Decrease In Severity Of Pain Research Articles

A Small Randomized Controlled Pilot Trial Comparing Mobile and Traditional Pain Coping Skills Training Protocols for Cancer Patients with Pain

Psychosocial pain management interventions are efficacious for cancer pain but are underutilized. Recent advances in mobile health (mHealth) technologies provide new opportunities to decrease barriers to access psychosocial pain management interventions. The objective of this study was to gain information about the accessibility and efficacy of mobile pain coping skills training (mPCST) intervention delivered to cancer patients with pain compared to traditional in-person pain coping skills training intervention. This study randomly assigned participants (N = 30) to receive either mobile health pain coping skills training intervention delivered via Skype or traditional pain coping skills training delivered face-to-face (PCST-trad). This pilot trial suggests that mPCST is feasible, presents low burden to patients, may lead to high patient engagement, and appears to be acceptable to patients. Cancer patients with pain in the mPCST group reported decreases in pain severity and physical symptoms as well as increases in self-efficacy for pain management that were comparable to changes in the PCST-trad group (p's < 0.05). These findings suggest that mPCST, which is a highly accessible intervention, may provide benefits similar to an in-person intervention and shows promise for being feasible, acceptable, and engaging to cancer patients with pain.

Childhood Irritable Bowel Syndrome Characteristics Are Related to Both Sex and Pubertal Development

To determine the relationship of both pubertal development and sex to childhood irritable bowel syndrome (IBS) clinical characteristics including gastrointestinal symptoms (eg, abdominal pain) and psychological factors. Cross-sectional study with children ages 7-17 years (n = 143) with a pediatric Rome III IBS diagnosis recruited from both primary and tertiary clinics between January 2009 and January 2014. Subjects completed 14-day prospective pain and stool diaries, as well as validated questionnaires assessing several psychological factors (somatization, depression, anxiety) and Tanner stage. Stool form ratings were completed using the Bristol Stool Form Scale. Girls with higher Tanner scores (more mature pubertal development) had both decreased pain severity and pain interference; in contrast, boys with higher Tanner scores had both increasing pain severity (β = 0.40, P = .02) and pain interference (β = 0.16, P = .02). Girls (vs boys), irrespective of pubertal status, had both increased somatic complaints (P = .005) and a higher percentage (P = .01) of hard (Bristol Stool Form Scale type 1 or 2) stools. Pubertal status and sex did not significantly relate to IBS subtype, pain frequency, stooling frequency, anxiety, or depression. In children with IBS, both pubertal development and/or sex are associated with abdominal pain severity, stool form, and somatization. These differences provide insight into the role of pubertal maturation during the transition from childhood to adult IBS.

A Randomized, Controlled Trial of Wholistic Hybrid Derived From Eye Movement Desensitization and Reprocessing and Emotional Freedom Technique (WHEE) for Self-Treatment of Pain, Depression, and Anxiety in Chronic Pain Patients

In this pilot study, a convenience sample of 24 chronic pain patients (17 with chronic fatigue syndrome/fibromyalgia) were randomized into WHEE treatment and wait-list control groups for 6 weeks. Assessments of depression, anxiety, and pain were completed before, during, and at 1 and 3 months after treatment. Wait-listed patients then received an identical course of WHEE and assessments. WHEE decreased anxiety ( P < .5) and depression ( P < .05) compared with the control group. The wait-list-turned-WHEE assessments demonstrated decreased pain severity ( P < .05) and depression ( P < .04) but not pain interference or anxiety. WHEE appears a promising method for pain, anxiety, and depression in patients with chronic pain, compared to standard medical care alone. Though a small pilot study, the present results suggest that further research appears warranted. An incidental finding was that a majority of patients with chronic pain had suffered psychological trauma in childhood and/or adulthood.

Radiographic, Surgeon and Owner Assessment of the BioMedtrix TATE(®) Elbow Arthroplasty.

To report the long-term radiographic and clinical outcome of the BioMedtrix TATE elbow arthroplasty system in dogs. Assessment was via radiographs, a surgeon-based questionnaire, and owner assessment of outcome using the Liverpool osteoarthritis in dogs (LOAD) and canine brief pain inventory (CBPI) questionnaires. Retrospective multicenter, case series. Client-owned dogs undergoing TATE elbow arthroplasty. Questionnaires were distributed to surgeons in the United Kingdom performing TATE elbow arthroplasty and to the owners of the dogs operated on. Owners completed the LOAD and CBPI questionnaires. All completed questionnaires from surgeons and owners, and radiographs of the dogs were collated and analyzed. Surgeon questionnaires and radiographs were obtained for 33 elbows from 32 dogs, with owner questionnaires obtained for 19 dogs. Perioperative, short-term, and mid-term complication rates were 60%, 15%, and 15%, respectively. Radiographic assessment of component alignment showed 62% of cartridges were valgus or varus malaligned and 56% of cartridges were either translated medially or laterally relative to the long axis of the ulnar. There was no significant association between component alignment and final clinical outcome. Surgeon assessment reported 24% of dogs to have full, 52% acceptable, and 24% unacceptable outcome. Owner assessment showed significant decreases in pain severity and pain interference from preoperative to final status but no change in mobility scores. A high complication rate and variability in component placement was recorded with TATE athroplasty. However, component malalignment did not negatively impact clinical outcome. Final clinical outcome was favorable for most cases with significant reductions in pain severity and interference scores despite no changes in mobility scores.

Effect of Eccentric Exercise in Treatment of De-Quervian's Disease

Objective: This study was carried to determine the effect of eccentric exercises in treatment of De Quervian’s disease Methods: Thirty female patients diagnosed as De Quervian’s tenosynovitis was randomly distributed into two equal experimental groups. Each patient was treated for twelve sessions each other day for a total period of four weeks. Patients in the experimental group (A) received phonophoresis, while patients in the experimental group (B) received a combined program of phonophoresis identical to those applied to group (A) in addition to eccentric exercises then visual analogue scale (VAS) was used to assess pain severity. The disability of arm, shoulder and hand outcome questionnaire (DASH) was used to assess hand functions. Jamar’s dynamometer and pinch gauge were used to assess hand grip and pinch strength. Results: Patients of both groups showed significant improvement in all the measured variables. In between group difference, the second group showed a significant improvement than the first group in all the measured variables. Conclusion: Both of phonophoresis and the combination of phonophoresis with eccentric exercise were effective on decreasing pain severity, functional disability as well as improving grip and pinch strength. However, the combination of phonophoresis with eccentric exercise was more effective than phonophoresis alone in treatment of De Quervian’s disease.

A Prospective Evaluation of Shared Decision-making Regarding Analgesics Selection for Older Emergency Department Patients With Acute Musculoskeletal Pain.

Musculoskeletal pain is a common reason for emergency department (ED) visit by older adults. Outpatient pain management following ED visits in this population is challenging as a result of contraindications to, and side effects from, available therapies. Shared decision-making (SDM) between patients and emergency physicians may improve patient experiences and health outcomes. Among older ED patients with acute musculoskeletal pain, we sought to characterize their desire for involvement in the selection of outpatient analgesics. We also sought to assess the impact of SDM on change in pain at 1 week, patient satisfaction, and side effects. This was a prospective study of adults aged 60 years and older presenting to the ED with acute musculoskeletal pain. Participants' desire to contribute to outpatient analgesic selection was assessed by phone within 24 hours of ED discharge using the Control Preferences Scale and categorized as active, collaborative, or passive. The extent to which SDM occurred in the ED was also assessed within 24 hours of discharge using the 9-item Shared Decision Making Questionnaire, and scores were subsequently grouped into tertiles of low, middle, and high SDM. The primary outcome was change in pain severity between the ED visit and 1 week. Secondary outcomes included satisfaction regarding the decision about how to treat pain at home, satisfaction with the pain medication itself, and side effects. Desire of participants (N = 94) to contribute to the decision regarding selection of outpatient analgesics varied: 16% active (i.e., make the final decision themselves), 37% collaborative (i.e., share decision with provider), and 47% passive (i.e., let the doctor make the final decision). The percentage of patients who desired an active role in the decision was higher for patients who were college educated versus those who were not college educated (28% vs. 11%; difference 17%, 95% confidence interval [CI] = 0% to 35%), received care from a nurse practitioner versus a resident or an attending physician (32% vs. 9%; difference 23%, 95% CI = 4% to 42%), or received care from a female versus a male provider (24% vs. 5%; difference 19%, 95% = CI 5% to 32%). After potential confounders were adjusted for, the mean decrease in pain severity from the ED visit to 1-week follow-up was not significantly different across tertiles of SDM (p = 0.06). Higher SDM scores were associated with greater satisfaction with the discharge pain medications (p = 0.006). SDM was not associated with the class of analgesic received. In this sample of older adults with acute musculoskeletal pain, the reported desire of patients to contribute to decisions regarding analgesics varied based on both patient and provider characteristics. SDM was not significantly related to pain reduction in the first week or type of pain medication received, but was associated with greater patient satisfaction.

The effect of Laser and taping on pain, functional status and quality of life in patients with fibromyalgia syndrome: A placebo- randomized controlled clinical trial.

Conservative treatments have been proved to be effective to control pain and optimize function in fibromyalgia, however there is need for scientific evidence to make better clinical application across various physiotherapy applications. The aim of this study was to investigate the effects of Laser and taping applications on pain, flexibility, anxiety, depression, functional status and quality of life in patients with fibromyalgia syndrome. Forty-five female patients with fibromyalgia syndrome were included to the study and randomly allocated into three treatment groups; Laser (n= 15), placebo Laser (n= 15), and taping applications (n= 15). Visual analogue scale for pain intensity, trunk flexibility, Fibromyalgia Impact Questionnaire for functional status, Short Form 36 Questionnaire for quality of life and health status, and Beck Depression Inventory for anxiety level were evaluated before and after three weeks interventions. There were decreased pain severity in activity (p= 0.028), anxiety level (p= 0.01) and improved general health status, quality of life (p= 0.01) found at Laser group, whereas there were increased trunk flexibility, flexion (p= 0.03), extension (p= 0.02) found at taping group. After interventions, there were decreased pain severity for whole groups at night for Laser group (p= 0.04), placebo Laser group (p= 0.001), taping group (p= 0.01) and improved functional status found for Laser group (p= 0.001), placebo Laser group (p= 0.001), taping group (p= 0.01). Kinesiotape application had a similar effect on parameters in FMS patient, so this method could be preferred instead of Laser application for rehabilitation program.

Comparison of aceclofenac and combination (Aceclofenac + Thiocolchicoside) therapy in acute low back pain patients

A prospective observational assessment of pain severity for acute low back pain patients conducted over a period of 12 months in ESI hospital, ayanavaram. In this study, 200 patients with acute low back pain were included and out of this 100 patients were given Aceclofenac and remaining 100 were given combination (Aceclofenac + Thiocolchicoside) therapy and the patients were selected based on the inclusion and exclusion criteria. During the study period, 26 patients from group A and 21 patients from Group B did not come for follow-up. Out of 200 patients, 46.5% were males and 53.5% were females. The intensity of the pain relief was 8.3 on day 0, 6.5 on day 3 and 3.9 on day 7 for Aceclofenac and 8.1 on day 0, 5.5 on day 3 and 2.5 on day 7 for combination (Aceclofenac + Thiocolchicoside) therapy. Out of 153 patients, 21 of them had no change, 10 of them had poor, 27 of them had moderate 10 of them had good and 06 of them had excellent efficacy for Aceclofenac therapy and 05 of them had no change, 09 of them had poor, 32 of them had moderate, 23 of them had good and 10 of them had excellent efficacy on combination (Aceclofenac + Thiocolchicoside) therapy. In this study we found that decrease in severity of pain at discharge assessed by VAS was more pronounced within patients receiving Aceclofenac + Thiocolchicoside as compared to patients receiving Aceclofenac therapy.

Role of vitamin E in management of mastalgia without a palpable lump

Background: Mastalgia also known as mastodynia/mammodynia/mazoplasia is defined as a dull ache or heaviness in the breast. It is a common and troubling condition occurring in about 60-70% of women at some stage of their lives. Mastalgia without a palpable lump poses a significant problem to the surgeons. Mastalgia can significantly affect the quality of life in some women. The major question that worries the patient is the risk of malignancy. Reassurance plays a key role. This study was done to assess the role of vitamin E in treating mastalgia. Methods: 700 patients who presented to surgical OPD with chief complaint of mastalgia between August 2013 and August 2015 in a tertiary care hospital were examined. 660 of these patients had a palpable lump. 40 patients who complained of pain in one or both breasts but without a palpable lump were included in the study. Severity of pain was marked on pain grading scale. Biochemical tests for lipid peroxidation i.e., malondialdehyde (MDA) and superoxide dismutase (SOD) which are markers of oxidative stress were assessed on first visit. Women complaining of mastalgia but without a palpable breast lump were treated by administration of vitamin E (cap. evion) 200 mg once daily for 3 months and reassessed both clinically and biochemically. Results: Women treated by vitamin E for 3 months showed a decrease in severity of pain as measured by numerical pain rating scale. Biochemical analysis showed significant decrease in oxidative stress markers MDA and SOD. Conclusions: Oxidative stress is the primary cause for mastalgia without a palpable lump. Vitamin E at a dosage of 200 mg once daily for 3months has a significant role in the management of such cases.

A Randomized Controlled Trial of Core Strengthening Exercises in Helicopter Crewmembers with Low Back Pain.

The purpose of this study was to determine if five core strengthening exercises would decrease pain severity and related disability in U.S. Air Force helicopter aircrew members with low back pain. The study was a randomized control group repeated measures design. The experimental manipulation consisted of a set of five core strengthening exercises performed 4 d/wk for 12 wk. Self-reported pain severity and disability were ascertained at baseline and 12 wk using the Numerical Pain Rating Scale (NPRS) and Modified Oswestry Low Back Pain Disability Index (MODI), respectively. The NPRS was used to ascertain both daily pain (NPRS(daily)) and in-flight pain (NPRS(flight)). Self-reported improvement or deterioration in low back pain was measured using the Global Rating of Change Scale (GRCS). There were 12 subjects enrolled and 5 were randomized to the intervention group. The mean NPRS(flight) score decreased 1.8 points vs. increasing 0.1 points during the trial for the intervention and control groups, respectively. The mean MODI score decreased 4.8 points vs. increasing 1.7 points during the trial for the intervention and control groups, respectively. The mean GRCS score at the end of the trial was 4.0 vs. 0 for the intervention and control groups, respectively. There was no difference between groups in terms of mean NPRS(daily) scores. Core strengthening exercises were effective in reducing in-flight pain and led to a reduction in pain symptoms and disability over the 12-wk study period as compared to those subjects who maintained their regular exercise regimen.

Short-term effects of anterior and posterior capsular stretching in frozen shoulder

The aim of this study is to investigate the short-term effects of stretching on pain, flexibility and range of movement in frozen shoulder. Thirty-six voluntary subjects diagnosed with frozen shoulder were included. Subjects were randomly separated into two groups; Group 1 (n=19) was received coldpack and posterior capsule stretching exercise, Group 2 (n=17) was received coldpack, posterior and anterior capsule stretching exercises. Pain severity, range of motion and posterior capsule tightness were assessed in one-week follow-up. Group 1 showed decreased pain severity during activity and posterior capsule tightness and increased shoulder flexion and active internal rotation at the end of the week (p .05). Short-term stretching exercises were resulted in decreased pain and increased range of motion in frozen shoulder. Posterior and anterior capsule stretching exercises were recommended to apply in early rehabilitation of frozen shoulder based on improvements in active total elevation as a functional outcome.

Drug therapy for treating post-dural puncture headache.

This is an updated version of the original Cochrane review published in Issue 8, 2011, on 'Drug therapy for treating post-dural puncture headache'.Post-dural puncture headache (PDPH) is the most common complication of lumbar puncture, an invasive procedure frequently performed in the emergency room. Numerous pharmaceutical drugs have been proposed to treat PDPH but there are still some uncertainties about their clinical effectiveness. To assess the effectiveness and safety of drugs for treating PDPH in adults and children. The searches included the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 6), MEDLINE and MEDLINE in Process (from 1950 to 29 July 2014), EMBASE (from 1980 to 29 July 2014) and CINAHL (from 1982 to July 2014). There were no language restrictions. We considered randomised controlled trials (RCTs) assessing the effectiveness of any pharmacological drug used for treating PDPH. Outcome measures considered for this review were: PDPH persistence of any severity at follow-up (primary outcome), daily activity limited by headache, conservative supplementary therapeutic option offered, epidural blood patch performed, change in pain severity scores, improvements in pain severity scores, number of days participants stay in hospital, any possible adverse events and missing data. Review authors independently selected studies, assessed risk of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because the included studies assessed different sorts of drugs or different outcomes. We performed an intention-to-treat (ITT) analysis. We included 13 small RCTs (479 participants) in this review (at least 274 participants were women, with 118 parturients after a lumbar puncture for regional anaesthesia). In the original version of this Cochrane review, only seven small RCTs (200 participants) were included. Pharmacological drugs assessed were oral and intravenous caffeine, subcutaneous sumatriptan, oral gabapentin, oral pregabalin, oral theophylline, intravenous hydrocortisone, intravenous cosyntropin and intramuscular adrenocorticotropic hormone (ACTH).Two RCTs reported data for PDPH persistence of any severity at follow-up (primary outcome). Caffeine reduced the number of participants with PDPH at one to two hours when compared to placebo. Treatment with caffeine also decreased the need for a conservative supplementary therapeutic option.Treatment with gabapentin resulted in better visual analogue scale (VAS) scores after one, two, three and four days when compared with placebo and also when compared with ergotamine plus caffeine at two, three and four days. Treatment with hydrocortisone plus conventional treatment showed better VAS scores at six, 24 and 48 hours when compared with conventional treatment alone and also when compared with placebo. Treatment with theophylline showed better VAS scores compared with acetaminophen at two, six and 12 hours and also compared with conservative treatment at eight, 16 and 24 hours. Theophylline also showed a lower mean "sum of pain" when compared with placebo. Sumatriptan and ACTH did not show any relevant effect for this outcome.Theophylline resulted in a higher proportion of participants reporting an improvement in pain scores when compared with conservative treatment.There were no clinically significant drug adverse events.The rest of the outcomes were not reported by the included RCTs or did not show any relevant effect. None of the new included studies have provided additional information to change the conclusions of the last published version of the original Cochrane review. Caffeine has shown effectiveness for treating PDPH, decreasing the proportion of participants with PDPH persistence and those requiring supplementary interventions, when compared with placebo. Gabapentin, hydrocortisone and theophylline have been shown to decrease pain severity scores. Theophylline has also been shown to increase the proportion of participants that report an improvement in pain scores when compared with conventional treatment.There is a lack of conclusive evidence for the other drugs assessed (sumatriptan, adrenocorticotropic hormone, pregabalin and cosyntropin).These conclusions should be interpreted with caution, due to the lack of information to allow correct appraisal of risk of bias, the small sample sizes of the studies and also their limited generalisability, as nearly half of the participants were postpartum women in their 30s.

Percutaneous ultrasound-guided celiac plexus neurolysis in advanced upper abdominal cancer pain

Back groundThe alleviation of suffering in cancer patients is universally acknowledged as a cardinal goal of medical care. Celiac plexuses neurolysis is an effective technique in decreasing pain severity in patients suffering from upper abdominal cancer as it decreases analgesic requirements. ObjectiveThis study aims to evaluate the efficacy of ultrasound-guided celiac plexus neurolysis (CPN) in controlling pain in patients with upper abdominal cancer pain. Materials & MethodsUltrasound-guided CPN was done for 21 adult patients suffering from upper abdominal cancer pain using ethanol (50%) as a neurolytic agent. Visual analog scale (VAS) score was used to assess the degree of pain relief immediately after injection at 1week, 1month and 3months post-neurolysis. ResultsMarked decrease of pain severity in all patients was noted as a sharp fall of the VAS score in the 1st day after CPN with relatively stationary course for 3months. Baseline VAS score was 9.1±0.85. One day after CPN, pain severity decreased markedly to 1.4±0.71. One week after CPN the decrease in pain severity was maintained at the same level 1.6±0.89. One month after CPN the decrease in pain severity maintained at the same level 2±0.79 .3months after CPN, pain severity decreased significantly to 2.3±1.02. ConclusionUltrasound-guided CPN is an effective method for reducing pain of upper abdominal cancer.

An Educational Intervention to Reduce Pain and Improve Pain Management for Malawian People Living With HIV/AIDS and Their Family Carers: A Randomized Controlled Trial

ContextAdvances being made in improving access to HIV drugs in resource-poor countries mean HIV patients are living longer, and, therefore, experiencing pain over a longer period of time. There is a need to provide effective interventions for alleviating and managing pain. ObjectivesTo assess whether a pain educational intervention compared with usual care reduces pain severity and improves pain management in patients with HIV/AIDS and their family carers. MethodsThis was a randomized, parallel group, superiority trial conducted at HIV and palliative care clinics of two public hospitals in Malawi. A total of 182 adults with HIV/AIDS (Stage III or IV) and their family carers participated; carer participants were those individuals most involved in the patient's unpaid care. The educational intervention comprised a 30 minute face-to-face meeting, a leaflet, and a follow-up telephone call at two weeks. The content of the educational intervention covered definition, causes, and characteristics of pain in HIV/AIDS; beliefs and myths about pain and pain medication; assessment of pain; and pharmacological and nonpharmacological management. The primary outcome was average pain severity measured by the Brief Pain Inventory-Pain Severity subscale. Assessments were recorded at baseline before randomization and at eight weeks after randomization. ResultsOf the 182 patient/carer dyads randomly allocated, 157 patient/carer dyads completed the trial. Patients in the intervention group experienced a greater decrease in pain severity (mean difference = 21.09 points, 95% confidence interval = 16.56–25.63; P < 0.001). ConclusionA short pain education intervention is effective in reducing pain and improving pain management for Malawian people living with HIV/AIDS and their family carers.

Efecto de la lidocaína venosa intraoperatoria sobre el dolor e interleucina-6 plasmática en pacientes sometidas a histerectomía

Background and objectivesInterleukin-6 (IL-6) is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma IL-6 after hysterectomy. MethodA prospective, randomized, comparative, double-blind study with 40 patients, aged 18-60 years. G1 received lidocaine (2mg.kg−1.h−1) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24hours), first analgesic request, and dose of morphine in 24hours were evaluated. IL-6 was measured before starting surgery (T0), 5hours after the start (T5), and 24hours after the end of surgery (T24). ResultsThere was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0±104.4min) than in G1 (26.7±23.3min). There was no difference in supplemental dose of morphine between G1 (23.5±12.6mg) and G2 (18.7±11.3mg). There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5±364.1ng.ml−1 in T5 and 30.1±14.2ng.ml−1 in T24. ConclusionIntravenous lidocaine (2mg.kg−1.h−1) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy.

Effect of intraoperative intravenous lidocaine on pain and plasma interleukin-6 in patients undergoing hysterectomy

Background and objectivesInterleukin-6 is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma interleukin-6 after hysterectomy. MethodA prospective, randomized, comparative, double-blind study with 40 patients, aged 18–60 years. G1 received lidocaine (2mgkg−1h−1) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24h), first analgesic request, and dose of morphine in 24h were evaluated. Interleukin-6 was measured before starting surgery (T0), 5h after the start (T5), and 24h after the end of surgery (T24). ResultsThere was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0±104.4min) than in G1 (26.7±23.3min). There was no difference in supplemental dose of morphine between G1 (23.5±12.6mg) and G2 (18.7±11.3mg). There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5±364.1ngmL−1 in T5 and 30.1±14.2ngmL−1 in T24. ConclusionIntravenous lidocaine (2mgkg−1h−1) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy.

Efeito da lidocaína venosa intraoperatória sobre dor e interleucina‐6 plasmática em pacientes submetidas a histerectomia

Background and objectivesInterleukin‐6 (IL‐6) is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma IL‐6 after hysterectomy. MethodA prospective, randomized, comparative, double‐blind study with 40 patients, aged 18‐60 years. G1 received lidocaine (2mg.kg−1.h−1) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24hours), first analgesic request, and dose of morphine in 24hours were evaluated. IL‐6 was measured before starting surgery (T0), five hours after the start (T5), and 24hours after the end of surgery (T24). ResultsThere was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0±104.4min) than in G1 (26.7±23.3min). There was no difference in supplemental dose of morphine between G1 (23.5±12.6mg) and G2 (18.7±11.3mg). There were increased concentrations of IL‐6 in both groups from T0 to T5 and T24. There was no difference in IL‐6 dosage between groups. Lidocaine concentration was 856.5±364.1 ng.mL−1 in T5 and 30.1±14.2 ng.mL−1 in T24. ConclusionIntravenous lidocaine (2mg.kg−1.h−1) did not reduce pain severity and plasma levels of IL‐6 in patients undergoing abdominal hysterectomy.

Comparison of Therapeutic Effects of Magnesium Sulfate vs. Dexamethasone/Metoclopramide on Alleviating Acute Migraine Headache

BackgroundThere is controversy about the efficacy of currently used treatment modalities to alleviate migraine headaches. ObjectiveWe aimed to evaluate and compare the effects of magnesium sulfate and combined use of dexamethasone/metoclopramide on relieving acute migraine headache. MethodsWe randomly divided 70 patients who had been referred to an emergency department, into two equal treatment groups with the two treatment plans, and analyzed pain severity at baseline using a numeric rating scale (NRS). We gave dexamethasone/metoclopramide to one group and magnesium sulfate to the other group, and evaluated pain severity at 20 min and at 1- and 2-h intervals after infusion. Finally, we used repeated-measure and two-way analysis of variance for intra- and inter-group evaluations of pain severity and complications, respectively. ResultsWe found no significant differences in demographic data and pain severity at baseline (8.2 vs. 8.0) between the two groups (p < 0.05). In the dexamethasone/metoclopramide group, pain severity (mean ± standard deviation) was 7.4 ± 1.4 (p = 0.36), 6.0 ± 2.4, and 2.5 ± 2.9 (p < 0.0001) at 20-min, 1-h, and 2-h intervals after treatment, respectively, with statistically significant differences between the baseline values and 1-h and 2-h interval values. Administration of magnesium sulfate was associated with decreased pain severity at the three intervals (5.2 ± 1.7, 2.3 ± 1.9, and 1.3 ± 0.66, respectively), exhibiting significant differences compared to baseline values and the corresponding time intervals in the dexamethasone/metoclopramide group (p < 0.0001). ConclusionsAccording to the results, magnesium sulfate was a more effective and fast-acting medication compared to a combination of dexamethasone/metoclopramide for the treatment of acute migraine headaches.

(154) The moderating effect of sleep fragmentation on the association of sleep duration and pain in adults with sickle cell disease

Poor sleep is typically inversely associated with pain severity. However, the influence of sleep architecture on clinical pain has not yet been systematically investigated in adults living with Sickle Cell Disease (SCD). Daily diaries are the gold standard for assessing time-variant fluctuations of sleep and pain in daily life. The purpose of the present study was to examine the relationship between daily reports of SCD pain and parameters of sleep architecture, including total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO). It was hypothesized that the relationship between TST and SCD pain would be qualified by levels of sleep fragmentation (i.e., WASO) and latency. Seventy-seven (77) adults with SCD completed daily morning (sleep) and evening (pain) diaries over a three-month period. Hierarchical linear model (HLM) with a random intercept was used to examine daily between-subjects and within-subjects effects of TST on SCD pain, as well as moderating effect of changes in WASO and SOL on pain over the study period. Results of the HLM analysis confirmed an inverse main effect of TST on self-reported pain whereby increasing TST was associated with decreased pain severity. Analyses also revealed a negative moderating effect of WASO, but not SOL, on the daily relationship between TST and pain. The moderating effect of WASO remained significant even after controlling for baseline depression and pain anxiety, two characteristics which are known to be positively associated with pain severity. These results suggest that both sleep duration and sleep fragmentation are associated with self-reported pain in adults with SCD. In particular, increased sleep duration has a positive effect on self-reported pain, but sleep fragmentation may diminish this effect. Taken together, the results suggest that reducing sleep fragmentation (WASO) may increase the positive benefit of increased sleep duration on pain.

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

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