Pain At Rest Research Articles

Preoperative measures of pain at rest and movement-evoked pain in knee arthroplasty: Associations with pain and function outcome trajectories from a prospective multicentre longitudinal cohort study.

The study of pain at rest (PAR) and movement-evoked pain (MEP) in persons with musculoskeletal pain has received substantial attention. Despite strong interest, relatively little attention has been directed to the psychometric development of these constructs. Our purpose was to explore the relationship between PAR and MEP and to examine the prognostic utility of these measures in persons with knee arthroplasty. We used prospectively collected data from persons scheduled for knee arthroplasty who had moderate to high levels of pain catastrophizing. Preoperative latent variables for PAR and MEP were developed and used to determine if they were associated with a binary latent variable of good versus poor pain and function outcome trajectories. Factor correlations were used to determine the extent to which the variance for PAR and MEP was overlapping. PAR and MEP are significant predictors of good versus poor pain and function classes. Odds ratios ranged from 1.21 to 1.64 (p < 0.001) indicating a significant increase in the likelihood of poor outcome. Correlation between PAR and MEP latent variables was high (r = 0.89; 95% CI: 0.86-0.92) indicating substantially overlapping variance. PAR and MEP, as defined in our study, can be used to make prognostic judgements regarding risk of poor postoperative outcome trajectory following knee arthroplasty. However, PAR and MEP showed substantially overlapping variance indicating that measurements of both are not necessary when making prognostic assessments. Preoperative PAR and MEP latent variables, as defined in our study, had prognostic significance for 1 year pain and function outcome trajectories. PAR and MEP latent variables had substantially overlapping variance which suggested that only one is needed to make prognostic judgements. The prognostic significance of PAR and MEP as well as their substantially overlapping variance is new to the field prognostic research in knee arthroplasty.

Intramuscular Botulinum Toxin as an Adjunct to Arthrocentesis with Viscosupplementation in Temporomandibular Disorders: A Proof-of-Concept Case-Control Investigation.

The reduction in joint load is a potential beneficial factor in managing osteoarthritis of the temporomandibular joint (TMJ). This paper aims to compare the effectiveness of the intramuscular injection of botulinum toxin (BTX-A) as an adjunct to TMJ arthrocentesis plus viscosupplementation with arthrocentesis plus viscosupplementation alone in the management of TMJ osteoarthritis. A pilot clinical retrospective study examined TMJ osteoarthritis treatments. Patients were divided into two groups: Group A received BTX-A injections and arthrocentesis with viscosupplementation, while Group B received only arthrocentesis with viscosupplementation. The study assessed outcomes based on mouth opening (MO), pain at rest (PR), pain at mastication (PF), and masticatory efficiency (ME) at various time points (baseline (T0), 1 week (T1), 2 weeks (T2), 3 weeks (T3), and 4 weeks (T4)) up to 2 months after treatment. The study included two groups, each with five patients. Group A received five weekly sessions of arthrocentesis plus viscosupplementation and a single BTX-A injection during the first arthrocentesis appointment. Group B underwent the five-session protocol of arthrocentesis plus viscosupplementation alone. MO, PF, PR, and ME improved quickly in T2 in both groups, but the improvement was of greater importance over the following weeks and lasted longer in Group A. Arthrocentesis with viscosupplementation associated with BTX-A was found to be more effective than arthrocentesis alone in improving clinical outcomes. This suggests that patients with TMJ osteoarthritis and myofascial pain may benefit from reduced muscle tone and joint load.

Race-specific associations: inflammatory mediators and chronic low back pain.

Chronic low back pain (cLBP) is a global health crisis that disproportionately burdens non-Hispanic Black (NHB) individuals, compared with those who identify as non-Hispanic White (NHW). Despite the growing personal and societal impact of cLBP, its biological underpinnings remain poorly understood. To elucidate the biological factors that underlie the racial disparities in cLBP, this study sought to determine whether inflammatory mediators associated with pain interference (PI), pain at rest (PAR), and movement-evoked pain (MEP) differ as a function of racial identity. Blood samples were collected from 156 individuals with cLBP (n = 98 NHB participants, n = 58 NHW participants). Enzyme-linked immunosorbent assay and multiplex assays were used to quantify concentrations of proinflammatory (fibrinogen, C-reactive protein [CRP], serum amyloid A, tumor necrosis factor α [TNF-α], and interleukin [IL]-1α, IL-1β, and IL-6) and anti-inflammatory markers (IL-4 and IL-13). Spearman rho correlations were used to assess associations among markers of inflammation and PI, PAR, and MEP using the Brief Pain Inventory-Short Form. Analyses revealed that for NHW patients, CRP, serum amyloid A, and IL-6 were positively associated with cLBP outcomes and IL-4 was inversely associated with PAR and MEP. However, for NHB patients, only IL-1α was positively associated with PAR. Our findings suggest that, while there are associations between inflammation and cLBP outcomes, the biomarkers that underlie the inflammation could very well differ as a function of racialized minority group. However, more research with racially inclusive samples is needed to elucidate the mechanisms that may contribute to racial disparities in cLBP.

Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis.

Knee Osteoarthritis (KOA) is mainly characterized by pain. The assessment of KOA-related pain frequently focuses on different constructs subject to sources of bias or drawbacks, as the classical Pain at Rest (PAR). Movement-evoked pain (MEP), recently defined as 'pain during walking', emerges as a differential concept, since PAR and MEP are driven by different underlying mechanisms. Given the novelty of the MEP approach, its association with PAR or with different performance-based tests has not been studied in KOA yet. A cross sectional study was conducted. PAR was measured, alongside the performance of four mobility tests and their corresponding MEP: Timed Up and Go Test, 10-metre Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test. Association and agreement were explored for MEP versus PAR, while the correlation of the tests versus each corresponding MEP-measure was assessed. Neither association nor agreement were found in the duality MEP versus PAR. Also, the lack of association between the performance of a mobility test and the perceived level of pain during the development of the test was stated. Movement-evoked pain is neither related to pain at rest nor to functional performance in subjects affected by knee osteoarthritis. The results from our study suggest that MEP and pain at rest measure and refer to different constructs in knee osteoarthritis. The implementation of MEP as an outcome in exercise-therapy could enhance the tracking of results, as well as the development of tailored interventions under different conditions. This research elucidates the relevance of MEP, recently defined as 'pain during walking', through the analysis of its association with PAR and with functional performance (measured through four mobility tests) in knee osteoarthritis. The results from our study highlight the absence of either association or agreement between MEP and PAR, fact that supports and endorses the idea that both concepts measure and refer to different constructs in knee osteoarthritis.

Movement-evoked Pain versus Pain at Rest in Postsurgical Clinical Trials and in Meta-analyses: An Updated Systematic Review.

Given the widespread recognition that postsurgical movement-evoked pain is generally more intense, and more functionally relevant, than pain at rest, the authors conducted an update to a previous 2011 review to re-evaluate the assessment of pain at rest and movement-evoked pain in more recent postsurgical analgesic clinical trials. The authors searched MEDLINE and Embase for postsurgical pain randomized controlled trials and meta-analyses published between 2014 and 2023 in the setting of thoracotomy, knee arthroplasty, and hysterectomy using methods consistent with the original 2011 review. Included trials and meta-analyses were characterized according to whether they acknowledged the distinction between pain at rest and movement-evoked pain and whether they included pain at rest and/or movement-evoked pain as a pain outcome. For trials measuring movement-evoked pain, pain-evoking maneuvers used to assess movement-evoked pain were tabulated. Among the 944 included trials, 504 (53%) did not measure movement-evoked pain (vs. 61% in 2011), and 428 (45%) did not distinguish between pain at rest and movement-evoked pain when defining the pain outcome (vs. 52% in 2011). Among the 439 trials that measured movement-evoked pain, selection of pain-evoking maneuver was highly variable and, notably, was not even described in 139 (32%) trials (vs. 38% in 2011). Among the 186 included meta-analyses, 94 (51%) did not distinguish between pain at rest and movement-evoked pain (vs. 71% in 2011). This updated review demonstrates a persistent limited proportion of trials including movement-evoked pain as a pain outcome, a substantial proportion of trials failing to distinguish between pain at rest and movement-evoked pain, and a lack of consistency in the use of pain-evoking maneuvers for movement-evoked pain assessment. Future postsurgical trials need to (1) use common terminology surrounding pain at rest and movement-evoked pain, (2) assess movement-evoked pain in virtually every trial if not contraindicated, and (3) standardize movement-evoked pain assessment with common, procedure-specific pain-evoking maneuvers. More widespread knowledge translation and mobilization are required in order to disseminate this message to current and future investigators.

Factors associated with disability and pain intensity in patients with complex regional pain syndrome

Purpose To examine the associations between psychological factors (pain catastrophizing, pain-related anxiety, and fear of pain) and level of pain and disability in patients with complex regional pain syndrome (CRPS). Methods One hundred and two patients with CRPS were recruited from tertiary care centers with the different upper limb injuries were evaluated for pain, disability, and psychological factors. Patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Patient Rated Wrist Evaluation (PRWE), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK-11), and Depression, Anxiety, and Stress Scale (DASS). The associations of pain and disability with presence of these behavioral and mental health factors were examined using bivariate and multivariable analyses. These models were adjusted for age, sex, injured dominant hand, and previous surgery. Results A higher pain catastrophizing score (β = 0.55, p = 0.00) was associated with greater disability. A higher pain catastrophizing score (β = 0.35, p = 0.001) and female gender (β = 0.24, p = 0.01) were associated with greater pain at rest (PAR). A higher pain catastrophizing score and having a surgical history were associated with greater pain with movement (β = 0.25, p = 0.02). Scores of ≥18.5 in PCS, ≥57.5 on TSK, and ≥15.5 on DASS were associated with higher risk of experiencing pain and disability. Conclusions Pain catastrophizing, female sex, and surgical intervention are associated with poor outcomes. Physiologic, psychological factors, and treatment factors interact to influence outcomes. The results of this study further validate the associations of chronic pain and disability with pain catastrophizing in patients with CRPS. The novel finding of this study is introducing cut-off scores for TSK, PCS, and DASS as a screening tool to predict pain, functional limitations. Implication for rehabilitation Pain catastrophizing has a vital role in the magnitude of disability and pain in patients with CRPS. The novel finding of this paper was the cut-off scores on the psychological evaluations that can enable using them as screening tool for bad outcomes in patients with CRPS. Cut off scores from different psychological evaluations can be used as a yellow flag for clinician’s for detecting patients with increased risk of pain and disability. The identification of a cut-off can also have implications for implementing change in clinical practice by identifying the need for early and intensive interventions.

Temporomandibular Joint Arthrocentesis in Patients with Degenerative Joint Disease: A 10- to 22-year Follow-up.

To report the effectiveness of temporomandibular joint (TMJ) arthrocentesis with viscosupplementation for degenerative joint disease (DJD) over a long-term (ie, 10-22 years) follow-up. A total of 103 patients aged between 30 and 91 years (13 men and 90 women; mean age 63.7 years) who received a cycle of five arthrocentesis sessions with HA viscosupplementation to manage their symptoms related to TMJ DJD during the time period from 1998 to 2010 were recalled for clinical evaluation. After the treatment cycle, clinical outcomes were assessed based on the following parameters: maximum mouth opening (MO), pain with function (PF), pain at rest (PR), and self-reported chewing efficiency (CE). Data were collected at baseline (T0) and at successive follow-up assessments, after at least 3 months (T1) and 1 year (T2), as per previous publications. Patients who had received treatment at least 10 years prior were then recalled for this study (T3: 10 to 22 years follow-up). Analysis of variance for repeated measures was performed to assess changes over time. Significant improvement in all clinical parameters was achieved at T1 and was maintained for up to 10 years (T3), with P < .01 for each parameter. At T3, treatment effectiveness was perceived as excellent by 56% and as good by 26.5% of subjects, while 10.7% perceived a moderate improvement, and 6.8% referred a slight improvement or did not have any improvement. Only seven individuals required additional treatments after T2. These findings suggest that the symptomatic management of TMJ DJD achieved in the short or medium term with a cycle of arthrocentesis and viscosupplementation was effectively maintained in the long term.

L’administration orale de prednisone réduit efficacement les douleurs subaiguës après arthroplastie totale du genou

IntroductionControlling the pain after TKA has always been our research focus. Dexamethasone has a significant effect in controlling acute pain following TKA. We hypothesis oral administration of prednisone could alleviate post-TKA subacute pain. MethodsThis was a prospective, randomized controlled trial dividing patients into prednisone group and control group. Routine analgesic regimens included injection of cocktail mixture intraoperatively, oral celecoxib and tramadol postoperatively. Patients in prednisone group received oral administration of prednisone (10mg, qd, from the first day postoperatively, for 2 weeks). VAS was applied for evaluating pain with ambulation (PWA) and pain at rest (PAR). Follow-up was performed for about three months. The primary end-points were PWA and PAR; secondary end-points were postoperative daily celecoxib use and tramadol use. ResultsA total of 49 patients were enrolled in prednisone group and control group, respectively. VAS of PWA was lower in prednisone group on the 7th, 14th and 28th (p=0.05) day after TKA than that in the control group. Meanwhile, VAS of PAR was lower in prednisone group on the postoperative 14th and 28th day (p=0.05) than that in the control group. ConclusionsContinuous oral administration of 10mg prednisone for 14 days after TKA effectively alleviates subacute pain (including PWA and PAR) and reduces postoperative consumption of analgesics. Level of evidenceII; low power randomized trial.

Early post-immobilization pain at rest, movement evoked pain, and their ratio as potential predictors of pain and disability at six- and 12-months after distal radius fracture

BackgroundRemoval of immobilization is a critical phase of distal radius fracture (DRF) rehabilitation, typically occurring by 2 months post injury. This study examined the extent to which pain at rest (PAR), movement evoked pain (MEP), or the ratio between those (MEPR) assessed at 2-months after DRF predicts the occurrence of chronic pain or disability at 6- and 12-months after the injury.MethodsThis secondary analysis of a prospective cohort study was done at the Hand and Upper Limb Centre (HULC), London, Ontario, Canada. A total of 229 patients with DRF (159 (69.4%) women) were included. Scores for the pain and function subscales of the Patient-Rated Wrist Evaluation (PRWE) were extracted for 2, 6 and 12 months after DRF. Logistic as well as nonlinear quartile regression examined whether PAR and MEP predicted the severity of chronic pain and disability at 6- and 12-months after DRF. Receiver Operating Characteristics Curve were plotted, where area under the curve (AUC) examined the accuracy of the PAR and MEP scores in classifying those who experienced chronic pain and disability.ResultsScores of ≥3 (AUC of 0.77) for PAR or ≥ 6 (AUC of 0.78) for MEP at 2 months after DRF predicted moderate to severe wrist pain at 6-months, whereas scores of ≥7 (AUC of 0.79) for MEP at 2-months predicted ongoing wrist disability at 6-months after the injury. The MEPR of 2 ≤ or ≥ 8 at 2-months was associated with adverse pain at 6-months and functional outcomes at 6- and 12-months (R-square = 0.7 and 0.04 respectively), but prediction accuracy was very poor (AUC ≤ 0.50).ConclusionChronic wrist-related pain at 6-months can be predicted by either elevated PAR ≥ 3/10) or MEP (≥ 6/10) reported at 2-months after the injury, while disability experienced at 6-months after DRF is best predicted by MEP (≥7/10) reported at 2-months. The ratio of these two pain indicators increases assessment complexity and reduces classification accuracy.

Oral administration of prednisone effectively reduces subacute pain after total knee arthroplasty

IntroductionControlling the pain after TKA has always been our research focus. Dexamethasone has a significant effect in controlling acute pain following TKA. We hypothesis oral administration of prednisone could alleviate post-TKA subacute pain. MethodsThis was a prospective, randomized controlled trial dividing patients into prednisone group and control group. Routine analgesic regimens included injection of cocktail mixture intraoperatively, oral celecoxib and tramadol postoperatively. Patients in prednisone group received oral administration of prednisone (10mg, qd, from the first day postoperatively, for 2 weeks). VAS was applied for evaluating pain with ambulation (PWA) and pain at rest (PAR). Follow-up was performed for about three months. The primary end-points were PWA and PAR; secondary end-points were postoperative daily celecoxib use and tramadol use. ResultsA total of 49 patients were enrolled in prednisone group and control group, respectively. VAS of PWA was lower in prednisone group on the 7th, 14th and 28th (p=0.05) day after TKA than that in the control group. Meanwhile, VAS of PAR was lower in prednisone group on the postoperative 14th and 28th day (p=0.05) than that in the control group. ConclusionsContinuous oral administration of 10mg prednisone for 14 days after TKA effectively alleviates subacute pain (including PWA and PAR) and reduces postoperative consumption of analgesics. Level of evidenceII; low power randomized trial.

Movement-Evoked Pain Versus Pain at Rest in Postsurgical Clinical Trials and Meta-Analyses: Protocol for a Follow-Up Systematic Review.

BackgroundPostoperative pain is one of the most prevalent and disabling complications of surgery that is associated with personal suffering, delayed functional recovery, prolonged hospital stay, perioperative complications, and chronic postsurgical pain. Accumulating evidence has pointed to the important distinction between pain at rest (PAR) and movement-evoked pain (MEP) after surgery. In most studies including both measures, MEP has been shown to be substantially more severe than PAR. Furthermore, as MEP is commonly experienced during normal activities (eg, breathing, coughing, and walking), it has a greater adverse functional impact than PAR. In a previous systematic review conducted in 2011, only 39% of reviewed trials included MEP as a trial outcome and 52% failed to identify the pain outcome as either PAR or MEP. Given the recent observations of postsurgical pain trials that continue to neglect the distinction between PAR and MEP, this updated review seeks to evaluate the degree of progress in this area.ObjectiveThis updated review will include postsurgical clinical trials and meta-analyses in which the primary outcome was early postoperative pain intensity. The primary outcome for this review is the reporting of MEP (vs PAR) as an outcome measure for each trial and meta-analysis. Secondary outcomes include whether trials and meta-analyses distinguished between PAR and MEP.MethodsTo be consistent with the 2011 review that we are updating, this review will again focus on randomized controlled trials and meta-analyses, from Medical Literature Analysis and Retrieval System Online and EMBASE databases, focusing on pain treatment after thoracotomy, knee arthroplasty, and hysterectomy in humans. Trials and meta-analyses will be characterized as to whether or not they assessed PAR and MEP; whether their pain outcome acknowledged the distinction between PAR and MEP; and, for trials assessing MEP, which pain-evoking maneuver(s) were used.ResultsScoping review and pilot data extraction are under way, and the results are expected by March 2020.ConclusionsIt is our belief that every postsurgical analgesic trial should include MEP as an outcome measure. The previous 2011 review was expected to have an impact on more widespread assessment of MEP in subsequent postoperative pain treatment trials. Thus, the purpose of this follow-up review is to reevaluate the frequency of use of MEP as a trial outcome, compared with PAR, in more recently published postoperative pain trials.Trial RegistrationPROSPERO CRD42019125855; https://tinyurl.com/qw9dty8International Registered Report Identifier (IRRID)DERR1-10.2196/15309

A prospective study to compare the quality of analgesia after breast cancer surgery using pectoral nerve block versus thoracic paravertebral block

Introduction: Pectoral Nerve block is an interfascial plane block which provides analgesia after breast cancer surgery while Thoracic Paravertebral block is also widely used. This study is designed to compare the quality of analgesia after Modified Radical Mastectomy using the two techniques in terms of, the time for the first request of rescue analgesic, 24 hrs analgesic requirement, Visual Analogue Score for pain at rest at 1 and 6 hours postoperatively. Results: Patients undergoing breast cancer surgeries done under general anaesthesia at Govt. Kilpauk Medical College and Govt. Royapettah Hospital, Chennai between January 2017 and June 2017 belonging to ASA 1 & 2 were included in this study, 30 patients in PECS group and 30 in TPB group. In TPB group, the time for first rescue analgesia was between 141-360 minutes postoperatively (n=17, 56.67%) than in PECS group where the time for first rescue analgesia was between 121-240 minutes postoperatively (n=27, 90.00%)(p= postoperatively (n=26, 86.67%) while in PECS group it was 300 mg tramadol postoperatively (n=13, 43.33%)(p= were 0.00 and 2.13 while VAS in PECS group at 1 hour and 6 hours were 2.00 and 4.00(p= unpaired t test) Conclusion: Thoracic paravertebral block reduced the 24 hour analgesic consumption, reduced VAS scores at 1 and 6 hours and prolonged the time required for the first request of analgesic compared to pectoral nerve block after modified radical mastectomy. Keywords: Pectoral nerve block, Thoracic paravertebral block, Modified radical mastectomy.

Patients with Pain 60 to 120 Days after Total Knee Arthroplasty More Likely to be Dissatisfied at Mid-Term Follow-Up

The purpose of this study was to determine if TKA patients with pain between 60 and 120 days are more likely to be dissatisfied at mid-term follow-up. At the 60–120 day follow-up, moderate to severe movement-elicited pain (MEP) and pain at rest (PAR) were reported by 25/316 TKAs (7.9%) and 44/316 TKAs (13.9%), respectively. A greater proportion of those with MEP at 60–120 days were dissatisfied at midterm follow-up (24% vs. 6.5%, P = .01), and those with MEP early after surgery were 4.5 times more likely to be dissatisfied at mid-term follow-up (P = .004). Similarly, those with PAR 60–120 days after surgery were 4.1 times more likely to be dissatisfied at mid-term follow-up (P = .002).

Efficacy and safety of diclofenac diethylamine 1.16% gel in acute neck pain: a randomized, double-blind, placebo-controlled study.

BackgroundNeck pain (NP) is a common musculoskeletal disorder in primary care that frequently causes discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce neck pain and associated inflammation and facilitate earlier recovery. Topical diclofenac diethylamine (DDEA) 1.16% gel is clinically proven to be effective and well tolerated in acute and chronic musculoskeletal conditions, but until now no clinical data existed for its use in acute NP. The aim of this study was to assess the efficacy and safety of DDEA 1.16% gel compared with placebo gel in acute NP.MethodsIn a randomized, double-blind, placebo-controlled study, patients with acute NP (n = 72) were treated with DDEA 1.16% gel (2 g, 4x/day, for 5 days) or placebo. Efficacy assessments included pain-on-movement (POM), pain-at-rest (PAR), functional neck disability index (NDI) and response to treatment (decrease in POM by 50% after 48 h). Adverse events (AEs) were recorded throughout the study.ResultsThe primary outcome, POM at 48 h, was statistically significantly lower with DDEA gel (19.5 mm) vs. placebo (56.9 mm) (p < 0.0001), representing a clinically relevant decrease from baseline (75% vs. 23%, respectively). All POM scores were significantly lower with DDEA gel vs. placebo from 1 h, as were PAR and NDI scores from first assessment (24 h) onwards (all p < 0.0001). Response to treatment was significantly higher with DDEA gel (94.4%) vs. placebo (8.3%) (p < 0.0001). There were no AEs with DDEA gel.ConclusionsDDEA 1.16% gel, which is available over-the-counter, was effective and well tolerated in the treatment of acute neck pain. The tools used to assess efficacy suggest that it quickly reduced neck pain and improved neck function. However, questions remain regarding the comparability and validity of such tools. Further studies will help ascertain whether DDEA 1.16% gel offers an alternative treatment option in this common, often debilitating condition.Trial registrationClinicalTrials.gov identifier: NCT01335724

OP0071 Efficacy and safety of diclofenac diethylamine 1.16% gel in the treatment of acute neck pain: A randomized, double-blind, placebo-controlled study

BackgroundNeck pain (NP) is a common musculoskeletal disorder that affects up to 71% of the population at some point in their lifetime1 and is a frequent cause of discomfort. Characteristics...

The effect of traditional cupping on pain and mechanical thresholds in patients with chronic nonspecific neck pain: a randomised controlled pilot study.

Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, n = 25) or waiting list control group (WL, n = 25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: −17.9 mm VAS, 95%CI −29.2 to −6.6; PM: −19.7, 95%CI −32.2 to −7.2; PaDi: −1.5 points on NRS, 95%CI −2.5 to −0.4; all P < 0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95%CI 1.4 to 13.5; Bodily Pain: 14.9, 95%CI 4.4 to 25.4; Physical Component Score: 5.0, 95%CI 1.4 to 8.5; all P < 0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95%CI 0.029 to 0.148, pain-adjacent: 0.118, 95%CI 0.038 to 0.199; both P < 0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP.

The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain - a randomised controlled pilot study

BackgroundIn this preliminary trial we investigated the effects of dry cupping, an ancient method for treating pain syndromes, on patients with chronic non-specific neck pain. Sensory mechanical thresholds and the participants' self-reported outcome measures of pain and quality of life were evaluated.MethodsFifty patients (50.5 ± 11.9 years) were randomised to a treatment group (TG) or a waiting-list control group (WL). Patients in the TG received a series of 5 cupping treatments over a period of 2 weeks; the control group did not. Self-reported outcome measures before and after the cupping series included the following: Pain at rest (PR) and maximal pain related to movement (PM) on a 100-mm visual analogue scale (VAS), pain diary (PD) data on a 0-10 numeric rating scale (NRS), Neck Disability Index (NDI), and health-related quality of life (SF-36). In addition, the mechanical-detection thresholds (MDT), vibration-detection thresholds (VDT), and pressure-pain thresholds (PPT) were determined at pain-related and control areas.ResultsPatients of the TG had significantly less pain after cupping therapy than patients of the WL group (PR: Δ-22.5 mm, p = 0.00002; PM: Δ-17.8 mm, p = 0.01). Pain diaries (PD) revealed that neck pain decreased gradually in the TG patients and that pain reported by the two groups differed significantly after the fifth cupping session (Δ-1.1, p = 0.001). There were also significant differences in the SF-36 subscales for bodily pain (Δ13.8, p = 0.006) and vitality (Δ10.2, p = 0.006). Group differences in PPT were significant at pain-related and control areas (all p < 0.05), but were not significant for MDT or VDT.ConclusionsA series of five dry cupping treatments appeared to be effective in relieving chronic non-specific neck pain. Not only subjective measures improved, but also mechanical pain sensitivity differed significantly between the two groups, suggesting that cupping has an influence on functional pain processing.Trial registrationThe trial was registered at clinicaltrials.gov (NCT01289964).

Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: A fundamental distinction requiring standardized measurement

To estimate frequency of movement-evoked pain (MEP) measurement in human postsurgical investigations, we reviewed thoracotomy, knee arthroplasty, and hysterectomy clinical trials and meta-analyses. Only 39% of trials measured MEP and 52% failed to identify pain outcome as pain at rest (PAR) or MEP. Temporal trending did not suggest that MEP measurement is becoming more frequent. Trials measuring both MEP and PAR suggest that MEP is 95–226% more intense than PAR in the first 3 postoperative days. Among trials measuring MEP, 38% did not specify the physical maneuver used to assess MEP. Five of 7 meta-analyses reviewed (71%) did not distinguish between PAR and MEP, and none of the 7 meta-analyses declared the 20–59% of reviewed trials that had failed to identify their pain outcome as PAR or MEP. These results suggest an unchanging neglect of MEP in postsurgical pain trials and frequent failure to identify pain outcome as PAR or MEP. This is an important problem because MEP is usually more severe than PAR; MEP exerts a more direct adverse impact on postsurgical functional recovery and several current and novel pain treatments differentially affect MEP vs PAR. Failure to distinguish between PAR and MEP and standardize their measurement threatens trial precision and ability to identify interventions with the most clinically relevant effects on pain. We therefore recommend developing consistent terminology regarding PAR and MEP, considering inclusion of MEP as a pain outcome in every postsurgical trial, and standardizing measurement of PAR and MEP on a procedure-specific basis.An unchanging neglect for movement-evoked pain (MEP) measurement in postsurgical trials is revealed; we recommend considering MEP as a pain outcome in every postsurgical trial and standardizing its measurement.

長崎市における腎透析患者の骨関節障害実態調査

A number of 341 patients who are under Haemodialysis (HD) in Nagasaki City were interviewed in person by a single observer with the use of sequence questioning concerning the bone and joint complaints complicated with HD such as pain at rest (PR) as well as in motion (PM), restricted range of motion (ROM) of joints, carpal tunnel syndrome (CTS) and pathological fracture (PF).The number of affected patients with PR, PM, restricted ROM and CTS were 127 (37.2%), 150 (44.0%), 61 (17.9%) and 86 (25.2%) respectively. The joints involved with PR and PM in order of frequency were the shoulder, knee and low back, and the common joints with restricted ROM were the knee, shoulder and fingers in this order, more than half of which were bilaterally. Twenty-six (7.2%) patients had PF and the most common sites of which were rib and metatarsal bone. The incidence of all these complications revealed that the age of patient was not significant, however, the trends appeared to correlate with the duration of HD.

The vectorcardiogram of cardiac infarction.

were studied andfoundtohavecertain constant characteristics thatwerecomparable withtheresults obtained byelectronic methods. Inthispaperwereport thevectorcardiographic findings of extensive cardiac infarction, andtheabnormal patterns obtained havebeenrelated totheQRS-T complexes recorded fromthesamepatients intheconventional manner.Duchosal andSulzer (1949) andVastesaeger (1949) havestudied thevectorcardiogram ofcardiac infarction, using an electronic apparatus. Ourfindings areinsubstantial agreement withthose recently reported by Scherlis andGrishman (1951); their three-plane vectorcardiograms wereseensimultaneously ona tribeam cathode-ray tubeandphotographed ononefilm. METHIOD Themethodofintegrating thescalar electrocardiograms hasbeenthesameaswedescribed, butthe leadpositions ofthereference system havebeenslightly modified. Thevoltage obtained fromleads in thehorizontal plane inthesystem advocated byDuchosal andSulzer (1949) issmall, anditwasfound that thehigher voltage that could beobtained bybringing theelectrodes nearer totheheart, madethe vectorcardiogram easier tocorrelate withtheconventional chest leads. Thehorizontal leadpositions have therefore beenraised fromtheiliac spine level toaplane through thexiphisternum; thereference system -then becomes almost cuboidal. Itisappreciated thatthere arecertain theoretical objections toplacing electrodes anynearer theheart, butthis newposition isconsidered tobeareasonable compromise that sacrifices little fundamental accuracy andfacilitates interpretation oftheloop.Grishman etal.(1951) havemadesimilar changes intheleadpositions. Thevalidity ofthis methodisshownbythesimilarities oftheQRScomplexes reconstructed fromour vectorcardiograms andtheactual leads obtained bytheconventional method.InFig.IAthereconstructed QRScomplexes fromthefrontal plane looparecompared withthestandard leads recorded from thesamenormal subject. A reconstruction oftheunipolar chest leads fromthehorizontal plane loopis showninFig. 2Atogether withtherecorded unipolar chest leads. Theprojections inthree planes of thespatial vectorcardiogram havebeendrawnin20cases ofcardiac infarction, ofwhich10wereanterior -and10posterior inposition. Allobservations weremadewiththesubject inareclining position. Each patient hadahistory ofprolonged chest pain atrest, andanelectrocardiogram thatshowed pathological Q waves. RESULTS Fourexamples ofthevectorcardiogram inpatients withposterior cardiac infarction areshown inFig. 3,andafrontal projection isshownwiththereconstructed complexes alongside therecorded limbleads inFig. lB.Allthepatients withthis condition showed loops that wereinitially directed upwards inthefrontal plane andtended tolieintheupperquadrants; thesagittal view(Fig. 3) -oftheloopshowsthesameupwards deviation. Thehorizontal projection showednoconstant 339