Substantial Pain Reduction Research Articles

Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial

Nonsteroidal anti-inflammatory drugs are used extensively for the management of acute and chronic pain, with ketorolac tromethamine being one of the most frequently used parenteral analgesics in the emergency department (ED). The drugs may commonly be used at doses above their analgesic ceiling, offering no incremental analgesic advantage while potentially adding risk of harm. We evaluate the analgesic efficacy of 3 doses of intravenous ketorolac in ED patients with acute pain. We conducted a randomized, double-blind trial to assess the analgesic efficacy of 3 doses of intravenous ketorolac (10, 15, and 30 mg) in patients aged 18 to 65 years and presenting to the ED with moderate to severe acute pain, defined by a numeric rating scale score greater than or equal to 5. We excluded patients with peptic ulcer disease, gastrointestinal hemorrhage, renal or hepatic insufficiency, allergies to nonsteroidal anti-inflammatory drugs, pregnancy or breastfeeding, systolic blood pressure less than 90 or greater than 180 mm Hg, and pulse rate less than 50 or greater than 150 beats/min. Primary outcome was pain reduction at 30 minutes. We recorded pain scores at baseline and up to 120 minutes. Intravenous morphine 0.1 mg/kg was administered as a rescue analgesic if subjects still desired additional pain medication at 30 minutes after the study drug was administered. Data analyses included mixed-model regression and ANOVA. We enrolled 240 subjects (80 in each dose group). At 30 minutes, substantial pain reduction was demonstrated without any differences between the groups (95% confidence intervals 4.5 to 5.7 for the 10-mg group, 4.5 to 5.6 for the 15-mg group, and 4.2 to 5.4 for the 30-mg group). The mean numeric rating scale pain scores at baseline were 7.7, 7.5, and 7.8 and improved to 5.1, 5.0, and 4.8, respectively, at 30 minutes. Rates of rescue analgesia were similar, and there were no serious adverse events. Secondary outcomes showed similar rates of adverse effects per group, of which the most common were dizziness, nausea, and headache. Ketorolac has similar analgesic efficacy at intravenous doses of 10, 15, and 30 mg, showing that intravenous ketorolac administered at the analgesic ceiling dose (10 mg) provided effective pain relief to ED patients with moderate to severe pain without increased adverse effects.

To evaluate the role of Gabapentin as preemptive analgesic in patients undergoing total abdominal hysterectomy in spinal anesthesia

Introduction:Preemptive analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input. Gabapentin, a structural analogue of gamma-amino butyric acid, has been used as an anticonvulsant and antinociceptive drug and is claimed to be more effective in preventing neuropathic component of acute nociceptive pain of surgery.Material and Methods:Fifty patients of ASA grade I and II were assigned to receive oral 600mg Gabapentin or Placebo 2 hours before surgery. Surgeries were conducted under spinal anesthesia. Post operatively pain was assessed by visual analogue score (VAS) at 2, 4, 8, 12 and 24 hrs. Patients were given rescue analgesic on demand. Sedation score and total numbers of analgesics during first 24 hours postoperatively were noted.Results:Gabapentin group resulted in faster onset of motor and sensory block, significantly longer duration of analgesia, substantial reduction in post-operative pain and the rescue analgesics. Patients remained in sleeping but co- operative state and Gabapentin group were not associated with side effects when compared with placebo group.Conclusions:Preemptive use of Gabapentin 600mg orally significantly prolongs the analgesia with reducing postoperative pain and rescue analgesics in patients undergoing total abdominal hysterectomy under spinal anesthesia.

Successful conversion of wrist prosthesis to arthrodesis in 11 patients.

IV.

Assessment of Lycopene and Levamisole in Management of Oral Lichen Planus-A Comparative Study

Objective: Oral Lichen Planus (OLP) is known to be persistent and resistant to treatment. Corticosteroids are the preferred mode of intervention in OLP, long courses of which have been shown to cause adverse effects. The goal of this study was to compare the safety and efficacy of Lycopene and of Levamisole in the management of Oral Lichen Planus. Methods: 50 symptomatic OLP patients satisfying the inclusion criteria were randomly divided into two groups (A and B). Group A patients were administered lycopene 8mg / day in two divided doses for 8 weeks. Group B patients were administered levamisole 50mg in cyclic dosage i.e. thrice daily for 3 consecutive days followed by no drug for next four days; for 8 weeks. The patients were scored at baseline, 2 weeks, 4 weeks and 8 weeks using Visual Analog Scale (VAS) for symptoms and Tel-Aviv San Francisco (TASF) scale for overall response to treatment. Statistical analysis was performed using repeated measures of ANOVA, Z test and chi square test. Results: Substantial reduction in pain and burning sensation was observed in both the groups at the end of treatment. A more potent therapeutic effect was observed in lycopene group. Specifically, 18 out of 25 (72%) patients in this group showed 50% or more improvement while 12 out of 25 (48%) patients showed 70-100% improvement. In levamisole group, 11 out of 25 (44 %) and 1 out of 25 patients showed 50% or more, and 70-100% improvement. No adverse effects were reported in either group. Conclusion: When used as monotherapeutic agents, both lycopene and levamisole were found to be safe and effective alternatives for treatment of Oral Lichen Planus. Lycopene demonstrated a faster and more potent therapeutic effect compared to levamisole. The results of this research motivate further studies with larger sample size to evaluate these drugs in the treatment of OLP. Key words: Lycopene, Levamisole, Oral lichen planus

HIFU for Palliative Treatment of Pancreatic Cancer.

Pancreatic cancer is one of the deadliest malignancies, with only a 6 % 5-year survival rate and over 50 % of patients being diagnosed at the advanced stage. Current therapies are ineffective, and the treatment of patients with advanced disease is palliative. In the past decade, HIFU ablation has emerged as a modality for palliative treatment of pancreatic tumors. Multiple preclinical and non-randomized clinical trials have been performed to evaluate the safety and efficacy of this procedure. Substantial tumor-related pain reduction was achieved in most cases after HIFU treatment and few significant side effects were observed. In addition, some studies indicate that combination of HIFU ablation with chemotherapy may provide a survival benefit. This chapter summarizes the pre-clinical and clinical experience obtained to date in HIFU treatment of pancreatic tumors and discusses the challenges, limitations and new approaches in this modality.

Total disc arthroplasty versus anterior cervical interbody fusion: use of the Spine Tango registry to supplement the evidence from randomized control trials

Background ContextSeveral randomized controlled trials (RCTs) have compared patient outcomes of anterior (cervical) interbody fusion (AIF) with those of total disc arthroplasty (TDA). Because RCTs have known limitations with regard to their external validity, the comparative effectiveness of the two therapies in daily practice remains unknown. PurposeThis study aimed to compare patient-reported outcomes after TDA versus AIF based on data from an international spine registry. Study Design and SettingA retrospective analysis of registry data was carried out. Patient SampleInclusion criteria were degenerative disc or disc herniation of the cervical spine treated by single-level TDA or AIF, no previous surgery, and a Core Outcome Measures Index (COMI) completed at baseline and at least 3 months' follow-up. Overall, 987 patients were identified. Outcome MeasuresNeck and arm pain relief and COMI score improvement were the outcome measures. MethodsThree separate analyses were performed to compare TDA and AIF surgical outcomes: (1) mimicking an RCT setting, with admission criteria typical of those in published RCTs, a 1:1 matched analysis was carried out in 739 patients; (2) an analysis was performed on 248 patients outside the classic RCT spectrum, that is, with one or more typical RCT exclusion criteria; (3) a subgroup analysis of all patients with additional follow-up longer than 2 years (n=149). ResultsMatching resulted in 190 pairs with an average follow-up of 17 months that had no residual significant differences for any patient characteristics. Small but statistically significant differences in outcome were observed in favor of TDA, which are potentially clinically relevant. Subgroup analyses of atypical patients and of patients with longer-term follow-up showed no significant differences in outcome between the treatments. ConclusionsThe results of this observational study were in accordance with those of the published RCTs, suggesting substantial pain reduction both after AIF and TDA, with slightly greater benefit after arthroplasty. The analysis of atypical patients suggested that, in patients outside the spectrum of clinical trials, both surgical interventions appeared to work to a similar extent to that shown for the cohort in the matched study. Also, in the longer-term perspective, both therapies resulted in similar benefits to the patients.

3D navigation of endoscopic rhizotomy at the lumbar spine

We present a detailed description of the surgical technique and the preliminary results of an endoscopic denervation for patients with chronic low back pain (CLBP) originating from the facet joints (FJ). Endoscopic denervation of the medial branches of the dorsal rami supplying the FJ has recently been appraised as providing excellent intraoperative visualization and long term pain relief for these patients. Conventional endoscopic rhizotomy has been expanded to include a the precise localization of 3D navigation. A surgical description and the results of our first four patients treated with 3D navigated endoscopic rhizotomy (3DNER) are presented. Four patients with a mean age of 59years and a follow-up time of 2months were included. All patients reported pain reduction in the immediate postoperative period, while three patients (75%) had long lasting relief. The patient without persisting relief had previously sustained a lumbar disc prolapse and only achieved minor pain relief with preoperative FJ infiltration, compared to the significant relief that was seen in the other patients. In contrast to conventional rhizotomy, 3DNER enables the surgeon to ablate more precisely and extensively, which is especially useful if scar tissue is present from previous injuries or surgeries. When successful, this technique may provide long lasting pain relief, especially if the preoperative FJ infiltrations are followed by a substantial pain reduction.

Treatment of the trapeziometacarpal osteoarthritis by arthroplasty with a pyrocarbon implant.

Trapeziometacarpal (TM) osteoarthritis is the most common type of arthritis of the hand. To date, among surgical alternatives proposed, no one type has been proven superior to others. In this prospective study we evaluated the efficacy of treating arthroplasty with a latest-generation pyrocarbon implant (Pyrocardan). Thirty-six patients with TM arthritis were treated using Pyrocardan implant arthroplasty. Results were evaluated through thumb radial and palmar abduction assessment, key pinch strength evaluation, thumb opposition assessment according to Kapandji classification, the visual analogue scale, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Patient's Satisfaction Index. There was substantial pain reduction and a satisfying increase in range of motion and strength (p < 0.01) and improvement in DASH score (p < 0.01). Average Patient's Satisfaction Index was 8 out of 10. TM arthroplasty with Pyrocardan implantation is a suitable option in treating Eaton-Littler grade II or III TM osteoarthritis.

CT-guided corticosteroid injection of the sacroiliac joints: quality assurance and standardized prospective evaluation of long-term effectiveness over six months

Steroid injection of the sacroiliac joints is widely used for the management of active sacroiliitis in patients with spondyloarthritis (SpA). The aims of this study were to prospectively investigate the effectiveness of corticosteroid injection of the sacroiliac joints and to identify factors determining positive and negative outcome. Twenty-nine patients (18 female, 11 male) suffering from sacroiliitis were treated by computed tomography (CT)-guided administration of 40 or 60 mg triamcinolone acetonide per joint. Clinical outcome of the intervention was determined using a visual analog scale from days 1 to 7 as well as after 1, 3, and 6 months. Patients were grouped according to intra-articular (n = 22) and peri-articular positions (n = 7) of the tip of the puncture needle. In patients with intra-articular needle position (76 %), the mean pain score decreased significantly from 7.3 (±1.9) to 3.9 (±3.4) at day 7 and to 3.9 (±3.4) after 1 month, 4.2 (±3.3) after 3 months, and 5.2 (±2.9) after 6 months. The group with peri-articular needle position (24 %) did not show a statistically significant pain reduction throughout the entire 6-month follow-up period. A substantial reduction of inflammatory back pain (reduction of at least 4 visual analog scale (VAS) points) was reported by 55 % of patients after 3 months and 45 % of patients after 6 months. Our results demonstrate that intra-articular CT-guided steroid instillation can achieve sufficient pain and symptom control for 6 months in patients suffering from active sacroiliitis. It is therefore recommended to perform this intervention under appropriate image guidance to ensure proper positioning of the needle tip.

MP25-14 THE TREATMENT OF CHRONIC ORCHALGIA WITH TMRTM: SUBSTANTIAL PAIN REDUCTION WITH DURABLE RESULTS

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2015MP25-14 THE TREATMENT OF CHRONIC ORCHALGIA WITH TMRTM: SUBSTANTIAL PAIN REDUCTION WITH DURABLE RESULTS Daniel H. Shin, and Aaron Spitz Daniel H. ShinDaniel H. Shin More articles by this author , and Aaron SpitzAaron Spitz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1217AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic orchalgia is a common urological complaint with treatments ranging from medication to denervation and orchiectomy. Here we report our five year experience in the treatment of chronic orchalgia with Therapeutic Magnetic Resonance (TMRTM), an FDA approved device for the treatment of pain. With TMRTM, an electric current is applied for 10-20 minutes directly to the skin overlying the spermatic cord via two metal probes positioned on opposite sides of the scrotum, reportedly altering nerve cell ion conduction and the sensation of pain. METHODS Men with chronic orchalgia who had failed conservative management and were treated with TMRTM were identified and contacted. Demographic and pain data were collected and results were analyzed with T-test and one-way ANOVA to determine statistical difference. Patients reported pain levels using the numerical (zero-ten) pain scale, which has been validated to correspond measurably to severity of painful stimuli. RESULTS Forty-nine patients met criteria. Mean age was 50 years (range 22-82). Forty-five percent reported left testicular pain, 25% right testicular pain, and 29% bilateral. Mean duration of pain prior to TMRTM was 84 months (range 3-408). Etiology was 39% post-surgical (vasectomy, varicocelectomy, and hernia surgery), 28% idiopathic, and 20% associated with anatomic abnormality such as varicocele or epididymal cyst. Mean pain level prior to treatment (baseline) was 5.7 (range 1-10, n=36). After treatment, mean nadir pain level was 39% lower than baseline (3.5, range 0-8, n = 26, p < 0.005). On followup, mean reported pain level was 58% lower than baseline (2.4, range 0-7, n = 24, p < 0.005). Mean number of treatments received was 3.2 (range 1-14). Mean years since treatment to the followup was 2.75 years (range 0.5-4.9 years). No adverse effects were reported from treatment. There were no significant differences in degree of pain improvement when patients were stratified by etiology of orchalgia. CONCLUSIONS TMRTM represents an effective treatment for chronic orchalgia, with substantial reductions in reported pain levels, durable response, and no reported side effects. Limitations to our study include a small sample size, lack of a control group, and reliance of post-treatment pain data on patient recall. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e290 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel H. Shin More articles by this author Aaron Spitz More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders

Objectives:The aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA).Materials and Methods:A total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months.Results:The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the 2 NSE groups (29% to 48%) compared with the PPA group (5%) at 3 months. At 6 months 39% to 44% of the patients in the 2 neck-specific groups and 28% in the PPA group reported substantial pain reduction. Reduction of disability was also larger in the 2 neck-specific exercise groups at both 3 and 6 months (P<0.02). Self-efficacy was only improved in the NSE group without a behavioral approach (P=0.02). However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups.Discussion:NSE resulted in superior outcomes compared with PPA in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.

Patient expectations for chronic pain management

In New Zealand, one in six people report chronic pain, but the literature indicates only a 30% pain reduction is typically achieved in about half of treated patients. Most patients expecting a cure of their pain, or even substantial pain reduction, are therefore likely to be disappointed. It is important to align patient expectations with this reality. This study analysed the responses of 250 patients referred to a Pain Management Centre to the free-text question: 'What are your main goals or reasons for attending the Pain Management Centre?' Free-text comments were analysed using ethnographic content analysis, an inductive approach in which the themes and subthemes are not predetermined, but emerge from the data during analysis, and thus reflect the issues of importance to patients themselves. Three themes emerged from the analysis: patients' desire to understand their pain, regain 'normality', and concerns about medication. Responses were divided into those with an expectation of cure, and those who seemed to be more accepting of their pain and who desired management. Patients hope to return to what they perceive as normal and to have clear, relevant information about their diagnosis, prognosis and medications. Those desiring cure, or significant pain reduction, present more of a challenge to their general practitioners and the Pain Management Centre. When referring a patient for chronic pain management, there is a need to align patient expectations at the point of referral with what can realistically be achieved.

The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicular pain.

To examine whether Modic changes influence pain during a 1-year follow-up in patients with lumbar radicular pain. A total of 243 patients with lumbar radicular pain due to disc herniation were recruited from two hospitals in Norway and followed up at 6 weeks, 6 months, and 12 months. On baseline lumbar magnetic resonance images, two observers independently evaluated Modic changes (types I-III; craniocaudal size 0-3). Outcomes were sensory pain (McGill Pain Questionnaire), back and leg pain (visual analogue scale, VAS). Association between Modic type and outcomes was explored with a mixed model and then by two-way analysis of variance (ANOVA) at each time point with Modic and treatment groups (surgical, n = 126; nonsurgical, n = 117) as fixed factors, adjusted for disc degeneration, age, sex, smoking, and duration of radicular pain. Modic size was also analyzed using ANOVA. Pain scores had decreased significantly at 1-year follow-up. Modic type was significantly related to McGill sensory scores (mixed model: p = 0.014-0.026; ANOVA: p = 0.007 at 6 weeks), but not to VAS back pain or VAS leg pain scores. At 6 weeks, the mean McGill sensory score was higher in Modic I than in Modic II-III patients (p = 0.003) and in patients without Modic changes (p = 0.018). Modic size L1-S1 was not associated with pain outcomes. Patients with lumbar radicular pain have a substantial pain reduction during 1-year follow-up, but Modic type I changes may imply a slower initial decrease in sensory pain.

Yıkama İşiyle uğraşan Hastanın Spinoglenoid Notch"daki Supraskapular Sinir Hasarı: Olgu Sunumu

Suprascapular Nerve injury is an uncommon cause of shoulder pain and weakness. Lesions of the Suprascapular Nerve can occur at the Supraspinatus or the Spinoglenoid Notch. We present here, report of a 26-year-old washer man who presented with pain in left shoulder and difficulty washing clothes. Clinical evaluation and electrodiagnostic studies confirmed injury to the left Suprascapular Nerve at the Spinoglenoid Notch. The patient was managed conservatively for six weeks with relative rest, supervised physiotherapy and non-steroidal anti-inflammatory drugs, following which he showed substantial reduction in pain and improvement in functional activities.

Are the treatment expectations of 'significant others' psychosocial obstacles to work participation for those with persistent low back pain?

Treatment expectations form a fundamental component of the self-regulatory model of health behavior, which defines such cognitions as illness perceptions. Unrealistic and/or unhelpful treatment expectations have been linked to detrimental clinical and work outcomes in those with persistent low back pain. However, research of this nature has rarely focused on the influence of 'significant others' (spouse/partner/close family member). To provide an in-depth examination of the treatment expectations of the 'significant others' of individuals who have become unable to work due to persistent low back pain, highlighting how significant others may influence recovery and work participation outcomes for such individuals. A convenience sample (n=18) of work disability benefit claimants and their significant others were recruited from two settings in the North of England. A qualitative research design was employed, and semi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with claimants and their significant others. Interview data were analysed using template analysis. It was found that significant others expected a substantial reduction or complete removal of pain in order for treatment to be considered successful. The pursuit of diagnostic tests was important in validating such expectations, and there was continued scepticism of treatments already undertaken or offered as an alternative. Like the individuals affected, significant others believed that a correct diagnosis had not yet been received, which led to a continued delay in return to work. This study demonstrates that significant others have similar unrealistic and/or unhelpful treatment expectations to those widely reported by individuals with persistent low back pain, and could further reinforce such illness perceptions and serve as wider psychosocial obstacles to recovery and continued work participation.

Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: Results from the OSTEOPATHIC Trial

PurposeTo assess response to osteopathic manual treatment (OMT) according to baseline severity of chronic low back pain (LBP). MethodsThe OSTEOPATHIC Trial used a randomized, double-blind, sham-controlled, 2×2 factorial design to study OMT for chronic LBP. A total of 269 (59%) patients reported low baseline pain severity (LBPS) (<50mm/100mm), whereas 186 (41%) patients reported high baseline pain severity (HBPS) (≥50mm/100mm). Six OMT sessions were provided over eight weeks and outcomes were assessed at week 12. The primary outcome was substantial LBP improvement (≥50% pain reduction). The Roland–Morris Disability Questionnaire (RMDQ) and eight other secondary outcomes were also studied. Response ratios (RRs) and 95% confidence intervals (CIs) were used in conjunction with Cochrane Back Review Group criteria to determine OMT effects. ResultsThere was a large effect size for OMT in providing substantial LBP improvement in patients with HBPS (RR, 2.04; 95% CI, 1.36–3.05; P<0.001). This was accompanied by clinically important improvement in back-specific functioning on the RMDQ (RR, 1.80; 95% CI, 1.08–3.01; P=0.02). Both RRs were significantly greater than those observed in patients with LBPS. Osteopathic manual treatment was consistently associated with benefits in all other secondary outcomes in patients with HBPS, although the statistical significance and clinical relevance of results varied. ConclusionsThe large effect size for OMT in providing substantial pain reduction in patients with chronic LBP of high severity was associated with clinically important improvement in back-specific functioning. Thus, OMT may be an attractive option in such patients before proceeding to more invasive and costly treatments.

Novel Spinal Cord Stimulation Parameters in Patients with Predominant Back Pain

To examine the feasibility of novel high-frequency spinal cord stimulation therapy in a cohort of patients with chronic predominant back pain during a four day, percutaneous trial. Prospective, multicenter open label pilot trial. Twenty-four patients with back pain greater than leg pain who were candidates for spinal cord stimulation were trialed at five U.S. centers. Patients completed a percutaneous trial with a commercially available spinal cord stimulator. The implanted leads were then connected to the novel external stimulation device and patients were trialed for an additional four days. Pain intensity ratings, subjective descriptions, and patients' preference. There was significant improvement from baseline in overall pain scores (8.68 to 2.03, [p < 0.001]) and back pain scores (8.12 to 1.88, [p < 0.001]) with the investigational stimulation. The investigational stimulation was preferred to the commercially available systems in 21 of 24 patients (88%). Patients with predominant back pain reported a substantial reduction in overall pain and back pain when trialed with high-frequency spinal cord stimulation therapy.

Quality of Life in Patients with Fibromyalgia

Objectives : The aim of this review is to provide practicing clinicians with detailed information on the quality of life (QoL) of patients with fibromyalgia, and the medical and non-medical management effects on quality of life in fibromyalgia. Methods : A systematic English language search of the medical literature from January 1980 to January 2013 using PubMed was conducted using the search terms “fibromyalgia” AND “quality of life.” The literature search revealed 1,086 publications; 259 were clinical trials on human patients, 230 were reviews and 20 were case reports. Three authors reached a consensus on selecting the studies based on specific inclusion and exclusion criteria. A total of 95 research studies were included in this review. Results : Overall quality of life is severely impaired in patients with fibromyalgia. Comorbidities have a further negative impact on QoL. Substantial pain reductions resulting in improvement of QoL were observed with medications and non-medication interventions such as exercise, acupuncture, cognitive behavioral therapy, neurofeedback and multidisciplinary approach. Conclusion : Fibromyalgia and its comorbidities including pain have a considerable negative impact on the quality of life of fibromyalgia patients. Substantial or moderate pain reduction seems to improve quality of life. A multidisciplinary approach appears to be most beneficial in management of this multifaceted illness, but more studies are needed to develop specific interventions necessary to alleviate pain and sufferings in these patients.

Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study

This study examined whether a non-thermal, non-invasive, pulsed electromagnetic field (PEMF), known to modulate the calmodulin (CaM)-dependent nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) signaling pathway, could reduce pain in early knee OA. This randomized, placebo-controlled, double-blind pilot clinical study enrolled 34 patients. Patient selection required initial VAS ≥4, 2 h of standing activity per day, and no recent interventions such as cortisone injections or surgery. Results showed VAS pain score decreased in the active cohort by 50 ± 11% versus baseline starting at day 1 and persisting to day 42 (P < 0.001). There was no significant decrease in VAS versus baseline at any time point in the sham cohort (P = 0.227). The overall decrease in mean VAS score for the active cohort was nearly threefold that of the sham cohort (P < 0.001). The results suggest that non-thermal, non-invasive PEMF therapy can have a significant and rapid impact on pain from early knee OA and that larger clinical trials are warranted.

Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study

This study examined whether a non-thermal, non-invasive, pulsed electromagnetic field (PEMF), known to modulate the calmodulin (CaM)-dependent nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) signaling pathway, could reduce pain in early knee OA. This randomized, placebo-controlled, double-blind pilot clinical study enrolled 34 patients. Patient selection required initial VAS ≥4, 2 h of standing activity per day, and no recent interventions such as cortisone injections or surgery. Results showed VAS pain score decreased in the active cohort by 50 ± 11% versus baseline starting at day 1 and persisting to day 42 (P < 0.001). There was no significant decrease in VAS versus baseline at any time point in the sham cohort (P = 0.227). The overall decrease in mean VAS score for the active cohort was nearly threefold that of the sham cohort (P < 0.001). The results suggest that non-thermal, non-invasive PEMF therapy can have a significant and rapid impact on pain from early knee OA and that larger clinical trials are warranted.