Reduction In Pain Intensity Research Articles

Repetitive Transcranial Magnetic Stimulation in Fibromyalgia: Exploring the Necessity of Neuronavigation for Targeting New Brain Regions.

Fibromyalgia and osteoarthritis are among the most prevalent rheumatic conditions worldwide. Nonpharmacological interventions have gained scientific endorsements as the preferred initial treatments before resorting to pharmacological modalities. Repetitive transcranial magnetic stimulation (rTMS) is among the most widely researched neuromodulation techniques, though it has not yet been officially recommended for fibromyalgia. This review aims to summarize the current evidence supporting rTMS for treating various fibromyalgia symptoms. Recent findings: High-frequency rTMS directed at the primary motor cortex (M1) has the strongest support in the literature for reducing pain intensity, with new research examining its long-term effectiveness. Nonetheless, some individuals may not respond to M1-targeted rTMS, and symptoms beyond pain can be prominent. Ongoing research aims to improve the efficacy of rTMS by exploring new brain targets, using innovative stimulation parameters, incorporating neuronavigation, and better identifying patients likely to benefit from this treatment. Summary: Noninvasive brain stimulation with rTMS over M1 is a well-tolerated treatment that can improve chronic pain and overall quality of life in fibromyalgia patients. However, the data are highly heterogeneous, with a limited level of evidence, posing a significant challenge to the inclusion of rTMS in official treatment guidelines. Research is ongoing to enhance its effectiveness, with future perspectives exploring its impact by targeting additional areas of the brain such as the medial prefrontal cortex, anterior cingulate cortex, and inferior parietal lobe, as well as selecting the right patients who could benefit from this treatment.

Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews.

Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisalchecklist developed by the umbrella review methodology working group. Only high-quality SRs were included. In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.

The impact of combined therapy on healing of foot injuries in runners

Purpose. The structure of the lower body has a very important role as support for the body and is often injured in runners. The aim of this study was to determine whether there is an impact of providing combined therapy on the healing of foot injuries. Material and methods. The type of research used was experimental, with a randomized pretest and posttest group design. The total research sample was 56 runners who were divided into four therapy groups, namely the sports massage, trigger point, chiropractic, and 1 control group. Measurement of the degree of strain uses visual analogue scale (VAS) criteria. Results. From the research results, it is known that providing therapy to the sports massage, trigger point, chiropractic group and 1 control group can reduce the intensity of strain pain (2.35 ± 0.756; 1.63 ± 0.840; 2.24 ± 0.840; 3.71 ± 0.756) with p-value = 0.001. Conclusions. Based on the stages of the research results, it can be concluded: 1) There was a significant impact after being given sports massage, trigger point and chiropractic therapy on reducing pain intensity 15 minutes after treatment; 2) There was no significant difference between the sports massage, trigger point and chiropractic treatment groups on pain intensity 15 minutes after treatment.

Cortical Mechanisms Underlying Effects of Repetitive Peripheral Magnetic Stimulation on Dynamic and Static Postural Control in Patients with Chronic Non-Specific Low Back Pain: A Double-Blind Randomized Clinical Trial.

Patients with chronic non-specific low back pain (CNLBP) often experience impaired postural control, contributing to pain recurrence. Although repetitive peripheral magnetic stimulation (rPMS) combined with core muscle training (CMT) could improve postural control, its neural mechanism remains unclear. This study aims to investigate the postural control-related cortical mechanism of the effect of rPMS on patients with CNLBP. This unicentric, prospective, randomized, double-blind, controlled trial was conducted in a public hospital from May to December 2023. A total of 40 patients (27 females and 13 males, mean age 29.38±7.72) with CNLBP were randomly assigned to either the rPMS group (real rPMS with CMT) or the sham-rPMS group (sham-rPMS with CMT) for 12 sessions over 4weeks. The rPMS was applied to the lumbar paravertebral multifidus muscle on the painful side. Pain and disability were quantified using the visual analog scale (VAS) and Oswestry dysfunction index (ODI) pre- and post-intervention. Furthermore, the sway area and velocity of the center of pressure (COP) were measured using a force platform. The cortical activities in 6 regions of interest during 4 tasks (standing with eyes open/closed on a stable/unstable plane) were recorded by functional near-infrared spectroscopy (fNIRS) pre- and post-intervention. The repeated measure ANOVA was applied for statistical analysis. Spearman's correlation was used to determine the relationships between variables. After the intervention, the rPMS group showed decreased pain intensity (p=0.001) and sway area (unstable eyes-closed task) (p=0.046) compared to the sham-rPMS group. Additionally, the rPMS group exhibited increased activation in left primary motor cortex (M1) (p=0.042) and reduced in left supplementary motor area (SMA) (p=0.045), whereas the sham-rPMS group showed no significant changes. The increased activation of left M1 was negatively correlated to the reduction of pain intensity (r=-0.537, p=0.018) and sway area (r=-0.500, p=0.029) under the static balancing task. Furthermore, there was a positive correlation between sway velocity and VAS (r=0.451, p=0.046) post-rPMS intervention. Repetitive peripheral magnetic stimulation combined with core muscle training demonstrated better analgesic effects and postural control improvements, compared to sham-stimulation. This may be attributed to the increased activation of the left primary motor cortex. The trial was registered on ClinicalTrials.gov (ChiCTR2300070943).

The effect of high tone external muscle stimulation on polyneuropathy: a systematic review and meta-analysis

Background and study aim. High-tone therapy, also known as High-Frequency External Muscle Stimulation (HTEMS), is a more recent and unique form of electrotherapy treatment. Unlike traditional electrotherapy methods, which use a single frequency, high-tone therapy modulates both frequency and amplitude to deliver more energy to the tissues. The options for treating neuropathy associated with any illness, including diabetes, are limited, especially non-pharmacological therapies. This review aims to investigate the evidence of the effectiveness of high-tone external muscle stimulation (HTEMS) for patients with polyneuropathy. Material and Methods. Google Scholar, Scopus, web of Science, PubMed, EMBASE, the Cochrane Central Register of Control Trials, CENTRAL, and Physiotherapy Evidence Database, Pedro, databases from inception to February 2022. We restricted the search to articles published in English only. Randomized controlled trials, RCTs, of HTEMS for peripheral neuropathy were included. Two independent reviewers screened the articles for eligibility, extracted the data, and assessed the risk of bias in eligible studies. Meta-analysis was performed using the random-effects model. The remaining results were presented using descriptive methods. The risk of bias was assessed using the PEDro scale. Results. Six articles fulfilled the eligibility criteria with 487 participants. Most trials have focused on investigating the effectiveness of HTEMS in treating diabetic polyneuropathy and entrapment neuropathies. Overall, HTEMS provided a slight, but not clinically significant, reduction in pain and Katz index scores compared with mean control difference with p is more then 0.05. Conclusions. HTEMS has been proven to be more efficient in most aspects, such as reduction in pain intensity and Katz index scores in patients with polyneuropathy compared to other treatment options. The included trials presented methodological issues and high heterogeneity, preventing the establishment of any firm recommendations to support or refute the use of HTEMS as a strategy for managing neuropathic pain.

(055) A RETROSPECTIVE ANALYSIS ON THE BENEFITS OF AN OVER-THE-COUNTER COMBINATION OF ASPIRIN, ACETAMINOPHEN, AND CAFFEINE (AAC) IN MENSTRUAL MIGRAINE

Abstract Introduction • Migraine affects approximately 15% of the general population globally. It is an episodic headache disorder that produces a wide spectrum of pain and associated disability. • Women are 3 times more likely than men to experience migraine headache. More than 60% of women with migraine experience attacks that occur in association with the menstrual periods. • Although some women experience migraine exclusively during the perimenstrual period others have attacks both during the perimenstrual period and at other times of the month. Menstrual migraine is thought to be more severe and disabling and less responsive to non-drug treatments than is non-menstrual migraine Objective Since menstrual migraine is an important health issue for women, we wanted to examine whether AAC is more effective than placebo in relieving menstruation associated migraine and improving the quality of life (QoL) of patients. Methods The study population selected for this analysis were adapted from a pooled analysis of women associated with menstrual migraine [Clin Therapeutics 21(3) 475, 1999]. A total of 185 women with menstrual associated migraine, of which 85 took one dose of AAC (aspirin/acetaminophen/caffeine – 250 mg/250 mg/65 mg) and 100 took placebo were included in this study. The data was analyzed using SAS Windows version 9.4. All post-rescue medication severity scores were assigned either the baseline value or the last recorded value whichever was most severe. Post-rescue medication pain relief scores were classified as “no relief”. Results It was observed that the intensity of the headache pain was reduced to mild or none (1) within 30 min in 20% (AAC treated) vs (10% in placebo). Within 1 hour in 40% (AAC treated) vs (14% placebo) (p<=0.001) treated patients and the pain relief lasted for at least six hours. The quality of life (able to perform all or usual activities with minimal or no additional effort) also improved within 1 hour in 48.2% (AAC treated patients) vs 28% (placebo) (p<=0.005) and within 3 hour in 68.2% AAC treated patients vs 40% (placebo) (p<=0.001). In addition, in terms of relative change (%) difference, there was a 19% improvement in QoL with a 24.6% reduction in pain intensity within 1 hour. At 3 hours the QoL scores improved to 38.1% with a reduction in pain intensity of 41.1% that lasted till 6 hours in AAC treated patients vs placebo. Conclusions This post- hoc pooled analysis provides evidence that a single dose of AAC provides significant benefits in relieving menstrual migraine associated pain relief and improves quality of life of patients in their ability to perform usual activities with minimal or no additional effort. Disclosure Yes, this is sponsored by industry/sponsor: Haleon Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Haleon.

Local injection therapy with hyaluronic acid preparations: in focus of rheumatologists and orthopedic traumatologists

Hyaluronic acid (HA) is an effective and safe medication for local injection therapy (LIT) widely used in the treatment of osteoarthritis (OA) of large joints. The therapeutic effect of HA is determined both by the replacement of the lubricating function of natural hyaluronate (viscosupplementation), which leads to an improvement in the biomechanical parameters of the joint, and by the biological effects that unfold when interacting with cellular receptors (CD44, RHAMM, etc.), resulting in an anti-inflammatory, anti-nociceptive and anabolic effect of HA. HA therapy has a reliable evidence base. According to a number of clinical studies and meta-analyses, LIT with HA – reduces pain intensity by 28–54 % and improves the function of the affected joint by 9–32 % compared to baseline over a 12-24 week observation period. Repeated administration of HA can delay the need for orthopedic surgery. HA extremely rarely causes serious adverse events and can also be prescribed to patients with concomitant diseases. The use of HA for the treatment of OA is included in Russian and several foreign clinical guidelines (in particular OARSI and ESCEO). A new direction in LIT for OA is therapy with combined (hybrid) HA preparations containing high molecular weight (HMW) and low molecular weight (LMW) fractions. A new HA preparation has appeared in our country, which is a stabilized, highly purified hydrogel containing 80 % HMW HA (molecular weight – 30,000 kDa) with transverse "crosslinking" BDDE (innovative ECHATM technology) and 20 % "uncluttered" linear HA (molecular weight – 1500 kDa). This product is characterized by favorable rheological parameters, which guarantee a long-term improvement in the biomechanics of the affected joint and a rapid onset of biological effects, reduction in pain and inflammation and activation of the synthesis of natural hyaluronate.

The efficacy of myofascial release at the cervicothoracic region in patients with rotator cuff repairs: A randomized controlled pilot study

BackgroundCoactivation between tonic and phasic muscles is essential for correct posture and movement. Impaired movement patterns and postural changes facilitate the flexor response to protect painful tissue in the injured area. Tone changes between tonic and phasic muscles lead to an imbalance in the rotator cuff (RC) muscles. DesignA randomized controlled pilot study. PurposeThe purpose of this study is to determine the effects of applying myofascial release (MFR) to the muscles in the cervicothoracic region for the treatment of fascia limitations in patients with postoperative RC tear. Materials and methodsA total of 20 patients were randomly divided into 2 groups. The patients in the control group performed exercises, whereas those in the MFR group performed exercises in addition to MFR. Pain intensity, grip strength, pectoralis minor flexibility, Constant Murley Score (CMS), and Short Form-36 (SF-36) score were evaluated. Pain intensity was recorded before and after the MFR sessions. ResultsThere were no significant differences between the groups regarding pain, grip strength, pectoralis minor flexibility, CMS values, or SF-36 score (p > 0.05). There were significant differences in pain levels measured before and after all MFR sessions. Moreover, a significant decrease is shown between the first and last sessions in the MFR group (p < 0.05). ConclusionMFR can be useful, especially in postoperative RC patients who have pain in the early period. Significant reductions in pain intensity after MFR can help prepare patients for exercise and reduce pain-related medication use.

Comparative Analysis of Therapeutic Showers and Bathtubs for Pain Management and Labor Outcomes-A Retrospective Cohort Study.

Hydrotherapy, including the use of therapeutic showers and bathtubs, has been studied for its potential benefits in labor pain management. Previous research has indicated that hydrotherapy can alleviate pain, but comparative studies between therapeutic showers and bathtubs are scarce. Objective: This study aims to compare the effects of therapeutic showers and bathtubs on pain perception, labor duration, use of epidural analgesia, and maternal and neonatal outcomes during labor. Methods: A total of 124 pregnant women were included in this study. Participants were divided into two groups: those who used a therapeutic shower and those who used a bathtub during labor. Pain levels were measured using a visual analog scale (VAS). Labor duration, use of epidural analgesia, types of delivery, maternal outcomes (postpartum hemorrhage, perineal status, maternal hypotension, fever, and breastfeeding), and neonatal outcomes (APGAR scores, fetal heart rate, complications, and neonatal unit admissions) were recorded and analyzed. Results: Both the therapeutic shower and the bathtub effectively reduced pain perception, with the bathtub showing a greater reduction in VAS scores. The therapeutic shower group experienced a significantly shorter labor duration compared to the bathtub group. The majority of participants in both groups did not require epidural analgesia, with no significant differences between the groups. There were no significant differences in the types of delivery. Maternal outcomes indicated a lower incidence of perineal tears and episiotomies in the therapeutic shower group. Neonatal outcomes, including APGAR scores and fetal heart rate, were similar between the groups, with no significant differences in complications or neonatal unit admissions. Conclusions: Both therapeutic showers and bathtubs are effective for pain relief during labor, with the bathtub showing a higher reduction in pain intensity. The therapeutic shower is associated with a shorter labor duration and a lower incidence of perineal tears and episiotomies. Both methods are safe for neonatal well-being, making hydrotherapy a viable non-pharmacological option for pain management in labor. However, the therapeutic shower may offer additional benefits in terms of labor duration and maternal outcomes.

The effect of postoperative pain on comfort in patients undergoing abdominal surgery

Background/Aim: Postoperative pain management aims to reduce pain intensity and improve patient comfort. This study was conducted to investigate the effects of postoperative pain on the well-being of patients undergoing abdominal surgery. Methods: This research was designed as a prospective, descriptive study. The study was conducted on 94 patients who underwent abdominal surgery in general surgery. Patients over 18 years of age, who volunteered to participate in the study and who did not need intensive care were included in the research. Postoperative pain and comfort levels of the patients were analyzed. Descriptive information from the patients was used in the first part of the study and the Perianesthesia Comfort Questionnaire (PCQ) was used in the second part. The visual pain scale (VAS) was used to assess pain. Results: The mean age of the patients was 54.7 (15.7) years; 54.3% of the patients were male; 76.6% were smokers; and the mean body mass index was 29.3 (6.3). Half of the patients underwent open and half underwent laparoscopic surgery, with 90.4% receiving general anesthesia. Patients were hospitalized an average of 3.5 (3.3) days after surgery. Patient comfort was at a good level, according to the PCQ. Whether they received local or general anesthesia did not affect their PCQ scores; however, pain was less in patients who received local anesthesia. Fasting time before surgery did not affect mean PCQ scores, but patients who fasted longer before surgery reported less pain. There were no differences in patients' mean scores on the PCQ scale and pain scores. The correlation between the mean PCQ and pain scales showed no significant relationship (r=-0.073, P=0.485). Conclusion: The absence of a significant correlation between the mean PCQ scale and the pain scale indicates no meaningful association between these variables.

Effectiveness of fentanyl buccal soluble film in cancer patients with inadequate breakthrough pain control

BackgroundClinical evidence for the rapidity and effectiveness of fentanyl buccal soluble film (FBSF) in reducing pain intensity of breakthrough cancer pain (BTcP) remains inadequate. This study aimed to evaluate the efficacy of FBSF proportional to the around-the‐clock (ATC) opioid regimens in rapidly relieving the intensity of BTcP episodes by determining the percentage of patients requiring further dose titration.MethodsThe study procedure included a dose-finding period followed by a 14-day observation period. Pain intensity was recorded with a Numeric Rating Scale (NRS) at onset and 5, 10, 15, and 30 min after FBSF self-administration. Meaningful pain relief was defined as the final NRS score ≤ 3. Satisfaction survey was conducted for each patient after treatment using the Global Satisfaction Scale.ResultsA total of 63 BTcP episodes occurred in 30 cancer patients. Only one patient required rescue medication at first BTcP episode and then achieved meaningful pain relief after titrating FBSF by 200 µg. Most BTcP episodes relieved within 10 min. Of 63 BTcP episodes, 30 (47.6%), 46 (73.0%), and 53 (84.1%) relieved within 5, 10, and 15 min after FBSF administration. Only grade 1/2 adverse events were reported, including somnolence, malaise, and dizziness. Of the 63 BTcP episodes, 82.6% were rated as excellent/good satisfaction with FBSF.ConclusionFBSF can be administrated “on demand” by cancer patients at the onset of BTcP, providing rapid analgesia by achieving meaningful pain relief within 10 min.Trial registrationThis study was retrospectively registered 24 December, 2021 at Clinicaltrial.gov (NCT05209906): https://clinicaltrials.gov/study/NCT05209906.

The use of low doses of gabapentin in patients with neuropathic pain and with thrombocytopenia

Introduction. Approximately 21–27% of patients with blood system diseases receive opioid analgesics, with neuropathic pain being one of the most common reasons for prescription. Gabapentin is used as a first-line drug for neuropathic pain (NP), but has been poorly studied in patients with blood system diseases.The objective was to study the effectiveness and safety of gabapentin in patients with blood system diseases with chronic pain.Materials and methods. A single-center, prospective observational study included 24 patients with thrombocytopenia and pain between October 2017 and October 2022. The patients’ age ranged from 18 to 71 years (median 40 years). All patients with blood system diseases: non-tumor blood system diseases (aplastic anemia) in 8% (n = 2), myeloid tumor blood system diseases (acute myeloid leukemia) in 34% (n = 8), lymphoid tumor blood system diseases (acute lymphoblastic leukemia, follicular lymphoma, diffuse B – large cell lymphoma, T-cell lymphomas, multiple myeloma) in 58% (n = 14). All patients had thrombocytopenia less than 150∙109/l, 66% (n = 16) had less than 90∙109/l. All patients were diagnosed with neuropathic pain (NP), localized according to the neuroanatomical distribution and accompanied by sensory disturbances typical of NP. The localization of pain was different, pain predominated in the lower extremities (63% (n = 15), 95% CI: 43 – 79%), caused by peripheral polyneuropathy of predominantly toxic origin (vincristine, bortezomib), and pain was also caused by the course of the underlying disease: cephalalgia and neck pain, this pain was caused by compression of the nerve structures by the lymph nodes, postherpetic neuralgia, trigeminal neuralgia caused by tumor growth. All patients had intractable, high-intensity pain requiring trimeperidine at a dose of 20–40 mg/day. All patients were prescribed gabapentin therapy at a dose of 900–1200 mg/day.Results. When taking gabapentin in the study group of patients (n = 24), already on the 3rd day, there was a clinically and statistically significant decrease in pain intensity: 1) by median: from the initial 6 to 4 points, p = 0.01 (and up to 3 points by 7th day of therapy) and 2) on average: from initial 6.5 to 3.9 points, p = 0.01 (and up to 3.2 points by the 7th day). Stratification of the dynamics of pain intensity reduction by type of blood system disease (BSD) shows that the decrease by day 3 (sustained and further by day 7) was clinically and statistically significant (p = 0.01) for groups of patients with lymphoid and myeloid BSD, and clinically and approximately statistically significant in patients (n = 2) with non-tumor BSD. Analgesic therapy using small doses of gabapentin gave a pronounced, stable positive effect (pain intensity statistically significantly decreased by an average of 50%). After 7 days of gabapentin therapy, a decrease in the opioid dose was noted in 52% of patients. Side effects were dominated by drowsiness 67% (n = 16), dizziness 32% (n = 8).Conclusion. The results of this study indicate that gabapentin is effective in the treatment of chronic neuropathic pain in patients with BSD and is safe when used in minimal/average therapeutic doses within the daily dosing ranges established by the official instructions for use.

Exercise as a means of preventing musculoskeletal problems in musicians, a systematic review

Abstract Introduction The lifetime prevalence of performance related musculoskeletal disorders in musicians is reported to reach a very high rate (93%) and many times affect the music performance, playing efficacy, the quality of their work or their career progression. It can also have a significant financial burden on the musicians as well as on the organizations/orchestras. Purpose This systematic review summarizes the evidence available from randomized clinical trials investigating the effect of exercise in the prevention of musculoskeletal disorders in musicians. Methods The search was performed in the PubMed database and the specialized Journal of Medical Problems of Performing Artists, Science &amp; Medicine, Inc. until March 2022. The keywords used were decided by Mesh terms. Studies that had titles and abstracts related to exercise or prevention programs in musicians to reduce or treat PRMDs were selected for detailed analysis. Exclusion and inclusion criteria were used for the final outcome. A qualitative assessment was also carried out with the PEDro scale. Results Of the 1050 articles found, 138 were selected by title for relevance and their abstracts were studied. Of these 22 randomized studies were selected for full reading. The criteria of the systematic review were met by 7 articles, which were examined in detail. Parallel searches were conducted with different combinations of keywords to cross-reference the selected randomized studies. Three clinical studies showed a reduction in the frequency of musculoskeletal disorders and a reduction in pain and symptom intensity with a statistically significant difference. Two clinical studies have had a positive effect on physical effectiveness. A control group in one study showed significant statistical significance in aerobic capacity. The same clinical study had a positive effect on the playing performance of the instrument. Another clinical study showed reduced inability related to music performance in both groups. Three clinical studies had an educational intervention together with the exercise intervention. No clinical research was found to assess the health costs of musculoskeletal disorders in musicians. Conclusions This systematic review provided evidence for the effect of exercise training in preventing musculoskeletal disorders in musicians. Prevention programs with exercise intervention had significant clinical value such as reducing the occurrence of musculoskeletal disorders in intensity, frequency and pain as well as improving their functional capacity and their quality of musical performance. Additional clinical randomized control studies are necessary with a larger number of participants and duration of follow-up of the results to confirm the above findings.

Workplace Injury Prevention and Wellness Program for Orchestra Musicians: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of a workplace injury prevention and wellness program compared to no intervention (control) on musicians' playing-related musculoskeletal pain intensity. The hypothesis was that musicians who completed the program would have a greater reduction in pain intensity than the control group. DESIGN: Pragmatic parallel randomized controlled trial. METHODS: Sixty-five orchestra musicians were recruited and completed patient-reported outcome measures (primary outcome: pain intensity over 11 months, using the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians; range: 0-40; lower is better) at baseline, 14 weeks (T1), and 11 months (T2). Following baseline assessment, participants were randomly assigned to the intervention (n = 33) or control (n = 32) groups, stratified by instrument and pain prevalence. The intervention group received a 14-week injury prevention and wellness program including education and exercise; the control group received no intervention. RESULTS: Pain intensity means (standard deviation) were 7.8 (6.2), 8.0 (7.5), and 8.6 (5.7) in the control group, and 9.0 (6.6), 5.0 (4.2), and 6.7 (6.6) in the intervention group at T0, T1, and T2, respectively. Using intention-to-treat analyses (3 dropouts, n = 65 analyzed), between-group differences in pain intensity (95% confidence interval) were T1-T0: -4.2 (-7.5, -0.9); T2-T0: -3.7 (-7.1, -0.3), type III (overall) P = .03, favoring the intervention group. No adverse events were reported. CONCLUSION: A workplace injury prevention and wellness program may have a clinically meaningful effect on reducing orchestra musicians' pain intensity. J Orthop Sports Phys Ther 2024;54(9):1-10. Epub 11 June 2024. doi:10.2519/jospt.2024.12277.

Evaluation of clinical characters and use of alternative medicines in the management of headache and predictors of treatment satisfaction among Saudi adults – A community-based study in Saudi Arabia

Background and objectiveThe use of alternative medicine (AM) is rising globally. Hence this study aimed to assess the Use of and Satisfaction with Alternative Medicine in the management of headache and Related Factors in Individuals, living in Saudi Arabia. MethodsA cross-sectional study was conducted from July to December 2023 using an online questionnaire in Riyadh Saudi Arabia. The data was collected using a series, of prevalidated questionnaires aimed to assess the utilization and satisfaction of AM for the headache. Convenience sampling was applied for data collection. ResultsA response rate of 93.1 % (n = 550) was obtained. Among the respondents, 78.7 % reported having headaches, while 69.2 % had a history of using AMs for headaches. However, among the users of AMs, 65.9 % of them were satisfied with the results of AMs, of those who were satisfied, 33.7 % said that AMs helped to prevent headache attacks, and 53.8 % reported that AMs use reduced pain intensity. The regression results demonstrated that there was a significant relationship between the satisfaction of AM for the headache and age (p < 0.004), and Active in sports (p < 0.019) and severity of the headache pain (p < 0.081) ConclusionThe findings reported that relatively high prevalence of AMs used to manage headaches, while 65.9% of the users were satisfied with the outcomes, the satisfaction was found to have a significant relationship with age, activity in sports and severity of pain. To avoid negative effects of AM, it is recommended to use under the qualified healthcare professionals.

A Randomized Control Trial of Dexketoprofen/Vitamin B (Thiamine, Pyridoxine and Cyanocobalamin) Fixed-Dose Combination in Post-Traumatic Grade I-II Cervical Sprains.

Musculoskeletal disorders are an important cause of work absence. Clinical practice guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs) for grade I-II cervical sprains. The combination of thiamine + pyridoxine + cyanocobalamin vitamins has been used, alone and in combination with NSAIDs, for pain and inflammation in musculoskeletal disorders. The objective of this study was to demonstrate the analgesic synergy of dexketoprofen, and the combination of vitamins thiamine + pyridoxine + cyanocobalamin in a fixed-dose combination (FDC) for the treatment of acute pain caused by grade I-II cervical sprains. We conducted a multicentre, prospective, randomized, double-blind, phase IIIb clinical study comparing two treatment groups: (1) dexketoprofen 25 mg/vitamin B (thiamine 100mg, pyridoxine 50mg and cyanocobalamin 0.50mg) in an FDC (two or more active ingredients combined in a single dosage form) versus (2) dexketoprofen 25mg monotherapy (single drug to treat a particular disease), one capsule or tablet orally, every 8h for 7 days. Final mean, average change, and percentage change in pain perception (measured using a visual analogue scale [VAS]) were compared with baseline between groups. A p value < 0.05 was considered statistically significant. Analyses were conducted using SPSS software, v.29.0. A statistically significant reduction in pain intensity was observed from the third day of treatment with the FDC compared with monotherapy (- 3.1±- 1.5 and - 2.6±- 1.1 cm, respectively) measured using the VAS (p=0.011). Regarding the degree of disability, using the Northwick Park Neck Pain Questionnaire (NPQ), statistical difference was observed for the final measurement (7.5%, interquartile range [IQR] 2.5, 10.5; vs. 7.9%, IQR 5.0, 13.8; p=0.028). A lower proportion of adverse events was reported when using the FDC. The FDC of dexketoprofen/thiamine + pyridoxine + cyanocobalamin vitamins demonstrated superior efficacy and a better safety profile compared with dexketoprofen monotherapy for pain treatment in patients with grade I-II cervical sprains. NCT05001555, registered 29 July 2021 ( https://clinicaltrials.gov/study/NCT05001555 ).

Efficacy of Co-Crystal of Tramadol-Celecoxib (CTC) in Patients with Acute Moderate-to-Severe Pain: A Pooled Analysis of Data from Two Phase 3 Randomized Clinical Trials.

New acute pain medications are needed that provide effective analgesia while minimizing side effects and opioid exposure. Clinical trials of co-crystal of tramadol-celecoxib (CTC) have demonstrated an improved benefit/risk profile versus tramadol or celecoxib alone. We pooled data from two phase 3 clinical trials to evaluate the efficacy of CTC 200mg twice daily (BID) in acute moderate-to-severe pain. Efficacy data were pooled from STARDOM1 [acute pain following oral surgery (NCT02982161)] and ESTEVE-SUSA-301 [acute pain following bunionectomy (NCT03108482)]. The primary efficacy outcome was sum of pain intensity difference from 0 to 48 h (SPID0-48). A total of 344 patients received CTC 200mg BID, 342 received tramadol 50 or 100mg four times a day, 181 received celecoxib 100mg BID, and 172 received placebo. The least-squares mean difference in SPID0-48 was -21.8 (p = 0.002) for CTC versus tramadol and -72.8 (p < 0.001) for CTC versus placebo. A similar pattern of SPID0-48 was observed with CTC versus comparator whether patients had moderate or severe pain at baseline. Reduction in pain intensity was faster and reached mild intensity earlier with CTC versus comparators. Patients were significantly (p ≤ 0.005) less likely to receive rescue medication within 4 or 48 h with CTC compared with tramadol or placebo. This pooled analysis reinforces the efficacy profile of CTC versus tramadol and, given that CTC permits lower daily tramadol dosing and thereby reduces unnecessary opioid use, this highlights its improved benefit/risk profile and its potential for the management of moderate-to-severe pain.

Onabotulinumtoxina (craniotomy scar combined with cranial suture line injections) for persistent post craniotomy headache: Case series with long-term follow-up.

There is no defined preventive treatment protocol for persistent post-craniotomy headache. In several small case series and individual case reports onabotulinumtoxinA injected into the craniotomy scar has shown possible efficacy. What is lacking is long term follow-up and if focusing on the cranial suture lines along with the craniotomy scar can enhance improvement and provide more sustained benefit. Retrospective chart review with case series. Four patients (three women, one man) with ICHD-3 defined persistent post craniotomy headache were treated using a novel onabotulinumtoxinA injection protocol. All the patients presented with continuous head pain of moderate to severe intensity. All had severe allodynia on the side of their craniotomy. All had significant reduction in quality of life. Our application of onabotulinumtoxinA involved injection into both the surgical scar and the transected/irritated cranial suture lines noted on neuroimaging and physical examination. With treatment all patients demonstrated significant benefit including a reduction in daily pain intensity (75%-100%), developing periods of pain freedom (2-7 days per week) and having a dramatic improvement in quality of life (close to 100% in all). The benefit was sustained for at least five years of follow-up. From our case series it appears that injection not only along the painful craniotomy scar but into the involved cranial suture lines provides positive efficacy and sustained improvement in patients with persistent post craniotomy headache.

THE EFFICACY OF MANUAL THERAPY AND ULTRASOUND IN TREATMENT OF CALCIFIC TENDINITIS OF THE SHOULDER

Introduction: Shoulder calcification, also known as calcific tendinopathy, is a common cause of shoulder pain, typically occurring between the ages of 30 and 50. It is approximately twice as common in women compared to men. The pathogenesis of the disease is not well understood, and it exhibits a cyclic nature. Objective: To investigate and assess the impact of ultrasound and manual therapy on reducing shoulder calcifications. Materials and Methods: This study, conducted at the Rehabilitation Center "Život" in Mostar from May to July 2023, involved 30 participants. Statistical analysis, using Microsoft Excel 2010 and IBM SPSS 23.0, included descriptive and inferential statistics, revealing significant insights into participants' perspectives and forming thebasis for a comprehensive discussion. Results: The research results demonstrated a statistically significant reduction in pain intensity after therapy, both in men and women. Additionally, calcification size significantly decreased, and shoulder range ofmotion improved. Analysis of demographic factors revealed differences between female and male participants, emphasizing the prompt seeking of therapy after the onset of pain.Conclusion: The combination of ultrasound and manual therapy shows promising effectiveness in treating shoulder calcifications, laying the groundwork for further study and personalized clinical practice.Keywords:calcification in the shoulder, manual therapy, ultrasound therapy.Correspondence: Darko Bilić, Master of Physiotherapy

Extended Treatment with Micron-Size Oral Palmitoylethanolamide (PEA) in Chronic Pain: A Systematic Review and Meta-Analysis.

Palmitoylethanolamide (PEA) emerged over the years as a promising approach in the management of chronic pain. Despite the fact that the efficacy of micron-size PEA formulations appears to be time-dependent, the optimal timing has not yet been elucidated. This systematic review and meta-analysis aim to estimate the possible advantage of an extended treatment in the relief of chronic pain. The literature search was conducted consulting scientific databases, to identify clinical trials in which micron-size PEA was administered for at least 60 days, and pain assessed by the Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS). Nine studies matched the required criteria, for a total of 742 patients involved. The meta-analysis showed a statistically and clinically significant pain intensity reduction after 60 days of micron-size PEA supplementation, compared to 30 days (1.36 points, p < 0.01). The secondary analysis revealed a weighted NRS/VAS score decrease of 2.08 points within the first month of treatment. These two obtained scores corresponded to a 35.1% pain intensity reduction within the first month, followed by a further 35.4% during the second month. Overall, these results confirm the clinically relevant and time-depended pain-relieving effect of micron-size PEA and therefore the advantage of an extended treatment, especially in patient with incomplete pain management.