Analgesic Effect of Extracorporeal Shock Wave Treatment Combined with Fascial Manipulation Theory for Adhesive Capsulitis of the Shoulder: A Retrospective Study

Objectives. This study aims to explore whether extracorporeal shockwave treatment (ESWT) based on the theory of fascial manipulation (FM) at select treatment points is superior to traditional local ESWT for pain relief in adhesive capsulitis of the shoulder. Methods. Data from patients with adhesive capsulitis of the shoulder who received weekly ESWT according to fascial manipulation theory (ESWT-FM) or local extracorporeal shockwave treatment (L-ESWT) during a 5-week treatment period were evaluated. Pain-on-movement numeric rating scale (p-NRS) and range of motion (ROM) testing were performed before the treatment period, after the first treatment, and after the fifth treatment. Results. There were significant reductions in pain scores in the ESWT-FM group (p<0.05) after the first treatment, and after the fifth treatment, both groups had marked, significant improvement (p<0.05), with a significantly greater reduction in pain (p-NRS) in the ESWT-FM group compared to the L-ESWT group (p<0.05). There was no significant difference in terms of ROM in the L-ESWT group, while there was slight improvement of forward flexion in the ESWT-FM group after the fifth treatment. Conclusions. ESWT-FM provided faster pain relief and slightly more notable improvement of function compared with L-ESWT for the patients with adhesive capsulitis of shoulder.

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Oral paracetamol versus zolmitriptan to treat acute migraine attack in the emergency department

10.22514/sv.2021.040 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Rating Scale ◽

Rescue Therapy ◽

Tertiary Care ◽

Numeric Rating Scale ◽

Controlled Study ◽

Care Hospital ◽

Acute Migraine ◽

Pain Scores ◽

Significant Difference

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks. Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy. Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596). Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.

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The influence of coccygeal dynamic patterns on ganglion impar block treatment results in chronic coccygodynia

Interventional Neuroradiology ◽

10.1177/1591019918781673 ◽

2018 ◽

Vol 24 (5) ◽

pp. 580-585 ◽

Cited By ~ 3

Author(s):

Savas Sencan ◽

Isa Cuce ◽

Ozgur Karabiyik ◽

Fatmagul U Demir ◽

Tulay Ercalik ◽

...

Keyword(s):

Pain Relief ◽

Rating Scale ◽

Complication Rates ◽

Pain Scores ◽

Significant Pain ◽

Group I ◽

Significant Difference ◽

Dynamic Patterns ◽

Ganglion Impar Block ◽

Ganglion Impar

Objective Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. Patients were assessed with standard and dynamic coccyx radiographs and classified according to coccygeal mobility. Pain scores were assessed with a numerical rating scale (NRS) before and after the intervention (at 1 hour and 4, 12 and 24 weeks). A 50% or more reduction in the NRS score was accepted as significant pain relief. Results Of the 37 patients included in the study, 14 had normal coccyx (Group I) and 23 had immobile coccyx (Group II) based on the radiological evaluation. The NRS scores were significantly reduced in both groups on each follow-up visit but there was no significant difference between the two groups in terms of pre- and post-intervention NRS scores. Significant pain relief was achieved in 42.9% and 61.9% of patients in Group I and II at the last examination, respectively. Conclusion GIB administered by transsacrococcygeal method in patients with chronic coccygodynia is a safe and alternative treatment approach with reduced pain scores and low complication rates. In patients with chronic coccygodynia, having a normal or immobile coccyx does not appear to affect treatment outcomes.

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Repeated Intravenous Lidocaine Infusions for Patients with Fibromyalgia: Higher Doses of Lidocaine Have a Stronger and Longer-Lasting Effect on Pain Reduction

Pain Medicine ◽

10.1093/pm/pnz251 ◽

2019 ◽

Vol 21 (6) ◽

pp. 1230-1239 ◽

Cited By ~ 1

Author(s):

Igor Wilderman ◽

Olga Pugacheva ◽

Vsevolod (Sev) Perelman ◽

Michael C T Wansbrough ◽

Yuri Voznyak ◽

...

Keyword(s):

Pain Relief ◽

Pain Intensity ◽

Magnesium Sulfate ◽

Statistical Difference ◽

Rating Scale ◽

Retrospective Chart Review ◽

Numeric Rating Scale ◽

Subjective Impression ◽

Number Of Patients ◽

Significant Difference

Abstract Objectives To determine the effect of escalating doses of lidocaine infusion with or without added magnesium on pain levels and the duration of pain relief in patients with fibromyalgia (FM). Methods A retrospective chart review of 74 patients diagnosed with FM who underwent at least three escalating doses of intravenous (IV) lidocaine infusions (5 mg/kg of body weight, 7.5 mg/kg, and 7.5 mg/kg of lidocaine + 2.5 g of magnesium sulfate) was conducted. Each patient’s subjective impression of change in pain intensity and duration of pain relief after each treatment was recorded, along with an 11-point numeric rating scale (NRS) for pain intensity, immediately before and after each infusion. Results Short-term lidocaine analgesia was evaluated by the reduction in NRS pain score according to the patients reported pre- (immediately before treatment) and post-treatment (immediately after treatment) values. There was a statistical difference in the NRS score reduction between doses 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.009). Long-term analgesia was evaluated at follow-up visits by the patient’s subjective impression of change in pain intensity and duration of pain relief. There was a statistical difference in the percentage of pain relief and the mean duration of pain relief between the treatments with 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.007 and P = 0.003). Although there was a trend of greater response to magnesium sulfate as a beneficial adjunct to the lidocaine infusion, we were unable to find a statistically significant difference for any of the variables studied. Conclusions This study demonstrated that escalating doses of IV lidocaine to 7.5 mg/kg safely and effectively reduced the pain with prolonged effect in a significant number of patients diagnosed with fibromyalgia. Larger, prospective clinical studies are required to confirm this finding.

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PERBANDINGAN INTERPRETASI SKALA NYERI ANTARA NRS-VAS-WBFS OLEH PASIEN PASCA OPERASI ELEKTIF ORTHOPEDI DI RSUD Dr. SOETOMO

Care Jurnal Ilmiah Ilmu Kesehatan ◽

10.33366/jc.v8i3.1802 ◽

2020 ◽

Vol 8 (3) ◽

pp. 447

Author(s):

Ginong Pratitdya ◽

Nancy M. Rehatta ◽

Dedi Susila

Keyword(s):

Rating Scale ◽

Health Management ◽

Numeric Rating Scale ◽

Cross Sectional Study ◽

Pain Scale ◽

Primary Data ◽

Research Subjects ◽

Cross Sectional ◽

Pain Scores ◽

Significant Difference

Health management is still a challenge in health services. An instrument that can cure pain is easy, easy, with accurate interpretation and can be used by every party involved in pain management. The purpose of this study was to analyze the Numeric Rating Scale (NRS), Visual Analogue Scale (VAS), and Wong Baker Faces Scale (WBFS), which can be interpreted well by postoperative care patients. The research method used was an observational analytic study with a cross-sectional study design that analyzed the scale application (NRS, VAS, WBFS) in patients after elective orthopedic surgery at RSUD Dr. Soetomo Surabaya. This study analyzed primary data of postoperative patients which contained socio-demographic characteristics, type of anesthesia given, pain scores and patient interpretation of pain scales through special instruments. The results showed that 102 research subjects were needed. The pain scale interpretation instrument was declared valid and reliable (Cronbach Alpha> 0.60). Mean pain scores from the VAS scale (4.29), NRS (4.82) and WBFS (4.81). No significant difference was obtained NRS scale and WBFS scale (Sig> 0.05). Mean interpretation of pain scale from the VAS scale (13.62), NRS (17.14) and WBFS (21.33). There was a significant difference in the pain score of the VAS scale against the NRS scale, also the WBFS scale (Sig

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28 Assessment of Pain and Provision of Non-Pharmacologic Analgesia to Children by Prehospital Providers in Southwestern Ontario: A Cross-Sectional Study

Paediatrics & Child Health ◽

10.1093/pch/pxab061.022 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e21-e21

Author(s):

Karina Burke ◽

Branka Vujcic ◽

Jonathan Hamilton ◽

Charlotte Mace ◽

John Teefy ◽

...

Keyword(s):

Primary Outcome ◽

Rating Scale ◽

A Priori ◽

Numeric Rating Scale ◽

Cross Sectional Study ◽

Subject Area ◽

Stepwise Logistic Regression ◽

Tertiary Referral Centre ◽

Cross Sectional ◽

Pain Scores

Abstract Primary Subject area Emergency Medicine - Paediatric Background There is abundant evidence that provision of pharmacologic analgesia by prehospital providers to children is suboptimal. Most paediatric calls are performed by primary care paramedics (PCPs) who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies. Objectives Our objective was to describe the provision of non-pharmacologic analgesia to children by prehospital providers. Design/Methods We reviewed all ambulance call reports (ACRs) of children 0-17 years with acutely painful conditions (headache, abdominal pain, injury, head/ears/eyes/nose/throat pain, and back pain) who were transported to a paediatric tertiary referral centre serving a catchment of > 1 million from 2017-2019. Data collection was recorded by two blinded assessors using a study-specific Excel™ sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, type of crew, complaint, pain score, call time, and prior analgesia. Results All 11,084 ACRs from January 1, 2017 to December 31, 2019 were reviewed. The sample included 5887/11084 (53.1%) males, ranging from 1 month to 17 years, with a mean (SD) age of 10.5 (5.6) years. Calls involved mainly PCPs [8576/11084 (77.4%)]. Non-trauma-related musculoskeletal injuries were most common, comprising 2743/11,084 (24.7%) of calls. Pain scores were documented in 6947/11084 (62.7%) of calls. The verbal numeric rating scale (0-10) was used in 5022/6947 (72.3%) of calls, with a mean (SD) score of 5.2 (3.2). Non-pharmacologic analgesia was provided in 2926/11084 (26.4%) of calls, most commonly splint (1115/2926, 38.1%) and ice (931/2926, 31.8%). Pharmacologic analgesia was provided in 458/11084 (4.1%) of calls. In the multivariate model, mild (OR: 3.2; 95% CI 2.3-4.4; p < 0 .001) and moderate pain (OR: 1.7; 95% CI 1.3-2.2) (versus no pain) were significant predictors of non-pharmacologic analgesia, whereas visible deformity (OR: 0.5; 95% CI 0.3-0.6; p < 0 .001) was a significant negative predictor. Conclusion The provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers is suboptimal, despite moderate to severe pain. There is a clear need for education surrounding approaches to non-pharmacologic analgesia in children among prehospital providers.

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A comparison of pain registration by Visual Analog Scale and Numeric Rating Scale – a cross-sectional study of primary triage registration

10.1101/2020.11.03.20225367 ◽

2020 ◽

Author(s):

Jofrid Kollltveit ◽

Malin Osaland ◽

Marianne Reimers ◽

Magnus Berle

Keyword(s):

Emergency Department ◽

Visual Analog Scale ◽

Rating Scale ◽

Emergency Admission ◽

Numeric Rating Scale ◽

University Hospital ◽

Analog Scale ◽

Cross Sectional ◽

Significant Difference ◽

Numeric Rating

BackgroundPain is a subjective sensation; self-reporting is important for quantifying pain intensity. There are several different validated tools for this, such as Visual Analog Scale and Numeric Rating Scale. In the clinic, these terms are often used as equivalent. The objective of this study was to examine correlation and agreement between the pain registration tools in triage in an emergency department.Materials and MethodsThe study was performed in the Department of Emergency Medicine at Haukeland University Hospital in the period June-August 2019. We registered the pain score with two tools in 200 unselected patients in emergency admission with pain. In addition, we registrered gender, age, triage and general department affiliation.ResultsWe found a strong correlation between the pain registration tools by Spearmans correlation test (rho=0,930, p<0,001). There were no significant difference between the pain registration tools within the subgroups. Bland-Altman analysis show agreement between the two pain registration tools.ConclusionsIn an Emergency Department triage is it acceptable to use Visual Analog Scale and Numeric Rating Scale as equivalent, as long as the correct terminology is used.

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Effectiveness and safety of extracorporeal shock wave treatment for low back pain:a systematic review and meta-analysis of RCTs

10.21203/rs.3.rs-25516/v1 ◽

2020 ◽

Author(s):

Jinhui Ma ◽

Yan Yan ◽

Bailiang Wang ◽

Wei Sun ◽

Debo Yue ◽

...

Keyword(s):

Shock Wave ◽

Rating Scale ◽

Meta Analysis ◽

Post Treatment ◽

Mean Difference ◽

Control Group ◽

Low Back ◽

China National Knowledge Infrastructure ◽

Pain Scores ◽

Extracorporeal Shock Wave

Abstract Background Extracorporeal shock wave therapy (ESWT) has been widely used in musculoskeletal disorders. This meta-analysis was designed to assess the effectiveness and safety of ESWT for patients with low back pain (LBP). Methods Multiple electronic databases including Pubmed, Embase, Cochrane’s library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December, 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences were calculated for continuous outcomes, while odd ratios were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Results Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P <0.0001), indicating that post-treatment pain scores was significantly higher by 2.37 in control group than in ESWT group. At a mean follow-up time of 4-6 weeks, the pooled mean difference in ODI scores was −14.10 (P <0.00001), indicating that the pooled mean difference of post-treatment ODI scores was 14.10 higher in control group than in ESWT group. Conclusions The use of focused ESWT is effective in alleviating pain and improving the general fuctional state for patients with LBP. However, more evidence was needed to verify its safety.

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Intravenous Paracetamol vs Intranasal Desmopressin for Renal Colic in the Emergency Department: A Randomized Clinical Trial

Pain Medicine ◽

10.1093/pm/pnaa240 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3437-3442

Author(s):

Hamed Basir Ghafouri ◽

Niloofar Abazarian ◽

Mohammadreza Yasinzadeh ◽

Ehsan Modirian

Keyword(s):

Clinical Trial ◽

Emergency Department ◽

Pain Score ◽

Randomized Clinical Trial ◽

Renal Colic ◽

Rating Scale ◽

Pain Scores ◽

Intravenous Paracetamol ◽

Significant Difference ◽

Intranasal Desmopressin

Abstract Objective To evaluate the analgesic efficacy of intranasal desmopressin alone vs intravenous paracetamol in patients referred to the emergency department with renal colic. Design Randomized clinical trial. Setting This study was conducted in the emergency unit of a university hospital. Subjects Patients referred to the emergency room with renal colic. Primary Outcome Effect of intranasal desmopressin in pain relief in comparison with intravenous paracetamol. Methods In this trial, 240 patients diagnosed with renal colic were randomly divided into two groups to compare the analgesic effect of intravenous paracetamol (15 mg/kg) and intranasal desmopressin spray (40 μg). Pain scores were measured by a numeric rating scale at baseline and after 15, 30, and 60 minutes. Adverse effects and need for rescue analgesic (0.05 mg/kg max 3 mg morphine sulphate) were also recorded at the end of the study. Results Three hundred patients were eligible for the study; however, 240 were included in the final analysis. The patients in the two groups were similar in their baseline characteristics and baseline pain scores. The mean pain score after 15 minutes was more reduced and was clinically significant (>3) in the desmopressin group (P < 0.0001). There was no significant difference between mean pain scores in the two groups after 30 minutes (P = 0.350) or 60 minutes (P = 0.269), but the efficacy of the two drugs was significant in terms of pain reduction (>6). Conclusions Our study showed that intranasal desmopressin is as effective as intravenous paracetamol for renal colic pain management; however, significant clinical reduction in pain score occurred faster with intranasal desmopressin.

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Long-Term Results of a Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Refractory Neuropathic Pain

Translational Neuroscience and Clinics ◽

10.18679/cn11-6030_r.2017.002 ◽

2017 ◽

Vol 3 (1) ◽

pp. 4-15

Author(s):

Byung-chul Son ◽

Jin-gyu Choi ◽

Sang-woo Ha ◽

Deog-ryeong Kim

Keyword(s):

Neuropathic Pain ◽

Pain Relief ◽

Motor Cortex ◽

Success Rate ◽

Rating Scale ◽

Long Term Results ◽

Motor Cortex Stimulation ◽

Significant Difference ◽

Deep Brain

Objective Although deep brain stimulation (DBS) and motor cortex stimulation (MCS) are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis (Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results Of the 11 patients implanted with both DBS and MCS electrodes, nine (81.8%) had successful trials. Seven of these nine patients (77.8%) responded to MCS, and two (18.2%) responded to Vc DBS. With long-term follow-up (56 ± 27.5 months), the mean numerical rating scale decreased significantly (P < 0.05). The degree of percentage pain relief in the chronic MCS (n = 7) and chronic DBS (n = 2) groups were 34.1% ± 18.2% and 37.5%, respectively, and there was no significant difference (P = 0.807). Five out of the seven MCS patients (71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

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The Outcome of Pulsed Radiofrequency Treatment According to Electodiagnosis in Patients with Intractable Lumbosacral Radicular Pain

Pain Medicine ◽

10.1093/pm/pnz028 ◽

2019 ◽

Vol 20 (9) ◽

pp. 1697-1701

Author(s):

Chan Hong Park ◽

Sang Ho Lee

Keyword(s):

Rating Scale ◽

Numeric Rating Scale ◽

Failed Back Surgery Syndrome ◽

Radicular Pain ◽

Spinal Nerve ◽

Pulsed Radiofrequency ◽

Pulsed Radiofrequency Treatment ◽

Significant Difference ◽

Failed Back Surgery ◽

Group 2

AbstractBackgroundRadicular pain is related to lesions that either directly compromise the dorsal root ganglion (DRG) or indirectly compromise the spinal nerve and its roots by causing ischemia or inflammation of the axons.ObjectiveOur study aimed to assess the outcomes of pulsed readiofrequency treatment (PRF) according to electrodiagnosis results in patients with chronic intractable lumbosacral radicular pain.MethodsA total of 82 failed back surgery syndrome (FBSS) patients were included in this study. All of them underwent electromyography/nerve conduction studies before pulsed radiofrequency (PRF) treatment at the DRG, and they were classified according to the electrodiagnostic results as: group 1, no definite finding (normal); group 2, radiculopathy; and group 3, neuropathy. Pain intensity was assessed according to a numeric rating scale score and the Oswestry Disability Index (ODI) before treatment and at one, three, six, and 12 months after treatment, and successful treatment was defined as a pain score reduction of ≥50% at 12 months, as compared with the pretreatment score.ResultsPretreatment electrodiagnosis identified 28 patients with no definite findings, 31 patients with radiculopathy, and 23 patients with neuropathy. The patients with neuropathy had less pain relief after treatment than those with no definite findings and those with radiculopathy. The prevalence of pain reduction of at least 50% was lower in the neuropathy group than in the other groups. There was no statistically significant difference in ODI between group.ConclusionOutcomes after PRF at the DRG did not show strong differences according to electrodiagnostic findings in FBSS patients with chronic intractable lumbosacral radicular pain.

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