Changes In Pain Levels Research Articles

Randomized controlled trial of belladonna and opiate suppository during intravesical onabotulinum toxin A injection

Intravesical injection with onabotulinum toxin A injection can be performed in-office under local anesthesia. Rectally administered pain medication presents a potentially feasible and previously uninvestigated adjunct to office-based anesthesia protocols. The primary aim of this study was to determine whether adding a belladonna and opiate suppository to standard lidocaine instillation resulted in reduction of bladder injection pain during onabotulinum toxin A injection procedure. This was a prospective, randomized, double-blind, placebo-controlled study of patients undergoing onabotulinum toxin A bladder injection at a single clinic. Patients age ≥18 years, who met clinical criteria for invasive treatment of refractory urinary symptoms, had previously documented postvoid residual volumes <150 mL, and elected for in-office intravesical onabotulinum toxin A injection were eligible to participate. Participants were randomized by computer-generated block randomization to receive a belladonna and opiate (belladonna alkaloid with morphine 16.2/7.5 mg) or placebo suppository. Suppositories were placed immediately prior to lidocaine-based anesthesia, which all participants received. All participants underwent a standardized injection procedure using the same rigid cystoscope, needle type, and injection pattern (20 injections total). A 0-10 numeric rating scale was used to assess pain intensity before anesthesia and suppository, 40 minutes after administration of anesthesia and suppository, after first 10 bladder injections, and immediately after completion of 20 injections. Pain increase during procedure was calculated using the difference between score 40 minutes after administration of anesthesia and suppository and score after first 10 bladder injections. Postvoid residual were measured immediately postprocedure and 2 weeks later. Patient satisfaction with pain control was measured using a Likert scale. Our primary outcome was change in pain level from anesthetic baseline to midprocedure (score after first 10 bladder injections to score 40 minutes after administration of anesthesia and suppository). A final sample size of 26 patients was needed to have 80% power (alpha= 0.05) to detect a 50% reduction in bladder injection pain during the procedure as defined by our primary outcome. An intent-to-treat approach was used for all analyses. In all, 26 participants were enrolled and randomized with 13 in each study arm. Participants in the treatment group were slightly older than in the placebo group (P= .05); there were no statistically significant differences in medical comorbidities. Median score after first 10 bladder injections to score 40 minutes after administration of anesthesia and suppository for the placebo group and treatment group was 4 (range 1-10) and 5 (range 0,9), respectively (P= .94). Median scores immediately after completion of 20 injections for the placebo group and treatment group were 3 (range 0-10) and 2 (range 0,8), respectively (P=.29). There were no significant differences in preinjection pain scores reported before anesthesia and suppository and at 40 minutes after administration of anesthesia and suppository. Postprocedure postvoid residual >200 mL was noted in 5 (38%) of the placebo group and 3 (23%) of the treatment group (P= .67). Two-week postprocedure postvoid residual >200 mL was noted in 3 (25%) of the placebo group and 2 (15%) of the treatment group (P= .64) for an overall rate of 20%. Eleven (84%) participants in each group reported being "mostly satisfied" or "very much satisfied" with pain control. Belladonna and opiate suppository use did not significantly reduce bladder injection pain, or increase risk of urinary retention immediately postprocedure or 2 weeks later. Satisfaction with pain control among onabotulinum toxin A injection patients is high.

Efficacy of a non-image-guided diagnostic hip injection in patients with clinical and radiographic evidence of intra-articular hip pathology.

ABSTRACTThe purpose of this study was to determine the likelihood of pain relief, as a measure of accurate diagnosis of intra-articular hip pathology and correct needle placement, with a non-image-guided intra-articular hip injection performed bedside in the clinic. A retrospective study of prospectively collected data was performed in a consecutive cohort of patients diagnosed with symptomatic intra-articular hip pathology who underwent a non-image-guided intra-articular injection in the clinic. All patients had clinical and radiographic evidence of hip impingement, hip instability, chondrolabral pathology, or other causes of intra-articular hip pain. A previously described technique for a non-image-guided hip injection was performed using 7–10 ml of 1% lidocaine for diagnostic evaluation with some patients receiving 2 ml of Kenalog®-40 if clinically indicated. Ten minutes following each injection, the patient was asked to report the percent improvement in pain (from 0 to 100%) while physical examination and provocative tests were repeated. The final study cohort comprised 142 patients (161 injections). In three cases, patients were either unable to assess or quantify any change in pain level 10 min following the injection. In the remaining 158 hip injections, pain relief was noted in 156 cases (156/158, 98.7%), with at least 70% improvement in pain level noted in 152 cases (152/158, 96.2%). Average pain relief among all 158 injections was 89 ± 16%. A non-image-guided diagnostic intra-articular hip injection yields reliable short-term pain relief, simultaneously endorsing accurate diagnosis of hip pathology and intra-articular needle placement.

Do mHealth interventions at the bedside work?—a pilot intervention for pediatric patients admitted with pain complaints

Background: Pediatric admissions for pain have been increasing, and pediatric consultation-liaison (CL) psychologists are frequently consulted to address pain coping for hospitalized youth. Many apps have been developed to target pain coping strategies, but no specific intervention has been developed to target pain coping using mobile health (mHealth) at the bedside. We describe an innovative, pilot, proof of concept mHealth intervention program using clinical apps to target pain coping strategies in youth referred for a pediatric psychology consult during their hospitalization. Methods: Parent-child dyads (n=18, youth ages 7–19) completed measures assessing the child’s pain history, pain catastrophizing, and pain interference during their child’s inpatient admission. Participants were loaned a tablet and prescribed specific clinical apps as part of their psychology consult to target pain coping. Youth tracked the frequency and duration of clinical app use. At about 2 weeks post-discharge families (n=10) completed a satisfaction survey about their experience with the intervention and again completed the pain outcome measures administered at baseline. Results: The clinical apps were used frequently during the hospitalization, primarily for relaxation. Youth who tracked their app use in the hospital were more likely to participate at Time 2. There was significant attrition from enrollment to Time 2. There were no changes in pain level from Time 1 to Time 2. Pain catastrophizing scores for youth decreased significantly at the follow-up interval. Most participants felt that the clinical apps helped with inpatient pain management and 70% continued to use the clinical apps after discharge. Parents universally would recommend the mHealth intervention to other families. Conclusions: The feasibility of this proof of concept intervention is mixed. The intervention was acceptable to our CL team, we had no implementation issues, and there were high levels of acceptability and accessibility for patients. However, attrition from across time points presents a challenge to interpretation of results and highlights the difficulty in implementing such an intervention with a high acuity population. Further research is needed to better describe the impact of clinical apps use on post-discharge outcomes, but this mHealth pilot showed promise as an adjunct to standard inpatient CL interventions for pediatric pain.

15: Randomized controlled trial of belladonna and opiate suppository during intradetrusor onabotulinum toxin-A injection

Intradetrusor onabotulimun toxin A (BTX-A) injection can be performed in the doctor’s office under local anesthesia. We aimed to evaluate the effectiveness of belladonna and opiate (BO) suppository in adjunct to standard anesthesia for in-office BTX-A treatment. We hypothesized the addition of a BO suppository would reduce bladder injection pain. This was a prospective, randomized, double-blind, placebo-controlled study of patients undergoing BTX-A bladder injection at a single clinic. Participants were randomized by computer generated block randomization to receive a BO (belladonna alkaloid with morphine 16.2/7.5 mg) or placebo suppository. Suppositories were placed immediately prior to lidocaine-based anesthesia, which all participants received. All participants underwent a standardized injection procedure using the same rigid cystoscope, needle type, and injection pattern (20 injections total). Participants reported bladder pain using a 0-10 numeric rating scale. Pain scores were obtained before anesthesia and suppository (P0), 40 minutes after administration of anesthesia and suppository (PA), after first 10 bladder injections (P10), and immediately after completion of 20 injections (P20). Pain increase during procedure was calculated using the difference between PA and P10. Post void residuals (PVRs) were measured immediately post-procedure and two weeks later. Patient satisfaction with pain control was measured using a Likert scale. Our primary outcome was change in pain level from anesthetic baseline to mid-procedure (P10-PA). Secondary outcomes were PVR >200 mL and satisfaction with pain control. A needed sample size of 26 was calculated in order to detect a 50% difference in P10-PA with 80% power. Categorical variables and median pain scores were compared using Fisher’s exact and Kruskal-Wallis tests, respectively. An intent-to-treat approach was used for all analyses. Twenty-six participants were enrolled and randomized with 13 in each study arm. One participant was lost to follow-up. There were no statistically significant differences in demographic variables or medical comorbidities between the groups. Median P10-PA for the placebo group and treatment group was 4 (range, 1-10) and 5 (range, 0-9), respectively (p = 0.94). Median P20 scores for the placebo group and treatment group were 3 (range, 0-10) and 2 (range, 0-8), respectively (p = 0.29). There were no significant differences in pre-injection pain scores reported at P0 and PA. Post-procedure PVR >200 mL was noted in 5 (38%) of the placebo group and 3 (23%) of the treatment group (p = 0.67). Two-week post-procedure PVR >200 mL was noted in 3 (25%) of the placebo group and 2 (15%) of the treatment group (p = 0.64) for an overall rate of 20%. Eleven (84%) participants in each group reported being “mostly satisfied” or “very much satisfied” with pain control. Addition of BO suppository to standard lidocaine-based anesthesia provided no added benefit to significantly reduce bladder injection pain. Suppository use did not increase risk of urinary retention immediately post-procedure or two weeks later. Satisfaction with pain control among BTX-A injection patients is high.

28 Are we measuring what we think we are measuring? Qualitative research exploring the role of the 0–10 pain score within the adult emergency department

Objectives and backgroundThe assessment of pain in the emergency department (ED) is difficult but important for appropriate management of pain. Guidelines for the management of acute pain in the ED...

The Use of Dehydrated Human Amnion/Chorion Membrane Allograft Injection for the Treatment of Tendinopathy or Arthritis: A Case Series Involving 40 Patients

BackgroundDegenerative joint and tendon injuries remain difficult to treat, with few effective conservative treatment options available. Regenerative approaches aim to promote the inherent healing capacity of injured tissues. Micronized dehydrated human amnion/chorion membrane (dHACM) injection is an emerging regenerative option with promising preclinical results. ObjectiveTo test the clinical effectiveness of dHACM injection in patients with chronic tendinopathy and arthropathy. DesignCase series. SettingAcademic medical center outpatient sports medicine clinic. PatientsA total of 40 patients with chronic tendinosis or arthropathy who received dHACM over a period of 9 months. MethodsA structured interview was administered to patients by telephone to supplement the clinical information available in the medical chart. All patients received an ultrasound-guided injection of dHACM. Main Outcome MeasuresThe primary outcome was change in pain level, and the secondary outcome was change in activities of daily living (ADLs) and sports/recreation function. More than 30% improvement in average pain and function was considered a successful outcome. ResultsPatient pain and function were measured at 1, 2, and 3 months after the procedure. Patient-reported average pain scores decreased from a baseline value of 6.4 (95% confidence interval [CI] = 5.7-7.0) to 2.7 (95% CI = 2.1-3.3; P < .001) at 1 month, 1.7 (95% CI = 1.1-2.2; P < .001) at 2 months, and 1.4 (95% CI = 0.9-1.9; P < .001) at 3 months. The percentage of patients achieving clinical success, defined as 30% or greater improvement in pain levels, was 68% at 1 month, 82% at 2 months, and 91% at 3 months. Patient-reported functional impairment in ADLs decreased from 6.8 (95% CI = 6.0-7.5) to 2.0 (95% CI = 1.4-2.7) (P < .001); impairment in sports/recreation decreased from 8.5 (95% CI = 7.9-9.1) to 3.2 (95% CI = 2.6-3.9) (P < .001). Frequency of pain medication use decreased from 29 of 40 patients (72.5%) before the procedure to 9 of 40 patients (22.5%) at final follow up (P < .001). Localized pain at the injection site was common, but no other adverse events or side effects were reported. ConclusionIn the setting of tendinosis or arthropathy, dHACM injection was clinically effective in reducing pain and improving function in a majority of adults. Level of EvidenceIV

Effectiveness of monotherapy and combined therapy with calcitonin and minodronic acid hydrate, a bisphosphonate, for early treatment in patients with new vertebral fractures: An open-label, randomized, parallel-group study.

Evidence related to the effectiveness of combination drug therapy for the treatment of osteoporosis is currently considered insufficient. Therefore, this study was performed to clarify the effects of monotherapy, and combination therapy, with a bisphosphonate (minodronic acid hydrate), a bone resorption inhibitor, and calcitonin (elcatonin), which is effective for the alleviation of pain due to vertebral fractures in osteoporotic patients. Study participants comprised of 51 female subjects with post-menopausal osteoporosis, whose main complaint was acute lower back pain caused by vertebral fractures. Subjects were randomly allocated into three groups and then administered with either intramuscular injections of elcatonin at a dose of 20 units weekly, minodronic acid hydrate at a dose of 1mg daily, or a combination of these two drugs. As primary endpoints, time-dependent changes in levels of pain were assessed using a visual analog scale from baseline to 6 months of duration. In addition, we examined the effects of monotherapies, and a combination therapy on bone resorption, with changes in bone mineral density at 4 sites and advanced hip assessment parameters from baseline to 6 months. A two-tailed significance level of 5% was used for hypothesis testing. Elcatonin monotherapy showed some alleviation of pain immediately after any vertebral fractures, which was more than in the minodronic acid hydrate monotherapy group. In addition, the minodronic acid hydrate monotherapy group experienced more effective inhibited bone resorption than the elcatonin monotherapy group. In the combination therapy, the efficacy for alleviating pain and inhibiting bone resorption was equivalent to the effect observed in the elcatonin and minodronic acid hydrate monotherapy groups respectively, with further improved values of bone mineral density observed in the femoral neck and lumbar vertebrae, and in parameters of advanced hip assessment compared with both monotherapy groups. Combination therapy with elcatonin and minodronic acid hydrate appears to be an effective treatment for osteoporosis patients with lower back pain, caused by fresh vertebral fractures.

Effect of acupressure on pain in Iranian leukemia patients: A randomized controlled trial study.

Nonpharmacological methods of pain relief such as acupressure are becoming increasingly popular worldwide. Practitioners often claim that such methods are highly effective and less invasive than analgesic drugs, but available empirical evidence is largely inconclusive. This study aimed to test the hypothesis that, postacupressure intervention, the amount of pain experienced by sampled leukemia patients, who received acupressure in addition to standard care, will reduce substantially compared to patients who received only routine treatment. This controlled trial was undertaken with hospitalized leukemia patients between February and June 2015. Our primary sample consisted of 100 participants who were randomly allocated to 2 groups. One (intervention) group underwent 12 acupressure sessions in addition to standard treatment while the control group received no intervention apart from being given the standard treatment for leukemia. The visual analogue scale was used to measure the levels of pain experienced. No significant differences were found between the 2 groups across 12 interventions. However, each group reported significantly different pain level changes before and after each intervention, suggested that the acupressure method was effective in reducing pain in the short term. Nurses are able to apply this complementary therapy alongside other procedures to manage these patients' pain. It is recommended that further studies be conducted to better understand the specific conditions under which acupressure can provide effective pain relief.

The effect of a 12-week McKenzie/William exercise program on the bodyfat ratio and pain levels of overweight adults

Background/Objectives: This study was conducted to verify the changes in pain levels after experiments by using overweight adults with a fear of potential lower back pain as subjects. Methods/Statistical analysis: The subjects were categorized by age, gender, and professional type. The changes in body-fat ratio and pain levels were recorded before and after the 12-week exercise program. The data collected were analyzed using SPSS 21.0 for statistical analysis and repeated measurement and variance analysis Findings. The result was that first, there was a statistically significant difference in body-fat ratio before and after. The body-fat ratio was higher in males than in females and lower 12 weeks after the treatment than before. There was a statistically significant difference in the pain levels before and after, too. The pain levels were lower 12 weeks after the treatment than before. Second, there was a statistically significant difference in the body-fat ratio and pain levels across different age groups, with after-treatment levels being lower than before treatment. Third, there was a statistically significant difference in body-fat ratio and pain levels across different professional categories, with after-treatment levels being lower than before-treatment levels. Improvements/Applications: McKenzie/William exercises are considered to have contributed to increased muscular strength in the lower back. In this study, individualized exercises seem to have increased the stability in the lower back, and the resistance exercises increased stability, leading to reduced pain.

Single-stage Treatment of Osteomyelitis of the Cervical Spine Using Anterior Instrumentation and Titanium Mesh Cages.

A case series. The aim of this study was to evaluate the clinical outcomes of patients with osteomyelitis of the cervical spine who were treated with single-stage anterior debridement and fusion using titanium mesh cages along with anterior plates. There have been few studies in single-stage surgical treatment of osteomyelitis of the cervical spine using titanium mesh cages along with anterior plates. Twenty-four patients treated for osteomyelitis of the cervical spine are presented. There were 11 male and 13 female with an average age of 53.3 years (42-63). Seventeen patients presented with a neurologic deficit at the time of diagnosis. Surgical treatment consisted of anterior debridement and fusion using titanium mesh cages along with anterior plates as a one-step procedure. The patients' records and radiographs were retrospectively analyzed and follow-up clinical and radiographic data obtained. The median follow-up period was 52 months. There were no implant failures. All patients showed a solid bony fusion without any recurrence of infection at latest follow-up. Changes in pain level, hematologic parameters, and neurologic status demonstrated a significant clinical improvement in all patients. This single-stage surgical treatment for osteomyelitis of the cervical spine provided satisfactory results. There is no increased risk of recurrence or persistence of infection related to the implantation of titanium mesh cages and instrumentation. 4.

Comparing Percutaneous Vertebroplasty and Conservative Therapy for Treating Osteoporotic Compression Fractures in the Thoracic and Lumbar Spine: A Systematic Review and Meta-Analysis.

Vertebral compression fractures are a common complication of osteoporosis and are often treated by percutaneous vertebroplasty (PVP). The ability of this procedure to relieve pain better than conservative treatment is still debated. The purpose of this study was to compare the degree and duration of pain relief following PVP with that following conservative treatment for osteoporotic compression fractures by means of meta-analysis of randomized controlled trials. The CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Web of Science databases were queried for randomized controlled trials comparing PVP with conservative treatment or placebo/sham. The methodological quality was assessed according to the Cochrane Collaboration's domain-based evaluation framework. Random-effects meta-analysis of the raw mean difference between groups in change in pain level was performed, with sensitivity analyses and the Egger test for potential publication bias. Of 209 records found, 11 were considered relevant, involving 1,048 participants. The risk of bias was considered low in 10 studies and high in 1. The 531 patients treated with PVP had a significantly lower pain level compared with the control group at 1 to 2 weeks, 2 to 3 months, and 12 months. The 95% CI (confidence interval) of the pooled effect size at every time interval included the score of 1.5, considered to be the minimal clinically important difference. The largest pooled effect size of -1.4 (95% CI, -2.3 to -0.5) was found during the first 1 to 2 weeks. The heterogeneity was high at all 3 time points (I(2), 71% to 96%). No significant publication bias was detected. Up to 1 year postoperatively, the effect of PVP exceeded the effect of conservative therapy with respect to pain relief in patients with osteoporotic compression fractures. The effect size was significant and close to the minimal clinically important difference.

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series

PurposeThe purpose of this case series is to report on changes in pain levels experienced by 69 postsurgical continued pain patients who received Cox Technic Flexion Distraction (CTFD). MethodsFifteen doctors of chiropractic collected retrospective data from the records of the postsurgical continued pain patients seen in their clinic from February to July 2012 who were treated with CTFD, which is a type of chiropractic distraction spinal manipulation. Informed consent was obtained from all patients who met the inclusion criteria for this study. Data recorded included subjective patient pain levels at the end of the treatments provided and at 24 months following the last treatment. ResultsFifty-four (81%) of the patients showed greater than 50% reduction in pain levels at the end of the last treatment, and 13 (19%) showed less than 50% improvement of pain levels at the end of active care (mean, 49 days and 11 treatments). At 24-month follow-up, of 56 patients available, 44 (78.6%) had continued pain relief of greater than 50% and 10 (18%) reported 50% or less relief. The mean percentage of relief at the end of active care was 71.6 (SD, 23.2) and at 24 months was 70 (SD, 25). At 24 months after active care, 24 patients (43%) had not sought further care, and 32 required further treatment consisting of chiropractic manipulation for 17 (53%), physical therapy, exercise, injections, and medication for 9 (28%), and further surgery for 5 (16%). ConclusionGreater than 50% pain relief following CTFD chiropractic distraction spinal manipulation was seen in 81% of postsurgical patients receiving a mean of 11 visits over a 49-day period of active care.

The Effect of Music Therapy on Pain The Level of Postoperative Patients' with Caesarean Section at Islamic Hospital A.Yani, Surabaya

Pain is the most common effects in patients after undergoing surgery of Caesarean section. Pain management using pharmacological and non pharmacological management, one of non-pharmacological management is using music therapy&#x0D; The purpose of this study was to analyze the effect of music therapy on pain level of postoperative patients' with Caesarean section. The type of study is analytic with True Experimental type with Pre Post Test Control Group Design done by Random Allocation. The study population is post-operative Caesarean section mothers who are hospitalized in Surabaya Islamic Hospital Surabaya Jl. A Yani since May 2011. The Sample are some populations above mentioned with amount of 24 respondents, 12 respondents as a control and 12 respondents were given music therapy. The Sampling technique uses Consecutive Sampling. Independent variable is music therapy and dependent variable is pain level. The instrument used to measure the independent variables is a check sheet lists while the dependent variable is Descriptive Pain Intensity Scale. To analyze the changes of pain level in the control group and the treatment used Paired T Test, the result showed that values of ρ is 0.166 or (ρ &gt; 0.05), so there is no significant change of pain level on a pre test and post test control group, whereas in treatment group obtained value of ρ is 0.000 or (ρ &lt; 0.05), so there is a significant change of pain level on a pre test and post test. To analyze differences of pain levels in control group and treatment group is used Independent T Test. The results of study got value of ρ is 0.807 (ρ &gt; 0.05). So there is no significant difference of pain level pre test in control and treatment groups, while the post test value of ρ is 0.024 (ρ &lt; 0.05). So there is a significant difference of pain level post test in control and treatment groups. So it can be conclude that there is influence of music therapy toward pain levels of postoperative patients of Caesarean section. Music therapy is expected to be used as a Complementary Therapy to reduce pain at the incision Caesarean section.

A randomized study of local anesthesia for pain control during intra-articular corticosteroid injection in children with arthritis.

BackgroundIntra-articular corticosteroid injections (IACI) are routinely used by pediatric rheumatologists in the treatment of chronic arthritis. Frequently, topical anesthetics are used to control procedural pain, but their relative efficacy has not been reported. In this study, we evaluated the level of pain associated with different anesthetic methods, Numby® 900 Iontophoretic Drug Delivery System, or EMLA® cream, with or without subcutaneous buffered lidocaine (SQBL), during IACI of the knee in children with arthritis.MethodsWe conducted a prospective study of patients, ages 4 to 21 years old, followed at three pediatric rheumatology centers who were undergoing IACI of a knee joint. Patients were randomized into two treatment groups: 1) topical anesthetic only (EMLA® or Numby® (E/N)), or 2) topical anesthetic (E/N) and SQBL. Pain was assessed at baseline, during topical anesthetic placement, and following the IACI (post-procedure). The Faces Pain Scale-Revised (FPS-R), the Face, Leg, Activity, Cry, Consolability (FLACC) behavioral scale and the parental global assessment (PGA) (0 = best experience, 10 = worst experience) were determined.ResultsSixty-three patients (44 females) with a median [IQR] age of 10.8 [IQR = (8.2–14.4)] years (range 4.7–20 years) with active knee arthritis were consented. FPS-R post-procedure (P = 0.03), FLACC (P = 0.02) and PGA (P = 0.01) scores were significantly lower in females treated with E/N plus SQBL compared to patients treated with E/N only. Females in the E/N only group had a significant worsening of their baseline pain (p < 0.0004) and a greater magnitude of change in their baseline FPS-R scores (p < 0.001) from the procedure compared to females in the E/N plus SQBL group who had no worsening of their baseline pain. No significant change in pain level or PGA score was found among males in either treatment group. Pain scores overall were similar to the oligoarthritis patients, a more homogeneous group of patients. Both EMLA® (n = 33) and Numby® (n = 29) were equally well tolerated with no significant difference in median FPS-R administration scores overall.ConclusionOur results suggest that a topical anesthetic plus SQBL is more effective for injection pain control than topical anesthesia only. Further studies addressing pain and anxiety will help determine the optimal method of pain control for IACI.

Motor Threshold: A Possible Guide to Optimizing Stimulation Parameters for Motor Cortex Stimulation.

No widely accepted programming guidelines for motor cortex stimulation (MCS) exist. We propose that an individual's effective stimulation voltage can be predicted as their percentage of motor threshold (PMT). Seven patients already successfully treated with MCS for neuropathic pain were included. Patients received stimulation that was the same as their baseline PMT ("medium"), 10% higher ("high") or 10% lower ("low") in a blinded, randomized study. Outcome was assessed after 14 days with the visual analogue scale for pain, the McGill pain questionnaire, and the SF-36 questionnaire. The best treatment response (mean VAS 3.4) was seen with the medium setting which was at a mean of 62% PMT. High and low settings both resulted in a significant increase in pain compared with the medium setting (mean VAS 6.0 and 6.3, respectively) and a significant decrease in SF-36 scores. No significant difference in pain control was observed between the high and low settings. The mean time from changes in treatment settings to reported change in pain level was 2.9 days (±1.0 day). We propose that the PMT represents an important parameter that measures the degree to which MCS may be affecting the motor cortex. A mean PMT of 62% was required for effective pain relief. Higher settings did not result in increased therapeutic efficacy but rather in a significant increase in pain. Targeting therapy to a PMT level may speed initial programming, allow more consistent longitudinal follow-up, and be a basis for a standardized programming paradigm.

요부 안정화운동과 하지 근력강화운동이 만성 요통환자의 통증과 하지근력에 미치는 영향

Purpose: This study was to investigate the effects of lumbar stabilization exercise and lower extremity strengthening program on pain, lower extremity muscle in patients with chronic low back pain. Method: The subject were randomly divided two groups. 15 people who were conducted lower extremity exercises and lumbar stabilization exercises called the combined exercise group and other(15 people) who were only conducted lower extremity exercise group. The assessment tools were the pain level and the led muscle power. Exercise was conducted for eight weeks. Result: Pain of the combined exercise group showed significant differences in the change in pain level(p

Self-checking Type, Repetitive, Education Efficacy for Temporomandibular Disorder Patients

Purpose: The purpose of this research was twofold: to compare the short-term efficacy of once-off education versus repetitive education (RE) of patients suffering from temporomandibular disorders (TMDs) and to determine whether there was any correlation amongst patient demographics, recommendation adherence degree and pain levels. Methods: A total of 848 patients with TMDs were enrolled. The control group consisted of patients who received a standard conservative treatment (STD) over at least 6 visits with education provided only during the first visit. The experimental group consisted of patients who received STD but had also been given RE (STD+RE). The RE was delivered through a standardized self-assessment questionnaire (SAQ) that was completed by the patient during each visit. Pain, which included maximum comfortable opening (MCO) of the mouth and limitation of mouth opening (LOM), was compared between the two groups. Behavior pattern and reported pain level changes in the group who used the SAQ were also analyzed. Results: The LOM was significantly improved in all of the experimental group patients (especially in females under 30 years of age, p＜0.05). The MCO was significantly higher in females (p=0.029). All of the patients displayed improvements in their habits following RE, which resulted in a strong correlation with pain reduction. Adhering to the recommendations regarding questions 14 and 15 of the SAQ appeared to have the greatest effect on pain reduction. Conclusions: These results clearly demonstrate that RE is more effective than once-off education for TMD patients who are female or under 30 years of age.

The Effect of Mother's Voice on Arterial Blood Sampling Induced Pain in Neonates Hospitalized in Neonate Intensive Care Unit.

Background and Objective:Due to devastating effects of pain in neonates, it is very important to ease it though safe and feasible methods. This study was to determine the effect of familiar auditory stimuli on the arterial blood sampling (ABS) induced pain in term neonates.Research Method:This study was done on 30 newborns hospitalized in neonate intensive care unit (NICU) of a hospital in Tehran. Research samples were selected by using convenience sampling and randomly divided into two groups of control and test. In the test group, the recorded mothers’ voices were played for the newborns before and after blood sampling procedure. Then, pain measures were recorded 10 minutes before, during and 10 minutes after blood collection based on Neonatal Infant Pain Scale (NIPS); then the pain level changes were reviewed and studied.Findings:The findings showed significant differences between the control and test groups that indicating the effect of mother’s voice on reducing the pain of neonates during the ABS (p<0.005).Conclusion:Research findings demonstrate that mother’s voice reduces ABS induced pain in the term neonates.

A feasibility pilot study on the use of complementary therapies delivered via mobile technologies on Icelandic surgical patients' reports of anxiety, pain, and self-efficacy in healing.

BackgroundComplementary therapies (CT), such as relaxation technique, massage, guided imagery, and accupuncture have shown to benefit patients undergoing surgery. The aim of this study was to determine the feasibility of using audio relaxation technique (ART), music intervention (MI), nature video application with music (NVAM), and nature video application without music (NVA) delivered via mobile technologies in a clinical setting. Secondary, the effects of ART, MI, NVAM and NVA on patients’ state anxiety, pain perception, and perceived self-efficacy in healing were determined.MethodsA randomized clinical trial (RCT) involving 105 same day surgery (SDS) patients, who were assigned to an ART (n = 25), MI (n = 25), NVAM (n = 15), NVA (n = 16), or a control group (n = 24) were assessed for state anxiety, self-reported pain, and self-efficacy four days prior to surgery, immediately prior and following a surgical intervention, and day five post-operative.ResultsANOVA found no statistically significant differences in anxiety scores; pain, or perceived self-efficacy between the five groups. Matched pairs t-Test revealed all participants had an increase in anxiety from pre-op to day 10 follow-up; a significant change in pain levels from pre-op to day 10 follow-up; and all participants had a significant increase in general self-efficacy from pre-op to day 10 follow-up. Mean pain level scores from day 1 to pre-op showed a significant decrease in pain for the ART group and NVAM group. Matched pairs t-Test for self-efficacy scores indicated the MI group and the NVA group had significant increases in self-efficacy. A significant decrease in anxiety from pre-op to day 10 for participants reporting a prior history of anxiety and for those reporting prior history of taking anti-anxiety medications.ConclusionsDespite the non-significant findings between the five groups, at any measurement point, there were valuable trends toward significance and confirmed feasibility in a clinical setting. Among the groups there were statistically significant findings for all interventions on anxiety, pain, and self-efficacy. The feasability of the implementation of novel interventions of NVAM and NVAM adds to clinical practice and the CT literature.Trial registrationClinicalTrials.gov Identifier: NCT02236455 (September 4, 2014)

Immediate changes in pressure pain threshold in the iliotibial band using a myofascial (foam) roller

Background Foam rolling is a self-release myofascial technique that can be applied to a variety of tissues. Previous studies have demonstrated physiological changes in range of motion and arterial stiffness with the application of a foam roller; however, no studies have investigated the change in pain levels. The present study investigated the effect on the pressure pain threshold (PPT) following the application of a foam roller for three minutes to the right iliotibial band (ITB) of asymptomatic participants. Methods Participants completed a questionnaire and had their height and mass measured. Three points on the ITB of the right leg were marked. The PPT was measured at each point using a pressure algometer. Measurements were taken pre-intervention, post-intervention and five minutes post-intervention. Participants completed a single three-minute bout on the foam roller. Findings Results demonstrated a statistically significant increase (p&lt;0.05) in the PPT at the lower thigh immediately post-treatment; however, the difference was ameliorated five minutes later. Conclusions Foam rolling the ITB produces an immediate increase in the PPT of the lower thigh in asymptomatic participants.