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A comparative evaluation of transdermal diclofenac patch with oral diclofenac sodium as an analgesic drug following periodontal flap surgery: A randomized controlled clinical study.
Diwan, V, Srinivasa, TS, Ramreddy, KY, Agrawal, V, Nagdeve, S, Parvez, H
Indian journal of dental research : official publication of Indian Society for Dental Research. 2019;(1):57-60
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Abstract
BACKGROUND Pain is an inevitable outcome of any periodontal surgery. Controlling postoperative pain is of utmost importance so as to increase patient compliance. The present study aims to compare the degree of postoperative analgesia with the use of oral diclofenac sodium and transdermal diclofenac patch following periodontal flap surgery in patients with chronic periodontitis. MATERIALS AND METHODS A total of 20 patients requiring full mouth flap surgery were selected for this study. Flap surgery was performed quadrant-wise and transdermal diclofenac patch was applied on the right arm following surgery of one of the quadrants and 100 mg oral diclofenac sodium twice daily was prescribed following surgery of the subsequent quadrant. The postoperative pain was recorded on visual analog scale and pain intensity scale 24 h after the surgery. RESULTS Both the statistical and clinical observation showed that diclofenac sodium administered transdermally has equal efficacy as compared to drug administered orally. CONCLUSION The study concludes that the diclofenac administered transdermally has equal potency in relieving postoperative pain as compared to orally administered diclofenac sodium following modified flap surgery. Transdermal patch has an added advantage of better patient compliance as it does not cause gastric disturbance.
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Trends in Prescription Analgesic Use Among Adults With Musculoskeletal Conditions in the United States, 1999-2016.
Stokes, A, Berry, KM, Hempstead, K, Lundberg, DJ, Neogi, T
JAMA network open. 2019;(12):e1917228
Abstract
IMPORTANCE Monitoring trends in prescription analgesic use among adults with musculoskeletal conditions provides insight into how changing prescribing practices, guidelines, and policy measures may affect those who need pain management. OBJECTIVE To evaluate trends in prescription opioid use and nonopioid analgesic use among adults with functional limitations attributable to musculoskeletal conditions. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study uses data from the National Health and Nutrition Examination Study from 1999 to 2016. Data were analyzed from January to July 2019. The participants were adults aged 30 to 79 years who reported functional limitations due to back or neck problems and/or arthritis or rheumatism. MAIN OUTCOMES AND MEASURES Any use of a prescription opioid or exclusive use of a prescription nonopioid analgesic. RESULTS In this population of 7256 adults with 1 or more functional limitations attributable to a musculoskeletal condition (4226 women [59.9%]; 3508 [74.4%] non-Hispanic white individuals; median [interquartile range] age, 63 [53-70] years), opioid use and exclusive nonopioid analgesic use exhibited approximately reciprocal patterns of change from 1999 to 2016. Opioid use increased significantly (difference in prevalence for 2015-2016 vs 1999-2000, 7.2%; 95% CI, 1.3% to 13%; P for trend = .002), and exclusive use of nonopioid analgesics decreased significantly (difference in prevalence for 2015-2016 vs 1999-2000, -13%; 95% CI, -19% to -7.5%; P for trend < .001) during this period. The increase in any opioid use was driven by long-term rather than short-term use. A crossover in the prevalence of opioid use and exclusive use of nonopioid analgesics occurred between 2003 and 2006, after which opioid use was more prevalent. Between 2013 and 2016, decreases in opioid use were observed among men (difference in prevalence for 2015-2016 vs 2013-2014, -11%; 95% CI, -21% to 1.8%) and participants with less than a high school education (difference, -15%; 95% CI, -24% to -6.1%). During this same period, exclusive nonopioid analgesic use also decreased markedly across the population (difference, -5.3%; 95% CI, -9.1% to -1.5%). CONCLUSIONS AND RELEVANCE The substitution of opioids for nonopioid analgesics between 2003 and 2006 may have occurred as evidence emerged on the cardiovascular risks associated with nonopioid analgesics. Reductions in opioid use between 2013 and 2016 were most substantial among those with low socioeconomic status, who may encounter barriers in accessing alternatives. Despite those decreases, opioid use remained more prevalent in 2015 to 2016 than in 1999 to 2000, suggesting a potentially long tail for the opioid epidemic.
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Analgesic Herbal Medicines in the Treatment of Knee Osteoarthritis: A Systematic Review.
Teymouri, S, Rakhshandeh, H, Baghdar, HN, Yousefi, M, Salari, R
Current rheumatology reviews. 2019;(4):290-303
Abstract
BACKGROUND Osteoarthritis (OA) is a type of progressive rheumatoid disease, which leads to the degeneration of the articular cartilage, synovium, subchondral bone, tendons, and the surrounding ligaments.There are various treatments for knee OA, including pharmaceutical, nonpharmaceutical, and surgical treatments. Considering the chronic nature of the disease as well as the necessity for the long-term use of chemical medications, various side effects could occur that include gastrointestinal bleeding, hypertension, congestive heart failure, hyperkalemia, and kidney failure. Therefore, suitable treatments with fewer side effects should be recommended. Recent investigations suggest increased tendency in people to use Complementary and Alternative Medicine (CAM) for knee OA treatment. OBJECTIVE This systematic review aimed to assess the effectiveness and safety of herbal preparations for the treatment of OA. METHODS The searched databases were Cochrane, Scopus, and PubMed. All the selected papers pertained to randomized controlled trials until August 8, 2017 in English in which one or several specific herbs had been used in knee OA treatment. RESULTS We included 24 randomized trials (involving 2399 women and men). There were several different herbal medicines used within the included trials. CONCLUSION The results show that the methods used in these trials may reduce symptoms and the extent of NSAID consumption and enhance the quality of life. Additional trials are suggested to investigate the safety and efficacy of herbs for the treatment of patients with OA.
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ANALGESIC EFFECT OF INTRAVENOUS ASCORBIC ACID VERSUS ACELCOFENAC POST-TRANSALVEOLAR EXTRACTION: A CASE-CONTROL STUDY.
Chaitanya, NC, Badam, R, Siva Prasad Reddy, G, Alwala, A, Srinivas, P, Saawarn, N, Chintada, S, Akhila, M, Bontala, P, Inamdar, P, et al
Journal of population therapeutics and clinical pharmacology = Journal de la therapeutique des populations et de la pharmacologie clinique. 2019;(2):e43-e52
Abstract
One of the most important aspects of postsurgical care is finding an efficient way for the management of pain. Third molar extractions/surgical impaction is one of the most frequent surgical procedures in dental hospitals, and it is most often associated with postoperative complications like severe pain, oedema and reduced mouth opening. This study was aimed to evaluate the efficacy of 2 g intravenous (IV) vitamin C compared to 100 mg aceclofenac on postsurgical pain, swelling and trismus after the surgical removal of third molars. A total of 101 patients were recruited for the study, and theywere divided into two treatment groups; group A (n = 51) received 2 g IV vitamin C and group B (n = 50) received 100 mg aceclofenac. Pain intensity, facial swelling and mouth opening were assessed till day 3 post-surgically. Statistical analysis of pain intensity revealed that IV vitamin C performed slightly better but not significantly different (p>0.05) from aceclofenac group at the end of day 3. No significant difference for facial swelling and mouth opening between the two treatment protocols was seen (p>0.05). Our results concluded that both treatment groups were overall similar in analgesic efficacy, postoperative oedema and reduction in mouth opening. It was also determined that the method devised administering 2 g IV vitamin C intravenously was well suited to the treatment of postoperative pain, swelling and trismus following the surgical extraction of impacted third molars.
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Analgesic Requirements in Adolescents Undergoing Bariatric Surgery-an Observational Study.
Vaughns, JD, Williams, EF, Mackey, ER, Muret, JC, van den Anker, J, Nadler, EP, Quezado, ZM
Obesity surgery. 2019;(5):1557-1562
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Abstract
AIM: To examine the impact of preexisting psychiatric/psychological diagnoses on perioperative analgesic requirements in adolescents with morbid obesity undergoing bariatric surgery. METHODS A retrospective cohort study of adolescents with morbid obesity undergoing bariatric surgery. Primary and secondary outcomes included perioperative analgesic intake and pain scores (Numerical Rating Scale (0-10) NRS) throughout the hospital stay. RESULTS From our Bariatric Surgery Research Registry, we identified 17 adolescents with psychiatric/psychological diagnoses prior to undergoing bariatric surgery. Fifteen patients from the same registry and without such diagnosis undergoing bariatric surgery during the same time interval served as controls. In both groups, there was a predominance of female patients. During the perioperative period, in both groups, oral morphine equivalent and ketorolac and acetaminophen intake were similar. Notably, the perioperative median pain scores at the times examined were below 5 for all patients. The median pain scores in the PACU, day of surgery, and first postoperative day were similar. Conversely, on postoperative day 2, pain scores were higher in patients with diagnoses of psychiatric/psychological disorders (p = 0.004) compared to those without. CONCLUSION In this cohort of morbidly obese adolescents undergoing bariatric surgery, patients with and without preexisting psychiatric/psychological diagnoses had similar analgesic requirements during the perioperative period. This finding appears contrary to those suggesting that preexisting depression and/or anxiety might be associated with increased analgesic requirements during the perioperative period.
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Comparison of the Post-Total Knee Arthroplasty Analgesic Effect of Intraoperative Periarticular Injection of Different Analgesics.
Liu, M, Zhang, D, Shi, B
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2019;(12):1169-1172
Abstract
OBJECTIVE To compare post-TKA (total knee arthroplasty) analgesic effect of periarticular injection of different analgesics during surgery. STUDY DESIGN Experimental study. PLACE AND DURATION OF STUDY Tianjin People's Hospital, from December 2016 to July 2018. METHODOLOGY Patients undergoing unilateral TKA were randomly divided into Group A and Group B, with 67 patients in each group. In Group A, compound analgesics of ropivacaine, ketorolac, adrenaline, morphine and normal saline were injected periarticularly during surgery. While in Group B, compound analgesics of bupivacaine, methylprednisolone, adrenalin, morphine and normal saline were injected periarticularly during surgery. Visual analogue scale (VAS), range of motion (ROM) of knee joint, and rehabilitation of knee joint of both groups were compared. RESULTS VAS scores of Group A at 6-hour, 24-hour, 48-hour and 72-hour after surgery was lower than those of Group B (p=0.046, p<0.001, p<0.001 and p<0.001, respectively). ROM of knee joint of Group A on the 3rd, 7th, 10th and 14th day after surgery was superior to that of Group B (all p<0.001). On the 14th day after surgery, excellent and good rate of rehabilitation of knee joint of Group A was higher than that of Group B (p=0.032). CONCLUSION Compared with periarticular injection of compound analgesics of bupivacaine, methylprednisolone, adrenaline, morphine and normal saline during surgery, periarticular injection of compound analgesics of ropivacaine, ketorolac, adrenaline, morphine and normal saline during surgery can alleviate post-TKA pain more effectively, improve early ROM of joint knee after surgery, increase rehabilitation effect of knee joint.
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Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial.
Hashem, A, Ghobrial, FK, Elbaset, MA, Atwa, AM, Fadallah, M, Laymon, M, El-Assmy, A, Sheir, KZ, Abol-Enein, H
Investigative and clinical urology. 2019;(4):251-257
Abstract
PURPOSE To compare the safety and efficacy of xylocaine gel and ketorolac as opioid-sparing analgesia compared with pethidine for shock wave lithotripsy (SWL) pain. MATERIALS AND METHODS A single-blinded randomized controlled trial (RCT) was performed in 132 patients with renal and upper ureteral stones amenable to treatment with SWL. The first patient group received intravenous (IV) pethidine and placebo gel; the second group received IV ketorolac plus placebo gel; the third group received lidocaine gel locally plus normal saline IV. Stone disintegration was classified as none (no change from basal by kidney, ureter, bladder X-ray or ultrasound [US] imaging), partial (fragmented and >4-mm residual fragments), and complete (≤4-mm residual fragments). Stone disintegration was assessed by kidney-ureter-bladder X-ray and US imaging. Pain was evaluated by use of the Numeric Pain Rating Scale (NPRS). RESULTS The NPRS scores were highest in the xylocaine group at 10, 20, and 30 minutes (p=0.0001) with no significant difference between the ketorolac and pethidine groups, except at 10 minutes (p=0.03) and a near significant difference at 30 minutes (p=0.054) in favor of ketorolac. Results for stone disintegration (none, partial, and complete, respectively) were as follows: 25 (50.0%), 23 (46.0%), and 2 (4.0%) for pethidine; 19 (35.8%), 23 (43.4%), and 11 (20.8%) for ketorolac; and 26 (89.7%), 3 (10.3%), and 0 (0.0%) for lidocaine (p=0.008). CONCLUSIONS Ketorolac is a safe and more effective alternative to morphine derivatives for SWL analgesia. Lidocaine gel should not be used as mono-analgesia for SWL.
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Migraine Treatment in Pregnant Women Presenting to Acute Care: A Retrospective Observational Study.
Hamilton, KT, Robbins, MS
Headache. 2019;(2):173-179
Abstract
OBJECTIVE To assess the acute treatment of pregnant women presenting to a hospital with migraine. BACKGROUND Migraine is a common problem in pregnancy; however, migraine treatment is challenging in pregnant women for fears of medication teratogenicity and lack of data in this population. To date, no study has directly explored physician practices for treatment of acute migraine in pregnant women. METHODS We conducted a retrospective chart review of medication administration for pregnant women who presented to an acute care setting with a migraine attack and received neurology consultation between 2009 and 2014. RESULTS We identified 72 pregnant women with migraine who were treated with pain medications. Fifty-one percent (37/72) were in the third trimester of pregnancy, 39% (28/72) in the second trimester, and 10% (7/72) in the first trimester. Thirty-two percent (23/72) had not tried any acute medications at home before coming to the hospital, and 47% (34/72) presented in status migrainosus. Patients received treatment in the hospital for a median of 23 hours (interquartile range = 5-45 hours). The most common medications prescribed were metoclopramide in 74% (53/72) of patients (95% confidence interval [CI] 62-82%) and acetaminophen in 69% (50/72) of patients (95% CI 58-79%). Metoclopramide was administered along with diphenhydramine in 81% (44/53) of patients (95% CI 71-91%). Acetaminophen was the most frequent medicine administered first (53%, 38/72). Patients were often treated with butalbital (35%, 25/72) or opioids (30%, 22/72), which were used as second- or third-line treatments in 29% of patients (20/72). Thirty-eight percent (27/72) received an intravenous (IV) fluid bolus, 24% received IV magnesium (17/72), and 6% (4/72) had peripheral nerve blocks performed. CONCLUSIONS While the majority of pregnant women with acute migraine received medications considered relatively safe in pregnancy, there was variation in treatment choice and sequence. Some acute medications considered potentially hazardous for fetal health and less effective for migraine (opioids and butalbital) were used frequently, whereas other treatments that may have low teratogenic risk (nerve blocks, IV fluid boluses, and triptans) were used less or not at all. These results indicate a need for developing guidelines and protocols to standardize acute treatment of migraine in pregnancy.
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Effectiveness of a Dietary Supplement Containing Hydrolyzed Collagen, Chondroitin Sulfate, and Glucosamine in Pain Reduction and Functional Capacity in Osteoarthritis Patients.
Puigdellivol, J, Comellas Berenger, C, Pérez Fernández, MÁ, Cowalinsky Millán, JM, Carreras Vidal, C, Gil Gil, I, Martínez Pagán, J, Ruiz Nieto, B, Jiménez Gómez, F, Comas Figuerola, FX, et al
Journal of dietary supplements. 2019;(4):379-389
Abstract
This observational, open, multicenter clinical trial with a single treatment group aimed to evaluate the effectiveness of a dietary supplement whose main ingredients are hydrolyzed gelatin, chondroitin sulfate, glucosamine sulfate, and devil's claw and bamboo extracts for pain reduction and improvement of functional capacities in patients with osteoarthritis (OA) of the knee and/or hip (REDART study). In all, 130 patients with OA recruited from Spanish hospitals received the dietary supplement for 6 months. The primary outcome was the patients' global assessment of pain in the affected joint as measured with a visual analogue scale (VAS). Other outcome measurements included the Lequesne Functional Index (subindexes for pain/discomfort, distance walked, and daily living) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC; subindexes for pain, stiffness, and physical function). Scores were taken at months 3 and 6 of the treatment. Patients (N = 78) showed a reduction of pain of 3.77 ± 1.77 points after 6 months (p < .0001) in the VAS. The total reduction in the Lequesne Functional Index was 6.30 ± 4.08 points after 6 months (p < .0001), with significant reductions in all subindexes of the scale. A similar pattern was found for the WOMAC index, with an overall reduction of 22.49 ± 14.03 points after 6 months (p < .0001) and significant reductions in all subindexes. No major adverse events were noted during the treatment. This exploratory study shows that treatment with the dietary supplement significantly reduces pain and improves locomotor function in patients with OA of the knee and/or hip.
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A Single Preoperative Administration of Dexamethasone, Low-dose Pregabalin, or a Combination of the 2, in Spinal Surgery, Does Not Provide a Better Analgesia Than a Multimodal Analgesic Protocol Alone.
Momon, A, Verdier, B, Dolomie, JO, Gardette, M, Pereira, B, Curt, I, Dualé, C
The Clinical journal of pain. 2019;(7):594-601
Abstract
OBJECTIVES A single perioperative dose of glucocorticoid or gabapentinoid, or a combination of the 2, may improve postoperative analgesia, but data are still insufficient to be conclusive. In this single-center, randomized, double-blind, and double-dummy trial, we aimed to test whether the analgesic effect of adding preoperative pregabalin, at a dose unlikely to induce side effects, to preoperative dexamethasone improves early mobilization after spinal surgery. MATERIALS AND METHODS A total of 160 patients undergoing scheduled lumbar disk surgery (145 analyzed) comprised the study cohort. The patients received either 0.2 mg/kg intravenous dexamethasone before incision, or 150 mg oral pregabalin 1 hour before surgery, or a combination of the 2, or none of the above (control). Analgesia was supplemented by acetaminophen and ketoprofen, plus oxycodone ad libitum. The primary outcome was pain intensity during the first attempt to sit up, assessed the morning of the first postoperative day on an 11-point Numerical Rating Scale. Pain at rest and when standing up, opioid consumption, and tolerance were also assessed. RESULTS None of the treatments tested differed from the control group in terms of efficacy or tolerance, even 6 months after surgery. The overall quality of analgesia was good, with only 10% and 30% of pain scores exceeding 3/10 for pain at rest and during movement, respectively. DISCUSSION In this surgical model with the given anesthetic and analgesic environment, there was no advantage gained by adding low-dose pregabalin or dexamethasone. The multimodal analgesic protocol applied to all patients may have reduced the size of the effect.