Significant Reduction In Pain Research Articles

Postoperative Benefits of Soft Tissue Wrist Arthroscopy: Retro- and Prospective Analyses of Outcome Measures.

Background: Elective soft-tissue-only wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist pain. A number of pathologies can be treated arthroscopically, with the aim of pain reduction and improved wrist mobility. A postinterventional evaluation of the treatment using objective and patient-reported outcome measures (PROMs) allows for an evidence-based statement about the benefits of soft-tissue-only wrist arthroscopy. Methods: A dual-center study combining retro- and prospective clinical analyses of patient outcomes after soft-tissue-only wrist arthroscopies was performed. The data were collected at two hospitals with departments specializing in hand surgery. The outcome was measured by assessing the range of motion of the wrist and its manual strength, as well as PROMs, including Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: A total of 154 soft interventions met the study criteria and could be included. Seven months after the elective soft-tissue-only wrist arthroscopies, mobility improved significantly for active extension and flexion, as well as the ulnar and radial abduction of the wrist. The grip strength also improved significantly, by an average of 6 kg, during this period. The DASH score improved significantly, from 35 points to 14 points. Additionally, wrist pain at rest was reduced significantly. Conclusions: After elective soft-tissue-only wrist arthroscopy, patients showed an overall functional improvement in their wrist, with a significant reduction in pain and improvement of mobility and grip strength. This study emphasizes the importance of wrist arthroscopy as a successful treatment option for soft tissue pathologies of the wrist.

A Comparative Analysis of Erector Spinae Plane Block Versus Conscious Sedation in Managing Percutaneous Cholecystostomy Pain.

This study investigates the efficacy of erector spinae plane block (ESPB) for managing perioperative and postoperative pain in patients undergoing percutaneous cholecystostomy (PC) for acute cholecystitis, particularly in high-risk elderly patients with extensive comorbidities and limited functional status. In a retrospective single-center study, 58 high-risk patients scheduled for PC were assessed. ESPB was administered to 23 patients, while 22 received conscious sedation. Pain intensity was measured using the numeric rating scale before any analgesic or ESPB administration, during the procedure and at 1 and 12h post-procedure and secondary outcomes included adverse effects and additional analgesic requirements. The ESPB group experienced significant pain reduction during and post-procedure compared to the conscious sedation group (p = 0.002). Procedure times were shorter (p = 0.015), and postoperative tramadol was less frequently needed in the ESPB group (p = 0.007). The incidence of nausea was also lower in the ESPB group (p = 0.001). No ESPB-related complications were reported. ESPB significantly alleviates perioperative and postoperative pain in PC patients, reducing additional analgesic use and side effects. It holds promise as a key component of pain management for high-risk surgical patients. Level 3, Non-randomized controlled cohort/follow-up study.

Impact of Single-Session Intraoral and Extraoral Photobiomodulation on Pain Control after Extraction of Impacted Mandibular Third Molar: A Pilot Study

This study aims to evaluate the impact of a single session of intraoral and extraoral photobiomodulation (PBM) on controlling pain and improving a patient’s daily activities following surgical extraction of the impacted mandibular third molar, using combined three wavelengths: “445 nm, 660 nm, and 970 nm”. A pilot study was conducted on 22 patients undergoing extraction of an impacted mandibular third molar. The patients were randomly divided into two groups: (1) The Test Group consisted of patients subjected to immediate postoperative PBM. The extraoral PBM parameters were power = 550 mW and spot area = 5 cm2, while the intraoral parameters were power = 200 mW and spot area = 2 cm2. (2) The Control Group consisted of the patients not subjected to PBM. For all the patients, the pain was evaluated via a Numeric Rating Scale (NRS) on day 0, day 1, day 3, and day 7 after surgical intervention. The patient’s daily activities were evaluated on day 7 via a custom-made questionnaire. A statistically significant difference was observed between groups in the pain NRS scores on day 0 (p = 0.022), day 1 (p = 0.047), and day 7 (p = 0.028). No significant difference was found on day 3 (p = 0.153). A marginal statistical significance was observed with the number of painkillers taken (p = 0.054). No significant difference was observed with the questionnaire score (p = 0.206). This pilot study showed a significant reduction in postoperative pain on days 0, 1, and 7 with a single session of intraoral and extraoral PBM. However, the number of painkillers taken and the scores of the daily activities questionnaire did not show statistical significance despite the observed better results in patients subjected to PBM.

Formulation and Evaluation of Diclofenac Transdermal Gel

Diclofenac sodium gel is a widely used nonsteroidal anti-inflammatory drug (NSAID) formulation designed for topical application, primarily targeting local pain and inflammation. This wok aims to provide a comprehensive analysis of the anti-inflammatory activity of diclofenac sodium gel, focusing on its mechanism of action, efficacy, safety profile, and clinical applications. Several clinical studies have investigated the efficacy of diclofenac sodium gel in various inflammatory conditions, including osteoarthritis, rheumatoid arthritis, and soft tissue injuries. Results consistently demonstrate significant reductions in pain, swelling, and functional impairment, validating the gel's anti-inflammatory properties. The safety profile of diclofenac sodium gel is generally favorable, with local skin reactions being the most commonly reported adverse events. Systemic absorption is low, reducing the risk of gastrointestinal complications and other systemic side effects associated with oral NSAIDs. However, caution should be exercised in individuals with a history of hypersensitivity reactions or skin disorders.

A Multi-centered Retrospective Study on the Efficacy of Pulsed Radiofrequency Nerve Ablation in the Treatment of Recalcitrant Plantar Fasciitis: A Mid-term Outcome.

Background Plantar fasciitis, a condition marked by persistent and often excruciating heel pain, frequently poses a formidable hurdle when conservative treatment approaches fall short. This multi-centered retrospective study embarks on a journey to explore the potential effectiveness of pulsed radiofrequency nerve ablation (RFNA), an innovative and less invasive procedure, as a novel avenue for treating recalcitrant plantar fasciitis. This investigation centers around a group of 24 patients who have faced the persistence of this challenging ailment. By meticulously scrutinizing patient outcomes and conducting a comprehensive analysis of safety aspects, this study aspires to offer enlightening revelations regarding the promise and practicality of pulsed RFNA as a therapeutic solution for tackling this intricate and tenacious condition. Methods This retrospective study included 24 patients who had undergone pulsed RFNA for recalcitrant plantar fasciitis between June 1, 2020, and June 1, 2022, at Hospital Pengajar Universiti Putra Malaysia (HPUPM), Hospital Universiti Teknologi Mara (UiTM), and Hospital Serdang. Patients were selected from the Orthopedic Clinics at HPUPM, Hospital UiTM, and Hospital Serdang and were screened according to the inclusion and exclusion criteria. Patient data was extracted from the hospital information systemand electronic medical records. Pre-procedure and post-procedure assessments were conducted at one, three, and six months on the selected patients using the visual analog scaleand American Orthopaedic Foot and Ankle SocietyAnkle-Hindfoot Scoring systems. All selected patient data was traced and tabulated accordingly. Results This study evaluates the effectiveness of pulsed RFNA in treating recalcitrant plantar fasciitis in 24 participants (39 feet). Results show a significant reduction in pain and improvement in functionality at one, three, and six months post-RFNA. Demographic factors (age, gender, and specific diagnosis) did not significantly impact outcomes. The study supports pulsed RFNA as an effective treatment for recalcitrant plantar fasciitis, emphasizing consistent benefits across various patient characteristics. Conclusion In conclusion, the study demonstrates the notable effectiveness of pulsedRFNAin improving pain reduction and functional outcomes for individuals with recalcitrant plantar fasciitis. The findings, consistent across various demographic factors, support pulsed RFNA as a promising and uniform treatment option for those who do not respond to conservative measures.

The anatomy of pain relief: Lumbar oxygen-ozone epidural infiltrations for cervicobrachialgia

Objective: This study investigates the efficacy and safety of epidural infiltration with drugs and an oxygen-ozone mixture for treating cervicobrachialgia due to disc-radicular conflict or on a degenerative basis, utilizing both retrospective analysis and direct visualization techniques. Methods: A retrospective study involving 10 patients treated with epidural infiltrations of an oxygen-ozone mixture and cortisone was conducted. The procedures were performed under CT guidance to ensure precise delivery and to monitor the diffusion of the injected substances. Pain levels were assessed using the Numerical Rating Scale (NRS) and treatment efficacy was evaluated based on symptom relief and reduction in NSAID intake. Results: Significant pain reduction was observed post-treatment, with median NRS scores decreasing from 9 (baseline) to 2 (follow-up), and a significant decrease in on-demand NSAID intake. Only one minor complication of a headache was reported. The study also demonstrated the ability of ozone to diffuse through the epidural adipose tissue, potentially enhancing treatment efficacy. Conclusion: The combined use of an oxygen-ozone mixture and cortisone for epidural infiltration is an effective and safe treatment for cervicobrachialgia, offering significant pain relief and minimizing the risk associated with traditional epidural injections. This technique presents a viable non-surgical option for patients suffering from disc-radicular conflict or degenerative conditions.

Clinical Study of Analgesic and Anti-inflammatory Properties of Cannabis Derivatives in Patients with Temporomandibular Joint Pathology: Preliminary Study

Abstract We all know that the use of marijuana is a potent anti-inflammatory and analgesic and possible mechanisms of action and components that can help reduce the effects of pain in temporomandibular joint (TMJ) disorders. Our study aimed to analyze the anti-inflammatory and analgesic characteristics of cannabis derivatives in patients with temporomandibular pathology. Thirty-six patients were divided into three groups: one was treated with Cannabidiol (CBD) cream, the second was treated with CBD Vaper, and the third was treated with conventional anti-inflammatories such as Ibuprofen 600 mg. All patients underwent a dental computed tomography scan at the beginning and another at the end of treatment 28 days later. In addition to the study treatment of Cannabis and anti-inflammatories, all patients received physiotherapy treatment on day 0, day 14, day 21, and day 28 of the study. The study’s results allow us to evaluate that using the CBD cream with physiotherapy results in a favorable pain reduction of 59%, CBD Vaper with physiotherapy has reduced pain by 35%, and the combined use of ibuprofen medication with physiotherapy has reduced pain by 45%. Therefore, using CBD and physiotherapy allows a biological reduction of pain and inflammation at TMJ. The most significant reduction in analgesia and pain occurred with CBD cream, followed by ibuprofen, which had less effect than CBD Vaper. We can control the pain of the TMJ with the use of CBD and treatment with the physiotherapist that allows us to maintain the dose and time of use of CBD both in cream and in Vaper; this improves the quality of life and returns the patient to cognitive relieving stress and anxiety.

Long-term treatment for endometriosis with dienogest: efficacy, side effects and tolerability

Background Dienogest (DNG) improves endometriosis-associated pain (EAP) and patients’ quality of life; however, the modern cornerstone of the management of endometriosis is the long-term adherence of the patient to medical treatment. Objective To evaluate DNG as a long-term treatment of endometriosis, focusing on patients’ compliance and side effects, also correlating with different phenotypes of endometriosis. Methods This was a cohort study on a group of patients with endometriosis (n = 114) undergoing long-term treatment with DNG. During the follow up visits (12, 24, and 36 months) patients were interviewed: an assessment of EAP was performed by using a visual analogue scale (VAS) and side effects were evaluated by using a specific questionnaire of 15 items. Results At 12 months, 81% were continuing the DNG treatment, with a significant reduction of dysmenorrhea, dyspareunia, dyschezia, dysuria and chronic pelvic pain. Of the 19% that discontinued the treatment: 62% was due to spotting, reduced sexual drive, vaginal dryness, and mood disorders. The improvement of EAP was significant for all endometriosis phenotypes, especially in patients with the deep infiltrating type. At 36 months, 73% of patients were continuing the treatment, showing a significant reduction of EAP through the follow up, along with an increase of amenorrhea (from 77% at 12 months to 93% at 36 months). In a subgroup of 18 patients with gastrointestinal disorders, DNG was administered vaginally at the same dosage, showing similar results in terms of efficacy and tolerability. Conclusions DNG was an effective long-term treatment for all endometriosis phenotypes, with few side effects that caused the discontinuation of the treatment mainly during the first year. Thus, the course of 1-year treatment is a predictive indicator for long-term treatment adherence.

Impact assessment of integrated-pathy on cancer-related fatigue in cancer patients: an observational study.

Integrated-pathy aims to integrate modern medicine with traditional systems via applying the holistic approach of Ayurveda, Yoga, and natural medicine. This is important for addressing the challenges surrounding the delivery of long-term palliative care for chronic ailments including cancer. The prime intent of this study was to substantiate the underlying hypothesis behind the differential and integrative approach having a positive impact on Quality of Life of cancer patients. Cross-sectional Observational study. A standardized questionnaire was developed and used, after obtaining written informed consent from patients to assess the impact of Integrated-pathy on patients (n = 103) diagnosed with cancer receiving care at Patanjali Yoggram. The research was carried out over 8 months. All participants received a uniform treatment protocol as prescribed by Patanjali. For the sample size determination and validation, α and 1-β was calculated and for the significance of the pre- and post-treatment QoL ratings, Shapiro wilk test and other descriptive statistics techniques were explored. A total of 103 patients seeking cancer special-healthcare were interviewed, out of which 39 (37.86%) remained finally based on the inclusion/exclusion criteria with age (25-65years), types of cancers (Carcinoma and Sarcoma), chemotherapy/radiotherapy received or not, before opting Integrated-pathy. Follow-ups revealed a significant increase in the QoL (17.91%) after receiving the integrated therapy over a course of at least 1 month. Further, a significant reduction in cancer-related pain followed by an increase in QoL index was reported in the patients. Shapiro-wilk test revealed significant pairing (p < 0.001) with validation of the model using test. To bolster evidence-based backing for Integrated-pathy, there is a need for clearly delineated clinical indicators that are measurable and trackable over time. Clinical investigators are encouraged to incorporate Integrated-pathy into their proposed interventions and conduct analogous studies to yield sustained advantages in the long run.

Prevalence and Causes of Blindness and Visual Impairment in Sudur Paschim Province of Nepal

Tonsillectomy is the complete removal of a tonsil from its bed and is one of the most common procedures in Otorhinolaryngology. The intensity of post-operative pain is severe enough to cause dysphagia which subsequently leads to infection of the fossa and other complications. Several studies on pain management have been conducted but not a single standard protocol currently exist. This study aims to evaluate the intensity of post tonsillectomy pain and to assess the efficacy of infiltration of Bupivacaine on the tonsillar fossa following tonsillectomy. A comparative study was conducted at Kathmandu Medical College, ENT-HNS department for a period of 18 months (January 2018 to June 2019). Ninety three patients were included. 2.5 ml of 0.5% Bupivacaine was infiltrated in right tonsillar fossa after tonsillectomy in all patients. The lateralization and intensity of pain at various post-operative period was assessed using visual analogue scale. The requirement of extra analgesics at various post-operative period was recorded. The pain score on the Bupivacaine side on the first and second post-operative day was decreased as compared to the other side. The pain score on the fourth hour and third post-operative day on Bupivacaine side was more than that of the other side. Infiltration of Bupivacaine over the tonsillar fossa has provided a good result with a significant reduction of pain in first post-operative day and in early post-operative period. However, other multi-centered and double blinded study is requires to provide better results.

Comparison of Post-operative Pain with and without Infiltration of Bupivacaine Hydrochloride in Tonsillectomy

Tonsillectomy is the complete removal of a tonsil from its bed and is one of the most common procedures in Otorhinolaryngology. The intensity of post-operative pain is severe enough to cause dysphagia which subsequently leads to infection of the fossa and other complications. Several studies on pain management have been conducted but not a single standard protocol currently exist. This study aims to evaluate the intensity of post tonsillectomy pain and to assess the efficacy of infiltration of Bupivacaine on the tonsillar fossa following tonsillectomy. A comparative study was conducted at Kathmandu Medical College, ENT-HNS department for a period of 18 months (January 2018 to June 2019). Ninety three patients were included. 2.5 ml of 0.5% Bupivacaine was infiltrated in right tonsillar fossa after tonsillectomy in all patients. The lateralization and intensity of pain at various post-operative period was assessed using visual analogue scale. The requirement of extra analgesics at various post-operative period was recorded. The pain score on the Bupivacaine side on the first and second post-operative day was decreased as compared to the other side. The pain score on the fourth hour and third post-operative day on Bupivacaine side was more than that of the other side. Infiltration of Bupivacaine over the tonsillar fossa has provided a good result with a significant reduction of pain in first post-operative day and in early post-operative period. However, other multi-centered and double blinded study is requires to provide better results.

Pericapsular Hip Block Guided by Ultrasonography in Elderly People with Hip Fracture in the Emergency Sector: Clinical Trial.

Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed. Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block. Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients ( p < 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group ( p < 0.05). Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group.

Randomized controlled trial investigating the role of yoga at workplace in improving fatigue, burnout, pain, strength, and quality of life among blue-collar workers

BACKGROUND: Due to the physical demands of work, blue-collar workers (BCW) frequently experience fatigue, musculoskeletal pain, and burnout. The purpose of this study was to determine the feasibility and utility of introducing yoga-based loosening exercises (YLE) at the workplace for improving fatigue, musculoskeletal pain, and burnout among BCW. MATERIALS AND METHODS: One hundred and twenty-eight BCW were randomized into a yoga group that received 40 minutes of supervised YLE daily, 5 days a week, for 1 month, followed by 1 month of unsupervised practice at home or a waitlisted control group. The Chalder Fatigue Scale (CFS), Visual Analog Scale for pain, Oldenburg Burnout Inventory (OLBI), sit-and-reach test (SRT), handgrip strength dynamometer, and the Short Form-8 (SF-8) questionnaire were measured at baseline, at the end of the first month, and at follow-up after the first month. RESULTS: All the participants adhered well to the YLE (≈86% at the workplace, ≈70% at home). Compared to the controls, the yoga group reported significant reductions in fatigue, pain, and burnout and significant improvements in flexibility, strength, and quality of life (P &lt; 0.001) at all the time points. CONCLUSION: Our findings demonstrate that workplace yoga programs for BCW are feasible and can considerably reduce fatigue, pain, and burnout and improve their quality of life.

Modified Surgical Treatment for Achilles Tendon Rupture Secondary to Insertional Achilles Tendinopathy Using Midline Dorsal Approach

Objective: To assess the pain relief and functional outcomes of patients who undergo surgical management of Achilles tendon rupture secondary to insertional Achilles tendinopathy and associated conditions using a midline dorsal approach.Methods: This prospective observational study included 30 patients diagnosed with Achilles tendon rupture secondary to insertional Achilles tendinopathy. We recorded risk factors, predisposing factors, and co-morbidities for all cases. Pain relief and functional improvement were assessed by comparing Visual Analogue Scale (VAS) scores and American Orthopedic Foot and Ankle Score (AOFAS) at the time of presentation and at the final follow-up. We conducted statistical analysis using SPSS 21.0 software, with a significance level of p&lt;0.05.Results: Of the participants, 17 (56.67%) were male and 13 (43.13%) were female, resulting in a male-to-female ratio of 1:0.76. The mean age of male and female patients was comparable (p=0.7515). The majority of patients (60%) were overweight, while 9 (30%) were obese, and 3 (10%) had a normal body mass index. We observed a significant reduction in pain and functional improvement in the studied cases, as evidenced by a statistically significant reduction in VAS scores and improvements in AOFAS. Eight (26.66%) patients experienced minor complications that could be managed conservatively, but no major complications were observed.Conclusion: Modified surgical treatment of Achilles tendon rupture secondary to insertional Achilles tendinopathy using a midline dorsal approach leads to significant improvements in pain and functional outcomes, with an acceptable complication rate.

The clinical use of cannabinoids for pain

Cannabis has been used for medicinal purposes more than millennia., further research concerning the potential applications of medicinal cannabis has gained considerable momentum in the medical community. Among the several cannabinoids produced by cannabis leaves, the most notable compounds include Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), which act on the endocannabinoid system and play significant physiological roles, such as pain regulation. This manuscript reviews the current knowledge and provides medical evidence about the analgesic potential of medicinal cannabis for chronic pain management. The following databases were searched: MEDLINE, COCHRANE, SCIELO and LILACS. Only randomized controlled trials published within six years were selected. Nine articles met the inclusion criteria for the present review. All nine RCTs reported a significant difference in the reduction in pain intensity; however, only five of the studies reported a significant reduction in pain. The presence of mild-to-moderate adverse events was greater in the intervention groups than in the control group, but these adverse events were well tolerated. The difference in opioid use and other analgesic drugs between the intervention group and the placebo group was not statistically significant. Cannabis-derived compounds promote beneficial effects when administered into patients with chronic pain.

Ethanol Sclerotherapy in the Management of Ovarian Endometrioma: Technical Considerations for Catheter- and Needle-Directed Sclerotherapy.

To provide technical guidance on applying catheter-directed and needle-directed ethanol sclerotherapy for endometriomas and present the results of these sclerotherapy methods. From January 2015 to March 2021, the results of the patients with symptomatic ovarian endometriomas who underwent needle-directed or catheter-directed sclerotherapy were evaluated, retrospectively. The decision to apply which sclerotherapy technique was made during the procedure for each patient considering the following factors: cyst size, cyst location, cyst viscosity, and tissue rigidity. Both needle-directed (n = 34 cysts) and catheter-directed (n = 34 cysts) sclerotherapy techniques were effective, with a 100% technical success rate and a 97% clinical success rate. In two of 34 cysts (6%) treated with needle-directed sclerotherapy, recurrence was detected and successfully retreated with catheter-directed sclerotherapy. Significant reductions in cyst size, pain, and serum cancer antigen 125 levels (p < 0.05) were noted. Serum anti-Müllerian hormone levels remained unaffected, indicating preserved ovarian reserve (p > 0.05). Among those treated for infertility, the pregnancy rate was 54% (n = 6/11). The mean ± SD cyst size decline was greater in catheter-directed sclerotherapy than needle-directed sclerotherapy (5.5 ± 3.1cm vs. 4.0 ± 2.1cm, p < 0.05). However, the pretreatment cyst volumes were considerably higher in catheter-directed sclerotherapy group (202.0 ± 233.5mL vs. 78.8 ± 59.7mL, p < 0.05) and were associated with significant post-treatment volume decrease (p < 0.05). The choice between catheter-directed and needle-directed ethanol sclerotherapy should be determined during the procedure, with a preference for catheter-directed sclerotherapy when feasible. Crucial factors in making this decision include cyst size, cyst location, cyst viscosity, and tissue rigidity. Level of evidence Level 3, non-controlled retrospective cohort study.

Can pain be self-managed? Pain change in vulnerable participants to a health education programme.

Chronic pain exerts a significant impact on the quality of life, giving rise to both physical and psycho-social vulnerabilities. It not only leads to direct costs associated with treatments, but also results in indirect costs due to the reduced productivity of affected individuals. Chronic conditions can be improved by reducing modifiable risk factors. Various educational programs, including the Chronic Disease Self-Management Programme (CDSMP), have demonstrated the advantages of enhancing patient empowerment and health literacy. Nevertheless, their efficacy in addressing pain symptoms has received limited attention, especially concerning vulnerable populations. This research aims to assess the effectiveness of the CDSMP in alleviating pain among socio-economically vulnerable participants with chronic conditions. By accounting for a wide range of variables, and using data from the EFFICHRONIC project (EU health programme), we investigated the changes in pain levels after the intervention, among 1070 participants from five European countries. Our analyses revealed a significant reduction in pain following the intervention. This finding supports the notion that training programs can effectively ameliorate pain and alleviate its impact on the quality of life, particularly in vulnerable populations. Younger participants, as well as those with higher education levels and individuals experiencing higher levels of pain at baseline, were more likely to experience a reduction in their pain levels. These findings underscore the importance of recognising the social determinants of health. The study was registered at ClinicalTrials.gov (ISRCTN70517103).

The effectiveness of non-pharmacological interventions on reducing pain in patients undergoing bone marrow aspiration and biopsy: A systematic review and meta-analysis of randomized controlled trials.

Patients often consider bone marrow aspiration and biopsy to be one of the most painful medical procedures. The effectiveness of non-pharmacological interventions to reduce pain during bone marrow aspiration and biopsy remains unclear. To synthesize existing evidence regarding the effectiveness of non-pharmacological interventions in mitigating procedural pain among patients undergoing bone marrow aspiration and biopsy. A systematic review and meta-analysis of randomized controlled trials. Six electronic databases, including PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library and Web of Science were searched from inception to July 15, 2023. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 2.0. Meta-analysis was conducted using STATA 16. The certainty of the evidence was assessed by the GRADE approach. This meta-analysis included 18 studies derived from 17 articles involving a total of 1017 participants. The pooled results revealed statistically significant pain reduction effects using distraction (SMD: -.845, 95% CI: -1.344 to -.346, p < .001), powered bone marrow biopsy system (SMD: -.266, 95% CI: -.529 to -.003, p = .048), and acupoint stimulation (SMD: -1.016, 95% CI: -1.995 to -.037, p = .042) among patients undergoing bone marrow aspiration and biopsy. However, the pooled results on hypnosis (SMD: -1.228, 95% CI: -4.091 to 1.515, p = .368) showed no significant impact on pain reduction. Additionally, the pooled results for distraction did not demonstrate a significant effect on operative anxiety (MD: -2.942, 95% CI: -7.650 to 1.767, p = .221). Distraction, powered bone marrow biopsy system and acupoint stimulation are effective in reducing pain among patients undergoing bone marrow aspiration and biopsy. Not applicable. This meta-analysis highlights the effectiveness of distraction, powered bone marrow biopsy system and acupoint stimulation for reducing pain in patients undergoing bone marrow biopsy. Healthcare professionals should consider integrating these interventions into pain management practices for these patients. (PROSPERO): CRD42023422854.

Effects of a mat Pilates-based exercise program for low back pain in helicopter pilots of the Brazilian Air Force: Randomized controlled trial

IntroductionHelicopter pilots may present chronic low back pain due to vibration exposure and asymmetric posture during flight. ObjectivesTo analyze the effects of a Pilates-based exercise program on low back pain of helicopter pilots of the Brazilian Air Force. MethodsThis is a randomized controlled trial with fifteen helicopter pilots of the Brazilian Air Force, who were assessed for pain intensity (Numerical Pain Rating Scale), disability associated with low back pain, and spine muscle endurance in three positions: trunk extension (Ito test) and left and right lateral bridge. Individuals were randomly distributed into the regular exercises group (REG) (n = 7), oriented to maintain their exercise routine, and Pilates group (PG) (n = 8), which performed an exercise program based on Pilates method twice a week for 12 weeks. Reassessments occurred after 6 and 12 weeks. Data were analyzed on SPSS 20.0 software using a significance level of 5%. ResultsPG showed a significant reduction in low back pain after 12 weeks of training compared with REG (mean difference of 3.5 points, p < 0.0001). We also observed increased endurance of trunk extensors (p = 0.002) and right (p = 0.001) and left lateral muscles (p = 0.001) in the PG compared with REG. However, the indexes of disability did not change between groups. ConclusionPain intensity was significantly reduced while spine muscle endurance increased in PG compared with REG after intervention; thus, Pilates-based exercises should be considered in physical conditioning programs for helicopter pilots.

Characterizing the opioidergic mechanisms of repetitive transcranial magnetic stimulation-induced analgesia: a randomized controlled trial.

Repetitive transcranial magnetic stimulation (rTMS) is a promising technology to reduce chronic pain. Investigating the mechanisms of rTMS analgesia holds the potential to improve treatment efficacy. Using a double-blind and placebo-controlled design at both stimulation and pharmacologic ends, this study investigated the opioidergic mechanisms of rTMS analgesia by abolishing and recovering analgesia in 2 separate stages across brain regions and TMS doses. A group of 45 healthy participants were equally randomized to the primary motor cortex (M1), the dorsolateral prefrontal cortex (DLPFC), and the Sham group. In each session, participants received an intravenous infusion of naloxone or saline before the first rTMS session. Participants then received a second dose of rTMS session after the drugs were metabolized at 90 minutes. M1-rTMS-induced analgesia was abolished by naloxone compared with saline and was recovered by the second rTMS run when naloxone was metabolized. In the DLPFC, double but not the first TMS session induced significant pain reduction in the saline condition, resulting in less pain compared with the naloxone condition. In addition, TMS over the M1 or DLPFC selectively increased plasma concentrations of β-endorphin or encephalin, respectively. Overall, we present causal evidence that opioidergic mechanisms are involved in both M1-induced and DLPFC-rTMS-induced analgesia; however, these are shaped by rTMS dosage and the release of different endogenous opioids.