Reduction In Numeric Rating Scale Research Articles

Combined Therapy of Paravertebral Nerve Pulsed Radiofrequency and Subcutaneous Block for Acute/Subacute Herpetic Neuralgia: A Retrospective Study.

This retrospective study aimed to investigate the effectiveness and safety of early combined therapy with CT-guided paravertebral nerve (PVN), pulsed radiofrequency (PRF), and subcutaneous block on acute/subacute herpes zoster (HZ). A total of 98 medical records were analyzed. All patients underwent CT-guided PRF on PVN immediately followed by a single subcutaneous block with lidocaine and dexamethasone in acute/subacute phase. The therapy efficacy was evaluated by pain numeric rating scale (NRS) and effective rate, which was defined as a percent of cases with a reduction in pain NRS>50% at day 1, week 2, 4, 12, and 24 after the procedure. The incidences of medication reduction and postherpetic neuralgia (PHN) were also retrieved. Further comparison was conducted between acute group (disease duration<30 days from HZ onset) and subacute group (30 day<duration<90 days from HZ onset). Early combined therapy indicated an immediate and sustained improvement in pain NRS as compared with before treatment ( P <0.0001), with effective rates of 74%, 79%, 80%, 76%, and 79% at day 1, week 2, 4, 12, and 24 after procedure, respectively. At the end of follow-up, the proportion of patients with a reduction of >50% in prior medications amounted to 83% and the incidence of clinically meaningful PHN decreased to 23%. The clinical efficacy was more profound in acute group than in subacute group at every time points ( P <0.05). No severe complications occurred. Our data revealed surprising levels of pain relief by combination therapies of PRF and subcutaneous block targeting different sites of pain pathway, thus suggesting a valuable treatment option for acute/subacute herpetic neuralgia.

Efficacy of ultrasound-guided pecto-intercostal fascial block and transversus thoracis muscle plane block for postoperative analgesia in cardiac surgery in adult patients: A randomized study

ABSTRACT Background Insufficient management of postoperative pain is a notable issue encountered by individuals after open-heart operations. The study aimed to evaluate the effect of ultrasound-guided pecto-intercostal fascial block (PIFB) and transversus thoracis muscle plane (TTB) on the analgesic efficacy in adult patients undergoing open-heart operations and the duration of mechanical ventilation (MV). Methods A randomized double-blind controlled trial was conducted on a cohort of 90 adult patients with elective open-heart surgery, namely valve replacement, with midline sternotomy. Patients were divided into three groups of similar size. The first group (control group) received conventional systemic analgesia alone, while the second group received bilateral TTB and the third group received bilateral PIFB, using ultra-sound guided technique. Results A significant reduction in NRS (Numeric Rating Scale) values was observed in both the TTB group and the PIFB group as compared to the control group at zero, three and 6-hour postoperative. The PIFB and TTB group exhibited an important delay in the initiation of first rescue analgesia, as well as a reduction in the overall intake of fentanyl for rescue purposes during a twenty-four-hour period. Additionally, the TTB group and the PIFB group demonstrated considerably shorter durations of mechanical ventilation as compared to the control group. Conclusions The utilization of ultrasound TTB and PIFB demonstrated efficacy in providing postoperative analgesia compared to the control group. This was evidenced by the less requirement for additional analgesic medication, reducing postoperative pain scores and a shorter duration of mechanical ventilation.

The Comparative Efficacy of Palmitoylethanolamide (PEA) With the Combination of Pregabalin and Nortriptyline on Post-extraction Trigeminal Neuropathy by Using Magnetic Resonance (MR) Neurography: A Randomized Clinical Trial.

Aim The aim of this randomized clinical trial is to compare the efficacy of palmitoylethanolamide (PEA) with the combination of pregabalin and nortriptyline in treating post-extraction trigeminal neuropathy using magnetic resonance neurography (MRN). Methods The present prospective, randomized controlled trial was conducted on 60 patients (20 in each group). In group I (positive control group), a combination of 75 mg of pregabalin and 10 mg of nortriptyline was administered once daily for the duration of 12 weeks. In group II, 600 mg of palmitoylethanolamide was given twice a day. In group III, a combination therapy of the abovementioned drugs was given. The efficacy of the drug was assessed by measuring pain intensity in terms of the numeric rating scale (NRS) (primary outcome)and changes (signal intensity and nerve thickness) in magnetic resonance neurography (secondary outcome) at various intervals of time. The data was collected and subjected to statistical analysis using the Statistical Package for Social Sciences (SPSS)version 25(IBM SPSS Statistics, Armonk, NY)at the significance level of P<0.05. Results A significant decrease in post-drug mean NRS scores was observed in all three groups. In terms of reduction in the mean NRS, the combination group showed the highest reduction. Palmitoylethanolamide significantly reduces pain scores with negligible side effects. Conclusion Palmitoylethanolamide helps in the reduction of mild to moderate pain of painful post-traumatic trigeminal neuropathy (PTTN) with minimal side effects, suggesting that it may be used where the use of the conventional drug is either contraindicated or not feasible.

Effectiveness of subcutaneous morphine in the treatment of pain crises in cancer patients

Objective: The purpose of this study was to evaluate the efficacy of subcutaneous morphine for managing pain crises resulting from various causes in cancer patients attended by the Pain Clinic in the immediate care area of the National Cancer Institute in Mexico City.&#x0D; Materials and Methods: This study was analytical, observational, retrospective, and descriptive. The oncology patients treated in the immediate care area for pain crises between August 1, 2020, and July 1, 2023, made up our study population. We documented the management of pain crises for patients who needed subcutaneous morphine treatment.&#x0D; Results: Considering a reduction in Numeric Rating Scale (NRS) score &gt;30% as effective and a reduction &lt;30% as ineffective, 566 patients didn’t require an additional dose of subcutaneous morphine to control the pain crisis; 11 patients reported a decrease of &lt;30%. A total of 24 patients needed a second rescue. Among this group, only 5 responded well to the second morphine rescue; in the remaining 19 patients, the rescue was deemed ineffective if the NRS decreased by at least 30%. Only 5 individuals experienced moderate pain, and only one patient reported severe pain. The variables were compared using the non-parametric Mann-Whitney U test with significance &lt;0.05. Consequently, it may be said that there is a statistically significant difference between the first and subsequent NRS values obtained.&#x0D; Conclusion: For oncology patients treated by the Pain Clinic in the immediate care section of the National Cancer Institute in Mexico City, subcutaneous morphine is beneficial in managing pain crises of different origins.&#x0D; Keywords: Morphine, Subcutaneous Pain crises, Efficacy, Numeric rating scale

The effectiveness of cervical transforaminal epidural steroid injections for the treatment of cervical radicular pain: A prospective cohort study reporting 12-month outcomes

ObjectivesTo evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain. DesignSingle-group prospective cohort study. MethodsOutcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-related quality of life (EQ-5D), global improvement (PGIC), personal goal achievement (COMBI), Chronic Pain Sleep Index (CPSI), and healthcare utilization at one, three, six, and 12 months. Data analysis included descriptive statistics with the calculations of 95% confidence intervals (CIs), contingency table analysis, and multilevel logistic regression (LR) analysis, including a worst-case (WC) sensitivity analysis in which missing data were treated as treatment failure. Participants who were treated surgically were considered failures in the categorical analyses. Results33 consecutively enrolled participants (63.6% females, 51.2 ± 12.2 years of age, BMI 28.3 ± 4.5 kg/m2) were analyzed. Success rates for ≥50% reduction in NRS for arm pain at one, three, six and 12 months were 57.6% (95% CI 40.8–72.8%), 71.9% (95% CI 54.6–84.4%), 64.5% (95% CI 46.9–78.9%), and 64.5% (95% CI 46.9–78.9%). Success rates for ≥30% improvement in NDI-5 were 60.6% (95% CI 43.7–75.3%), 68.8% (95% CI 51.4–82.0%), 61.3% (95% CI 43.8–76.3%), and 71.0% (95% CI 53.4–83.9%). In WC analysis, success rates for ≥50% arm NRS and NDI-5 were 0–4.3% lower between 1 and 12 months. PGIC scores were at least “much improved” or “very much improved,” in 48.4–65.6% of participants between 1 and 12 months. 6.1%, 6.1%, and 3.0% had one, two, or three repeat injections, respectively. 18.2% of participants underwent surgery by 12 months. Participants showed significant improvements in arm NRS and NDI-5 after treatment (p < 0.05), multilevel logistic regression models showed no significant decline in improvements across the follow-up time points (p > 0.05). ConclusionStatistically significant and clinically meaningful improvements in pain and disability were observed after CTFESI for up to 12 months in individuals with unilateral cervical radicular pain.

Transcutaneous electrical acupoint stimulation for cancer-related pain management in patients receiving chronic opioid therapy: a randomized clinical trial.

The opioid crisis resulting from its use disorder and overdose poses additional challenges for cancer pain management. The American Society of Clinical Oncology Practice Guideline recommends acupuncture therapy for the management of adult cancer-related pain (CRP), but the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on CRP remains uncertain. This 5-week prospective randomized clinical trial was conducted at 2 hospitals in China, and participants with CRP receiving chronic opioid therapy were randomized 1:1 into two groups between December 2014 and June 2018. The true TEAS group underwent 15 sessions of TEAS treatments over 3 consecutive weeks, while the control group received sham stimulation. The primary outcome was the numerical rating scale (NRS) score in the past 24h at week 3. The secondary outcomes included morphine equivalent daily dose, quality of life and adverse events. A total of 159 participants were included in the modified intention-to-treat population. The baseline characteristics were similar in both groups. The mean NRS scores were 0.98 points at week 3 in the true TEAS group and 1.41 points in the sham group, with the mean difference between groups of -0.43 points (P < 0.001; OR = 0.68, P < 0.05). The proportion of patients with NRS reduction more than thirty percentage at week 3 was 50.00% in the true TEAS group and 35.44% in the sham group (RD = 0.15, P > 0.05; RR = 1.41, P > 0.05). No significant difference in pain intensity between the two groups was observed during the follow-up period without TEAS intervention (week 4, OR = 0.83, P > 0.05; week 5, OR = 0.83, P > 0.05). The Karnofsky Performance Status value suggested that patients in the true TEAS group experienced an improved quality of life (Between-group differences: week 3, 3.5%, P < 0.05; week 4, 4.6%, P < 0.001; week 5, 5.6%, P < 0.001). The 3-week application of TEAS in patients with CRP receiving chronic opioid therapy resulted in a statistically significant reduction in pain scores, but the observed reduction was of uncertain clinical significance. The prolonged analgesic effect of TEAS was not confirmed in this trial. GOV: ChiCTR-TRC-13003803.

“Low-dose ketamine versus morphine in the treatment of acute pain in the emergency department: A meta-analysis of 15” randomized controlled trials

ObjectiveTo compare the effectiveness and safety of ketamine and morphine in adult patients with acute pain in emergency department (ED) by using a meta-analysis method. MethodsThis study was based on the Cochrane methodology for conducting a meta-analysis. Only randomized controlled trials (RCTs) were eligible for this study, with an experimental group that received low-dose ketamine and a control group that received morphine. The participants were adults who had acute pain in the ED. The primary outcome measures were the numeric rating scale (NRS) and visual analog scale (VAS). The secondary outcome measures were the complete resolution of pain, NRS reduction ≥3 points, NRS reduction ≥50% or 60%, change of NRS score, change of VAS score, rescue analgesia, satisfaction and adverse events. Subgroup analysis was performed for studies with intravenous and intranasal administration of ketamine. The Review Manager Database was used to analyze the included studies. Results15 RCTs involving 1768 patients were included. The ketamine group had lower NRS scores than morphine group at 30 min (MD, −0.77 [95% CI, −0.93 to −0.61]; p < 0.00001), while the morphine had better analgesic effects at 120 min after treatment (MD, 0.33 [95% CI, 0.15 to 051]; p = 0.0003). The subjects of complete resolution of pain in the ketamine group performed better than those in the morphine group at 15 min (RR 3.18, 95% CI 1.75 to 5.78; p = 0.0001). Compared with the morphine group, the ketamine group had a lower incidence of adverse events requiring intervention (RR, 0.34 [95% CI, 0.18 to 0.66]; p = 0.001). Subgroup analysis of intravenous ketamine showed that ketamine had lower VAS score than the morphine group at 30 min. However, also on the 30-min VAS score, intranasal ketamine analgesia was less effective than morphine. ConclusionsKetamine had better analgesic effects in the early stages after treatment, while morphine maintained more durable effects. Compared with morphine, ketamine had a lower incidence of adverse events requiring intervention. The results of subgroup analysis showed that intravenous administration of ketamine was more effective than intranasal administration.

An ultrasound-guided serratus anterior plane block with continuous local anaesthetic infusion and epidural analgesia for rib fracture pain.

We compared analgesia with an ultrasound (US)-guided serratus anterior plane block (SAPB) to thoracic epidural analgesia (EA) with continuous local anaesthetic infusion in patients with unilateral multiple traumatic rib fractures. EA often carries contraindications in patients with multiple rib fractures (MRFs), whereby having alternative effective methods to treat rib fracture pain remains important to patient care. Thus, we hypothesised that both regional anaesthetic techniques would provide effective pain relief. In this study, we included 59 patients with unilateral MRFs and a numerical rating scale (NRS) pain score ≥4 at rest or upon movement. Patients were randomised to receive a US-guided SAPB or continuous infusion EA with 2 mg/mL ropivacaine. Patients were given a patient-controlled analgesia (PCA) device with intravenous oxycodone boluses for rescue medication. The primary outcome was a change in the NRS score at rest and upon movement from baseline to Day 2 following the block. We also measured the forced expiratory volume in 1 s of expiration (FEV1) and FEV1% at the same time points when NRS was measured. The total consumption of oxycodone with PCA was measured at 24 and 48 h after the block. We detected a significant reduction (≥2) in NRS for both groups; however, EA associated with a greater reduction in NRS upon movement after block initiation. The mean reduction in NRS upon movement within 1 h was 3 (1.8, p < .01) in the SAPB group versus 4.7 (2.4, p < .01) in the EA group. We found no significant difference between groups in pain scores on Days 1 and 2 following the block. In the EA group, FEV1% increase in the first 12 h from baseline. Finally, PCA oxycodone consumption did not differ between groups. SAPB with continuous local anaesthetic infusion is an effective alternative to treat rib fracture pain when EA is contraindicated. We found that SABP significantly reduces pain in patients with unilateral MRFs, although EA achieves better analgesia over the first 12 h following the block.

Ozone treatment combined with sodium fluoride for the treatment of dentin hypersensitivity: an exploratory study.

Dentin hypersensitivity is one of the most common complains faced by dental professionals, and there is still lack of consensus for the most effective treatment approaches. The aim of the present study was to evaluate the efficacy of ozone therapy combined with sodium fluoride in reducing pain associated with dental hypersensitivity, compared to a paint-on adhesive desensitizing agent. The study included 20 patients (131 teeth), selected according to specific inclusion criteria and divided into two groups according to the type of desensitizing therapy (ozone with sodium fluoride or paint-on adhesive). The efficacy of both treatments were evaluated recording pain for each treated tooth immediately after treatment, after 1 month and after 6 months using a Numeric Rating Scale (NRS). Subjective parameters were also recorded: patients were asked to report whether they experienced pain caused by air, teeth brushing, cold and hot topical stimuli (present/absent). In both groups, pain values significantly decreased over time. Six months after treatment we registered significantly lower pain values in the ozone-treated group compared with the adhesive group and the mean percentage of NRS reduction from was significantly higher in the ozone-treated group. We did not register significant differences in subjective pain-related parameters between groups. The results of this exploratory study were aimed at exploring the combined effect of ozone with natrium fluoride, which was before described only in vitro. With the limitation of the sample size, our results suggest that this approach provides a pain reduction that was comparable to the paint-on adhesive.

A New, Effective, Safe, and Accurate Method of Cervical Selective Nerve Root Block

Objective: Cervical selective nerve root block (SNRB) is an effective procedure that has long been performed for patients with radiating pain or paresthesia. However, there are several delicate structures around the cervical nerve root, damage to which could lead to irreversible neurovascular injury. Therefore, cervical SNRB requires a high skill level and extensive experience to execute it safely. To overcome these disadvantages, we used biplane computed tomography (CT)-guided fluoroscopy and a needle guidance program to achieve symptom improvement in a safer and shorter procedure. This study aimed to investigate the new method and report on its excellent clinical effects.Methods: A total of 57 patients who experienced radiating pain due to cervical spinal stenosis resulting from a herniated disc were enrolled. From September 2020 to September 2021 subjects underwent a biplane CT-guided fluoroscopic nerve block at an outpatient clinic. All procedures were performed by biplane CT-guided fluoroscopy. We analyzed treatment effects with a numerical rating scale (NRS) at 2 and 4 weeks after the procedure. Logistic regression was performed to reveal the significance of changes in NRS after the injection.Results: Pain improved in 56 of 57 patients (98%) after 2 and 4 weeks of follow-up compared to pre-injection pain. At the 2-week follow-up, the mean reduction based on NRS scores was 3.226 (2.782-3.674, 0; 95% confidence interval [CI], p &lt; 0.001) indicating a 48% decrease in pain scores compared with the initial NRS. The mean reduction in NRS 4 weeks after the procedure was 3.544 (3.090-3.998, 0; 95% CI, p &lt; 0.001) indicating a 52% reduction compared with the initial NRS. The average duration of the procedure was 4 minutes. Conclusion: We demonstrate a clinically effective, safe, and accurate method using a biplane CT-guided fluoroscopy and needle guide program. This new method can be an easy and relatively uncomplicated alternative to treatment for patients with cervical radiculopathy and provides safe and accurate targeting, making it easy for inexperienced surgeons.

Multiphase Spinal Cord Stimulation in Participants With Chronic Back or Leg Pain: Results of the BENEFIT-02 Randomized Clinical Trial

ObjectiveThis study aimed to assess the safety and effectiveness of a new charge-distributed multiphase stimulation paradigm during an extended spinal cord stimulation (SCS) trial. Materials and MethodsThis prospective, multicenter, randomized, single-blind, feasibility study included participants with chronic low back and/or leg pain and baseline numerical rating scale (NRS) for overall pain intensity ≥6. After a successful commercial SCS trial, participants were randomized to multiphase SCS therapy A (approximately 600–1500 Hz) or B (approximately 300–600 Hz), delivered via an investigational external pulse generator and existing leads during an 11-to-12–day testing period. Primary end points were mean NRS change from baseline to final in-office visit for each multiphase therapy and between therapies. Secondary end points included mean NRS change from end of commercial trial to final study visit and incidence of device-related adverse events (AEs). Additional measures included patient-reported outcomes collected at home through electronic watches and written diaries. Power usage was compared between multiphase and commercial therapies. ResultsA total of 122 participants initiated a commercial trial; 77 were randomized to a multiphase arm, and 65 completed the study. Reductions in mean NRS scores from baseline to final study visit were significant for multiphase therapy A and B (−4.3 and −4.7, respectively; both p < 0.0001). There was no statistically significant difference in mean NRS reduction or percent pain relief between multiphase therapies. In an additional analysis, 63.9% of participants reported greater pain relief with multiphase than with commercial SCS therapy in the at-home setting. On average, multiphase required less power than did commercial devices. One non–serious device-related AE was reported, and no infections occurred during the extended trial. ConclusionsMultiphase SCS effectively reduced pain in participants with chronic low back and/or leg pain during a trial, with no unanticipated device-related AEs reported. Future studies should evaluate long-term effectiveness of multiphase stimulation. Clinical Trial RegistrationThe Clinicaltrials.gov registration number for the study is NCT03594266.

Pain Management with Inhalation of Methoxyflurane Administrated by Non-Medical Ski Patrol: A Quality Assessment Study.

Pain management can be challenging, especially in remote locations where first responders are not certified health care personnel. In these settings, traditional intravenous administration of analgesics is not feasible. In this study, we explore the feasibility of using methoxyflurane as a first-line analgesic in ski-related traumas, administered by the ski patrol, acting as the municipality physician's aiding personnel. This is a quality assessment of a project aimed at improving pain management in trauma patients at the largest ski resort in Norway. Members of the ski patrol were trained and delegated administration of methoxyflurane on behalf of the municipality physician. Patients > 18years with ski-related trauma and pain Numeric Rating Scale (NRS) of 6 or more were included. The patients received inhalational methoxyflurane on site, with continued administration during transport. Data were collected by the ski patrol and entered into a quality register. In total, 53 patients (18 to 76years, 32 (60%) males) accepted to be registered. The injuries were fractures in 35 (66%), joint luxation in seven (13%), combination of fracture and luxation in seven (13%), and blunt soft tissue damage in four (8%) cases. Median NRS before administration of methoxyflurane was 8 decreasing to median NRS 5 after 5-10min. The median NRS reduction of 3 (25-75% percentiles 2-5) was significant, p < 0.001. Patients rated the perceived effect as good in 40 (80%) moderate in nine (18%) and no effect in 1 (2%). Side effects were mild: Six patients (11%) experienced dizziness, one patient (2%) was considered drowsy. Methoxyflurane is feasible as a first-line analgesic administered by a non-medical ski patrol in a responsibly organized system. Early pain management with inhalation of methoxyflurane provides good perceived effect with mild adverse events and can be of great value in settings where few alternatives for pain management are available.

Computed tomography-guided Gasserian ganglion interventions for cancer-related facial pain in patients with complex anatomy: insights and recommendations.

The Gasserian ganglion is a well-known target for facial pain management, and patients with cancer present an anatomical challenge owing to tumor progression or treatment itself. Computed tomography (CT) is an alternative method for guiding these procedures. This was an observational retrospective analysis of patients with cancer-related facial pain who underwent CT-guided Gasserian ganglion interventions using local anesthetics, local anesthetics with steroids, phenol, and radiofrequency. Demographic, clinical, and procedure-related variables were collected from January 1, 2015, to December 30, 2018, at the National Cancer Institute. Data distribution was determined using the Kolmogorov-Smirnov test. A paired sample t-test (with a cut-off of P < 0.05 for statistical significance) was used for comparing outcome. We observed a significant reduction in numerical rating scale (NRS) and douleur neuropathique 4 (DN4) scores from 7.6 ± 1.4 and 4.4 ± 1.4 to 3.2 ± 2.0 and 2.2 ± 1.4 points, respectively (P < 0.001). After the procedure, 70.8% of the patients were satisfied; 16.7% were very satisfied, and 12.5% were unsatisfied. No intra- or postoperative complications were observed. The most common neoplasms were head and neck tumors (83.3%). Our data suggest that CT guidance is an effective and safe option for managing cancer-related facial pain in patients with complex anatomy, resulting in a significant reduction in pain, high satisfaction rates, and no mechanical complications. Future research should aim to refine the role of CT guidance in multimodal pain management in this population.

Efficacy of curcumin for amelioration of radiotherapy-induced oral mucositis: a preliminary randomized controlled clinical trial

BackgroundOral mucositis (OM) is one of the main problems in almost all patients undergoing head and neck radiotherapy (RT). Owning to the antioxidant and anti-inflammatory properties of curcumin, the effect of both oral and topical formulations of curcumin was assessed on radiation-induced OM (ROM) in this study.MethodsThe safety and efficacy of curcumin mouthwash 0.1% (w/v) and curcumin-nanocapsule were evaluated in ameliorating severity and pain/burning associated with OM during RT. The current randomized, placebo-controlled trial was conducted on 37 patients with head and neck cancers. Patients with grades 1 to 3 of ROM were randomized to receive one of the three interventions: curcumin mouthwash (0.1% w/v); Sinacurcumin soft gel containing 40 mg curcuminoids as nano-micelles (SinaCurcumin®40); or placebo mouthwash with a similar transparent appearance to curcumin mouthwash for 1 min three times daily during RT. Study evaluations were conducted at baseline and weekly thereafter for up to 3 weeks using the Numeric rating scale (NRS) and world health organization (WHO) scale.ResultsAmong the 45 patients randomized, 37 (mean (SD) age of 53.36 (15.99) years; 14 [37.8%] women) completed the treatment according to the protocol. Patients treated with either oral or topical curcumin showed a significantly reduced severity and burning related to OM during the first 3 weeks after administration (P-Value < 0.001) as compared with the placebo. At study termination, more than 33% of subjects utilizing curcumin mouthwash and 15% of patients utilizing curcumin-nanocapsule remained ulcer free while all of the placebo-receiving subjects had OM. The reduction of NRS and WHO scale between curcumin groups was comparable without significant differences.ConclusionBoth curcumin mouthwash and nanocapsule were effective, safe, and well-tolerated in the treatment of radiation-induced OM. Higher doses of curcumin and larger sample sizes can be used for further investigation in future studies.Trial registration:https://irct.ir/ IRCT20190810044500N17 (13/08/2021).

Propensity score matching comparing short-term nerve electrical stimulation to pulsed radiofrequency for herpes zoster-associated pain: A retrospective study.

Zoster-associated pain (ZAP) is notoriously difficult to treat. Pulsed radiofrequency (PRF) and short-term nerve electrical stimulation (st-NES) have been proven effective treatments for ZAP. However, it is still unclear which technique provides improved analgesia in ZAP. This study is based on a large-scale, long-term follow-up to evaluate the efficacy and safety between st-NES and PRF. All eligible ZAP patients treated with st-NES or PRF in our department were enrolled. Cohorts were divided into the st-NES group and the PRF group. A 1:1 ratio propensity score matching (PSM) was used to balance the baseline characteristics. The PS-matched cohort was adopted to investigate the efficacy and safety of the two treatments. The ordinal regression analysis was performed to determine the variables affecting the treatment effect of ZAP. A total of 226 patients were included after PSM. The numerical rating scale (NRS) scores in st-NES and PRF groups considerably reduced compared to baseline levels after treatment. The NRS scores in the st-NES group were obviously lower than those in the PRF group at discharge, 1, 3, 6, 12, and 24 months. During the follow-up period, the NRS reduction rate remained higher in the st-NES group than in the PRF group (P < 0.01). The dosage of medication, Pittsburgh Sleep Quality Index (PSQI) score, and the number of patients with aggravated pain after discharge in the st-NES group were significantly less than in the PRF group after treatment. Short-term nerve electrical stimulation has been shown to be more advantageous than PRF for pain relief and quality of life improvement for ZAP patients.

Application of Edmonton Symptom Assessment system in daily cancer pain management by acupuncture: Retrospective analysis of data from an inpatient oncology department and a pilot prospective study☆ 埃德蒙顿症状评估量表在针灸治疗癌痛患者中的应用:基于肿瘤科住院患者的回顾性分析和一项前瞻性预试验

BackgroundAs pain is the most prominent clinical symptom for cancer patients and closely related to other symptoms, it is necessary to have a comprehensive assessment on promising intervention to improve pain management. MethodsA retrospective study of 489 inpatient cancer patients (1081 visits) was conducted by querying the electronic medical record database to test the reliability and validity of the Edmonton Symptom Assessment System. Data from a pilot prospective randomized controlled study on acupuncture for cancer pain was analyzed to validate the Edmonton Symptom Assessment System (ESAS) as the primary outcome in the integrative oncology research. ResultsIn the retrospective analysis, scores of the numerical rating scale (NRS) and the ESAS total score were significantly correlated (r=0.15, P = 0.02), and the correlation coefficient between NRS and pain sub-scale in ESAS was 0.47 (P < 0.001). The pilot study showed the proportions of participants experiencing more than a 2-point reduction in NRS at the end of the treatment were 80% (n = 12/15) in the acupuncture group and 50% (n = 7/14) in the control group, without a significant difference between groups (P = 0.13). For the total scores of ESAS, more responders were found in the acupuncture group (n = 13/15) compared to that in the control group (n = 7/14), with no significant difference between groups (P = 0.05). ConclusionsESAS is suitable for the comprehensive assessment in patients with cancer pain and could be an appropriate outcome measurement in acupuncture research for cancer pain. Trial registrationRegistered on 09/07/2018 with ChiCTR1800017023 (https://www.chictr.org.cn/edit.aspx?pid=28879&htm=4)

The quality of physiotherapy and rehabilitation program and the effect of telerehabilitation on patients with knee osteoarthritis.

ObjectiveTo compare the effects of telerehabilitation vs home-based exercise programs for knee osteoarthritis (KOA).MethodPatients diagnosed with moderate/mild KOA were enrolled in the study and randomized into two groups. The patients in the telerehabilitation group did their exercises via video conference simultaneously, accompanied by a physiotherapist, while the patients in the control group were given a brochure showing how to do the exercises and explaining how to do each exercise. Patients completed 30-s chair stand test (30 CST), Knee Injury and Osteoarthritis Outcome Score (KOOS), Numeric Rating Scale (NRS), International Physical Activity Questionnaire Short Form (IPAQ-SF), Hospital Anxiety and Depression Scale (HADS), TAMPA Kinesiophobia Scale (TKS), Fatigue Severity Scale (FSS) twice before and after 8-week treatment, and Quality Indicators Questionnaire for Physiotherapy Management of Hip and Knee Osteoarthritis (QUIPA) and Exercise Adherence Rating Scale (EARS) after treatment only. Moreover, the number of painkillers that patients used in the last 15 days was recorded before and after treatment, and patient satisfaction with treatment was questioned after treatment.ResultsForty-eight patients were included in the study. The mean age of patients was 55.83 ± 6.93 years, and 43 (89.6%) patients were women. No significant differences were determined between groups in terms of baseline characteristics. After the 8-week follow-up, telerehabilitation group demonstrated better 30 CST, IPAQ-SF, KOOS, QUIPA, treatment satisfaction, and total and C subscale of EARS scores increment and greater NRS, HADS, TKS, and FSS score reduction than the control group. It was determined that there was a statistically significant difference between the telerehabilitation and control groups for all of the specified parameters; however, no statistically significant difference was found for the B subscale of EARS.ConclusionThis study indicated that telerehabilitation is superior to self-management. Moreover, through this innovative and population specific web-based approach for KOA, a vast number of patients who have internet access could be reached. Thus, patients with KOA received effective treatment. Key Points • Telerehabilitation is superior to self-management. • Telerehabilitation is a quality practice with the potential to reduce symptoms in patients with knee OA.

FT-IR Analysis of Structural Changes in Ketoprofen Lysine Salt and KiOil Caused by a Pulsed Magnetic Field.

High-intensity, low-frequency magnetic fields (MFs) have been widely used in the treatment of diseases and in drug delivery, even though they could induce structural changes in pharmacological molecules. Morphological changes in ketoprofen and KiOil were investigated through Fourier-transform infrared spectroscopy (FT-IR). Unsupervised principal component analysis was carried out for data clustering. Clinical validation on 22 patients with lower back pain was managed using diamagnetic therapy plus topical ketoprofen or KiOil. The Numerical Rating Scale (NRS) and Short-Form Health Survey 36 (SF-36) were used to evaluate clinical and functional response. Ketoprofen showed clear clustering among samples exposed to MF (4000–650 cm−1), and in the narrow frequency band (1675–1475 cm−1), results evidenced structural changes which involved other excipients than ketoprofen. KiOil has evidenced structural modifications in the subcomponents of the formulation. Clinical treatment with ketoprofen showed an average NRS of 7.77 ± 2.25 before and an average NRS of 2.45 ± 2.38 after MF treatment. There was a statistically significant reduction in NRS (p = 0.003) and in SF-36 (p < 0.005). Patients treated with KiOil showed an average NRS of 7.59 ± 2.49 before treatment and an average NRS of 1.90 ± 2.26 after treatment (p < 0.005). SF-36 showed statistical significance for all items except limitations due to emotional problems. A high-intensity pulsed magnetic field is an adjunct to topical treatment in patients with localized pain, and the effect of MF does not evidence significant effects on the molecules.

Is the Erector Spinae Plane Block Effective for More than Perioperative Pain? A Retrospective Analysis.

Introduction: The thoracic Erector Spinae Plane Block (ESPB) is an ultrasound-guided block that has gained popularity and is widely used in acute pain setups. However, data regarding its role in chronic and cancer-related pain are anecdotal. Material and Methods: The study is a retrospective analysis of patients who underwent ESPB. The cohort was divided into subgroups based on three determinants: etiology, pain type, and chronicity. Results: One hundred and ten patients were included, and genders were affected equally. The average age was 61.2 ± 16.1 years. The whole group had a statistically significant reduction in a numerical rating scale (NRS) (7.4 ± 1.4 vs. 5.0 ± 2.6, p-value > 0.001). NRS reduction for 45 patients (41%) exceeded 50% of the pre-procedural NRS. The mean follow-up was 7.9 ± 4.6 weeks. Baseline and post-procedure NRS were comparable between all subgroups. The post-procedural NRS was significantly lower than the pre-procedural score within each group. The proportion of patients with over 50% improvement in NRS was lower for those with symptom duration above 12 months (p-value = 0.02). Conclusions: Thoracic ESPB is a simple and safe technique. The results support the possible role of ESPB for chronic as well as cancer-related pain.

Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis

IntroductionGenicular nerve radiofrequency ablation (GNRFA) is a minimally invasive intervention for patients with chronic knee pain (CKP) not responding to conservative treatments. Few investigations have compared treatment outcomes of cooled-RFA...