Decrease In Visual Analogue Score Research Articles

A COMPARATIVE STUDY ON DYNAMIC NECK EXERCISE VERSUS ISOMETRIC NECK EXERCISES WITH THERABAND IN CHRONIC NECK PAIN

Objective: To compare the efficacy of dynamic neck exercises versus isometric neck exercises with theraband in chronic neck pain Methods: 60 patients with chronic neck pain selected as per the inclusion criteria; all the conditions in exclusion criteria was excluded. By dividing them into group A (n =30) (treated with dynamic neck exercise), group B (n=30) (treated with isometric neck exercise with theraband). Results: After screening of the 60 patients for study eligibility, a total of 30 patients were included for analysis, of whom 30 were in the control group A (Dynamic neck exercise with theraband) and 30 were in group B (Isometric neck exercise with theraband) Analysis pre-test and post-test score within and between the values of groups are tabulated with intervention of the result of the study. Group B showed significant change in ROM and Neck pain. Conclusion: Isometric Exercise is very well known for its pain reliving and long-lasting properties, but variability of techniques make it difficult to document but Theraband is known to provide consistency in training whilst preventing fatigue. Hence, patients in group B (treated with Theraband) showed decrease in VAS (Visual Analog Score) and NDI (Neck Disability Index) scores, which prove that isometric with theraband is better in treating Chronic Neck Pain.

Warming acupuncture-moxibustion combined with Bushen Qianggu Recipe effectively improves bone metabolism in osteoporosis patients.

Osteoporosis (OP) increases the risk of fractures in older adults, with no effective treatment options at present. To analyze the effects of warming acupuncture-moxibustion (WAM) combined with Bushen Qianggu Recipe on bone metabolism, bone mineral density (BMD), and pain intensity in OP patients. This retrospective study involved 103 patients with OP who were admitted to Wuhan Hospital of Traditional Chinese Medicine between July 2021 and December 2023. The control group consisted of 47 cases given WAM and the research group consisted of 56 cases receiving WAM + Bushen Qianggu Recipe (Rehmanniae Radix 15 g, Radix Rehmanniae Preparata 15 g, Poria cocos 10 g, yam 10 g, rhizoma alismatis 10 g, raspberry 10 g, medlar 10 g, Schisandra chinensis 10 g, Semen Cuscutae 10 g, Epimedium 10 g, Polygonatum sibiricum Red. 10 g, Drynaria 10 g, and Eucommia ulmoides 10 g). Bone metabolism markers (procollagen type I N-terminal propeptide (PINP) and bone-specific alkaline phosphatase (B-ALP)), BMD (lumbar vertebrae at L2-4, femoral neck, and distal 1/3 of the radius), pain intensity (visual analog score (VAS)), dysfunction (Oswestry Dysfunction Index), quality of life (Short-Form 36 Item Health Survey (SF-36)), and overall treatment efficacy were analyzed comparatively. Compared with the baseline (before treatment) and post-treatment levels in the control group, the research group showed a reduction in PINP and B-ALP, an increase in BMD at the lumbar vertebrae L2-4, femoral neck, and distal 1/3 of the radius, and a decrease in VAS and Oswestry Disability Index scores. Additionally, the research group performed better across various dimensions of the SF-36 scale and had a higher overall effective rate. WAM combined with Bushen Qianggu Recipe is effective in alleviating pain intensity and improving bone metabolism, BMD, and quality of life in OP patients; therefore it is deserving of clinical promotion.

Assessment of 5% Amlexanox, 0.1% Triamcinolone Acetonide and 0.03% Tacrolimus in the Management of Oral Lichen Planus.

Compare 5% amlexanox, 0.1% triamcinolone acetonide, and 0.03% tacrolimus in the management of oral lichen planus (OLP). A received 0.03% tacrolimus, group B received 0.1% triamcinolone acetonide and group C received topical 5% amlexanox. All patients were evaluated for pain on visual analog scale (VAS) and erosive area on day 1, 7, and 15. There was decrease in visual analogue score (VAS) for pain in all tested group after 15 days. There was significant decrease in erosive area in left and right buccal mucosa in all groups after 15 days for inter and intra group comparison. All the drugs used were effective in management of patients with OLP and thus it can be advised to consider these agents as alternatives.

Subcutaneous allergen specific immunotherapy with gramineae pollen in children with allergic rhinoconjunctivitis

Background/aim: Allergen specific immunotherapy (ASIT) should be considered in patients with moderate to severe allergic rhinoconjunctivitis, whose complaints persists despite symptomatic treatment. The aim of this study is to evaluate the efficacy and safety of ASIT with gramineae pollen in children with allergic rhinoconjunctivitis. Materials and methods: The patients aged 5-18 years with allergic rhinoconjunctivitis were included in the study. The patients were divided in two groups. One group received ASIT, the other was control group that did not. The control group, in which participant have similar age and similar duration of disease. Visual analogue score (VAS), daily symptom score (dSS), daily medications score (dMS) and combined symptom and medication score (CSMS) were evaluated at three times points: baseline, after ASIT for first and second year. Results: 188 children with a diagnosis of allergic rhinoconjunctivitis were included in the study. 94 of the patients had received immunotherapy.105 (55.9%) of the patients were male, the median age was 14 (min-max: 7-18 years). In the group of patients who received ASIT; there was statistically significant decreases in VAS, dSS, dMS and CSMS through one and two years therapy in comparison to the baseline values (p < 0.001). When the group of patients receiving ASIT was compared with the control group after two years of follow-up, there was a significant decrease in VAS, dSS, dMS and CSMS (p <0.001). Systemic reaction was occurred in five (5.3%) patients. Conclusion: The current study demonstrated that ASIT with gramineae pollen is clinically effective in patients with graminae pollen induced allergic rhinoconjunctivitis.

Efficacy of Ultrasound-Guided Injection of Botulinum Toxin, Ozone, and Lidocaine in Piriformis Syndrome.

Background: Piriformis syndrome (PS) is a painful musculoskeletal condition characterized by a deep gluteal pain that may radiate to the posterior thigh and leg. This study was designed to compare the effectiveness of ozone and BTX to lidocaine injection in treating piriformis syndrome that was resistant to medication and/or physical therapy. Study design: Between November 2018 and August 2019, we involved eighty-four subjects diagnosed with piriformis syndrome in a double-blinded, prospective, randomized comparative study to receive an ultrasound-guided injection of lidocaine (control group), botulinum toxin A, or local ozone (28 patients each group) in the belly of the piriformis muscle. Pain condition evaluated by the visual analog score (VAS) was used as a primary outcome, and the Oswestry Disability Index (ODI) as a secondary outcome, before, at one month, two months, three months, and six months following the injection. Results: The majority (58.3%) of patients were male, while (41.7%) were female. At one month, a highly significant decrease occurred in VAS and ODI in the lidocaine and ozone groups compared to the botulinum toxin group (p < 0.001). At six months, there was a highly significant decrease in VAS and ODI in the botulinum toxin group compared to the lidocaine and ozone groups (p < 0.001). Conclusion: Botulinum toxin may assist in the medium- and long-term management of piriformis syndrome, while lidocaine injection and ozone therapy may help short-term treatment in patients not responding to conservative treatment and physiotherapy.

A Randomized Controlled Trial to Assess the Efficacy of a Pre-operative Virtual Operation Theatre Tour on Anxiety and Patient Satisfaction in Adults Undergoing Elective Surgery.

The study objective involves the evaluation of preoperative audiovisual information on the operation theater environment as a tool to relieve anxiety in patients posted for infra umbilical elective surgery under spinal anesthesia. Perioperative anxiety is detrimental to both intraoperative hemodynamic instability and postoperative recovery. The design was a single-center, prospective, randomized control trial. There were 120 patients in this study within the 18-60-year-old age range who were American Society of Anaesthesiologists (ASA)class I-II admitted for infra-umbilical surgery excluding lower segment cesarean section (LSCS) under spinal anesthesia. Patients were randomized into two groups: those who were not exposed to an audiovisual tour (NA) (n = 60) and those who were exposed to an audiovisual tour (A) (n = 60). The measurements are based on the demographic details of the patient; the visual analogue score (VAS); and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) for anxiety, hemodynamic parameters i.e., blood pressure (BP), heart rate (HR), respiratory rate (RR), and patient satisfaction score (PSS) on a five-point Likert scale were noted perioperatively for both the groups. The main results showed a significant (p-value <0.05) decrease in VAS and APAIS for anxiety, HR, and PSS. This was observed during the intraoperative and postoperative periods in the A group in comparison to the NA group. The preoperative audiovisual virtual tour of the operation theater effectively reduces perioperative anxiety and stabilizes HR; it also improves the satisfaction of patients undergoing elective surgery under spinal anesthesia.

Comparison of the Analgesic Effectof Intramuscular Pethidine andIntramuscular Morphine on anOrthopedic Population in a CaribbeanTerritory

Introduction: Comparison of the analgesic effect of Intramuscular Pethidine and Intramuscular Morphine on an Orthopedic Population. Settings and Design: 1) Single Blinded Randomized Controlled study: Patients were divided into Morphine group or Pethidine group 2) Patient Satisfaction survey was administered to patients at the end of stay. Material and Methods: 1) Visual Analogue Scores (VAS) were taken at eight hourly intervals for three consecutive days or until the day of discharge. Incidence of opioid related complications was noted 2) A patient satisfaction survey was administered at the end of stay. Statistical Analysis: Average VAS during movement on day one during the 8am to 4pm period was calculated for both the morphine group and pethidine group. The percentage decrease in VAS was calculated for morphine vs. pethidine group on movement on Day 1. Pearson’s correlation was used to assess the relationship between opioid, side effects and overall patient satisfaction. T-test was used to evaluate the relationship between morphine, pethidine and twenty-four-hour pain relief.A one-way ANOVA test was used to evaluate the statistical significance between the morphine and the pethidine group and patient satisfaction. Results: The morphine group as compared with the pethidine group experienced an 18.5% decrease in Visual Analogue Score for pain on movement on day 1 (8 am-4 pm period). The morphine group was associated more drowsiness and prolonged time to first bowel action compared to the pethidine group. Only 1.4% (1) of patients experienced desaturation during the study which occurred in the morphine group. Overall, opioids were associated with minimal side effects and were generally safe to use. Patients who underwent regional anaesthesia used more morphine equivalents compared to those undergoing general anaesthesia. The morphine group was associated with overall increased patient satisfaction when compared to the Pethidine group. Conclusion: The study demonstrated a notable 18.5% decrease in VAS on movement with the morphine group as compared to pethidine group. Statistical significance was placed at 15%. Opioids were found to have a limited adverse side effect profile, with drowsiness and time to first bowel action being the most predominant. Only one patient representing 1.4% of the population had an episode of desaturation (Sp02 < 90%). Due to the minimal side effect profile opioids should be considered safe to use.

Is There Clinical Improvement Associated With Intradiscal Therapies? A Comparison Across Randomized Controlled Studies.

Study Design:Post hoc comparison using single-site data from 4 multicenter randomized controlled trials.Objectives:Discogenic back pain is associated with significant morbidity and medical cost. Several terminated, unreported randomized controlled trials have studied the effect of intradiscal biologic injections. Here we report single-center outcomes from these trials to determine if there is clinical improvement associated with these intradiscal injections.Methods:Post hoc comparison was performed using single-site data from 4 similar multi-center randomized controlled trials. All trials evaluated an injectable therapy (growth factor, fibrin sealant, or stem cells) for symptomatic lumbar disc disease with near-identical inclusion and exclusion criteria. Demographics and patient reported outcomes were analyzed across treatment arms postinjection.Results:A total of 38 patients were treated with biologic agents and 12 were treated with control saline injections. There was a significant decrease in visual analogue score (VAS) pain for both the investigational and saline groups up to 12 months postinjection (P < .01). There was no significant difference in VAS scores between the saline and investigational groups at 12 months. Similarly, there was significant improvement in patient-reported disability scores in both the investigational and saline groups at all time points. There were no significant differences in disability score improvement between the saline and investigational treatment groups at 12 months postinjection.Conclusions:A single-center analysis of 4 randomized controlled studies demonstrated no difference in outcomes between therapeutic intradiscal agents (growth factor, fibrin sealant, or stem cells) and control saline groups. In all groups, patient reported pain and disability scores decreased significantly. Future studies are needed to evaluate the therapeutic benefit of any intradiscal injections.

Significant immunomodulatory properties of curcumin in patients with osteoarthritis; a successful clinical trial in Iran

Osteoarthritis (OA) routinely is known as a multifactorial degenerative joint disease. This trial aimed to assess the curcumin (an active element of turmeric) effects on the immune responses in OA patients. Thirty patients were selected according to the American College of Rheumatology (ACR) criteria and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and equally divided into the two groups; intervention (received Sinacurcumin® 80 mg daily) and placebo, followed for 3 months. In the intervention group, our data showed a noticeably decrease in Visual Analog Score (VAS), C-reactive protein (CRP), CD4+ and CD8+ T cells, Th17 cells and B cells frequency. Additionally, Treg cells indicated a significant increase and Treg/Th17 cells ratio showed a meaningfully shifted toward Treg lymphocytes. In conclusion, our data indicated that clinical manifestation was ameliorated considerably following the administration of curcumin. Moreover, our data demonstrated the immunomodulatory effects of curcumin in OA patients.

Lateral Flexor Digitorum Longus Transfer for Peroneal Tendinopathy

Category:SportsIntroduction/Purpose:Flexor digitorum longus (FDL) transfer to the lateral foot for concomitant irreparable rupture of the peroneal tendons has been reported in few clinical series. The purpose of this study is to provide midterm outcomes including subjective outcome scores, clinical examination data, and objective power after single-stage FDL tendon transfer.Methods:Twenty-five consecutive patients over a 7 year period (2008-2015) underwent FDL to fifth metatarsal transfer for irreparable peroneal tendon tears. Fifteen patients with a mean follow-up of 53.7 months completed the pain visual analog score (VAS), Foot Function Index (FFI), Short Musculoskeletal Functional Assessment (SMFA), and Foot and Ankle Ability Measure (FAAM) scores and participated in range of motion, peak force, and peak power testing.Results:All 15 patients were satisfied with their surgery and reported a reduction in their pain level with the average decrease in VAS of 5.59 +/- 2.5 (range: 1 - 9). The mean FAAM was 86.4 +/- 9.7 (range: 52.4 - 100). The mean FFI was 12.8 +/- 9.2 (range: 0 - 21.4). The mean SMFA Function index was 12.4 +/- 8 and the mean SMFA Bothersome Index was 11.5 +/- 11. Patients had on average 58% less eversion and 28% less inversion compared to the nonoperative side. Both isometric peak torque and isotonic peak velocity were decreased by 38.4% and 28.8%, respectively. On average, power in the operative limb was diminished by 56% compared to the nonoperative limb.Conclusion:FDL transfer to the lateral foot for significant, non-reconstructable peroneal tendinopathy is an effective, and durable treatment option.

A single dose of bone marrow mononuclear cells (BMMNCs) and bone marrow aspirate concentrate (BMAC) for the treatment of knee OA. First 6 months of follow up.

Background & Aim Autologous mesenchymal stem cells have been utilized to treat degenerative orthopedic conditions for more than two decades. The intra-articular injection of the Bone Marrow Mononuclear Cells (BMMNCS) seems to be a safe manipulation for the treatment of Knee Osteoarthritis (Knee OA). Also, Bone Marrow Aspirate Concentrate (BMAC) is one of the best options in USA. The aim of this study is to evaluate safe and effectiveness of a single dose from a double concentration of Autologous Stem Cell Product. Methods, Results & Conclusion This is a level I, prospective, descriptive study, between January and June 2018. 21 patients, range: 55-88 years, with knee OA Kellgren Lawrence (K-L) grade III and IV received one intra-articular injection of BMMNCs and BMAC in a same syringe (8ml) in a medium dose of 1.26 × 10 (9)/ml Mononuclear Cells and 650.000/ml Platelets. The main symptoms of knee osteoarthritis and tissue structure changes were evaluated after 6 months comparing the Visual Analogue Score (VAS) and Knee Injury and Orthopedic Outcome Score (KOOS) at different times. The initial VAS value varied between 4 and 10 with the median being equal to 8.5 in the patients. Initial KOOS varied between 13.4 and 70.1 with the median being equal to 35.7. In order to evaluate the evolution of patients with respect to their knees and associated problems, the KOOS and VAS scores were calculated at the initial time and some time later (between 1-2 months in 10 patients, between 2-3 months in 9 patients, and between 4-6 months in 10 patients). The VAS and KOOS medians were compared in each of the moments versus the initial moment. The decrease in VAS was not significant in the moments 1-2 months (p = 0.375) and 2-3 months (p = 0.202) but was in the 4-6 months (p = 0.036). The increase in KOOS was significant at all times (1-2 months: p = 0.016, 2-3 months: p = 0.004 and 4-6 months: p = 0.0016). All KOOS sub-scales were significant at 4-6 months. No adverse effects were detected.

Home-based Application of Sphenopalatine Ganglion Block for Head and Neck Cancer Pain Management.

Background:Head and neck cancer pain is intractable and difficult to manage. Many a times it is difficult to treat with oral opioids and adjuvants.Aim:This study aims to study the effects of transnasal sphenopalatine ganglion block (SPGB), administered using cotton swab/ear bud by patients’ caretaker, at home, for pain management.Study Design:This is a prospective, single-arm observational study conducted on 100 head and neck cancer patients, from January 2014 to December 2015. Patients and caretaker were given a demonstration of the procedure using sterile cotton swab/ear buds. They were advised to repeat the procedure when their visual analog score (VAS) was more than 5. They continued with the oral analgesics. They kept the records of pre- and post-procedure pain score (VAS), the frequency of repetition, ease of performance of procedure, and morphine requirement. A paired t-test (SPSS software) was used for statistical analysis.Results:A significant reduction in pain was noted by a decrease in mean VAS from 8.57 ± 1.31 to 2.46 ± 1.23 (P < 0.0001), immediately on first administration. The mean duration of analgesia was 4.95 ± 3.43 days. Pre- and post-procedure mean morphine requirement were 128.2 ± 84.64 and 133.8 ± 81.93 (P > 0.05) mg per day, at the end of 2 months. Ease of performance was observed in 88 patients.Conclusion:The home-based application of SPGB is an easy, safe, and cost-effective method to manage cancer pain. It provides excellent immediate pain relief with a minimum side effect. It can be performed bilaterally, repeatedly and even with a feeding tube in place.

Postoperative analgesia of ultrasound guided rectus sheath catheters versus continuous wound catheters for colorectal surgery: A randomized clinical trial

PurposeThe purpose of this study was to evaluate the postoperative analgesia and morphine requirements of ultrasound guided rectus sheath catheters versus continuous wound catheters in midline open colorectal surgery patients.MethodsSixty patients of both sexes aged 40–65 years were randomized into 2 equal groups to receive postoperative analgesia through either a wound catheter continuous infusion (group I) or rectus sheath catheters (group II). The trial is registered in the Australian New Zealand Clinical Trials Registry: ACTRN12615000636550.ResultsHeart rate and mean arterial blood pressure increased significantly in group I at 12 and 24 h as compared to time 0 and 48 h (P < 0.05). There was a significant increase in heart rate and mean arterial blood pressure in group I as compared to group II at all-time intervals (p < 0.05). There was a significant decrease in Visual analogue score at rest and with movement and in group II as compared to group I at all-time intervals (p < 0.05). Concerning the need for rescue analgesia, 8 patients (26%) in group I required rescue analgesia; 7 patients of them required only one dose and one patient required two doses. In group II two patients (6.6%) required rescue analgesia, and both required one dose. The total morphine consumption was lower and the patient satisfaction was better in group II compared with group I (p = 0.005). There were no serious complications in the two groups.ConclusionUltrasound-guided rectus sheath catheters provided better postoperative analgesia compared with wound catheter continuous infusion for colorectal surgery without undesirable side effects.

Does anodal transcranial direct current stimulation modulate sensory perception and pain? A meta-analysis study

ObjectiveThe primary aim of this systematic review was to evaluate the effects of anodal transcranial direct current stimulation (a-tDCS) on sensory (STh) and pain thresholds (PTh) in healthy individuals and pain levels (PL) in patients with chronic pain. MethodsElectronic databases were searched for a-tDCS studies. Methodological quality was examined using the PEDro and Downs and Black (D&B) assessment tools. Resultsa-tDCS of the primary motor cortex (M1) increases both STh (P<0.005, with the effect size of 22.19%) and PTh (P<0.001, effect size of 19.28%). In addition, STh was increased by a-tDCS of the primary sensory cortex (S1) (P<0.05 with an effect size of 4.34). Likewise, PL decreased significantly in the patient group following application of a-tDCS to both the M1 and dorsolateral prefrontal cortex (DLPFC). The average decrease in visual analogue score was 14.9% and 19.3% after applying a-tDCS on the M1 and DLPFC. Moreover, meta-analysis showed that in all subgroups (except a-tDCS of S1) active a-tDCS and sham stimulation produced significant differences. ConclusionsThis review provides evidence for the effectiveness of a-tDCS in increasing STh/PTh in healthy group and decreasing PL in patients. However, due to small sample sizes in the included studies, our results should be interpreted cautiously. Given the level of blinding did not considered in inclusion criteria, the result of current study should be interpreted with caution. SignificanceSite of stimulation should have a differential effect over pain relief.

Catheter Virtual Lumbar Discectomy (Early and 5 Year Follow-up Results) A New Minimally Invasive Alternative, on an Outpatient Bases

Background: After at least six weeks of conservative management of lumbar disc disease patients, some will require additional treatment. Surgeries available do not offer clear, safe options free of complications in all cases. Moreover, some reported postoperative complications are more difficult to treat than the original illness. I am offering a new modified intervention for such cases. Objectives: The purpose of this study was to assess the safety and effectiveness of epidural cocktail instillation for lumbar degenerative diseases, confirm its indications, and evaluate the clinical outcomes of patients. Study Design: Patients were prospectively selected to receive catheter virtual discectomy (CVD) in a prospective, randomized, blinded, crossover cohort study. Setting: The enrollment took place from January 2007 through February 2012 in major tertiary Hospitals in Cairo, including Cairo University Hospitals, Naser Institute Hospital, and Al-Helal Hospital. Material & Methods: A total of 100 patients underwent epidural cocktail injections for lumbar degenerative indications by one neurological spine surgeon. The mean follow-up was 48 months. Outcomes Assessment: After one week, one month and every 3 month thereafter, for the first year, then yearly, the pain was assessed using visual analogue score (VAS). Any decrease in VAS of more than two scales was defined as a significant VAS improvement. Patients were screened for any major or minor complications. The patients were then followed for three up to five years to determine the outcome of treatment. Follow-up images were taken to assess results and determine any injection-related issues. Results The most prevalent diagnoses were disc bulges, especially in young ages. The mean severity of LBP decreased by 80% at 3-month follow-up, and 60% at 1-year follow-up. The results of pain relief were best at early follow-up visits. Forty two patients (70%) stated that they would undergo this procedure again. The late 5 year follow up, if not superimposed by an additional new insult, and after exclusion of the 14 patients who did not complete the study, had a stationary clinical course. Limitations: Fourteen patients did not complete the study, with reasons ranging from loss to follow-up (not returning) to pursuing exclusion criteria items. Eighty six patients were included in the final analysis. Conclusion Despite the supposed argue, the current study provides evidence that immediate pain relief and increase in function can be provided by the epidural cocktail injections with a very low rate of morbidity. The follow-up images showed, in addition to the clinical improvement, definite structural decrease of the disc bulges in a way as if discectomy was done without any surgical or interventional intervention. That is why the name catheter virtual discectomy (CVD) was introduced.

Clinical Course of Pain in Acute Osteoporotic Vertebral Compression Fractures

The authors prospectively determined the natural course of pain in patients with conservatively treated acute osteoporotic vertebral compression fractures (VCF). In addition, the type of conservative therapy that these patients received was assessed. Patients older than 50 years, referred for spine radiography for acute back pain, were asked to complete a baseline clinical questionnaire. Patients with an acute VCF were followed up at 6 and 23 months with a questionnaire that included a Visual Analog Score (VAS) and type of pain medication and other conservative treatment. Significant pain relief was defined as a decrease in VAS of 50% or more. Forty-nine patients (mean age, 78 years; range, 51-95) with acute VCF were followed up for almost 2 years. Significant pain relief was noted in 22 of 35 patients (63%) at 6 months and in 25 of 36 (69%) at 23 months. In patients with persisting pain at 23 months (mean VAS 6.4), some decrease in VAS was apparent at 6 months but not in the 6-23 months interval. No predictors for significant pain relief could be identified. Patients with significant pain relief used less pain medication and had less physical therapy. In most patients with an acute VCF, pain decreases significantly with conservative therapy, predominantly in the first 6 months. However, almost 2 years after an acute VCF, a third of patients still had severe pain necessitating pain medication and physical therapy in the majority. No predictors for transition from acute to chronic pain could be identified.

Prospective randomized non‐blinded clinical trial on the use of dapsone plus antihistamine vs. antihistamine in patients with chronic idiopathic urticaria

Treatment of chronic idiopathic urticaria (CIU) is difficult. The purpose of this study was to evaluate the efficacy and safety of dapsone in CIU. The response to dapsone was evaluated in 65 CIU patients with a randomized, two armed study: 3-month dapsone + desloratadin and 3-month desloratadin. All were followed for up to 3 months and 3 months after; all took desloratadine 10 mg daily throughout the study. The primary measure of efficacy was a daily urticaria activity score (UAS) of weal numbers and itch (maximum score, 42 per week). Sixty-five patients completed the randomized 3-month trial medication. Mean reduction in UAS from baseline at 3 months was 7 [95% confidence interval (95% CI), 6.92-7.08] for active group and 5.77 (95% CI, 5.47-6.08) for control subjects (P < 0.001). The reduction in visual analogue score (VAS) at 3 months for active group (mean, 2.58; 95% CI, 2.33-2.83) and control subjects (mean, 2.55; 95% CI, 2.38-2.73) was also significant (P < 0.001). The reduction of UAS and VAS at 3 months compared between active group and control subjects showed no significant difference. Mean reduction in UAS from the end of the study at 3 months after was 1.16 and -4.8 for active and control subjects, respectively. These results were compared with each other, and it was statistically significant (P <or= 0.05). No placebo was used. The study was not blinded. Lack of blinding may have led to bias. The follow-up period was short. This study shows that dapsone leads to a persistent decrease in VAS and UAS and is associated with complete remission in some patients.

A Controlled Trial of Naloxone Infusions for the Pruritus of Chronic Cholestasis

To test the hypothesis that opioid agonist activity contributes to the pruritus of cholestasis, a placebo-controlled single-blinded trial of naloxone, an opioid antagonist, was conducted in eight patients with primary biliary cirrhosis. After discontinuation of all conventional antipruritic medications, one or two continuous (24-hour) IV infusions of naloxone (0.2 micrograms.kg-1.min-1) and placebo solution were administered consecutively in an order that was not predetermined. Pruritus was assessed subjectively by means of four hourly recordings of a visual analogue score. In addition, objective measurements of scratching activity that were independent of gross body movements were continuously recorded using an apparatus specifically designed to measure the frequencies associated with this activity. No side effects associated with naloxone infusions were observed. Only scratching activity data obtained for the same periods of day and night during both naloxone and placebo infusions were compared. Naloxone infusions were consistently associated with a decrease in values of the scratching activity index. In addition, in 50% of the patients the infusions were associated with a decrease in visual analogue score. The mean decrease in scratching activity ranged from 29% to 96% (mean, 50%; P less than 0.001). These findings imply that increased opioid agonist activity contributes to scratching activity in cholestatic patients.

A controlled trial of naloxone infusions for the pruritus of chronic cholestasis

To test the hypothesis that opioid agonist activity contributes to the pruritus of cholestasis, a placebo-controlled single-blinded trial of naloxone, an opioid antagonist, was conducted in eight patients with primary biliary cirrhosis. After discontinuation of all conventional antipruritic medications, one or two continuous (24-hour) IV infusions of naloxone 0.2 μg · kg−1 · min−1) and placebo solution were administered consecutively in an order that was not predetermined. Pruritus was assessed subjectively by means of four hourly recordings of a visual analogue score. In addition, objective measurements of scratching activity that were independent of gross body movements were continuously recorded using an apparatus specifically designed to measure the frequencies associated with this activity. No side effects associated with naloxone infusions were observed. Only scratching activity data obtained for the same periods of day and night during both naloxone and placebo infusions were compared. Naloxone infusions were consistently associated with a decrease in values of the scratching activity index. In addition, in 50% of the patients the infusions were associated with a decrease in visual analogue score. The mean decrease in scratching activity ranged from 29% to 96% (mean, 50%; P < 0.001). These findings imply that increased opioid agonist activity contributes to scratching activity in cholestatic patients.