Decrease In Pain Intensity Research Articles

Pengaruh Pijat Endorphin Terhadap Penurunan Intensitas Nyeri Persalinan Di BPM Sagita Darma Sari Palembang Tahun 2023

Background: Childbirth is a series of events when a baby is released from the mother's womb, followed by the expulsion of the placenta and fetal membranes from the mother's body. The main problem that is usually complained of by labor patients in labor during the first active phase is that pain causes the mother to feel stressed and excessively worried. Respiration and pulse will also increase thereby disrupting the supply of fetal needs from the placenta. The simple way that can be done to reduce labor pain is to give endorphins massage. Objective: Knowing the analysis of differences in pain intensity in the active phase of labor in the first stage of labor before endorphin massage and after endorphin massage. Method: This study used a quasy experimental design. This type of research is pre-experimental design with one group pret test-post test design. Results: The results of the study obtained by the researchers were 20 respondents during the active phase of the first active phase of brenatal mothers who experienced severe pain with a scale of 7-9 and very severe 10 as measured by a numeric rating scale. Before doing the endorphin massage, it was found that those who experienced pain on average had a minimum of 5 and a maximum of 10 after the endorphin massage had an average minimum of 4 pain and a maximum of 9. Conclusion: There is a difference in the decrease in pain intensity in labor in labor during the 1st active phase before and after being given endorphine massage treatment.

Effectiveness of exercise on pain intensity and physical function in patients with knee and hip osteoarthritis: an umbrella and mapping review with meta-meta-analysis

Purpose The aim of this review was to provide a qualitative and quantitative overview of the effects of exercise on pain, physical function, and quality of life for patients with knee and hip osteoarthritis. Materials and methods This study was an umbrella and mapping review with meta-meta-analysis. Meta-analyses of randomized controlled trials were included. The methodological quality and risk of bias were evaluated using the Modified Quality Assessment Scale for Systematic Reviews and the Risk of Bias in Systematic Reviews tool. The quality of evidence was evaluated using the Physical Activity Guidelines Advisory Committee Grading Criteria. Results 41 meta-analyses were included, 43.9% of the studies had adequate methodological quality, and 56.1% of the studies had a low risk of bias. Moderate evidence was found that exercise decreases pain intensity (33 meta-analyses; SMD = −0.49; 95% CI −0.56 to −0.42), improves function (19 meta-analyses; SMD = −0.50; 95% CI −0.58 to −0.41), strength (6 meta-analyses; SMD = −0.57; 95% CI −0.70 to −0.44) and quality of life (SMD = −0.36; 95% CI −0.46 to −0.27) for patients with hip and knee osteoarthritis. Conclusion Exercise is an effective intervention to decrease pain intensity and improve function in patients with hip and knee osteoarthritis. (PROSPERO, CRD42020221987)

АНАЛИЗ ФАКТОРОВ, АССОЦИИРУЮЩИХСЯ С УХУДШЕНИЕМ КАЧЕСТВА ЖИЗНИ И ЭМОЦИОНАЛЬНОГО СОСТОЯНИЯ ПОСЛЕ ОПЕРАЦИИ ПО КОРРЕКЦИИ ПРИОБРЕТЕННЫХ ПОРОКОВ СЕРДЦА

Introduction. The assessment of factors associated with the deterioration of the quality of life (QOL) and emotional state after heart surgery suggests the possibility of their timely elimination and, as a result, a faster return to working capacity and socialization of a patient with acquired heart disease. Target. Identification of factors affecting the deterioration of QoL and emotional state of patients undergoing surgical correction of acquired heart valve defects in the postoperative period. Materials and methods. The study included 103 patients (median age 60.0 years [51.0; 66.0]) from November 2020 to October 2022 who underwent surgical correction of mitral valve disease or in combination with correction of aortic valve disease and /or tricuspid valves. To assess the level of QOL, patients filled out the questionnaire "Shot Form-36 health status survey" (SF-36), to assess the emotional state of the Hospital Anxiety and Depression Scale (HADS) before surgical treatment, on the 7th, 30th day, a year later after the intervention. Results. According to regression analysis, the presence of preoperative atrial fibrillation (AF) was associated with a decrease in the physical component of health according to the SF-36 questionnaire by B-factor = -6.39; p=0.002 before surgery, and B-factor = -10.92; p=0.03 one week after the operation, as well as with a decrease in the mental health component on the 30th day (B-coefficient = -12.66; p=0.006). With an increase in age by 1 unit, the initial level of the physical component of health decreased by B-coefficient = -0.21 (p=0.014). There was an association of males with levels of anxiety (B-value = 3.58; p=0.002) and depression (B-value = 3.04; p=0.002) assessed before and one week after surgery: B-value = 2.34; p=0.03 and B-factor=2.47; p=0.02, respectively, as well as with a higher level of anxiety after a month (B-factor = 2.79; p=0.03). Patients were divided into groups with the presence (group 1) or absence (group 2) of pulmonary hypertension (PH) before surgery according to echocardiography. On the 7th day after the operation, group 1 noted an improvement in mental health (MH; p=0.03), regardless of the increase in the intensity of the pain syndrome (BP; p=0.005). Patients without PH noted a worsening of QoL in terms of self-service and freedom of movement (PF, p=0.04), because of the pain syndrome they considered their QoL to be lower compared to preoperative (BP; p=0.03). On the 7th day in the group without PH, the median level of anxiety decreased by 3 points, in the group with PH only by 1.5 points (p=0.04). The level of depression by the 30th day decreased to 1 point in both groups, remaining stable throughout the year. A month later, the PH group noted an increase in physical capabilities (PF; p=0.03), an increase in overall health (GH; p=0.003), an increase in physical (p<0.0001) and mental (p=0.006) components of QoL , and patients without PH indicated a limitation in the performance of work duties (RP, p=0.047). During the year after the operation, the PH group noted a decrease in pain intensity (BP, p=0.003), an improvement in the emotional state (RE, p=0.04), an increase in the possibility of self-care and free movement (PF, p=0.00008), work responsibilities (RP, p=0.001), which increased overall health (GH, p=0.002), vitality (VT, p=0.0002) and increased social contacts (SF, p=0.001). The quality of life of patients from the group without PH improved only on three points with less significant dynamics: physical functioning (PF, p=0.03), pain intensity (BP, p=0.01) and vital activity (VT, p=0.04 ). Conclusion. The factors influencing the deterioration of QoL and emotional state after surgical correction of PPS are: the presence of preoperative AF, male gender. And the presence of PH before defect correction is associated with better QoL and emotional status after the intervention compared to patients without PH, which may be due to a more severe condition before surgery in people with PH.

Efficacy of Massage on Pain Intensity in Post-Cesarean Women: a Systematic Review and Meta-Analysis.

Cesarean section is a common surgical procedure that may be considered a safe alternative to natural birth and helps to resolve numerous obstetric conditions. Still, the Cesarean section is painful; relieving pain after a Cesarean section is crucial, therefore analgesia is necessary for the postoperative period. However, analgesia is not free of complications and contraindications, so massage may be a cost-effective method for decreasing pain post-Cesarean. Our study aims to determine the massage role in pain intensity after Cesarean sections. We searched five electronic databases for relevant studies. Data were extracted from the included studies after screening procedures. We calculated the pooled mean difference (MD) and standardized mean difference (SMD) for our continuous outcomes, using random or fixed-effect meta-analysis according to heterogenicity status. Interventional studies were assessed for methodological quality using the Cochrane risk-of-bias assessment tool, while observational studies were assessed using the National Institutes of Health's tools. Our study included 10 RCTs and five observational studies conducted with over 1,595 post-Cesarean women. The pooled MDs for pain intensity considering baseline values either immediately or post 60-90 minutes were favoring the massagegroup over the control group as follows:(stand. MD = -2.64, 95% CI [-3.80, -1.48], p >.00001; MD = -2.64, 95% CI [-3.80, -1.48], p >.00001, respectively). While pooled MDsregarding post-intervention only eitherimmediately or post 60-90 minutes were:(stand. MD = -2.04, 95% CI [-3.26, -0.82], p =.001; stand. MD = -2.62, 95% CI [-3.52, -1.72],p > .00001, respectively). Our study found that using massage was superior to the control groups in decreasing pain intensity either when the pain was assessed immediately after or 60-90 minutes post-massage application.

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.