Rapid Pain Reduction Research Articles

Comparison of Efficacy and Safety of Intramuscular Piroxicam and Tramadol for Post-operative Pain in Patients Undergoing Caesarean Delivery.

Post-caesarean section pain can be both stressful and unfavourable. Effective and rapid reduction of pain facilitates early ambulation and care of the new born. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and opioids are used for pain relief but they are associated with adverse effects both in the mother and the child. To evaluate efficacy and safety of piroxicam and tramadol in post-caesarean section pain. Primigravidae who underwent elective caesarean section received either piroxicam 20mg or tramadol 100mg intra-muscularly, following recovery from anaesthesia. Severity of pain was assessed using Visual Analogue Scale (VAS) and side-effects to study drugs were noted. Rescue analgesic butorphanol 2mg was administered if VAS score was more than four. Patient's satisfaction score was assessed at 12 hours post-operatively. Mean age in piroxicam and tramadol groups were 23.32±3.43 and 22.03±2.0 years respectively. Significant reduction in pain was observed at 2, 4, 8, 12 and 24 hours in both groups (p<0.001). Pain relief was significant at 2, 4 and 8 hours in piroxicam group compared to tramadol. Twenty-one and 12 patients in tramadol and piroxicam groups received rescue analgesic respectively. Sedation and nausea was significantly higher in tramadol group (p<0.001), 46.66% of patients graded their satisfaction score as good and 15% as excellent in piroxicam group. Intra-muscular piroxicam was effective in reducing post-caesarean section pain for 24 hours with minimal side-effects compared to tramadol.

Application of bifurcation analysis for determining the mechanism of coding of nociceptive signals

The patch clamp method is used for studying the characteristics of slow sodium channels responsible for coding of nociceptive signals. Quantitative estimates of rate constants of transitions of “normal” and pharmacologically modified activation gating mechanisms of these channels are obtained. A mathematical model of the type of Hogdkin–Huxley nociceptive neuron membrane is constructed. Cometic acid, which is a drug substance of a new nonopioid analgesic, is used as a pharmacological agent. The application of bifurcation analysis makes it possible to outline the boundaries of the region in which a periodic impulse activity is generated. This boundary separates the set of values of the model parameter for which periodic pulsation is observed from the values for which such pulsations are absent or damped. The results show that the finest effect of modulation of physical characteristic of a part of a protein molecule and its effective charge suppresses the excitability of the nociceptive neuron membrane and, hence, leads to rapid reduction of pain.

Implementation and evaluation of a rapid access palliative clinic in a New Zealand cancer centre.

IntroductionPalliative patients with metastatic bone pain endure long waiting times and multiple visits to radiation therapy departments for treatment. This can prolong suffering and may be a factor in patients consenting for treatment. Rapid Access Palliative Clinics (RAPC) have been established around the world to provide a multidisciplinary approach to consultation, simulation and treatment on the same day. This paper describes the implementation and evaluation of a RAPC at Waikato Regional Cancer Centre (WRCC) by reducing the time from referral to first specialist appointment (FSA).MethodsThe structure and process for the RAPC day was outlined and the roles of staff were defined. A retrospective study was undertaken of the 261 consecutive patients seen in the RAPC from April 2009 to April 2013. Tracking sheets were created to record patient information at the initial consultation. Follow‐up telephone calls were used to assess the patient post‐treatment. Patient information was entered into a database.ResultsA total of 226 patients received radiation therapy treatment to 307 sites. All patients were seen within 1 week of referral. Sixty‐three per cent of patients were simulated and treated on the same day. The change in radiation therapy fractionation prescriptions was statistically significant (P = 0.0012). There was a statistically significant difference between initial and follow‐up pain scores (P < 0.0001).ConclusionEvaluation of the clinic has shown that it compares favourably with similar international clinics. The RAPC has decreased the referral to FSA for palliative radiation therapy and reduced the number of visits the patient has to endure due to an increase in single fraction prescriptions. This has resulted in rapid reduction in pain for the majority of patients.

SAT0344 Intravenous Bisphosphonate Reduces Rapidly Pain in Complex Regional Pain Syndrome (CRPS)

BackgroundThe treatment of CRPS remains controversial, but multidisciplinary and interdisciplinary approaches is mandatory to prevent long-standing or permanent disability. Bisphosphonates, apart from their antiresorptive activity, have been shown to have...

Massage versus Kinesio Taping. Possibilities to Enhance the Kinetic Program in Mechanically Triggered Neck Pain

Mechanically triggered cervicalgia is frequently encountered in persons holding a fixed, monotonous position and it causes pain at the level of the cervical paraspinal muscles and ligaments which may be associated with muscular contraction, with stiffness and blocking of the upper thorax and shoulders.The study we have undertaken started out from the assumption that massage, on the one hand, and kinesio taping, on the other hand, in association with physiotherapy, can yield different effects in obtaining painlessness, diminishing discomfort and enhancing the range of motion in the cervical region.For testing purposes we used: the pain numeric scale (0-10), the neck disability index (NDI) and the range of motion testing (CROM). The patients belonging to the experimental and control groups were dynamically tested at the beginning of the study and after a week during which they underwent differential treatment.The test results showed a minimal difference between the two groups from the point of view of pain, discomfort and range of motion in the cervical region; the patients benefiting from kinesio taping recorded a more rapid reduction of pain.

Die osteoporotische Humeruskopffraktur

BackgroundTreatment of complex dislocated fractures of the proximal humerus has been contoversially discussed in recent years, particularly for elderly patients. The question of the optimal treatment of this severe injury remains unanswered.Operative therapyAlthough there was a temporary trend towards angled locking plate osteosynthesis, the euphoria was dampened by several reports of high complication and revision rates. A better understanding of fracture morphology and important prognostic factors, such as the integrity of medial support, led to further developments in implant design. In addition, augmentation of the humeral head with spongiosa or bone substitute material which can be applied directly or via cannulated screws as well as intramedullary support by fibula transplantation are gaining in importance. In the primary treatment the use of fracture prostheses plays a more subordinate role. In contrast inverse prostheses have proven to be good and reliable alternatives. The advantages are mainly in rapid reduction in pain and a much lower revision rate in comparison to osteosynthesis.Conservative therapyIn recent years conservative therapy has been increasingly and more intensively propagated. ConclusionIt must be noted that despite the frequency of proximal humeral head fractures in elderly patients, the available data are still insufficient. An established therapy algorithm does not exist, decisions concerning therapy must be individualized for each case and adapted to the requirements of patients.

Rezidivierende Ulzerationen bei Livedovaskulopathie

A 50-year-old women had suffered from recurrent and extremely painful ulcerations of both legs and the back of her feet for about 3 weeks. The clinical examination showed multiple hemorrhagic and bizarre configured ulcerations with a surrounding livid-erythematous discoloration, hyperpigmentation and extensive atrophie blanche. Neither instrument-based nor serological tests revealed specific pathological findings. Histological results from the border area of the ulceration confirmed the diagnosis of livedoid vasculopathy. A systemic treatment with low-molecular-weight heparin was initiated, resulting in a rapid pain reduction and complete healing of the ulcerations after some weeks of therapy. This case report demonstrates that unusual entities like livedoid vasculopathy should be considered as rare causes for recurrent leg ulcers because different underlying etiologies need different specific treatment strategies. Until now treatment for patients with livedoid vasculopathy has not been standardized but anticoagulative therapy with low-molecular-weight heparin is considered to be one treatment of first choice.

Successful Treatment of a Sacral Aneurysmal Bone Cyst With Zoledronic Acid

Aneurysmal bone cysts (ABCs) in the sacrum pose a management challenge as their location usually means that surgical excision is not possible. Strategies such as embolization have been used previously but have the potential for significant side effects. We report the successful use of bisphosphonate treatment (zoledronic acid) in an 8-year-old boy who presented with an ABC that did not respond to embolization. The patient presented with pain and progressive limp. After radiologic and histologic confirmation of the diagnosis, embolization therapy was trialed, which was unsuccessful. At this point, he had severe pain and extremely limited mobility, requiring the use of a wheelchair. His ability to lie flat or sit erect was limited by the pain. Zoledronic acid therapy was subsequently commenced at 0.04 mg/kg per dose by intravenous infusion, at 4 monthly intervals, for a total of 2 years (7 doses). The infusions were well tolerated, with rapid reduction in pain and resolution of previously severe immobility, from being bed and chair bound at baseline to normal independent ambulation over several months. This was associated with marked radiologic improvement. We postulate that the effect of treatment is a combination of the anti-inflammatory effect of zoledronic acid and the antiresorptive effect of osteoclast inhibition. We conclude that bisphosphonates should be considered as possible second-line agents for ABCs. Further, study of a larger cohort would help to establish their efficacy in this setting. Level IV (case report, no comparator/control arm).

AB1060 Bisphosphonate intravenous allows a rapid contrast of pain in complex regional pain syndrome (CRPS)

BackgroundThe treatment of CRPS remains controversial, but multidisciplinary and interdisciplinary approaches seem to be inevitable to prevent long-standing or permanent disability (1). Bisphosphonates, apart from their antiresorptive activity, could also...

Application and tolerability of Herpotherm&amp;reg; in the treatment of genital herpes

Genital herpes is the manifestation of a herpes simplex virus 2 infection. Standard treatment uses both local and systemic approaches. Here, we report on the results of a local therapy approach with 31 female patients at a gynecological practice. In the here-described approach, established genital herpes infection was treated with the medical device Herpotherm®, with or without virostatic drugs. Herpotherm® is a certified medical device operating on the basis of local heat application. Parameters evaluated during the approach were (i) subjective patient assessments and (ii) objective assessment of the physician. In the described therapy approach a positive effect in terms of nature and severity in the course of the disease using Herpotherm® could be demonstrated. It could be shown that Herpotherm® can also be used for genital herpes and that it is well tolerated. In relation to other therapies using topical treatment for genital herpes, an extremely rapid reduction of pain and herpetic symptoms could be observed. Intolerances or discontinued use as a result of complications were not observed.

Ganganalyse nach minimal-invasiver Hüftprothesenimplantation

Upon implantation of a hip prosthesis by total hip arthroplasty (THA), clinical criteria are not always sufficient for an objective assessment of the functional outcome. Thus, functional improvement of gait behavior was comparatively validated by instrumented 3D gait analysis for a current, minimally invasive surgical approach (MIS; anterolateral approach) and a conventional, transgluteal approach (KONV). In selected cases, disturbed motion sequences were registered by measuring the muscle activity via high-resolution, monopolar surface electromyography (S-EMG) above the operation area. Despite continuous and significant improvement of practically all analyzed kinematic and kinetic gait parameters for both surgical approaches already after 5 weeks but in particular after 6 and 12 months, no significant differences were detected between the 2 procedures for any parameter or time point. The S-EMG demonstrated non-physiological muscle activation on the operated, but also on the non-operated side, even at 6 months after surgery. Advantages of the MIS approach thus seem primarily restricted to early, post-operative results, such as more rapid pain reduction and rehabilitation.

Therapeutic Properties and Tolerance of Procaine and Phenazone Containing Ear Drops in Infants and Very Young Children

Since ear pain is often intolerable in very young children with acute otitis media (AOM), a safe pain reduction is indispensable both from the medical as well as from the ethical point of view. To confirm the safety and therapeutic properties of ear drops (Otalgan) consisting of the short acting local anesthetic procaine hydrochloride (CAS 51-05-8) and the anti-inflammatory component phenazone (CAS 60-80-0), a multi-center, non-interventional post marketing surveillance (PMS) study was performed in 428 children (f/m: 45.6%/ 54.4%) aged between 0 and 6 years (mean 3.44 ys). Otalgia as the overall diagnostic criterion present in all children was allotted to otitis media in 398 (93%) and to otitis externa in 28 patients (6.5%), while in two patients, both diagnoses were documented. No adverse drug reactions (ADR) to the target medication have been detected during the entire study. The evaluation of tolerance by the physicians (mean score 1.38) and by the children/ parents (mean score 1.48) was in compliance with the absence of ADR. The drug tolerance was rated by the physicians in 99.8% of the cases as very good (62.2%; n = 266) or good (37.6%; n = 161). In one child (0.2%), the tolerance was evaluated by the physician as moderate. The judgement of parents revealed for all children either a very good (51.9%; n = 222) or good (48.1%; n = 206) evaluation of tolerance. The target medication was tolerated well, independent of the duration of treatment (2 to 10 days with a median of 5 days), of the daily dose and of the accumulated dose per treatment cycle, i.e. longer treatments and higher doses were not associated with a worsening of tolerance evaluations. Even in the highest dose class of over 100 drops per treatment cycle, no changes of tolerance could be revealed. As far as can be derived from non-controlled observational data, the results also confirm the known efficacy profile of the target medication in children. Under the treatment, the initial mean pain score of 2.33 was reduced by nearly 93% down to 0.17, accompanied by a corresponding normalization of the otoscopic findings of the ear canal and the tympanic membrane, and by the Improvement of the general condition. In 95.3% of the children, the physicians rated the efficacy of the target medication as very good (n = 156; 36.4%) or good (n = 252; 58.9%) while in 14 patients (3.3%) the efficacy was scored as moderate, in 4 patients (0.9%) as minimal and in two patients as inadequate (0.5%). The results also demonstrate that with the use of the target medication for local symptomatic treatment of pain in the outer ear canal and in AOM in children, the use of antibiotics in most of the cases can be avoided. The findings are in full accordance with the results of former clinical studies, with positive evaluations of ototoxicity and with accumulated pharmacovigilance data showing that since introduction of the drug in 1911, no ADR have ever been reported in children. The study confirms that the target medication provides a safe and rapid pain reduction and improvement of inflammation in very young children suffering from painful acute inflammatory ear conditions.

Canakinumab relieves symptoms of acute flares and improves health-related quality of life in patients with difficult-to-treat Gouty Arthritis by suppressing inflammation: results of a randomized, dose-ranging study.

IntroductionWe report the impact of canakinumab, a fully human anti-interleukin-1β monoclonal antibody, on inflammation and health-related quality of life (HRQoL) in patients with difficult-to-treat Gouty Arthritis.MethodsIn this eight-week, single-blind, double-dummy, dose-ranging study, patients with acute Gouty Arthritis flares who were unresponsive or intolerant to - or had contraindications for - non-steroidal anti-inflammatory drugs and/or colchicine were randomized to receive a single subcutaneous dose of canakinumab (10, 25, 50, 90, or 150 mg) (N = 143) or an intramuscular dose of triamcinolone acetonide 40 mg (N = 57). Patients assessed pain using a Likert scale, physicians assessed clinical signs of joint inflammation, and HRQoL was measured using the 36-item Short-Form Health Survey (SF-36) (acute version).ResultsAt baseline, 98% of patients were suffering from moderate-to-extreme pain. The percentage of patients with no or mild pain was numerically greater in most canakinumab groups compared with triamcinolone acetonide from 24 to 72 hours post-dose; the difference was statistically significant for canakinumab 150 mg at these time points (P < 0.05). Treatment with canakinumab 150 mg was associated with statistically significant lower Likert scores for tenderness (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.27 to 7.89; P = 0.014) and swelling (OR, 2.7; 95% CI, 1.09 to 6.50, P = 0.032) at 72 hours compared with triamcinolone acetonide. Median C-reactive protein and serum amyloid A levels were normalized by seven days post-dose in most canakinumab groups, but remained elevated in the triamcinolone acetonide group. Improvements in physical health were observed at seven days post-dose in all treatment groups; increases in scores were highest for canakinumab 150 mg. In this group, the mean SF-36 physical component summary score increased by 12.0 points from baseline to 48.3 at seven days post-dose. SF-36 scores for physical functioning and bodily pain for the canakinumab 150 mg group approached those for the US general population by seven days post-dose and reached norm values by eight weeks post-dose.ConclusionsCanakinumab 150 mg provided significantly greater and more rapid reduction in pain and signs and symptoms of inflammation compared with triamcinolone acetonide 40 mg. Improvements in HRQoL were seen in both treatment groups with a faster onset with canakinumab 150 mg compared with triamcinolone acetonide 40 mg.Trial registrationclinicaltrials.gov: NCT00798369.

Rapid pain reduction following loading-dose ibandronate in bone metastases

Introduction: Severe and sometimes intractable bone pain is often the first symptom of metastatic bone disease. In many cases the standard pain therapy is not sufficient and side effects are severe. Several clinical trials have demonstrated that ibandronate can cause effective and sustained relief from metastatic bone pain by standard dosage and a longer observation period. Particularly in the first weeks after diagnosis of bone metastasis it is necessary to reduce pain and prevent quality of life. Methods: 26 patients with bone pain from newly diagnosed skeletal metastases were treated with loading-dose intravenous ibandronate (6 mg infused over 1 h on 3 consecutive days). All patients were previously untreated with bisphosphonates and obtained a symptomatic pain therapy with opioids or nonsteroidal anti-inflammatory drugs. The bone pain severity was rated by the patients daily on a visual analogue scale (VAS, range: 0 (no pain) to 10 (worst pain imaginable)), within 3 weeks all patients were referred to further therapy (e.g. radiation, surgery, and chemotherapy). Results: In 23 patients loading-dose ibandronate therapy significantly reduced bone pain within the first 5 to 7 days (VAS day 0: 6.8 vs. day 7: 3.7). Only 3 patients showed no response concerning a distinct pain reduction within the first days of therapy. There was no increase in pain medication and no severe side effects during the treatment. Discussion: This clinical pilot study using an intensive high dosed ibandronate-therapy demonstrated that the loading-dose concept resulted in a remarkable reduction of metastatic bone pain within days after initiation. These findings are in concordance with earlier clinical trials evaluating a loading-dose ibandronate-therapy in other tumour types. Controlled clinical trials in a variety of tumour entities are mandatory to provide evidence based recommendations for a routine use of the concept of ibandronate loading dose.

Osteoporosebedingte Wirbelkörperfrakturen

Vertebral compression fractures are among the most common forms of manifestations of osteoporosis. Conservative treatment comprises adequate analgesia, osteoporosis medication and individualized physiotherapy or braces. Nevertheless, vertebral compression fractures frequently lead to persisting pain and decrease daily activity and quality of life. In these cases, kyphoplasty and vertebroplasty can be efficient treatment options. Vertebroplasty is a minimally invasive procedure, in which bone cement is filled into the vertebral body under fluoroscopic control. In most cases, this internal stabilization leads to a rapid reduction in pain. Kyphoplasty additionally aims to correct the kyphotic deformation of the broken vertebra via introducing and inflating a balloon catheter. There is broad clinical experience with both procedures. For kyphoplasty, randomized controlled trials showed significant improvements in pain and quality of life in patients undergoing kyphoplasty. However, cement leakages lead to rare but severe complications such as pulmonary embolism and nerve palsies.

Pregabalin for painful diabetic peripheral neuropathy

Painful symptoms of diabetic peripheral neuropathy have been shown to be improved by treatment with the antiepileptic drug pregabalin. Freeman et al. performed a meta-analysis of 7 randomized, placebo-controlled trials that evaluated the efficacy and safety of pregabalin treatment for painful diabetic peripheral neuropathy. The trials were consistent in their inclusion and exclusion criteria, but involved a variety of doses (150, 300 and 600 mg/day) and dosing intervals (2 or 3 times per day). Pregabalin was found to be effective for painful diabetic peripheral neuropathy at all doses and intervals reviewed. Additionally, higher pregabalin doses resulted in faster reduction in pain scores and sleep interference when compared with lower doses and placebo. The greatest and apparently most rapid pain reduction was observed in patients receiving pregabalin 600 mg/day, divided into 2 or 3 doses. On the basis of these findings, pregabalin can be a useful therapy for painful diabetic neuropathy.

Clinical Responses to Gene Therapy in Joints of Two Subjects with Rheumatoid Arthritis

This paper provides the first evidence of a clinical response to gene therapy in human arthritis. Two subjects with rheumatoid arthritis received ex vivo, intraarticular delivery of human interleukin-1 receptor antagonist (IL-1Ra) cDNA. To achieve this, autologous synovial fibroblasts were transduced with a retrovirus, MFG-IRAP, carrying IL-1Ra as the transgene, or remained as untransduced controls. Symptomatic metacarpophalangeal (MCP) joints were injected with control or transduced cells. Joints were clinically evaluated on the basis of pain; the circumference of MCP joint 1 was also measured. After 4 weeks, joints underwent surgical synovectomy. There were no adverse events in either subject. The first subject responded dramatically to gene transfer, with a marked and rapid reduction in pain and swelling that lasted for the entire 4 weeks of the study. Remarkably, joints receiving IL-1Ra cDNA were protected from flares that occurred during the study period. Analysis of RNA recovered after synovectomy revealed enhanced expression of IL-1Ra and reduced expression of matrix metalloproteinase-3 and IL-1beta. The second subject also responded with reduced pain and swelling. Thus, gene transfer to human, rheumatoid joints can be accomplished safely to produce clinical benefit, at least in the short term. Using this ex vivo procedure, the transgene persisted within the joint for at least 1 month. Further clinical studies are warranted.

Efficacy of Treating Low Back Pain and Dysfunction Secondary to Osteoarthritis: Chiropractic Care Compared With Moist Heat Alone

Objective To evaluate the efficacy of chiropractic spinal manipulation, manual flexion/distraction, and hot pack application for the treatment of low back pain from osteoarthritis (OA) compared with moist heat alone. Methods Two hundred fifty-two patients with low back pain secondary to OA were randomly assigned to either the treatment group (moist hot pack plus chiropractic care) or the moist heat group subjects, which attended 20 treatment sessions over several weeks. At sessions 1, 5, 10, 15, and 20, they rated pain using a visual analog pain scale, activities of daily living using the Oswestry Low Back Pain Questionnaire, and a range of motion (ROM) using the J-Tech Dual Digital Inclinometer (JTECH Medical Model no. AA036). Results Session I ratings indicated that the two groups were equivalent on all pain and flexion scores. The treatment group reported greater and more rapid pain reduction and greater and more rapid ROM improvement than the moist heat group. The treatment group also had greater improvements than the moist heat group in daily living activities in 4 of the 9 areas measured. Conclusion Chiropractic care combined with heat is more effective than heat alone for treating OA-based lower back pain. Pain reduction occurs more rapidly and to a greater degree, and ROM increases more rapidly and to a greater degree.

Can we use nerve gliding exercises in women with carpal tunnel syndrome?

This study investigated the effectiveness of nerve gliding exercises used in combination with conservative treatment approaches in patients with carpal tunnel syndrome. A total of 35 hands of 26 patients with carpal tunnel syndrome were divided into 2 groups. Static volar wrist splints were applied to 16 hands in the control group, and these patients were trained to modify their functional activities in accordance with conservative treatment. In the experimental group, nerve gliding exercises were applied to 19 hands that were also treated conservatively. A day-and-night splint, together with the conservative training program, was applied for 6 weeks to both groups. Subsequently, a night splint only was used in both groups, and nerve gliding exercises were continued in the experimental group for the remaining 4 weeks. Pretreatment and posttreatment assessments of pain, sensation, muscle strength, and grip and pinch strength, along with Tinel and Phalen tests, were performed in all cases; electrophysiologic measurements were recorded. Significant progress was detected in both control and experimental groups during the posttreatment phase compared with the initial phase (P < .05). However, when the 2 groups were compared, the experimental group in which nerve gliding exercises were added to conservative therapy approaches demonstrated more rapid pain reduction; these patients also showed greater functional improvement, especially in grip strength (P < .05).

Primary pulmonary osteosarcoma in a dog

ABSTRACTAn 11‐year‐old mixed breed dog was referred because of coughing and painful swelling of the distal extremities which had not resolved with antibiotic treatment. A consolidated left cranial lung lobe and hypertrophic osteopathy were identified by radiographs. A unique feature of this report is the marked, rapid reduction in pain and lameness associated with hypertrophic osteopathy after treatment with corticosteroids. Histological examination of an 8 cm diameter, spherical mass found in the excised cranial lung lobe revealed osteosarcoma. No evidence of local or distant metastases was present. The dog survived one year after diagnosis.