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Impact of radon and combinatory radon/carbon dioxide spa on pain and hypertension: Results from the explorative RAD-ON01 study.
Rühle, PF, Klein, G, Rung, T, Tiep Phan, H, Fournier, C, Fietkau, R, Gaipl, US, Frey, B
Modern rheumatology. 2019;(1):165-172
Abstract
OBJECTIVES Therapies with low doses of radon have beneficial effects on patients suffering from chronic painful degenerative and inflammatory diseases. We already showed that this is accompanied by systemic immune modulations. We here focus on pain-reducing effects of very low doses of radon by adding carbon dioxide water and its impact on heart rate variability (HRV), blood pressure and free radicals. METHODS 97 of 103 patients receiving radon spa (1.200 Bq/l at 34 °C or 600 Bq/l, 1 g/l CO2 at 34 °C) were monitored before and at three different time points after therapy. Individual pain perception was analyzed and the capability to process radicals. At each time point, the hypertensive patients (n = 46) were examined over 24 h for blood pressure and HRV. RESULTS Long-term pain reduction was observed in the majority of patients. A modulation of superoxide dismutase was identified, presumably representing a priming effect for lowering radiation stress. Further, lowering of blood pressure, especially in those patients who additionally received carbon dioxide, was seen. Radon did in particular impact on HRV implying lasting relaxation effects. CONCLUSION Radon/carbon dioxide spa efficiently reduces pain. In particular, patients simultaneously suffering from painful and cardiovascular diseases should be treated by combination of radon and CO2.
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Effects of Kinesio Taping on the Relief of Delayed Onset Muscle Soreness: A Randomized, Placebo-Controlled Trial.
Hazar Kanik, Z, Citaker, S, Yilmaz Demirtas, C, Celik Bukan, N, Celik, B, Gunaydin, G
Journal of sport rehabilitation. 2019;(8):781-786
Abstract
OBJECTIVE The purpose of this study was to examine the effects of Kinesio taping (KT) on delayed onset muscle soreness. DESIGN Randomized controlled study. SETTING Clinical laboratory. PARTICIPANTS Fifty-four nonathletic volunteers were assigned randomly to KT (n = 27) and placebo KT (n = 27) groups. INTERVENTIONS The intense exercise protocol consisted of 100 consecutive drop jumps from a 0.60-m-high platform. Kinesio tape was applied with the fan technique on the quadriceps muscles in the KT group. The placebo KT group received the Kinesio tape with no technique and tension. MAIN OUTCOME MEASURE Muscle soreness, maximal isometric quadriceps muscle strength, vertical jump height, and blood analyses (creatine kinase, lactate dehydrogenase, myoglobin, and C-reactive protein) were measured preexercise, immediately postexercise, 48 hours postexercise, and 72 hours postexercise. RESULTS There was a significant effect of time in all outcome measures (P < .05) except serum C-reactive protein level (P > .05). The intensity of muscle soreness was significantly lower in the KT group relative to the placebo KT group at 72 hours postexercise (P = .01). The serum creatine kinase level was significantly higher in the KT group compared with the placebo KT group at 72 hours postexercise (P = .01). There were no statistically significant differences between groups for the other outcome measures (P > .05). CONCLUSIONS These findings indicate that KT intervention following the intense exercise protocol reduced muscle soreness. However, it had no effect on maximal quadriceps isometric strength and vertical jump height or serum lactate dehydrogenase, myoglobin, and C-reactive protein levels. Furthermore, KT application after intense exercise also increased serum creatine kinase levels.
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The efficacy of topical sesame oil in patients with knee osteoarthritis: A randomized double-blinded active-controlled non-inferiority clinical trial.
Askari, A, Ravansalar, SA, Naghizadeh, MM, Mosavat, SH, Khodadoost, M, Jazani, AM, Hashempur, MH
Complementary therapies in medicine. 2019;:102183
Abstract
OBJECTIVE Sesame oil is an herbal product that has been used to treat the joints pain in several traditional medicines. In this study, we evaluated the efficacy of topical sesame oil versus diclofenac gel in patients with knee osteoarthritis (OA). METHODS One hundred and four patients were randomly enrolled in two arms of the trial. Patients were treated by topical sesame oil or diclofenac (three times a day) for 4 weeks. Outcome measures were knee pain via visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, knee joint's flexion angle, 8-meter walk test and number of used analgesics. Patients were evaluated at baseline, 2 and then 4 weeks after the intervention. RESULTS At the follow-up visits, sesame oil was not inferior to diclofenac regarding scores of WOMAC pain, 8-meter walk test, and knee flexion angle. Although, its non-inferiority was not proved regarding scores of VAS, WOMAC stiffness, and WOMAC total at the 4th week. Moreover, sesame oil was not inferior to diclofenac regarding consumed analgesics. CONCLUSION It seems that the topical sesame oil was non-inferior to diclofenac gel on the reduction of the knee OA pain and improvement of some indicators of its function.
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Effectiveness of Parecoxib Sodium Combined with Transversus Abdominis Plane Block for Pain Management After Hepatectomy for Hepatocellular Carcinoma: A Prospective Controlled Study.
Qiao, XF, Jia, WD, Li, YQ, Lv, JG, Zhou, H
Medical science monitor : international medical journal of experimental and clinical research. 2019;:1053-1060
Abstract
BACKGROUND This study aimed to investigate the effectiveness of perioperative parecoxib sodium combined with transversus abdominis plane (TAP) block on postoperative pain management following hepatectomy in patients with hepatocellular carcinoma (HCC). MATERIAL AND METHODS One hundred patients with HCC who underwent hepatectomy were randomized into a study group (n=51) and a control group (n=49). The study group received 40 mg of parecoxib sodium 30 minutes before anesthetic induction, and 150 mg of 0.375% ropivacaine with 5 mg dexamethasone as TAP inhibitors, before closing the abdominal incision. The control group received 40 mg of placebo 30 minutes before anesthetic induction, without TAP block. Postoperatively, all patients received patient-controlled intravenous analgesia (PCIA) and evaluation with subjective visual analog scale (VAS) pain scores. Data on adverse events, postoperative ambulation (>6 hours/day), time of flatus and defecation, and hospitalization duration were recorded. RESULTS Pain scores of the study group were significantly lower compared with the control group on the first three postoperative days. No significant differences were found between the two groups in terms of adverse events. In the study group, the number of cases of postoperative ambulation was significantly more than the control group. The onset of flatus and defecation and duration of hospital stay in the study group were significantly shorter in the study group compared with the control group. CONCLUSIONS Parecoxib sodium combined with TAP block effectively reduced postoperative pain, improved ambulation, improved gastrointestinal function, and shortened hospitalization time following hepatectomy in patients with HCC without adverse effects.
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Membrane Stabilizer Medications in the Treatment of Chronic Neuropathic Pain: a Comprehensive Review.
Viswanath, O, Urits, I, Jones, MR, Peck, JM, Kochanski, J, Hasegawa, M, Anyama, B, Kaye, AD
Current pain and headache reports. 2019;(6):37
Abstract
PURPOSE OF REVIEW Neuropathic pain is often debilitating, severely limiting the daily lives of patients who are affected. Typically, neuropathic pain is difficult to manage and, as a result, leads to progression into a chronic condition that is, in many instances, refractory to medical management. RECENT FINDINGS Gabapentinoids, belonging to the calcium channel blocking class of drugs, have shown good efficacy in the management of chronic pain and are thus commonly utilized as first-line therapy. Various sodium channel blocking drugs, belonging to the categories of anticonvulsants and local anesthetics, have demonstrated varying degrees of efficacy in the in the treatment of neurogenic pain. Though there is limited medical literature as to efficacy of any one drug, individualized multimodal therapy can provide significant analgesia to patients with chronic neuropathic pain.
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Pain Management Using Perioperative Administration of Parecoxib for Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial.
Xiao, K, Yu, L, Xiao, W, Peng, H, Bian, Y, Wu, Z, Weng, X
Pain physician. 2019;(6):575-582
Abstract
BACKGROUND Controlling postoperative pain and improving outcomes after total hip arthroplasty (THA) remain an important challenge, which affects the functional recovery of the hip. OBJECTIVES To assess the effect of preemptive administration of the selective cyclooxygenase-2 inhibitor parecoxib sodium (PS) after THA. STUDY DESIGN A prospective, randomized, double-blinded clinical trial. SETTING An academic medical center. METHODS This randomized double-blind clinical trial compared postoperative analgesia intervention for unilateral primary THA. Patients were assigned in a 1:1 ratio to the PS group and the control group. The PS group received 40 mg dose of PS 30 minutes before incision, 12 hours after THA, and every 12 hours for 2 days postoperatively, and the control group received normal saline solution at the same time point. In addition, both groups received patient-controlled intravenous analgesia of morphine. Perioperative visual analog scale (VAS) scores, cumulative morphine consumption, functional recovery, perioperative bleeding risk, and the selected indicators of the inflammatory response were compared between the PS group and the control group. RESULTS From October 2014 to June 2015, 180 patients undergoing unilateral primary THA were screened for this prospective clinical trial. A total of 141 patients were enrolled and randomly assigned into the PS group (n = 69) and the control group (n = 72). Compared with the control group, VAS scores at rest were significantly lower in the PS group at 4, 12, and 24 hours after surgery, and VAS scores during movement were also lower in the PS group at 4, 12, 24, 36, and 48 hours after surgery (all P < 0.001). Both the cumulative morphine consumption and its associated nausea and vomiting were reduced in the PS group (P < 0.001 and P = 0.021, respectively). The length of hospitalization in the PS group was shorter than the control group (PS group 5.91 ± 1.15 days, control group 6.41 ± 1.49 days; P = 0.019). The PS group had lower body temperature than the control group at postoperative day (POD) 1 (P = 0.003) and POD 3 (P = 0.001), and the levels of high-sensitivity C-reactive protein in the PS group at POD 3 (P = 0.016) and POD 6 (P = 0.006) were also lower than those in the control group. The concentration of interleukin (IL)-6 and IL-10 were significantly different between the 2 groups (IL-6, P = 0.007; IL-10, P = 0.006) on the first day postoperatively. The PS group was not significantly different from the control group with respect to any outcomes: blood loss, postoperative blood drainage and blood transfusion, and number of days needed to accomplish straight-leg raising and off-bed exercise. LIMITATIONS PS was used only until POD 2, and there was no long-term follow-up. CONCLUSIONS Perioperative administration of PS is an effective addition to a multimodal regimen that alleviates postoperative pain, reduces the cumulative morphine consumption, length of hospitalization, and perioperative inflammatory response, without increasing perioperative bleeding risk. KEY WORDS Parecoxib sodium, multimodal analgesia, total hip arthroplasty, inflammatory response.
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Expert Consensus on Clinical Use of an Orally Administered Dexketoprofen Plus Tramadol Fixed-Dose Combination in Moderate-To-Severe Acute Pain: A Delphi Study.
Varrassi, G, Coaccioli, S, De-Andrés, J, Hanna, M, Macheras, G, Montero, A, Perrot, S, Piras, V, Scarpignato, C
Advances in therapy. 2019;(11):3174-3185
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Abstract
INTRODUCTION In 2016, the orally administered fixed-dose combination of dexketoprofen 25 mg and tramadol 75 mg (DKP/TRAM FDC) was approved in Europe for short-term treatment of moderate-to-severe acute pain, an indication that encompasses a wide range of post-operative and non-surgical painful conditions. This has suggested the necessity to have a clearer indication on its clinical use, with the support of expert pain clinicians, working in different medical specialities, and reinforced by the data present in the literature. METHODS With the aim of assisting clinicians in the use of DKP/TRAM FDC in daily practice, two rounds of a modified Delphi process were conducted. In the first round, a board of nine experts developed a series of consensus statements based on available evidence, and their clinical experience, with DKP/TRAM FDC. In the second round, 75 clinicians with extensive experience in pain management expressed individually their agreement with the statements, using a dedicated online platform. Consensus was defined as at least 70% agreement. RESULTS Twenty-eight statements were developed. Of these, 19 reached the defined level of consensus. CONCLUSION The agreed consensus statements may assist clinicians in applying the results of clinical studies and clinical experience to routine care settings, providing guidance for use of this new analgesic combination in moderate-to-severe post-operative and non-surgical acute pain. FUNDING Menarini Group.
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Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis.
Abbas, AM, Samy, A, El-Naser Abd El-Gaber Ali, A, Khodry, MM, Ahmed, MAM, El-Rasheedy, MI, Abdallah, KM, Mohammed, AE, Abdelbaky, WH, Raslan, OK, et al
Fertility and sterility. 2019;(1):140-148.e12
Abstract
OBJECTIVE To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). DESIGN Systematic review and network meta-analysis of randomized controlled trials. SETTING Not applicable. PATIENT(S): Pre- or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. INTERVENTION(S): We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). MAIN OUTCOME MEASURE(S): The intensity of pain during, immediately after, and 10-30 minutes after procedure assessed by the 10-cm visual analog scale. RESULT(S): Lidocaine spray was the most effective medication for reducing pain during OEB (P-score = 0.83) and immediately after OEB (P-score = 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score = 1.00), followed by misoprostol plus lidocaine (P-score = 0.87). CONCLUSION(S): Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA.
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A Multimodal Approach to Pain Management for Patients with Chronic Back Pain: Outcome Measures at 1 Year.
Eskander, JP, Beakley, BD, Zhang, S, Paetzold, J, Sharma, B, Kaye, AD, Sharma, S
Current pain and headache reports. 2019;(8):54
Abstract
PURPOSE OF REVIEW The purpose of this study is to evaluate the effectiveness of a multimodal approach to treating chronic low back pain. RECENT FINDINGS Chronic non-cancer-related back pain is often a frustrating and poorly managed problem for patients. It poses a significant public health issue worsened by the widespread use of narcotics. In 2016, the CDC released guidelines with noticeably more strict recommendations on prescription of narcotics for pain. Veterans at an interventional pain clinic presenting with chronic back pain refractory to medical and to surgical care were enrolled in an 8-week interdisciplinary pain management program. Pain scores were significantly reduced 1 year after completion of the program. Patients in this study benefitted from lower and sustained pain scores, a reduction in emergency room, and urgent care clinic visits, as well as generally high satisfaction with the interdisciplinary program.
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Literature review informs clinical guidelines for pain management during screening and laser photocoagulation for retinopathy of prematurity.
Pirelli, A, Savant Levet, P, Garetti, E, Ancora, G, Merazzi, D, Bellieni, CV, Lago, P, ,
Acta paediatrica (Oslo, Norway : 1992). 2019;(4):593-599
Abstract
AIM: The aim of this study was to carry out a literature review and develop clinical guidelines for pain prevention and control during screening and laser photocoagulation for retinopathy of prematurity (ROP) in neonatal intensive care units (NICUs). METHODS The Italian Society of Neonatology assessed papers published between 1986 and June 2017 and used the Grading of Recommendations, Assessment, Development and Evaluation approach, to develop new guidelines on pain and ROP. RESULTS The Society's pain experts assessed the full texts of 47 papers, including randomised or quasi-randomised controlled trials and case-control studies on nonpharmacological and pharmacological measures used in NICUs during the screening and laser photocoagulation of neonates for ROP. The literature suggested methods for reducing the stress and pain associated with ROP screening procedures. The panel concluded that the literature showed that it was feasible to provide laser photocoagulation for ROP in spontaneously breathing patients with adequate analgesia. CONCLUSION This literature review on managing pain in infants with ROP in NICUs led to the development of national guidelines, which will help physicians and nurses to reduce the stress and pain experienced by premature newborn infants during unavoidable screening and treatment for ROP.