Painless Treatment Research Articles

Pain perception during and after VNUS ClosureFAST™ procedure

The objective of the study was first to quantify the level of pain that patients experience during VNUS ClosureFAST™ and in the first week following treatment. Secondly, to investigate the use of pain medication. Thirdly, to identify after how many days patients return to daily activities and whether pain is a factor of influence. A prospective descriptive cohort study was carried out. In all, 104 consecutive VNUS ClosureFAST procedures for greater saphenous vein (GSV) incompetence between 18 May and 28 August 2009 in the HagaZiekenhuis were included. A visual analogue score (VAS) was recorded immediately after the procedure. These patients were asked to register pain scores during the week following the procedure, the amount of pain medication if used and the time elapsed between the procedures and resuming daily activities. The average VAS score during the VNUS Closure procedure was four. The first three days after the procedure the VAS score was 2. After four days, the average score was 1. The average return to daily activities was on day two after the procedure. In total, 24% of all patients used paracetamol after the procedure. In summary, VNUS ClosureFAST procedure for GSV incompetence is not a painless treatment. After an average of two days, patients return to their daily activities. Pain does not seem to be a major factor in the resumption. Seventy-six percent of patients do not use any pain medication.

The use of extracorporeal magnetic innervation for the treatment of stress urinary incontinence in older women: a pilot study

Stress urinary incontinence (SUI) is a major health problem that has substantial and important effects on health-related quality of life. In recent years, extracorporeal magnetic innervation (ExMI) has become a preferred method of treatment in urinary incontinence. This study presents the effects of ExMI treatment on pelvic floor muscle strength, urinary symptoms, incontinence conditions and quality of life of older women with SUI. A total of 13 patients between the ages of 61 and 69 (mean 65.23 ± 2.8 years) were treated for SUI with ExMI. The following parameters were investigated: urinary symptoms, pelvic floor electromyographic (EMG) activity, 1-h pad test, incontinence conditions utilizing visual analog scale (VAS) and quality of life using Turkish version of the Urogenital Distress Inventory (UDI-6) and the Incontinence Quality of Life Instrument (I-QoL). All assessments were conducted at baseline and at the end of the study. Treatment lasted for 20 min, twice a week and for a total of 6 weeks. The urinary symptoms and incontinence conditions decreased after the ExMI treatment sessions. The pad test results indicated a reduction in urine loss (p = 0.016). EMG values were improved (p = 0.005). Scores of I-QoL, UDI-6 and VAS were reduced after the treatment, respectively (p = 0.002), (p = 0.002) and (p = 0.006). Extracorporeal magnetic innervation can be considered as it is an alternative, non-invasive and painless treatment method with good compliance for treatment of SUI in older patients.

Extracorporeal Magnetic Innervation for the Treatment of Stress Urinary Incontinence: Results of Two-Year Follow-Up

Introduction: Extracorporeal magnetic innervation (ExMI) is a relatively new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We aimed to evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress urinary incontinence. Materials and Methods: A total of 30 patients with demonstrable stress urinary incontinence were enrolled in this study. All were neurologically normal with normal urinalysis and none was pregnant. Evaluation before treatment included 3-day bladder diaries, a dynamic pad weight test, urodynamics, and a validated quality of life survey. Treatment sessions lasted 20 min, twice a week, for 6 weeks. After ExMI, all measures were repeated at follow-up including 3-day bladder diary, dynamic pad weight test, urodynamics and quality of life survey. The follow-up was done at 3, 12 and 24 months after ExMI therapy but urodynamics were performed only at first follow-up. Results: After ExMI therapy, 8 out of the 27 patients were cured (29.7%) and 13 patients were improved (48.1%) at 3 months. The cumulative success rate was 77.8%. Six patients did not show any improvement after treatment. Pad weight was reduced from 14.4 ± 10.7 to 6.5 ± 5.1 g. The mean score of quality of life survey at baseline was 61.6 and this increased to 75.4 at 12 weeks. The effect of ExMI approximately continued until the 1st year after therapy but gradually decreased and came close to baseline at the 2nd year after therapy. Conclusion: As a result, ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI also offers a noninvasive, effective and painless treatment for women with stress urinary incontinence. Further studies are needed to address how long the therapy will continue and benefits will last and whether retreatment or continuation therapy sessions will be necessary.

A utilização do laser em Ortodontia

O laser vem sendo amplamente utilizado na área da saúde, encontrando-se em franca evolução na Odontologia, beneficiando o paciente com tratamentos atraumáticos, sem dor, com melhor pós-operatório, entre muitas outras vantagens. A Ortodontia também tem muito a ganhar com a utilização da luz laser, apesar de suas aplicações e seus efeitos não se encontrarem bem difundidos entre os profissionais. O presente trabalho objetivou realizar uma revisão na literatura a fim de elucidar o ortodontista sobre como ele poderá se beneficiar desta forma de energia, elevando a qualidade do seu trabalho e melhorando as condições do tratamento tanto para o profissional como para o paciente.

Transcranial magnetic stimulation for the treatment of depression in neurologic disorders

Depression is commonly associated with neurologic disorders. Although depression in neurologic conditions often is associated with a negative impact on quality of life, it frequently is poorly managed. Some factors, such as a multidrug regimen, lack of efficacy, and side effects of antidepressants may explain why depression is not adequately treated in patients with neurologic disorders. Therefore, this population needs new approaches for depression treatment, and repetitive transcranial magnetic stimulation (rTMS) may be one of them because it has been shown to be effective for the treatment of depression alone and depression in certain neurologic diseases such as Parkinson's disease and stroke. rTMS is a noninvasive, focal, and painless treatment associated with few, mild side effects. It may be effective in the treatment of neurologic diseases such as Parkinson's disease, stroke, and epilepsy. In this paper, we discuss the potential risks and benefits of rTMS treatment for depression in Parkinson's disease, epilepsy, stroke, multiple sclerosis, and Alzheimer's disease. Lastly, a framework that includes the parameters of stimulation (intensity, frequency, number of pulses, and site of stimulation) for the treatment of depression in neurologic diseases is proposed.

Functional extracorporeal magnetic stimulation as a treatment for female urinary incontinence: ‘the chair’

To evaluate, in a prospective study, the efficiency and applicability of functional magnetic stimulation (FMS) of the pelvic floor for treating urinary incontinence in women. FMS was provided by a 'magnetic chair'; 24 patients were treated twice weekly for 8 weeks (12 with urge incontinence and 12 with a mixture of urge and stress incontinence). The outcome was assessed urodynamically, by a pad test, and by patient satisfaction. In 58% of the patients there was an objective improvement in incontinence; three patients were completely dry and 71% reported a subjective improvement (P < 0.001). FMS is a safe, noninvasive and painless treatment for urinary incontinence; it is effective and easy to administer as an outpatient treatment.

Extracorporeal shockwave lithotripsy for treatment of sialolithiasis of salivary glands

Following the clinical introduction of extracorporeal shockwave lithotripsy in the 1980s for the treatment of sialolithiasis of salivary glands this method has been widely used and replaced surgical interventions in selected patients. Between 1/1995 and 1/1999 35 patients were treated by extracorporeal shockwave lithotripsy (ESWL) with the "Minilith SL-1" lithotripter on an outpatient basis. Radiography and sonography were performed to verify sialolithiasis and scintigraphic investigation was done to control sufficient gland function. Treatment was performed in a fractionated manner with up to 3000 shockwaves per session, normally without anesthesia or analgosedation. After treatment 45.4 % of the patients with sialolithiasis of the parotid gland (n = 11) were stone-free and in 36.3 % an adequate desintegration of the stones was achieved. These patients underwent 2.6 sessions on average for sufficient stone-destruction. 41.6 % of the patients with sialolithiasis of the submandibular gland (n = 24) were stone-free and 3.1 sessions were necessary on average. Desintegration of the stones was achieved in 25 %. Mild pain, swelling, bleeding out of the intraoral orifice of the affected gland and skin petechia were the only complications. All patients were symptom-free after lithotripsy, although fragmented stones persisted in the parotid gland (18.3 %) and the submandibular gland (33.4 %). The advantages of ESWL are the relatively painless treatment and the elimination of the need for an operation with its surgical risks.

Intravenous Regional Anesthesia (Bierʼs Block) for Botulinum Toxin Therapy of Palmar Hyperhidrosis is Safe and Effective

BACKGROUND Botulinum toxin type A (BTX-A) has been shown to be highly effective in reducing palmar hyperhidrosis. Since palmar injections is a painful procedure, the use of an anesthesia method is recommended. OBJECTIVE To assess the efficacy of intravenous regional anesthesia (IVRA) for painless treatment of palmar hyperhidrosis with BTX-A compared to topical application of a local anesthetic agent. METHODS Thirty patients with palmar hyperhidrosis were treated with BTX-A injections, using a total dose of 100 U BTX-A for each hand. One palm was pretreated with a topical application of local anesthetizing cream (EMLA cream), while the other palm was anesthetized with IVRA. Sweat secretion was visualized with Minor's test and quantified by corneometer analysis before and after BTX-A therapy. RESULTS BTX-A therapy was significantly less painful in palms anesthetized with IVRA than in palms pretreated with EMLA cream (P < 0.0001, paired Wilcoxon rank test). Two weeks after the BTX-A injections, corneometer measurements showed that spontaneous sweat production had declined significantly, from 115 ± 16.25 (left hand) and 114 ± 17.58 (right hand) before therapy to 81.5 ± 27.33 (left hand) and 74 ± 28.08 (right hand) after therapy (P < 0.001, paired t test). CONCLUSION IVRA safely and effectively alleviates the pain associated with BTX-A treatment for palmar hyperhidrosis. Quantitative analysis with the corneometer showed that BTX-A significantly reduces sweat production. We conclude that IVRA is a suitable method for providing pain relief in the treatment of patients with palmar hyperhidrosis.

Intravenous Regional Anesthesia (Bier's Block) for Botulinum Toxin Therapy of Palmar Hyperhidrosis is Safe and Effective

Botulinum toxin type A (BTX-A) has been shown to be highly effective in reducing palmar hyperhidrosis. Since palmar injections is a painful procedure, the use of an anesthesia method is recommended. To assess the efficacy of intravenous regional anesthesia (IVRA) for painless treatment of palmar hyperhidrosis with BTX-A compared to topical application of a local anesthetic agent. Thirty patients with palmar hyperhidrosis were treated with BTX-A injections, using a total dose of 100 U BTX-A for each hand. One palm was pretreated with a topical application of local anesthetizing cream (EMLA cream), while the other palm was anesthetized with IVRA. Sweat secretion was visualized with Minor's test and quantified by corneometer analysis before and after BTX-A therapy. BTX-A therapy was significantly less painful in palms anesthetized with IVRA than in palms pretreated with EMLA cream (P < 0.0001, paired Wilcoxon rank test). Two weeks after the BTX-A injections, corneometer measurements showed that spontaneous sweat production had declined significantly, from 115 +/- 16.25 (left hand) and 114 +/- 17.58 (right hand) before therapy to 81.5 +/- 27.33 (left hand) and 74 +/- 28.08 (right hand) after therapy (P < 0.001, paired t test). IVRA safely and effectively alleviates the pain associated with BTX-A treatment for palmar hyperhidrosis. Quantitative analysis with the corneometer showed that BTX-A significantly reduces sweat production. We conclude that IVRA is a suitable method for providing pain relief in the treatment of patients with palmar hyperhidrosis.

Modified topical photodynamic therapy of superficial skin tumors, utilizing aminolevulinic acid, penetration enhancers, red light, and hyperthermia.

Photodynamic therapy (PDT) is a noninvasive selective therapy for a specific group of skin tumors. In this study we used a modified topical medication in which ethyleneamine tetra acetic acid (EDTA) and dimethylsulphoxid (DMSO) were added to 5-aminolevulinic acid 20% (ALA) followed by exposure to a novel high output light source emitting red and infrared irradiation. ALA 20%-EDTA 2%-DMSO 2% in a water in oil cream base was applied to the tumors. After 12 hours the tumor was exposed to red (585-720 nm; 150 mW/cm2) and near infrared irradiation (1.25-1.6 mm; 50 mW/cm2) for 10-15 minutes by the VersaLight incoherent filtered light source. Complete responses were achieved after one to three ALA-PDT treatments in 26/31 lesions of superficial or small nodular basal cell carcinoma (BCC) (84%), and in four of five in superficial squamous cell carcinoma (SCC) (80%). Complete clearance was achieved in one patient with Bowen's disease of the penis. Topical PDT utilizing ALA 20%-EDTA 2%-DMSO 2% as the photosensitizer and VersaLight as the light source is a noninvasive, nearly painless treatment with excellent therapeutic and cosmetic results. Our data show the efficiency of this therapy for patients with certain subtypes of BCC, SCC, and Bowen's disease.

Painless treatment of hydrocele: EMLA cream anaesthesia and fibrin adhesive sclerotherapy.

Sclerotherapy for hydroceles was performed in 18 patients. Cutaneous anaesthesia was induced with an anaesthetic cream (lidocaine and prilocaine, EMLA cream) and a fibrin sealant (Tissucol) was injected into the sac after fluid aspiration. Patients experienced no pain during needle insertion and sclerosant procedure; 2 recurrences were observed during follow-up. EMLA cream anaesthesia and fibrin adhesive sclerotherapy represent a useful alternative to surgical treatment of hydroceles.

Acquisition and maintenance of dental anxiety: the role of conditioning experiences and cognitive factors

This study presents a contribution to the understanding of the mechanisms that are involved in the development and maintenance of dental anxiety. Subjects were 224 undergraduate psychology students who completed questionnaires regarding dental anxiety, painful and traumatic experiences, negative cognitions, dental beliefs, and how their attitude to dental treatment had changed during their life. The results showed that both the extent to which earlier dental treatments were perceived as painful and the extent to which these incidents were reported as traumatic were significantly related to dental anxiety. Evidence was also found to support the latent inhibition hypothesis, which predicts that patients less easily acquire dental anxiety in case they received a number of relatively painless treatments prior to conditioning. Both findings confirmed those earlier obtained by Davey in a conceptually similar design ( Behaviour Research and Therapy, 27, 51–58, 1989). In addition, frequency of negative cognitions about dental treatment and dental anxiety appeared to be positively related ( r = 0.74; P < 0.001). Significant differences were found between highly anxious Ss and Ss showing low levels of anxiety on a variety of expectations and beliefs related to undergoing dental treatment. The results are discussed in terms of a cognitive-behavioural perspective of dental anxiety.

Propofol for pulsed dye laser treatments in paediatric outpatients

Pulsed dye laser is a new treatment for port-wine stains, congenital lesions in the cutaneous vascular plexus. We report our anesthetic experience with paediatric outpatients treated in the dermatology clinic. From April to November 1993, 48 ASA 1 children were anaesthetised for a total of 105 consecutive laser treatments. The youngest was eight months old, the oldest was 12 yrs old and most of the sessions (43%) were done for children aged from two to four years. Each received acetaminophen (10 mg.kg-1 p.o.) before treatment. A propofol infusion was chosen for anaesthesia to achieve early discharge and to reduce the incidence of postoperative emesis. The infusion was adjusted to maintain blood pressure within 20% of baseline and to keep the child immobile. The dose was progressively reduced during the procedure from 400 micrograms.kg-1.min-1 to 100 micrograms.kg-1.min-1. Fentanyl (2 micrograms.kg-1 i.v.) was added for analgesia. Respiration was spontaneous through a nasopharyngeal airway (air in oxygen 40%). Anaesthesia proceeded uneventfully in all cases and lasted for 15-30 min (63% of treatments), 30-45 min (28%) or 45-60 min (9%) according to the size of the lesion. The mean stay in the recovery room was 25.1 min and none of the patients experienced emesis. Our experience shows that general anaesthesia with propofol supplemented with fentanyl offers a rapid onset and awakening, a painless treatment and an immobile child. It is a safe solution to alleviate pain from repeated painful procedures even in small children under two years of age.

TRANSRECTAL LOW LEVEL LASER THERAPY IN THE MANAGEMENT OF PROSTATIC PROBLEMS:

A pilot study is presented on the transrectal application of helium neon (HeNe) laser energy (20 mW, c/w) via a specially-designed probe for the treatment of chronic prostatitis in a patient population of 235. Laser therapy was administered at doses of from 11.5∼14.4 J per 12∼15 minute daily session, with 8∼12 sessions required. Results were graded as: good (complaints relieved, ultrasound assessment, uroflowmetry and speed of micturation normal, and semen tests showed no inflammation); satisfactory (complaints reduced with partial improvements as above); and negative (little or no change). 70.2% were graded good, 20.9% as satisfactory and 21% as negative. The same system was also applied in the treatment of benign prostatic hypertrophy (BPH), in a patient population of 167 (69 BPH I and 98 BPH II). 12∼15 daily sessions of 20 min were required, with doses of 19.0∼20.8 J per session. With the same grading criteria as for the prostatitis group, results were good in 14.4%, satisfactory in 42.5% and negative in 43.1%. An additional group of 13 patients with prostatodynia received 5∼6 daily sessions of from 8 to 10 minutes, average dosage of 8.8 J/session. All 13 patients were graded good. All patients in the three groups had received conventional medical therapies, some over a period of years, but without effect. Although there was no attempt at double blinding in the present study, the author suggests that the positive results should encourage such a double blind trial to be set up, and that HeNe low level laser therapy (LLLT) applied transrectally is a valid alternative or adjunctive therapy for the minimally invasive and painless treatment of prostatic problems.

Clinical Experience Using the Wolf Piezolith Device at 2 British Stone Centers

Machines using the principle of piezoelectric extracorporeal shock wave lithotripsy have been developed. This has allowed the prospect of painless treatment for renal and ureteral calculi. The experience with use of 2 Wolf Piezolith machines for 1 year is presented.Different second generation lithotriptors have varying techniques of production of shock waves and different imaging methods. The Wolf Piezolith device uses ultrasound imaging and piezoelectric crystals for shock wave generation. Between June 1987 and May 1988, 545 patients 5 to 84 years old were treated with the Wolf Piezolith device. Of these patients 2-month followup data are available for 367 (398 renal units). Outpatient treatment was used routinely. For renal calculi complete fragmentation (into particles less than 2mm. in size) was achieved in 94 per cent of the patients, with 53 per cent being completely free of stone at 2 months. For ureteral stones treated in situ the best results were obtained in the upper and lower ureter. Over-all, 62 per cent of the patients required more than 1 treatment, with the number of treatment sessions required increasing with the size of the stone treated. Morbidity was low. Ultrasound imaging has proved to be as effective as x-ray imaging. Compared to Dornier HM-3 lithotripsy, installation and running costs were low. The machine offers a favorable alternative to first generation lithotriptors.

Therapy With The Knife: Is It Still Needed for Renal Stones?

Therapy With The Knife: Is It Still Needed for Renal Stones?

LASER SURGERY FOR CERVICAL INTRAEPITHELIAL NEOPLASIA

Rationale The advantages of laser surgery over scalpel surgery and cryotherapy for cervical intraepithelial neoplasia (CIN) are several: 1. microsurgical precision; 2. complete removal of diseased tissue to any depth or breadth required; 3. no-touch surgery with an unobstructed operating field; 4. minimal effect on adjacent normal tissue and rapid healing to normal or near-normal volume with a new squamocolumnar junction located most often at the level of the external 0s; 5. quick, virtually painless treatment performed in the vast majority of cases in an office or clinic with little discharge, minimal complications and no apparent effect on subsequent fertility or cervical competence; 6. most often concomitant hemostasis; 7. the highest rate of success after one treatment of all alternatives; 8. early identification of persistent disease; and 9. easy retreatment, usually in the office or clinic (1).

Cryosurgical treatment of dysplasia and carcinoma in situ of the cervix uteri.

Fifty-nine patients (age range 18-40 years, mean 28 years) with dysplasia or carcinoma in situ of the cervix uteri were treated with cryosurgery. Healing occurred in 54 patients (91.6%) after one treatment ("double-freeze" technic) and in 2 patients after refreezing. No early or late complications occurred during a follow-up period of 7-37 months. Five of the patients with carcinoma in situ were followed immunologically with determinations of serum TPA (tissue polypeptide antigen), which can be employed as a parameter of malignancy. In all instances, the initially elevated TPA normalized after cryosurgical treatment. Cryosurgery is a simple, painless and safe treatment method in ectocervically localized carcinoma in situ and dysplasia that is particularly suited for out-patient use.

TREATMENT OF CARCINOID LIVER METASTASES BY HEPATIC-ARTERY EMBOLISATION

Two patients with multiple hepatic carcinoid metastases experienced considerable symptomatic relief after the hepatic artery was embolised with fragments of absorbable gelatin sponge administered through a percutaneous arterial catheter. With adequate pharmacological cover the technique is a safe, effective, and relatively painless treatment for a condition which is usually very difficult to manage.

Towards a Biblical Doctrine of Punishment

In recent discussions philosophers have come to some measure JLof agreement as to what they mean by ‘punishment’, although they admit that there can be no sharp line delimiting the use of the term.1 A standard case of punishment (I) must involve the suffering of some unpleasantness by its victim, (2) must be for an offence against rules either legal or moral, (3) must be of a supposed or an actual offender, (4) must be administered by personal beings other than the offender, and (5) must be imposed by the authority upholding the system of rules against which the offence has been committed. We note from this account that punishment so defined necessarily involves suffering. For this reason punishment requires to be justified, for the deliberate infliction of pain is something that Christians would normally refuse to do to others, and something which may be regarded as unjust to its victim, if St. Paul's statement is universally true, ‘I can will what is right, but I cannot do it’ (Rom. 7.18). There may be other ways of dealing with wrongdoers like the Russian correctional colonies intended to provide a largely painless curative treatment for criminals or the approved schools without any corporal punishment desired by a recent Home Secretary, but unless some suffering is involved these are not methods of punishment.