Significant Decrease In Pain Intensity Research Articles

Effectiveness of pharmacopuncture by “alloplant” biomaterial in complex therapy of knee joint osteoarthritis

Background. Osteoarthritis is characterized by a decrease in the quality of life, which is currently considered as the main measure of well-being of an individual and a criterion for the effectiveness of treatment and rehabilitation measures. Modern research emphasizes the need for an integrated approach to the treatment of osteoarthritis, which should include pharmacological and non-drug methods of treatment.
 Aim. The purpose of the study was to evaluate the effectiveness of pharmacopuncture administration of Alloplant biomaterial by patients with osteoarthritis of the knee joint from the standpoint of influencing the immunological mechanisms of the disease.
 Methods. The randomization methodology was divided into 3 groups, comparable in terms of clinical and functional characteristics. Group I patients (n = 39) have standard basic drug therapy according to the federal clinical guidelines Osteoarthritis approved by the Association of Rheumatologists of Russia (2013), with additions from 2016; in patients of group II (n = 39), in addition to drug therapy, dispersed Alloplant biomaterial was used according to the original method; group III patients (n = 39) against the background of basic drug therapy are additionally prescribed a combination of dispersed Alloplant biomaterial at biologically active points and magnetic therapy with a pulsed magnetic field.
 Results. Against the background of the treatment of patients with osteoarthritis using pharmacopuncture with Alloplant biomaterial and magnetotherapy, there was a positive dynamics in clinical data with a significant decrease in pain intensity when walking and at rest, stiffness, with the restoration of immune status parameters and an improvement in the quality of life in the field of physical and psychological health . A more pronounced and lasting positive dynamics was observed in patients of group III against the background of the combined effects of pharmacopuncture with Alloplant biomaterial and magnetotherapy.
 Conclusion. The Alloplant biomaterial has a positive effect in the treatment of patients with stage III osteoarthritis according to the KellgrenLawrens classification. The similarity of the mechanism of action with drugs with a structurally modifying effect on cartilage allows us to recommend pharmacopuncture with Alloplant biomaterial for widespread use in the treatment of osteoarthritis.

Efficacy of an innovative smartphone application for office workers with chronic non-specific low back pain: a pilot randomized controlled trial

Objective: To evaluate the efficacy of a newly developed evidence-based low back pain (LBP) management smartphone application. Design: A double-blinded randomized controlled trial where participants randomly assigned to either an experimental group (EG) or a control group (CG). Setting: Governmental and private institutions. Participants: About 40 office workers, aged 30 to 55 years, had pain due to non-specific LBP > 3 on Visual Analogue Scale, and with pain chronicity > 3 months. Interventions: The EG received full version of the application ‘Relieve my back’ included evidence-based instructions and therapeutic exercises for LBP management, whereas the CG received placebo version included instructions about nutrition. Main measures: Primary outcome measures included pain measured by Visual Analogue Scale (VAS), disability measured by Oswestry Disability Index (ODI), and quality of life measured by Short-Form Health Survey (SF-12). Results: Following six weeks of using the application, compared to CG, the EG group demonstrated significant decrease in pain intensity (−3.45 (2.21) vs −0.11 (1.66), P < 0.001), in ODI score (−11.05 (10.40) vs −0.58 (9.0), P = 0.002), and significant increase in physical component of SF-12 (12.85 (17.20) vs −4.63 (12.04), P = 0.001). Conclusion: ‘Relieve my back’ application might be efficacious in reducing pain and disability and improving the quality of life of office workers with non-specific LBP.

Circle therapy for headache management: case studies

Recent findings have indicated that hypnotic interventions produce significant decrease in pain intensity. This current case studies are focused to highlight significant impact on pain management including headache. All the patients underwent a complete observation and clinical interview and only patients with psychological pain were included in the study group. For the management of headache, a novel hypnotic intervention - Circle Therapy (CT), was applied on a group of ten patients indicating their pain intensity in the range of 8-10 on subjective pain rating scale. According to rating scale, headache above 8 was considered as severe, 5-8 moderate and &lt; 5 as mild. CT is a brief hypnotic technique limited to about 10 min. Post hypnosis ratings were also measured. The pre and post hypnosis data were recorded and analyzed by paired samples t test. Use of CT showed significant results between pre and post rating e.g. 9 ± 0.25 vs. 1 ± 0.21 (p &lt; 0.001). This brief CT intervention provided an immediate relief from headache, however, this is limited to few case studies focusing on just headache. So, we recommend large sample studies to document the effects of CT in different types of pain.&#x0D; Citation: Rafiq M. Circle therapy for headache management: case studies. Anaesth pain intensive care 2020;24(1):__&#x0D; DOI: https://doi.org/10.35975/apic.v24i1.&#x0D; Received – 28 December 2019;&#x0D; Reviewed – 10 January 2020;&#x0D; Accepted - 10 January 2020;

Hypnosis Associated with 3D Immersive Virtual Reality Technology in the Management of Pain: A Review of the Literature.

Hypnosis is well documented in the literature in the management of acute and chronic pain. Virtual reality (VR) is currently gaining credibility in the same fields as hypnosis for medical applications. Lately, the combination of hypnosis and VR was considered. The aim of this scoping review is to understand the current studied contexts and effects of virtual reality hypnosis (VRH) for the management of pain. We searched on PubMed, Taylor & Francis Online, and ProQuest databases with the following terms: “virtual reality,” “3D,” “hypnosis,” and “pain”. We included 8 studies that combined hypnosis and VR. All articles are in English. Two included healthy volunteers and six are clinical studies. Short-term results indicated significant decreases in pain intensity, pain unpleasantness, time spent thinking about pain, anxiety, and levels of opioids. However, results are not consistent for all patients all the days. VR alone seems to reduce pain independently of the hypnotizability level. One study claimed that VR and hypnosis could alter each other’s effects and another argued that VR did not inhibit the hypnotic process and may even facilitate it by employing visual imagery. We cannot affirm that VR added value to hypnosis when they are combined. These trials and case series gave us indications about the possible applications of VRH in different contexts. Additional randomized clinical trials on VRH in the future will have to test this technique in clinical practice and help define guidelines for VRH utilization in pain management.

Evaluation of Post-operative Pain after Irrigation Using End-vented NaviTip Tips versus Vibringe Sonic Irrigating System in Teeth with Acute Pulpitis with Apical Periodontitis: A Randomized Clinical Trial

AIM: This clinical study was conducted to evaluate and compare the post-operative pain after the using of two different irrigating techniques: Vibringe sonic irrigating system with end-vented NaviTip and conventional needle with end-vented NaviTip immediate postoperatively and 4, 12, 24, 48, and 72 h and 7 days utilizing a numerical rating scale (NRS).&#x0D; METHODS: Thirty-eight patients with acute pulpitis with apical periodontitis were involved in this study. Root canals were prepared using NiTi ProTaper Universal rotary system then randomized into two equal groups according to the technique used for irrigation Group A, Vibringe sonic irrigating system with end-vented NaviTip and Group B, conventional syringe with end-vented NaviTip® irrigating tip. The needles of irrigation were penetrated 2 mm shorter than the working length. The trial design of this study is a parallel randomized controlled trial.&#x0D; RESULTS: All demographic data, clinical and radiographic findings, and modified NRS scores obtained from patients were statistically analyzed. Results showed that there was no statistically difference between the two groups regarding the demographic data, prevalence of pre-operative pain, after 4 h, 12 h, 24 h, and 48 h and 7 days, while in both groups, there was a statistically significant decrease in pain intensity preoperatively compared with all other time periods.&#x0D; CONCLUSION: There is no statistical significance difference between Vibringe sonic irrigating syringe with endvented needle and conventional syringe with end-vented NaviTip, while in both groups, there was a statistically significant decrease in pain intensity preoperatively compared with all other time periods.

Efficacy of tolperisone versus meloxicam in the treatment of nonspecific acute neck pain

Neck pain is a widespread disease that significantly impairs quality of life in patients. General approaches to managing patients with acute neck pain are generally consistent with the recommendations for the treatment of acute back pain: its pharmacotherapy includes nonsteroidal antiinflammatory drugs (NSAIDs) and muscle relaxants. Objective of the observational program: to compare the efficiency of treatment for nonspecific acute neck pain with tolperisone 150 mg/day, followed by dose escalation up to 450 mg/day, versus meloxicam 15 mg/day for 14 days. Patients and methods. The observational program covered 37 patients aged 18–65 years who were diagnosed with acute nonspecific neck pain; of them 19 patients made up Group 1 and 18 formed Group 2. Group 1 was prescribed tolperisone (Calmirex) as tablets: 150 mg/day on day 1, 300 mg/day on day 2, and 450 mg/day on day 3 until the end of therapy. On day 1 of the investigation, Group 2 received meloxicam 15 mg/day in two divided doses (7.5 mg in the morning and evening). At baseline and on days 7 and 14 days of therapy, the investigators assessed the dynamics of pain using a visual analogue scale (VAS), as well as its intensity at rest and during movement; neck disability index (NDI) and recorded adverse events. Results and discussion . The two groups showed a significant decrease in pain intensity on both 7 and 14 days of therapy. The rate of effect onset was significantly faster in the meloxicam group. On day 14 of treatment, both patient groups showed a considerably better functional state in terms of activity limitations due to neck pain (NDI); patients' perceptions of therapy were rated as good and excellent in most cases. On 14 days of therapy, the degree of pain reduction in the meloxicam group was higher, but the differences with that in the tolperisone group did not reach statistical significance, which can indicate the comparable efficacy of the drugs. Conclusion. The data of this observational program are consistent with the recommendations for the treatment of nonspecific acute neck pain, which indicate NSAIDs and muscle relaxants as drugs for the treatment of this disease.

Efekti peto- i desetonedeljne primene mehaničkih udarnih talasa na smanjenje bola uzrokovanog hroničnim lateralnim epikondilitisom

Introduction: Shock wave therapy represents a new method in the treatment of lateral epicondylitis - tennis elbow, which achieves good results. Aim: The aim of this paper was to test and analyze the effect of five-week and ten-week shock wave therapy on the reduction of pain intensity in men with lateral epicondylitis, who played tennis recreationally. Materials and methods: The study included 21 male patients, aged 22 - 65 years (x̄ ± sd, 41.7 ± 10.5 years), with the diagnosis of chronic lateral epicondylitis, without calcifications, which had been established with a clinical and ultrasound examination. The subjects were divided into two groups, according to age: the younger group (≤ 40 years) and the older group (> 40 years). Once in seven days, all the patients were treated with shock wave therapy, which was applied with a focused probe (frequency of 10 Hz; 1,600 shocks; pressure at 1.6 bars). The patients had a total of ten therapies. The intensity of pain was determined with the visual analog scale (VAS) for pain. The assessment of pain intensity with the visual analog scale (VAS) was performed before the start of therapy, as well as after five and after ten applications of shock wave therapy, i.e. after five and ten weeks of therapy application. Results: In men with chronic lateral epicondylitis, a statistically significant decrease in pain intensity occurred on the VAS scale (p < 0.001), during the observation period of then weeks. A statistically significant decrease of pain intensity on the VAS scale during the observation period occurred both in patients aged under 40 years (p < 0.001) and in those aged over 40 years (p = 0.001). There was no significant difference in pain intensity between the younger and older men, neither at the beginning of therapy, nor after five and ten shock wave therapy sessions. Conclusion: To conclude, our results indicate that the application of ten shock wave treatments in men with chronic lateral epicondylitis significantly reduces pain.

Immunochemical and electromyographic indicators for assessment of pain status in myofascial back pain syndrome

A complex examination of patients with chronic myofascial pain syndrome (MPS). This study included 136 patients with MPS (66 men and 70 women). Pain was assessed using a Visual Analogue Scale (VAS). Investigation of profiles of natural antibodies (nAbs) to specific opioid peptides (β-endorphin and orphanin), biogenic amines (dopamine and serotonin), surface electromyography (SEMG) of m. errector spinae at the L3-L4 level bilaterally were performed. Measurements were done at 1st, 10th and 21st days of treatment. There was a significant decrease in pain intensity (by 71% in men and by 63% in women) accompanied by a decrease in muscle tension by 10-25% in group values of SEMG amplitudes, and by 34-38% as assessed by individual dynamics of SEMG amplitudes. All nAbs levels were elevated or high in the 1st day. The dynamics of nAbs levels was multidirectional. At the 21st day, there was the increase in the incidence of patients with high nAbs levels to opioid peptides (39-41% women and 33-39% men) and patients with normal nAbs levels to serotonin (59% men and 52% women), while the levels of nAbs to dopamine decreased to normal levels in women (56%) and remained elevated (50%) or highly elevated (17%) in men. The dynamics of immune indicators correlates with pain intensity that possibly reflects the pathological changes in neural/humoral interactions in chronic pain. In this regard, monitoring of nAbs levels is prognostically relevant for assessment of risk of pain chronification.

The Effects of Stabilization Exercise on the Thickness of Lateral Abdominal Muscles During Standing Tasks in Women With Chronic Low Back Pain: A Randomized Triple-Blinded Clinical Trial Study.

Chronic low back pain (CLBP) often presents with a dysfunction in deep abdominal muscles activity during standing tasks. Although some studies indicated that deep abdominal muscle activity improved during some functional tasks following stabilization exercise (SE), there is no study to evaluate the effect of SE on lateral abdominal muscles thickness during standing postural tasks. The purpose of this study was (1)to evaluate the lateral abdominal muscles thickness in the participants with CLBP while standing on a balance board and (2)to compare the effects of SE and a general exercise (GE) program on the lateral muscles thickness changes. This was a between-groups, triple-blinded randomized controlled trial design. In total, 40 females with CLBP were randomly assigned into 2 groups: GE (control group) and supervised progressive SE (experimental group). Diagnostic ultrasound imaging was used before and after the intervention to measure lateral abdominal muscles thickness during standing on 2 different levels of platform in the Biodex Balance System. Visual analog scale and Roland-Morris Disability Questionnaire were used to evaluate changes in pain intensity and disability. The results indicated significant increases in transverse abdominis muscle thickness during all standing tasks (P = .02) and significant decreases in pain intensity and disability following SE intervention (P < .001). However, the lateral abdominal muscle thicknesses were not changed after GE intervention while standing postural tasks (P > .05). The GE group revealed only significant decreases in pain intensity after intervention (P = .03). Supervised progressive SE improved the activity of deep abdominal muscles in standing postural tasks in the patients with CLBP.

Ketamine Infusion in Post-Surgical Pain Management after Head and Neck Surgery: A Retrospective Observational Study

Background: Head and neck cancer affects approximately 382,000 new patients per year worldwide with a significant portion undergoing surgical treatment. During postoperative period key elements in the Intensive Care Unit (ICU) are airway management and pain control. Objective: We evaluated the average change of inpatient pain control using a Numerical Rating Score (NRS). We also evaluated the time of extubation after ICU admission recording the incidence of desaturation and the necessity of re-intubation. Secondary outcomes were the incidence of postoperative complications, included those narcotics-related, and the use of rescue analgesics. Methods: In this retrospective observational study, we analyzed data of registry before and after we have changed our postoperative analgesic protocol from remifentanil infusion to ketamine infusion. Results: Medical records of 20 patients were examined. 10 patients received 0.5 mg/kg ketamine bolus at the end of surgery, followed by a continuous infusion of 0.25 mg/kg/h. All patients presented a significant decrease in pain intensity from the 4th to 48th postoperative hour (p &lt; 0.05), but statically not a significant difference in NRS score was recorded between the two groups. Time to extubation was shorter in ketamine group compared to the remifentanil group (112.30 min ± 16.78 vs. 78 min ± 14.17; p &lt; 0.05). Desaturation rate was 10% in the remifentanil group, while no case was recorded in the ketamine group. Conclusion: The level of analgesia provided by ketamine and remifentanil was comparable. Ketamine was superior in ventilatory management of the patient with more rapid extubation and with no case of desaturation.

The impact of modified exercise and relaxation therapy on chronic lower back pain in office workers: a randomized clinical trial.

This study aimed to evaluate the effectiveness of a modified package of exercise therapy combined with relaxation on pain intensity, range of motion (ROM), anxiety, and quality of life (QoL) in office workers with chronic lower back pain. In this clinical trial, 72 office workers aged 20 to 50 years with chronic low back pain were randomized to one of four groups including; group 1, exercise therapy; group 2, psychotherapy (relaxation therapy); group 3, modified protocol (exercise therapy followed by relaxation therapy); group 4, control group (no intervention). Participants exercised 3 times weekly for 6 weeks for 40–45 min of exercise/relaxation. Pain intensity, ROM, anxiety, and QoL were evaluated at baseline, 6 weeks, and 12 weeks after the end of the intervention. Results showed significant decreases in pain intensity and anxiety in the three experimental groups compared to the control group. The three intervention groups indicated a significant decrease in pain intensity and anxiety after 6 and 12 weeks. ROM significantly improved in the exercise therapy and the modified protocol over time (after 6 and 12 weeks). A significant difference in QoL was found between the groups, with the greatest improvement found in the psychotherapy and modified protocol groups. This therapeutic package (including exercise movements and psychological interventions) was found to have a superior effect on pain intensity, ROM, anxiety, and QoL after 6 and 12 weeks compared to other interventions (only exercise and psychotherapy).

Surgical and medical treatments for discogenic low back radiculopathy

Objective: to compare the efficiency of medical and surgical treatments for discogenic low back radiculopathy.Patients and methods. 32 patients (including 13 men; mean age, 39.1±11.8 years) received inpatient medical treatment with epidural glucocorticoids; 32 patients (including 19 men; mean age. 42.3±12.1 years) had surgical treatment (removal of a herniated disk). A questionnaire [numerical pain rating scale (NPRS), Oswestry disability index, and quality of life questionnaire (QOL), SF-12] survey was carried out on admission to the clinic, after 7–14 days during treatment (pain intensity and functional status), and after 3, 6, and 12 months.Results and discussion. There were no clinical differences between the patient groups at baseline. Both groups showed a significant decrease in pain intensity and reduced disability after 7–14 days of treatment, with a persistent positive effect over 12 months (p &lt; 0.01). During a year, both groups exhibited better quality of life (p &lt; 0.01). In the surgical treatment group, leg pain intensity was noted to become lower in the early stages (NPRS scores were 0.97 vs 2.41 after 7–14 days and 0.84 vs 1.56 scores after 3 months; p &lt; 0.05); however, this advantage did not persist in the long-term. No significant differences were found between the groups in back pain intensity, disability, and QOL indicators throughout the follow-up period.Conclusion. There were no significant clinical differences between patients with discogenic low back radiculopathy who are referred to hospital for surgical or medical treatment. Surgery makes it possible to reduce more rapidly the intensity of leg pain; however, no benefits of surgical treatment in terms of back pain intensity, disability, and QOL are noted. It is advisable to inform patients about the favorable course of the disease and the possibility of natural regression of disc herniation.

The relationships between worry, happiness and pain catastrophizing in the experience of acute pain

The current study aimed to (a) evaluate the effects of an experimental manipulation of worry and happiness on pain perception and measures of worry about pain and pain catastrophizing and (b) determine if changes in situation-specific worry about pain and pain catastrophizing would be related to changes in acute pain. The study included 120 healthy, pain-free volunteers. Participants were exposed to four levels of noxious stimulation and asked to report on the pain intensity, worry about pain and pain catastrophizing they experienced during the stimulation procedures. They were then randomly assigned to either a Happy or a Worry condition, where they were exposed to emotion induction procedures. The noxious exposure procedures and measures of pain, pain-related worry and pain catastrophizing were then repeated. Participants in the Worry condition reported significant increases in pain intensity, and those in the Happy condition reported significant decreases in pain intensity. Further, the Worry condition participants reported significant increases in both pain-related worry and pain catastrophizing, while the Happy condition showed the opposite effects. Finally, changes in worry about pain and pain catastrophizing were found to mediate the impact of the affect induction procedure on pain intensity. The findings demonstrate that pain intensity, worry about pain and pain catastrophizing are all sensitive to changes in mood. The results have potential clinical implications. The current study shows that manipulation-induced changes in pain-related worry, pain catastrophizing, and affect have direct effects on the experience of acute pain. More broadly, the overlap of these three variables provides with anxiety and mood disorders offers the promise of new vistas for research and treatment of pain conditions by assessing and targeting the cognitions and behaviors that are common to worry and catastrophizing.

Relaxation to relieve muscle tension to the upper trapezius level in young adults

Introduction: The tightness and reduction in the flexibility have been reported to be associated with the occurrence of back pain in adolescents and adults [1]. Chronic mechanical neck pain can have a complex clinical presentation and is often difficult to treat [2]. In the clinical population, stretching is used to deal with numerous pathophysiological conditions such as various musculoskeletal disorders in order to provide relief from pain [3]. The purpose of this study was to determine which of these techniques, relaxation of muscle stretching and Laura Mitchell method, is more effective in decreasing the tension of the upper trapezius muscle in young adults. Materials and methods: Sixty young university students with pain and muscle tension in neck, mean age of 22.1 ± 3.8 years old and 79% female, were randomly distributed into three groups. The control group (G1) attended a lecture on stress control techniques, one of the experimental groups (G2) was submitted to Laura Mitchel relaxation method and, the other (G3) was submitted to stretching muscle techniques. The techniques were applied to the respective groups for a period of three weeks, three sessions per week, with 45 to 60 min per session. The variables, pain and muscle tension, were quantified by applying the scale of EVA and electromyography, respectively. was approved by Egas Moniz institutional board. All participants gave their informed consent. Results: At the end of 3 weeks there were only significant differences (p<0.05) on muscle tension measurements, with a decrease, within G3, accompanied by a significant decrease in pain intensity. In G1 and G2 were observed only small variations in pain intensity. Discussion and conclusions: This study revealed that stretching muscle techniques, to relieve upper trapezius muscular tension and pain in young adults, was more effective than Laura Mitchell relaxation technique.

Evaluation of efficacy and safety of long-term use of amtolmetin guacil in rheumatic diseases: results of a 9-month observational AURORA study (Amtolmetin guacil: allRussian Register for Osteoarthritis, Rheumatoid arthritis and Ankylosing spondylitis)

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of rheumatic diseases (RD). In some cases, their long-term use is advisable: NSAIDs slow the progression of spondylarthritis, are an important element in the control of chronic pain in osteoarthritis (OA) and rheumatoid arthritis (RA). However, the risk of serious adverse events (AE) should be considered. A good choice for long-term therapy may be amtolmetin guacil (AMG), which rarely induce gastrointestinal AE.The aimof the study was to assess the effect and safety of long-term use of AMG in RD.Material and methods.An open observational study was conducted in which AMG (Nayzilat) was assigned to 442 patients with OA (mean age 60.6±10.2 years, women 88.7%), 126 patients with RA (55.0±14.0 years, women 84.2%) and 73 with ankylosing spondylitis (AS, 47.0±12.0 years, women 30.0%). The dose of AMG depended on the clinical situation and was determined by the attending physician: from 1800 to 600 mg/day. The main criterion of the effect was the changes of pain by numeric rating scale (NRS), additional measures of efficacy were pain on the WOMAC and HAQ for OA, DAS28 for RA, BASDAI, BASFI and ASDAS-CRP for AS. The result of treatment was evaluated during three consecutive visits every 3 months (9 months of follow-up).Results and discussion.At the end of follow-up 65.2% of patients with OA, 75.3% of patients with RA and 82.2% of patients with AS continued treatment with AMG. The reasons for discontinuation of treatment were significant reduction or absence of pain (70.3%), the patient's decision (26.6%) or AE (3.1%). At the end of follow-up, there was a significant decrease in pain intensity compared to the baseline: in OA, the median pain decreased from 5.6 [4.1; 6.9] to 3.4 [1.7; 5.1], in RA from 5.8 [4.0; 7.5] to 3.4 [2.0; 4.8], in AS from 5.8 [4.2; 7.5] to 3.1 [1.5; 5.0] according to NRS, the difference was significant in all groups (p&lt;0.001). In OA, the median WOMAC pain decreased from 127 [24; 159] to 13.7 [14; 40] (p&lt;0.001), the average HAQ value – from 0.54±0.44 to 0.34±0.26 (p&lt;0.001). In RA, the average value of DAS28 decreased from 4.81±1.18 to 4.30±1.24 (p&lt;0.05). The number of painful and swollen joints, ESR and C-reactive protein also significantly decreased. In AS, the median BASDAI index decreased from 4.5 [1.0; 8.0] to 3.0 [0; 8.0] (p&lt;0.001). The number of patients with high activity according to ASDAS-CRP (&gt;3.5) decreased from 76.9 to 25.8% (p&lt;0.001). The BASFI index did not changed. 77.9% of patients with OA, 77.0% with RA and 74.5% with AS were satisfied with the results of AMG treatment. AMG tolerance was good. Mild dyspepsia was observed in 15–25% of patients. AE, which caused the discontinuation of therapy, were observed only in 6 (0.93%) patients. There was no development or deterioration of hypertension, as well as other cardiovascular complications.Conclusion.AMG is an effective NSAID with good tolerability, which is advisable to use for long-term treatment of RD. Limitations are the open nature of the study and the absence of a control group.

Treatment of uncomplicated vertebral compression fractures

To compare the outcomes of surgical (vertebroplasty) and conservative treatment in management of pain syndrome in patients with uncomplicated spine injury. The study involved 60 patients with stable uncomplicated compression fractures of vertebral bodies in the thoracic and lumbosacral spine. These patients were subdivided into two groups. Group 1 consisted of 30 patients who had undergone unilateral transpedicular percutaneous vertebroplasty; Group 2 involved 30 patients who had undergone a course of conservative treatment. The medical records and the catamnestic follow-up data of patients treated at the Neurosurgery Department of the Research Clinical Center of JSC Russian Railways in 2015-2017 were analyzed for this purpose. No statistically significant differences in sex, age, and level of injury were revealed between the study groups. A comparative analysis of treatment outcomes demonstrated that pain intensity assessed using the VAS scale was significantly reduced after one-year follow-up in both groups as compared to the baseline. A statistically significant decrease in pain intensity in the group of patients who had undergone vertebroplasty was observed as early as one month after the injury. No significant intergroup differences were observed in the long-term follow-up period (3 and 6 months) for this parameter. In five out of 60 patients, examination 12 months after the injury revealed that vertebral body height decreased by up to 10%. No statistically significant correlation with the treatment method was observed. Vertebroplasty provides a statistically better pain relief during the first month after spine injury as compared to conservative treatment. For patients, this means earlier activization and quicker return to daily routines and work.

The efficacy of therapeutic nerve blocks in patients with cervicogenic headache

To compare the efficacy of 2% articaine solution and 2% lidocaine solution used to perform therapeutic nerve blocks of the large occipital nerve in patients with cervicogenic headache. A randomized prospective comparative clinical study was conducted in two groups treated with articaine (n=22) or lidocaine (n=21). The therapeutic great occipital nerve blocks were performed on the 1st, 3d and 5th days of treatment. The efficacy of treatment was assessed by the pain intensity measured with the Visual Analogue scale (VAS) and the duration of individual pain paroxysms on the 5th and 10th days. The baseline VAS pain intensity was 6.3±1.2 and 5.9±2.0 centimeters, whereas the duration of individual pain paroxysms was 7.8±2.3 and 9.1±2.8 hours in the articaine group and the lidocaine group, respectively. By the 5th day, there was a more dramatically decrease in VAS pain intensity and duration in the articaine group (up to 3.0±0.8 and 4.3±1.2 centimeters VAS (p<0.05)) compared to the lidocaine group (up to 1.9±0.6 to 4.8±1.3 hours (p<0.05)). By the 10th day, the pain intensity did not differ between groups (1.2±0.5 and 1.7±0.7 centimeters (p>0.05)). The duration of pain episodes was still lower in the articaine group (0.5±0.08 hours) compared to the lidocaine group (2.4±0.8 hours) (p<0.05). Therapeutic large occipital nerve blocks with 2% solution of articaine show the significant decrease in pain intensity and duration of pain paroxysms in a short period of time for patients with cervicogenic headache.

Effect of Ultrasound Versus Low Level Laser Therapy in Treatment of Postnatal Low Back Pain

AbstractBackground: Postnatal low back pain is considered as a serious health problem worldwide because it certainly can limit function and capacity in both work and personal life.Purpose: To compare between the effect of ultrasound and low level laser in treatment of postnatal low back pain.Participants: Thirty women were diagnosed with postnatal low back pain shared in this study. Their ages were ranged from 20 to 35 years old and their Body Mass Indices (BMI) did not exceed 30kg/m2. Patients with spinal fractures, lumbar spinal stenosis from lumbar disc herniation, degenerative joint diseases, or spondylolisthesis, women with BMI exceed 30kg/m2, patients who had polyneuropathy or other neurolog-ical disorders and patients with skin diseases interferes with ultrasound or laser application are excluded from the study. The study was conducted from June to December 2016.Design: They were selected randomly from outpatient clinic of obstetrics department.Location: This study conducted at Al-Zahraa University Hospital in Cairo, Al-Azhar University.Methods: They were divided randomly into two groups equal in number. Group (A) consisted of 15 women and treated by therapeutic ultrasound three times per week for 4 weeks. Group (B) consisted of 15 women and treated by low level laser therapy three times per week for 4 weeks. Evaluations of all patients in both groups (A & B) were done before and after the treatment program.Outcome Measures: Measuring pain intensity with VAS, lumber flexion and extension range of motion with Modified Schober method as well as lateral flexion for right and left sides with tape measurement.Results: There was a statistically significant improvement of pain intensity, significant improvement of lumbar flexion, extension ROM and significant improvement of lateral side bending for right side and left side in both groups (A & B) when comparing post-treatment values to its corresponding pre-treatment values. When comparing both groups together, LLLT group (B) showed significant decrease in pain intensity, significant increase in lumbar flexion and extension and significant improvement of trunk side bending for right side and left side compared with ultrasound group (A).Conclusion: The study revealed that both ultrasound and low level laser therapy are effective modalities for treating post-natal low back pain, as there were significant differences in pain intensity, flexion, extension and lateral side bending ROM after treatment. LLLT is better than ultrasound in decreasing pain intensity and increasing lumbar flexion, extension and lateral side bending ROM.

Effectiveness of myofascial release after breast cancer surgery in women undergoing conservative surgery and radiotherapy: a randomized controlled trial.

The scars derived from the treatment of breast cancer lead to adverse effects such as fibrosis or retractions of the connective tissue. Myofascial release (MR) seeks to reduce restrictions of the fascial system. Therefore, the aim of this study was to analyze the clinical impact of MR treatment on women survivors of breast cancer. We enrolled 24 women with breast cancer, 13 received myofascial release treatment (MR) and 11, a placebo manual lymphatic drainage treatment (PMLD). Both interventions were administered over a period of 4weeks. The outcomes studied were pain, shoulder range of motion (ROM), functionality, quality of life (QoL), and depression, immediately after treatment and 1month later. After 4weeks of treatment, only the participants who received MR experienced a significant decrease in pain intensity in the short and midterm (p < 0.05). This therapy also achieved a general improvement in ROM (p < 0.05), except for internal rotation, that persisted 1month after treatment. Regarding functionality, both therapies achieved the level of significance (p < 0.05), but only MRG sustained the improvement in the midterm. General QoL, assessed with FACT-B, and its physical well-being dimension were significantly improved after MR implementation (p < 0.05), while the emotional dimension and the breast cancer subscale improved only with PMLD (p < 0.05). In conclusion, an MR-based treatment shows physical benefits (i.e., overall shoulder movement, functionality, and perceived pain) in women after breast cancer surgery. This study is registered on ClinicalTrials.gov NCT03182881.

Comparative evaluation of the efficiency of a sumatriptan/dexketoprofen combination versus sumatriptan monotherapy in the treatment of a migraine attack

Migraine is a chronic brain disease with a high prevalence and a marked deterioration in quality of life. Triptans are the gold standard for migraine attack therapy, but they are not effective in all patients. The aim of an observational program was to compare a sumatriptan/dexketoprofen combination and sumatriptan monotherapy for attack relief. Patients and methods. The observation program included 38 migraine patients. A migraine attack was relieved with a combination of sumatriptan 100 mg and dexketoprofen 25 mg in 20 patients and with only sumatriptan 100 mg in 18 patients (Group 2). All the study participants filled out a questionnaire in which they indicated the time of attack onset, the time of drug intake, the intensity of pain, and the presence of concomitant symptoms (nausea, phono-and photophobia) before and 0.5, 1, 2, 4, 8, and 24 hours after drug administration. The investigators estimated the key indicators of the observation program: pain relief at 2, 4, 8, and 24 hours and a significant decrease in pain intensity at 30 minutes, 1 and 2 hours. Therapy satisfaction was determined using the Patient Perception of Migraine Questionnaire (PPMQ) that the patients filled out at 24 hours after the attack. Results. A larger number of patients receiving combined therapy with sumatriptan 100 mg and dexketoprofen 25 mg noted a significant decrease in the intensity of headache at 1 hour and the absence of pain at 2 and 4 hours compared with those in the sumatriptan monotherapy group. According to the PPMQ questionnaire, the combined therapy group showed higher treatment satisfaction. Conclusion. The combination of sumatriptan 100 mg and dexketoprofen 25 mg was shown to have some advantage over sumatriptan 100 mg monotherapy in treating migraine attack. The results of the observation program are correlated with those of previous studies. The higher efficiency of combined therapy with triptan + nonsteroidal anti-inflammatory drugs versus that of monotherapy with triptans reflects a variety of pathophysiological processes that accompany a migraine attack, as well as the presence of several targets for pathogenetic therapy.