Low-Intensity Electromagnetic Millimeter Waves for Pain Therapy

Millimeter wave therapy (MWT), a non-invasive complementary therapeutic technique is claimed to possess analgesic properties. We reviewed the clinical studies describing the pain-relief effect of MWT. Medline-based search according to review criteria and evaluation of methodological quality of the retrieved studies was performed. Of 13 studies, 9 of them were randomized controlled trials (RCTs), only three studies yielded more than 3 points on the Oxford scale of methodological quality of RCTs. MWT was reported to be effective in the treatment of headache, arthritic, neuropathic and acute postoperative pain. The rapid onset of pain relief during MWT lasting hours to days after, remote to the site of exposure (acupuncture points), was the most characteristic feature in MWT application for pain relief. The most commonly used parameters of MWT were the MW frequencies between 30 and 70 GHz and power density up to 10 mW cm−2. The promising results from pilot case series studies and small-size RCTs for analgesic/hypoalgesic effects of MWT should be verified in large-scale RCTs on the effectiveness of this treatment method.

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Characteristic of Clinical Studies on Baduanjin during 2000–2019: A Comprehensive Review

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/4783915 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Jing Zhou ◽

Yunyang Yu ◽

Biwei Cao ◽

Xiaoya Li ◽

Miao Wu ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Clinical Studies ◽

Methodological Quality ◽

Case Reports ◽

Case Series ◽

Small Sample ◽

Chronic Obstructive ◽

Controlled Trials ◽

Randomized Controlled

To date, a growing number of clinical studies have demonstrated the safety and health benefits from Baduanjin intervention. Based on this, our objective is to systematically retrieve and summarize the clinical studies on Baduanjin, with a view to providing more evidence-based evidence in support of the application of Baduanjin for healthcare, and to identify the shortcomings of existing research and provide feasibility suggest for further clinical research. Both four English language and four Chinese language electronic databases were used to search articles related to Baduanjin during 2000–2019. SPSS 22.0 software was used to analyze the data, and the risk of bias tool in the RevMan 5.3.5 software was used to evaluate the methodological quality of randomized controlled trials. A total of 810 publications were identified, including 43 (5.3%) systematic reviews, 614 (75.8%) randomized controlled trials, 66 (8.1%) nonrandomized controlled clinical studies, 84 (10.4%) case series, and 3 (0.4%) case reports. The top 10 diseases/conditions included diabetes, chronic obstructive pulmonary disease, hypertension, low back pain, neck pain, stroke, coronary heart disease, cognitive impairment, insomnia, and osteoporosis or osteopenia. The style of State General Administration of Sport of China in 2003 was the most commonly used version of Baduanjin, and Baduanjin was practiced with an average of 35 minutes, 1 or 2 times a day, 3–5 days per week, and a 18-week average duration. It is also worth noting that there were no serious adverse events related to Baduanjin intervention. Most studies were small sample size research, and the methodological quality of randomized controlled trials is generally low. The clinical studies of Baduanjin have a substantial quantity and evidence base. However, there are significant differences among different studies in the specific intervention measures such as style, intensity, duration, learning, and practice methods, which need to be further standardized and unified. Further high-quality designed and reporting studies are recommended to further validate the clinical benefits of Baduanjin.

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Methodological quality and synthesis of case series and case reports

BMJ evidence-based medicine ◽

10.1136/bmjebm-2017-110853 ◽

2018 ◽

Vol 23 (2) ◽

pp. 60-63 ◽

Cited By ~ 312

Author(s):

Mohammad Hassan Murad ◽

Shahnaz Sultan ◽

Samir Haffar ◽

Fateh Bazerbachi

Keyword(s):

Methodological Quality ◽

Medical Literature ◽

Case Reports ◽

Case Series ◽

Evidence Based ◽

Level Of Evidence ◽

Increased Risk ◽

Study Designs ◽

Inform Decision Making

Case reports and case series are uncontrolled study designs known for increased risk of bias but have profoundly influenced the medical literature and continue to advance our knowledge. In this guide, we present a framework for appraisal, synthesis and application of evidence derived from case reports and case series. We propose a tool to evaluate the methodological quality of case reports and case series based on the domains of selection, ascertainment, causality and reporting and provide signalling questions to aid evidence-based practitioners and systematic reviewers in their assessment. We suggest using evidence derived from case reports and case series to inform decision-making when no other higher level of evidence is available.

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An Assessment of the Methodological Quality of Research Published in the American Journal of Sports Medicine

The American Journal of Sports Medicine ◽

10.1177/0363546505278304 ◽

2005 ◽

Vol 33 (12) ◽

pp. 1812-1815 ◽

Cited By ~ 12

Author(s):

Robert H. Brophy ◽

Michael J. Gardner ◽

Omar Saleem ◽

Robert G. Marx

Keyword(s):

Data Collection ◽

Sports Medicine ◽

Methodological Quality ◽

Case Series ◽

Evidence Based ◽

Prospective Data ◽

Article Type ◽

Based Medicine ◽

Published Research

Background Evidence-based medicine has become a popular topic in academic medicine during the past several decades and more recently in orthopaedics and sports medicine. Hypothesis Articles published in The American Journal of Sports Medicine have shown an improvement in methodological quality in 2001-2003, compared with 1991-1993. Study Design Systematic review. Methods All articles published in The American Journal of Sports Medicine during the periods 1991-1993 and 2001-2003 were reviewed and classified by type of study. The use of pertinent methodologies such as prospective data collection, randomization, blinding, and controlled studies was noted for each article. The frequency of each article type and the use of evidence-based techniques were compared across study periods. Results Case series and descriptive studies decreased during the study period, from 27.4% to 15.3% (P=. 00003) and from 11.9% to 5.6% (P=. 001), respectively, of articles published. Prospective cohort studies increased from 4.7% to 14.1% (P=. 000005), and randomized, prospective clinical trials increased from 2.7% to 5.9% of articles (P=. 04). More studies tested an explicit hypothesis (P=. 0000002), used prospective data collection (P=. 000003), and used blinding (P=. 02), and more studies identified a funding source (P=. 004). Conclusions Overall, there was a shift toward more prospective and randomized research designs published in The American Journal of Sports Medicine during 2001-2003 compared to 1991-1993, demonstrating an improvement in the methodological quality of published research.

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An Audit of Self Acupuncture for Chronic Musculoskeletal Pain

Acupuncture in Medicine ◽

10.1136/aim.24.2.80 ◽

2006 ◽

Vol 24 (2) ◽

pp. 80-86 ◽

Cited By ~ 6

Author(s):

Silje Teig ◽

Sue Peacock ◽

Lorraine Stevens ◽

Kimberley Tordoff ◽

Edwina Maguire ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Pain Relief ◽

Cost Effective ◽

Postal Questionnaire ◽

Pain Clinic ◽

Acupuncture Points ◽

Retrospective Audit ◽

The Cost

Background Acupuncture is increasingly offered as a treatment for chronic pain, but continued treatment is expensive. Self acupuncture might offer a cost effective alternative. The aim of this project was to investigate the effectiveness and safety of self acupuncture in a pain clinic. Methods A retrospective audit was conducted by postal questionnaire of all patients with chronic pain who were taught self acupuncture as a home pain management strategy in the previous three years. The study was conducted by a researcher not involved in the patient's treatment. The patients selected for self acupuncture were those who had responded to acupuncture previously, met certain criteria, and had been taught self acupuncture successfully. Patients were taught self acupuncture using three acupuncture points (LI4, ST44, LR3). Results Of 52 eligible patients (70% female) who were approached, 38 valid questionnaires were returned, giving a response rate of 73.1%. Of these, 76.3% were female; 86.8% (33) still used self acupuncture and 13.3% (5) had stopped; 86.8% of the patients continued to experience pain reduction with self acupuncture. The reported pain relief gained was 5.7 (SD 2.6) measured on a visual analogue scale, improvement in quality of life was reported by 73.7% and no serious adverse effects were reported. Conclusion This audit suggests that self acupuncture is effective for pain relief and improves quality of life in this selected group of patients. Safety can be maintained provided that pre-selection is done with care, and appropriate training is carried out. Self acupuncture has considerable potential to reduce clinic waiting lists and appointment times for patients. Further research is required to determine the cost effectiveness of this approach.

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Diagnosis and management of carotid free-floating thrombus: A systematic literature review

International Journal of Stroke ◽

10.1177/1747493019828554 ◽

2019 ◽

Vol 14 (3) ◽

pp. 247-256 ◽

Cited By ~ 8

Author(s):

Sebastian Fridman ◽

Stephen P Lownie ◽

Jennifer Mandzia

Keyword(s):

Transient Ischemic Attack ◽

Large Scale ◽

Cox Regression ◽

Case Reports ◽

Case Series ◽

Duplex Ultrasound ◽

Stroke Patients ◽

Ischemic Attack ◽

Associated Risk Factors

Background There is no consensus regarding the management of carotid free-floating thrombi in patients with acute ischemic stroke and transient ischemic attack. Aims This systematic review aims to (1) describe the current imaging methods for diagnosis of carotid free-floating thrombi and its associated risk factors, (2) estimate the proportion of carotid free-floating thrombi diagnosed in stroke patients, (3) estimate the proportion of carotid free-floating thrombi patients treated medically and surgically, and (4) evaluate 30-day outcomes. Methods We searched MEDLINE, EMBASE, and manually for references reporting carotid free-floating thrombi from 1960 until June 2017. We estimated the frequency of carotid free-floating thrombi and evaluated 30-day outcomes using Cox regression. We defined the timing of surgical intervention as early (less than 72 h) and delayed (more or equal to 72 h). Summary of review We retrieved 525 carotid free-floating thrombi cases from 58 case series and 83 case reports. Carotid free-floating thrombi were present in 1.53% of stroke patients. Carotid free-floating thrombi diagnosis was made by digital subtraction angiography (38.1%), carotid duplex ultrasound (29.5%), and computed tomography angiography (29.5%). The 30-day risk of transient ischemic attack, silent brain ischemia, any stroke or death was 17.1%. In multivariate analyses, there were no differences in outcome for any anticoagulation regime or timing of revascularization procedure. Conclusions The diagnosis of carotid free-floating thrombi is more common due to the increased use of early noninvasive vascular imaging in transient ischemic attack and stroke. It poses a high short-term risk of stroke and death, but there is as yet no established treatment. The low quality of evidence in the carotid free-floating thrombi literature limits the interpretation of our results and warrants a large-scale prospective cohort study in carotid free-floating thrombi.

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721 Treatment of Hypertrophic Burn and Wound Scars Using a Novel Cold Laser System

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.305 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S191-S192

Author(s):

Jenn Tsai ◽

Samy Bendjemil ◽

Colin Dowling ◽

Stathis Poulakidas

Keyword(s):

Quality Of Life ◽

High Intensity ◽

Hypertrophic Scar ◽

Case Series ◽

Hypertrophic Scars ◽

Non Invasive ◽

High Intensity Laser ◽

Intensity Laser ◽

Scar Reduction

Abstract Introduction Hypertrophic scars are seen in 70% of individuals after a burn. Survival from acute burns have psychosocial and functional challenges. Hypertrophic scars contain disorganized whorls of collagen, an increase in occluded blood vessels resulting in raised discoloration, inflamed dermis/epidermis and painful sequelae. Management of such scars have been limited to invasive and non-invasive management. One innovative technology is a non-invasive high-intensity laser operating at 1275 nm and 74 Watts, optimizing increased depth of penetration into the tissue utilizing photomechanical effects to biostimulate tissue to heal and regenerate. We present a series of 10 patients. Methods 10 patients were enrolled with hypertrophic scarring secondary to deep partial or full thickness burns. Hypertrophic areas were identified and numerical pain scale, Vancouver Scar Scale and the World Health Organization Quality of Life score were recorded. The non-contact, high-intensity laser was passed over the hypertrophic scars, continuously moving the laser over the entirety of the scar. Each area of hypertrophic scar tissue was lasered for progressively longer sessions, reaching a therapeutic time of 10 min in each section. Results Patients were utilizing previously known non-invasive therapies for scar reduction, such as, compression garments, scar treatment ointments, as well as steroid injection and non-medical therapies such as acupuncture. In our series, 90% of the patients reported decrease in scar pain, inflammation, pigmentation and improved pliability by the second treatment. Decreased scar height was identified by the eighth session, where conventional protocols could require months to years before any changes were observed. Changes in the scars were even identified after the normal time period identified for maximal improvement using conventional burn therapies. In a survey presented to patient, even pain was improved, identified with reduction in narcotic/NSAID use in patients undergoing the therapies. Conclusions Non-invasive high-intensity laser therapies are useful adjuncts for reduction of hypertrophic burn scars. Our case series presents a treatment option in patients that have functional, physical and cosmetic challenges. We anticipate broader applications for hypertrophic burn scar reduction utilizing adjunctive non-invasive laser therapy, reducing the need for invasive scar revision and limiting psychosocial strain. Applicability of Research to Practice In this case series, non-invasive high-intensity laser therapy provided timely decrease in hypertrophic scar characteristics in an outpatient setting. Thus, leading to decrease in invasive operative therapy and overall improvement in quality of life. Further studies are needed to elucidate other benefits and utility of the laser and possible evaluation of keloid scars.

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The Evidence Base of Neuropsychological Rehabilitation in Acquired Brain Impairment (ABI): How Good is the Research?

Brain Impairment ◽

10.1375/brim.7.2.119 ◽

2006 ◽

Vol 7 (2) ◽

pp. 119-132 ◽

Cited By ~ 19

Author(s):

Michael Perdices ◽

Regina Schultz ◽

Robyn Tate ◽

Skye McDonald ◽

Leanne Togher ◽

...

Keyword(s):

Research Design ◽

Methodological Quality ◽

Case Series ◽

Evidence Base ◽

Speech Disorders ◽

Single Subject ◽

Target Area ◽

Level Of Evidence ◽

Significant Difference

AbstractIn the context of evidence-based clinical practice (EBCP), the reliability of empirical data is largely determined by the methodological quality of research design. PsycBITE™ (Psychological Database of Brain Impairment Treatment Efficacy) is a web-based database listing all published, empirical reports on the effectiveness of nonpharmacological interventions for the psychological consequences of acquired brain impairment (ABI). The aim of this study was to survey the listings of PsycBITE™ and examine the methodological quality of the reports it contains. Reports listed in PsycBITE™ include systematic reviews (SRs), randomised controlled trials (RCTs), non-RCTs, case series (CSs) and single-subject designs (SSDs). They are indexed according to research design, neurological group, patient age group, target area and intervention type. The PEDro Scale is used to rate the methodological quality of RCTs, nonRCTs and CSs, with maximum obtainable methodological quality rating (MQR) of 10/10, 8/10 and 2/10 respectively. A search identified 1298 reports indexed in PsycBITE™. The largest proportion was SSDs (39%), followed by CSs (22%), RCTs (21%), non-RCTs (11%) and SRs (7%). The majority of reports was concerned with stroke (41%), traumatic brain injury (29%) and Alzheimer's and related dementias (22%). The most frequently investigated deficits were communication/language/speech disorders (24%); independent/self-care activities (19%); behaviour problems (17%); memory impairments (17%); anxiety, depression, stress, adjustment (15%). Approximately half of the RCTs, non-RCTs and CSs were rated for methodological quality. Mean MQR scores for RCTs, non-RCTs and CSs were 4.49, 2.85 and 1.15 respectively. While some PEDro criteria were met by a high proportion of RCTs and non-RCTs (≥ 70%), other criteria were only met by a small proportion of reports (as low as 1.6%). There was no significant difference in MQR scores between RCTs focusing on different neurological groups or target areas. Furthermore, there was no discernible improvement in MQR score for RCTs published over the last three decades. The methodological quality of studies investigating the efficacy of rehabilitation interventions in ABI has been consistently modest over several decades. This is largely attributable to poor adherence to fundamental tenets of research design, and requires urgent remediation. RCTs (and to a lesser extent, non-RCTs) are research methodologies which can potentially yield a high level of evidence, but only if they are adequately designed. PsycBITE™ has the facility to raise awareness of these issues and be instrumental in promoting EBCP in the field of ABI.

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Radiofrequency Treatment of the Thoracic Paravertebral Nerve Combined with Glucocorticoid for Refractory Neuropathic Pain Following Breast Cancer Surgery

January 2018 - Pain Physician ◽

10.36076/ppj.2009/12/e277 ◽

2009 ◽

Vol 4;12 (4;7) ◽

pp. E277-E283

Author(s):

Ken-ichiro Uchida

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Neuropathic Pain ◽

Pain Relief ◽

Negative Impact ◽

Case Series ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Radiofrequency Treatment

Background: Neuropathic pain following breast cancer surgery can have a profoundly negative impact on the physical and psychosocial functioning of patients. Radiofrequency treatment has been used as therapy for chronic pain, which also has a problem under debate of its neurodestructive nature. Although the efficacy and safety of using glucocorticoids in nerve block treatment are controversial, they have been used to treat neuropathic pain for many years and have been used to alleviate acute and continued postoperative pain. Neither radiofrequency combined with glucocorticoids nor radiofrequency treatment of the thoracic paravertebral nerve for neuropathic pain following breast cancer surgery has been reported. Objective: To describe the efficacy of thoracic paravertebral nerve radiofrequency treatment combined with glucocorticoids for refractory neuropathic pain following breast cancer surgery. Design: A series of 3 patients, who following breast cancer surgery with neuropathic pain that did not respond to conservative treatment, were selected. They received radiofrequency treatment of the thoracic paravertebral nerve combined with betamethasone. If pain remained after this treatment at a dermatome of a different level or at the same level, the same treatment was administered after at least 2 months had passed. Results: A total of 21 treatments were administered to the 3 patients. After these treatments, all 3 patients experienced pain relief and their quality of life improved as evaluated by the SF36. Hypoesthesia worsened slightly after treatment. However, anesthesia dolorosa and transient burning pain in the corresponding dermatome, which seemed to be related to neuro-injury after radiofrequency treatment, were not seen. Conclusion: This case series suggests that it is possible that radiofrequency treatment of the thoracic paravertebral nerve combined with glucocorticoid may help in pain relief and improve the quality of life of patients with refractory neuropathic pain following breast cancer surgery. Key words: Radiofrequency, neuropathic pain, glucocorticoid, breast cancer surgery, thoracic paravertebral nerve, postmastectomy pain

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Assessment of Methodologic Quality of Randomized Trials of Interventional Techniques: Development of an Interventional Pain Management Specific Instrument

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/e263 ◽

2014 ◽

Vol 3;17 (3;5) ◽

pp. E263-E290 ◽

Cited By ~ 7

Author(s):

Laxmaiah Manchikanti

Keyword(s):

Pain Management ◽

Methodological Quality ◽

Randomized Trials ◽

Cochrane Review ◽

Bias Assessment ◽

Interventional Techniques ◽

Methodologic Quality ◽

Interventional Pain Management ◽

Review Criteria

Background: A major component of a systematic review is an assessment of the methodological quality and bias of randomized trials. The most commonly utilized methodological quality assessment and bias assessment for randomized trials is by the Cochrane Review Group. While this is not a “gold standard,” it is an indication of the current state-of-the-art review methodology. There is, however, no specific instrument to assess the methodological quality of manuscripts published for interventional techniques. Objectives: Our objective was to develop an instrument specifically for interventional pain management, to assess the methodological quality of randomized trials of interventional techniques. Methods: Item generation for the instrument was based on a definition of quality, to the extent to which the design and conduct of the trial were congruent with the objectives of the trial. Applicability was defined as the extent to which the trial produced procedures could be applied with contemporary interventional pain management techniques. Multiple items based on Cochrane review criteria were utilized along with specific requirements for interventional techniques. Results: A total of 22 items were developed which formed IPM-QRB or Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment tool. This included 9 of the 12 items from the Cochrane review criteria with deletion of some items that were repetitive or duplicate, and the addition of 13 new items. The results were compared for inter-rater reliability of Cochrane review criteria and IPM-QRB, and interinstrument reliability. The assessment was performed in multiple stages with an initial learning curve. The final assessment was for 4 randomized controlled trials (RCTs) utilizing both Cochrane review criteria and IPM-QRB criteria. The inter-rater agreement for Cochrane review criteria with overall intra-class correlation coefficient was 0.407 compared to an intra-class correlation coefficient of 0.833 for IPM-QRB criteria. The inter-rater agreement was superior for IPM-QRB criteria compared to Cochrane review criteria despite twice the items of Cochrane review criteria as IPM-QRB criteria with the detailed nature of assessment. Limitations: Limited validity or accuracy assessment of the instrument and the large number of items to be scored. Conclusion: We have developed a new comprehensive instrument to assess the methodological quality of randomized trials of interventional techniques. This instrument is superior to Cochrane review methodology criteria in that it provides more extensive and specific information for interventional techniques that will be useful in assessing the methodologic quality and bias of interventional techniques. Key words: Methodological quality assessment, evidence-based medicine, comparative effectiveness research, Cochrane Reviews, interventional techniques, risk of bias assessment

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Advantages wth Using the Levonorgestrel-Releasing Intrauterine System in Females with Hemostatic Disorders.

Blood ◽

10.1182/blood.v108.11.3303.3303 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3303-3303

Author(s):

Andrea S. Lukes ◽

Gowthami Arepally

Keyword(s):

Quality Of Life ◽

Large Scale ◽

Case Series ◽

Factor V Leiden ◽

Menstrual Bleeding ◽

Effective Control ◽

Bleeding Complications ◽

Life Questionnaire ◽

Hemostatic Disorders

Abstract BACKGROUND: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a small device placed within the uterus that is used for both contraception and treatment of menorraghia. This system releases 20 micrograms of levonorgestrel every 24 hours over 5 years. We hypothesized that females with inherited or acquired bleeding disorders would have decreased menstrual bleeding with the LNG-IUS and improved quality of life. METHODS: A small, retrospective case series of females with hemostatic disorders who used the LNG-IUS within a 2 year period and who were seen at a tertiary medical center. RESULTS: Seven females were treated with the LNG-IUS for menorrhagia and contraception. We did not reverse anticoagulation for placement of the device and there were no bleeding complications associated with the LNG-IUS insertion. The average age was 36.7 years (range 28 – 48 years). Four females had von Willebrand’s disease (VWD). Four females were on antithrombotic therapy, 2 warfarin and 2 aspirin. One female with VWD was heterozygous for factor V Leiden and was on warfarin for treatment of deep venous thrombosis. Six females had menorrhagia and one had bleeding most of the time. The average days of menstrual bleeding prior to LNG-IUS was 8.3 days which improved to 4.5 days after placement of the LNG-IUS. Three of 7 females discontinued use of the LNG-IUS, yet one had the LNG-IUS removed because she no longer required contraception. This female became pregnant and after an uncomplicated normal spontaneous vaginal delivery elected to use the LNG-IUS again for contraception and the benefit of decreased menstrual bleeding. The other 2 females (2/7, 29%) discontinued use of the LNG-IUS because there was worsening of heavy menses or ‘failed’ therapy - one with VWD and one on anticoagulation. The female on anticoagulation in this case also had significant uterine fibroids. A ten item quality of life questionnaire developed by Kouides was administered, and showed overall improvement in quality of life. CONCLUSION: The levonorgestrel-releasing intrauterine system is an effective method of contraception and an effective treatment for heavy menses. For females with hemostatic disorders, this device has unique advantages: it is technically easy to use in females at increased bleeding risk, offers effective control of menorrhagia, and may likely improve overall quality of life. Additional prospective large scale studies are required to validate these findings.

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