Pain Reduction In Group Research Articles

Efficacy of stromal vascular fraction for knee osteoarthritis: A prospective, single-centre, non-randomized study with 2 years follow-up.

Current osteoarthritis (OA) treatments focus on symptom relief without addressing the underlying disease process. In regenerative medicine, current treatments have limitations. In regenerative medicine, more research is needed for intra-articular stromal vascular fraction (SVF) injections in OA, including dosage optimization, long-term efficacy, safety, comparisons with other treatments, and mechanism exploration. To compare the efficacy of intra-articular SVF with corticosteroid (ICS) injections in patients with primary knee OA. The study included 50 patients with Kellgren-Lawrence grades II and III OA. Patients were randomly assigned (1:1) to receive either a single intra-articular SVF injection (group A) or a single intra-articular ICS (triamcinolone) (group B) injection. Patients were followed up at 1, 3, 6, 12, and 24 months. Visual analog score (VAS) and International Knee Documentation Committee (IKDC) scores were administered before the procedure and at all follow-ups. The safety of SVF in terms of adverse and severe adverse events was recorded. Statistical analysis was performed with SPSS Version 26.0, IBM Corp, Chicago, IL, United States. Both groups had similar demographics and baseline clinical characteristics. Follow-up showed minor patient loss, resulting in 23 and 24 in groups A and B respectively. Group A experienced a notable reduction in pain, with VAS scores decreasing from 7.7 to 2.4 over 24 months, compared to a minor reduction from 7.8 to 6.2 in Group B. This difference in pain reduction in group A was statistically significant from the third month onwards. Additionally, Group A showed significant improvements in knee functionality, with IKDC scores rising from 33.4 to 83.10, whereas Group B saw a modest increase from 36.7 to 45.16. The improvement in Group A was statistically significant from 6 months and maintained through 24 months. Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA. More adequately powered, multi-center, double-blinded, randomised clinical trials with longer follow-ups are needed to further establish safety and justify its clinical use.

Comparison of the Effect of Intralesional Injection of Corticosteroid and Platelet-rich Plasma in Patients with de Quervain’s Tenosynovitis

Background: De Querveins’ tenosynovitis affects the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment of the wrist. Corticosteroid injection is the mainstay of treatment for those patients who do not respond to conservative management. Platelet-rich plasma (PRP) is a currently used strategy in the clinical practice to provide a regenerative stimulus for tendon healing. Objective: To evaluate the effects of Platelet-rich plasma in the treatment of DQVD in comparison with corticosteroid (CS) injection. Materials and Methods: The present randomized clinical trial had been conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka. A total of 100 patients with pain and swelling over the radial aspect of the wrist with positive Finkelstein test were randomly allocated into three groups: group A (received platelet-rich plasma injection), group B (received corticosteroid injection) and group C (received conservative management). The severity of pain and functional status of the wrist joint were recorded according to VAS and Mayo’s wrist score both pre-procedurally on day 0 and post-procedurally at the end of 1st, 3rd and 6th month. Results: The mean age of the participants in group A, B and C were 45.6 (±10.4), 46.9 (±11.3) and 42.4 (±6.3) years respectively. In all groups, majority of the study participants were female and housewives. No significant statistical difference was observed among the groups regarding VAS scores and Mayo’s Wrist Scores at baseline. At the end of 6 months, the reduction of pain in group A was significantly lower than group B (p<0.001). Again, at the end of 6 months, the improvement of Mayo’s Wrist Scores in group A group was significantly higher than group B (p<0.001). In group A, 77.8% reduction of pain score was achieved while in group B, 68.4%reduction of pain score was achieved after 6 month of treatment (p<0.001). Conclusions: Platelet-rich plasma provides better functional outcome than corticosteroid in the treatment of de Quervain tenosynovitis. Bangladesh Medical Res Counc Bull 2023; 49(1): 32-38

Effectiveness of caudal block in patients with spinal stenosis accompanied by redundant nerve root syndrome

Redundant nerve root syndrome (RNRS) is characterized by tortuous, elongated, and enlarged nerve roots in patients with lumbar spinal stenosis. This study was performed to evaluate the effects of caudal block in patients with RNRS and assess factors associated with RNRS. Patients with lumbar spinal stenosis who underwent caudal block were retrospectively analyzed. A comparative analysis of pain reduction was conducted between patients with RNRS (Group R) and those without RNRS (Group C). Generalized estimating equation analysis was used to identify factors related to the treatment response. RNRS-associated factors were analyzed using logistic regression analysis. In total, 54 patients were enrolled (Group R, n = 22; Group C, n = 32). Group R had older patients than Group C. The caudal block showed less pain reduction in Group R than in Group C, but the difference was not statistically significant. Generalized estimating equation analysis showed that RNRS was the factor significantly associated with the treatment response. The dural sac anteroposterior diameter and left ligamentum flavum thickness were associated with RNRS in the logistic regression analysis. Caudal block tended to be less effective in patients with than without RNRS, but the difference was not statistically significant.

Analysis of pain intensity and postural control for assessing the efficacy of shock wave therapy and sonotherapy in Achilles tendinopathy – A randomized controlled trial

BackgroundThe troublesome symptoms of Achilles tendinopathy prompt patients to seek effective forms of conservative treatment. The main aim of the study was to determine the therapeutic efficacy of shock wave and ultrasound therapies for Achilles tendinopathy in reducing pain intensity. Treatment efficacy was also assessed using objective posturographic measurements. MethodsThirty-nine patients patients were randomly allocated to one of three experimental groups that received shock wave therapy (group A), ultrasound therapy (group B) and placebo ultrasound (group C). Posturographic measurements and subjective assessment of pain intensity were taken prior to therapy and at weeks 1 and 6 of therapy completion. FindingsA comparison of percentage change in activity-related pain from baseline to 6 weeks post-therapy revealed a significantly greater pain reduction in group A compared to group B. The three-way ANOVA demonstated an effect of treatment type on all posturographic variables. The Bonferroni post-hoc test showed the means of all variables were significantly smaller for group A than group B. Limb condition also had an effect on the center-of-pressure trajectories in anteroposterior plane; the post-hoc test showed the mean values of the variables were significantly greater for the non-affected compared to affected limb. InterpretationShock wave therapy was significantly more effective than sonotherapy for alleviation of activity-related pain of Achilles tendinopathy. An association was also shown between shock wave therapy and more efficient postural control in patients with Achilles tendinopathy. The parameters of center-of-pressure trajectories in the sagittal plane were significantly greater for the non-affected compared to affected limb.The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12617000860369; registration date: 9.06.2017).

Comparing the Effect of Chamomile and Mefenamic Acid on Primary Dysmenorrhea Symptoms and Menstrual Bleeding: A Randomized Clinical Trial

Background: Dysmenorrhea in young women reduces their quality of life. Objectives: This research reviewed the impact of chamomile sachet and mefenamic acid on primary dysmenorrhea, its relevant symptoms as well as bleeding. Methods: Two hundred female students afflicted with primary dysmenorrhea from Arak universities were randomly assigned to two groups and participated in this randomized clinical trial. The first group (A) received mefenamic acid (250 mg) and the second group (B) received chamomile (5000 mg) three times a day in two consecutive cycles from two days before up to the first three days after menstruation. Intensity of pain, related symptoms and bleeding were evaluated by visual analog scale, Andersch-Milsom Verbal Scale and Higham chart, respectively. Data analysis was performed by SPSS 21. Results: Severe pain lasting two months after intervention was observed in 6 subjects (6.3%) of group (B) as well as 6 participants (6.3%) in group (A) (p=0.351, p=0.332). Two months after treatment, mean severity of related symptoms was 4.93±3.54 in group (B) and 5.62±3.54 in group (A), which shows further reduction of pain in group (B) that was not significant (p=0.278). Two months later, mean of bleeding was 88.71±66.4 and 70.54 ±53. 34 in group (B) and (A), respectively. Thus, the decrease of pain in the two groups was not significant (p=0.567). Conclusion: It appears that chamomile sachet can decrease the severity of pain and bleeding, which is similar to the effect of mefenamic acid and even further alleviates the symptoms of dysmenorrhea. (IRCT code no. 20161008250B1N5).

Assessment of Lornoxicam as a Mouth Dissolving film in Management of Post Extraction Pain-A Randomized Control Trial

Background: Mouth dissolving film (MDF) is a fast-dissolving drug delivery system that provides a practical means to administer drugs not just to special populations with swallowing difficulties but also to the general public. MDFs are novel dosage forms that dissolve and disintegrate quickly within the mouth. Aim: To assess the efficacy of lornoxicam mouth dissolving film as a potent analgesic and drug delivery system and compare it with the aceclofenac tablet in the management of post-extraction pain. Methodology: The study group comprised 60 subjects of either sex of age group 20–50 years who were divided into an experimental group (group A) and a control group (group B). Group A was administered lornoxicam MDF and group B was administered aceclofenac tablets. Pre-treatment and post-treatment pain assessments were recorded using a visual analog scale (VAS) and an oral pain scale (OPS). Results: In a comparison of the mean value of pre-treatment VAS and VAS after 24 h, the percentage of pain reduction in group A was 86.66%, and in group B was 75%. When comparing the mean value of pre-treatment OPS and OPS after 24 h, the percentage of pain reduction in group A was 93.33% and in group B was 75%. These results were statistically significant, with a P value of 0.00 in both groups. Conclusion: Lornoxicam as an MDF showed promising results in managing post-extraction pain. The potential delivery of lornoxicam through the MDF was safe, with better patient compliance, and no reported cases of adverse effects.

COMPARISION OF LANDMARK GUIDED FEMORAL NERVE BLOCK AND SYSTEMIC INTRAVENOUS ANALGESIA FOR PAIN RELIEF IN TRAUMATIC SHAFT FEMUR FRACTURE.

Background: Femoral nerve block is useful technique for acute pain relief in case of fracture shaft femur in comparison to systemic analgesia. a) To study and compare whether femoral nerve block is more efficaciousAims and Objective: in pain management of femoral shaft fractures than systemic intravenous analgesia. b) To study the duration of action of femoral nerve block for pain relief in femoral shaft fractures. c) To notify any complication. 60Materials and Methods: patients of ASA I and II, aged 20-60 years, having fracture traumatic shaft femur at either level (mid, upper, lower) were studied after admission of patient in emergency ward. They were randomly allocated to group A (n-30, femoral nerve block using 15 ml 2% Lignocaine) and group B (n-30, systemic analgesia using Inj. Paracetamol 1 gm). Each case was subsequently followed up for onset and total duration of analgesia till 6 hrs. Efficacy in both groups was assessed by visual analogue scale. There is no significant difference in onset of action between both theResults and Summary: groups. The duration of action in group A was more (4.08±1.06 hours) than group B (2.18±1.24hours). Visual analogue score showed significant pain reduction in group A after 15 minutes and also at 180 minutes (p=0.000) in comparison with group B. femoral nerve block is safe, simple and more efficacious procedure in comparison toConclusion: systemic IV analgesia for acute pain management in patients with fracture shaft femur.

Assessment of Clinical Efficacy of Microbiome and Topical Hyaluronic Acid Gel Combination Therapy in Minor Aphthous Ulcer Management – A comparative study

Aim: This study aimed to determine the clinical efficacy of the combination of microbiomes and 0.2% topical hyaluronic acid gel, alongside topical monotherapy with 0.2% hyaluronic acid gel and steroids, respectively, in minor aphthous ulcer management. Subjects and Methods: A total of 45 patients were divided into three groups: Group A (n = 15) –– a combination of microbiome therapy––pre- and probiotics capsules p. o. and topical 0.2% hyaluronic acid gel; Group B (n = 15)––topical 0.2% hyaluronic acid gel; and Group C (n = 15)––0.1% triamcinolone acetonide oromucosal paste. Numerical rating scale (NRS) for pain, ulcer dimensions measured by Digital Planimetry using android mobile application to determine the degree of ulcer healing (%) and occurrence of new ulcers were recorded on 0, third, and seventh days of treatment. Statistical Analysis Used: One-way ANOVA with post hoc Tukey test among the groups and independent t - test for the degree of ulcer healing between third and seventh days were applied. Results: NRS for pain at day 3 showed a statistically significant pain reduction in Group A compared with Groups B and C (P = 0.04, 0.01, respectively). Though Group A showed the highest grade of closure (93.4 ± 2.5%) and a greater decrease in mean NRS score (0.2 ± 0.42) on the seventh day when compared to Groups B and C, results were not statistically significant (P > 0.05). Conclusion: Microbiome and topical hyaluronic acid gel combination therapy helps in immediate pain relief and faster healing. Hence, it could be an excellent alternative for topical steroid management.

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

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

A Clinical Study on Comparative Evaluation of the Effectiveness of Carbamazepine and Combination of Carbamazepine with Baclofen or Capsaicin in the Management of Trigeminal Neuralgia.

Background:Trigeminal neuralgia (TN) is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. Various medicinal and surgical procedures have been utilized for the treatment of TN. Over the time, several drugs other than carbamazepine have been used but none of them have shown satisfying results.Objective:The objective of the study is to evaluate the effectiveness of carbamazepine and combination of carbamazepine with baclofen or capsaicin in the management of TN.Materials and Methods:A total of 45 patients diagnosed with TN were randomly divided into three groups. The patients were prescribed carbamazepine in Group 1, carbamazepine and baclofen in Group 2, and carbamazepine and capsaicin in Group 3. All the patients were followed on the 7th day, 15th day, and 1-month period to evaluate the response to the drugs. Data were subjected to statistics.Results:The results are composed of a total of 45 patients (15 in each group). The mean visual analogue scale scores were calculated for each group at day 0, 7th day, 15th day, and 30 days, and it was found that there was statistically significant reduction of pain (P < 0.001) in all the three groups at different intervals. At day 7, comparative percentage reduction of pain in both groups was not statistically significant. At 15-days and 30 days, percentage change in pain reduction in Group 1 was 42.3% and 48.0% respectively and in Group 2 it was found to be 60.3% and 83.4%, respectively. The reduction in pain percentage was found to be statistically significant. Similarly, Group 1 was compared to Group 3, significant reduction of pain was found for carbamazepine-capsaicin combination at 30-day interval but the comparative reduction of pain at 7th day and 15th day was not statistically significant.Conclusion:Carbamazepine in combination with baclofen is more efficient and effective in reducing pain in TN patients, followed by carbamazepine-capsaicin combination compared to carbamazepine alone.

Intratissue percutaneous electolysis combined with active physical therapy for the treatment of adductor longus enthesopathy-related groin pain: a randomized trial

Adductor longus enthesopathy-related groin pain (ALErGP) is the most common cause of groin pain in soccer players. The aim of this study was to evaluate the therapeutic utility of intratissue percutaneous electrolysis (EPI®) technique in combination with an active physical therapy (APT) program to treat ALErGP. Twenty-four non-professional male soccer players diagnosed with ALErGP were included in this study and randomly divided into two groups. Group A was treated with EPI® technique in combination with a standardized APT program. Group B only underwent the APT program. The Numeric Rating Scale (NRS) and the Patient Specific Functional Scale (PSFS) were used to assess the effectiveness of the two interventions. The follow-up covered a 6-month period. Both groups significantly improved pain and functional scores after treatment and maintained this therapeutic result throughout the follow-up. The combined intervention of APT program and EPI® ensured a greater and faster reduction of pain in group A. In addition, functional recovery tended to be greater in group A than B after the treatment and throughout the follow-up by 7.8±3.8% (P=0.093). EPI® treatment in association with APT ensured a greater and more rapid reduction of pain and tended to promote greater functional recovery in soccer players with ALErGP compared to APT only. This positive therapeutic result lasted for at least 6 months after the end of the treatment. These findings support the combined use of EPI® and APT to treat ALErGP.

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

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

Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial

The subacromial syndrome is the most common source of shoulder pain. The mainstays of conservative treatment are non-steroidal anti-inflammatory drugs and exercise therapy. Recently, low-level laser therapy (LLLT) has been popularized in the treatment of various musculoskeletal disorders. The aim of this study is to evaluate the additive effects of LLLT with exercise in comparison with exercise therapy alone in treatment of the subacromial syndrome. We conducted a randomised clinical study of 80 patients who presented to clinic with subacromial syndrome (rotator cuff and biceps tendinitis). Patients were randomly allocated into two groups. In group I (n = 40), patients were given laser treatment (pulsed infrared laser) and exercise therapy for ten sessions during a period of 2 weeks. In group II (n = 40), placebo laser and the same exercise therapy were given for the same period. Patients were evaluated for the pain with visual analogue scale (VAS) and shoulder range of motion (ROM) in an active and passive movement of flexion, abduction and external rotation before and after treatment. In both groups, significant post-treatment improvements were achieved in all parameters (P = 0.00). In comparison between the two groups, a significant improvement was noted in all movements in group I (P = 0.00). Also, there was a substantial difference between the groups in VAS scores (P = 0.00) which showed significant pain reduction in group I. This study indicates that LLLT combined exercise is more effective than exercise therapy alone in relieving pain and in improving the shoulder ROM in patients with subacromial syndrome.