Post-treatment Pain Intensity Research Articles

Effect of cognitive-behavior therapy for children with functional abdominal pain: a meta-analysis

BackgroundCognitive-Behavior Therapy (CBT) is the validated non-pharmacological treatment for chronic pain in pediatric patients. While some suggested CBT were comparable to the usual care in reducing children’s functional abdominal pain. This meta-analysis was designed to systematically review the literature for RCTs that investigated the efficacy of CBT in children with functional abdominal pain (FAP).MethodsPubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. Studies applying different CBT delivery methods (in-person, web-based, phone-based) were included in this meta-analysis to evaluate the comprehensive effectiveness of CBT compared with usual care. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcome was the decrease of functional disability inventory (FDI) and the secondary outcomes were the decrease of severity in pain intensity, depression, anxiety, gastrointestinal symptoms, and improvement in physical quality of life (QoL).ResultsA total of 10 RCTs with 1187 children were included in the final analysis. The results showed that CBT resulted in better effect in reducing functional disability inventory (SMD=-2.282, 95%CI: -4.537 to -0.027, P = 0.047), pain intensity (SMD=-0.594, 95%CI: -1.147 to -0.040, P = 0.036), and improving QoL (SMD = 14.097, 95%CI: 0.901 to 27.292, P = 0.036) compared with the control groups. Comparable effects were observed in the severity of depression (SMD=-0.493, 95%CI: -1.594 to 0.608, P = 0.380), anxiety (SMD=-0.062, 95%CI: -0.640 to 0.517, P = 0.835), and gastrointestinal symptoms (SMD=-1.096 95%CI: -2.243 to 0.050, P = 0.061) between CBT and usual treatment.ConclusionsWe observed the differences in post-treatment FAP and pain intensity for children receiving CBT compared with children receiving treatment as usual. CBT in the setting of FAP demonstrates promising developments and highlights the need for future research.

Assessing the occurrence and severity of pre- and postendodontic pain in anemic and healthy female patients.

The objective of this current survey was to assess both the occurrence and severity of pre- and post-endodontic pain among female individuals, distinguishing between those with anemia and those without. In the current study, we included a total of 60 women with anemia (hemoglobin < 11) and those without anemia (hemoglobin > 13). We recorded the occurrence and severity of pain before and at 24, 48, and 72 h following root canal treatment using a visual analog scale (VAS)ranging from 0 to 10. Additionally, we collected data on patient age, tooth type, as well as pulpal and periapical conditions. Statistical analysis was carried out using two-way ANOVA, pairedt-tests, and Pearson correlation coefficient. The significance level for statistical tests was set at p ≤ .05. The incidence of preoperative pain in both anemic and non-anemic patients was 80%. The total incidence of post-operative pain was recorded as 71.7% (82.2% in anemic and 61.1% in non-anemic women). Compared with the pretreatment pain incidence and intensity, the values increased in 24 h but declined in 48 hand 72 h after treatment. Considering the posttreatment pain intensity, the mean values were higher in the three time intervals (24, 48, and 72 h) in anemic patients. Pulpal and periapical status, in contrast to age and tooth type, significantly contributed to the intensity of posttreatment pain. Regarding the importance of pain phenomenon in human life, it is recommended to consider anemia as an important risk factor for post-endodontic pain. Early diagnosis and analgesic treatment interventions in anemic females, alongside the pain control during root canal treatment, could promote the patient's satisfaction and quality of care.

The efficacy of acceptance and commitment therapy for chronic pain: A three-level meta-analysis and a trial sequential analysis of randomized controlled trials

The current study included randomized controlled trials (RCTs) to assess the benefits of Acceptance and commitment therapy (ACT) for chronic pain. Searches were conducted in Web of Science, PsycINFO, PubMed, Scopus, Cochrane Library, and Embase from inception until September 30, 2022. Thirty-three RCTs, including 2293 participants, were included. Small to medium effect sizes for pain intensity/physical function favoring ACT were found both at post-treatment (pain intensity: g = 0.44; physical function: g = 0.59) and follow-up (pain intensity: g = 0.34; physical function: g = 0.56). The effect sizes on psychological outcomes were significant at post-treatment (depression: g = 0.43; anxiety: g = 0.43; quality of life: g = 0.45) and follow-up (depression: g = 0.43; anxiety: g = 0.35; quality of life: g = 0.43). The results of the trial sequential analyses indicated that pooled estimates were unlikely to be incidental findings, as effects of multiple testing were controlled and power was adequate. Face-to-face ACT yielded significantly larger effects on physical outcomes than internet-delivered ACT. Participants with chronic headache and fibromyalgia showed greater benefit from ACT compared to those with non-specific pain or mixed pain. In addition, the longer the follow-up duration, the smaller the effect sizes for pain intensity/physical function at follow-up. The present meta-analysis suggests sufficient evidence for the significant benefits of ACT for people with chronic pain.

Are acupuncture and dry needling effective in the management of masticatory muscle pain: A network meta-analysis of randomised clinical trials.

Several studies have shown that both acupuncture and dry needling are effective in the treatment of musculoskeletal pains. Therefore, the aim of this network meta-analysis (NMA) was to investigate the treatment outcome of acupuncture and dry-needling for masticatory muscle pain (TMD-M) and to compare with active and inactive placebo. An electronic search was performed to identify randomised controlled trials (RCTs) published until September 2019, comparing dry-needling, acupuncture, and inactive as well as active placebo in patients with TMD-M. Outcome variables were post-treatment pain intensity, pressure pain threshold (PPT), and maximum mouth opening (MMO). The quality of evidence was rated according to Cochrane's tool for assessing the risk of bias. Mean difference was used to analyse via frequentist NMA using STATA-software. Both NMA and direct pairwise meta-analysis have shown that there was no difference between active treatment with either acupuncture or dry-needling when compared to active and inactive placebo in patients with TMD-M with respect to pain intensity, and PPT (p > .05). However, there was a significant increase in MMO following dry-needling when compared to the placebo (very low-quality evidence). Despite the short-term positive effect of MMO by dry-needling, this NMA could not show any pain-reducing effect in patients with TMD-M by acupuncture or dry-needling when compared to an active or inactive placebo. Taken together, this NMA indicates that it is the placebo effect that accounts for the majority of the treatment effect of TMD-M, rather than a real therapeutic effect of acupuncture/dry-needling.

The hierarchy of different treatments for myogenous temporomandibular disorders: a systematic review and network meta-analysis of randomized clinical trials.

The best treatment modality for the management of painful temporomandibular disorders of muscular origin (M-TMD) with predictable outcomes based on solid evidence is still not well defined. Thus, the aim of this network meta-analysis (NMA) was to identify the best treatment for adult patients with M-TMD. An electronic search was undertaken from the inception of each database to August 2018, to identify randomized clinical trials (RCTs), which are comparing two or more of the following treatment modalities in patients with M-TMD: counseling therapy; occlusal appliances; manual therapy; laser therapy; dry needling; intramuscular injection of local anesthesia (LA) or botulinum toxin-A (BTX-A); muscle relaxants; hypnosis/relaxation therapy; oxidative ozone therapy; and placebo or no treatment. Primary outcome variables were the reduction of pain and mechanical sensitivity. The secondary outcome was the maximal mouth opening (MMO). The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Standardized mean difference was used to analyze via frequentist network meta-analysis (NMA), using STATA software.52 RCTs were included in this NMA. At the most follow up moments, manual therapy, counseling therapy, occlusal splints therapy, and needling using BTX-A or LA as well as dry needling significantly decreased post-treatment pain intensity in M-TMDs, when compared to placebo. At short term (≤5 months), the four highest-ranked treatments for post-treatment pain reduction were manual therapy (83.5%, low quality evidence), ozone therapy (75.7%, very low quality evidence),counseling therapy (71.2%, moderate quality), and occlusal appliances (71.7%,moderate quality evidence). When intermediate term (≥6 months)was considered, BTX-A (85.8%, very low quality evidence) , counseling therapy(80%, low quality evidence), occlusal appliances (62.8%, low quality evidence) and hypnosis (50.6%, very low quality evidence) were the four highest-ranked treatments. This NMA reveals that manual therapy can be considered the most effective treatment for M-TMD, followed by counseling treatment, intramuscular injection of LA, and occlusal appliances . However, considering the limitations of the studies included, and the scarce of strong evidence, the present findings should be interpreted cautiously.

The effectiveness of tensioning neural mobilization of brachial plexus in patients with chronic cervical radiculopathy: a randomized clinical trial

IntroductionTensioning neural mobilization (NM) is accomplished through increasing the distance between nerve bed ends via elongation. NM techniques have different biomechanical effects on the nervous system. Evidence for their use in treating certain upper-quarter conditions like cervicobrachial pain is limited. The study was to determine tensioning NM efficacy on unilateral chronic cervical radiculopathy regarding mechanosensitivity of the affected nerve roots and intensity of neck and arm pain.MethodsForty participants with chronic unilateral cervical radiculopathy were randomly assigned to group A (&lt;i&gt;n&lt;/i&gt; = 20), receiving traditional physical therapy (manual traction and infrared irradiation), and group B (&lt;i&gt;n&lt;/i&gt; = 20), receiving traditional physical therapy in addition to tensioning NM of brachial plexus. Mechanosensitivity of the affected brachial nerve roots and intensity of neck and arm pain were evaluated at baseline and after a 3-week program with the upper limb tension test-1 and visual analogue scale. The normal (Z) test, paired and unpaired t-test, Wilcoxon signed-rank test, and Wilcoxon rank-sum test (Mann-Whitney) were used in data analysis.ResultsThere were significant within-group differences in both groups regarding mechanosensitivity and pain intensity (mechanosensitivity: &lt;i&gt;p&lt;/i&gt; = 0.001 for group A, &lt;i&gt;p&lt;/i&gt; = 0.001 for group B; pain: &lt;i&gt;p&lt;/i&gt; &lt; 0.01 for group A, &lt;i&gt;p&lt;/i&gt; &lt; 0.01 for group B). There was no statistically significant between-group difference regarding mechanosensitivity (&lt;i&gt;p&lt;/i&gt; = 0.07) or pain intensity (&lt;i&gt;p&lt;/i&gt; = 0.838).ConclusionsThe addition of tensioning NM to traditional physical therapy had no significant benefits, although both groups showed decreased post-treatment mechanosensitivity and pain intensity.

Effectiveness of Transcutaneous Electrical Nerve Stimulation on Pain and Disability Among Patients with Hip Arthroplasty: A Randomized Control Study

Background: Pain after surgery is highly inevitable, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been reported with side effects. Objectives: This study evaluated the effectiveness of transcutaneous electrical nerve stimulation (TENS) on pain intensity and disability of patients who underwent hip arthroplasty. Methods: A purposive sampling technique was used to recruit 56 subjects that underwent hip arthroplasty. They were randomly allocated to the TENS group (TG) and control group (CG) equally. The subjects in the TG group were treated with conventional TENS twice a day for three weeks, but the CG group was treated with normal drugs only. Pain intensity and hip disability were measured in both groups with the Visual Analogue scale (VAS) and Oxford hip score before the treatment and after the intervention, respectively. Results: The results showed that there was a significant reduction between the pre-treatment and post-treatment pain intensity (t = 3.83, P = 0.003) and hip disability (t = -4.45, P &lt; 0.001) in the TG group. A significant reduction was also observed in pain intensity (t = 3.16, P = 0.01) and hip disability (t = -6.71, P = 0.000) between the pre-treatment and post-treatment periods in the CG group. There was a significant reduction in post-treatment pain intensity (t = 10, P = 0.000) and hip disability (t = -3.51, P = 0.006) when the TG group was compared with the CG group. Conclusions: TENS was effective in the management of acute post-surgical pain and disability of patients with hip arthroplasty.

Clinical Characteristics and Patient-Reported Outcomes of Primary Care Physiotherapy in Patients with Whiplash-Associated Disorders: A Longitudinal Observational Study.

BackgroundWhiplash-associated disorders (WADs) constitute a state of health characterized by a wide diversity of symptoms as a result of impairments of functions, activity limitations, and participation restrictions. Patient-reported outcome measurements (PROMs) and patient-reported outcomes (PROs) seem appropriate when describing and evaluating the health status of patients with WAD.AimTo measure the use of PROMs and PROs as quality indicators in clinical reasoning, and to analyze and evaluate pre- and post-treatment ‘pain intensity’ and ‘functioning’, and for ‘perceived improvement’ in patients with WAD in primary care physiotherapy practice by year of referral, with the phase after accident and prognostic health profile embedded in the clinical reasoning process.Materials and MethodsData were collected over a period of 10 years. Pain intensity, functioning, and perceived improvement were measured using the Visual Analogue Scale for Pain (VAS-P), the Neck Disability Index (NDI) and the Global Perceived Effect scale (GPE). Pre- and post-treatment mean differences were tested for statistical significance and compared to minimal clinically important differences (MCID). Effect sizes were expressed as Cohen’s d. Multivariable regression analysis was performed to explore independent associations of year of referral, phase after the accident, and the patient’s prognostic health profile with post-treatment pain intensity and functioning.ResultsA consecutive sample of 523 patients was included. Pre- and post-treatment mean differences on VAS-P and NDI were statistically significant (P<0.000) and clinically relevant, with ‘large’ effect sizes for pain intensity and functioning. MCIDs were achieved by 80% for VAS-P and for 60% for NDI. Year of referral and phase after the accident were independently associated with worse post-treatment functioning. About half of the patients (n=241 [46.1%]) perceived themselves as improved.ConclusionThe PROMs and PROs pain intensity, functioning and perceived improvement were integrated as quality indicators in the physiotherapy clinical reasoning process for patients with WAD. Significant differences in pain intensity and functioning were found but were unrelated to year of referral, phase after whiplash-related injury or prognostic health profile. The MCID VAS-P scores did not differ depending on experienced pain.

Effect of adjuvant frequency-specific microcurrents on pain and disability in patients treated with physical rehabilitation for neck and low back pain

ObjectivesTo evaluate the efficacy of adjuvant frequency-specific microcurrent (FSM) application on pain and disability in patients treated with physical rehabilitation for mechanical low back pain (LBP) and neck pain (NP). MethodsIn this retrospective case-control study, pre- and post-treatment numerical pain rating scale (NPRS) score, Oswestry disability index (ODI) score, neck disability index (NDI) score, disability categories, and treatment outcome categories were compared between 213 patients in the FSM group (167 patients with LBP, 46 patients with NP) and 78 patients in the control group (61 patients with LBP, 17 patients with NP). ResultsIn LBP patients, mean post-treatment NPRS score was significantly lower (p = 0.02) and a significantly higher percentage of patients were in the ≤3 NPRS score (p = 0.02), in the minimal disability (p = 0.01), and the full success (p = 0.006) categories post-treatment in the FSM group when compared to the control group. In NP patients, there was no significant difference in the post-treatment pain intensity, disability or treatment outcome when the 2 groups were compared. ConclusionsThe use of adjuvant FSM application in patients treated with physical rehabilitation for LBP significantly improved pain and disability when compared to patients in the control group. Frequency specific microcurrent could be a useful adjuvant in the rehabilitation treatment of patients with low back pain.

The predictive value of quantitative sensory testing: a systematic review on chronic postoperative pain and the analgesic effect of pharmacological therapies in patients with chronic pain.

Studies have suggested that quantitative sensory testing (QST) might hold a predictive value for the development of chronic postoperative pain and the response to pharmacological interventions. This review systematically summarizes the current evidence on the predictive value of QST for chronic postoperative pain and the effect of pharmacological interventions. The main outcome measures were posttreatment pain intensity, pain relief, presence of moderate-to-severe postoperative pain, responders of 30% and 50% pain relief, or validated questionnaires on pain and disability. A systematic search of MEDLINE and EMBASE yielded 25 studies on surgical interventions and 11 on pharmacological interventions. Seventeen surgical and 11 pharmacological studies reported an association between preoperative or pretreatment QST and chronic postoperative pain or analgesic effect. The most commonly assessed QST modalities were pressure stimuli (17 studies), temporal summation of pain (TSP, 14 studies), and conditioned pain modulation (CPM, 16 studies). Of those, the dynamic QST parameters TSP (50%) and CPM (44%) were most frequently associated with chronic postoperative pain and analgesic effects. A large heterogeneity in methods for assessing TSP (n = 4) and CPM (n = 7) was found. Overall, most studies demonstrated low-to-moderate levels of risk of bias in study design, attrition, prognostic factors, outcome, and statistical analyses. This systematic review demonstrates that TSP and CPM show the most consistent predictive values for chronic postoperative pain and analgesic effect, but the heterogeneous methodologies reduce the generalizability and hence call for methodological guidelines.

Needling therapies in the management of myofascial pain of the masticatory muscles: A network meta-analysis of randomised clinical trials.

A network meta-analysis (NMA) of randomised clinical trials (RCTs) was performed aiming to compare the treatment outcome of dry needling, acupuncture or wet needling using different substances in managing myofascial pain of the masticatory muscles (TMD-M). An electronic search was undertaken to identify RCTs published until September 2019, comparing dry needling, acupuncture or wet needling using local anaesthesia (LA), botulinum toxin-A (BTX-A), granisetron, platelet-rich plasma (PRP) or passive placebo versus real active placebo in patients with TMD-M. RCTs meeting the inclusion criteria were stratified according to the follow-up time: immediate post-treatment to 3weeks, and 1 to 6months post-treatment. Outcome variables were post-treatment pain intensity, increased mouth opening (MMO) and pressure threshold pain (PPT). The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Mean difference (MD) was used to analysed via frequentist NMA using Stata software. Twenty-one RCTs involving 959 patients were included. The quality of evidence of the included studies was low or very low. There was significant pain decrease after PRP when compared to an active/passive placebo and acupuncture. There was a significant improvement of MMO after LA (MD=3.65; CI: 1.18-6.1) and dry needling therapy (MD=2.37; CI: 0.66-4) versus placebo. The three highest ranked treatments for short-term post-treatment pain reduction in TMD-M (1-20days) were PRP (95.8%), followed by LA (62.5%) and dry needling (57.1%), whereas the three highest ranked treatments at intermediate-term follow-up (1-6months) were LA (90.2%), dry needling (66.1%) and BTX-A (52.1%) (all very low-quality evidence). LA (96.4%) was the most effective treatment regarding the increase in MMO followed by dry needling (72.4%). Based on this NMA, one can conclude that the effectiveness of needling therapy did not depend on needling type (dry or wet) or needling substance. The outcome of this NMA suggests that LA, BTX-A, granisetron and PRP hold some promise as injection therapies, but no definite conclusions can be drawn due to the low quality of evidence of the included studies. This NMA did not provide enough support for any of the needling therapies for TMD-M.

Massage Therapy for Dystonia: a Case Report

Dystonia is a neurological disorder, characterized by involuntary muscle spasms and tremors, resulting in abnormal movements and posture. Symptoms include pain, spasms, tremors, and dyskinesia-a difficulty in performing voluntary muscular movements. Conventional treatments include medication, botulism injections, and surgical intervention. Many dystonia patients seek complementary and alternative medicine (CAM) therapies, such as massage, but these treatments are not well documented. This clinical case study documents massage treatment for dystonia for a specific individual. To examine the effects of massage therapy on pain, spasms, and dyskinesia in activities of daily living (ADL), in a patient diagnosed with dystonia as an adult, following trauma. A student massage therapist administered 5 massage treatments over a six-week period to a 51-year-old female patient diagnosed with dystonia. The patient presented with symptoms of pain, spasms, tremors, and dyskinesia in ADL. Techniques applied included Swedish massage and hydrotherapy to decrease pain and spasms, and myofascial release and stretching, to decrease dyskinesia. Treatments aimed to increase overall relaxation. Remedial exercise was given to practice smoother movement patterns. Pre- and postnumeric rating scales (NRS) for pain were evaluated each session. Frequency of night pain and spasms, the Modified Bradykinesia Rating Scale (MBRS), the Timed Up and Go (TUG) test, the Functional Rating Index (FRI) and the Modified Gait Efficacy Scale (MGES) were measured at the start and end of the study. Posttreatment pain intensity generally remained the same or decreased. Positive outcomes were exhibited in the frequency of night pain and spasms, TUG, MBRS, and FRI test scores. The MGES score was negatively affected. The results suggest massage therapy may temporarily decrease pain intensity, pain and spasm frequency, and dyskinesia in ADL, associated with dystonia.

Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials

A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of temporomandibular disorders (TMDs) and to rank them according to their effectiveness. An electronic search was undertaken to identify RCTs published until August 2019. Predictor variables were control, non-occluding splint, hard stabilization splint (HSS), soft stabilization splint (SSS), prefabricated splint, mini-anterior splint, anterior repositioning splint (ARS), and counselling therapy (CT) with or without HSS. Outcome variables were pain improvement, post-treatment pain intensity, improvement in mouth opening, and disappearance of temporomandibular joint (TMJ) sounds. Forty-eight RCTs were included. There was a significant decrease in post-treatment pain intensity in arthrogenous TMDs after ARS (low quality evidence), CT+HSS (moderate quality evidence), mini-anterior splints (very low quality evidence), and HSS alone (low quality evidence), when compared to the control. There was a significant decrease in post-treatment pain intensity in myogenous TMDs with mini-anterior splints (very low quality evidence), SSS (very low quality evidence), CT alone (moderate quality evidence), CT+HSS (moderate quality evidence), and HSS alone (moderate quality evidence), when compared to control. ARS and CT were superior in decreasing TMJ clicking than control and HSS alone. The three highest-ranked treatments for post-treatment pain reduction in arthrogenous TMDs were ARS (92%, very low quality evidence), CT+HSS (67.3%, low quality evidence), and HSS alone (52.9%, moderate quality evidence). For myogenous TMDs, they were mini-anterior splints (86.8%, low quality evidence), CT+HSS (61.2%, very low quality evidence), and HSS alone (59.7%, moderate quality evidence). Based on this NMA of 48 RCTs, there is moderate to very low quality evidence confirming the effectiveness of occlusal splint therapy in the treatment of TMDs. Multimodal therapy consisting of CT+HSS may produce the maximum improvement for TMD patients.

Temporal disconnection between pain relief and trigeminal nerve microstructural changes after Gamma Knife radiosurgery for trigeminal neuralgia.

Gamma Knife radiosurgery (GKRS) is a noninvasive surgical treatment option for patients with medically refractive classic trigeminal neuralgia (TN). The long-term microstructural consequences of radiosurgery and their association with pain relief remain unclear. To better understand this topic, the authors used diffusion tensor imaging (DTI) to characterize the effects of GKRS on trigeminal nerve microstructure over multiple posttreatment time points. Ninety-two sets of 3-T anatomical and diffusion-weighted MR images from 55 patients with TN treated by GKRS were divided within 6-, 12-, and 24-month posttreatment time points into responder and nonresponder subgroups (≥ 75% and < 75% reduction in posttreatment pain intensity, respectively). Within each subgroup, posttreatment pain intensity was then assessed against pretreatment levels and followed by DTI metric analyses, contrasting treated and contralateral control nerves to identify specific biomarkers of successful pain relief. GKRS resulted in successful pain relief that was accompanied by asynchronous reductions in fractional anisotropy (FA), which maximized 24 months after treatment. While GKRS responders demonstrated significantly reduced FA within the radiosurgery target 12 and 24 months posttreatment (p < 0.05 and p < 0.01, respectively), nonresponders had statistically indistinguishable DTI metrics between nerve types at each time point. Ultimately, this study serves as the first step toward an improved understanding of the long-term microstructural effect of radiosurgery on TN. Given that FA reductions remained specific to responders and were absent in nonresponders up to 24 months posttreatment, FA changes have the potential of serving as temporally consistent biomarkers of optimal pain relief following radiosurgical treatment for classic TN.

Thermographic evaluation of occlusal splint and low level laser therapy in myofascial pain syndrome

ObjectiveThe purpose of this study was to compare and evaluate the effects of occlusal splint and low dose laser treatments clinically and thermographically in patients with myofascial pain syndrome. MethodsTwenty patients aged 18–45 with myofascial pain syndrome were involved into this study. Patients were examined by clinically and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used for the diagnosis of TMD. Patients divided into two groups. First group treated with stabilisation splint, while the other one with low level laser therapy (LLLT). Pre- and post-treatment pain intensity, muscle sensitivity and the superficial skin temperature differences over the masseter and anterior temporal muscle were assessed, and comparison was made within and between the groups pre- and post-operatively. ResultsIn both groups, there was a significant decrease in temperature values, especially in the masseter region (p < 0.05) and post-treatment pain intensity and muscle sensitivity values were lower than the pre-treatment values (p < 0.05). In addition, the heat values in certain regions of the masseter were lower in the LLLT group than in the splint group and there was a statistical difference in these regions between two groups (p < 0.05). However, there was no statistical difference in the pain intensity and muscle sensitivity between both groups (p > 0.05). ConclusionIt was concluded that both occlusal splint therapy and low level laser therapy were effective in the treatment of MPS, and when thermographic data were taken into account, LLLT treatments could provide more advantageous results in these patients.

Arnica compositum, Hekla lava and Acidum Nitricum Together are Superior to Arnica compositum Alone in the Local Treatment of Symptomatic Calcific Periarthritis of the Shoulder: A Pilot Study.

To evaluate the usefulness of Arnica compositum (AC) + Acidum nitricum (AN) + Hekla lava (HL) ointment in Emergency Medicine Department (EMD) as alternative nonpharmacological local treatment of patients with symptomatic calcific periarthritis of the shoulder (CPS) and to compare the effectiveness of this mixture against AC ointment alone. A series of 41 consecutive patients (20 women, 19 men, median age 49 years, range 25-80 years) with non-traumatic painful unilateral CPS were randomly assigned to receive local treatment with AC+AN+HL ointment mixture (Group A, cases, N=21) or AC ointment alone (Group B, controls, N=20). The radiological Gartner classification of the CPS, and the quantification of pre- and post-treatment pain intensity using a Visual Analogue Scale (VAS) were obtained. The orthopedic evaluation of Shoulder Motion (SM) was also performed. The use of painkillers was reported as a number of doses needed. Age, gender distribution, Gartner type, main calcification size, baseline VAS (VAS-0) and degree of SM did not differ (p=NS) between Groups. After 3-day therapy, the reduction of pain in Group A (4.5±2.5) was superior to that observed in Group B (2.7±2.6) (p =0.03). The same result was observed in the improvement of SM in Group A (69.4±24.9) than in Group B (51.1±21.1) (p =0.015). No local or general adverse effects were noted. The number of doses of paracetamol was similar, but Group A patients used less ibuprofen (p =0.007). Local administration of the AC+AN+HL ointment mixture, which in our pilot study was superior to AC alone, could be safely suggested as an alternative uneventful treatment of patients with CPS.

Effect of Medications, Dietary Supplements and Psychosocial Interventions in Burning Mouth Syndrome Patients: A Systematic Review with Meta-analyses

The objective of this review is to determine the efficacy of cognitive behavioral therapy, oral and topical medications as well as dietary supplements to reduce pain in burning mouth syndrome patients (BMS). Methods: The Cochrane Library, Medline via PubMed and Web of Science were searched. Eligible studies were limited to randomized placebo-controlled trials on interventions used to treat BMS. Risk of bias was independently assessed in triplicate. Results: Twenty-two studies were included in this review. Fifteen reported baseline and post-treatment pain intensity, however due to the heterogeneity of the interventions subgroup analyses are presented by intervention. Subgroup analyses on the reduction of pain with alpha-lipoic acid (ALA) showed no significant difference with placebo (p=.713). However, a subgroup analysis with four studies showed ALA improved patients' symptoms significantly (RR=2.676; 95% CI 1.933 to 3.705; p .05). Pooled results with two studies each showed capsaicin (p<.001) and CBT (p=.031) significantly improved patients' symptoms. Conclusions: Low quality of evidence is available due to heterogeneity of the interventions, unclear or high risk of bias and differences in outcomes reported resulting in small number of studies included in each subgroup analysis. ALA, topical clonazepam, CBT, catuama and capsaicin should be studied further in high quality randomized clinical trials to provide recommendations for BMS patients.

Transcutaneous nerve stimulation versus aerobic exercise in diabetic neuropathy

Background Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, which is frequently associated with pain. Studies targeting the painful DPN are necessary to support clinical decision-making. Objective The aim of the present study was to investigate the efficacy of transcutaneous electric nerve stimulation (TENS) versus aerobic exercise, and to compare them with regular pharmacological therapy in patients with DPN, using sensory nerve conduction study and the visual analogue scale (VAS). Patients and methods This study included 60 diabetic patients with a history of DPN for 5 years. Patients were divided into three equal groups, all receiving regular pharmacological therapy. Group A received TENS of both lower limbs, three times per week. Group B received aerobic exercise. Group C received only pharmacological therapy. Patients were assessed before and 8 weeks after treatment. The VAS was used to measure the pain intensity before and after treatment, and the medial plantar nerve conduction velocity (NCV) to assess nerve function. Results Group A and B only showed a significant statistical difference between pretreatment and post-treatment pain intensity on VAS, with 41.67 and 16.67% improvement on the VAS, respectively. There was no statistically significant difference in pretreatment and post-treatment as regards the medial plantar NCV in any of the groups. Conclusion TENS, of moderate intensity, carried out at 14 Hz, with a pulse width of 250 ms, for 30 min and three times a week is more efficient than aerobic exercise training program in relieving pain in patients with DPN, whereas neither TENS nor exercise showed any significant effect on medial plantar conduction velocity (CV) in patients with DPN.

Therapeutic efficacy of Lofnac Gel via phonophoresis in the management of chronic nonspecific low back pain: A randomised controlled trial.

The prevalence of nonspecific low back pain is very high among Nigerians and in Africa. Lofnac Gel is a nonsteroidal anti-inflammatory gel that has been used to treat musculoskeletal pain, but its efficacy on nonspecific low back pain is inconclusive. The objective of this study was to examine the therapeutic efficacy of Lofnac Gel in the management of nonspecific low back pain. Seventy patients diagnosed with mechanical low back pain of 3 months' duration were divided into two groups: experimental group (n = 35) and control group (n = 35). Participants in both groups were placed on supervised strengthening exercises for multifidus muscles of the low back. The experimental group was placed on ultrasound phonophoresis therapy with Lofnac Gel (with diclofenac and methyl salicylate as active ingredients), whereas the control group was placed on ultrasound with water as coupling medium. The treatment was applied twice per week for 6 weeks. Present pain intensity and disability were measured before treatment, and in the 3rd week and 6th week of treatment. Data were analysed using descriptive and inferential statistics, and post hoc analysis was carried out when necessary. There was a significant difference between the pre- and posttreatment pain intensity and disability index for both the experimental (F = 17.947, p < 0.001; F = 20.712, p < 0.001) and control (F = 14.791, p < 0.001; F = 10.418, p < 0.001) groups. There was also a significant difference between the experimental and control group data in terms of pain intensity (F = 28.76, p < 0.001) and disability index (F = 39.817, p < 0.001) in the 6th week. Exercise combined with Lofnac phonophoresis was more effective in the management of patients with chronic low back pain than exercise and ultrasound alone.

External Noninvasive Peripheral Nerve Stimulation Treatment of Neuropathic Pain: A Prospective Audit.

Peripheral nerve stimulation (PNS) is a neuromodulation technique in which electrical current is applied to the peripheral nerves to ameliorate chronic pain through preferential activation of myelinated fibres, inducing long-term depression of synaptic efficacy. External noninvasive peripheral nerve stimulation (EN-PNS) is a novel and simple form of PNS that involves stimulation via an external nerve-mapping probe that is placed on the skin and connected to a power source. We aimed to assess the clinical utility of EN-PNS in patients with refractory neuropathic pains referred to a tertiary pain treatment center. We undertook a prospective audit of EN-PNS. Patients with a diagnosis of either complex regional pain syndrome or neuropathic pain after peripheral nerve injury who met inclusion criteria were included. Participants completed three stages of the audit: stage 1, six weekly outpatient treatment sessions; stage 2, six-week equipment home loan; stage 3, six weeks of no EN-PNS treatment. The primary outcome was the average post-treatment instantaneous pain intensity during the last week in stage 2 compared with baseline (11-point numerical rating scale). EN-PNS provided significant short-term pain relief (n = 20 patients, average reduction of 2.8 numerical rating scale points, 95% CI 1.6-4.0, p < 0.001, intention-to-treat analysis). Eight patients (40%) improved in several outcome parameters ("responders"), including quality of life and function. In this first prospective report on the use of EN-PNS in neuropathic pain, this technology provided significant clinical benefit for some patients. Controlled studies are required to confirm our results and the place of EN-PNS in future neuromodulation treatment algorithms. Given the refractory nature of these conditions, these results are encouraging.