Mean Reduction In Pain Intensity Research Articles

Effects of an eight-week physical exercise program on low back pain and function in fruit workers: A randomized controlled trial.

Low back pain is prevalent in workers' health and functional performance. To evaluate the effects of a physical exercise program on low back pain and disability in fruit workers. This randomized controlled trial assigned 44workers (37 ± 9years) to two groups. The experimental group consisted of 10men and 12women with an average age of 38 (± 9) years, and the control group consisted of 8men and 14women with an average age of 36 (± 10) years. The experimental group (EG) performed a program of strength and flexibility exercises for eight weeks, twice a week. The control group (CG) received minimal care, with a booklet with guidelines for performing exercises. The primary outcomes included changes in perceived disability and the intensity of pain evaluated by the Rolland-Morris questionnaire and the Numerical Pain Scale, respectively. All outcomes were measured at baseline and after eight weeks of intervention. A significant difference was observed in the within-group analysis, with a mean reduction in pain intensity in the EG and CG of -4.55 (95%CI -7.01 to -2.09) and -3.81 (95%CI 1.72-5.90), respectively. For disability, a reduction of -4.45 (95% CI -8.89 to -0.02) was observed in the EG and of -4.43 (-7.38 to -1.48) in the CG. There were no significant differences in the between-groups analysis. The exercise program was not superior to using the educational booklet. However, both interventions showed substantial decreases in pain and disability levels.

EFFICACY, SAFETY, AND COST-EFFECTIVE ANALYSIS OF LOW-DOSE ETORICOXIB AND ADD-ON PARACETAMOL VERSUS THERAPEUTIC DOSE ETORICOXIB FOR PAIN IN PATIENTS AFTER TOOTH EXTRACTION: A RANDOMIZED INTERVENTIONAL DOUBLE-BLIND STUDY

Objectives: The objectives of the study were to study the efficacy, safety, and cost-effective analysis of low-dose etoricoxib and add-on paracetamol versus therapeutic dose etoricoxib in patients who experienced pain after tooth extraction. Methods: Patients were recruited and randomized to two study groups E1P and E2 on etoricoxib 30 mg and add-on paracetamol 500 mg 8 hourly and etoricoxib 60 mg once respectively for 3 days. The efficacy was assessed by visual analog scale, pain relief score, and global evaluation score. Patients were assessed at 0, 6, 24, 48, and 72 h. Safety was assessed by adverse drug reactions reported by the patients after 72 h. Cost-effective analysis was done by calculating the cost of treatment and the cost-effective ratio in both groups. Results: Eighty patients completed the study having 40 patients in each group. Mean pain intensity reduction, mean pain relief score, and global evaluation score all showed significantly better results (p<0.05) in Group E1P as compared to Group E2 at 6, 24, 48, and 72 h, respectively. No patient had reported any serious adverse drug reaction in both the groups; however, incidence of headache and fatigue was twice in the etoricoxib only treated group (n=4) than low-dose etoricoxib-treated group (n=2). The treatment cost of Group E1P was lesser than Group E2 and was also cost effective. Conclusion: Low-dose etoricoxib with add-on paracetamol is a better analgesic than therapeutic dose etoricoxib and is also found to be safer and cost effective.

A Randomized Double-Blind Comparative Study of Efficacy and Safety Between Low-Dose Etoricoxib and Ibuprofen Coadministered with Low-Dose Paracetamol for Dental Pain

Objective: To study the safety and efficacy of low-dose etoricoxib and low-dose paracetamol versus ibuprofen and low-dose paracetamol treatments in patients who experienced acute pain after tooth extraction. Methods: A total of 80 patients were recruited and randomized to two study groups, i.e., EP and IP. Group EP received etoricoxib 30 mg once a day and add-on paracetamol 325 mg eight-hourly, and Group IP received ibuprofen 400 mg and paracetamol 325 mg eight-hourly for three days. The analgesic efficacy was assessed by a visual analog scale, pain relief score, and global evaluation score. Patients were assessed at 0, 6, 24, 48, and 72 h. Safety was assessed by the patient’s estimation of the severity of adverse drug reactions using a 3-point scale and the type of adverse drug reactions reported by the patients after 72 h. Results: Mean pain intensity reduction, mean pain relief score, and global evaluation score all showed better analgesic efficacy results in Group EP as compared to Group IP but were not significant ( P > 0.05) at 6, 24, 48, and 72 h, respectively. No patient had reported any serious adverse drug reaction in both the groups. Mild to moderate adverse reactions were reported in 20% cases in the IP group and 10% cases in the EP group; however, the incidence of GIT intolerance was seen in 17.5% of the cases in the IP group and none in the EP group. Conclusion: Low-dose etoricoxib with low-dose paracetamol has comparable analgesic efficacy with better safety than therapeutic dose ibuprofen and low-dose paracetamol.

Evaluation of the First Contact Physiotherapy (FCP) model of primary care: patient characteristics and outcomes

ObjectiveFirst Contact Physiotherapy (FCP) is a primary care model where expert musculoskeletal (MSK) physiotherapists undertake the first patient consultation, to enhance MSK-patient care and free-up GP capacity. The authors report the quantitative findings from the FCP National Evaluation (Phase 3) which evaluated the FCP model against success criteria. Design and settingA mixed-methods 24-month service evaluation involving 40 FCP sites and 240 FCPs across England. MethodsAn online platform collected patient-reported experience and outcomes following the FCP consultation and at 1, 2 and 3-months follow-up. These included the Keele STarT MSK Tool, pain intensity (0–10 NRS scale), Musculoskeletal Health Questionnaire (MSK-HQ, range 0–56), and Friends-and-Family Test. ResultsOver 13 months, 2825 patients were invited by email and 24% (n=680) completed their initial questionnaire. Their mean age was 56.2 (SD 14.9), 61% were female, ethnicity was 97% white, mean pain intensity was 6.1 (SD 2.13) and mean MSK-HQ score was 33.8 (SD 9.5). At 3-months follow-up (n=370) there was a 2.8 (CI 2.5 to 3.1) mean pain intensity reduction from baseline, a mean 7.1 (6.0 to 8.2) score improvement in MSK-HQ and 64% reporting overall improvement (much better/better) since seeing the FCP. One of the six success criteria was not met; 29% of those in employment reported receiving specific work advice from the FCP (target ≥75%). ConclusionAhead of the planned scale-up of the FCP primary care model across the UK, this evaluation provides useful data on patients who access this service, their short-term clinical outcomes and whether key success criteria are being met.

Impact of variability in baseline pain on the placebo response in randomized, placebo-controlled, crossover trials in peripheral neuropathic pain.

Large placebo responses often negatively affect randomized controlled trials within the pain area. Understanding different possible factors that influence the placebo response is therefore important. In this retrospective analysis, we hypothesized that a large variability in baseline pain score would predict a greater placebo response and analyzed the impact of the coefficient of variation, SD, and difference between the highest and lowest numeric rating scale (NRS) score at baseline on the placebo response. A total of 160 observations on placebo response from 3 controlled clinical trials with a crossover design were included in this study. In general, the placebo response was low with a mean reduction in pain intensity of 0.5 points (range -5 to 7) measured on a 0 to 10 point NRS, and only 15% were placebo responders as defined by more than 30% reduction in NRS pain score from baseline to the end of the placebo treatment period. We found no significant impact of baseline pain coefficient of variation, SD, or the difference between lowest and highest baseline pain score on the placebo response. Placebo response in one trial did not predict placebo response in another trial. A large placebo response was not associated with a large treatment response. In conclusion, in this retrospective data analysis, there was no impact of baseline pain variability on the placebo response in controlled clinical trials with a crossover design in patients with peripheral neuropathic pain.

PENGARUH PEMBERIAN AROMATERAPI LEMON TERHADAP PENURUNAN INTENSITAS NYERI PERSALINAN KALA 1 FASE AKTIF PADA IBU PRIMIGRAVIDA DI BIDAN PRAKTEK MANDIRI (BPM) WILAYAH KERJA PUSKESMAS BATU AJI

Background Lemon oil Aromatherapy can improve mood, relax the mind, increase concentration, overcome pain and anxiety. Linalool, one of the substances contained in lemon, is useful to stabilize the nervous system so that it can cause a calm effect for anyone who inhales it. The purpose of this study was to find out the effects of lemon aromatherapy on the reduction of labor pain intensity of primigravida mothers active phase I This research methodapplied posttest only control group design, conducted at BPM, Puskesmas Batu Aji Work Area on February-July 2018 with a total population of 3872 pregnant women and a sample of 60 respondents, sampling applied Accidental Sampling with a sample of 30 experimental groups and 30 control groups. Data was analyzed using test analysis techniquesT-Test. The results of the study found that the mean reduction in pain intensity in the control group 1.60 ± 0.498 and in the experimental group 0.50 ± 0.509 from 30 respondents in the control group and 30 experimental groups experienced a decrease in pain 1.1, then the results of the T-Test test p-value value 0,000 (p <0,05). The conclusionof this study there is the effect of lemon aromatherapy on reducing the intensity of labor pain. Suggestions Respondents are expected to apply aromatherapyfor maternal mother and community as an alternative treatment for people who experience labor pain .

Disease duration before surgical resection for chronic pancreatitis impacts long-term outcome.

Many patients with chronic pancreatitis (CP) undergo a step-up approach with interventional procedures as first-line treatment and resection reserved for later stages. The aim of this study was to identify predictive factors for a significant clinical improvement (SCI) after surgical treatment.All patients operated for CP between September 2012 and June 2017 at our center was retrospectively reviewed. A prospective patient survey was conducted to measure patients postoperative outcome. The primary endpoint SCI was defined as stable health status, positive weight development and complete pain relief without routine pain medication. Additionally, risk factors for relaparotomy were analyzed.A total of 89 patients with a median follow-up of 38 months were included. In most cases, a duodenum-preserving pancreatic head resection (n = 48) or pancreatoduodenectomy (n = 28) was performed. SCI was achieved in 65.3% (n = 47) of the patients after the final medium follow-up of 15.0 months (IQR: 7.0–35.0 months), respectively. Patients with a longer mean delay (7.7 vs 4 years) between diagnosis and surgical resection were less likely to achieve SCI (P = .02; OR .88; 95%CI .80–98). An endocrine insufficiency was a negative prognostic factor for SCI (P = .01; OR .15; 95%CI .04–68). In total, 96.2% of the patients had a complete or major postoperative relief with a mean pain intensity reduction from 8.1 to 1.9 on the visual analogue scale.The results support that surgical resection for CP should be considered at early stages. Resection can effectively reduce postoperative pain intensity and improve long-term success.

Nonsteroidal Anti-inflammatory Drugs for Acute Low-back Pain.

Low back pain is a common reason for emergency department presentation and is a leading cause of acute disability. Up to 70% of individuals experience low back pain during their lifetime. Many patients recover from acute back pain within 6 weeks, but some patients experience multiple episodes or chronic pain.Guidelines recommend avoidance of bedrest, early activity, patient education, attention to patient psychosocial factors, and administration of analgesic medications. Clinical practice guidelines from the American College of Physicians recommend non-steroidal anti-inflammatory drugs (NSAIDs) as a treatment option due to their analgesic and anti-inflammatory properties.

«I am getting better» and «I feel good»: searching for an objective criterion for a clinical response to analgesic therapy for rheumatic diseases

Analysis of the results of clinical trials should be based on the use of objective parameters that allow for assessing the significance of the data obtained for real medical practice. These parameters include Minimal Clinically Important Improvement (MCII) and Patient Acceptable Symptom State (PASS).Objective: to determine the approximate value of the parameters MCII and PASS on the basis of data from the PARACELS (Regular Piascledine and Artrosilene Administration for osteoarthritis (OA): Expediency of the Unified Treatment Regimen) study.Patients and methods. A study group consisted of 6,448 patients (70.9% female, 29.1% male) (mean age, 57.8±10.2 years) with knee OA and moderate or severe pain of ≥40 mm on a 100-mm visual analogue scale (VAS). All the patients took during 12 weeks avocado/soybean unsaponifiables 300 mg/day and a nonsteroidal anti-inflammatory drug (ketoprofen lysine salt) 320 mg/day, which was prescribed at the beginning of treatment for 10–14 days and then could be used on demand with more pain to come. Pain intensity was measured using the 100-mm VAS. Patient satisfaction with treatment results was also studied with a point scale, where 0 is worsening or no effect, while 5 is an excellent effect. The dynamics of pain was compared and treatment results were assessed by patients.Results and discussion. After 12 weeks, most patients showed a substantial improvement: a mean pain intensity reduction of 77.7±29.6%. A satisfactory treatment result estimate (that can be considered as a surrogate measure of MCII) corresponded to an average pain reduction of 32.0±11.7 mm on VAS (a 47.3% improvement compared to the baseline level). A good treatment result estimate (that can be considered as a surrogate measure of PASS) corresponded to an average pain reduction of 41.0±13.3 mm on VAS (a 62.9% improvement compared to the baseline level).Conclusion. The PARACELS study has shown that in Russian patients receiving analgesic therapy, MCII can correspond to a pain reduction of &gt;30 mm on VAS (&gt;40% of the baseline level), PASS can do to its reduction of &gt;40 mm on VAS (&gt;60% of the baseline level).

Effectiveness and Safety of Dorsal Root Ganglion Stimulation for the Treatment of Chronic Pain: A Pooled Analysis

IntroductionSince it became available in the mid‐2010s, dorsal root ganglion (DRG) stimulation has become part of the armamentarium to treat chronic pain. To date, one randomized controlled trial, and several studies of moderate sample size and various etiologies have been published on this topic. We conducted a pooled analysis to investigate the generalizability of individual studies and to identify differences in outcome between chronic pain etiologic subgroups and/or pain location.Materials and MethodsOne prospective, randomized comparative trial and six prospective, single‐arm, observational studies were identified that met pre‐defined acceptance criteria. Pain scores and patient‐reported outcome (PRO) measures were weighted by study sample sizes and pooled. Safety data are reported in aggregate form.ResultsOur analysis included 217 patients with a permanent implant at 12‐month follow‐up. Analysis of pooled data showed an overall weighted mean pain score of 3.4, with 63% of patients reporting ≥50% pain relief. Effectiveness sub‐analyses in CRPS‐I, causalgia, and back pain resulted in a mean reduction in pain intensity of 4.9, 4.6, and 3.9 points, respectively. Our pooled analysis showed a pain score for primary affected region ranging from 1.7 (groin) to 3.0 (buttocks) and responder rates of 80% for foot and groin, 75% for leg, and 70% for back. A substantial improvement in all PROs was observed at 12 months. The most commonly reported procedural or device complications were pain at the IPG pocket site, lead fracture, lead migration, and infection.ConclusionsDRG stimulation is an effective and safe therapy for various etiologies of chronic pain.

Methadone vs. morphine SR for treatment of neuropathic pain: A randomized controlled trial and the challenges in recruitment

ABSTRACT Introduction Accumulating evidence has identified a number of advantages for methadone over other opioids for the treatment of chronic pain including: agonist action at both μ and δ opioid receptors, N-methyl-d-aspartate (NMDA) antagonist activity and the ability to inhibit the reuptake of monoamines. It was hypothesized that with these three mechanisms of action methadone might be a good option for the treatment of neuropathic pain. Methods This was a double-blind randomized controlled trial comparing methadone to controlled-release morphine. The primary objective was to determine whether methadone is clinically inferior versus noninferior to morphine as an analgesic. Results We attempted recruitment at three academic pain centers over a 3-year period. In the end only 14 participants were able to be recruited; 5 withdrew and only 9 completed the trial. This study was underpowered. All participants showed a mean reduction in pain intensity according to the Numeric Rating Scale for Pain Intensity (morphine 5.86 to 4.38, methadone 6.11 to 4.5) and reported pain relief compared to pretreatment, but the sample size was too small for statistical analysis. Discussion Reasons for challenges in recruitment included tight inclusion and exclusion criteria and high participant burden. In addition, there was significant heterogeneity of patients between the three sites, leading to differences in reasons for exclusion. This included seemingly disparate reasons at the different sites, including few participants who were methadone naïve vs. avoidance or fear of opioids. In the end, we were unable to answer the question of the study.

A Comparative Study on the Effect of EMLA Cream and Diclofenac Gel on Pain Caused by Needle Port Placement in Patients Under Chemotherapy: A Clinical Trial

Background: Injections are common nursing interventions, which usually cause pain. The pain caused by injection causes anxiety, discomfort, and reduced patient confidence in nursing performance. Since applying methods that enhance patients’ comfort is a nursing task, the aim of this study was to determine the effect of EMLA cream and diclofenac gel on pain caused by needle port placement in patients undergoing chemotherapy at the oncology department. Methods: This cross-sectional clinical trial study was conducted on 40 inpatients of the Oncology Ward of Khatam-al-Anbia Hospital in Zahedan, during year 2017. Patients were selected by conventional sampling, based on the Inclusion criteria of the study. Patients were randomly assigned to use EMLA cream, diclofenac gel or the placebo. The severity of pain was measured immediately after injection, using the visual analogue scale (VAS). Blindness was done for pain the assessor and data analyzer. The SPSS 22 software was used for statistical analysis. First, descriptive statistics were used to determine the frequency, percentage, and mean, and then inferential statistics of paired t-test, for group comparison. Results: The mean scores of the severity of pain in three groups of EMLA, diclofenac gel, and placebo were 5.49 ± 2.05, 5.88 ± 1.93, and 6.71 ± 1.96, respectively. Comparison between diclofenac gel and placebo showed that the mean decrease in pain intensity in the diclofenac gel group was far more than the placebo (P < 0.0001). Comparing EMLA cream and placebo, the mean reduction in pain intensity in the EMLA cream was far higher than the placebo (P < 0.0001). Finally, the EMLA cream was more effective than diclofenac gel in pain reduction, although the difference was not statically significant. Conclusions: Although the use of EMLA cream and diclofenac gel can reduce pain at the injection site, applying diclofenac gel is recommended due to its availability, cost-effectiveness, and domestic production.

Mirtazapine for fibromyalgia in adults

Mirtazapine for fibromyalgia in adults

Single Centre Prospective Study of Systematic Pain Evaluation in Portuguese Patients with Metastatic Prostate Cancer

Pain is one of the most common symptoms reported by cancer patients and is associated with decreased quality of life. Assessment of pain with standardized questionnaires reduces variability in its interpretation and may increase effectiveness of medical interventions. Prostate cancer is the most frequent male neoplasm in Portugal. We designed this study to evaluate the impact of a standardized pain questionnaire on pain management in patients with metastatic prostate cancer. Single centre prospective observational study of patients with metastatic prostate cancer. The study was designed to evaluate the benefit of systematically evaluating pain with Brief Pain Inventory-Short Form prior to a scheduled medical oncology consult. Patients reporting pain were reassessed one week later by telephone. To assess the benefit two consecutive cohorts were established based on communication of questionnaire results to the treating physician. We recruited 207 patients of which 60% reported pain. Statistically significant decrease in mean pain intensity one week after the scheduled appointment was noted (3.95 vs 3.01; p < 0.001). Patients whose Brief Pain Inventory-Short Form was provided to their oncologist experienced greater reduction in pain, which was non-significant (p = 0.227). Using Brief Pain Inventory-Short Form assessment resulted in a higher probability of pain control (43.5% vs 30.9%; p = 0.193). The prevalence of pain founded was higher than described in the literature, probably because our sample was less selected than the published in clinical trials. After the scheduled appointment, there was a statistically significant reduction in mean pain intensity, but the explicit use of this questionnaire was not associated with a statistically significant reduction of pain. Patients with metastatic prostate cancer have a high prevalence of pain. Evaluation and treatment by medical oncologists is associated with a reduction of mean pain intensity. The use of Brief Pain Inventory-Short Form was associated with a non-significant increased reduction of pain.

Mirtazapine for fibromyalgia in adults

Mirtazapine for fibromyalgia in adults

Effects of acupuncture on quality of life and pain in patients with osteoporosis-a pilot randomized controlled trial.

Standard analgesic treatment is associated with adverse events in patients with osteoporosis, especially elderly and/or comorbid patients. As acupuncture has gained widespread acceptance as a complementary treatment modality with few side effects, the aim of this study was to evaluate the effects of acupuncture on the pain and quality of life of patients with osteoporosis. In total, 53 patients with vertebral compression fractures, osteoporosis-associated spinal deformities, and resultant pain were randomly allocated to the verum acupuncture with deep needling of specific points following the principles of traditional Chinese medicine (n=29) or control acupuncture group with superficial needling of non-acupuncture points (n=24). All patients received 10 sessions of standardized verum or control acupuncture treatment over 5weeks. Pain (VAS score 1-100) and quality of life (QUALEFFO-41) were measured at the start of treatment (T0), before each acupuncture session (T1), and at 1 (T2) and 3months (T3) post-treatment. Both acupuncture treatments significantly reduced activity-related pain and pain at rest over time. The verum acupuncture group experienced a significantly greater reduction in mean pain intensity at rest than the control group. In the control group, quality of life improved only temporarily post-treatment (T2) and slightly declined at the end of the follow-up period (T3). In contrast, patients in the verum acupuncture group experienced continuous and significant improvements in quality of life up to 3months after treatment (T3). Both types of acupuncture were equally effective in producing sustained, clinically relevant pain relief in patients with osteoporosis. Verum acupuncture had stronger and longer-lasting effects on quality of life and pain at rest. The possible reasons for these findings include the specificity of acupuncture point selection and the performance of needle stimulation.

Pain management assessment in children with limb fractures in an emergency service

IntroductionThe tool most widely used for measuring the intensity of pain in children is the Faces Pain Score – Revised (FPS-R). Pain management depends on the level of care and the knowledge of the physician regarding dosing, indications and side effects of the medications available for use. ObjectiveTo assess pain management in patients 3–17 years of age with limb fractures using the FPS-R within the first 6h. Materials and methodsObservational cohort of patients 3–17 years of age presenting with limb fractures between October 2013 and January 2014. Patients with comorbidities associated with chronic pain were excluded. The tool was administered four times in accordance with the validated instructions – on admission, at first hour, at three hours and at six hours. ResultsOverall, 60 patients were assessed and 4 pharmacological regimens were identified: dipyrone alone (63.3%), combined therapy with dipyrone plus tramadol (10%), tramadol alone (8.3%), acetaminophen alone (6.6%).The mean pain intensity reduction with the use of dipyrone was 1.7 points on the FPS-R within the first hour, with a mean reduction of 4 points by the end of the six hours of follow-up. With tramadol, pain reduction was 1.6 points and 4.6 points, respectively. The combined use of dipyrone plus tramadol did not result in significant pain reduction within the first hour. ConclusionFracture immobilization is the mainstay for analgesia but it does not suffice as a form of pain management. Monotherapy with dipyrone or tramadol resulted in the best pain reduction, whereas the combined use of dipyrone plus tramadol was not better than the use of either medication alone.

Evaluación del manejo de dolor en niños con fractura en extremidades en un servicio de urgencias

IntroductionThe tool most widely used for measuring the intensity of pain in children is the faces pain score - revised (FPS-R). Pain management depends on the level of care and the knowledge of the physician regarding dosing, indications and side effects of the medications available for use. ObjectiveTo assess pain management in patients 3 to 17 years of age with limb fractures using the FPS-R within the first 6hours. Materials and methodsObservational cohort of patients 3-17 years of age presenting with limb fractures between october 2013 and january 2014. Patients with comorbidities associated with chronic pain were excluded. The tool was administered four times in accordance with the validated instructions – on admission, at first hour, at three hours and at six hours. ResultsOverall, 60 patients were assessed and 4 pharmacological regimens were identified: dipyrone alone (63.3%), combined therapy with dipyrone plus tramadol (10%), tramadol alone (8.3%), acetaminophen alone (6.6%).The mean pain intensity reduction with the use of dipyrone was 1.7 points on the FPS-R within the first hour, with a mean reduction of 4 points by the end of the six hours of follow-up. With tramadol, pain reduction was 1.6 points and 4.6 points, respectively. The combined use of dipyrone plus tramadol did not result in significant pain reduction within the first hour. ConclusionFracture immobilization is the mainstay for analgesia but it does not suffice as a form of pain management. Monotherapy with dipyrone or tramadol resulted in the best pain reduction, whereas the combined use of dipyrone plus tramadol was not better than the use of either medication alone.

A randomized, phase 2 study investigating TRV130, a biased ligand of the μ-opioid receptor, for the intravenous treatment of acute pain

Efficacy of conventional opioids can be limited by adverse events (AEs). TRV130 is a structurally novel biased ligand of the μ-opioid receptor that activates G protein signaling with little β-arrestin recruitment. In this phase 2, randomized, placebo- and active-controlled study, we investigated the efficacy and tolerability of TRV130 in acute pain after bunionectomy. We used an adaptive study design in which 144 patients experiencing moderate-to-severe acute pain after bunionectomy were randomized to receive double-blind TRV130, placebo, or morphine in a pilot phase. After pilot phase analysis, 195 patients were randomized to receive double-dummy TRV130 0.5, 1, 2, or 3 mg every 3 hours (q3h); placebo; or morphine 4 mg q4h intravenously. The primary end point was the time-weighted average change in numeric rating scale pain intensity over the 48-hour treatment period. Secondary end points included stopwatch and categorical assessments of pain relief. Safety and tolerability were also assessed. TRV130 2 and 3 mg q3h, and morphine 4 mg q4h produced statistically greater mean reductions in pain intensity than placebo over 48 hours (P < 0.005). TRV130 at 2 and 3 mg produced significantly greater categorical pain relief than morphine (P < 0.005) after the first dose, with meaningful pain relief occurring in under 5 minutes. TRV130 produced no serious AEs, with tolerability similar to morphine. These results demonstrate that TRV130 rapidly produces profound analgesia in moderate-to-severe acute pain, suggesting that G-protein-biased μ-opioid receptor activation is a promising target for development of novel analgesics.

Patient Controlled Analgesia for Adults with Sickle Cell Disease Awaiting Admission from the Emergency Department.

Background. A treatment algorithm for sickle cell disease (SCD) pain in adults presenting to a single emergency department (ED) was developed prioritizing initiation of patient controlled analgesia (PCA) for patients awaiting hospitalization. Objectives. Evaluate the proportion of ED visits in which PCA was started in the ED. Methods. A two-year retrospective chart review of consecutive SCD pain ED visits was undertaken. Data abstracted included PCA initiation, low versus high utilizer status, pain scores, bolus opioid number, treatment times, and length of hospitalization. Results. 258 visits resulted in hospitalization. PCA was initiated in 230 (89%) visits of which 157 (68%) were initiated in the ED. Time to PCA initiation was longer when PCA was begun after hospitalization versus in the ED (8.6 versus 4.5 hours, p < 0.001). ED PCA initiation was associated with fewer opioid boluses following decision to admit and less time without analgesic treatment (all p < 0.05). Mean pain intensity (MPI) reduction did not differ between groups. Among visits where PCA was begun in the ED, low utilizers demonstrated greater MPI reduction than high utilizers (2.8 versus 2.0, p = 0.04). Conclusions. ED PCA initiation for SCD-related pain is possible and associated with more timely analgesic delivery.