Significant Decrease In Visual Analogue Scale Research Articles

Low-level Laser Treatment Relieves Pain and Neurological Symptoms in Patients with Carpal Tunnel Syndrome

[Purpose] This placebo-controlled study investigated the therapeutic effects of low-level laser treatment (LLLT) on the transverse carpal ligament in carpal tunnel syndrome (CTS). [Subjects and Methods] Idiopathic CTS patients were recruited and were randomly assigned to two groups. The laser group (n = 45) received laser treatment (10 Hz, 60 mW, 9.7 J/cm2, 830 nm), and the placebo group (n = 42) received sham laser treatment. The visual analog scale (VAS), Boston Questionnaire scale, neurological symptoms and nerve conduction study (NCS) were conducted before, immediately after and 5 weeks after the treatment. [Results] After LLLT, there was statistically significant decrease in VAS in the laser group (p<0.05). Especially, the effect of LLLT on pain alleviation in the mild CTS group continued after five weeks. Regarding the Boston Questionnaire scale neurological symptoms and NCS, only mild CTS patients in the laser group showed statistically significant improvements after treatment (p<0.05). [Conclusions] LLLT with 830 nm diode lasers on the transverse carpal ligament had verifiable therapeutic effects for mild CTS patients.

Single-stage posterior debridement and transforaminal lumbar interbody fusion with autogenous bone grafting and posterior instrumentation in the surgical management of lumbar tuberculosis

To describe a case series to highlight the clinical effectiveness of single-stage posterior debridement and transforaminal lumbar interbody fusion (TLIF) with autogenous bone grafting and posterior instrumentation in the surgical management of lumbar tuberculosis. This case series involves 14 lumbar tuberculosis patients treated with the above given surgical procedure. The following parameters have been evaluated: visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR) and C-reactive protein value, vertebral body loss, deformity angle, kyphotic angle, lumbar lordotic angle and fusion status of affected segment. The mean time of follow-up is 38.2 months (30-46). Significant improvement was found in all radiologic parameters, and significant decrease in VAS and ESR were noted after surgery. Bony fusion was seen in all cases within a mean time of 4.3 months (range 3-7 months). No postoperative instrumental complication and recurrence were noted. Single-stage posterior debridement and TLIF with autogenous bone grafting and posterior instrumentation is a safe and effective approach to treating with early-diagnosed and less-involved lumbar tuberculosis.

Intra-peritoneal bupivacaine alone or in combination with morphine in patients undergoing vertical bypass gastroplasty

Background and knowledge: Intra-peritoneal instillation of local anesthesia and morphine has been used to alleviate post-operative pain in laparoscopic surgery. Controversy exists about the efficacy of this technique. Methods: We studied 48 patients scheduled for Vertical Bypass Gastroplasy (VBG). All of them received the same technique of general anesthesia (GA). Patients were randomly allocated into four equal groups. They received equal volumes of the test drug instilled in the peritoneal cavity at the end of laparoscopy, 50 ml of normal saline (Group S): 50 ml of bupivacaine 0.25% (Group B), 50 ml of bupivacaine 0.25%, plus morphine 40 mcg.kg-1 (maximum of 5 rug) Group M or (Group D) patients received the same regimen as Group M in addition, they received 75 mg intra-muscular diclophenac after induction of general anesthesia. Wound edges were infiltrated with 10 ml bupivacaine 0.25% in all patients. Morphine 25-50 mcg.kg-1 was given intravenously every 10 mm as a rescue analgesic to control postoperative pain in Post Anesthesia Care Unit (PACU). Post operative pain was evaluated using Visual Analogue Scale (VAS). vital signs and morphine consumption, and time to receive rescue analgesia were measured at different intervals. The incidence of postoperative complications (respiratory depression. oxygen de-saturation. arid nausea and vomiting) was recorded as well as hospital stay. Results: There was significant decrease in VAS, HR. MBP and morphine consumption in Groups M & D when compared to Groups S & B on admission and on discharge from PACU. There were significant decrease in time to receive rescue analgesia as well as significant reduction in hospital study in Groups M and D when compared to Groups S and B. However, there was no significant difference between group S & B regarding the same parameters. Conclusions: The presented technique is safe and easy to use with good postoperative morphine sparing analgesia, excellent patient satisfaction and short hospital stay.

Bilateral thoracic paravertebral block versus intraperitoneal bupivacaine for pain management after laparoscopic cholecystectomy

Background and Objectives: The efficacy of bilateral thoracic paravertebral block (TPVB ) was compared to intraperitoneal ( IP ) bupivacaine in reducing postoperative pain following laparoscopic cholecystectomy (LC ) using a prospective randomized study design. Methods: We studied forty two patients scheduled for laparoscopic cholecystectomy. All of them received the same technique of general anaesthesia. Patients were randomly allocated into 3 equal groups, 14 patients each; Group PV received bilateral thoracic paravertebral block at T5-6 level with 25 mL of bupivacaine 0.25 % with epinephrine 1 : 200.000 on each side, Group IP received 50 mL of bupivacaine 0.25 % with epinephrine 1: 200.000 sprayed into the peritoneal cavity immediately after the pneumoperitoneum, and Group GA, received general anaesthesia only. Postoperative pain was assessed used visual analogue scale (VAS) and analgesic requirements and complications were recorded. Results: There was significant decrease in VAS, HR, MAP, and morphine consumption in groups PV & IP when compared to group GA, also there were significant prolongation in time to rescue analgesia and reduction in hospital stay in group PV and IP compared to group GA. In comparison between the 2 active groups, paravertebral block was significantly superior to intraperitoneal bupivacaine in all parameters. Conclusion: Both TPVB and IP bupivacaine are effective in reducing pain after LC. TPVB is superior to IP bupivacaine in controlling postoperative course of LC.

Use of Tramadol Drip in Controlling Renal Colic Pain

Although the continuous perfusion of antispasmodic drugs has been the traditional mainstay in the treatment of renal colic, the results more often than not are unsatisfactory. Our hypothesis was that a continuous intravenous (IV) drip of tramadol would be an effective and safe alternative. In this prospective study, 300 patients with renal colic were randomized into four treatment groups, single blind for the patients. At the start, all received an anti-inflammatory drug intramuscularly and an antiemetic and antispasmodic IV. Group A was given the classical IV antispasmodic perfusion combined with a sham drip. Group B received the classical antispasmodic perfusion in combination with a tramadol drip. Group C had a sham perfusion and drip. Group D received a sham perfusion and tramadol drip. There was no significant difference in the degree of pain between the groups on a visual analog scale (VAS) at the start. The pain was scored again on the VAS at 30 minutes, 1 hour, and 4 hours after the start of the treatment and at IV urography. Side effects, as well as the need for rescue medication, were registered. Both tramadol groups scored significantly better after 60 and 240 minutes and during IV urography (P < 0.005). There was a significant decrease in VAS in group B after 30 minutes. The tramadol groups needed significantly less rescue medication (P = 0.001). There was no significant difference in the reported side effects. The combination spasmolytic-tramadol drip scored the best, although the difference was not statistically significant. We consider our hypothesis proved that a continuous tramadol drip is a safe and valuable analgesic regimen in renal colic.

Affective Images: Relieving Chronic Pain and Enhancing Quality of Life for Older Persons

With increasing life expectancy, the incidence of chronic illness and chronic pain also increase. Chronic pain robs older people of their quality of life, and limits functional mobility and ambulation, which leads to muscle atrophy. Older people are often reluctant to request pain relief, attempting to endure pain as a "normal" part of ageing. Innovative non-pharmacological interventions in pain management are appealing. In this study, affective images and pictures were used in 15 elderly patients (12 female and three male) in chronic pain who needed to perform stretching and standing exercises in their physiotherapy sessions. Pain scores were measured by the Visual Analogue Scale (VAS), and health-related quality of life was measured by the Medical Outcomes Study Short Form 36 (SF-36). VAS and SF-36 were administered in weeks 1 and in 6. Pain scores were measured during physiotherapy session in the following weeks. There was a significant decreased in VAS from week 1 to week 6 (t = 3.607; df = 14; p < 0.05). Also, a significant decrease in VAS occurred when the patients were watching affective pictures while performing the physiotherapy exercise in weeks 2 and 3, but not in weeks 4 and 5. SF-36 increased in week 6, which indicated an increase in health-related quality of life, though not statistically significant. Affective images and pictures appear to be an effective non-pharmacological intervention in pain management for the older person.

The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis

Objective: Evaluation of the effect of a ginger extract (Zintona EC) on patients suffering from gonarthritis. Material and methods: Twenty-nine patients (6 men and 23 women) with symptomatic gonarthritis (ACR criteria), in the age range 42–85 years, were included after randomization in a double blind, placebo controlled, crossover study of 6 months' duration. The treatment group was given a ginger extract (250 mg of Zingiberis Rhizoma per capsule, qid), while the placebo group received the same number of identical looking capsules per day. The crossover occurred after 3 months of therapy. Results were evaluated by a 100 mm visual analog scale (VAS) of pain on movement and of handicap. Results: Eight patients dropped out because of inefficacy, three from group 1 (ginger extract first) and five from group 2 (placebo first). One patient from group 1 and one from group 2 dropped out because of heartburn (while they were on ginger extract). Twenty patients completed the study period of 24 weeks and 19 that of 48 weeks follow-up. By the end of 24 weeks there was a highly statistically significant difference between the VAS of pain and handicap of the two groups ( P<0.001). However, at crossover both groups showed a statistically significant decrease in VAS of pain on movement and of handicap, but the differences between the groups did not reach statistical significance. Conclusions: Zintona EC was as effective as placebo during the first 3 months of the study, but at the end of 6 months, 3 months after crossover, the ginger extract group showed a significant superiority over the placebo group.