Reduction In Pain Severity Research Articles

Electro-Acupuncture Effects Measured by Functional Magnetic Resonance Imaging-A Systematic Review of Randomized Clinical Trials.

Electro-acupuncture, an innovative adaptation of traditional acupuncture, combines electrical stimulation with acupuncture needles to enhance therapeutic effects. While acupuncture is widely used, its biological mechanisms remain incompletely understood. Recent research has explored the neurophysiological aspects of acupuncture, particularly through functional magnetic resonance imaging (fMRI) to investigate its effects on brain activity. In this systematic review, we conducted an extensive search for randomized clinical trials examining electro-acupuncture effects measured by fMRI. We employed strict eligibility criteria, quality assessment, and data extraction. Five studies met our inclusion criteria and were analyzed. The selected studies investigated electro-acupuncture in various medical conditions, including carpal tunnel syndrome, fibromyalgia, Crohn's disease, irritable bowel syndrome, and obesity. Notably, electro-acupuncture was found to modulate brain activity and connectivity in regions associated with pain perception, emotional regulation, and cognitive processing. These findings align with the holistic approach of traditional Chinese medicine, emphasizing the interconnectedness of body and mind. In carpal tunnel syndrome, electro-acupuncture at both local and distal sites showed neurophysiological improvements, suggesting distinct neuroplasticity mechanisms. In fibromyalgia, somatosensory electro-acupuncture correlated with reduced pain severity, enhanced brain connectivity, and increased gamma-aminobutyric acid levels. For Crohn's disease, electro-acupuncture influenced the homeostatic afferent processing network, potentially mitigating gut inflammation. Electro-acupuncture for irritable bowel syndrome led to decreased activity in the anterior cingulate cortex, offering pain relief, while electro-acupuncture for obesity impacted brain regions associated with dietary inhibition and emotional regulation. This systematic review provides evidence that electro-acupuncture can positively impact a range of medical conditions, possibly by modulating brain activity and connectivity. While the quality of the reviewed studies is generally good, further research with larger sample sizes and longer-term assessments is needed to better understand the mechanisms and optimize electro-acupuncture protocols for specific health conditions. The limited number of studies in this review emphasizes the need for broader investigations in this promising field. The research protocol was registered in PROSPERO (CRD42023465866).

Battlefield acupuncture for chronic musculoskeletal pain in cancer survivors: a novel care delivery model for oncology acupuncture.

Battlefield Acupuncture (BFA), a standardized auricular acupuncture protocol, is widely used for pain in the military but is not well-studied in oncology. This study examined cancer survivors who received BFA for pain. This is a secondary analysis of a randomized trial that compared the effectiveness of BFA and electroacupuncture vs. usual care for chronic musculoskeletal pain in cancer survivors. This study focused on participants randomized to BFA. Participants received 10 weekly treatments. Needles were placed until one of these stop conditions were satisfied: ten needles were administered; pain severity decreased to ≤1 out of 10; patient declined further needling, or vasovagal reaction was observed. Pain severity was assessed using Brief Pain Inventory. Responders were those with ≥30% pain severity reduction. We examined pain location, BFA stop reason, and pain reduction of participants during the first session. We also examined which factors predicted responder status after the first session (week 1) or the full treatment (week 12). Among 143 randomized to BFA, most common pain locations were lower back (30.8%) and knee/leg (18.2%). Of 138 who initiated treatment, 41 (30.0%) received ten needles; 81 (59.1%) achieved pain ≤1; 14 (10.2%) declined further needling; and 1 (0.7%) had vasovagal reaction. BFA reduced pain severity by 2.9 points (95% CI 2.6 to 3.2) after the first session (P < 0.001). After adjusting for baseline pain severity, responders at week 1 were 2.5 times more likely to be responders at week 12, compared to those who were non-responders at week 1 (AOR 2.5, 95% CI 1.02 to 6.11, P = 0.04). Among those who achieved pain ≤1, 74% were responders at week 12, a higher proportion compared to the proportion of responders among those who received ten needles (39.5%), those who declined further needling (50%), and those with vasovagal reaction (0.0%) (P = 0.001). Those with pain in proximal joints had a higher proportion of responders at week 12, compared to those with pain in distal joints (64.2% vs. 20%, P = 0.008). Specific factors may predict the likelihood of achieving meaningful pain reduction from BFA. Understanding these predictors could inform precision pain management and acupuncture delivery models.

Efeito da técnica de tosse durante injeção subcutânea de heparina na intensidade da dor e satisfação individual

Objective: to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. Method: the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. Results: there was a statistically significant difference between patients’ mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. Conclusion: the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.

Efficacy of electroacupuncture in improving postoperative ileus in patients receiving colorectal surgery: a systematic review and meta-analysis.

This meta-analysis aimed to evaluate the efficacy and safety of electroacupuncture (EA) in improving postoperative ileus after colorectal surgery. Electronic databases (e.g. Medline) were screened to identify randomized controlled trials that focused on the association between EA and postoperative ileus. Time to first flatus served as the primary outcome, while the secondary outcomes included time required for the recovery of other gastrointestinal functions (e.g. bowel sound recovery), time to tolerability of liquid/solid food, postoperative pain scores, risk of overall complications, and hospital length of stay. Our meta-analysis focusing on 16 studies with a total of 1562 patients demonstrated positive associations of EA with shorter times to the first flatus [mean difference (MD): -10.1h, P <0.00001, n =1562], first defecation (MD: -11.77h, P <0.00001, n =1231), bowel sound recovery (MD: -10.76h, P <0.00001, n =670), tolerability of liquid (MD: -16.44h, P =0.0002, n =243), and solid food (MD: -17.21h, P =0.005, n =582) than those who received standard care. The use of EA was also correlated with a lower risk of overall complications (risk ratio:0.71, P =0.04, n =1011), shorter hospital length of stay (MD: -1.22 days, P =0.0001, n =988), and a lower pain score on postoperative days two (standardized MD: -0.87, P =0.009, n =665) and three (standardized MD: -0.45, P <0.00001, n =795), without a difference in time to first ambulation. Our findings showed an association between EA and enhanced gastrointestinal functional recovery and reduced pain severity following colorectal surgery, highlighting the potential benefits of incorporating EA into perioperative care to enhance recovery outcomes in this setting.

Safety, tolerability, and effectiveness of repetitive intravenous dihydroergotamine for refractory chronic migraine with cardiovascular risk factors: A retrospective study.

Dihydroergotamine (DHE), like triptans, is contraindicated in patients with ischemic heart disease or coronary vasospasm. Its true safety, tolerability, and efficacy in patients with cardiovascular risk without ischemic heart disease or coronary vasospasm remain unclear. To assess the safety, tolerability, and effectiveness of repetitive intravenous DHE in patients with cardiovascular risk factors. A single-center, retrospective cohort study was conducted at the Jefferson Headache Center inpatient unit for refractory chronic migraine patients treated with our intravenous DHE protocol between January 1, 2019, and October 15, 2019. We evaluated tolerability and effectiveness outcomes based on atherosclerotic cardiovascular disease 10-year calculated risk scores, stratified into low (<5.0%) and elevated (≥5.0%) risk. Data were presented in mean ± standard deviation or median (25th percentile, 75th percentile) if non-normally distributed. Among 347 patients (median age of 46 [36, 57], female n = 278 [80.1%]), who received inpatient intravenous DHE, 227 patients (age 53 [45, 60], female 81.1%) had calculable risk scores, 64 (28.2%) had elevated risk, and 38 (16.7%) had cardiology consultations. There were no clinically significant electrocardiogram abnormalities or cardiovascular adverse events. The median hospital length of stay was 6 (5, 7) days. Compared to the low-risk group, those with elevated risk had higher nausea (31.3% vs. 14.1%, p = 0.008), but similar initial DHE dose (0.5 [0.25, 0.5] vs. 0.5 [0.25, 0.5], p = 0.009), lower final DHE dose (0.75 [0.5, 1] vs. 1 [0.75, 1] p < 0.001), and lower pain reduction after admission (-3.8 [2.1, 6] vs. -5 [3, 7] p = 0.037). Patients receiving intravenous DHE by the Jefferson Headache Center inpatient headache protocol had significantly reduced pain severity at discharge. No clinically significant cardiac or electrocardiogram abnormalities were detected in patients with elevated (or low) atherosclerotic cardiovascular disease risk. Repetitive intravenous DHE used by our protocol was safe in refractory chronic migraine patients.

Yoga is effective for treating chronic pain in veterans with Gulf War Illness at long-term follow-up

BackgroundClinical Practice Guidelines for Gulf War Illness (GWI) recommend integrative health approaches such as yoga for relief from symptoms, yet little is known about the long-term efficacy of yoga in reducing symptoms of GWI. Here, we evaluated the long-term efficacy of yoga and cognitive-behavioral therapy (CBT) chronic pain treatment in a randomized controlled trial (RCT) of 75 Veterans (57 men, 42–71 ± 7.1 years of age) with Gulf War Illness (GWI).MethodsParticipants received either 10 weeks of yoga or 10 weeks of CBT for chronic pain. The primary outcome measures were pain severity, and pain interference (Brief Pain Inventory-Short Form). The secondary outcome measures were fatigue, as indicated by a measure of functional exercise capacity (6-Minute Walk Test), depression, autonomic symptom severity, and quality of life. Piecewise linear mixed models were used to examine study hypotheses.ResultsCompared to the CBT group, yoga was associated with greater reductions in pain severity during the 6-month follow-up period (group × time interaction: b = 0.036, se = 0.014, p = .011). Although we did not find between-group differences in the other primary or secondary outcome measures during follow-up (p’s > 0.05), exploratory analyses revealed within-group improvements in pain interference, total pain (an experimental outcome variable which combines pain severity and interference), and fatigue in the yoga group (p’s < 0.05) but not in the CBT group.ConclusionsThis is the first study to report long-term follow-up results of yoga as a treatment for GWI. Our results suggest that yoga may offer long-term efficacy in reducing pain, which is a core symptom of GWI.Trial registrationSecondary analyses of ClinicalTrials.gov NCT02378025.

Therapeutic effects of 7- to 14-day subanesthetic ketamine infusions for chronic pain on standardized psychiatric measures.

Background: We have previously shown that subanesthetic ketamine infusions effectively reduce refractory pain. However, the effects of ketamine infusions on comorbid conditions of depression and anxiety have not been explored in this patient population. Methods: We investigated the effects of ketamine on mood and anxiety in patients with refractory chronic pain treated with 7-14days of subanesthetic continuous intravenous ketamine infusions, using well-validated clinical scales. Results: There was a significant 52% reduction in pain severity and 33% reduction in pain interference scores following ketamine treatment. Ketamine treatment also reduced scores on the depression module of the Patient Health Questionnaire (PHQ-9) by 28% and scores on the Generalised Anxiety and Depression Assessment (GAD-7) by 36%. Conclusion: Multiday subanesthetic ketamine infusions effectively reduce pain, anxiety and depression in patients with complex chronic pain.

Omega-3 Polyunsaturate Fatty Acid Supplementation Potential to Improve Activity Components of Rheumatoid Arthritis: A Systematic Review

Introduction: Rheumatoid arthritis (RA) is a chronic disease that causes deformity in most productive age and can lead to death as disease activity increases. Omega-3 polyunsaturated fatty acids have the potential to complement available therapies in reducing disease activity. Currently, the effect of omega-3 PUFAs on disease activity components is still unclear. The current systematic reviews determine the effect of omega-3 PUFAs’ supplementation on the components of RA disease activity. Methods: This research is guided by the PRISMA guidelines systematically. Literature was searched in the databases: PubMed, MDPI, and Clinicaltrials.gov. The inclusion criteria used were: giving omega-3 PUFAs, free full-text, RCT, in English or Indonesian, assessing disease activity and its components; while the exclusion criteria were: unpublished, comparisons were inappropriate. Assessment of literature quality with the Cochrane Collaboration's tool. The study included six studies from 1994 to 2017. Results: The effect of omega-3 PUFAs is diversity in changes of disease activity in 4 of 5 studies. There are significant reductions in the number of joint pains in the literature by daily doses above 2.9 grams or at lower doses taking longer; and swollen joints in 2 studies that were only affected in doses above 2.9 grams. There are significant reductions in pain severity in the studies. Change increases with higher doses. There are variable LED and CRP changes. Conclusion: Depending on their dose and administration duration, omega-3 PUFAs can directly and indirectly affect disease activity through the influence of most of its components, namely: the number of joints affected and the degree of pain.

Impact of Short-Course Palliative Radiation Therapy on Pancreatic Cancer-Related Pain: Prospective Phase 2 Nonrandomized PAINPANC Trial

Clinical evidence is limited regarding palliative radiation therapy for relieving pancreatic cancer-related pain. We prospectively investigated pain response after short-course palliative radiation therapy in patients with moderate-to-severe pancreatic cancer-related pain. In this prospective phase 2 single center nonrandomized trial, 30 patients with moderate-to-severe pain (5-10, on a 0-10 scale) of pancreatic cancer refractory to pain medication, were treated with a short-course palliative radiation therapy; 24 Gy in 3 weekly fractions (2015-2018). Primary endpoint was defined as a clinically relevant average decrease of ≥2 points in pain severity, compared with baseline, within 7 weeks after the start of treatment. Secondary endpoint was global quality of life (QoL), with a clinically relevant increase of 5 to 10 points (0-100 scale). Pain severity reduction and QoL were assessed 9 times using the Brief Pain Inventory and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C15-PAL, respectively. Both outcomes were analyzed using joint modeling. In addition, acute toxicity based on clinician reporting and overall survival (OS) were assessed. Overall, 29 of 30 patients (96.7%) received palliative radiation therapy. At baseline, the median oral morphine equivalent daily dose was 129.5 mg (range, 20.0-540.0 mg), which decreased to 75.0 mg (range, 15.0-360.0 mg) after radiation (P=.021). Pain decreased on average 3.15 points from baseline to 7 weeks (one-sided P=.045). Patients reported a clinically relevant mean pain severity reduction from 5.9 to 3.8 points (P=.011) during the first 3 weeks, which further decreased to 3.2 until week 11, ending at 3.4 (P=.006) in week 21 after the first radiation therapy fraction. Global QoL significantly improved from 50.5 to 60.8 during the follow-up period (P=.001). Grade 3 acute toxicity occurred in 3 patients and no grade 4 to 5 toxicity was observed. Median OS was 11.8 weeks, with a 13.3% 1-year actuarial OS rate. Short-course palliative radiation therapy for pancreatic cancer-related pain was associated with rapid, clinically relevant reduction in pain severity, and clinically relevant improvement in global QoL, with mostly mild toxicity.

Comparison of Three Different Doses of Dexamethasone Added to Midazolam for Prophylaxis against Nausea and Vomiting after Laparoscopic Cholecystectomy during Early Postoperative Period

Abstract Background General anesthesia using volatile anesthetics is associated with high incidence of postoperative nausea and vomiting ranging between 20% - 30% within 24 hours after surgery. Postoperative nausea and vomiting is thought to be of multifactorial etiology involving anesthetics, surgical and individual factors. Objective To compare between three different doses of Dexamethasone in conjunction with predetermined fixed dose of Midazolam which can provide effective prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy. Patients and Methods 1ry outcome was to decrease nausea and vomiting after laparoscopic cholecystectomy and 2ry outcome was itching and dizziness. The present study was conducted in Ain shams University hospitals on 120 adult female patients aged 21 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled to an elective laparoscopic cholecystectomy. After obtaining approval from the research ethical committee of faculty of medicine of Ain Shams University, a written informed consent was obtained from every patient after explaining the procedure. Results Over 24 h, the incidence of nausea, vomiting and rescue antiemtic use reduced significantly in Group ІІ and Group ІІІ when compared to group І. As with incidence, the severity of nausea was even significantly reduced in the group ІІ and group ІІІ group (P 0.043 and 0.009) respectively compared to group І in 24 hours postoperative. Postoperative pain was assessed for initial 6 h. Group ІІ and group ІІІ had significant reduction in severity of pain (P &amp;lt; 0.016 and 0.006) respectively when compared to group І while there was no significant difference between group ІІ and group ІІІ. Moreover, the incidence of use of rescue analgesia significantly reduced from 82.5% in group І to 52.5% and 45% in group ІІ and group ІІІ, respectively. However, dose of rescue analgesia used in 6 h was significantly reduced in Group ІІІ only (P = 0.013). Conclusion The minimum effective dose for prevention of postoperative nausea is 4 mg of Dexamethasone in combination with Midazolam in female patients undergoing Laparoscopic cholecystectomy with additional advantage of analgesia in the early postoperative period. Further reduction in incidence and severity of PONV can be achieved with a dose of 8 mg dexamethasone.

Effect of Body Mechanics Training Program on Low Back Pain and Disability among Patients with Lumbar Disc Prolapse

Context: Lumbar disc prolapse is one of the most common spinal pathologies, which can be associated with debilitating pain and neurological dysfunction. Evidence suggests that patients with disc prolapse and low back pain must be taught proper body mechanics to move safely and with the least strain possible on their back.&#x0D; Aim: Evaluate the effect of body mechanics training program on low back pain and disability among patients with lumbar disc prolapse. Methods: A quasi-experimental research design (study and control group) was utilized to achieve the aim of this study. This study was conducted in the neurosurgery department and neurosurgery outpatient clinic at Benha University Hospital on a purposive sample of patients diagnosed with lumbar disc prolapse. Three tools for data collection were used; a Structured interviewing questionnaire for patients; a visual analog pain scale, and Oswestry low back pain disability questionnaire.&#x0D; Results: Showed that the total mean knowledge score for the study and control group was 33.500±3.862 and 8.140±6.402, respectively, after one-month post-program implementation, with a statistically significant difference between both groups. Also, 75% of the study group had mild pain, and 58% of the control group had moderate pain post-program implementation, with statistically significant differences between the study and control group post-program, where p=0.000. Regarding functional disability scores among study and control groups pre and one month after program implementation. It shows that (67% and 63%) of the study and control groups had severe disability pre-program implementation. In contrast, post-program implementation, 65% of the study group had moderate disability, while 13% of the control group had moderate disability.&#x0D; Conclusion: Implementing body mechanics training program for patients with lumbar disc prolapse improved knowledge, reduced pain severity, and reduced disability among the study group compared to the control group. A simplified colored booklet about using body mechanics when performing activities of daily living should be available for all patients with lumber disc prolapse.

REPRINTED WITH PERMISSION OF IASP PAIN 164 (2023) 741748: Adjuvanted recombinant zoster vaccine decreases herpeszoster-associated pain and the use of pain medicationacross 3 randomized, placebo-controlled trials

Herpes zoster (HZ) and HZ-associated pain greatly affect patients quality of life, particularly in older andimmunocompromised adults, for whom comorbidities and polypharmacy are often reported. Three phase III,randomized, placebo-controlled clinical trials have reported the adjuvanted recombinant zoster vaccine (RZV) ashighly efficacious in preventing HZ and reducing pain severity in healthy adults 50 years old (Zoster Efficacy Study[ZOE]-50 study, NCT01165177) and 70 years old (ZOE-70; NCT01165229) and in immunocompromised adults18 years old undergoing autologous hematopoietic stem cell transplantation (ZOE-HSCT; NCT01610414). Here,we investigated efficacy of RZV in reducing (i) the duration of clinically significant pain (Zoster Brief Pain Inventorypain score 3) and (ii) HZ-associated pain medication use and duration of use in participants with confirmed HZ(breakthrough cases) from the 3 studies. Recombinant zoster vaccine effectively reduced the duration of clinicallysignificant HZ-associated pain during HZ episodes by 38.5% (P-value: 0.010) in the ZOE-HSCT study. Althougha similar trend was observed in the ZOE-50 and ZOE-70 studies, the results were not statistically significant becauseof the high vaccine efficacy (VE) against HZ resulting in rare breakthrough cases.VE in reducing pain medication use(39.6%;P-value: 0.008) and duration of medication use (49.3%, P-value: 0.040) was reported in the ZOE-70 study;corresponding positive VE estimates were observed in the ZOE-50 and ZOE-HSCT studies but were not statisticallysignificant. Data reported here demonstrate efficacy of RZV in reducing HZ-associated pain duration and painmedication use in breakthrough cases, thereby improving quality of life of those with HZ.

Pilot trial of the feasibility, acceptability, and potential efficacy of a pain management intervention adapted for older adults with cancer in rural settings.

e24021 Background: Among the growing older adult U.S. population, under-treated cancer pain is a major public health concern. Those living in rural areas are even more vulnerable due to less access to care, patients’ concerns around the over-use of pain medication, and patients’ preferences for non-pharmacological interventions. There is a clear need for interventions designed to improve pain management among this vulnerable population. Methods: In this study, older adults with cancer (age 65+ years) were enrolled in an open arm trial in rural Tennessee to test feasibility, acceptability, and potential efficacy of a previously developed intervention, Ca-HELP, to improve pain communication with one’s oncologist. Prior to the trial, the original Ca-HELP intervention was adapted for use among older adults in rural settings. Feasibility was examined through accrual and intervention completion rates. Acceptability was measured through single-item questions assessing helpfulness, difficulty, and satisfaction with the intervention. Intervention efficacy was assessed using mean score differences from pre- and post-intervention assessments of pain self-management, self-efficacy for communicating with physicians about pain severity, pain severity, and misconceptions about pain. Mean score differences were analyzed using one-tailed paired samples t-tests, with an alpha level = 0.05. Results: A total of n = 30 patients were enrolled in this trial, adequately powering this trial (0.85) to detect moderate effect size differences. Participants were 56.7% female, predominately white (80.0%), less educated (53.3% less than high school), and lower income (50.0% household income less than $21,000). Fidelity rates of 90% for communication consistency (pacing, volume, introduction to purpose of intervention) and 100% for delivery of intervention components were observed. This intervention was highly feasible, with a 100% accrual rate and 100% intervention completion rate. Regarding acceptability, all patients (n = 30) rated the intervention as helpful, with the majority rating it as “very helpful” (n = 24, 80.0%). Most patients rated the intervention as “not at all difficult” (90.0%), enjoyed participating in the intervention (70.0%), and were “very satisfied” with the intervention (83.3%). Pre/post changes in outcomes indicated significant improvements in pain self-management and self-efficacy for communicating with physicians about pain severity, as well as significant reductions in pain severity and pain misconceptions (all p &lt; .05). Conclusions: Results of this study indicate the adapted version of Ca-HELP was feasible, acceptable, and had potential efficacy for improving pain related outcome measures among older adults with cancer in a rural setting. Clinical trial information: NCT04262232 .

Impact of nirogacestat on pain, a key symptom in patients with desmoid tumors (DT): Results from the phase 3 DeFi study.

11564 Background: Pain reduction is a key treatment goal in DT (aggressive fibromatosis): 60% of patients (pts) experience chronic pain. In the phase 3 DeFi trial, nirogacestat (NIRO; n = 70) significantly improved progression-free survival compared with placebo (PBO; n = 72) in pts with progressing DT (HR: 0.29 [95% CI, 0.15–0.55]; P&lt; 0.001). Also as previously reported, NIRO significantly reduced pain severity by 1.50 points (on a 10-point scale) compared with PBO at cycle 10 (28-day cycles; P&lt; 0.001) per the prespecified secondary endpoint of “worst pain” from the Brief Pain Inventory Short Form (BPI-SF). Additional aspects of pain were collected in DeFi to further characterize treatment impact and consistency across multiple pain assessment tools. Methods: In DeFi, pts completed 3 prespecified pain assessment tools through end of treatment: BPI-SF (worst pain), GOunder/Desmoid Tumor Research Foundation DEsmoid Symptom Scale (GODDESS-DTSS pain scale: worst pain, dull pain, shooting pain), European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30 pain scale: pain, pain interference with daily activities). Change from baseline (BL) in pain scores was compared between arms; analyses included mixed models for repeated measures to compare change from BL and stratified Cochran-Mantel-Haenszel to compare proportions of pts with clinically meaningful pain reduction (defined using prespecified thresholds) at cycle 10. Cycle 10 was preselected to allow adequate time for a treatment effect to be observed. Results: Statistically significant and clinically meaningful pain reductions were observed with NIRO compared with PBO at cycle 10 across all assessment tools; statistically significant differences between arms occurred as early as cycle 2 and were sustained throughout treatment. At cycle 10, NIRO reduced mean BL pain per GODDESS-DTSS (0–10 range) by 1.78 points (SE = 0.26) and PBO increased pain by 0.32 points (SE = 0.27; P&lt; 0.001). At cycle 10, NIRO reduced mean BL pain per QLQ-C30 (0–100 range) by 22.05 points (SE = 3.38) and PBO increased pain by 7.19 points (SE = 3.64; P&lt; 0.001). Clinically meaningful pain reduction (by ≥2.0 points) per BPI-SF worst pain (0–10 range) was achieved by 72% of pts with NIRO vs 29% of pts with PBO at cycle 10 ( P&lt; 0.001). Per GODDESS-DTSS, clinically meaningful pain reduction (by ≥1.9 points) was achieved by 62% of pts with NIRO vs 19% of pts with PBO at cycle 10 ( P= 0.002). Conclusions: Rapid, sustained, and consistent reductions in different aspects of pain were observed with NIRO compared with PBO across multiple assessment tools in pts with DT. Furthermore, a significantly greater proportion of pts achieved clinically meaningful reductions in pain with NIRO than with PBO. As pain is the most commonly reported symptom, pain reduction should be a key clinical trial endpoint and a key treatment goal in DT. Clinical trial information: NCT03785964 .

The Effect of Inhalation Aromatherapy on Patients with Cardiovascular Disease Seeking Pain Relief: A Systematic Review and Meta-analysis

Background: Untreated cardiovascular disease (CVD) can commonly cause disability and morbidity and increase the mortality risk. Objective: This systematic review and meta-analysis study aimed to investigate the pain-relieving effects of aromatherapy with medicinal plants on patients with cardiovascular diseases. Methods: This meta-analysis followed PRISMA guidelines. Several keywords were explored using an extensive search of databases, including PubMed, Web of Science (ISI), EMBASE, and Scopus, on May 15, 2022. In addition, an excel form was designed for recording the data of the RCT studies. Standardized mean difference (SMD) and their 95% confidence intervals (CI) were used to estimate the overall effect size. The Cochran Q test and the statistic I2 were used to evaluate the heterogeneity of studies. Lastly, Egger's and Begg's tests were used to assess potential publication bias. Results: We included studies examining the effect of inhalation aromatherapy on pain in patients with CVD after 5 minutes (five papers) and 15-30 minutes (six papers) of intervention. The results showed a significant decrease in pain in the intervention group compared to the control group after 5 minutes (SMD = -2.25, 95% CI = -3.21 to -1.29, P &lt; 0.001) and after 15-30 minutes (SMD = -3.22, 95% CI = - 4.41 to -2.03, P &lt; 0.001) of intervention in CVD patients. No publication bias was observed related to the association between inhalation aromatherapy and pain relief. Conclusion: In CVD patients, inhalation aromatherapy could significantly reduce pain severity and can be used as a complementary medicine for pain reduction.

Immediate Effects of Dry Needling vs. Functional Dry Needling in Patients with Shortened Calf Muscles

Background: Shortened muscle is a condition of physical shortening of the length of the muscle and is also accompanied by other soft tissues surrounding the muscle. In shortened calf muscles the muscles (gastrocnemius and soleus) of lower leg have reduction in their length resulting in pain, reduced range of motion of joint and somehow limiting the functional ability and capability of and individual. The use of dry needling as well as functional dry needling is thought to reduce pain and increase range of motion. Objective: This study was aimed at finding the immediate effects of dry needling versus functional dry needling on pain and range of motion. Methods: It was a quasi-experimental study conducted at Buch International Hospital, Multan &amp; Ali Rehabilitation &amp; pain relief center, Multan from February 01, 2023, to April 31, 2023. There were two groups in total. One group was provided with functional dry needling and the other with dry needling. Only single session was taken and measurements of Numeric Pain Rating Scale and range of motion with goniometry were recorded before and after the treatment. SPSS-27 was used to analyze the data. Results: There were a total of 40 patients. 20 patients were assigned to functional dry needling group and 20 patients to dry needling group. The mean age of patients was 27.65 + 2.368 and 27.80 + 1.852 in functional dry needling and dry needling groups respectively. Pain severity in functional dry needling group reduced significantly compared to dry needling group at the end of the session (p-value=&lt;0.01). Active range of motion and passive range of motion were found non-significant at the end of session (p-value=.089 and p-value=.146) respectively. Conclusion: Both functional dry needling and dry needling reduces pain severity but functional dry needling resulted in reduction in pain severity more than dry needling whereas, both showed non-significant effects on range of motion. Keywords: FDN; functional dry needling, DN; dry needling, AROM; active range of motion, PROM; passive range of motion.

Headache Frequency and Pain Severity Following a Nerve Stimulator Implant for Chronic Migraine: A Systematic Review and Meta-Analysis

Migraines affect approximately one billion individuals worldwide. Implanted nerve stimulator devices can provide relief to some individuals who have chronic migraines refractory to other treatments. This study defines the change in headache pain severity and headache frequency following implanted nerve stimulator treatment in chronic migraineurs. A PRISMA-compliant systematic review of six databases was performed to identify all clinical trials treating at least 10 chronic migraineurs with an implanted nerve stimulator. Inverse variance random effects meta-analyses were performed to define the relative change in headache pain severity and headache frequency as compared to baseline. Nine studies met criteria, including 5 randomized controlled clinical trials and 4 uncontrolled clinical trials, and treated 559 individuals. Among studies that reported gender, 306 females and 154 males were treated. Mean patient ages ranged from 45 to 50 years. All included studies targeted the greater occipital nerve with an implanted nerve stimulator. Implanted nerve stimulator treatment reduced pain severity at 1 month by 36.42% (95%-CI: 28.35-44.49, I&lt;sup&gt;2&lt;/sup&gt; = 55%) and 3 months by 50.04% (95%-CI: 39.67-60.42%, I&lt;sup&gt;2&lt;/sup&gt; = 26%). Implanted nerve stimulators reduced headache frequency by 49.86% (95%-CI: 31.49-68.23, I&lt;sup&gt;2&lt;/sup&gt; = 92%) at 1 to 3 months and 27.43% (95%-CI: 17.68-37.18, I&lt;sup&gt;2&lt;/sup&gt; = 63%) at 6 to 97 months. Implanted nerve stimulator devices provide clinically and statistically significant improvements in headache severity and frequency in individuals with chronic migraines.

Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health.

Digital therapeutics (DTx, software as a medical device) provide personalized treatments for chronic diseases and expand precision medicine beyond pharmacogenomics-based pharmacotherapies. In this perspective article, we describe how DTx for chronic low back pain (CLBP) can be integrated with pharmaceutical drugs (e.g., NSAIDs, opioids), physical therapy (PT), cognitive behavioral therapy (CBT), and patient empowerment. An example of an FDA-authorized DTx for CLBP is RelieVRx, a prescription virtual reality (VR) app that reduces pain severity as an adjunct treatment for moderate to severe low back pain. RelieVRx is an immersive VR system that delivers at-home pain management modalities, including relaxation, self-awareness, pain distraction, guided breathing, and patient education. The mechanism of action of DTx is aligned with recommendations from the American College of Physicians to use non-pharmacological modalities as the first-line therapy for CLBP. Herein, we discuss how DTx can provide multimodal therapy options integrating conventional treatments with exposome-responsive, just-in-time adaptive interventions (JITAI). Given the flexibility of software-based therapies to accommodate diverse digital content, we also suggest that music-induced analgesia can increase the clinical effectiveness of digital interventions for chronic pain. DTx offers opportunities to simultaneously address the chronic pain crisis and opioid epidemic while supporting patients and healthcare providers to improve therapy outcomes.

Treatment of Painful Diabetic Neuropathy Using Frequency Rhythmic Electro Magnetic Neural Stimulation (FREMS); Effectiveness in Daily Practice.

Painful diabetic peripheral neuropathy (PDPN) is common and difficult to treat with limited treatment options. We assessed the efficacy of frequency rhythmic electromagnetic neural stimulation (FREMS) in patients with PDPN. An uncontrolled prospective survey of patients with PDPN and pain despite at least two lines of pharmacotherapy. The primary outcome, 50% reduction in pain scores at 1 and/or 3 months post FREMS. FREMS was applied to both legs below the knees using 4 sets of electrodes per leg; the treatment consisted of 10 sessions of 35 min applications given over 14 days. FREMS was repeated every 4 months and patients were followed up for 12 months. Pain was assessed using the neuropathic pain symptom inventory (NPSI) and quality of life (QOL) by the EQ-5D. Out of 336 subjects, 248 patients met the inclusion criteria (56% men), average age and diabetes duration were 65 and 12.6 years respectively. FREMS was associated with a median decrease NPSI of 31% at M1 (range -100;+93%), and a median decrease of -37.5% at M3 (range -100;+250%). The 50% reduction in pain was reached in 80/248 (32.3%) and 87/248 (35.1%) after M1 and M3 respectively. The change in NPSI was accompanied by a decrease in self reported use of opiates of >50%. FREMS treatment was associated with a significant reduction in pain severity over a three months period in patients who did not have adequate response to pharmacotherapy. Randomised (sham)-controlled trials examining the role of FREMS as a treatment for PDPN in non-responders to pharmacotherapy are needed.

IS MESENCHYMAL STROMAL CELL-BASED CELLULAR THERAPY BENEFICIAL IN THE MANAGEMENT OF ROTATOR CUFF TEARS? A META-ANALYSIS OF COMPARATIVE CLINICAL STUDIES

To analyse the efficacy and safety of cellular therapy utilizing Mesenchymal Stromal Cells (MSCs) in the management of rotator cuff(RC) tears from clinical studies available in the literature.We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science, and Cochrane Library on August 2021 for studies analyzing the efficacy and safety of cellular therapy (CT) utilizing MSCs in the management of RC tears. VAS for pain, ASES Score, DASH Score, Constant Score, radiological assessment of healing and complications and adverse events were the outcomes analyzed. Analysis was performed in R-platform using OpenMeta [Analyst] software.RESULTS:6 studies involving 238 patients were included for analysis. We noted a significant reduction in VAS score for pain at 3 months (WMD=-2.234,p&lt;0.001) and 6 months (WMD=-3.078,p&lt;0.001) with the use of CT. Concerning functional outcomes, utilization of CT produced a significant short-term improvement in the ASES score (WMD=17.090,p&lt;0.001) and significant benefit in functional scores such as Constant score (WMD=0.833,p=0.760) at long-term. Moreover, we also observed a significantly improved radiological tendon healing during the long-term follow-up (OR=3.252,p=0.059). We also noted a significant reduction in the retear rate upon utilization of CT in RC tears both at short- (OR=0.079,p=0.032) and long-term (OR=0.434,p=0.027). We did not observe any significant increase in the adverse events as compared with the control group (OR=0.876,p=0.869).Utilization of CT in RC tear is safe and it significantly reduced pain severity, improved functional outcome, enhanced radiological tendon healing, and mitigated retear rates at short- and long-term follow-up.