Significant Difference In Pain Reduction Research Articles

Hyoscine-n-butylbromide in treating abdominal pain caused by gastroenteritis: a double-blind randomized placebo-controlled study.

Hyoscine-N-butylbromide (HBB) is an anticholinergic agent widely used to treat pain caused by spasms in the gastrointestinal and urogenital systems. The aim of this study was to compare the efficacy of HBB with a placebo in treating abdominal cramping pain caused by acute gastroenteritis in the emergency department (ED). This was a prospective, double-blind, placebo-controlled, randomized trial conducted in a single-center academic ED from September to November 2021. Patients aged 18-65 years with acute gastroenteritis symptoms were included. The study compared the efficacy of intravenous HBB (20 mg) to a placebo. The primary outcome was the absolute change in pain score at 30 min after treatment, with secondary outcomes including pain relief at 60 min, adverse events, and the need for rescue analgesics. Fifty patients were randomized (25 in each group). There was no significant difference in 30-min and 60-min pain scores between the groups. At 60 min, pain reduction and the need for rescue analgesia were similar in both groups. Changes in pain scores from admission to 30 and 60 min did not significantly differ between the groups. Intravenous HBB did not show a statistically or clinically significant difference in pain reduction compared to a placebo in patients with acute gastroenteritis and cramping abdominal pain in the ED.

Exploring intradermal sterile water injection as an alternative to natrium diclofenac for kidney-stone related pain relief: A systematic review and meta-analysis of randomized controlled trials.

Kidney stone-related pain often presents significant challenges in clinical practice, mainly due to the adverse effects by NSAIDs, which are the current first-line treatment for urolithiasis. Patients presenting with gastrointestinal tract disorders and contraindications toward NSAIDs are particularly susceptible. Intradermal sterile water injection (SWI) has evidently become apparent as one of the promising alternatives, offering rapid pain relief with minimal adverse effects. This purpose of this study to assess the safety and efficacy of SWI in comparison to NSAIDs particularly Natrium Diclofenac in the management of kidney-stone related pain. A systematic review and meta-analysis was performed on papers published up to January 2024 obtained from scientific databases, guided by the PRISMA flowchart. The Cochrane risk of bias 2.0 tool was used to assess quality of the included studies. Statistical analyses were then performed using Review Manager 5.4.1 on studies that provide the baseline and complete follow-up numerical outcomes (e.g. mean and standard deviation) required. After screening was done, 3 retrievable studies met the inclusion and exclusion criteria with a total of 770 participants with kidney stone related pain. The result revealed no significant difference in pain reduction between SWI and Natrium diclofenac at 30 min (MD -0.12, 95% CI -0.68 to 0.44) and 60 min (MD -0.23, 95% CI -0.65 to 0.18). Furthermore, patients treated with SWI display a reduced need for rescue analgesia compared to Natrium Diclofenac (OR 0.73, 95% CI 0.36 to 1.49). Adverse events result was more superior in SWI, having lower occurrence when compared to Natrium Diclofenac, although not significant (OR 0.14, 95% CI 0.05 to 0.39). Intradermal sterile water injection (SWI) appears to be a promising alternative to NSAIDs for kidney stone related pain management, offering comparable efficacy in pain reduction, reduced need for rescue analgesia while maintaining a favorable safety profile. However, further research with larger sample sizes and standardized treatment protocols are required to further validate its safety and efficacy.

Pengaruh Perbedaan Modalitas Short Wave Diathermy (SWD) dan Transcutaneous Electrical Nerve Stimulation (TENS) terhadap Penurunan Nyeri pada Kasus Low Back Pain Myogenic

Background: Myogenic low back pain is a common musculoskeletal disorder often triggered by repetitive or sustained incorrect body movements, leading to mild to moderate pain. Physiotherapy interventions, such as Short Wave Diathermy (SWD) and Transcutaneous Electrical Nerve Stimulation (TENS), are frequently utilized for pain management. Objective: This study aimed to investigate the comparative effectiveness of SWD and TENS in reducing pain intensity in individuals with myogenic low back pain. Method: A quasi-experimental pre-test and post-test group design was employed. Thirty-eight participants were allocated to either the SWD or TENS intervention group. The Numeric Rating Scale (NRS) was utilized to assess pain levels before and after the interventions. Results: Both SWD and TENS interventions demonstrated significant reductions in pain levels within their respective groups (p < 0.005). However, the Mann-Whitney U test revealed no statistically significant difference in pain reduction between the SWD and TENS groups (p = 0.259). 2Conclusion: While both SWD and TENS are effective in alleviating myogenic low back pain, this study found no significant difference in their efficacy.

Meta-analysis and sequential analysis of acupuncture compared to carbamazepine in the treatment of trigeminal neuralgia.

In this randomized controlled trial (RCT) comparing current acupuncture with carbamazepine for trigeminal neuralgia, meta- and sequential analyses were utilized. To guide clinical decision making regarding the treatment of trigeminal neuralgia with carbamazepine. The RCT literature on needle comparison was searched in various Chinese biomedical databases including Chinese Biomedical Literature Database, Wanfang Data, VIP Database, as well as international databases such as Excerpt Medica Database, Cochrane Library, PubMed, and Web of Science, along with related clinical registration platforms such as World Health Organization International Clinical Trial Registry Platform, ChiCTR, and Clinical Trials up to 1 April 2020. Risk of bias was evaluated using the Cochrane Collaborative Risk Bias tool, primary outcome measures (pain reduction) were analyzed using STATA meta-analysis, outcome measures were analyzed using trial sequential analysis 0.9.5.10 Beta sequential analysis, GRADE was used to assess the evidence, and adverse reactions were documented. This study analyzed 16 RCTs with a total of 1231 participants. The meta-analysis revealed a statistically significant difference in pain reduction between acupuncture and carbamazepine [standardized mean difference (SMD) = 1.47; 95% confidence interval (CI): 0.99-1.95], although the quality of evidence was deemed to be of extremely low quality. Cumulative meta-analysis based on the year of publication indicated that carbamazepine treatment first demonstrated a statistically significant difference in pain reduction in 2014 and remained relatively stable over time [SMD = 1.84; 95%CI: 0.22-3.47]. Additionally, the number of adverse events associated with acupuncture was significantly lower compared to carbamazepine. Acupuncture for trigeminal neuralgia is better than analgesia and safer than carbamazepine; however, firm conclusions still require a high-quality, multicenter, large-sample RCT to confirm these findings.

Assessment of a combined mouthwash on pain relief in pericoronitis: a randomized clinical study

BackgroundPericoronitis, an inflammation near wisdom teeth, often occurs when they are partially emerged, especially in the lower jaw. Commonly, the gingiva partially envelops the tooth. Treatments vary from gingival surgery to extraction. This study assessed the efficacy of a mouthwash with Chlorhexidine, Benzydamine, Nanosilver, Amoxicillin, and Metronidazole for pain reduction and enhancement of maximum mouth opening in acute pericoronitis cases.Materials and methodsIn this randomized controlled clinical trial conducted at the Gorgan Dental Faculty, 48 pericoronitis patients were randomized into two groups. The control group used a 0.12% chlorhexidine mouthwash, while the case group used a mouthwash containing Chlorhexidine, Benzydamine, Nanosilver, Amoxicillin, and Metronidazole. The study recorded Visual Analog Scale (VAS) scores for 7 days, and Maximum mouth opening (MMO) was measured at the start and after 7 days. The analysis was performed using SPSS v20.ResultsIn this study, we compared the effects of a combined mouthwash with those of a chlorhexidine mouthwash on pericoronitis in 48 patients, with an average age of 21.56 years. No significant difference in pain reduction was observed between the groups; however, both groups exhibited decreased pain and improved MMO post-treatment. The gender distribution was balanced across both groups.ConclusionThe results indicate that both chlorhexidine mouthwash and combined mouthwash significantly improved maximum mouth opening. Nonetheless, there were no notable differences in efficacy between the two groups. These findings suggest that these mouthwashes may be beneficial for oral hygiene, warranting further in-depth research.Trial registrationRegistered on 12/03/2023, registration number IRCT20230104057046N1.

Effects of Aloe vera on Burn Injuries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Burn injuries cause severe pain, infection risks, psychological distress, financial burdens, and mortality, necessitating effective care. Aloe vera, a traditional burn remedy, shows wound-healing potential, but its analgesic effects and efficacy with varying burn severity are uncertain. This study aims to investigate A. vera's effect on wound healing, pain management, and infection prevention in patients with burns. A systematic search on PubMed, Embase, and CENTRAL was performed on October 9, 2023, for randomized controlled trials (RCTs). The risk of bias was examined using the Cochrane risk-of-bias tool (version 2), and the meta-analysis was carried out using a random-effects model. The primary outcome was wound-healing time, with secondary outcomes examining pain severity and wound infection. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence for each outcome. Nine RCTs were included in the current study, of which 6 provided data on the primary outcome. Aloe vera significantly reduced mean wound-healing time compared to other topicals (mean difference [MD] -3.76 days; 95% CI, -5.69 to -1.84). Additionally, the meta-analysis of the secondary outcomes found no significant differences in pain reduction (MD -0.76 points; 95% CI, -1.53 to 0.01) and wound infection risk (risk ratio 1.10; 95% CI, 0.34-3.59) between A. vera and control groups. In conclusion, A. vera expedites wound healing in patients with second-degree burns without increased infection risk compared to other antimicrobial agents. The analgesic effects on burn injuries remain uncertain.

Comparing Ureteral Catheterization's Impact on Flank Pain Post Ureteroscopic Stone Management

Background: Urolithiasis, or kidney stone disease, is a prevalent condition that poses significant challenges in urological practice. The management of ureteral stones, particularly through ureteroscopy, is a common intervention. The use of short-term ureteral catheterization as a postoperative pain management strategy following ureteroscopic stone removal has been a subject of debate, with limited evidence on its efficacy and necessity. Objective: This study aimed to evaluate the effectiveness of short-term ureteral catheterization in reducing postoperative flank pain compared to non-catheterization in patients undergoing uncomplicated ureterolithotripsy for the management of distal ureteral stones. Methods: A prospective, randomized, controlled trial was conducted at Liaquat National Hospital, Karachi, from January to July 2013, involving 60 patients aged 15-70 years with distal ureteral stones less than 1.0 cm. Patients were randomized into two groups: Group A received short-term ureteral catheterization, and Group B did not. The primary outcome measured was the reduction in mean pain score by at least 4 points from the baseline at every 6-hour interval for the first 24 hours post-procedure. Statistical analysis was performed using SPSS version 25, applying chi-square tests, independent sample t-tests, and Mann-Whitney tests, with a p-value of less than 0.05 considered significant. Results: Both groups demonstrated a significant reduction in pain scores at 12, 18, and 24 hours post-operation. However, there was no significant difference in pain reduction between the catheterized (Group A) and non-catheterized (Group B) groups, with p-values of 0.55 for efficacy in pain reduction. The mean age, stone size, and postoperative hospital stay did not significantly differ between the groups, indicating that short-term ureteral catheterization did not offer additional benefits in managing postoperative pain or recovery. Conclusion: Short-term ureteral catheterization following uncomplicated ureterolithotripsy does not significantly improve pain management compared to non-catheterization. This suggests that routine catheterization may be unnecessary, potentially leading to a paradigm shift in postoperative care for patients undergoing ureteroscopic stone removal. Future studies with larger sample sizes and long-term follow-up are needed to further validate these findings.

Comparison between Lidocaine Spray and Oral Paracetamol for Pain Reduction during Amniocentesis in Second Trimester Pregnancy; A Randomize Controlled Trial

Objective: The aim of this study was to compare the efficacy of lidocaine spray and oral paracetamol on pain reduction in pregnant women in the second trimester during amniocentesis. Materials and Methods: This was a prospective randomized-controlled trial study conducted at Maternal and Fetal Medicine unit, Thammasat University Hospital, Pathum Thani, Thailand between June 2022 and April 2023. Participants were pregnant women who underwent amniocentesis during gestational age between 15 and 20 weeks. They were allocated into three groups namely lidocaine, paracetamol and control groups. Subjects in lidocaine group received 8 puffs of 10% lidocaine (80 mg) spray onto the marked puncture site for five minutes before amniocentesis and ingested 1 placebo tablet 1 hour before procedure. Paracetamol group ingested 650 mg paracetamol orally 1 hour before amniocentesis and received 8 puffs of normal saline spray on the marked puncture site. Control group received 8 puffs of normal saline spray onto the marked puncture site for five minutes before amniocentesis and ingested 1 placebo tablet 1 hour before amniocentesis. Expected pain (Te), during procedure (T0), 15 and 30 minutes after procedure (T15 and T30) were evaluated based on 10-cm visual analog scale (VAS). Results: A total of 510 pregnant women were recruited and divided equally (170 cases per group). Mean maternal age was 36.1 years old. Demographic characters of three groups were comparable. Lidocaine had more pain reduction than paracetamol and control group at T0, T15 and T30 (at T0: 3.06±2.16 vs 3.96±2.42 vs 3.92±2.35, P value < 0.001, T15: 1.12±1.38 vs 1.92±1.47 vs 1.98±1.87, P value < 0.001, T30: 0.64±0.95 vs 1.33±0.97 vs 1.09±1.44, P value < 0.001). However, paracetamol had no significant difference in pain reduction compared to control group. Conclusion: Lidocaine spray before amniocentesis had more efficacy on pain reduction during amniocentesis, 15 and 30 minutes after procedure.

Comparative Study of Radial and Median Nerve Blocks with Hematoma Block under Ultrasound Guide in Distal Radius Fracture Reduction: A Randomized Clinical Trial.

Distal radius fractures are one of the most common upper extremity fractures, and their incidence continues to increase due to an aging population and an increase in osteoporosis. Various methods of analgesia for distal radius fractures have been described-including hematoma blocks and nerve blocks. Hematoma blocks are a simple and effective method of providing analgesia; nonetheless, their efficacy may be limited in some cases. On the other hand, nerve blocks provide more targeted analgesia and may be more effective in reducing pain during fracture reduction. This study aimed to compare the analgesic effectiveness of radial and median nerve blocks with hematoma blocks under ultrasound guidance in treating distal radius fractures. Also, this study aimed to compare the analgesia of radial and median nerve blocks with hematoma blocks under ultrasound guidance to reduce distal radius fractures. In this prospective trial, patients with distal radius fractures referring to 2 academic centers were placed into 2 randomized groups, including hematoma block, and radial median block, both of which were ultrasound-guided. The patient's pain levels were measured and recorded based on the visual analog scale before the block, 5, 10, and 15 minutes after the block, at the start of reduction, during reduction, and 5, 10, and 15 minutes after reduction. Patient satisfaction and physician satisfaction rates were assessed, and side effects were also observed for 1 week. Quantitative variables were reported as mean ± standard deviation, and number and frequency percentages were reported for qualitative variables. The Student t test and the chi-square test were used on a case-by-case basis. The significance level was set at P ˂ 0.05. In this study, 120 patients were included. The groups had no significant differences in pain reduction during the procedure. Analgesic medication was needed during the procedure for 17 patients; nerve blocks were applied for 6 patients, and hematoma blocks for 11 patients, which was statistically significant (P = 0.041). Satisfaction rates for patients and physicians performing the procedure were significantly higher in the nerve block group than in the hematoma block group ( P = 0.001; P ˂ 0.001, respectively). The results of this study suggest that ultrasound-guided radial and median nerve blocks can be used as alternative methods of analgesia with other techniques in the reduction of distal radius fractures in emergency departments.

Court-Type Thai Traditional Massage for Patients with Intractable Peripheral Neuropathic Pain: a Randomized Controlled Trial

Objective: Neuropathic pain management involves both pharmacological and non-pharmacological interventions. Despite this, no prior research has demonstrated the efficacy of court-type Thai traditional massage (CTTM) for neuropathic pain relief. This study aimed to investigate the potential benefits of CTTM in alleviating neuropathic pain. Materials and Methods: A preliminary single-blind randomized controlled trial was conducted on 28 participants with peripheral neuropathic pain, who were equally assigned to 2 groups. Both groups received standard drug treatment; however, the intervention group additionally received CTTM and hot herbal compression, while the active control group only received HHC. The adjuvant treatments were administered twice weekly for 4 weeks (V1-V8). A follow-up was conducted 4 weeks posttreatment (V9). Outcome measures were assessed at V1, V4, V8, and V9 using a numerical rating scale and the Thai versions of the Neuropathic Pain Symptom Inventory, the Brief Pain Inventory, and the EQ‑5D‑5L health questionnaire. Results: The data revealed that the intervention and active control groups had statistically significant differences in their pain intensity scores (P < 0.001), total neuropathic pain intensity scores (P = 0.001), and utility of health scores (P = 0.007) during the follow-up period. When comparing outcomes between V1 and V8, the groups exhibited significant differences in pain reduction (P = 0.003) and quality of life (P = 0.027). Conclusion: This study provides initial evidence supporting the potential benefits of CTTM in alleviating peripheral neuropathic pain and improving quality of life. Future research should further investigate the application of CTTM in managing peripheral neuropathic pain conditions.

Trapeziectomy versus Maïa Prosthesis in Trapeziometacarpal Osteoarthritis.

Background Osteoarthritis at the base of the thumb is the most frequent osteoarthritis of the hand. Trapeziectomy in a broad variety of surgical methods have been proposed to achieve pain reduction and improvement of thumb function. A well-known disadvantage is the long recovery time. Arthroplasty of the thumb carpometacarpal joint is a competing new method for this indication with different revision and complication rates reported. Purposes The aim of this study is to assess whether there are significant differences in outcome during the first 12 months and time return to work after either, implant of a Maïa joint prosthesis, or trapeziectomy with tendon interposition after Weilby. Patients and Methods This clinical follow-up study compares the efficacy of total basal joint replacement using the Maïa prosthesis with tendon interposition arthroplasty in 59 thumbs. Clinical, functional, and radiological results at preoperative, 3-, 6-, and 12-month postoperative are presented. Results We found a significant shorter return to work in the prosthesis group with 4.5 compared with 8.6 weeks. In addition to a significant difference in pain reduction with a better Mayo wrist score in the Maïa group after 3 months. The scores are closer after 6 months and nearly match after 12 months. Measurement of the pinch grip showed a parallel course. A radiological loosening of the cup in two patients was detected after 12 months. Conclusion Implantation of Maïa prosthesis enables a significant shorter recovery but is associated with the risk of loosening and higher costs. Level of Evidence Level IV, case-control study.

Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis

ObjectiveParacetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opiates/opioids, administered parenterally via intravenous or intramuscular route, are widely used to provide analgesia for patients with moderate to severe pain. This systematic review...

CT-guided quadratus femoris injection for ischiofemoral impingement.

To describe the technique, efficacy, and safety of CT-guided quadratus femoris injection with corticosteroid and local anesthetic for the treatment of ischiofemoral impingement in a series of cases at our institution. Cases of CT-guided quadratus femoris injections from 2000 to 2021 were identified in the enterprise-wide electronic medical record of our institution. Patient charts and our institutional picture archiving and communication system (PACS) were searched for demographics, pain level on a 0-10 scale before and immediately following the procedure, procedure technique, and follow-up outcomes if available. There were 13 cases among 12 patients with clinical and imaging findings of ischiofemoral impingement included in this study. Of the 12 patients, 10 were female and two were male. There were eight posterior approaches and five posterolateral approaches. Of the 13 cases, 11 resulted in immediate pain reduction. The median reduction in pain score was four (average 3.46, range 0-8.5). There was no statistically significant difference in pain reduction between the posterior approach cases and the posterolateral approach cases. No cases reported immediate complications or increases in pain score. Of the 12 cases, seven resulted in at least 1month of pain relief, three had subsequent surgeries, and three had no follow-up. CT-guided quadratus femoris injection is safe and effective for treating ischiofemoral impingement. Further and larger scale study is needed to fully delineate differences in technique effectiveness. • CT-guided quadratus femoris injection is safe and effective for treating ischiofemoral impingement. • We found no statistically significant difference in pain reduction between the posterior approach and the posterolateral approach.

Functional outcome of autologus platelet rich plasma injection as treatment for patients with lateral epicondylitis

Background: Lateral epicondylitis is the most common chronic disabling painful condition affecting 1% to 3% of the population predominantly those between 35 and 55 years of age. Elbow pain with tenderness and restricted wrist extension is its common manifestations. Although a few conservative methods of treatment are available, recent studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy in relieving pain and improving function for tennis elbow. Aim: This study aims to study the efficacy of autologous PRP in tennis elbow. Materials and Methods: A prospective observational study was conducted in our hospital. Fifty patients with chronic lateral epicondylitis aged above 18 years were included in the study. All the patients had a minimum of 3 months of symptoms, were selected based on the inclusion and exclusion criteria and underwent the same method of treatment. All patients had a baseline assessment of numerical pain score and were repeated at 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months posttreatment. The PRP was prepared from venous whole blood. All patients had a single-dose injection of autologous PRP in their extensor tendons at the elbow through a peppering needling technique. Results: The patients were more often successfully treated. When baseline numerical pain scores were compared with those at 8 weeks, 12 weeks, and 24 weeks follow-up, they showed improvement over time. There were no complications observed related to the use of PRP. The difference between 1-, 2-, 4-, and 6-month pain reduction was tested for significance by Friedman's test and found that there was no significant difference in pain reduction between 2 months and 3 months, 2 months and 6 months, and 3 months and 6 months scores. However, there was a statistically significant difference in pain score in 1 and 2 months. Duration of symptoms suggests the chronic nature of disease. In this study, analysis was done based on the duration of symptoms. Thirty-two out of the 50 patients had pain for <6 months, 16 out of 50 patients between 6 and 12 months, and 2 out of 50 had symptoms of >1 year. In our study, it was found that mean pain score at the end of 6 months for patients with symptoms <6 months was 0.59, whereas the mean pain score of patients with symptoms from 6 to 12 months was 1.81. This indicates that duration of symptoms had a significant correlation with the clinical outcome after injection. Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of tennis elbow. Maximum benefit after PRP injection was observed at 2 months and had sustained for at least 6 months. More trials are required to optimize the technique for separating PRP. These improvements were maintained over in our follow-up period without any significant complications. Long-term follow-up with more number of patients is needed to evaluate the lasting benefits of pain relief and functional improvement in lateral epicondylitis.

Efficacy of incobotulinumtoxinA for Spasticity-Associated Pain in a Series of Patients with Spasticity of Diverse Etiologies

Background: Spasticity is a motor disorder that appears as a cause of upper and lower limb motor disability, frequently causing pain. IncobotulinumtoxinA (IncoA) has proved effective for treating diverse musculoskeletal pathologies, including spasticity and spasticity-related pain. Aims: The aim was to determine the efficacy of IncoA for the treatment of pain associated to limb spasticity of diverse etiologies. Methods: Prospective, single-center study including 30 patients treated with IncoA between May and August 2021 at the University Hospital Center of Central Lisbon (Lisbon, Portugal). Primary endpoint was improvement in spasticity-related pain, assessed by employing pain numerical rating scale for pain at baseline and 12 weeks post-injection, scoring between 0 (no pain) and 10 (severe pain). Results: Patients showed spasticity due to different etiologies, mainly ischemic stroke (46.7%), hemorrhagic stroke (23.3%) and cerebral palsy (20.0%). Mean pain score significantly decreased from baseline (mean: 6.8, range: 2-10) to 12 weeks post-injection (mean: 1.6; range: 0-5). Mean reduction of pain was of -5.2 points (95%CI: -5.9, -4.5). All patients achieved minimum clinically significant difference in pain reduction, showing sustained effect over 12 weeks regardless of spasticity etiology. Conclusion: IncoA may be considered as an alternative for the treatment of spasticity-associated pain of diverse etiologies in upper and lower limbs.

Botulinum Toxin A for Provoked Vestibulodynia: 12 Months’ Follow-up of a Randomized Controlled Trial

BackgroundProvoked vestibulodynia (PVD) is a common pain disorder afflicting primarily young women, and botulinum toxin A (BTA) has been to a limited extent tested as a treatment. AimEvaluate outcome 12 months after injection with BTA as a treatment for PVD. MethodsWe conducted a double-blinded, placebo-controlled trial of twice repeated injections of 50 units of BTA or placebo in the bulbocavernosus muscles, 3 months apart, in women with PVD. Treatment outcome after six months’, failed to show any significant difference in pain reduction between the groups, as previously reported. Here, we report treatment outcomes 12 months after the first injections. In addition to injections, participants where instructed to perform pelvic floor exercises during month 6-12. 38 participants/group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (mean score range 56-76±31 SD). OutcomesPrimary outcome was self-reported dyspareunia or pain at tampon use, using a visual analogue scale (VAS) 0-100. Secondary outcomes were vaginal pressure measurements, psychological health, sexual function and distress. ResultsFrom the initial 88 randomized women with PVD, 75 remained at 12 months; 38 in the BTA and 37 in the placebo group. There was no significant difference in primary outcome between the groups. Vaginal pressure in the BTA group had been restored to pre-treatment levels, with no differences between the groups at 12 months. There was an increase in sexual function in the BTA group, with a Female Sexual Function Index of 22.8 (±4.8) compared to the placebo group to 19.7 (±5.0), P=.048. No differences were observed in sexual distress, stress and anxiety. There was an increase in number of women attempting intercourse in the BTA group (74%) compared with placebo (43%), P=.005. Too few patients performed the pelvic floor exercises for this intervention to be analyzed. Clinical ImplicationsThis study highlights BTA as a safe treatment option for patients with PVD. Strengths and limitationsThe randomized, double-blinded design and repeated treatments are the major strengths of this study and it is the first study to objectively evaluate muscular effect after BTA injections. The major shortcoming is that few participants performed the pelvic floor exercises, preventing analyses. ConclusionAt 12 months’ follow up, no significant difference in reduction of dyspareunia or pain at tampon use was observed. Women receiving BTA attempted intercourse more often and improved their sexual function compared with women receiving placebo.Haraldson P, Mühlrad H, Heddini U, et al. Botulinum Toxin A for Provoked Vestibulodynia: 12 Months’ Follow-up of a Randomized Controlled Trial. J Sex Med 2022;19:1670–1679.

Local anaesthetics in dermatological surgery: a review of adjuncts and pain reduction techniques.

A variety of adjuncts for local anaesthesia (LA) exists for dermatological surgery, along with many options to reduce the pain of LA. This review aims to summarize the evidence relating to such adjuncts and methods to reduce the pain of LA. Adjuncts to LA can be an important consideration to optimize anaesthetic effect. Current evidence suggests that buffering and warming of LA fluid, along with cooling, pinching and administering vibrations to the skin are effective at reducing pain during administration. In this review, no significant difference in pain reduction was found between cooling and administering vibrations to the skin. Studies demonstrate that, overall, LA injection into distal sites is safe. However, the evidence specific to dermatological surgery is limited with regard to ways to reduce pain during LA injection and in determining the safety of LA for distal sites with confidence. Further high-quality research in the form of multicentre randomized controlled trials is required.

The effectiveness of dry needling in patients with chronic low back pain: a prospective, randomized, single-blinded study

Dry needling (DN) is a standard procedure for treating musculoskeletal disorders. However, there are no clear recommendations for using DN in low back pain (LBP). Therefore, this study aimed to assess the effectiveness of the novel DN program for reducing pain intensity and improving functional efficiency in patients with chronic LBP. A group of 40 patients with chronic LBP due to the L5-S1 discopathy were eligible and randomized into experimental (n = 20) and control (n = 20) groups. The DN program was performed for the experimental group according to the Five Regulatory Systems (FRS) concept. The control group received sham therapy using placebo needles. DN sessions were performed twice a week for 4 weeks. A single needling application lasted 60 min. Both groups received standard treatment and physical exercise of LBP for 1 month. Subjective pain was measured by a visual analog scale (VAS), functional efficiency was assessed with the Oswestry Disability Index (ODI), and the lower spine range of motion was measured with the Schober test. There were significant differences in pain reduction (VAS) in both groups (p < 0.001). The strongest analgesic effect in the DN group yielded 6.45 points immediately after the therapy, 6.2 points after 1 month, and 6 points after 3 months. The DN group scored higher VAS reduction than the control group (p < 0.001). There were significant differences in the functional state (ODI) in the experimental group (p < 0.001). There was a significant ODI decrease by 18.1 points, after 1 month by 18.9 points, and after 3 months by 17.6 points. No significant differences were found in the control group (p > 0.05). Intergroup differences were observed in the functional efficiency in ODI in all measurement time-points (p < 0.001). There were significant differences in the range of motion (Schober test) in the DN group (main effect: p < 0.001). For all measurements, differences (p < 0.001) were observed in favor of DN compared to the control. In conclusion, DN program according to the FRS concept stands for the novel treatment method supplemented by an exercise program, effectively reducing pain and improving functional efficiency in LBP patients.

Therapeutic Efficacy of Great Plantain (Plantago major L.) in the Treatment of Second-Degree Burn Wounds: A Case-Control Study.

Background Great plantain (Plantago major L. or P.major) is a medicinal plant that is available all around the world. The whole plant has several bioactive compounds including terpenoids, flavonoids, phenolic compounds, alkaloids, fatty acids, iridoid glycosides, polysaccharides, and vitamins. Scientific studies have recognized several medical benefits like wound healing, anti-inflammatory, antimicrobial, antiulcerative, and antioxidative agents. The wound-healing capacity of this plant has been investigated under in vivo and ex vivo conditions. In the current study, we aim to compare the therapeutic effect of the P.major extract with 1% sulfadiazine on the healing of second-degree burn wounds. Method Second-degree burn victims were included in our study. The investigation and control group, respectively, received P. major ointment 10% and silver sulfadiazine ointment 1%. The bacterial culture from the wound site was taken on days 3, 7, 10, 13, and last day of hospitalization. Patients' subjective complaints were obtained through the visual analog scale (VAS). All patients were treated and evaluated in the hospital. Result Among the 15 patients, 11 were male, and the mean age was 33.3 years. The average complete healing duration was 11.73 vs. 13 days in the P. major and control group, respectively (P=0.166). On the third day, infection control was similar between the two groups, and on the seventh day, all bacterial cultures were negative. Although there was a significant reduction in pain scores during the recovery time, no significant differences in pain reduction were noted between the two groups (P=0.849). Conclusion We showed that P.major ointment is a safe and suitable herbal compound in the treatment of second-degree burn wounds that not only has wound-healing properties but also is an analgesic and antimicrobial compound.

Platelet-rich fibrin a new approach in management of persistent oral ulcers in blistering skin diseases.

The present study designed to evaluate the healing power of platelet-rich fibrin (PRF) in terms of pain control and mucosal repair. A randomised, controlled, pilot clinical trial was conducted on 16 patients randomly distributed with 1:1 allocation ratio into two groups. The treatment group received PRF minced and mixed with orabase and the control group received clobetasol propionate 0.05% mixed with orabase. Pain reduction was evaluated as primary outcome along with mucositis healing as secondary outcome. A statistically significant difference in pain reduction was observed between the two groups (p ≤ 0.05). The clinical results at Day 7 has shown that PRF group had 100% pain reduction while, CP group had 32.5% reduction from base line. PRF offered superior clinical results providing rapid pain alleviation and accelerated ulcer healing compared to corticosteroids.