Effect of non-invasive intranasal neurostimulation on tear volume, dryness and ocular pain

2019 ◽  
pp. bjophthalmol-2019-315065 ◽  
Author(s):  
Monika Farhangi ◽  
Anny Mansim Cheng ◽  
Brandon Baksh ◽  
Constantine D Sarantopoulos ◽  
Elizabeth R Felix ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Case Series ◽  
Phenol Red ◽  
Ocular Pain ◽  
Symptom Report ◽  
Subjective Change ◽  
Pain Scores ◽  
Lower Baseline ◽  
Numerical Rating

PurposeTo evaluate the effect of one TrueTear session on change in tear volume and symptoms of dryness and ocular pain.MethodsRetrospective interventional case series of patients seen in a dry eye clinic. Seventy-five individuals underwent an ocular surface examination and one session of neurostimulation. Outcome measures included objective change in tear volume measured via phenol red test, and subjective change in sensations of dryness and ocular pain measured on a 0–10 Numerical Rating Scale.ResultsThe mean age of the 75 individuals was 59±13 years, and the majority were male (73%). Intranasal neurostimulation increased tear volume (mean 13.40±8.00 mm, p<0.0005) and reduced intensities of dryness (mean −2.85±2.79, p<0.0005) and ocular pain (mean −1.48±2.41, p<0.0005 for both). However, these effects were independent of one another as change in symptom report did not correlate with change in tear volume (r=−0.13, p=0.25 for dryness; r=0.07, p=0.56 for pain). In a multivariable model, the strongest predictors for increased tear volume were lower baseline tear volume (standardised beta (β)=−0.50, p<0.0005) and absence of an autoimmune disease (β=−0.36, p=0.001) (R2=0.30). The strongest predictors for reduced dryness and pain scores were lower baseline dryness and ocular pain scores. No complications related to neurostimulation were noted.ConclusionIntranasal neurostimulation increased tear volume and reduced intensities of dryness and ocular pain, independently of one another.

scholarly journals EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1666
Author(s):  
Won Jae Yoon ◽  
Yul Oh ◽  
Changhoon Yoo ◽  
Sunguk Jang ◽  
Seong-Sik Cho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Back Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intractable Pain ◽  
Point Reduction ◽  
Pain Scores ◽  
Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

scholarly journals The Use of a Dynamic Elastomeric Fabric Orthosis in Supporting the Management of Athletic Pelvic and Groin Injury

2016 ◽  
Vol 25 (2) ◽  
pp. 101-110 ◽  
Author(s):  
Leanne Sawle ◽  
Jennifer Freeman ◽  
Jonathan Marsden
Keyword(s):  
Outcome Measures ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Preliminary Investigation ◽  
Case Series ◽  
Baseline Period ◽  
Numerical Rating ◽  
Straight Leg Raise ◽  
Type Of Injury ◽  
Groin Injury

Context:Athletic pelvic and groin injuries are a common yet challenging problem. Pelvic belts have been successfully used to reduce pain and improve function but are not a practical solution for athletes. Therefore, there is scope to explore the use of a more dynamic intervention developed to aid in the management of this type of injury.Objectives:To undertake a preliminary investigation into the effectiveness of a dynamic elastomeric fabric orthosis (DEFO) in supporting the management of athletic pelvic and groin injury.Design:A case series with an AB design. Daily assessments were undertaken over 15 days; the onset of intervention was randomized with a minimum baseline period of 6 d. Follow-up assessment was undertaken after 1 mo.Settings:Community and university.Participants:8 athletes presenting with pelvic or groin injury confirmed through clinical screening.Intervention:A bespoke DEFO.Main Outcome Measures:Force produced on bilateral resisted hip adduction and self-scored pain (using a numerical rating scale of 0–10) at rest and during an active straight-leg raise and a broad jump.Results:In 7 cases a significant improvement was observed on at least 1 measure (2-SD method, celeration line, and/or the point of nonoverlapping data). The remaining case showed minimal symptoms during testing.

Acute Cervical Radiculopathy Outcomes: Soft Disc Herniations vs Osteophytes

Pain Medicine ◽  
2020 ◽  
Author(s):  
William Jeremy Beckworth ◽  
Benjamin A Abramoff ◽  
Iain M Bailey ◽  
Sook Yoon ◽  
Monica Umpierrez ◽  
...  
Keyword(s):  
Pain Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Pain Scores ◽  
Plain Films ◽  
Numerical Rating ◽  
Disc Herniations

Abstract Objective Prospectively evaluate the clinical outcomes of acute cervical radiculopathy with respect to soft disc herniations vs osteophytes. Methods Sixty consecutive patients who had had cervical radiculopathy for ≤1 month were enrolled in the study. Inclusion criteria were radicular pain greater than axial pain and a pain score ≥4 out of 10 on a numerical rating scale. Patients had at least one positive clinical finding: motor, sensory, or reflex changes. Plain films and magnetic resonance imaging were ordered. Follow-up was at 6 weeks and 3, 6, and 12 months. Outcomes included pain scores (neck and upper limb), neck disability index, medication use, opioid use, and need for surgery. Two attending musculoskeletal radiologists reviewed imaging findings for osteophytes vs soft disc herniations at the symptomatic level. Results More than 75% reduction in pain was seen in 77% of patients with soft disc herniations and 66% of patients with osteophytes (P &gt; 0.05) at 12 months. A pain score ≤2 out of 10 within 6 to 12 months was seen in 86% of patients with soft disc herniations and 81% of patients with osteophytes (P &gt; 0.05). Moderate or marked improvement at 12 months was seen in 85% of patients with soft discs and 77% of patients with osteophytes (P &gt; 0.05). Baseline–to–12-month numerical rating scale pain scores of patients with soft discs vs osteophytes had overlapping confidence intervals at each follow-up. At 12 months, very few had undergone surgery (7% of patients with soft discs, 11% of patients with osteophytes; P &gt; 0.05) or were on opioids (7% of patients with soft discs, 9% of patients with osteophytes; P &gt; 0.05). Conclusions The majority of patients, but not all patients, with acute radiculopathies improved with time. This was seen with both soft disc herniations and osteophytes.

Reactive oxygen species in an oleic matrix for healing deep and narrow wounds: a case series

2020 ◽  
Vol 18 (Sup4) ◽  
pp. S23-S30
Author(s):  
Giulia Vidotto ◽  
Teresita Gaiani ◽  
Umberto Cazzarò ◽  
Sara Maria Lupi ◽  
Ognibene Lina Carmela ◽  
...  
Keyword(s):  
Reactive Oxygen Species ◽  
Rating Scale ◽  
Hypochlorous Acid ◽  
Numerical Rating Scale ◽  
Case Series ◽  
Reactive Oxygen ◽  
Oxygen Species ◽  
Chemical Additives ◽  
Numerical Rating ◽  
Dressing Change

Use of reactive oxygen species (ROS) involves continual introduction of molecular oxygen to a wound, activating the local immune system and inducing the development of hypochlorous acid, with beneficial antimicrobial effects. NOVOX is an ROS device that uses olive oil, over-oxidised through an ozone (O3), to create an oleic matrix, with film-forming and protective functions. By avoiding accumulation of exudate, it decreases bacterial proliferation. It is administered to the wound bed through a prefilled plastic syringe, without antimicrobials or chemical additives, for safe and easy self-treatment and painless dressing change. The oil's consistency allows for a homogenous spread, reaching all tunnelling tracts and promoting contact between wound bed and dressing. A case series was carried out of 34 patients with deep and narrow wounds, most in the leg or sternum and resulting from dehiscence (80%). ROS therapy was used in combination with a secondary dressing, such as negative pressure wound therapy or polyurethane foam. At baseline, average wound/fistula depth was 1.6cm, Wound Bed Score (WBS) was 11.8 and Numerical Rating Scale (NRS) for pain was 3.6. Average wound/fistula depth decreased by 43% at 2 weeks and 77% at 4 weeks. WBS increased by 11% at 2 weeks and by 27% at 4 weeks. NRS decreased by 60% at 2 weeks. Most wounds took 2–4 weeks to heal, and there were no episodes of intolerance or recurrence.

Low dose ketamine versus morphine for acute severe vaso occlusive pain in children: a randomized controlled trial

2018 ◽  
Vol 18 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Felix Anthony Lubega ◽  
Mithrika S. DeSilva ◽  
Deogratias Munube ◽  
Rita Nkwine ◽  
Janat Tumukunde ◽  
...  
Keyword(s):  
Side Effects ◽  
Sickle Cell ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Duration Of Action ◽  
Pain Scores ◽  
Sickle Cell Crisis ◽  
Numerical Rating ◽  
Life Threatening ◽  
Intravenous Ketamine

AbstractBackground and aims:Acute pain episodes associated with sickle cell disease (SCD) are very difficult to manage effectively. Opioid tolerance and side effects have been major roadblocks in our ability to provide these patients with adequate pain relief. Ketamine is cheap, widely safe, readily available drug, with analgesic effects at sub-anesthetic doses and has been used in wide range of surgeries, pediatric burns dressing change and cancer related pain however, literature concerning its use in sickle cell crises is still limited in our setting. This study aimed to establish if 1 mg/kg of intravenous ketamine is non inferior to intravenous morphine 0.1 mg/kg in severe SCD-associated pain.Methods:We performed an institutional review board-approved randomized, prospective, double-blinded, active-control, non-inferiority trial at the national referral sickle cell center. Children between 7 and 18 years of age with severe painful sickle cell crisis, defined by numerical rating scale score of greater or equal to 7 were enrolled. Patients were consented and randomized to receive, either IV ketamine (LDK) 1 mg/kg or IV morphine (MOR) 0.1 mg/kg as an infusion over 10 min. The primary endpoint is maximal change in Numerical Rating Scale (NRS) pain score. Secondary outcomes were, incidence of adverse effects, optimal time to and duration of action of ketamine and incidence of treatment failures by treatment group. A clinically meaningful difference in validated pain scores was defined as 1.3 units. Assuming both treatments are on average equal, a sample size of 240 patients (120 per group) provided 95% power to demonstrate that IV LDK is non-inferior to IV morphine with a 0.05 level of significance and a 10% non-inferiority margin. All analyses were based on a modified intention to treat. This trial was registered with clinicaltrials.gov NCT02434939.Results:Two hundred and forty patients were enrolled (LDK120, MOR120). Demographic variables and baseline NRS scores (8.9 vs. 9.2) were similar. LDK was comparable to MOR in the maximum change in NRS scores, 66.4% vs. 61.3% (MD 5.5; 95% CI −2.2 to −13.2). Time to achieve maximum reduction in NRS pain scores was at 19.8 min for LDK and 34.1 min for MOR. The average duration of action for LDK was 60 min. MOR had more patients still at maximum effect at 120 min (45.8% vs. 37.5%; RR 1.2; 95% CI 0.9–1.7). LDK patients were 11.3 times more likely to develop side effects, though were transient, anticipated and non-life threatening (37.5% vs. 3.3%). MOR had significantly more treatment failures 40% vs. 28.3% (RR 0.7; 95% CI 0.5–1.03,p=0.07) Vital signs and sedation scores were similar in both groups.Conclusions:Intravenous LDK at 1 mg/kg provides comparable analgesic effectiveness as IV MOR in the acute treatment of severe painful sickle cell crisis in children in the day care sickle cell center. However, it is associated with a high incidence of several transient, non-life threatening mild side effects.Implications:Intravenous ketamine at 1 mg/kg can be a reliable alternative to morphine in the management of severe painful sickle cell crisis especially in a resource limited area where morphine is not readily available.

scholarly journals THE EFFECTS OF INJECTING INTRA ARTICULAR PLATELET-RICH PLASMA ON PAIN SCORES IN KNEE JOINT OSTEOARTHRITIS

2021 ◽  
Vol 71 (4) ◽  
pp. 1278-81
Author(s):  
Khaleel Ahmad ◽  
Liaquat Ali ◽  
Muhammad Aasam Masoom Maan
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Platelet Rich Plasma ◽  
Functional Limitation ◽  
Military Hospital ◽  
Dramatic Improvement ◽  
Pain Scores ◽  
Numerical Rating

Objective: To determine the effects of intra articular platelet rich plasma (PRP) injection on level of pain of knee joint in patients with knee osteoarthritis. Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Aug 2018 to Jan 2019. Methodology: Forty patients with pain due to knee osteoarthritis for intra-articular injection were included in this observational clinical trial after informed consent and fulfilling inclusion criteria. After measuring pain by numerical rating scale, patients received intra articular platelet rich plasma (10ml) therapy in affected knee under fluoroscopy. Using the Numerical rating scale level of pain was evaluated and recorded for each patient at different intervals. Results: There was dramatic improvement in pain score after first and second injection of platelet rich plasma. There was 33.33% improvement at 3rd week, 54.32% at 6th week and 71.60% at 6th month. Conclusion: Platelet rich plasma is safe, cost effective and minimally invasive in reducing pain scores and functional limitation in knee osteoarthritis.

Conversion of Schedule II Opioids to Buprenorphine Buccal Film: A Retrospective Analysis

Pain Medicine ◽  
2020 ◽  
Author(s):  
Amanda Zimmerman ◽  
Rami Bikdash ◽  
Richard Rauck
Keyword(s):  
Chronic Pain ◽  
North Carolina ◽  
Chart Review ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Inclusion Criteria ◽  
Pain Scores ◽  
Numerical Rating ◽  
Long Acting

Abstract Objective To provide clinical data for the conversion of Schedule II opioids to buprenorphine buccal film and to demonstrate sustained analgesia and a reduction in morphine milligram equivalents after conversion. Design Retrospective review of electronic medical records. Setting Group clinical practice providing outpatient chronic pain management care in Winston-Salem, North Carolina. Subjects Patients who received opioids for chronic pain between January 1, 2016, and June 30, 2019, were selected for chart review if they were converted to buprenorphine buccal film from a Schedule II opioid. Methods Patients who met inclusion criteria were stratified into subgroups on the basis of preconversion morphine milligram equivalents, whether they remained on opioids for breakthrough pain postconversion, and pre- and postconversion numerical rating scale pain scores. Outcomes of interest included the differences between pre- and postconversion numerical rating scale pain scores and daily morphine milligram equivalents for each subgroup. Results Of 157 patients reviewed, 87.9% were successfully converted to buprenorphine buccal film. Overall, numerical rating scale pain scores were stable after conversion. Statistically significant reductions were demonstrated in the &lt;90 daily morphine milligram equivalent subgroup. Postconversion daily morphine milligram equivalents decreased by 85.4% from baseline. Change in daily morphine milligram equivalents is representative of patients who remained on breakthrough pain medication. Conclusions Results demonstrate continued analgesia after conversion to buprenorphine buccal film despite reductions in daily morphine milligram equivalents. Most patients were able to convert directly from their long-acting opioid to buprenorphine buccal film and stabilized without the use of concomitant opioids for breakthrough pain. Aggressive titration strategies were associated with greater success.

scholarly journals Postoperative pain and comfort scores: Do they correlate?

2019 ◽  
Vol 47 (5) ◽  
pp. 435-441
Author(s):  
Michelle W Miu ◽  
Andrew Martin ◽  
Allan M Cyna
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
P Value ◽  
Nocebo Effect ◽  
Suitable Alternative ◽  
Pain Experience ◽  
Pain Scores ◽  
Comfort Levels ◽  
Numerical Rating

Research on the nocebo effect has shown that some words can hurt. Pain is defined as ‘unpleasant’ and ‘associated with actual or potential tissue damage’. So, a sensation described as ‘pain’ may function as a negative suggestion or nocebo communication. This can lead to pain being experienced or exacerbated where it would not have been otherwise. The nocebo effect has also been implicated as adversely affecting the pain experience during the assessment of pain postoperatively. Words that avoid this potential nocebo effect such as ‘comfort’ may represent a more satisfactory alternative. We therefore aimed to determine whether ‘comfort’ and ‘pain’ scores correlate when assessing patients postoperatively at the same timepoint. Patients were questioned before routine post-anaesthesia rounds to rate their pain and comfort levels, with the sequence of questions randomised. Patients were asked to rate pain and comfort on a 0–10 verbal numerical rating scale, where 0 represents ‘no pain’ or ‘no comfort’ and 10 ‘worst pain’ or ‘most comfort’ imaginable, respectively. To provide a clinically relevant correlation of approximately 0.7 between pain and inverted comfort scores, a sample size of 100 would provide adequate precision (95% confidence interval (CI) 0.58–0.79). A P-value of <0.05 was considered significant. We recruited 100 patients. A positive correlation of 0.62 was found between pain and inverted comfort scores (95% CI 0.47–0.72; P<0.0001). The question sequence of asking about pain or comfort did not affect either score. Comfort and pain scores are moderately correlated. This finding represents a first step in validating comfort scores and suggests that they could be considered a suitable alternative to pain scores when assessing patients postoperatively. As comfort is not an exact antonym to pain, caution is required when using these measures interchangeably.

Comparison of treatment outcomes in lumbar disc herniation patients treated with epidural steroid injections: interlaminar versus transforaminal approach

2019 ◽  
Vol 61 (3) ◽  
pp. 361-369 ◽  
Author(s):  
Susanne Bensler ◽  
Melissa Walde ◽  
Michael A Fischer ◽  
Christian WA Pfirrmann ◽  
Cynthia K Peterson ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Transforaminal Approach ◽  
Pain Scores ◽  
Numerical Rating ◽  
Epidural Steroid

Background The study describes the difference of pain reduction in interlaminar and transforaminal injections. Purpose To compare treatment outcomes after interlaminar versus transforaminal epidural steroid injections in patients with disc herniations at the level L3/4–L5/S1 and analyze associated magnetic resonance imaging (MRI) findings. Material and Methods This retrospective comparative effectiveness outcome study included 198 patients with computed tomography (CT)-guided interlaminar (n = 99) or transforaminal (n = 99) epidural injections with particulate steroids. Pain levels at baseline and one day, one week, and one month after injection were assessed using the 11-point Numerical Rating Scale for Pain. Overall improvement was assessed after one day, one week, and one month using the Patients Global Impression of Change. MRI analysis was performed by two radiologists. Student’s t-test, Chi-square test, and Fisher’s exact test were calculated. Results Baseline pain scores were equal for interlaminar and transforaminal injections (6.23, SD = 2.10 vs. 5.84, SD = 2.02; P = 0.18). There were no significant differences in improvement between the interlaminar and transforaminal approach of epidural steroid injections after one day (30.5% vs. 21.2%, P = 0.432), one week (41.7% vs. 40.8%, P = 1.000), and one month (53.3% vs. 43.9%, P = 0.322), but there was a trend towards better effect of interlaminar injections at one day and one month. The change in Numerical Rating Scale for Pain scores showed no significant differences between the two cohorts after one day, one week, and one month ( P ≥ 0.115). None of the MR findings predicted a better or worse outcome ( P ≥ 0.171). Conclusion Interlaminar and transforaminal injections with particulate corticosteroids were equally effective, with a non-significant advantage of interlaminar injections at one day and one month. None of the MR findings were associated with treatment outcomes.

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