McGill Pain Questionnaire Scores Research Articles

Immediate Effects of the Combination of Interferential Therapy Parameters on Chronic Low Back Pain: A Randomized Controlled Trial.

To compare the immediate analgesic effects of 2kHz or 4kHz interferential current (IFC) with different amplitude-modulated frequencies (AMFs) (2Hz or 100Hz) on chronic low back pain (CLBP). Three-arm double-blinded randomized controlled trial. Primary care. 175 patients (19 to 60years of age, 105 female) with CLBP. One session of IFC: Interferential group (GI):GI2kHz/100Hz, GI2kHz/2Hz, GI4kHz/100Hz, GI4kHz/2Hz, or placebo. Pain intensity by numerical rating scale of pain (NRS), McGill Pain Questionnaire (MPQ), and algometry. There was a significant difference in NRS scores (P<0.05) in the GI2kHz/2Hz, GI4kHz/2Hz, and GI4kHz/100Hz groups compared with those of the placebo group (PG), and a significant difference in MPQ scores in the GI4kHz/2Hz and GI4kHz/100Hz groups compared with those of the PG. In algometry, only the GI4kHz/100Hz group showed a significant difference (by 2 points in the lumbar region) compared with the PG. Of the carrier frequencies, an IFC of 4kHz showed more effective results, although no significant difference was noted between the AMFs. An IFC with a carrier frequency of 4kHz and an AMF of 100Hz provide immediate analgesic effects in individuals with CLBP. RBR-59YGRB.

A systematic review on the efficacy of vitamin D supplementation on diabetic peripheral neuropathy.

Vitamin D deficiency is known to be prevalent in patients with diabetes and in particular in those having symptoms of diabetic peripheral neuropathy (DN). Thus, it is worthy to investigate whether a supplementation of vitamin D would improve pain among those having diabetes and DN. A systematic literature search was performed to identify studies that reported the impact of vitamin D supplementation on the signs and symptoms of DN. Random effect models were used to meta-analyze effect sizes. Quality assessment was also performed. Four studies including 364 patients met the inclusion criteria. Meta-analytical results were as follows: Serum Vitamin D level change of 1.39 (95% CI=1.220 to 1.573, p=0.008), HbA1c change of 0.134 (95% CI=-0.153 to 0.418, p=0.3), McGill Pain Questionnaire score of 1.14 (95% CI=1.222 to 1.672, p<0.0001), all in favor of the vitamin D supplementation group. Non-meta-analytical results of all individual studies showed significant amelioration of pain scores. One study reported no significant change in nerve conduction study. Pain improvement was not correlated to baseline or change in serum vitamin D level. Vitamin D supplementation could be an added value in the treatment of painful peripheral diabetic neuropathy. Amelioration in pain might be related to the absolute value of vitamin D attained following supplementation. The findings of this review are promising and further research with large sample randomized trials is warranted.

P45 Treat the arthritis, not just the chest

Abstract Background Very little literature exists in supporting the assessment and management of cystic fibrosis related arthritis (CFA) particularly in paediatric and adolescent cases. Methods A 12 year-old male with cystic fibrosis (CF) was admitted via A&amp;E with severe joint pain that was thought to be associated with a respiratory infection and was treated accordingly. Repeated exacerbations of joint disease occurred every 1-2 months, lasting approximately 1 week with significant joint pain, stiffness, and reduced function. The patient did not feel his exacerbations of CFA were related to his respiratory symptoms, admitting he under reported arthritis symptoms to avoid being admitted for IV antibiotics. Initial rheumatology review resulted in treatment with IV antibiotics and piroxicam. Flares continued, prompting his CF physiotherapist and multidisciplinary team to seek further specialist review for his now longstanding symptoms. He scored 16 out of 50 on the McGill Pain Questionnaire (MPQ) with a visual analogue score (VAS) of 46 out of 100. At 16 years old he was seen by an MSK physiotherapy and rheumatology team working within a wider CF team. He had a 4 year history of symmetrical joint pain affecting knees, wrists and hands, on a background of bronchiectasis with previous non-tuberculous mycobacteria infection, cystic fibrosis related diabetes, and poor nutrition. He reported some episodes being so bad he was unable to get out of bed, and struggling with the stairs at college. He had 6 swollen and 8 tender joints including wrists, MCPs and knees. Ultrasound imaging of the wrists and hands showed confirmed active synovitis with grade 3 greyscale changes and grade 2 power Doppler. Hydroxychloroquine was commenced with naproxen as required, and wrist splints were provided. Results At follow-up he reported significant symptomatic improvement with occasional minor stiffness in wrists and knees which responded quickly to naproxen and was no longer limiting his activities. Repeat ultrasound confirmed improvement with no active power Doppler, but some ongoing grade 1 greyscale changes and a small wrist effusion. He has returned to previous function with an MPQ score of 0, and VAS of 10 out of 100. He reported improved quality of life due to reduced pain and fewer, shorter, and more manageable exacerbations. Conclusion Specialist review and commencement on disease modifying anti-rheumatic medication helped to manage CFA in this case. All cases of suspected CFA should be referred for specialist rheumatology opinion. CF physiotherapists are in an excellent position to identify cases and empowering the multidisciplinary team has been vital in this case. Further trials are required to investigate optimal management of CFA, but it seems likely that directly addressing the arthritis with disease modifying therapy may play an important role. Conflicts of Interest The authors declare no conflicts of interest.

Dose-effect relationship in treatment of chronic neck pain with the direct moxibustion of small moxa cone

To evaluate the effectiveness in treatment of chronic neck pain with the direct moxibustion of small moxa cone and explore the dose-effect relationship in treatment of chronic neck pain with different small moxa cones. A total of 120 patients with chronic neck pain were randomized into a 3-moxa-cone group, a 5-moxa-cone group, a 7-moxa-cone group and a sham-moxibustion group, 30 cases in each one. Fengchi (GB 20), Tianzhu (BL 10), Jingbailao (EX-HN 15), Jianzhongshu (SI 15) and Jianjing (GB 21) were selected in each of the groups. The direct moxibustion with 3, 5 and 7 moxa cones as well as the sham-moxibustion therapy were provided successively in each of the above groups. In the sham-moxibustion group, the lower 1/3 section of moxa cone (about 1.5 mm in length) was soaked in wanhua oil before used in treatment. In each group, the treatment was given twice a week, for 10 treatments totally. Separately, before treatment, after treatment and in 1-month follow-up, the scores of the Northwick Park neck pain questionnaire (NPQ), the scores of McGill pain questionnaire (MPQ) and the local pressure pain threshold (PPT) were observed in each group. After treatment and in 1-month follow-up, the therapeutic effects were evaluated in each group. After treatment and in 1-month follow-up, NPQ scores and MPQ scores in the 3-moxa-cone group, the 5-moxa-cone group and the 7-moxa-cone group were reduced as compared with those before treatment separately (all P<0.01), PPT values were increased as compared with those before treatment (all P<0.01). But the differences were not statistically significant in the sham-moxibustion group as compared with those before treatment (all P>0.05). After treatment and in 1-month follow-up, NPQ scores and MPQ scores in the 3-moxa-cone group, the 5-moxa-cone group and the 7-moxa-cone group were lower as compared with the sham-moxibustion group separately (all P<0.05), PPT values were higher as compared with the sham-moxibustion group (all P<0.05). After treatment, the NPQ score and MPQ score in the 7-moxa-cone group were lower than the 3-moxa-cone group and PPT values was higher than the 3-moxa-cone group (all P<0.05). After treatment and in 1-month follow-up, the therapeutic effects in the 3-moxa-cone group, the 5-moxa-cone group and the 7-moxa-cone group were better than the sham-moxibustion group separately (all P<0.05). But, the therapeutic effects were not significantly different in comparison among the moxibusiton groups (P>0.05). The direct moxibustion therapy with different small-moxa-cones effectively relieves chronic neck pain. There is a trend of improvement of the therapeutic effects with increase of the numbers of moxa cones.

Evidence for miniscalpel-needle/needle knife in the management of chronic pain related conditions

Objective:The aim of this systematic review with meta-analysis is to determine the effect of miniscalpel-needle/needle-knife in treatment of chronic pain symptoms.Methods:The following electronic databases will be searched by 2 independent reviewers: PubMed, Cochrane Library, EMBASE, Springer, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Biomedical Literature Database (CBM). All randomized controlled trials on miniscalpel-needle/need-knife for chronic pain published in electronic databases from inception to August 1, 2019 with language restricted in Chinses and English will be included in the study.Methodologic quality is assessed by 2 blinded reviewers independently screen and score the articles using the Physiotherapy Evidence Database (PEDro) scale and the Cochrane Collaboration risk of bias tool. A meta-analysis was performed when there is sufficient clinical homogeneity in at least 2 studies. The Grading of Recommendations Assessment, Development and Evaluation approach is used to rate the body of evidence in each meta-analysis. When the quantitive evaluation is not available, a qualitative description of the results of single study is provided.Results:A high-quality synthesis of current evidence of miniscapel-needle/needle-knife treating chronic pain will be illustrated using subjective reports and objective measures of performance. The primary outcomes consisted of pain intensity improvement rate clinically meaningful improvements in pain and disability are also noted. Secondary outcomes involve the short form of McGill Pain Questionnaire score (SF-MPQ) and the side effects.Conclusion:This protocol will present the evidence of whether miniscalpel-needle/needle-knife is an effective intervention for chronic pain.PROSPERO registration number:CRD42019129076

Feasibility of Resistance Exercise Training in Gulf War Veterans with Widespread Pain

Roughly 25-33% of US Veterans of Operations Desert Shield or Desert Storm report a constellation of chronic symptoms including fatigue, confusion and widespread pain. Although exercise is routinely prescribed, and found to be efficacious, for many chronic pain conditions; Veterans’ reports of post-exertional exacerbation of symptoms complicates the question of whether exercise should be used as an adjunct treatment to standard care. PURPOSE: To determine the safety and efficacy of a resistance exercise training (RET) program in Gulf War Veterans (GV) with chronic widespread musculoskeletal pain (CMP). METHODS: Gulf Veterans suffering medically unexplained CMP lasting at least 3 months (N=50) were randomized to either 16 weeks of twice weekly RET or wait-list control (WLC). Training was supervised by exercise specialists and consisted of 10 exercises targeting major muscle groups. The program started at a very low intensity [25-35% of estimated 1-repetition maximum (1-RM)] and progressed in small (≤5%) increments. Thus, training was both individualized and standardized. Testing of 1-RM was completed at baseline and reevaluated at 16 weeks. The McGill Pain Questionnaire (MPQ) and Profile of Mood States (POMS) were completed at weeks 1, 6, 12 and 16. Exercisers not completing >50% of training were excluded from statistical analyses (n=4). Average 1-RM values were compared using dependent t-tests, and MPQ and POMS data were evaluated using repeated-measures ANOVAs. RESULTS: The final sample consisted of 22 GV in the RET group, with >90% adherence, and 20 WLC Veterans. No drop outs were due to negative complications with exercise. Following RET, participants on average lifted 67 kg/kg of body weight and significant (p<0.05) 1-RM increases were observed in all 8 lifts. Estimated 1-RM increased by at least 20% for 7 of 8 lifts. Mood scores significantly improved in both groups over the course of the trial with no significant difference between groups. No time or group effects (p>0.05) were observed in MPQ scores. CONCLUSIONS: RET significantly increased strength in GV with CMP. It resulted in no exacerbation of pain symptoms and did not increase mood disturbance. Resistance exercise appears safe and efficacious for Gulf Veterans with widespread pain. Supported by Dept. of Veterans Affairs grant: IO1-CX000383.

Effect of Duloxetine for the Treatment of Chronic Central Poststroke Pain.

Central poststroke pain (CPSP) is the neuropathic pain in areas of the body corresponding to stroke lesions. It is often refractory to treatment, reduces quality of life, and impedes rehabilitation. The pharmacological treatment of CPSP is challenging. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is known to be effective against neuropathic pain. The current study describes the efficacy of duloxetine in reducing pain severity in CPSP patients. For the purpose of this study, CPSP was defined as spontaneous pain within an area of the body corresponding to the brain lesion that emerged at or after stroke onset. Any previously prescribed medical therapy for the patients was not changed or stopped; duloxetine 30 mg was added to their ongoing treatment. Pain was assessed at baseline and thereafter at 1 and 3 weeks using Numeric Rating Scale (NRS) and Short-form MC Gill Pain Questionnaire scores. At the first follow-up, scores were reviewed and dose was doubled if no improvement or adverse effects were observed. From a total of 37 patients, 4 were withdrawn because of adverse effects including nausea, agitation, and somnolence. The mean elapsed time of observed symptoms since stroke onset was 3.1 ± 4.1 years. There was a significant difference between the mean values of Short-form MC Gill Pain Questionnaire and NRS scores at baseline and those at the follow-up assessment. Twenty-six (70.3%) of the patients showed at least 30% reduction of NRS compared with baseline at the third week. Our findings suggest that duloxetine can be effective for managing CPSP.

Spinal Cord Stimulation for the Treatment of Chronic Pain Reduces Opioid Use and Results in Superior Clinical Outcomes When Used Without Opioids.

Chronic pain causes a significant burden to the US health care system, is difficult to treat, and remains a significant contributor to increased opioid use in the United States. Spinal cord stimulation (SCS) has been FDA approved for the treatment of chronic pain. To evaluate the hypothesis that SCS reduces opioid use, and alone maintains clinical outcome measures of pain and psychosocial determinants of health. In this prospective cohort study, we evaluated 86 patients undergoing SCS surgery for the treatment of chronic pain between September 2012 and August 2015. Preoperatively and postoperatively, patients completed the Numerical Rating Scale (NRS), McGill Pain Questionnaire (MPQ), Pain Catastrophizing Scale (PCS), Oswestry Disability Index (ODI), and Beck's Depression Inventory (BDI). VAS scores were retrospectively analyzed. Fifty-three patients used opioids before SCS implantation. The 33 nonusers had lower mean VAS, NRS, and ODI scores than both opioid groups at 1 yr and improved significantly at 1 yr on the VAS (P<.001), NRS (P<.001), MPQ (P=.002), PCS (P<.001), BDI (P=.04), and ODI (P=.002). After surgery, 41.5% remained opioids and 58.5% reduced/eliminated use. Discontinued (n=29) or reduced (n=2) use resulted in VAS, NRS, total MPQ, and ODI score reduction (P<.001, P=.002, P=.002, and P=.009 respectively). At 1 yr, survey scores in opioid users were unchanged. There was no difference between groups in revision or failure rates. Sixty-four percent of patients who were using opioids prior to SCS reduced (n=2) or eliminated opioid use (n=29) at 1 yr postoperatively. Patients who eliminated opioid use or never used opioids had superior clinical outcomes to those who continued use.

A Multicenter Study on Neuropathic Pain in China: Characteristics and the Efficacy of Pregabalin

Background: This clinical study aims to analyse the characteristics of neuropathic pain patients across country nationwide and evaluate the efficacy and tolerability of pregabalin for the treatment of neuropathic pain. The GABA analogue, pregabalin, is being studied to try to establish standardized management of neuropathic pain as it is commonly used in postherpetic neuralgia in China.Methods: Patients with neuropathic pain from 17 hospitals were included for four weeks. The demographics and baseline characteristics of patients were analyzed. The primary outcome was the difference in the pain intensity scores in the numerical rating scale from baseline to follow-up visits. Secondary outcomes included the differing visual analogue scale (VAS) of the short-form McGill Pain Questionnaire, sleep quality, anxiety and depression scores, and side effects during four weeks of follow-up.Results: As 355 patients completed the 4-week follow up, various types of neuropathic pain intensity scores significantly decreased at the first week of treatment and improved through the course of the study. Meanwhile; the difference in the percentage change in patient global impression of change scores, mean sleep interference scores, anxiety and depression scores are all significantly higher after 4-week treatment. Most of the side effects went away during treatment as patients adjust to the medicine.Conclusions: The data demonstrated that pregabalin was effective and well tolerated in Chinese patients with neuropathic pains. This study also analyzed the distribution features of neuropathic pain in a general population and established standardized management of neuropathic pain in China.

Efficacy and safety of thread embedding acupuncture for chronic low back pain: a randomized controlled pilot trial

BackgroundWe investigated the efficacy and safety of thread-embedding acupuncture (TEA) for chronic low back pain (LBP) in a randomized controlled pilot trial with the aim of laying the foundation for a large-scale randomized controlled trial on this topic.MethodsForty participants were recruited for this two-arm, assessor-blinded randomized controlled pilot trial. The participants were randomly allocated to a TEA group (experimental group) or an acupuncture group (control group). The TEA group received TEA once every 2 weeks for 8 weeks (four sessions in total), while the acupuncture group received acupuncture twice per week for 8 weeks (16 sessions in total). The primary outcome was the visual analog scale (VAS) score for pain and the secondary outcomes were short-form McGill Pain Questionnaire (SF-MPQ) and Oswestry Disability Index (ODI) scores. Assessments were performed at screening and at 2, 4, 6, 8, and 10 weeks after treatment initiation (the 10-week assessment was conducted at 2 weeks after treatment cessation).ResultsOf the 40 participants, 36 completed the study and four dropped out. Both the TEA group and the acupuncture group showed significant improvements in VAS, SF-MPQ, and ODI scores in a time-dependent manner. Furthermore, with regard to ODI, a significant interaction between group and time was observed, with the two groups exhibiting a different pattern of change at 8 weeks according to contrast analysis with Bonferroni’s correction. No serious adverse event occurred, and hematological and biochemical test findings were within normal limits.ConclusionThis pilot study has provided basic data for a larger clinical trial to demonstrate the efficacy and safety of TEA for chronic LBP.Trial registrationClinical Research Information Service of the Korea National Institute of Health, ID: KCT0001819. Registered on 15 February 2016.

Characteristics of Glutamate-Evoked Pain in the Masseter Region: Differences Between Targeted Injections in Subcutaneous, Muscle, and Bone Tissues

To investigate whether glutamate-evoked pain in the masseter region differs between three different depths of injection, targeting subcutaneous, muscle, and bone tissues. A total of 16 healthy volunteers participated and, in a randomized order, received injections of glutamate (1.0 M, 0.2 mL) and isotonic saline (0.9%, 0.2 mL) in the masseter region that targeted subcutaneous, intramuscular, and bone surface tissues. Following injection, pain intensity was measured using electronic visual analog scale (eVAS) and numeric rating scale (NRS) scores of unpleasantness, tiredness, tension, soreness, and stiffness. Pressure pain sensitivity (PPS), pain drawing areas, and McGill Pain Questionnaire (MPQ) scores were also assessed. Repeated-measures analysis of variance, McNemar test, and Tukey post hoc tests were used for statistical analyses. P < .05 was considered statistically significant. Overall, subcutaneous injections induced significantly more unpleasantness and pain than intramuscular injections, and PPS scores evoked after glutamate injection at the surface of the bone were significantly higher than after intramuscular glutamate injection. Subcutaneous glutamate injections were more often described as "sharp" and "pinching." The subcutaneous injection was more painful and unpleasant than the intramuscular injection. The glutamate injection at the surface of the bone sensitized the deep pain tissues to pressure stimulation. Clinically, it may be difficult to differentiate between the source or site of pain originating from the masseter region, but the specific quality and word descriptors could assist in differential diagnosis.

Clinical effect of grain-moxibustion combined with acupuncture in treating cervical spondylosis with neck pain

To observe the differences in the clinical effects on cervical spondylosis with neck pain between the grain-moxibustion combined with acupuncture and simple acupuncture. Eighty-eight cervical spondylosis patients with neck pain who met the inclusion criteria were randomly divided into an observation group and a control group, 44 cases in each one. The patients in the control group were treated with conventional acupuncture, and grain-moxibustion was applied on the basis treatment of the control group in the observation group. The treatment was given 3 times a week, once every other day, 10 times as one course, and followed up after 6 months. Northwick Park neck pain inventory (NPQ) and the McGill pain questionnaire (MPQ) of the two groups before and after treatment and 6 months follow-up were observed. The clinical efficacy was compared. After one course of treatment in both groups, the effective rate was 84.1% (37/44) in the control group and 86.4% (38/44) in the observation group; after 6 months follow-up, the effective rate was 79.5% (35/44) in the control group, and 81.8% (36/44) in the observation group. There was no significant difference in overall efficacy between the two groups (both P>0.05). Compared before treatment, the NPQ scores and MPQ scores were decreased at the end of one course of treatment and after 6 months follow-up in the two groups (all P<0.05). There was no significant difference in NPQ scores and MPQ scores between the two groups after one course of treatment (both P>0.05), but the NPQ scores and MPQ scores in the observation group were significantly lower than those in the control group after 6 months follow-up (both P<0.05). The immediate efficacy of grain-moxibustion combined with acupuncture for cervical spondylosis with neck pain is similar to that of simple acupuncture, however, the long-term curative effect is better.

Postoperative Pain After Surgical Treatment of Ankle Fractures: A Prospective Study.

Background:Postoperative pain after fixation of ankle fractures has a substantial effect on surgical outcome and patient satisfaction. Patients requiring large amounts of narcotics are at higher risk of long-term use of pain medications. Few prospective studies investigate patient pain experience in the management of ankle fractures.Methods:We prospectively evaluated the pain experience in 63 patients undergoing open reduction and internal fixation of ankle. The Short-Form McGill Pain Questionnaire was administered preoperatively and postoperatively (PP) at 3 days (3dPP) and 6 weeks (6wPP). Anticipated postoperative pain (APP) was recorded.Results:No significant differences were found between PP, APP, and 3dPP; however, 6wPP was markedly lower. Significant correlations were found between PP and APP and between preoperative and postoperative Short-Form McGill Pain Questionnaire scores. PP and APP were independent predictors of 3dPP; however, only APP was predictive of 6wPP. Sex, age, and inpatient versus outpatient status were not notable factors. No statistically significant differences were found in pain scores between fracture types.Conclusions:Both preoperative pain severity and anticipated postoperative pain are predictive of postoperative pain levels. Orthopaedic surgeons should place a greater focus on the postoperative management of patient pain and expectations after surgical procedures.

Comparison of efficacy of adriamycin chemo-ganglionectomy and radiofrequency thermocoagulation of gasserian ganglionin in treating craniofacial postherpetic neuralgia

Objective To compare the efficacy of adriamycin chemo-ganglionectomy and radiofrequency thermocoagulation (RFT) of semilunar ganglion in treating craniofacial postherpetic neuralgia (PHN). Methods A total of 95 patients with PHN in the areas innervated by maxillary and mandibular divisions of trigeminal nerve, aged 55-90 yr, with the course of disease 6 months-3 yr, were divided into 2 groups using a random number table method: adriamycin chemo-ganglionectomy group (ADM group, n=48) and RFT group (n=47). Hartel anterior approach to puncture was performed via the foramen ovale under the guidance of CT in two groups.In group ADM, 0.5% adriamycin 2.5 mg (0.5 ml) was injected via the foramen ovale, and RFT of gasserian ganglion was performed in group RFT.Visual Analog Scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) scores were evaluated before and after treatment.The rate of effective treatment was calculated, and treatment-related complications were recorded. Results Compared with group RFT, no significant change was found in VAS or SF-MPQ scores before treatment, VAS and SF-MPQ scores were increased and the rate of effective treatment was decreased at 1 and 7 days after treatment, VAS and SF-MPQ scores were decreased and the rate of effective treatment was increased at 6 and 12 months after treatment, the incidence of facial numbness, hypoesthesia, masticatory muscle weakness and weakened corneal reflex was decreased in group ADM (P<0.05). Conclusion Compared with semilunar ganglion RFT, the long-term efficacy of adriamycin chemo-ganglionectomy of semilunar ganglion in treating craniofacial PHN is enhanced, and the safety is higher. Key words: Neuralgia, postherpetic; Doxorubicin; Electrocoagulation; Trigeminal ganglion

The effect and safety of ozone autohemotherapy combined with pharmacological therapy in postherpetic neuralgia.

IntroductionWe investigated the effect and safety of ozone autohemotherapy combined with pharmacological therapy in postherpetic neuralgia (PHN).MethodsNinety-eight patients with PHN were enrolled in this study and randomly divided into a pharmacological therapy group and ozone autohemotherapy group (49 patients in each group). The PHN patients in the pharmacological therapy group were administered pharmacological therapy for 2 weeks, whereas PHN patients in the ozone autohemotherapy group were given ozone autohemotherapy (200 mL blood from patients, the concentration of medical ozone was set as 30 μg/mL using an ozone medical apparatus, 40 mL medical ozone was incubated in 200 mL autologous blood for 3–5 minutes) combined with pharmacological therapy for 2 weeks. The Visual Analog Scale (VAS), the 50% VAS reduction in the initial value, McGill Pain Questionnaire (MPQ), the Patients’ Global Impression of Change (PGIC) scale, and the World Health Organization Quality of Life (WHOQOL-BREF) instrument were used to evaluate the outcomes of all PHN patients before therapy and at 1 week, 1 month, and 3 months after therapy.ResultsForty-five patients in the pharmacological therapy group and 47 patients in the ozone autohemotherapy group completed the study. Compared with before therapy, the two groups showed significant improvements in VAS, MPQ, PGIC, and WHOQOL-BREF scores after therapy (P<0.05). Moreover, compared with the scores of the pharmacological therapy group, the ozone autohemotherapy group’s scores were significantly improved in the VAS, MPQ, PGIC, and WHOQOL-BREF as well as the 50% VAS reduction of the initial value after therapy (P<0.05). Finally, there were no statistically significant differences in adverse effects between groups after therapy (P>0.05).ConclusionThe results of this study demonstrated that ozone autohemotherapy combined with pharmacological therapy was superior to isolated pharmacological therapy in patients with PHN and was an effective and safe way to relieve PHN.

Comparative study of the efficacy and safety of Chondroguard® during its combined (intra-articular and intramuscular) and intramuscular injection in patients with knee osteoarthritis

Objective : to evaluate the efficacy and safety of Chondroguard® in the combined (intra-articular (IA) + intramuscular (IM)) and IM injection in patients with knee osteoarthritis (OA). Patients and methods . The study enrolled 150 patients with knee OA who were divided into two groups with 75 patients in each group. Group 1 received the drug (100 mg/ml) intramuscularly: 25 injections every other day, the first three injections at a dose of 100 mg, the fourth injection was started with a dose of 200 mg. Group 2 had five IA injections into the target joint at a daily dose of 200 mg with an interval of 3 days between injections, then 16 IM injections at 200 mg every other day. All the patients were prescribed nonsteroidal anti-inflammatory drugs (NSAIDs), such as meloxicam 15 mg. To determine the efficiency of treatment, the investigators estimated the following parameters: pain intensity on a visual analogue scale (VAS), the total WOMAC index and its components (pain, stiffness, and functional insufficiency), sensory and affective-emotional pain characteristics (for the target joint) according to McGill Pain Questionnaire (MPQ) scores. Clinical and biochemical blood tests, clinical urinalysis, coagulogram, and electrocardiography were performed in all the patients at the beginning and the end of the study. Results and discussion . Comparison of two Chondroguard® regimens showed that by the end of treatment, the pain intensity on VAS was significantly lower in Group 2 (IA + IM administration) than in Group 1 (16.81±13.49 and 21.88±13.24, respectively; p<0.0001). Analysis revealed that there were no significant differences between Groups 1 and 2 in the changes of the overall WOMAC index and its components (pain, stiffness, and functional performance), as well as in MPQ pain scores. No serious adverse events (AEs) were recorded in the study. There were 11 AEs in 3.3% (n = 5/150) of the patients throughout the study. By its end, resolution/termination of AEs was noted in 100% of cases. There were no clinically significant pathological laboratory and ECG findings. Conclusion . The test drug during any (IM or combined) route of administration quickly and effectively reduces pain syndrome and stiffness and improves joint functional performance and at the same time it is a safe drug. Its important advantage is a quick effect achieved by IA and IM administration. This makes it possible to reduce the dose of NSAIDs or to discontinue the latter, which is very important for OA patients with comorbidity.

Successful Use of Renal Denervation in Patients With Loin Pain Hematuria Syndrome—The Regina Loin Pain Hematuria Syndrome Study

IntroductionLoin pain hematuria syndrome (LPHS) is characterized by severe unilateral or bilateral loin pain that suggests a renal origin but occurs in the absence of identifiable or relevant urinary tract disease. Hematuria can either be microscopic or macroscopic, but the renal abnormalities responsible for the hematuria are unexplained. Debilitating pain refractory to conventional pain medications is the main cause of morbidity.MethodsWe conducted a single-arm, single-center study. Twelve patients between the ages of 21 and 62 years (11 female, 1 male) with LPHS underwent endovascular ablation of the renal nerves between July 2015 and November 2016, using the Vessix renal denervation system. The primary objective was to achieve 30% reduction in self-reported pain with the McGill Pain Questionnaire (MPQ) at 6 months. The secondary objectives were to measure changes in disability (Oswestry Disability Index [ODI]), mood (Geriatric Depression Scale [GDS]), and quality of life (EuroQol-5D [EQ-5D] and the MOS 36-Item Short Form Survey [SF-36]) scores from baseline to 6 months postprocedure.ResultsTen of 12 patients at 3 months and 11 of 12 patients at 6 months reported a >30% reduction in pain based on the MPQ at 3 and 6 months. We found consistent improvements in MPQ, ODI, GDS, EQ-5D, and SF-36 scores from baseline to 6 months postprocedure.ConclusionWe conclude that renal denervation is associated with a considerable improvement in pain, disability, quality of life, and mood. Our results suggest that percutaneous catheter−based delivery of radiofrequency energy is a safe, rapid treatment option that should be considered in all patients with LPHS.

EFFECTS OF ONCE-DAILY VERSUS TWICE DAILY DOSING OF CALCIUM FRUCTOBORATE ON KNEE DISCOMFORT. A 90 DAY, DOUBLE-BLIND, PLACEBO CONTROLLED RANDOMIZED CLINICAL STUDY

Importance: Previous research showed that a twice-daily 108 mg dose of calcium fructoborate (CFB) improved knee discomfort during a 2-week supplementation period. This current double-blind, placebo-controlled randomized study investigates the effects of CFB supplementation on knee discomfort during 90 days of supplementation. Purpose: To evaluate the comparative effects of once-daily and twice-daily dosing of calcium fructoborate on knee joint discomfort for ninety days. Design: 120 participants with self-reported knee discomfort were recruited and randomized into three groups (each N=40). Participants received: 108 mg CFB twice per day (CFB-G1); or, 216 mg CFB in a single dose (CFB-G2); or, placebo. Setting: Subjects were recruited through advertisement in local papers. The researchers assessed intake and within-study levels of knee discomfort by using the McGill Pain Questionnaire (MPQ) and the Western Ontario and McMaster University Arthritis Index (WOMAC). Results: 62 female and 59 male subjects completed the study. Subjects’ average age was (52.84 ± 8.19 years) and average BMI was (26.76 ± 2.50 kg/m2). Statistical differences between groups were calculated using a two-sided, two-sample t-test. Analysis of variance (ANOVA) was used to estimate within-group changes in mean WOMAC and MPQ scores as well as against the control group. When compared to placebo, CFB-G1 showed a significant decrease in reported discomfort on day 14 (P=0.02,) day 30 (P=0.003), day 60 (P&lt;0.0001) and day 90 (P&lt;0.0001) according to WOMAC Scores. A similar decrease was observed for CFB-G2 WOMAC Scores on day 14 (P=0.02), day 30 (P=0.0003), day 60 (P&lt;0.0001) and day 90 (P&lt;0.0001). When compared to placebo, the MPQ score for CFB-G1 group decreased on day 7 (P=0.002), day 14 (P=0.001), day 30 (P&lt;0.0001), day 60 (P&lt;0.0001) and day 90 (P&lt;0.0001). MPQ score decreases were also observed for CFB-G2 group on day 7 (P=0.02), day 14 (P=0.01), day 30 (P&lt;0.0001), day 60 (P&lt;0.0001) and day 90 (P&lt;0.0001). When comparing CFB-G1 and CFB-G2, no significant differences were observed. Importantly, no changes were observed in the WOMAC and MPQ scores within the placebo group. Conclusion: Both CFB groups showed early and significantly improved levels of knee comfort. Knee comfort continued to significantly improve throughout the duration of this 90-day study. No significant differences were observed between the once-daily and the twice–daily doses of CFB.

The Relationship Between Salivary Alpha Amylase Activity and Score of McGill Pain Questionnaire in Patients With Tension Type Headache.

Introduction:Tension-type headache is the most common type of headache across the world. Saliva as a non-invasive medium is used to detect a wide range of diseases. Salivary Alpha-Amylase (SAA) levels has been suggested as a potential indirect marker for detecting Sympathoadrenal Medullary (SAM) activity, which is activated by pain. Significant correlation was found between SAA levels and pain scale in patients with chronic pain. The purpose of the present study was to measure SAA activity in Frequent Episodic Tension-Type Headache (FETTH). In addition to the Visual Analogue Scale (VAS), we intend to assess intensity and various aspects of pain by McGill Pain Questionnaire (MPQ).Methods:A total of 45 females with FETTH (case group) and 45 healthy voluntary females (control group) were enrolled in our case-control study. Unstimulated saliva by spitting method was taken from each participant.Results:SAA levels were significantly higher in patients with FETTH (P<0.001) when compared with the control group. There was significant correlation between SAA activity and MPQ score (P<0.001).Conclusion:This is the first study using MPQ as a subjective means of assessing quality and quantity of pain alongside the VAS as an objective tool for evaluating pain in patients with FETTH. SAA may be an appropriate marker for assessing of pain levels in patients with FETTH. MPQ versus the VAS may be a more accurate measurement tools along VAS.

Efficacy of silver needle acupuncture combined with muscle relaxation in the treatment of capulohumeral periarthritis: study protocol for a prospective, single-center, randomized, parallel-controlled trial

Background and objectives: Muscle relaxation therapy comprising general anesthesia and an intra-articular injection of betamethasone is commonly used to treat capulohumeral periarthritis. This treatment quickly improves the limited motion of the shoulder joint and restores the shoulder to its functional position, but cannot effectively inhibit the inflammatory response. Aseptic inflammatory pain can reportedly be relieved by silver needle acupuncture. However, there is insufficient high-quality evidence to validate the efficacy of silver needle acupuncture in the treatment of capulohumeral periarthritis. Therefore, the proposed study aims to evaluate the efficacy of silver needle acupuncture combined with muscle relaxation therapy in the treatment of capulohumeral periarthritis. Design: A prospective, single-center, open-label, randomized, parallel-controlled trial. Methods: Sixty patients with capulohumeral periarthritis will be assigned to receive either silver needle acupuncture plus muscle relaxation therapy (n = 30) or muscle relaxation therapy alone (n = 30). Patients will be followed up at 3 and 14 days, and 1, 3, 6, and 12 months post-treatment. Outcome measures: The primary outcome measure is a Visual Analog Scale score obtained at 3 days post-treatment. The secondary outcome measures are: the Visual Analog Scale scores before treatment and at 14 days, and 1, 3, 6, and 12 months post-treatment; the Shoulder Joint Activity Function Rating Scale (Melle scale) score, American Shoulder and Elbow Surgeons Standardized Shoulder score, McGill Pain Questionnaire score, University of California at Los Angeles shoulder score before treatment and at 3 and 14 days, and 1, 3, 6, and 12 months post-treatment; 12-item Short-Form Health Survey score at 1, 3, 6, and 12 months post-treatment; and the incidence of adverse events at 3 and 14 days, and 1, 3, 6, and 12 months post-treatment. Conclusion: The study results will provide evidence indicating whether silver needle acupuncture plus muscle relaxation is more effective than muscle relaxation alone in the treatment of capulohumeral periarthritis. We hypothesize that silver needle acupuncture plus muscle relaxation not only improves shoulder joint function, but also reduces inflammatory pain in the shoulder joint. Ethics and dissemination: This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Qingdao University of China on June 25, 2018 (approval No. QDDXFSYY-LL-06-25). This study will be performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. Written informed consent regarding the study protocol and surgery procedure will be obtained from each participant. This study was designed in June 2018. Patient recruitment and data collection began in September 2018 and patient recruitment will end in April 2019. Result analysis will be performed in May 2020. This study will be scheduled to end in June 2020. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. Trial registration: This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800016706). Study protocol version: 1.0.