Frequency Of Analgesic Use Research Articles

Surgical outcomes and prognosis of intracorporeal versus extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matching study

This study compared the surgical outcomes and long-term prognosis of intracorporeal and extracorporeal esophagojejunostomy after laparoscopic total gastrectomy (LTG) for gastric cancer patients. In total 228 clinical stage I gastric cancer patients undergoing LTG were enrolled from January 2012 and December 2022. Each case in the totally laparoscopic total gastrectomy (TLTG) group was 1:1 propensity score-matched to control cases in the laparoscopy-assisted total gastrectomy (LATG) group. In total, 95 and 93 LATG and TLTG patients were included after propensity score matching (PSM). Clinicopathological features, surgical outcomes, and survival variables were compared, and risk factors for postoperative complications were analyzed. Patient characteristics were well balanced between the LATG and TLTG groups after PSM. The TLTG group showed less blood loss, decreased frequency of analgesic use, and shorter duration of analgesic use. The TLTG group had significantly lower rates of intestinal obstruction and surgical site infection. Larger tumor size and advanced pTNM stage were independent risk factors for postoperative complications. There was no significant difference in overall survival (OS). Compared with LATG, TLTG was associated with better surgical outcomes and fewer postoperative surgical complications in gastric cancer patients although there was no significant difference in OS.

Real-world experiences of migraine patients on Erenumab: a Kuwait single center cohort

ABSTRACT Background Migraine is a prevalent headache disorder with a significant impact on the quality of life. This study aims to investigate the effectiveness and safety of erenumab, mAb targeting the CGRP receptor, in treating chronic (CM) and episodic (EM) migraine in clinical practice Kuwait, providing region-specific insights to treatment options. Method This was a prospective observational cohort study of patients diagnosed with EM or CM treated with erenumab. The primary outcome of the study was to assess the proportion of patients achieving ≥ 50% reduction in monthly mean migraine days, and several changes including the mean number of monthly migraine days, the frequency of analgesic use, attack severity, AEs, and QoL. Results The study included 151 patients with a mean age of 44.0±11.4 years, and 81.9% female. The primary outcome was achieved in 74.2% of patients, with a significant (p < 0.001) reduction in headache frequency, pain severity, analgesic use, and improvement in QoL. Age and duration of migraine were significant predictors of achieving a ≥ 50% reduction in headache frequency after therapy (OR = 0.955; p = 0.009) and (OR = 0.965; p = 0.025), respectively. Treatment compliance was observed in 76.2% of patients, and 24.5% discontinued treatment. Constipation was the most commonly reported AEs (6.0%), and conservative management was the most common approach to managing AEs. Conclusion Erenumab was effective in reducing the frequency and severity of migraine attacks and improving QoL, and safe with manageable AEs in a real-world setting in Kuwait. Further research is needed to better understand erenumab’s effectiveness and safety in different populations and settings, as well as to compare it with other migraine prophylactic treatments.

Popping Pills in Youth Elite Sports-Fact or Fiction? A 36-Week Prospective Cohort Study of Analgesic Use in 1195 Youth Elite Athletes and Student Controls.

OBJECTIVE: To investigate analgesic use in a cohort of Danish youth elite athletes and compare weekly analgesic use over 36 weeks to student controls. We also investigated and compared reasons for analgesic use and types of analgesics used. DESIGN: Prospective cohort study. METHODS: Six hundred ninety youth elite athletes (44% females) and 505 student controls (59% females) (aged 15-20 years) provided weekly reports on analgesic use over 36 weeks. We asked about the number of days with analgesic use, reasons for use, and types of analgesics used. Prevalence and frequency of analgesic use was compared between youth elite athletes and student controls using mixed-effects logistic regression and mixed-effects Poisson regression models. Reasons for and types of analgesics used were compared between groups using chi-square tests. Subgroup analyses were performed, stratified by sex. RESULTS: Overall, athletes had lower odds of analgesic use (odds ratio = 0.78; 95% confidence interval [CI], 0.64 to 0.95) compared with student controls. The overall usage rate was similar between the groups (incidence rate ratio = 1.04; 95% CI, 0.99 to 1.11). Subgroup analyses suggested no statistically significant differences in the odds of analgesic use. Significantly more athletes reported using analgesics to prevent or treat pain or injury in relation to sports participation and to use topical gels compared with student controls. CONCLUSION: Participating in youth elite sports was associated with lower odds of analgesic use compared to student controls, but usage rate was similar between the groups. Reasons for use and types of analgesics used differed between athletes and student controls. J Orthop Sports Phys Ther 2024;54(8):551-559. Epub 9 May 2024. doi:10.2519/jospt.2024.12407.

The Impact of Self-acupressure on the Pain, Joint Stiffness, and Physical Functioning of Patients With Knee Osteoarthritis

Background: People with knee osteoarthritis have a low quality of life due to joint pain and stiffness, severely limiting their daily activities. This study aims to investigate the impact of self-acupressure on the pain, joint stiffness, and physical functioning of patients with knee osteoarthritis. Methods: This randomized clinical trial was conducted on 78 patients aged 50 to 70 with knee osteoarthritis, referred to Imam Khomeini Hospital and private orthopedic clinics in Ahvaz City, Iran, in 2018. The patients were recruited based on the inclusion criteria and then randomly assigned to three groups: self-acupressure (n=26), sham (n=26), and control (n=26). Patients in the intervention group applied daily self-acupressure to 5 specific points around their knees for 8 consecutive weeks. The sham group applied pressure on the points different from those used by the intervention group. The control group received no intervention. The study data were collected using the Western Ontario and McMaster osteoarthritis index (WOMAC), visual analog scale (VAS), and a checklist for daily recordings of pain medication. The obtained data were analyzed using the chi-square test and analysis of variance in SPSS software, version 20. The significance level was set at P&lt;0.05. Results: The comparison of changes within the group showed that the intensity of pain in the intervention group decreased over time (P&lt;0.0001). Also, the joint stiffness, physical functioning, and total WOMAC score significantly decreased in the intervention group (P&lt;0.0001). The frequency of analgesic use was also reduced in the intervention group over time (P=0.026). Conclusion: According to the results, self-acupressure effectively reduces the intensity of pain and joint stiffness and improves the physical performance of older adults with knee osteoarthritis. Overall, this easy and affordable intervention is recommended for this group.

Prevalence of sport-relatedanalgesic use in German elite handball Players

With its high physical demands on players’ bodies and high rates of injury, elite-level handball constitutes an ideal environment for studying analgesic use. We aimed to investigate the career and season prevalence of sport-related analgesics use among elite youth and elite senior handball players. We explored the frequency of analgesic use on practice and competition days within one season. The sample consisted of 459 elite handball players (233 female, 226 male). Sport-related analgesic use was assessed with two replicable measures of prevalence complemented by two frequency measures. χ2 analyses were performed to determine group differences in prevalences for gender, age group, contract situation, and role within the team. We conducted hierarchical binomial linear regression analyses for the analgesic prevalences to evaluate the prediction of the prevalences from the independent variables. The sport-related career prevalence of analgesic use was 70.7% (95% CI[66.6, 74.9]). Throughout one season, 55.6% (95% CI[51.0-60.1]) of handball players used analgesics. Gender, age, contract status, and role within the team seemed to impact the use of analgesics. Further, analgesics were used significantly more often on competition than on practice days. Our findings indicate that the sport-related use of analgesics is relatively common among elite handball players, with female players, senior players, players with a contract, and perceived rotation players reporting significantly higher career and season prevalences. Therewith, our findings offer a starting point for targeted prevention strategies.

Analgesic efficacy of modified thoracoabdominal nerves block through the perichondrial approach in laparoscopic cholecystectomy: A retrospective study with propensity analysis.

Modified thoracoabdominal nerves block through the perichondral approach (M-TAPA) was recently reported to provide broad analgesia with only a single injection of local anesthetics (LA) on each side. However, the effectiveness of M-TAPA in laparoscopic cholecystectomy (LC) is not often reported. We retrospectively evaluated the analgesic efficacy of M-TAPA in patients who underwent LC and compared it with conventional LA infiltration (LAI) by calculating the propensity score. The primary outcome was the frequency of analgesic use after surgery. Although there was no difference in the frequency of analgesic use within 48 hours (P=.063), there was significantly less analgesic use 24-48 hours after surgery in the TAPA group (P=.02). Intraoperative remifentanil administration also significantly decreased in the TAPA group (P < .001). We found that pre-incisional M-TAPA may have an advantage over LAI with respect to analgesia on postoperative day 1.

The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: A prospective cohort study with a one-year followup.

BackgroundAnalgesics are the most common form of managing low back pain (LBP). No previous study has examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for LBP and its related activity limitation.MethodsThis cohort study forms part of the AUstralian Twin low BACK pain study, investigating the impact of physical activity on LBP. Information on demographics, LBP and health‐related factors, including physical activity, were collected at baseline. Data on the total counts of analgesic use and activity limitation for LBP were collected weekly for one‐year. Negative binomial regression models were conducted separately for each type of physical activity. Results were presented as incidence rate ratios (IRRs) and 95% confidence intervals (CIs).ResultsFrom an initial sample of 366 participants, 86 participants reported counts of analgesic use and 140 recorded counts of activity limitation across the follow‐up period. The negative binomial regression models for analgesic use counts indicated that engagement in moderate‐vigorous physical activity was protective for use of analgesics (IRR 0.97, 95% CI 0.96–0.99), while physical workload was associated with greater use (IRR 1.02, 95% CI 1.01–1.05). No other significant relationships were observed for the other measures of physical activity. For activity limitation counts, engagement in leisure activity was associated with less counts of activity limitation (IRR 0.94, 95% CI 0.81–0.99), while greater amounts of sedentary time was associated with higher counts (IRR 1.04, 95% CI 1.01–1.09). No other significant relationships were observed for the other measures of physical activity.ConclusionsOur findings highlight the potential importance of supporting engagement in moderate–vigorous and leisure physical activity as well as minimizing sedentary time and physical workload to reduce the risk of activity limitation and the need for analgesic use in people with LBP.SignificanceWe examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for low back pain and its related activity limitation. Engaging in moderate–vigorous and leisure physical activity as well as minimizing sedentary time and physical workload has the potential to reduce the risk of activity limitation and the need for analgesic use in people with low back pain.

Real-time ultrasound-guided stellate ganglion block for migraine: an observational study

ObjectiveTo observe whether ultrasound-guided stellate ganglion block (SGB) can effectively relieve migraine pain and improve the quality of migraine patients’ life.Methods81 patients with migraines were enrolled in this study. The patients received SGB with 6 ml of 0.15% ropivacaine once every week for four times. Migraine was assessed with the Migraine Disability Assessment Scale (MIDAS) at baseline and three-months follow-up (Tm). The numerical rating scale (NRS) score at baseline, one day after treatment (Td) and Tm, the frequency of analgesic use in 3 months and the side effects were also recorded at the same time.ResultsThe NRS score of migraine subjects decreased significantly from 7.0 (2.0) to 3.0 (1.0) at Td and 2.0 (2.0) at Tm (vs baseline, P < 0.01). The MIDAS total scores were 14.0 (10.5) at baseline and 7.0 (4.5) at Tm (P < 0.001). During the three months, the frequency of analgesic consumption was decreased from 6.2 ± 2.8 to 1.9 ± 1.8. There were no serious side effects.ConclusionsThis study confirmed that ultrasound-guided SGB is an effective method to treat migraines. This technique can reduce pain and disability and then improve the quality of life of patients with migraines.

Physical Activity is Associated with Less Analgesic Use in Women Reporting Headache-A Cross-Sectional Study of the German Migraine and Headache Society (DMKG).

IntroductionThe aim of this analysis is to determine whether regular physical activity is associated with less analgesic use in men and women suffering from headache disorders based on population-based cross-sectional data.MethodsWe used data from a random general population sample in Germany that comprised 2477 participants aged ≥ 14 years. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey.ResultsThirty-nine percent of the participants reported headache. Of these, 37.5% of men and 33.6% of women were physically active. Of the participants with headache, 43.3% reported taking analgesics on < 2 days a month, 40.7% on 2–5 days a month, 10.1% on 6–10 days a month, and 5.9% on > 10 days a month. Frequent headache, severe impact of headache on daily life, and depressive symptoms were associated with higher analgesic use in both men and women. For women, physical inactivity was associated with the frequency of analgesic use adjusted for sociodemographic and headache-related variables. For men, results did not suggest any association between physical inactivity and frequency of analgesic use.ConclusionsThere are both sex-unspecific and sex-specific factors associated with analgesic use among men and women with headache. In women with increased analgesic use, promoting physical activity may reduce analgesic use. For men, education about the therapeutic effects of physical activity for headaches is an important resource.

Increased use of analgesics in midlife women but no association with mental stress: observations from the Prospective Population Study of Women in Gothenburg

BackgroundThe study is part of the ongoing Prospective Population Study of Women in Gothenburg, Sweden, initiated in 1968–1969 with the aim of characterising a total population of women who were representative of middle-aged females. The aim of the present study was to investigate the prevalence of actual analgesic use (prescribed and self-medication) and the possible association with perceived mental stress among women aged 38 and 50 years, respectively, in the Population Study of Women.MethodsTwo different cohorts of population-based samples of 38- and 50-year-old women examined in 2004–2005 and 2016–2017, respectively, were eligible participants. The women were representative for their age cohort at the time of the examinations. Use of medicines and especially analgesics, as well as perceived mental stress, was registered. Changes in medicine use among 38- and 50-year-old women between 2004 and 2005 and 38- and 50-year-old women in 2016–2017 were studied. Data were analysed using logistic regression. Use of analgesics and mental stress were analysed controlling for lifestyle factors, use of other medicines and pain.ResultsThe overall sample size across the time periods was 1,073 individuals. The frequency of analgesic use in 38- and 50-year-old women was about 26% in 2004–2005 and 58% in 2016–2017. 28% of women who reported high mental stress in 2004–2005 used analgesics, compared to 60% in 2016–2017. There were no associations between self-perceived mental stress and the use of analgesics.ConclusionThe higher use of analgesics among midlife women in 2016–2017 is in line with global findings and could be due to increased availability in Sweden of over the counter medicines. The impact of mental stress on analgesic use found previously by other researchers was not confirmed. However, medicine use as a potential coping strategy is an important public health issue that needs to be further explored.

Comparative Study of Postoperative Analgesic Effects of Intraoperative Levobupivacaine Local Infiltration Anesthesia and Transversus Abdominis Plane Block Following Gynecologic Laparoscopy.

We aim to assess the postoperative analgesic effect of intraoperative levobupivacaine local infiltration anesthesia (LA) and transversus abdominis plane (TAP) block in gynecologic laparoscopy. We conducted a retrospective analysis on the data of 260 patients treated by gynecologic laparoscopy (adnexal surgery, hysterectomy, and myomectomy) between January 2019 and December 2020 at Minoh City Hospital, Osaka Japan. Patients were divided into two groups: intraoperative LA group and TAP block group. We assessed clinical characteristics, surgical results, postoperative numerical rating scale (NRS) pain scores, and the frequency of analgesic use up to 24 h after surgery in overall and by each type of surgery. Pearson's χ2 test, Fisher's exact test, and Wilcoxon/Kruskal-Wallis test were used for statistical analysis. Multiple regression analysis was used for multivariate analysis. NRS pain score was statistically significantly higher in the LA group than in the TAP group 1 h after surgery in overall (P = 0.04), with NRS difference of 0.4 which was not clinically significant. No significant differences were observed in NRS pain scores at 3, 6, 12, and 24 h after surgery or in the frequency of analgesic use up to 24 h after surgery in overall and by type of surgery. Endometriosis was associated with increased postoperative pain at 1 h after surgery in adnexal surgeries (P = 0.04) and suggestive for all surgeries. Younger age was related to more frequency of analgesic use up to 24 h after surgery in overall, adnexal surgeries, and hysterectomy. Intraoperative levobupivacaine LA may have similar postoperative analgesic effects as TAP block in gynecologic laparoscopy.

Dydrogesterone in the treatment of endometriosis: evidence mapping and meta-analysis

PurposeEndometriosis is a common, chronic gynecological disease that affects women’s fertility potential. Dydrogesterone is an effective and safe drug that is under-utilized due to limited clinical research. The purpose of this evidence mapping is to identify, describe, and analyze the current available evidence regarding dydrogesterone for the treatment of endometriosis.Materials and methodsWe performed a search in electronic databases: Medline, The Cochrane Library, EMBASE, PubMed, CNKI, Wanfang, VIP, and CBM. We also hand-searched google for relevant studies. Our primary outcomes included changes in pain relief including pelvic pain, dysmenorrhea, and dyspareunia. Secondary outcomes included pregnancy rate, frequency of analgesic use, and other reported outcomes according to specific settings in the studies.ResultsOf 377 references screened, 19 studies were included in the data synthesis involving 1709 female participants. Nearly three-quarters were either randomized control trials or clinical control trials. Compared with gestrinone, dydrogesterone relieved dysmenorrhea, increased the pregnancy rate, and reduced the risk of certain adverse events. Compared with GnRH-a, dydrogesterone also lowered the risk of endometriosis recurrence and elevated transaminase levels. Whether there was any difference in efficacy between dydrogesterone and leuprolide acetate, letrozole or traditional Chinese medicine remains unclear due to insufficient data.ConclusionsThe amount and quality of evidence evaluating the effects of dydrogesterone for the treatment of endometriosis is generally very low. Limited evidence suggests that dydrogesterone may have some advantages over gestrinone, GnRH agonists, and other therapeutic interventions in treating endometriosis. However, this conclusion should be interpreted with caution.

Comparative efficacy of different exercise interventions in chronic non-specific low back pain: protocol of a systematic review and network meta-analysis

IntroductionChronic non-specific low back pain is a major public health problem. Evidence supports the effectiveness of exercise as an intervention. Due to a paucity of direct comparisons of different exercise...

The Prevalence of Self-Medication With Painkillers Among Iraqi Medical Students

BACKGROUND: The use of painkillers is widespread worldwide, some people experience unwanted side effects, and some may overuse them. Self-medication is the selection and use of medicines by individuals to treat self-recognized illnesses and collateral symptoms.&amp;nbsp;&amp;nbsp; &#x0D; &#x0D; OBJECTIVES: We aim to determine the prevalence and pattern of self-medication with painkillers among a population of undergraduate medical students in Baghdad.&#x0D; &#x0D; METHODS: We carried out a cross-sectional study, via convenient sampling, among 502 medical students (n=502) from the University of Baghdad, Al-Mustansirya University, Al-Kindy University, Al-Nahrain University, and Al-Iraqia University. We distributed an anonymous online questionnaire to the students. The survey included questions on demographic variables and information on self-medicating with painkillers during the academic year of 2018-2019.&#x0D; &#x0D; RESULTS: The prevalence of use of painkillers was 68.73%, 73% were females, and 27% were males. There was a statistically significant association between gender and the use of analgesics. Still, there was no statistically significant association between the academic level of students and analgesic use. The frequency of analgesic use per month was less than once (34.5%) of the participants, 1-3 times (37.1%), 4-6 times (14.2%), 7-9 times (7%), 10-12 times (3.1%), and more than 13 times (4%) of the participants. Most of the respondents (68%) reported that there was no difference in use between regular college days and exam days. The most common cause of use was headache (71%) for males and females, while dysmenorrhea was the second most common cause among female participants (36%). The most common source of information about analgesics relied on by the respondents was from friends (50.1%), family members, pharmacists, textbooks, the internet, and nurses. The most commonly used drug was Acetaminophen.&#x0D; &#x0D; CONCLUSION: Self-medication with analgesics is highly prevalent among undergraduate medical students in Baghdad, and we need to raise the awareness of the public on the potentials of addictive behavior.

Analgesic drug use in elderly persons: A population-based study in Southern Italy.

IntroductionAnalgesics such as non-steroidal anti-inflammatory drugs (NSAIDs), weak and strong opioids are commonly used among elderly persons. The aim of this study was to describe the demographic and clinical characteristics of elderly analgesic users and to measure the frequency of analgesic use, including the frequency of potentially inappropriate analgesic use.MethodsThe Arianna database was used to carry out this study. This database contains prescription data with associated indication of use for 1,076,486 inhabitants registered with their general practitioners (GPs) in the Caserta Local Health Unit (Caserta district, Campania region in Italy). A cohort of persons aged ≥65 years old with >1 year of database history having at least one analgesic drug (NSAIDs, strong or weak opioids) between 2010 and 2014 were identified. The date of the first analgesic prescription in the study period was considered the index date (ID).ResultsFrom a source population of 1,076,486 persons, 116,486 elderly persons were identified. Of these, 94,820 elderly persons received at least one analgesic drug: 36.6% were incident NSAID users (N = 36,629), while 13.2% were incident weak opioid users (N = 12,485) and 8.1% were incident strong opioid users (N = 7,658). In terms of inappropriate analgesic use, 9.2% (N = 10,763) of all elderly users were prescribed ketorolac/indomethacin inappropriately, since these drugs should not be prescribed to elderly persons. Furthermore, at least half all elderly persons with chronic kidney disease or congestive heart failure were prescribed NSAIDs, while these drugs should be avoided.ConclusionAnalgesics are commonly used inappropriately among elderly persons, suggesting that prescribing practice in the catchment area may yet be improved.

Effects of C8 nerve root block during interscalene brachial plexus block on anesthesia of the posterior shoulder in patients undergoing arthroscopic shoulder surgery: study protocol for a prospective randomized parallel-group controlled trial

BackgroundA classical approach to produce interscalene brachial plexus block (ISBPB) consistently spares the posterior aspect of the shoulder and ulnar sides of the elbow, forearm, and hand, which are innervated by the lower trunk of the brachial plexus (C8–T1). As an alternative to the classical approach, a caudal approach to ISBPB successfully produces anesthesia of the ulnar sides of the elbow, forearm, and hand. However, its beneficial effects on anesthesia in the posterior aspect of the shoulder have not been investigated. In addition, the C8 nerve root is not routinely selectively blocked during ISBPB. Therefore, we will compare the C5 to C7 and C5 to C8 nerve root blocks during a caudal approach to ISBPB to assess the clinical benefit of C8 nerve blocks for the surgical anesthesia of the posterior aspect of the shoulder.Methods/designIn this prospective parallel-group single-blind randomized controlled trial, 74 patients scheduled to undergo arthroscopic shoulder surgery under ISBPB are randomly allocated to receive the C5 to C7 or C5 to C8 nerve root block at a 1:1 ratio. The primary outcome is pain intensity, which is rated as 0 (no pain), 1 (mild pain), or 2 (severe pain), during the introduction of a posterior portal into the glenohumeral joint. The secondary outcomes are (1) the extent of the ipsilateral sensory, motor, hemidiaphragmatic, and stellate ganglion blockade, (2) changes in the results of a pulmonary function test, (3) incidence of complications related to ISBPB, (4) postoperative numerical pain rating scale scores, (5) patients’ satisfaction with the ISBPB, (6) dose and frequency of analgesic use, and (7) incidence of conversion to general anesthesia.DiscussionThis study is the first to evaluate the beneficial effects of the C8 nerve root block during ISBPB, which has rarely been performed due to the technical challenge in visualizing and blocking the C8 nerve root. It is expected that a C8 nerve root block performed during ISBPB will provide sufficient surgical anesthesia of the posterior aspect of the shoulder, which cannot be achieved by a classical approach to ISBPB.Trial registrationClicnicalTrials.gov, NCT03487874. Registered on 4 April 2018.

An international study of analgesic dependence among people with pain in the general population

Background: Overuse of and dependence on analgesics (including opioids and other pain medications) are major international public health problems. Objective: To identify influences on analgesic dependence among analgesic users in the general populations of different countries. Methods: Online surveys of 1,283 people with pain in the UK, USA, Australia, Germany, Egypt and China/Macau/Hong Kong. Results: Levels of analgesic overuse and dependence were highest in Egypt and lowest in China/Macau/Hong Kong. In every country except Egypt, frequency of pain and frequency of analgesic use were correlated with analgesic dependence, and scores on the Need subscale of the Pain Medication Attitudes Questionnaire (PMAQ) independently predicted analgesic dependence. In the UK, USA, Australia, and Germany, frequency of analgesic use mediated the effects of pain frequency or intensity, and Need scores mediated the effects of frequency of analgesic use. In Egypt, more recent pain, analgesic overuse, and the Emotion and Solicitude subscales of the Survey of Pain Attitudes independently predicted analgesic dependence. Conclusions: Across multiple countries, the impact of pain on analgesic dependence was mediated by frequency of analgesic use rather than overuse or abuse, and self-reported need for analgesics was the strongest independent predictor of dependence. Asking people directly about their feelings of needing analgesics could therefore identify those who could be helped to use analgesics less frequently, which should reduce their risk of dependence.

Pain experience in adults undergoing treatment: A longitudinal evaluation.

To quantify the intensity and duration of pain experience in adults over the initial three visits of fixed appliance-based orthodontic treatment. A secondary objective was to assess the relationship between pain experience and analgesic use, dental irregularity, gender, and age. A prospective longitudinal study design was adopted. Fifty-eight adults undergoing fixed appliance treatment in five orthodontic practices recorded pain experience at four time points (4 hours, 24 hours, 3 days, and 7 days) following the initial bond-up appointment (T0) and first (T1) and second (T2) routine follow-up adjustment appointments using a visual analogue scale. In addition, subjects recorded the dosage and frequency of analgesic use. A slightly greater proportion of women (57%) were recruited, with a mean sample age of 34.69 (SD 12.11) years. Peak pain was experienced between 24 hours and 3 days following appliance placement (T0) and subsequent adjustments (T1 and T2). The highest mean pain score arose at T0 followed by T2 and T1 adjustments, with the difference between pain levels at these appointment intervals being statistically significant ( P < .001). The use of analgesics following each appointment mirrored pain experience, with pain score, appointment, and time point all being significant predictors of analgesic consumption. The level of dental irregularity, gender, or age did not predict pain levels reported. Adults undergoing fixed orthodontic therapy should be advised that they are most likely to experience increased levels of pain for 1 to 3 days following placement of their appliance and subsequent adjustment visits.

Integrative versus Conventional Therapy of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children: A Prospective Observational Study

Background: Chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) are common entities in the pediatric population. The conventional treatment approach (conventional medicine; COM) involved mainly surgery after a period of close observation. In this study, we aimed to introduce an integrative, non-invasive approach (integrative medicine; IM) for COME, AH, and associated episodes of recurrent acute otitis media, and compared outcomes with conventional treatment. Methods: We conducted a prospective, non-randomized study in an integrative primary care pediatric practice and a conventional pediatric otolaryngological clinic, where treatment modality was determined by patient preference. Out of a total 101 patients aged 1-8 years, integrative therapy was chosen by 46, and conventional treatment by 55. All patients had COME and AH diagnosed by an otolaryngologist and had moderate to severe hearing impairment. COM treatment was based on close observation over time, nasal decongestants and surgical intervention. In contrast, the IM involved a complex personalized approach with non-invasive interventions, non-allopathic medications, diet and patient education. Results: The number of surgical interventions (adenoidectomy, pressure-equalization tube insertion, myringotomy) was significantly less in the IM cohort (1 of 28 vs. 15 of 35 in the COM group, p < 0.001). The frequency of antibiotic use was significantly less in the IM group (p < 0.001). The frequency of analgesic use was also significantly less in the IM group (p = 0.029). Improvement in tympanometric measures (normal A-type curve) was higher in IM patients compared to expected spontaneous remission during the observation period. Improvement in audiometric measures (intact hearing) of IM patients was also higher than expected compared to spontaneous remission during the observation period. Conclusion: Compared to conventional treatment, integrative treatment of patients with COME and AH showed significantly lower invasive surgical intervention rates and significantly decreased antibiotic and analgesic use. The integrative treatment was effective, safe and well tolerated.

Antibiotics for Post-Tonsillectomy Morbidity: Comparative Analysis of a Single Institutional Experience.

BackgroundWe have conducted this study to evaluate the effect of antibiotics, whether oral or intravenous, compared to no antibiotic protocol on post-tonsillectomy morbidity.MethodsA total of 270 patients aged 3 - 12 years were included in the study. Patients were assigned into three groups randomly; each group consisted of 90 patients. In the first group (group A), patients were given intravenous injections of ceftriaxone 50 mg/kg/24 hours in divided doses, the second group (group B) received oral co-amoxiclav (dose according to weight) for 5 days post-operatively, and in the third group, patients were not given antibiotics. Patients were evaluated for the incidence of any bleeding, number of days before resuming normal diet, incidence of nausea and vomiting, incidence of abdominal pain, frequency of analgesic use in the first week, and pain.ResultsOur study groups were comparable in age, gender, and weight. There were no statistically significant differences between our study groups with regard to the incidence of post-tonsillectomy bleeding, time relapsed to resume normal diet, and pain score scale. Incidence of nausea, vomiting, and abdominal pain was more in the oral antibiotic group, and it was statistically significant.ConclusionWe do not recommend the routine use of antibiotics in post-tonsillectomy period in pediatric age group and oral antibiotics prove to have worse outcome with regard to the incidence of nausea, vomiting, and abdominal pain, and these recommendations need to be evaluated by multicenter evaluation.