Severity Of Rest Pain Research Articles

Effectiveness of dry needle therapy in patients with chronic nonspecific low back pain

Background: Low back pain is a prevalent symptom worldwide, with various underlying causes, making differential diagnosis essential. This study aims to investigate the efficacy of dry needling treatment added to exercise in patients with chronic Nonspecific Low Back Pain (NLBP). The McKenzie exercise program was applied to all participants.Materials and Method: The study comprised sixty participants, randomly allocated into two groups: the dry needling (DNG) and the exercise group (EG). The participants in DNG received a total of six sessions of dry needling treatment, two days a week, to the gluteus medius and quadratus lumborum and multifidus muscles. All participants were given a McKenzie exercise program two sets per day for three weeks.Results: A significant difference was noted in the VAS-night values of the patients within the DNG before treatment (p: 0.004), and the EG also exhibited a significant difference in the VAS-activity (p: 0.017) and VAS-resting (p: 0.024) values following the treatment. A statistically significant decrease was observed in favor of DNG in VAS-rest, VAS-night, VAS-activity values (p>0.001) in the comparions of the groups.Conclusions: Dry needling treatment added to exercise therapy in chronic NLBP patients is effective on activity and rest pain severity in the shortterm results. However, no additive efficacy of dry needling treatment was found on the number of trigger points, disability, and depression.

Improved Perioperative Sleep Quality or Quantity Reduces Pain after Total Hip or Knee Arthroplasty: A Systematic Review and Meta-Analysis.

ObjectiveTo investigate the effects of improved perioperative sleep on pain, analgesic consumption, and postoperative nausea and vomiting (PONV) in patients who were undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA).MethodsOriginal studies published from 1 January 1970 to 30 September 2020 were queried in three unique databases using a common search term. The searches sought randomized controlled trials (RCT) investigating the effectiveness of sleep quality or quantity interventions for pain control early after TKA or THA. Grey literature was also searched by screening trial registers. There was no limitation on published language and patients. Two reviewers then assessed studies for eligibility. Eligible studies should have primary outcomes including perioperativeWe have comfirmed the edits. visual analogue scale (VAS) pain score and analgesic consumption; and secondary outcomes including side effects, such as PONV. Data extracted from the literature were abstracted into a comma‐separated database spreadsheet using Microsoft Excel. A meta‐analysis was then performed. Pooled statistics were calculated with weighting by inverse variance assuming a random effect model. I2 was calculated as a quantifier of heterogeneity and interpreted according to the Cochrane manual. All data analysis was performed using Revman software.ResultsFrom a total of 1285 potential records identified in the electronic search, six studies eventually fulfilled the eligibility criteria. The six controlled RCTs consisted of 207 patients in the sleep‐improving group and 209 patients in the control group. The severity of rest pain was significantly lower in the sleep‐improving group compared with the control group at day 1 and day 3 postoperatively; the severity of active pain was significantly lower in the sleep‐improving group compared with the control group at day 3 postoperatively. Data concerning analgesic drugs could not undergo a meta‐analysis due to the difference of eligible studies. No significant difference was found in the incidence of PONV between the sleep‐improving group and the control group.ConclusionImproved perioperative sleep, regardless of quality or quantity, could significantly reduce the pain level at the early stage after TKA or THA, thus the total amount of analgesic drugs consumed was decreased, without significant increase in the incidence of PONV.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

Perineural Liposomal Bupivacaine Is Not Superior to Nonliposomal Bupivacaine for Peripheral Nerve Block Analgesia.

Liposomal bupivacaine is purported to extend analgesia of peripheral nerve blocks when administered perineurally. However, evidence of the clinical effectiveness of perineural liposomal bupivacaine is mixed. This meta-analysis seeks to evaluate the effectiveness of perineural liposomal bupivacaine in improving peripheral nerve block analgesia as compared with nonliposomal local anesthetics. The authors identified randomized trials evaluating the effectiveness of peripheral nerve block analgesic that compared liposomal bupivacaine with nonliposomal local anesthetics. The primary outcome was the difference in area under the receiver operating characteristics curve (AUC) of the pooled 24- to 72-h rest pain severity scores. Secondary outcomes included postoperative analgesic consumption, time to first analgesic request, incidence of opioid-related side effects, patient satisfaction, length of hospital stay, liposomal bupivacaine side effects, and functional recovery. AUC pain scores were interpreted in light of a minimal clinically important difference of 2.0 cm · h. Nine trials (619 patients) were analyzed. When all trials were pooled, AUC pain scores ± SD at 24 to 72 h were 7.6 ± 4.9 cm · h and 6.6 ± 4.6 cm · h for nonliposomal and liposomal bupivacaine, respectively. As such, perineural liposomal bupivacaine provided a clinically unimportant benefit by improving the AUC (95% CI) of 24- to 72-h pain scores by 1.0 cm · h (0.5 to 1.6; P = 0.003) compared with nonliposomal bupivacaine. Excluding an industry-sponsored trial rendered the difference between the groups nonsignificant (0.7 cm · h [-0.1 to 1.5]; P = 0.100). Secondary outcome analysis did not uncover any additional benefits to liposomal bupivacaine in pain severity at individual timepoints up to 72 h, analgesic consumption, time to first analgesic request, opioid-related side effects, patient satisfaction, length of hospital stay, and functional recovery. No liposomal bupivacaine side effects were reported. Perineural liposomal bupivacaine provided a statistically significant but clinically unimportant improvement in the AUC of postoperative pain scores compared with plain local anesthetic. Furthermore, this benefit was rendered nonsignificant after excluding an industry-sponsored trial, and liposomal bupivacaine was found to be not different from plain local anesthetics for postoperative pain and all other analgesic and functional outcomes. High-quality evidence does not support the use of perineural liposomal bupivacaine over nonliposomal bupivacaine for peripheral nerve blocks.

Analgesic efficacy of cannabinoids for acute pain management after surgery: a systematic review and meta-analysis

BackgroundEvidence regarding the role of cannabinoids in managing acute postoperative pain is conflicting. The purpose of this systematic review and meta-analysis was to determine the analgesic efficacy of perioperative cannabinoid...

Bone Marrow Stem Cell Therapy (SCT) for Peripheral Arterial Disease (PAD): an Initial Experience

Introduction: 30% of patients with critical limb ischaemia (CLI) are not suitable for conventional treatment. Use of stem cell therapy (SCT) is relatively new. This study shares an initial experience using SCT in 4 patients. Methods: Approval from Institutional Medical Board Ethics Committee was obtained prior to commencement and informed consent was sought. Patients included had extensive CLI history that was no longer amenable to standard treatment. Bone marrow aspiration from the iliac crest was carried out under regional anaesthesia. This was later centrifuged and injected intramuscularly and adjacent to affected vessels. Wound surveillance was then performed. Results: SCT was well tolerated in all 4 patients and 2 had favourable results. None developed related complications. Patients 1 and 2 showed improvement of rest pain, claudication symptoms and healing of ulcers. Angiogenesis and neovascularization can be seen in follow up angiography for patient 1. Wound healing was not noted in the other 2 patients, with both requiring amputations eventually. Discussion: The experience while early has been invaluable. The varied response suggests that factors determining treatment success remained unknown. Likewise, most other trials have consisted of small uncontrolled patient series, with few randomized studies. Haemodialysis, diabetes mellitus and coronary arterial disease factors seemed to negatively affect angiogenesis. Severity of rest pain and number of repeated interventions, in particular bypass procedures, may negatively intervene with neo-capillary formation. SCT may eventually provide hope to patients and physicians. More research can help determine a specific group of patients that will benefit most.

EVALUATION OF SAFETY AND EFFECTIVENESS OF HYLAN GF-20 IN PATIENTS WITH KNEE OSTEOARTHRITIS IN REAL LIFE PRACTICE: PRELIMINARY RESULTS

Combined conservative treatment of osteoarthritis includes intra-articular injections of hyaluronic acid. The paper presents the interim results of a prospective observational multicenter non-comparative study conducted in accordance with routine clinical practice to assess the safety and effectiveness of Hylan GF-20 in patients with knee osteoarthritis. The primary objective of the study is to assess walking and rest pain severity by WOMAC VA3.1 scale after 26 weeks and 52 weeks compared to the baseline. To date, 42 patients completed the study (71.43% women, 28.57% men), patients mean age is 59.79 years. After intraarticular injection of Hylan GF-20 patients were examined after 3, 6 and 12 months. After 3 months a positive clinical response was observed: pain severity decreased by 51.31% (p0,001) on WOMAC A, joint stiffness decreased by 51.02% (p0,001) on WOMAC B, daily life difficulties decreased by 42.03% (p0,001) on WOMAC C. The same tendency was observed in the following periods. By week 52 pain severity reduced by 53.25% (p0,001) on WOMAC A, joint stiffness by 41.63% (p0,001) on WOMAC B, daily life difficulties -by 47.55% (p0.001) on WOMAC C. Level of clinical response didn't correlate with the osteoarthritis stage. Therapy resulted in improvement of life quality of patients with knee osteoarthritis by 36% (p0,001) according to the questionnaire EQ-5D. The general patients status according to physicians improved by 33.96% (p0,001) on VAS, and by 45.91% (p0,001) according to patients response on VAS. By week 52 of follow-up 11,90% of patients demonstrated a decrease in required concomitant therapy of osteoarthritis. Given the chronic nature of the osteoarthritis it's the most important that the therapeutic effect of Hylan GF-20 maintains until week 52. The above results confirm the efficiency of intraar-ticular injection of hyaluronic acid in patients with knee osteoarthritis especially in early disease stage.

Combination of Autologous Transplantation of G-CSF–mobilized Peripheral Blood Mononuclear Cells and Panax notoginseng Saponins in the Treatment of Unreconstructable Critical Limb Ischemia

The aim of this study is to explore the efficacy and safety of the combination of autologous transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood mononuclear cells (PBMNCs) and Panax notoginseng saponins (PNS) in the treatment of unreconstructable critical limb ischemia (CLI). We performed an open-label, parallel-group, single-center, randomized clinical trial in this study. A total of 52 patients were enrolled and randomly divided into 2 groups (the PBMNC + PNS group and the PBMNC group) in a 1:1 ratio. Evaluation variables, including changes in the ankle-brachial index (ABI) of ischemic limbs, ulcer area, severity of rest pain, transcutaneous oxygen pressure (T(C)PO2), and 6-min walk distance from baseline to week 8 and 16, as well as angiographic scores for new collateral vessel formation at week 16, were used to compare the benefits of these 2 treatment approaches. After 16 weeks of treatment, improvement in ABI, T(C)PO2, and 6-min walk distance was significantly better in the PBMNC + PNS group. In addition, the combination of PBMNC transplantation and PNS administration yielded a greater reduction in ulcer area and severity of rest pain than did PBMNC transplantation alone. The proportion of patients experiencing any adverse event was similar between both treatment groups. Adverse events caused by PBMNC transplantation or PNS were generally mild and no serious adverse events occurred throughout the entire period of study. A combination of PNS and PBMNC transplantation appears to be a safe and effective treatment for patients with unreconstructable CLI. This combination may have great potential advantages in comparison with PBMNC transplantation alone and might constitute a novel therapeutic option for unreconstructable CLI.

Improvement in Blood Supply After “Heparin-Dextran” Therapy in Patients of Buerger’s Disease with Critical Limb Ischemia

Alleviating the agonizing pain of critical limb ischemia (CLI) in patients of Buerger's disease (BD) has been challenging, due to lack of definitive treatment; "Heparin-Dextran" infusion has been tried in this study. Assessment of clinical improvement and vascular changes following therapy. Patients with CLI admitted to emergency surgical ward were studied prospectively. BD was diagnosed by Shionoya's criteria, and confirmed by digital subtraction angiography (DSA). Heparin and Dextran intravenous infusion was administered for 10days. Severity of rest pain, ischemic changes in the feet, claudication distance and ankle brachial index (ABI) were estimated prior to therapy, at completion and 3weeks after therapy. Vascular changes were assessed by CT angiography (CTA) performed prior to and 3weeks after therapy. Twenty consecutive patients were studied. Successful hemodilution reflected by decreased hematocrit (37.4 % to 32.6%, p < 0.05) and increased mean ABI (0.46 to 0.83, p < 0.01), improved rest pain in 75% patients (p < 0.001), increased claudication distance in 94% (p < 0.05) and ulcers healing in 70% patients. CTA revealed recanalised vessels (decreased length of occluded segments) in 10 (50%, p = 0.005), increased collaterals in 12 (60%, p < 0.01) and improved distal run-off in 13 (65%, p < 0.01) patients. "Heparin-Dextran" therapy in patients of CLI from BD improves tissue perfusion by increasing collaterals and recanalisation of vessels, resulting in significant relief from rest pain and clinical improvements. CTA is as efficacious as DSA for evaluation of BD.

Abstract 5091: Long-Term Clinical Outcome of Therapeutic Angiogenesis by Autologous Transplantation of Bone Marrow Mononuclear Cells for Patients With Chronic Limb Ischemia - Results of the TACT Trial, Prognosis, Efficacy and Safety

Therapeutic Angiogenesis by Cell Transplantation (TACT) study is the first randomized controlled angiogenic cell therapy by intramuscular injection of autologous bone marrow mononuclear cells (BM-MNCs) in the patients with critical limb ischemia. The feasibility of TACT was reported in the Lancet (2002). Objective and Results The present study was designed to assess the 3-year safety and clinical outcomes of this angiogenic cell therapy by investigating the mortality and leg amputation-free interval as primary endpoints. Three year overall survival rates were 80% in patients with peripheral artery disease (PAD) (11 died in 74 patients) and 100% (no death) in 41 patients with thromboangiitis obliterans (TAO, Buerger’s disease). Three-year amputation-free rate was 60% in PAD and 91% in TAO patients (Fig ). These mortality and amputation-free rate were lower than the historical data from the conventional therapies. The multi-variate analysis revealed that the severity of rest pain and repeated experience of bypass surgery are the prognostic factors negatively affecting amputation-free interval. The significant improvement in the rest pain, ulcer size and walking distance was maintained during at least 2 year after the therapy. Conclusions The present study demonstrates that the angiogenic cell therapy using BM-MNCs has an ability to induce a long-term efficient increase in the regional perfusion in ischemic limbs, leading to extension of amputation-free interval. The safety and efficacy are superior to the conventional revascularization therapies. The severity of rest pain and the history of bypass surgery negatively influence the responsiveness to this cell therapy.

Long-term clinical outcome after intramuscular implantation of bone marrow mononuclear cells (Therapeutic Angiogenesis by Cell Transplantation [TACT] trial) in patients with chronic limb ischemia

Angiogenic cell therapy by intramuscular injection of autologous bone marrow mononuclear cells was first attempted in patients with peripheral artery disease (PAD) with critical limb ischemia, and the feasibility was shown by a randomized controlled Therapeutic Angiogenesis by Cell Transplantation (TACT) study. The present study was designed to assess the 3-year safety and clinical outcomes of this angiogenic cell therapy by investigating the mortality and leg amputation-free interval as primary end points. The median follow-up time for surviving patients was 25.3 months (range, 0.8-69.0 months), and 3-year overall survival rates were 80% (95% CI 68-91) in patients with atherosclerotic peripheral arterial disease (11 died in 74 patients) and 100% (no death) in 41 patients with thromboangiitis obliterans (TAO; Buerger's disease). Three-year amputation-free rate was 60% (95% CI 46-74) in PAD and 91% (95% CI 82-100) in patients with TAO. The multivariate analysis revealed that the severity of rest pain and repeated experience of bypass surgery were the prognostic factors negatively affecting amputation-free interval. The significant improvement in the leg pain scale, ulcer size, and pain-free walking distance was maintained during at least 2 years after the therapy, although the ankle brachial index and transcutaneous oxygen pressure value did not significantly change. The angiogenic cell therapy using bone marrow mononuclear cells can induce a long-term improvement in limb ischemia, leading to extension of amputation-free interval. The safety and efficacy are not inferior to the conventional revascularization therapies.

Intravenous pentoxifylline for the treatment of chronic critical limb ischaemia

To investigate the safety and efficacy of intravenous pentoxifylline infusion therapy, 600 mg twice daily for up to 21 days, for the management of patients with chronic critical limb ischaemia (CLI). A prospective, randomised, double-blind, placebo-controlled, parallel-group, multicentre trial. County and university hospitals in six European countries. A total of 314 patients suffering from CLI were enrolled: 157 patients were allocated to each treatment. Patients were reviewed after 7 days of treatment and continued in the study for up to a further 14 days if their condition had not deteriorated. Rest pain (assessed by pain score and visual analogue scale), sleep disturbances and analgesic consumption were measured. Both intention-to-treat and per protocol analyses showed significantly positive results in favour of pentoxifylline over placebo. Severity of rest pain was consistently and significantly lower as shown by the results of the pre-infusion pain scores (p = 0.007), pain visual analogue scales (p < 0.001) and scores describing rest pain-related sleep disturbances (p = 0.003). Treatment response was not influenced by the presence of diabetes mellitus or by eligibility for surgery. These results justify the use of intravenous pentoxifylline infusion therapy for the management of rest pain in patients with CLI.

Primary osteoarthritis of the hip. Interrelationship between intraosseous pressure, X-ray changes, clinical severity and bone density.

The intraosseous pressure of the femoral head and greater trochanter was measured during 146 Charnley hip replacement operations. In 108 hips with primary osteoarthritis the pressure in the femoral head averaged 49.6 and in the greater trochanter 31.6 mmHg. The pressures in the greater trochanter were significantly lower than those in the femoral head. There was no sex difference, and the pressures were independent of age. The intraosseous pressure in the femoral head varied appreciably with a dispersion which did not significantly differ from the normal distribution. There was a faintly positive correlation between the mean blood pressure and the intraosseous pressure. No relationship was found between the pressure in the femoral head and the radiological severity of the osteoarthritis or between the intraosseous pressure and the duration of symptoms, severity of rest pain, walking ability, range of motion or degree of bone density at the site of measurement. The haemodynamic conditions in bone depend upon blood flow and resistance. Variations in these two factors determine the actual intraosseous pressure. As a consequence intraosseous pressure measurement as the only evaluation of the haemodynamic conditions is of limited value. The vascular factor in osteoarthritis needs further clarification.