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Sample records for sustained pain relief

  1. 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.

  2. Surgical suture assembled with polymeric drug-delivery sheet for sustained, local pain relief.

    Science.gov (United States)

    Lee, Ji Eun; Park, Subin; Park, Min; Kim, Myung Hun; Park, Chun Gwon; Lee, Seung Ho; Choi, Sung Yoon; Kim, Byung Hwi; Park, Hyo Jin; Park, Ji-Ho; Heo, Chan Yeong; Choy, Young Bin

    2013-09-01

    Surgical suture is a strand of biocompatible material designed for wound closure, and therefore can be a medical device potentially suitable for local drug delivery to treat pain at the surgical site. However, the preparation methods previously introduced for drug-delivery sutures adversely influenced the mechanical strength of the suture itself - strength that is essential for successful wound closure. Thus, it is not easy to control drug delivery with sutures, and the drug-delivery surgical sutures available for clinical use are now limited to anti-infection roles. Here, we demonstrate a surgical suture enabled to provide controlled delivery of a pain-relief drug and, more importantly, we demonstrate how it can be fabricated to maintain the mechanical strength of the suture itself. For this purpose, we separately prepare a drug-delivery sheet composed of a biocompatible polymer and a pain-relief drug, which is then physically assembled with a type of surgical suture that is already in clinical use. In this way, the drug release profiles can be tailored for the period of therapeutic need by modifying only the drug-loaded polymer sheet without adversely influencing the mechanical strength of the suture. The drug-delivery sutures in this work can effectively relieve the pain at the surgical site in a sustained manner during the period of wound healing, while showing biocompatibility and mechanical properties comparable to those of the original surgical suture in clinical use. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  3. Pain relief can be painful

    Directory of Open Access Journals (Sweden)

    Ashish Bindra

    2015-01-01

    Full Text Available Mandibular nerve block is periodically used procedure used to treat neuralgic pain in the distribution of trigeminal nerve. It is a commonly performed block in outpatient settings at our institute. We present a case of an elderly edentulous patient with trigeminal neuralgia who suffered recurrent temporomandibular joint (TMJ dislocation following mandibular nerve block. The patient presented with complaints of severe pain, inability to close mouth, and eat food since 2 days. Anterior closed reduction of TMJ resulted in reduction of joint and immediate pain relief. However, the maneuver failed due to recurrent dislocation of the joint. A Barton dressing was applied to prevent another dislocation. This was followed by autologous blood injection into the joint. This case focuses on the preponderance of clinical evaluation and accentuates the need for additional forethought to be taken during pain procedures, particularly in the geriatric population.

  4. Music for pain relief.

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    Cepeda, M S; Carr, D B; Lau, J; Alvarez, H

    2006-04-19

    The efficacy of music for the treatment of pain has not been established. To evaluate the effect of music on acute, chronic or cancer pain intensity, pain relief, and analgesic requirements. We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, LILACS and the references in retrieved manuscripts. There was no language restriction. We included randomized controlled trials that evaluated the effect of music on any type of pain in children or adults. We excluded trials that reported results of concurrent non-pharmacological therapies. Data was extracted by two independent review authors. We calculated the mean difference in pain intensity levels, percentage of patients with at least 50% pain relief, and opioid requirements. We converted opioid consumption to morphine equivalents. To explore heterogeneity, studies that evaluated adults, children, acute, chronic, malignant, labor, procedural, or experimental pain were evaluated separately, as well as those studies in which patients chose the type of music. Fifty-one studies involving 1867 subjects exposed to music and 1796 controls met inclusion criteria. In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity ( I(2) = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a zero to ten scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2). Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13). Three

  5. Lidocaine/ketorolac-loaded biodegradable nanofibrous anti-adhesive membranes that offer sustained pain relief for surgical wounds.

    Science.gov (United States)

    Kao, Ching-Wei; Lee, Demei; Wu, Min-Hsuan; Chen, Jan-Kan; He, Hong-Lin; Liu, Shih-Jung

    2017-01-01

    The aim of this study was to develop and evaluate the effectiveness of biodegradable nanofibrous lidocaine/ketorolac-loaded anti-adhesion membranes to sustainably release analgesics on abdominal surgical wounds. The analgesic-eluting membranes with two polymer-to-drug ratios (6:1 and 4:1) were produced via an electrospinning technique. A high-performance liquid chromatography (HPLC) assay was employed to characterize the in vivo and in vitro release behaviors of the pharmaceuticals from the membranes. It was found that all biodegradable anti-adhesion nanofibers released effective concentrations of lidocaine and ketorolac for over 20 days post surgery. In addition, a transverse laparotomy was setup in a rat model for an in vivo assessment of activity of postoperative recovery. No tissue adhesion was observed at 2 weeks post surgery, demonstrating the potential anti-adhesion capability of the drug-eluting nanofibrous membrane. The postoperative activities were recorded for two groups of rats as follows: rats that did not have any membrane implanted (group A) and rats that had the analgesic-eluting membrane implanted (group B). Rats in group B exhibited faster recovery times than those in group A with regard to postoperative activities, confirming the pain relief effectiveness of the lidocaine- and ketorolac-loaded nanofibrous membranes. The experimental results suggested that the anti-adhesion nanofibrous membranes with sustainable elution of lidocaine and ketorolac are adequately effective and durable for the purposes of postoperative pain relief in rats.

  6. Osteopathic manipulative treatment results in sustained relief from spinal pain in older patients: A pilot crossover study

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    Pannunzio A

    2016-01-01

    Full Text Available Osteopathic Manipulative Treatment is commonly used to complement conventional treatment of back pain. The present study verified whether OMT, associated with training program, reduces spinal pain in older. A pilot randomized, double-blind crossover study was conducted at Sport Association of Milan, Italy. We recruited 19 subjects above 60 years old, with presence of SP for more than 3 weeks and with intensity score higher than 3 (NRS score. All patients underwent a multi-component group exercise program for older adults and were randomized in two groups: in the study group (SG OMT was added, while the control group (CG continued with the exercise only. After 6 weeks a crossover was applied to the 2 groups and OMT was added to CG, while SG continued with the exercise only. Self-reported measures: the Numeric Rating Scale (NRS was used at each time to evaluate treatment outcomes. At pre-crossover, SG had a significant improvement in pain perception (p<0.05, while CG had a not significate improvement in pain perception (p=0.33.At post-crossover, the SG remains relatively stable (p=0.37, while CG after OMT addition have a significant benefit on pain perception (p=0.001. At follow-up, pain improvement is sustained (p=0.32. OMT associated to exercise reduce spinal pain in older patients. Our study suggests that OMT associated to exercise leads to significant improvement on pain relief in patients with chronic SP in a short term and the exercise allows to maintain these improvements for several months

  7. Exercise Based- Pain Relief Program

    DEFF Research Database (Denmark)

    Zadeh, Mahdi Hossein

    Exercise-based pain management programs are suggested for relieving from musculoskeletal pain; however the pain experienced after unaccustomed, especially eccentric exercise (ECC) alters people´s ability to participate in therapeutic exercises. Subsequent muscle pain after ECC has been shown...... in the current study was to use exercise induced- muscle damage followed by ECC as an acute pain model and observe its effects on the sensitivity of the nociceptive system and blood supply in healthy subjects. Then, the effect of a repeated bout of the same exercise as a healthy pain relief strategy...

  8. PAIN RELIEF IN POLYTRAUMA PATIENTS

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    M. C. Rajesh

    2016-09-01

    Full Text Available BACKGROUND Pain management in Polytrauma is a poorly-addressed concern at the time of active resuscitation. But, very often, pain assessment is also a challenge! Opioids belong to conventional analgesics of choice in any acute pain conditions. But, recently application of regional anaesthesia techniques and subanaesthetic doses of ketamine are satisfactorily employed. A clear understanding of neuropathic element of pain must be made as they require specific therapy. It must be emphasised that effective pain therapy is a multidisciplinary team work with active involvement of pain psychologist.

  9. Reward and motivation in pain and pain relief.

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    Navratilova, Edita; Porreca, Frank

    2014-10-01

    Pain is fundamentally unpleasant, a feature that protects the organism by promoting motivation and learning. Relief of aversive states, including pain, is rewarding. The aversiveness of pain, as well as the reward from relief of pain, is encoded by brain reward/motivational mesocorticolimbic circuitry. In this Review, we describe current knowledge of the impact of acute and chronic pain on reward/motivation circuits gained from preclinical models and from human neuroimaging. We highlight emerging clinical evidence suggesting that anatomical and functional changes in these circuits contribute to the transition from acute to chronic pain. We propose that assessing activity in these conserved circuits can offer new outcome measures for preclinical evaluation of analgesic efficacy to improve translation and speed drug discovery. We further suggest that targeting reward/motivation circuits may provide a path for normalizing the consequences of chronic pain to the brain, surpassing symptomatic management to promote recovery from chronic pain.

  10. Topical Drugs for Pain Relief

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    Anjali Srinivasan

    2015-03-01

    Full Text Available Topical therapy helps patients with oral and perioral pain problems such as ulcers, burning mouth syndrome, temporomandibular disorders, neuromas, neuropathies and neuralgias. Topical drugs used in the field of dentistry are topical anaesthetics, topical analgesics, topical antibiotics and topical corticosteroids. It provides symptomatic/curative effect. Topical drugs are easy to apply, avoids hepatic first pass metabolism and more sites specific. But it can only be used for medications that require low plasma concentrations to achieve a therapeutic effect.

  11. Pain relief that matters to patients

    DEFF Research Database (Denmark)

    Olsen, Mette Frahm; Bjerre, Eik; Damkjær Hansen, Maria

    2017-01-01

    relief. Subgroup analyses showed that the definition of improved patients (one or several categories improvement or meaningful change) and the design of studies (single or multiple measurements) also influenced MCID values. CONCLUSIONS: The MCID in acute pain varied greatly between studies...... and was influenced by baseline pain, definitions of improved patients and study design. MCID is context-specific and potentially misguiding if determined, applied or interpreted inappropriately. Explicit and conscientious reflections on the choice of a reference value are required when using MCID to classify...

  12. 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.

  13. Canadian Pain Society Position Statement on Pain Relief

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    Judith H Watt-Watson

    1999-01-01

    Full Text Available The present report outlines key requirements that are central to helping patients manage pain effectively. Although current standards are available as guides for practice, the prevalence of pain suggests that many health professionals do not know and/or cannot relate to these standards. Therefore, a brief, pragmatic statement may be more useful initially for health professionals and patients learning about problematic pain outcomes. The principles in the brief statement produced by the Canadian Pain Society clarify and emphasize key underlying assumptions that have directed the development of many pain standards. The aim of the present paper is to increase awareness of ineffective pain practices and the importance of pain relief, and to stimulate further work in this area.

  14. Trends in intraoperative pain relief in anesthesized Nigerian ...

    African Journals Online (AJOL)

    shobha

    Background: New drugs and new modalities for intraoperative pain relief is the current trend in pain management. Aim: The study aims at examining the current trend in intraoperative pain relief in patients of pediatric age at the. University of Benin Teaching Hospital (UBTH) and its implications for a developing economy ...

  15. Knowledge of and attitude towards pain relief during labour of ...

    African Journals Online (AJOL)

    Most of the women gained knowledge regarding pain relief from past experiences or from friends and relatives. Even though the few women who received information about what to expect during labour found the information useful, most expressed little confidence in labour pain relief. South African Family Practice Vol.

  16. Mechanisms of pain relief by vibration and movement.

    OpenAIRE

    Kakigi, R; Shibasaki, H

    1992-01-01

    Mechanisms of pain relief induced by vibration and movement were investigated. A CO2 laser beam, which is useful for pure nociceptive stimulation, was used for recording pain-related somatosensory evoked potentials (pain SEPs) and for measuring pain threshold and reaction time (RT). Concurrently applied vibratory stimuli to and active movements of the fingers significantly reduced and prolonged pain SEPs, increased pain threshold, and prolonged RT, indicating that an increase in the inhibitor...

  17. Medications for Pain Relief during Labor and Delivery

    Science.gov (United States)

    ... that carry feeling to the vagina , vulva , and perineum . Local anesthetics provide relief from pain in these ... spine. Episiotomy: A surgical incision made into the perineum (the region between the vagina and the anus) ...

  18. Pain relief and clinical outcome: from opioids to balanced analgesia

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids...... were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts...

  19. Japanese women's experiences of pharmacological pain relief in New Zealand.

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    Doering, Keiko; Patterson, Jean; Griffiths, Christine R

    2014-06-01

    In Japan, most women manage labour pain without pharmacological interventions. However, New Zealand statistics show a high percentage of epidural use amongst Asian women. Entonox (a gas mixture of nitrous oxide and oxygen) and pethidine are also available to women in New Zealand. This article investigates how Japanese women in New Zealand respond to the use of pharmacological pain relief in labour. The study was guided by two research questions: (1) How do Japanese women experience and manage labour pain in New Zealand? (2) How do they feel about the use of pharmacological pain relief? Thirteen Japanese women who had given birth in New Zealand were interviewed individually or in a focus group. The conversations were analysed using thematic analysis. Although in Japan very few women use pain relief, nine women received epidural and/or Entonox out of 11 women who experienced labour pain. The contrast between their Japanese cultural expectations and their birth experiences caused some of the women subsequent personal conflict. Japanese women's cultural perspectives and passive attitudes were demonstrated to influence the decision-making process concerning pain relief. It was concluded that understanding Japanese cultural worldviews and approaches to the role of pain in labour would help maternity providers in their provision of appropriate care for Japanese women. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  20. Careful: Acetaminophen in Pain Relief Medicines Can Cause Liver Damage

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    ... the-Counter Pain Relievers and Fever Reducers Careful: Acetaminophen in pain relief medicines can cause liver damage ... More sharing options Linkedin Pin it Email Print Acetaminophen (a∙SEET∙a∙MIN∙o∙fen) is an ...

  1. Assessment of immediate pain relief with laser treatment in recurrent aphthous stomatitis.

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    Prasad R, Shesha; Pai, Anuradha

    2013-08-01

    To compare immediate pain relief, healing time between minor recurrent aphthous ulcers treated with a single session of carbon dioxide (CO2) laser and a placebo. A prospective clinical study was performed on 25 patients with minor recurrent aphthous stomatitis. Pretreatment pain levels were recorded using a numerical rating scale. Ulcers were randomized to either receive treatment or placebo. Pain levels were assessed immediately after treatment and after 24 h. Healing was assessed on days 3 and 4, and once every 2 days thereafter for 2 weeks. Mean pain scores in the laser group were significantly reduced immediately after treatment (0.68 ± 0.6) compared with pretreatment (8.48 ± 0.71; P recurrent aphthous stomatitis (RAS) provides immediate pain relief sustained over 24 h, along with accelerated healing time. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Non-pharmacologic labour pain relief.

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    Prasertcharoensuk, Witoon; Thinkhamrop, Jadsada

    2004-10-01

    Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined currently available evidence supporting the use of alternative and complementary therapies for pain management in labour. To examine the effectiveness of complementary and alternative therapies for pain management in labour on maternal and perinatal morbidity. The trials included three trials of hypnosis (n = 189), one involving audio-analgesia (n = 25), one involving (n = 22), and one trial of music (n = 30). Women receiving hypnosis were more satisfied with their pain management in labour compared with controls (RR 2.33, 95% CI 1.55 to 4.71). No differences were seen for women recieving, music or audio analgesia. Hypnosis may be beneficial for the management of pain during labour. However, few complementary therapies have been subjected to proper scientific study.

  3. [Rehabilitation for Pain Relief: Preface and Comments].

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    Hanaoka, Kazuo

    2015-07-01

    Chronic intractable pain is difficult to manage as the mechanisms of chronic pain are complicated. Recently rehabilitation is used in patients with chronic pain not responding to NSAIDs, non-opioids, anti-depressants and so on. Rehabilitation includes acute, recovery and maintained modes of rehabilitation. This review is focused on the concept of rehabilitation, rehabilitation therapy, rehabilitation during recovery period, nerve rehabilitation, music-trampoline therapy and so on.

  4. A novel and effective acupuncture modality as a complementary therapy to acute pain relief in inpatients with rib fractures

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    Hsin-Yi Ho

    2014-06-01

    Full Text Available Background: Pain control has been emphasized as a priority for both practitioners and inpatients with rib fractures, since analgesia could only offer limited relief from severe pain. A prospective and randomized controlled trial was conducted to analyze the efficacy and efficiency of acupuncture in acute pain relief for inpatients with rib fractures. Methods: A total of 58 inpatients were recruited and allocated to two groups, receiving identical doses of conventional oral analgesics as well as filiform needles as treatment and thumbtack intradermal (TI needles placed upon the skin surface as a control, respectively, via novel acupuncture modality once daily for three consecutive days. The effect of pain relief was evaluated during activities that induce pain, and sustained maximal inspiration (SMI lung volumes and sleep quality were assessed. Results: The patients treated with filiform needles had more effective pain relief than those in the TI needle group during deep breathing, coughing, and turning over the body (p < 0.05, and the effect persisted for at least 6 h in most patients. Sustained maximal inspiration lung volumes and sleep quality did not show improvement through every acupuncture intervention, and they could not respond accurately to pain relief via acupuncture. Conclusion: The active evaluation could provide a more adaptive model for assessing pain intensity due to rib fractures. This novel acupuncture modality in which the needle insertion sites are corresponding to the pain spots can be a safe and viable therapy for relieving pain in inpatients with rib fractures.

  5. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De

    1993-01-01

    for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case...... the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been...

  6. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De

    1993-01-01

    Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine...... the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been...

  7. Pain relief that matters to patients

    DEFF Research Database (Denmark)

    Olsen, Mette Frahm; Bjerre, Eik; Hansen, Maria Damkjær

    2017-01-01

    BACKGROUND: The minimum clinically important difference (MCID) is used to interpret the clinical relevance of results reported by trials and meta-analyses as well as to plan sample sizes in new studies. However, there is a lack of consensus about the size of MCID in acute pain, which is a core...

  8. Knowledge of and attitude towards pain relief during labour of ...

    African Journals Online (AJOL)

    Objective: This study determined women's knowledge of and attitudes to pain relief during labour. Methods: This descriptive study included 151 women, 18 years or older, attending the antenatal clinic of Cecilia Makiwane Hospital. Women were interviewed using a questionnaire that determined their knowledge of and ...

  9. Dysmenorrhoea: Pain relief strategies among a cohort of ...

    African Journals Online (AJOL)

    McRoy

    Dysmenorrhoea: Pain relief strategies among a cohort of undergraduates in Nigeria. Emmanuel A1*, Achema G2, Gimba SM1, Mafuyai MJ1, Afoi BB3, Ifere I.O1. 1Department of Nursing, University of Jos, Plateau, Nigeria, 2School of Nursing and Public. Health, Howard College, University of Kwazulu-Natal, Durban, South ...

  10. Trends in intraoperative pain relief in anesthesized Nigerian ...

    African Journals Online (AJOL)

    shobha

    IV NSAID, e.g., ketorolac. IV ketamine. IV PCA (PICA). 568. 4. 16. –. 550 (96.8). 2 (50). 14 (87.5). –. Regional blocks: Caudal block. Epidural/ spinal blocks. 41. 5. 41 (100). 5 (100). Local infiltration of local anesthetic. 6. 6 (100). Unspecified. 41. –. Total. *689. 612. Multimodal pain relief methods were used in some patients.

  11. A novel and effective acupuncture modality as a complementary therapy to acute pain relief in inpatients with rib fractures.

    Science.gov (United States)

    Ho, Hsin-Yi; Chen, Chao-Wei; Li, Ming-Chieh; Hsu, Yu-Pao; Kang, Shih-Ching; Liu, Erh-Hao; Lee, Ko-Hung

    2014-01-01

    Pain control has been emphasized as a priority for both practitioners and inpatients with rib fractures, since analgesia could only offer limited relief from severe pain. A prospective and randomized controlled trial was conducted to analyze the efficacy and efficiency of acupuncture in acute pain relief for inpatients with rib fractures. A total of 58 inpatients were recruited and allocated to two groups, receiving identical doses of conventional oral analgesics as well as filiform needles as treatment and thumbtack intradermal (TI) needles placed upon the skin surface as a control, respectively, via novel acupuncture modality once daily for three consecutive days. The effect of pain relief was evaluated during activities that induce pain, and sustained maximal inspiration (SMI) lung volumes and sleep quality were assessed. The patients treated with filiform needles had more effective pain relief than those in the TI needle group during deep breathing, coughing, and turning over the body (p acupuncture intervention, and they could not respond accurately to pain relief via acupuncture. The active evaluation could provide a more adaptive model for assessing pain intensity due to rib fractures. This novel acupuncture modality in which the needle insertion sites are corresponding to the pain spots can be a safe and viable therapy for relieving pain in inpatients with rib fractures.

  12. The importance of context: when relative relief renders pain pleasant.

    Science.gov (United States)

    Leknes, Siri; Berna, Chantal; Lee, Michael C; Snyder, Gregory D; Biele, Guido; Tracey, Irene

    2013-03-01

    Context can influence the experience of any event. For instance, the thought that "it could be worse" can improve feelings towards a present misfortune. In this study we measured hedonic feelings, skin conductance, and brain activation patterns in 16 healthy volunteers who experienced moderate pain in two different contexts. In the "relative relief context," moderate pain represented the best outcome, since the alternative outcome was intense pain. However, in the control context, moderate pain represented the worst outcome and elicited negative hedonic feelings. The context manipulation resulted in a "hedonic flip," such that moderate pain elicited positive hedonics in the relative relief context. Somewhat surprisingly, moderate pain was even rated as pleasant in this context, despite being reported as painful in the control context. This "hedonic flip" was corroborated by physiological and functional neuroimaging data. When moderate pain was perceived as pleasant, skin conductance and activity in insula and dorsal anterior cingulate were significantly attenuated relative to the control moderate stimulus. "Pleasant pain" also increased activity in reward and valuation circuitry, including the medial orbitofrontal and ventromedial prefrontal cortices. Furthermore, the change in outcome hedonics correlated with activity in the periacqueductal grey (PAG) of the descending pain modulatory system (DPMS). The context manipulation also significantly increased functional connectivity between reward circuitry and the PAG, consistent with a functional change of the DPMS due to the altered motivational state. The findings of this study point to a role for brainstem and reward circuitry in a context-induced "hedonic flip" of pain. Copyright © 2012 International Association for the Study of Pain. All rights reserved.

  13. Parenteral opioids for maternal pain relief in labour.

    Science.gov (United States)

    Ullman, Roz; Smith, Lesley A; Burns, Ethel; Mori, Rintaro; Dowswell, Therese

    2010-09-08

    Parenteral opioids are used for pain relief in labour in many countries throughout the world. To assess the acceptability, effectiveness and safety of different types, doses and modes of administration of parenteral opioids given to women in labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2010) and reference lists of retrieved studies. We included randomised controlled trials examining the use of intramuscular or intravenous opioids (including patient controlled analgesia) for women in labour. We looked at studies comparing an opioid with placebo or another opioid. At least two review authors independently assessed study eligibility, collected data and assessed risk of bias. We included 54 studies involving more than 7000 women that compared an opioid with placebo or another opioid administered intramuscularly or intravenously. The 54 studies reported on 27 different comparisons, and for many outcomes only one study contributed data. Overall the evidence was of poor quality regarding the analgesic effect of opioids, satisfaction with analgesia, adverse effects and harm to women and babies. There were few statistically significant results. Many of the studies had small sample sizes, and low statistical power. Overall, findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour, although up to two-thirds of women who received opioids reported moderate or severe pain and/or poor or moderate pain relief one or two hours after administration. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids on the newborn. We did not have sufficient evidence to assess which opioid drug provided the best pain relief with the least adverse effects. Parenteral opioids provide some relief from pain in labour but are associated

  14. Acupucture as pain relief during delivery - a randomized controlled trial

    DEFF Research Database (Denmark)

    Borup, Lissa; Wurlitzer, Winnie; Hedegaard, Morten

    2009-01-01

    with the intention-to-treat principle. Results: Use of pharmacological and invasive methods was significantly lower in the acupuncture group (acupuncture vs traditional, p acupuncture vs TENS, p = 0.031). Pain scores were comparable. Acupuncture did not influence the duration of labor or the use of oxytocin......Background: Many women need some kind of analgesic treatment to relieve pain during childbirth. The objective of our study was to compare the effect of acupuncture with transcutaneous electric nerve stimulation (TENS) and traditional analgesics for pain relief and relaxation during delivery...... with respect to pain intensity, birth experience, and obstetric outcome. Methods: A randomized controlled trial was conducted with 607 healthy women in labor at term who received acupuncture, TENS, or traditional analgesics. Primary outcomes were the need for pharmacological and invasive methods, level of pain...

  15. Acupuncture as pain relief during delivery: a randomized controlled trial

    DEFF Research Database (Denmark)

    Borup, Lissa; Wurlitzer, Winnie; Hedegaard, Morten

    2009-01-01

    with the intention-to-treat principle. RESULTS: Use of pharmacological and invasive methods was significantly lower in the acupuncture group (acupuncture vs traditional, p acupuncture vs TENS, p = 0.031). Pain scores were comparable. Acupuncture did not influence the duration of labor or the use of oxytocin......BACKGROUND: Many women need some kind of analgesic treatment to relieve pain during childbirth. The objective of our study was to compare the effect of acupuncture with transcutaneous electric nerve stimulation (TENS) and traditional analgesics for pain relief and relaxation during delivery...... with respect to pain intensity, birth experience, and obstetric outcome. METHODS: A randomized controlled trial was conducted with 607 healthy women in labor at term who received acupuncture, TENS, or traditional analgesics. Primary outcomes were the need for pharmacological and invasive methods, level of pain...

  16. Inadequate pain relief and consequences in oncological elderly patients.

    Science.gov (United States)

    Caltagirone, Carlo; Spoletini, Ilaria; Gianni, Walter; Spalletta, Gianfranco

    2010-09-01

    Elderly patients with cancer are particularly burdened with pain, which has an impact on physical, psychological and cognitive symptoms, and consequently, on the overall quality of life. Here, the existing literature on pain and its consequences in elderly patients with cancer is reviewed, in order to understand the impact of cancer pain and its related symptoms, and the importance of its correct assessment and management, in the geriatric population. From the literature, it emerges that cancer pain has a complex and multidimensional phenomenology in this population, and it is often underestimated and consequently untreated. Furthermore, elderly cancer patients are at higher risk of suffering from pain. Aetiology of cancer pain in elderly patients is still an emergent issue, and immunological findings on the link between pain, cancer and aging may help enlighten the pathophysiological mechanisms underlying pain in elderly cancer patients. Particularly, immune dysfunction may represent a common pathogenic ground of pain and its more common related symptoms (i.e. depression and cognitive decline) in elderly cancer patients. Appropriate pain relief represents a challenge in oncological research, in order to improve patients' and caregivers' quality of life. Copyright 2009 Elsevier Ltd. All rights reserved.

  17. How does pain experience relate to the need for pain relief?

    DEFF Research Database (Denmark)

    Johnsen, Anna Thit; Petersen, Morten A; Snyder, Claire F

    2016-01-01

    to be a burden was similar, and pain experience and pain burden were highly correlated (correlation coefficients ranged from 0.85 to 0.91). Pain experience and pain burden were moderately correlated with the need for pain relief. A receiver-operating characteristic (ROC) curve analysis showed that the EORTC QLQ......-C30 discriminated between patients with and without a need for pain relief to an acceptable degree (area under the curve (AUC) 0.73-0.77). The cut-point a little gave a sensitivity of 84 % and specificity of 59 % for the item "Have you had pain?" and a sensitivity of 72 % and a specificity of 72......PURPOSE: To explore (1) the information obtained from related but conceptually different approaches to pain assessment and (2) the extent to which the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) can be used as a screening tool...

  18. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De

    1993-01-01

    the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been...... for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case...... established as yet, but 50 micrograms/kg every 8 h, supplemented with small doses of bupivacaine, provides excellent analgesia in the immediate postoperative period after major abdominal surgery. The side effects are few, but the risk of respiratory depression is always present and observation...

  19. Music therapy in relief of pain in oncology patients

    Directory of Open Access Journals (Sweden)

    Mariana Franco

    2009-03-01

    Full Text Available Objective: To evaluate the perception of oncology patients with chronic pain as to the effects of music in alleviating pain, to identify if there are changes in the vital signs of these patients before and after the musicotherapy session, and to identify whether the intensity of pain is diminished after the music session as per an analogic scale of pain. Methods: This level II, descriptive-exploratory and cross-sectional study used a quantitative and qualitative approach. The sample consisted of ten oncology patients with chronic pain. Rresults: There was a reduction in vital signs and in intensity of pain in ten patients of the sample; after the music sessions, the patients reported a sensation of relief of pain, relaxation, and a belief in the power of music as a supplementary therapy. Cconclusions: Music showed an influence in reducing vital signs and pain intensity, and the patients perceived a reduction of pain and anxiety, and began to believe in music as a form of therapy.

  20. Trends in intraoperative pain relief in anesthesized Nigerian ...

    African Journals Online (AJOL)

    Keywords: Intraoperative period, pain relief, trends. Arrière-plan: De nouveaux médicaments et nouvelles modalités pour soulager la douleur peropératoire est la tendance actuelle dans la gestion de la douleur. L'étude vise à examiner la tendance actuelle dans le soulagement de la douleur peropératoire chez les patients ...

  1. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De

    1993-01-01

    Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine for postop......Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine...... for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case...... of respiratory depression was seen and 20% of the children had pruritus. There were four dural punctures and three catheters slipped out accidentally, but otherwise the treatment was continued as long as it was considered necessary (1-11 days). The use of postoperative ventilatory support decreased during...

  2. [Postoperative pain relief by patient controlled analgesia using intravenous pentazocine].

    Science.gov (United States)

    Sugai, N; Yajima, C; Chinzei, M; Nagase, M; Nishitateno, K

    1995-02-01

    Patient controlled analgesia (PCA) by intravenous pentazocine was performed to determine its efficacy and the dose required for the pain relief after gynecological or obstetric operations. After obtaining informed consent, studies were performed on 28 female patients (ASA I, II: Mean age 38.1 years: Mean weight, 53.8 kg) who had received gynecological or obstetric operations with lower abdominal incision. Anesthesia given was nitrous oxide and isoflurane combined with epidural anesthesia with 1% mepivacaine used only during the operation. Six patients had cesarian section under spinal anesthesia. No patients received opioid during anesthesia. PCA was performed with a Graseby PCA pump. Lockout time was 8 minutes and the bolus dose was 3 mg. In all the patients, satisfactory pain relief was obtained and no other analgesic was necessary. Mean initial dose was 169.4 micrograms.kg-1 and the mean doses used for following each 6 hours until 24 hours were 409.7, 368.6, 279.3 and 211.1 micrograms.kg-1 respectively. Evaluation of PCA by the patients after the procedure showed excellent (13 patients) good (12) and passable (3) analgesia. No significant complication was observed except temporary nausea in two patients. Satisfactory postoperative pain relief could be obtained by relatively small doses of pentazocine and adverse reactions related especially to sigma receptor could be avoided.

  3. Does a view of nature promote relief from acute pain?

    Science.gov (United States)

    Kline, Grace A

    2009-09-01

    Inadequate control of acute pain is a well-recognized and serious problem. Distraction is one of the methods used in adjunct with medications to relieve pain. Nature-related sensory stimuli are frequently used for both distraction and relaxation. The human response model that focuses on individual adaptation to health conditions is used in this article to guide an analysis of relevant studies. Four studies in clinical settings evaluated the effect of nature (as a visual stimulus) to determine whether it promoted relief of acute pain. All these studies also used audio stimuli (nature sounds or music). Distracting visual and auditory stimuli used together provided stronger evidence of pain reduction than when either type of stimulus was used alone.

  4. Human milk for neonatal pain relief during ophthalmoscopy

    Directory of Open Access Journals (Sweden)

    Laiane Medeiros Ribeiro

    2013-10-01

    Full Text Available Ophthalmoscopy performed for the early diagnosis of retinopathy of prematurity (ROP is painful for preterm infants, thus necessitating interventions for minimizing pain. The present study aimed to establish the effectiveness of human milk, compared with sucrose, for pain relief in premature infants subjected to ophthalmoscopy for the early diagnosis of ROP. This investigation was a pilot, quasi-experimental study conducted with 14 premature infants admitted to the neonatal intensive care unit (NICU of a university hospital. Comparison between the groups did not yield a statistically significant difference relative to the crying time, salivary cortisol, or heart rate (HR. Human milk appears to be as effective as sucrose in relieving acute pain associated with ophthalmoscopy. The study’s limitations included its small sample size and lack of randomization. Experimental investigations with greater sample power should be performed to reinforce the evidence found in the present study.

  5. How does pain experience relate to the need for pain relief?

    DEFF Research Database (Denmark)

    Johnsen, Anna Thit; Petersen, Morten A; Snyder, Claire F

    2016-01-01

    -C30 discriminated between patients with and without a need for pain relief to an acceptable degree (area under the curve (AUC) 0.73-0.77). The cut-point a little gave a sensitivity of 84 % and specificity of 59 % for the item "Have you had pain?" and a sensitivity of 72 % and a specificity of 72...

  6. Pentazocine pain relief in adult patients with acute abdominal ain: A ...

    African Journals Online (AJOL)

    Background: Reported studies in the African population, on early pain relief in patients with acute abdominal pain are few. The objective of the study was to evaluate the effect of pentazocine (PZ) on pain relief, diagnostic accuracy and treatment decisions in patients with acute abdominal pain. Methods: This was a ...

  7. Cognitive orientation as predictor of pain relief following acupuncture.

    Science.gov (United States)

    Kreitler, S; Kreitler, H; Carasso, R

    1987-03-01

    The study investigated the role of beliefs concerning pain relief after treatment. Following the cognitive orientation theory, we hypothesized that beliefs concerning goals, norms, oneself, and general beliefs would predict the extent of improvement following acupuncture. Subjects were 30 Israeli chronic-pain patients (22 women, 8 men; mean age 41.6 years). They were administered a questionnaire assessing the 4 belief types, and control measures assessing personality traits, demographic variables, and pain characteristics. All underwent 4-6 acupuncture sessions. Improvement was determined by patient and physician ratings, and an index based on medication, subjective evaluations, and duration of resting. There were two follow-ups. Three improvement groups were defined: none (n = 8), slight (n = 12), and high (n = 10). These groups did not differ on any of the variables tested except the 4 belief types. A discriminant analysis with belief types as predictors enabled correct classification of the patients in 83% of the cases. A stepwise regression analysis showed that beliefs accounted for 85% of the variance. Discussion focuses on the nature of pain relief and the role of beliefs in disease.

  8. Requests for cesarean deliveries: The politics of labor pain and pain relief in Shanghai, China.

    Science.gov (United States)

    Wang, Eileen

    2017-01-01

    Cesarean section rates have risen dramatically in China within the past 25 years, particularly driven by non-medical factors and maternal requests. One major reason women request cesareans is the fear of labor pain, in a country where a minority of women are given any form of pain relief during labor. Drawing upon ethnographic fieldwork and in-depth interviews with 26 postpartum women and 8 providers at a Shanghai district hospital in June and July of 2015, this article elucidates how perceptions of labor pain and the environment of pain relief constructs the cesarean on maternal request. In particular, many women feared labor pain and, in a context without effective pharmacological pain relief or social support during labor, they came to view cesarean sections as a way to negotiate their labor pain. In some cases, women would request cesarean sections during labor as an expression of their pain and a call for a response to their suffering. However, physicians, under recent state policy, deny such requests, particularly as they do not view pain as a reasonable indication for a cesarean birth. This disconnect leads to a mismatch in goals for the experience of birth. To reduce unnecessary C-sections, policy makers should instead address the lack of pain relief during childbirth and develop other means of improving the childbirth experience that may relieve maternal anxiety, such as allowing family members to support the laboring woman and integrating a midwifery model for low-risk births within China's maternal-services system. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Cultural differences in music chosen for pain relief.

    Science.gov (United States)

    Good, M; Picot, B L; Salem, S G; Chin, C C; Picot, S F; Lane, D

    2000-09-01

    Nurses use music therapeutically but often assume that all patients will equally appreciate the same type of music. Cultural differences in music preferences are compared across five pain studies. Music preferences for pain relief are described as the most frequently chosen type of music for each culture. Findings indicate that in four studies, musical choices were related to cultural background (p = .002 to .049). Although the majority in each group chose among the other types of music, Caucasians most frequently chose orchestra music, African Americans chose jazz, and Taiwanese chose harp music. For culturally congruent care, nurses should become aware of cultural differences in music preference and provide culturally specific selections among other music expected to have a therapeutic effect.

  10. 21 CFR 882.5880 - Implanted spinal cord stimulator for pain relief.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted spinal cord stimulator for pain relief... Implanted spinal cord stimulator for pain relief. (a) Identification. An implanted spinal cord stimulator... severe intractable pain. The stimulator consists of an implanted receiver with electrodes that are placed...

  11. Motion and Pain Relief Remain 23 Years After Manipulation Under Anesthesia for Frozen Shoulder

    National Research Council Canada - National Science Library

    Vastamäki, Heidi; Vastamäki, Martti

    2013-01-01

    Manipulation under anesthesia (MUA) as treatment for idiopathic frozen shoulder increases motion, provides pain relief, and restores function, but it is unclear whether the improvements persist long...

  12. Multiple 60-Minute Massages per Week Offer Relief for Chronic Neck Pain

    Science.gov (United States)

    ... Minute Massages per Week Offer Relief for Chronic Neck Pain Share: © Bob Stockfield Courtesy: National Center for Complementary ... fewer or shorter sessions for people with chronic neck pain, suggesting that several hour-long massages per week ...

  13. Characteristics of local field potentials correlate with pain relief by deep brain stimulation.

    Science.gov (United States)

    Huang, Yongzhi; Luo, Huichun; Green, Alexander L; Aziz, Tipu Z; Wang, Shouyan

    2016-07-01

    To investigate the link between neuronal activity recorded from the sensory thalamus and periventricular gray/periaqueductal gray (PVAG) and pain relief by deep brain stimulation (DBS). Local field potentials (LFPs) were recorded from the sensory thalamus and PVAG post-operatively from ten patients with neuropathic pain. The LFPs were quantified using spectral and time-frequency analysis, the relationship between the LFPs and pain relief was quantified with nonlinear correlation analysis. The theta oscillations of both sensory thalamus and PVAG correlated inversely with pain relief. The high beta oscillations in the sensory thalamus and the alpha oscillations in the PVAG correlated positively with pain relief. Moreover, the ratio of high-power duration to low-power duration of theta band activity in the sensory thalamus and PVAG correlated inversely with pain relief. The duration ratio at the high beta band in the sensory thalamus correlated positively with pain relief. Our results reveal distinct neuronal oscillations at the theta, alpha, and beta frequencies correlating with pain relief by DBS. The study provides quantitative measures for predicting the outcomes of neuropathic pain relief by DBS as well as potential biomarkers for developing adaptive stimulation strategies. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Deshmukh, Ajit J.; Rodriguez, Jose A. [North Shore LIJ Lenox Hill Hospital, Department of Orthopaedic Surgery, New York, NY (United States); Panagopoulos, Georgia [North Shore LIJ Lenox Hill Hospital, Department of Research, New York, NY (United States); Alizadeh, Ahmadreza; Klein, Devon A. [North Shore LIJ Lenox Hill Hospital, Department of Radiology, New York, NY (United States)

    2011-11-15

    Intra-articular injection is being used widely for both diagnostic and therapeutic purposes in the hip. However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren-Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p < 0.001). 94% of patients reporting immediate relief also reported relief 2 weeks later. Univariate and multivariate analysis revealed that neither gender nor age was related to immediate or delayed pain relief. Only severity of OA (based on radiographic analysis) was observed to be predictive of pain relief. Pain relief following intra-articular hip injection correlated with radiographic severity of OA. This intervention may be of therapeutic and prognostic value in patients awaiting hip arthroplasty. (orig.)

  15. [Everything is valid in chronic pain: Interventions by older adults for pain relief].

    Science.gov (United States)

    Alvarado-García, Alejandra María; Salazar-Maya, Ángela María

    To describe interventions used by older adults with benign chronic pain. Qualitative study with 25 older adults with benign chronic pain, inhabitants of the cities of Medellín and Bogotá. The technique used to collect information was in-depth interview. The analysis was made using the tools of the theory based on the guidelines of Strauss and Corbin. Using open, axial and selective coding, the constant comparison method allowed the identification of categories and subcategories and simultaneously memos and diagrams were made to reach theoretical saturation. A number of categories were found in this study, suggesting interventions used by the elderly to address chronic pain. They started looking at a number of options such as: taking medication, self-prescribing, feeling fear of taking pills, identifying the damage caused by drugs, using hot water, staying still, taking right postures, walking and exercising, using attachments that help them and making home remedies; all of them become alternatives that can cause pain relief. The study allowed describing interventions that older adults use to mitigate their pain. This ranged from pharmacological to non-pharmacological interventions, as simple as posture, cold, heat, massage or distractions among others, which play an important role in pain relief. Knowing these interventions helps healthcare professionals consider care options different to medication intake, proposing strategies that are easily accessible and can operate at the time to address a patient with chronic pain. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  16. Food-Derived Natural Compounds for Pain Relief in Neuropathic Pain

    Directory of Open Access Journals (Sweden)

    Eun Yeong Lim

    2016-01-01

    Full Text Available Neuropathic pain, defined as pain caused by a lesion or disease of the somatosensory nervous system, is characterized by dysesthesia, hyperalgesia, and allodynia. The number of patients with this type of pain has increased rapidly in recent years. Yet, available neuropathic pain medicines have undesired side effects, such as tolerance and physical dependence, and do not fully alleviate the pain. The mechanisms of neuropathic pain are still not fully understood. Injury causes inflammation and immune responses and changed expression and activity of receptors and ion channels in peripheral nerve terminals. Additionally, neuroinflammation is a known factor in the development and maintenance of neuropathic pain. During neuropathic pain development, the C-C motif chemokine receptor 2 (CCR2 acts as an important signaling mediator. Traditional plant treatments have been used throughout the world for treating diseases. We and others have identified food-derived compounds that alleviate neuropathic pain. Here, we review the natural compounds for neuropathic pain relief, their mechanisms of action, and the potential benefits of natural compounds with antagonistic effects on GPCRs, especially those containing CCR2, for neuropathic pain treatment.

  17. 21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted intracerebral/subcortical stimulator for... Devices § 882.5840 Implanted intracerebral/subcortical stimulator for pain relief. (a) Identification. An implanted intracerebral/subcortical stimulator for pain relief is a device that applies electrical current...

  18. Paracetamol for pain relief after surgical removal of lower wisdom teeth

    NARCIS (Netherlands)

    Weil, K.; Hooper, L.; Afzal, Z.; Esposito, M.; Worthington, H.V.; van Wijk, A.J.; Coulthard, P.

    2008-01-01

    Background: Paracetamol has been commonly used for the relief of postoperative pain following oral surgery. In this review we investigated the optimal dose of paracetamol and the optimal time for drug administration to provide pain relief, taking into account the side effects of different doses of

  19. Attitude of Nigerian Mothers to Labour Pain and its Relief | Akpan ...

    African Journals Online (AJOL)

    The attitude of 110 mothers to labour pains and its relief were assessed 24 hours after normal vaginal deliveries in the post-natal ward of the University of Calabar Teaching Hospital. The study was carried out with the view of formally introducing pain relief in labour (epidural analgesia in the University of Calabar Teaching ...

  20. Pharmacological interventions for pain relief during orthodontic treatment.

    Science.gov (United States)

    Monk, Aoife B; Harrison, Jayne E; Worthington, Helen V; Teague, Annabel

    2017-11-28

    Pain is a common side effect of orthodontic treatment. It increases in proportion to the amount of force applied to the teeth, and the type of orthodontic appliance used can affect the intensity of the pain. Pain during orthodontic treatment has been shown to be the most common reason for people wanting to discontinue treatment, and has been ranked as the worst aspect of treatment. Although pharmacological methods of pain relief have been investigated, there remains some uncertainty among orthodontists about which painkillers are most suitable and whether pre-emptive analgesia is beneficial. We conducted this Cochrane Review to assess and summarize the international evidence relating to the effectiveness of analgesics for preventing this unwanted side effect associated with orthodontic treatment. The objectives of this review are to determine:- the effectiveness of drug interventions for pain relief during orthodontic treatment; and- whether there is a difference in the analgesic effect provided by different types, forms and doses of analgesia taken during orthodontic treatment. Cochrane Oral Health's Information Specialist searched the following databases: the Cochrane Oral Health Trials Register (to 19 June 2017), the Cochrane Central Register of Controlled Trials (CENTRAL;the Cochrane Library 2016, Issue 7), MEDLINE Ovid (1946 to 19 June 2017), Embase Ovid (1980 to 19 June 2017) and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 19 June 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched on the 19 June 2017 for ongoing studies. We placed no restrictions on language or date of publication when searching the electronic databases. We included randomized controlled trials (RCTs) relating to pain control during orthodontic treatment. Pain could be measured on a visual analogue scale (VAS), numerical

  1. Diclofenac suppository versus intramuscular pethidine in post herniorrhaphy pain relief

    Directory of Open Access Journals (Sweden)

    Noroozinia H

    2011-06-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Non-steroidal anti-inflammatory drugs (NSADs and opioids are frequently administered to relieve postoperative pain. Uncontrolled postoperative pain may produce a range of detrimental acute and chronic health consequences and increase mortality and morbidity. Practically, the analgesic efficacy of opioids is typically limited by the development of tolerance to them or by opioid-related side-effects such as nausea, vomiting, sedation or respiratory depression. This study aims to assess the effects of suppository diclofenac on post-herniorrhaphy pain management."n"nMethods: In this prospective double-blind clinical trial, 60 patients who were candidate for the surgical repair of inguinal hernia were divided into two groups. Patients in group A received 100 mg of suppository diclofenac and patients in group B 50 mg of pethidine after the induction of anesthesia and before surgical incision. Postoperative pain assessment was done by an unbiased observer on the arrival of patients in the recovery room, using a 10-cm visual analogue scale (VAS( at 2-hour intervals for 6 hours."n"nResults: Pain relief was similar in the two groups (P=0.3. Patients in group B required more analgesia two hours post-operatively (P=0

  2. The effect of standard care, ibuprofen, and music on pain relief and patient satisfaction in adults with musculoskeletal trauma.

    Science.gov (United States)

    Tanabe, P; Thomas, R; Paice, J; Spiller, M; Marcantonio, R

    2001-04-01

    The purposes of this study were to determine the most effective nursing intervention to decrease pain for patients with minor musculoskeletal trauma and moderate pain at triage and to examine patient satisfaction. Patients were assigned to 1 of 3 intervention groups: (1) standard care (ice, elevation, and immobilization); (2) standard care and ibuprofen; or (3) standard care and music distraction. Patients were monitored for pain ratings for 60 minutes. Patients who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 4 or greater were included. Two patient satisfaction questions were asked upon discharge from the emergency department. Seventy-seven patients met the inclusion criteria. No differences in pain ratings between groups were demonstrated. A statistically significant reduction in pain for all patients occurred at 30 minutes (F = 16.18, P pain ratings of 4 or greater (on a scale of 1 to 10) at 60 minutes. The reduction in pain was not found to be clinically significant.Eighty-four percent of patients stated that they were more satisfied with their overall care in the emergency department because of the immediate attention to pain relief they received at triage. No differences in satisfaction existed between treatment groups, although patients who reported higher pain ratings expressed statistically significant lower satisfaction with pain management scores (F = 9.375, P =.003). None of the therapies-standard care (ice, elevation, immobilization), standard care with ibuprofen, or standard care with music distraction-provided clinically significant pain relief to patients who had minor musculoskeletal trauma (ie, sprains and fractures) and moderate pain at triage. Interestingly, satisfaction scores were sometimes positive, even when pain was not relieved.

  3. (153)Sm-EDTMP for pain relief of bone metastases from prostate and breast cancer and other malignancies.

    Science.gov (United States)

    Correa-González, Luis; Arteaga de Murphy, Consuelo; Pichardo-Romero, Pablo; Pedraza-López, Martha; Moreno-García, Claudia; Correa-Hernández, Luis

    2014-05-01

    Approximately 85% of patients with cancer suffer severe metastatic bone pain for which radionuclide therapy has been employed for pain palliation. We undertook this study to evaluate the pain relief effect of (153)Sm-EDTMP in Mexican patients with severe and painful bone metastases from mainly prostate, breast, and renal cancer and other malignancies. Patients (277) with intense sustained pain caused by bone metastases were referred to the Nuclear Medicine Department of the Oncology Hospital of the Mexican Social Security Institute. The patients had to have acceptable physical conditions, a previous positive (99m)Tc-MDP scan and blood values within normal range. (153)Sm-EDTMP was prepared at the Instituto Nacional de Investigaciones Nucleares (ININ) and 37 MBq/kg of body weight was injected intravenously. Pain palliation was evaluated with a visual analogue scale (VAS) and a verbal rating scale (VRS) before treatment and 3 and 12 weeks after treatment was started. The age interval of the patients was 24-92 years with a mean age of 64 ± 12 years. Mean values for hemoglobin, leukocyte and platelet counts did not statistically differ at zero time, 3 and 12 weeks after treatment. Pain intensity and relief assessment were statistically different: 9.1 ± 0.61 units initially; 4.2 ± 1.3 units 3 weeks later (54%) and after 12 weeks the pain diminished to 2.4 ± 1.4 units (74%) in the pain relief score scales. (153)Sm-EDTMP was readily available, safe and well tolerated. We conclude that (153)Sm-EDTMP was an adequate palliative agent and was the best option for our Mexican patients to relieve their severe metastatic bone pain. Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.

  4. The Efficacy of Thermotherapy and Cryotherapy on Pain Relief in Patients with Acute Low Back Pain, A Clinical Trial Study

    OpenAIRE

    Dehghan, Morteza; Farahbod, Farinaz

    2014-01-01

    Introduction: Acute low back pain is one of the most common health problems especially in industrialized countries where 75 per cent of the population develop it at least once during their life. This study examined the efficacy of thermotherapy and cryotherapy, alongside a routine pharmacologic treatment, on pain relief in patients with acute low back pain referring an orthopedic clinic in Shahrekord, Iran.

  5. Somatosensory sensitivity in patients with persistent idiopathic orofacial pain is associated with pain relief from hypnosis and relaxation.

    Science.gov (United States)

    Baad-Hansen, Lene; Abrahamsen, Randi; Zachariae, Robert; List, Thomas; Svensson, Peter

    2013-06-01

    In a recent study hypnosis has been found to relieve persistent idiopathic orofacial pain. Quantitative sensory testing (QST) is widely used to evaluate somatosensory sensitivity, which has been suggested as a possible predictor of management outcome. The objectives of this study were to examine: (1) possible associations between clinical pain relief and baseline somatosensory sensitivity and (2) the effect of hypnosis management on QST parameters. Forty-one patients with persistent idiopathic orofacial pain completed this randomized controlled study in 1 of 2 groups: hypnosis (hypnotic analgesia suggestions) or control (relaxation). QST at 2 intraoral (pain region and contralateral mirror image region) and 3 extraoral (hand and both cheeks) sites was performed at baseline and after the hypnosis/control management, together with pressure pain thresholds and pressure pain tolerance thresholds determined bilaterally at the masseter and temporalis muscles, the temporomandibular joints, and the third finger. Degree of pain relief was negatively correlated with a summary statistic of baseline somatosensory sensitivity (summed z-score), that is, high baseline somatosensory sensitivity was associated with low pain relief (r=-0.372, P=0.020). Hypnosis had no major effect on any QST measure compared with relaxation (P>0.063). High pain sensitivity at baseline may predict poor pain management outcome. In addition, despite clear clinical pain relief, hypnosis did not significantly or specifically influence somatosensory sensitivity. Future studies should further explore QST measures as possible predictors of different management response in orofacial pain conditions.

  6. Housing environment influences the need for pain relief during post-operative recovery in mice

    NARCIS (Netherlands)

    Pham, T.M.; Hagman, B.; Codita, A.; Loo, P.L.P. van; Strömmer, L.; Baumans, V.

    2010-01-01

    The impact of invasive experimental procedures on perceived stress and pain may be dependent on both physical and social environmental conditions. The aim of this study was to evaluate the effects of a physically and a socially enriched environment on the need for pain relief following painful

  7. Comparison of two analgesics used for pain relief after placement of orthodontic separators

    Directory of Open Access Journals (Sweden)

    Nasser Alqahtani

    2017-12-01

    Conclusion: The patients prescribed ibuprofen did not report any problem with tooth movement along with significant reduction in pain as compared to paracetamol. Pain relief medication after placement of separators should be taken only if patient feels intolerable pain but not as routine practice.

  8. Relationship between onset of pain relief and patient satisfaction with fentanyl pectin nasal spray for breakthrough pain in cancer.

    Science.gov (United States)

    Torres, Luis M; Revnic, Julia; Knight, Alastair D; Perelman, Michael

    2014-10-01

    Satisfaction with pain relief in patients with breakthrough pain in cancer (BTPc) has typically been assessed by overall efficacy without consideration of the rapidity of that response. To determine the relationship between speed of onset of pain relief and patient satisfaction for treated BTPc episodes overall and for individual treatments. Pooled data from two randomized, double-blinded crossover studies. Patients having 1-4 BTPc episodes per day on ≥60 mg/day oral morphine or equivalent. Episodes treated with fentanyl pectin nasal spray (FPNS; 100-800 μg), immediate-release morphine sulfate (IRMS), or placebo. Pain intensity was measured on an 11-point scale (5-60 minutes posttreatment); satisfaction was measured on a 4-point scale (30 and 60 minutes). The primary analysis assessed the overall relationship of time to onset of pain relief (pain intensity difference [PID]≥1) or time to clinically meaningfully reduction in pain (PID≥2) versus patient satisfaction and overall pain intensity (summed pain intensity difference at 30 [SPID30] and 60 minutes [SPID60]) assessed by analysis of variance (ANOVA). A secondary analysis assessed whether satisfaction was different between treatments using a within-patient comparison. Eight hundred thirty-one FPNS-treated, 368 IRMS-treated, and 200 placebo-treated episodes were analyzed. Overall, within the pool there was a statistically significant relationship between time to onset of pain relief (PID≥1 and PID≥2) and patient satisfaction (both speed of relief and overall) at 30 and 60 minutes (p<0.001); this relationship was also true within individual treatment groups (p<0.01). Similar results were found for overall pain intensity reduction. When treatment groups were compared using within-patient data, FPNS provided earlier onset of pain relief than IRMS or placebo (p<0.05), which translated into better satisfaction at 60 minutes (p<0.01). Earlier onset of pain relief resulted in greater patient satisfaction

  9. Double-blind, placebo-controlled, randomized pilot study of cerebral blood flow patterns employing SPECT imaging in dental postsurgical pain patients with and without pain relief.

    Science.gov (United States)

    Newberg, Andrew B; Hersh, Elliot V; Levin, Lawrence M; Giannakopoulos, Helen; Secreto, Stacey A; Wintering, Nancy A; Farrar, John T

    2011-12-01

    reporting relief of pain. Subjects who reported reduced pain after the intervention had significantly different (P dental pain was associated with moderate thalamic asymmetry that improved following successful pain management. Sustained or worsening pain was associated with increased CBF in brain regions associated with pain pathways, whereas pain relief was associated with decreased activity in the same areas. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

  10. Increased joint loads during walking--a consequence of pain relief in knee osteoarthritis

    DEFF Research Database (Denmark)

    Henriksen, Marius; Simonsen, Erik B; Alkjaer, T

    2006-01-01

    Joint pain is a primary symptom in knee osteoarthritis (OA), but the effect of pain and pain relief on the knee joint mechanics of walking is not clear. In this study, the effects of local knee joint analgesia on knee joint loads during walking were studied in a group of knee osteoarthritis...... patients. A group of healthy subjects was included as a reference group. The joint loads were calculated from standard gait analysis data obtained with standardised walking speed (4 km/h). The gait analyses were performed before and after pain relief by intra-articular injections of 10 mL lidocaine (1...

  11. Mindfulness meditation–based pain relief: a mechanistic account

    National Research Council Canada - National Science Library

    Zeidan, Fadel; Vago, David R

    2016-01-01

    .... 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.

  12. 'Birthgasm': A Literary Review of Orgasm as an Alternative Mode of Pain Relief in Childbirth.

    Science.gov (United States)

    Mayberry, Lorel; Daniel, Jacqueline

    2016-12-01

    Childbirth is a fundamental component of a woman's sexual cycle. The sexuality of childbirth is not well recognized in Western society despite research showing that some women experience orgasm(s) during labor and childbirth. Current thinking supports the view that labor and childbirth are perceived to be physically painful events, and more women are relying on medical interventions for pain relief in labor. This review explores the potential of orgasm as a mode of pain relief in childbirth and outlines the physiological explanations for its occurrence. Potential barriers to sexual expression during childbirth and labor, including the influence of deeply held cultural beliefs about sexuality, the importance of privacy and intimacy in facilitating orgasmic birth experiences, and the value of including prospective fathers in the birthing experience, are discussed. The role of midwives and their perceptions of the use of complementary and alternative therapies for pain relief in labor are examined. While there are indications of widespread use of complementary and alternative therapies such as hydrotherapy, herbal remedies, and breathing techniques for pain relief in childbirth, orgasm was not among those mentioned. Lack of recognition of the sexuality of childbirth, despite findings that orgasm can attenuate the effects of labor pain, suggests the need for greater awareness among expectant parents, educators, and health professionals of the potential of orgasm as a means of pain relief in childbirth. © The Author(s) 2015.

  13. Terminal sedation: between pain relief, withholding treatment and euthanasia.

    Science.gov (United States)

    Gevers, J K M

    2006-12-01

    In the last five to ten years there has been increasing debate on terminal sedation, a medical practice that is difficult to place between other decisions at the end of life, like alleviating pain, withholding treatment, and (in jurisdictions where this is allowed) euthanasia or physician-assisted suicide. Terminal sedation is the administration of sedative drugs with the aim to reduce the consciousness of a terminal patient in order to relieve distress. It is frequently accompanied by the withdrawal (or withholding) of life-sustaining interventions, such as hydration and nutrition. It is typically a measure of the last resort, to be considered in situations where all other measures to reduce pain and suffering have failed. While similar to palliative measures as far as the sedation itself is concerned, withholding of hydration and nutrition brings terminal sedation into the realm of non treatment decisions. At the same time, to the extent that the combination of these two measures may shorten the patient's life, the practice may be easily associated with euthanasia. It is no surprise therefore, that terminal sedation has been called (and has been disqualified as) 'slow euthanasia' or 'backdoor euthanasia'. This paper addresses the question how terminal sedation may be looked upon from a legal point of view. Is it indeed a disguised form of euthanasia, or should it be considered as a practice in its own right? In the latter case, what does it imply in legal terms, and under which conditions and safeguards could it be legally justified? To answer these questions, I will look first at the different clinical realities that may be brought under the heading 'terminal sedation'. Then I will deal with its two components--sedation on the one hand, and withholding artificial feeding on the other--in a legal perspective. The paper ends with conclusions on terminal sedation as a whole.

  14. A comparison of pulpectomy alone versus pulpectomy with trephination for the relief of pain.

    Science.gov (United States)

    Moos, H L; Bramwell, J D; Roahen, J O

    1996-08-01

    Patients who when initially seen have pain of endodontic origin have a higher incidence of posttreatment pain than those who are pain-free pretreatment. The purpose of this study was to compare two methods of treatment--pulpectomy alone or pulpectomy with trephination--for the reduction of posttreatment pain in patients presenting with acute periradicular pain of pulpal origin. Seventeen patients with pretreatment pain were studied. Eleven received a pulpectomy to the radiographically determined working length. Six patients received a pulpectomy and trephination using a #4 round bur through a vertical incision. Visual analog scales were used preoperatively to measure pain intensity and unpleasantness, and postoperatively to measure intensity, unpleasantness, and pain relief at 4, 8, 16, 24, 48, 72, and 96 h. Analysis of preoperative data showed no difference between control and experimental groups. Posttreatment, at 4 h, the trephination group reported significantly more pain intensity and unpleasantness and less pain relief than the control group. Pulpectomy alone provided significantly better postoperative pain relief at 4 h compared with pulpectomy with trephination. At no time interval did the trephination group have less pain than the group without trephination.

  15. Pain relief using paraceevical block in patients undergoing manual ...

    African Journals Online (AJOL)

    Intra and post operative assessment of pain was made using McGills and facial expression scales. Results: The untreated group experienced significantly more pain than the treated group, especially lower abdominal pain and backache. The pain was especially marked intraoperatively, less so 30 minutes post-operatively.

  16. An audit of aspects of informed consent and pain relief in general ...

    African Journals Online (AJOL)

    There is the need to adequately inform patients about their disease, treatment options, surgery and post-operative complications. Adequate pain relief after surgery leads to less morbidity. Two important aspects of surgical practice are being addressed in this paper, the need for informed consent and post operative pain ...

  17. 21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted peripheral nerve stimulator for pain....5870 Implanted peripheral nerve stimulator for pain relief. (a) Identification. An implanted peripheral... the stimulating pulses across the patient's skin to the implanted receiver. (b) Classification. Class...

  18. Effects of an eight-week training programme on pain relief and ...

    African Journals Online (AJOL)

    Effects of an eight-week training programme on pain relief and physical condition of overweight and obese women with early stage primary knee osteoarthritis. ... with the requirements of the Osteoarthritis Research Society International Committee in terms of pain, physical function, strength and cardiorespiratory endurance.

  19. Intravenous morphine after gynecological surgery : pain relief, endocrine and immune respone

    OpenAIRE

    Eriksson-Mjöberg, Marianne

    1997-01-01

    Background: We need more efficient methods to alleviate postoperative pain and reduce endocrine / immune stress response. Subjects and methods: Patient controlled analgesia (PCA) with iv morphine was evaluated with respect to pain relief and endocrine / immune response to surgical trauma in 130 patients undergoing gynecological surgery. Anesthetic regimens included general anesthesia, epidural anesthesia, epidural morphine and combinations of these methods. Results: Lar...

  20. Pain relief produces negative reinforcement through activation of mesolimbic reward-valuation circuitry.

    Science.gov (United States)

    Navratilova, Edita; Xie, Jennifer Y; Okun, Alec; Qu, Chaoling; Eyde, Nathan; Ci, Shuang; Ossipov, Michael H; King, Tamara; Fields, Howard L; Porreca, Frank

    2012-12-11

    Relief of pain is rewarding. Using a model of experimental postsurgical pain we show that blockade of afferent input from the injury with local anesthetic elicits conditioned place preference, activates ventral tegmental dopaminergic cells, and increases dopamine release in the nucleus accumbens. Importantly, place preference is associated with increased activity in midbrain dopaminergic neurons and blocked by dopamine antagonists injected into the nucleus accumbens. The data directly support the hypothesis that relief of pain produces negative reinforcement through activation of the mesolimbic reward-valuation circuitry.

  1. Music therapy in relief of pain in oncology patients

    National Research Council Canada - National Science Library

    Mariana Franco; Andrea Bezerra Rodrigues

    2009-01-01

    Objective: To evaluate the perception of oncology patients with chronic pain as to the effects of music in alleviating pain, to identify if there are changes in the vital signs of these patients before...

  2. Mindfulness meditation–based pain relief: a mechanistic account

    Science.gov (United States)

    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

  3. Music therapy in relief of pain in oncology patients

    OpenAIRE

    Mariana Franco; Andrea Bezerra Rodrigues

    2009-01-01

    Objective: To evaluate the perception of oncology patients with chronic pain as to the effects of music in alleviating pain, to identify if there are changes in the vital signs of these patients before and after the musicotherapy session, and to identify whether the intensity of pain is diminished after the music session as per an analogic scale of pain. Methods: This level II, descriptive-exploratory and cross-sectional study used a quantitative and qualitative approach. The sample consisted...

  4. Improving pain relief for children in Thailand | CRDI - Centre de ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Children in low- and middle-income countries (LMICs) often have limited access to pain care. Yet it is neither difficult nor expensive to prevent or treat most types of pain in children if attitude and information barriers are overcome. ... Read a journal article about pediatric pain management in a teaching hospital in Brazil.

  5. Topical cryotherapy-use for relief of pain and spasticity.

    Science.gov (United States)

    Mead, S; Knott, M

    1966-09-01

    Cold applications are sometimes of pronounced symptomatic benefit in some rheumatic disorders such as acute myalgia; in the temporary relief of spasticity; in helping to release tight structures in poliomyelitis and allied diseases; and in temporary recovery of energy in multiple sclerosis.

  6. Topical Cryotherapy—Use for Relief of Pain and Spasticity

    Science.gov (United States)

    Mead, Sedgwick; Knott, Margaret

    1966-01-01

    Cold applications are sometimes of pronounced symptomatic benefit in some rheumatic disorders such as acute myalgia; in the temporary relief of spasticity; in helping to release tight structures in poliomyelitis and allied diseases; and in temporary recovery of energy in multiple sclerosis. PMID:18730022

  7. Effects of perceived and exerted pain control on neural activity during pain relief in experimental heat hyperalgesia: a fMRI study.

    Science.gov (United States)

    Mohr, C; Leyendecker, S; Petersen, D; Helmchen, C

    2012-04-01

    Perceived control over pain can attenuate pain perception by mechanisms of endogenous pain control and emotional reappraisal irrespective of whether this control is exerted or only perceived. Self-initiated termination of pain elicits different expectations of subsequent pain relief as compared to perceived pain control. It is unknown whether and how this perceived vs. exerted control on pain differs and affects subsequent pain relief. Using fMRI, we studied two factors of pain control on pain relief: the (i) sense of control (perceived control but no execution) and (ii) the execution of control (exerted control). To account for the impact of factual execution of pain control on pain relief we applied bearable short and hardly bearable long contact-heat stimuli which were applied either controllable or not. Using controllability as factor, there was dissociable neural activity during pain relief: following the perceived control condition neural activity was found in the orbitofrontal and mediofrontal cortex and, following the exerted control condition, in the anterolateral and dorsolateral prefrontal cortex and posterior parietal cortex. We conclude that (i) pain controllability has an impact on pain relief and (ii) the prefrontal cortex shows dissociable neural activity during pain relief following exerted vs. perceived pain control. This might reflect the higher grade of uncertainty during pain relief following perceived pain control mediated by the orbitofrontal and medial prefrontal cortex and processes of working memory and updating expectations during pain relief following exerted control mediated by the lateral prefrontal cortex. © 2011 European Federation of International Association for the Study of Pain Chapters.

  8. Knee pain relief with genicular nerve blockage in two brain injured patients with heterotopic ossification.

    Science.gov (United States)

    Adiguzel, Emre; Uran, Ayça; Kesikburun, Serdar; Köroğlu, Özlem; Demir, Yasin; Yaşar, Evren

    2015-01-01

    Heterotopic ossification (HO) is the ectopic bone formation in non-osseous tissues. This study aimed to present two patients with traumatic brain injury (TBI) who had HO in knee joint and pain relief after genicular nerve blockage. Case 1: A 14-year-old patient with TBI was admitted with bilateral knee pain and limited range of motion. Physical examination and x-ray graphics revealed calcification which was diagnosed as HO. Ultrasonography (US) guided genicular nerve blockage was performed to both knees with 2 ml lidocaine and 1 ml betamethasone. VAS of pain was decreased to 30 mm from 80 mm. At 6-month follow-up, VAS of pain was still 30 mm. Case 2: A 29-year-old patient with TBI was admitted for rehabilitation. He had right knee pain and his pain was 80 mm according to VAS. Investigation revealed HO. US guided genicular nerve blockage was performed to the right knee and pain was decreased to 20 mm. US guided genicular nerve blockage can provide pain relief in HO and this technique may be effective and alternative for pain relief in patients with neurogenic knee HO to increase patient's compliance.

  9. Ear Acupuncture versus  local anaestethic for pain relief during perineal repair - a randomised controlled trial

    DEFF Research Database (Denmark)

    Kindberg, Sara

    2007-01-01

    ACUPUNCTURE OR LOCAL ANAESTETICS FOR PAIN RELIEF DURING PERINEAL REPAIR AFTER VAGINAL DELIVERY: A RANDOMISED CONTROLLED TRIAL.   By:  Sara Kindberg. Midwife and PhD student, Sønderborg Hospital, Denmark. Objective: To evaluate acupuncture as a new method of pain relief for postpartum perineal...... as photos of the acupuncture points. Perspectives:  Basic midwifery services such as providing sufficient pain relief during perineal repair still need improvement. Clinical practice should be improved continuously and thus produce reliable evidence on different pain relief methods. Website:        http...

  10. Survey of plants popularly used for pain relief in Rio Grande do Sul, southern Brazil

    Directory of Open Access Journals (Sweden)

    Eveline D. Stolz

    Full Text Available Ethnobotanical data can be an important tool in the search for new drugs. The Brazilian Health Surveillance Agency accepts the registration of herbal medicines based on ethnopharmacological and ethnobotanical studies. With the purpose of increasing the knowledge of potentially useful plants for the treatment of painful conditions, we analyzed the ethnobotanical studies carried out in Rio Grande do Sul state (RS-Southern Brazil; we had access to nineteen studies.To our knowledge, this is the first compilation of ethnobotanical studies that focus on pain relief carried out in RS. The species native to RS cited in at least nine (about 50% of these studies were selected. The search retrieved 28 native species cited as used to alleviate painful conditions, which are distributed in eighteen botanical families, being Asteraceae the most mentioned. The species more frequently cited for pain relief were Achyrocline satureioides, Baccharis articulata, Baccharis crispa, Lepidium didymum, Eugenia uniflora and Maytenus ilicifolia. The only species not reported in any pre-clinical study associated with pain relief was B. articulata. Among the six species cited, no studies on clinical efficacy were found. In conclusion, the folk use of native plants with therapeutic purposes is widespread in RS State (Brazil, being pain relief an important property.

  11. Spouses' Perspective of their Participation and Role in Childbirth Pain Relief

    Science.gov (United States)

    Emelonye, AU; Pitkäaho, T; Aregbesola, A; Vehviläinen-Julkunen, K

    2016-01-01

    Background: Childbirth is a period characterized by severe pain, and most women desire to ameliorate their pain among other things by having their spouses present and involved in the birthing process. In developing countries like Nigeria, spousal involvement is still an emerging concept in childbirth. Aim: To investigate and provide an insight into spousal perceptions toward their participation and role in labor pain relief during childbirth in Nigeria. Subjects and Methods: A cross-sectional descriptive study of 142 spouses was conducted in the maternity units of four hospitals in Abuja, Nigeria, from June to December 2014. Data were collected through a pretested interview-administered 24 item questionnaire, the Abuja Instrument for Parturient Spouse. The data were analyzed statistically using Chi-square test for association between the variables and content analysis for open-ended questions. Results: Most (94.4%, 134/142) of the spouses had a positive perception toward labor pain relief. They believed that their presence and activities contributed to labor pain relief and are willing to be present at subsequent births. Conclusion: Findings in this study have revealed a positive trend in spousal perception and involvement during childbirth and pain relief, as contrast to the prevailing assumption that childbirth is an exclusive woman affair. Spousal presence during childbirth can be beneficial not only to the woman but also to the spouse and family. PMID:28540105

  12. No Pain Relief with the Rubber Hand Illusion

    Science.gov (United States)

    Petkova, Valeria I.; Dey, Abishikta; Barnsley, Nadia; Ingvar, Martin; McAuley, James H.; Moseley, G. Lorimer; Ehrsson, Henrik H.

    2012-01-01

    The sense of body ownership can be easily disrupted during illusions and the most common illusion is the rubber hand illusion. An idea that is rapidly gaining popularity in clinical pain medicine is that body ownership illusions can be used to modify pathological pain sensations and induce analgesia. However, this idea has not been empirically evaluated. Two separate research laboratories undertook independent randomized repeated measures experiments, both designed to detect an effect of the rubber hand illusion on experimentally induced hand pain. In Experiment 1, 16 healthy volunteers rated the pain evoked by noxious heat stimuli (5 s duration; interstimulus interval 25 s) of set temperatures (47°, 48° and 49°C) during the rubber hand illusion or during a control condition. There was a main effect of stimulus temperature on pain ratings, but no main effect of condition (p = 0.32), nor a condition x temperature interaction (p = 0.31). In Experiment 2, 20 healthy volunteers underwent quantitative sensory testing to determine heat and cold pain thresholds during the rubber hand illusion or during a control condition. Secondary analyses involved heat and cold detection thresholds and paradoxical heat sensations. Again, there was no main effect of condition on heat pain threshold (p = 0.17), nor on cold pain threshold (p = 0.65), nor on any of the secondary measures (prubber hand illusion does not induce analgesia. PMID:23285026

  13. Dying for Pain Relief (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2013-07-04

    It’s an increasingly common story— a woman is found dead in her home from a prescription pain killer overdose. In this podcast, Dr. Karin Mack discusses the growing problem of pain killer overdoses among women.  Created: 7/4/2013 by MMWR.   Date Released: 7/4/2013.

  14. Effects of low-dose IV ketamine on peripheral and central pain from major limb injuries sustained in combat.

    Science.gov (United States)

    Polomano, Rosemary C; Buckenmaier, Chester C; Kwon, Kyung H; Hanlon, Alexandra L; Rupprecht, Christine; Goldberg, Cynthia; Gallagher, Rollin M

    2013-07-01

    Examine response patterns to low-dose intravenous (IV) ketamine continuous infusions on multiple pain outcomes, and demonstrate effectiveness, safety, and tolerability of ketamine administration on general wards. Retrospective case series of consecutive patients given low-dose IV ketamine continuous infusions. Walter Reed Army Medical Center, Washington, DC. Nineteen eligible inpatients with neuropathic pain from major limb injuries sustained in combat with inadequate pain control from multimodal analgesia. A 3-day IV infusion of ketamine at doses ≤ 120 μg/kg/h. Daily present (PPI), average (API), and worst (WPI) pain intensity (0-10), global pain relief (GPR) (1 "no relief" to 5 "complete relief"), daily assessments of adverse events, and daily opioid requirements measured during therapy. A significant reduction in PPI (P injury pain were safe and effective, and demonstrated response patterns over time and by baseline pain score stratification and presence or absence of PLP. Wiley Periodicals, Inc.

  15. Correlation between changes in regional cerebral blood flow and pain relief in complex regional pain syndrome type 1.

    Science.gov (United States)

    Wu, Ching-Tang; Fan, Yu-Ming; Sun, Chen-Ming; Borel, Cecil O; Yeh, Chun-Chang; Yang, Chih-Ping; Wong, Chih-Shung

    2006-06-01

    Analyzing changes in regional cerebral blood flow (rCBF) with SPECT in complex regional pain syndrome type 1 (CRPS 1), formerly known as reflex sympathetic dystrophy, is an optimal method for evaluating effective pain relief. We attempted to investigate the correlation of changes in rCBF with pain relief during treatments of sympathetic blockade and multimodal epidural pain control. We describe a patient with severe CRPS 1 in whom conventional treatment failed to relieve the pain. Combined repeated lumbar sympathetic blocks and long-term epidural morphine, bupivacaine, and ketamine administration provided satisfactory pain relief and functional activity recovery. Six normal control subjects having one Tc-99m HMPAO scan each and the patient with CRPS having 3 Tc-99m HMPAO scans (once before treatment and twice at 4 months and 6 months after treatment, respectively). The patient with CRPS showed lower rCBF than normal controls in the left thalamus and higher rCBF than normal controls in the right parietal lobe and left frontal lobe. After subsequent treatment, the subtraction images showed increased rCBF in the left thalamus and decreased rCBF in the right parietal and left frontal lobes. Tc-99m HMPAO SPECT showed a relationship of rCBF in the thalamus, parietal lobe, and frontal lobe with pain relief. rCBF alterations may provide an indicator for the quality of pain management for neuropathic pains. Subtraction analysis between pre- and posttreatment, by using statistical parametric mapping (version 2), can be used as an objective indicator for the effectiveness of therapy.

  16. Complementary and Alternative Approaches to Pain Relief during Labor

    Directory of Open Access Journals (Sweden)

    Michel Tournaire

    2007-01-01

    Full Text Available This review evaluated the effect of complementary and alternative medicine on pain during labor with conventional scientific methods using electronic data bases through 2006 were used. Only randomized controlled trials with outcome measures for labor pain were kept for the conclusions. Many studies did not meet the scientific inclusion criteria. According to the randomized control trials, we conclude that for the decrease of labor pain and/or reduction of the need for conventional analgesic methods: (i There is an efficacy found for acupressure and sterile water blocks. (ii Most results favored some efficacy for acupuncture and hydrotherapy. (iii Studies for other complementary or alternative therapies for labor pain control have not shown their effectiveness.

  17. Anti-Seizure Medications: Relief from Nerve Pain

    Science.gov (United States)

    ... drugs often are used to help control the type of pain caused by damaged nerves. By Mayo Clinic Staff Anti-seizure medications were originally designed to treat people with epilepsy. But the nerve-calming qualities of some of ...

  18. Crossover clinical trial of pain relief in cataract surgery.

    Science.gov (United States)

    Choi, Suvin; Park, Sang-Gue; Bellan, Lorne; Lee, Hyung-Hwan; Chung, Sung Kun

    2017-06-20

    To determine the effects of intra-operative Korean traditional music on pain experienced by Korean patients undergoing sequential bilateral cataract surgery. This was a two-sequence, two-period, and two-treatment crossover study. Fifty-two patients with cataracts were divided into two groups by block randomization, and bilateral cataract surgery was performed. In group 1, patients listened to Korean traditional music (KTM) during their first but not second cataract surgery. This sequence was reversed for patients in group 2. After each surgery, patients scored their pain intensity (PI) using a visual analog scale (VAS) ranging from 0 to 10, where 0 was 'no pain' and 10 was 'unbearable pain.' There was a statistically significant reduction in the mean VAS score with KTM (3.1 ± 2.0) compared to that without KTM (4.1 ± 2.2; p = 0.013). However, there were no statistically significant differences in blood pressure or pulse rates. KTM had a significant effect on reducing pain experienced by patients during cataract surgery. This may be useful in the context of other surgical procedures to reduce pain in Korean patients.

  19. Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study.

    Science.gov (United States)

    Livshits, Anna; Machtinger, Ronit; David, Liat Ben; Spira, Maya; Moshe-Zahav, Aliza; Seidman, Daniel S

    2009-05-01

    To determine the efficacy of a nonsteroidal anti-inflammatory drug vs. paracetamol in pain relief during medical abortion and to evaluate whether nonsteroidal anti-inflammatory drugs interfere with the action of misoprostol. A prospective double-blind controlled study. University-affiliated tertiary hospital. One hundred twenty women who underwent first-trimester termination of pregnancy. Patients received 600 mg mifepristone orally, followed by 400 microg of oral misoprostol 2 days later. They were randomized to receive ibuprofen or paracetamol when pain relief was necessary. Patients completed a questionnaire about side effects and pain score and returned for an ultrasound follow-up examination 10-14 days after medical abortion. Success rates, as defined by no surgical intervention, and pain scores were assessed. Ibuprofen was found to be statistically significantly more effective for pain relief after medical abortion compared with paracetamol. There was no difference in the failure rate of medical abortion, and the frequency of surgical intervention was slightly higher in the group that received paracetamol (16.3% vs. 8.5%). Ibuprofen was found to be more effective than paracetamol for pain reduction during medical abortion. A history of surgical or medical abortion was predictive for high pain scores. Despite its anti-prostaglandin effects, ibuprofen use did not interfere with the action of misoprostol.

  20. Acupuncture: a first approach on pain relief using a 617 nm LED device

    Science.gov (United States)

    Costa, J. M.; Corral-Baqués, M. I.; Amat, A.

    2007-02-01

    In this study, a preliminary approach for pain relief using a novel pulsated LED device was conducted. 12 patients were treated with a Photopuncture device designed by SORISA, which consisted in a 10-channel LED system at 617 nm. 15 patients with different pain localizations were treated: cervicobrachialgia (3 cases), lumbago / sciatica (4 cases), gonalgia (3 cases), cephalalgia (2 cases), talalgia (1 case), epicondylitis (1 case) and trigeminal neuralgia (1 case). To characterize the pain level, the Categorical Pain Scale (none (0), mild (1-3), moderate (4-6) and severe (7-10)) was used. Just patients with severe pain (7-10) were treated. Patients were treated twice a week for 25 minutes; 5 to 8 sessions were given at the following treatment parameters: 10 mW per channel pulsed at 60 Hz with a 50 % duty cycle. The total dose for point was 7.5 J. To characterize the response to the treatment, the results were classified as: "no result", no changes in pain degree; "poor", pain decreased one category; "good", pain decreased two categories; "very good", complete healing (no pain). The results were: 1 case with "very good" result; 11 cases with "good" result; 3 cases with "poor" result; and 0 cases with "no result". We conclude that the Photopuncture led device may be a good alternative to classical Acupuncture in pain relief, although further experimentation is required.

  1. Pain relief with lidocaine 5% patch in localized peripheral neuropathic pain in relation to pain phenotype

    DEFF Research Database (Denmark)

    Demant, Dyveke T; Lund, Karen; Finnerup, Nanna B

    2015-01-01

    (-1 to 5) points more (p=0.036). For these measures, there was no significant interaction between treatment and phenotype, but there was a significant interaction for pain paroxysms (0.8, 95% CI 0.4;1.2, p

  2. Delivery systems of opioid analgesics for pain relief: a review.

    Science.gov (United States)

    Leppert, Wojciech; Krajnik, Malgorzata; Wordliczek, Jerzy

    2013-01-01

    Chronic pain is usually treated with pharmacological measures using opioids alone or in combination with adjuvant analgesics that play an important role in the treatment of pain not fully responsive to opioids administered alone, especially in neuropathic, bone and visceral colicky pain. The important part of the chronic pain treatment is the appropriate use of non-pharmacological measures along with psychosocial and spiritual support. Opioids may be administered by different routes; the most common and most convenient for majority of treated patients are oral and transdermal. However, in certain circumstances such as inability to swallow, lack of analgesic efficacy and intractable opioid-induced adverse effects parenteral routes (subcutaneous, intravenous) might be more useful. When these routes fail, in some patients intrathecal administration of opioids is required. Recently, more patients have been treated with short-acting opioids for breakthrough pain with sublingual, buccal and intranasal routes of opioid administration that may provide efficacy superior to oral and comparable to intravenous routes. Alternative routes comprise rectal, inhaled and topical administration of opioids. This article discusses various routes of opioid administration.

  3. Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur

    Directory of Open Access Journals (Sweden)

    Rachel Cherian Koshy

    2010-01-01

    Full Text Available Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

  4. The pharmacogenetics of codeine pain relief in the postpartum period.

    Science.gov (United States)

    Baber, M; Chaudhry, S; Kelly, L; Ross, C; Carleton, B; Berger, H; Koren, G

    2015-10-01

    The objective of this study was to examine interindividual variability in codeine requirements and pain management by examining select genetic polymorphisms in the codeine pharmacological pathway. The study included a nested cohort of 98 women who were prescribed codeine following cesarean section. Participants were genotyped for select polymorphisms of the COMT, ABCB1, CYP2D6, UGT2B7 and OPRM1 genes and instructed to describe their level of pain using the visual analog scale (mm) 1 h following each dose of codeine. Analysis revealed that reported pain increases with maternal age (P=0.041). Asians required more codeine than Caucasians (P=0.048). Significant differences in mean dose consumption were seen among the genotypic groups of the OPRM1 A118G (P=0.001) and UGT2B7 C802T (P=0.015) variants. These variants were found to predict codeine consumption in the cohort overall (P=0.000) and among Caucasians (P=0.001). These findings will assist in customizing therapy to effectively manage postpartum pain.

  5. Is Music Effective For Pain Relief In Burn Victims?

    Directory of Open Access Journals (Sweden)

    Lidiane Souza Lima

    2017-02-01

    Full Text Available Objective: to describe the effect of music on pain of burn victims during the dressing change. Methods: applied, descriptive, exploratory and quantitative research held in a Burn Treatment Unit from October 2015 to April 2016. The study included 16 burn victims who were divided in three groups: A: patients heard music before dressing; B: patients hear music during dressing; C: patients did not hear music. Results: the average age was 31.8 years (± 14.1 and most of the subjects were male. Lower limbs and trunk were the most affected parts of the body, especially with second-degree burns and which affected an average of 15.8% (± 11.5 of the body surface. There was a predominance of gospel music (50.0%. The music reduced the average heart rate and oxygen saturation, but did not change ventilatory rate. There was a decrease in the average of pain intensity in groups GB (p = 0.0505 and GC (p = 0.0055. During the dressing, the burning was unanimous characteristic for all subjects, in the same manner as verbal reports was the form of manifestation. Conclusion: music proved to be a simple and effective resource in controlling pain in burn victims. Keywords: Burns; Music; Pain.

  6. Patellofemoral arthrodesis as pain relief in extreme patella alta

    NARCIS (Netherlands)

    Venkatesan, S.; Kampen, A. van

    2014-01-01

    PURPOSE: There is no golden standard management for neglected, chronic patellar tendon rupture as they are fairly rare. Nevertheless, accompanying pain can be highly debilitating. By presenting a case of patellar tendon repair, the exceptional results of a patellofemoral arthrodesis are described.

  7. Dysmenorrhoea: Pain relief strategies among a cohort of ...

    African Journals Online (AJOL)

    A null hypothesis tested at significant level of 0.05 suggested that relationship between age and pain intensity is not significant. Most (51%) of the respondents reported that dysmenorrhoea limits their activities. Conclusion: The various strategies adopted by the females are drugs, relaxation/rest, warm bath, exercise, diet ...

  8. Terminal sedation: between pain relief, withholding treatment and euthanasia

    NARCIS (Netherlands)

    Gevers, J. K. M.

    2006-01-01

    In the last five to ten years there has been increasing debate on terminal sedation, a medical practice that is difficult to place between other decisions at the end of life, like alleviating pain, withholding treatment, and (in jurisdictions where this is allowed) euthanasia or physician-assisted

  9. Dysmenorrhoea: Pain relief strategies among a cohort of ...

    African Journals Online (AJOL)

    McRoy

    There are various strategies used in menstrual pain management which differ with individuals. Aim: This study investigates various management options of dysmenorrhoea among female undergraduates in Nigeria. Methods: A total of 285 questionnaires were distributed in four faculties using purposive and convenience ...

  10. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth

    NARCIS (Netherlands)

    Bailey, E.; Worthington, H.V.; van Wijk, A.; Yates, J.M.; Coulthard, P.; Afzal, Z.

    2013-01-01

    Background Both paracetamol and ibuprofen are commonly used analgesics for the relief of pain following the surgical removal of lower wisdom teeth (third molars). In 2010, a novel analgesic (marketed as Nuromol) containing both paracetamol and ibuprofen in the same tablet was launched in the United

  11. A Novel Uni-Acupoint Electroacupuncture Stimulation Method for Pain Relief

    Directory of Open Access Journals (Sweden)

    Chuansen Niu

    2011-01-01

    Full Text Available Electroacupuncture stimulation (EAS has been demonstrated effective for pain relief and treating other various diseases. However, the conventional way of EAS, the bi-acupoint method, is not suitable for basis study of acupoint specificity. Moreover, its operations are inconvenient and difficult to be persevered, especially for long-term, continuous and even imperative treatments. These disadvantages motivate designs of new EAS methods. We present a novel uni-acupoint electrical stimulation method, which is applied at a single acupoint and quite meets the needs of basis study and simpler clinical application. Its pain relief effect has been evaluated by animal tests of Wistar rats. During the experiments, rats were given 30 min 2/100 Hz uni- and bi-acupoint EAS and their nociceptive thresholds before and after EAS were attained by hot-plate test. The analgesic effect was defined as the change of nociceptive threshold and used to evaluate the effectiveness of uni-acupoint EAS for pain relief. The hot-plate test results indicated that analgesic effect of uni-acupoint group was significantly higher than that of the control group and there was no significant difference of analgesic effects between uni- and bi-acupoint EAS. The results suggested that uni-acupoint method was an effective EAS method and had comparable pain relief effect with bi-acupoint method.

  12. Knowledge, attitude and use of pain relief in labour among women ...

    African Journals Online (AJOL)

    Objective: To find out the knowledge, attitude and practice of pain relief methods during labour among mothers attending antenatal clinics at Shalom Community Hospital, Athi River, Kenya. Design: Cross Sectional study. Setting: Shalom Community Hospital, Athi River, Kenya Subjects: Two hundred and seven participants ...

  13. Introducing a patient-controlled analgesia-based acute pain relief ...

    African Journals Online (AJOL)

    The 10 months after the introduction of the first acute pain relief service (APRS) in southern Africa is described. Seven hundred patients were treated with morphine by means of patient-controlled analgesia (PCA), administered to patients after major surgery or extensive burns via the intravenous (IV) or subcutaneous (SC) ...

  14. Massage therapy versus traditional therapy for low back pain relief: implications for holistic nursing practice.

    Science.gov (United States)

    Melancon, Bryan; Miller, Lucy H

    2005-01-01

    This study explored whether there is a significant difference in perceived low back pain relief between patients receiving massage versus traditional therapy, using a 2-variable by 3-variable fully crossed, factorial, comparative research design. Statistical results showed slightly more efficacy for traditional therapy; however, the additional benefits of massage add to its value for holistic nursing practice.

  15. Parents' knowledge, attitudes, use of pain relief methods and satisfaction related to their children's postoperative pain management: a descriptive correlational study.

    Science.gov (United States)

    Chng, Hui Yi; He, Hong-Gu; Chan, Sally Wai-Chi; Liam, Joanne Li Wee; Zhu, Lixia; Cheng, Karis Kin Fong

    2015-06-01

    To examine parents' knowledge about and attitudes towards pain management, use of pain relief strategies and satisfaction with their children's postoperative pain management, as well as the relationships among these variables. Children's postoperative pain is inadequately managed worldwide. Despite increasing emphasis on parental involvement in children's postoperative pain management, few studies have examined parents' management of their child's postoperative pain in Singapore. A descriptive correlational study. A convenience sample of 60 parents having 6- to 14-year-old children undergoing inpatient elective surgery in a public hospital in Singapore was recruited. Data were collected one day after each child's surgery using the Pain Management Knowledge and Attitudes questionnaire and the Parents' Use of Pain Relief Strategies questionnaire. Descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests and Spearman's rank correlation coefficient were used for data analyses. Parents displayed moderate levels of knowledge, attitudes and use of pain relief methods in relation to their children's postoperative pain and pain management. They were generally satisfied with the management of their child's postoperative pain. There was significant difference in Parents' Use of Pain Relief Strategies scores between parents with and without previous experience of caring for their hospitalised child. Statistically significant positive correlations were found between parents' knowledge and attitude, knowledge and satisfaction, attitude and satisfaction, knowledge and pain relief strategies, as well as attitude and pain relief strategies. This study indicates the need to provide parents with more information regarding their children's postoperative pain management. Future studies are needed to develop educational interventions for parents to improve their knowledge and attitudes, which will eventually improve their use of pain relief strategies for their children. Health

  16. Music-listening as an intervention for chronic pain relief : a case study

    OpenAIRE

    Campbell, Elsa

    2014-01-01

    The field of audioanalgesia is vast. Research shows a combination of pharmacology and music interventions helps to reduce anxiety and stress, resulting in lower levels of pain, pre- and post-operatively. This study is an exploration of the use of music-listening as a method of pain relief with the knowledge that certain types of music aid in reaching altered states of consciousness. In reaching this state of relaxation, the realisation one’s own methods of pain management and goals towards be...

  17. Relief of depression and pain improves daily functioning and quality of life in patients with major depressive disorder.

    Science.gov (United States)

    Lin, Ching-Hua; Yen, Yung-Chieh; Chen, Ming-Chao; Chen, Cheng-Chung

    2013-12-02

    The objective of this study was to investigate the effects of depression relief and pain relief on the improvement in daily functioning and quality of life (QOL) for depressed patients receiving a 6-week treatment of fluoxetine. A total of 131 acutely ill inpatients with major depressive disorder (MDD) were enrolled to receive 20mg of fluoxetine daily for 6 weeks. Depression severity, pain severity, daily functioning, and health-related QOL were assessed at baseline and again at week 6. Depression severity, pain severity, and daily functioning were assessed using the 17-item Hamilton Depression Rating Scale, the Short-Form 36 (SF-36) Body Pain Index, and the Work and Social Adjustment Scale. Health-related QOL was assessed by three primary domains of the SF-36, including social functioning, vitality, and general health perceptions. Pearson's correlation and structural equation modeling were used to examine relationships among the study variables. Five models were proposed. In model 1, depression relief alone improved daily functioning and QOL. In model 2, pain relief alone improved daily functioning and QOL. In model 3, depression relief, mediated by pain relief, improved daily functioning and QOL. In model 4, pain relief, mediated by depression relief, improved daily functioning and QOL. In model 5, both depression relief and pain relief improved daily functioning and QOL. One hundred and six patients completed all the measures at baseline and at week 6. Model 5 was the most fitted structural equation model (χ(2) = 8.62, df = 8, p = 0.376, GFI = 0.975, AGFI = 0.935, TLI = 0.992, CFI = 0.996, RMSEA = 0.027). Interventions which relieve depression and pain improve daily functioning and QOL among patients with MDD. The proposed model can provide quantitative estimates of improvement in treating patients with MDD. © 2013 Elsevier Inc. All rights reserved.

  18. Immediate and short-term pain relief by acute sciatic nerve press: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zhang Wenlong

    2007-05-01

    Full Text Available Abstract Background Despite much research, an immediately available, instantly effective and harmless pain relief technique has not been discovered. This study describes a new manipulation: a "2-minute sciatic nerve press", for rapid short-term relief of pain brought on by various dental and renal diseases. Methods This randomized, single-blind, placebo-controlled trial ran in three hospitals in Anhui Province, China, with an enrollment of 66 out of 111 solicited patients aged 16 to 74 years. Patients were recruited sequentially, by specific participating physicians at their clinic visits to three independent hospitals. The diseases in enrolled dental patients included dental caries, periodontal diseases and dental trauma. Renal diseases in recruits included kidney infections, stones and some other conditions. Patients were randomly assigned to receive the "2-minute sciatic nerve press" or the "placebo press". For the "2-minute sciatic nerve press", pressure was applied simultaneously to the sciatic nerves at the back of the thighs, using the fists while patients lay prone. For the "placebo press", pressure was applied simultaneously to a parallel spot on the front of the thighs, using the fists while patients lay supine. Each fist applied a pressure of 11 to 20 kg for 2 minutes, after which, patients arose to rate pain. Results The "2-minute sciatic nerve press" produced greater pain relief than the "placebo press". Within the first 10 minutes after sciatic pressure, immediate pain relief ratings averaged 66.4% (p Conclusion Two minutes of pressure on both sciatic nerves can produce immediate significant conduction analgesia, providing a convenient, safe and powerful way to overcome clinical pain brought on by dental diseases and renal diseases for short term purposes. Trial registration ACTR 12606000439549

  19. Codeine and its alternates for pain and cough relief*

    Science.gov (United States)

    Eddy, Nathan B.; Friebel, Hans; Hahn, Klaus-Jürgen; Halbach, Hans

    1968-01-01

    This report—the first of a series on codeine and its alternates for pain and cough relief—presents a detailed evaluation of experimental and clinical data concerning the analgesic action of codeine (the antitussive action will be assessed separately). The authors discuss the pharmacology of the drug, including side-effects and toxicity; effects on the respiratory, circulatory, digestive and urinary systems; tolerance, dependence and liability to abuse; metabolic effects; and mechanism of action. Though codeine is generally more toxic than morphine to animals on account of its convulsant action, it is less toxic to man, possibly because it produces less respiratory depression. Again, tolerance to its analgesic effects has been demonstrated in several animal species, but dependence in man is observed far less frequently than it is with morphine, and the abstinence syndrome is less intense. From their extensive review of the evidence available, the authors conclude that codeine is a good analgesic and that little risk to public health is likely to arise from its clinical use to relieve pain. PMID:4972938

  20. Ibuprofen is superior to paracetamol for pain relief following third molar removal.

    Science.gov (United States)

    Ferraiolo, Debra M; Veitz-Keenan, Analia

    2014-12-01

    The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and the metaRegister of Controlled Trials were searched with no language restrictions. Randomised controlled double-blinded clinical trials using the third molar model were included. Two review authors independently and in duplicate extracted data. The proportion of patients with at least 50% pain relief (based on total pain relief (TOTPAR) and summed pain intensity difference (SPID) data) was calculated for all three drugs at both two and six hours post-dosing and meta-analysed for comparison. Seven studies involving 2241 patients were included. Two studies were considered to be at low risk of bias, three at high risk and two unclear risk of bias. Ibuprofen was found to be a superior analgesic to paracetamol at several doses, with high quality evidence suggesting that ibuprofen 400 mg is superior to 1000 mg paracetamol based on pain relief (estimated from TOTPAR data) and the use of rescue medication meta-analyses. Risk ratio (RR) for at least 50% pain relief (based on TOTPAR) at six hours was 1.47 (95% confidence interval (CI) 1.28 to 1.69; five trials) favouring 400 mg ibuprofen over 1000 mg paracetamol, RR for not using rescue medication (also favouring ibuprofen) was 1.50 (95% CI 1.25 to 1.79; four trials). For combined drug RR for at least 50% of the maximum pain relief over six hours of 1.77 (95% CI 1.32 to 2.39) (paracetamol 1000 mg and ibuprofen 400 mg) (one trial; moderate quality evidence). RR not using rescue medication 1.60 (95% CI 1.36 to 1.88) (two trials; moderate quality evidence). Adverse events were comparable between the treatment groups, but no formal analysis could be undertaken. There is high quality evidence that ibuprofen is superior to paracetamol at doses of 200 mg to 512 mg and 600 mg to 1000 mg respectively based on pain relief and use of rescue medication data collected at six hours postoperatively. The

  1. EFFECT OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUE ON PAIN RELIEF DURING LABOR

    Directory of Open Access Journals (Sweden)

    M. Bagharpoosh

    2006-07-01

    Full Text Available Labor pain is a cause of stress and suffering; for which many women seek methods to relieve this pain. The aim of this study was to determine the effect of relaxation techniques on pain relief during labor. This study was carried out on 62 pregnant women referred to Fatemieh hospital (Hamadan, Iran during their labor. They were selected using convenience sampling and were divided randomly in two groups. The first group (control received routine way of ward during their labor and the second group (test went through the relaxation technique after training. The intensity of pain was determined using a standard pain number rating scale, and the behavioral reactions were recorded using an observational checklist. The statistical analysis of data showed significant difference in intensity of pain between the two groups (P = 0.0001. Also there was a significant difference in behavioral reactions between the two groups (P < 0.0001. Since the relaxation technique is easy to perform and without any risk and also has low expenses it is recommended for pain relief during labor.

  2. Intrathecal ziconotide and baclofen provide pain relief in seven patients with neuropathic pain and spasticity: case reports.

    Science.gov (United States)

    Saulino, M; Burton, A W; Danyo, D A; Frost, S; Glanzer, J; Solanki, D R

    2009-03-01

    Seven cases of combination of intrathecal (IT) ziconotide and baclofen therapy in patients with refractory neuropathic pain and spasticity were reviewed. Five of the seven adult patients were receiving IT baclofen treatment when ziconotide was initiated. All five patients had experienced at least one previous failed IT treatment regimen. Pain intensity scores improved by a mean of 50.3% with the use of ziconotide-baclofen therapy. Mean time to onset of pain relief was 15 weeks, at a mean ziconotide dose of 3.7 microg/day. Within this group of patients, adverse events were observed in one patient, but they were not considered to be ziconotide related and subsequently resolved. The remaining two patients were receiving ziconotide treatment when baclofen was initiated. Pain intensity scores improved by 75% and 30%, respectively. Pain relief was evident at two weeks and one week, with corresponding ziconotide doses of 2.4 microg/day and 14.4 microg/day, respectively. One patient in this group reported adverse events, but all resolved during continued treatment with the study drugs. Treatment regimens varied between patients in these case series; each regimen used a different titration strategy and different concentrations of ziconotide and baclofen. Combination IT ziconotide and baclofen therapy may be a treatment option for patients with neuropathic pain and spasticity. Future studies are warranted to determine the optimal dosing and titration schedules for ziconotide-baclofen usage.

  3. Transcutaneous electrical stimulation for pain relief during labor: a systematic review and meta-analysis.

    Science.gov (United States)

    Mello, Larissa F D; Nóbrega, Luciana F; Lemos, Andrea

    2011-01-01

    Transcutaneous electrical stimulation (TENS) is a non-pharmacological pain relief method. It is an auxiliary method and not intended to replace other techniques. To perform a systematic review assessing the effectiveness of TENS compared to no TENS treatment or placebo with the following outcomes: pain relief (primary outcome), analgesic requirements, duration of labor, the mother's satisfaction, type of delivery and fetal repercussions (secondary outcomes). The Pubmed, LILACS and Scielo databases were searched for randomized controlled trials and quasi-randomized trials published between 1966 and 2008 using the keywords 'TENS', 'Labor', 'Labor pain' and 'obstetric labor'. The selection of eligible items and assessment of methodological quality were performed independently by two researchers. Random effects meta-analysis was performed for studies that were sufficiently homogeneous. Nine studies involving a total of 1076 pregnant women were included. There was no statistically significant difference between groups in pain relief during labor (pooled RR = 1.09, 95% CI = 0.72 to 1.65) or the need of additional analgesia (pooled RR = 0.89, 95% CI = 0.74 to 1.08). There was no evidence that TENS interfered in any of the outcomes except the mothers' desire to use TENS in future deliveries. The use of TENS had no impact on mother or child and no influence on labor. According to the results of this review, there is no evidence that TENS reduces the use of additional analgesia.

  4. Post-operative pain relief in children following caudal bupivacaine and buprenorphine--a comparative study.

    Directory of Open Access Journals (Sweden)

    Anilkumar T

    1994-04-01

    Full Text Available Eighty-five paediatric patients (age range: 6 mths-12yrs undergoing lower abdominal surgery were studied for post-operative pain relief following either caudal bupivacaine (GpI: n = 43 or buprenorphine (GpII: n = 42. Bupivacaine was administered as 0.5ml/kg body weight of 0.25% solution and buprenorphine as 4 micrograms/ml and volume of 0.5 ml/Kg body weight in normal saline. Post-operatively pain was graded on a 4-point scale and behaviour on a 5-point scale. Any post-operative complications and need for additional analgesia were also noted. Bupivacaine provided good pain relief in the early post-operative hours but buprenorphine provided pain relief lasting for 24 hrs or more post-operatively. Post-operative behaviour of 10 patients receiving buprenorphine was graded as cheerful as compared to 2 from bupivacaine group. Till the end of observation period (i.e. 8 hr post-operatively, majority of patients receiving buprenorphine remained cheerful.

  5. Effect of birth ball on labor pain relief: A systematic review and meta-analysis.

    Science.gov (United States)

    Makvandi, Somayeh; Latifnejad Roudsari, Robab; Sadeghi, Ramin; Karimi, Leila

    2015-11-01

    To critically evaluate the available evidence related to the impact of using a birth ball on labor pain relief. The Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed and Scopus were searched from their inception to January 2015 using keywords: (Birth* OR Swiss OR Swedish OR balance OR fitness OR gym* OR Pezzi OR sport* OR stability) AND (ball*) AND (labor OR labour OR Obstetric). All available randomized controlled trials involving women using a birth ball for pain relief during labor were considered. The search resulted in 341 titles and abstracts, which were narrowed down to eight potentially relevant articles. Of these, four studies met the inclusion criteria. Pain intensity on a 10 cm visual analogue scale was used as the main outcome measure. Risk of bias was assessed using the Cochrane Risk of Bias tool. Comprehensive Meta-Analysis Version 2 was used for statistical analysis. Four RCTs involving 220 women were included in the systematic review. One study was excluded from the meta-analysis because of heterogeneous interventions and a lack of mean and standard deviation results of labor pain score. The meta-analysis showed that birth ball exercises provided statistically significant improvements to labor pain (pooled mean difference -0.921; 95% confidence interval -1.28, -0.56; P = 0.0000005; I(2)  = 33.7%). The clinical implementation of a birth ball exercise could be an effective tool for parturient women to reduce labor pain. However, rigorous RCTs are needed to evaluate the effect of the birth ball on labor pain relief. © 2015 Japan Society of Obstetrics and Gynecology.

  6. IMPACT OF INTERFERENTIAL CURRENT ON PAIN RELIEF AMONG PATIENTS WITH ORCHIALGIA

    Directory of Open Access Journals (Sweden)

    Hany M.I. Elgohary

    2016-08-01

    Full Text Available Background: Scrotal discomfort can contribute to unusual impact on body scheme and result in behavioral alterations, as well as changes in sexual function such as delay of sexual ability that may affect both man and his companion. There are many physiotherapy modalities to reduce the intratesticular pain such as pelvic floor muscle training, hydrotherapy, ultrasound and electrotherapy. Interferential current therapy is a noninvasive therapy used to reduce acute and chronic, post-operative and post-trauma acute pain. It provides a safe and effective alternative to pharmacological approaches to pain control. The purpose of the current study was to investigate the efficacy of interferential current in alleviating testicular pain. Methods: Randomized clinical study conducted on 50 participants. They divided into two equal groups: Group A received interferential current with two electrodes placed over the upper medial aspects of thighs and the other two electrodes were positioned over the suprapubic area. While group B received placebo interferential current. The treatment protocol was applied 3 times/ week for six successive weeks, in a total of 18 sessions. Patients were evaluated before and after the six weeks of the treatment by visual analogue scale and pain intensity while pain relief scale was measured after the treatment. Results: Group A showed a significant pain improvement in both inter and intra group comparison in all measured parameters (visual analogue scale and pain intensity while pain relief scale (p <0.05. Conclusion: The findings show that interferential current is an effective modality and can be recommended for the treatment of testicular pain.

  7. Preoccupation in an early-romantic relationship predicts experimental pain relief.

    Science.gov (United States)

    Nilakantan, Aneesha; Younger, Jarred; Aron, Arthur; Mackey, Sean

    2014-06-01

    Individuals involved in the early stages of a passionate romantic relationship can be consumed by the experience and report emotional dependence and constant focus on their romantic partner. A few studies have shown that viewing pictures of a romantic partner can significantly reduce experimental pain. The strength of the effect, however, varies substantially between individuals. To study why some individuals experience significant pain reduction when looking at a picture of their partner, we examined partner preoccupation. We hypothesized that a greater degree of preoccupation in the early stages of a romantic relationship would be associated with greater analgesia during a pain induction task. Participants were shown pictures of their romantic partner or an equally attractive and familiar acquaintance while exposed to low, moderate, or high levels of thermal pain. Participants were also asked to rate how much time they spent thinking about their romantic partner during an average day. Degree of preoccupation was defined as the percentage of time participants spent thinking about their partner on an average day. In two separate experiments, viewing pictures of a romantic partner produced an analgesic effect. The degree of pain relief was positively correlated with partner preoccupation. The results suggest that preoccupation with a romantic partner during early stage romantic love is a predictor of pain relief when viewing pictures of the beloved. Wiley Periodicals, Inc.

  8. Anticipation and choice heuristics in the dynamic consumption of pain relief.

    Science.gov (United States)

    Story, Giles W; Vlaev, Ivo; Dayan, Peter; Seymour, Ben; Darzi, Ara; Dolan, Raymond J

    2015-03-01

    Humans frequently need to allocate resources across multiple time-steps. Economic theory proposes that subjects do so according to a stable set of intertemporal preferences, but the computational demands of such decisions encourage the use of formally less competent heuristics. Few empirical studies have examined dynamic resource allocation decisions systematically. Here we conducted an experiment involving the dynamic consumption over approximately 15 minutes of a limited budget of relief from moderately painful stimuli. We had previously elicited the participants' time preferences for the same painful stimuli in one-off choices, allowing us to assess self-consistency. Participants exhibited three characteristic behaviors: saving relief until the end, spreading relief across time, and early spending, of which the last was markedly less prominent. The likelihood that behavior was heuristic rather than normative is suggested by the weak correspondence between one-off and dynamic choices. We show that the consumption choices are consistent with a combination of simple heuristics involving early-spending, spreading or saving of relief until the end, with subjects predominantly exhibiting the last two.

  9. The stress response to surgery: release mechanisms and the modifying effect of pain relief

    DEFF Research Database (Denmark)

    Kehlet, H

    1989-01-01

    This short review updates information on the release mechanisms of the systemic response to surgical injury and the modifying effect of pain relief. Initiation of the response is primarily due to afferent nerve impulses combined with release of humoral substances (such as prostaglandins, kinins......, leukotrienes, interleukin-1, and tumor necrosis factor), while amplification factors include semi-starvation, infection, and hemorrhage. The relative role of the various signals in producing the complex injury response has not been finally determined, but the neural pathway is probably most important...... in releasing the classical endocrine catabolic response, while humoral factors are important for the hyperthermic response, changes in coagulation and fibrinolysis immunofunction, and capillary permeability. The modifying effect of pain relief on the surgical stress response is dependent upon the technique...

  10. An investigation into the onset, pattern, and effects of pain relief on lumbar extensor electromyography in people with acute and chronic low back pain.

    Science.gov (United States)

    Williams, Jonathan M; Haq, Inam; Lee, Raymond Y

    2013-02-01

    The aim of this study was to use an experimental pain relief model to determine the effect of pain relief on lumbar muscle function in people with low back pain. A test-retest design was used with all data collection being completed within a therapy setting. Twenty people with acute and 20 with chronic low back pain were recruited from general practitioner and therapist referrals. Participants completed spinal movements and lifting. Electromyography (EMG) was used to measure the pattern of muscle activity, onset of muscle activation, and peak activation of bilateral lumbar multifidus and iliocostalis. Movements were investigated before and after pain relief, through the self-administration of oral analgesia. Electromyography profiles and peak values were reliable across 3 trials, and EMG profiles correlated well with kinematic profiles. Specific EMG profiles were commonly associated with specific kinematic values, and on the whole, the EMG profiles were unaffected by pain relief. Muscle onset times and peak muscle amplitudes were not affected by pain relief in either acute or chronic low back pain. This study showed that the EMG activities from the lumbar region, including lumbar multifidus and iliocostalis, are reliable, and specific EMG profiles are identifiable. Pain relief as achieved in this study did not affect the pattern of EMG activity, onset of muscle activation, or peak activation values. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  11. Effectiveness of Acupressure Treatment for Pain Management and Fatigue Relief in Gulf War Veterans

    Science.gov (United States)

    2016-10-01

    pharmaceutical treatment, physical therapy , and/or nutritional supplements to temporarily alleviate their symptoms, with limited effect. The severity of...listed in table 1 for the Acupressure group and Reiki group. A 6-week Acupressure intervention produced fatigue relief and pain alleviation...management in veterans with GWI. The results from the four subjects who have completed the intervention look promising and are indicative of the

  12. Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review.

    Science.gov (United States)

    Suter, Valerie G A; Sjölund, Sophia; Bornstein, Michael M

    2017-05-01

    The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables were pain relief, duration of wound healing and reduction in episode frequency. A PICO approach was used as a search strategy in Medline, Embase and Cochrane databases. After scanning and excluding titles, abstracts and full texts, 11 studies (ten RCTs and one non-randomised controlled trial) were included. Study selection and data extraction was done by two observers. Study participants varied between 7-90 for the laser and 5-90 for the control groups. Laser treatment included Nd:YAG laser ablation, CO2 laser applied through a transparent gel (non-ablative) and diode laser in a low-level laser treatment (LLLT) mode. Control groups had placebo, no therapy or topical corticosteroid treatment. Significant pain relief immediately after treatment was found in five out of six studies. Pain relief in the days following treatment was recorded in seven studies. The duration of RAS wound healing was also reduced in five studies. However, criteria of evaluation differed between the studies. The episode frequency was not evaluated as only one study addressed this outcome parameter, but did not discriminate between the study (LLLT) and control (corticosteroid) groups. Jadad scores (ranging from 0 to 5) for quality assessment of the included studies range between 0 and 2 (mean = 1.0) for studies analysing pain relief and between 0 and 3 (mean = 1.1) for studies evaluating wound healing. The use of lasers (CO2 laser, Nd:YAG laser and diode laser) to relieve symptoms and promote healing of RAS is a therapeutic option. More studies for laser applications are necessary to demonstrate superiority over topical pharmaceutical treatment and to recommend a specific laser type, wavelength, power output and applied energy (ablative versus photobiomodulation).

  13. Automated discovery of safety and efficacy concerns for joint & muscle pain relief treatments from online reviews.

    Science.gov (United States)

    Adams, David Z; Gruss, Richard; Abrahams, Alan S

    2017-04-01

    Product issues can cost companies millions in lawsuits and have devastating effects on a firm's sales, image and goodwill, especially in the era of social media. The ability for a system to detect the presence of safety and efficacy (S&E) concerns early on could not only protect consumers from injuries due to safety hazards, but could also mitigate financial damage to the manufacturer. Prior studies in the field of automated defect discovery have found industry-specific techniques appropriate to the automotive, consumer electronics, home appliance, and toy industries, but have not investigated pain relief medicines and medical devices. In this study, we focus specifically on automated discovery of S&E concerns in over-the-counter (OTC) joint and muscle pain relief remedies and devices. We select a dataset of over 32,000 records for three categories of Joint & Muscle Pain Relief treatments from Amazon's online product reviews, and train "smoke word" dictionaries which we use to score holdout reviews, for the presence of safety and efficacy issues. We also score using conventional sentiment analysis techniques. Compared to traditional sentiment analysis techniques, we found that smoke term dictionaries were better suited to detect product concerns from online consumer reviews, and significantly outperformed the sentiment analysis techniques in uncovering both efficacy and safety concerns, across all product subcategories. Our research can be applied to the healthcare and pharmaceutical industry in order to detect safety and efficacy concerns, reducing risks that consumers face using these products. These findings can be highly beneficial to improving quality assurance and management in joint and muscle pain relief. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Pharmaceutical services in a Mexican pain relief and palliative care institute

    OpenAIRE

    Escutia Gutierrez R; Cortéz Alvarez CR; Álvarez Alvarez RM; Flores Hernandez JL; Gutiérrez Godinez J; López y Lopez JG

    2007-01-01

    Neither the purchase nor the distribution of pharmaceuticals in hospitals and community pharmacies in Mexico is under the care of pharmacists. Some are under control of physicians.This report presents the results of the implementation of somef pharmaceutical services for the Jalisco Pain Relief, and Palliative Care Institute (Palia Institute), under the direction of the Secretary of Health, Government of Jalisco. The services implemented were drug distribution system, Drug Information Service...

  15. Effectiveness of Acupressure Treatment for Pain Management and Fatigue Relief in Gulf War Veterans

    Science.gov (United States)

    2017-12-01

    fatigue relief in veterans with GWI. Pain scale and fatigue scale decreased during the intervention . EMG data in both groups shows increased mean EMG...advancements in acupressure intervention for veterans with GWI. 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18...conclusive treatment. Veterans with GWI rely on pharmaceutical treatment, physical therapy, and/or nutritional supplements to temporarily alleviate their

  16. Review: femoral nerve block may be the most effective option for pain relief following total knee replacement.

    Science.gov (United States)

    Krych, Aaron J; Pagnano, Mark W

    2015-04-01

    Implications for practice and research: Utilisation of continuous femoral nerve blockade (FNB) following knee replacement surgery can provide superior pain relief and fewer side effects, compared to traditional patient-controlled opioid analgesia. Further research is needed to compare the effectiveness of FNB to other pain management strategies, such as local anaesthetic infiltration and multimodal oral pain medication.

  17. Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia.

    Science.gov (United States)

    Pandazi, Ageliki; Kanellopoulos, Ilias; Kalimeris, Konstantinos; Batistaki, Chrysanthi; Nikolakopoulos, Nikolaos; Matsota, Paraskevi; Babis, George C; Kostopanagiotou, Georgia

    2013-11-01

    Epidural and intravenous patient-controlled analgesia (PCA) are established methods for pain relief after total hip arthroplasty (THA). Periarticular infiltration is an alternative method that is gaining ground due to its simplicity and safety. Our study aims to assess the efficacy of periarticular infiltration in pain relief after THA. Sixty-three patients undergoing THA under spinal anaesthesia were randomly assigned to receive postoperative analgesia with continuous epidural infusion with ropivacaine (epidural group), intraoperative periarticular infiltration with ropivacaine, clonidine, morphine, epinephrine and corticosteroids (infiltration group) or PCA with morphine (PCA group). PCA morphine provided rescue analgesia in all groups. We recorded morphine consumption, visual analog scale (VAS) scores at rest and movement, blood loss from wound drainage, mean arterial pressure (MAP) and adverse effects at 1, 6, 12, 24 h postoperatively. Morphine consumption at all time points, VAS scores at rest, 6, 12 and 24 h and at movement, 6 and 12 h postoperatively were lower in infiltration group compared to PCA group (p clearly superior to PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.

  18. Ear acupuncture or local anaesthetics as pain relief during postpartum surgical repair: a randomised controlled trial

    DEFF Research Database (Denmark)

    Kindberg, S; Klünder, L; Strøm, J

    2009-01-01

    -hour hands-on training in the use of ear acupuncture. All midwives (n= 36) in the department had previous experience in using acupuncture for obstetric pain relief. Pain and wound healing were evaluated using validated scores. Data collection was performed by research assistants blinded towards...... treatment allocation. Randomisation was computer assisted. A total of 207 women were randomised to receive ear acupuncture (105) and local anaesthetics (102), respectively. Main outcome measures The primary outcome was pain during surgical repair. Secondary outcomes were wound healing at 24-48 hours and 14...... days postpartum, participant satisfaction, revision of wound or dyspareunia reported 6 months postpartum. Results Pain during surgical repair was more frequently reported by participants allocated to ear acupuncture compared with participants receiving local anaesthetics (89 versus 54%, P

  19. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery.

    Science.gov (United States)

    Ullah, Hameed; Samad, Khalid; Khan, Fauzia A

    2014-02-04

    Postoperative pain may lead to adverse effects on the body, which might result in an increase in morbidity. Its management therefore poses a unique challenge for the clinician. Major shoulder surgery is associated with severe postoperative pain, and different modalities are available to manage such pain, including opioid and non-opioid analgesics, local anaesthetics infiltrated into and around the shoulder joint and regional anaesthesia. All of these techniques, alone or in combination, have been used to treat the postoperative pain of major shoulder surgery but with varying success. The objective of this review was to compare the analgesic efficacy of continuous interscalene brachial plexus block (ISBPB) with parenteral opioid analgesia for pain relief after major shoulder surgery. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12), MEDLINE (1950 to December 2012), EMBASE (1980 to December 2012), Web of Science (1954 to December 2012), CINAHL (1982 to December 2012) and bibliographies of published studies. We included randomized controlled trials assessing the effectiveness of continuous ISBPB compared with different forms of parenteral opioid analgesia in relieving pain in adult participants undergoing elective major shoulder surgery. Two review authors independently assessed trial quality and extracted outcome data. We included two randomized controlled trials (147 participants). A total of 17 participants were excluded from one trial because of complications related to continuous ISBPB (16) or parenteral opioid analgesia (one). Thus we have information on 130 participants (66 in the continuous ISBPB group and 64 in the parenteral opioid group). The studies were clinically heterogeneous. No meta-analysis was undertaken. However, results of the two included studies showed better pain relief with continuous ISBPB following major shoulder surgery and a lower incidence of complications when interscalene block is performed under

  20. Effects of music therapy and distraction cards on pain relief during phlebotomy in children.

    Science.gov (United States)

    Aydin, Diler; Sahiner, Nejla Canbulat

    2017-02-01

    To investigate three different distraction methods (distraction cards, listening to music, and distraction cards + music) on pain and anxiety relief in children during phlebotomy. This study was a prospective, randomized, controlled trial. The sample consisted of children aged 7 to 12years who required blood tests. The children were randomized into four groups, distraction cards, music, distraction cards + music, and controls. Data were obtained through face-to-face interviews with the children, their parents, and the observer before and after the procedure. The children's pain levels were assessed and reported by the parents and observers, and the children themselves who self-reported using Wong-Baker FACES. The children's anxiety levels were also assessed using the Children's Fear Scale. Two hundred children (mean age: 9.01±2.35years) were included. No difference was found between the groups in the self, parent, and observer reported procedural pain levels (p=0.72, p=0.23, p=0.15, respectively). Furthermore, no significant differences were observed between groups in procedural child anxiety levels according to the parents and observer (p=0.092, p=0.096, respectively). Pain and anxiety relief was seen in all three methods during phlebotomy; however, no statistically significant difference was observed. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Antagonism of nerve growth factor-TrkA signaling and the relief of pain.

    Science.gov (United States)

    Mantyh, Patrick W; Koltzenburg, Martin; Mendell, Lorne M; Tive, Leslie; Shelton, David L

    2011-07-01

    Nerve growth factor (NGF) was originally discovered as a neurotrophic factor essential for the survival of sensory and sympathetic neurons during development. However, in the adult NGF has been found to play an important role in nociceptor sensitization after tissue injury. The authors outline mechanisms by which NGF activation of its cognate receptor, tropomyosin-related kinase A receptor, regulates a host of ion channels, receptors, and signaling molecules to enhance acute and chronic pain. The authors also document that peripherally restricted antagonism of NGF-tropomyosin-related kinase A receptor signaling is effective for controlling human pain while appearing to maintain normal nociceptor function. Understanding whether there are any unexpected adverse events and how humans may change their behavior and use of the injured/degenerating tissue after significant pain relief without sedation will be required to fully appreciate the patient populations that may benefit from these therapies targeting NGF.

  2. Assessment of the effectiveness of non-pharmacological methods in pain relief during labor

    Directory of Open Access Journals (Sweden)

    Samara Maria Borges Osório

    2014-04-01

    Full Text Available This is a systematic review that aimed to evaluate the effectiveness of non-pharmacological methods for pain relief during labor. The articles’ selection was based on BDENF, PubMed, LILACS and Cochrane Library, published between 2007 and 2012. One analyzed seven studies that assessed the non-pharmacological methods and met the eligibility criteria. It was evident that massage, aromatherapy, immersion bath, acupuncture and acupressure are effective methods to relieve pain during labor, because besides reducing pain perception, they still lower levels of anxiety and stress. Among them, the most efficient one was the massage, mainly when done in the first stage of labor. Furthermore, the interventions don’t interfere in the kind and duration of labor, being safe to clinical practice.

  3. Does pain relief influence recovery of consciousness? A case report of a patient treated with ziconotide.

    Science.gov (United States)

    Lanzillo, Bernardo; Loreto, Vincenzo; Calabrese, Claudio; Estraneo, Anna; Moretta, Pasquale; Trojano, Luigi

    2016-04-01

    For people with cervical spinal cord injury (SCI), access to computers can be difficult, thus several devices have been developed to facilitate their Disorders of consciousness (DOC) are difficult to classify. The degree of consciousness varies from coma to vegetative state or unresponsive wakefulness syndrome (UWS) and minimally conscious state. Correct diagnosis has important ethical and legal implications, and pain may be cause of misdiagnosis. We describe here a patient with traumatic brain injury, classified as UWS. His clinical picture was dominated by spasticity, and pain. He underwent intrathecal treatment of spasticity with baclofen. Improvement was not that expected. However, there was a dramatic improvement when ziconotide was added to relieve pain; the patient began to eat by mouth, talk, and his tracheal tube could be removed and he is currently classified as having severe disability. The suspension of ziconotide caused a clear re-worsening of clinical condition, reverted by his reintroduction. Pain is an important factor in patients with DOC. Anecdotal reports of improved consciousness with intrathecal baclofen therapy may be due to pain relief. Reduction of pain in DOC is important and drugs should not interfere with cognition, and must be effective and manageable. Ziconotide may be one of the possible candidate due to its synergistic antispastic action in combination with baclofen when an intratecal pump has been implanted.

  4. Multiple sites and actions of gabapentin-induced relief of ongoing experimental neuropathic pain.

    Science.gov (United States)

    Bannister, Kirsty; Qu, Chaoling; Navratilova, Edita; Oyarzo, Janice; Xie, Jennifer Yanhua; King, Tamara; Dickenson, Anthony H; Porreca, Frank

    2017-08-21

    Gabapentin (GBP) is a first-line therapy for neuropathic pain, but its mechanisms and sites of action remain uncertain. We investigated GBP-induced modulation of neuropathic pain following spinal nerve ligation (SNL) in rats. Intravenous or intrathecal GBP reversed evoked mechanical hypersensitivity and produced conditioned place preference (CPP) and dopamine (DA) release in the nucleus accumbens (NAc) selectively in SNL rats. Spinal GBP also significantly inhibited dorsal horn wide-dynamic-range neuronal responses to a range of evoked stimuli in SNL rats. By contrast, GBP microinjected bilaterally into the rostral anterior cingulate cortex (rACC), produced CPP, and elicited NAc DA release selectively in SNL rats but did not reverse tactile allodynia and had marginal effects on wide-dynamic-range neuronal activity. Moreover, blockade of endogenous opioid signaling in the rACC prevented intravenous GBP-induced CPP and NAc DA release but failed to block its inhibition of tactile allodynia. Gabapentin, therefore, can potentially act to produce its pain relieving effects by (a) inhibition of injury-induced spinal neuronal excitability, evoked hypersensitivity, and ongoing pain and (b) selective supraspinal modulation of affective qualities of pain, without alteration of reflexive behaviors. Consistent with previous findings of pain relief from nonopioid analgesics, GBP requires engagement of rACC endogenous opioid circuits and downstream activation of mesolimbic reward circuits reflected in learned pain-motivated behaviors. These findings support the partial separation of sensory and affective dimensions of pain in this experimental model and suggest that modulation of affective-motivational qualities of pain may be the preferential mechanism of GBP's analgesic effects in patients.

  5. Relief of postoperative pain with jaw relaxation, music and their combination.

    Science.gov (United States)

    Good, M; Stanton-Hicks, M; Grass, J A; Cranston Anderson, G; Choi, C; Schoolmeesters, L J; Salman, A

    1999-05-01

    The aim of this randomized controlled trial was to determine the effect of jaw relaxation, music and the combination of relaxation and music on postoperative pain after major abdominal surgery during ambulation and rest on postoperative days 1 and 2. Opioid medication provided for pain, following abdominal surgery, does not always give sufficient relief and can cause undesired side effects. Thus, additional interventions such as music and relaxation may provide more complete relief. Previous studies have found mixed results due to small sample sizes and other methodological problems. In a rigorous experimental design, 500 subjects aged 18-70 in five Midwestern hospitals were randomly assigned by minimization to a relaxation, music, relaxation plus music, or control group. Interventions were taught preoperatively and tested postoperatively. The same amount of time was spent with subjects in the control group. Pain was measured with the visual analogue sensation and distress of pain scales. Demographic and surgical variables, and milligrams of parenteral or oral opioids in effect at the time of testing were not significantly different between the groups, nor did they correlate with pain scores. Controlling for pretest sensation and distress, orthogonal a priori contrasts and multivariate analysis of covariance indicated that the three treatment groups had significantly less pain than the controls, (P = 0.028-0.000) which was confirmed by the univariate analysis of covariance (P = 0.018-0.000). Post hoc multivariate analysis revealed that the combination group had significantly less sensation and distress of pain than the control group on all post-tests (P = 0.035-0.000), and the relaxation and music groups had significantly less on all tests (P = 0.022-0.000) except after ambulation. At post ambulation those using relaxation did not have significantly less pain than the controls on both days and those using music did not on day 1, although there were some univariate

  6. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study.

    Science.gov (United States)

    Dehghan, Morteza; Farahbod, Farinaz

    2014-09-01

    Acute low back pain is one of the most common health problems especially in industrialized countries where 75 per cent of the population develop it at least once during their life. This study examined the efficacy of thermotherapy and cryotherapy, alongside a routine pharmacologic treatment, on pain relief in patients with acute low back pain referring an orthopedic clinic in Shahrekord, Iran. This clinical trial study was conducted on 87 patients randomly assigned to three (thermotherapy and cryotherapy as intervention, and naproxen as control) groups of 29 each. The first (thermotherapy) group underwent treatment with hot water bag and naproxen, the second (cryotherapy) group was treated with ice and naproxen, and the naproxen group was only treated with naproxen, all for one week. All patients were examined on 0, 3(rd), 8(th), and 15(th) day after the first visit and the data gathered by McGill Pain Questionnaire. The data were analyzed by SPSS software using paired t-test, ANOVA, and chi-square. In this study, mean age of the patients was 34.48 (20-50) years and 51.72 per cent were female. Thermotherapy patients reported significantly less pain compared to cryotherapy and control (p≤0.05). In thermotherapy and cryotherapy groups, mean pain in the first visit was 12.70±3.7 and 12.06±2.6, and on the 15(th) day after intervention 0.75±0.37 and 2.20±2.12, respectively. The results indicated that the application of thermo-therapy and cryotherapy accompanied with a pharmacologic treatment could relieve pain in the patients with acute low back pain.

  7. Weekly and Twice-Weekly Yoga Classes Offer Similar Low-Back Pain Relief in Low-Income Minority Populations

    Science.gov (United States)

    ... Weekly and Twice-Weekly Yoga Classes Offer Similar Low-Back Pain Relief in Low-Income Minority Populations Share: © Photodisc ... in minority and low-income populations with chronic low-back pain. Researchers from Boston University School of Medicine, Boston ...

  8. Low degree of satisfactory individual pain relief in post-operative pain trials

    DEFF Research Database (Denmark)

    Geisler, A; Dahl, J B; Karlsen, A P H

    2017-01-01

    BACKGROUND: The majority of clinical trials regarding post-operative pain treatment focuses on the average analgesic efficacy, rather than on efficacy in individual patients. It has been argued, that in acute pain trials, the underlying distributions are often skewed, which makes the average unfit...... controlled trials of post-operative pain treatment and from meta-analyses of a systematic review regarding hip arthroplasty. The predefined success criterion was that at least 80% of patients in active treatment groups should obtain VAS post-operatively. RESULTS: In the analysis of data...... from the randomised controlled trials, we found that at 6 h post-operatively, 50% (95% CI: 31-69) of patients allocated to active treatment reached the success criterion for pain at rest and 14% (95% CI: 5-34) for pain during mobilisation. At 24 h post-operatively, 60% (95% CI: 38-78) of patients...

  9. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth.

    Science.gov (United States)

    Bailey, Edmund; Worthington, Helen V; van Wijk, Arjen; Yates, Julian M; Coulthard, Paul; Afzal, Zahid

    2013-12-12

    Both paracetamol and ibuprofen are commonly used analgesics for the relief of pain following the surgical removal of lower wisdom teeth (third molars). In 2010, a novel analgesic (marketed as Nuromol) containing both paracetamol and ibuprofen in the same tablet was launched in the United Kingdom, this drug has shown promising results to date and we have chosen to also compare the combined drug with the single drugs using this model. In this review we investigated the optimal doses of both paracetamol and ibuprofen via comparison of both and via comparison with the novel combined drug. We have taken into account the side effect profile of the study drugs. This review will help oral surgeons to decide on which analgesic to prescribe following wisdom tooth removal. To compare the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth, at different doses and administered postoperatively. We searched the Cochrane Oral Health Group'sTrials Register (to 20 May 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 4); MEDLINE via OVID (1946 to 20 May 2013); EMBASE via OVID (1980 to 20 May 2013) and the metaRegister of Controlled Trials (to 20 May 2013). We checked the bibliographies of relevant clinical trials and review articles for further studies. We wrote to authors of the identified randomised controlled trials (RCTs), and searched personal references in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied to the searches of the electronic databases. Only randomised controlled double-blinded clinical trials were included. Cross-over studies were included provided there was a wash out period of at least 14 days. There had to be a direct comparison in the trial of two or more of the trial drugs at any dosage. All trials used the third molar pain model. All trials

  10. OnabotulinumtoxinA (Botox) nerve blocks provide durable pain relief for men with chronic scrotal pain: a pilot open-label trial.

    Science.gov (United States)

    Khambati, Aziz; Lau, Susan; Gordon, Allan; Jarvi, Keith A

    2014-12-01

    Chronic scrotal pain (CSP) is a common, often debilitating, condition affecting approximately 4.75% of men. While nerve blocks using local anesthetics usually provide temporary pain relief, there are no publications on the use of longer acting nerve blocks to provide more durable pain relief for men with CSP. The aim of this study was to determine if onabotulinumtoxinA (Botox) cord blocks provide durable pain relief for men with CSP. In this pilot open-label study, men with CSP who had failed medical management but experienced temporary pain relief from a standard cord block underwent a cord block with 100U Botox. The outcomes measured were changes 1, 3, and 6 months post-Botox injection in (i) a 10-point visual analog scale (VAS) pain score; (ii) scrotal tenderness on a three-point scale as rated by physical examination; and (iii) the Chronic Epididymitis Symptom Index (CESI) to measure the severity and impact of scrotal pain on men. Paired t-tests were used to compare groups. Eighteen patients with CSP seen between April and September 2013 had Botox injected as a cord block. At the 1-month follow-up, pain reduction was reported by 72% of patients (mean VAS score: 7.36 vs. 5.61, P Botox cord blocks provide pain reduction for 3 months or more for most men with CSP. © 2014 International Society for Sexual Medicine.

  11. Development of dependence following treatment with opioid analgesics for pain relief: a systematic review.

    Science.gov (United States)

    Minozzi, Silvia; Amato, Laura; Davoli, Marina

    2013-04-01

    To assess the incidence or prevalence of opioid dependence syndrome in adults (with and without previous history of substance abuse) following treatment with opioid analgesics for pain relief. Medline, Embase, CINHAL and the Cochrane Library were searched up to January 2011. Systematic reviews and primary studies were included if they reported data about incidence or prevalence of opioid dependence syndrome (as defined by DSM-IV or ICD-10) in patients receiving strong opioids (or opioid-type analgesics) for treatment of acute or chronic pain due to any physical condition. The data were abstracted, and the methodological quality was assessed using validated checklists. Data were extracted from 17 studies involving a total of 88 235 participants. The studies included three systematic reviews, one randomized controlled trial, eight cross-sectional studies and four uncontrolled case series. Most studies included adult patients with chronic non-malignant pain; two also included patients with cancer pain; only one included patients with a previous history of dependence. Incidence ranged from 0 to 24% (median 0.5%); prevalence ranged from 0 to 31% (median 4.5%). The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  12. 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 meditation reduced pain intensity (p = 0.032) and pain unpleasantness (p 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 modulation. SIGNIFICANCE

  13. Clinically relevant pain relief with an ibuprofen-releasing foam dressing

    DEFF Research Database (Denmark)

    Fogh, Karsten; Andersen, Maibritt B; Bischoff-Mikkelsen, Morten

    2012-01-01

    The objective of this 6-week, 120-patient, double-blind, randomized, controlled trial was to investigate if a foam dressing with ibuprofen provided clinically relevant pain relief (PAR) for exuding, painful venous leg ulcers in comparison with a similar foam dressing without ibuprofen. Primary......) and the corresponding number needed to treat (NNT). Wound-related parameters such as ulcer healing, ulcer area reduction, and peri-ulcer skin condition as well as adverse events were recorded during all 6 weeks of the investigation. PAR was significantly greater in the ibuprofen foam group than the comparator group (p...... = 0.0438). There were 34% responders in the ibuprofen foam group vs. 19% in the comparator group (NNT = 6.8). When evening data were analyzed separately to evaluate PAR over daytime, NNT was 5.3. Wound healing parameters and adverse events were comparable. In conclusion, in this study, the ibuprofen...

  14. The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome.

    Science.gov (United States)

    Anderson, R; Thomas, D W; Phillips, C J

    2005-01-22

    To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. Two health authorities in South Wales, UK. A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.

  15. EFFECTIVENESS OF BREASTFEEDING AND NON-NUTRITIVE SUCKING ON PAIN RELIEF IN INFANT IMMUNIZATION

    Directory of Open Access Journals (Sweden)

    Etri Probowati

    2017-04-01

    Full Text Available Background: Immunization in infants is an action that can cause trauma due to injection of the immunization that can cause pain. Breastfeeding and non-nutritive sucking are considered to be non-pharmacologic strategy of pain management. Objective: This study aims to investigate the effectiveness of breastfeeding and non-nutritive sucking on pain relief in infant immunization Methods: This was a quasy experimental study with posttest only control group. This study was conducted on 26 October till 30 November 2016 at hree Community Health Centers (Puskesmas, namely Puskesmas Cilacap Utara I, Puskesmas Cilacap Tengah, and Puskesmas Cilacap Selatan I. The population was infants aged 2-4 months who got immunization of DPT-HB-Hib 1. Samples were recruited using consecutive sampling technique. There were 69 samples in this study, which were divided into three groups. 1 The group was given a breastfeeding intervention (23 respondents, 2 The second group was given a non Nutritive sucking intervention (23 respondents, and 3 The control group (23 respondents. Data were analyzed using ANOVA. Results: The pain response of the three groups was groups was 2.74 in breastfeeding group, 1.87 in non-nutritive sucking group, and 3.26 in control group. There was a significant difference between non-nutritive sucking and control group with p-value = 0,000, and also the significant difference between breastfeeding and non-nutritive sucking with p-value = 0.016. However, there was no difference between breastfeeding and control group with p value = 0.142. Conclusion: Breastfeeding and non-nutritive sucking were effective in reducing pain during infant immunization. It is suggested that midwives could administer these interventions to reduce pain in infant immunization, and it could be applied as non-pharmacological strategy in pain management in the Community Health Center in Indonesia.

  16. Oral pregabalin for postoperative pain relief after third molar extraction: a randomized controlled clinical trial.

    Science.gov (United States)

    Olmedo-Gaya, Maria Victoria; Manzano-Moreno, Francisco J; Galvez-Mateos, Rafael; González-Rodriguez, Maria Paloma; Talero-Sevilla, Cristina; Vallecillo-Capilla, Manuel

    2016-09-01

    The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars. The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded. No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p medication received was more positive in the pregabalin group (p = 0.042). The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity. These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.

  17. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth, a Cochrane systematic review.

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    Bailey, E; Worthington, H; Coulthard, P

    2014-04-01

    This paper compares the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth. In this systematic review only randomised controlled double-blinded clinical trials were included. We calculated the proportion of patients with at least 50% pain relief at 2 and 6 hours post dosing, along with the proportion of participants using rescue medication at 6 and 8 hours. Adverse events were also analysed. Data was meta-analysed where possible. Seven studies were included with a total of 2,241 participants enrolled. Ibuprofen 400 mg is superior to 1,000 mg paracetamol with a risk ratio for at least 50% pain relief at 6 hours of 1.47 (95% confidence interval [CI] 1.28 to 1.69). For the combined drug, the risk ratio for at least 50% maximum pain relief over 6 hours is 1.77 (95% CI 1.32 to 2.39) based on total pain relief (TOTPAR) data. There is high quality evidence that ibuprofen is superior to paracetamol. The novel combination drug shows encouraging results when compared to the single drugs (based on two trials).

  18. Social inequality in use of dental services: relief of pain and extractions.

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    Roberts-Thomson, Kaye F; Luzzi, Liana; Brennan, David S

    2008-10-01

    The aim of this study was to assess social inequality in use of dental services by examination of visiting for relief of pain and receipt of extractions. Data were collected in the period of 2004-06, from a stratified clustered sample of Australians aged 15+ years, using a computer-aided telephone interview. Analysis was restricted to n=10,099 dentate adults. Visiting for relief of pain varied by age, country of birth, education and income with lower odds (Odds ratio, 95%CI) among 55-74 (0.43, 0.35-0.54) and 75+ year-olds (0.22, 0.15-0.33) compared to the 15-34 year-olds, lower odds among Australian-born persons (0.82,0.69-0.98) compared to those born overseas, higher odds for those with no post-secondary education (1.31, 1.07-1.61) and with TAFE, trade or other qualifications (1.34, 1.09-1.66) compared to university qualified, and for those in the dental services and suggest an urgent need for the dental profession and governments to address this inequality.

  19. More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labour

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    Macphail Sheila

    2008-03-01

    Full Text Available Abstract Background Childbirth is one of the most painful events that a woman is likely to experience, the multi-dimensional aspect and intensity of which far exceeds disease conditions. A woman's lack of knowledge about the risks and benefits of the various methods of pain relief can heighten anxiety. Women are increasingly expected, and are expecting, to participate in decisions about their healthcare. Involvement should allow women to make better-informed decisions; the National Institute for Clinical Excellence has stated that we need effective ways of supporting pregnant women in making informed decisions during labour. Our aim was to systematically review the empirical literature on women's expectations and experiences of pain and pain relief during labour, as well as their involvement in the decision-making process. Methods A systematic review was conducted using the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL, Bath Information and Database Service (BIDS, Excerpta Medica Database Guide (EMBASE, Midwives Information and Resource (MIDIRS, Sociological Abstracts and PsychINFO. Studies that examined experience and expectations of pain, and its relief in labour, were appraised and the findings were integrated into a systematic review. Results Appraisal revealed four key themes: the level and type of pain, pain relief, involvement in decision-making and control. Studies predominantly showed that women underestimated the pain they would experience. Women may hope for a labour free of pain relief, but many found that they needed or benefited from it. There is a distinction between women's desire for a drug-free labour and the expectation that they may need some sort of pain relief. Inaccurate or unrealistic expectations about pain may mean that women are not prepared appropriately for labour. Many women acknowledged that they wanted to

  20. Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain.

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    Olsen, Mette Frahm; Bjerre, Eik; Hansen, Maria Damkjær; Hilden, Jørgen; Landler, Nino Emanuel; Tendal, Britta; Hróbjartsson, Asbjørn

    2017-02-20

    The minimum clinically important difference (MCID) is used to interpret the clinical relevance of results reported by trials and meta-analyses as well as to plan sample sizes in new studies. However, there is a lack of consensus about the size of MCID in acute pain, which is a core symptom affecting patients across many clinical conditions. We identified and systematically reviewed empirical studies of MCID in acute pain. We searched PubMed, EMBASE and Cochrane Library, and included prospective studies determining MCID using a patient-reported anchor and a one-dimensional pain scale (e.g. 100 mm visual analogue scale). We summarised results and explored reasons for heterogeneity applying meta-regression, subgroup analyses and individual patient data meta-analyses. We included 37 studies (8479 patients). Thirty-five studies used a mean change approach, i.e. MCID was assessed as the mean difference in pain score among patients who reported a minimum degree of improvement, while seven studies used a threshold approach, i.e. MCID was assessed as the threshold in pain reduction associated with the best accuracy (sensitivity and specificity) for identifying improved patients. Meta-analyses found considerable heterogeneity between studies (absolute MCID: I2 = 93%, relative MCID: I2 = 75%) and results were therefore presented qualitatively, while analyses focused on exploring reasons for heterogeneity. The reported absolute MCID values ranged widely from 8 to 40 mm (standardised to a 100 mm scale) and the relative MCID values from 13% to 85%. From analyses of individual patient data (seven studies, 918 patients), we found baseline pain strongly associated with absolute, but not relative, MCID as patients with higher baseline pain needed larger pain reduction to perceive relief. Subgroup analyses showed that the definition of improved patients (one or several categories improvement or meaningful change) and the design of studies (single or multiple measurements

  1. Monoaminergic Antidepressants in the Relief of Pain: Potential Therapeutic Utility of Triple Reuptake Inhibitors (TRIs

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    Bruno P. Guiard

    2011-01-01

    Full Text Available Over 75% of depressed patients suffer from painful symptoms predicting a greater severity and a less favorable outcome of depression. Imaging, anatomical and functional studies have demonstrated the existence of common brain structures, neuronal pathways and neurotransmitters in depression and pain. In particular, the ascending serotonergic and noradrenergic pathways originating from the raphe nuclei and the locus coeruleus; respectively, send projections to the limbic system. Such pathways control many of the psychological functions that are disturbed in depression and in the perception of pain. On the other hand, the descending pathways, from monoaminergic nuclei to the spinal cord, are specifically implicated in the inhibition of nociception providing rationale for the use of serotonin (5-HT and/or norepinephrine (NE reuptake inhibitors (SSRIs, NRIs, SNRIs, in the relief of pain. Compelling evidence suggests that dopamine (DA is also involved in the pathophysiology and treatment of depression. Indeed, recent insights have demonstrated a central role for DA in analgesia through an action at both the spinal and suprasinal levels including brain regions such as the periaqueductal grey (PAG, the thalamus, the basal ganglia and the limbic system. In this context, dopaminergic antidepressants (i.e., containing dopaminergic activity, such as bupropion, nomifensine and more recently triple reuptake inhibitors (TRIs, might represent new promising therapeutic tools in the treatment of painful symptoms with depression. Nevertheless, whether the addition of the dopaminergic component produces more robust effects than single- or dual-acting agents, has yet to be demonstrated. This article reviews the main pathways regulating pain transmission in relation with the monoaminergic systems. It then focuses on the current knowledge regarding the in vivo pharmacological properties and mechanism of action of monoaminergic antidepressants including SSRIs, NRIs

  2. Intraperitoneal Hydrocortisone plus Bupivacaine versus Bupivacaine alone for Pain Relief after Laparoscopic Cholecystectomy

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    Mahesh Sharma

    2016-11-01

    Full Text Available Introduction: Laparoscopic cholecystectomy has been the gold standard in the treatment of gallstones since last decades. Beside several benefits of laparoscopic cholecystectomy compared with open surgery, postoperative pain is still a frequent melancholy.  Hence, pain management is utmost regarding patients' comfort. The main objective of the study was to compare the effect of intraperitoneal hydrocortisone plus bupivacaine with bupivacaine alone on pain relief following laparoscopic cholecystectomy.   Methods: A randomized study was conducted from December 2015 to August 2015 that included 100 patients aged 20 to 60 years of both genders who were found to have symptomatic gallstones and were scheduled for elective laparoscopic cholecystectomy at Lumbini Medical College. Patients randomly received 100 mg hydrocortisone plus 100 mg bupivacaine in 200 ml normal saline (group A or 100 mg bupivacaine in 200 ml normal saline (group B into the peritoneum. Post-operative abdominal and shoulder pain were evaluated using Visual Analog Score (VAS. The patients were also followed up for postoperative analgesic requirements, and recovery variables. Data were collected, tabulated and analyzed statistically using SPSS version 19.   Results: Total number of patients in this study were 100. Age and gender among both groups were comparable. VAS scores for pain was significantly lower for group A as compared to group B at 0, 2, 4, 6, 12, and 24 hours. Time of oral intake in hrs for liquids and solids was statistically significant in Group A compared to Group B. Rescue analgesic requirement was also significantly low in Group A compared to Group B. Hospital stay in both group were comparable.   Conclusion: Combination of hydrocortisone plus bupivacaine can relieve pain after laparoscopic cholecystectomy better compared to bupivacaine alone when administered intraperitoneally.

  3. Etoricoxib improves osteoarthritis pain relief, joint function, and quality of life in the extreme elderly

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    Wen-Nan Huang

    2017-09-01

    Full Text Available Etoricoxib is a selective cyclooxygenase-2 (COX-2 inhibitor, with a lower risk of gastrointestinal toxicity compared to traditional nonsteroidal anti-inflammatory drugs (NSAIDs. We evaluated the effectiveness and tolerability of etoricoxib in extreme elderly patients with chronic pain due to osteoarthritis (OA. A prospective, single-center, single-arm study was conducted, enrolling 19 extreme elderly men with OA (mean age 85.9, range 79-96 years, who responded inadequately to NSAIDs or other analgesics. Patients were switched to etoricoxib, 60 mg once daily for 4 weeks, without prior medication washout. Data were recorded before and after etoricoxib treatment. The primary endpoint was the pain improvement, assessed using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC after the 4-week treatment. Other endpoints included the Brief Pain Inventory Short Form (BPI-SF, Treatment Satisfaction Questionnaire for Medication (TSQM, Short Form 36 (SF36, and European Quality of Life-5 Dimensions (EQ-5D. Safety and tolerability were assessed by collecting adverse events data. After switching to etoricoxib, pain and disability measured by WOMAC index both decreased (pain, p = < 0.001; disability, p = 0.020. BPI-SF showed a significant improvement in joint function when walking and performing normal work (walking, p = 0.021; normal work, p = 0.030. SF36 scores improved for 7 out of 11 items after etoricoxib treatment (#1, p = 0.032; #4, p = 0.026; #5, p = 0.017; #6, p = 0.008; #7, p = 0.009; #8, p = 0.013; and #10, p = 0.038. EQ-5D showed a significant improvement in visual analogue scale (VAS scores (p = 0.036. TSQM results demonstrated increased patient perceptions of overall satisfaction. No adverse events were reported. Pain relief, joint function, quality of life, and treatment satisfaction improved significantly in elderly patients with OA after etoricoxib administration.

  4. The Effect of Magnesium Sulfate on Renal Colic Pain Relief; a Randomized Clinical Trial

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    Abolfazl Jokar

    2017-01-01

    Full Text Available Introduction: Renal colic can be managed by preventing the contraction movements of ureter muscles. By reducing acetylcholine in the nerve terminals, magnesium sulfate could be effective in this regard. The aim of this study is to investigate the effect of magnesium sulfate on acute renal colic pain relief. Method: The present study was a double-blind clinical trial in which the patients suffering from acute renal colic were randomly divided into 2 groups of who either received standard protocol (intravenous infusion of 0.1 mg/Kg morphine sulfate, 30 mg of Ketorolac, and 100 ml normal saline as placebo/15 minutes or standard protocol plus 15 mg/Kg of intravenous magnesium sulfate 50%/100 ml normal saline/15 minutes. Severity of patients’ pain was measured by visual analogue scale (VAS at baseline, and 30 and 60 minutes after infusion. The collected data were analyzed using STATA statistical software. Results: 100 cases were randomly allocated to intervention or control group. The two groups were similar in baseline pain score and demographic characteristics. At 30 and 60 minutes, mean pain score was less in the intervention group compared to the control group. Moreover, the difference between the two groups was statistically significant regarding the additional amount of morphine, suggesting that the intervention group needed less additional morphine than the control group. Conclusion: The results of this study showed that Magnesium sulfate can be used as an adjunct drug in treatment of patients suffering from renal colic. It not only alleviates the pain in the patients, but also diminishes the need for pain medications.

  5. Combination paracetamol and ibuprofen for pain relief after oral surgery: a dose ranging study.

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    Atkinson, Hartley C; Currie, John; Moodie, John; Carson, Simon; Evans, Steven; Worthington, James P; Steenberg, Leon J; Bisley, Eileen; Frampton, Chris

    2015-05-01

    Combined paracetamol and ibuprofen has been shown to be more effective than either constituent alone for acute pain in adults, but the dose-response has not been confirmed. The aim of this study was to define the analgesic dose-response relationship of different potential doses of a fixed dose combination containing paracetamol and ibuprofen after third molar surgery. Patients aged 16 to 60 years with moderate or severe pain after the removal of at least two impacted third molars were randomised to receive double-blind study medication as two tablets every 6 h for 24 h of either of the following: two tablet, combination full dose (paracetamol 1000 mg and ibuprofen 300 mg); one tablet, combination half dose (paracetamol 500 mg and ibuprofen 150 mg); half a tablet, combination quarter dose (paracetamol 250 mg and ibuprofen 75 mg); or placebo. The primary outcome measure was the time-adjusted summed pain intensity difference over 24 h (SPID 24) calculated from the 100-mm VAS assessments collected over multiple time points for the study duration. Data from 159 patients were included in the analysis. Mean (SD) time-adjusted SPID over 24 h were full-dose combination 20.1 (18.0), half dose combination 20.4 (20.8), quarter dose combination 19.3 (20.0) and placebo 6.6 (19.8). There was a significant overall effect of dose (p = 0.002) on the primary outcome. Planned pairwise comparisons showed that all combination dose groups were superior to placebo (full dose vs. placebo p = 0.004, half dose vs. placebo p = 0.002, quarter dose vs. placebo p = 0.002). The overall effect of dose was also significant for maximum VAS pain intensity score (p = 0.048), response rate (p = 0.0094), percentage of participants requiring rescue (p = 0.025) and amount of rescue (p < 0.001). No significant dose effect was found for time to peak reduction in VAS or time to meaningful pain relief. The majority of adverse events recorded were of mild (52.75%) or moderate

  6. Trial of Music, Sucrose, and Combination Therapy for Pain Relief during Heel Prick Procedures in Neonates.

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    Shah, Swapnil R; Kadage, Shahajahan; Sinn, John

    2017-11-01

    To compare the effectiveness of music, oral sucrose, and combination therapy for pain relief in neonates undergoing a heel prick procedure. This randomized, controlled, blinded crossover clinical trial included stable neonates >32 weeks of postmenstrual age. Each neonate crossed over to all 3 interventions in random order during consecutive heel pricks. A video camera on mute mode recorded facial expressions, starting 2 minutes before until 7 minutes after the heel prick. The videos were later analyzed using the Premature Infant Pain Profile-Revised (PIPP-R) scale once per minute by 2 independent assessors, blinded to the intervention. The PIPP-R scores were compared between treatment groups using Friedman test. For the 35 participants, the postmenstrual age was 35 weeks (SD, 2.3) with an average weight of 2210 g (SD, 710). The overall median PIPP-R scores following heel prick over 6 minutes were 4 (IQR 0-6), 3 (IQR 0-6), and 1 (IQR 0-3) for the music, sucrose, and combination therapy interventions, respectively. The PIPP-R scores were significantly lower at all time points after combination therapy compared with the groups given music or sucrose alone. There was no difference in PIPP-R scores between the music and sucrose groups. In relatively stable and mature neonates, the combination of music therapy with sucrose provided better pain relief during heel prick than when sucrose or music was used alone. Recorded music in isolation had a similar effect to the current gold standard of oral sucrose. www.anzctr.org.au ACTRN12615000271505. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Pain Relief in CRPS-II after Spinal Cord and Motor Cortex Simultaneous Dual Stimulation.

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    Lopez, William Oc; Barbosa, Danilo C; Teixera, Manoel J; Paiz, Martin; Moura, Leonardo; Monaco, Bernardo A; Fonoff, Erich T

    2016-05-01

    We describe a case of a 30-year-old woman who suffered a traumatic injury of the right brachial plexus, developing severe complex regional pain syndrome type II (CRPS-II). After clinical treatment failure, spinal cord stimulation (SCS) was indicated with initial positive pain control. However, after 2 years her pain progressively returned to almost baseline intensity before SCS. Additional motor cortex electrode implant was then proposed as a rescue therapy and connected to the same pulse generator. This method allowed simultaneous stimulation of the motor cortex and SCS in cycling mode with independent stimulation parameters in each site. At 2 years follow-up, the patient reported sustained improvement in pain with dual stimulation, reduction of painful crises, and improvement in quality of life. The encouraging results in this case suggests that this can be an option as add-on therapy over SCS as a possible rescue therapy in the management of CRPS-II. However, comparative studies must be performed in order to determine the effectiveness of this therapy. Chronic neuropathic pain, Complex regional pain syndrome Type II, brachial plexus injury, motor cortex stimulation, spinal cord stimulation.

  8. Lornoxicam versus tramadol for post-operative pain relief in patients undergoing ENT procedures

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    Ashraf A Abdelhalim

    2014-01-01

    Full Text Available Background: Pain following ear-nose and throat surgery is one of the most important complaints for which, several drugs are used. This prospective, randomized, double-blind controlled trial was designed to compare the analgesic effect of tramadol versus lornoxicam for post-operative pain relief in patients undergoing ENT surgical procedures. Methods: One hundred and twenty patients of ASA class I-II, who had undergone elective ENT surgical procedures under general anesthesia, were assigned in a randomized manner into three equal groups. Group L received lornoxicam8 mg IV, Group T received tramadol 1 mg/kg IV and Group C received IV saline after induction of anesthesia before the start of the surgery. Post-operative pain was assessed using the visual analogue scale (VAS and sedation level was evaluated during stay in the post-anesthesia care unit with a four-point sedation scale. Intraoperative blood loss was estimated using the Five-Point Scale. Adverse events in the first 24 h post-operative were recorded. Results: The VAS pain scores were significantly higher in Group C as compared with those in Groups L and T at 30 min and 1, 2, 4and 6 h post-operatively, with no significant difference between Group L and Group T. The amount of morphine consumption post-operatively was significantly lower in Group L (5.2 ± 2.5 mg and Group T (5.0 ± 2.0 mg as compared with that in Group C (7.4 ± 2.3 mg (P = 0.001. The time for the first analgesic requirement was significantly less in Group L (92.62 ± 24.23 min and Group T (88 ± 21.43 min as compared with that in Group C (42.82 ± 25.61 min, with no significant difference between the other two groups. Estimated intraoperative blood loss score by the surgeons showed no significant difference between the three groups. The most frequent side-effects in the three groups were nausea and vomiting, and their incidence was significantly higher in the placebo group as compared with the other two groups. Conclusion

  9. Prices need no preferences: social trends determine decisions in experimental markets for pain relief.

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    Vlaev, Ivo; Seymour, Ben; Chater, Nick; Winston, Joel S; Yoshida, Wako; Wright, Nicholas; Symmonds, Mkael; Dolan, Ray

    2014-01-01

    A standard view in health economics is that, although there is no market that determines the "prices" for health states, people can nonetheless associate health states with monetary values (or other scales, such as quality adjusted life year [QALYs] and disability adjusted life year [DALYs]). Such valuations can be used to shape health policy, and a major research challenge is to elicit such values from people; creating experimental "markets" for health states is a theoretically attractive way to address this. We explore the possibility that this framework may be fundamentally flawed-because there may not be any stable values to be revealed. Instead, perhaps people construct ad hoc values, influenced by contextual factors, such as the observed decisions of others. The participants bid to buy relief from equally painful electrical shocks to the leg and arm in an experimental health market based on an interactive second-price auction. Thirty subjects were randomly assigned to two experimental conditions where the bids by "others" were manipulated to follow increasing or decreasing price trends for one, but not the other, pain. After the auction, a preference test asked the participants to choose which pain they prefer to experience for a longer duration. Players remained indifferent between the two pain-types throughout the auction. However, their bids were differentially attracted toward what others bid for each pain, with overbidding during decreasing prices and underbidding during increasing prices. Health preferences are dissociated from market prices, which are strongly referenced to others' choices. This suggests that the price of health care in a free-market has the capacity to become critically detached from people's underlying preferences. 2014 APA, all rights reserved

  10. Pain-relief learning in flies, rats, and man: basic research and applied perspectives

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    Gerber, Bertram; Yarali, Ayse; Diegelmann, Sören; Wotjak, Carsten T.; Pauli, Paul; Fendt, Markus

    2014-01-01

    Memories relating to a painful, negative event are adaptive and can be stored for a lifetime to support preemptive avoidance, escape, or attack behavior. However, under unfavorable circumstances such memories can become overwhelmingly powerful. They may trigger excessively negative psychological states and uncontrollable avoidance of locations, objects, or social interactions. It is therefore obvious that any process to counteract such effects will be of value. In this context, we stress from a basic-research perspective that painful, negative events are “Janus-faced” in the sense that there are actually two aspects about them that are worth remembering: What made them happen and what made them cease. We review published findings from fruit flies, rats, and man showing that both aspects, respectively related to the onset and the offset of the negative event, induce distinct and oppositely valenced memories: Stimuli experienced before an electric shock acquire negative valence as they signal upcoming punishment, whereas stimuli experienced after an electric shock acquire positive valence because of their association with the relieving cessation of pain. We discuss how memories for such punishment- and relief-learning are organized, how this organization fits into the threat-imminence model of defensive behavior, and what perspectives these considerations offer for applied psychology in the context of trauma, panic, and nonsuicidal self-injury. PMID:24643725

  11. Fixed-dose Sumatriptan/Naproxen Sodium Compared with each Monotherapy Utilizing the Novel Composite Endpoint of Sustained Pain-free/no Adverse Events.

    Science.gov (United States)

    Landy, Stephen; White, Jonathan; Lener, Shelly E; McDonald, Susan A

    2009-05-01

    A novel composite endpoint, sustained pain-free/no adverse events, was recently proposed as a more rigorous means of capturing in a single measure the attributes of migraine pharmacotherapy that patients consider most important: rapid and sustained pain-free response with no side-effects. Using pooled data from two replicate randomized, double-blind, parallel-group, placebo-controlled studies, this post hoc analysis compared the fixed-dose combination tablet sumatriptan/naproxen sodium (n = 726) with sumatriptan monotherapy (n = 723), naproxen sodium monotherapy (n = 720), and placebo (n = 742) with respect to sustained pain-free/no adverse events and closely related composite measures. Sustained pain-free/no adverse events was defined as having both a sustained pain-free response from 2 through 24 hours post-dose with no use of rescue medication and having no adverse events within up to 5 days after dosing with study medication. The percentage of patients with sustained pain-free/no adverse events was 16% with sumatriptan/naproxen sodium compared with 11%, 9% and 7% for sumatriptan, naproxen sodium and placebo, respectively (ppain-free/no adverse events within 1 day; (2) sustained pain-free/no drug-related adverse events within up to 5 days; (3) sustained pain-free/no drug-related adverse events within 1 day; (4) sustained pain relief/no adverse events within up to 5 days; and (5) sustained pain relief/no adverse events within 1 day. The results demonstrate the superiority of sumatriptan/naproxen sodium to sumatriptan monotherapy, naproxen sodium monotherapy and placebo with respect to the rigorous and clinically relevant endpoint of sustained pain-free/no adverse events and reinforce the usefulness of utilizing this new composite endpoint.

  12. Compliance and subjective relief by corset treatment in chronic low back pain.

    Science.gov (United States)

    Alaranta, H; Hurri, H

    1988-01-01

    The aim of this questionnaire-based 12-month follow-up study of 113 patients was to elucidate patient compliance and subjective help achieved with a first, elastic or semirigid corset in chronic, idiopathic low back pain. Subjective help obtained from the corset was reported as excellent or good in 37% of the returned questionnaires. A total of 60% reported having worn the corset even during the preceding month. Low semirigid and elastic models were found to be better by the males and high semirigid ones by the females (p less than 0.001). Age, height, weight, body mass index, retirement or physical strenuousness of work showed no statistically significant correlation with the subjective relief gained from the corset. It is important that sufficient time be allocated to fitting the corset and that adequate information be provided about wearing the brace and about suitable trunk exercises.

  13. Intrathecal Ziconotide and Morphine for Pain Relief: A Case Series of Eight Patients with Refractory Cancer Pain, Including Five Cases of Neuropathic Pain.

    Science.gov (United States)

    de la Calle Gil, Ana Bella; Peña Vergara, Isaac; Cormane Bornacelly, María Auxiliadora; Pajuelo Gallego, Antonio

    2015-12-01

    Studies have shown that, at low doses and with careful titration, combination therapy with intrathecal ziconotide and morphine results in rapid control of opioid-refractory cancer pain. However, there is a lack of published data regarding the efficacy and safety of intrathecal ziconotide specifically for the treatment of neuropathic cancer pain. Case reports of ziconotide intrathecal infusion in eight patients (age 45-71 years; 75% male) with chronic, uncontrolled cancer pain during therapy with intrathecal morphine plus bupivacaine were reviewed. Neuropathic pain was confirmed in five patients. Treatment was initiated with adjunctive ziconotide when pain ≥5 on a visual analog scale persisted in spite of 3 successive 20% dose increases of intrathecal morphine. Ziconotide was initiated at 0.5-1.0 µg/day, with mean increases of 0.5 µg every 4-7 days if required (maximum dose 10 µg/day; mean dose 4.9 µg/day). Pain intensity was reduced in all patients after 3-5 days. Of the eight patients, three died for reasons unrelated to ziconotide, three discontinued treatment due to adverse effects (predominantly psychoneurological disorders), and one patient is still receiving treatment. One patient discontinued ziconotide due to confusion and delirium. Due to continued lack of pain control with intrathecal morphine, intrathecal fentanyl was initiated; however, effective pain relief was not achieved with 1500 µg/day. Ziconotide was restarted and the patient then achieved pain control. On the basis of our clinical experience, we recommend adding ziconotide to intrathecal opioid-based therapy in cancer patients with neuropathic pain inadequately controlled by intrathecal morphine alone. Eisai, Spain.

  14. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis

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    Maher, Chris G; Ferreira, Manuela L; Ferreira, Paulo H; Hancock, Mark; Oliveira, Vinicius C; McLachlan, Andrew J; Koes, Bart

    2012-01-01

    Objective To investigate the efficacy and tolerability of analgesic and adjuvant pain drugs typically administered in primary care for the management of patients with sciatica. Design Systematic review. Data source International Pharmaceutical Abstracts, PsycINFO, Medline, Embase, Cochrane Central Register of Clinical Trials (CENTRAL), CINAHL, and LILACS. Study selection Randomised controlled trials assessing the efficacy and tolerability of drugs versus placebo or other treatment for sciatica. Data extraction Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability outcomes were converted to a common 0 to 100 scale. Data were pooled with a random effects model, and the GRADE approach was used in summary conclusions. Results Twenty three published reports met the inclusion criteria. The evidence to judge the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics ranged from moderate to low quality. Most of the pooled estimates did not favour the active treatment over placebo. The pooled results of two trials of corticosteroids (mean difference in overall and leg pain −12.2, 95% confidence interval −20.9 to −3.4) and a single trial of the anticonvulsant gabapentin for chronic sciatica (mean difference in overall pain relief −26.6, −38.3 to −14.9) showed some benefits but only in the short term. The median rate of adverse events was 17% (interquartile range 10-30%) for the active drugs and 11% (3-23%) for placebo. Trial limitations included failure to use validated outcome measures, lack of long term follow-up, and small sample size. Conclusions As the existing evidence from clinical trials is of low quality, the efficacy and tolerability of drugs commonly prescribed for the management of sciatica in primary care is unclear. PMID:22331277

  15. Effect of the Raga Ananda Bhairavi in Post Operative Pain Relief Management.

    Science.gov (United States)

    Kumar, Thirumurthy Sathish; Muthuraman, M; Krishnakumar, R

    2014-10-01

    Music is considered as an universal language and has influences the human existence at various levels.In recent years music therapy has evolved as a challenge of research with a clinical approach involving science and art. Music therapy has been used for various therapeutic reasons like Alzheimer's disease,Hypertension and mental disorders to name a few. We conducted a study to establish the effect of the classical ragam Anandhabhairavi on post operative pain relief. A randomized controlled study involving 60 patients who were to undergo surgery was conducted at PSG Institute of Medical Sciences and Research,Coimbatore.30 patients selected at random and were exposed to the ragam Anandhabhairavi which was played in their room pre operatively (from the day they got admitted for surgery) and 3 days post operatively. The control group did not listen to the music during their stay in the hospital. An observation chart was attached in which the requirement of analgesics by the patient was recorded. On completion of the study and on analysis,the ragam Anandhabhairavi had a significant effect in post operative pain management which was evidenced by the reduction in analgesic requirement by 50 % in those who listened to the ragam.A significant p value of <0.001 was obtained.

  16. A new analgesic method, two-minute sciatic nerve press, for immediate pain relief: a randomized trial

    Directory of Open Access Journals (Sweden)

    Zhang Fenglin

    2008-01-01

    Full Text Available Abstract Background Current analgesics have drawbacks such as delays in acquisition, lag-times for effect, and side effects. We recently presented a preliminary report of a new analgesic method involving a two-minute sciatic nerve press, which resulted in immediate short-term relief of pain associated with dental and renal diseases. The present study investigated whether this technique was effective for pain associated with other disease types, and whether the relief was effective for up to one hour. Methods This randomized, placebo-controlled, parallel-group trial was conducted in four hospitals in Anhui Province, China. Patients with pain were sequentially recruited by participating physicians during clinic visits, and 135 patients aged 15 – 80 years were enrolled. Dental disease patients included those with acute pulpitis and periapical abscesses. Renal disease patients included those with kidney infections and/or stones. Tumor patients included those with nose, breast, stomach and liver cancers, while Emergency Room patients had various pathologies. Patients were randomly assigned to receive a "sciatic nerve press" in which pressure was applied simultaneously to the sciatic nerves at the back of both thighs, or a "placebo press" in which pressure was applied to a parallel region on the front of the thighs. Each fist applied a pressure of 11 – 20 kg for 2 minutes. Patients rated their level of pain before and after the procedure. Results The "sciatic nerve press" produced immediate relief of pain in all patient groups. Emergency patients reported a 43.5% reduction in pain (p th minutes, and the relief decreased 47% by the 60th minutes. Conclusion Two minutes of pressure on both sciatic nerves produced immediate significant short-term conduction analgesia. This technique is a convenient, safe and powerful method for the short-term treatment of clinical pain associated with a diverse range of pathologies. Trial registration Current

  17. Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands

    Science.gov (United States)

    2010-01-01

    Background A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process. Methods Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed. Results Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the

  18. Mobile Satellite Communications for Disaster Emergency Relief , Education, Sustainable Development, and Land Mine Detection: Youth Perspectives

    Science.gov (United States)

    Marshall, W.

    2002-01-01

    Policy and technical issues associated with the use of satellite communications for disaster mitigation and relief, sustainable development, education, and land mine detection were discussed at the Space Generation Forum (SGF), at UNISPACE-III. The youth perspective on this topic is being further developed at the Space Generation Summit (SGS), an event at World Space Congress (WSC) which shall unite international students and young professionals to develop a youth vision and strategy for the peaceful uses of space. SGS, endorsed by the United Nations, will take place from October 11-13th, during which the 200 delegates will discuss ongoing youth space activities, particularly those stemming from the UNISPACE-III/SGF and taken forward by the Space Generation Advisory Council. Delegates will address a variety of topics with the goal of devising new recommendations according to the theme, 'Accelerating Our Pace in Space'. The material presented here and in other technical sessions throughout WSC includes the findings of these discussions. In this paper, we present the work of the SGS delegates relating to Satellite communication and Global Information Infrastructure. This international team of young people has been working to support the United Nations Committee on the Peaceful Uses of Outer Space (COPUOS) on their Action Teams for the implementation of disaster mitigation, planetary defense, sustainable development, and education recommendations from UNISPACE III. Results of work to date will be presented.

  19. Low-level laser therapy for pain relief after episiotomy: a double-blind randomised clinical trial.

    Science.gov (United States)

    Santos, Jaqueline de O; de Oliveira, Sonia M J V; da Silva, Flora M B; Nobre, Moacyr R C; Osava, Ruth H; Riesco, Maria L G

    2012-12-01

    To evaluate the effectiveness of a low-level laser therapy for pain relief in the perineum following episiotomy during childbirth. Laser irradiation is a painless and non-invasive therapy for perineal pain treatment and its effects have been investigated in several studies, with no clear conclusion on its effectiveness. A double-blind randomised controlled clinical trial. One hundred and fourteen women who underwent right mediolateral episiotomies during vaginal birth in an in-hospital birthing centre in São Paulo, Brazil and reported pain ≥ 3 on a numeric scale (0-10) were randomised into three groups of 38 women each: two experimental groups (treated with red and infrared laser) and a control group. The experimental groups were treated with laser applied at three points directly on the episiotomy after suturing in a single session between 6-56 hours postpartum. We used a diode laser with wavelengths of 660 nm (red laser) and 780 nm (infrared laser). The control group participants underwent all laser procedures, excluding the emission of irradiation. The participants and the pain scores evaluator were blinded to the type of intervention. The perineal pain scores were assessed at three time points: before, immediately after and 30 minutes after low-level laser therapy. The comparison of perineal pain between the three groups showed no significant differences in the three evaluations (p = 0.445), indicating that the results obtained in the groups treated with low-level laser therapy were equivalent to the control group. Low-level laser therapy did not decrease the intensity of perineal pain reported by women who underwent right mediolateral episiotomy. The effect of laser in perineal pain relief was not demonstrated in this study. The dosage may not have been sufficient to provide relief from perineal pain after episiotomy during a vaginal birth. © 2012 Blackwell Publishing Ltd.

  20. Efficacy of transdermal buprenorphine patch on post-operative pain relief after elective spinal instrumentation surgery

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    Saikat Niyogi

    2017-01-01

    Full Text Available Background and Aims: Transdermal buprenorphine patch (TDB is increasingly used for chronic pain management because of non-invasive dosing, longer duration of action and minimal side effects. However its role in acute post-operative pain management for spinal instrumentation surgery is not well established. The aim of this study was to evaluate the analgesic efficacy of buprenorphine patch for postoperative pain relief in patients undergoing spinal instrumentation surgery. Methods: In this randomised, placebo-controlled, double-blinded, prospective study, 70 adult patients undergoing elective spinal instrumentation surgery were randomly allocated into two groups-TDB Group (buprenorphinepatch and TDP Group (placebo patch. Time to first rescue analgesic requirement was the primary outcome. All patients also were monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status till 48 h after surgery. Statistical analysis was carried out using student independent t-test if normally distributed or with Mann–Whitney U-test if otherwise. Results: Time to first post-operative rescue analgesic (tramadol requirement was much delayed in TDB Group than TDP Group (708.0 ± 6.98 min vs 54 ± 0.68 min, P < 0.001 and the total tramadol requirement was higher in TDB Group (490.60 ± 63.09 averagevs. 162.93 ± 63.91 mg, P < 0.001. Intra-and post-operative haemodynamic status was also stable in TDB Group without any adverse event. Conclusion: A TDB patch (10 μg/hour applied 24 hours before surgery can be used as a postoperative analgesic for lumber fixation surgery without any drug-related adverse effect.

  1. Periacetabular osteotomy. Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years.

    Science.gov (United States)

    Pogliacomi, Francesco; Stark, André; Wallensten, Richard

    2005-02-01

    When surgical treatment of dysplastic hip osteoarthrosis is necessary, osteotomy is preferable to fusion or THR. We evaluated periacetabular osteotomy as a method of choice. We treated 36 symptomatic dysplastic hip joints (32 patients) with the Bernese periacetabular osteotomy (PAO) between 1994 and 2001. We used the ilio-inguinal (I-I) approach in 32 hips and a modified Smith-Petersen (S-P) approach in 4. The patients were followed for mean 4 (1.5-8) years. In 1 patient with coxa valga, a varus femoral osteotomy was performed 1 year after PAO. 2 hips, in which we used the modified S-P approach, necessitated a capsulotomy. The median Merle d'Aubignè score increased from 13 points preoperatively to 16 points postoperatively. This improvement in terms of pain, motion and ambulation was accompanied by spatial reorientation and correction. The lateral center edge angle of Wiberg (CE) improved from an average of 7 degrees to 28 degrees. The anterior center edge angle of Lequesne (FP) improved from an average of 18 degrees to 28 degrees. The acetabular index angle (AC) improved from an average of 22 degrees to 10 degrees. Major complications included 1 partial lesion of the sciatic nerve, 1 malunion and 1 combined nonunion of the pubic and ischiatic osteotomy. 2 patients underwent subsequent total hip replacement (THR) for progressive osteoarthrosis with pain. We found good radiographic correction of deformities, improvement of hip function and pain relief with an acceptable complication rate. With appropriate patient selection, this procedure is the most physiological treatment of symptomatic hip dysplasia in young adults. In addition to relieving symptoms, it may prevent and postpone the development of secondary osteoarthrosis.

  2. Preoperative hypoalgesia after cold pressor test and aerobic exercise is associated with pain relief six months after total knee replacement

    DEFF Research Database (Denmark)

    Vaegter, Henrik Bjarke; Handberg, Gitte; Emmeluth, Claus

    2017-01-01

    investigated the association between exercise-induced hypoalgesia (EIH) and CPM on post-TKR pain relief. METHODS: Before and six months post-TKR, 14 patients with chronic knee osteoarthritis performed the cold pressor test on the non-affected leg and two exercise conditions (bicycling and isometric knee...... extension), randomized and counterbalanced. Before and during the cold pressor test and after exercises test-stimuli were applied to extract the pain sensitivity difference: Computer-controlled cuff inflation on the affected lower leg until the subjects detected the cuff pain threshold (c...... at the affected leg improved post-TKR compared with pre-TKR (P

  3. The Use of Analgesic and Other Pain-Relief Drugs to Manage Chronic Low Back Pain: Results from a National Survey.

    Science.gov (United States)

    Gouveia, Nélia; Rodrigues, Ana; Ramiro, Sofia; Eusébio, Mónica; Machado, Pedro M; Canhão, Helena; Branco, Jaime C

    2017-03-01

    To analyze and characterize the intake profile of pain-relief drugs in a population-based study of adults with chronic low back pain (CLBP). EpiReumaPt was a cross-sectional Portuguese population-based study (10,661 subjects). Self-reported active CLBP was considered to be low back pain on the day of enrollment and for ≥ 90 days. Prevalence and profile of analgesic intake was characterized among those self-reporting active CLBP, taking into account the intensity of pain and the World Health Organization (WHO) analgesic ladder. We further investigated whether the presence of active CLBP was a factor independently associated with the intake of analgesics (adjusted for potential confounders). Among 1,487 subjects with active CLBP, only 18.7% were using analgesic/pain-relief drugs. Estimated prevalence was anxiolytics, 14.1%; nonsteroidal anti-inflammatory drugs (NSAIDs), 12.3%; antidepressants, 10.1%; analgesic, antipyretics, 6.6%; anticonvulsants, 3.4%; central muscle relaxants, 2.6%; and analgesic opioids, 1.6%. Most subjects with severe pain were in the first step of the WHO analgesic ladder: NSAIDs plus anxiolytics (4.6%), NSAIDs plus antidepressants (3.2%), or NSAIDs plus muscle relaxants (2.5%). The presence of active CLBP was significantly associated with the intake of all therapeutic groups: antidepressants (odds ratio [OR] = 12.56; P pain-relief drug intake in patients with active CLBP was very low, even for those with severe pain. The WHO analgesic ladder was carefully followed, with an extremely conservative use of analgesic opioids even for those with severe pain. © 2016 World Institute of Pain.

  4. The effect of mefenamic acid and ginger on pain relief in primary dysmenorrhea: a randomized clinical trial.

    Science.gov (United States)

    Shirvani, Marjan Ahmad; Motahari-Tabari, Narges; Alipour, Abbas

    2015-06-01

    The aim of the study was to compare the effect of mefenamic acid and ginger on pain management in primary dysmenorrhea. One hundred and twenty-two female students with moderate to severe primary dysmenorrhea were randomly allocated to the ginger and mefenamic groups in a randomized clinical trial. The mefenamic group received 250 mg capsules every 8 h, and the ginger group received 250 mg capsules (zintoma) every 6 h from the onset of menstruation until pain relief lasted 2 cycles. The intensity of pain was assessed by the visual analog scale. Data were analyzed by descriptive statistics, t test, Chi-square, Fisher exact test and repeated measurement. The pain intensity in the mefenamic and ginger group was 39.01 ± 17.77 and 43.49 ± 19.99, respectively, in the first month, and 33.75 ± 17.71 and 38.19 ± 20.47, respectively, in the second month (p > 0.05). The severity of dysmenorrhea, pain duration, cycle duration and bleeding volume was not significantly different between groups during the study. The menstrual days were more in the ginger group in the first (p = 0.01) and second cycle (p = 0.04). Repeated measurement showed a significant difference in pain intensity within the groups by time, but not between groups. Ginger is as effective as mefenamic acid on pain relief in primary dysmenorrhea. Ginger does not have adverse effects and is an alternative treatment for primary dysmenorrhea.

  5. Long term effects of oral sustained release morphine on neuropsychological performance in patients with chronic non-cancer pain.

    Science.gov (United States)

    Tassain, V; Attal, N; Fletcher, D; Brasseur, L; Dégieux, P; Chauvin, M; Bouhassira, D

    2003-07-01

    Morphine is increasingly used in patients with chronic non-cancer pain, but a major concern associated with chronic use relates to possible cognitive side-effects. The aim of this long-term prospective study was to evaluate the cognitive impact of oral sustained release morphine in patients with non-cancer pain. A battery of neuropsychological tests to explore attention, psychomotor speed and memory was administered. The effects of morphine on pain, quality of life, mood, subjective memory impairment and side-effects were also investigated. Evaluations were performed at baseline in patients free from opioids and then after 3, 6 and 12 months. Twenty-eight patients were included: 18 received oral sustained morphine (range 40-140 mg/day), ten patients stopped morphine prematurely because of side-effects or insufficient pain relief and were followed as a control group. There was no impairment of any neuropsychological variable over time in the morphine treated patients in comparison with the control group. Two measures of information processing speed - the Stroop interference score and the digit symbol test were improved at 6 and 12 months and there were significant correlations with the pain relief and improvement of mood. Self-reported memory impairment improved notably in responders to morphine. Morphine induced persisting effects on pain, and to a lesser extent on quality of life and mood. The visual analog scale score for side-effects increased at 12 months and essentially consisted of gastrointestinal disorders. This study demonstrates that 12 months treatment with oral morphine does not disrupt cognitive functioning in patients with chronic non-cancer pain and instead results in moderate improvement of some aspects of cognitive functioning, as a consequence of the pain relief and concomitant improvement of well-being and mood.

  6. A Multimodal Approach to Post-Operative Pain Relief in Children Undergoing Ambulatory Eye Surgery

    Directory of Open Access Journals (Sweden)

    V V Jaichandran

    2008-01-01

    Full Text Available This study was carried to assess the efficacy of multimodal analgesia using ketorolac and fentanyl, for post-operative pain relief in children undergoing ambulatory eye surgery. Total of 161 children, aged 1 to 5 years, were randomly stratified to three different analgesic regimens: Group A Ketorolac 0.75 mg.kg -1 I.M. , Group B Fentanyl 0.75 µg.kg -1 I.V. and Group C Ketorolac 0.50mg.kg -1 I.M. and Fentanyl 0.50µg.kg -1 I.V. Ketorolac I.M. was given 45 minutes before extubation and fentanyl I.V. was given soon after extubation in the respective groups. Post-operative pain was assessed in a double blinded manner using Children′s Hospital of Eastern Onatario Pain Scale (CHEOPS scoring system and by recording the heart rate at 10, 30 and 60 minutes. If the score was above 8, the child was left with the parents. In case the score did not improve and persisted to be greater than 8, fentanyl 0.50µg.kg -1 I.V. was given as the rescue analgesia. The incidence of nausea, vomiting, sleep disturbances or any other complaints were recorded by a staff nurse 24 hours post operatively. Mean CHEOPS score at 10, 30 and 60 minutes and mean heart rate at 10 and 30 minutes were significantly higher for Group A compared with Group C. Mean pain score emerged significantly higher for Group B compared with Group C at 30 and 60 minutes, (P< 0.01. Rescue analgesia required was significantly higher in Group A compared to Groups B and C, (P< 0.0001. Post-operatively, significant incidence of drowsiness was reported in children in Group B compared to Groups A and C, (P< 0.01. A multimodal approach using both ketorolac and fentanyl at low doses produce effective and safe analgesia in children undergoing ambula-tory eye surgery.

  7. Relief as a reward: hedonic and neural responses to safety from pain.

    Directory of Open Access Journals (Sweden)

    Siri Leknes

    2011-04-01

    Full Text Available Relief fits the definition of a reward. Unlike other reward types the pleasantness of relief depends on the violation of a negative expectation, yet this has not been investigated using neuroimaging approaches. We hypothesized that the degree of negative expectation depends on state (dread and trait (pessimism sensitivity. Of the brain regions that are involved in mediating pleasure, the nucleus accumbens also signals unexpected reward and positive prediction error. We hypothesized that accumbens activity reflects the level of negative expectation and subsequent pleasant relief. Using fMRI and two purpose-made tasks, we compared hedonic and BOLD responses to relief with responses during an appetitive reward task in 18 healthy volunteers. We expected some similarities in task responses, reflecting common neural substrates implicated across reward types. However, we also hypothesized that relief responses would differ from appetitive rewards in the nucleus accumbens, since only relief pleasantness depends on negative expectations. The results confirmed these hypotheses. Relief and appetitive reward task activity converged in the ventromedial prefrontal cortex, which also correlated with appetitive reward pleasantness ratings. In contrast, dread and pessimism scores correlated with relief but not with appetitive reward hedonics. Moreover, only relief pleasantness covaried with accumbens activation. Importantly, the accumbens signal appeared to specifically reflect individual differences in anticipation of the adverse event (dread, pessimism but was uncorrelated to appetitive reward hedonics. In conclusion, relief differs from appetitive rewards due to its reliance on negative expectations, the violation of which is reflected in relief-related accumbens activation.

  8. Impact of Empathy in the Patient-Doctor Relationship on Chronic Pain Relief and Quality of Life: A Prospective Study in Spanish Pain Clinics.

    Science.gov (United States)

    Cánovas, Luz; Carrascosa, Antonio-José; García, Modesto; Fernández, Mariano; Calvo, Almudena; Monsalve, Vicente; Soriano, José-Francisco

    2017-07-13

    To assess the impact of the empathy of physicians, perceived by patients with chronic pain, regarding pain relief and health-related quality of life (HR-QoL). A prospective noninterventional study was conducted in 2,898 patients with moderate to severe chronic pain who were referred to pain clinics. The same physician visited each patient at baseline and after one and three months. Study questionnaires included the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), the Life Orientation Test-Revised (LOT-R), the Pain Coping Questionnaire (CAD-R), the Brief Pain Inventory Short Form (BPI-SF), and the EuroQol-5D (EQ-5D). Regression analyses were used to evaluate the independent contribution of the changes in perceived empathy over pain intensity and improvement of HR-QoL. BPI-SF scores for pain intensity, rated as worst, least, average, and current pain, decreased significantly ( P  < 0.001) from baseline to month 3, with reductions of 33.7%, 42.5%, 40.0%, and 46.9%, respectively. Pain intensity decreased from 6.3 ± 1.5 at baseline to 4.7 ± 1.8 at one month and 3.8 ± 1.9 at three months ( P  < 0.050). Significant ( P  < 0.001) improvements in the EQ-5D tariff (+37.1%) and EQ-5D VAS (+26.7%) were also recorded. In the linear regression analysis, JSPPPE and LOT-R, but not CAD-R, were significantly associated with pain relief and HR-QoL. Physicians' empathy and patients' dispositional optimism have a role in determining positive outcomes in patients with chronic pain. Physicians' empathy may therefore be a suitable, yet relatively unexplored, target for intervention.

  9. Pharmaceutical services in a Mexican pain relief and palliative care institute.

    Science.gov (United States)

    Escutia Gutiérrez, Raymundo; Cortéz Álvarez, César R; Alvarez Álvarez, Rosa M; Flores Hernández, Jorge Lv; Gutiérrez Godínez, Jéssica; López Y López, José G

    2007-10-01

    Neither the purchase nor the distribution of pharmaceuticals in hospitals and community pharmacies in Mexico is under the care of pharmacists. Some are under control of physicians. This report presents the results of the implementation of somef pharmaceutical services for the Jalisco Pain Relief, and Palliative Care Institute (Palia Institute), under the direction of the Secretary of Health, Government of Jalisco. The services implemented were drug distribution system, Drug Information Service, Pharmacovigilance Program, and home pharmacotherapy follow-up pilot program for patients with advanced illness, with the ultimate using the appropriate medication. The drug distribution system included dispensing of opioid pain medications, antidepressants, anticonvulsants, NSAIDs, anxiolytic drugs, steroid drugs, laxatives, and anti-emetics. The frequently used drugs were morphine sulfate (62%), amitriptyline (6.4%), and dextropropoxyphene (5.8%). The Drug Information Service answered 114 consultations, mainly asked by a physician (71%) concerned with adverse drug reactions and contraindications (21%). The pharmacovigilance program identified 146 suspected adverse drug reactions and classified them reasonably as possible (27%), probable (69%), and certain (4%). These were attributed mainly to pregabalin and tramadol. The home pharmacotherapy follow-up pilot program cared patients with different cancer diagnoses and drug-related problems (DRP), which were identified and classified (according to second Granada Consensus) for pharmaceutical intervention as DRP 1 (5%), DRP 2 (10%), DRP 3 (14%), DRP 4 (19%), DRP 5 (24%), or DRP 6 (28%). This report provides information concerning the accurate use of medication and, above all, an opportunity for Mexican pharmacists to become an part of health teams seeking to resolve drug-related problems.

  10. Pharmaceutical services in a Mexican pain relief and palliative care institute

    Directory of Open Access Journals (Sweden)

    Escutia Gutierrez R

    2007-12-01

    Full Text Available Neither the purchase nor the distribution of pharmaceuticals in hospitals and community pharmacies in Mexico is under the care of pharmacists. Some are under control of physicians.This report presents the results of the implementation of somef pharmaceutical services for the Jalisco Pain Relief, and Palliative Care Institute (Palia Institute, under the direction of the Secretary of Health, Government of Jalisco. The services implemented were drug distribution system, Drug Information Service, Pharmacovigilance Program , and home pharmacotherapy follow-up pilot program for patients with advanced illness, with the ultimate using the appropriate medication. The drug distribution system included dispensing of opioid pain medications, antidepressants, anticonvulsants, NSAIDs, anxiolytic drugs, steroid drugs, laxatives, and anti-emetics. The frequently used drugs were morphine sulfate (62%, amitriptyline (6.4%, and dextropropoxyphene (5.8%. The Drug Information Service answered 114 consultations, mainly asked by a physician (71% concerned with adverse drug reactions and contraindications (21%. The pharmacovigilance program identified 146 suspected adverse drug reactions and classified them reasonably as possible (27%, probable (69%, and certain (4%. These were attributed mainly to pregabalin and tramadol. The home pharmacotherapy follow-up pilot program cared patients with different cancer diagnoses and drug-related problems (DRP, which were identified and classified (according to second Granada Consensus for pharmaceutical intervention as DRP 1 (5%, DRP 2 (10%, DRP 3 (14%, DRP 4 (19%, DRP 5 (24%, or DRP 6 (28%. This report provides information concerning the accurate use of medication and, above all, an opportunity for Mexican pharmacists to become an part of health teams seeking to resolve drug-related problems.

  11. The changes of regional cerebral blood flow: successful pain relief of intractable CRPS type II patients by motor cortex stimulation

    Energy Technology Data Exchange (ETDEWEB)

    Jung, J. A.; Son, H. S.; Kim, S. H.; Jung, S. G [The Catholic University of Korea, Seoul (Korea, Republic of)

    2004-07-01

    Authors report the effectiveness of MCS in extraordinarily extended pain due to intractable CRPS type II and rCBF study result for mechanism of pain control by MCS. A 43-year-old male presented severe spontaneous burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. Authors planned MCS as a neuromodulation therapy for this intractable peripheral neuropathic pain patient because further neurodestructive procedure did not work anymore and have a potential risk of further aggrevation of neuopathic pain. We performed baseline and stimulation brain perfusion SPECT using 20 mCi of Tc-99m ECD. The baseline CBD studies were done with stimulator 'off' state and stimulation studies were done after stimulator 'on' with satisfactory pain relief. For the stimulation study, the radioisotope was injected immediately after pain-relief and the images were taken about 50 minutes after injection of radioisotope. In resting rCBF in the patient was compared with normal control datas, we found significant increase in rCBF in the bilateral prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, left temporooccipital area. When rCBF datas obtained after alleviation of pain with stimulator 'on' . there were significant increase in rCBF in bilateral prefrontal cortex and left temporoocipital area. After subtraction of ECD SPECT, we found significant increase in rCBF in the right premotor and supplementary motor cortex left sensorimotor cortex, right cingulated cortex, right posterior insular cortex, right anterior limb of internal capsule. left orbitofrontal cortex and right pyramidal tract in cerebral peduncle. Authors report exellent pain control by MCS in a case of severe CRPS type II with hemibody involvement and regional cerebral blood flow changes according to successful pain control.

  12. Effects of six-week exercise training protocol on pain relief in patients with lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Amir Hossein Yazdani

    2016-02-01

    Full Text Available Introduction: Paraspinal, abdominal, and core muscles are playing the main role in lumbar disc herniation. The aim of the present study was to investigate the efficacy of a 6 weeks exercise training protocol on pain relief in males and females with lumbar disc herniation. Methods: In this before-after trial study, 64 patients with lumbar disc herniation were assigned to a 6 weeks exercise training program. Training protocol included leg press, trunk lateral flexion, trunk rotation, trunk flexion/extension, and stretching exercises in two sessions a week with 25-30 minutes each. Pain was measured with visual analog scale (VAS at 1st, 6th, and 12th sessions. Results: A total of 64 patients (13 males with mean age 47.53 ± 11.71 years and 51 females with mean age 46.50 ± 11.76 years completed the protocol. The pain was significantly reduced in both males and females during sessions 6 and 12 in comparison with the first session (P = 0.001. The amount of pain relief in males was higher than females (P = 0.047. Conclusion: About 6 weeks exercise training program could reduce more pain in males with lumbar disc herniation compared to females. This core stabilizing exercise protocol could be a good recommendation for patients with disk herniated low back pain (LBP.

  13. A preliminary study to determine if a muscle pain protocol can produce long-term relief in chronic back pain patients.

    Science.gov (United States)

    Marcus, Norman J; Shrikhande, Allyson Augusta; McCarberg, Bill; Gracely, Edward

    2013-08-01

    To assess the effectiveness of a muscle protocol to treat patients diagnosed with neuraxial low back pain (LBP) before and after invasive treatments. Patients with chronic (>6 months) LBP-postinvasive treatment and pre-spine surgery-were assessed and treated. An electrical device rather than palpation was used to determine muscle(s) as possible sources of pain. Patients testing positive for muscle pain were treated with a comprehensive protocol and were followed for >3 months to determine the effect of treatment on pain severity and interference in function. Study 1: In 56 (postinvasive treatment) patients who had failed back surgery, epidural steroid injections, facet blocks, and/or trigger point injections, mean Brief Pain Inventory (BPI) pain severity dropped from 5.54 at baseline to 3.96 (P muscle protocol, canceled their surgeries, and obtained significant relief at the 16-19 month follow-up point. In patients thought to have neuraxial pain, identification and treatment of painful muscles had statistically significant long-lasting and clinically meaningful reductions in pain and improvement in function. Muscle and tendon attachments may be an important and treatable source of pain in patients diagnosed with pre and postsurgical neuraxial pain. Wiley Periodicals, Inc.

  14. Comparative clinical study using laser and LED-therapy for orofacial pain relief: dentin hypersensitivity and cervicogenic headache

    Science.gov (United States)

    Lizarelli, Rosane F. Z.; Pizzo, Renata C. A.; Florez, Fernando L. E.; Grecco, Clovis; Speciali, Jose G.; Bagnato, Vanderlei S.

    2015-06-01

    Considering several clinical situations, low intensity laser therapy has been widely applied in pain relief or analgesia mechanism. With the advent of new LED-based (light emitting diode) light sources, the need of further clinical experiments aiming to compare the effectiveness among them is paramount. The LED system therapeutic use can be denominated as LEDT - Light Emitting Diode Therapy. This study proposed two clinical evaluations of pain relief effect: to dentin hypersensitivity and to cervicogenic headache using different sources of lasers (low and high intensity) and light emitting diodes (LEDs), one emitting at the spectral band of red (630+/- 5nm) and the other one at infrared band (880+/- 5nm). Two different clinical studies were performed and presented interesting results. Considering dentin hypersensitivity, red and infrared led were so effective than the control group (high intensity laser system); by the other side, considering cervicogenic headache, control group (infrared laser) was the best treatment in comparison to red and infrared led system.

  15. Does Acupressure Hit the Mark? A Three-Arm Randomized Placebo-Controlled Trial of Acupressure for Pain and Anxiety Relief in Athletes With Acute Musculoskeletal Sports Injuries.

    Science.gov (United States)

    Mącznik, Aleksandra K; Schneiders, Anthony G; Athens, Josie; Sullivan, S John

    2017-07-01

    Injuries are a common consequence of sports and recreational activity. The optimal management of symptoms is a crucial element of sports injury management. Acupressure has previously been shown to effectively decrease symptoms of musculoskeletal injury, thus may be considered a potentially useful intervention in the management of sport-related injuries. Therefore, this study was conducted to examine the effectiveness of acupressure in decreasing pain and anxiety in acutely injured athletes. A prospective 3-arm randomized placebo-controlled trial. A sports injury clinic, Dunedin, New Zealand. Seventy-nine athletes who sustained a sport-related musculoskeletal injury on the day. Three minutes of either acupressure, sham acupressure, or no acupressure. The primary outcomes of pain and anxiety intensity were measured before and immediately after the intervention on a 100-mm visual analog scale (VAS). Pain and anxiety relief, satisfaction with treatment, willingness to repeat a similar treatment, and belief in the effect of acupressure were secondary outcomes measured on Likert scales after the intervention. The acupressure group reported 11 mm less pain (95% CI: 5-17) on average than the sham acupressure group, and 9 mm less (95% CI: 3-16) than the control group as a result of the intervention (P sports injury when measured on the VAS, but did not change anxiety levels.

  16. Phantom limb pain relief by contralateral myofascial injection with local anaesthetic in a placebo-controlled study: preliminary results.

    Science.gov (United States)

    Casale, Roberto; Ceccherelli, Francesco; Labeeb, Alaa Abd Elaziz Mohamed; Biella, Gabriele E M

    2009-05-01

    To ascertain the existence of contralateral painful muscle areas mirroring phantom pain and to evaluate the short-term effects of anaesthetic vs saline, injected contra notlaterally to control phantom and phantom limb pain. Double-blinded cross-over study. Inpatients; rehabilitation institute. Eight lower limb amputees with phantom limb pain in the past 6 months. Either 1 ml of 0.25% bupivacaine or 0.9% saline injected alternately in each point with a 28-gauge needle, with 72 h between injections. Main outcome measurePhantom sensation modification and the intensity of phantom limb pain (visual analogue scale) before and after injections. Although present, painful muscle areas in the healthy limb do not mirror the topographical distribution of phantom limb pain. Sixty minutes after the injection, a statistically significant greater relief of phantom limb pain was observed after using local anaesthetic than when using saline injection (p = 0.003). Bupivacaine consistently reduced/abolished the phantom sensation in 6 out of 8 patients. These effects on phantom sensation were not observed after saline injections. Contralateral injections of 1 ml 0.25% bupivacaine in myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. The clinical importance of this treatment method requires further investigation.

  17. The use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour: a review of the evidence.

    Science.gov (United States)

    Bedwell, Carol; Dowswell, Therese; Neilson, James P; Lavender, Tina

    2011-10-01

    to assess the effects of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. studies were identified from a search of the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). randomised controlled trials comparing women receiving TENS for pain relief in labour vs routine care or placebo devices. All types of TENS machines were included. two review authors assessed all trials identified by the search strategy, carried out data extraction and assessed risk of bias. 14 studies including 1256 women were included: 11 examined TENS applied to the back, two to acupuncture points and one to the cranium. Overall, there was little difference in satisfaction with pain relief or in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32-0.55). The majority of women using TENS would use it again in a future labour. There was no evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and infants. No adverse events were reported. there is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact on other outcomes for mothers or infants. The use of TENS at home in early labour has not been evaluated. Although the guidelines of the National Institute for Health and Clinical Excellence recommend that TENS should not be offered to women in labour, women appear to be choosing it and midwives are supporting them in their choice. Given the absence of adverse effects and the limited evidence base, it seems unreasonable to deny women that choice. More robust studies of effectiveness are needed. Copyright © 2009 Elsevier Ltd. All rights reserved.

  18. Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

    OpenAIRE

    Gaonkar V; Daftary Swati

    2004-01-01

    In this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25) or peri-incisional infiltration (n=25) pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline. The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia...

  19. Preoperative analgesics for additional pain relief in children and adolescents having dental treatment.

    Science.gov (United States)

    Ashley, Paul F; Parekh, Susan; Moles, David R; Anand, Prabhleen; MacDonald, Laura C I

    2016-08-08

    Fear of dental pain is a major barrier to treatment for children who need dental care. The use of preoperative analgesics has the potential to reduce postoperative discomfort and intraoperative pain. We reviewed the available evidence to determine whether further research is warranted and to inform the development of prescribing guidelines. This is an update of a Cochrane review published in 2012. To assess the effects of preoperative analgesics for intraoperative or postoperative pain relief (or both) in children and adolescents undergoing dental treatment without general anaesthesia or sedation. We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 5 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2015, Issue 12), MEDLINE via OVID (1946 to 5 January 2016), EMBASE via OVID (1980 to 5 January 2016), LILACS via BIREME (1982 to 5 January 2016) and the ISI Web of Science (1945 to 5 January 2016). We searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials to 5 January 2016. There were no restrictions regarding language or date of publication in the searches of the electronic databases. We handsearched several specialist journals dating from 2000 to 2011.We checked the reference lists of all eligible trials for additional studies. We contacted specialists in the field for any unpublished data. Randomised controlled clinical trials of analgesics given before dental treatment versus placebo or no analgesics in children and adolescents up to 17 years of age. We excluded children and adolescents having dental treatment under sedation (including nitrous oxide/oxygen) or general anaesthesia. Two review authors assessed titles and abstracts of the articles obtained from the searches for eligibility, undertook data extraction and assessed the risk of bias in the included studies. We assessed the quality of the

  20. Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kooij, Sanne M. van der, E-mail: s.m.vanderkooij@amc.uva.nl; Moolenaar, Lobke M.; Ankum, Willem M. [Academic Medical Centre, Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands); Mol, Ben Willem J. [Academic Medical Centre, Department of Gynaecology (Netherlands); Hehenkamp, Wouter J. K. [VU University Medical Centre, Department of Gynaecology (Netherlands)

    2013-12-15

    Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were Euro-Sign 191 and Euro-Sign 355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were Euro-Sign 105 and Euro-Sign 179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.

  1. Activation of mesocorticolimbic reward circuits for assessment of relief of ongoing pain: a potential biomarker of efficacy.

    Science.gov (United States)

    Xie, Jennifer Y; Qu, Chaoling; Patwardhan, Amol; Ossipov, Michael H; Navratilova, Edita; Becerra, Lino; Borsook, David; Porreca, Frank

    2014-08-01

    Preclinical assessment of pain has increasingly explored operant methods that may allow behavioral assessment of ongoing pain. In animals with incisional injury, peripheral nerve block produces conditioned place preference (CPP) and activates the mesolimbic dopaminergic reward pathway. We hypothesized that activation of this circuit could serve as a neurochemical output measure of relief of ongoing pain. Medications commonly used clinically, including gabapentin and nonsteroidal anti-inflammatory drugs (NSAIDs), were evaluated in models of post-surgical (1 day after incision) or neuropathic (14 days after spinal nerve ligation [SNL]) pain to determine whether the clinical efficacy profile of these drugs in these pain conditions was reflected by extracellular dopamine (DA) release in the nucleus accumbens (NAc) shell. Microdialysis was performed in awake rats. Basal DA levels were not significantly different between experimental groups, and no significant treatment effects were seen in sham-operated animals. Consistent with clinical observation, spinal clonidine produced CPP and produced a dose-related increase in net NAc DA release in SNL rats. Gabapentin, commonly used to treat neuropathic pain, produced increased NAc DA in rats with SNL but not in animals with incisional, injury. In contrast, ketorolac or naproxen produced increased NAc DA in animals with incisional but not neuropathic pain. Increased extracellular NAc DA release was consistent with CPP and was observed selectively with treatments commonly used clinically for post-surgical or neuropathic pain. Evaluation of NAc DA efflux in animal pain models may represent an objective neurochemical assay that may serve as a biomarker of efficacy for novel pain-relieving mechanisms. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  2. A Comparison of Change in the 0–10 Numeric Rating Scale to a Pain Relief Scale and Global Medication Performance Scale in a Short-term Clinical Trial of Breakthrough Pain Intensity

    Science.gov (United States)

    Farrar, John T.; Polomano, Rosemary C.; Berlin, Jesse A.; Strom, Brian L.

    2010-01-01

    Background Pain intensity is commonly reported using a 0–10 numeric rating scale in breakthrough pain clinical trials. Analysis of the change on the Pain Intensity Numerical Rating Scale as a proportion as most consistently correlated with clinically important differences reported on the Patient Global Impression of Change. The analysis of data using a different global outcome measures and the pain relief scale will extend our understanding of these measures. Use of the pain relief scale is also explored in this study Methods Data came from the open titration phase of a multiple crossover, randomized, double-blind clinical trial comparing oral transmucosal fentanyl citrate to immediate-release oral morphine sulfate for treatment of cancer-related breakthrough pain. Raw and percent changes in the pain intensity scores on 1,307 from 134 oral transmucosal fentanyl citrate-naive patients were compared to the clinically relevant secondary outcomes of the pain relief verbal response scale and the global medication performance. The changes in raw and percent change were assessed over time and compared to the ordinal pain relief verbal response scale and global medication performance scales. Results The p-value of the interaction between the raw pain intensity difference was significant but not for the percent pain intensity difference score over 4 15 minute time periods (p = 0.034 and p = 0.26 respectively), in comparison with the ordinal pain relief verbal response scale (p = 0.0048 and p = 0.36 respectively), and global medication performance categories (p = 0.048 and p = 0.45 respectively). Conclusion The change in pain intensity in breakthrough pain was more consistent over time and when compared to both the pain relief verbal response scale and global medication performance scale when the percent change is used rather than raw pain intensity difference. PMID:20463579

  3. Activation of mesocorticolimbic reward circuits for assessment of relief of ongoing pain: a potential biomarker of efficacy

    Science.gov (United States)

    Xie, Jennifer Y.; Qu, Chaoling; Patwardhan, Amol; Ossipov, Michael H.; Navratilova, Edita; Becerra, Lino; Borsook, David; Porreca, Frank

    2014-01-01

    Preclinical assessment of pain has increasingly explored operant methods that may allow behavioral assessment of ongoing pain. In animals with incisional injury, peripheral nerve block produces conditioned place preference (CPP) and activates the mesolimbic dopaminergic reward pathway. We hypothesized that activation of this circuit could serve as a neurochemical output measure of relief of ongoing pain. Medications commonly used clinically including gabapentin and non-steroidal anti-inflammatory drugs (NSAIDs) were evaluated in models of post-surgical (one day following incision) or neuropathic (14 days following spinal nerve ligation, SNL) pain to determine if the clinical efficacy profile of these drugs in these pain conditions was reflected by extracellular dopamine (DA) release in the nucleus accumbens (NAc) shell. Microdialysis was performed in awake rats. Basal DA levels were not significantly different between experimental groups and no significant treatment effects were seen in sham-operated animals. Consistent with clinical observation, spinal clonidine produced CPP and produced a dose-related increase in net NAc DA release in SNL rats. Gabapentin, commonly used to treat neuropathic pain produced increased NAc DA in rats with SNL, but not in animals with incisional, injury. In contrast, ketorolac or naproxen produced increased NAc DA in animals with incisional, but not neuropathic, pain. Increased extracellular NAc DA release was consistent with CPP and observed selectively with treatments commonly used clinically for post-surgical or neuropathic pain. Evaluation of NAc DA efflux in animal pain models may represent an objective neurochemical assay that may serve as a biomarker of efficacy for novel pain-relieving mechanisms. PMID:24861580

  4. A comparison of change in the 0-10 numeric rating scale to a pain relief scale and global medication performance scale in a short-term clinical trial of breakthrough pain intensity.

    Science.gov (United States)

    Farrar, John T; Polomano, Rosemary C; Berlin, Jesse A; Strom, Brian L

    2010-06-01

    Pain intensity is commonly reported using a 0-10 Numeric Rating Scale in pain clinical trials. Analysis of the change on the Pain Intensity Numerical Rating Scale as a proportion has most consistently correlated with clinically important differences reported on the patient's global impression of change. The correlation of data from patients with breakthrough pain with a Pain Relief Scale and a different global outcome measures will extend our understanding of these measures. Data were obtained from the open titration phase of a multiple crossover, randomized, double-blind clinical trial comparing oral transmucosal fentanyl citrate with immediate-release oral morphine sulfate for the treatment of cancer-related breakthrough pain. Raw and percentage changes in the pain intensity scores from 1,307 episodes of pain in 134 oral transmucosal fentanyl citrate-naïve patients were correlated with the clinically relevant secondary outcomes of Pain Relief Verbal Response Scale and the global medication performance scale. The changes in raw and percentage change were assessed over time and compared with the ordinal Pain Relief Verbal Response Scale and Global Medication Performance Scale. The P value of the interaction between the raw pain intensity difference was significant (P = 0.034) for four 15-min time periods but not for the percentage pain intensity difference score (P = 0.26). We found similar results in comparison with the ordinal Pain Relief Verbal Response Scale (P = 0.0048 and P = 0.36 respectively) and global medication performance categories (P = 0.048 and P = 0.45, respectively). The change in pain intensity in breakthrough pain was more consistent over time and when compared with both the Pain Relief Verbal Response Scale and the Global Medication Performance Scale when the percentage change is used rather than raw pain intensity difference.

  5. Effervescent morphine results in faster relief of breakthrough pain in patients compared to immediate release morphine sulfate tablet.

    Science.gov (United States)

    Freye, Enno; Levy, Joseph Victor; Braun, Dagmar

    2007-12-01

    Morphine tablets have been formulated to produce an easily ingested effervescent solution when placed in water. It was hypothesized that an aqueous solution would result in fast gastrointestinal transit with a more rapid onset of action compared to immediate release morphine sulfate (IRMS), which would be especially beneficial in treating breakthrough pain (BTP). In an open-label safety and efficacy study, effervescent morphine was given to 76 chronic cancer pain patients for treatment of BTP evaluating time until pain relief, global satisfaction and side effects. Results were compared to those obtained using an IRMS formulation in a preceding run-in period. For BTP, a mean dose of 28 mg of effervescent morphine (range 10-80 mg) resulted in a highly significant reduction of pain score (mean 7.8 to mean 3.2; P effervescent morphine. The dose for treatment of BTP was determined by individual titration and not predicted by the dose taken with the basic pain medication. Compared to IRMS, overall satisfaction for effervescent morphine was rated "superior" by 16.7%, and "better" by 63.2% of patients. Effervescent morphine offers an alternative for management of breakthrough cancer pain compared with the commonly used IRMS.

  6. Superior hypogastric plexus combined with ganglion impar neurolytic blocks for pelvic and/or perineal cancer pain relief.

    Science.gov (United States)

    Ahmed, Doaa G; Mohamed, Mohamed F; Mohamed, Sahar Abd-Elbaky

    2015-01-01

    The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain resulting from malignancy in these organs. The ganglion impar (GI) innervats the perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. Different approaches to the ganglion impar neurolysis have been described in the literature. To assess the feasibility, safety, and efficacy of combining the block of the SHGP through the postero-median transdiscal approach with the GI block by the trans-sacro-coccygeal approach for relief of pelvic and/or perineal pain caused by pelvic and/or perineal malignancies or any cancer related causes. Fifteen patients who had cancer-related pelvic pain, perineal pain, or both received a combined SHGP neurolytic block through the postero-median transdiscal approach using a 20-gauge Chiba needle and injection of 10 mL of 10% phenol in saline plus a GI neurolytic block by the trans-sacro-coccygeal approach using a 22-gauge 5 cm needle and injection of 4 - 6 mL of 8% phenol in saline. Pain intensity (measured using a visual analogue scale) and oral morphine consumption pre- and post-procedure were measured. All patients presented with cancer-related pelvic, perineal, or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.87 ± 1.19 pre-procedurally to 2.40 ± 2.10 one week post-procedurally (P pain in cancer patients presented with pelvic and/or perineal pain. Also, a combined SHGP block through a posteromedian transdiscal approach with a GI block through a trans-sacrococcygeal approach may be considered more effective and easier to perform than the recently invented bilateral inferior hypogastric plexus neurolysis through a transsacral approach.

  7. Hypnosis and Local Anesthesia for Dental Pain Relief-Alternative or Adjunct Therapy?-A Randomized, Clinical-Experimental Crossover Study.

    Science.gov (United States)

    Wolf, Thomas Gerhard; Wolf, Dominik; Callaway, Angelika; Below, Dagna; d'Hoedt, Bernd; Willershausen, Brita; Daubländer, Monika

    2016-01-01

    This prospective randomized clinical crossover trial was designed to compare hypnosis and local anesthesia for experimental dental pain relief. Pain thresholds of the dental pulp were determined. A targeted standardized pain stimulus was applied and rated on the Visual Analogue Scale (0-10). The pain threshold was lower under hypnosis (58.3 ± 17.3, p local anesthesia. The pain stimulus was scored higher under hypnosis (3.9 ± 3.8) than with local anesthesia (0.0, p Local anesthesia was superior to hypnosis and is a safe and effective method for pain relief in dentistry. Hypnosis seems to produce similar effects observed under sedation. It can be used in addition to local anesthesia and in individual cases as an alternative for pain control in dentistry.

  8. Functional Outcome of Lumbar Discectomy by Fenestration Technique in Lumbar Disc Prolapse – Return to Work and Relief of Pain

    Science.gov (United States)

    Umashankar, Mahesh Kotehal; Reddy, B.S. Jayakrishna

    2016-01-01

    Introduction Low back pain affects every population and is one of world’s foremost debilitating conditions. Clinically significant sciatica due to lumbar disc prolapse occurs in 4-6% of population. Fenestration discectomy as a surgical procedure is less time consuming, with lesser blood loss, lesser post-operative complications and does not compromise with stability of spine when compared to laminectomy. Aim Present study was conducted to determine extent of functional recovery i.e. pain relief and return to work in patients with lumbar disc prolapse treated by fenestration technique. Materials and Methods From October 2010 to March 2012, 50 patients with signs and symptoms of prolapsed lumbar intervertebral disc who failed to respond to conservative treatment were operated for discectomy by fenestration technique and studied prospectively. Functional outcome was evaluated by ‘Back Pain Functional Score (BPFS)’ of Strafford et al., PROLO rating scale to determine preoperative functional and economical status and outcome at final follow up after 6 months. In order to identify physical signs from non organic signs Wadell’s score system was used. Result of surgery was evaluated with help of McNab’s criteria. Results In our study, according to Back Pain Functional Scale by Strafford et al., and PROLO scale, good results were found in 42 (84%) cases, fair result in 8 cases (16%) and none with poor results at follow up of six months. According to PROLO economical and functional scale, 84% cases were able to join their previous occupation at end of six months and 76% cases had complete pain relief. In our study, correlation of age and duration of symptoms to functional outcome was statistically significant (p=0.089 & p = 0.098+ respectively) showing more good results among patients with age less than 30 years and patients having duration of symptoms less than 6 months. Conclusion Functional outcome of fenestration technique in terms of return to work and

  9. Functional Outcome of Lumbar Discectomy by Fenestration Technique in Lumbar Disc Prolapse - Return to Work and Relief of Pain.

    Science.gov (United States)

    Wankhade, Ujjwal Gowardhan; Umashankar, Mahesh Kotehal; Reddy, B S Jayakrishna

    2016-03-01

    Low back pain affects every population and is one of world's foremost debilitating conditions. Clinically significant sciatica due to lumbar disc prolapse occurs in 4-6% of population. Fenestration discectomy as a surgical procedure is less time consuming, with lesser blood loss, lesser post-operative complications and does not compromise with stability of spine when compared to laminectomy. Present study was conducted to determine extent of functional recovery i.e. pain relief and return to work in patients with lumbar disc prolapse treated by fenestration technique. From October 2010 to March 2012, 50 patients with signs and symptoms of prolapsed lumbar intervertebral disc who failed to respond to conservative treatment were operated for discectomy by fenestration technique and studied prospectively. Functional outcome was evaluated by 'Back Pain Functional Score (BPFS)' of Strafford et al., PROLO rating scale to determine preoperative functional and economical status and outcome at final follow up after 6 months. In order to identify physical signs from non organic signs Wadell's score system was used. Result of surgery was evaluated with help of McNab's criteria. In our study, according to Back Pain Functional Scale by Strafford et al., and PROLO scale, good results were found in 42 (84%) cases, fair result in 8 cases (16%) and none with poor results at follow up of six months. According to PROLO economical and functional scale, 84% cases were able to join their previous occupation at end of six months and 76% cases had complete pain relief. In our study, correlation of age and duration of symptoms to functional outcome was statistically significant (p=0.089 & p = 0.098+ respectively) showing more good results among patients with age less than 30 years and patients having duration of symptoms less than 6 months. Functional outcome of fenestration technique in terms of return to work and complete back and leg pain relief at end of six months had been

  10. Improving Pain Relief in Elder Patients (I-PREP): An Emergency Department Education and Quality Intervention.

    Science.gov (United States)

    Hogan, Teresita M; Howell, Michael D; Cursio, John F; Wong, Alexandra; Dale, William

    2016-12-01

    To assess the effectiveness of a novel combined education and quality improvement (QI) program for management of pain in older adults in the emergency department (ED). Controlled pre/postintervention examination. An academic urban ED seeing 60,000 adult visits annually. Individuals aged 65 and older experiencing moderate to severe pain. Linked standardized education and continuous QI for multidisciplinary staff in an urban, academic ED from January 2012 to January 2014. Pain intensity, percentage receiving and time to pain assessment and reassessment, percentage receiving and time to delivery of analgesic. The percentage of participants with final pain score of 4 or less (out of 10) increased 47.5% (95% confidence interval (CI) = 41.8-53.2%). Median decrease in pain intensity improved significantly, from 0.0 to 5.0 points (P improvement increased 43.7% (95% CI = 37.1-50.3%, P improved pain management in older adults in the ED with moderate to severe musculoskeletal or abdominal pain. Significant reductions in pain intensity were achieved, the timing of pain assessments and reassessments was improved, and analgesics were delivered faster. Tightly linking education to targeted QI improved pain management of older adults in the ED. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  11. Chronic pain relief after the exposure of nitrous oxide during dental treatment: longitudinal retrospective study.

    Science.gov (United States)

    Mattos Júnior, Francisco Moreira; Mattos, Rafael Villanova; Teixeira, Manoel Jacobsen; Siqueira, Silvia Regina Dowgan Tesseroli de; Siqueira, Jose Tadeu Tesseroli de

    2015-07-01

    The objective was to investigate the effect of nitrous/oxygen in chronic pain. Seventy-seven chronic pain patients referred to dental treatment with conscious sedation with nitrous oxide/oxygen had their records included in this research. Data were collected regarding the location and intensity of pain by the visual analogue scale before and after the treatment. Statistical analysis was performed comparing pre- and post-treatment findings. It was observed a remarkable decrease in the prevalence of pain in this sample (only 18 patients still had chronic pain, p nitrous oxide/oxygen. Nitrous oxide may be a tool to be used in the treatment of chronic pain, and future prospective studies are necessary to understand the underlying mechanisms and the effect of nitrous oxide/oxygen in patients according to the pain diagnosis and other characteristics.

  12. Chronic pain relief after the exposure of nitrous oxide during dental treatment: longitudinal retrospective study

    Directory of Open Access Journals (Sweden)

    Francisco Moreira Mattos Júnior

    2015-07-01

    Full Text Available The objective was to investigate the effect of nitrous/oxygen in chronic pain. Seventy-seven chronic pain patients referred to dental treatment with conscious sedation with nitrous oxide/oxygen had their records included in this research. Data were collected regarding the location and intensity of pain by the visual analogue scale before and after the treatment. Statistical analysis was performed comparing pre- and post-treatment findings. It was observed a remarkable decrease in the prevalence of pain in this sample (only 18 patients still had chronic pain, p < 0.001 and in its intensity (p < 0.001. Patients that needed fewer sessions received higher proportions of nitrous oxide/oxygen. Nitrous oxide may be a tool to be used in the treatment of chronic pain, and future prospective studies are necessary to understand the underlying mechanisms and the effect of nitrous oxide/oxygen in patients according to the pain diagnosis and other characteristics.

  13. Comparing Transcervical Intrauterine Lidocaine Instillation with Rectal Diclofenac for Pain Relief During Outpatient Hysteroscopy: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Sussan S. Mohammadi

    2015-05-01

    Full Text Available Objectives: There are a number of potential advantages to performing hysteroscopy in an outpatient setting. However, the ideal approach, using local uterine anesthesia or rectal non-steroidal anti-inflammatory drugs, has not been determined. Our objective was to compare the efficacy of intrauterine lidocaine instillation with rectal diclofenac for pain relief during diagnostic hysteroscopy. Methods: We conducted a double-blind randomized controlled trial on 70 nulliparous women with primary infertility undergoing diagnostic hysteroscopy. Subjects were assigned into one of two groups to receive either 100mg of rectal diclofenac or 5mL of 2% intrauterine lidocaine. The intensity of pain was measured by a numeric rating scale 0–10. Pain scoring was performed during insertion of the hysteroscope, during visualization of the intrauterine cavity, and during extrusion of the hysteroscope. Results: There were no statistically significant differences between the groups with regard to the mean pain score during intrauterine visualization (p=0.500. The mean pain score was significantly lower during insertion and extrusion of the hysteroscope in the diclofenac group (p=0.001 and p=0.030, respectively. Nine patients in the lidocaine group and five patients in diclofenac group needed supplementary intravenous propofol injection for sedation (p=0.060. Conclusions: Rectal diclofenac appears to be more effective than intrauterine lidocaine in reducing pain during insertion and extrusion of hysteroscope, but there are no significant statistical and clinical differences between the two methods with regard to the mean pain score during intrauterine inspection.

  14. Pain relief is associated with decreasing postural sway in patients with non-specific low back pain

    DEFF Research Database (Denmark)

    Ruhe, A.; Fejer, René; Walker, B.

    2012-01-01

    Background: Increased postural sway is well documented in patients suffering from non-specific low back pain, whereby a linear relationship between higher pain intensities and increasing postural sway has been described. No investigation has been conducted to evaluate whether this relationship...... is maintained if pain levels change in adults with non-specific low back pain. Methods: Thirty-eight patients with non-specific low back pain and a matching number of healthy controls were enrolled. Postural sway was measured by three identical static bipedal standing tasks of 90 sec duration with eyes closed...... in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS 11). The patients received three manual interventions (e. g. manipulation, mobilization or soft tissue techniques) at 3-4 day intervals, postural sway measures were obtained at each occasion. Results...

  15. The Effect of Non-Pharmacological Methods of Labor Pain Relief on Mothers’ Perceived Stress: ARandomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Mojghan Mirghafourvand

    2014-12-01

    Full Text Available Background & objectives: Childbirth is the most stressful event for the women both mentally and physically affecting their physiological and psychological indicators during labour. The aim of this study was to assess the effect of non-pharmacological methods of labor pain relief in mothers’ perceived stress conducted in Alavi hospital of Ardabil, 2013.  Methods: In this double blind randomized controlled trial, 320 mothers were allocated into two groups by stratified block randomization . The intervention group (n=158 received continuous support throughout the labour process, positioning and movement, music, aromatherapy, showering andconsumption of a light diet or water.The control group received only a routine care. The perceived stress scale (PSS was employed to collect data in three stages at the beginning of the active phase, before the intervention, six hours after birth and then eight weeks postpartum. The two groupswere compared using General Linear Model with controlling the baseline scores. Results: There were 14 participants loss to follow-up. The mean of perceived stress score in the intervention group was significantly lower than the control group at 6 hours [adjusted mean difference: -1.0 (95% confidence interval: -0.01 to -1.9]. However, there was no difference between two groups in terms of perceived stress score at 8 weeks postpartum (p=0.692.  Conclusion: Non-pharmacological methods of labor pain relief are an effective intervention for reducing perceived stress level in mothers during labor and therefore use of this intervention is recommended.

  16. Pain relief is associated with decreasing postural sway in patients with non-specific low back pain

    Directory of Open Access Journals (Sweden)

    Ruhe Alexander

    2012-03-01

    Full Text Available Abstract Background Increased postural sway is well documented in patients suffering from non-specific low back pain, whereby a linear relationship between higher pain intensities and increasing postural sway has been described. No investigation has been conducted to evaluate whether this relationship is maintained if pain levels change in adults with non-specific low back pain. Methods Thirty-eight patients with non-specific low back pain and a matching number of healthy controls were enrolled. Postural sway was measured by three identical static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11. The patients received three manual interventions (e.g. manipulation, mobilization or soft tissue techniques at 3-4 day intervals, postural sway measures were obtained at each occasion. Results A clinically relevant decrease of four NRS scores in associated with manual interventions correlated with a significant decrease in postural sway. In contrast, if no clinically relevant change in intensity occurred (≤ 1 level, postural sway remained similar compared to baseline. The postural sway measures obtained at follow-up sessions 2 and 3 associated with specific NRS level showed no significant differences compared to reference values for the same pain score. Conclusions Alterations in self-reported pain intensities are closely related to changes in postural sway. The previously reported linear relationship between the two variables is maintained as pain levels change. Pain interference appears responsible for the altered sway in pain sufferers. This underlines the clinical use of sway measures as an objective monitoring tool during treatment or rehabilitation.

  17. The effect of oral tizanidine on postoperative pain relief after elective laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Reihanak Talakoub

    2016-01-01

    Conclusion: Oral administration of 4 mg tizanidine before laparoscopic cholecystectomy reduces postoperative pain, opioid consumption, and consequence of the duration of stay in recovery room without any complication.

  18. The comparison between suppository diclofenac and pethidine in post-cesarean section pain relief: a randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Ziba Zahiri Soroori

    2006-12-01

    appropriate replacement therapy for pain relief after C/S. KEY WORDS: Diclofenac, pethidine, cesarean section, pain relief.

  19. Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Axelsen, Solveig Forberg

    2016-01-01

    of ∼250 people. MAIN OUTCOME MEASURES: The primary trial outcome was use of epidural analgesia. Other types of pain relief and obstetric interventions were analysed as explorative outcomes. RESULTS: There was no statistically significant difference in use of epidural analgesia between participants...... in the intervention group (30.9%) versus the control group (29.1%), adjusted OR 1.10 (95% CI 0.87 to 1.34). Also, the two groups did not differ regarding other types of pain relief or obstetric interventions. Concomitant birth preparation was common in both groups and highest in the control group, but did not seem...... to influence our results noticeably. CONCLUSIONS: Antenatal education in small groups versus standard auditorium-based lectures did not differ regarding use of epidural analgesia, other pain relief, or obstetric interventions. TRIAL REGISTRATION NUMBER: NCT01672437; Results....

  20. Prevalence and relief of pain in trauma patients in emergency medical services

    NARCIS (Netherlands)

    Berben, S.A.A.; Schoonhoven, L.; Meijs, T.H.; Vugt, A.B. van; Grunsven, P.M. van

    2011-01-01

    OBJECTIVES: The aim of this study was to give insight in the prevalence of pain, and the (effect of) pain management according to the national emergency medical services analgesia protocol in trauma patients in the Netherlands. METHODS: The retrospective document study included adult and alert

  1. Pain relief at trigger points: a comparison of moist heat and shortwave diathermy.

    Science.gov (United States)

    McCray, R E; Patton, N J

    1984-01-01

    This study compared the pain-relieving effects of shortwave diathermy and moist heat on trigger points. Patients with trigger points on the neck or back were randomly assigned one of these treatments. The sensitivity of each trigger point was measured with a pressure algometer before treatment, 5 minutes after treatment, and 30 minutes after treatment. Sensitive trigger points, at which 2000 grams of force or less caused pain, were more responsive to treatment than moderate trigger points (painful only at 2000 grams or greater force). Both treatments were effective in relieving the pain of sensitive trigger points but shortwave diathermy was more effective at decreasing the sensitivity of both sensitive and moderate trigger points (P > 0.0581). The pressure algometer was shown to be a useful device for objectively measuring pain and may be useful in selecting the most effective type of treatment for trigger points.J Orthop Sports Phys Ther 1984;5(4):175-178.

  2. Using Life Cycle Sustainability Assessment to trade off sourcing strategies for humanitarian relief items

    NARCIS (Netherlands)

    van Kempen, E.; Spiliotopoulou, E.; Stojanovski, G.; de Leeuw, S.L.J.M.

    2017-01-01

    Purpose: While interest in supply chain sustainability has risen over the past few years in academic and business worlds, very little research has been conducted on sustainability in humanitarian supply chains, specifically. This study aims to contribute to the development of the field by conducting

  3. Outcomes of an Alternating Ibuprofen and Acetaminophen Regimen for Pain Relief After Tonsillectomy in Children.

    Science.gov (United States)

    Liu, Christopher; Ulualp, Seckin O

    2015-10-01

    To determine the outcomes of alternating doses of ibuprofen and acetaminophen in the treatment of post-tonsillectomy pain in children and to identify characteristics of children who had inadequate pain control. The medical records of children who received alternating doses of ibuprofen and acetaminophen for post-tonsillectomy pain between August 2012 and November 2013 at a tertiary care children's hospital were reviewed. Incidences of postoperative bleeding and unresolved pain were determined. A total of 583 patients (304 males, 279 females, age range=1-18 years) had received alternating doses of ibuprofen and acetaminophen after tonsillectomy and adenoidectomy. Of the 583 patients, 56 (9.6%) reported inadequate pain control. Age, sex, obesity, presence of comorbid conditions, indications for surgery, and concurrent surgical procedures were not different between children who had adequate analgesia and children who had unresolved pain. Twenty-four patients (4.1%) had postoperative bleeding. Nine patients (1.5%) required surgical intervention for bleeding. Alternating doses of ibuprofen and acetaminophen provided an effective treatment for post-tonsillectomy pain in the majority of children and did not increase rate of bleeding. Means of improving response rate to alternating doses of ibuprofen and acetaminophen merit further investigation. © The Author(s) 2015.

  4. Evaluation of the Effects of Music and Poetry in Oncologic Pain Relief: A Randomized Clinical Trial.

    Science.gov (United States)

    Arruda, Maurilene Andrade Lima Bacelar; Garcia, Marília Arrais; Garcia, João Batista Santos

    2016-09-01

    Various forms of art therapy have been tested as adjuvants in the treatment of physical and emotional disorders, including music and poetry. To evaluate the effect of passive listening to music and poetry on the variation in pain, depression, and hope scores. This was a randomized trial, with multiple aspects and an allocation ratio of 1:1:1, in which one group listened to music, one group listened to poetry, and another group received no intervention over a period of three days. A total of 75 adult patients experiencing pain and hospitalized in a cancer facility were included. The study was conducted over a period of three months. The primary outcome consisted of pain evaluation using a Visual Analog Scale, and the secondary outcomes consisted of evaluations of depression (Beck Depression Inventory) and hope (Herth Hope Scale). The final sample consisted of 65 participants, with 22 in the music group, 22 in the poetry group, and 21 controls. Music promoted an improvement in pain (p pain (p music and poetry groups and the control group after the study was only observed for the pain outcome (p music and poetry produced a similar improvement in the pain intensity. The two therapies also affected depression scores, and only poetry increased hope scores. Further investigation of the effects and comparisons between the two therapies should be performed.

  5. Efficacy of ibuprofen, naproxen and mefenamic acid for relief of pain from primary dysmenorrheal

    Directory of Open Access Journals (Sweden)

    Azita Norouzi

    2003-09-01

    Full Text Available Cyclic pain associated with menses during ovulatory cycles, but without demonstrable lesions affecting the reproductive cycle, is a common disability, which causes significant absence from school or work. To evaluate the efficacy of naproxen, ibuprofen and mefenamic acid in the treatment of primary dysmenorrheal, 120 girls were randomized to four groups (three as treatment groups and the other as placebo. The pain intensity was recorded using self visual analogue scale in 0, 1, 2, 4 and 6 hours after treatment. There was no significant difference in intensity of pain between groups at zero time, however the pain intensity decreased significantly in all treatment group in comparison to placebo (p<0.05. The mean of pain intensity was lower in ibuprofen in comparison to the other treatment groups, however there was no significant difference in pain intensity between the treatment groups in the sixth hour of treatment. Therefore, ibuprofen is recommended as a treatment choice for pain reduction in primary dysmenorrheal due to its rapid onset of action.

  6. Does visualisation during urethrocystoscopy provide pain relief? Results of an observational study.

    Science.gov (United States)

    Koenig, J; Sevinc, S; Frohme, C; Heers, H; Hofmann, R; Hegele, A

    2015-07-01

    To measure the effects of real-time visualisation during urethrocystoscopy on pain in patients who underwent ambulatory urethrocystoscopy. An observational study was designed. From June 2012 to June 2013 patients who had ambulatory urethrocystoscopy participated in the study. In order to measure pain perception we used a numeric rating scale (NRS) 0 to 10. Additional data was collected including gender, reason for intervention, use of a rigid or a flexible instrument and whether the patient had had urethrocystoscopy before. 185 patients were evaluated. 125 patients preferred to watch their urethrocystoscopy on a real-time video screen, 60 patients did not. There was no statistically relevant difference in pain perception between those patients who watched their urethrocystoscopy on a real-time video screen and those who did not (p = 0.063). However, men who were allowed to watch their flexible urethrocystoscopy experienced significantly less pain, than those who did not (p = 0.007). No such effects could be measured for rigid urethrocystoscopy (p = 0.317). Furthermore, women experienced significantly higher levels of pain during the urethrocystoscopy than men (p = 0.032). Visualisation during urethrocystoscopy procedures in general does not significantly decrease pain in patients. Nevertheless, men who undergo flexible urethrocystoscopy should be offered to watch their procedure in real-time on a video screen. To make urethrocystoscopy less painful for both genders, especially for women, should be subject to further research.

  7. Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

    Directory of Open Access Journals (Sweden)

    Coderre Terence J

    2009-09-01

    Full Text Available Abstract Background During the chronic stage of Complex Regional Pain Syndrome (CRPS, impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS. Discussion The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin. Summary The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients.

  8. Acupuncture provides short-term pain relief for patients in a total joint replacement program.

    Science.gov (United States)

    Crespin, Daniel J; Griffin, Kristen H; Johnson, Jill R; Miller, Cynthia; Finch, Michael D; Rivard, Rachael L; Anseth, Scott; Dusek, Jeffery A

    2015-06-01

    Given the risks of opioid medications, nonpharmacological strategies should be considered for total joint replacement patients. We investigated acupuncture as an adjunct therapy for postsurgical pain management in a total joint replacement program by examining which total hip and knee replacement patients elected to receive acupuncture and the effect of acupuncture on short-term pain. A total joint replacement program using fast-track physiotherapy offered elective postsurgical acupuncture to all patients, at no additional cost, as an adjunct therapy to opioids for pain management. The Joint Replacement Center at Abbott Northwestern Hospital, a 630-bed teaching and specialty hospital in Minneapolis, Minnesota from 2010 to 2012. Our sample included 2,500 admissions of total hip (THR) and total knee replacement (TKR) patients. Self-reported pain was assessed before and after acupuncture using a 0-10 scale and categorized as none/mild (0-4) and moderate/severe pain (5-10). Seventy-five percent of admissions included acupuncture. Women (Odds Ratio: 1.48, 95% Confidence Interval (CI): 1.22, 1.81) had higher odds of receiving acupuncture compared to men, and nonwhite patients (Odds Ratio: 0.55, 95% CI: 0.39, 0.78) had lower odds of receiving acupuncture compared to white patients. Average short-term pain reduction was 1.91 points (95% CI: 1.83, 1.99), a 45% reduction from the mean prepain score. Forty-one percent of patients reported moderate/severe pain prior to receiving acupuncture, while only 15% indicated moderate/severe pain after acupuncture. Acupuncture may be a viable adjunct to pharmacological approaches for pain management after THR or TKR. Wiley Periodicals, Inc.

  9. Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hannerz Harald

    2011-09-01

    Full Text Available Abstract Background Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers. Methods Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units. Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282 or a control group receiving advice to stay physically active (n = 255. The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9. Results 85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1 and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07. For pain-cases at baseline (pain intensity > = 3 the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity Conclusion High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain. Trial registration NCT01071980.

  10. Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

    Science.gov (United States)

    2011-01-01

    Background Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers. Methods Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9). Results 85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders. Conclusion High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain. Trial registration NCT01071980. PMID:21936939

  11. Editor's Choice-Chest pain relief in patients with acute myocardial infarction.

    Science.gov (United States)

    Parodi, Guido

    2016-06-01

    Chest pain is the prevalent symptom at presentation in patients with acute myocardial infarction (AMI). Despite the complete absence of rigorous studies designed to assess the impact of morphine administration in patients with AMI, clinical practice guidelines strongly recommend morphine for analgesia. However, when using morphine to relieve chest pain in AMI patients, physicians must be aware that hypotension, respiratory depression, vomiting, and delayed onset of action of antiplatelet agents are potential unwanted side effects of the drug. The purpose of this report is to review morphine's clinical and side effects and to propose strategies able to reduce chest pain in AMI patients. © The European Society of Cardiology 2015.

  12. The Relief of Unilateral Painful Thoracic Radiculopathy without Headache from Remote Spontaneous Spinal Cerebrospinal Fluid Leak

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    Byung-chul Son

    2016-01-01

    Full Text Available Spontaneous intracranial hypotension (SIH caused by spontaneous spinal cerebrospinal fluid (CSF leaks produces orthostatic headaches. Although upper arm pain or paresthesia is reportedly associated with SIH from spontaneous spinal CSF leak in the presence of orthostatic headache, low thoracic radicular pain due to spontaneous spinal CSF leak unassociated with postural headache is extremely rare. We report a 67-year-old female who presented with chronic, positional radicular right T11 pain. Computed tomography myelography showed a spontaneous lumbar spinal CSF leak at L2-3 and repeated lumbar epidural blood patches significantly alleviated chronic, positional, and lower thoracic radiculopathic pain. The authors speculate that a chronic spontaneous spinal CSF leak not severe enough to cause typical orthostatic headache or epidural CSF collection may cause local symptoms such as irritation of a remote nerve root. There might be considerable variabilities in the clinical features of SIH which can present a diagnostic challenge.

  13. Sublingual Fentanyl Tablets for Relief of Breakthrough Pain in Cancer Patients and Association with Quality-of-Life Outcomes.

    Science.gov (United States)

    Guitart, Jordi; Vargas, María Isabel; De Sanctis, Vicente; Folch, Jordi; Salazar, Rafael; Fuentes, José; Coma, Jordi; Ferreras, Julia; Moya, Jordi; Tomás, Albert; Estivill, Pere; Rodelas, Francisco; Jiménez, Antonio Javier

    2015-12-01

    Breakthrough pain (BTP) is highly prevalent in patients with cancer and is strongly associated with adverse outcomes related to health status, mood, anxiety and depression. However, studies on the effect of BTP medication on quality of life (QOL) are lacking. The purpose of this study was to provide a qualitative evaluation of the effect of sublingual fentanyl tablets (SFT), a therapy specifically developed for BTP, on the QOL of cancer pain patients. We conducted a multicentre, prospective observation post-authorisation, open-label study between March and December 2013. The study consisted of a screening visit and four assessment points at 3, 7, 15 and 30 days. Pain intensity (PI), frequency of BTP, onset of pain relief and adverse events (AEs) were assessed at each visit. Anxiety and depression were evaluated using the validated Hospital Anxiety and Depression Scale (HADS) and health status using the Short Form 12, version 2 (SF-12v2) Health Survey. Of the 102 patients considered eligible, 81 (79.4 %) were enrolled; of these, 69 (85.1 %) completed the study. Significant pain reduction was achieved for average PI (p < 0.001) compared with baseline. At the end of the observational period, HADS scores showed significant improvement in the depression subscale (p = 0.005) and the anxiety subscale (p < 0.001). Similarly, SF-12 scores showed significant improvement, both in the mental component score (p < 0.001) and the physical component score (p = 0.002). SFT was well-tolerated and only one patient withdrew from the study due to drug-related AEs. SFT represents an effective, well-tolerated treatment for cancer BTP. Results provide consistent evidence for the positive impact of SFT on health-related QOL and physical functioning as well as other co-morbidities of cancer BTP such as anxiety and depression.

  14. Effect of Zingiber officinale R. rhizomes (ginger on pain relief in primary dysmenorrhea: a placebo randomized trial

    Directory of Open Access Journals (Sweden)

    Rahnama Parvin

    2012-07-01

    Full Text Available Abstract Background Zingiber officinale R. rhizome (ginger is a popular spice that has traditionally been used to combat the effects of various inflammatory diseases. The aim of this study was to evaluate the effects of ginger on pain relief in primary dysmenorrhea. Method This was a randomized, controlled trial. The study was based on a sample of one hundred and twenty students with moderate or severe primary dysmenorrhea. The students were all residents of the dormitories of Shahed University. They were randomly assigned into two equal groups, one for ginger and the other for placebo in two different treatment protocols with monthly intervals. The ginger and placebo groups in both protocols received 500 mg capsules of ginger root powder or placebo three times a day. In the first protocol ginger and placebo were given two days before the onset of the menstrual period and continued through the first three days of the menstrual period. In the second protocol ginger and placebo were given only for the first three days of the menstrual period. Severity of pain was determined by a verbal multidimensional scoring system and a visual analogue scale. Results There was no difference in the baseline characteristics of the two groups (placebo n = 46, ginger n = 56. The results of this study showed that there were significant differences in the severity of pain between ginger and placebo groups for protocol one (P = 0.015 and protocol two (P = 0.029. There was also significant difference in duration of pain between the two groups for protocol one (P = 0.017 but not for protocol two (P = 0.210. Conclusion Treatment of primary dysmenorrhea in students with ginger for 5 days had a statistically significant effect on relieving intensity and duration of pain. Trial registration IRCT201105266206N3

  15. Factors affecting pain relief in response to physical exercise interventions among healthcare workers.

    Science.gov (United States)

    Jakobsen, M D; Sundstrup, E; Brandt, M; Andersen, L L

    2016-12-28

    The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Wound infiltration with local anesthetics for post-operative pain relief in lumbar spine surgery

    DEFF Research Database (Denmark)

    Kjærgaard, M; Møiniche, S; Olsen, K S

    2012-01-01

    In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery.......In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery....

  17. Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

    Directory of Open Access Journals (Sweden)

    Taras I. Usichenko

    2005-01-01

    Full Text Available Auricular acupuncture (AA is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points or sham procedure (three non-acupuncture points on the auricular helix before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

  18. Synergistic Effects of Citalopram and Morphine in the Renal Colic Pain Relief; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mehrdad Esmailian

    2014-03-01

    Full Text Available Introduction: Although the synergistic effects of opioids and other analgesic drugs such as non-steroidal anti-inflammatory drugs (NSAIDs have been established in relieving acute pain due to renal calculi, no studies today have evaluated the concomitant administration of opiates and other drugs with analgesic effects, such as serotonin re-uptake inhibitors. Considering the high prevalence of renal colic, the present study was carried out to compare the effect of concomitant prescription of morphine and a placebo with that of morphine and citalopram on the management of acute pain due to renal calculi. Methods: The present double-blind randomized clinical trial was carried out from October 2012 to March 2013 in the Al-Zahra educational Hospital in Isfahan, Iran. A total of 90 patients with acute renal colic pain were randomly divided into two groups of 45 subjects. The subjects in one group received morphine/ placebo and another one morphine/citalopram. The patients’ pain severity was determined by visual analogue scale (VAS before and 20 minutes after administration of medications. In case of persistent pain the second or even third dose was administered and the pain severity was once again determined. Data were analyzed with STATA 11.0 using chi-squared, two-way ANOVA, Bonferroni post hoc test, and log rank test. Results: The decrease in pain severity in the morphine/citalopram group was significantly compared to the morphine/placebo group and the time before administration of the medications (p<0.001. In contrast, administration of morphine/placebo did not have a significant effect on pain severity at this interval (p=0.32. Kaplan-Meier curve showed that the first injection was successful in relieving pain in 15 (33.3% and 26 (57.8% subjects in the morphine/placebo and morphine/citalopram groups, respectively. The second injection of these medications resulted in therapeutic success in 35 (87.8% and 42 (95.6% subjects in the above groups

  19. Benztropine for the relief of acute non-traumatic neck pain (wry neck): a randomised trial.

    Science.gov (United States)

    Asha, Stephen Edward; Kerr, Andrew; Jones, Keryn; McAlpine, Ann

    2015-08-01

    The aim of this study was to determine the effect of intra-muscular benztropine on pain and range of motion in patients presenting to the emergency department with acute, non-traumatic neck pain (wry neck). In this two-centre randomised, double-blind, placebo-controlled, parallel-group superiority trial, participants were allocated to receive 2 mg intramuscular benztropine or normal saline. Participants were aged 16-65 years, no history of neck disorders and no use of medication that cause dystonia. Randomisation was computer generated, with allocation concealment by opaque sequentially numbered sealed envelopes. Pain scores and neck range of motion were measured immediately before drug administration, and 30 min after. Pain scores, range of motion and adverse effects were compared between the groups. No funding was received. The trial was registered. Thirty participants were enrolled, 15 randomised to placebo and 15 to benztropine. Pain scores at 30 min were lower in those allocated to benztropine, but the difference was neither statistically nor clinically significant (0.6 points, 95% CI -0.8 to 1.8, p=0.40). The range of motion of the cervical spine was greater in those receiving benztropine, but the differences were very small and not statistically significant. Adverse events were more common in those receiving benztropine. Benztropine was ineffective for reducing pain or improving range of motion of the cervical spine in patients suffering from acute, non-traumatic neck pain, but frequently caused anticholinergic side effects. However, as the CI for the primary outcome included the minimum difference considered clinically significant, an important effect of benztropine cannot be ruled out. ANZCTR#12612000354886. 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.

  20. Massage or music for pain relief in labour: a pilot randomised placebo controlled trial.

    Science.gov (United States)

    Kimber, L; McNabb, M; Mc Court, C; Haines, A; Brocklehurst, P

    2008-11-01

    Research on massage therapy for maternal pain and anxiety in labour is currently limited to four small trials. Each used different massage techniques, at different frequencies and durations, and relaxation techniques were included in three trials. Given the need to investigate massage interventions that complement maternal neurophysiological adaptations to labour and birth pain(s), we designed a pilot randomised controlled trial (RCT) to test the effects of a massage programme practised during physiological changes in pain threshold, from late pregnancy to birth, on women's reported pain, measured by a visual analogue scale (VAS) at 90 min following birth. To control for the potential bias of the possible effects of support offered within preparation for the intervention group, the study included 3 arms--intervention (massage programme with relaxation techniques), placebo (music with relaxation techniques) and control (usual care). The placebo offered a non-pharmacological coping strategy, to ensure that use of massage was the only difference between intervention and placebo groups. There was a trend towards slightly lower mean pain scores in the intervention group but these differences were not statistically significant. No differences were found in use of pharmacological analgesia, need for augmentation or mode of delivery. There was a trend towards more positive views of labour preparedness and sense of control in the intervention and placebo groups, compared with the control group. These findings suggest that regular massage with relaxation techniques from late pregnancy to birth is an acceptable coping strategy that merits a large trial with sufficient power to detect differences in reported pain as a primary outcome measure.

  1. Antidepressants inhibit P2X4 receptor function: a possible involvement in neuropathic pain relief

    Directory of Open Access Journals (Sweden)

    Tozaki-Saitoh Hidetoshi

    2009-04-01

    Full Text Available Abstract Background Neuropathic pain is characterized by pain hypersensitivity to innocuous stimuli (tactile allodynia that is nearly always resistant to known treatments such as non-steroidal anti-inflammatory drugs or even opioids. It has been reported that some antidepressants are effective for treating neuropathic pain. However, the underlying molecular mechanisms are not well understood. We have recently demonstrated that blocking P2X4 receptors in the spinal cord reverses tactile allodynia after peripheral nerve injury in rats, implying that P2X4 receptors are a key molecule in neuropathic pain. We investigated a possible role of antidepressants as inhibitors of P2X4 receptors and analysed their analgesic mechanism using an animal model of neuropathic pain. Results Antidepressants strongly inhibited ATP-mediated Ca2+ responses in P2X4 receptor-expressing 1321N1 cells, which are known to have no endogenous ATP receptors. Paroxetine exhibited the most powerful inhibition of calcium influx via rat and human P2X4 receptors, with IC50 values of 2.45 μM and 1.87 μM, respectively. Intrathecal administration of paroxetine produced a striking antiallodynic effect in an animal model of neuropathic pain. Co-administration of WAY100635, ketanserin or ondansetron with paroxetine induced no significant change in the antiallodynic effect of paroxetine. Furthermore, the antiallodynic effect of paroxetine was observed even in rats that had received intrathecal pretreatment with 5,7-dihydroxytryptamine, which dramatically depletes spinal 5-hydroxytryptamine. Conclusion These results suggest that paroxetine acts as a potent analgesic in the spinal cord via a mechanism independent of its inhibitory effect on serotonin transporters. Powerful inhibition on P2X4 receptors may underlie the analgesic effect of paroxetine, and it is possible that some antidepressants clinically used in patients with neuropathic pain show antiallodynic effects, at least in part

  2. Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

    Directory of Open Access Journals (Sweden)

    Gaonkar V

    2004-01-01

    Full Text Available In this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25 or peri-incisional infiltration (n=25 pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline. The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia was rapid and complete. There was excellent postoperative analgesia. The children were calm and comfortable postoperatively. We conclude that infra-orbital nerve block with 0.25% bupivacaine with adrenaline provides more prolonged analgesia than peri-incisional infiltration in cleft lip repair. Infra-orbital block given by modified approach is easy to perform and free of side-effects.

  3. Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

    Science.gov (United States)

    Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

    2017-11-01

    Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

  4. Effect of preemptive topical diclofenac on postoperative pain relief after photorefractive keratectomy.

    Science.gov (United States)

    Mohammadpour, Mehrdad; Jabbarvand, Mahmood; Nikdel, Mojgan; Adelpour, Mohsen; Karimi, Nasser

    2011-04-01

    To assess the prophylactic effect of preoperative application of topical diclofenac on postoperative pain control in patients having photorefractive keratectomy (PRK). Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Randomized masked clinical trial. In this paired-eye study, patients having bilateral PRK received 1 drop of diclofenac 0.1% in 1 eye and 1 drop of placebo in the fellow eye 2 hours before PRK. Postoperatively, both arms of the trial (both eyes of each patient) received topical diclofenac every 6 hours for 2 days. One day and 2 days postoperatively, patients were asked to rate the perceived pain in each eye using an 11-point verbal numerical rating scale. A trained examiner noted the eye-specific responses. All 70 patients (140 eyes) completed the study and were included in the statistical analysis. Twenty-four hours after PRK, patients reported pain scores that were clinically and statistically significantly lower in the eyes pretreated with diclofenac than in the fellow eyes (0.97 versus 2.09) (P=.018). Pain scores at 2 days did not differ significantly (P=.877). Administration of a single drop of topical diclofenac 0.1% 2 hours before PRK seemed to increase the efficacy of postoperative pain management in a clinically and statistically significant manner. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  5. Inhaled methoxyflurane for pain and anxiety relief during burn wound care procedures: an Australian case series.

    Science.gov (United States)

    Wasiak, Jason; Mahar, Patrick D; Paul, Eldho; Menezes, Hana; Spinks, Anneliese B; Cleland, Heather

    2014-02-01

    Pain is a common and significant feature of burn injury. The use of intravenous opioids forms the mainstay of procedural burn pain management, but in an outpatient setting, the demand for novel agents that do not require parenteral access, are easy to administer and have a rapid onset are urgently needed. One such agent is the inhaled anaesthetic agent, methoxyflurane (MF). The aim of this study was to conduct a pilot investigation into the clinical effectiveness of MF inhaler on pain and anxiety scores in patients undergoing burn wound care procedures in an outpatient setting. A prospective case series involved recruiting patients undergoing a burn wound care procedure in an ambulatory burn care setting. Pain and anxiety were assessed using numerical rating scales. Overall, median numerical pain rating score was significantly higher post-dressing [pre-dressing: 2; interquartile range (IQR): 1-3 versus post-dressing: 3; IQR 1·5-4; P = 0·01], whereas median numerical anxiety score significantly reduced following the dressing (pre-dressing: 5; IQR 4-7 versus post-dressing: 2; IQR 1-2; P burn care procedures in the ambulatory care setting. However, there is an urgent need for larger case series and randomised controlled trials to determine its overall clinical effectiveness. © 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  6. 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.

    Science.gov (United States)

    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

  7. The effect of mud therapy on pain relief in patients with knee osteoarthritis: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Liu, Hua; Zeng, Chao; Gao, Shu-guang; Yang, Tuo; Luo, Wei; Li, Yu-sheng; Xiong, Yi-lin; Sun, Jin-peng; Lei, Guang-hua

    2013-10-01

    A meta-analysis was conducted to examine the effect of mud therapy on pain relief in patients with knee osteoarthritis (OA). A detailed search of PubMed®/MEDLINE® was undertaken to identify randomized controlled trials and prospective comparative studies published before 9 March 2013 that compared mud therapy with control group treatments in patients with knee OA. A quantitative meta-analysis of seven studies (410 patients) was performed. There was a significant difference between the groups in the visual analogue scale pain score (standardized mean difference [SMD] -0.73) and Western Ontario and McMaster Universities Osteoarthritis Index pain score (SMD -0.30), with differences in favour of mud therapy. Mud therapy is a favourable option for pain relief in patients with knee OA. Additional high-quality randomized controlled trials need to be conducted to explore this issue further and to confirm this conclusion.

  8. Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial.

    Science.gov (United States)

    Chen, Chun-Chieh; Yang, Chien-Chung; Hu, Chih-Chien; Shih, Hsin-Nung; Chang, Yu-Han; Hsieh, Pang-Hsin

    2015-01-01

    The effectiveness of acupuncture in relieving acute postoperative pain is still controversial. This patient-evaluator blinded and sham auricular acupuncture (AA)-controlled study tested whether acupuncture is effective in controlling acute postoperative pain after total knee arthroplasty. Patients were randomly assigned to receive true acupuncture (knee, scalp, and AA) or sham AA. All procedures were conducted under general anesthesia, and the AA needles were retained in situ for 3 days. Postoperative pain was managed with intravenous fentanyl using a patient-controlled analgesia pump. The amount of postoperative fentanyl required, the time to the first fentanyl request, pain intensity on a 100-mm visual analog scale, incidence of analgesia-related adverse effects, and success of patients' blinding were recorded. This study comprised 60 patients (30 in the study group and 30 in the control group). The fentanyl requirement via patient-controlled analgesia in the study group was lower [mean (SD), 620.7 (258.2) vs 868.6 (319.3) μg; P = 0.002). The time to first request for fentanyl was longer in the study group. Pain intensity on a 100-mm visual analog scale was lower in the study group in the first 24 hours after the operation. The incidence of analgesia-related adverse effects of nausea and vomiting was lower in the study group. The success of blinding was not significantly different between the 2 groups (P = 0.731). The data obtained from this clinical trial demonstrate the potential advantages of using acupuncture for postoperative pain control after total knee arthroplasty.

  9. The Chitranjan Ranawat Award: Periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial.

    Science.gov (United States)

    Spangehl, Mark J; Clarke, Henry D; Hentz, Joseph G; Misra, Lopa; Blocher, Joshua L; Seamans, David P

    2015-01-01

    Two of the more common methods of pain management after TKA are peripheral nerve blocks and intraarticular/periarticular injections. However, we are not aware of any study directly comparing the commonly used combination of a continuous femoral block given with a single-shot sciatic block with that of a periarticular injection after TKA. This randomized clinical trial compared a combined femoral and sciatic nerve block with periarticular injection as part of a multimodal pain protocol after total knee arthroplasty with respect to (1) pain; (2) narcotic use; (3) quadriceps function and length of stay; and (4) peripheral nerve complications. One hundred sixty patients completed randomization into two treatment arms: (1) peripheral nerve blocks (PNB; n=79) with an indwelling femoral nerve catheter and a single shot sciatic block; or (2) periarticular injection (PAI; n=81) using ropivacaine, epinephrine, ketorolac, and morphine. All patients received standardized general anesthesia and oral medications. The primary outcome was postoperative pain, on a 0 to 10 scale, measured on the afternoon of postoperative day 1 (POD 1). Secondary outcomes were narcotic use, quadriceps function, length of stay, and peripheral nerve complications. Mean pain scores on the afternoon of POD 1 were not different between groups (PNB group: 2.9 [SD 2.4]; PAI group: 3.0 [SD 2.2]; 95% confidence interval, -0.8 to 0.6; p=0.76). Mean pain scores taken at three times points on POD 1 were also similar between groups. Hospital length of stay was shorter for the PAI group (2.44 days [SD 0.65] versus 2.84 days [SD 1.34] for the PNB group; p=0.02). Narcotic consumption was higher the day of surgery for the PAI group (PAI group: 11.7 mg morphine equivalents [SD 13.1]; PNB group: 4.6 mg [SD 9.1]; pblocks. Periarticular injections provide adequate pain relief, are simple to use, and avoid the potential complications associated with nerve blocks. Level I, therapeutic study. See Guidelines for Authors for

  10. Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain.

    Science.gov (United States)

    Saunders, Mary; Adelgais, Kathleen; Nelson, Douglas

    2010-11-01

    The objective was to evaluate the use of a single 2 μg/kg dose of intranasal fentanyl as analgesia for painful orthopedic injuries in children presenting to a pediatric emergency department (ED). This was a prospective, nonblinded interventional trial, in a convenience sample of patients 3 to 18 years of age seen in a tertiary care pediatric ED. All had clinically suspected fractures and were treated between July and November 2006. Eligible patients had moderate to severe pain based on initial pain scores using the Wong Baker Faces Scale (WBS) for patients aged 3-8 years or the Visual Analog Scale (VAS) for patients aged 9-18 years. All enrolled patients received fentanyl via intranasal atomization. Pain scores were obtained at baseline and at 10, 20, and 30 minutes after intranasal fentanyl administration. Satisfaction scores were obtained using a 100-mm VAS. Vital signs and adverse events were recorded. Eighty-one patients were enrolled, 28 in the VAS group and 53 in the WBS group. The mean patient age was 8 years. Fracture locations included forearm, 38 (47%); supracondylar, 16 (20%); clavicle, 7 (9%); tibia/fibula, 5 (6%); and other, 15 (18%). In the WBS group, the median pain scores decreased from five faces (interquartile range [IQR] = 4-6) at baseline to three faces (IQR = 2-5) at 10 minutes, two faces (IQR = 1-4) at 20 minutes, and two faces (IQR = 1-3) at 30 minutes. The mean pain score in the VAS group at baseline was 70 mm (95% confidence interval [CI] = 63 to 77 mm). In this group, the pain scores decreased by a mean of 21 mm (95% CI = 14 to 28 mm) at 10 minutes, 25 mm (95% CI = 15 to 34 mm) at 20 minutes, and 27 mm (95% CI = 16 to 37 mm) at 30 minutes. Mean satisfaction scores were 79 mm for providers, 74 mm for parents, and 62 mm for patients. No adverse events were recorded.   Intranasal fentanyl at a dose of 2 μg/kg provides effective analgesia for pediatric ED patients with painful orthopedic trauma within 10 minutes of administration. © 2010

  11. Tramadol suppositories are less suitable for post-operative pain relief than rectal acetaminophen/codeine

    NARCIS (Netherlands)

    Pluim, M. A.; Wegener, J. T.; Rupreht, J.; Vulto, A. G.

    1999-01-01

    The suitability of tramadol suppositories for inclusion in our hospital formulary for the treatment of mild to moderate post-operative pain was evaluated. In an open randomized trial, rectal tramadol was compared with our standard treatment acetaminophen/codeine suppositories. We expected tramadol

  12. Music and 25% glucose pain relief for the premature infant: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Maria Vera Lúcia Moreira Leitão Cardoso

    2014-10-01

    Full Text Available OBJECTIVE: to analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture during music and 25% glucose interventions, and to assess their association with neonatal and therapeutic variables.METHOD: a randomized clinical trial with 80 premature infants; 24 in the Experimental Group 1 (music, 33 in the Experimental Group 2 (music and 25% glucose, 23 in the Positive Control Group (25% glucose. All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2; 25% glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture.RESULTS: 60.0% of premature infants had moderate or maximum pain; pain scores and intervention groups were not statistically significant. Statistically significant variables: Experimental Group 1: head and chest circumference, Apgar scores, corrected gestational age; Experimental Group 2: chest circumference, Apgar scores, oxygen therapy; Positive Control group: birth weight, head circumference.CONCLUSION: neonatal variables are associated with pain in premature infants. Brazilian Registry of Clinical Trials: UTN: U1111-1123-4821.

  13. Music and 25% glucose pain relief for the premature infant: a randomized clinical trial.

    Science.gov (United States)

    Cardoso, Maria Vera Lúcia Moreira Leitão; Farias, Leiliane Martins; de Melo, Gleicia Martins

    2014-10-01

    To analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture during music and 25% glucose interventions, and to assess their association with neonatal and therapeutic variables. A randomized clinical trial with 80 premature infants; 24 in the Experimental Group 1 (music), 33 in the Experimental Group 2 (music and 25% glucose), 23 in the Positive Control Group (25% glucose). All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2; 25% glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture. 60.0% of premature infants had moderate or maximum pain; pain scores and intervention groups were not statistically significant. Statistically significant variables: Experimental Group 1: head and chest circumference, Apgar scores, corrected gestational age; Experimental Group 2: chest circumference, Apgar scores, oxygen therapy; Positive Control group: birth weight, head circumference. Neonatal variables are associated with pain in premature infants. Brazilian Registry of Clinical Trials: UTN: U1111-1123-4821.

  14. Effect of music therapy during vaginal delivery on postpartum pain relief and mental health.

    Science.gov (United States)

    Simavli, Serap; Kaygusuz, Ikbal; Gumus, Ilknur; Usluogulları, Betul; Yildirim, Melahat; Kafali, Hasan

    2014-03-01

    Childbirth is an important experience in a woman's life, and unfavorable birth experiences have been shown to negatively impact postpartum maternal health. Aim of this study was to evaluate the effects of music therapy on postpartum pain, anxiety level, satisfaction and early pospartum depression rate. Totally 161 primiparous women were recruited and randomized either music group (n=80) or a control group (n=81). Women in the music group listened to self-selected music during labor. Postpartum pain intensity, anxiety level and satisfaction rate were measured using the visual analog scale (VAS), postpartum depression rate was assessed with Edinburg Postpartum Depression Scale (EPDS) at postpartum day one and day eight. Mothers in the music therapy group had a lower level of postpartum pain and anxiety than the control group and it was statistically significant at all time intervals (1, 4, 8, 16 and 24h, pmusic therapy on early postpartum depression rate. Effect of music on late postpartum depression rate should be investigated in future. Using music therapy during labor decreased postpartum anxiety and pain, increased the satisfaction with childbirth and reduced early postpartum depression rate. Music therapy can be clinically recommended as an alternative, safe, easy and enjoyable nonpharmacological method for postpartum well-being. Published by Elsevier B.V.

  15. Pain relief, spiritual needs, and family support: three central areas in intercultural palliative care.

    Science.gov (United States)

    Hanssen, Ingrid; Pedersen, Gry

    2013-12-01

    The purpose of this study was to draw out and coalesce the topic-specific information found in research literature regarding the provision of culturally sensitive palliative practice. This was a literature study and Gadamerian hermeneutic text analysis. It is more difficult to assess the level of pain in ethnic minority patients, and healthcare providers may become frustrated and interpret pain symptoms as fabrication. These patients are more likely to receive inadequate pain medication. Physical symptom management has become the priority in palliative care, but pain must also be viewed from the perspective of its social, cultural, and spiritual significance. Collectivist values may lead to an other-reliant and dependent coping style. This and religious demands may cause the family to rally around the patient. Many dying patients wish to be cared for at home by their families, but as the patient often has complex needs, the family may not be able to cope with the patient's care. Formal education and in-service programs are needed for healthcare providers, together with empirical studies regarding how to achieve more culturally appropriate care in intercultural palliative practice. The immigrant population needs to be educated about cancer and the various kinds of palliative and hospice care offered in the society in which they now live.

  16. Motor Cortex Stimulation for Pain Relief: Do Corollary Discharges Play a Role?

    Science.gov (United States)

    Brasil-Neto, Joaquim P

    2016-01-01

    Both invasive and non-invasive motor cortex stimulation techniques have been successfully employed in the treatment of chronic pain, but the precise mechanism of action of such treatments is not fully understood. It has been hypothesized that a mismatch of normal interaction between motor intention and sensory feedback may result in central pain. Sensory feedback may come from peripheral nerves, vision and also from corollary discharges originating from the motor cortex itself. Therefore, a possible mechanism of action of motor cortex stimulation might be corollary discharge reinforcement, which could counterbalance sensory feedback deficiency. In other instances, primary deficiency in the production of corollary discharges by the motor cortex might be the culprit and stimulation of cortical motor areas might then be beneficial by enhancing production of such discharges. Here we review evidence for a possible role of motor cortex corollary discharges upon both the pathophysiology and the response to motor cortex stimulation of different types of chronic pain. We further suggest that the right dorsolateral prefrontal cortex (DLPC), thought to constantly monitor incongruity between corollary discharges, vision and proprioception, might be an interesting target for non-invasive neuromodulation in cases of chronic neuropathic pain.

  17. knowledge, attitude and use of pain relief in labour among women ...

    African Journals Online (AJOL)

    2014-07-01

    Jul 1, 2014 ... labour leads to release of catecholamines hence a reflex increase in blood pressure and oxygen consumption all of which could adversely affect uterine blood ... evoke intense negative reaction in some women (14). Early detection of risk factors such as pain will help improve on the psychological impact of ...

  18. Effectiveness of preemptive intra-articular levobupivacaine on pain relief after arthroscopic knee surgery

    Directory of Open Access Journals (Sweden)

    Seher Altinel

    2017-06-01

    Conclusion: Preemptive analgesia using intraarticular levobupivacaine 5 mg/ml (20 ml total volume provides better pain control-evaluated through VAS scoring, time to first analgesic request and opioid consumption - compared to saline in patients undergoing arthroscopic knee surgery. [Arch Clin Exp Surg 2017; 6(2.000: 91-95

  19. Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department

    Directory of Open Access Journals (Sweden)

    Dickason, R. Myles

    2015-05-01

    Full Text Available Introduction: The decision to treat pain in the emergency department (ED is a complex, idiosyncratic process. Prior studies have shown that EDs undertreat pain. Several studies demonstrate an association between analgesia administration and race. This is the first Midwest single institution study to address the question of race and analgesia, in addition to examining the effects of both patient and physician characteristics on race-based disparities in analgesia administration. Methods: This was a retrospective chart review of patients presenting to an urban academic ED with an isolated diagnosis of back pain, migraine, or long bone fracture (LBF from January 1, 2007 to December 31, 2011. Demographic and medication administration information was collected from patient charts by trained data collectors blinded to the hypothesis of the study. The primary outcome was the proportion of African-Americans who received analgesia and opiates, as compared to Caucasians, using Pearson’s chi-squared test. We developed a multiple logistic regression model to identify which physician and patient characteristics correlated with increased opiate administration. Results: Of the 2,461 patients meeting inclusion criteria, 57% were African-American and 30% Caucasian (n=2136. There was no statistically significant racial difference in the administration of any analgesia (back pain: 86% vs. 86%, p=0.81; migraine: 83% vs. 73%, p=0.09; LBF: 94% vs. 90%, p=0.17, or in opiate administration for migraine or LBF. African-Americans who presented with back pain were less likely to receive an opiate than Caucasians (50% vs. 72%, p<0.001. Secondary outcomes showed that higher acuity, older age, physician training in emergency medicine, and male physicians were positively associated with opiate administration. Neither race nor gender patient-physician congruency correlated with opiate administration. Conclusion: No race-based disparity in overall analgesia administration was

  20. Effect of adding celecoxib to a single dose of gabapentin on postoperative pain relief

    Directory of Open Access Journals (Sweden)

    Mansour Choubsaz

    2015-01-01

    Full Text Available Background: In recent years, several studies with conflicting results have been done on the role of gabapentin and non-steroidal anti-inflammatory drugs in pre-emptive analgesia to control postoperative pain. The purpose of this study was to evaluate the effect of adding low doses of celecoxib to gabapentin on increasing the analgesic effect and patients’ satisfaction. Methods: In this double-blind randomized clinical trial, 130 patients with ASA I, II class were divided in two groups as they were the candidates for elective inguinal hernia surgery with spinal anesthesia. Before the surgery, the control group (G received 300 mg oral dose of gabapentin and the study group (GC received 100 mg celecoxib in addition to the above dose. Severity of patients’ pain was measured using the visual analogue scale (VAS. By the same token, the amount of painkillers usedwas measured and statistically analyzed. Results: The results suggested a statistically significant difference between the two groups in terms of pain level 4, 6 and 24 hours after surgery (P<0.05. Adding low-dose of celeoxib to gabapentin before the surgery and the combination of these two drugs caused further reduction of pain 4, 6 and 24 h after the surgery in comparison to the administration of gabapentin alone. Conclusion: Adding 100 mg celecoxib to 300 mg gabapentin resulted in a reduction of pain level 24 h after elective surgery of inguinal hernia in patients of control group (P<0.05. However, in terms of using painkillers (analgesics, there was no statistically significant difference between the two groups.

  1. Immediate and Sustained Effects of 5-Day Transcranial Direct Current Stimulation of the Motor Cortex in Phantom Limb Pain.

    Science.gov (United States)

    Bolognini, Nadia; Spandri, Viviana; Ferraro, Francesco; Salmaggi, Andrea; Molinari, Alessandro C L; Fregni, Felipe; Maravita, Angelo

    2015-07-01

    The study explored the analgesic effects of transcranial direct current stimulation (tDCS) over the motor cortex on postamputation phantom limb pain (PLP). Eight subjects with unilateral lower or upper limb amputation and chronic PLP were enrolled in a crossover, double-blind, sham-controlled treatment program. For 5 consecutive days, anodal (active or sham) tDCS was applied over the motor cortex for 15 minutes at an intensity of 1.5 mA. The 5-day treatment with active, but not sham, tDCS induced a sustained decrease in background PLP and in the frequency of PLP paroxysms, which lasted for 1 week after the end of treatment. Moreover, on each day of active tDCS, patients reported an immediate PLP relief, along with an increased ability to move their phantom limb. Patients' immediate responses to sham tDCS, on the contrary, were variable, marked by an increase or decrease of PLP levels from baseline. These results show that a 5-day treatment of motor cortex stimulation with tDCS can induce stable relief from PLP in amputees. Neuromodulation targeting the motor cortex appears to be a promising option for the management of this debilitating neuropathic pain condition, which is often refractory to classic pharmacologic and surgical treatments. The study describes sustained and immediate effects of motor cortex stimulation by tDCS on postamputation PLP, whose analgesic action seems linked to the motor reactivation of the phantom limb. These results are helpful for the exploitation of tDCS as a therapeutic tool for the management of neuropathic pain. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

  2. Intra-operative ketamine infiltration in tonsillar bed for relief of post-tonsillectomy pain

    Directory of Open Access Journals (Sweden)

    Sonbolestan SM

    2008-09-01

    Full Text Available "nBackground: Post-tonsillectomy pain is often severe and usually prevents patients from routine eating and drinking. A new option for reducing postoperative pain is "preemptive analgesia", the pre-, intra- or post-operative administration of analgesic agents. Ketamine, an N-methyl D-aspartate receptor antagonist, has recently received attention for this aim. Herein, we study the effect of submucosal injection of ketamine in the tonsillar bed for the reduction of post-tonsillectomy pain. "nMethods: In this double-blind clinical trial, three groups of patients underwent infiltration of 0.5mg/kg ketamine, 1mg/kg ketamine or normal saline in their tonsillar bed. Age, sex and weight of patients, duration of surgery, systolic and diastolic blood pressure (before and after surgery, volume of blood loss, reoccurrence of bleeding, time to initiation of oral intake, nausea, vomiting, pain score and dysphasia were recorded in information sheet. Data analysis was performed by one-way ANOVA and chi squared tests, with significance at a P value of <0.5. "nResults: There is no significant difference between the three groups with regard to age, sex, weight, duration of surgery, blood pressure (before surgery, volume of blood loss, nausea and vomiting. However, for the ketamine groups, pain score, dysphasia, need for opioid administration and time to initiation of oral intake is significantly lower (P<0.00. Reoccurrence of bleeding was observed in one patient in the lower-dose ketamine group, which is not statistically significant. The effectiveness of the two doses of ketamine is similar, with no statistical difference between the two groups (P=0.84. "nConclusions: This study demonstrated that a submucosal injection of ketamine into the tonsillar bed preoperatively is a safe option for reducing post-tonsillectomy pain, dysphasia, need for opioid and time to initiation of oral intake, without increasing the risk of excessive bleeding, reoccurrence of bleeding

  3. The β-lactam clavulanic acid mediates glutamate transport-sensitive pain relief in a rat model of neuropathic pain.

    Science.gov (United States)

    Kristensen, P J; Gegelashvili, G; Munro, G; Heegaard, A M; Bjerrum, O J

    2018-02-01

    Following nerve injury, down-regulation of astroglial glutamate transporters (GluTs) with subsequent extracellular glutamate accumulation is a key factor contributing to hyperexcitability within the spinal dorsal horn. Some β-lactam antibiotics can up-regulate GluTs, one of which, ceftriaxone, displays analgesic effects in rodent chronic pain models. Here, the antinociceptive actions of another β-lactam clavulanic acid, which possesses negligible antibiotic activity, were compared with ceftriaxone in rats with chronic constriction injury (CCI)-induced neuropathic pain. In addition, the protein expression of glutamate transporter-1 (GLT1), its splice variant GLT1b and glutamate-aspartate transporter (GLAST) was measured in the spinal cord of CCI rats. Finally, protein expression of the same GluTs was evaluated in cultured astrocytes obtained from rodents and humans. Repeated injection of ceftriaxone or clavulanic acid over 10 days alleviated CCI-induced mechanical hypersensitivity, whilst clavulanic acid was additionally able to affect the thermal hypersensitivity. In addition, clavulanic acid up-regulated expression of GLT1b within the spinal cord of CCI rats, whereas ceftriaxone failed to modulate expression of any GluTs in this model. However, both clavulanic acid and ceftriaxone up-regulated GLT1 expression in rat cortical and human spinal astrocyte cultures. Furthermore, clavulanic acid increased expression of GLT1b and GLAST in rat astrocytes in a dose-dependent manner. Thus, clavulanic acid up-regulates GluTs in cultured rodent- and human astroglia and alleviates CCI-induced hypersensitivity, most likely through up-regulation of GLT1b in spinal dorsal horn. Chronic dosing of clavulanic acid alleviates neuropathic pain in rats and up-regulates glutamate transporters both in vitro and in vivo. Crucially, a similar up-regulation of glutamate transporters in human spinal astrocytes by clavulanic acid supports the development of novel

  4. [Pre-emptive ketoprofen for postoperative pain relief after urologic surgery].

    Science.gov (United States)

    Rutyna, Rafał; Popowicz, Magdalena; Wojewoda, Paweł; Nestorowicz, Andrzej; Białek, Waldemar

    2011-01-01

    Effective multimodal postoperative analgesia is one of determinants of patient satisfaction after successful surgery. Following the recommendations of non-steroidal antiinflammatory agents (NSAIDs) for pre-emptive analgesia, we assessed the efficacy of ketoprofen administered before urological surgery. Fifty-two ASA I and II adult patients, scheduled for elective urologic procedures under general anaesthesia, were enrolled in this prospective, double blind study. They were randomized to receive intravenously either 100 mg ketoprofen or placebo (0.9% saline), one hour before the procedure, and at 8, 24, 36 and 48 h after. Pethidine was given for rescue analgesia. VAS was used for pain scoring. Pain scores were similar in both groups and identified as severe (VAS >4) during the first 48 h after surgery. There was no difference in the number of patients requiring rescue pethidine analgesia, mostly required during the first 12 postoperative hours. Pre-emptive analgesia with intravenous ketoprofen was ineffective in patients undergoing urological surgery.

  5. Immediate Pain Relief in Adhesive Capsulitis by Acupuncture-A Randomized Controlled Double-Blinded Study.

    Science.gov (United States)

    Schröder, Sven; Meyer-Hamme, Gesa; Friedemann, Thomas; Kirch, Sebastian; Hauck, Michael; Plaetke, Rosemarie; Friedrichs, Sunja; Gulati, Amit; Briem, Daniel

    2017-11-01

    Primary adhesive capsulitis (AC), or frozen shoulder, is an insidious and idiopathic disease. Severe pain is predominant in the first two of the three stages of the condition, which can last up to 21 months. Sixty volunteers with primary AC were randomly assigned to acupuncture with press tack needles compared with press tack placebos in a patient- and observer-blinded placebo-controlled study. The participants were subsequently offered classical needle acupuncture in an open follow-up clinical application. Thirty-four volunteers received conservative therapy, including 10 classical needle acupuncture treatments over 10 weeks, 13 volunteers received conservative therapy without classical needle acupuncture. All subjects agreed to follow-up after one year. Acupuncture treatment was performed using a specific distal needling concept, using reflex areas on distant extremities avoiding local treatment. An immediate improvement of 3.3 ± 3.2 points in Constant-Murley Shoulder Score (CMS) pain subscore was seen in the press tack needles group and of 1.6 ± 2.8 points in the press tack placebos group (P acupuncture significantly improved the pain subscore within 14.9 ± 15.9 weeks compared with 30.9 ± 15.8 weeks with only conservative therapy (P efficiency of distal needling acupuncture on immediate pain reduction was demonstrated in patients with AC and confirmed the applicability of press tack needles and press tack placebos for double-blind studies in acupuncture. Subsequent clinical application observation proved that results obtained with press tack needles/press tack placebos can be transferred to classical needle acupuncture. Integrating acupuncture with conservative therapy showed superior effectiveness with respect to the time course of the recovery process in AC compared with conservative therapy alone.

  6. IMPACT OF INTERFERENTIAL CURRENT ON PAIN RELIEF AMONG PATIENTS WITH ORCHIALGIA

    OpenAIRE

    Hany M.I. Elgohary; Sayed A. Tantawy; Hadaya M. R. Eladl

    2016-01-01

    Background: Scrotal discomfort can contribute to unusual impact on body scheme and result in behavioral alterations, as well as changes in sexual function such as delay of sexual ability that may affect both man and his companion. There are many physiotherapy modalities to reduce the intratesticular pain such as pelvic floor muscle training, hydrotherapy, ultrasound and electrotherapy. Interferential current therapy is a noninvasive therapy used to reduce acute and chronic, post-operative and...

  7. Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

    OpenAIRE

    Hannerz Harald; Roessler Kirsten K; Boysen Marianne; Pedersen Mette M; Andersen Christoffer H; Mortensen Peter; Pedersen Mogens T; Andersen Lars L; Zebis Mette K; Mortensen Ole S; Sjøgaard Gisela

    2011-01-01

    Abstract Background Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers. Methods Cluster-randomized controlled trial involving 537 adults from ...

  8. EMG biofeedback training, relaxation training, and placebo for the relief of chronic back pain.

    Science.gov (United States)

    Stuckey, S J; Jacobs, A; Goldfarb, J

    1986-12-01

    24 patients with chronic low back pain were randomly assigned to three treatment conditions: EMG biofeedback, relaxation training, and a placebo condition. Patients were seen for eight sessions and were evaluated before Session 1 and after Session 8. Eight analyses of covariance which were adjusted for age and pretest scores were computed on the final scores to find which variables could detect significant difference between treatments. Age was included as a covariate because the differences in age between conditions were significant. Four variables with significant and nearly significant differences were chosen for analysis. The second set of analyses identified the nature of the differences among the three conditions. These included a priori planned comparisons among conditions, and paired t tests. Relaxation-trained subjects were significantly superior to subjects in the placebo condition, in decreasing pain during the function test, increasing relaxation, and decreasing Upper Trapezius EMG. They were superior to EMG Biofeedback training in increasing reported activity. Both Relaxation and EMG trained subjects were able to reduce Upper Trapezius EMG by Session 8. Relaxation-trained subjects showed significant change on eight of the 14 possible comparisons for each treatment condition. EMG biofeedback training showed significant favorable results in only one condition; the placebo condition showed no significant results. Relaxation training gave better results in reducing EMG and pain, and in increasing relaxation and activity than either EMG biofeedback alone or a placebo condition.

  9. A Self-Administered Method of Acute Pressure Block of Sciatic Nerves for Short-Term Relief of Dental Pain: A Randomized Study

    Science.gov (United States)

    Wang, Xiaolin; Zhao, Wanghong; Wang, Ye; Hu, Jiao; Chen, Qiu; Yu, Juncai; Wu, Bin; Huang, Rong; Gao, Jie; He, Jiman

    2014-01-01

    Objectives While stimulation of the peripheral nerves increases the pain threshold, chronic pressure stimulation of the sciatic nerve is associated with sciatica. We recently found that acute pressure block of the sciatic nerve inhibits pain. Therefore, we propose that, the pain pathology-causing pressure is chronic, not acute. Here, we report a novel self-administered method: acute pressure block of the sciatic nerves is applied by the patients themselves for short-term relief of pain from dental diseases. Design This was a randomized, single-blind study. Setting Hospital patients. Patients Patients aged 16–60 years with acute pulpitis, acute apical periodontitis, or pericoronitis of the third molar of the mandible experiencing pain ≥3 on the 11-point numerical pain rating scale. Interventions Three-minute pressure to sciatic nerves was applied by using the hands (hand pressure method) or by having the patients squat to force the thigh and shin as tightly as possible on the sandwiched sciatic nerve bundles (self-administered method). Outcomes The primary efficacy variable was the mean difference in pain scores from the baseline. Results One hundred seventy-two dental patients were randomized. The self-administered method produced significant relief from pain associated with dental diseases (P ≤ 0.001). The analgesic effect of the self-administered method was similar to that of the hand pressure method. Conclusions The self-administered method is easy to learn and can be applied at any time for pain relief. We believe that patients will benefit from this method. PMID:24400593

  10. Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial

    Directory of Open Access Journals (Sweden)

    Ana C. R. Pitangui

    2014-01-01

    Full Text Available Objective: To evaluate the effectiveness of low-frequency TENS (LFT and high-frequency TENS (HFT in post-episiotomy pain relief. Method: A randomized, controlled, double-blind clinical trial with placebo composed of 33 puerperae with post-episiotomy pain. TENS was applied for 30 minutes to groups: HFT(100 Hz; 100 µs, LFT (5 Hz; 100 µs, and placebo (PT. Four electrodes were placed in parallel near the episiotomy and four pain evaluations were performed with the numeric rating scale. The first and the second evaluation took place before TENS application and immediately after its removal and were done in the resting position and in the activities of sitting and ambulating. The third and fourth evaluation took place 30 and 60 minutes after TENS removal, only in the resting position. Intragroup differences were verified using the Friedman and Wilcoxon tests, and the intergroup analysis employed the Kruskal-Wallis test. Results: In the intragroup analysis, there was no significant difference in the PT during rest, sitting, and ambulation (P>0.05. In the HFT and LFT, a significant difference was observed in all activities (P<0.001. In the intergroup analysis, there was a significant difference in the resting position in the HFT and LFT (P<0.001. In the sitting activity, a significant difference was verified in the second evaluation in the HFT and LFT (P<0.008. No significant difference was verified among the groups in ambulation (P<0.20. Conclusions: LFT and HFT are an effective resource that may be included in the routine of maternity wards.

  11. Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial

    Science.gov (United States)

    Pitangui, Ana C. R.; Araújo, Rodrigo C.; Bezerra, Michelle J. S.; Ribeiro, Camila O.; Nakano, Ana M. S.

    2014-01-01

    Objective To evaluate the effectiveness of low-frequency TENS (LFT) and high-frequency TENS (HFT) in post-episiotomy pain relief. Method A randomized, controlled, double-blind clinical trial with placebo composed of 33 puerperae with post-episiotomy pain. TENS was applied for 30 minutes to groups: HFT(100 Hz; 100 µs), LFT (5 Hz; 100 µs), and placebo (PT). Four electrodes were placed in parallel near the episiotomy and four pain evaluations were performed with the numeric rating scale. The first and the second evaluation took place before TENS application and immediately after its removal and were done in the resting position and in the activities of sitting and ambulating. The third and fourth evaluation took place 30 and 60 minutes after TENS removal, only in the resting position. Intragroup differences were verified using the Friedman and Wilcoxon tests, and the intergroup analysis employed the Kruskal-Wallis test. Results In the intragroup analysis, there was no significant difference in the PT during rest, sitting, and ambulation (P>0.05). In the HFT and LFT, a significant difference was observed in all activities (P<0.001). In the intergroup analysis, there was a significant difference in the resting position in the HFT and LFT (P<0.001). In the sitting activity, a significant difference was verified in the second evaluation in the HFT and LFT (P<0.008). No significant difference was verified among the groups in ambulation (P<0.20). Conclusions LFT and HFT are an effective resource that may be included in the routine of maternity wards. PMID:24675915

  12. Menthol pain relief through cumulative inactivation of voltage-gated sodium channels.

    Science.gov (United States)

    Gaudioso, Christelle; Hao, Jizhe; Martin-Eauclaire, Marie-France; Gabriac, Mélanie; Delmas, Patrick

    2012-02-01

    Menthol is a natural compound of plant origin known to produce cool sensation via the activation of the TRPM8 channel. It is also frequently part of topical analgesic drugs available in a pharmacy, although its mechanism of action is still unknown. Compelling evidence indicates that voltage-gated Na(+) channels are critical for experiencing pain sensation. We tested the hypothesis that menthol may block voltage-gated Na(+) channels in dorsal root ganglion (DRG) neurons. By use of a patch clamp, we evaluated the effects of menthol application on tetrodotoxin (TTX)-resistant Nav1.8 and Nav1.9 channel subtypes in DRG neurons, and on TTX-sensitive Na(+) channels in immortalized DRG neuron-derived F11 cells. The results indicate that menthol inhibits Na(+) channels in a concentration-, voltage-, and frequency-dependent manner. Menthol promoted fast and slow inactivation states, causing use-dependent depression of Na(+) channel activity. In current clamp recordings, menthol inhibited firing at high-frequency stimulation with minimal effects on normal neuronal activity. We found that low concentrations of menthol cause analgesia in mice, relieving pain produced by a Na(+) channel-targeting toxin. We conclude that menthol is a state-selective blocker of Nav1.8, Nav1.9, and TTX-sensitive Na(+) channels, indicating a role for Na(+) channel blockade in the efficacy of menthol as topical analgesic compound. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  13. EFFECTIVENESS OF RADIOFREQUENCY DENERVATION FOR PAIN RELIEF IN HIP DEGENERATIVE DISEASES

    Directory of Open Access Journals (Sweden)

    G. I. Nazarenko

    2014-01-01

    Full Text Available Objective - to compare the effectiveness of radiofrequency denervation (RFD and conservative treatment of patients with hip degenerative diseases. Material and methods. 66 patients with various stages of hip degeneration were followed up for 12 months, including 36 patients who underwent RFD and 30 patients of control group with conservative treatment. Treatment results were assessed using Visual Analogue Scale (VAS and Harris Hip Score before treatment, during the first day, 2 days later, as well as at 1, 6 and 12 months. Results: RFD patients demonstrated significantly better results compared with conservative group. Patients with coxarthrosis stage I and II, besides higher efficiency had prolonged period of remission, while patients with coxarthrosis stage III returned to the near-baseline level of pain only in 3-6 months. Conclusions: RFD is an effective treatment modality for patients with initial coxarthrosis stages, which helps to reduce significantly the disability period compared with conservative therapy. RFD is the only method of effective hip pain relieve in patients with severe comorbidities allowing to reduce analgesic consumption. This method is minimally invasive, has low cost, permits repeated procedures, making it attractive for both physicians and patients.

  14. Parecoxib versus dipyrone (metamizole) for postoperative pain relief after hysterectomy : a prospective, single-centre, randomized, double-blind trial.

    Science.gov (United States)

    Soltesz, Stefan; Gerbershagen, Mark U; Pantke, Bernhard; Eichler, Frank; Molter, Gerd

    2008-01-01

    Selective cyclo-oxygenase-2 (COX-2) inhibitors provide postoperative pain relief similar to conventional NSAIDs. However, many of these non-opioid analgesics are available only for oral administration, and are therefore ineffective in patients experiencing postoperative nausea or vomiting. The aim of this study was to compare the analgesic efficacy of the COX-2 inhibitor parecoxib with that of dipyrone (metamizole) administered intravenously for 48 hours after vaginal hysterectomy. Fifty women undergoing vaginal hysterectomy under general anaesthesia were randomly assigned to two groups: the parecoxib group, who received intravenous parecoxib 40 mg intraoperatively and every 12 hours after surgery over a period of 48 hours, and the dipyrone group, who received intravenous dipyrone 2.5 g injected intraoperatively, followed by dipyrone 1 g every 6 hours after surgery over a period of 48 hours. Because of the double-blinded study protocol, patients in the parecoxib groups were required to receive placebo infusions 6, 18, 30 and 42 hours after the operation. Visual analogue scale (VAS [scale 0-10]) scores were recorded 0.5, 1, 2, 3, 4, 6, 9, 12, 15, 18, 24, 36 and 48 hours after surgery. To assess the cumulative opioid administration, all patients were fitted with an intravenous patient-controlled analgesia (PCA) device containing the opioid piritramide. An alpha value of 0.05 was considered statistically significant. VAS scores did not differ between groups with one exception: VAS scores were lower in the parecoxib group 12 hours after surgery than in the dipyrone group (1 and 2, respectively; p < 0.05). No significant differences in cumulative piritramide administration were measured between groups 1 hour or 24 hours after surgery (parecoxib 14.7 [+/- SD 4.4] and 30.6 [+/- 12.8] mg, respectively; dipyrone 11.8 [+/- 4.9] and 36.5 [+/- 10.7] mg, respectively). Parecoxib 40 mg twice daily provides postoperative pain relief equivalent to that of dipyrone 4 g daily during

  15. Ilex paraguariensis Promotes Orofacial Pain Relief After Formalin Injection: Involvement of Noradrenergic Pathway.

    Science.gov (United States)

    de Carvalho, Eudislaine Fonseca; de Oliveira, Simone Kobe; Nardi, Viviane Koepp; Gelinski, Tathiana Carla; Bortoluzzi, Marcelo Carlos; Maraschin, Marcelo; Nardi, Geisson Marcos

    2016-03-01

    Drinking mate or chimarrão, a hot infusion of Ilex paraguariensis (ILEX) leaves, is a common habit in Southern South America that has a social and almost ritualistic role. It has been used as a stimulant beverage in South America and analgesic in regions of Argentina for treatment of headache and others painful inflammatory conditions such as arthritis and rheumatism. The aim of this study was to evaluate the pharmacological activity of I. paraguariensis infusion (ILEX) on orofacial nociception model induced by formalin, and study its mechanism of action. The analgesic effect of ILEX was assessed through writhing test, paw formalin test, paw edema induced by carrageenan, and orofacial pain induced by formalin. To study the action mechanism of ILEX, opioidergic, dopaminergic, nitrergic, and adrenergic pathways were investigated. The high-performance liquid chromatography analysis of ILEX infusion revealed caffeine and theobromine. The treatment with ILEX reduced the number of writhing. However, it was effective neither in the formalin paw test nor in the paw edema induced by carrageenan. Different from formalin paw test, ILEX was able to reduce the orofacial reactivity to formalin in 31.8% (70.4 ± 2.5 s; first phase), and 20% (127.3 ± 18.9 s; second phase). The analgesic effect of ILEX results from the modulation of noradrenergic pathways since prazosin (α1-adrenoceptor antagonist, 0.15 mg/kg; intraperitoneal) reversed the analgesic effect of ILEX. The present report demonstrates that analgesic effect of ILEX in orofacial formalin test is due mainly to modulation of noradrenergic pathways. Ilex paraguariensis (ILEX) has been used as a stimulant beverage in South America and analgesic in regions of Argentina for the treatment of headache and others painful inflammatory conditions such arthritis and rheumatism.The aim of this study was to evaluate the pharmacological activity of ILEX on orofacial nociception model induced by formalin, and study its mechanism of

  16. Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.

    LENUS (Irish Health Repository)

    McMorrow, R C N

    2012-02-01

    BACKGROUND: Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial. METHODS: Eighty patients were randomized to one of four groups to receive (in addition to spinal anaesthesia) either spinal morphine 100 microg (S(M)) or saline (S(S)) and a postoperative bilateral TAP block with either bupivacaine (T(LA)) 2 mg kg(-1) or saline (T(S)). RESULTS: Pain on movement and early morphine consumption were lowest in groups receiving spinal morphine and was not improved by TAP block. The rank order of median pain scores on movement at 6 h was: S(M)T(LA) (20 mm)

  17. Comparison between intrathecal morphine with paravertebral patient controlled analgesia using bupivacaine for intraoperative and post-thoracotomy pain relief

    Directory of Open Access Journals (Sweden)

    Haitham Abou Zeid

    2012-01-01

    Full Text Available Objectives : This study was designed to compare the intrathecal morphine and paravertebral block with bupivacaine given before induction of anesthesia for intra-operative and post-thoracotomy pain relief for 48 hours using patient controlled paravertebral analgesia in post-operative period. Methods : After taken an approval from the ethics committee of the University, 40 patients were randomly assigned to receive either preservative-free intrathecal morphine 0.3 mg in 3 ml normal saline together with paravertebral block (group I or paravertebral block alone using bupivacaine (group II before an induction of anesthesia. No continuous infusion of bupivacaine was started in both groups. Primary outcomes were Visual Analogue Score (VAS at rest and on coughing. Hemodynamic and respiratory effects, bupivacaine consumption, patient′s satisfaction, and side effects like nausea, vomiting, urinary retention, and itching were considered as secondary outcomes. All patients in both groups received paracetamol 1 gram (gm IV every 6 hourly for the 1 st 24 hr. Amount of rescue analgesic (pethidine 0.5 mg/kg IV in both groups and total bupivacaine cumulative doses in 48 hrs were calculated. Results : VAS at rest and on coughing did not differ significantly between the 2 groups at 0, 1, 6, 12, 18, 24, and 48 hours (P=>0.1. At 24 hours, VAS increased in both the groups, but the increase in VAS was comparable in both groups. There were insignificant incidences of nausea, purities, and urinary retention in intrathecal group compared with paravertebral group. The other side effects and patient satisfaction did not show any statistical significant difference between 2 groups. Conclusion : Intrathecal morphine 0.3 mg is safe and effective way to improves pain control for thoracic surgery and was comparable to paravertebral patient control analgesia (PPCA with bupivacaine for the 1 st 48 hours post-thoracotomy.

  18. Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis.

    Science.gov (United States)

    Shalimar; Midha, Shallu; Hasan, Ajmal; Dhingra, Rajan; Garg, Pramod Kumar

    2017-01-01

    Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach. All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure. A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P treatment. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  19. Improved Pain Relief With Burst Spinal Cord Stimulation for Two Weeks in Patients Using Tonic Stimulation: Results From a Small Clinical Study

    Science.gov (United States)

    Courtney, Peter; Espinet, Anthony; Mitchell, Bruce; Russo, Marc; Muir, Andrew; Verrills, Paul

    2015-01-01

    Objectives Conventional spinal cord stimulation (SCS) delivers a tonic waveform with consistent stream of pulses; burst delivers groups of pulses separated by short pulse‐free periods. The current study compared the short‐term safety and efficacy of burst with tonic stimulation in subjects already receiving SCS. Materials and Methods At 4 IRB‐approved sites, 22 subjects previously implanted with an SCS device for intractable, chronic pain gave informed consent and received burst stimulation for 14 days. Subjects reported average daily Visual Analog Scale (VAS) for overall, trunk, and limb pain using tonic stimulation and after 7 and 14 days of burst stimulation. Thoughts about pain were assessed using the Pain Catastrophizing Scale. Areas of paresthesia were assessed during tonic and burst stimulation using body maps. Assessment of patient satisfaction and preferred stimulation occurred after 14 days of burst. Results Average daily overall VAS reduced 46% from a mean of 53.5 (±20.2) mm during tonic SCS to 28.5 (±18.1) mm during burst (p VAS scores were also reduced by 33% and 51%, respectively. During burst, 16 subjects (73%) reported no paresthesia, 5 (23%) reported a reduction, and 1 (4%) reported increased paresthesia. After 14 days, 21 subjects (95%) reported being very satisfied or satisfied with burst. Burst was preferred by 20 subjects (91%), tonic by 1 (5%), and 1 (5%) reported no preference. Better pain relief was the most common reason cited for preference. Conclusions A majority of subjects reported improved pain relief using burst compared with tonic stimulation. Most subjects experienced less paresthesia during burst and preferred burst citing better pain relief. PMID:25879884

  20. Acid-suppressive therapy with esomeprazole for relief of unexplained chest pain in primary care: a randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Flook, Nigel W; Moayyedi, Paul; Dent, John; Talley, Nicholas J; Persson, Tore; Karlson, Björn W; Ruth, Magnus

    2013-01-01

    High-quality data regarding the efficacy of acid-suppressive treatment for unexplained chest pain are lacking. The aim of this study was to evaluate the efficacy of esomeprazole in primary-care treatment of patients with unexplained chest pain stratified for frequency of reflux/regurgitation symptoms. Patients with a ≥ 2-week history of unexplained chest pain (unrelated to gastroesophageal reflux) who had at least moderate pain on ≥ 2 of the last 7 days were stratified by heartburn/regurgitation frequency (≤ 1 day/week (stratum 1) vs. ≥ 2 days/week (stratum 2)) and randomized to 4 weeks of double-blind treatment with twice-daily esomeprazole 40 mg or placebo. Chest pain relief during the last 7 days of treatment (≤ 1 day with minimal symptoms assessed daily using a 7-point scale) was analyzed by stratum in keeping with the predetermined analysis plan. Overall, 599 patients (esomeprazole: 297, placebo: 302) were randomized. In stratum 1, more esomeprazole than placebo recipients achieved chest pain relief (38.7% vs. 25.5%; P=0.018); no between-treatment difference was observed in stratum 2 (27.2% vs. 24.2%; P=0.54). However, esomeprazole was superior to placebo in a post-hoc analysis of the whole study population (combined strata; 33.1% vs. 24.9%; P=0.035). A 4-week course of high-dose esomeprazole provided statistically significant relief of unexplained chest pain in primary-care patients who experienced infrequent or no heartburn/regurgitation, but there was no such significant reduction in patients with more frequent reflux symptoms.

  1. Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: a randomized controlled trial.

    Science.gov (United States)

    Zhu, Jiemin; Hong-Gu, He; Zhou, Xiuzhu; Wei, Haixia; Gao, Yaru; Ye, Benlan; Liu, Zuguo; Chan, Sally Wai-Chi

    2015-03-01

    to test the effectiveness of breast feeding (BF), music therapy (MT), and combined breast feeding and music therapy (BF+MT) on pain relief in healthy-term neonates during heel lance. randomised controlled trial. in the postpartum unit of one university-affiliated hospital in China from August 2013 to February 2014. among 288 healthy-term neonates recruited, 250 completed the trial. All neonates were undergoing heel lancing for metabolic screening, were breast fed, and had not been fed for the previous 30 minutes. all participants were randomly assigned into four groups - BF, MT, BF+MT, and no intervention - with 72 neonates in each group. Neonates in the control group received routine care. Neonates in the other three intervention groups received corresponding interventions five minutes before the heel lancing and throughout the whole procedure. Neonatal Infant Pain Scale (NIPS), latency to first cry, and duration of first crying. mean changes in NIPS scores from baseline over time was dependent on the interventions given. Neonates in the BF and combined BF+MT groups had significantly longer latency to first cry, shorter duration of first crying, and lower pain mean score during and one minute after heel lance, compared to the other two groups. No significant difference in pain response was found between BF groups with or without music therapy. The MT group did not achieve a significantly reduced pain response in all outcome measures. BF could significantly reduce pain response in healthy-term neonates during heel lance. MT did not enhance the effect of pain relief of BF. healthy-term neonates should be breast fed to alleviate pain during heel lance. There is no need for the additional input of classical music on breast feeding in clinic to relieve procedural pain. Nurses should encourage breast feeding to relieve pain during heel lance. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Single intradiscal injection of the interleukin-6 receptor antibody tocilizumab provides short-term relief of discogenic low back pain; prospective comparative cohort study.

    Science.gov (United States)

    Sainoh, Takeshi; Orita, Sumihisa; Miyagi, Masayuki; Inoue, Gen; Yamauchi, Kazuyo; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Go; Oikawa, Yasuhiro; Inage, Kazuhide; Sato, Jun; Nakata, Yukio; Aoki, Yasuchika; Takahashi, Kazuhisa; Ohtori, Seiji

    2016-01-01

    Inflammatory cytokines, such as interleukin-6 and tumor necrosis factor-α, are gaining attention as important etiologic factors associated with discogenic low back pain. We conducted a prospective cohort study to evaluate the efficacy and safety of intradiscal injection of the interleukin-6 receptor antibody tocilizumab in patients with discogenic low back pain. Thirty-two consecutive patients were intradiscally injected with 2 mL of 0.5% bupivacaine (control group). Another 31 consecutive patients were intradiscally injected with 40 mg tocilizumab and 1-2 mL of 0.5% bupivacaine (tocilizumab group) at the same time. Prior to treatment, the vertebral origin of low back pain was confirmed in all patients based on pain provocation during discography and pain relief with 1 mL of 1% xylocaine. Numeric rating scale and Oswestry disability index scores were used to evaluate pain level before and after treatment between the 2 groups. The association between pain relief with tocilizumab and intervertebral disc degeneration grade was also determined. At the end of the study (8 weeks after treatment), 30 patients in each group were evaluable. In the tocilizumab group, numeric rating scale and Oswestry disability index scores improved significantly at 2 and 4 weeks after treatment, respectively. Intervertebral disc degeneration was not associated with improvement of numeric rating scale score in the tocilizumab group. Local infection (i.e., discitis) was observed in 1 patient in the tocilizumab group. The results demonstrate the clinical relevance of interleukin-6 in discogenic low back pain. Intradiscal tocilizumab injection was shown to exert a short-term analgesic effect in patients with discogenic low back pain. Further research is required to determine the long-term effects of intradiscal tocilizumab therapy in patients with discogenic low back pain. Copyright © 2015 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  3. Breastfeeding and skin-to-skin contact for pain relief of newborns during hepatitis B vaccination

    Directory of Open Access Journals (Sweden)

    Adriana Moraes Leite

    2015-09-01

    Full Text Available The objective was to compare the combination of skin-to-skin contact with breastfeeding, to skin-to-skin contact during hepatitis B vaccination in newborns. Randomized clinical trial with a sample of 55 full-term newborns divided between two groups, namely; skin-to-skin contact (GP, n = 38, and breastfeeding combined with skin-to-skin contact (GPA, n = 27. The pain of newborns was assessed by facial movements. The heart rate (HR of all newborns was measured, as well as the suckling frequency of newborns in the GPA. There was a statistically significant difference in the periods of compression and recovery between the groups for the NFCS scores. The average values of HR were significantly higher in the GP during antisepsis/injection. The suckling in the GPA ranged between 10-28 suckles per minute. The breastfeeding combined with maternal skin-to-skin contact can enhance the analgesic effect of maternal skin-to-skin contact, contributing to a better recovery of newborns after the procedure.

  4. Non-pharmacologic measures for relief of pain Medidas no farmacológicas para el alivio del dolor

    Directory of Open Access Journals (Sweden)

    Tiberio Alvarez Echeverri

    1998-01-01

    Full Text Available In this review the author discusses some aspects of non-pharmacologic therapies for relief of pain and suffering; both physical and psychological approaches are included; the former include heat and cold applicatio", exercises, neurostimulation and acupuncture; the latter are education, biofeedback, relaxation, musictherapy, hypnosis, thought sustitution, images and group and family therapy. Aiso discussed are spiritual assistance and humanized touch. The goal of these approaches is to obtain proximity with the suffering human being. El objetivo de esta revisión es discutir algunos aspectos de las terapias no farmacológicas para aliviar el dolor y el sufrimiento las cuales no han recibido la atención que merecen por parte del personal de la salud. Se incluyen elementos de la terapia física como el calor, el frío, el ejercicio, la neuroestimulación y la acupuntura; la terapia cognoscitiva y conductual con métodos como la educación, la retroalimentación, la relajación, la musicoterapia, la hipnosis, la distracción, la sustitución de pensamientos e imágenes y la terapia grupal y familiar. Se discuten aspectos de la asistencia espiritual y el tacto humanizado. Todo esto con el fin de lograr un acercamiento humanizado al hombre que sufre.

  5. Computer modeling of electrical and thermal performance during bipolar pulsed radiofrequency for pain relief

    Energy Technology Data Exchange (ETDEWEB)

    Pérez, Juan J. [Instituto de Investigación Interuniversitario en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia 46022 (Spain); Pérez-Cajaraville, Juan J. [Pain Unit and Department of Anesthesia and Critical Care, Clínica Universidad de Navarra, University of Navarra, Pamplona 31008 (Spain); Muñoz, Víctor [Neurotherm Spain, Barcelona 08303 (Spain); Berjano, Enrique, E-mail: eberjano@eln.upv.es [Biomedical Synergy, Electronic Engineering Department, Universitat Politècnica de València 46022 (Spain)

    2014-07-15

    Purpose: Pulsed RF (PRF) is a nonablative technique for treating neuropathic pain. Bipolar PRF application is currently aimed at creating a “strip lesion” to connect the electrode tips; however, the electrical and thermal performance during bipolar PRF is currently unknown. The objective of this paper was to study the temperature and electric field distributions during bipolar PRF. Methods: The authors developed computer models to study temperature and electric field distributions during bipolar PRF and to assess the possible ablative thermal effect caused by the accumulated temperature spikes, along with any possible electroporation effects caused by the electrical field. The authors also modeled the bipolar ablative mode, known as bipolar Continuous Radiofrequency (CRF), in order to compare both techniques. Results: There were important differences between CRF and PRF in terms of electrical and thermal performance. In bipolar CRF: (1) the initial temperature of the tissue impacts on temperature progress and hence on the thermal lesion dimension; and (2) at 37 °C, 6-min of bipolar CRF creates a strip thermal lesion between the electrodes when these are separated by a distance of up to 20 mm. In bipolar PRF: (1) an interelectrode distance shorter than 5 mm produces thermal damage (i.e., ablative effect) in the intervening tissue after 6 min of bipolar RF; and (2) the possible electroporation effect (electric fields higher than 150 kV m{sup −1}) would be exclusively circumscribed to a very small zone of tissue around the electrode tip. Conclusions: The results suggest that (1) the clinical parameters considered to be suitable for bipolar CRF should not necessarily be considered valid for bipolar PRF, and vice versa; and (2) the ablative effect of the CRF mode is mainly due to its much greater level of delivered energy than is the case in PRF, and therefore at same applied energy levels, CRF, and PRF are expected to result in same outcomes in terms of

  6. Can altering motions, postures, and loads provide immediate low back pain relief: a study of 4 cases investigating spine load, posture, and stability.

    Science.gov (United States)

    Ikeda, Dianne M; McGill, Stuart M

    2012-11-01

    A quantitative biomechanical analysis of mechanism of pain alteration in 4 cases of low back pain. To investigate the contributions of a number of biomechanical factors associated with pain alteration. Some clinicians use mechanically based manual interventions in attempt to reduce low back pain. However, the mechanism of pain alteration remains unknown. A sample was formed with 4 patients with low back pain seeking consults for pain relief. All could produce "catches" of pain with movement. Manual interventions involving coached changes in motion and muscle activation attempted to reduce pain. Electromyographic and kinematic data were collected before and after intervention. These data were input to an anatomically detailed spine model that calculated muscle force, joint compression and shear, and spine stability. Using a clinically significant criterion of pain reduction of 2 or more, 3 of 4 subjects reduced pain immediately upon the intervention. Using a change of 10% as a criterion for biological significance for kinematic and kinetic variables, each subject demonstrated a different reaction. For example, subject 1 demonstrated increased stability, subject 2 increased mediolateral shear, subject 3 increased mediolateral shear and decreased spine flexion, and subject 4 increased stability. The pain-reducing interventions required to obtain these results were also different for each individual. Immediate pain reduction can be achieved by altering muscle-activation and movement patterns. However, the combination for optimal success seems to be different for every individual. Pain provocation tests help to "tune" the intervention. This also suggests that patient-classification schemes may need more refinement to address this heterogeneity.

  7. [The Pain-Relief Efficacy of Passive Music-Based Interventions in Cancer Patients Undergoing Diagnostic Biopsies and Surgery: A Systematic Review and Meta-Analysis].

    Science.gov (United States)

    Hung, Tsai-Tzu; Liu, Yu-Chen; Tsai, Pei-Cheng; Lin, Mei-Feng

    2018-02-01

    Music-based intervention is commonly used as a non-pharmacological strategy to reduce pain in hospitalized patients. To conduct a systematic review and meta-analysis to examine the effects of passive music-based interventions on pain relief in cancer patients undergoing diagnostic biopsies and surgeries and to identify the moderating variables in order to identify clinically validated interventional strategies and related suggestions. Studies using an RCT (randomized clinical trial) design that were published before 2016 were collected from the following databases: Cochrane Library/Trials, PubMed, PsycINFO, CINHAL, and Index to Taiwan Periodical Literature System. The high-quality studies, defined as those earning a modified Jadad scale score >3, were then analyzed using comprehensive meta-analysis software. The passive music-based interventions had a small-to-moderate overall effect (g = -.42, p = .02) on pain relief in the subjects undergoing diagnostic biopsies and surgery in the analyzed studies (n = 12). Subgroup analysis identified the moderating variables affecting pain reduction as the type of anesthesia administered and the settings, frequency, and music therapist that were used in the intervention. Passive music-based interventions have a significant pain reduction effect and may be used as an effective, non-pharmacologic intervention for cancer patients undergoing diagnostic biopsies and surgery. Delivering 2-3 intervention sessions daily, using a certificated music therapist to deliver/guide the sessions, holding the sessions in waiting-room or ward settings, and administering a general anesthesia were identified as the crucial factors impacting the effectiveness of music intervention on pain relief.

  8. Changes in Relatives' Perspectives on Quality of Death, Quality of Care, Pain Relief, and Caregiving Burden Before and After a Region-Based Palliative Care Intervention.

    Science.gov (United States)

    Maeda, Isseki; Miyashita, Mitsunori; Yamagishi, Akemi; Kinoshita, Hiroya; Shirahige, Yutaka; Izumi, Noriko; Yamaguchi, Takuhiro; Igarashi, Miyuki; Kato, Masashi; Morita, Tatsuya

    2016-11-01

    A region-based palliative care intervention (Outreach Palliative Care Trial of Integrated Regional Model Study) increased home death, access to specialist palliative care, quality of care, and quality of death and dying. The objective of this study was to examine changes in palliative care outcomes in different care settings (hospitals, palliative care units, and home) and obtain insights into how to improve region-level palliative care. The intervention program was implemented from April 2008 to March 2011. Two bereavement surveys were conducted before and after intervention involving 4228 family caregivers of deceased cancer patients. Family-perceived quality of care (range 1-6), quality of death and dying (1-7), pain relief (1-7), and caregiver burden (1-7) were measured. Response rates were 69% (preintervention) and 66% (postintervention), respectively. Family-perceived quality of care (adjusted mean 4.89, 95% CI 4.54-5.23) and quality of death and dying (4.96, 4.72-5.20) at home were the highest and sustained throughout the study. Palliative care units were at the intermediate level between home and hospitals. In hospitals, both quality of care and quality of death and dying were low at baseline but significantly improved after intervention (quality of care: 4.24, 4.13-4.34 to 4.43, 4.31-4.54, P = 0.002; quality of death and dying: 4.22, 4.09-4.36 to 4.36, 4.22-4.50, P = 0.012). Caregiver burden did not significantly increase after intervention, regardless of place of death. The dual strategies of transition of place of death to home and improving quality of care in hospitals should be recognized as important targets for improving region-level palliative care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Comparison of impacts of friction massage, stretching exercises and analgesics on pain relief in primary fibromyalgia syndrome: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Amanollahi A

    2013-01-01

    Full Text Available Background: Stretching exercises and massage therapy are both suggested for pain relief in fibromyalgia syndrome. Previous studies have not proved their superiority over each other. This study compared the therapeutic effects of friction massage, stretching exercises, and analgesics on pain relief in patients with fibromyalgia syndrome.Methods: We evaluated 129 female patients with the diagnosis of primary fibromyalgia visited at the physical medicine clinics of Baqiyatallah Hospital in Tehran, Iran during 2010- 2011. Patients were randomly divided into three groups: the first group received 400 mg ibuprofen P.O. (3 times per day and 25 mg nortriptyline (daily P.O. as analgesic, the second group was treated by friction massage and the third group performed stretching exercises. Patients were assessed three times (initially, after one and four weeks by visual analogue scale (VAS.Results: The mean age of participants was 60.46 years. The mean age in each treatment group was 46.66 years in medication group, 46.73 years in stretching group and 46.65 years in friction massage group. Changes in VAS score over 4 weeks were 2.4, 3.1 and 1.9, in the first, second, and third groups, respectively. The changes in VAS were significantly different in the first and second groups rather than the controls (P<0.05.Conclusion: The effect of stretch exercise on pain relief was similar to analgesics, but it was more effective than friction massage. Moreover, the therapeutic effect of stretching exercise on pain relief upon four weeks was more permanent than friction massage but it was similar to analgesics.

  10. Unexpected consequences: women's experiences of a self-hypnosis intervention to help with pain relief during labour.

    Science.gov (United States)

    Finlayson, Kenneth; Downe, Soo; Hinder, Susan; Carr, Helen; Spiby, Helen; Whorwell, Peter

    2015-09-25

    Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women's views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth. Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8-12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis. Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of 'unexpected consequences', supported by 5 organising themes, 'calmness in a climate of fear', 'from sceptic to believer', 'finding my space', 'delays and disappointments' and 'personal preferences'. Most respondents reported positive experiences of self-hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth experiences did not match

  11. Sustained-release morphine sulfate with sequestered naltrexone for moderate to severe pain: a new opioid analgesic formulation and beyond.

    Science.gov (United States)

    Ruan, Xiulu

    2011-05-01

    Opioid usage during chronic nonmalignant pain has increased substantially over the past two decades. Prescription opioids have become the second most misused drug in the USA and prescription opioid abuse has escalated into a widespread public health problem. It is hoped that abuse-deterrent opioid formulations will take an important role in reducing opioid abuse, misuse and diversion. Embeda (sustained-release morphine sulfate with sequestered naltrexone)represents a new opioid formulation with an intended abuse-deterrent feature, now available on the market. Although Embeda seems to be a successful formulation by passing the efficacy trial, safety trial, pharmacokinetic study and abuse liability study, etc., it will require some long-term prospective epidemiological studies to substantiate fully its abuse-deterrent benefit. Embeda represents a new opioid formulation, adding to our arsenal to treat moderate to severe pain and playing its potential role in discouraging opioid abuse, misuse and diversion. Faced with an overwhelmingly expanding public health burden due to prescription opioid abuse, clinicians should always keep in mind the balance of maximizing pain relief and minimizing prescription opioid abuse. © 2011 Informa UK, Ltd

  12. Alternative medicine - pain relief

    Science.gov (United States)

    Alternative medicine refers to treatments that are used instead of conventional (standard) ones. If you use an alternative ... considered complementary therapy. There are many forms of ... Acupuncture involves stimulating certain acupoints on the body ...

  13. Magnets for Pain Relief

    Science.gov (United States)

    ... better ways to prevent, diagnose, and treat diseases. Web site: www.nih.gov/health/clinicaltrials/ Key References Colbert AP, Markov MS, Souder JS. Static magnetic field therapy: dosimetry considerations. Journal of Alternative ...

  14. Descending pain modulation and its interaction with peripheral sensitization following sustained isometric muscle contraction in fibromyalgia

    DEFF Research Database (Denmark)

    Ge, H-Y; Nie, Hongling; Graven-Nielsen, Thomas

    2012-01-01

    OBJECTIVE: Sustained isometric muscle contraction (fatiguing contraction) recruits segmental and/or extrasegmental descending inhibition in healthy subjects but not in fibromyalgia (FM). We hypothesized that fatiguing contraction may shift descending pain modulation from inhibition towards...

  15. National audit of the quality of pain relief provided in emergency departments in Aotearoa, New Zealand: The PRiZED 1 Study.

    Science.gov (United States)

    2017-04-01

    Pain is a common feature of ED presentations and the timely provision of adequate analgesia is important for patient care. However, there is currently no New Zealand data with respect to this indicator of care quality. The present study aimed to provide a baseline for the quality of care with respect to the provision of timely and adequate analgesia in New Zealand EDs. The present study is a secondary analysis of data initially collected for the Shorter Stays in Emergency Department Study, using a retrospective chart review of 1685 randomly selected ED presentations (2006-2012) from 26 New Zealand public hospital EDs. Of the 1685 charts randomly selected, 1547 (91%) were reviewed from 21 EDs. There were 866 ED presentations with painful conditions, of whom 132 (15%) did not have pain recorded, 205 (24%) did not receive pain relief and 19 (2%) did not have time of analgesia documented leaving 510 (59%) for the analysis of time to analgesia. Four hundred and fifty-seven (53%) did not have pain well documented sufficiently to assess adequacy, leaving 277 (32%) for the analysis of adequacy of analgesia. The median (interquartile range) time to analgesia was 62 (30-134) min and the provision of adequate analgesia was 141/277 (51%, 95% CI: 45-57%); however, there was some variation between hospitals for both outcomes. Although these outcomes are on a par with other countries, this baseline audit has shown both poor documentation and variation in the provision of timely and adequate pain relief in New Zealand EDs, with room for improvement with respect to this quality indicator. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. Predictors of improvement in quality of life and pain relief in lumbar spinal stenosis relative to patient age: a study based on the Spine Tango registry.

    Science.gov (United States)

    Sobottke, Rolf; Herren, Christian; Siewe, Jan; Mannion, Anne F; Röder, Christoph; Aghayev, Emin

    2017-02-01

    An open decompression is the most common treatment for lumbar spinal canal stenosis (LSS), even in the elderly. However, it is not clear whether the treatment outcome is age dependent. The main purpose of this study was to evaluate the improvement in quality of life (QoL) and pain relief, after open decompression for LSS in relation to patient age. The study was performed on the basis of Spine Tango registry data. The database query resulted in 4768 patients from 40 international Spine Tango centres. The patients were subdivided into three age groups: (1) 20-64, (2) 65-74, and (3) ≥75 years. In multivariate logistic regression models, predictors for improvement in QoL and achievement of the minimum clinically relevant change in pain of two points were analysed. All groups benefited from significant improvement in QoL and back and leg pain relief. Age group had no significant influence on the outcomes. The preoperative status of each outcome was a predictor for its own postoperative outcome. Fewer previous surgeries, rigid or dynamic stabilization, and lower patient comorbidity also had a partially predictive influence for one or the other outcome. Our results confirm that all age groups significantly benefit from the open decompressive treatment of LSS. Age group had no significant influence on any outcome.

  17. Predictors of Nurses' Intentions to Administer As-Needed Opioid Analgesics for Pain Relief to Postoperative Orthopaedic Patients in the Acute Care Setting.

    Science.gov (United States)

    Taylor, Colleen Y; Sheu, Jiunn-Jye; Chen, Huey-Shys; Glassman, Tavis; Dake, Joseph

    Patients undergoing orthopaedic surgery experience severe postoperative pain that is frequently undertreated. No study was found that examined the predictors of nurses' intentions to administer as needed (PRN) opioid analgesics for postoperative pain relief. The purpose of this study was to determine what constructs from the Integrated Behavioral Model (IBM) can predict nurses' intentions to administer PRN opioid analgesics for pain relief to hospitalized postoperative orthopaedic patients. A nonexperimental, cross-sectional quantitative format was used. The sample consisted of 800 nurses. Data collection was done by survey. Path analysis revealed the significant predictors of nurses' intention to administer opioid analgesics to be self-efficacy (β= 0.15), normative beliefs (β= 0.21), and salience (importance) of the behavior (β= 0.25). The study showed that the IBM constructs are useful for predicting intentions toward performance of a professional behavior. The inclusion of self-efficacy, underlying beliefs, and salience of the behavior was new and unique contributions to the existing body of knowledge.

  18. High resolution ultrasound evaluation of synovial thickness as a marker to assess response to deep tissue heating for pain relief in knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Bhawana Anand

    2012-01-01

    Full Text Available Background: High-resolution ultrasound (HRUS is a useful tool in assessing synovial tissue response to deep tissue heating (DTH/short wave diathermy (SWD for pain relief in knee osteoarthritis. Shortwave (SW diathermy can be used to improve vascular circulation and reduce inflammation and pain in patients with osteoarthritis. The purpose of this study was to assess the role of ultrasound in investigating whether repetitive SW diathermy, could reduce synovial thickening in patients with knee osteoarthritis. Materials and Methods: Synovial thickness measurement of superior, medial, and lateral patellar recesses was done using ultrasonography over a span of nineteen months from April 2010 to Nov 2011 following three sessions of short wave diathermy. The sum of these three measurements was taken as the total synovial thickness and pre and post test analysis was done using primer statistical software. Result: Synovial thickening continued to become significantly thinner with sessions of treatment and after the twelfth SW diathermy treatment, there was 20.58% reduction in the synovial thickening. Conclusion: Synovial thickness is a sensitive marker in gauging the response to short wave diathermy therapy. Synovial thickness is an objective marker to assess pain relief in knee osteoarthritis following deep tissue heating.

  19. The Effect of the Posture of the “Hermit Doing Body Contortion” on Relief of Shoulder and Scapular Pain Caused by Chronic Myofascial Pain Syndrome: A Randomized, Parallel Group, Controlled Trial

    Directory of Open Access Journals (Sweden)

    Peamruetai Butdapan

    2016-11-01

    Full Text Available Objective: To explore the ability of the posture of the “Hermit Doing Body Contortion” (HDBC to relieve shoulder and scapular pain in patients with chronic myofascial pain syndrome (MPS. Methods: One hundred and thirty-six out-patients with chronic MPS were randomly assigned to one of two groups. The experimental group was advised to perform a posture of the HDBC named “posture for relieving abdominal pain, pain of the scapular blade” (PRASP every day for two months. Both groups received Thai traditional massage treatment and hot herbal compresses once a week for four weeks. Using a numeric rating scale and dolorimeter, outcomes were assessed prior to commencing the intervention (M0 , and one and two months after commencing the intervention (M1 and M2 . Results: The mean change in pain intensity between M1 and M2 differed significantly between the groups (1.32±1.45 in the experimental group and 0.47±2.26 in the control group; p = 0.039. Similarly, the mean change in pressure pain threshold between M0 and M2 also differed significantly between the groups (1.39±1.76 in the experimental group and 0.53±1.90 in the control group; p =0.027. In both cases, the experimental group achieved greater pain relief. Conclusion: In patients with chronic MPS, the posture of the HDBC combined with standard Thai traditional medicine treatments provided better ongoing relief of shoulder and scapular pain than did standard Thai traditional medicine treatments alone. Clinical trial registration no.: TCTR20151230002

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

    National Research Council Canada - National Science Library

    Zeidan, Fadel; 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...

  1. Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting

    National Research Council Canada - National Science Library

    Garland, Eric L; Baker, Anne K; Larsen, Paula; Riquino, Michael R; Priddy, Sarah E; Thomas, Elizabeth; Hanley, Adam W; Galbraith, Patricia; Wanner, Nathan; Nakamura, Yoshio

    2017-01-01

    ... interventions.We hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantly...

  2. Comparative Effectiveness of Suprascapular Nerve Block in the Relief of Acute Post-Operative Shoulder Pain: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Chang, Ke-Vin; Wu, Wei-Ting; Hung, Chen-Yu; Han, Der-Sheng; Yang, Rong-Sen; Chang, Chung-Hsun; Lin, Chih-Peng

    2016-01-01

    The suprascapular nerve accounts for 70% of shoulder sensory innervations, and suprascapular nerve block (SSNB) has been shown to be effective in the relief of chronic shoulder pain including rotator cuff tendinitis, subdeltoid impingement syndrome, and adhesive capsulitis. However, this remains inconclusive for patients undergoing surgery. The present meta-analysis aimed to explore the effectiveness of SSNB for relieving acute post-operative shoulder pain. To explore the effectiveness of SSNB for relieving acute post-operative shoulder pain. A systematic review and meta-analysis. Services of general surgery, orthopaedics, and anaesthesiology. A systematic search of studies on SSNB for post-operative shoulder pain was conducted mainly in PubMed and Scopus. The standardized mean difference (SMD) of post-operative pain scales of SSNB versus placebo was treated as the primary outcome, whereas the odds ratio of nausea of SSNB versus placebo comprised the secondary outcome. The meta-analysis included 7 randomized controlled trials and 2 comparative studies comprising 681 participants in total. The quantitative analysis showed a significantly lower pain level of SSNB versus placebo in the shoulder surgery patient group (SMD: -0.33; 95% confidence level [CI]: -0.51 to -0.15), but not in the non-shoulder surgery group (SMD: 0.28; 95% CI: -0.37 to 1.93). The pooled odds ratio of nausea in the SSNB arm compared with the placebo arm was 0.20 (95% CI: 0.09 to 0.45), indicating a reduction in the incidence of nausea following SSNB. Heterogeneity of included trials. SSNB significantly reduced acute post-operative shoulder pain in the shoulder surgery group but not in patients undergoing laparoscopic surgery or thoracotomy. This suggests that SSNB can be used as a method of polymodal analgesia for patients undergoing shoulder surgery; however, it is not recommended for the non-shoulder surgery patient population. Suprascapular nerve, shoulder surgery, thoracotomy, laparoscopic

  3. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) during unsedated colonoscopy: a randomized double-blind placebo-controlled trial.

    Science.gov (United States)

    Amer-Cuenca, J J; Goicoechea, C; Girona-López, A; Andreu-Plaza, J L; Palao-Román, R; Martínez-Santa, G; Lisón, J F

    2011-01-01

    Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative to traditional pain treatments. TENS has been studied in the past as a pain reduction modality in colonoscopy with limited success. Reviews and meta-analysis have shown that the inconclusive results of TENS may be due to the lack of randomized controlled trials and the difficulty in defining precise output parameters. The objective of this double-blind randomized placebo-controlled trial was to investigate the pain-relieving effect of a new application of TENS in unsedated screening colonoscopy. Ninety patients undergoing unsedated screening colonoscopy were randomly allocated to one of three groups: a control group (n=30), a group to receive active TENS (n=30), or a group to receive placebo TENS (n=30). A visual analogue scale (VAS) and a five-point Likert scale were used to assess pain 5 min into the procedure and at the end of the procedure. The patient's bloating sensation during colonoscopy and the effect on the duration of the procedure were also evaluated. Throughout the procedure, the active TENS group experienced a VAS pain score reduction ≥50% compared to the placebo TENS group (PTENS group compared to the placebo TENS and control groups (P=0.009). No significant differences were found between the study groups as to the bloating sensation and the duration of the procedure. We conclude that TENS can be used as a pain relief therapy in unsedated screening colonoscopy. Copyright © 2010 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  4. Development of a mucoadhesive delivery system for control release of doxepin with application in vaginal pain relief associated with gynecological surgery.

    Science.gov (United States)

    Sanz, Roser; Clares, Beatriz; Mallandrich, Mireia; Suñer-Carbó, Joaquim; Montes, María Jesús; Calpena, Ana C

    2018-01-15

    The main purpose of this study was to develop a semisolid mucoadhesive formulation for the non-invasive vaginal administration of doxepin (DOX) for relief of pain derived from the scarring process after surgery. An orafix ® platform loading DOX was tested for adequate stability, rheology and vaginal mucoadhesion capacity. The formulation exhibited appropriate pH and was microbiologically stable. The rheological studies confirmed its pseudoplastic and thixotropic nature with prevalence of the elastic behavior component over the viscous one. Appropriate syringeability and spreadability results were also confirmed. Different experiments showed adequate mucoadhesion capacity even in the presence of simulated vaginal fluid. Finally, DOX release, permeation and retention in vaginal mucosa studies were also accomplished with promising results. DOX release kinetics followed the modified Higuchi model and the permeation studies did not render such high values as to suggest potential systemic absorption which could lead to undesirable systemic side effects. Therefore, we can hypostatize that the proposed formulation may assist to fill in the therapeutic gap regarding pure pain relief at local level in vagina. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Effect of applied voltage, duration and repetition frequency of RF pulses for pain relief on temperature spikes and electrical field: a computer modelling study.

    Science.gov (United States)

    Ewertowska, Elżbieta; Mercadal, Borja; Muñoz, Víctor; Ivorra, Antoni; Trujillo, Macarena; Berjano, Enrique

    2018-02-01

    The thermal and electrical effects of pulsed radiofrequency (PRF) for pain relief can be controlled by modifying the characteristics of the RF pulses applied. Our goal was to evaluate the influence of such modifications on the thermal and electric performance in tissue. A computational model was developed to compare the temperature and electric field time courses in tissue between a standard clinical protocol (45 V pulses, 20 ms duration, 2 Hz repetition frequency) and a new protocol (55 V pulses, 5 ms duration, 5 Hz repetition frequency) with a higher applied electric field but a smaller impact on temperature alterations in tissue. The effect of including a temperature controller was assessed. Complementarily, an agar-based experimental model was developed to validate the methodology employed in the computer modelling. The new protocol increased the electric field magnitude reached in the tissue by around +20%, without increasing the temperature. The temperature controller was found to be the fundamental factor in avoiding thermal damage to the tissue and reduced the total number of pulses delivered by around 67%. The experimental results matched moderately well with those obtained from a computer model built especially to mimic the experimental conditions. For the same delivered energy, the new protocol significantly increases the magnitude of the applied electric field, which may be the reason why it is clinically more effective in achieving pain relief.

  6. Intramuscular ketorolac versus oral ibuprofen for pain relief in first-trimester surgical abortion: a randomized clinical trial.

    Science.gov (United States)

    Braaten, Kari P; Hurwitz, Shelley; Fortin, Jennifer; Goldberg, Alisa B

    2014-02-01

    Oral nonsteroidal antiinflammatory medications (NSAIDs) have been shown to reduce pain with first-trimester surgical abortion compared to placebo, but it is unclear if one NSAID is better than another. Some providers administer intramuscular ketorolac, though data regarding its efficacy in abortion are limited. This study was designed to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester surgical abortion. This was a randomized, double-blind, controlled trial. Women undergoing first-trimester surgical abortion with local anesthesia were randomized to preprocedural oral ibuprofen, 800 mg given 60-90 min preprocedure, or intramuscular ketorolac, 60 mg given 30-60 min preprocedure. The primary outcome was pain with uterine aspiration on a 21-point, 0-100, numerical rating scale. Secondary outcomes included pain with cervical dilation, postoperative pain and patient satisfaction. Ninety-four women were enrolled; 47 were randomized to ibuprofen and 47 to ketorolac. The groups did not differ with regards to demographics, reproductive history or Depression Anxiety Stress Scale scores. Mean pain scores for suction curettage did not differ between groups (52.3 vs. 56.2, p=.53). There was also no difference in pain with cervical dilation (41.6 vs. 45.4, p=0.48) or postoperative pain (22.3 vs. 15.0 p=.076), though patients in the ketorolac group experienced significantly greater arm pain than those who received a placebo injection (30.4 vs. 15.6, p<.001). Satisfaction with pain control did not differ significantly by group. Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen for first-trimester surgical abortion. Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during first-trimester surgical abortion, is more expensive and causes patients significant arm discomfort. Its use should therefore be reserved for patients who cannot tolerate oral NSAIDs. © 2014.

  7. The role of single nucleotide polymorphism of IL-6 and IL-10 cytokine on pain severity and pain relief after radiotherapy in multiple myeloma patients with painful bone destructions

    Directory of Open Access Journals (Sweden)

    Rudzianskiene Milda

    2014-01-01

    Full Text Available Multiple myeloma (MM cells interact with bone marrow stromal cells stimulating transcription and secretion of cytokines like IL-6 and IL-10, which are implicated in the progression and dissemination of MM. Regulation of cytokines secretion is under genetic control through genetic polymorphisms in their coding and promoter sequences. It seems that single nucleotide polymorphism (SNP in the promoter region of various genes may regulate the plasma concentrations of cytokines. Cytokines could be also hypothesized to function as pain modulators as peripheral nociceptors are sensitized by cytokines. The aim was to determine if the SNP of IL-6 and IL-10 cytokines could influence the analgesic response of radiotherapy in the treatment of painful bone destructions in MM patients. 30 patients (19 women and 11 men, median age: 67 years with MM and painful bone destructions were treated with palliative radiotherapy. Pain was evaluated according to the visual analogue scale and analgesics intake. Pain scores and analgesics use were measured prior to radiotherapy as well as 4, 12 and 24 weeks afterward. Opioid analgesics were converted to the morphine-equivalent daily dose (MEDD. Genomic DNA was extracted from peripheral blood leukocytes and IL-6 and IL-10 gene promoter polymorphisms were analysed with polymerase chain reaction. 60% of patients reported severe pain prior to radiotherapy, which decreased to 13% at the first follow-up visit (p <0.001. The MEDD on admission to the hospital was 75 mg/day which decreased to 46 mg/day at the first follow-up visit (p = 0.033. A significant parameter in pain relief was: age < 65 years (p=0.029. We analysed 6 SNPs in the gene promoter region of IL-6 (-597 G/A, -572 G/C, -174 G/C and IL-10 (-592 A/C, -819 C/T, -1082 A/G as well as their relation with pain severity and analgesic consumption. Patients who are IL-10 -1082 A/G carriers are prone to respond better to radiotherapy than other patients (p<0.05. A borderline

  8. The Effect of Virtual Reality Distraction on Pain Relief During Dressing Changes in Children with Chronic Wounds on Lower Limbs.

    Science.gov (United States)

    Hua, Yun; Qiu, Rong; Yao, Wen-Yan; Zhang, Qin; Chen, Xiao-Li

    2015-10-01

    It has been demonstrated that patients with chronic wounds experience the most pain during dressing changes. Currently, researchers focus mostly on analgesics and appropriate dressing materials to relieve pain during dressing changes of chronic wounds. However, the effect of nonpharmacologic interventions, such as virtual reality distraction, on pain management during dressing changes of pediatric chronic wounds remains poorly understood. To investigate the effect of virtual reality distraction on alleviating pain during dressing changes in children with chronic wounds on their lower limbs. A prospective randomized study. A pediatric center in a tertiary hospital. Sixty-five children, aged from 4 to 16 years, with chronic wounds on their lower limbs. Pain and anxiety scores during dressing changes were recorded by using the Wong-Baker Faces picture scale, visual analogue scale, and pain behavior scale, as well as physiological measurements including pulse rate and oxygen saturation. Time length of dressing change was recorded. Virtual reality distraction significantly relieved pain and anxiety scores during dressing changes and reduced the time length for dressing changes as compared to standard distraction methods. The use of virtual reality as a distraction tool in a pediatric ward offered superior pain reduction to children as compared to standard distractions. This device can potentially improve clinical efficiency by reducing length time for dressing changes. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  9. Progression of function and pain relief as indicators for returning to sports after arthroscopic isolated type II SLAP repair-a prospective study.

    Science.gov (United States)

    Boesmueller, Sandra; Tiefenboeck, Thomas M; Hofbauer, Marcus; Bukaty, Adam; Oberleitner, Gerhard; Huf, Wolfgang; Fialka, Christian

    2017-06-13

    One of the currently used surgical techniques in isolated type II SLAP lesions is arthroscopic SLAP repair. Postoperatively, patients tend to suffer from a prolonged period of pain and are restricted in their sports activities for at least 6 months. The aim of this study was to prospectively evaluate the clinical outcome as well as the postoperative course of pain after arthroscopic type II SLAP repair. Outcome measures were assessed using the Individual Relative Constant Score (CS indiv ), the American Shoulder and Elbow Surgeons (ASES) Score, the Visual Analogue Scale (VAS), and the Short Form 36 (SF-36). Data were collected preoperatively, as well as at 3, 6, 12 and >24 months postoperatively. Eleven patients with an average age of 31.8 years (range: 22.8-49.8 years) underwent arthroscopic repair of isolated type II SLAP lesions. Mean follow-up time was 41.9 months (range: 36.1-48.4 months). 6 months after surgery, there was a statistically significant improvement of function according to the CS indiv (p = 0.004), the ASES Score (p = 0.006), and the SF-36 subscale "physical functioning" (p = 0.014) and a statistically significant decrease of pain according to the VAS (p = 0.007) and the SF-36 subscale "bodily pain" (p = 0.022) compared to preoperative levels. Arthroscopic repair of isolated type II SLAP lesions with suture anchors leads to a satisfactory functional outcome and return to pre-injury sports levels, with delayed, but significant pain relief observed 6 months after surgery. Thus, a return to sports should not be allowed earlier than 6 months after surgery, when patients have reached pain-free function and recovered strength. Researchregistry1761 (UIN).

  10. 'Tough love': The experiences of midwives giving women sterile water injections for the relief of back pain in labour.

    Science.gov (United States)

    Lee, Nigel; Kildea, Sue; Stapleton, Helen

    2017-10-01

    To explore midwives' experiences of administering sterile water injections (SWI) to labouring women as analgesia for back pain in labour. A qualitative study, which generated data through semi-structured focus group interviews with midwives. Data were analysed thematically. Two metropolitan maternity units in Queensland, Australia. Eleven midwives who had administered SWI for back pain in labour in a randomised controlled trial. Three major themes were identified including: i. SWI, is it an intervention?; ii. Tough love, causing pain to relieve pain; iii. The analgesic effect of SWI and impact on midwifery practice. Whilst acknowledging the potential benefits of SWI as an analgesic the midwives in this study described a dilemma between inflicting pain to relieve pain and the challenges encountered in their discussions with women when offering SWI. Midwives also faced conflict when women requested SWI in the face of institutional resistance to its use. The procedural pain associated with SWI may discourage some midwives from offering women the procedure, providing women with accurate information regarding the intensity and the brevity of the injection pain and the expected degree of analgesic would assist in discussion about SWI with women. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Pain is a major component of quality of life in patients with ankylosing spondylitis and the possibilities of its relief

    Directory of Open Access Journals (Sweden)

    Oksana Anatolyevna Pirogova

    2013-01-01

    Full Text Available The paper gives the results of an investigation of quality of life (QL in patients with ankylosing spondylitis. It shows the implication of chronic pain syndrome in lowering QL and considers the issues of combination therapy with nimesulide (nise and tizanidine (sirdalud for pain syndrome.

  12. Derivatives of furanditerpenes from Pterodon genus: Pharmacological studies disclose their potential as chronic pain relief in mice.

    Science.gov (United States)

    Spindola, Humberto M; Grando, Rogério; Figueiredo, Mariana C; Basting, Rosana; Queiroz, N C A; de Fátima, Ângelo; de Carvalho, João E; Wang, Zaijie J; Foglio, M A

    2017-06-05

    Pterodon genus fruits are commercially available at the Brazilian medicinal market used in folk medicine due to their anti-inflammatory, analgesic, and anti-rheumatic effects. Previous studies demonstrated that furanditerpenes possessing vouacapan skeleton, isolated from Pterodon genus, possess expressive antinociceptive activities, with promising moiety for the development of new analgesic products. The antinociceptive properties of compounds 6α,7β-6α-hidroxivouacapan-7β-17β-lactone (HVL) and 6α-oxovouacapan-7β-17β-lactone (OVL), semi-synthetic analogues of furanditerpenes previously reported as analgesic agents were evaluated on animal experimental models (Spindola et al., 2010, 2011). The chemical-induced pain methods used in the present work, demonstrated for the first time that both compounds HVL and OVL have potential as important templates for the development of chronic pain control drugs. The main findings of this work were that both compounds were: effective in the writhing test; reduced paw edema in the carrageenan test; effective in the inflammatory phase of the formalin test corroborating their activity against inflammatory pain conditions; effective on reducing pain through the stimulation of vanilloid receptors sensible to capsaicin (an important pathway for chronic pain maintenance); reduced the pain stimulus caused by PGE2 injection (a pathway involved in chronic pain hypersensitivity); effective on decreasing mechanical allodynia in the CFA-model, demonstrating their potential use against chronic pain disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain

    OpenAIRE

    Waqqar, Saira; Shakil-ur-Rehman, Syed; Ahmad, Shakeel

    2016-01-01

    Background and Objective: Chronic mechanical low back pain is common among different age groups and genders. Different manual therapy techniques combined with exercise therapy and electrotherapy modalities play an important role in its management. Our objective was to compare the effects of McKenzie extension exercisesprogram (EEP) versus Mulligan Sustained Natural Apophyseal Glides (SNAGs) for chronic mechanical low back pain (CMLBP). Methods: This randomized control trial (RCT) was conducte...

  14. Comparison of Anterior and Posterior Cortico-steroid Injections for Pain Relief and Functional Improvement in Shoulder Impingement Syndrome.

    Science.gov (United States)

    Ramappa, Arun; Walley, Kempland C; Herder, Lindsay M; Iyer, Sravisht; Zurakowski, David; Hall, Amber; DeAngelis, Joseph P

    Subacromial impingement syndrome (SIS) is the most common cause of shoulder pain. Treatment options for SIS include conservative modalities such as use of nonsteroidal anti-inflammatory drugs, physical therapy, and subacromial corticosteroid injections (CSIs). Although studies have found improvement in pain, function, and range of motion after CSI, the effect of injection route (anterior or posterior) on shoulder pain in patients with SIS has not been investigated. In the study reported here, patients were randomly assigned to 2 treatment groups: anterior CSI and posterior CSI. Pain was assessed with a visual analog scale (VAS) and function with the Single Assessment Numeric Evaluation (SANE). Patients were evaluated before injection (baseline) and 1, 3, and 6 months after injection. Of the 55 patients enrolled, 25 received anterior CSI and 30 received posterior CSI. The 2 groups showed no significant difference in VAS pain at baseline or 1, 3, or 6 months after injection. SANE scores were statistically different at 3 months. Each group had significantly less pain and better function 1, 3, and 6 months after injection than at baseline. Age, sex, and body mass index did not significantly affect the efficacy of anterior or posterior CSIs. In patients with SIS, subacromial CSI reduces pain and improves function for up to 6 months. These effects are no different for anterior and posterior injection routes. As a result, clinicians should rely on their clinical acumen when selecting injection routes, as anterior and posterior are both beneficial.

  15. Evaluation of the durability of pain relief throughout a 12 hour dosing interval of a novel, extended-release, abuse-deterrent formulation of oxycodone.

    Science.gov (United States)

    Nalamachu, Srinivas; Kopecky, Ernest A; Taylor, Robert; Vaughn, Ben; O'Connor, Melinda

    2016-07-01

    Abuse deterrent formulations (ADF) are designed to prevent the misuse of opioids by tampering (e.g. physical and chemical manipulation) in order to ingest the opioid in a manner other than intended. Extended-release (ER) formulations are formulated with a larger drug load than immediate-release (IR) formulations, which makes ER opioids more desirable to drug abusers than I.R. formulations. ADFs, therefore, are particularly useful with ER opioid agents, which are designed to produce consistent analgesia over prolonged dosing intervals. However, the drug release properties of these formulations vary and sometimes may not provide adequate pain relief throughout the intended dosing interval, requiring patients to take additional medication for pain relief. Oxycodone DETERx* (Xtampza ER * ) is a novel, microsphere-in-capsule opioid formulation, which allows for twice daily dosing (i.e. every 12 hours) and mitigates the ability to tamper with the formulation. To evaluate the durability of pain relief of a novel formulation of oxycodone throughout the 12 hour dosing interval. This study is a post-hoc analysis of 193 subjects in a Phase 3 randomized withdrawal, double-blind, placebo-controlled, enriched-enrollment, parallel-group, multicenter, 12-week clinical study. The analysis evaluated the frequency and distribution of use of oxycodone ER and rescue medication during the Double-blind Maintenance Phase of the study. Usage patterns captured by an electronic diary indicated limited overall and limited per-day use of rescue medication with no increase in rescue medication consumption 8 to 12 hours post-dose, suggesting that subjects did not experience end-of-dose failure during this time period. This study is limited in that it is a post-hoc analysis based on data gathered electronically from a large, prospective, double-blind, randomized, placebo-controlled, Phase 3 clinical study. The evaluation of dosing patterns indicates that this ER oxycodone capsule

  16. Pain Relief with Wet Cupping Therapy in Rats is Mediated by Heat Shock Protein 70 and ?-Endorphin

    OpenAIRE

    Imam Subadi; Boya Nugraha; Hening Laswati; Harjanto Josomuljono

    2017-01-01

    Background: Wet cupping therapy is a complementary therapy in pain management. The mechanism of this therapy, however, needs further elucidation. Cells injured by wet cupping therapy seem to stimulate the expression of heat shock protein 70 (HSP70). Its benefit in pain reduction could be mediated by the expression of ß-endorphin. This study aimed at determining the correlation between HSP70 and ß-endorphin after wet cupping therapy. Methods: Sixteen male Wistar rats were divided into contr...

  17. Nav1.7 and other voltage-gated sodium channels as drug targets for pain relief.

    Science.gov (United States)

    Emery, Edward C; Luiz, Ana Paula; Wood, John N

    2016-08-01

    Chronic pain is a massive clinical problem. We discuss the potential of subtype selective sodium channel blockers that may provide analgesia with limited side effects. Sodium channel subtypes have been linked to human pain syndromes through genetic studies. Gain of function mutations in Nav1.7, 1.8 and 1.9 can cause pain, whilst loss of function Nav1.7 mutations lead to loss of pain in otherwise normal people. Intriguingly, both human and mouse Nav1.7 null mutants have increased opioid drive, because naloxone, an opioid antagonist, can reverse the analgesia associated with the loss of Nav1.7 expression. We believe there is a great future for sodium channel antagonists, particularly Nav1.7 antagonists in treating most pain syndromes. This review deals with recent attempts to develop specific sodium channel blockers, the mechanisms that underpin the Nav1.7 null pain-free phenotype and new routes to analgesia using, for example, gene therapy or combination therapy with subtype specific sodium channel blockers and opioids. The use of selective Nav1.7 antagonists together with either enkephalinase inhibitors or low dose opioids has the potential for side effect-free analgesia, as well as an important opioid sparing function that may be clinically very significant.

  18. Effect of music on labor pain relief, anxiety level and postpartum analgesic requirement: a randomized controlled clinical trial.

    Science.gov (United States)

    Simavli, Serap; Gumus, Ilknur; Kaygusuz, Ikbal; Yildirim, Melahat; Usluogullari, Betul; Kafali, Hasan

    2014-01-01

    The control of labor pain and the prevention of suffering are major concerns of clinicians and their patients. The aim of this study was to evaluate the effect of music on labor pain and anxiety, maternal hemodynamics, fetal-neonatal parameters and postpartum analgesic requirement in primiparous women. Overall, 156 primiparous women who expected vaginal delivery were recruited and randomly assigned to a music group (n = 77) or a control group (n = 79). Women in the music group listened to music during labor. Pain intensity and anxiety level were measured using a visual analogue scale (0-10 cm). The two groups were compared in terms of pain severity, anxiety level, maternal hemodynamics, fetal-neonatal parameters and postpartum analgesic requirement. Mothers in the music therapy group had a lower level of pain and anxiety compared with those in the control group at all stages of labor (p music therapy group (p music during labor has a positive impact on labor pain and anxiety, maternal-fetal parameters and analgesic requirement. © 2014 S. Karger AG, Basel.

  19. Palmitoylethanolamide Is a Disease-Modifying Agent in Peripheral Neuropathy: Pain Relief and Neuroprotection Share a PPAR-Alpha-Mediated Mechanism

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    L. Di Cesare Mannelli

    2013-01-01

    Full Text Available Neuropathic syndromes which are evoked by lesions to the peripheral or central nervous system are extremely difficult to treat, and available drugs rarely joint an antihyperalgesic with a neurorestorative effect. N-Palmitoylethanolamine (PEA exerts antinociceptive effects in several animal models and inhibits peripheral inflammation in rodents. Aimed to evaluate the antineuropathic properties of PEA, a damage of the sciatic nerve was induced in mice by chronic constriction injury (CCI and a subcutaneous daily treatment with 30 mg kg−1 PEA was performed. On the day 14, PEA prevented pain threshold alterations. Histological studies highlighted that CCI induced oedema and an important infiltrate of CD86 positive cells in the sciatic nerve. Moreover, osmicated preparations revealed a decrease in axon diameter and myelin thickness. Repeated treatments with PEA reduced the presence of oedema and macrophage infiltrate, and a significant higher myelin sheath, axonal diameter, and a number of fibers were observable. In PPAR-α null mice PEA treatment failed to induce pain relief as well as to rescue the peripheral nerve from inflammation and structural derangement. These results strongly suggest that PEA, via a PPAR-α-mediated mechanism, can directly intervene in the nervous tissue alterations responsible for pain, starting to prevent macrophage infiltration.

  20. A randomised non-inferiority controlled trial of a single versus a four intradermal sterile water injection technique for relief of continuous lower back pain during labour

    Directory of Open Access Journals (Sweden)

    Webster Joan

    2011-03-01

    Full Text Available Abstract Background Almost one third of women suffer continuous lower back pain during labour. Evidence from three systematic reviews demonstrates that sterile water injections (SWI provide statistically and clinically significant pain relief in women experiencing continuous lower back pain during labour. The most effective technique to administer SWI is yet to be determined. Therefore, the aim of this study is to determine if the single injection SWI technique is no less effective than the routinely used four injection SWI method in reducing continuous lower back pain during labour. Methods/design The trial protocol was developed in consultation with an interdisciplinary team of clinical researchers. We aim to recruit 319 women presenting at term, seeking analgesia for continuous severe lower back pain during labour. Participants will be recruited from two major maternity hospitals in Australia. Randomised participants are allocated to receive a four or single intradermal needle SWI technique. The primary outcome is the change in self-reported pain measured by visual analogue scale at baseline and thirty minutes post intervention. Secondary outcomes include VAS change scores at 10, 60, 90 and 120 min, analgesia use, mode of birth and maternal satisfaction. Statistical analysis Sample size was calculated to achieve 90% power at an alpha of 0.025 to detect a non-inferiority margin of ≤ 1 cm on the VAS, using a one-sided, two-sample t-test. Baseline demographic and clinical characteristics will be analysed for comparability between groups. Differences in primary (VAS pain score and secondary outcomes between groups will be analysed by intention to treat and per protocol analysis using Student's t-test and ANOVA. Conclusion This study will determine if a single intradermal SWI technique is no less effective than the routinely used four injection technique for lower back pain during labour. The findings will allow midwives to offer women

  1. Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice.

    Science.gov (United States)

    Gaertner, Jan; Stamer, Ulrike M; Remi, Constanze; Voltz, Raymond; Bausewein, Claudia; Sabatowski, Rainer; Wirz, Stefan; Müller-Mundt, Gabriele; Simon, Steffen T; Pralong, Anne; Nauck, Friedemann; Follmann, Markus; Radbruch, Lukas; Meißner, Winfried

    2017-01-01

    Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain. First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life. The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948-2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts. Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5-2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased. Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.

  2. A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma.

    Science.gov (United States)

    Clark, Eric; Plint, Amy C; Correll, Rhonda; Gaboury, Isabelle; Passi, Brett

    2007-03-01

    Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries. Children 6 to 17 years old with pain from a musculoskeletal injury (to extremities, neck, and back) that occurred in the preceding 48 hours before presentation in the emergency department were randomly assigned to receive orally 15 mg/kg acetaminophen, 10 mg/kg ibuprofen, or 1 mg/kg codeine. Children, parents, and the research assistants were blinded to group assignment. The primary outcome was change in pain from baseline to 60 minutes after treatment with study medication as measured by using a visual analog scale. A total of 336 patients were randomly assigned, and 300 were included in the analysis of the primary outcome (100 in the acetaminophen group, 100 in the ibuprofen group, and 100 in the codeine group). Study groups were similar in age, gender, final diagnosis, previous analgesic given, and baseline pain score. Patients in the ibuprofen group had a significantly greater improvement in pain score (mean decrease: 24 mm) than those in the codeine (mean decrease: 11 mm) and acetaminophen (mean decrease: 12 mm) groups at 60 minutes. In addition, at 60 minutes more patients in the ibuprofen group achieved adequate analgesia (as defined by a visual analog scale ibuprofen provides the best analgesia among the 3 study medications.

  3. Design of Diclofenac Sodium Indicator Strips Using Polystyrene (PS and Polymethylmethacrylate (PMMA for Detection of Diclofenac Sodium in Traditional Pain Relief Herbal Medicines

    Directory of Open Access Journals (Sweden)

    Ibrahim Dalli

    2017-04-01

    Full Text Available Diclofenac sodium is one of analgesic which is often added to traditional pain relief herbal medicines to enhance the effects. One of qualititative method that is easy, efficient and simple testing is an indicator strip. Indicator strip based Polystyrene (PS and Polymethylmethacrylate (PMMA was made for the examination of diclofenac sodium that were misused as a drug chemical compound in traditional pain relief herbal medicine. Strip indikator was made by reagent blending method with specific reagents used, namely, copper sulphate (CuSO4, ferric chloride (FeCl3 and vanillin sulphate. The working principle of the indicator strip in detecting the presence of diclofenac sodium in herbal medicine is with the occurrence of a color reaction. The concentration of PS and PMMA was made in a variation of 5%, 7.5% and 10%, and the mixture of PS: PMMA 1: 5 and 1: 6 concecutively with a ratio of solvent: reactant 6: 4; 7: 3 and 8:2. The test results showed that the best indicator strip is PMMA-CuSO4 5% (7: 3, PMMA-FeCl3 5% (7: 3 and PMMA-Vanillin sulphate 7.5% (7: 3. The detection limit and stability of the strip indicators PMMA-CuSO4 5% (7: 3 are at 50 ppm and is stable up to 29 weeks, PMMA-FeCl3 5% (7: 3 has a detection limit 12,500 ppm and is stable up to 29 weeks, and PMMA-vanillin sulphate 7,5% (7: 3 has a detection limit 500 ppm and is stable up to 29 weeks. The results showed that the indicator strip can be used as an alternative method to detect diclofenac sodium in herbal medicine and finally controlling addition of chemicals in to herbal medicine.

  4. First steps toward understanding the variability in acute pain service provision and the quality of pain relief in everyday practice across the United Kingdom.

    Science.gov (United States)

    Duncan, Fiona; Day, Ruth; Haigh, Carol; Gill, Stuart; Nightingale, Jeremy; O'Neill, Olga; Counsell, David

    2014-01-01

    Pain management for patients in hospital is a major problem. There is significant variation in care provision. Evidence is needed about the ways in which acute pain services are organized in order to understand whether these are linked to important differences in patient outcomes. The National Inpatient Pain Study group is a voluntary collaborative venture of inpatient pain specialists in the United Kingdom who are working toward establishing a national prospective database of service provision and activity. The objectives of this article are (1) to describe current pain service provision and activity (2) to define and monitor the quality and side effects of the primary analgesic techniques, such as central neuraxial block or systemic analgesia, and identify variations in practice. Phase 1: Surveys were conducted in two phases during 2010-2011. Information about the organization of services was collected from 121 centers via a live Website. Phase 2: The pilot clinical dataset was collected from 13 hospitals in 2011. Results indicated that staffing varied widely from one to nine nurses per hospital site. Twelve percent of hospitals did not routinely collect data. The main workload was orthopedic and general surgery based on data from 13 hospitals and 29,080 patients in 2011. Thirty-seven percent of patients reported a pain score of moderate to severe pain on the first assessment by the specialist pain team, and 21% reported severe pain. Nausea and vomiting was the most frequent adverse event reported. Sixty-nine major adverse events were logged, of which 64 documented respiratory depression (N = 29,080, 0.22%). Prospective longitudinal data has the potential to improve our understanding of variation in process and outcome measures and establish future research priorities. Wiley Periodicals, Inc.

  5. Pain relief and improved physical function in knee osteoarthritis patients receiving ongoing hylan G-F 20, a high-molecular-weight hyaluronan, versus other treatment options: data from a large real-world longitudinal cohort in Canada

    Directory of Open Access Journals (Sweden)

    Petrella RJ

    2015-10-01

    Full Text Available Robert J Petrella,1,2 Craig Wakeford31Departments of Family Medicine, Medicine (Cardiology and Kinesiology, University of Western Ontario; 2Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, London, ON; 3Health Economics and Health Outcomes, Sanofi-Aventis Inc., Laval, QC, CanadaAbstract: From the Southwestern Ontario database, one of the largest primary-care datasets in Canada, 1,263 patients with osteoarthritis (OA of one or both knees were identified who received two consecutive series of intra-articular (IA injections of hylan G-F 20 preparation and no other prescribed OA medications, and were evaluated fully between 2006 and 2012. A cohort of 3,318 demographically matched OA patients who had not been treated with IA injection therapy was identified from the same database for comparison. Responses to therapy were assessed by means of a 10-point visual analog scale (VAS for pain at rest and after completion of a 6-minute walk test (6MWT, while physical capacity was measured by performance in the 6MWT itself. After two cycles of hylan G-F 20 therapy, the average VAS score for pain at rest declined from 7.82±1.27 at baseline to 4.16±1.51 (average change 3.66±1.78, significantly more than the reduction of 3.12±2.03 seen in the reference group [P<0.012] and the average VAS score for pain after the 6MWT decreased by 5.56±1.74 points (from 9.58±0.4 at baseline to 4.02±1.67 at the final assessment, a significantly larger change than that seen in the reference group (Δ2.99±1.85; P<0.001 for intergroup comparison. Distance walked in the 6MWT increased on average by 115 m, significantly more than that seen in the reference group (Δ91 m; P<0.001 for intergroup comparison. These findings from a primary-care database suggest sustained benefits in terms of pain and physical function from repeat cycles of IA injections of hylan G-F 20 and no other prescribed OA medications in adults with OA of the knee

  6. A candidate gene study of serotonergic pathway genes and pain relief during treatment with escitalopram in patients with neuropathic pain shows significant association to serotonin receptor2C (HTR2C)

    DEFF Research Database (Denmark)

    Brasch-Andersen, Charlotte; Møller, Malik U; Christiansen, Lene

    2011-01-01

    PURPOSE: Previous studies have shown that a small fraction of patients with peripheral neuropathic pain experiences >50% pain relief during treatment with selective serotonin reuptake inhibitors (SSRIs), whereas most patients have no or only slight relief. The aim of this study was to investigate...... receptor 2A (HTR2A) gene, the serotonin receptor 2C (HTR2C) gene, the ABCB1 gene encoding for the P-glycoprotein, the CYP2C19 gene, and the serotonin transporter gene (SLC6A4). RESULTS: The SNP rs6318 (Cys23Ser) in the HTR2C gene showed significant association with treatment response in men (p = 0...... with increasing number of short alleles for the 5-HTTLPR polymorphism of the serotonin transporter (OR 5.7, p = 0.057). None of the other polymorphisms showed a significant association with treatment response to escitalopram. CONCLUSION: This study indicates that variation in the HTR2C gene is associated...

  7. Double-blind, placebo-controlled, randomized pilot study of cerebral blood flow patterns employing SPECT imaging in dental postsurgical pain patients with and without pain relief

    National Research Council Canada - National Science Library

    Newberg, Andrew B; Hersh, Elliot V; Levin, Lawrence M; Giannakopoulos, Helen; Secreto, Stacey A; Wintering, Nancy A; Farrar, John T

    2011-01-01

    .... The purpose of this pilot study was to employ SPECT to measure CBF distribution associated with postoperative dental pain and to compare these CBF patterns to subsequent images in the same patients...

  8. Preoperative gabapentin alone or in combination with dexamethasone on postoperative pain relief after abdominal hysterectomies. A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ahmed A. Badawy

    2015-04-01

    Conclusion: Gabapentin alone reduced the intraoperative and postoperative opioid requirement as well as postoperative pain and PONV which was significant in comparison with the placebo effect in the control. Obviously these effects were more prominent and highly significant when dexamethasone was added to gabapentin.

  9. Pain Relief with Wet Cupping Therapy in Rats is Mediated by Heat Shock Protein 70 and ß-Endorphin.

    Science.gov (United States)

    Subadi, Imam; Nugraha, Boya; Laswati, Hening; Josomuljono, Harjanto

    2017-07-01

    Wet cupping therapy is a complementary therapy in pain management. The mechanism of this therapy, however, needs further elucidation. Cells injured by wet cupping therapy seem to stimulate the expression of heat shock protein 70 (HSP70). Its benefit in pain reduction could be mediated by the expression of ß-endorphin. This study aimed at determining the correlation between HSP70 and ß-endorphin after wet cupping therapy. Sixteen male Wistar rats were divided into control (CG; n=8) and treatment (TG; n=8) groups. The rats in both groups were injected with complete Freund's adjuvant (CFA) at the footpad. In the TG, wet cupping therapy was done at the left and right paralumbar regions 48 hours after the CFA injection. Twenty-four hours after therapy, the hot plate test was done to assess pain threshold. Thereafter, immunohistochemistry from the skin subjected to wet cupping therapy was conducted for HSP70 and ß-endorphin. The expression of HSP70 was significantly higher in the keratinocytes of the TG (20.25±3.53; Pcupping therapy was significantly higher in the TG (22.81±6.34 s; P=0.003) than in the CG (11.78±3.56 s). The benefit of wet cupping therapy in terms of pain reduction in rats could be mediated by the expression of HSP70 and ß-endorphin.

  10. Comparison of paracetamol, ibuprofen, and diclofenac potassium for pain relief following dental extractions and deep cavity preparations.

    Science.gov (United States)

    Gazal, Giath; Al-Samadani, Khalid H

    2017-03-01

    To compare the effectiveness of different oral analgesics for relieving pain and distress in adults following the extraction of teeth and deep cavity preparations under local anesthesia. Methods: This randomized controlled study was conducted between November 2015 and May 2016. One hundred and twenty patients were randomly allocated to 3 groups. Forty patients were in the paracetamol (1 gram) group, 40 in the ibuprofen (400 mg) group and 40 in the diclofenac potassium (50 mg) group. Evaluation of the post extraction and deep cavity preparations pain was made by patients immediately postoperatively, 2, 4 and 6 hours postoperatively on standard 100 mm visual analogue scales (VAS). Furthermore, each patient was observed preoperatively and immediately postoperatively for signs of distress by using a 5 point face scale. Results: There were significant decreases in mean pain VAS scores for diclofenac potassium group compared to paracetamol and ibuprofen groups at 4 hours postoperatively (one-way Analysis of Variance: p=0.0001, p=0.001) and 6 hours postoperatively (p=0.04, p=0.005). Changes in distress scores from the preoperative score to the postoperative score were made using the paired sample t-test. There were significant decreases in distress scores between the preoperative and postoperative scores (p=0.0001). Conclusions: Diclofenac potassium was more effective than paracetamol or ibuprofen for reducing postoperative pain associated with tooth extraction and deep cavity preparation. Patients' distress levels can be alleviated by using preemptive analgesics.

  11. Clinical Outcome in Relation to Timing of Surgery in Chronic Pancreatitis A Nomogram to Predict Pain Relief

    NARCIS (Netherlands)

    Ahmed Ali, Usama; Nieuwenhuijs, Vincent B.; van Eijck, Casper H.; Gooszen, Hein G.; van Dam, Ronald M.; Busch, Olivier R.; Dijkgraaf, Marcel G. W.; Mauritz, Femke A.; Jens, Sjoerd; Mast, Jay; van Goor, Harry; Boermeester, Marja A.; Gouma, D. J.; van Gulik, T. M.; van Hooft, J. E.; Fockens, P.; Voermans, R. P.; van der Schelling, G. P.; Rijk, M. C. M.; Rosman, C.; Tan, A.; de Hingh, I. H. J. T.; Schoon, E.; van Eijck, C. H.; Bruno, M. J.; van Duijvendijk, P.; Erkelens, G. W.; Vecht, J.; Meijssen, M. A. C.; Bosscha, K.; Römkens, T. E. H.; van Munster, I.; Schaapherder, A. F.; Veenendaal, R. A.; Straathof, J. W.; Hadithi, H.; van der Harst, E.; Consten, E. C. J.; Brink, M. A.; HOUDIJK, A. P. J.; Manusama, E.; Pierie, J. P. E. N.; Gerritsen, J. J. G. M.; Kolkman, J.; Deiong, C. H. C.; Masclee, A.; de Ridder, R. J. J.; Keulemans, Y.; Jansen, J. M.; Festen, S.; Karsten, T. M.; Spanier, B. W. M.; Spillenaar Bilgen, E. J.; Heisterkamp, J.; Grubben, M. J. A. L.; Bollen, T. L.; van Ramshorst, B.; Boerma, D.; Weusten, B. L.; Timmer, R.; Gooszen, H. G.; van Baal, M. C.; van Brunschot, S.; Bouwense, S. A. W.; Schepers, N. J.; Issa, Y.; van Goor, H.; Wilder-Smith, O. H. G.; Drenth, J. P.; Rijkers, G. R.; van Santvoort, H. C.; Molenaar, I. Q.; Besselink, M. G. H.; Bakker, O. J.; Nijmeijer, R. M.; Vleggaar, F. P.; Siersema, P. D.; van Leeuwen, M. S.; Nieuwenhuijs, V. B.; Hofker, H. S.; van Dullemen, H. M.; Beese, U.; van der Peet, D. L.; Cuesta, M. A.; Mulder, C. J.; Kruyt, P. H.; Witteman, B. J.

    2012-01-01

    Objective: To evaluate the effect of timing of surgery on the long-term clinical outcome of surgery in chronic pancreatitis (CP). Design: Cohort study with long-term follow-up. Setting: Five specialized academic centers. Patients: Patients with CP treated surgically for pain. Interventions:

  12. Accuracy and efficacy of fluoroscopy-guided pars interarticularis injections on immediate and short-term pain relief.

    Science.gov (United States)

    Kershen, L Michael; Nacey, Nicholas C; Patrie, James T; Fox, Michael G

    2016-10-01

    To determine the accuracy and short-term efficacy of fluoroscopy-guided steroid/anesthetic injections for symptomatic pars interarticularis (pars) defects. Following IRB approval, all fluoroscopically guided pars injections from a single institution (6/2010 to 3/2016) were retrospectively and independently reviewed by two MSK radiologists. The radiologists evaluated the fluoroscopic images to determine if all of the pars injections associated with each procedure were intra-pars (n = 57 procedures; 106 pars injections), peri-pars (n = 3 procedures; three pars injected), or a combination of intra-pars and peri-pars (n = 6 procedures; 12 pars injected). The patients were asked their pain score (graded on a scale of 0-10) pre-injection, 5-10 min and 1-week post-injection. Age, gender, and fluoroscopic times were recorded. Statistical analysis was performed on the all intra-pars injections only. Exact inter-reader agreement was present in 92 % (112/121) of the injections, with 57 of the procedures (106 pars injections) performed on 41 patients (mean age 36; 18 M, 23 F) all intra-pars. The mean pre-injection and 5-10 min post-injection reduction in pain for the all intra-pars injections was -3.0 units (95 % CI: [-3.9, -2.1] units; p pars) reduction in pain of -0.7 units (95 % CI [-1.5, 0.0]; p = 0.06). The geometric mean fluoroscopic time per pars injected was 42 s. Over 92 % of fluoroscopically guided injections for symptomatic spondylolysis are technically successful with minimum fluoroscopic time, resulting in statistically significant pain reduction immediately post-injection and a trend in pain reduction 1-week post-injection.

  13. Is manipulative therapy clinically necessary for relief of neck pain? A systematic review and meta-analysis.

    Science.gov (United States)

    Yao, Min; Sun, Yue-Li; Dun, Rong-Liang; Lan, Tian-Ying; Li, Jin-Long; Lee, Hyo Jin; Haraguchi, Noriko; Wang, Yong-Jun; Cui, Xue-Jun

    2017-07-01

    To summarize and critically assess the effificacy of Eastern and Western manipulative therapies for the treatment of neck pain in adults. A search of PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, EMBASE, etc. from their inception date to January 2014 with Chinese, Japanese, and Korean databases. Two reviewers independently selected randomized controlled trials (RCTs) with negative control or blank control, extracted data and assessed methodological quality. Meta-analysis and levels of evidence were performed by Revman5.1 and Grades of Recommendations Assessment, Development and Evaluation (GRADE) approach. Nineteen clinical trials with adequate randomization were included in this review, 11 of them had a low risk of bias. The primary outcome for short-term pain had no significant differences, however, the secondary outcome, only the Numerical Pain Rating Scale (NPRS) score of intermediate-term [n=916, pooled mean differences (MD) =-0.29, P=0.02], the Neck Disability Index (NDI) score of short-term (n=1,145, pooled MD=-2.10, PVisual Analogue Scale and NPRS pain score to be 13 mm, while NDI was 3.5 points. The meta-analysis only suggested a trend in favor of manipulative therapy rather than clinical signifificance. The results do not support the existing evidences for the clinical value of Eastern or Western manipulative therapy for neck pain of short-term follow-up according to MCIDs. The limitations of our review related to blinding, allocation concealment and small sample size.

  14. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...... also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree...

  15. Assessment of feasibility and efficacy of Class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: A pilot study

    Directory of Open Access Journals (Sweden)

    Anil Karlekar

    2015-01-01

    Full Text Available Background: Laser therapy, for its established analgesic properties with minimal side effects, has been used for the treatment of chronic pain. However, it has not been used for the treatment of acute postoperative pain. This pilot study was designed to assess the feasibility and efficacy of Class IV laser on postoperative pain relief following off-pump coronary artery bypass graft (OPCABG surgery, as a component of multimodal analgesia (MMA technique. Methods: This open observational prospective study comprised of 100 adult patients (84 male, 16 female who underwent OPCABG through sternotomy. For postoperative analgesia, they were subjected to laser therapy subjected to laser therapy in addition to the standard institutional pain management protocol comprising of IV infusion/bolus of tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain intensity was measured by Verbal Rating Scale (VRS. The laser therapy was scheduled as once a day regime for three consecutive postoperative days (PODs starting on POD 1, 30 min following tracheal extubation. The subsequent laser applications were also scheduled at the same time of the day as on day 1 if VRS was ≥5. 10 W Class IV laser was applied over 150 cm 2 sternal wound area for 150 s. VRS was used to assess pain severity and was recorded for statistical analysis using Friedman Test. Results: The mean (standard deviation [SD] VRS of all the 100 patients just before application of the first dose of laser was 7.31 (0.94 while on MMT; the same fell to 4.0 (1.279 and 3.40 (2.697 at 1 h and 24 h respectively following first dose of laser. The change of VRS over first 24 h among all the 100 patients was statistically significant (P = 0.000. Laser was re-applied in 40 patients whose VRS was ≥5 (mean [SD] - 6.38 [0.868] at 24 th h. After receiving the 2 nd dose of laser the VRS scores fell significantly (P = 0.000 and became 0 at 54 th h. No patients required 3 rd dose of the laser. No patient

  16. Comparison of Intravenous Ketamine with Morphine in Pain Relief of Long Bones Fractures: a Double-Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Saeed Majidinejad

    2014-03-01

    Full Text Available Introduction: The selective medication for pain control in many clinical situations is morphine but its complications prevent its widespread use. Ketamine has been introduced as an alternative for morphine in some studies. However, the efficacy of its solitary use has not yet been evaluated. Therefore, the present study was undertaken to evaluate the effect of ketamine alone in relieving pain in trauma patients referring to an emergency unit. Methods: In this double-blind clinical trial, patients with long bone fractures were randomly divided into two groups of treatment with intravenous (IV morphine at a dose of 0.1 mg/kg and treatment with IV ketamine at a dose of 0.5 mg/kg. Pain severity of the patients was recorded before and 10 minutes after injection based on numeric rating scale. The means in the two groups were compared using independent t-test. Then the Kaplan-Meier curve and log rank analysis were used to evaluate the success of treatment. Results: A total of 126 patients were included in this study. The mean ages of the patients in the morphine and ketamine groups were 33.6±14.3 and 35.1±13.5 years, respectively (P=0.54. After therapeutic intervention, the pain severity significantly decreased in ketamine (2.7±1.8; P<0.0001 and morphine (2.4±1.5; P<0.0001 groups, with a similar effect of both medications on alleviating pain (P=0.28. The success rate of the treatment at 10-minute interval in groups receiving ketamine and morphine were 59 (93.65% and 61 (96.8% patients, respectively (P=0.62. Conclusion: The results of the present study showed that administration of ketamine at a low dose (0.5 mg/kg results in a significant decrease in the severity of acute pain in patients with fractures of long bones. This palliative effect is very similar to that of morphine. 

  17. Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Jan, Andrew L; Aldridge, Emogene S; Rogers, Ian R; Visser, Eric J; Bulsara, Max K; Niemtzow, Richard C

    2017-10-01

    Objective: Ear acupuncture might be the form of acupuncture best suited to improving acute pain management in the emergency department (ED). The primary aim of this review was to assess the analgesic efficacy of ear acupuncture in the ED. Secondary outcomes included measures of patient satisfaction, adverse effects, cost, administration techniques, and reduction of medication usage. Methods: Seven databases and Google Scholar were searched up to April 27, 2017, using MeSH descriptors for three overarching themes (ear acupuncture, pain management, and emergency medicine). Meta-analyses were performed in 3 comparator groups: (1) ear acupuncture versus sham; (2) ear acupuncture-as-adjunct to standard care; and (3) ear acupuncture (both as sole therapy and adjuvant) versus control to calculate the standardized mean difference (SMD) and weighted mean difference (WMD) for pain scores out of 10. Results: Six randomized controlled trials and 2 observational studies, totaling 458 patients, were retrieved after exclusions. The meta-analysis used data from 4 randomized studies representing 286 patients. The above 3 comparator groups resulted in SMDs of 1.69, 1.68, and 1.66, and WMDs of 2.47, 2.84, and 2.61 respectively, all favoring acupuncture. Battlefield (ear) acupuncture was the most commonly used technique. There were no significant adverse effects and patient satisfaction improved. Results regarding if acupuncture reduced medication use were equivocal. Significant study bias and heterogeneity were found. Conclusions: While study numbers are limited, ear acupuncture, either as stand-alone or as-an-adjunct technique, significantly reduced pain scores and has potential benefits for use in the ED. Further studies will define acupuncture's role and if it reduces use of analgesic medications.

  18. Effect of microcurrent skin patch on the epidural fentanyl requirements for post operative pain relief of total hip arthroplasty.

    Science.gov (United States)

    Sarhan, Tarek M; Doghem, Maher A

    2009-10-01

    Major orthopedic surgery that cause considerable pain like total hip arthroplasty, requires good post operative pain management. Microcurrent therapy (MCT) is a new therapy whereby electric current is provided in literally millionth of an ampere. MCT comes as two self adherent active electrode patches linked by a cable Efficacy of MCT in the management of musculoskeletal pain and enhancement of wound healing has been reported. To study the effect of microcurrent therapy (MCT) on the epidural fentanyl requirements and degree of wound healing after total hip arthroplasty. Twenty eight patients undergoing total hip replacement (THR) were randomly allocated into two groups. Group I: had micro current skin patches (two adhesive electrode) attached above the site of operation in addition to the lumbar epidural catheter. Post operative epidural fentanyl infusion with a syringe pump given at a rate ranged between 25 and 75 microgram per hour to keep visual analogue pain score (VAS) less than 3/10. Group II had only continuous epidural infusion with fentanyl at the same range to keep VAS less than 3/10 without MCT. There was statistically significant lower mean epidural fentanyl requirement in Group I (23.24 microgram) when compared to Group II (58.36 microgram). There was 23% incidence of dermatitis in Group I due to application of micro- current skin patch which resolved by treatment. There was statistically significant higher frequency of grade 1 of wound healing in the microcurrent group (41.3 %) when compared to Group II (7.2%). Grade 2 and 3 were more frequent in Group II) CONCLUSION: The microcurrent skin therapy lead to reduction in the requirements of the post operative epidural fentanyl with improvement of degrees of wound healing but with considerable incidence of skin dermatitis after total hip arthroplasty.

  19. Suprazygomatic Access for Continuous Bilateral Mandibular Nerve Block for Pain and Trismus Relief in the Tetraplegic Patient.

    Science.gov (United States)

    Dziadzko, Mikhail A; Heritier, Fabrice

    2016-10-01

    Extraoral mandibular nerve block (MNB) is used in oropharyngeal surgery for analgesia and anesthesia. Repeated or continuous MNB has been used successfully as treatment for uncontrollable pain, masseter spasticity, and airway assessment. The usual technique involves transcutaneous infrazygomatic access. However, in some specific settings, this approach is not always feasible. A continuous bilateral MNB with a suprazygomatic approach to the pterygomandibular space was used to resolve a case of refractory and painful trismus in a patient with tetraplegia. Analgesia was achieved and maintained by bilateral catheter placement to the pterygomandibular space and repeated injection of local anesthetic for 48 hours. The right-side catheter was accidentally withdrawn; the left-side catheter was maintained up to 72 hours. The efficiency of analgesia was not affected. This block provided effective analgesia within the first few hours after local anesthetic injection, helped to improve mouth opening, and resolved acute pain. Because kinesitherapy could be introduced, the patient was left on nonopioid analgesics. Continuous bilateral MNB through the suprazygomatic approach was used safely and efficiently. The suggested approach is quite unique, as is the clinical circumstance, and might be considered when the usual technique is challenging. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Intraperitoneal pre-insufflation of 0.125% bupivaciane with tramadol for postoperative pain relief following laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Aslam Jamal

    2016-01-01

    Full Text Available Background and Aims: Laparoscopic cholecystectomy is associated with a fairly high incidence of postoperative discomfort which is more of visceral origin than somatic. Studies have concluded that the instillation of local anesthetic with opioid around gall bladder bed provides more effective analgesia than either local anesthetic or opioid alone. Material and Methods: The study included 90 American Society of Anesthesiologists I-II patients of age 16-65 years scheduled for laparoscopic cholecystectomy under general anesthesia. The patients received the study drugs at the initiation of insufflation of CO 2 in the intraperitoneal space by the operating surgeon under laparoscopic camera guidance over the gallbladder bed. Patients in Group T received tramadol 2 mg/kg in 30 ml normal saline, in Group B received bupivacaine 30 ml of 0.125% and in Group BT received tramadol 2 mg/kg in 30 ml of 0.125% bupivacaine intraperitoneally. Postoperative pain assessment was done at different time intervals in the first 24 h using Visual Analog Scale of 0-10 (0 = No pain, 10 = Worst pain imagined. Time to first dose of rescue analgesic and total analgesics required in the first 24 h postoperatively were also recorded. The incidence of side effects during the postoperative period was recorded. Results: Reduction in postoperative pain was elicited, at 4 and 8 h postoperatively when Group BT (bupivacaine-tramadol group was compared with Group T (tramadol group or Group B (bupivacaine group (P < 0.01. There was a significantly lower requirement of analgesics during first 24 h postoperatively in Group BT compared to Group B or T but no significant difference in the intake of analgesics was noted between Groups B Group T. Time to first dose of rescue analgesic was also significantly prolonged in Group BT compared to Group B or T. The incidence of nausea and vomiting was comparable in all the study groups. Conclusions: Intraperitoneal application of bupivacaine with

  1. Pain Relief with Wet Cupping Therapy in Rats is Mediated by Heat Shock Protein 70 and ß-Endorphin

    Directory of Open Access Journals (Sweden)

    Imam Subadi

    2017-07-01

    Full Text Available Background: Wet cupping therapy is a complementary therapy in pain management. The mechanism of this therapy, however, needs further elucidation. Cells injured by wet cupping therapy seem to stimulate the expression of heat shock protein 70 (HSP70. Its benefit in pain reduction could be mediated by the expression of ß-endorphin. This study aimed at determining the correlation between HSP70 and ß-endorphin after wet cupping therapy. Methods: Sixteen male Wistar rats were divided into control (CG; n=8 and treatment (TG; n=8 groups. The rats in both groups were injected with complete Freund’s adjuvant (CFA at the footpad. In the TG, wet cupping therapy was done at the left and right paralumbar regions 48 hours after the CFA injection. Twenty-four hours after therapy, the hot plate test was done to assess pain threshold. Thereafter, immunohistochemistry from the skin subjected to wet cupping therapy was conducted for HSP70 and ß-endorphin. Results: The expression of HSP70 was significantly higher in the keratinocytes of the TG (20.25±3.53; P<0.001 than in the keratinocytes of the CG (10.50±2.44; P<0.001. The expression of ß-endorphin was significantly higher in the keratinocytes of the TG (22.37±3.52; P<0.001 than in the keratinocytes of the CG (5.12±1.72; P<0.001. The results also revealed a high correlation between HSP70 and ß-endorphin (β=0.864; P<0.001. Pain threshold after wet cupping therapy was significantly higher in the TG (22.81±6.34 s; P=0.003 than in the CG (11.78±3.56 s. Conclusions: The benefit of wet cupping therapy in terms of pain reduction in rats could be mediated by the expression of HSP70 and ß-endorphin.

  2. Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial.

    Science.gov (United States)

    Lopez-Lopez, A; Alonso Perez, J L; González Gutierez, J L; La Touche, R; Lerma Lara, S; Izquierdo, H; Fernández-Carnero, J

    2015-04-01

    Three different types of manual therapy techniques for patients with neck pain and relationship with psychological factors has not been evaluated. To compare the effectiveness high velocity and low amplitude (HVLA) manipulation vs. posteroanterior mobilization (PA mob) vs. sustain appophyseal natural glide (SNAG) in the management of patients with neck pain and to evaluate the interaction with psychological factors. Randomized clinical trial. Primary Health Care Center. Patients with history of chronic neck pain over the last 3 months were recruited. Patients were randomly assigned to receive treatment with HVLA (N.=15), with PA mob (N.=16) or with SNAG (N.=17). One session was applied. Pain intensity of neck pain, pressure pain threshold over processus spinosus of C2 (PPT_C2) and cervical range of motion (CROM) were measured pre- and post-intervention. Pain catastrophizing, depression, anxiety and kinesiophobia were assessed in baseline. ANOVAs were performed, with main effects, two-way (treatment x time) and three-way interactions (treatment x psychological variable x time) were examined. Fourthy-eight patients (mean±SD age, 36.5±8.7 years; 87.5% female). A significant interaction treatment x time was observed for VAS-rest in HVLA and AP mob groups (P<0.05). With more pain relief to HVLA and AP mob groups than SNAG groups but all groups improve the same in CROM. Also, a significant three-way treatment x anxiety x time interaction for VAS in Flexion/Extension was identified (P<0.01), and a trend toward significance was observed for the three way treatment x anxiety x time interaction, with respect to CROM in Lateral-Flexion movement (P<0.05). The results suggest that an HVLA and PA mob groups relieved pain at rest more than SNAG in patients with Neck pain. Among psychological factors, only trait anxiety seems interact with Manual therapy, mainly high anxiety conditions interact with the Mobilization and SNAG effects but under low anxiety conditions interact with

  3. Efficacy of three IV non-opioid-analgesics on opioid consumption for postoperative pain relief after total thyroidectomy: a randomised, double-blind trial.

    Science.gov (United States)

    Abdulla, Susanne; Eckhardt, Regina; Netter, Ute; Abdulla, Walied

    2012-02-01

    In a randomized, double-blind trial, the synergistic action of intravenous parecoxib, metamizol or paracetamol on postoperative piritramide consumption was compared in patients recovering from total thyroidectomy during the first 24 h while evaluating pain intensity and patient satisfaction. 120 patients were randomly allocated to four patient groups treated with normal saline and/or one of non-opioid analgesics (parecoxib 40 mg twice daily, metamizol 1 g three times daily, paracetamol 1 g three times daily) in addition to piritramide using the PCA pump. Beginning in the recovery room (PACU), patients were asked every 2 h for 6 hours and afterwards once every 6 h to quantify their pain experience and patient satisfaction while piritramide consumption was recorded. Upon arrival in the PACU piritramide consumption was high and decreased thereafter significantly in all groups (P < 0.05). There were no significant differences between groups in incremental and cumulative piritramide consumption during the investigation. Also, VAS scores were high upon arrival in the PACU and dropped in all groups continuously after surgery: At 2 h and 4 h after surgery they were significantly lower in parecoxib group compared with NaCl (P < 0.01). For overall patient satisfaction, no significant differences were observed. Pain relief scores at 24 h were significantly higher in parecoxib group as compared to metamizol and paracetamol (P < 0.01). Mild PONV was observed frequently in all groups and was treated with metoclopramide. There is no clear-cut difference between the non-opioid drugs used, even though parecoxib seems to be superior in regard to VAS scores and piritramide consumption. However, the clinical significance is debatable.

  4. Magnet therapy for the relief of pain and inflammation in rheumatoid arthritis (CAMBRA: A randomised placebo-controlled crossover trial

    Directory of Open Access Journals (Sweden)

    Richmond Stewart J

    2008-09-01

    Full Text Available Abstract Background Rheumatoid arthritis is a common inflammatory autoimmune disease. Although disease activity may be managed effectively with prescription drugs, unproven treatments such as magnet therapy are sometimes used as an adjunct for pain control. Therapeutic devices incorporating permanent magnets are widely available and easy to use. Magnets may also be perceived as a more natural and less harmful alternative to analgesic compounds. Of interest to health service researchers is the possibility that magnet therapy might help to reduce the economic burden of managing chronic musculoskeletal disorders. Magnets are extremely cheap to manufacture and prolonged treatment involves a single cost. Despite this, good quality scientific evidence concerning the safety, effectiveness and cost-effectiveness of magnet therapy is scarce. The primary aim of the CAMBRA trial is to investigate the effectiveness of magnet therapy for relieving pain and inflammation in rheumatoid arthritis. Methods/Design The CAMBRA trial employs a randomised double-blind placebo-controlled crossover design. Participant will each wear four devices: a commercially available magnetic wrist strap; an attenuated wrist strap; a demagnetised wrist strap; and a copper bracelet. Device will be allocated in a randomised sequence and each worn for five weeks. The four treatment phases will be separated by wash out periods lasting one week. Both participants and researchers will be blind, as far as feasible, to the allocation of experimental and control devices. In total 69 participants will be recruited from general practices within the UK. Eligible patients will have a verified diagnosis of rheumatoid arthritis that is being managed using drugs, and will be experiencing chronic pain. Outcomes measured will include pain, inflammation, disease activity, physical function, medication use, affect, and health related costs. Data will be collected using questionnaires, diaries, manual

  5. Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children.

    Science.gov (United States)

    Sjoukes, Alies; Venekamp, Roderick P; van de Pol, Alma C; Hay, Alastair D; Little, Paul; Schilder, Anne Gm; Damoiseaux, Roger Amj

    2016-12-15

    Acute otitis media (AOM) is one of the most common childhood infectious diseases and a significant reason for antibiotic prescriptions in children worldwide. Pain from middle ear infection and pressure behind the eardrum is the key symptom of AOM. Ear pain is central to children's and parents' experience of the illness. Because antibiotics provide only marginal benefits, analgesic treatment including paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) is regarded as the cornerstone of AOM management in children. Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 7, July 2016; MEDLINE (Ovid, from 1946 to August 2016), Embase (from 1947 to August 2016), CINAHL (from 1981 to August 2016), LILACS (from 1982 to August 2016) and Web of Science (from 1955 to August 2016) for published trials. We screened reference lists of included studies and relevant systematic reviews for additional trials. We searched WHO ICTRP, ClinicalTrials.gov, and the Netherlands Trial Registry (NTR) for completed and ongoing trials (search date 19 August 2016). We included randomised controlled trials (RCTs) comparing the effectiveness of paracetamol or NSAIDs, alone or combined, for pain relief in children with AOM. We also included trials of paracetamol or NSAIDs, alone or combined, for children with fever or upper respiratory tract infections (URTIs) if we were able to extract subgroup data on pain relief in children with AOM either directly or after obtaining additional data from study authors. Two review authors independently assessed methodological quality of the included trials and extracted data. We used the GRADE approach to rate

  6. Comparative Study of Acetaminophen, Ibuprofen and Combination Effects for Pain Relief Following Tooth Extraction in Children under Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Z. Pahlavani

    2012-01-01

    Full Text Available Introduction & Objective: It is clear that tooth extraction is painful. Different drugs with various functions have been used in order to relieve the pain after extraction. Ibuprofen is a non-narcotic analgesic and acetaminophen is considered as one of the most consumption anti-inflammatory drugs and is administrated to relieve moderate to severe pains. Our purpose is comparing the effects of acetaminophen, ibuprofen and combination of them to relieve the teeth pain due to extraction under local anesthesia. Materials & Methods: In this randomized clinical trial, we divided 105 children (6-11 years old referred to pediatrics ward of dental faculty of Hamadan University into 3 groups of 35 after getting their parent's consents, taking, their history and weighing them. Group1: received acetaminophen syrup with dose of 15mg/kg, group2: received ibuprofen syrup with dose of 5 mg/kg, and group3 received acetaminophen syrup with dose of 7.5mg/kg and ibuprofen syrup with dose of 2.5mg/kg. . One hour before and 15 min after tooth extraction, severity of their pain was evaluated according to table(CHEOPS.Drug effects in every group was studied by c2 , t-test and Mann Whitney U test. Results: Age average of the children under survey in the group of acetaminophen syrup was 8.62±1.81 years old and in the group of ibuprofen syrup was 8.45±1.68 years old, and in the group of acetaminophen with ibuprofen was equal with 8.71±1.27 years old. Sex combination of the under survey children in the group of acetaminophen syrup was 51.4% / 48.6% (female/male, in the group of ibuprofen syrup was 51.4%/48.6%, and in the group of acetaminophen syrup with ibuprofen syrup was 65.7%/34.3%. Grade average of toothache immediately after extraction in the group treated with acetaminophen syrup was 33.19 and, in group treated with ibuprofen syrup equaled 37.81, and in the group treated with acetaminophen syrup with ibuprofen syrup was 47.86. Grade average of toothache 15 min

  7. Oral intake of a liquid high-molecular-weight hyaluronan associated with relief of chronic pain and reduced use of pain medication: results of a randomized, placebo-controlled double-blind pilot study.

    Science.gov (United States)

    Jensen, Gitte S; Attridge, Victoria L; Lenninger, Miki R; Benson, Kathleen F

    2015-01-01

    The goal for this study was to evaluate the effects of daily oral intake of a consumable liquid fermentate containing high-molecular-weight hyaluronan, as well as to perform a basic evaluation of safety and tolerability. A randomized, double-blind placebo-controlled study design was used to examine the effects of oral intake of hyaluronan on chronic pain conditions. Safety assessment included a complete blood count with differential, blood chemistry and electrocardiogram. The study duration was 4 weeks, where three tablespoons (45 mL) product or placebo was ingested during the first 2 weeks, and two tablespoons (30 mL) was consumed during the last 2 weeks. Seventy-eight people between the age of 19 and 71 years enrolled, and 72 people completed the study. Statistical analysis was performed using the two-tailed independent t-test for between-group significance and using the paired t-test for within-group significance. A reduction in pain scores was seen after 2 weeks of consumption of both placebo (Ppain scores was seen after 2 weeks of consumption of three tablespoons of active product (Ppain scores was seen in the placebo group. During the reduced intake for the last 2 weeks of study participation, pain scores showed a slight increase. During the last 2 weeks, a significant increase in the quality of sleep (Ppain reduction during the initial 2 weeks was associated with significant reduction in the use of pain medication (Poral liquid formula containing high-molecular-weight hyaluronan was associated with relief of chronic pain.

  8. Fentanyl buccal tablet for the relief of breakthrough pain in opioid-tolerant adult patients with chronic neuropathic pain: a multicenter, randomized, double-blind, placebo-controlled study.

    Science.gov (United States)

    Simpson, David M; Messina, John; Xie, Fang; Hale, Martin

    2007-04-01

    Patients with chronic noncancer pain, including neuropathic pain, may have transitory exacerbations of pain (median duration, 60 minutes), termed breakthrough pain (BTP), that may reach peak intensity within minutes. Typical short-acting oral opioids may not provide sufficiently rapid relief (30- to 60-minute onset of analgesia). The fentanyl buccal tablet (FBT) provides a rapid onset of analgesia (10-15 minutes) by enhancing fentanyl absorption across the buccal mucosa. This study evaluated the efficacy and tolerability of FBT in opioid-tolerant patients with BTP associated with chronic noncancer neuropathic pain. This was a multicenter, randomized, double-blind, placebo-controlled study in men and women aged 18 to 80 years who were opioid tolerant; had a >/= 3-month history of chronic persistent neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, traumatic injury, or complex regional pain syndrome; and reported having episodes of BTP. After an open-label titration period to identify an effective FBT dose (the dose at which the patient reported receiving adequate pain relief within 30 minutes after administration of a single tablet of that dose during at least 2 of 3 BTP episodes), patients were randomly assigned to treat 9 consecutive episodes of BTP over the next 21 days with 1 of 3 double-blind dose sequences of FBT and placebo tablets. Pain intensity (PI) (rated on an 11-point pain scale, from 0 = no pain to 10 = worst pain) and other outcomes were assessed before dosing and for 2 hours after dosing. The primary efficacy measure was the sum of PI differences (PIDs) for the first 60 minutes (SPID(60)). Secondary efficacy measures included the proportion of BTP episodes with >/= 33% and >/= 50% improvement in PI from baseline; PID at other time points (5, 10, 15, 30, 45, 60, 90, and 120 minutes after dosing); pain relief (PR) at the same time points (rated on a 5-point Likert scale from 0 = none to 4 = complete); proportion

  9. Seeking 'energy' vs. pain relief in spas in Brazil (Caldas da Imperatriz) and Portugal (Termas da Sulfurea).

    Science.gov (United States)

    Quintela, Maria Manuel

    2011-04-01

    This paper is a comparative ethnography of the therapeutic practices at two different spa locations: Caldas da Imperatriz, SC, Brazil, and Termas da Sulfurea in Cabeco de Vide, Portugal. The comparison reveals the existence of contrasting 'explanatory models' held by the spa-goers as well as by the official medical systems. In the Portuguese context this model is highly medicalized; in the Brazilian case, spa treatments are viewed as 'alternative' or 'complementary' therapy and are also related to religious philosophies. Each model corresponds to a different idiom expressing certain experiences and world views, one focusing on 'pains' (dores) and the other on 'energy' (energia), the former leading to the rationale of 'curing', the latter to the notion of 'energizing'. In this paper the author intends to analyze and contrast the categories found in these models, which originate from different conceptions of health, illness and healing for Brazilian and Portuguese spa-goers.

  10. Early post-operative relief of pain and shivering using diclofenac suppository versus intravenous pethidine in spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Ali Janpour Ebrahim

    2014-01-01

    Full Text Available Background: Pain and shivering are two challenging components in the post operative period. Many drugs were used for prevention and treatment of them. The aim of this study was to compare the effects of prophylactic prescription of diclofenac suppository versus intravenous (IV pethidine in spinal anesthesia. Materials and Methods: We conducted a multi central, prospective, double-blind, randomized clinical trial on a total of 180 patients who were scheduled for surgery under spinal anesthesia including 60 patients in three groups. Patients were randomly allocated to receive 100 mg sodium diclofenac suppository or 30 mg IV pethidine or placebo. Categorical and continuous variables were analyzed by Chi-square test, t-test, Mann-Whitney and ANOVA or Kruskal-Wallis tests. Results: There was no statistical difference with regard to patient characteristics and hemodynamic indices among the three groups. Nine (15%, 10 (16.65% and 24 (40% of patients in diclofenac, pethidine and control groups reported pain and 2, 2, 7 patients received treatment due to it, respectively (P = 0.01. Prevalence of shivering in pethidine group and diclofenac group was the same and both of them were different from the control group (P < 0.001. Pruritus was repetitive in the pethidine group and was statistically significant (P = 0.036 but, post-operative nausea and vomiting was not significantly different among groups. Conclusion: A single dose of sodium diclofenac suppository can provide satisfactory analgesia immediately after surgery and decrease shivering without remarkable complications. This investigation highlights the role of pre-operative administration of a single dose of rectal diclofenac as a sole analgesic for early post-operative period.

  11. The study of vascular dynamics for the effect of a compress pack on pain relief using magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Ji Won; Lim, Young Khi [Gachon University, Sungnam (Korea, Republic of)

    2015-12-15

    This study was to investigate the effects of the hot compress pack on alleviating local muscular discomfort, stiffness in limbs as well as the chronic pains such as migraine in terms of hemodynamics. In this study, the hot compress band was put on the neck and the local physiological change on the stimulation site and the cranial blood circulation change were examined. We recruited healthy volunteers (n=8, mean age: 32.13 (4.61)), who participated in the magnetic resonance imaging (MRI) study. Local skin color and temperature were measured for the local effect of the hot compress band and the changes of intra-cranial and extra-cranial blood vessels were examined with MR angiography (MRA) images. The skin temperature increased from 36.4 degrees Celsius at the rest condition to 36.7 degrees Celsius and 37.1 degrees Celsius after 15 min and 30 min stimulation, respectively. The change of the extra-cranial blood vessels between pre-stimulation and post-stimulation of 30 min was significantly increased (+38.8%), while the change of the intra-cranial blood vessels was negligible. In this study, we demonstrated that the hot compress band on the neck yielded the increase of local skin temperature on the stimulation site and it made an effect on the extracranial circulation. In conclusion, the stimulation with a hot compress could facilitate the blood circulation, causing to relieve the muscular discomfort, stiffness in limbs as well as the chronic pains such as migraine.

  12. Bilateral extraoral, infraorbital nerve block for postoperative pain relief after cleft lip repair in pediatric patients: a randomized, double-blind controlled study.

    Science.gov (United States)

    Takmaz, Suna Akin; Uysal, Hale Yarkan; Uysal, Afsin; Kocer, Ugur; Dikmen, Bayazit; Baltaci, Bulent

    2009-07-01

    The objective of this study was to evaluate the effectiveness of bilateral extraoral infraorbital nerve block with 0.25% bupivacaine administered at the end of surgery in postoperative pain relief after cleft lip repair. Forty ASA I-II children were randomly divided into 2 groups. Group I received 1.5 mL 0.25% bupivacaine and group II received 1.5 mL saline. FLACC scores of the patients in the recovery room in group I were 4 times less than in group II (P = 0.001) and in the first 4 hours postoperatively were apparently less in group I (P = 0.001). Mean time to first paracetamol requirement was longer in group I (P = 0.001). Total paracetamol consumption was lower in group I (P = 0.001). None of the patients required rescue tramadol in group I, whereas all patients in group II needed. In group I, parent satisfaction scores were higher (P = 0.001). Vomiting incidence was higher in group II (P = 0.028). Bilateral extraoral, infraorbital nerve block administered at the end of surgery provides satisfactory analgesia with high parental satisfaction and lower complication rates and reduces rescue analgesic consumption in patients undergoing repair of cleft lip.

  13. Experimental muscle pain changes the spatial distribution of upper trapezius muscle activity during sustained contraction.

    Science.gov (United States)

    Madeleine, Pascal; Leclerc, Fredéric; Arendt-Nielsen, Lars; Ravier, Philippe; Farina, Dario

    2006-11-01

    To investigate the effect of local excitation of nociceptive muscle afferents on the spatial distribution of muscle activity. Surface electromyographic (EMG) signals were recorded from the upper trapezius muscle of 10 healthy volunteers with a 5 x 13 electrode grid during 90-s isometric contractions before, during, 15 and 30 min after intramuscular injection of hypertonic (painful) or isotonic (non-painful) saline. From the multi-channel EMG recordings, two-dimensional maps of root mean square and mean power frequency were obtained. The centre of gravity of the root mean square map was used to quantify global changes in the spatial distribution of muscle activity. During sustained contractions, average root mean square increased, average mean frequency decreased and the centre of gravity moved cranially. During experimental muscle pain, compared to before injection, the average root mean square decreased and there was a caudal shift of the centre of gravity. Fifteen minutes after the painful injection the centre of gravity returned to its original position. Short-term dynamic reorganization of the spatial distribution of muscle activity occurred in response to nociceptive afferent input. The study furnishes an extension of the pain adaptation model indicating heterogeneous inhibition of muscle activity.

  14. An evaluation of a morphine public health programme for cancer and AIDS pain relief in Sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Harding Richard

    2005-08-01

    Full Text Available Abstract Background Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication. Methods A multi-methods protocol appraised morphine regulation, storage, prescribing, and consumption in three phases: key informant interviews throughout the opioid supply chain, and direct observation and audit of clinical practice. Results Regulation had achieved its goal of preventing misuse and leakage from the supply chain. However, the Government felt that relaxation of regulation was now appropriate. Confusion and complexity in storage and authorisation rules led to discontinuation of opioid pain management at the patient level and also wasted service time in trying to obtain supplies to which they were entitled. Continued neglect to prescribe among clinicians and public fear of opioids led to under prescribing, and clinical skills showed some evidence of need for improvement with respect to physical assessment and follow-up. Conclusion The Ugandan programme offers a successful model for both advocacy and Governmental support in achieving opioid roll-out across health districts. Despite initial concerns, abuse of opioids has not been evident. Further work is required to ensure that available supplies of opioids are prescribed to those in need, and that clinical standards are met. However, the programme for roll-out has proved a useful model to expand opioid availability as the first step in improving patient care, and may prove a useful template for other Sub-Saharan African countries.

  15. Managing cancer pain and symptoms of outpatients by rotation to sustained-release hydromorphone: a prospective clinical trial

    NARCIS (Netherlands)

    Wirz, Stefan; Wartenberg, Hans Christian; Elsen, Christian; Wittmann, Maria; Diederichs, Marta; Nadstawek, Joachim

    2006-01-01

    PURPOSE: In this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain. METHODS: Before and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical

  16. STUDY OF ULTRASOUND-GUIDED CONTINUOUS FEMORAL NERVE BLOCKADE WITH EPIDURAL ANALGESIA FOR PAIN RELIEF AFTER TOTAL KNEE REPLACEMENT

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    Srinivas Rapolu

    2016-11-01

    Full Text Available BACKGROUND Total knee replacement causes moderate-to-severe pain requiring effective analgesia. With use of ultrasound guidance, we may prove a more suitable approach compared with the epidural technique. Aim of this study is the comparison between Continuous Epidural Analgesia (CEA and Continuous Femoral Block (CFB techniques in Total Knee Replacement surgeries. MATERIALS AND METHODS This study was conducted on 60 adult male and female patients undergoing total knee replacement surgery for a period of 2 years. Patients were divided into 2 groups. Group - 1: Continuous epidural analgesia patients, Group - 2: Continuous femoral blockage patients. All patients were assessed clinically preoperatively and investigated to rule out any systemic disease. RESULTS The mean age of patient in Group - 1 was 66.54 ± 4.98 and in Group - 2 was 66.98 ± 5.02 years. P value was > 0.05, which was not significant. No significant differences in gender is observed between the groups. VAS scores were significantly high (P < 0.05 in the femoral group at 6 h, after which there was a declining trend and scores were essentially similar from 24 h. The use of rescue analgesic was also higher in the femoral group. Analysis of side-effects showed that all the five common sideeffects were twice as common in the epidural group than in the femoral study group. Only one patient in the femoral group had urinary retention when compared with four in the epidural group. The differences were not statistically significant. Muscle power at 48 h, time getting out of the bed and time stay in hospital (days are significant in comparison in 2 groups, range of movement is insignificant in groups. Patient satisfaction score was measured on a scale of 1 - 10. Patients in the Femoral group were slightly more satisfied with a mean ± SD score of 8.1 ± 1.2 when compared with the epidural group 7.3 ± 1.01. CONCLUSION Continuous femoral blockade using US guidance provides equivalent analgesia

  17. A PLGA–PEG–PLGA Thermosensitive Gel Enabling Sustained Delivery of Ropivacaine Hydrochloride for Postoperative Pain Relief

    National Research Council Canada - National Science Library

    Fu, Xudong; Zeng, Huilin; Guo, Jiaping; Liu, Hong; Shi, Zhen; Chen, Huhai; Li, Dezong; Xie, Xiangyang; Kuang, Changchun

    2017-01-01

    .... In the current work, we used a poly(lactic-co-glycolic acid) (PLGA)–polyethylene glycol (PEG)–PLGA (PLGA–PEG–PLGA) temperature-sensitive gel to deliver a local anesthetic, ropivacaine hydrochloride...

  18. Light Irradiation And Response Of The Living Body - Effect Of Pain Relief And Promotion Of Wound Healing -

    Science.gov (United States)

    Taguchi, Yoshio; Kurokawa, Yoshimochi; Ohara, Itaru; Ueki, Hamaichi; Inaba, Humio

    1989-09-01

    The first report of laser irradiation for wound healing was done by Mester, E., et al. in 1968. From their reports, we can get many knowledges and suggestions as for laser irradiation. At that time he used ruby laser (694.3 nm wave length) for surgical wounds and burns on the back skin of mice. The condition of irradiation was studied with energy density between 0.5-10 J/cm2 twice a week. As a result, they noticed 1 J/cm2 irradiation was effective for those wounds. After a few experimental reports, they published their clinical studies in 1975. Clinically, they used He-Ne laser (632.8 nm wave length) irradiation. Human leg ulcers due to peripheral circulatory disturbance were treated with energy density of 4 J/cm2 twice a week. And they got good results, obtaining complete healing in two-thirds of the cases. We became strongly stimulated by those reports. We have been studying the effect of light on experimental and clinical wound healing as well as on various kinds of biological phenomena since 1980. Particularly, its effect according to the difference of light has been studied. In October 1982, the first clinical case was tried by Argon laser (514.5 nm wave length) irradiation for therapeutic purpose. A man had a chronic ulcer of the left first toe due to Buerger's disease for 5 months. Surprizingly, on the 14th day after 6 treatments of the light irradiation, his ulcer completely healed. During these treatments, the patient noticed that the pain completely disappeared after 2 treatments. Fifty Argon laser treatments were carried out on clinical cases after these experiences, we reached to a conclusion that light irradiation stimulated something in the injured tissues and lead to good clinical results. Several studies concerning mechanism for these effects i.e. peripheral circulation, histology of granulation, cell proliferation, chemistry and other studies were carried out. From these investigations, peripheral circulation was improved when in those who were

  19. Post hoc analyses of data from a 90-day clinical trial evaluating the tolerability and efficacy of tapentadol immediate release and oxycodone immediate release for the relief of moderate to severe pain in elderly and nonelderly patients

    Science.gov (United States)

    Vorsanger, Gary; Xiang, Jim; Biondi, David; Upmalis, David; Delfgaauw, Jacqueline; Allard, René; Moskovitz, Bruce

    2011-01-01

    OBJECTIVE: To evaluate the tolerability and efficacy of tapentadol immediate release (IR) and oxycodone IR for relief of moderate to severe pain in elderly and nonelderly patients. METHODS: Post hoc data analyses were conducted on a 90-day randomized, phase 3, double-blind, flexible-dose study (ClinicalTrials.gov: NCT00364546) of adults with moderate to severe lower back pain or osteoarthritis pain who received tapentadol IR 50 mg or 100 mg, or oxycodone HCl IR 10 mg or 15 mg every 4 h to 6 h as needed for pain relief. Treatment-emergent adverse events and study discontinuations were recorded. RESULTS: Data from 849 patients randomly assigned (4:1 ratio) to treatment with a study drug (tapentadol IR [n=679] or oxycodone IR [n=170]) were analyzed according to age (younger than 65 years of age [nonelderly], or 65 years of age or older [elderly]) and treatment group. Among elderly patients, incidences of constipation (19.0% versus 35.6%) and nausea or vomiting (30.4% versus 51.1%) were significantly lower with tapentadol IR versus oxycodone IR (all Ptapentadol IR versus oxycodone IR (both P≤0.031). Tapentadol IR-treated elderly patients had a lower percentage of days with constipation than oxycodone IR-treated patients (P=0.020). For tapentadol IR- and oxycodone IR-treated elderly patients, respectively, incidences of study discontinuation due to gastrointestinal treatment-emergent adverse events were 15.8% and 24.4% (P=0.190). Tapentadol IR and oxycodone IR provided similar pain relief, with no overall age-dependent efficacy differences (mean pain scores [11-point numerical rating scale] decreased from 7.0 and 7.2 at baseline, to 4.9 and 5.2 at end point, respectively). CONCLUSIONS: Tapentadol IR was safe and effective for the relief of lower back pain and osteoarthritis pain in elderly patients, and was associated with a better gastrointestinal tolerability profile than oxycodone IR. PMID:22059194

  20. Efficacy of a buccal meloxicam formulation for pain relief in Merino lambs undergoing knife castration and tail docking in a randomised field trial.

    Science.gov (United States)

    Small, A H; Belson, S; Holm, M; Colditz, I G

    2014-10-01

    To assess the efficacy of oral transmucosal meloxicam for pain relief in lambs at marking. A blinded, placebo-controlled, randomised, block design field study of 60 Merino lambs aged 7-10 weeks allocated to placebo and meloxicam treatments and studied in two cohorts of 30. Placebo-treated lambs received 1 mL/10 kg of drug vehicle and meloxicam-treated lambs received 1 mg/kg meloxicam at 10 mg/mL. Treatments were administered into the buccal cavity immediately before knife castration and hot-iron tail docking. Lambs were then released into a grassed paddock (0.34 ha). Time to mother-up was recorded and behaviours were observed every 15 min for 8 h and again for 45 min at 24 h. The sequence in which lambs exited the paddock with their mothers was then recorded. Weight change and wound scores were recorded 4 and 7 days after marking. Meloxicam did not affect mothering-up. In the 8 h following marking, meloxicam led to a 7-fold reduction (P meloxicam group spent significantly less time in standing postures and tended to spend more time grazing, suckling and in normal lying postures. At 24 h, the meloxicam group spent more time lying and less time standing. There was no effect of treatments on the sequence in which lambs moved into a fresh paddock or on weight change. The buccal meloxicam formulation provided substantial analgesia to lambs on the day of marking. Slight benefits were evident the following morning. © 2014 Australian Veterinary Association.

  1. Lipid-colloid dressing shows improved reepithelialization, pain relief, and corneal barrier function in split-thickness skin-graft donor wound healing.

    Science.gov (United States)

    Tanaka, Katsuya; Akita, Sadanori; Yoshimoto, Hiroshi; Houbara, Seiji; Hirano, Akiyoshi

    2014-09-01

    Donor-site wound healing was tested with a nonadherent petrolatum- and hydrocolloid-impregnated polyester, a lipid-colloid dressing, and a nonadherent polyester dressing, supplemented with petrolatum manually by a physician onsite. Ten patients, 1 woman and 9 men (22 to 79 years old; average 58.4 ± 17.54 years), were enrolled in this prospective comparison study. The split-thickness skin graft was 14.5 ± 7.49 cm long × 8.2 ± 4.07 cm wide (5.5-27 cm long and 4.0-14.0 wide) and 14/1000 inches (0.356 mm) deep. The degree of reepithelialization in lipid-colloid dressing was significantly better than that in polyester mesh dressing, with 1.7 ± 1.00 and 2.8 ± 0.83 for the lipid-colloid dressing and polyester mesh dressing, respectively (P colloid dressing than that in polyester dressing, 1.7 ± 1.11 and 2.9 ± 1.12 for the lipid-colloid dressing and polyester mesh dressing, respectively (P colloid at wound healing was significantly smaller than those in polyester mesh (effective contact coefficient: 11.7 ± 1.87% and 15.6 ± 3.09% for lipid-colloid and polyester mesh, respectively, P colloid and polyester mesh, respectively, P colloid polyester dressing has superior wound healing and pain relief and demonstrates better corneal barrier function delineated by effective contact coefficient and corneal thickness at healing in split-thickness donors. © The Author(s) 2014.

  2. A novel and cost-effective way to follow-up adequacy of pain relief, adverse effects, and compliance with analgesics in a palliative care clinic

    Directory of Open Access Journals (Sweden)

    Radhika Kannan

    2013-01-01

    Full Text Available Introduction: A way to assess compliance with analgesics in an outpatient palliative care clinic is essential since often the patient is too ill or weak to come to hospital for weekly follow-ups. A pilot study was conducted using Short Messaging Service via mobile phone as a follow-up tool. Context: A predominantly outpatient palliative care clinic of a 300 bedded multidisciplinary hospital. Materials and Methods: Sixty patients attending the palliative care clinic were enrolled in the study. Analgesic drugs, co-analgesics, and adjuvants were prescribed on an outpatient basis. If possible, patients were admitted for 1 or 2 days. A simple scoring system was devised and taught to the patients and their attenders. A short message service had to be sent to the author′s mobile number. The period was fixed at 2 weeks by which the patients and attenders were familiar with the drugs and pain relief as well. Drowsiness was a worrisome complaint. The mobile number of the patient was called and attender instructed to skip one or two doses of morphine and reassurance given. If required, attender was asked to bring patient to the hospital or come to the hospital for a different prescription as the situation warranted. Results: Out of 60 patients, 22 were admitted initially for dose titration and all others were outpatients. Three patients were lost to follow-up and one patient died after 7 days. 93% of patients responded promptly. Random survey was done in 10 patients to confirm their SMS response and the results were analyzed. Conclusion: Mobile phones are available with all strata of people. It is easy to train patients to send an SMS.This technology can be used to follow- up palliative care patients and help them comply with their treatment regimen.

  3. The Comparison between Two Methods for the Relief of Knee Osteoarthritis Pain: Radiofrequency and Intra-Periarticular Ozone Injection: A Clinical Trial Study

    Directory of Open Access Journals (Sweden)

    Masoud Hashemi

    2016-07-01

    Full Text Available Knee osteoarthritis is not always well controlled by usual treatments, therefore new therapeutic methods such as radiofrequency and ozone injection should be investigated. Comparing the efficacy of two methods: radiofrequency and intra-periarticular ozone injection. This randomized clinical trial study was performed in an academic Pain Clinic of Guilan University of Medical Sciences in Iran from September 2014 to June 2015. The research was carried out on seventy-two patients, were randomly allocated in two groups by triple blocks. thirty-six patients in ozone group received intra-periarticular ozone injection and 36 patients in RF group, after a positive diagnostic genicular nerve blocks received Conventional Radiofrequency(CRFand then intra articular Pulse Radiofrequency(PRF. The evaluation was based on Visual Analog Scale (VAS and Oxford Knee Score (OKS before and 12 weeks after the procedure. The analysis was performed by paired t-test, Fisher, Chi square and Mann-Whitney-U tests in SPSS version18. In Ozone group the mean of initial OKS was 38.77±7.75 compare to 41.22±7.44 in RF group. After 12 weeks, it diminish ed to 21.77±7.78 and 22±6.21 respectively (p=0.0001 . In Ozone group VAS decreased from 9±1.43 to 3.38±1.79 (p=0.0001 while in RF group from 9.44±0.85 to 2.77±1.06 (p=0.0001. Comparing two methods, there was no significant difference between two groups based on OKS(p=0.23 and VAS (p=0.202. Also RF resulted in more acceptable pain relief based on OKS among subjects older than 65 years (p=0.0001. Both radiofrequency and intra-periarticular ozone injection have good clinical effects on knee osteoarthritis with superiority of radio frequency in age above 65 years old.

  4. An ancient Greek pain remedy for athletes

    DEFF Research Database (Denmark)

    Bartels, Else M; Swaddling, Judith; Harrison, Adrian P

    2006-01-01

    While Hippocratic writings make no reference to the actual Olympics, there is frequent mention of diet, exercise, and the treatment of injuries sustained by the athletic participants. Indeed, Galen in his Composition of Medicines gives details of a remedy prescribed for the relief of pains and sw...

  5. An ancient greek pain remedy for athletes

    DEFF Research Database (Denmark)

    Bartels, Else M.; Swaddling, Judith; Harrison, Adrian Paul

    2006-01-01

    While Hippocratic writings make no reference to the actual Olympics, there is frequent mention of diet, exercise, and the treatment of injuries sustained by the athletic participants. Indeed, Galen in his Composition of Medicines gives details of a remedy prescribed for the relief of pains and sw...

  6. Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation

    Directory of Open Access Journals (Sweden)

    Thomas Hadjistavropoulos

    2016-01-01

    Full Text Available Background. Although feasible protocols for pain assessment and management in long-term care (LTC have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.

  7. Novel polymeric bioerodable microparticles for prolonged-release intrathecal delivery of analgesic agents for relief of intractable cancer-related pain.

    Science.gov (United States)

    Han, Felicity Y; Thurecht, Kristofer J; Lam, Ai-Leen; Whittaker, Andrew K; Smith, Maree T

    2015-07-01

    Intractable cancer-related pain complicated by a neuropathic component due to nerve impingement is poorly alleviated even by escalating doses of a strong opioid analgesic. To address this unmet medical need, we developed sustained-release, bioerodable, hydromorphone (potent strong opioid)- and ketamine (analgesic adjuvant)-loaded microparticles for intrathecal (i.t.) coadministration. Drug-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles were prepared using a water-in-oil-in-water method with evaporation. Encapsulation efficiency of hydromorphone and ketamine in PLGA (50:50) microparticles was 26% and 56%, respectively. Microparticles had the desired size range (20-60 μm) and in vitro release was prolonged at ≥28 days. Microparticles were stable for ≥6 months when stored refrigerated protected from light in a desiccator. Desirably, i.t. injected fluorescent dye-labeled PLGA microparticles in rats remained in the lumbar region for ≥7 days. In a rat model of neuropathic pain, i.t. coinjection of hydromorphone- and ketamine-loaded microparticles (each 1 mg) produced analgesia for 8 h only. Possible explanations include inadequate release of ketamine and/or hydromorphone into the spinal fluid, and/or insufficient ketamine loading to prevent development of analgesic tolerance to the released hydromorphone. As sub-analgesic doses of i.t. ketamine at 24-48 h intervals restored analgesia on each occasion, insufficient ketamine loading appears problematic. We will investigate these issues in future work. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.

  8. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain

    Science.gov (United States)

    Waqqar, Saira; Shakil-ur-Rehman, Syed; Ahmad, Shakeel

    2016-01-01

    Background and Objective: Chronic mechanical low back pain is common among different age groups and genders. Different manual therapy techniques combined with exercise therapy and electrotherapy modalities play an important role in its management. Our objective was to compare the effects of McKenzie extension exercisesprogram (EEP) versus Mulligan Sustained Natural Apophyseal Glides (SNAGs) for chronic mechanical low back pain (CMLBP). Methods: This randomized control trial (RCT) was conducted at Riphah Physical Rehabilitation Centre, Pakistan Railways General Hospital Rawalpindi, from 1st July to 31st December 2014. The inclusion criteria was patients of both gender and age range 30-70 years with minimum 4 weeks history of CMLBP. A total of 37 patients were screened out as per inclusion criteria and randomly placed into two groups. Twenty patients in group A were treated with Mulligan SNAGs and 17 patients in group B with McKenzie EEP for four weeks at two session per week and single session per day. Visual Analogue Scale (VAS), Oswestry Disability Scale (ODI) and lumber Range of Motion (ROM) were used as an assessment tools and were measured at baseline and at the completion 4 weeks intervention. The data was analyzed with SPSS to draw the statistical and clinical significance of both interventions. Results: At the completion of 4 weeks intervention the pre and post statistical analysis revealed that clinically the McKenzie EEP improved pain (mean 9.12 to 1.46) and disability (73.82 to 6.24) slightly more than Mulligan SNAGs (pain: from 8.85 to 2.55, disability 73.75 to 7.05), while the Mulligan SNAGs improved lumbar ROM more effectively than McKenzie EEP in all directions including flexion, extension, side bending and rotation. Statistically there was no significant difference between the effects of two interventions in managing pain and disability, and improving Lumber ROM. Conclusion: McKenzie EEP is clinically slightly more effective in the management of pain

  9. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain.

    Science.gov (United States)

    Waqqar, Saira; Shakil-Ur-Rehman, Syed; Ahmad, Shakeel

    2016-01-01

    Chronic mechanical low back pain is common among different age groups and genders. Different manual therapy techniques combined with exercise therapy and electrotherapy modalities play an important role in its management. Our objective was to compare the effects of McKenzie extension exercisesprogram (EEP) versus Mulligan Sustained Natural Apophyseal Glides (SNAGs) for chronic mechanical low back pain (CMLBP). This randomized control trial (RCT) was conducted at Riphah Physical Rehabilitation Centre, Pakistan Railways General Hospital Rawalpindi, from 1(st) July to 31(st) December 2014. The inclusion criteria was patients of both gender and age range 30-70 years with minimum 4 weeks history of CMLBP. A total of 37 patients were screened out as per inclusion criteria and randomly placed into two groups. Twenty patients in group A were treated with Mulligan SNAGs and 17 patients in group B with McKenzie EEP for four weeks at two session per week and single session per day. Visual Analogue Scale (VAS), Oswestry Disability Scale (ODI) and lumber Range of Motion (ROM) were used as an assessment tools and were measured at baseline and at the completion 4 weeks intervention. The data was analyzed with SPSS to draw the statistical and clinical significance of both interventions. At the completion of 4 weeks intervention the pre and post statistical analysis revealed that clinically the McKenzie EEP improved pain (mean 9.12 to 1.46) and disability (73.82 to 6.24) slightly more than Mulligan SNAGs (pain: from 8.85 to 2.55, disability 73.75 to 7.05), while the Mulligan SNAGs improved lumbar ROM more effectively than McKenzie EEP in all directions including flexion, extension, side bending and rotation. Statistically there was no significant difference between the effects of two interventions in managing pain and disability, and improving Lumber ROM. McKenzie EEP is clinically slightly more effective in the management of pain and disability as compared with Mulligan SNAGs

  10. Combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream and lidocaine-ketorolac gel provide better pain relief than combined PI LP cream and periprostatic nerve block during transrectal prostate biopsy.

    Science.gov (United States)

    Cormio, Luigi; Pagliarulo, Vincenzo; Lorusso, Fabrizio; Selvaggio, Oscar; Perrone, Antonia; Sanguedolce, Francesca; Bufo, Pantaleo; Carrieri, Giuseppe

    2012-06-01

    What's known on the subject? and What does the study add? Study Type - Harm Reduction RCT Level of Evidence 1b The combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block effectively counteracts probe and sampling related pain during transrectal prostate biopsy, but not pain due to periprostatic infiltration. The novel combination of lidocaine-prilocaine cream and lidocaine-ketorolac gel, both administered perianal-intrarectally, provides the same probe and sampling-related pain relief than combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block and prevents the non-negligible pain due to periprostatic infiltration, thus leading to better overall patients' compliance to the procedure. • To compare the efficacy and safety of combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream and lidocaine-ketorolac (LK) gel with combined PI LP cream and periprostatic nerve block (PPNB) in relieving pain during transrectal ultrasonography guided prostate biopsy (TPB). • In all, 200 patients were randomized to receive combined PI LP cream and LK gel (group 1) or combined PI LP cream and PPNB (group 2) before TPB. • The 0-10-point visual analogue scale (VAS) was used for assessing pain at probe insertion and movements (VAS-1), periprostatic infiltration (VAS-2) when applied, and prostate sampling (VAS-3), as well as maximal procedural pain (MPP). • Complications occurring ≤ 20 days after the TPB were recorded. • The groups were comparable for patients' age, serum PSA level, prostate volume, and cancer detection rate. • All patients tolerated the procedure well. The two anaesthetic regimens provided almost equal mean VAS-1 (0.33 vs 0.37; P= 0.701) and VAS-3 (0.52 vs 0.51; P= 0.954) scores, but patients in group 2 reported significantly greater MPP scores (0.68 vs 1.53; P PI LP cream and LK gel provided the same probe- and sampling- related pain relief as combined PI LP and PPNB; moreover

  11. Novel treatment protocol for ameliorating refractory, chronic pain in patients with autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Casteleijn, Niek F; van Gastel, Maatje D A; Blankestijn, Peter J; Drenth, Joost P H; de Jager, Rosa L; Leliveld, Anna M; Stellema, Ruud; Wolff, Andreas P; Groen, Gerbrand J; Gansevoort, Ron T

    2017-04-01

    Autosomal dominant polycystic kidney disease (ADPKD) patients can suffer from chronic pain that can be refractory to conventional treatment, resulting in a wish for nephrectomy. This study aimed to evaluate the effect of a multidisciplinary treatment protocol with sequential nerve blocks on pain relief in ADPKD patients with refractory chronic pain. As a first step a diagnostic, temporary celiac plexus block with local anesthetics was performed. If substantial pain relief was obtained, the assumption was that pain was relayed via the celiac plexus and major splanchnic nerves. When pain recurred, patients were then scheduled for a major splanchnic nerve block with radiofrequency ablation. In cases with no pain relief, it was assumed that pain was relayed via the aortico-renal plexus, and catheter-based renal denervation was performed. Sixty patients were referred, of which 44 were eligible. In 36 patients the diagnostic celiac plexus block resulted in substantial pain relief with a change in the median visual analogue scale (VAS) score pre-post intervention of 50/100. Of these patients, 23 received a major splanchnic nerve block because pain recurred, with a change in median VAS pre-post block of 53/100. In 8 patients without pain relief after the diagnostic block, renal denervation was performed in 5, with a borderline significant change in the median VAS pre-post intervention of 20/100. After a median follow-up of 12 months, 81.8% of the patients experienced a sustained improvement in pain intensity, indicating that our treatment protocol is effective in obtaining pain relief in ADPKD patients with refractory chronic pain. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  12. The efficacy of preventive parasternal single injection of bupivacaine on intubation time, blood gas parameters, narcotic requirement, and pain relief after open heart surgery: A randomized clinical trial study

    Directory of Open Access Journals (Sweden)

    Mahmoud Saeidi

    2011-01-01

    Full Text Available Background: Postsurgical pain usually results in some complications in the patients. This study has tried to investigate the effects of parasternal single injection of bupivacaine on postoperative pulmonary and pain consequences in patients after open heart surgery. Methods: : In a prospective double blind clinical study, 100 consenting patients undergoing elective open heart surgery were randomized into two groups. In case group, bupivacaine was injected at both sides of sternum, immediately before sternal closure. In the control group, no intervention was performed. Then, the patients were investigated regarding intubation period, length of ICU stay, arterial blood gas (ABG parameters, morphine requirement, and their severity of postoperative pain using a visual analogue scale (VAS device. Results: No differences were found between the two groups regarding to age, sex, pump time, operation time, and body mass index and preoperative cardiac ejection fraction. Mean intubation length in case group was much shorter than that in control group. Mean PaO 2 in case group was lower in different checking times in postoperative period. The patients in the case group needed less morphine compared to those in the control group during the 24-hour observation period in the ICU. Finally, mean VAS scores of pain in case group were significantly lower than those in control group at 6, 12, and 24 hours postoperatively. Conclusions: Patients′ pain relief by parasternal single injection of bupivacaine in early postoperative period can facilitate earlier ventilator weaning and tracheal extubation after open heart surgery as well as achieving lower pain scores and narcotic requirements.

  13. Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children

    NARCIS (Netherlands)

    Sjoukes, Alies|info:eu-repo/dai/nl/413981436; Venekamp, Roderick P|info:eu-repo/dai/nl/343020211; van de Pol, Alma C|info:eu-repo/dai/nl/304816736; Hay, Alastair D; Little, Paul; Schilder, Anne GM|info:eu-repo/dai/nl/09110906X; Damoiseaux, Roger Amj|info:eu-repo/dai/nl/183925858

    2016-01-01

    BACKGROUND: Acute otitis media (AOM) is one of the most common childhood infectious diseases and a significant reason for antibiotic prescriptions in children worldwide. Pain from middle ear infection and pressure behind the eardrum is the key symptom of AOM. Ear pain is central to children's and

  14. THE EFFECT OF ACUPRESSURE AND EFFLEURAGE ON PAIN RELIEF IN THE ACTIVE PHASE OF THE FIRST STAGE OF LABOR IN THE COMMUNITY HEALTH CENTER OF KAWUNGANTEN, CILACAP, INDONESIA

    Directory of Open Access Journals (Sweden)

    Yuli Sya’baniah Khomsah

    2017-10-01

    Full Text Available Background: Pain during pregnancy and childbirth is a physiological process, but it leads to discomfort without pain management. Acupressure and effleurage are considered to be effective in reducing labor pain. Objective: To examine the effect of acupressure and effleurage in reducing pain during in the active phase of the first stage of labor in the community health center of Kawunganten, Cilacap regency. Methods: This was a quasi-experimental study with pretest-posttest control group design. There were 33 respondents recruited using simple random sampling. Numerical rating scale was used to measure labor pain. Data were analyzed using one way anova, Post hoc anova and repeated anova for normal data distribution. Kruskal Wallis was also used for non-normal data distribution. Results: There was a statistically significant mean difference of pain scale before and after given acupressure and effleurage (p-value <0.05. However, acupressure treatment had a greater effect in reducing pain compared with effleurage. Conclusion: Acupressure and efflurage had a significant effect in reducing pain in mothers in the active phase of the first stage of labor. The results of this study are expected to enrich and contribute to the development of science in the field of health promotion, and serve as an additional input for midwives in order to carry out the care of mother during labor.

  15. Pain

    Science.gov (United States)

    ... Grant Funding for Pain Initiatives Current Funding Opportunities Research on the Impact of Creative Arts in Military Populations More Health Professional Information Earn CME More Related Topics Chronic Pain ( NINDS ) NIH Pain Seminar Series Pain: You Can Get Help ( NIA ) NIH ...

  16. Evaluation of pretreatment with gelofen and novafen on pain relief after endodontic treatment; A double-blind randomized clinical trial study

    Directory of Open Access Journals (Sweden)

    Seyed Mehdi Dejkam

    2015-03-01

    Full Text Available Introduction: Feeling pain after root canal therapy has always been a major problem for patients and dentists. One of the suggested methods to manage the pain is using the prophylactic medication before treatment process. This study aimed at investigating the comparison of pretreatment with novafen versus gelofen on reducing the pain after root canal therapy. Materials &Methods: This double-blind randomized clinical trial study was conducted on 60 patients aged 18-65 who were indicated for root canal therapy. Patients were randomly assigned to receive gelofen capsules (400mg, novafen capsules (200mg and placebo two capsules by every patient of these groups one hour prior to sampling. Pre/post-treatment pain was measured using Visual Analog Scale (VAS before treatment and 4, 8, 12, 24 and 48 hours after treatment. Results: Both novafen and gelofen indicated significant analgesic effect during the study period (p<0.001. Pain severity within 8 hours after treatment was significantly lower in novafen group than two other groups (p=0.03. The difference between the severity of pain did not show any association to their place of life and gender in any groups. Conclusion: Our findings revealed that the prophylactic novafen in comparison to gelofen had a better analgesic effect in short-term and could be a good candidate for the management of post-endodontic treatment pain.

  17. How a Simple Ankle Sprain Turned Into Neuropathic Pain: Complex Reflex Sympathetic Dystrophy Versus Erythromelalgia.

    Science.gov (United States)

    Lurati, Ann Regina

    2017-11-01

    A 36-year-old woman sustained a Grade 2 ankle sprain at work. Two days after the injury, the ankle and foot became red and she complained of "intense burning pain." First diagnosed with complex reflex sympathetic dystrophy, the employee was prescribed medications that provided some pain relief; a subsequent temporary nerve block provided additional relief. However, the symptoms returned and she was treated unsuccessfully with surgical sympathectomy. The employee was referred to a neurologist and diagnosed with primary erythromelalgia, a rare pain disorder that can be mistaken as complex reflex sympathetic dystrophy.

  18. Botulinum type A toxin complex for the relief of upper back myofascial pain syndrome: how do fixed-location injections compare with trigger point-focused injections?

    Science.gov (United States)

    Benecke, Reiner; Heinze, Axel; Reichel, Gerhard; Hefter, Harald; Göbel, Hartmut

    2011-11-01

    This was a prospective, randomized, double-blind, placebo-controlled, 12-week, multicenter study to evaluate the efficacy and tolerability of fixed location injections of botulinum type A toxin (BoNT-A, Dysport) in predetermined injection sites in patients with myofascial pain syndrome of the upper back. Patients with moderate-to-severe myofascial pain syndrome affecting cervical and/or shoulder muscles (10 trigger points, disease duration 6-24 months) and moderate-to-severe pain intensity were randomized to BoNT-A (N = 81) or saline (N = 72). Patients received treatment into 10 predetermined fixed injection sites in the head, neck, and shoulder (40 units of BoNT-A per site or saline, a total of 400 units of BoNT-A). The primary efficacy outcome was the proportion of patients with mild or no pain at week 5 (responders). Secondary outcomes included changes in pain intensity and the number of pain-free days per week. At week 5, 49% (37/76) of BoNT-A patients and 38% (27/72) of placebo patients had responded to treatment (P = 0.1873). Duration of daily pain was reduced in the BoNT-A group compared with the placebo group from week 5, with statistically significant differences at weeks 9 and 10 (P = 0.04 for both). Treatment was well tolerated. Fixed-location treatment with BoNT-A of patients with upper back myofascial pain syndrome did not lead to a significant improvement of the main target parameter in week 5 after treatment. Only in week 8 were significant differences found. Several secondary parameters, such as physicians' global assessment and patients' global assessment, significantly favored BoNT-A over placebo at weeks 8 and 12. Wiley Periodicals, Inc.

  19. Topical cryoanesthesia for the relief of pain caused by steroid injections used to treat hypertrophic scar/span>s and keloids

    Science.gov (United States)

    Wang, Xiuxia; Wu, Xiaoli; Liu, Ke; Xia, Lingling; Lin, Xunxun; Liu, Wei; Gao, Zhen

    2017-01-01

    Abstract Intralesional steroid injections are the standard treatment for hypertrophic scar/span>s and keloids. The procedure is, however, quite painful and is unpopular with patients because of this. Topical application of anesthetic creams, such as Ametop gel (tetracaine) and EMLA cream (lidocaine and prilocaine), has limited efficacy because of poor drug penetration. The onset of the analgesic effect is also slow, which means that the use of topical anesthetics is time-consuming in clinical practice. We hypothesized that a commercially available cryotip could be used to provide fast-acting topical cryoanesthesia that would reduce the pain associated with steroid injections. Thirty patients with hypertrophic scar/span>s or keloids were enrolled in the study. Scars were injected with the steroid, triamcinolone acetonide, with or without prior application of the cryotip (−10 °C) for 15 seconds. The degree of pain was evaluated in each case using the visual analogue scale (VAS) and the verbal descriptor scale (VDS), together with any side-effects caused by application of the cryotip. The VAS pain scores showed a statistically significant (P scars (pain scores 7.87 ± 1.31 and 2.7 ± 1.37, respectively). The VDS pain scores also showed a statistically significant (P scars. And its average scores were 7.89 ± 0.32 and 2.68 ± 0.25, respectively. Application of the cryotip before injection could provide a rapid and effective means of reducing the pain associated with steroid injections. Painless would result in better therapeutic effect. PMID:29069016

  20. Virtual Reality as a Distraction Technique in Chronic Pain Patients

    Science.gov (United States)

    Gao, Kenneth; Sulea, Camelia; Wiederhold, Mark D.

    2014-01-01

    Abstract We explored the use of virtual reality distraction techniques for use as adjunctive therapy to treat chronic pain. Virtual environments were specifically created to provide pleasant and engaging experiences where patients navigated on their own through rich and varied simulated worlds. Real-time physiological monitoring was used as a guide to determine the effectiveness and sustainability of this intervention. Human factors studies showed that virtual navigation is a safe and effective method for use with chronic pain patients. Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures. PMID:24892196

  1. Virtual reality as a distraction technique in chronic pain patients.

    Science.gov (United States)

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

    2014-06-01

    We explored the use of virtual reality distraction techniques for use as adjunctive therapy to treat chronic pain. Virtual environments were specifically created to provide pleasant and engaging experiences where patients navigated on their own through rich and varied simulated worlds. Real-time physiological monitoring was used as a guide to determine the effectiveness and sustainability of this intervention. Human factors studies showed that virtual navigation is a safe and effective method for use with chronic pain patients. Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures.

  2. Whole-body Vibration at Thoracic Resonance Induces Sustained Pain and Widespread Cervical Neuroinflammation in the Rat.

    Science.gov (United States)

    Zeeman, Martha E; Kartha, Sonia; Jaumard, Nicolas V; Baig, Hassam A; Stablow, Alec M; Lee, Jasmine; Guarino, Benjamin B; Winkelstein, Beth A

    2015-09-01

    Whole-body vibration (WBV) is associated with back and neck pain in military personnel and civilians. However, the role of vibration frequency and the physiological mechanisms involved in pain symptoms are unknown. This study asked the following questions: (1) What is the resonance frequency of the rat spine for WBV along the spinal axis, and how does frequency of WBV alter the extent of spinal compression/extension? (2) Does a single WBV exposure at resonance induce pain that is sustained? (3) Does WBV at resonance alter the protein kinase C epsilon (PKCε) response in the dorsal root ganglia (DRG)? (4) Does WBV at resonance alter expression of calcitonin gene-related peptide (CGRP) in the spinal dorsal horn? (5) Does WBV at resonance alter the spinal neuroimmune responses that regulate pain? Resonance of the rat (410 ± 34 g, n = 9) was measured by imposing WBV at frequencies from 3 to 15 Hz. Separate groups (317 ± 20 g, n = 10/treatment) underwent WBV at resonance (8 Hz) or at a nonresonant frequency (15 Hz). Behavioral sensitivity was assessed throughout to measure pain, and PKCε in the DRG was quantified as well as spinal CGRP, glial activation, and cytokine levels at Day 14. Accelerometer-based thoracic transmissibility peaks at 8 Hz (1.86 ± 0.19) and 9 Hz (1.95 ± 0.19, mean difference [MD] 0.290 ± 0.266, p resonant frequency (8 Hz) compared with 15 Hz WBV. PKCε in the nociceptors of the DRG increases according to the severity of WBV with greatest increases after 8 Hz WBV (p resonance. WBV at resonance produces long-lasting pain and widespread activation of a host of nociceptive and neuroimmune responses as compared with WBV at a nonresonance condition. Based on this work, future investigations into the temporal and regional neuroimmune response to resonant WBV in both genders would be useful. Although WBV is a major issue affecting the military population, there is little insight about its mechanisms of injury and pain. The neuroimmune responses

  3. [6]-gingerol and [6]-shogaol, active ingredients of the traditional Japanese medicine hangeshashinto, relief oral ulcerative mucositis-induced pain via action on Na(+) channels.

    Science.gov (United States)

    Hitomi, Suzuro; Ono, Kentaro; Terawaki, Kiyoshi; Matsumoto, Chinami; Mizuno, Keita; Yamaguchi, Kiichiro; Imai, Ryota; Omiya, Yuji; Hattori, Tomohisa; Kase, Yoshio; Inenaga, Kiyotoshi

    2017-03-01

    The traditional Japanese herbal medicine hangeshashinto (HST) has beneficial effects for the treatment of oral ulcerative mucositis (OUM) in cancer patients. However, the ingredient-based mechanism that underlies its pain-relieving activity remains unknown. In the present study, to clarify the analgesic mechanism of HST on OUM-induced pain, we investigated putative HST ingredients showing antagonistic effects on Na(+) channels in vitro and in vivo. A screen of 21 major ingredients using automated patch-clamp recordings in channel-expressing cells showed that [6]-gingerol and [6]-shogaol, two components of a Processed Ginger extract, considerably inhibited voltage-activated Na(+) currents. These two ingredients inhibited the stimulant-induced release of substance P and action potential generation in cultured rat sensory neurons. A submucosal injection of a mixture of [6]-gingerol and [6]-shogaol increased the mechanical withdrawal threshold in healthy rats. In a rat OUM model, OUM-induced mechanical pain was alleviated 30min after the swab application of HST despite the absence of anti-bacterial and anti-inflammatory actions in the OUM area. A swab application of a mixture of [6]-gingerol and [6]-shogaol induced sufficient analgesia of OUM-induced mechanical or spontaneous pain when co-applied with a Ginseng extract containing abundant saponin. The Ginseng extract demonstrated an acceleration of substance permeability into the oral ulcer tissue without an analgesic effect. These findings suggest that Na(+) channel blockage by gingerol/shogaol plays an essential role in HST-associated analgesia of OUM-induced pain. This pharmacological mechanism provides scientific evidence supporting the use of this herbal medicine in patients suffering from OUM-induced pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Postoperative Analgesia Due to Sustained-Release Buprenorphine, Sustained-Release Meloxicam, and Carprofen Gel in a Model of Incisional Pain in Rats (Rattus norvegicus).

    Science.gov (United States)

    Seymour, Travis L; Adams, Sean C; Felt, Stephen A; Jampachaisri, Katechan; Yeomans, David C; Pacharinsak, Cholawat

    2016-01-01

    Postoperative analgesia in laboratory rats is complicated by the frequent handling associated with common analgesic dosing requirements. Here, we evaluated sustained-release buprenorphine (Bup-SR), sustained-release meloxicam (Melox-SR), and carprofen gel (CG) as refinements for postoperative analgesia. The aim of this study was to investigate whether postoperative administration of Bup-SR, Melox-SR, or CG effectively controls behavioral mechanical and thermal hypersensitivity in a rat model of incisional pain. Rats were randomly assigned to 1 of 5 treatment groups: saline, 1 mL/kg SC BID; buprenorphine HCl (Bup HCl), 0.05 mg/kg SC BID; Bup-SR, 1.2 mg/kg SC once; Melox-SR, 4 mg/kg SC once; and CG, 2 oz PO daily. Mechanical and thermal hypersensitivity were tested daily from day-1 through 4. Bup HCl and Bup-SR attenuated mechanical and thermal hypersensitivity on days 1 through 4. Melox-SR and CG attenuated mechanical hypersensitivity-but not thermal hypersensitivity-on days 1 through 4. Plasma concentrations, measured by using UPLC with mass spectrometry, were consistent between both buprenorphine formulations. Gross pathologic examination revealed no signs of toxicity in any group. These findings suggest that postoperative administration of Bup HCl and Bup-SR-but not Melox-SR or CG-effectively attenuates mechanical and thermal hypersensitivity in a rat model of incisional pain.

  5. EMLA for pain relief during arterial cannulation. A double-blind, placebo-controlled study of a lidocaine-prilocaine cream

    DEFF Research Database (Denmark)

    Nilsson, A; Danielson, K; Engberg, G

    1990-01-01

    The aim of the study was to evaluate the effect of a lidocaine-prilocaine cream (EMLA cream, Astra) in relieving pain during arterial cannulation. The study had a random, double-blind, placebo-controlled design and included altogether 90 patients. All the patients were premedicated with an opioid...

  6. A comparison of paracetamol, ibuprofen or their combination for pain relief following extractions in children under general anaesthesia: a randomized controlled trial.

    Science.gov (United States)

    Gazal, Giath; Mackie, Iain C

    2007-05-01

    This study was designed to compare the effectiveness of different oral analgesics for relieving pain and distress in children following the extraction of teeth under general anaesthesia (GA). The analgesics included paracetamol alone, ibuprofen alone, and paracetamol and ibuprofen in combination. Two hundred and one subjects were randomly allocated to one of four groups. Forty-seven children were included in the ibuprofen alone (5 mg kg(-1)) group, 51 in the paracetamol/ibuprofen combination (15/5 mg kg(-1)) group, 48 in the high-dose paracetamol (20 mg kg(-1)) group, and 55 children were included in the usual-dose paracetamol (15 mg kg(-1)) group (control group). Evaluation of distress for children was made immediately pre-operatively, on recovery from anaesthesia and again after 15 min by using a five-point face scale. Furthermore, each child was observed immediately postoperatively and 15 min postoperatively for signs of pain using the Children's Hospital of Eastern Ontario Pain Scale. There were significant decreases in the mean pain and distress scores for both the ibuprofen alone and paracetamol/ibuprofen combination groups compared to the control group (usual-dose paracetamol) at 15 min postoperatively. This study provides evidence to support the oral administration of ibuprofen alone or in combination with paracetamol for postoperative analgesia in children who are having teeth extracted under GA.

  7. Acute postoperative pain relief with immediate-release tapentadol: randomized, double-blind, placebo-controlled study conducted in South Korea.

    Science.gov (United States)

    Lee, Y K; Ko, J S; Rhim, H Y; Lee, E J; Karcher, K; Li, H; Shapiro, D; Lee, H S

    2014-12-01

    To broaden the ethnic groups in which tapentadol IR is evaluated for treating acute postoperative pain to include Asians. In this phase 3, multicenter, double-blind, randomized study, 352 Korean adults with moderate-to-severe pain following hallux valgus surgery received tapentadol IR 50 or 75 mg or placebo orally every 4-6 hours for 72 hours. Patients requesting other (rescue) analgesics during this period were discontinued for lack of efficacy. The primary endpoint, sum of pain intensity difference (SPID) over 48 hours, was evaluated based on the difference between tapentadol IR and placebo in least squares (LS) mean change from baseline using analysis of covariance (ANCOVA). Secondary endpoints included the time to first rescue medication use and the distribution of responder rates. A treatment effect, favoring tapentadol IR, was observed for SPID48 (p tapentadol IR 50 mg and 90.6 (95% CI: 65.1, 116.1) for tapentadol IR 75 mg. Time to first rescue medication use was delayed for tapentadol IR (p tapentadol IR (p ≤ 0.001 for both doses vs. placebo; Cochran-Mantel-Haenszel test). Dizziness, nausea, and vomiting were each reported in ≥ 10% tapentadol-treated patients and at an incidence ≥ 2-fold higher vs. placebo. The study findings may be limited by study drug dosing every 4 to 6 hours and frequent monitoring during treatment, neither of which mimic pain treatment in clinical practice. However, any potential bias based on this systematic monitoring of patients would be mitigated by the randomized, double-blind nature of the study, with all treatment groups similarly affected by such biases, if any. Tapentadol IR reduced acute pain intensity, significantly more than placebo, after orthopedic surgery in Korean patients. NCT01516008.

  8. Histamine H4 receptor agonist-induced relief from painful peripheral neuropathy is mediated by inhibition of spinal neuroinflammation and oxidative stress.

    Science.gov (United States)

    Sanna, Maria Domenica; Lucarini, Laura; Durante, Mariaconcetta; Ghelardini, Carla; Masini, Emanuela; Galeotti, Nicoletta

    2017-01-01

    Neuropathic pain is under-treated, with a detrimental effect on quality of life, partly because of low treatment efficacy, but also because pathophysiological mechanisms are not fully elucidated. To clarify the pathobiology of neuropathic pain, we studied the contribution of neuroinflammation and oxidative stress in a model of peripheral neuropathy. We also assessed an innovative treatment for neuropathic pain by investigating the effects of histamine H4 receptor ligands in this model. A peripheral mononeuropathy was induced in mice, by spared nerve injury (SNI). Neuroinflammation and oxidative stress parameters were evaluated by spectrophotometry. The mechanical (von Frey test) and thermal (plantar test) nociceptive thresholds were evaluated. SNI mice showed increased expression of the pro-inflammatory cytokines IL-1ß and TNF-α, decreased antioxidant enzyme Mn-containing SOD (MnSOD), increased levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), an indicator of oxidative DNA damage, and of PARP, nuclear enzyme activated upon DNA damage. Intrathecal administration of VUF 8430 (H4 receptor agonist) reversed the mechanical and thermal allodynia and was associated with decreased expression of IL-1ß, TNF-α, 8-OHdG and PARP and with restoration of MnSOD activity in the spinal cord and sciatic nerve. These effects were prevented by JNJ 10191584 (H4 receptor antagonist). In the SNI mouse model of neuropathic pain, neuronal H4 receptor stimulation counteracts hyperalgesia and reduces neuroinflammation and oxidative stress in the spinal cord and sciatic nerve. Targeting both oxidative stress and pro-neuroinflammatory pathways through H4 receptor-mediated mechanisms could have promising therapeutic potential for neuropathic pain management. © 2016 The British Pharmacological Society.

  9. An ancient Greek pain remedy for athletes.

    Science.gov (United States)

    Bartels, Else M; Swaddling, Judith; Harrison, Adrian P

    2006-09-01

    While Hippocratic writings make no reference to the actual Olympics, there is frequent mention of diet, exercise, and the treatment of injuries sustained by the athletic participants. Indeed, Galen in his Composition of Medicines gives details of a remedy prescribed for the relief of pains and swellings, which was reserved for use by the winners of Olympic events, the so-called "Fuscum Olympionico inscriptum"--(ointment) entitled "dark Olympic victor's." In a time when the Olympic games have recently returned to their homeland, we examine the potential efficacy of this ancient remedy in terms of pain relief, the novelty of transdermal pain management, and the ability of ancient physicians to attend to the sports-related needs of highly tuned athletes.

  10. Methylprednisolone versus triamcinolone in painful shoulder using ultrasound-guided injection.

    Science.gov (United States)

    Chávez-López, Mario Alfredo; Navarro-Soltero, Luis Alberto; Rosas-Cabral, Alejandro; Gallaga, Adán; Huerta-Yáñez, Guillermo

    2009-01-01

    There is little evidence about the comparative efficacy of corticosteroids in the treatment of painful shoulder. The main aim was to compare the efficacy of methylprednisolone (MTP) versus triamcinolone (TMC) in the treatment of painful shoulder using an ultrasound-guided injection. Patients with painful shoulder due to subacromial bursitis and partial or full-thickness rotator cuff tears demonstrated by musculoskeletal ultrasound received a guided-injection of MTP acetate 40 mg (12 patients) or TMC acetonide 40 mg (12 patients). Range of motion and pain visual analogue scale were registered at 10 and 30 min, 1 and 2 weeks postinjection. Two weeks postinjection, both groups reported a mean improvement in range of motion (33%) and relief of pain (61%). Relief of pain of 50% or more was observed in 92% of patients in MTP group and 50% of TMC group (p = 0.02). Two months postinjection, 50% of the patients in MTP group and 25% in TMC group reported total relief of pain (p = 0.3). Patients with painful shoulder receiving an ultrasound-guided injection of MTP or TMC have a rapid and sustained overall response. Relief of pain tends to be more rapid with MTP than TMC.

  11. Efficacy of Codeine When Added to Paracetamol (Acetaminophen) and Ibuprofen for Relief of Postoperative Pain After Surgical Removal of Impacted Third Molars: A Double-Blinded Randomized Control Trial.

    Science.gov (United States)

    Best, Adrian D; De Silva, R K; Thomson, W M; Tong, Darryl C; Cameron, Claire M; De Silva, Harsha L

    2017-10-01

    The use of opioids in combination with nonopioids is common practice for acute pain management after third molar surgery. One such combination is paracetamol, ibuprofen, and codeine. The authors assessed the efficacy of codeine when added to a regimen of paracetamol and ibuprofen for pain relief after third molar surgery. This study was a randomized, double-blinded, placebo-controlled trial conducted in patients undergoing the surgical removal of at least 1 impacted mandibular third molar requiring bone removal. Participants were randomly allocated to a control group (paracetamol 1,000 mg and ibuprofen 400 mg) or an intervention group (paracetamol 1,000 mg, ibuprofen 400 mg, and codeine 60 mg). All participants were treated under intravenous sedation and using identical surgical conditions and technique. Postoperative pain was assessed using the visual analog scale (VAS) every 3 hours (while awake) for the first 48 hours after surgery. Pain was globally assessed using a questionnaire on day 3 after surgery. There were 131 participants (36% men; control group, n = 67; intervention group, n = 64). Baseline characteristics were similar for the 2 groups. Data were analyzed using a modified intention-to-treat analysis and, for this, a linear mixed model was used. The model showed that the baseline VAS score was associated with subsequent VAS scores and that, with each 3-hour period, the VAS score increased by an average of 0.08. The treatment effect was not statistically meaningful, indicating there was no difference in recorded pain levels between the 2 groups during the first 48 hours after mandibular third molar surgery. Similarly, the 2 groups did not differ in their global ratings of postoperative pain. Codeine 60 mg added to a regimen of paracetamol 1,000 mg and ibuprofen 400 mg does not improve analgesia after third molar surgery. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights

  12. Terapia neural como tratamiento contra el dolor en la displasia mamaria cíclica de grado II Neural therapy as pain-relief treatment in grade III cyclic breast dysplasia

    Directory of Open Access Journals (Sweden)

    Orlando R Expósito Reyes

    2007-09-01

    Full Text Available De enero a diciembre de 2004 se realizó un estudio experimental del tipo ensayo clínico de fase II, controlado y monocéntrico, cuyo objetivo fue evaluar la eficacia de la terapia neural en el tratamiento del dolor como manifestación de la displasia mamaria cíclica de grado II en comparación con la terapéutica convencional. Se estudiaron 240 pacientes, que fueron divididos en 4 grupos según el tipo de tratamiento: con terapia neural (grupo I, con vitamina E (grupo II, con progesterona (grupo III y con antiinflamatorios no esteroideos (grupo IV. Se observó mejoría del dolor en más de 60 % del grupo I y fue similar con el uso de la progesterona. Con los antiinflamatorios no esteroideos y la vitamina E hubo diferencias significativas. Se obtuvieron resultados satisfactorios con el empleo de la terapia neural con procaína al 1 %, por lo que pudimos considerarla eficaz en la terapéutica de esta manifestaciónA controlled monocentered experimental study of phase II clinical assay type was carried out from January to December, 2004 to evaluate the effectiveness of neural therapy in treating pain as manifestation of grade II cyclic breast dysplasia in comparison to the conventional therapy. Two hundred and forty patients were studied. They were divided into 4 groups according to the type of treatment: neural therapy (group I; vitamin E (group II; progesterone (group III; and non-steroidal anti-inflammatory drugs (group IV. Pain relief was observed in over 60 % of patients in group I, a result similar to that of group III (progesterone. There were significant differences in groups treated with non-steroidal anti-inflammatory drugs and Vitamin E. The use of neural therapy based on 1% procaine yielded satisfactory results, so we considered it as an effective therapy for pain relief in grade II breast dysplasia

  13. Ultrasound-guided alcohol neurolysis and radiofrequency ablation of painful stump neuroma: effective treatments for post-amputation pain

    Directory of Open Access Journals (Sweden)

    Zhang X

    2017-02-01

    Full Text Available Xin Zhang, Yongming Xu, Jin Zhou, Shaofeng Pu, Yingying Lv, Yueping Chen, Dongping Du Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China Background: Post-amputation pain (PAP is highly prevalent after limb amputation, and stump neuromas play a key role in the generation of the pain. Presently, PAP refractory to medical management is frequently treated with minimally invasive procedures guided by ultrasound, such as alcohol neurolysis and radiofrequency ablation (RFA.Objective: To record the immediate and long-term efficacy of alcohol neurolysis and RFA. We first used alcohol neurolysis and then, when necessary, we performed RFA on PAP patients.Study design: Prospective case series.Setting: Pain management center.Methods: Thirteen subjects were treated with ultrasound-guided procedures.Results: All patients were treated with neurolysis using alcohol solutions guided by ultrasound. Seven (54% of 13 subjects achieved pain relief after 1–3 alcohol injection treatments. The remaining 6 subjects obtained pain relief after receiving 2 administrations of ultrasound-guided RFA. After a 6-month follow-up evaluation period, pain quantities were also assessed. Both stump pain (including intermittent sharp pain and continuous burning pain and phantom pain were relieved. The frequency of intermittent sharp pain was decreased, and no complications were noted during the observation.Conclusion: The use of ultrasound guidance for alcohol injection and RFA of painful stump neuromas is a simple, radiation-free, safe, and effective procedure that provides sustained pain relief in PAP patients. In this case series, RFA was found to be an effective alternative to alcohol injection. Keywords: post-amputation pain, neuroma, ultrasound-guided, alcohol neurolysis, radiofrequency ablation

  14. Acupuncture-induced pain relief and the human brain's default mode network - an extended view of central effects of acupuncture analgesia.

    Science.gov (United States)

    Otti, Alexander; Noll-Hussong, Michael

    2012-01-01

    As a complementary medical procedure, acupuncture has a significant impact on the treatment of acute and chronic pain. Though the physiological mechanisms behind this method are still unclear, acupuncture has been claimed to rely also on changes in the central nervous system. Recent functional imaging studies indicate that the so-called default mode network (DMN) which consists of cortical midline structures and lateral parietal regions plays an important role in these processes. This brief overview describes the effects of analgesic acupuncture on the DMN architecture. The stronger interplay between systems dedicated to endogenous analgesia (periaqueductal gray), affective processing (anterior cingulate cortex, amygdala), memory (hippocampus), and self-projective thinking (DMN) following this therapy supports the notion that acupuncture is a mind-body therapy which helps to reintegrate important neural dimensions of inner life and to establish psychophysical pain homeostasis. Copyright © 2012 S. Karger AG, Basel.

  15. Slow-5 dynamic functional connectivity reflects the capacity to sustain cognitive performance during pain.

    Science.gov (United States)

    Cheng, J C; Bosma, R L; Hemington, K S; Kucyi, A; Lindquist, M A; Davis, K D

    2017-08-15

    Some individuals are more distracted by pain during a cognitive task than others, representing poor pain coping. We have characterized individuals as A-type (attention dominates) or P-type (pain dominates) based on how pain interferes with task speed. The ability to optimize behavior during pain may relate to the flexibility in communication at rest between the dorsolateral prefrontal cortex (DLPFC) of the executive control network, and the anterior mid-cingulate cortex (aMCC) of the salience network (SN) - regions involved in cognitive-interference. The aMCC and aIns (SN hub) also signify pain salience; flexible communication at rest between them possibly allowing prioritizing task performance during pain. We tested the hypotheses that pain-induced changes in task performance are related to resting-state dynamic functional connectivity (dFC) between these region pairs (DLPFC-aMCC; aMCC-aIns). We found that 1) pain reduces task consistency/speed in P-type individuals, but enhances performance in A-type individuals, 2) task consistency is related to the FC dynamics within DLPFC-aMCC and aMCC-aIns pairs, 3) brain-behavior relationships are driven by dFC within the slow-5 (0.01-0.027Hz) frequency band, and 4) dFC across the brain decreases at higher frequencies. Our findings point to neural communication dynamics at rest as being associated with prioritizing task performance over pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Effects of muscle pain induced by glutamate injections during sustained clenching on the contraction pattern of masticatory muscles.

    Science.gov (United States)

    Michelotti, Ambrosina; Cioffi, Iacopo; Rongo, Roberto; Borrelli, Roberta; Chiodini, Paolo; Svensson, Peter

    2014-01-01

    To evaluate the contraction pattern of masticatory muscles during sustained clenching tasks with or without experimental pain induced by glutamate injection into the masseter muscle. It was hypothesized that acute muscle pain could induce compensatory changes in the electromyographic (EMG) activity of the masticatory muscles. Fifteen volunteers (seven males, mean age ± SD = 29.7 ± 1.1 years; eight females, mean age ± SD = 23.5 ± 1.2 years) were recruited in a crossover experimental study. All subjects participated in two randomized 20-minute experimental sessions. Each subject was asked to clench at 25% of the maximum voluntary contraction (MVC). After 10 minutes, isotonic saline or glutamate was injected in random order into the right masseter. EMG activity (root mean square [RMS] and mean power frequency [MPF]) was assessed in the masseter and anterior temporalis muscles on both sides. Pain and fatigue were assessed by 0-10 numeric rating scales (NRS) every minute. Differences between conditions (isotonic saline vs glutamate) for all the outcome parameters were analyzed by using a mixed effect model. The EMG activity of the masticatory muscles and pain and fatigue scores were not dependent on isotonic saline/glutamate injection (all P > .05). The RMS in the temporalis and masseter muscles increased with time (right masseter P = 0.001, left masseter P = .004, right temporalis P = .22, left temporalis P = .006), whereas the MPF decreased (right masseter P = .0001, left masseter P muscles during a sustained clenching task. This finding strongly suggests the adaptive capacity of the stomatognathic system in the presence of acute nociceptive inputs.

  17. Preoperative dexamethasone reduces acute but not sustained pain after lumbar disk surgery

    DEFF Research Database (Denmark)

    Nielsen, Rikke V; Siegel, Hanna; Fomsgaard, Jonna S

    2015-01-01

    with morphine. Primary outcome was pain during mobilization (visual analog scale) 2 to 24 hours postoperatively. Secondary outcomes were acute pain at rest, morphine consumption, nausea, vomiting, ondansetron consumption, sedation, and quality of sleep. Patients were followed up by written questionnaire 3...... months postoperatively. Acute pain during mobilization (weighted average area under the curve, 2-24 hours) was significantly reduced in the dexamethasone group: 33 (22) mm vs placebo 43 (18) mm, (95% confidence interval [CI] 3-16) P = 0.005. Vomiting 0 to 24 hours postoperatively was reduced...

  18. Ultrasound guided peritubal infiltration of 0.25% Bupivacaine versus 0.25% Ropivacaine for postoperative pain relief after percutaneous nephrolithotomy: A prospective double blind randomized study

    Directory of Open Access Journals (Sweden)

    Geeta P Parikh

    2014-01-01

    Full Text Available Background and Aim: Percutaneous nephrolithotomy (PCNL is a common for managing renal calculi. Pain in the initial post operatie period is relieved by infiltration of local anaesthetic around the nephrostomy tract.We aimed to compare the analgesic efficacy of bupivacaine and ropivacaine. Methods: A total of 100 adult patients undergoing elective PCNL- under balanced general anaesthesia were randomly divided into bupivacaine group (Group B and ropivacaine group (Group R. After completion of procedure, 23G spinal needle was inserted at 6 and 12 O′clock position under ultrasonic guidance up to renal capsule along the nephrostomy tube. A volume of 10 ml of either 0.25% bupivacaine or 0.25% ropivacaine solution was infiltrated in each tract while withdrawing the needle. Post-operative pain was assessed using visual analogue scale (VAS and dynamic visual analogue scale (D-VAS for initial 24 h. Intravenous tramadol was given as rescue analgesia when VAS >4. Time to first rescue analgesic, number of doses and total amount of tramadol required in initial 24 h and side-effects were noted. Results: Visual analogue scale and D-VAS at 6 h and 8 h in Group B was significantly higher than Group R. Mean time to first rescue analgesia in Group R was significantly longer than Group B. Mean number of doses of tramadol and total consumption of tramadol in 24 h was less in Group R, though not statistically significant. Conclusion: Peritubal infiltration of 0.25% ropivacaine infiltration along the nephrostomy tract is more effective than 0.25% bupivacaine in alleviating initial post-operative pain after PCNL.

  19. Calculation of the Dose of Samarium-153-Ethylene Diamine Tetramethylene Phosphonate (153Sm-EDTMP as a Radiopharmaceutical for Pain Relief of bone Metastasis

    Directory of Open Access Journals (Sweden)

    Fatemeh Razghandi

    2016-04-01

    Full Text Available Introduction One of the important applications of nuclear physics in medicine is the use of radioactive elements as radiopharmaceuticals. Metastatic bone disease is the most common form of malignant bone tumors. Samarium-153-ethylene diamine tetramethylene phosphonate (153Sm-EDTMP as a radiopharmaceutical is used for pain palliation. This radiopharmaceutical usually emits beta particles, which have a high uptake in bone tissues. The purpose of this study was to calculate the radiation dose distribution of 153Sm-EDTMP in bone and other tissues, using MCNPX Monte Carlo code in the particle transport model. Materials and Methods Dose delivery to the bone was simulated by seeking radiopharmaceuticals on the bone surface. The phantom model had a simple cylindrical geometry and included bone, bone marrow, and soft tissue. Results The simulation results showed that a significant amount of radiation dose was delivered to the bone by the use of this radiopharmaceutical. Conclusion Thebone acted as a fine protective shield against rays for the bone marrow. Therefore, the trivial absorbed dose by the bone marrow caused less damage to bone-making cells. Also, the high absorbed dose of the bone could destroy cancer cells and relieve the pain in the bone.

  20. Mixture of Arnebia euchroma and Matricaria chamomilla (Marhame-Mafasel) for pain relief of osteoarthritis of the knee - a two-treatment, two-period crossover trial.

    Science.gov (United States)

    Soltanian, Ali Reza; Mehdibarzi, Dariush; Faghihzadeh, Soghrat; Naseri, Mohsen; Gerami, Abbas

    2010-12-01

    Osteoarthritis is the most prevalent chronic non-infective joint arthritis. Because of its chronic disease nature, local drugs are preferred due to lower complications. In the present study, the new herbal pomade Marhame-Mafasel for knee osteoarthritis was used in a double-blind crossover trial. The aim of the study was to assess the efficacy and safety of Marhame-Mafasel pomade, which consists of several medical herbs including Arnebia euchroma and Matricaria chamomilla, in osteoarthritis of the knee. This study was a placebo-controlled double-blind crossover trial. Forty-two patients with pain associated with osteoarthritis of the knee (diagnosed by criteria of the European League against Rheumatism and physical examination) were drawn from patients attending the Clinic of Mostafa-Khomeini Hospital. In this study we assessed efficacy (analgesic effect and improved function) of herbal pomade Marhame-Mafasel, which was used locally in patients with primary osteoarthritis of the knee over three weeks. The instrument of the study was the Western Ontario and McMaster Universities (WOMAC) LK3.1 standard questionnaires. The participants in each group were 21 patients; 30 (71.4%) were women and 12 (28.6%) of them were men. The participants were between 40 and 76 years old. Six patients had mild arthritis, 15 had moderate arthritis and 21 had severe arthritis. The positive analgesic effect of the herbal pomade Marhame-Mafasel in primary knee osteoarthritis was proven. The herbal joint pomade Marhame-Mafasel had a significantly greater mean change in score compared to the placebo group for osteoarthritis severity (p < 0.05). Herbal pomade Marhame-Mafasel in comparison to placebo has more effect on reduction of pain of primary knee osteoarthritis.

  1. Addition of buprenorphine to local anesthetic in adductor canal blocks after total knee arthroplasty improves postoperative pain relief: a randomized controlled trial.

    Science.gov (United States)

    Krishnan, Sandeep H; Gilbert, Lisa A; Ghoddoussi, Farhad; Applefield, Daniel J; Kassab, Safa S; Ellis, Terry A

    2016-09-01

    For the hundreds of thousands of patients who undergo total knee arthroplasty (TKA) in the United States each year, early mobilization has been demonstrated to improve functional outcomes and reduce complications. Management of postoperative pain is a critical factor in achieving early mobilization. Recent studies have shown that the use of an adductor canal block (ACB) after TKA results in increased preservation of quadriceps muscle strength, without significant difference in postoperative pain when compared to femoral nerve block. This increased preservation of quadriceps muscle strength leads to earlier mobilization. Studies have also demonstrated a prolongation of analgesia with the addition of buprenorphine to local anesthetic for regional block placement. This study examined the effect on postoperative opioid consumption when adding buprenorphine to an ACB vs an ACB with local anesthetic alone, for postoperative analgesia after unilateral TKA. A total of 100 patients scheduled for TKA were randomized to receive postoperative ACB with local anesthetic alone or with local anesthetic and buprenorphine. The primary outcome examined was total opioid analgesic (milligrams of hydrocodone equivalent) consumption in the first 24 hours postsurgery. The secondary outcomes examined were the reported incidence of the opioid side effects nausea, vomiting, and pruritis. Postoperative opioid consumption decreased significantly in the group that received an ACB with local anesthetic and buprenorphine compared to an ACB with local anesthetic only (25.34±2.62 vs 35.84±2.86; P=.0076). Secondary outcomes showed no statistical difference between the 2 groups in terms of the incidence of nausea, vomiting, or pruritus. The addition of buprenorphine to an adductor canal block decreases postoperative opioid consumption when compared to an ACB with local anesthetic alone. This reduction in opioid consumption, without significant increase in side effects, makes this an attractive

  2. Antinociceptive effects of sustained-release buprenorphine in a model of incisional pain in rats (Rattus norvegicus).

    Science.gov (United States)

    Chum, Helen H; Jampachairsri, Katechan; McKeon, Gabriel P; Yeomans, David C; Pacharinsak, Cholawat; Felt, Stephen A

    2014-03-01

    Effective management of postoperative pain is an essential component of the care and welfare of laboratory animals. A sustained-release formulation of buprenorphine (Bup-SR) has recently been introduced to the veterinary market and has been reported to provide analgesia for as long as 72 h. Using evoked mechanical and thermal hypersensitivity tests, we here evaluated the antinociceptive effects of Bup-SR in a model of incisional pain in rats. Paw withdrawal responses were obtained before and 1 through 4 d after surgery. Rats are assigned to receive Bup-SR (0.3, 1.2, or 4.5 mg/kg SC once) or buprenorphine HCl (Bup HCl, 0.05 mg/kg SC twice daily for 3 d). Responses to mechanical and thermal stimuli in the 1.2 and 4.5 Bup-SR groups did not differ from those of rats in the Bup HCl group. Thermal latency on day 3 in rats that received 0.3 mg/kg Bup-SR was significantly different from baseline, indicating that this dose effectively decreased thermal hypersensitivity for at least 48 h. Marked sedation occurred in rats in the 4.5 Bup-SR group. Our findings indicate that Bup-SR at 0.3 or 1.2 mg/kg SC is effective in minimizing hypersensitivity with minimal sedation for at least 48 h (thermal hypersensitivity) and 72 h, respectively, in the incisional pain model in rats.

  3. Evaluation of location and number of aid post for sustainable humanitarian relief using agent based modeling (ABM) and geographic information system (GIS)

    Science.gov (United States)

    Khair, Fauzi; Sopha, Bertha Maya

    2017-12-01

    One of the crucial phases in disaster management is the response phase or the emergency response phase. It requires a sustainable system and a well-integrated management system. Any errors in the system on this phase will impact on significant increase of the victims number as well as material damage caused. Policies related to the location of aid posts are important decisions. The facts show that there are many failures in the process of providing assistance to the refugees due to lack of preparation and determination of facilities and aid post location. Therefore, this study aims to evaluate the number and location of aid posts on Merapi eruption in 2010. This study uses an integration between Agent Based Modeling (ABM) and Geographic Information System (GIS) about evaluation of the number and location of the aid post using some scenarios. The ABM approach aims to describe the agents behaviour (refugees and volunteers) in the event of a disaster with their respective characteristics. While the spatial data, GIS useful to describe real condition of the Sleman regency road. Based on the simulation result, it shows alternative scenarios that combine DERU UGM post, Maguwoharjo Stadium, Tagana Post and Pakem Main Post has better result in handling and distributing aid to evacuation barrack compared to initial scenario. Alternative scenarios indicates the unmet demands are less than the initial scenario.

  4. Quality of life and pain relief in men with metastatic castration-resistant prostate cancer on cabazitaxel: the non-interventional 'QoLiTime' study.

    Science.gov (United States)

    Hofheinz, Ralf-Dieter; Lange, Carsten; Ecke, Thorsten; Kloss, Susanne; Linsse, Burkhard; Windemuth-Kieselbach, Christine; Hammerer, Peter; Al-Batran, Salah-Eddin

    2017-05-01

    To examine health-related quality of life (QoL) in men with metastatic castration-resistant prostate cancer (mCRPC) on cabazitaxel. Men with mCRPC receiving cabazitaxel (25 mg/m², every 3 weeks) and 10 mg/day oral prednis(ol)one were enrolled (2011-2014) in the non-interventional prospective 'QoLiTime' study. Primary outcome was change in QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item) with respect to prostate-specific antigen (PSA) response after four cycles of cabazitaxel. Secondary outcomes included occurrence of adverse events (AEs). Of 527 men, 348 received four cycles of cabazitaxel and 266 had the necessary PSA level measurements. After four cycles, 92 (34.6%) men had a PSA level decrease ≥50% (responders). QoL remained stable throughout the study (P = 0.62). Change in QoL did not differ between responders and non-responders (P = 0.69). Change in PSA level and global health status between baseline and four cycles showed an inversely proportional relationship (correlation coefficient -0.14; 95% confidence interval -0.26 to -0.01; P = 0.03), with increasing PSA level corresponding to lower health status. Responders showed no change in physical functioning vs baseline (-1.75, P = 0.12); non-responders showed a reduction vs baseline (-7.00, P Prostate-specific antigen level response was associated with stable physical functioning and improvement in pain. Symptom increases were seen in areas typical of chemotoxicity, but QoL was maintained. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  5. Redução da dor em mulheres com osteoporose submetidas a um programa de atividade física Pain relief in women with osteoporosis after a physical activity program

    Directory of Open Access Journals (Sweden)

    Patricia Driusso

    2008-09-01

    (from 7.33±3.05 to 4.17±2.61, p=0,0007, and a lesser use of analgesics was reported. These results suggest that the program of physical activity brought pain relief, thus contributing to improve quality of life of women with osteoporosis.

  6. Pharmacological evidence favouring the traditional use of the root bark of Condalia buxifolia Reissek in the relief of pain and inflammation in mice.

    Science.gov (United States)

    Simões, Róli R; Coelho, Igor S; Junqueira, Stella C; Maldaner, Graciela; Morel, Ademir F; Venzke, Dalila; Ruani, Ana Paula; Pizzolatti, Moacir G; Zanchet, Eliane M; Santos, Adair R S

    2015-12-04

    The Condalia buxifolia root bark infusion is used in traditional medicine in Brazil as antipyretic, anti-inflammatory and against dysentery. This study was designed to investigate whether the methanolic extract of the root bark of Condalia buxifolia (MECb) exhibits antinociceptive and anti-inflammatory effects in mice. Furthermore, also was investigated the involvement of glutamatergic and opioidergic system in the antinociceptive effect induced by MECb. The antinociceptive and anti-inflammatory effects of intra-gastric gavage (i.g.) administered MECb (10-300 mg/kg) were evaluated in mice subjected to chemical (formalin, acetic-acid, glutamate) or thermal (hot plate) models of pain. The involvement of opioid system in the antinociceptive effect of the MECb was investigated in formalin test. Furthermore, a nonspecific effect of MECb was evaluated by measuring locomotor activity and exploratory behavior in open field test. Finally, was performed a phytochemical analysis of MECb. The phytochemical analysis of MECb was performed through HPLC analysis showing that the alkaloid Condaline-A is the main constituent. The intragastric administration of MECb (100-300 mg/kg) significantly inhibited the nociception caused by acetic acid (48 ± 2%), inflammatory phase (49 ± 3%) and paw edema (32 ± 6) caused by formalin, and MECb (100mg/kg, i.g.) also inhibited nociception caused by glutamate (41 ± 7%). In addition, MECb (100-300 mg/kg, i.g.) increased the paw withdrawal latency in hot-plate test, without affecting the locomotor activity and exploratory behavior in open field test. Finally, the antinociceptive effects of MECb (100mg/kg, i.g.) were significantly reversed by naloxone (1mg/kg, i.p.) in the formalin test. These data show, for the first time, that MECb has significant antinociceptive and anti-inflammatory effects, which appear to be related to the inhibition of the glutamatergic system and the activation of opioid mechanism, besides present central effects. These

  7. Attitude of medical practitioners to chronic pain management at the University of Maiduguri Teaching Hospital

    Directory of Open Access Journals (Sweden)

    S A Balarabe

    2012-01-01

    Conclusion: Adequate rather than absolute pain relief or moderate pain relief is the main goal of chronic pain management among medical practitioners. Many clinicians demonstrated negative attitude regarding use of opiates.

  8. Low back pain and the post-laminectomy pain syndrome

    African Journals Online (AJOL)

    Back pain is one of the most common disorders seen in general practice. Patients with chronic low back pain form a large proportion of the work of any pain relief unit. The aetiology of low back pain and the post-laminectomy pain syndrome are briefly presented and treatment of the 'failed back surgery patient' and the ...

  9. Effects of pollen extract in association with vitamins (DEPROX 500®) for pain relief in patients affected by chronic prostatitis/chronic pelvic pain syndrome: results from a pilot study.

    Science.gov (United States)

    Cai, Tommaso; Luciani, Lorenzo Giuseppe; Caola, Iole; Mondaini, Nicola; Malossini, Gianni; Lanzafame, Paolo; Mazzoli, Sandra; Bartoletti, Riccardo

    2013-04-24

    The therapeutic efficacy of CP/CPPS is not very satisfactory and the impact on young male's quality of life is considerable. The aim of the present study is to evaluate the efficacy of pollen extract associated with vitamins (DEPROX 500®) in order to improve the quality of life of young patients affected by chronic prostatitis type IIIb (CP/CPPS) by pain relieving. All patients with clinical and instrumental diagnosis of CP/CPPS (class b) underwent DEPROX 500® 2 tablets in a single dose daily for 30 days. Clinical and microbiological analyses were carried out at the enrolment and after 1 month. NIH-CPSI and IPSS questionnaires have been used. The main outcome measure was the improvement of quality of life at the end of the whole study period, evaluated by questionnaires results. 20 men (mean age 32.8 ± 6.78) were enrolled in this pilot study. The baseline questionnaire mean scores were 25.90 ± 2.1 and 8.01 ± 3.64 for NIH-CPSI and IPSS, respectively. At the follow-up examination (1 month after treatment), 18 out of 20 patients (90.0%) reported an improvement of quality of life, in terms of pain reduction. The questionnaire results after 1 month from treatment were as follows: NIH-CPSI 12.8 ± 2.20, IPSS 7.6 ± 1.58. Statistically significant differences were then reported between the two visits, in terms of NIH-CPSI scores (pvitamins (DEPROX 500®) significantly improved 
total symptoms, pain, and QoL in patients with non-inflammatory CP/CPPS without severe side 
effects.

  10. Once-Daily, Controlled-Release Tramadol and Sustained-Release Diclofenac Relieve Chronic Pain due to Osteoarthritis: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    André D Beaulieu

    2008-01-01

    Full Text Available OBJECTIVE: The present study was a randomized, parallel, double-blind comparison between controlled-release (CR tramadol and sustained-release (SR diclofenac in patients with chronic pain due to osteoarthritis of the hips and/or knees.

  11. Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip.

    Science.gov (United States)

    Blankenbaker, Donna G; De Smet, Arthur A; Keene, James S

    2006-08-01

    The purpose of this study was to compare sonographic evaluations of patients referred with suspected snapping of their iliopsoas tendon with the pain relief achieved from anesthetic injection of the iliopsoas bursa, and with the subsequent surgical outcome. This study also assessed the effectiveness of Kenalog injection into the iliopsoas bursa for long-term pain relief. Dynamic and static sonography was performed in 40 patients with clinically diagnosed snapping hips. The iliopsoas bursa was injected with Bupivicaine and Lidocaine in the first 22 patients, and an additional 1 ml Kenalog-40 was added to this mixture in the last 18 patients. We compared the static and dynamic sonographic findings with change in the patients' level of pain at 2 days after anesthetic injection. The sonographic findings and response to anesthetic injection were also compared to the response to Kenalog injection and the results of any subsequent surgery. Static sonography of the iliopsoas tendon was normal in 38 patients, and detected iliopsoas bursitis in one patient and iliopsoas tendinopathy in another. Snapping of the iliopsoas tendon was observed using dynamic sonography in 9 of the 40 patients. Following anesthetic injection of the iliopsoas bursa, 29 patients had complete or partial pain relief, and 11 patients had no pain relief. Eight of the nine patients with a snapping iliopsoas tendon had complete or partial pain relief from the bursal injection. Twelve of the 29 patients with pain relief after anesthetic injection later had an arthroscopic iliopsoas tendon release, and all of these 12 patients had a good postoperative result. Of the 18 patients who had Kenalog-40 injected into the iliopsoas bursa and did not have iliopsoas surgery, 16 had sustained pain relief following the injection. Patients with groin pain and a clinically suspected snapping iliopsoas tendon can benefit from injection into the iliopsoas bursa even if the snapping tendon is not visualized sonographically

  12. Review of oral oxymorphone in the management of pain

    Directory of Open Access Journals (Sweden)

    Paul Sloan

    2008-09-01

    Full Text Available Paul SloanUniversity of Kentucky Medical Center, Department of Anesthesiology, Lexington, KY, USAAbstract: Chronic cancer and nonmalignant pain (CNMP is a common and major health problem afflicting approximately 40 million persons in the US. Most cancer patients, and many patients with CNMP, require opioid analgesics to obtain adequate pain relief. Oral oxymorphone is a new formulation of an existing parenteral opioid that has become available for the treatment of significant pain: acute postoperative, chronic arthritis, chronic low back, and chronic cancer pain. Oxymorphone is a typical mu-opioid agonist that is effective in both immediate- and extended-release (IR and ER formulations. Oxymorphone is more lipid soluble than morphine, resulting in a rapid onset of action when given in tablet formulation, with a duration of action of approximately 4–6 hours in IR and 12 hours in ER preparations. Oxymorphone provides excellent pain relief for significant pain, with typical opioid side effects that are usually mild or moderate in intensity. Multiple double-blind, prospective, placebo-controlled clinical trials have demonstrated the clinical efficacy and safety of this new oral opioid preparation. Oral oxymorphone is an effective opioid that provides a new therapeutic option for the physician.Keywords: chronic pain, oxymorphone, opioids, extended-release, sustained-release, cancer pain

  13. PERINEAL PAIN RELIEF THERAPIES AFTER POSTPARTUM

    Directory of Open Access Journals (Sweden)

    Marília Vieira Peleckis

    2017-01-01

    Full Text Available Objetivo: identificar las terapias para el tratamiento del dolor perineal en el post-parto normal y verificar indicación técnica y duración de la crioterapia. Método: estudio exploratorio ( survey conducido en 32 maternidades publicas del Municipalidad de São Paulo (Brasil. En cada maternidad, se entrevistó una enfermera u obstetra que prestase asistencia directa a la puérpera. Se investigaron: caracterización institucional, calificación profesional, método de alivio del dolor, criterio de administración de las terapias, indicación, contraindicación, modalidad de la técnica e intervalo de la crioterapia. Se realizó análisis descriptivo. Resultados: métodos medicamentosos y no medicamentosos fueron utilizados en el alivio del dolor perineal, a pesar del uso de las terapias no medicamentosas no estar protocolado en estas instituciones. Entre los métodos medicamentosos se destacaron los analgésicos y anti- inflamatorios. La crioterapia fue el método no medicamentoso más utilizado, siendo su principal indicación el edema perineal. Tiempo de aplicación e intervalo de la crioterapia varió 10-30 minutos y 3-8 horas, respectivamente. Cubos de hielo en guante de latex fue la principal técnica de resfrío. Conclusión: las terapia medicamentosos predominaron en el control del dolor perineal. Considerando las ventajas de las terapia no medicamentosas, se hace necesario desarrollar protocolos para garantizar su empleo seguro y eficaz en la asistencia obstétrica.

  14. Analgesia for acute pain

    African Journals Online (AJOL)

    human right, and therefore the aim of acute pain management is adequate pain control to achieve ... the intervention causes unacceptable side-effects, it can lead to suboptimal pain relief and potentially dire outcomes. Knowledge .... it was found in a systematic review that music therapy reduces anxiety and analgesia ...

  15. Iraq's Debt Relief: Procedure and Potential Implications for International Debt Relief

    National Research Council Canada - National Science Library

    Weiss, Martin A

    2009-01-01

    .... Reducing this debt to a sustainable level has been a priority of the U.S. government. Since 2003, debt relief negotiations have taken place in a variety of fora and led to the cancellation of a significant amount of Iraq's external debt...

  16. MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain

    Energy Technology Data Exchange (ETDEWEB)

    Joshi, Dharmdev H.; Thawait, Gaurav K.; Fritz, Jan [Johns Hopkins University School of Medicine, Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Del Grande, Filippo [Johns Hopkins University School of Medicine, Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Ospedale Regionale di Lugano, Servizio di Radiologia, Lugano, Ticino (Switzerland)

    2017-07-15

    Neuropathy of the posterior femoral cutaneous nerve may manifest as pain and paresthesia in the skin over the inferior buttocks, posterior thigh, and popliteal region. Current treatment options include physical and oral pain therapy, perineural injections, and surgical neurectomy. Perineural steroid injections may provide short-term pain relief; however, to our knowledge, there is currently no minimally invasive denervation procedure for sustained pain relief that could serve as an alternative to surgical neurectomy. Percutaneous cryoablation of nerves is a minimally invasive technique that induces a sustained nerve conduction block through temporary freezing of the neural layers. It can result in long-lasting pain relief, but has not been described for the treatment of neuropathy-mediated PFCN pain. We report a technique of MR-guided cryoablation of the posterior femoral cutaneous nerve resulting in successful treatment of PFCN-mediated sitting pain. Cryoablation of the posterior femoral cutaneous nerve seems a promising, minimally invasive treatment option that deserves further investigation. (orig.)

  17. Pain Management: Knowledge and Attitudes of Senior Nursing Students and Practicing Registered Nurses

    Science.gov (United States)

    Messmer, Sherry

    2009-01-01

    Despite scientific advances in pain management, inadequate pain relief in hospitalized patients continues to be an on-going phenomenon. Although nurses do not prescribe medication for pain, the decision to administer pharmacological or other interventions for pain relief is part of nursing practice. Nurses play a critical role in the relief of…

  18. A randomized clinical trial of the effectiveness of photon stimulation on pain, sensation, and quality of life in patients with diabetic peripheral neuropathy.

    Science.gov (United States)

    Swislocki, Arthur; Orth, Marla; Bales, Maurice; Weisshaupt, Jennifer; West, Claudia; Edrington, Janet; Cooper, Bruce; Saputo, Len; Islas, Melissa; Miaskowski, Christine

    2010-01-01

    Peripheral neuropathy is one of the most common complications of diabetes. The purpose of this study was to evaluate the effects of photon stimulation on pain intensity, pain relief, pain qualities, sensation and quality of life (QOL) in patients with painful diabetic peripheral neuropathy. In this randomized, placebo-controlled trial, patients were assigned to receive either four photon stimulations (n=63) or four placebo (n=58) treatments. Pain intensity, pain relief, and pain qualities were assessed using self-report questionnaires. Sensation was evaluated using monofilament testing. QOL was measured using the Medical Outcomes Study Short Form-36 (SF-36). Multilevel regression model analyses were used to evaluate between-group differences in study outcomes. No differences, over time, in any pain intensity scores (i.e., pain intensity immediately post-treatment, average pain, worst pain) or pain relief scores were found between the placebo and treatment groups. However, significant decreases, over time, were found in some pain quality scores, and significant improvements in sensation were found in patients who received the photon stimulation compared with placebo. In addition, patients in the treatment group reported significant improvements in SF-36 social functioning and mental health scores. Findings from a responder analysis demonstrated that no differences were found in the percentages of patients in the placebo and treatment groups who received 30% or more or 50% or more reduction in pain scores immediately post-treatment. However, significant differences were found in the distribution of the changes in pain relief scores, with most of the patients in the photon stimulation group reporting a slight (28.6%) to moderate (34.9%) improvement in pain relief from the beginning to the end of the study compared with no change in pain relief (43.1%) in the placebo group. Four treatments with photon stimulation resulted in significant improvements in some pain

  19. Effect of sustained typing work on changes in scapular position, pressure pain sensitivity and upper trapezius activity.

    Science.gov (United States)

    Park, Se-Yeon; Yoo, Won-Gyu

    2013-01-01

    The aim of this study was to investigate the effects of sustained computer keyboard typing on the human musculoskeletal system by assessing the pressure-pain threshold (PPT), scapular position and activation of the upper trapezius. Vertical and horizontal positional changes of the scapular were measured with a palpation meter before and after keyboard work, and the PPT was measured using a pressure algometer. Activation of the upper trapezius during 20 minutes of computer keyboard work was measured by electromyography, and four consecutive 5-minute segments were analyzed. The vertical distance from the seventh cervical process to the acromion, and the horizontal distance from the inferior angle to the same level of the spinal process were significantly increased after keyboard typing work compared with before keyboard typing work (ptrapezius activity increased with increased time at the keyboard. The percent reference voluntary contraction of phase 1 (from start to 5 minutes) was lower than those of phase 2 (from 5 to 10 minutes), and phase 3 (from 10 to 15 minutes) (ptrapezius. To prevent musculoskeletal problems in the shoulder region, posture reeducation during computer work should be considered in terms not only of neck and trunk posture, but also of scapular position.

  20. Alívio da dor crônica não neoplásica com opiáceos Alivio del dolor cronico no neoplásico con opiáceos Non oncologic chronic pain relief with opioids

    Directory of Open Access Journals (Sweden)

    Cibele Andrucioli de Mattos Pimenta

    1999-10-01

    Full Text Available O uso de opiáceos para o controle da dor crônica não relacionada ao câncer é controverso. Avaliar o alívio da dor e as mudanças nas atividades de vida diária advindas da infusão intratecal de opiáceos em 11 doentes, com dor crônica não neoplásica, foram os objetivos deste estudo. Todos os doentes haviam previamente sido submetidos a diversas modalidades terapêuticas sem alívio significativo. Os doentes foram solicitados a avaliar as características da dor e as atividades de vida diária comparando-as antes e após o tratamento com opiáceo intratecal por meio de sistemas implantados. Observou-se alívio da dor. No entanto, melhora da funcionalidade não foi observada com a mesma magnitude.El uso de opiáceo para el control del dolor crónico no relacionado al cáncer es controvertido. Evaluar el alivio del dolor y los cambios en las actividades de la vida diaria debidas a la infusión intratecal de opiáceos, en 11 pacientes con dolor crónico no neoplásico fue el objetivo de este estudio. Todos los pacientes habían previamente sido sometidos a las diversas modalidades terapéuticas sin alivio significativo del dolor. Los pacientes fueron entrevistados y se les solicitó evaluar el dolor y las actividades de la vida diaria, comparando antes y después del tratamiento con opiáceo intratecal. La infusión de opiáceo intratecal resulto en alivio del dolor. Sim embargo, la mejoría de la funcionalidad no fue observada con la misma magnitud.Opioids for non cancer pain control are controversial. The evaluation of the pain relief, changes in quality of life and complications due to long term infusion of opioids in the lumbar subarachnoid space in 11 patients with non cancer pain were the goals of this study. Patients were previously treated with drugs and surgical procedures, without significant pain relief. Patients were asked to compare pain characteristics and daily life activities before and after this treatment. The long term

  1. Neuropathic pain due to fibromatosis: Does anticancer treatment help?

    Directory of Open Access Journals (Sweden)

    David Mathew

    2011-01-01

    Full Text Available Desmoid fibromatosis, although histologically benign, infiltrates local structures. The involvement of neural structures can lead to difficult neuropathic pain and the escalating use of analgesics. We report a patient with desmoid fibromatosis of the chest wall causing brachial plexus infiltration. As the tumor was locally invasive and unresectable, he was treated with radiation therapy and oral tamoxifen. On follow-up, there was significant pain relief, sustained reduction in the tumor size, and reduced analgesic requirement. Antineoplastic treatments like local radiation therapy and targeted systemic therapy with hormones or other agents can be considered in the management of selected unresectable desmoid fibromatosis to improve symptom control and reduce polypharmacy.

  2. Paper relief architecture

    NARCIS (Netherlands)

    Latka, J.F.

    2014-01-01

    The article presents two contemporary projects of paper structures relief architecture designed and built by Shigeru Ban Architects and Voluntary Architect Network. Author of the article took part in design and construction process of one of the projects. The project of Yaan Nursery School, which

  3. Itching for Allergy Relief?

    Science.gov (United States)

    ... function, you don't find relief from OTC drugs, or you experience allergy symptoms over a long period. You may need ... available OTC and in generic form. The prescription drugs Astelin ... sprays approved to treat allergy symptoms. They can be used several times a ...

  4. Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy

    Directory of Open Access Journals (Sweden)

    Flávio Ramalho Romero

    2015-06-01

    Full Text Available Sacroiliac joint (SIJ pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS. Secondary outcome measure was Patient Global Impression of Change Scale (PGIC.Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001. Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

  5. Orthopedic surgery and bone fracture pain are both significantly attenuated by sustained blockade of nerve growth factor.

    Science.gov (United States)

    Majuta, Lisa A; Longo, Geraldine; Fealk, Michelle N; McCaffrey, Gwen; Mantyh, Patrick W

    2015-01-01

    The number of patients suffering from postoperative pain due to orthopedic surgery and bone fracture is projected to dramatically increase because the human life span, weight, and involvement in high-activity sports continue to rise worldwide. Joint replacement or bone fracture frequently results in skeletal pain that needs to be adequately controlled for the patient to fully participate in needed physical rehabilitation. Currently, the 2 major therapies used to control skeletal pain are nonsteroidal anti-inflammatory drugs and opiates, both of which have significant unwanted side effects. To assess the efficacy of novel therapies, mouse models of orthopedic and fracture pain were developed and evaluated here. These models, orthopedic surgery pain and bone fracture pain, resulted in skeletal pain-related behaviors that lasted 3 weeks and 8 to 10 weeks, respectively. These skeletal pain behaviors included spontaneous and palpation-induced nocifensive behaviors, dynamic weight bearing, limb use, and voluntary mechanical loading of the injured hind limb. Administration of anti-nerve growth factor before orthopedic surgery or after bone fracture attenuated skeletal pain behaviors by 40% to 70% depending on the end point being assessed. These data suggest that nerve growth factor is involved in driving pain due to orthopedic surgery or bone fracture. These animal models may be useful in developing an understanding of the mechanisms that drive postoperative orthopedic and bone fracture pain and the development of novel therapies to treat these skeletal pains.

  6. A eficácia da sacarose no alívio de dor em neonatos: revisão sistemática da literatura The efficacy of sucrose for the relief of pain in neonates: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Cláudia M. Gaspardo

    2005-12-01

    : Sucrose solution has demonstrated efficacy in pain relief during puncture procedures on samples of preterm and fullterm neonates. The recommendation is to administer oral sucrose, to the front of the tongue, 2 minutes before the painful procedure. Other non-pharmacological interventions, such as human breastmilk via nasogastric tube, non-nutritional suckling and being held at the breast, also demonstrated synergic analgesic effects when administered in association with sucrose. The majority of studies demonstrated a positive pain relief effect with a single 2 ml dose at 25%. Conclusions could not be drawn on the best repeat administration scheme; in the few studies that did provide an indication, the dose was 0.1 ml at 24%. The analgesic pain relief effect promoted by the sucrose was observed through altered behavioral responses, facial activity and crying. Heart rate underwent larger reductions as a result of sucrose administration during painful procedures than any of the other physiological responses. CONCLUSIONS: The efficacy of a single dose of sucrose for the relief of acute pain neonates is well documented in the literature. However, there are not yet definite conclusions on the scheme of use for repeated doses of sucrose.

  7. Brief cognitive interventions for burn pain.

    Science.gov (United States)

    Haythronthwaite, J A; Lawrence, J W; Fauerbach, J A

    2001-01-01

    This study tested the efficacy of 2 brief cognitive interventions in supplementing regular medical treatment for pain during burn dressing change. Forty-two burn inpatients were randomly assigned to 3 groups: sensory focusing, music distraction, and usual care. Patients reported pain, pain relief satisfaction with pain control, and pain coping strategies. The sensory focusing group reported greater pain relief compared to the music distraction group and a reduction in remembered pain compared to the usual care group, although group differences were not observed on serial pain ratings. In addition, after controlling for burn size and relevant covariates, regression analyses indicated that catastrophizing predicted pain, memory for pain, and satisfaction with pain control. Refinement of the sensory focusing intervention is warranted to reduce catastrophic thinking and improve pain relief

  8. Neutrophil-lymphocyte ratio, pain perception, and disease activity score may serve as important predictive markers for sustained remission in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    S. Chandrashekara

    2016-02-01

    Full Text Available The implementation of new treatment strategies based on current recommendations has enabled a greater number of patients with rheumatoid arthritis (RA to achieve remission. However, there are no definite predictors of sustained remission. Moreover, the absence of clear consensus on the time of withdrawal or reduction of treatment further adds to the treatment burden. This pilot study was intended to evaluate the prognostic potential of various RA-related parameters. All the enrolled subjects (n=124 were clinically evaluated on the basis of various parameters including age, gender, duration of illness before the initiation of disease-modifying anti-rheumatic drugs, tender and swollen joints (28 joints, erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, hemoglobin percentage, lymphocyte count, total white-blood cell counts, and neutrophil to lymphocyte ratio (NLR. Student’s t-test and discriminant function analysis were performed. The specificity of all parameters and their best possible cut-off to predict relapse were calculated using the receiver operating characteristic (ROC analysis. A significant difference in terms of pain perception, NLR, tendency to have a significant tender joint count and absolute lymphocyte counts was identified between the patients in sustained remission and those in relapse. The ROC analysis indicated that NLR was consistent in predicting remission. CRP, ESR, and/or disease activity score may not be very effective in differentiating patients with sustainable remission/low disease activity. NLR along with patient’s perception of pain may assist in predicting sustained remission.

  9. Memory decay and susceptibility to amnesia dissociate punishment- from relief-learning

    Science.gov (United States)

    Diegelmann, Sören; Preuschoff, Stephan; Appel, Mirjam; Niewalda, Thomas; Gerber, Bertram; Yarali, Ayse

    2013-01-01

    Painful events shape future behaviour in two ways: stimuli associated with pain onset subsequently support learned avoidance (i.e. punishment-learning) because they signal future, upcoming pain. Stimuli associated with pain offset in turn signal relief and later on support learned approach (i.e. relief-learning). The relative strengths of such punishment- and relief-learning can be crucial for the adaptive organization of behaviour in the aftermath of painful events. Using Drosophila, we compare punishment- and relief-memories in terms of their temporal decay and sensitivity to retrograde amnesia. During the first 75 min following training, relief-memory is stable, whereas punishment-memory decays to half of the initial score. By 24 h after training, however, relief-memory is lost, whereas a third of punishment-memory scores still remain. In accordance with such rapid temporal decay from 75 min on, retrograde amnesia erases relief-memory but leaves a half of punishment-memory scores intact. These findings suggest differential mechanistic bases for punishment- and relief-memory, thus offering possibilities for separately interfering with either of them. PMID:23658002

  10. Orthopedic surgery and bone fracture pain are both significantly attenuated by sustained blockade of nerve growth factor

    OpenAIRE

    Majuta, Lisa A.; Longo, Geraldine; Fealk, Michelle N.; McCaffrey, Gwen; Mantyh, Patrick W.

    2015-01-01

    The number of patients suffering from postoperative pain due to orthopedic surgery and bone fracture is projected to dramatically increase because the human life span, weight, and involvement in high-activity sports continue to rise worldwide. Joint replacement or bone fracture frequently results in skeletal pain that needs to be adequately controlled for the patient to fully participate in needed physical rehabilitation. Currently, the 2 major therapies used to control skeletal pain are nons...

  11. Auriculotherapy on low back pain in the elderly.

    Science.gov (United States)

    Suen, Lorna K P; Wong, Thomas K S; Chung, Joanne W Y; Yip, Vera Y B

    2007-02-01

    The objective of the study was to examine the effectiveness of auriculotherapy using magnetic pellets for the elderly suffering from low back pain (LBP). Sixty participants who were 60-years old or above and had been suffering from LBP were recruited. Participants were randomly allocated to receive auriculotherapy on a 3-week basis using either Semen Vaccariae (control group=30) or magnetic pellets (experimental group=30). Seven auricular acupoints that are believed to have an effect on LBP were selected. Treatment effects were evaluated using the Chinese Pain Intensity Verbal Rating scale (VRS). The experimental group had indeed experienced a significant improvement in pain relief when compared with the control group; and the therapeutic effects were sustained at 2 and 4-week follow-up periods after the therapy. Findings of this study demonstrated that auriculotherapy using magnetic pellets significantly reduce the pain intensity level of the elderly suffering from non-specific LBP.

  12. Eficácia do resfriamento da pele no alívio da dor desencadeada pela injeção de toxina botulínica tipo A nas distonias faciais Skin cooling efficacy on pain relief in periocular injections with botulinum toxin A in facial dystonias

    Directory of Open Access Journals (Sweden)

    Paula Barros Bandeira de Mello Monteiro

    2012-12-01

    Full Text Available OBJETIVO: Avaliar a eficácia do resfriamento da pele com gelo no alívio da dor desencadeada pela injeção de toxina botulínica tipo A na região periocular em pacientes portadores de distonia facial. MÉTODOS: Neste estudo prospectivo, 13 pacientes receberam injeção de toxina botulínica tipo A em região glabelar (m. prócero e periocular (m. orbicular para tratamento de distonia facial. Antes das aplicações, um lado da região glabelar foi resfriado com gelo durante 5 minutos, enquanto no outro lado foi aplicada pomada Epitezan®, funcionando como placebo. A aplicação foi feita primeiramente no lado resfriado. Após a aplicação em cada um dos lados os pacientes foram instruídos a dar uma nota para a dor desencadeada pela injeção, em uma escala de 0 a 10 onde 0 era ausência de dor e 10 a dor mais intensa. RESULTADOS: A média das notas dadas pelos pacientes à dor desencadeada pela injeção no lado onde foi aplicado placebo foi 3,92 ± 3,28. No local onde foi aplicado gelo a média das notas foi de 2,92 ± 2,18 (p PURPOSE: To evaluate the efficacy of skin cooling with ice on pain relief in periocular injection with botulinum toxin type A in patients with facial dystonias. METHODS: In this prospective study, 13 patients received botulinum toxin type A injection in glabela (procerus m. and periocular region (orbicular m. for facial dystonias treatment. Before the injections, one side of the glabela was submitted to a 5-minute cooling period, while the opposite side had Epitezan® cream applied, as a placebo. The application was done at the cooled side first. After the application on each side the patients were instructed to rate the pain associated with the injection on a scale from 0 to 10, with 0 indicating no pain and 10 the worst pain. RESULTS: The average pain score on the side where cold was applied was 3,92 ± 3,28, while on the control side the average pain score was 2,92 ± 2,18 (p < 0,0166. CONCLUSION: In this study

  13. Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort

    NARCIS (Netherlands)

    Choi, David; Fox, Zoe; Albert, Todd; Arts, Mark; Balabaud, Laurent; Bunger, Cody; Buchowski, Jacob Maciej; Coppes, Maarten Hubert; Depreitere, Bart; Fehlings, Michael George; Harrop, James; Kawahara, Norio; Martin-Benlloch, Juan Anthonio; Massicotte, Eric Maurice; Mazel, Christian; Oner, Fetullah Cumhur; Peul, Wilco; Quraishi, Nasir; Tokuhashi, Yasuaki; Tomita, Katsuro; Verlaan, Jorit Jan; Wang, Miao; Wang, Michael; Crockard, Hugh Alan

    2016-01-01

    Introduction Metastatic spinal cancer is a common condition that may lead to spinal instability, pain and paralysis. In the 1980s, surgery was discouraged because results showed worse neurological outcomes and pain compared with radiotherapy alone. However, with the advent of modern imaging and

  14. Cortical effect of oxaliplatin associated with sustained neuropathic pain: exacerbation of cortical activity and down-regulation of potassium channel expression in somatosensory cortex.

    Science.gov (United States)

    Thibault, Karine; Calvino, Bernard; Dubacq, Sophie; Roualle-de-Rouville, Marie; Sordoillet, Vallier; Rivals, Isabelle; Pezet, Sophie

    2012-08-01

    Oxaliplatin is a third-generation platinum-based chemotherapy drug that has gained importance in the treatment of advanced metastatic colorectal cancer. Its dose-limiting side effect is the production of chronic peripheral neuropathy. Using a modified model of oxaliplatin-induced sensory neuropathy, we investigated plastic changes at the cortical level as possible mechanisms underlying the chronicity of pain sensation in this model. Changes in gene expression were studied using DNA microarray which revealed that when oxaliplatin-treated animals displayed clinical neuropathic pain symptoms, including mechanical and thermal hypersensitivity, approximately 900 were down-regulated in the somatosensory cortex. Because of the known role of potassium channels in neuronal excitability, the study further focussed on the down-regulation of these channels as the possible molecular origin of cortical hyperexcitability. Quantification of the magnitude of neuronal extracellular signal-regulated kinase (ERK) phosphorylation in cortical neurons as a marker of neuronal activity revealed a 10-fold increase induced by oxaliplatin treatment, suggesting that neurons of cortical areas involved in transmission of painful stimuli undergo a chronic cortical excitability. We further demonstrated, using cortical injection of lentiviral vector shRNA against Kv2.2, that down-regulation of this potassium channel in naive animals induced a sustained thermal and mechanical hypersensitivity. In conclusion, although the detailed mechanisms leading to this cortical excitability are still unknown, our study demonstrated that a cortical down regulation of potassium channels could underlie pain chronicity in this model of chemotherapy-induced neuropathic pain. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  15. Parental Perceptions about Pain and Pain Management Practices in ...

    African Journals Online (AJOL)

    Background: Pain management in neonates remains sub-optimal in sub-Saharan countries like Kenya due to lack of resources to procure pharmacological analgesics. There, however, exist low-cost, mother-driven pain management strategies such as breastfeeding and kangaroo care that can be used for pain relief in ...

  16. Cannabis and Pain: A Clinical Review

    OpenAIRE

    Hill, Kevin P.; Palastro, Matthew D.; Johnson, Brian; Ditre, Joseph W.

    2017-01-01

    Abstract Introduction: Cannabis has been used for medical purposes across the world for centuries. As states and countries implement medical and recreational cannabis policies, increasing numbers of people are using cannabis pharmacotherapy for pain. There is a theoretical rationale for cannabis' efficacy for pain management, although the subjective pain relief from cannabis may not match objective measurements of analgesia. As more patients turn to cannabis for pain relief, there is a need f...

  17. Improvements in physical function and pain sustained for up to 10 years after knee or hip arthroplasty irrespective of mental health status before surgery.

    Science.gov (United States)

    Geeske Peeters, G M E E; Rainbird, Sophia; Lorimer, Michelle; Dobson, Annette J; Mishra, Gita D; Graves, Stephen E

    2017-04-01

    Background and purpose - There are concerns that mental health (MH) may influence outcomes of total knee arthroplasty (TKA) or total hip arthroplasty (THA). We examined effects of poor MH before surgery on long-term outcomes of osteoarthritis-related TKA or THA in women. Patients and methods - The data were from 9,737 middle-aged participants (47-52 years) and 9,292 older participants (73-78 years) in the Australian Longitudinal Study on Women's Health who completed surveys between 1998 and 2013. Dates of arthroplasties were obtained from the Australian Orthopaedics Association National Joint Replacement Registry. Participants without procedures were matched with participants with procedures. Trajectories of the Short-Form 36 scores for physical functioning, bodily pain, social functioning, and mental health based on mixed modeling were plotted for participants with and without surgery (stratified according to mental health, separately for TKA and THA, and for middle-aged and older participants). Results - In middle-aged women with poor and good MH, TKA improved physical function and reduced bodily pain, with improvements sustained up to 10 years after surgery. TKA contributed to restoration of social function in women with good MH, but this was less clear in women with poor MH. In both MH groups, mental health appeared to be unaffected by TKA. Similar patterns were observed after THA, and in older women. Interpretation - Recovery of physical and social function and reductions in pain were sustained for up to 10 years after surgery. Improvements in physical function and pain were also observed in women with poor mental health. Thus, in our view poor mental health should not be a contraindication for arthroplasty.

  18. [Analgesic treatment of cancer pain].

    Science.gov (United States)

    Ghimouz, Abdelmalek

    2015-04-01

    Cancer pain can be nociceptive, neuropathic or mixed. It is linked to the tumour, to the metastases and to the treatments for the disease and is managed by multimodal analgesia corresponding to the pain relief drugs of the WHO's pain ladder, antidepressants, antiepileptic drugs and local anaesthetics. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Persistent orodental pain, atypical odontalgia, and phantom tooth pain: when are they neuropathic disorders?

    Science.gov (United States)

    Clark, Glenn T

    2006-08-01

    Patients with unrelenting pain in the teeth, gingival, palatal or alveolar tissues often see multiple dentists and have multiple irreversible procedures performed and still have their pain. Up to one-third of patients attending a chronic facial pain clinic have undergone prior irreversible dental procedures for their pain without success. In these cases, if no local source of infectious, inflammatory, or other pathology can be found, then the differential diagnosis must include a focal neuropathic pain disorder. The common diagnoses given include the terms atypical odontalgia, persistent orodental pain, or if teeth have been extracted, phantom tooth pain. One possibility is that these pain complaints are due to a neuropathic alteration of the trigeminal nerve. There are several diagnostic procedures that need to be performed in any patient suspected of having a trigeminal neuropathic disorder including (1) cold testing of involved teeth for pulpal nonvitality; (2) a periapical radiograph examining the teeth for apical change; (3) a panoramic radiograph examining for other maxillofacial disease; (4) a thorough head and neck examination also looking for abnormality; (5) a cranial nerve examination including anesthetic testing which documents any increased or decreased nerve trigeminal nerve sensitivity and rules out other neurologic changes outside the trigeminal nerve; and (6) MRI imaging in some cases. Finally, when a nonobvious atypical toothache first presents, direct microscopic examination of the tooth for incomplete tooth fracture is also suggested. The majority of these patients are women over the age 30 with pain in the posterior teeth/alveolar arch. Multiple causes exist for sustained neuropathic pain including direct nerve injury (e.g., associated with fracture or surgical treatment), nerve injection injury, nerve compression injury (e.g., implant, osseous growth, neoplastic invasion) and infection-inflammation damage to the nerve itself. Sustained nerve

  20. Low back pain and the post-laminectomy pain syndrome | Shipton ...

    African Journals Online (AJOL)

    Back pain is one of the most common disorders seen in general practice. Patients with chronic low back pain form a large proportion of the work of any pain relief unit. The aetiology of low back pain and the post-laminectomy pain syndrome are briefly presented and treatment of the 'failed back surgery patient' and the ...

  1. SIRT1-related inhibition of pro-inflammatory responses and oxidative stress are involved in the mechanism of nonspecific low back pain relief after exercise through modulation of Toll-like receptor 4.

    Science.gov (United States)

    Cheng, Yuan-Yang; Kao, Chung-Lan; Ma, Hsin-I; Hung, Ching-Hsia; Wang, Chin-Tien; Liu, Ding-Hao; Chen, Po-Yin; Tsai, Kun-Ling

    2015-10-01

    Low back pain is a common clinical problem that causes disability and impaired quality of life. While the reason behind low back pain was largely considered to be of musculoskeletal origin, the contribution of inflammatory cytokines and oxidative stress could never be overlooked. Exercise has been proven to be an effective approach to treat low back pain. However, the mechanism of the exercise effect on the inflammatory cytokines and oxidative stress is still largely unknown. In this study, we revealed that exercise intervention reduces Toll-like receptor 4 (TLR-4) pathway and enhances Sirtuin 1 (SIRT1) expression in low back pain patients. We also confirmed that exercise up-regulates the expression of peroxisome proliferator-activated receptor-gamma, PPAR-γ coactivator-1 and FoxOs family proteins and also increases the activity of catalase and superoxide dismutase in patients with low back pain. Furthermore, we found that exercise intervention attenuates the oxidative stress, pro-inflammatory cytokine concentrations and p53 expression in patients with low back pain. This study demonstrates that exercise intervention improves low back pain symptoms through regulation of the SIRT1 axis with repression of oxidative stress and TLR-4 inhibition. © The Authors 2015. Published by Oxford University Press on behalf of the Japanese Biochemical Society. All rights reserved.

  2. Clinical Inquiries: How do hyaluronic acid and corticosteroid injections compare for knee OA relief?

    Science.gov (United States)

    Lyon, Corey; Spencer, Emily; Spittler, Jack; Desanto, Kristen

    2018-01-01

    Inconsistent evidence shows a small amount of pain relief early (one week to 3 months) with corticosteroid (CS) injections and an equally small improvement in pain relief and function later (3 to 12 months) with hyaluronic acid (HA) injections (strength of recommendation [SOR]: B, meta-analysis of a randomized controlled trial and inconsistent RCTs). Guidelines state that CS injections can be considered for symptomatic knee osteoarthritis, but that insufficient evidence exists to recommend HA injections (SOR: B, evidence-based guidelines).

  3. Avaliação da estimulação elétrica transcutânea do nervo para alívio de dor após cesárea: ensaio clínico randomizado Assessment of transcutaneous electrical nerve stimulation for pain relief after cesarean section: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Ligia Sousa

    2009-03-01

    Full Text Available OBJETIVOS: avaliar a utilização da estimulação elétrica transcutânea do nervo no alívio de dor após cesárea. MÉTODOS: realizou-se um estudo clínico controlado randomizado e simples-cego. Participaram do estudo 20 puérperas no grupo experimental que recebiam a estimulação elétrica transcutânea do nervo e 20 no grupo controle. Para avaliar a dor foi usada a escala de categoria numérica e o questionário de dor McGill. Foram realizadas três avaliações: a primeira antes da intervenção com a estimulação elétrica transcutânea do nervo, a segunda após a intervenção e a terceira, uma hora após a intervenção. Para a análise estatística foi utilizado o teste nãoparamétrico de Mann-Whitney U. RESULTADOS: o grupo experimental apresentou redução maior da dor estatisticamente significante que o grupo controle na segunda e na terceira avaliação pela escala numérica de dor (pOBJECTIVES: to assess the use of transcutaneous electrical nerve stimulation (TENS for post-cesarean pain relief. METHODS: a simple-blind and random clinical controlled-study was carried out. The experimental group comprised twenty puerperal women to whom the TENS technique had been applied and 20 others as a control group. The numeric rating scale and the McGill Pain Questionnare were used to evaluate pain. Three evaluations were carried out: the first before the intervention using transcutaneous electrical nerve stimulation; a second, after the intervention and a third, one hour after the intervention. For statistical analysis, the Mann-Whitney's non-parametric test was used. RESULTS: the experimental group presented a statistically significant larger reduction in pain than the control group on the second and the third evaluation using both the numeric rating scale (p<0.001 and McGill (p<0.001. CONCLUSIONS: transcutaneous electrical nerve stimulation is effective for the reduction of pain and the resulting relief persists for an hour subsequent to

  4. Inciting Events Associated With Lumbar Facet Joint Pain.

    Science.gov (United States)

    Odonkor, Charles A; Chen, Yian; Adekoya, Peju; Marascalchi, Bryan J; Chaudhry-Richter, Hira; Tang, Teresa; Abruzzese, Christopher; Cohen, Berklee K; Cohen, Steven P

    2017-07-10

    Low back pain is the leading cause of years lost to disability with approximately 15%-25% of the chronic back pain population suffering from lumbar facet arthropathy. No large-scale study has sought to systematically identify inciting events for lumbar facet arthropathy. The aim of this study is to quantify the proportion of individuals with lumbar facetogenic pain who report a specific precipitating event(s) and to determine if there is a correlation between these events and treatment outcome. Institutional electronic medical records were searched based on the current procedural terminology (CPT) codes representing lumbar facet joint radiofrequency ablation for procedures performed between January 2007 and December 2015. All patients had obtained ≥50% pain relief based on 6-hour pain diaries after 1 or more diagnostic facet blocks. A positive outcome was defined as ≥50% pain relief sustained for longer than 3-month after procedure, without additional procedural interventions. One thousand sixty-nine people were included in analysis. In the 52% of individuals who described an inciting event, the most commonly reported causes were falls (11%), motor vehicle collisions (11%), sports-related injuries (11%, of which weightlifting accounted for 62%), nonspine postsurgical injuries (2%), and "other" (17%). Six hundred seventeen (57.7%) individuals experienced ≥50% pain relief sustained for >3 months. Patients whose pain was preceded by an inciting event were more likely to have a positive outcome than those who could not recall a specific precipitating factor (odds ratio, 1.5; confidence interval, 1.02-2.1, P = .01). Another factor associated with outcome was shorter duration of pain (8.1 ± 9.2 vs 9.7 ± 10.1 years, P = .02), with an observed modifier effect of age on outcomes. For a 1-year increase in age, there was a 10% increase in the odds of a positive response. Inciting events are common in patients diagnosed with lumbar facetogenic pain and may be

  5. Pain Disorder

    Directory of Open Access Journals (Sweden)

    Carlos Capela

    2014-06-01

    Full Text Available Pain disorder is a psychiatric disorder diagnosed when the pain becomes the predominant focus of the clinical presentation and causes significant distress or impairment. Besides the high economic impact, there is a reciprocal relationship with the affective state. Pain is a subjective sensation and its severity and quality of experience in an individual is dependent on a complex mix of factors. In the treatment of acute pain, the primary purpose is pain relief, while chronic pain typically requires a combination of psychotropic drugs. In this context, it is also important to recognize and treat depression. Psychological treatments aimed at providing mechanisms to allow patients to "control and live with the pain" rather than aspire to eliminate it completely. A growing group of researchers proposes the elimination of the chapter of Somatoform Disorders and the modification of the category "psychological factors affecting a medical condition" to "psychological factors affecting an identified or feared medical condition" with clinical entities as ubchapters, largely based upon Diagnostics for Psychosomatic Research criteria.

  6. Efficacy of single-dose, extended-release naproxen sodium 660 mg in postsurgical dental pain: two double-blind, randomized, placebo-controlled trials.

    Science.gov (United States)

    Laurora, Irene; An, Robert

    2016-01-01

    To evaluate the efficacy of a novel formulation of extended-release/immediate-release (ER) naproxen sodium over 24 h in a dental pain model. Two randomized, double-blind, placebo-controlled trials in moderate to severe pain after extraction of one or two impacted third molars (at least one partial mandibular bony impaction). Treatment comprised oral ER naproxen sodium 660 mg (single dose), placebo (both studies) or immediate-release (IR) naproxen sodium 220 mg tid (study 2). Primary efficacy endpoint: 24-h summed pain intensity difference (SPID). Secondary variables included total pain relief (TOTPAR), use of rescue medication. All treatment-emergent adverse events were recorded. NCT00720057 (study 1), NCT01389284 (study 2). Primary efficacy analyses: pain intensity was significantly lower over 24 h with ER naproxen sodium vs. placebo (p patients required rescue medication vs. ER and IR naproxen sodium from 2-24 h post-dose. Once daily ER naproxen sodium was generally safe and well tolerated, with a similar safety profile to IR naproxen sodium tid. The studies were single dose, with limited ability to assess efficacy or safety of multiple doses over time. As the imputed pain score meant that estimated treatment differences may have been biased in favor of ER naproxen sodium, a post hoc analysis evaluated the robustness of the results for pain relief. A single dose of ER naproxen sodium 660 mg significantly reduced moderate to severe dental pain vs. placebo and was comparable to IR naproxen sodium 220 mg tid. Significant pain relief was experienced from 15 min and sustained over 24 h, resulting in a reduced need for rescue medication. ER naproxen sodium 660 mg once daily is a convenient and effective therapy providing 24 h relief of pain.

  7. Therapeutic equivalence of diclofenac sustained-released 75 mg tablets and diclofenac enteric-coated 50 mg tablets in the treatment of painful osteoarthritis.

    Science.gov (United States)

    Le Loët, X; Dreiser, R L; Le Gros, V; Febvre, N

    1997-09-01

    Efficacy and tolerability of diclofenac sustained-released (SR) 75 mg tablets taken b.i.d. were compared with that of enteric-coated diclofenac sodium 50 mg tablets given t.i.d. in a seven-day, randomised, double-blind, double-dummy, parallel groups study in 294 outpatients suffering from painful femorotibial or hip osteoarthritis. Primary efficacy criteria were spontaneous joint pain assessed on serial visual analogue scales during the first 36 hours and after 48 hours of treatment. The two treatments had equivalent efficacy since all the 90% confidence intervals of differences between means for pain intensity between the two groups were included within the interval (-10 mm; +10 mm). Rates of overall efficacy judged good to excellent ranged from 74.3-78.5% in both groups. One or more drug-related adverse events, mainly gastrointestinal, was reported by 24.5% and 27.2% of patients in diclofenac SR 75 mg and diclofenac 50 mg groups, respectively. Percentage of good compliance (i.e. > 90%) was higher with diclofenac SR 75 mg (p < 0.001).

  8. COMPARING THE EFFECTIVENESS OF TRANSDERMAL DICLOFENAC PATCH AND INRAMUSCULAR DICLOFENAC INJECTON IN POSTOPERATIVE PAIN RELIEF AFTER INGUINAL HERNIA MESH REPAIR: A RANDOMISED STUDY IN THE DEPARTMENT OF GENERAL SURGERY

    Directory of Open Access Journals (Sweden)

    Ravikumar Reddy

    2015-08-01

    Full Text Available Post - operative pain management has been a constant challenge to many of the surgeons. There is a need for developing newer modalities which can provide good analgesia with fewer side effects. A randomized clinical trial was designed with a sample size of 60 patients, which were divided into two groups. These were randomized to receive intramuscular diclofenac sodium injection (Group A or diclofenac diethylamine transdermal patch (Group B afte r 1 hour from the time of spinal anaesthesia. Statistical analysis was done using UNPAIRED t - test and Mann - Whitney test. It was concluded that diclofenac diethylamine transdermal patch is effective in the management of post - operative pain after inguinal he rnia mesh repair. Pain scores were significantly lower in diclofenac patch group. Meantime of rescue analgesia is longer in diclofenac patch group. Demand for rescue analgesia is lower in diclofenac transdermal patch group. However there is a need for broa der studies to confirm the above results

  9. Transdermal opioids for cancer pain.

    Science.gov (United States)

    Cachia, Elaine; Ahmedzai, Sam H

    2011-03-01

    Cancer patients with moderate-to-severe pain require opioids for analgesia. Whereas early guidelines recommend oral morphine as the 'drug of choice', newer synthetic opioids can be given by a reliable and effective nonoral transdermal route. We examine the mode of action of transdermal patches and we review the evidence on two drugs, which are currently available in this formulation - buprenorphine and fentanyl - covering physicochemical characteristics and pharmacokinetics of the patches, clinical efficacy data and adverse effects. Both buprenorphine and fentanyl possess ideal characteristics for transdermal delivery, being small molecules with high lipophilicity. Studies of buprenorphine patches show benefits but there is poor randomized controlled trial evidence comparing them with oral opioids. Fentanyl patches have been used for longer and have a larger body of evidence supporting their use, with data to suggest improved pain relief and reduced opioid side effects compared with sustained release oral morphine. Patients who have used both oral morphine and transdermal fentanyl express a preference for the patch drug. Transdermal buprenorphine and fentanyl are now established for moderate-to-severe cancer pain. There is still a need for further comparative studies with other opioids, especially for buprenorphine.

  10. Southern Alaska Coastal Relief Model

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NOAA's National Geophysical Data Center (NGDC) is building coastal-relief models (CRM) for select U.S. coastal regions. Bathymetric, topographic, and shoreline data...

  11. A history of low back pain affects pelvis and trunk coordination during a sustained manual materials handling task

    Directory of Open Access Journals (Sweden)

    Joseph F. Seay

    2016-03-01

    Conclusion: Differences between groups demonstrate residual consequences of LBP in an occupational scenario, even though the HBP group was pain-free for >6 months prior to data collection. More in-phase coordination in the HBP group may represent a coordination pattern analogous to “guarded gait” which has been observed in other studies, and may lend insight as to why these individuals are at increased risk for re-injury.

  12. SoluMatrix® Diclofenac: Sustained Opioid-Sparing Effects in a Phase 3 Study in Patients with Postoperative Pain.

    Science.gov (United States)

    Argoff, Charles; McCarberg, Bill; Gudin, Jeff; Nalamachu, Srinivas; Young, Clarence

    2016-10-01

    To evaluate opioid rescue medication usage and the opioid-sparing effect of low-dose SoluMatrix(®) diclofenac developed using SoluMatrix Fine Particle Technology™ in a phase 3 study in patients experiencing pain following bunionectomy surgery. Multicenter, randomized, double-blind, parallel-group study (NCT01462435). Four clinical research centers in the United States. Four hundred twenty-eight patients aged 18 to 65 years who experienced moderate-to-severe pain following bunionectomy surgery. Patients were randomized to receive low-dose SoluMatrix diclofenac 35 mg or 18 mg capsules three times daily (35-mg group or 18-mg group), celecoxib 400 mg loading dose followed by 200-mg capsules twice daily (celecoxib 200-mg group), or placebo capsules postsurgery. Patients were permitted to receive opioid-containing rescue medication as needed. Significantly fewer patients who received SoluMatrix diclofenac 35 mg or 18 mg or celecoxib required rescue medication during 0-24 h and >24-48 h postsurgery compared with placebo. Patients in the SoluMatrix diclofenac 35 mg or 18 mg groups or in the celecoxib group used fewer mean rescue medication tablets over 0-24 h and >24-48 h compared with placebo-treated patients. Patients in the SoluMatrix diclofenac 35 mg and 18 mg groups and in the celecoxib group also required rescue medication at later times and at slower rates compared with placebo-treated patients. No serious adverse effects occurred in patients receiving SoluMatrix diclofenac. SoluMatrix diclofenac at two dosage strengths demonstrated an opioid-sparing effect postoperatively in this phase 3 study. The opioid-sparing effect following low-dose SoluMatrix diclofenac (35 mg or 18 mg three times daily) administration was evaluated in patients experiencing pain following bunionectomy. Significantly fewer patients receiving SoluMatrix diclofenac or celecoxib (400 mg loading, 200 mg twice daily) required rescue medication during 0-24

  13. Nutmeg oil alleviates chronic inflammatory pain through inhibition of COX-2 expression and substance P release in vivo

    Directory of Open Access Journals (Sweden)

    Wei Kevin Zhang

    2016-04-01

    Full Text Available Background: Chronic pain, or sometimes referred to as persistent pain, reduces the life quality of patients who are suffering from chronic diseases such as inflammatory diseases, cancer and diabetes. Hence, herbal medicines draw many attentions and have been shown effective in the treatment or relief of pain. Methods and Results: Here in this study, we used the CFA-injected rats as a sustainable pain model to test the anti-inflammatory and analgesic effect of nutmeg oil, a spice flavor additive to beverages and baked goods produced from the seed of Myristica fragrans tree. Conclusions: We have demonstrated that nutmeg oil could potentially alleviate the CFA-injection induced joint swelling, mechanical allodynia and heat hyperanalgesia of rats through inhibition of COX-2 expression and blood substance P level, which made it possible for nutmeg oil to be a potential chronic pain reliever.

  14. A Comparative Study Between Longitudinal Pancreacticojejunostomy v/s Lateral Pancreaticogastrostomy as a Drainage Procedure for Pain Relief in Chronic Pancreatitis Done in a Tertiary Referral Centre of Eastern India

    OpenAIRE

    Halder, Shyamal Kumar; Bhattacharjee, Prosanta Kumar; Bhar, Partha; Das, Cinjini; Pandey, Pranjal; Rakshit, Krishna Pada; Pachaury, Anadi

    2012-01-01

    Chronic pancreatitis (CP) is a chronic inflammation of pancreas that leads to progressive fibrosis of pancreatic parenchyma. Commonest indication of surgery in chronic pancreatitis is intractable pain. Choice of procedure depends upon the main pancreatic duct (MPD) morphology. Decompression is useful in dilated and obstructed ducts. Traditional form of decompression is construction of a pancreatico-jejunal anastomosis (LPJ). Another method to achieve ductal decompression is by a pancreaticoga...

  15. Acute dental pain II

    DEFF Research Database (Denmark)

    Jonasson, Peter; Kirkevang, Lise-Lotte; Rosen, Annika

    2016-01-01

    Acute dental pain most often occurs in relation to inflammatory conditions in the dental pulp or in the periradicular tissues surrounding a tooth, but it is not always easy to reach a diagnose and determine what treatment to perform. The anamnesis and the clinical examination provide valuable...... dental pain, they expect that the dentist starts treatment at once and that the treatment should provide pain relief. In this situation many patients are fragile, anxious and nervous. If the dentist is able to manage emergency treatment of acute dental pain this will build confidence and trust between...

  16. Mild analgesics in postoperative pain.

    Science.gov (United States)

    Tammisto, T; Tigerstedt, I

    1980-10-01

    1 The intensity of postoperative pain is influenced by many factors, for example, individual variation, site of incision and type of operation, anaesthetic technique, and the interval from the end of operation to the appearance of pain. 2 These factors affect the efficacy of analgesics. 3 Mild analgesics provide adequate pain relief in half of our patients in the immediate postoperative phase when the pain is slight to moderate. 4 The maximum effect of mild analgesics corresponds to that produced by morphine 6-10 mg. Adequate analgesia may not therefore be provided for the treatment of severe postoperative pain unless narcotic analgesics have been used peroperatively. 5 When mild analgesics are combined with narcotics synergism is achieved. 6 As postoperative pain decreases with time, mild analgesics usually provide adequate pain relief on the first and following postoperative days.

  17. Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review.

    Science.gov (United States)

    Daniels, Jane P; Champaneria, Rita; Shah, Laila; Gupta, Janesh K; Birch, Judy; Moss, Jonathan G

    2016-10-01

    Chronic pelvic pain (CPP) in the presence of dilated and refluxing pelvic veins is often described as pelvic congestion syndrome (PCS), although the causal relationship between pelvic vein incompetence and CPP has not been established. Percutaneous embolization is the principal treatment for PCS, with high success rates cited. This study was undertaken to systematically and critically review the effectiveness of embolization of incompetent pelvic veins. A comprehensive search strategy encompassing various terms for pelvic congestion, pelvic pain, and embolization was deployed in 17 bibliographic databases, with no restriction on study design. Methodologic quality was assessed. The quality and heterogeneity generally precluded meta-analysis. Results were tabulated and described narratively. Twenty-one prospective case series and one poor-quality randomized trial of embolization (involving a total of 1,308 women) were identified. Early substantial relief from pain was observed in approximately 75% of women undergoing embolization, and generally increased over time and was sustained. Significant pain reductions following treatment were observed in all studies that measured pain on a visual analog scale. Repeat intervention rates were generally low. There were few data on the impact on menstruation, ovarian reserve, or fertility, but no concerns were noted. Transient pain was common following foam embolization, and there was a < 2% risk of coil migration. Embolization appears to provide symptomatic relief of CPP in the majority of women and is safe, although the quality of the evidence is low. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  18. Children's pain perspectives.

    Science.gov (United States)

    Esteve, R; Marquina-Aponte, V

    2012-05-01

    Previous studies on children's pain perspectives remain limited to English-speaking populations. An exploratory cross-sectional descriptive design was used to investigate the developmental progression of children's pain perspectives, including their pain experience, its definition and attributes, causality and coping. The Children's Pain Perspectives Inventory was applied to 180 healthy Spanish children. A coding system was developed following the content analysis method. Three age groups were compared: 4-6 years, corresponding to the Piagetian pre-operational stage of cognitive development; 7-11 years, corresponding to stage of concrete operations; and 12-14 years, corresponding to the period of early formal operations. In children between 4 and 6, the predominant narratives related to physical injuries, the notion of causality and the definition of pain. In children between 7 and 11, the predominant narratives were those in which pain was described as a sensation in one part of the body. The view of pain as having an emotional basis significantly increased with age and was more frequent in adolescents. In contrast, children between 4-6 and 7-11 indicated that pain occurs spontaneously. The denial of any positive aspects of pain significantly decreased with age; some children between 7 and 11 referred to the 'possibility of relief', while the view that pain is a 'learning experience' was significantly more frequent among adolescents aged between 12 and 14 years. The use of cognitive strategies to control pain significantly increased with age. Between 12 and 14 years of age, adolescents communicate pain by non-verbal behaviour and reported that they do not express demands for relief. There was a progression from concrete to more complex notions of pain as age increased. These results may be of use to health professionals and parents to understand how children at various developmental stages express and cope with pain and to develop tools that effectively assess and

  19. The Pain of Labour

    Science.gov (United States)

    Labor, Simona

    2008-01-01

    Labour is an emotional experience and involves both physiological and psychological mechanisms. The pain of labour is severe but despite this its memory diminishes with time. Labour pain has two components: visceral pain which occurs during the early first stage and the second stage of childbirth, and somatic pain which occurs during the late first stage and the second stage. The pain of labour in the first stage is mediated by T10 to L1 spinal segments, whereas that in the second stage is carried by T12 to L1, and S2 to S4 spinal segments. Pain relief in labour is complex and often challenging without regional analgesia. Effective management of labour pain plays a relatively minor role in a woman's satisfaction with childbirth. PMID:26526404

  20. Spinal fusion surgery: From relief to insecurity.

    Science.gov (United States)

    Damsgaard, Janne B; Jørgensen, Lene B; Norlyk, Annelise; Birkelund, Regner

    2017-02-01

    During their decision-making process patients perceive surgery as a voluntary yet necessary choice. Surgery initiates hope for a life with less pain but also creates a feeling of existential insecurity in terms of fear, isolation and uncertainty. The aim of this study was to explore how patients experience their situation from the point of making the decision to undergo spinal fusion surgery to living their everyday life after surgery. A phenomenological-hermeneutic study design was applied based on the French philosopher Paul Ricoeur's theory of interpretation. Data were collected through observations and semi-structured interviews. The recommendation and decision to undergo spinal fusion surgery felt like a turning point for the patients and brought hope of regaining their normal lives, of being a more resourceful parent, partner, friend and colleague with no or less pain. Thus, deciding to undergo surgery created a brief feeling of relief. However, life with back pain had changed the patients' understanding of themselves. Consequently, some patients postoperatively experienced insecurity and a weakened self-image with difficulties creating meaning in their lives. Being recommended and undergoing spinal fusion surgery initiates hope for a life with less pain and altered life conditions. At the same time, paradoxically, this creates a feeling of existential insecurity in terms of facing the surgery and the future to come. It is, therefore, important to recognise and include the patients' everyday life experiences concerning how they give (or may not give) meaning to their illness, i.e. their understanding of how it is affecting them. These aspects are essential for the patients' definition and re-definition of themselves and thus crucial to draw upon in the relationship and communication between patient and healthcare professional. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Pain Management in Neurocritical Care

    NARCIS (Netherlands)

    Petzold, A.; Girbes, A.R.J.

    2013-01-01

    The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the

  2. Coblation of Femoral and Sciatic Nerve for Stump Pain and Phantom Limb Pain: A Case Report.

    Science.gov (United States)

    Zeng, Yuanjie; Wang, Xiaoping; Guo, Yuna; He, Liangliang; Ni, Jiaxiang

    2016-02-01

    There is currently no reliable treatment for stump pain and phantom limb pain. Peripheral factors play a significant role in the pathophysiology of stump pain and phantom limb pain. Coblation technology is a relatively new technology that has shown promise in treating neuropathic pain. This report describes the use of coblation technology on femoral and sciatic nerve for stump pain and phantom limb pain. An ultrasound-guided perineural infiltration anesthesia surrounding the neuroma was first performed and achieved approximately 60% stump pain relief that lasted for 2 hours, but no relief of the phantom limb pain. An ultrasound-guided femoral and sciatic nerve block was performed to obtain longer pain relief. The patient reported approximately 80% pain relief in both stump pain and phantom limb pain that lasted for 40 hours. This finding suggested other factors in addition to the ultrasound-detected neuroma in the residual limb generating pain for this patient. Coblation of femoral and sciatic nerves was performed. The stump pain was completely relieved immediately after operation. At 1, 3, and 6 months postoperative review, 80% relief of both stump and phantom limb pain was achieved. Overall activity was improved and there was no need for pain medications. The analgesic effect was stable during the 6-month follow-up period. Our report suggests that coblation technology may be useful treatment for stump pain and phantom limb pain. Treatments focusing on peripheral nerves may be more effective than those focusing on the neuroma. This finding needs additional study for confirmation. © 2015 World Institute of Pain.

  3. BUPRENORPHINE-NALXONE THERAPY IN PAIN MANAGEMENT

    Science.gov (United States)

    Chen, Kelly Yan; Chen, Lucy; Mao, Jianren

    2014-01-01

    Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone®, Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggests that bup/nal may provide pain relief in chronic pain patients with opioid depen