Reduced Pain Perception Research Articles

INTRODUCTION OF A MULTIMODAL PAIN REHABILITATION INTERVENTION IN PRIMARY CARE: A PILOT STUDY.

To evaluate patient-reported outcome measures in patients with chronic musculoskeletal pain 1 year after participation in a case manager-led multimodal rehabilitation intervention in a Finnish primary care centre. Changes in healthcare utilization (HCU) were also explored. A prospective pilot study with 36 participants. The intervention consisted of screening, multidisciplinary team assessment, a rehabilitation plan and case manager follow-up. Data were collected through questionnaires filled in after the team assessment and 1 year later. HCU data 1 year before and 1 year after team assessment were compared. At follow-up, satisfaction with vocational situation, self-reported work ability and health-related quality of life (HRQoL) had improved and pain intensity had diminished significantly for all participants. The participants who reduced their HCU improved their activity level and HRQoL. Early intervention by a psychologist and mental health nurse was distinctive for the participants who reduced HCU at follow-up. The findings demonstrate the importance of early biopsychosocial management of patients with chronic pain in primary care. Identification of psychological risk factors at an early stage may lead to better psychosocial wellbeing, improve coping strategy and reduce HCU. A case manager may free up other resources and thereby contribute to cost savings.

Social Touch Reduces Pain Perception—An fMRI Study of Cortical Mechanisms

Unmyelinated low-threshold mechanoreceptors (C-tactile, CT) in the human skin are important for signaling information about hedonic aspects of touch. We have previously reported that CT-targeted brush stroking by means of a robot reduces experimental mechanical pain. To improve the ecological validity of the stimulation, we developed standardized human-human touch gestures for signaling attention and calming. The attention gesture is characterized by tapping of the skin and is perceived as neither pleasant nor unpleasant, i.e., neutral. The calming gesture is characterized by slow stroking of the skin and is perceived as moderately to very pleasant. Furthermore, the attention (tapping) gesture is ineffective, whereas the calming (stroking) gesture is effective in activating CT-afferents. We conducted an fMRI study (n = 32) and capitalized on the previous development of touch gestures. We also developed an MR compatible stimulator for high-precision mechanical pain stimulation of the thenar region of the hand. Skin-to-skin touching (stroking or tapping) was applied and was followed by low and high pain. When the stroking gesture preceded pain, the pain was rated as less intense. When the tapping gesture preceded the pain, the pain was rated as more intense. Individual pain perception related to insula activation, but the activation was not higher for stroking than for tapping in any brain area during the stimulation period. However, during the evaluation period, stronger activation in the periaqueductal gray matter was observed after calming touch compared to after tapping touch. This finding invites speculation that human-human gentle skin stroking, effective in activating CT-afferents, reduced pain through neural processes involving CT-afferents and the descending pain pathway.

A feasibility study of pre-sleep audio and visual alpha brain entrainment for people with chronic pain and sleep disturbance.

Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10 Hz stimulation through flickering light or binaural beats was developed for use at night, pre-sleep, with the aim of improving night time pain and sleep and thereby subsequent pain and related daytime symptoms. The aim of this study was to assess the feasibility and give an indication of effect of this programme for individuals with chronic pain and sleep disturbance. In a non-controlled feasibility study participants used audio or visual alpha entrainment for 30 min pre-sleep each night for 4 weeks, following a 1 week baseline period. The study was pre-registered at ClinicalTrials.gov with the ID NCT04176861. 28 participants (79% female, mean age 45 years) completed the study with high levels of data completeness (86%) and intervention adherence (92%). Daily sleep diaries showed an increase compared to baseline in total sleep time of 29 min (p = 0.0033), reduction in sleep onset latency of 13 min (p = 0.0043), and increase in sleep efficiency of 4.7% (p = 0.0009). Daily 0-10 numerical rating scale of average pain at night improved by 0.5 points compared to baseline (p = 0.027). Standardised questionnaires showed significant within-participant improvements in sleep quality (change in median Global PSQI from 16 to 12.5), pain interference (change in median BPI Pain Interference from 7.5 to 6.8), fatigue (change in median MFI total score from 82.5 to 77), and depression and anxiety (change in median HADS depression score from 12 to 10.5 and anxiety from 13.5 to 11). Pre-sleep use of a smartphone programme for alpha entrainment by audio or visual stimulation was feasible for individuals with chronic pain and sleep disturbance. The effect on symptoms requires further exploration in controlled studies.

The effectiveness of slow paced breathing on pain perception during first stage of labour among primigravida mothers

Natural childbirth is a profound and powerful human experience which is a mixture of feeling of empowerment and accomplishment. Both pharmacological and non-pharmacological methods are available today and it is known that the non- pharmacological options involve less risk when used in this process. Breathing exercises helps labour women to relax and distract from the painful response. The research design adopted for this study was quasi experimental design. The sample size was 60 (30 experimental and 30 control group) and was drawn through purposive sampling technique. The level of labour pain perception was assessed by using Numeric pain rating scale. Slow paced breathing was instructed to practice during contractions for 2 hours during active phase for experimental group. Pre-test was assessed before intervention and Post test done after intervention for both group. The data gathered were analyzed by descriptive and inferential statistical method. The mean post-test score on level of pain perception during first stage of labour in experimental group was 1.6, but in control group it was 2.5. The calculated unpaired„ t‟ value was 5.92, which is more than the table value at 5% significance (table value=2.02). Hence, it was statistically significant at 5% (p<0.05). It shows that slow paced breathing is effective in reduction of pain perception during first stage of labour. Hence, the research hypothesis (H1) is accepted. There is no significant association between demographic variables. Hence, the research hypothesis (H2) is rejected. This study finding revealed that slow paced breathing exercise helps in reducing the level of pain perception among primigravida mothers in the experimental group. So this can be practiced as a Non-pharmacological method to relieve pain perception during labour in various settings.

Feasibility of Mindfulness-Based Intervention for Veterans Managing Chronic Pain.

Background. Chronic pain impacts people's activity participation, productivity, mental health, and sense of wellbeing. Purpose. This study aimed to (1) evaluate the feasibility of the Mindfulness-Based Chronic Pain Management (MBCPMTM) program on reducing pain perception and enhancing the quality of life, and (2) understand veterans' experience with the program. Method. The pretest-posttest single-group, mixed-methods design was used. Thirty-one veterans were offered the 12-week intervention. The Pain Catastrophizing Scale (PCS) and the Patient-Reported Outcomes Measurement Information System-29 were administered before and after the program. Focus groups and individual interviews were conducted to understand the experience. Findings. Participants' PCS scores improved (Z = -3.116, p = .002), but the pain intensity did not change significantly. Themes from qualitative data include: (1) We are not alone! (2) I have a sense of awareness, choices, and control; and (3) It does work! Implications. The study shows preliminary feasibility of MBCPMTM for veterans. This promising effect supports future rigorous testing of this intervention.

Pain Relief in Dental Local Anaesthesia with Vibrational Devices: Much Ado about Nothing? A Scoping Review

In recent years, vibrational devices have been introduced in order to reduce patient discomfort in some situations such as orofacial pain, orthodontic therapy, and injection of local anaesthetics. This article aims to review the clinical experience given by the use of these devices in local anaesthesia. The literature search was carried out on the main scientific databases for articles up to November 2022. Eligibility criteria were established, and pertinent articles selected. The results were classified by author, year, type of study, sample size and characteristics, purpose of use, type of vibrational device used, protocol used, and outcomes. Nine relevant articles were found. These are split mouth randomized clinical trials which evaluate the reduction in pain perception with different devices and different protocols of use in children, during procedures which require local analgesia by injection, compared with traditional local anaesthesia with premedication based on anaesthetic gels. Different objective and subjective scales of pain and discomfort perception were used. Although results are promising, some data, such as those relating to vibrational intensity and frequency, are not clear. Evaluations on samples varying by age and context of use are necessary to fully define the indications for this type of aid during oral rehabilitation procedures.

Photobiomodulation with Laser Technology to Reduce Pain Perception during Fixed Orthodontic Treatment: Literature Review and New Perspectives with LED Devices

Despite the growing demand for improving smile aesthetics and occlusal functionality, a significant percentage of patients still refuse or discontinue orthodontic treatment because of pain and discomfort related to this therapy. As consequence, controlling the pain experienced by patients during the same therapy represents a primary concern for both patients and clinicians. Recent pieces of evidence have suggested that photobiomodulation can reduce pain experienced by patients during the decrowding stage or during specific protocols, for example, rapid maxillary expansion. PBM can be performed with lasers and also with a light-emitting diode (LED) device. Nonetheless, few studies on the latter are still present in the literature. The aim of this research is to evaluate the efficacy of photobiomodulation (PBM) with Laser devices in pain management in fixed orthodontic treatment. Only 14 of all articles met the inclusion and exclusion criteria and were therefore used to conduct the research. The different studies compared, in most cases, patients whose mouths were divided into a part treated with PBM and a placebo part. Most of their results show a statistically significant difference in perceived pain between the irradiated arch and the nonirradiated arch. Three authors did not find statistically significant results in favor of PBM, but they used different laser parameters. To obtain generally valid studies, with consistent and reproducible results, it is necessary to standardize the different laser parameters used. LED is less operator-dependent than laser and PBM using this technology seems to have a biological basis similar to that with lasers. In some studies, its clinical efficacy in pain reduction in some orthodontic therapies has been verified. Finally, this article aims to consider LED technology as a future prospect of research on PBM use in orthodontics.

Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique.

To compare freezed cone and 5% lignocaine as a numbing agent before intraoral injection and evaluate the effect of virtual reality distraction (VRD) as a distraction technique in reducing pain perception in children. Around 60 children of 6-11 years old undergoing treatment for the extraction or any pulp therapy of primary tooth were selected. Freezed cone and 5% lidocaine were used to decrease the pain during local anesthesia (LA). VRD was used as a distraction method and to analyze the pain perception, Wong-Baker Faces Pain Rating Scale was used. Each child was randomly assigned to receive ice as a topical anesthetic or lignocaine 5% as a topical anesthetic agent. The pain perception was evaluated after the injection of 2% lignocaine hydrochloride (HCL). The primary researcher evaluated the pain during injection using the sound, eye, motor (SEM) scale. The pain experienced during injection was evaluated using Wong-Baker Faces Pain Rating Scale. In the freezed cone group with the VRD technique, maximum responded to the less pain score. On the contrary, many responded to higher pain scores in the freezed cone group without the VRD technique. It was concluded that the VRD technique can be used for distraction and the frozen ice cone can be an alternative method to reduce the pain perception during LA. Singh R, Gupta N, Gambhir N. Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique. Int J Clin Pediatr Dent 2022;15(5):558-563.

The preliminary outcomes of platelet-rich fibrin injection on pain perception following insertion of archwire: A randomized controlled clinical study

Objectives: This study aimed to determine the efficacy of platelet-rich fibrin (PRF) injection on orthodontic pain perception during the 1st week of the alignment and leveling process. Material and Methods: The study sample included 18 patients (11 females and 7 males). The patients were randomly divided into two groups, the PRF group (9 patients) and the control group (9 patients). The mean age of the sample members was 21.9 ± 2.5 and 20.8 ± 2.4 in the control and the PRF group, respectively. Conventional brackets were applied for both groups. PRF was injected into the six upper front teeth at a rate of 0.6 mm for each point before starting the primary wire insertion process. The pain parameters of each patient were evaluated for both groups during the 1st week of the alignment and leveling process by application of the Visual Analog Scale (VAS) at the durations of (2 h, 6 h, 1 day, 2 days, and 7 days) and all patients were followed up until the end of the alignment and leveling process. Results: PRF injection can reduce pain perception in orthodontic patients, overall (P < 0.05), with an effect size of approx. 53 ± 0.13%. The biggest effect was observed 2 h after exposure (P < 0.1) which showed a 50% reduction in pain in the PRF group. No significant effects were observed at later times (P > 0.1). Conclusion: The present study concludes that PRF injection can be an effective alternative for decreasing pain perception levels; however, its efficacy needs to be leveraged immediately after the injection of PRF.

Is there an effective way to control pain perception after free gingival graft removal? A systematic review and meta-analysis.

The literature describes multiple ways to stimulate wound healing to reduce the patient's perception of pain. This systematic review aimed to evaluate if methods that enhance wound healing can reduce the patient's perception of pain after free gingival graft removal from the palate region compared to natural healing. A systematic review protocol was written following the PRISMA checklist. Electronic searches of five databases were performed to identify randomized clinical trials (RCTs) that assessed the patient's perception of pain after the removal of a free gingival graft from the palate. The primary outcome was the visual analog scale (VAS) score assessing the patient's perception of pain 7 days after the free gingival graft removal from the palate region. Of the 1,622 potentially relevant articles retrieved from the electronic databases, 16 RCTs were selected for qualitative analysis, and of these, 6 RCTs were included in the meta-analysis. RCTs showed a significant VAS reduction associated with the use of methods to enhance wound healing. The pooled estimates revealed a significant overall VAS reduction of 2.20 (95% CI 2.32, 2.07) 7 days after surgery. The methods that presented the greatest reduction in the perception of pain were platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue. Methods that enhance wound healing, including platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue, can reduce pain perception after free gingival graft removal in the palate region. However, only 1 RCT investigated each approach, which hinders the conclusion regarding the best procedure to reduce the perception of pain.

Effectiveness of an extraoral cold and vibrating device in reducing pain perception during deposition of local anesthesia in pediatric patients aged 3-12 years: a split-mouth crossover study

Effectiveness of an extraoral cold and vibrating device in reducing pain perception during deposition of local anesthesia in pediatric patients aged 3-12 years: a split-mouth crossover study

The Effect of Lavender Inhalation on the Pain Perception of Orthodontic Separator Placement: An Open-Label Randomized Controlled Trial

Lavandula angustifolia Mill. (lavender) is known for its antibacterial, muscle relaxant, antispasmodic, sedative, and anesthetic effects, and is also proposed to be used as an analgesic agent. Despite several studies on the analgesic activity of lavender, this is the first experiment in patients with orthodontic pain. This "2-arm parallel" study aims to evaluate the effect of lavender oil inhalation on reducing pain after elastomeric separator placement as a part of orthodontic treatment. Patients who needed elastic separator placement in mesial and distal of first permanent molars of all quadrants prior to their first-ever fixed orthodontic treatment, with the age range of 20 to 24, were randomly assigned to one of the two study groups: lavender oil and sesame oil. Participants had to breathe in their medication for 2 minutes just before separator insertion, as well as 4, 8, 12, 24, 36, and 48 h afterward. A visual analog scale (VAS) was used to measure the level of pain during three oral situations, including rest, fitting posterior teeth, and chewing at the following periods: just before separator placement (T0), immediately after insertion (T1), 3 h post-insertion (T2), 12 h post-(T3), 24 insertion h post-insertion (T4), and 48 h after separator placement (T5). The current study indicated the effectiveness of lavender oil inhalation in reducing pain perception while chewing 48 h after elastic separator placement. The pain level in lavender inhalation was lower from 12 h to 48 h after separator insertion, although not considerable, indicating the probability of its effectiveness on delayed responses to orthodontic pain.

Comparison of pain perception between computer-controlled local anesthetic delivery and the conventional syringe for inferior alveolar nerve block in children.

Local anesthesia (LA) is commonly used for pain control in clinical dental practice. However, it is often perceived as the most painful part of the treatment and the factor leading to the avoidance of dental care. Hence, research on better means of pain management is being conducted. The aim of the study was to evaluate and compare pain perception using the No Pain III™ computer-controlled local anesthesia delivery (CCLAD) system and the conventional syringe, for inferior alveolar nerve block (IANB) in children. Thirty children aged 6-12 years were included in the study. Children were randomly allocated into 2 groups by the flip of a coin. Group A received LA by conventional syringe and group B received LA by No Pain III™, on the contralateral side. Physiological parameters including blood pressure (BP), heart rate (HR) and respiratory rate (RR) were assessed at baseline, during the deposition and after the deposition of LA. A subjective evaluation of pain perception was assessed using the Wong-Baker FACES Pain Rating Scale (WBS). The measured values were subjected to statistical analysis. A statistically significant difference was observed between group A and group B for pain perception using the WBS, systolic BP and RR. The use of the No Pain III™ CCLAD system resulted in reduced pain perception and better acceptance when compared to the use of the conventional syringe, for IANB in children.

Effect of addition of antispasmodic to local and systemic analgesics on pain perception during hysterosalpingography: a randomized controlled trial

<p><strong>Background: </strong>Tubal factor is responsible for most of the causes of infertility, especially in our environment, and hysterosalpingography (HSG) is the investigation of choice for assessing tubal patency.<strong> </strong>Objective of current study was to evaluate the effect of the addition of intramuscular hyoscine-N-butyl bromide (HBB) to local and systemic analgesics on pain perception during hysterosalpingography.<strong></strong></p><p><strong>Methods: </strong>This randomized controlled trial was conducted at the radiology departments and infertility clinics of four health institutions in Bayelsa State, Nigeria, from January 2020 to April 2022. One thousand and forty infertile women undergoing hysterosalpingography were randomized into four groups, and each group administered four different pain relief methods. Pain scores at different steps of the procedure were recorded. Data were analysed using the Statistical Product and Service Solutions for Windows®, version 25. Student’s t-test was used to compare sample means, while the chi-square test was used to compare the proportion of women in the two study groups, who expressed pain during the procedure.</p><p><strong>Results: </strong>The Paracervical block+HBB appeared to the most effective agent for pain relief in the study as women receiving this medication indicated the least pain intensity scores at all levels of the procedure except at the insertion of the speculum. The differences observed in the indicated pain intensity scores were also statistically significant (p<0.05).<strong></strong></p><p><strong>Conclusions: </strong>Our study revealed that adding HBB, an antispasmodic agent, to diclofenac and paracervical block significantly reduces pain perception during HSG compared to using diclofenac and paracervical block alone.</p>

Prevalence of work-related musculoskeletal symptoms among young orthopedics during the surgical practice: an intervention study.

Work-related muscle-skeletal symptoms (WRMS) represent a substantial social and economic impact on the way of work and have a high incidence in surgeons. In the literature, several studies address the impact of WRMS in surgeons performing gynecological, laparoscopic, and robotic surgery, but there are no studies in the field of orthopedic surgery. This pilot study aims to assess the effectiveness of a preventive program to reduce pain. All workers filled in a standardized questionnaire, and postoperative pain in the operating room was quantified using a numeric scale (NAS). The intervention group followed ergonomic principles in the operating room supervised by a physiotherapist and specific physical exercises before and after surgery. Data were analyzed using the statistical program STATA rel. 14.0. Twenty-one surgeons were assigned to intervention groups and thirty-three to controls. At baseline, the two groups were homogeneous for anthropometric factors, and controls were older and with higher work seniority. Pain perception resulted in high in both groups in many body districts. At follow-up, after three months, the intervention group significantly reduced pain perception in all body districts for the lumbar back, knees, ankles and feet (p<0.05). In the control group, pain perception increased in all body districts investigated. We found a high prevalence of WRMS in young orthopedic surgeons, and we demonstrated the effectiveness of a preventive program through targeted ergonomic education and exercises for the most affected body districts.

Manual Physiotherapy Combined with Pelvic Floor Training in Women Suffering from Stress Urinary Incontinence and Chronic Nonspecific Low Back Pain: A Preliminary Study.

Stress urinary incontinence (SUI) represents one of the most common subtypes of urinary incontinence (UI) reported by women. Studies have shown an association of SUI with nonspecific low back pain (NSLBP). The primary aim of the present study was to explore the long-term effects of a combined treatment of manual techniques and pelvic floor muscle (PFM) training in women suffering from SUI associated with NSLBP. The secondary aim was to evaluate which manual approach combined with PFM rehabilitation is more effective in improving symptoms related to SUI and in reducing pain perception related to NSLBP. Twenty-six patients suffering from SUI associated with chronic NSLBP were randomly assigned to one of two groups: the postural rehabilitation group (PRg) or the spinal mobilization group (SMg). Both groups performed a manual approach combined with PFM rehabilitation. All patients were evaluated before the treatment (T0), after 10 sessions (T1) and after 30 days from the end of the treatment (T2). The results showed an improvement in both groups in all of the investigated outcomes. Combining manual therapy and PFM training within the same therapy session may be useful for improving both SUI and NSLBP and increasing the quality of life of women suffering from SUI associated with NSLBP.

Complementary Approaches for Military Women with Chronic Pelvic Pain: A Randomized Trial.

Introduction: Active duty (AD) women suffer with chronic pelvic pain (CPP) while providers tackle diagnoses and treatments to keep them functional without contributing to the opioid epidemic. The purpose of this randomized trial was to determine the effectiveness of noninvasive, self-explanatory mindfulness-based stress reduction (MBSR) or self-paced healthy lifestyle (HL) interventions on CPP in AD women. Methods: A 6-week, interventional prospective study with AD women aged 21-55 years at Mountain Home (MTHM), Idaho, was conducted. Women were randomly assigned to MBSR (N = 21) or HL (N = 20) interventions. The primary outcome was pain perception. The secondary outcomes were depression and circulating cytokine levels. Results: Women in the MBSR group exhibited reduced pain interference (p < 0.01) and depression (p < 0.05) alongside decreased interleukin (IL)-4 (p < 0.05), IL-6 (p < 0.05), eotaxin (p < 0.05), monocyte chemoattractant protein-1 (p = 0.06), and interleukin-1 receptor antagonist (IL-1ra) (p < 0.01) and increased vascular endothelial growth factor (p < 0.05). Women in the HL group did not have changes in pain; however, they did exhibit reduced depression (p < 0.05) alongside decreased granulocyte-macrophage colony-stimulating factor (p < 0.05) and increased tumor necrosis factor alpha (p < 0.05), stromal cell-derived factor-1 (p < 0.01), and IL-1ra (p < 0.01). Conclusions: AD women receiving MBSR or HL had reduced depression scores and altered circulating cytokine levels; however, only those receiving MBSR had reduced pain perception. Findings support MBSR as an effective and viable behavioral treatment for AD women suffering from CPP and provide premise for larger randomized controlled studies. Clinical Trial Registration: MOCHI-An RCT of mindfulness as a treatment for CPP in AD Women NCT04104542 (September 26, 2019).

Investigation of Natural Compounds for Therapeutic Potential in Streptozotocin-induced Diabetic Neuroinflammation and Neuropathic Pain.

Diabetic neuropathy (DN) is a serious microvascular complication of diabetes mellitus (DM) that impacts the nervous system. Several risk factors are involved in the progression and maintenance of DN-associated pain, such as higher expression of various inflammatory mediators, e.g., tumor necrotic factor-alpha (TNF-α), nuclear factor-kappa B (NF-κB), and cyclo-oxygenase-2 (COX-2). The present research explores the neuroprotective potential of natural isolates, including berbamine, bergapten, and carveol, on the DM-induced neuroinflammation and neurodegeneration that cause neuropathic pain. The study utilized computerized techniques, including computational analysis (a docking assay and a molecular dynamic simulation) before moving to in vivo protocols. Diabetic neuropathy was induced by intraperitonial injection (IP) of streptozotocin (65 mg/kg), and the animal subjects (rats) were kept for 4 weeks for the development of DN. Once diabetic neuropathy was confirmed, the subjects were treated with berbamine, bergapten, and carveol until the sixth week (i.e., 2 weeks of treatment). At the sixth week, the rats were sacrificed, and the sciatic nerve and spinal cord of each was collected for further molecular investigation. Docking and a molecular dynamic simulation (MDS) delivered the information that the natural compounds (berbamine, bergapten, and carveol) were interacting with the selected target protein (i.e., mitogen-activated protein kinase). After IP, it was found that berbamine, bergapten, and carveol had ameliorated mechanical allodynia and thermal hyperalgesia by the 28th day of the study (2 weeks after treatment) without affecting blood glucose levels. Berbamine, bergapten, and carveol markedly elevated the levels of glutathione (GSH) and glutathione s-transferase (GST), in both the sciatic nerve and spinal cord, and also reduced lipid peroxidase (LPO) and nitric oxide (NO). The abovementioned natural isolates reduced pathologic alterations provoked through DN, a finding confirmed through histopathological assays (hematoxylin and eosin staining and immuno-histochemical analysis). Treatment down regulated higher expressions of the inflammatory mediatorcyclooxygenase-2 (COX-2), tumor necrosis factor-α (TNF-α), and nuclear factor kappa B (NF-κB), as confirmed by ELISA and polymerase chain reaction (PCR). The outcomes of berbamine, bergapten, and carveol are compared with those of pregabalin as a positive control group. Compared to pregabalin, treatment with the aforementioned three natural compounds improved nociception and reduced hyperalgesic effects, and consequently reduced pain perception and inflammation. Our results suggest the mechanism for the neuro-protective impact of berbamine, bergapten, and carveol might possibly be arbitrated via COX-2, TNF-α, and NF-κB, and regulated by mitogen-activated protein kinase, ultimately ameliorating STZ-provoked, DM-induced neuroinflammation and neurodegeneration, and associated neuropathic pain.

Efficacy of Extracorporeal Shock Wave Therapy on Active Trigger Point in the Upper Trapezius Muscle

Introduction: To demonstrate the effectiveness of extracorporeal shock wave therapy (ESWT) in treating active trigger points to relieve pain and increase range of motion (ROM) and improve the function of the cervical region in fewer sessions.&#x0D; Materials and Methods: In this single-group, pretest-posttest study, 15 participants with active myofascial trigger points (MTrPs) in the upper trapezius muscle took part. Before and after each treatment, visual analog scale (VAS), pressure pain threshold (PPT), neck disability index (NDI) questionnaire, and range of active contra lateral flexion (CLF) were assessed. Participants were given three treatments over a week, with at least a two- day break between them, and then all outcomes were evaluated.&#x0D; Results: The general results of this study demonstrate a significant reduction in pain perception in terms of VAS (P=0.0001), increased pressure pain threshold (P=0.0001), increased CLF of ROM (P=0.0001), and improved neck function by reduction of NDI (P=0.0001), after the third session of ESWT intervention in participants with MTrP in the upper trapezius muscle.&#x0D; Conclusion: It reveals that ESWT has positive effects on pain reduction, cervical range of motion, and cervical function in participants treated with MTrPs in the upper trapezius muscle.

The impact of combination of core stabilization exercise and walking on pain perception and low-back pain disability

Background and Study Aim. Low-back pain (LBP) has increasingly been the leading cause affecting work performance, daily activities, and rising the cost of healthcare services. Currently, sitting time increases and walking activity lessens among people. The purpose of this study - identify the effect of Core Stabilization Exercise (CSE) with walking on pain perception and LBP disability among people who suffered from non-specific low-back pain (NSLBP).&#x0D; Material and Methods. In this study, a total of 36 active people (18-42 years old) with BMI≥24.9 kg.m-2 voluntarily participated and were divided randomly into three groups. Intervention groups included CSE group (CSEG; n=12), CSE with walking (CSEWG; n=12), and control group (CG; n=12). The intervention groups carried out the exercise programs (CSE with and without 30 minutes of walking), three times a week for six weeks. In this study, the pain perception was assessed via the Numerical Pain Rating Scale (NPRS) and LBP disability was measured by using a modified Oswestry Disability (ODI) questionnaire.&#x0D; Results. A one-way analysis of variance (ANOVA) displayed significant effectiveness of CSEG and CSEWG on pain perception as the interaction between time and group [f (2, 33) = 4.95, p=0.032]. The pain perception significantly decreased in CSEG (p=0.021) and CSEWG (p=0.003) after six weeks of the intervention programs compare to CG. The results also showed a significant effect on LBP disability for the interaction between time and group after six weeks of both intervention programs (f (2, 33) =6.52, p=0.015). Disability function (ODI score) significantly improved in CSEG (p=0.031) and CSEWG (p=0.007). Even though the results revealed no significant difference between CSEG and CSEWG, and both groups proved to reduce pain perception and LBP disability, the disability index improvement was greatest in CSEWG.&#x0D; Conclusions. In conclusion, CSE with 30 minutes of walking, as an intervention program, has shown greater improvement with a larger effect size in pain perception and LBP disability among people who suffered from NSLBP.