Post-treatment Discomfort Research Articles

The XP-endo Shaper and Its Impact on Posttreatment Discomfort: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis assess the impact of the XP-endo Shaper (XPS) on postoperative pain following root canal treatment and compare its efficacy with other endodontic systems. A comprehensive literature search was conducted in MEDLINE, Web of Science, Embase, and the Cochrane Library from January 2000-August 2024. Randomized controlled trials using XPS and reporting postoperative pain were included. Pain levels were measured using the Visual Analog Scale at multiple postoperative time points. Data were pooled and analyzed using a random effects model, revealing significant heterogeneity. Six randomized controlled trials involving 731 patients met the inclusion criteria. The pooled analysis revealed that XPS significantly reduced pain scores at the 6, 12, and 24-hour time points (standardized mean difference [SMD] -1.30, 95% confidence interval [CI] [-2.36, -0.24], P=.016; SMD -3.00, 95% CI [-3.54, -2.46], P<.001; SMD -0.91, 95% CI [-1.53, -0.28], P=.005, respectively) compared to other systems, including WaveOne Gold and HyFlex EDM. Pain scores beyond 48hours were comparable between XPS and other file systems. XPS shows substantial short-term efficacy in reducing postoperative pain following root canal treatments, likely due to its flexible design and reduced debris extrusion. The findings suggest that XPS can potentially improve patient comfort, though long-term pain outcomes remain similar to other systems.

Puzzle Facelift: A Nonsurgical, Whole Treatment for Facial Modeling and Rejuvenation.

The assessment of correct anatomy of face and the evaluation of the dynamic interplay between anatomy and function, to get an overall improvement, is a leading topic in aesthetic surgery and has increased its impact in recent years. A nonsurgical impact technique reduces both post-treatment discomfort and the overall cost. Obtaining the simultaneous correction in forehead, nose, lips, and chin means obtaining an overall improvement in face view. Likewise, the high predictability of the procedure and the absence of alloplastic implant, bone re-absorption, and scars have to be considered in nonsurgical aesthetic medicine. In conclusion, a single session of profile correction using hyaluronic acid filler should be proposed to patients, every time the aesthetic practitioner sees a coexistence of forehead, nose lips, and chin defects.

Effectiveness of Flexible Ureterorenoscopy Versus Extracorporeal Shock Wave Lithotripsy for Renal Calculi of 5–15 mm: Results of a Randomized Controlled Trial

BackgroundPrimary flexible ureterorenoscopy (URS) and extracorporeal shock wave lithotripsy (SWL) are treatment options in patients with renal calculi of 5–15 mm. ObjectiveTo compare effectiveness, complication rates, and pain scores between primary URS and SWL. Design, setting, and participantsBetween 2011 and 2016, patients with renal calculi between 5 and 15 mm were randomized to undergo either primary URS or SWL. Outcome measurements and statistical analysisStone-free rate and size of residual fragments assessed by computed tomography after 3 mo, complications, and pain scores were evaluated. Results and limitationsThe study was prematurely closed after randomizing 44 patients due to poor accrual. The 3-mo stone-free rate and mean residual stone size were, respectively, 61% and 1.8 mm after URS and 48% and 2.4 mm after SWL. Early post-treatment pain scores were significantly higher after URS than after SWL on day 1 (3.3 vs 1.6, p = 0.02) and day 7 (5.2 vs 3.4, p = 0.04), but were no longer detectable after 3 wk and 3 mo, respectively. One Clavien-Dindo grade II complication was observed after URS (5%) and SWL (4%), while one (4%) grade IIIb complication was observed after SWL. ConclusionsURS appears to be associated with higher early post-treatment discomfort, which could be associated with routine postoperative stenting. Owing to premature closure of this trial, the power was insufficient to formally compare URS and SWL; however, the present data might be informative to counsel patients about treatment outcomes and allow future meta-analyses. Patient summaryThis study was ended prematurely, but it contributes data about efficacy and side effects of different treatment options in patients with renal calculi.

Effectiveness and Safety of Polydioxanone Thread Embedding Acupuncture Compared to Physical Therapy in the Treatment of Patients with Non-Specific Chronic Neck Pain: An Assessor-Blinded, Randomized, Controlled, Clinical Trial.

BackgroundThread embedding acupuncture (TEA) has recently been used as a conservative treatment method for non-specific chronic neck pain (CNP). The objective of this study was to evaluate the effectiveness and safety of TEA compared to physical therapy (PT) for treating patients with CNP.MethodsA total of 128 patients diagnosed with CNP were randomly assigned to a TEA group and a PT group at a 1:1 ratio. The TEA group received four sessions of TEA, while the PT group received eight sessions of PT over 4 weeks. Outcomes were assessed using Neck Pain and Disability Scale (NPDS), clinically important difference (CID), cervical spinal angle, Beck Depression Inventory II (BDI-II), Beck Anxiety Inventory (BAI), Patient Global Impression of Change (PGIC), and EuroQol Five-Dimension (EQ-5D) at baseline and 5, 9, and 13 weeks.ResultsThe TEA group showed significant improvement in NPDS compared to the PT group at 5, 9, and 13 weeks. Proportions of patients with decreased NPDS scores of more than 11.5 points (minimal CID) were significantly higher in the TEA group at 5, 9, and 13 weeks. There were significant differences between the two groups at 5, 9, and 13 weeks for BDI-II, and at 5 and 9 weeks for BAI. For EQ-5D, the TEA group showed significant improvement at 5, 9, and 13 weeks. There was no significant difference in cervical spinal angle between the two groups. For PGIC, better improvement was observed at 9 and 13 weeks in the TEA group. Adverse events associated with interventions were mostly temporary and mild.ConclusionFor patients with CNP, TEA treatment was found to be more effective than PT treatment for improving their pain and dysfunction, quality of life, and psychological distress. Despite some post-treatment discomfort, TEA treatment can be considered as a useful treatment method for patients with CNP.Trial RegistrationThis trial has been registered 5 April 2019 in Clinical Research Information Service of South Korea (CRIS- KCT0003720).

Using betaxolol for the prevention of paronychia induced by epidermal growth factor receptor inhibitors: a case-control cohort study.

High rates of posttreatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion resulting from epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)-induced paronychia, which may even interrupt the course of treatment for EGFR-TKI therapy. Thus, we conducted this study to determine how effectively a topical β-blocker, betaxolol, prevents EGFR-TKI-induced paronychia. This case-control cohort study included a total of 131 non-small-cell lung cancer patients. The prevention group comprised 40 patients treated with topical betaxolol 0.25% solution to prevent paronychia while they received EGFR-TKI therapy. The control group comprised 91 patients who did not preventively use topical betaxolol 0.25% solution while receiving EGFR-TKI therapy. The patients' age, gender, antineoplastic regimen, duration of antineoplastic treatment before the appearance of lesions, number of involved digits (fingernails or toenails) with lesions, grading of paronychia, and pain score were recorded. In terms of the cumulative incidence of paronychia, significant differences (P<0.01) were noted at both the 2nd and 3rd months after starting EGFR-TKIs. Furthermore, the average visual analogue scale scores were 3.125 and 6.29 in the prevention group and control group, respectively (P<0.01). The average grades of paronychia were 1.5 and 2.12 in the prevention group and control group, respectively (P<0.01). The average numbers of involved digits were 2.25 (range: 1-5 digits) in the prevention group and 3.03 (range: 1-7) in the control group (P=0.07). Preventively using topical betaxolol can significantly decrease the incidence, VAS score, and grading of EGFR-TKI-induced paronychia.

A new technique for the treatment of nasal telangiectasia using atmospheric plasma (voltaic arc dermabrasion): Postoperative pain assessment by thermal infrared imaging.

Nasal telangiectasias are superficial, small vessels in the ala nasi and nasolabial crease with a varying origin. They represent an unaesthetic condition, frustrating patients who frequently request their removal. Microsclerotherapy, electrosurgery, different types of laser therapy, needle-assisted electrocoagulation, and TRASER therapy have been described for treating this condition. The aim of this study is to describe a novel technique that removes nasal telengectiasias using voltaic arc dermabrasion (VAD). Voltaic arc dermabrasion treatment was used to remove nasal telangiectasia in 23 patients. The post-treatment condition was monitored by means of photographic records and the evaluation of erythema, pain score, patient and surgeon satisfaction, and skin temperature. The timing points were 1, 4, 6days and 1year after treatment. Patients referred a moderate pain during the treatment that ceased at the end of the procedure. Moderate erythema and punctiform fine crusting were present in all patients that lasted until the 6th day after treatment. No other adverse effects were observed. After 1-year, the mean patient and surgeon satisfaction scores were 2.90 and 3.00±0.3, respectively. A single treatment was effective in 85% of the patients and no recurrences were recorded for one year. The skin temperature increased about 18.2±3.2°C during the treatment but returned to basal values in about 20seconds in most of the patients. Voltaic arc dermabrasion treatment is a viable, easy to use, and inexpensive tool for successful nasal telangiectasia removal, with minimal post-treatment discomfort.

Analysis of adverse reactions of acupoint catgut embedding therapy

To objectively evaluate the safety of acupoint catgut embedding therapy. A total of 331 patients who received acupoint catgut embedding therapy were enrolled and summarized through the inpatient medical record system, follow-up record and adverse reaction report card. The statistical analysis was performed from the aspects of patients' gender, age, marital status, history of allergy, history of diabetes and the time, symptoms, duration and prognosis of adverse reactions, etc. Among 331 patients who received acupoint catgut embedding therapy, 70 patients had adverse reactions, which were divided into 9 types, including post-treatment discomfort, local hematoma or subcutaneous hemorrhage, local swelling, local induration, severe pain, thread-body rejection, local pruritus, post-treatment body temperature rising, local redness, swelling, fever and pain. The incidence rate of adverse events was 21.15%, and the incidence of serious adverse events was 0. Among the patients with adverse reactions, 58 patients (82.86%) relieved without treatment, and 12 patients (17.14%) received after symptomatic treatment; all patients had no sequelae. The acupoint catgut embedding therapy is relatively safe and the incidence of adverse reactions is low.

Endovenous laser treatment for uncomplicated varicose veins

Endovenous laser ablation (EVLA) of incompetent truncal veins has been proposed as a minimally invasive alternative to conventional surgery for varicose veins. Various strategies have been proposed for successful treatment and this study reviews the evidence for these. A Medline and 'controlled trials online database' search was performed to identify original articles and randomized controlled trials (RCTs) reporting outcomes for EVLA. Information on patient selection, equipment, technique and outcomes were recorded. Ninety-eight original studies, including five RCTs, were identified. RCT data indicate short-term outcomes (abolition of reflux, improvement in quality of life [QOL], patient satisfaction) were equivalent to those for surgery. Long-term follow-up is not available. A further RCT showed superior outcomes for ablation commencing at the lowest point of superficial venous reflux rather than at an arbitrary point (fewer residual varicosities, greater improvement in QOL). Non-randomized series suggest that laser energy of >60 J/cm results in reliable truncal vein occlusion and that longer wavelength lasers may be associated with less post-treatment discomfort. In the short-term EVLA is a safe and effective treatment for patients with varicose veins. Long-term follow-up is still required.

Enamel Matrix Derivative Exhibits Anti‐Inflammatory Properties in Monocytes

Enamel matrix derivative (EMD) is used clinically to promote periodontal tissue regeneration with variable efficacy. EMD application results in significantly higher frequencies of sites without clinical signs of inflammation; additionally, patients receiving EMD therapy report significantly less post-treatment discomfort. However, there are few reports that focus on defining the biologic mechanisms for the observed anti-inflammatory effects of EMD. The aim of this study was to evaluate the influence of EMD on inflammatory-associated markers using an in vitro monocyte assay. Rat monocytes were exposed to lipopolysaccharide (LPS; 100 ng/ml from Escherichia coli or Actinobacillus actinomycetemcomitans) along with EMD (0, 50, 100, or 200 microg/ml). Levels of tumor necrosis factor-alpha (TNF-alpha) and prostaglandin E(2) (PGE(2)) in conditioned media were analyzed by enzyme-linked immunosorbent assay. In addition, the effects of exogenous PGE(2) on TNF-alpha production from LPS-stimulated monocytes were determined. LPS-stimulated monocytes exposed to EMD exhibited a decrease in TNF-alpha production (0.10- to 0.52-fold) and an increase in PGE(2) production (1.31- to 2.71-fold) compared to controls not treated with EMD. Exogenously applied PGE(2) decreased TNF-alpha production by LPS-stimulated monocytes in a dose-dependent manner, and EMD treatment enhanced this PGE(2)-mediated inhibition of TNF-alpha production. In addition to EMD's published role in inducing proliferation, migration, adhesion, mineralization, and differentiation of periodontal ligament cells, our results indicated that EMD modulates two inflammation-associated factors, TNF-alpha and PGE(2), in monocytes.

Use of light‐emitting diode photomodulation to reduce erythema and discomfort after intense pulsed light treatment of photodamage

This study evaluates the use of light-emitting diode (LED) photomodulation therapy to accelerate resolution of post-intense pulsed light (IPL) erythema. In this split-face study, 15 subjects were randomized to receive LED treatment to one side of the face as determined by computer-generated randomization numbers. All 15 subjects received a single IPL treatment for facial photodamage. Immediately after IPL treatment, one side of the face was treated for 35 s with the LED device. The other side was not treated. Subjects returned 24 h later for a second LED treatment on the same side of the face. Posttreatment erythema was rated on both sides of the face by the blinded investigator and by subjects immediately after IPL treatment, 24 h later, and 1 week later on a scale of 0% (no erythema) to 100% (severe erythema). Patients commented on posttreatment discomfort immediately after IPL treatment. Mean erythema scores on the first visit were significantly higher (P = 0.0054) on the side not treated with LED (52.7 +/- 24.6) than on the LED-treated side (43.3 +/- 21.9). Visit 2 data showed a similar trend (P = 0.0281). The subjects reported similar findings with mean erythema scores on the first visit on the LED-treated side (46.7 +/- 25.3) compared with the untreated side (60.0 +/- 23.3); the difference was significant (P = 0.0382). On the second visit, the mean erythema scores trended lower on the LED-treated side (24.3 +/- 22.1) than on the untreated side (27.9 +/- 25.8), but the difference did not reach statistical significance (P = 0.1365). Erythema scores on both facial sides were 0 for all subjects 1 week after IPL treatment. Four patients commented that posttreatment discomfort was considerably less on the LED-treated side immediately after treatment. LED photomodulation treatment may accelerate the resolution of erythema and reduce posttreatment discomfort in IPL-treated patients with photodamage.

Conservative treatment of ingrowing toenails.

A combination of conservative measures was used to treat 105 patients with 119 ingrowing toenails. The method proved to be simple and cheap, but time consuming. Post-treatment discomfort and the time taken to return to normal activities were acceptable; the cosmetic result was good. Two-year follow-up revealed that the success rate of the method in less advanced cases (stages I and II) was high (96 per cent), although in the long term there was a tendency to recurrence in stage II cases. The failure rate in advanced cases (stage III) was high (up to 62 per cent). Conservative treatment can be used successfully in mild cases of ingrowing toenails.

Comparison of postoperative pain between laser-assisted uvulopalatoplasty, uvulopalatopharyngoplasty, and radiofrequency volumetric tissue reduction of the palate

Objectives: This study compares the posttreatment discomfort between laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), and radiofrequency volumetric tissue reduction (RFVTR) of the palate through the use of visual analog pain scales and a quantitative assessment of the analgesic medication taken. Methods: In one group, LAUP (n = 10) or UPPP (n = 9) was used to treat patients’ snoring or sleep-disordered breathing (SDB), and the other group underwent RFVTR (n = 22). Results: The mean numbers of days with pain after RFVTR, LAUP, and UPPP were 2.6, 13.8, and 14.3 days, respectively. Narcotic analgesics were required in the RFVTR, LAUP, and UPPP groups in 9%, 100%, and 100% of the subjects, respectively. The mean number of these days requiring narcotic pain medications for RFVTR, LAUP, and UPPP was 0.2, 11.8, and 12.4 days, whereas the total narcotic equivalent was 0.3, 7.4 and 29.6 days, respectively. Conclusion: RFVTR of the soft palate produced less posttreatment pain than LAUP or UPPP. LAUP and UPPP appeared to show little difference in the severity or duration of posttreatment discomfort. (Otolaryngol Head Neck Surg 2000;122:402-9.)

Comparison of postoperative pain between laser‐assisted uvulopalatoplasty, uvulopalatopharyngoplasty, and radiofrequency volumetric tissue reduction of the palate

OBJECTIVESThis study compares the posttreatment discomfort between laser‐assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), and radiofrequency volumetric tissue reduction (RFVTR) of the palate through the use of visual analog pain scales and a quantitative assessment of the analgesic medication taken.METHODSIn one group, LAUP (n = 10) or UPPP (n = 9) was used to treat patients' snoring or sleep‐disordered breathing (SDB), and the other group underwent RFVTR (n = 22).RESULTSThe mean numbers of days with pain after RFVTR, LAUP, and UPPP were 2.6, 13.8, and 14.3 days, respectively. Narcotic analgesics were required in the RFVTR, LAUP, and UPPP groups in 9%, 100%, and 100% of the subjects, respectively. The mean number of these days requiring narcotic pain medications for RFVTR, LAUP, and UPPP was 0.2, 11.8, and 12.4 days, whereas the total narcotic equivalent was 0.3, 7.4 and 29.6 days, respectively.CONCLUSIONRFVTR of the soft palate produced less posttreatment pain than LAUP or UPPP. LAUP and UPPP appeared to show little difference in the severity or duration of posttreatment discomfort.

Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: A pilot study

Objectives: Ideal treatment for nasal obstruction caused by turbinate hypertrophy remains in question. Medical therapy is often ineffective. Surgical procedures have associated morbidity including pain, bleeding, crusting, adhesion, infection, and dryness. Radiofrequency has recently been shown to be safe and effective in volumetric tissue reduction of the tongue in the animal model and of the palate in human beings. We prospectively evaluate the safety and effectiveness of radiofrequency volumetric tissue reduction (RFVTR) for the treatment of nasal obstruction caused by inferior turbinate hypertrophy. Methods: Twenty-two consecutive patients with nasal obstruction and associated inferior turbinate hypertrophy refractory to medical therapy were evaluated for RFVTR. The study design limited the region of treatment to the anterior third of the inferior turbinate. The procedures were performed in an ambulatory facility with patients under local anesthesia. Clinical examinations, patient questionnaires, and visual analog scales were used to assess treatment outcomes. Results: No adverse effects were encountered, including bleeding, crusting, dryness, infection, adhesion, or a worsening of obstruction. Mild edema was noted in all patients but was of short duration (24 to 48 hours). Posttreatment discomfort was well controlled with acetaminophen. Eight weeks after treatment, nasal breathing improved in 21 of 22 patients, with a 58.5% reduction in severity and a 56.5% decrease in the frequency of nasal obstruction. Conclusion: The results of this study demonstrate that RFVTR of the hypertrophic inferior turbinate is associated with minimal adverse effects. Furthermore, this new treatment modality achieves subjective improvement in patients with symptoms of nasal obstruction. However, because of the small sample size and short follow-up, future investigations are needed to fully evaluate the use of RFVTR in the treatment of nasal obstruction caused by turbinate hypertrophy. (Otolaryngol Head Neck Surg 1998;119:569-73.)

Histopathological and Clinical Examination of an Immediate Canal Filling after Vital Pulp Extirpation in Combination with the Pulsed Nd: YAG Laser

The purpose of this study was to evaluate histopathologically and clinically, the effects of the pulsed Nd: YAG laser irradiation on the apical seat of root canals after vital pulp extirpation, using dogs and human teeth. First of all, the histopathological examina tion was conducted to estimate the clinical effects and safety of laser irradiation. 192 vital teeth of 18 dogs were instrumented up to #40 by the conventional method and divided into lased and control groups. In the lased group, the fiber of pulsed Nd: YAG laser (d-Lase 3 0 0; American Dental Laser Co., USA) was introduced to the apical seat and the laser was ir radiated under the condition of 1, 2 and 3W, 15 and 20PPS and 0.5, 1, 2, 3 and 4sec. Then, the access cavity of both groups was sealed with guttapercha and amalgam. Histopathological study of the two groups was carried out after 1, 2 and 4 weeks. The following results were obtained;1. Debris in the apical seat could be removed depending on the condition of the laser irra diation.2. Irradiation of higher energy output in case of 2 W-2 sec and 3 W-2 sec often produced carbonized dentin and periapical chronic inflammation including root resorption.3. Irradiation under the condition of 1 W-2 sec, 2 W-1 sec and 3 W-0.5 sec was acceptable to the apical seat and periapical tissues.Sixty human pulp extirpated teeth were divided into lased and control groups and immedi ately root canal filling were carried out. Under the consideration of the safety to the perio dontal ligament, the condition of lased group in the clinical study was determined as 1 W (1 5 PPS)-1 sec irradiation at the apical seat. Clinical examination up to 3 weeks revealed that significant reduction of post-treatment discomfort or pain in lased group was comfirmed with the 5% level according to the Chi-Square analysis. Irradiation under the condition of 1 W-1 sec at the apical seat was safe and useful in case of an immediate canal filling after vital pulp extirpation. The mechanism of laser effects was considered hemostasis and removal debris and remunant pulp at the lased potion.