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1.
Clinical trials on pain lowering effect of ginger: A narrative review.
Rondanelli, M, Fossari, F, Vecchio, V, Gasparri, C, Peroni, G, Spadaccini, D, Riva, A, Petrangolini, G, Iannello, G, Nichetti, M, et al
Phytotherapy research : PTR. 2020;(11):2843-2856
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Abstract
Ginger has a pain-reducing effect and it can modulate pain through various mechanisms: inhibition of prostaglandins via the COX and LOX-pathways, antioxidant activity, inibition of the transcription factor nf-kB, or acting as agonist of vanilloid nociceptor. This narrative review summarizes the last 10-year of randomized controlled trials (RCTs), in which ginger was traditionally used as a pain reliever for dysmenorrhea, delayed onset muscle soreness (DOMS), osteoarthritis (AO), chronic low back pain (CLBP), and migraine. Regarding dysmenorrhea, six eligible studies suggest a promising effect of oral ginger. As concerned with DOMS, the four eligible RCTs suggested a reduction of inflammation after oral and topical ginger administration. Regarding knee AO, nine RCTs agree in stating that oral and topical use of ginger seems to be effective against pain, while other did not find significant differences. One RCT considered the use of ginger in migraine and suggested its beneficial activity. Finally, one RCT evaluated the effects of Swedish massage with aromatic ginger oil on CLBP demonstrated a reduction in pain. The use of ginger for its pain lowering effect is safe and promising, even though more studies are needed to create a consensus about the dosage of ginger useful for long-term therapy.
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Review of nonopioid multimodal analgesia for surgical and trauma patients.
George, S, Johns, M
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2020;(24):2052-2063
Abstract
PURPOSE Pain is a frequent finding in surgical and trauma patients, and effective pain control remains a common challenge in the hospital setting. Opioids have traditionally been the foundation of pain management; however, these agents are associated with various adverse effects and risks of dependence and diversion. SUMMARY In response to the rising national opioid epidemic and the various risks associated with opioid use, multimodal pain management through use of nonopioid analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, α 2 agonists, N-methyl-d-aspartate (NMDA) receptor antagonists, skeletal muscle relaxants, sodium channel blockers, and local anesthetics has gained popularity recently. Multimodal analgesia has synergistic therapeutic effects and can decrease adverse effects by enabling use of lower doses of each agent in the multimodal regimen. This review discusses properties of the various nonopioid analgesics and encourages pharmacists to play an active role in the selection, initiation, and dose-titration of multimodal analgesia. The choice of nonopioid agents should be based on patient comorbidities, hemodynamic stability, and the agents' respective adverse effect profiles. A multidisciplinary plan for management of pain should be formulated during transitions of care and is an area of opportunity for pharmacists to improve patient care. CONCLUSION Multimodal analgesia effectively treats pain while decreasing adverse effects. There is mounting evidence to support use of this strategy to decrease opioid use. As medication experts, pharmacists can play a key role in the selection, initiation, and dose-titration of analgesic agents based on patient-specific factors.
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A population-based study of inflammatory mechanisms and pain sensitivity.
Iordanova Schistad, E, Kong, XY, Furberg, AS, Bäckryd, E, Grimnes, G, Emaus, N, Rosseland, LA, Gordh, T, Stubhaug, A, Engdahl, B, et al
Pain. 2020;(2):338-350
Abstract
Two recent studies suggest that experimental pain sensitivity is associated with low-grade systemic inflammation. However, only 2 biomarkers have been identified, and the studies were conducted in adult individuals where confounding effects of comorbid diseases cannot be excluded. We therefore tested associations between pain sensitivity and 119 inflammation-related serum biomarkers in 827 healthy adolescents (15-19 years) in the population-based Tromsø Study: Fit Futures. The main outcome measure was cold-pressor pain tolerance (CPT), tested by placing the dominant hand in circulating cold (3°C) water for a maximum of 105 seconds. Secondary outcomes were heat and pressure pain threshold and tolerance. Twelve proteins and 6 fatty acids were significantly associated with CPT after adjustment for possible confounding factors and correction for multiple comparisons. Of these, all fatty acids and 10 proteins were protective, ie, higher biomarkers levels were associated with increased CPT, whereas 2 biomarkers were associated with lower tolerance. Taken together, these biomarkers predicted completion of the tolerance test with a C-statistic of 0.65. Results for heat and pressure pain tolerance were remarkably similar, strengthening the generalizability of our findings. In this cohort of young healthy individuals, we found a relationship between inflammation-related biomarkers and pain tolerance and thresholds. Biomarkers with anti-inflammatory and analgesic effects predominated, suggesting that the development of prophylactic dietary or pharmaceutical treatments may be possible.
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Opioid Use and Misuse in Pregnancy.
Shatil, B, Landau, R
Clinics in perinatology. 2020;(4):769-777
Abstract
The rate of pregnant women with an opioid use disorder has risen drastically in the past 20 years, paralleling that in the general population. Pregnancies associated with opioid use, abuse, or dependence have significantly higher rates of complications, such as neonatal opioid withdrawal syndrome, intrauterine growth restriction, neural tube defects, stillbirth, increased maternal mortality, greater postpartum pain, and longer inpatient stays. Patient education about the risks and benefits of multimodal analgesia and empowering shared decision making may help curb the opioid epidemic. Tailoring pain management to individual needs might be the solution to the problem.
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Ibuprofen Safety at the Golden Anniversary: Are all NSAIDs the Same? A Narrative Review.
Varrassi, G, Pergolizzi, JV, Dowling, P, Paladini, A
Advances in therapy. 2020;(1):61-82
Abstract
Ibuprofen first came to market about 50 years ago and rapidly moved to over-the-counter (OTC) sales. In April 2019, the National Agency for the Safety of Medicines and Health Products (ANSM) of France issued a warning for NSAID uses by patients with infectious diseases based on an analysis of 20 years of real-world safety data on ibuprofen and ketoprofen. Nevertheless, ibuprofen remains a mainstay in the analgesic armamentarium and with numerous randomized clinical trials, head-to-head studies, and decades of clinical experience. The authors offer a review of the safety of ibuprofen and how it may differ from other NSAIDs. Ibuprofen is associated with certain well-known gastrointestinal adverse effects that are related to dose and patient population. Among nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen has a comparatively low risk of cardiovascular adverse effects. It has been associated with renal and hepatic adverse effects, which appear to depend on dose, concomitant medications, and patient population. The association of ibuprofen with infections is more complex in that it confers risk in some situations but benefits in others, the latter in cystic fibrosis. Emerging interest in the literature is providing evidence of the role of ibuprofen as a possible endocrine disrupter as well as its potential antiproliferative effects for cancer cells. Taken altogether, ibuprofen has a favorable safety profile and is an effective analgesic for many acute and chronic pain conditions, although it-like other NSAIDs-is not without risk. After 50 years, evidence is still emerging about ibuprofen and its unique safety profile among NSAIDs. FUNDING The Rapid Service Fee was funded by Abbott Established Pharmaceuticals Division (EPD).
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Magnesium and Pain.
Shin, HJ, Na, HS, Do, SH
Nutrients. 2020;(8)
Abstract
In terms of antinociceptive action, the main mode of action of magnesium involves its antagonist action at the N-methyl-d-aspartate (NMDA) receptor, which prevents central sensitization and attenuates preexisting pain hypersensitivity. Given the pivotal function of NMDA receptors in pain transduction, magnesium has been investigated in a variety of pain conditions. The oral and parenteral administration of magnesium via the intravenous, intrathecal, or epidural route may alleviate pain and perioperative anesthetic and analgesic requirements. These beneficial effects of magnesium therapy have also been reported in patients with neuropathic pain, such as malignancy-related neurologic symptoms, diabetic neuropathy, postherpetic neuralgia, and chemotherapy-induced peripheral neuropathy. In addition, magnesium treatment is reportedly able to alleviate fibromyalgia, dysmenorrhea, headaches, and acute migraine attacks. Although magnesium plays an evolving role in pain management, better understanding of the mechanism underlying its antinociceptive action and additional clinical studies is required to clarify its role as an adjuvant analgesic.
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Effect of Ibuprofen on Muscle, Hematological and Renal Function, Hydric Balance, Pain, and Performance During Intense Long-Distance Running.
de Souza, RF, de Matos, DG, Ferreira, ARP, Chilibeck, P, Barros, NA, Oliveira, AS, Cercato, LM, da Silva, DS, Aidar, FJ
Journal of strength and conditioning research. 2020;(7):2076-2083
Abstract
de Souza, RF, de Matos, DG, Ferreira, ARP, Chilibeck, P, Barros, NdA, de Oliveira, AS, Cercato, LM, da Silva, DS, and Aidar, FJ. Effect of ibuprofen on muscle, hematological and renal function, hydric balance, pain, and performance during intense long-distance running. J Strength Cond Res 34(7): 2076-2083, 2020-The aim of this study was to investigate the effect of prophylactic use of nonsteroidal anti-inflammatory drugs (i.e., ibuprofen) on physical performance, vertical jump, muscle biomarkers, liver, kidney, acute pain, and hydration status of participants in the 42-km Trail Running Challenge, a long-distance race integrated over mountain routes. The sample consisted of 20 men randomly divided into 2 groups: a control group (CG) and an experimental group (EG), with 12 completing the race (41.1 ± 8.8 years; 75.7 ± 12.1 kg) and included in the final analysis. The EG were administered an ibuprofen capsule (400 mg) 15 minutes before the beginning of the race and again after 5 hours of racing if the route was not yet completed. There were significant time main effects for creatine kinase (p = 0.001; f Cohen = 0.25), lactate dehydrogenase (p < 0.001; f Cohen = 2.05), aspartate aminotransferase (p = 0.002; f Cohen = 1.53), creatinine (p = 0.002; f Cohen = 2.24), urea (p = 0.001; f Cohen = 2.25), heart rate (p < 0.001; f Cohen = 4.88), and pain scores (p < 0.001; f Cohen = 1.93) all of which increased during the race. There was a group × time interaction for squat jump, which significantly decreased only in the CG (p = 0.045; f Cohen = 2.17). This may have been related to increased frequency of pain reported after the race in the gastrocnemius of the CG compared with the EG (p ≤ 0.05). It was concluded that ibuprofen intake did not reduce muscle damage during the competition but maintained leg muscular power performance (i.e., vertical jump), possibly by reducing gastrocnemius muscle pain.
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Non-pharmacological pain control in outpatient hysteroscopies.
Amer-Cuenca, JJ, Marín-Buck, A, Vitale, SG, La Rosa, VL, Caruso, S, Cianci, A, Lisón, JF
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy. 2020;(1):10-19
Abstract
Outpatient hysteroscopy has become the standard technique for gynaecological exploration of the uterine cavity. The most common reason for failure of the procedure is pain. During the last decade many studies were carried out to improve the equipment as well as the procedural technical aspects. Even so, hysteroscopy is still painful for many patients. Pharmacological pain control has been widely used for hysteroscopy, but these modalities can be invasive, have side effects and are contraindicated in many women. This review examines current literature on non-pharmacological interventions (pressure, stretching, heat, electricity, music and hypnosis) on the pain experienced during outpatient hysteroscopy.
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Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications.
Poggio, ED, McClelland, RL, Blank, KN, Hansen, S, Bansal, S, Bomback, AS, Canetta, PA, Khairallah, P, Kiryluk, K, Lecker, SH, et al
Clinical journal of the American Society of Nephrology : CJASN. 2020;(11):1595-1602
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Abstract
BACKGROUND AND OBJECTIVES Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare. RESULTS A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location. CONCLUSIONS Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
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Tracking implementation strategies in the randomized rollout of a Veterans Affairs national opioid risk management initiative.
Rogal, SS, Chinman, M, Gellad, WF, Mor, MK, Zhang, H, McCarthy, SA, Mauro, GT, Hale, JA, Lewis, ET, Oliva, EM, et al
Implementation science : IS. 2020;(1):48
Abstract
BACKGROUND In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete "case reviews" for Veterans identified in the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard as high risk for adverse outcomes among patients prescribed opioids. Half of the facilities were randomly assigned to a Notice version including additional oversight. We evaluated implementation strategies used, whether strategies differed by randomization arm, and which strategies were associated with case review completion rates. METHODS Facility points of contact completed a survey assessing their facility's use of 68 implementation strategies based on the Expert Recommendations for Implementing Change taxonomy. We collected respondent demographic information, facility-level characteristics, and case review completion rates (percentage of high-risk patients who received a case review). We used Kruskal-Wallis tests and negative binomial regression to assess strategy use and factors associated with case reviews. RESULTS Contacts at 89 of 140 facilities completed the survey (64%) and reported using a median of 23 (IQR 16-31) strategies. The median case review completion rate was 71% (IQR 48-95%). Neither the number or types of strategies nor completion rates differed by randomization arm. The most common strategies were using the STORM dashboard (97%), working with local opinion leaders (80%), and recruiting local partners (80%). Characteristics associated with case review completion rates included respondents being ≤ 35 years old (incidence rate ratio, IRR 1.35, 95% CI 1.09-1.67) and having < 5 years in their primary role (IRR 1.23; 95% CI 1.01-1.51), and facilities having more prior academic detailing around pain and opioid safety (IRR 1.40, 95% CI 1.12-1.75). Controlling for these characteristics, implementation strategies associated with higher completion rates included (1) monitoring and adjusting practices (adjusted IRR (AIRR) 1.40, 95% CI 1.11-1.77), (2) identifying adaptations while maintaining core components (AIRR 1.28, 95% CI 1.03-1.60), (3) conducting initial training (AIRR 1.16, 95% CI 1.02-1.50), and (4) regularly sharing lessons learned (AIRR 1.32, 95% CI 1.09-1.59). CONCLUSIONS In this national evaluation of strategies used to implement case reviews of patients at high risk of opioid-related adverse events, point of contact age and tenure in the current role, prior pain-related academic detailing at the facility, and four specific implementation strategies were associated with case review completion rates, while randomization to additional centralized oversight was not. TRIAL REGISTRATION This project is registered at the ISRCTN Registry with number ISRCTN16012111. The trial was first registered on May 3, 2017.