik; Schabel, Christoph; Wichmann, Julian L; Arshid, Rami; Notohamiprodjo, Mike; Nikolaou, Konstantin; Bamberg, Fabian

2018-01-01

Background Patients with acute non-traumatic abdominal pain often undergo abdominal computed tomography (CT). However, abdominal CT is associated with high radiation exposure. Purpose To evaluate diagnostic performance of a reduced-dose 100 kVp CT protocol with advanced modeled iterative reconstruction as compared to a linearly blended 120 kVp protocol for assessment of acute, non-traumatic abdominal pain. Material and Methods Two radiologists assessed 100 kVp and linearly blended 120 kVp series of 112 consecutive patients with acute non-traumatic pain (onset diagnostic confidence. Both 100 kVp and linearly blended 120 kVp series were quantitatively evaluated regarding radiation dose and image noise. Comparative statistics and diagnostic accuracy was calculated using receiver operating curve (ROC) statistics, with final clinical diagnosis/clinical follow-up as reference standard. Results Image quality was high for both series without detectable significant differences ( P = 0.157). Image noise and artifacts were rated low for both series but significantly higher for 100 kVp ( P ≤ 0.021). Diagnostic accuracy was high for both series (120 kVp: area under the curve [AUC] = 0.950, sensitivity = 0.958, specificity = 0.941; 100 kVp: AUC ≥ 0.910, sensitivity ≥ 0.937, specificity = 0.882; P ≥ 0.516) with almost perfect inter-rater agreement (Kappa = 0.939). Diagnostic confidence was high for both dose levels without significant differences (100 kVp 5, range 4-5; 120 kVp 5, range 3-5; P = 0.134). The 100 kVp series yielded 26.1% lower radiation dose compared with the 120 kVp series (5.72 ± 2.23 mSv versus 7.75 ± 3.02 mSv, P diagnostic accuracy for the assessment of acute non-traumatic abdominal pain.

Optimal pain management for radical prostatectomy surgery

DEFF Research Database (Denmark)

Joshi, Grish P; Jaschinski, Thomas; Bonnet, Francis

2015-01-01

BACKGROUND: Increase in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has not been systematically evaluated. Thus, optimal pain therapy for patients undergoing radical prostatectomy remains...... controversial. METHODS: Medline, Embase, and Cochrane Central Register of Controlled Trials were searched for studies assessing the effects of analgesic and anesthetic interventions on pain after radical prostatectomy. All searches were conducted in October 2012 and updated in June 2015. RESULTS: Most...... treatments studied improved pain relief and/or reduced opioid requirements. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis and consensus recommendations. CONCLUSIONS: This systematic review reveals that there is a lack...

kinesiotaping reduces pain and modulates sensory function in patients with focal dystonia: a randomized crossover pilot study.

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Pelosin, Elisa; Avanzino, Laura; Marchese, Roberta; Stramesi, Paola; Bilanci, Martina; Trompetto, Carlo; Abbruzzese, Giovanni

2013-10-01

Pain is one of the most common and disabling "nonmotor" symptoms in patients with dystonia. No recent study evaluated the pharmacological or physical therapy approaches to specifically treat dystonic pain symptoms. To evaluate the effectiveness of KinesioTaping in patients with cervical dystonia (CD) and focal hand dystonia (FHD) on self-reported pain (primary objective) and on sensory functions (secondary objective). Twenty-five dystonic patients (14 with CD and 11 FHD) entered a randomized crossover pilot study. The patients were randomized to 14-day treatment with KinesioTaping or ShamTaping over neck (in CD) or forearm muscles (in FHD), and after a 30-day washout period, they received the other treatment. The were 3 visual analog scales (VASs) for usual pain, worst pain, and pain relief. Disease severity changes were evaluated by means of the Toronto Western Spasmodic Torticollis Rating Scale (CD) and the Writer's Cramp Rating Scale (FHD). Furthermore, to investigate possible KinesioTaping-induced effects on sensory functions, we evaluated the somatosensory temporal discrimination threshold. Treatment with KinesioTape induced a decrease in the subjective sensation of pain and a modification in the ability of sensory discrimination, whereas ShamTaping had no effect. A significant, positive correlation was found in both groups of patients between the improvement in the subjective sensation of pain and the reduction of somatosensory temporal discrimination threshold values induced by KinesioTaping. These preliminary results suggest that KinesioTaping may be useful in treating pain in patients with dystonia.

The rubber hand illusion increases heat pain threshold.

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Hegedüs, G; Darnai, G; Szolcsányi, T; Feldmann, Á; Janszky, J; Kállai, J

2014-09-01

Accumulating evidence shows that manipulations of cortical body representation, for example, by simply viewing one's own body, can relieve pain in healthy subjects. Despite the widespread use of the rubber hand illusion (RHI) as an effective experimental tool for the manipulation of bodily awareness, previous studies examining the analgesic effect of the RHI have produced conflicting results. We used noxious heat stimuli to induce finger pain in 29 healthy subjects, and we recorded the participants' pain thresholds and subjective pain ratings during the RHI and during the control conditions. Two control conditions were included in our experiment - a standard one with reduced illusion strength (asynchronous stroking control) and an additional one in which the participants viewed their own hand. Raw data showed that both the RHI and the vision of the own hand resulted in slightly higher pain thresholds than the asynchronous stroking control (illusion: 47.79 °C; own-hand: 47.99 °C; asynchronous: 47.52 °C). After logarithmic transformation to achieve normality, paired t-tests revealed that both increases in pain threshold were significant (illusion/asynchronous: p = 0.036; own-hand/asynchronous: p = 0.007). In contrast, there was no significant difference in pain threshold between the illusion and the own-hand conditions (p = 0.656). Pain rating scores were not log-normal, and Wilcoxon singed-rank tests found no significant differences in pain ratings between the study conditions. The RHI increases heat pain threshold and the analgesic effect of the RHI is comparable with that of seeing one's own hand. The latter finding may have clinical implications. © 2014 European Pain Federation - EFIC®

Improvement in Anxiety and Pain After Whole Body Whirlpool Hydrotherapy Among Patients With Myofascial Pain Syndrome

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Im, Sang Hee

2013-01-01

Objective To evaluate the effect of the Whirlpool hydrotherapy on pain and anxiety in chronic myofascial pain syndrome (MPS) patients, compared to the conventional hydrocollator pack therapy. Methods Forty-one subjects who have MPS in the upper trapezius muscles without depression were recruited. The patients were randomly assigned into two groups: the whirlpool therapy group whose bodies were immersed in a whirlpool bath at 34℃-36℃ for 30 minutes; the hydrocollator group who took a 30-minute application of a standard hot hydrocollator pack. Patients in both groups received therapy three days a week for 2 weeks and underwent several evaluations at baseline and after treatment. The variables we analyzed during evaluations were as follows: the primary outcome we considered was pain severity using a visual analogue scale. And the secondary outcomes examined included anxiety using the Korean version of the Beck Anxiety Inventory and quality of life (QoL) using the Korean version of the World Health Organization QoL Assessment, Brief Form. All follow-up values were compared with the baseline values. Results The baseline parameters did not show significant differences between two groups. And after 2-week treatment, both groups revealed significant improvement in anxiety levels and QoL, as well as in pain. However, the improvement on pain (p=0.002) and anxiety (p=0.010) was significantly greater in the whirlpool group, compared to the hydrocollator group. Conclusion The whirlpool hydrotherapy can be used as a more effective therapeutic method to reduce pain and anxiety in chronic MPS patients without depression. PMID:24020034

EFFECTIVENESS OF CHIROPRACTIC ADJUSTMENT IN LUMBAR PAIN IN CROSSFIT PRACTITIONERS

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DESIREE MOEHLECKE

Full Text Available ABSTRACT Objective: To evaluate the efficacy of acute chiropractic adjustment in individuals who practice CrossFit with regard to complaints of low back pain and the joint range of motion in this region. Methods: A randomized clinical trial comprised of CrossFit practitioners from a box in Novo Hamburgo-RS, of both sexes and aged 18 to 40 years who had low back pain at the time of the study. The following tools were used: Semi-structured Anamnesis Questionnaire, Visual Analog Scale, McGill Pain Questionnaire, and SF-36 Quality of Life Questionnaire. Individuals in the control group answered the questionnaires before and after CrossFit training. The chiropractic group performed the same procedure, plus pre-training chiropractic adjustment and joint range of motion (ROM before and after lumbar adjustment. Results: There was a significant increase in pain in the control group, and a significant decrease in pain in the chiropractic group, including one day after the chiropractic adjustment. In the chiropractic group, the joint ranges of motion had a significant increase in flexion and extension of the lumbar spine after chiropractic adjustment. Conclusion: The chiropractic group achieved a significant improvement in pain level and joint range of motion, suggesting that acute chiropractic adjustment was effective in reducing low back pain.

The effects of nature images on pain in a simulated hospital patient room.

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Vincent, Ellen; Battisto, Dina; Grimes, Larry; McCubbin, James

2010-01-01

Views of nature have been reported to relieve stress and pain, making nature an ideal medium for use in healthcare settings. In hospitals whose design does not allow for a view of nature, virtual and surrogate views of nature may be viable therapeutic options. This study tests the effects of specific nature images, as defined by Appleton's prospect refuge theory of landscape preference, on participants experiencing pain. The hypotheses were: (1) Nature views are variable in their impact on specific psychological and physiological health status indicators; and (2) Prospect and refuge nature scenes are more therapeutic than hazard nature scenes. The research question was (1) Which nature image categories are most therapeutic as evidenced by reduced pain and positive mood? An experiment using mixed methods assessed the effects of four different nature scenes on physiological (blood pressure, heart rate) and psychological (mood) responses when a person was subjected to a pain stressor. Four groups were subjected to a specific nature image category of prospect, refuge, hazard, or mixed prospect and refuge; the fifth group viewed no image. The Short-Form McGill Pain Questionnaire and the Profile of Mood States survey instruments were used to assess pain and mood, respectively. Continuous physiological readings of heart rate and blood pressure were collected. Pain was induced through a cold pressor task, which required participants to immerse their nondominant hand in ice water for up to 120 seconds. The mixed prospect and refuge image treatment showed significantly lower sensory pain responses, and the no-image treatment indicated significantly higher affective pain perception responses. The hazard image treatment had significantly lower diastolic blood pressure readings during the pain treatment, but it also had significantly high total mood disturbance. Although there was no clear "most" therapeutic image, the mixed prospect and refuge image showed significant

The effect of transcranial direct current stimulation on experimentally induced heat pain.

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Aslaksen, Per M; Vasylenko, Olena; Fagerlund, Asbjørn J

2014-06-01

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulatory technique that can affect human pain perception. Placebo effects are present in most treatments and could therefore also interact with treatment effects in tDCS. The present study investigated whether short-term tDCS reduced heat pain intensity, stress, blood pressure and increased heat pain thresholds in healthy volunteers when controlling for placebo effects. Seventy-five (37 females) participants were randomized into three groups: (1) active tDCS group receiving anodal tDCS (2 mA) for 7 min to the primary motor cortex (M1), (2) placebo group receiving the tDCS electrode montage but only active tDCS stimulation for 30 s and (3) natural history group that got no tDCS montage but the same pain stimulation as the active tDCS and the placebo group. Heat pain was induced by a PC-controlled thermode attached to the left forearm. Pain intensity was significantly lower in the active tDCS group when examining change scores (pretest-posttest) for the 47 °C condition. The placebo group displayed lower pain compared with the natural history group, displaying a significant placebo effect. In the 43 and 45 °C conditions, the effect of tDCS could not be separated from placebo effects. The results revealed no effects on pain thresholds. There was a tendency that active tDCS reduced stress and systolic blood pressure, however, not significant. In sum, tDCS had an analgesic effect on high-intensity pain, but the effect of tDCS could not be separated from placebo effects for medium and low pain.

The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings.

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Gheldof, Els L M; Vinck, Jan; Vlaeyen, Johan W S; Hidding, Alita; Crombez, Geert

2005-01-01

This cross-sectional questionnaire study investigated the role of pain (pain severity, radiating pain), work characteristics (physical workload, job stressors, job satisfaction), negative affect and pain-related fear in accounting for low back pain (LBP) and sick leave (SL) in 1294 employees from 10 companies in Belgium and the Netherlands. An increased risk for short-term LBP (1-30 days during the last year) was observed for workers reporting high physical workload (OR=2.39), high task exertion (OR=1.63) and high negative affect (OR=1.03). For prolonged LBP (>30 days during the last year) severe pain (OR=13.03), radiating pain (OR=2.37) and fear of work-related activities (OR=3.17) were significant risk factors. A lack of decision latitude decreased the risk of long-term LBP (OR=0.39). Short-term SL (1-30 days during the last year) was associated with severe pain (OR=2.83), high physical workload (OR=2.99) and high fear of movement/(re)injury (OR=1.88). A lack of decision latitude increased the risk of short-term SL (OR=1.92). Long-term SL (>30 days during the last year) was associated with radiating pain (OR=3.80) and high fear of movement/(re)injury (OR=6.35). A lack of co-worker support reduced the risk of long-term SL (OR=0.27). These results suggest that physical load factors are relatively more important in the process leading to short-term LBP and short-term SL, whereas job stressors, severe pain, radiation, and pain-related fear are more important in determining the further course and maintenance of the inability to work. The potential implications of these findings for primary and secondary prevention, and occupational rehabilitation are discussed.

Central Pain Processing in Early-Stage Parkinson's Disease: A Laser Pain fMRI Study.

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Christine Petschow

Full Text Available Pain is a common non-motor symptom in Parkinson's disease. As dopaminergic dysfunction is suggested to affect intrinsic nociceptive processing, this study was designed to characterize laser-induced pain processing in early-stage Parkinson's disease patients in the dopaminergic OFF state, using a multimodal experimental approach at behavioral, autonomic, imaging levels.13 right-handed early-stage Parkinson's disease patients without cognitive or sensory impairment were investigated OFF medication, along with 13 age-matched healthy control subjects. Measurements included warmth perception thresholds, heat pain thresholds, and central pain processing with event-related functional magnetic resonance imaging (erfMRI during laser-induced pain stimulation at lower (E = 440 mJ and higher (E = 640 mJ target energies. Additionally, electrodermal activity was characterized during delivery of 60 randomized pain stimuli ranging from 440 mJ to 640 mJ, along with evaluation of subjective pain ratings on a visual analogue scale.No significant differences in warmth perception thresholds, heat pain thresholds, electrodermal activity and subjective pain ratings were found between Parkinson's disease patients and controls, and erfMRI revealed a generally comparable activation pattern induced by laser-pain stimuli in brain areas belonging to the central pain matrix. However, relatively reduced deactivation was found in Parkinson's disease patients in posterior regions of the default mode network, notably the precuneus and the posterior cingulate cortex.Our data during pain processing extend previous findings suggesting default mode network dysfunction in Parkinson's disease. On the other hand, they argue against a genuine pain-specific processing abnormality in early-stage Parkinson's disease. Future studies are now required using similar multimodal experimental designs to examine pain processing in more advanced stages of Parkinson's disease.

Effect of core stabilization exercises versus conventional exercises on pain and functional status in patients with non-specific low back pain: a randomized clinical trial.

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Inani, Sumit B; Selkar, Sohan P

2013-01-01

Low Back Pain (LBP) results in significant level of disability, producing significant restriction on usual activity such as an inability to work. Nearly two third of the adults are affected by non-specific low back pain at some point in their lives. The purpose of the study was to determine the effect of core stabilization exercises in comparison with conventional exercises on pain, functional status in patients with non-specific LBP. Thirty patients diagnosed with non-specific LBP participated with age group between 20-50 years and divided in to 2 groups, one with core stabilization exercises and other conventional exercises, 15 subjects each. Three months study, pre and post treatment outcome measures used were VAS for pain intensity and Modified Oswestry Low Back Pain Disability Index for functional status (disability). Data were analyzed using student 't' test (paired and unpaired). Whereas both groups improved significantly from the initiation of treatment, a between-group comparison revealed significantly greater (ppain and functional status for experimental group compared to control group. Core stabilization exercises were found to be more effective in reducing pain and improving functional status by decreasing disability of patients with non-specific low back pain in comparison with conventional exercises.

Challenging emotional prejudice by changing self-concept: priming independent self-construal reduces racial in-group bias in neural responses to other's pain.

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Wang, Chenbo; Wu, Bing; Liu, Yi; Wu, Xinhuai; Han, Shihui

2015-09-01

Humans show stronger empathy for in-group compared with out-group members' suffering and help in-group members more than out-group members. Moreover, the in-group bias in empathy and parochial altruism tend to be more salient in collectivistic than individualistic cultures. This work tested the hypothesis that modifying self-construals, which differentiate between collectivistic and individualistic cultural orientations, affects in-group bias in empathy for perceived own-race vs other-race pain. By scanning adults using functional magnetic resonance imaging, we found stronger neural activities in the mid-cingulate, left insula and supplementary motor area (SMA) in response to racial in-group compared with out-group members' pain after participants had been primed with interdependent self-construals. However, the racial in-group bias in neural responses to others' pain in the left SMA, mid-cingulate cortex and insula was significantly reduced by priming independent self-construals. Our findings suggest that shifting an individual's self-construal leads to changes of his/her racial in-group bias in neural responses to others' suffering. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Music Therapy Increases Comfort and Reduces Pain in Patients Recovering From Spine Surgery.

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Mondanaro, John F; Homel, Peter; Lonner, Baron; Shepp, Jennifer; Lichtensztein, Marcela; Loewy, Joanne V

The treatment of pain continues to gain in saliency as a component of defining best practice in medical care. Music therapy is an integrative treatment modality that impacts patient outcomes in the treatment of spinal pain. At Mount Sinai Beth Israel, we conducted a mixed-methods study addressing the effects of music therapy interventions on the recovery of patients after spine surgery. The study combined standard medical approaches and integrative music therapy. Sixty patients (35 female, 25 male) ranging in age from 40 to 55 years underwent anterior, posterior, or anterior-posterior spinal fusion and were randomly assigned to either music therapy plus standard care (medical and nursing care with scheduled pharmacologic pain intervention) or standard care only. Measurements for both groups were completed before and after the intervention. Music therapy involved the use of patient-preferred live music that supported tension release/relaxation through incentive-based clinical improvisation, singing, and/or rhythmic drumming or through active visualization supported by live music that encompasses tension resolution. The control and music groups showed significant differences in degree and direction of change in the visual analog scale (VAS) pain ratings from before to after intervention (P = .01). VAS pain levels increased slightly in the control group (to 5.87 from 5.20) but decreased by more than 1 point in the music group (to 5.09 from 6.20). The control and music therapy groups did not differ in the rate of change in scores on Hospital Anxiety and Depression Scale (HADS) Anxiety (P = .62), HADS Depression (P = .85), or Tampa Scale for Kinesiophobia (P = .93). Both groups had slight increases in HADS Anxiety, comparable decreases in HADS Depression, and minimal changes in fear-related movement (Tampa scale).

An educational and physical program to reduce headache, neck/shoulder pain in a working community: a cluster-randomized controlled trial.

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Franco Mongini

Full Text Available Noninvasive physical management is often prescribed for headache and neck pain. Systematic reviews, however, indicate that the evidence of its efficacy is limited. Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing headache and neck/shoulder pain.Cluster-randomized controlled trial. All municipal workers of the City of Turin, Italy, were invited to participate. Those who agreed were randomly assigned, according to their departments, to the intervention group (IG or to the control group and were given diaries for the daily recording of pain episodes for 1 month (baseline. Subsequently, only the IG (119 departments, 923 workers began the physical and educational program, whereas the control group (117 departments, 990 workers did not receive any intervention. All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention. The primary outcome was the change in the frequency of headache (expressed as the proportion of subjects with a ≥50% reduction of frequency; responder rate; among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain. Differences between the two groups were evaluated using mixed-effect regression models. The IG showed a higher responder rate [risk ratio, 95% confidence interval (CI] for headache (1.58; 1.28 to 1.92 and for neck/shoulder pain (1.53; 1.27 to 1.82, and a larger reduction of the days per month (95% CI with headache (-1.72; -2.40 to -1.04 and with neck/shoulder pain (-2.51; -3.56 to -1.47.The program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary-care settings. Further trials are needed to investigate the program effectiveness in a clinical setting, for highly selected patients suffering from specific headache types.ClinicalTrials.gov NCT00551980.

Comparison of granisetron and lidocaine on reducing injection pain of etomidate: a controlled randomized study

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Alireza Saliminia

2017-11-01

Full Text Available Background and objectives: Reducing pain on injection of anesthetic drugs is of importance to every anesthesiologist. In this study we pursued to define if pretreatment by granisetron reduces the pain on injection of etomidate similar to lidocaine. Methods: Thirty patients aged between 18 and 50 years of American Society of Anesthesiologists physical status class I or II, whom were candidates for elective laparoscopic cholecystectomy surgery were enrolled in this study. Two 20 gauge cannulas were inserted into the veins on the dorsum of both hands and 100 mL of normal saline was administered during a 10 min period from each cannula. Using an elastic band as a tourniquet, venous drainage of both hands was occluded. 2 mL of granisetron was administered into one hand and 2 mL of lidocaine 2% at the same time into the other hand. One minute later the elastic band was opened and 2 mL of etomidate was administered to each hand with equal rates. The patients were asked to give a score from 0 to 10 (0 = no pain, 10 = severe pain to each the pain sensed in each hand. Results: Two patients were deeply sedated after injection of etomidate and unable to answer any questions. The mean numerical rating score for injection pain of intravenously administered etomidate after intravenous granisetron was 2.3 ± 1.7, which was lower when compared with pain sensed due to intravenously administered etomidate after administration of lidocaine 2% (4.6 ± 1.8, p < 0.05. Conclusion: The result of this study demonstrated that, granisetron reduces pain on injection of etomidate more efficiently than lidocaine. Resumo: Justificativa e objetivos: A redução da dor causada pela injeção de anestésicos é importante para todos os anestesiologistas. Neste estudo buscamos definir se o pré-tratamento com granisetrona reduz a dor causada pela injeção de etomidato de forma semelhante à lidocaína. Métodos: Trinta pacientes com idades entre 18 e 50 anos

Deep brain stimulation for phantom limb pain.

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Bittar, Richard G; Otero, Sofia; Carter, Helen; Aziz, Tipu Z

2005-05-01

Phantom limb pain is an often severe and debilitating phenomenon that has been reported in up to 85% of amputees. Its pathophysiology is poorly understood. Peripheral and spinal mechanisms are thought to play a role in pain modulation in affected individuals; however central mechanisms are also likely to be of importance. The neuromatrix theory postulates a genetically determined representation of body image, which is modified by sensory input to create a neurosignature. Persistence of the neurosignature may be responsible for painless phantom limb sensations, whereas phantom limb pain may be due to abnormal reorganisation within the neuromatrix. This study assessed the clinical outcome of deep brain stimulation of the periventricular grey matter and somatosensory thalamus for the relief of chronic neuropathic pain associated with phantom limb in three patients. These patients were assessed preoperatively and at 3 month intervals postoperatively. Self-rated visual analogue scale pain scores assessed pain intensity, and the McGill Pain Questionnaire assessed the quality of the pain. Quality of life was assessed using the EUROQOL EQ-5D scale. Periventricular gray stimulation alone was optimal in two patients, whilst a combination of periventricular gray and thalamic stimulation produced the greatest degree of relief in one patient. At follow-up (mean 13.3 months) the intensity of pain was reduced by 62% (range 55-70%). In all three patients, the burning component of the pain was completely alleviated. Opiate intake was reduced in the two patients requiring morphine sulphate pre-operatively. Quality of life measures indicated a statistically significant improvement. This data supports the role for deep brain stimulation in patients with phantom limb pain. The medical literature relating to the epidemiology, pathogenesis, and treatment of this clinical entity is reviewed in detail.

The Effectiviness of Dysmenorrhea Gymnastics as an Alternative Therapy in Reducing Menstrual Pain

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Mei Lina Fitri Kumalasari

2017-04-01

Full Text Available Menstrual pain occurs due to the imbalance of the hormones which will cause the uterine muscles to contract and lead to colic pain. Approximately 50 % of women worldwide  and  90 % of Indonesian women  suffer from menstrual pain. Pharmacological therapy is the most popular treatment used to relieve menstrual pain. Unfortunately, it leads to indisputable side effects on health. Therefore, safety alternative treatments such as dysmenorrhea gymnastics are signifficantly needed to improve bloodstream in the uterus and produce endorphins which can relieve menstrual pain. The aim of the study wasto determine the effectiveness of dysmenorrhea gymnastics to relieve the level of menstrual pain. The method of study is systematic review on 14 studies of the efectiveness of exercise dysmenorrhea gymnastics to relieve menstrual pain. The results obtained are dysmenorrhea gymnastcs can relieve menstrual pain with a mean value of 4.006. Conclusion: dysmenorrhea gymnastics can relieve menstrual pain and better  done in the afternoon.

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

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Korhan, Esra Akın; Uyar, Meltem; Eyigör, Can; Hakverdioğlu Yönt, Gülendam; Çelik, Serkan; Khorshıd, Leyla

2014-03-01

The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

LAVENDER (LAVANDULA ANGUSTIFOLIA AROMATHERAPY AS AN ALTERNATIVE TREATMENT IN REDUCING PAIN IN PRIMIPAROUS MOTHERS IN THE ACTIVE FIRST STAGE OF LABOR

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Hilda Yani Karo Karo

2017-08-01

Full Text Available Background: Labor and childbirth is an extremely painful process. Aromatherapy is considered as one of the nonpharmacological methods to reduce labor pain. Objective: To determine the effect of Lavender (Lavandula Angustifolia aromatherapy on the level of pain in primipara in the first stage of labor. Methods: A quasy-experimental research with pretest and posttest design with control group conducted between October until November 2016. Forthy respondents selected using consecutive sampling, which 20 assigned in each group. a Numerical Rating Scale (NRS pain scale was used. Paired and independent t-test were used for data analyses. Results: The results showed that the p-value of labor pain after intervention was 0.000 (<0.05, which indicated that there was statistically mean difference of labor pain between intervention (6.10 and control group (4.05 in primipara in the first active stage of labor. Conclusion: The women in the lavender aromatherapy group reported lower intensity of labor pain. The intervention study could be practiced in the community health centers for pregnant women in order for them to apply this healing method.

Bone pain

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Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

2016-01-01

Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

Happiness, Pain Intensity, Pain Interference, and Distress in Individuals with Physical Disabilities.

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Müller, Rachel; Terrill, Alexandra L; Jensen, Mark P; Molton, Ivan R; Ravesloot, Craig; Ipsen, Catherine

2015-12-01

The aim of this study was to examine how the construct of happiness is related to pain intensity, pain interference, and distress in individuals with physical disabilities. This study involves cross-sectional analyses of 471 individuals with a variety of health conditions reporting at least mild pain. The first hypothesis that happiness mediates the relationship between pain intensity and two outcomes, pain interference and distress, was not supported. The second hypothesis was supported by a good fitting model (χ2(10) = 12.83, P = 0.23, root-mean-square error of approximation = 0.025) and indicated that pain intensity significantly mediated the effect of happiness on pain interference (indirect effect: β = -0.13, P Happiness showed a significant direct effect on pain intensity (β = -0.20, P happiness components meaning, pleasure, and engagement fitted well (χ2(4) = 9.65, P = 0.05, root-mean-square error of approximation = 0.055). Pain intensity acted as a significant mediator but only mediated the effect of meaning on pain interference (indirect effect: β = -0.07, P = 0.05) and on distress (indirect effect via pain interference: β = -0.04, P = 0.05). Only meaning (β = -0.10, P = 0.05), but neither pleasure nor engagement, had a significant direct effect on pain intensity. Participants who reported greater happiness reported lower pain interference and distress through happiness' effects on pain intensity. Experiencing meaning and purpose in life seems to be most closely (and negatively) associated with pain intensity, pain interference, and distress. Findings from this study can lay the groundwork for intervention studies to better understand how to more effectively decrease pain intensity, pain interference, and distress.

Does suprascapular nerve block reduce shoulder pain following stroke: a double-blind randomised controlled trial with masked outcome assessment

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Crotty Maria

2010-09-01

Full Text Available Abstract Background Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation programs and has been associated with poorer outcomes. The evidence base for current medical and therapeutic management options of hemiplegic shoulder pain is limited. This study will evaluate the use of suprascapular nerve block injection as part of an interdisciplinary approach to the treatment of shoulder pain following stroke. The technique has previously been proven safe and effective in the treatment of shoulder pain associated with rheumatoid arthritis and degenerative shoulder conditions but its usefulness in a stroke population is unclear. Methods/Design A double blind randomised placebo controlled trial will assess the effect of a suprascapular nerve block compared with placebo in a population of 66 stroke patients. The trial will measure effect of injection on the primary outcome of pain, and secondary outcomes of function and quality of life. Measurements will take place at baseline, and 1, 4 and 12 weeks post intervention. Both groups will continue to receive routine physiotherapy and standard ward care. Discussion The results of this study could reduce pain symptoms in persons with mechanical shoulder pain post stroke and provide improvement in upper limb function. Trial Registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR - ACTRN12609000621213.

Utilizing Z-track Air Lock Technique to Reduce Pain in Intramuscular Injections

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Evelyn Hemme Tambunan

2015-04-01

Full Text Available Introduction: Injection is one of most painful and common medical interventions that more than 12 billion of it are administered annually throughout the world. Pain remains as one of the unresolved health problems. The objective of this research was to investigate the pain severity utilizing the z-track air lock technique during intra muscular injection procedure. Method:This study was conducted as an unblinded cinical trial, where 90 female subjects aged between 18-25 years old were randomly assigned to three groups of 30. Each group received z-track air lock (Group ZTAL, air lock (AL, and z-track (Group ZT techniques. Neurobion 5000 vitamin used as an injection substance.A Verbal Rating Scale (VRS on 0–3 was used to evaluate the severity of pain during procedure. Data were analized using the SPSS version 19. Groups’ age, Body Mass Index (BMI and pain severity were analyzed through descriptive and One Way ANOVA statistics. Results: Results showed that there were no signifi cant differences of pain severity both within and between groups (p > 0.05. Discussion: Both Z-track and air lock method are less pain compared to traditional method according to previous studies. Noncicepti stimulus inhibited nocicepti stimulus in z-track technique while locking effect inhibit leakeage of substance injection to subcutaneous layer of skin which contain of nerve fi bers. However All techniques are recommended to produce less pain therefore it can be considered as a standard procedure for intra muscular injection. Keywords: intramuscular injection, z-track air lock technique, pain

Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial.

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Santana, Licia Santos; Gallo, Rubneide Barreto Silva; Ferreira, Cristine Homsi Jorge; Duarte, Geraldo; Quintana, Silvana Maria; Marcolin, Alessandra Cristina

2016-01-01

In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS) relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4cm, and without the use of any medications from hospital admission until randomisation. The principal investigator applied TENS to the experimental group for 30minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. After the intervention, a significant mean difference in change in pain of 15mm was observed favouring the experimental group (95% CI 2 to 27). The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0hours (95% CI 4.1 to 5.9) longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. TENS produces a significant decrease in pain during labour and postpones the need for pharmacological analgesia for pain relief. NCT01600495. Copyright © 2015. Published by Elsevier B.V.

Mid-Treatment Sleep Duration Predicts Clinically Significant Knee Osteoarthritis Pain reduction at 6 months: Effects From a Behavioral Sleep Medicine Clinical Trial.

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Salwen, Jessica K; Smith, Michael T; Finan, Patrick H

2017-02-01

To determine the relative influence of sleep continuity (sleep efficiency, sleep onset latency, total sleep time [TST], and wake after sleep onset) on clinical pain outcomes within a trial of cognitive behavioral therapy for insomnia (CBT-I) for patients with comorbid knee osteoarthritis and insomnia. Secondary analyses were performed on data from 74 patients with comorbid insomnia and knee osteoarthritis who completed a randomized clinical trial of 8-session multicomponent CBT-I versus an active behavioral desensitization control condition (BD), including a 6-month follow-up assessment. Data used herein include daily diaries of sleep parameters, actigraphy data, and self-report questionnaires administered at specific time points. Patients who reported at least 30% improvement in self-reported pain from baseline to 6-month follow-up were considered responders (N = 31). Pain responders and nonresponders did not differ significantly at baseline across any sleep continuity measures. At mid-treatment, only TST predicted pain response via t tests and logistic regression, whereas other measures of sleep continuity were nonsignificant. Recursive partitioning analyses identified a minimum cut-point of 382 min of TST achieved at mid-treatment in order to best predict pain improvements 6-month posttreatment. Actigraphy results followed the same pattern as daily diary-based results. Clinically significant pain reductions in response to both CBT-I and BD were optimally predicted by achieving approximately 6.5 hr sleep duration by mid-treatment. Thus, tailoring interventions to increase TST early in treatment may be an effective strategy to promote long-term pain reductions. More comprehensive research on components of behavioral sleep medicine treatments that contribute to pain response is warranted. © Sleep Research Society 2016. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients.

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Pan, Ruihuan; Zhou, Mingchao; Cai, Hao; Guo, Youhua; Zhan, Lechang; Li, Mei; Yang, Zhijing; Zhu, Leying; Zhan, Jie; Chen, Hongxia

2018-01-01

To evaluate the effect of modified wheelchair arm-support to mitigate hemiplegic shoulder pain and reduce pain frequency in stroke patients. A single-blind randomized controlled trial using computer-generated simple randomization. Participants recruited from inpatients at the Guangdong Provincial Hospital of Chinese Medicine. A total of 120 patients with stroke were divided into two groups. All subjects underwent basic rehabilitation training and wheelchair assistance with eight weeks follow-up period. Patients in the treatment group additionally received modified wheelchair arm-support for at least 60 minutes a day, six days a week, for four weeks. Primary outcome was measured by the Visual Analogue Pain Scale or Numeric Pain Rating Scale. Secondary outcome was measured using the Upper Extremity Fugl-Meyer Assessment scale, Modified Barthel Index and Quality of Life Index. Measurements were made at 4 weeks and 12 weeks, following the intervention. Patients age from 21 to 83 years (mean ± SD = 62.41 ± 12.26). The average duration of disease was 1.9 ± 1.3 months. At four weeks, the median of pain intensity was higher in the control group (median, interquartile range = 3, 5.75 vs. 2, 3.75; P = 0.059). At 12 weeks, the median of pain intensity was higher in the control group (median, interquartile range = 3, 5.00 vs. 0, 1.00; P vs. 1; P stroke patients. It may also improve the patients' quality of life.

Exercise training as treatment of neck pain among fighter pilots

DEFF Research Database (Denmark)

Murray, Mike; Lange, Britt; Andersen, Christoffer Højnicke

) seldom, trained but stopped, 6) no participation at all. Maximal Voluntary Isometric Contraction (MVC) and Rate of Force Development (RFD) for cervical flexion and extension were measured by strain-gauge transducers. Results Prevalence of neck pain was significantly reduced in ET from baseline (mean ± SD......Introduction Neck and shoulder pain is a common complaint among fighter pilots and a growing aero-medical concern. Unfortunately, previous intervention studies have been unsuccessful in relieving such pain within this occupational group. The aim of this study was to investigate if an exercise...... intervention could reduce the high prevalence of neck pain among fighter pilots. Methods F-16 pilots were randomized in a controlled intervention trial, to either an exercise-training-group (ET, n=27) or reference-group (REF, n=28). ET underwent 24 weeks of strength, endurance, and coordination training, 3...

Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial.

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Petrofsky, Jerrold S; Laymon, Michael; Alshammari, Faris; Khowailed, Iman Akef; Lee, Haneul

2017-01-01

It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (ppain significantly improved pain attenuation and it causes greater compliance for home.

The effectiveness of the Pilates method: reducing the degree of non-structural scoliosis, and improving flexibility and pain in female college students.

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Alves de Araújo, Maria Erivânia; Bezerra da Silva, Elirez; Bragade Mello, Danielli; Cader, Samária Ali; Shiguemi Inoue Salgado, Afonso; Dantas, Estélio Henrique Martin

2012-04-01

To evaluate the effectiveness of Pilates with regard to the degree of scoliosis, flexibility and pain. The study included 31 female students divided into two groups: a control group (CG = 11), which had no therapeutic intervention, and an experimental group (EG = 20), which underwent Pilates-based therapy. We used radiological goniometry measurements to assess the degree of scoliosis, standard goniometry measurements to determine the degree of flexibility and the scale of perceived pain using the Borg CR 10 to quantify the level of pain. The independent t test of the Cobb angle (t = - 2.317, p = 0.028), range of motion of trunk flexion (t = 3.088, p = 0.004) and pain (t = -2.478, p = 0.019) showed significant differences between the groups, with best values in the Pilates group. The dependent t test detected a significant decrease in the Cobb angle (Δ% = 38%, t = 6.115, p = 0.0001), a significant increase in trunk flexion (Δ% = 80%, t = -7.977, p = 0.0001) and a significant reduction in pain (Δ% = 60%, t = 7.102, p = 0.0001) in the EG. No significant difference in Cobb angle (t = 0.430, p = 0.676), trunk flexion, (t = 0.938p = 0.371) or pain (t = 0.896, p = 0.391) was found for the CG. The Pilates group was better than control group. The Pilates method showed a reduction in the degree of non-structural scoliosis, increased flexibility and decreased pain. Copyright © 2011 Elsevier Ltd. All rights reserved.

Effect of specific resistance training on musculoskeletal pain symptoms

DEFF Research Database (Denmark)

Pedersen, Mogens Theisen; Andersen, Lars Louis; Jørgensen, Marie Birk

2013-01-01

.16, p = 0.045), and there was a significant dose-response relationship between training volume per session and change in pain index (ß = -0.20, p = 0.034). In contrast, training attendance (mean 1.69 sessions per week, SD = 0.8) was not significantly related to the change in pain index. In conclusion......, achieving higher accumulated training volumes was important for reducing musculoskeletal pain in female office workers. The training volume per session should be optimized by securing a load at 10-15 repetition maximum and adhering to principles of progressive overload.......ABSTRACT: Pedersen, MT, Andersen, LL, Jørgensen, MB, Søgaard, K, and Sjøgaard, G. Effect of specific resistance training on musculoskeletal pain symptoms: Dose-response relationship. J Strength Cond Res 27(1): 229-235, 2013-The purpose of this study was to investigate the dose-response of strength...

Sources of pain in laparoendoscopic gynecological surgeons: An analysis of ergonomic factors and proposal of an aid to improve comfort.

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Lee, Sa Ra; Shim, Sunah; Yu, Taeri; Jeong, Kyungah; Chung, Hye Won

2017-01-01

Minimally invasive surgery (MIS) offers cosmetic benefits to patients; however, surgeons often experience pain during MIS. We administered an ergonomic questionnaire to 176 Korean laparoscopic gynecological surgeons to determine potential sources of pain during surgery. Logistic regression analysis was used to identify factors that had a significant impact on gynecological surgeons' pain. Operating table height at the beginning of surgery and during the operation were significantly associated with neck and shoulder discomfort (P ergonomic solutions to reduce gynecological laparoscopic surgeons' pain. Based on our results, we propose the use of an ergonomic surgical step stool to reduce physical pain related to performing laparoscopic operations.

The effect of diclofenac mouthwash on periodontal postoperative pain

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Jaber Yaghini

2011-01-01

After the operation in addition to ibuprofen 400 mg, one quadrant randomly received Diclofenac mouthwash (0/01% for 30 seconds, 4 times a day (for a week and for the contrary quadrant, ibuprofen and placebo mouthwash was given to be used in the same manner. The patients scored the number of ibuprofen consumption and their pain intensity based on VAS index in a questionnaire in days 1, 2, 3 and the first week after operation. The findings were analysed using two-way ANOVA, t-test and Wilcoxon. P-value less than 0.05 considered to be significant. Results: There was a significant difference between the mean values of pain intensity of two quadrants in four periods (P = 0.031. But, there was no significant difference between the average ibuprofen consumption in two groups (P = 0.51. Postoperative satisfaction was not significantly different in two quadrants (P = 0.059. 60% of patients preferred Diclofenac mouthwash. Conclusion: Diclofenac mouthwash was effective in reducing postoperative periodontal pain but it seems that it isn′t enough to control postoperative pain on its own.

Differences in Pain Processing Between Patients with Chronic Low Back Pain, Recurrent Low Back Pain, and Fibromyalgia.

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Goubert, Dorien; Danneels, Lieven; Graven-Nielsen, Thomas; Descheemaeker, Filip; Meeus, Mira

2017-05-01

The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing in LBP remains ambiguous, partly due to the diversity in the LBP population. The purpose of this study is to compare quantitative sensory assessment in different groups of LBP patients with regard to chronicity. Recurrent low back pain (RLBP), mild chronic low back pain (CLBP), and severe CLBP are compared on the one hand with healthy controls (HC), and on the other hand with fibromyalgia (FM) patients, in which abnormal pain processing has previously been reported. Cross-sectional study. Department of Rehabilitation Sciences, Ghent University, Belgium. Twenty-three RLBP, 15 mild CLBP, 16 severe CLBP, 26 FM, and 21 HC participated in this study. Quantitative sensory testing was conducted by manual pressure algometry and computer-controlled cuff algometry. A manual algometer was used to evaluate hyperalgesia as well as temporal summation of pain and a cuff algometer was used to evaluate deep tissue hyperalgesia, the efficacy of the conditioned pain modulation and spatial summation of pain. Pressure pain thresholds by manual algometry were significantly lower in FM compared to HC, RLBP, and severe CLBP. Temporal summation of pain was significantly higher in FM compared to HC and RLBP. Pain tolerance thresholds assessed by cuff algometry were significantly lower in FM compared to HC and RLBP and also in severe CLBP compared to RLBP. No significant differences between groups were found for spatial summation or conditioned pain modulation. No psychosocial issues were taken into account for this

Zoledronic Acid improves clinical outcomes when administered before onset of bone pain in patients with prostate cancer.

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Saad, Fred; Eastham, James

2010-11-01

To evaluate, in an exploratory analysis, the effect of zoledronic acid (ZOL) on skeletal-related event (SRE) incidence as determined by the bone pain levels at study entry. Bone metastases can undermine skeletal integrity long before the onset of symptoms. Treating patients before symptom onset might be more effective in preventing SREs and improving patients' quality of life. ZOL has shown significant reductions in SREs and pain compared with placebo in patients with bone metastases from advanced prostate cancer in a randomized placebo-controlled trial. Patients from a placebo-controlled, Phase III trial of men with castration-resistant prostate cancer, randomized to receive ZOL 4 mg (n = 214) or placebo (n = 208) for ≤ 24 months, were stratified by pain or no pain at baseline. Bone pain was assessed at baseline, week 3, and week 6 and at 6-week intervals thereafter. The primary endpoint was the proportion of patients with ≥ 1 SRE. ZOL significantly reduced the mean pain scores compared with placebo at 3, 9, 21, and 24 months (P ≤ .03 for each point) and reduced the annual incidence of SREs. Among patients without baseline pain, ZOL decreased the percentage of patients with ≥ 1 SRE by 39% and reduced the annual incidence of SREs by 49% compared with placebo. ZOL delayed the onset of bone pain in those patients without pain at baseline compared with placebo. ZOL reduced bone pain and SREs compared with placebo in patients with bone metastases from castration-resistant prostate cancer, irrespective of the baseline pain status, and appeared more efficacious when initiated before the onset of pain. Copyright © 2010 Elsevier Inc. All rights reserved.

The Effect of 8 weeks of combined training on the angle of lumbar lordosis and pain of women suffering from sciatica pain

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Behnaz Karimi

2016-11-01

Full Text Available Chronic low back pain is among the most commonly pains caused by malfunctions, poor physical condition, and mental stresses. Various non-surgical methods are recommended to reduce pain, to maintain mobility, and to minimize disability in patients. The main objective of this study was to determine the impact of 8 weeks of combined exercises on lumbar lordosis angle, pain, and quality of life of females suffering from sciatic pain. In this study, 15 female patients participated aged between 30 and 50 years with low back pain, sciatic pain, and lumbar lordosis. Lumbar lordosis angle (flexible ruler and pain (McGill questionnaire of patients before and after 8 weeks of exercise were evaluated. Data were analyzed using t-test (P<0.05. In this study, no significant difference was found in lumbar lordosis angle of sciatica patients before (± 0.1 43.2 and after the exercises (0.8 ± 34.2 (p<0.05.Significant difference was observed in pain perceptions between the before (0.8 ± 2.6 and after exercises (0.5 ± 1.8, emotional perceptions of pain between before (0.26 ± 1.4 and after exercises (0.3 ± 1.9 and various pain perceptions between before (0.6 ± 2.2 and after exercises (0.2 ± 1.5 (P<0.05. It can be concluded that hydrotherapy exercises along with on land exercises can improve lumbar lordosis and pain in patients with sciatic pain. Therefore, it can be recommended as a modality for these patients.