Significant Reduction In Pain Intensity Research Articles

A Randomized Control Trial to Compare the Effects of Endurance Training Versus Strength Training Among Students with Neck Pain

Neck pain is pain perceived as arising in a region bounded superiorly by the superior nuchal line and inferiorly by an imaginary transverse line through the spinous process of the first thoracic vertebra. Musculoskeletal disorders are common among general population; the yearly prevalence of neck pain is almost 30% to 50%. Objective: The purpose of this study was to compare the effects of endurance training versus strengthening exercises among students with chronic neck pain. Methods: It was Randomized Control Trial. A total of 30 patients were recruited into the study and were randomly allocated into two groups, the treatment group and control group. Treatment group received endurance therapy while control group was treated with strengthening exercises. Pre-test and post-test assessments were performed among both groups to compare the effect of these interventions. Results: Independent t-Test interpretation of PNS. Pre-treatment PNS for control group Mean=4.93, SD=1.53, p-value=.614, for experimental group Mean=5.20, SD=1.32, P-value=.614. According to results of Post-treatment PNS, there was significant reduction in pain intensity and p-value<0. 01i.e for experimental group Mean=0.40, SD=0.507, P-Value=0.000. Independent t-Test interpretation of duration of symptoms (DOS). Pre-treatment duration of symptoms for control group Mean=2.60, SD=.632, p-value=.148, for experimental group Mean=2.93, SD=0.594, P-value=.148 Conclusions: It is concluded that endurance exercises were more effective than strength training in improving chronic neck pain among medical students of RMU.

Highly selective nonsteroidal anti-inflammatory drugs in the prevention of postoperative pain symptoms

BACKGROUND: Patients often visit healthcare institutions for the treatment of various diseases, which are accompanied by painful symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for the prevention and relief of pain symptoms in surgical and trauma departments, providing good clinical results and analgesic effects.
 AIM: This study aimed to evaluate the effectiveness of etoricoxib at various dosages for the prevention of pain symptoms after complex removal of the lower wisdom teeth.
 MATERIAL AND METHODS: The patients were 108 (67 men and 41 women) young people (1832 years old) who underwent a complex removal of an impacted and/or dystopic lower wisdom tooth for orthodontic indications. During the clinical study, the patients were divided into five groups depending on the use and dosage of the highly selective NSAID etoricoxib.
 RESULTS: In the clinical study, etoricoxib was used at dosages of 30, 60, 90, and 120 mg to prevent pain in 108 patients aged 1832 years who underwent complex removal of the lower wisdom teeth according to orthodontic parameters. For these purposes, it is effective and sufficient to use the drug at a dosage of 60 mg. Etoricoxib also prevented the occurrence of infectious and inflammatory postoperative complications, such as alveolitis, and provided better patient tolerance to the surgical intervention.
 CONCLUSION: This clinical study on the effectiveness of etoricoxib at various dosages for the prevention of pain symptoms after removal the lower wisdom tooth showed the effectiveness of 60 mg, which should be taken 6090 min before surgery and in the next 23 days in the morning. Etoricoxib not only provided a significant reduction in pain intensity in the postoperative period but also prevented the occurrence of infectious and inflammatory postoperative complications and enabled better patient tolerance to the surgical intervention. Etoricoxib dosages of 90 mg and 120 mg are not advisable for the prevention of pain symptoms in surgical dentistry. Such dosages are necessary for complex treatment of dental diseases, accompanied by a chronic pain syndrome.

Effectiveness between Duloxetine and Pregabalin for the Management of Neuropathic Chronic Low Back Pain

Background: Chronic low back pain has as a mixture of nociceptive and neuropathic component. This neuropathic component is often overlooked during management which increases the sufferings of patients. Prevalence of neuropathic pain is quite high and approximately 37% of chronic low back patients suffer from predominantly neuropathic pain. Treatment of neuropathic component of low back pain remains challenging and multiple modalities of treatments have been tried but not all of them are satisfactory. Among these, duloxetine and pregabalin have been shown to be promising in treatment of various neuropathic syndromes, but there is no direct comparative study between these two drugs in patients with back pain with neuropathic component. Objective of this study was to compare the effcetiveness between duloxetine and pregabalin which one reduce the pain and improve quality of life better.Methods: This is a prospective, observational study. Chronic low back pain patients with neuropathic components were recruited according to inclusion and exclusion criteria. Pain was measured by visual analog scale and neuropathic component measured by painDETECT questionnaire score. Patients were randomly assigned to either duloxetine or pregabalin group. Both drugs were initiated with their lowest dose. Duloxetine was started with 20mg/day with optional up titration to 60mg/day (20mg, weekly increments) and pregabalin was started with 50mg/day with optional up titration to 300mg/day (50mg weekly increments) for six weeks. A fixed dose combination of paracetamol and tramadol (325mg + 37.5mg) was used as rescue medication for breakthrough pain. Follow up were carried out weekly by face to face visits or over phone. At week four and six, additional assessment of patients’ quality of life was assessed by SF-36. The primary outcome parameter was mean VAS score and quality of life improvement by assessing SF-36 was secondary outcome parameter.Results: Out of 80 patients enrolled, 62 completed trial, eight patients in duloxetine and ten patients in pregabalin group dropped out. In this study, a significant reduction of pain intensity was observed with both Duloxetine and Pregabalin compared with their baseline values, but there was no statistically significant difference between the two treatments. The SF-36 score at the end of each treatment phase was significantly improved with both treatments. But when comparing in between two groups, the changes of mean SF-36 score was not significant as well.Conclusion: Both duloxetine and pregabalin are well-tolerated having good safety profiles. Further clinical trials with long term follow up are needed to determine their long term effect.

Nonoperative Treatment of Finger Flexor Tenosynovitis in Sport Climbers-A Retrospective Descriptive Study Based on a Clinical 10-Year Database.

Simple SummaryFinger flexor tenosynovitis is among the most frequent overuse injuries in sport climbers. Targeted therapy is currently based mostly on reports of the anecdotal practical experience of single centers rather than scientific investigations, as there is very little research available on this pathology. The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis treatments in sport climbers by retrospectively asking patients about injury triggers, therapy contents and outcomes. All patients were initially treated conservatively, and only one of the patients needed further therapy in the form of a single injection with hyaluronic acid; none of them underwent further operative treatment. The average symptom duration was 30.5 weeks, and all patients were able to resume climbing, with approximately 75% of them regaining or exceeding their initial climbing level. These good to excellent outcomes and no correlation between particular therapy contents and therapy outcome suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations from this study.The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis in sport climbers and to evaluate the association with baseline measures and therapy contents. Sixty-five sport climbers (49 males, mean age 34.1 years) diagnosed with tenosynovitis of the finger flexors were retrospectively asked about injury triggers, therapy contents and outcomes. Pulley thickness was measured by ultrasound. All patients were initially treated conservatively, and only one of the patients needed further therapy (single injection with hyaluronic acid); none of them underwent surgical treatment. The most frequently applied therapy was climbing-related load reduction (91%). The treatment resulted in a statistically significant reduction in pain intensity during climbing (before/after therapy ratio [Visual Analog Scale (VAS)/VAS] = 0.62, 95% CI = 0.55, 0.68). The average duration of the symptoms was 30.5 weeks (range 1–120 weeks). In a multiple linear regression analysis, initial daily life pain intensity and a climbing level higher than 7b according to the French/sport grading scale were the only predictive parameters for the relative change in pain intensity and symptom duration, respectively. All patients were able to resume climbing, with 75% regaining or even exceeding their initial climbing level. The good to excellent outcomes and no correlation between particular therapy contents and therapy outcome may suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations.

Efficacy of active stretching exercises against symptoms of primary dysmenorrhoea in young adult females: a randomized controlled trial

IntroductionPrimary dysmenorrhea symptoms affect most women’s daily life activities. The aim of the current study was to assess the efficacy of active stretching exercises in reducing pain intensity and improving menstruation characteristics of young adult females.MethodsThirty-three females with primary dysmenorrhea, were randomly assigned into three equal groups; group A (<i>n</i> = 11) practiced a supervised active stretching program three times a week for four weeks, group B (<i>n</i> = 11) practiced a non-supervised active stretching three times a week for four weeks and a control group C (<i>n</i> = 11). Pain intensity and menstruation characteristics were measured by Visual Analog Scale (VAS) and Verbal Multidimensional Scoring System (VMS) respectively, before and at the end of the study. Kruskal-Wallis test was used to test differences between groups; While Wilcoxon Signed-Ranks test was used to within-group comparison.ResultsA significant reduction in pain intensity was obtained in both intervention groups (A&B) (<i>p</i> = 0.003; 0.007 respectively), whereas post-treatment comparison between groups revealed a statistically significant reduction in pain intensity in favor of group A (<i>p</i> ˂ 0.001). A significant improvement in menstruation characteristics was found in group A (<i>p</i> = 0.007) with non-significant improvements in either group B or the control group C (<i>p</i> = 0.07; 1.0 respectively).ConclusionsBoth supervised and non-supervised active stretching exercises could provide a safe non-pharmacological alternative for pain relief in primary dysmenorrhea.

The Impact of Rapid Weight Loss on Pain in Non-Hispanic Black and Hispanic/Latino/a/x Adults with Obesity

The Impact of Rapid Weight Loss on Pain in Non-Hispanic Black and Hispanic/Latino/a/x Adults with Obesity

Azathioptrine in Refractory Tolosa-Hunt Syndrome: Two Case Report

Introduction: Tolosa-Hunt syndrome (THS) is an inflammatory disease with painful ophthalmoplegia and unilateral periorbital headache as detailed by the International Classification of Headache Disorders, 3rd edition (ICHD-3). Azathioprine has been suggested as a second-line treatment in refractory THS when oral corticosteroid only gives a partial response. Case: Two cases of THS, 45-year-old and 41-year-old women with unilateral headache, drooping of the left upper eyelid, and diplopia. They presented with complete ophthalmoplegia and ophthalmic division of trigeminal nerve disturbance. Magnetic resonance imaging (MRI) showed thickening of the left cavernous sinus, suggesting THS, while the other was normal. Corticosteroid (prednisone 1-1,5 mg/day) was given orally for the first two weeks, and according to the Numeric Pain Rating Scale (NPRS), pain intensity was reduced from severe to moderate. As a second-line treatment, azathioprine (2 mg/kg/day) was given afterward, with a significant reduction in pain intensity and remission of ophthalmoplegia within seven days. Azathioprine was used as an immunosuppressive agent and was continued for another three months without any deterioration in neurological deficits. The levels of complement 3, 4 (C3, C4), and C-reactive protein (CRP) were normal in both patients, with a slight increase in erythrocyte sedimentation rate (ESR) and equivocal values on antinuclear antibody (ANA) results. Other differentials of THS were eliminated from history-taking, physical examination, and proper investigations. Conclusion: Azathioprine as a second-line treatment can be used instead of an oral corticosteroid for refractory cases of THS with fewer side effects. Complete remission of ophthalmoplegia and a significant reduction in pain intensity was obtained.

A prospective, multicentric study to determine the safety and effectiveness of fixed-dose combination of camylofin dihydrochloride and nimesulide in patients presenting with acute colicky abdominal pain in India

Background: Spasmolytics and NSAIDs are a therapy of choice in colic pain. However, the tolerability and effectiveness of this combination remains unexplored. The aim of this prospective, single-arm, open label, multicenter study was to evaluate the safety and effectiveness of Anafortan-N® (fixed-dose combination of camylofin dihydrochloride 50 mg + nimesulide 100 mg) in patients with acute colicky abdominal pain.Methods: In all, 295 patients with acute colicky abdominal pain and at least one episode of colicky pain in the last 24 hours were enrolled in this study. None of the patients were hospitalized. All patients were advised Anafortan-N® tablets twice daily orally for 5 days. The safety of Anafortan-N® was assessed by number and percentage of patients with adverse events (AEs) and change in the severity and frequency of AEs by the end of treatment. The tolerability was determined by number and percentage of patients who had to discontinue the treatment due to AEs. The effectiveness was evaluated as percentage change in the mean intensity of pain score (based on a 100-mm visual analog scale) from baseline to end of treatment.Results: Overall, 14 (4.7%) patients reported 14 AEs, all of which were treatment-emergent and non-serious. Of the 14 AEs, 7 AEs were mild, 6 AEs were moderate, and 1 AE was severe. No serious adverse events (SAEs) were reported. No adjustment of the study medication was required in response to any of the AEs, and none of the AEs led to discontinuation of the study treatment. At end of treatment (EOT), the pain intensity significantly (p<0.0001) reduced to 1.7±5.49 with a mean change of -69.9±17.42 from baseline, and the daily pain intensity significantly (p<0.0001) reduced to 0.1±0.38 with a mean change of -3.5±1.77 from baseline.Conclusions: Among Indian patients presenting with acute abdominal colicky pain, twice daily treatment with a FDC of camylofin dihydrochloride 50 mg and nimesulide 100 mg (Anafortan-N®) showed significant reduction in pain intensity with very few side effects, thereby confirming its safety, tolerability, and effectiveness in acute colicky abdominal pain.

Effects of pharmacist interventions on pain intensity: Systematic review and meta-analysis of randomized controlled trials

Effects of pharmacist interventions on pain intensity: Systematic review and meta-analysis of randomized controlled trials

The Effect of Gluteus Medius Dry Needling on Pain and Physical Function of Non-athlete women with Unilateral Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial

The Effect of Gluteus Medius Dry Needling on Pain and Physical Function of Non-athlete women with Unilateral Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial

Effectiveness of a hybrid arts-based Cognitive Behavioral Therapy intervention for patients with non-malignant chronic pain.

Chronic Pain (CP) is defined as pain that persists or recurs for more than 3 to 6 months and may be conceived as a health condition in its own right. CP is a frequent condition, affecting an estimated 20% of people worldwide and requires special treatment and care. CP can contribute to depression, anxiety, sleep disturbances, poor quality of life and increased health care costs. Psychosocial approaches based on a cognitive conceptualization of pain can provide a solid foundation for research and clinical work. The development of a 10 week-session group treatment was based on key principles from the literature on Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) and Creative Arts Therapy, integrated with advances in research on CP management framework. The aim of this study is to evaluate a CBT-CP arts-based group intervention for patients with non-malignant CP addressing the biopsychosocial factors that influence pain perception. A total of 100 University Pain Management Unit outpatients participated, 50 in the intervention group and 50 in the control group (treatment as usual). In analyses of the pretest-posttest research design intervention including all participants, treatment gains were observed in almost all domains examined: severity of pain measured by the Brief Pain Inventory, conceptualization of mental pain measured by the Orbach and Mikulincer Mental Pain Scale, tolerance for psychological pain measured by the Tolerance for Mental Pain Scale, anxiety and depression levels measured by the Hospital Anxiety and Depression Scale, and quality of life measured by the WHO Quality of Life-BREF Questionnaire. The participants' mean age was 52.3 years and most were female (84%). Findings suggest that postprogram, there was significant reduction in pain intensity (p<0.001), depressive symptoms (p<0.001), confusion about pain (p=0.037), and improvement of emotional distress tolerance (p=0.012) and global health-related quality of life (p<0.001) in the intervention group. Beneficial effects can be expected from the implementation of an integrated CP intervention (including: creative and CBT techniques) reappraising some of the coping responses defined as adaptive within current psychosocial non-malignant CP regimens.

Effectiveness of different acupuncture therapies for chronic cancer pain: A protocol for systematic review and Bayesian network meta-analysis.

Background:Pain is a common and distressing symptom experienced by cancer patients. Previous research found acupuncture was associated with significant reductions in pain intensity and opioid use. Acupuncture therapies are various, and the difference in efficacy and safety has never been assessed. This paper aims to assess and rank the effectiveness of the different acupuncture methods and provide an acupuncture treatment guideline for relieving chronic pain in cancer survivors.Methods:Four English databases (PubMed, Embase, Cochrane library, and Web of Science) and 4 Chinese databases (China National Knowledge Infrastructure, Wanfang Data, and Chinese Biomedical Literature Database) will be searched for randomized controlled trials (RCTs) published from the database inception to November 30, 2021. The primary outcomes will be patient-reported pain intensity measured by the Brief Pain Inventory, Visual Analog Scale, Verbal Rating Scale, Numerical Rating Scale, and other valid outcome measures. The Grading of Recommendations Assessment, and Development and Evaluation System will evaluate the quality of evidence. Bayesian network meta-analysis will be performed in WinBUGS V.1.4.3 to determine the comparative effectiveness of the acupuncture therapies.Results:This study will quantify the effectiveness of each acupuncture intervention for chronic cancer pain with pain scores and the use of analgesics. The adverse events of acupuncture treatment for cancer pain will also be reported.Conclusion:The conclusion of our study will help physicians and patients choose suitable acupuncture methods to manage cancer pain.

Electrical Dry Needling Plus Corticosteroid Injection for Osteoarthritis of the Knee: A Randomized Controlled Trial

Electrical Dry Needling Plus Corticosteroid Injection for Osteoarthritis of the Knee: A Randomized Controlled Trial

Muscle energy technique and static stretching in patients with mechanical neck pain – a randomized study

Introduction and aim. Neck pain is becoming increasingly common throughout the world with a considerable impact on individuals. This study compared the effects of muscle energy techniques (MET) and static stretching (SS) on pain intensity and functional disability of patient with mechanical neck pain. Material and methods. Fifty subjects with mechanical neck pain recruited were randomly allocated into MET and SS groups equally. Subjects in MET received MET protocol, and SS groups were treated with SS; both groups had treatment twice a week for six weeks. Pain intensity and functional disability at baseline, 3rd and 6th week of treatment were measured. Descriptive and Inferential statistics were used to analyze the data. Alpha level was set at &lt;0.05. Results. There were 12 males and 13 females for MET with age ranged between 31–53 years mean was 42.41± 7.35 years and 11 males and 14 females in SS group with age range 22–60 years and mean age of 42.91±10.44 years. There was a significant reduction in pain intensity and disability in MET’s and SS group (p&lt;0.05) when pre-treatment, 3rd week and 6th week treatment were compared. Pain intensity was lower at SS than MET while functional disability was lower in MET than SS p&lt;0.05 at 6th week Conclusion. MET reduces ND more than SS and SS reduces pain intensity better MET.

Brief interprofessional intervention for chronic pain management: a pilot study.

To test the effects of a brief interprofessional intervention for chronic pain management. Before and after pilot study. The brief interprofessional intervention had a psychoeducational focus and was based on the Self-Efficacy Theory, using Cognitive-Behavioral Therapy strategies. The intervention aimed to improve the management of chronic pain. It was conducted in group, over six weeks, with a two-hour weekly meeting, including educational strategies on pain management, stretching, and relaxation techniques. Self-efficacy, pain intensity, disability, fatigue, and depressive symptoms were assessed. Data were analyzed using the paired t-test and Pearson's correlation. Adults with moderate to severe pain took part in the study. Post-intervention analysis showed significant improvement in self-efficacy (p = 0.004) and significant reduction in pain intensity (p = 0.024), disability (p = 0.012), fatigue (p = 0.001), and depressive symptoms (p = 0.042). The effects of brief interprofessional intervention were positive for chronic pain management. We suggest the conduction of studies with more robust designs and a larger sample to confirm these findings.

PAIN INTENSITY AND FUNCTIONAL STATUS 30 DAYS AFTER SURGERY: DIFFERENCE BETWEEN TRANSFORAMINAL AND INTERLAMINAR PERCUTANEOUS ENDOSCOPICLUMBAR DISCECTOMIES

ABSTRACT Objective: To compare the differences between transforaminal and interlaminar endoscopic approaches in terms of pain intensity and functionality 30 days after the surgical procedure. Methods: A retrospective cohort study, with patients treated by percutaneous interlaminar or transforaminal endoscopic discectomy at the Spine Service of the ISCMPA, in southern Brazil. Data were collected from the patients’ electronic medical records by two independent physicians. The clinical outcomes of pain intensity and lumbar functionality were evaluated, respectively, using the visual analogue scale and the Oswestry Disability Index. Results: Thirty-six patients were included in the study, with a mean age of 50.8 ± 15.3 years, 19 (52.8%) of whom were males. As for the clinical outcomes for both transforaminal and interlaminar percutaneous endoscopic approaches, we observed a statistically significant reduction in pain intensity (mean difference of 3.5 points, p &lt; 0.001) and a statistically significant improvement in functionality (mean difference of 33.2 points, p &lt; 0.001) when we compared the pre- and 30-day postoperative periods, with no significant differences in terms of approaches. The type of technical approach also differed in relation to the patients’ age, the location, type, and migration of the herniated disc, and the patient’s time in the operating room. Conclusion: There was a similar effect on pain reduction and restoration of lumbar functions, 30 days after percutaneous endoscopic discectomy, in both technical approaches, with no significant differences between them. Level of Evidence III; Retrospective comparative study.

Prognosis of adenosine triphosphate infusion for anticonvulsants efficacy in patients with intensive cancer pain: a prospective observational study

INTRODUCTION: Pain is a common symptom in cancer patients even when analgesics were given. OBJECTIVE: To assess the prognostic value of intravenous infusion of non-selective purine receptors agonist adenosine triphosphate for effectiveness of anticonvulsant gabapentin in cancer patients with moderate and severe pain who received non-selective inhibitor of cyclooxygenase plus weak opioid tramadol. MATERIALS AND METHODS: Thirty-four cancer patients with intensive pain were scheduled for the study. The intravenous infusion of adenosine triphosphate 35–45 mg∙kg–1∙min–1 was performed within the period from 100 to 160 minutes. Then all patients were taken gabapentin (900 mg in three times daily). Pain was estimated 30 minutes before infusion, 30 minutes after infusion, and after taking 900 mg/day gabapentin for 4 days. Moreover, we studied prognostic significance of adenosine triphosphate infusion for the effectiveness of gabapentin administration. RESULTS: We revealed significant reduction of pain intensity after adenosine triphosphate infusion (Z = 4.0; р &lt; 0.0001 — Wilcoxon signed rank test). The same result was obtained after taking of gabapentin for 4 days (Z = 4.9; р &lt; 0.0001 — Wilcoxon signed rank test). Moreover, we found statistically moderate correlation link (t(N – 2) = 3.94; closeness correlation = 0.57; р &lt; 0.0004 — Spearman’s rank correlation coefficient) between pain intensity value after adenosine triphosphate infusion and taking of gabapentin. Regression analysis demonstrated satisfactory predictive ability of the resulting model (R2 = 0.55 (corrected R2 = 0.53); F = 38.74; р &lt; 0.0001). CONCLUSIONS: 1. Intravenous infusion of adenosine triphosphate may has significance for prognosis of taking anticonvulsant gabapentin effectiveness in cancer patients with moderate and severe pain who received non-selective cyclooxygenase inhibitor plus weak opioid tramadol. 2. Intravenous infusion of adenosine triphosphate or taking anticonvulsant gabapentin may significantly reduce pain intensity in cancer patients who had weak effect of administration of non-selective inhibitor of cyclooxygenase plus weak opioid tramadol.

Clinical Hypnosis For Pain Reduction In Breast Cancer Mastectomy: A Randomized Clinical Trial

ABSTRACT Surgical procedures for breast cancer treatment are commonly followed by pain. Clinical hypnosis has been shown to be effective in reducing pain during and after surgery, but most of the studies have used analogical scales, which only measure pain intensity. The aim of this study was to evaluate the effect of clinical hypnosis on pain intensity and its interference in daily activities in patients before and after mastectomy. The patients were evaluated using the Brief Pain Inventory. Forty patients were randomly assigned to an experimental or control group and evaluated 5 times: 1) baseline, 2) after clinical hypnosis session, 3) before surgery, 4) 1 day after surgery, and 5) 1 week after the surgery (follow-up). The results showed that after surgery the hypnosis group had a statistically significant reduction in pain intensity, less interference of pain with daily activities, sleep and life enjoyment compared with a control group. Clinical hypnosis may be recommended as a complementary treatment procedure for postmastectomy pain reduction and improving the quality of life of these patients.

The importance of the local twitch response during needling interventions in spinal pain associated with myofascial trigger points: a systematic review and meta-analysis.

To compare the clinical effects of needling interventions eliciting local twitch responses (LTRs) versus needling without eliciting LTRs when applied to muscle trigger points (TrPs) associated with spinal pain of musculoskeletal origin. Electronic databases were searched for randomized or non-randomized clinical trials where one group received needling intervention where LTRs were elicited and was compared with another group receiving the same intervention without elicitation of LTRs in spinal pain disorders associated with TrPs. Outcomes included pain intensity, pain-related disability, and pressure pain thresholds. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool or ROBINS-I tool, methodological quality was assessed with the PEDro score, and quality of evidence was evaluated using the GRADE approach. Six trials were included. The application of a needling intervention eliciting LTRs was associated with a significant reduction in pain intensity immediately after treatment (mean difference (MD): -2.03 points, 95% confidence interval (CI): -3.77 to -0.29; standardized MD (SMD): -1.35, 95% CI: -2.32 to -0.38, p = 0.02) when compared to the same needling intervention without elicitation of LTRs. No effect at short-term follow-up (MD: -0.20 points, 95% CI: -1.46 to 1.06, p = 0.75) was observed. No significant differences based on elicitation or non-elicitation of LTRs were found in related disability (SMD: -0.05, 95% CI: -0.41 to 0.30, p = 0.77) or pressure pain thresholds (MD: 23.39 kPa, 95% CI: -13.68 to 60.47, p = 0.22). Low-level evidence suggests an immediate effect of obtaining LTRs during needling interventions on pain intensity, with no significant effects on related disability or pressure pain sensitivity in spinal pain disorders associated with muscle TrPs. OSF Registry-https://doi.org/10.17605/OSF.IO/5ZX9N.

Evaluation of bovhyaluronidase azoxymer efficacy in combined treatment of patients with endometriosis based on the results of multicenter prospective non-interventional study (ISLAND)

Background. Endometriosis is a chronic progressive recurrent disease associated with pelvis pain, menses disorders and infertility. The prevalence of endometriosis (EGE) tends to increase steadily and reaches 15% among women of reproductive age. Endometriosis-associated pain can persist despite surgical and drug treatment of this disease, resulting in a significant decrease in the quality of life of patients. The main causes of EGE-associated pain are local inflammatory, adhesive, neuro- and angiogenic processes. Currently, the search for alternative methods of pathogenesis-based therapy of the disease is one of the priority tasks. Given its anti-inflammatory, enzymatic, antioxidant effects and anti-adhesion mechanism of action, bovhyaluronidase azoximer, an enzyme agent with hyaluronidase activity, is a promising drug in the complex therapy of EGE.&#x0D; Aim. To compare bovhyaluronidase azoxymer efficacy in complex therapy of patients with EGE using dienogest (2 mg) versus monotherapy with this progestogen in real clinical practice.&#x0D; Materials and methods. 149 female patients of reproductive age were enrolled in the study after surgical treatment for EGE. The patients were divided into two groups: the first group (n=94) was treated with complex therapy by dienogest (2 mg) daily within 6 months in combination with suppositories containing bovhyaluronidase azoxymer (3000 IU): 1 suppositorium once within 3 days,10 administrations; and then 1 suppositorium once in 7 days, 17 administrations, within 120 days; the second group (n=55) received monotherapy with dienogest (2 mg) daily up to 6 months. EGE-associated pelvic pain intensity, uterine bleeding severity and life quality were assessed during the study, after 30, 90, 150 and 180 days with regard to the basic values.&#x0D; Results. There was a statistically significant reduction of pain intensity observed in both groups compared to the basic level, using visual analogue scale of pain (VAS), the Biberoglu and Berman scale, but there was a distinct trend towards a more significant decrease in pelvic pain score basing on VAS in patients received complex therapy versus monotherapy with dienogest 2 mg after 30 days of treatment (p=0.051). Life quality assessment of patients in both groups revealed statistically significant increase in scores for all values of the SF-36 life quality scale just after the second follow-up visit. More significant life quality improvement in patients was observed with complex therapy with regard to such descriptors of the SF-36 Questionnaire as Physical functioning, Role-physical functioning, Pain intensity (p0.05).&#x0D; Conclusion. Bovhyaluronidase azoxymer in combination with dienogest (2 mg) improves the overall therapy effectiveness for EGE and is associated with more significant reduction in pelvic pain intensity, inflammatory and adhesive processes in the pelvis, and significant life quality improvement compared to monotherapy with 2 mg dienogest.