Mean Baseline Visual Analogue Scale Research Articles

Methoxyflurane Analgesia in Adult Patients in the Emergency Department: A Subgroup Analysis of a Randomized, Double-blind, Placebo-controlled Study (STOP!).

IntroductionAcute pain remains highly prevalent in the Emergency Department (ED) setting. This double-blind, randomized, placebo-controlled UK study investigated the efficacy and safety of low-dose methoxyflurane analgesia for the treatment of acute pain in the ED in the adult population of the STOP! trial.MethodsPatients presenting to the ED requiring analgesia for acute pain (pain score of 4–7 on the Numerical Rating Scale) due to minor trauma were randomized in a 1:1 ratio to receive methoxyflurane (up to 6 mL) or placebo (normal saline), both via a Penthrox® (Medical Developments International Limited, Scoresby, Australia) inhaler. Rescue medication (paracetamol/opioids) was available immediately upon request. Change from baseline in visual analog scale (VAS) pain intensity was the primary endpoint.Results300 adult and adolescent patients were randomized; data are presented for the adult subgroup (N = 204). Mean baseline VAS pain score was ~66 mm in both groups. The mean change from baseline to 5, 10, 15 and 20 min was greater for methoxyflurane (−20.7, −27.4, −33.3 and −34.8 mm, respectively) than placebo (−8.0, −11.1, −12.3 and −15.2 mm, respectively). The primary analysis showed a highly significant treatment effect overall across all four time points (−17.4 mm; 95% confidence interval: −22.3 to −12.5 mm; p < 0.0001). Median time to first pain relief was 5 min with methoxyflurane [versus 20 min with placebo; (hazard ratio: 2.32; 95% CI: 1.63, 3.30; p < 0.0001)]; 79.4% of methoxyflurane-treated patients experienced pain relief within 1–10 inhalations. 22.8% of placebo-treated patients requested rescue medication within 20 min compared with 2.0% of methoxyflurane-treated patients (p = 0.0003). Methoxyflurane treatment was rated ‘Excellent’, ‘Very Good’ or ‘Good’ by 77.6% of patients, 74.5% of physicians and 72.5% of nurses. Treatment-related adverse events (mostly dizziness/headache) were reported by 42.2% of patients receiving methoxyflurane and 14.9% of patients receiving placebo; none caused withdrawal and the majority were mild and transient.ConclusionThe results of this study support the evidence from previous trials that low-dose methoxyflurane administered via the Penthrox inhaler is a well-tolerated, efficacious and rapid-acting analgesic.FundingMedical Developments International (MDI) Limited and Mundipharma Research GmbH & Co.KG.Trial registrationClinicaltrials.gov identifier: NCT01420159, EudraCT number: 2011-000338-12.

Ultrasound-guided percutaneous injection to treat de Quervain's disease using three different techniques: a randomized controlled trial.

To compare the six-month outcome of three different ultrasound-guided treatments for de Quervain's disease (DQD). We prospectively treated 75 consecutive patients (51 females, 24 males, mean age ± standard deviation = 45.3 ± 9.8 years) with DQD. Patients' features (hand dominance, intraretinaculum septum, accessory tendons) were recorded. Visual analogue scale (VAS), reduced disability (quickDASH) score, and retinaculum thickness were evaluated at baseline and after one (excluding retinaculum thickness), three, and six months. Patients were randomized into three groups of 25 patients each treated under ultrasound guidance: Group A (1 ml methylprednisolone acetate; mean baseline thickness = 1.6 mm; mean baseline VAS = 6; mean baseline quickDASH = 55); Group B (1 ml methylprednisolone acetate +15-day delayed 2 ml saline 0.9 %; 1.4; 6; 56); Group C (1 ml methylprednisolone acetate +15-day delayed 2 ml low molecular weight hyaluronic acid; 1.7; 6; 55). After one month results were: Group A mean VAS = 2; mean quickDASH = 23; Group B 2; 22; Group C 2; 21. After three months results were: Group A retinaculum thickness = 0.7 mm; 3; 27); Group B 0.8 mm; 1; 25; Group C 0.5 mm; 1; 23. After six months results were: Group A 1.5 mm; 3; 51; Group B 1 mm; 2; 51; Group C 0.7 mm; 1; 26 (P < 0.001 for all vs. baseline). Patients' age, sex, hand dominance, presence of subcompartment dividing septum, and supernumerary tendons had no influence on outcome (P ≥ 0.177). Addition of hyaluronic acid to ultrasound-guided injections of steroids to treat DQD seems to improve the outcome and to reduce the recurrence rate. • Ultrasound guidance allows for safe injection procedures to treat de Quervains' disease • Steroid injections allow prompt recovery in de Quervain's disease with short-term recurrence • Addition of hyaluronic acid allows recurrence rate reduction compared to simple steroid injections.

Outcome of Salvage Lumbar Fusion after Lumbar Arthroplasty

Study DesignRetrospective review.PurposeThis study aims to define the role of lumbar fusion for persistent back pains after the lumbar disc replacement.Overview of LiteratureLittle is written about lumbar fusion after optimally placed lumbar arthroplasty in patients with persistent lower back pains.MethodsRetrospective review of cases of lumbar artificial disc requiring subsequent fusion because of persistent back pains despite optimally placed artificial discs. Outcomes were evaluated using Oswestry Disability Index (ODI) and visual analogue scale (VAS). Clinical improvements indicated 25% improvement in ODI and VAS values.ResultsFive patients met the study criteria. The mean baseline ODI for the five patients was 52. The mean baseline VAS scores for back and leg pains were 76 and 26, respectively. All the five patients had optimally placed prosthesis. The indication for surgery was the constant low back pains found in all the patients. Revision surgery involved disc explantation and fusion in two of the patients and posterolateral fusion without removing the prosthesis in three. None of the patients achieved adequate pain control after the revision surgery despite the solid bony fusion documented by postoperative computed tomography. The mean ODI value after the fusion was 55. The mean values for back and leg pains VAS were 72 and 30, respectively.ConclusionsLack of good pain relief after successful lumbar artifical disc replacements may indicate different etiology for the back pains. The spine-treating surgeons should have a high threshold level to perform salvage fusion at that level.

English

Pain control is one of the major aspects in dental practice. Dental pain can usually be controlled using different techniques such as local anesthesia and medications. Acetaminophen is a pain reliever and fever reducer. However, it shows no effect on inflammation. Therefore, non-steroidal anti-inflammatory drugs are currently used to control inflammation and pain. This study sought to compare the efficacy of premedication with ibuprofen, gelofen and acetaminophen in the depth of anesthesia in mandibular molars with irreversible pulpitis. In this double-blind randomized controlled trial, 60 patients with at least one mandibular molar with symptoms of irreversible pulpitis requiring root canal therapy were recruited. Another tooth in the same quadrant was selected as the control. Patients were randomly allocated to one of the following groups: ibuprofen 400 mg, gelophen 400 mg, acetaminophen 325 mg, and placebo 500 mg. The medications were taken 30 min prior to local anesthesia and the cold test and electric pulp test (EPT) were repeated for the test teeth and the control teeth after 10 min with the development symptoms of anesthesia. Access preparation was then initiated and the patients were asked to quantify the level of pain during exposure of the dentin and pulp using a visual analogue scale (VAS). Data was analyzed using analysis of variance (ANOVA), and repeated measure ANOVA, P &lt; 0.05 were deemed significant. There were significant differences between the mean baseline VAS score, and the mean VAS score recorded at the time of dentin and pulp exposure however revealed a significant difference in the VAS score only at the time of dentin exposure among the study groups (P &lt; 0.005). No significant difference was observed in the mean VAS score at the time of pulp exposure among groups (P = 0.076). The EPT was significantly higher after the test compared with the baseline (P = 0.421). Premedication with ibuprofen and gelofen have significant effect in the depth of anesthesia in mandibular molars with irreversible pulpitis, and significantly decreased VAS but placebo and acetaminophen are functionally alike and had no significant effect. &nbsp; Key words:&nbsp;Irreversible pulpitis, pain, root canal therapy.

A Comparative Pilot Study to Evaluate the Adjunctive Role of Levosulpride with Trigger Point Injection Therapy in the Management of Myofascial Pain Syndrome of Orofacial Region.

To evaluate the effect of therapy with levosulpride combined with conventional trigger point injection therapy in terms of pain and depression in the chronic myofascial pain syndrome patients. This was a comparative prospective study in which subjects with at least one trigger point and symptom duration of at least 3months were recruited and randomized into two groups. Group A subjects received trigger point injections with 0.5% bupivacaine and tablet levosulpride and group B received trigger point injections and a placebo. Subjects were assessed for pain with visual analog scale (VAS) and depression with Beck's depression inventory (BDI) at the follow-up periods of 1, 4, 6 and 12weeks. The treatment effect was measured in terms of mean difference of BDI and VAS scores at various studied intervals from the baseline values. The sample was composed of 15 subjects with 8 in group A (6 females and 2 males, with a mean age of 41.88±15.13years, disease duration of 12.37±16.11months) and 7 in group B (6 females and 1 male, with a mean age of 43.86±12.34years, disease duration of 9.64±9.34months). The mean baseline VAS score and BDI score was 6.75±1.03 in group A and 6.86±1.06 in group B and 24.25±10.20 in group A and 24.43±11.16 in group B respectively. The mean difference of VAS scores at 12thweek interval from the baseline values was highly significant. Although the mean difference of VAS scores at all the other intervals and mean difference of BDI scores at all the intervals was statistically nonsignificant, there was improvement in the mean differences at all the follow-up intervals in terms of both pain as well as depression. The combined therapy with conventional trigger point injection and levosulpride as antidepressant significantly reduce pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region.

SAT0402 Efficacy of Naltrexone in the Treatment of Fibromyalgia: Randomized Controlled Trial

BackgroundFibromyalgia (FM) is a common and potentially debilitating syndrome characterized by chronic and widespread musculoskeletal pain, fatigue, sleep disturbance, and physical and psychological impairment. The aetiology of FM remains unknown...

Bloqueo tricompartimental del hombro doloroso: estudio preliminar

Introduction Painful shoulder is one of the most common reasons for consulting in primary care and affects between 7% and 34% of the general adult population. The most frequent etiology is rotator cuff dysfunction, accounting for over 70% of cases, including tendinitis, bursitis and rupture of the rotator cuff or any of its components. Various treatments have been proposed for painful shoulder. The aim of this study was to present a new technique for patients refractory to conventional treatments. Material and methods We analyzed the efficacy of the technique using a visual analog scale (VAS), administered to patients at baseline and 1 month later. In the same period, we evaluated patient satisfaction and the percentage of improvement. Finally, we analyzed complications, if any, and the patients were asked if they would repeat the process or not. Results The technique was performed in 12 patients. The mean baseline VAS was 8.5 ± 1, which decreased to 5.5 ± 3 after the procedure. In patients who benefitted from the procedure, the decrease in VAS score was close to 5 points with respect to baseline. The technique seemed to be more effective in patients with arthrosis than in those mainly with soft tissue involvement. The mean improvement in the entire sample was 45.83 ± 42.05. Seven patients reported they would repeat the technique compared with five who reported they would not. No complications resulted from the procedure. Conclusions Tricompartmental blockade of the shoulder seems to be a promising technique in the treatment of shoulder pain, especially when the underlying disease is degenerative.

The short- and long-term effect of duloxetine on painful physical symptoms in patients with generalized anxiety disorder: Results from three clinical trials

Generalized anxiety disorder (GAD) is associated with painful physical symptoms (PPS). These post hoc analyses of previous trial data assessed PPS and their response to duloxetine treatment in GAD patients. Studies 1 and 2 (n=840) were 9- to 10-week efficacy trials; study 3 (n=887) was a relapse prevention trial comprising a 26-week open-label treatment phase and a 26-week double-blind, placebo-controlled treatment continuation phase. Mean baseline visual analog scale scores (VAS, 0–100; n=1727) ranged from 26 to 37 for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time in pain while awake. In studies 1 and 2, improvement on all VAS scores was greater in duloxetine-treated than in placebo-treated patients (p≤0.01). In study 3, pain symptoms worsened in responders switched to placebo compared with those maintained on duloxetine (p≤0.02). In conclusion, duloxetine was efficacious in the short- and long-term treatment of PPS, which are common in GAD patients.

The Use of Intra-articular Hylan G-F 20 in the Treatment of Symptomatic Osteoarthritis of the Shoulder

Background While hylan G-F 20 is an approved therapy for the treatment of knee osteoarthritis, there are few reports of its use in shoulder osteoarthritis. Hypothesis Hylan G-F 20 can reduce pain and improve function in patients with glenohumeral osteoarthritis. Study Design Case series; Level of evidence, 4. Methods Thirty consecutive patients with idiopathic glenohumeral osteoarthritis who failed to respond to standard conservative measures were enrolled. Patients received 3 weekly intra-articular hylan G-F 20 injections in their affected shoulder and completed a visual analog scale for pain, the UCLA score, and the Simple Shoulder Test at baseline and at 1, 3, and 6 months after the third injection. Results Of the 30 patients, 3 withdrew during the washout period before treatment; the remaining patients (17 men and 10 women) had an average age of 62 years. The mean baseline visual analog scale score was 54, UCLA score was 15.7, and Simple Shoulder Test score was 5.7 (of 12 possible “yes” responses). At the 6-month follow-up, hylan G-F 20 significantly improved visual analog scale (mean 30, P < .001), UCLA (mean 24, P < .001), and Simple Shoulder Test (7.6 “yes” responses, P < .001) scores. More patients slept comfortably after treatment (56%) versus before treatment (15%). Nine patients had a visual analog scale improvement >40 points after 6 months. No device-related adverse events were observed. Conclusion Hylan G-F 20 may have a beneficial therapeutic effect on some symptomatic patients with glenohumeral osteoarthritis.

Management of drooling for children with neurological problems in Hong Kong

Abstract Objectives: To share our experience in the management of drooling in Hong Kong, to describe the clinical profile of children with this problem, and to report the clinical outcome of oro-motor training. Methods: Children attending the Drooling Clinic of Alice Ho Miu Ling Nethersole Hospital, Hong Kong between January 2000 and June 2003 were included. Multidisciplinary assessment was performed to ascertain the medical condition, functional status and oro-motor difficulties of each child. Intervention might include optimization of medical condition, oro-motor training and surgery. Severity of drooling was rated by a 10-point visual analogue scale (VAS). The outcome of oro-motor training was assessed by the change in VAS from baseline. Results: Eight children, with a mean age of 11.9 years, were included. Six children suffered from cerebral palsy and two had syndromal diagnoses. All had moderate or severe mental retardation. Poor lip closure, inadequate jaw control and delay in swallowing were common oro-motor difficulties. All children received oro-motor training. The mean duration of follow-up for seven children was 17 months. The mean baseline VAS was 7.1. When compared with the baseline, VAS rating during the training period decreased with a mean difference of 3.0. The difference remained at 1.9 at 4 months after training had stopped. Other functional gains, such as improved sucking and swallowing, were identified. Six caregivers declined surgery. One child improved and did not require surgery. Conclusions: Short-term follow-up of oro-motor training suggested beneficial outcome.

The Incidence and Treatment of Prehospital Motion Sickness

Objectives The authors' objectives were: 1) to determine the incidence of motion sickness during ambulance transport on a mountainous route in healthy volunteers, and 2) to determine if droperidol alleviated the signs and symptoms of motion sickness in those volunteers who developed it. Methods This was a prospective, randomized, double-blind, placebo-controlled trial. Subjects were healthy volunteers over age 18 and not currently taking an antiemetic. Participants were transported in the back of an ambulance over a mountainous road. Those who developed motion sickness rated their nausea on a 100-mm visual analog scale (VAS) and were randomized to receive placebo (saline) or 2.5 mg droperidol intravenously. Symptoms were recorded on a VAS every 5 minutes until the end of the transport. Incidence of motion sickness was calculated as a percentage with 95% confidence intervals (CIs). Pretreatment characteristics were compared with chi-square tests, and mean VAS scores were compared using t-tests. Results Thirty-seven subjects completed the study. Sixteen (43%, 95% CI = 27%–59%) developed motion sickness. Fifteen were randomized and completed data collection. Eight received droperidol (mean baseline VAS, 45) and seven received placebo (mean baseline VAS, 40). Droperidol trended toward a greater mean reduction of nausea than placebo at 5 minutes (20 versus 4, p = 0.077). Conclusions The incidence of motion sickness during ambulance transport in a mountainous setting is substantial. There was a strong trend toward a positive treatment effect with droperidol. Further prospective study in an actual patient setting is warranted.

T HE I NCIDENCE AND T REATMENT OF P REHOSPITAL M OTION S ICKNESS

Objectives. The authors' objectives were: 1) to determine the incidence of motion sickness during ambulance transport on a mountainous route in healthy volunteers, and 2) to determine if droperidol alleviated the signs and symptoms of motion sickness in those volunteers who developed it. Methods. This was a prospective, randomized, double-blind, placebo-controlled trial. Subjects were healthy volunteers over age 18 and not currently taking an antiemetic. Participants were transported in the back of an ambulance over a mountainous road. Those who developed motion sickness rated their nausea on a 100-mm visual analog scale (VAS) and were randomized to receive placebo (saline) or 2.5 mg droperidol intravenously. Symptoms were recorded on a VAS every 5 minutes until the end of the transport. Incidence of motion sickness was calculated as a percentage with 95% confidence intervals (CIs). Pretreatment characteristics were compared with chi-square tests, and mean VAS scores were compared using t-tests. Results. Thirty-seven subjects completed the study. Sixteen (43%, 95% CI = 27%−59%) developed motion sickness. Fifteen were randomized and completed data collection. Eight received droperidol (mean baseline VAS, 45) and seven received placebo (mean baseline VAS, 40). Droperidol trended toward a greater mean reduction of nausea than placebo at 5 minutes (20 versus 4, p = 0.077). Conclusions. The incidence of motion sickness during ambulance transport in a mountainous setting is substantial. There was a strong trend toward a positive treatment effect with droperidol. Further prospective study in an actual patient setting is warranted.