Decrease In Pain Intensity Research Articles

Is acetaminophen beneficial in patients with cancer pain who are on strong opioids? A randomized controlled trial.

Pain is common among cancer patients. The evidence recommends using strong opioids in moderate to severe cancer pain. No conclusive evidence supports the effectiveness of adding acetaminophen to patients with cancer pain who are already using this regime. To assess the analgesic efficacy of acetaminophen in hospitalized cancer patients with moderate to severe pain receiving strong opioids. In this randomized blinded clinical trial, hospitalized cancer patients with moderate or severe acute pain managed with strong opioids were randomized to acetaminophen or placebo. The primary outcome was pain intensity difference between baseline and 48 hours using the Visual Numeric Rating Scales (VNRS). Secondary outcomes included change in morphine equivalent daily dose (MEDD), and patients' perception of improved pain control. Among 112 randomized patients, 56 patients received placebo, 56 acetaminophen. Mean (standard deviation (SD)) decrease in pain intensity (VNRS) at 48 hours were 2.7 (2.5) and 2.3 (2.3), respectively (95% Confidence Interval(CI) [-0.49;1.32];p=0.37). Mean (SD) change in MEDD was 13.9 (33.0) mg/day and 22.4 (57.7), respectively (95% CI [-9.24;26.1];p=0.35). The proportion of patients perceiving pain control improvement after 48 hours was 82% in the placebo and 80% in the acetaminophen arms (p=0.81). Among patients with cancer pain on strong opioid regime, acetaminophen may not improve pain control, or decrease total opioid use. These results add to the current evidence available suggesting not to use acetaminophen as an adjuvant for advanced cancer patients with moderate to severe cancer pain who are on strong opioids.

Effect of acupressure therapy to reduce chest pain in NSTEMI patients

Introduction: Acute coronary syndrome (ACS) describes the sudden ischemia of the myocardium due to loss of blood flow to the heart muscle, causing a cessation of oxygen supply to heart cells. Non-pharmacological management is needed to be applied instead of intervention or combination in reducing pain intensity. Acupressure is done by applying physical pressure at several points on the surface of the body that are places of energy circulation and balance in cases of pain symptoms. Objective: To reduce chest pain in patients with acute coronary syndrome with NSTEMI by using acupressure therapy. Methods: The method used in this study used case studies with pre and post intervention, patients were given acupressure therapy given at the location of the LI4 point located at the back of the right / left hand between the first and second metacarpal bones and almost along the radial bone. Performed for ± 20 minutes in 10 seconds, pressure is applied according to the tolerance level acceptable to the patient and a rest period of 2 seconds. Results: There was a decrease in pain intensity in patients after acupressure therapy. Conclusion: Pressure therapy with appropriate methods and procedures can be an alternative to reduce chest pain in NStemi patients

Role of Local Anesthetic Infiltration of Port Sites in Laparoscopic Cholecystectomy in Reducing Postoperative Pain and Opioid Consumption

Abstract Background Laparoscopic cholecystectomy is the gold standard for treating patients with cholelithiasis. It is a minimally invasive technique that reduces surgical trauma with small and more cosmetic incision, reduces blood loss and is associated usually with fewer postoperative complications and decreased length of hospital stay. Aim of the Work The aim of this study was to evaluate the efficacy of the long acting local anesthetic (bupivacaine) infiltrated at the port sites in laparoscopic cholecystectomy, in reducing postoperative pain and opioid consumption. Patients and Methods In the period from March 2021 to September 2021 fifty patients who underwent laparoscopic cholecystectomy were randomly allocated to one of two groups and comparative study was done. In the bupivacaine group (A), after skin preparation and before port insertion, 20 ml of 0.25% bupivacaine solution was infiltrated through the abdominal wall 4 ml around each port site. Postoperatively, pain score using VAS score, time of rescue analgesic and total rescue analgesic dose was calculated. Results The results showed that there a decrease in pain intensity in the bupivacaine group compared to control group with a significant difference, and there was delay in the time of rescue analgesia and total doses of rescue analgesia the bupivacaine group compared to control group with a statistically significant difference. Conclusion Port- site infiltration of bupivacaine in laparoscopic cholecystectomy successfully decrease post-operative pain during first 6 hour and delayed the time of rescue analgesia.

Oxaliplatin causes increased offset analgesia during chemotherapy- a feasibility study.

Offset analgesia (OA) is the phenomenon where the perceived pain intensity to heat stimulation disproportionally decreases after a slight decrease in stimulation temperature. The neural mechanisms of OA are not fully understood, but it appears that both peripheral and central temporal filtering properties are involved. Chemotherapy with oxaliplatin often causes acute peripheral sensory neuropathy, and manifests primarily as a cold induced allodynia. The aim of this exploratory patient study was to investigate if OA was affected by the neurotoxic effects of adjuvant oxaliplatin treatment. OA was assessed in 17 colon cancer patients during 12 cycles of adjuvant oxaliplatin treatment. The OA response was estimated as the decrease in pain intensity caused by a temperature decrease from 46 °C to 45 °C. Changes in the OA during the treatment period was estimated using a mixed linear model and corrected for multiple comparisons by Sidak's test. OA was increased significantly when assessed before the 2nd, 3rd, 5th, 6th, 9th, and 10th treatment cycle compared to the first (baseline) treatment (p<0.05). OA is generally decreased in persons suffering from chronic pain or peripheral neuropathy as compared tohealthy controls. But in the present study, OA increased during chemotherapy with oxaliplatin. The underlying mechanism of this unexpected increase should be further explored.

Effectiveness of Therapeutic Education in Patients with Cancer Pain: Systematic Review and Meta-Analysis.

(1) Objective: To review the existing evidence on pain education in patients with pain derived from an oncological process. (2) Methods: A systematic review was conducted using the databases Pubmed, Web of Science, PEDro, and Scopus. The selected studies had to incorporate instruction about the neurophysiology of pain into their educational program. The target population was cancer patients who had suffered pain for at least one month. The methodological quality of the articles collected was assessed using the PEDro scale. (3) Results: Some 698 studies were initially identified, of which 12 were included in this review. Four different models of pain education programs were found in the studies' interventions. Pain intensity, pain experience, quality of life, pain tolerance, and catastrophism were the variables that appeared most frequently. (4) Conclusions: This review demonstrates that pain education in patients with cancer pain may produce effects such as decreased pain intensity and catastrophism. Knowledge about pain also seems to increase. However, no benefit was reported for patients' overall quality of life. Therefore, more research is needed to clarify the effects of these interventions on the oncology population.

Penerapan Mobilisasi Dini terhadap Penurunan Intensitas Nyeri pada Ibu Post Sectio Caesarea

Sectio Caesarea is considered very risky to be carried out by mothers who are about to give birth, due to the method that requires opening the wall or in medical terms Trans Abdominal Uterine Incision with pain that will be felt by a mother, which is a stressor that will be felt by the mother biologically which is felt physically. psychological and physical. The non-pharmacological techniques that can be used to reduce postoperative pain is early mobilization techniques. Early mobilization techniques are effective in reducing pain through several mechanisms, including eliminating the patient's concentration at the location of the pain in the operating area, reducing the activity of chemical mediators in the inflammatory process which increases the pain response. and minimize pain nerve transmission to the central nervous system. This research aims to know the results of implementationEarly Mobilization of Reducing Pain Intensity in Post Sectio Caesarea Mothers. This study used a quasi-experimental design with the pretest-posttest Nonequivalent Control Group design methodwithcase study descriptive method to 2 respondentsPost Sectio Caesarea. Based on the results of the implementation that has been done there is a decrease in pain intensity in patientspost sectio caesarea after being given the application of early mobilization.

The clinical and biomechanical effects of customized foot orthoses in individuals with plantar heel pain: A pre-post intervention study

BackgroundCustomized foot orthoses (CFOs) are often recommended for the management of plantar heel pain. However, there is a lack of information regarding lower limb and multi-segment foot motion during gait. Research questionThis study aimed to determine the effects of heat moulded CFOs on foot and lower limb kinematics when compared with prefabricated foot orthoses (PFOs) and wearing no orthoses (shod condition), and to determine the short-term effects of CFOs on pain intensity and foot function. MethodsThe immediate effects of CFOs on the lower limb and multi-segment foot motion were assessed. Participants were then asked to use the CFOs for one month and foot pain, function, and temporal-spatial parameters were assessed at baseline and at one month follow up. ResultsThirty-five participants (22 females), aged 40.1 (10.5) years, with a mean duration of symptoms of 12.59 months were recruited. The symptomatic limbs showed a higher forefoot varus angle and greater rearfoot and forefoot corrections were required compared to the non-symptomatic limbs. When compared with PFOs and shod conditions, CFOs provided the least forefoot and knee motion in the transverse plane during contact phase (P < 0.05, d=0.844–1.720), least rearfoot motion in the coronal plane during midstance (P < 0.05, d=0.652), and least forefoot motion in the frontal plane, knee motion in the transverse plane, and hallux motion during the propulsive phase (P < 0.05, d=0.921–1.513). Significant improvements were seen for foot pain and function (P < 0.05, d=1.390–2.231) with significant increases in cadence and walking velocity after one month of CFO use (P < 0.05, d=0.315–0.353), and those most likely to respond had greater pain and less ankle eversion (P < 0.05, d=0.855–1.115). SignificanceCFOs appear to improve pathological biomechanics associated with plantar heel pain. After one month follow up, the CFOs decreased pain intensity and increased foot function, and showed significant improvements in temporal and spatial parameters of gait.

The Application of Cinnamon Compresses To Reduce Pain Scale In Older Age With Gout Arthritis: Case Study

ABSTRACTIntroduction: The main complaint of patients with Gout Arthritis is pain problems. Bat to treat joint pain problems in the elderly with Gout Arthritis in total still does not exist, but there are many treatment options to relieve symptoms can be done. Giving warm compresses using cinnamon spices (cinnamomun burmani) containing eugenol and cinamaldehid can reduce the sensitivity of the nociceptor, so as to relieve pain symptoms. This study aimed to analyze the administration of cinnamon compresses in the elderly with Gout Arthritis with chronic pain nursing problems.Methods: This research uses a descriptive method with a case study approach. Samples used by 2 elderly people with Gout Arthritis using the format of family nursing care assessment, and pain scale assessment. The application of cinnamon compress is done for 4x a week using cinnamon liquid as much as 2 ml, with 200 cc of water, at a temperature of 40-450C, followed by compress for 15-20 minutes using a washlap. Data was analyzed using descriptive analysisResults: After applying cinnamon compresses four times a week, the study showed a decrease in pain intensity before and after the intervention was given to the two subjects. The subject's pain intensity decreased from moderate pain intensity to mild pain.Conclusion: The application of cinnamon compresses is effective in reducing the intensity of Gout Arthritis pain.Keywords: Cinnamon; Compress; Gout Arthritis; Painful

Treatment of Chronic Pain in Patients with Osteoarthritis of the Hip and Knee with a Combination of Hydroxytyrosol, Omega 3 Fatty Acids and Curcumin: Results of a Pilot Study

Chronic pain is the most common symptom of osteoarthritis and is very often accompanied by limitations in the performance of activities of daily living and has a negative impact on patients’ quality of life. It is estimated that 14% of the elderly population routinely use NSAIDs for pain management, not without serious adverse effects. Objective: We aimed to test the efficacy and possible side effects of OliminaDol (encapsulated combination of purified hydroxytyrosol, omega-3 fatty acids and curcumin) in the treatment of chronic osteoarthritis pain. Seventy-four patients with a diagnosis of osteoarthritis who had chronic pain were selected. The therapeutic intervention consisted of self-administering one capsule of the supplement every 12 h for 30 days. A visual analogue scale (VAS) was used for pain assessment. The efficacy was assessed by comparing the means of pain intensity at baseline and at the end of treatment. The data on the National Cancer Institute (NCI-CTCAE) version 4 criteria were also analyzed. Results: Thirty-six patients were evaluable for the primary objective. The mean value + standard deviation of pain intensity measured by the VAS scale at day +1 was 5.78 + 0.15 and the mean value of pain 30 days after initiation of treatment was 4.19 + 0.22. There was a decrease in pain intensity of 1.63 + 2.28 with p = 0.000. A total of 27 patients (75%) had pain reduction and in 19 of them (52.7%), the difference was greater than 2 points on the VAS scale. OliminaDOL administration was associated with very few and insignificant side effects, notably constipation in two patients (5.4%) and a fishy taste in three patients (8.1%). Conclusions: The administration of OliminaDOL produced a significant decrease in the mean value of pain intensity without side effects. These results, together with other published studies, demonstrate the possibility that some supplements, or a combination of them as in our case, can be an alternative for the treatment of chronic pain.

High-intensity laser therapy in low back pain management: a systematic review with meta-analysis.

Low back pain (LBP) is a widespread health issue affecting people globally and is the second leading cause of missed workdays. High-intensity laser therapy (HILT) promises to decrease pain intensity in LBP patients. The aim of this work was to evaluate the effect of HILT in adult LBP patients. We searched for randomized controlled studies (RCTs) published before January of 2023. Our primary outcome was pain intensity, while our secondary outcomes included disability and flexibility scores. We synthesized the evidence using RevMan v.5.4 and assessed methodological quality with the Oxford/Jadad scale and the Cochrane collaboration's risk of bias tool 1. The model favors the HILT group over the control group in terms of pain intensity after treatment (MD with 95% CI is -1.65 [-2.22, -1.09], p-value < 0.00001, I2=67%), Oswestry disability index (MD with 95% CI is -0.67 [-1.22, -0.12], p-value = 0.02, I2=73%), and Roland disability index (MD with 95% CI is -1.36 [-1.76, -0.96], p-value <0.00001, I2=0%). The patients in the high-intensity laser therapy had statistically significantly lower (low back) pain intensity compared to the patients in the control group. Based on three RCTs, our model also showed the positive effect of the HILT on LBP in terms of the Oswestry disability index and Roland disability index.

Acupuncture at points LI4 and SP6 on Postpartum Sectio Caesarea (SC) Pain

This study will look at the effect of acupuncture at LI4 and SP6 points on postpartum SC pain. The research design is a quasi experimental clinical non-equivalent pre-post test control group design. The total sample is 60 respondents consisting of the intervention and control groups. The instrument used was the PNRS pain scale by measuring the level of pain before and after the intervention was given. Bivariate analysis using Independent Sample t-Test. The results of the study stated that the average pain intensity score before acupuncture intervention using PNRS there was a decrease after acupuncture intervention at points LI4 and SP6 after acupuncture intervention at points LI4 and SP6 for 30 minutes, analysis p value 0.00 &lt;0.05. Conclusion There is a significant effect after being given acupuncture intervention at points LI4 and SP6 on reducing pain intensity in postpartum SC.&#x0D; Highlights:&#x0D; &#x0D; The study examines the effect of acupuncture on postpartum SC pain using a quasi-experimental design with intervention and control groups (n=60).&#x0D; &#x0D; Acupuncture at LI4 and SP6 points significantly reduces pain intensity in postpartum SC, as measured by the PNRS pain scale.&#x0D; &#x0D; &#x0D; Bivariate analysis (Independent Sample t-Test) shows a significant decrease in pain intensity after 30 minutes of acupuncture intervention at LI4 and SP6 points.&#x0D; &#x0D; &#x0D; Keywords: Acupuncture, Postpartum SC pain, LI4, SP6, Pain intensity.

First Report on Real-World Outcomes with Evoked Compound Action Potential (ECAP)-Controlled Closed-Loop Spinal Cord Stimulation for Treatment of Chronic Pain.

A novel closed-loop spinal cord stimulation (SCS) system has recently been approved for use which records evoked compound action potentials (ECAPs) from the spinal cord and utilizes these recordings to automatically adjust the stimulation strength in real time. It automatically compensates for fluctuations in distance between the epidural leads and the spinal cord by maintaining the neural response (ECAP) at a determined target level. This data collection was principally designed to evaluate the performance of this first closed-loop SCS system in a 'real-world' setting under normal conditions of use in a single European center. In this prospective, single-center observational data collection, 22 patients were recruited at the outpatient pain clinic of the St. Antonius Hospital. All candidates were suffering from chronic pain in the trunk and/or limbs due to PSPS type 2 (persistent spinal pain syndrome). As standard of care, follow-up visits were completed at 3months, 6months, and 12months post-device activation. Patient-reported outcome data (pain intensity, patient satisfaction) and electrophysiological and device data (ECAP amplitude, conduction velocity, current output, pulse width, frequency, usage), and patient interaction with their controller were collected at baseline and during standard of care follow-up visits. Significant decreases in pain intensity for overall back or leg pain scores (verbal numerical rating score=VNRS) were observed between baseline [mean±SEM (standard error of the mean); n=22; 8.4±0.2)], 3months (n=12; 1.9±0.5), 6months (n=16; 2.6±0.5), and 12months (n=20; 2.0±0.5), with 85.0% of the patients being satisfied at 12months. Additionally, no significant differences in average pain relief at 3months and 12months between the real-world data (77.2%; 76.8%) and the AVALON (71.2%; 73.6%) and EVOKE (78.1%; 76.7%) studies were observed. These initial 'real-world' data on ECAP-controlled, closed-loop SCS in a real-world clinical setting appear to be promising, as they provide novel insights of the beneficial effect of ECAP-controlled, closed-loop SCS in a real-world setting. The presented results demonstrate a noteworthy maintenance of pain relief over 12months and corroborate the outcomes observed in the AVALON prospective, multicenter, single-arm study and the EVOKE double-blind, multicenter, randomized controlled trial. The data collection is registered on the International Clinical Trials Registry Platform (Trial NL7889).

The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta-analysis.

The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP. We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data. A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship. These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP. The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.

Impact of antidepressant medication on the analgetic effect of repetitive transcranial magnetic stimulation treatment of neuropathic pain. Preliminary findings from a registry study.

Repetitive transcranial magnetic stimulation (rTMS) has been found to be effective in chronic neuropathic pain conditions. However, information about the combined effects of rTMS and antidepressant treatment is scarce. We studied the outcome of rTMS and concurrent antidepressant treatment in patients with neuropathic pain. In this retrospective, real-world study, 34 patients with neuropathic pain, who were considered resistant or not benefitting from conventional treatment, received rTMS treatment between 2017 and 2020. Pain-related factors were measured using the Numerical Rating Scale (NRS), Global Impression of Change (GIC), and Beck Depression Inventory. A decrease in pain intensity and pain interference assessed with NRS was observed after 10 treatment sessions in 16 patients. The impression of change was positive in 20 patients. Half of the patients (n=17) used antidepressant medication, while half (n=17) did not. A concurrent use of antidepressants with therapeutic rTMS was significantly linked with less pain intensity relief when compared with the nonuse of antidepressants (p=0.019). The impression of change was significantly in favor of the antidepressant nonuser group (p=0.002). No group differences in pain interference were found between the groups. Therapeutic rTMS for neuropathic pain is plausibly sensitive to interference with antidepressant medication. The exact mechanism of our findings remains to be elucidated; confirmatory studies are warranted.

Digitally delivered education and exercises for patients with hand osteoarthritis-An observational study.

Hand osteoarthritis (OA) is a common form of OA, for which education and exercise are considered the first-line treatment. The aim of the present study was to examine pain and perceived hand function in participants following 3months of digitally delivered first-line treatment for hand OA. Three-hundred-and-seventy-nine of 846 participants with clinical signs and symptoms of hand OA completed the study. The digital hand OA treatment program consists of video instructed daily exercises and patient education through text lessons. Pain (NRS, 0 no pain, 10 worst) was the primary outcome, and stiffness (NRS) and the Functional Index for Hand OsteoArthritis (FIHOA, 0 best, 30 worst) were among secondary outcomes. The McNemar test and linear mixed effect regression model were used to assess the changes in outcomes from baseline to 3-month. After three months, the digitally delivered program was associated with a significant decrease in pain intensity (mean change -1.30 (95% CI -1.49, -1.12)) and hand stiffness (mean change -0.81 (95% CI -1.02, -0.60)) but no conclusive changes in the FIHOA scores (mean change 0.3 (95% CI -0.2, 0.7)). The results agree with reports on face-to-face delivered first-line treatment for hand OA suggesting that digital treatment is a viable treatment option in patients with hand OA.

The short-term effect of glucosamine-sulfate, nonanimal chondroitin-sulfate, and S-adenosylmethionine combination on ultrasonography findings, inflammation, pain, and functionality in patients with knee osteoarthritis: A pilot, double-blind, randomized, placebo-controlled clinical trial.

This study aimed to investigate the efficacy of glucosamine-sulfate (GS), nonanimal chondroitin-sulfate (naCS), and S-adenosylmethionine (SAMe) combination on ultrasound findings, inflammation, pain, and functionality in knee osteoarthritis. In the prospective, randomized, double-blind, placebo-controlled pilot study conducted between August 2019 and November 2019, 120 participants (28 males, 92 females; mean age: 66.4±7.9 years; range, 42.4 to 74.5 years) were randomized at a 1:1:1 ratio to the placebo group, the first experimental group (a combination of GS, naCS, and SAMe was administered to the experimental groups. The first experimental group received 375 mg of GS, 300 mg of naCS, and 100 mg of SAMe, whereas the second experimental group received 750 mg of GS, 600 mg of naCS, and 200 mg of SAMe). Laboratory (erythrocyte sedimentation rate, C-reactive protein, tumor necrosis factor alpha, interleukin [IL]-1β, IL-6, IL-17), clinical (Visual Analog Scale [VAS], short form health survey [SF-36], the Western Ontario and McMaster Universities Arthritis Index [WOMAC], and the Tegner Lysholm Knee Scoring Scale [TLKS]), and musculoskeletal ultrasound (MSUS) assessments were performed at baseline and after three and six months. A minor increase was observed in the second experimental group after six months using ultrasonography to evaluate articular cartilage thickness (p<0.05). The investigational product's superiority in reducing osteoarthritis ultrasonographic findings was not proven. A moderately negative association was found between cartilage thickness and VAS scores at baseline (ρ=-0.36, p<0.01), while the presence of massive osteophytes on MSUS showed a low to moderate association with all clinical outcomes. There was no difference in the delta changes between groups for the VAS, TLKS, WOMAC, and SF-36. The only serum inflammatory marker outside the reference range was IL-1β, but no significant changes were observed after six months. According to the results of our investigation, treatment for knee osteoarthritis should be evaluated using more objective outcomes. The most important conclusion of our study is that IP may result in a slight increase in articular cartilage thickness, which was associated with a decrease in pain intensity at baseline. Clarification of the potential influence of this combination on radiographic progression and laboratory markers of inflammation requires further exploration.

Spinal displacement during thoracic manipulative therapy in mechanical neck pain patients: an observational study

ABSTRACT Introduction Thoracic manipulative therapy (TMT) is recommended for treating patients with mechanical neck pain (MNP). However, there are multiple proposed recommendations for the mechanism for neck pain reduction. Objective To investigate displacement of the cervicothoracic spine during the application of TMT in patients with MNP. Methods Thirty-five male patients with MNP were recruited. Displacements of C3, C5, C7, T2, T4 and T6 were measured using a motion capture system while a therapist applied a grade III central posteroanterior TMT (cpa-TMT) to T6. Results Mean (SD) displacement ranged from 2.2 (0.62) to 5.5 (1.1) mm. A significant decrease in neck pain intensity at rest was found after the application of the cpa-TMT (mean difference 17 mm, p < 0.001). A downward trend in spinal displacement was noted, with the largest and smallest displacement occurring at T6 and C3, respectively. Correlations between the displacement of T6 and adjacent spinal levels were moderate to high (Pearson’s r range 0.70–0.90, p < 0.001). It was showed that cpa-TMT applied to T6 produced the PA displacement toward the upper cervical spine. Conclusion TMT produces spinal segmental displacements toward the upper cervical spine in MNP patients. These segmental displacements would activate the alleviation effect at both the spinal and supraspinal levels resulting in neck pain reduction. These findings would provide supporting evidence for the use of TMT in neck pain reduction.

Dexmedetomidine and Fentanyl as Adjuvant to Bupivacaine for Epidural Analgesia in Gastrectomy Surgery

Background: Opioids as epidural adjunct to local anaesthetics have been in use so long and the synergism between epidural local anaesthetic agents and opioids are well established. Dexmedetomidine (α-2 agonist) is being increasingly used for similar purpose but evidence for the combination of local anaesthetic agents with dexmedetomidine in epidural analgesia is limited. Gastic cancer is increasing day by day in our country and removal of tumor by gastrectomy surgery is choice of treatment. The present study was conducted to compare the analgesic, hemodynamic, sedative effects of epidurally administered dexmedetomidine and fentanyl when combined with bupivacaine in a patient undergoing gastrectomy surgery along with general anaesthesia.Methods: This randomized controlled trial study was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU, Dhaka. The study was been conducted 12 month after obtaining approval from the institutional Review Board and informed written consent from the patient. About 40 patients aged between 40 and 70 years, posted for gastrectomy surgery were included in this study. The patients were randomly allocated into two equal groups. Group A received general anaesthesia along with epidural fentanyl and bupivacaine. Group B received general anaesthesia along with epidural dexmedetomidine andbupivacaine. During surgery, hemodynamic status of the patients had been carefully recorded. Following surgery, pain intensity was recorded using a visual analog scale (VAS) for 6 hours and observed for the time of first rescue analgesic requirement, post-operative sedation score by Ramsay sedation score, and surgeons satisfaction by likert scale. A statistical analysis was carriedout by using the Statistical Package for Social Sciences version 23.0 for Windows. Chi-Square test used to analyze the categorical variables and student t-test used for continuous variables. P value &lt;0.05 was considered as statistically significant.Results: Age, height, and weight were almost identical between two groups. Duration of surgery and anaesthesia were almost similar between two groups. Systolic blood pressures, diastolic blood pressure, MAP were almost similar between two groups and were statically not significant (p&gt;0.05). Mean heart rate of group B was significantly lower (p&lt;0.05) than that of group A. Post-operative visual analog scale was reduced significantly (p&lt;0.05) in group B than group A. The time of first analgesic requirement was significantly higher (p&lt;0.05) in group B. The mean sedation score was also significantly higher (p &lt; 0.05) in group B than group A.Conclusion: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant to local anaesthetics as it decreases pain intensity during post-operative period, delayed time of first analgesic supplementation, provides better sedation level without harmful derangement on hemodynamics.

Exploring the Impact of Occupational Adaptation-Focused Interventions on Music Student Health

Abstract Date Presented 04/22/2023 This study explored occupational adaptation interventions for playing-related musculoskeletal disorders. Results indicate decreased pain intensity, decreased Disabilities of the Arm, Shoulder, and Hand scores, and increased adaptive capacity among university-level music students. Primary Author and Speaker: Allison Naber Additional Authors and Speakers: Katherine Ericsson

Cases, Prevalence and Treatment of Low Back Pain at Bandung Pain Rehab

Background: Low back pain (LBP) is one of the pain complaints that affects almost every aspect of a person's life, urging many patients to come for treatment. The incidence of LBP in Indonesia is estimated between 7,6% and 37%, but it is still precisely unknown. A clinician must be able to make an accurate diagnosis to treat patients according to the etiology. In this study, we aim to determine the distribution of prevalence, demographic data, and the success of LBP treatment in order to help clinicians in management of LBP to reduce the global burden.&#x0D; Methods: This was a descriptive analytic study with a cross-sectional design. This research was conducted at the Bandung Pain Rehab Center (BPRC) clinic from July 2019 to December 2021. We included all patients complaining of low back pain who came for treatment at the BPRC. The data of this study were taken from medical records. The success of therapy in the interventional pain management (IPM) and non-IPM groups was assessed by comparing the VAS values before and after treatment. Statistical analysis was performed using the IBM SPSS Statistics 23 program with the Wilcoxon test.&#x0D; Results: Of the 704 patients, the majority were female (59,2%), aged 51-60 years (23,6%), with obese body mass index (54,4%), and worked as housewives (35,5%). The most common etiology of LBP was piriformis syndrome (50,9%), followed by sacroiliac joint arthropathy (18,5%) and lumbar radiculopathy (14,8%). In the IPM and non-IPM groups, there was a significant decrease in pain intensity after therapy (p &lt;0,001).&#x0D; Conclusion: Our research shows that LBP is most common at the age of 51-60 years, female gender, with a body mass index classified as obese, and working as a housewife. Piriformis syndrome is the most common prevalent etiology of LBP. The use of therapy in both IPM and non-IPM showed significant improvements in alleviating pain experienced by the patients.&#x0D; Keywords: Low back pain, case, prevalence, IPM, non-IPM, VAS score