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

2018 ◽  
Vol 24 (5) ◽  
pp. 580-585 ◽  
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.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Xiangnan Yuan ◽  
Fenghua Zhou ◽  
Lixin Zhang ◽  
Zhiqiang Zhang ◽  
Jianjun Li
Keyword(s):  
Pain Relief ◽  
Treatment Period ◽  
Rating Scale ◽  
Adhesive Capsulitis ◽  
Numeric Rating Scale ◽  
Extracorporeal Shockwave ◽  
Pain Scores ◽  
Extracorporeal Shock Wave ◽  
Significant Difference ◽  
Extracorporeal Shock Wave Treatment

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.

scholarly journals Local Bupivacaine Infiltration to Reduce Pain after Tonsillectomy: A Low Cost Approach

2021 ◽  
Vol 28 (3) ◽  
pp. 228-233
Author(s):  
Rakesh B S ◽  
Bharathi M B ◽  
Thanzeemunisa U ◽  
Kumar Shankar De ◽  
Nitish Aggarwal
Keyword(s):  
Rating Scale ◽  
Low Cost ◽  
Major Drawback ◽  
Group Iii ◽  
Pain Scores ◽  
Group I ◽  
Significant Difference ◽  
Average Pain ◽  
Group Ii ◽  
Double Blinded

Introduction Tonsillectomy is one of the most commonly performed surgical procedures worldwide, with the major drawback of significant post operative pain.There is no consensus regarding topical application or local infiltration of anesthetics post operatively to reduce pain. The present study was performed to evaluate the effect of bupivacaine infiltration in the tonsillar fossae after tonsillectomy. Materials and Methods A double-blinded clinical trial was performed on 75 patients undergoing tonsillectomy between January 2019 and January 2020. All patients underwent tonsillectomy under general anesthesia and were then randomly divided into 3 groups of 25 patients each. For Group I, a swab soaked in normal saline was applied to the tonsillar fossae for 5 minutes just before extubation. In Group II, a swab soaked in 5 ml of 0.5% bupivacaine was placed for 5 minutes, while in Group III, 5ml of 0.5% bupivacaine was infiltrated in the tonsillar fossae. The intensity of pain for each group was measured in the immediate post op period, at6 hours, 24 hours and 1 week by Wong Baker Faces Pain Rating Scale. Results There was a significant difference in the mean level of pain between groups I and III in the immediate post op period, at 6 hours and 24 hours. Although the average pain scores of group III were better than those of group II, the results were significant only in the 6 hour post op period. Conclusion To reduce post-tonsillectomy pain,0.5% bupivacaine can be infiltrated into the tonsillar fossa.

A randomized trial of pain relief in termination of pregnancy in South Africa

2005 ◽  
Vol 35 (3) ◽  
pp. 136-139 ◽  
Author(s):  
O T Owolabi ◽  
J Moodley
Keyword(s):  
Pain Relief ◽  
Pain Score ◽  
Prospective Trial ◽  
Termination Of Pregnancy ◽  
Local Infiltration ◽  
Vacuum Aspiration ◽  
Pain Scores ◽  
Group I ◽  
Significant Difference ◽  
Paracervical Block

The aim of this prospective trial was to evaluate and compare paracervical block with diclofenac for pain relief during manual vacuum aspiration (MVA) for surgical termination of pregnancy. Participants were randomized into three groups, viz. group (i) diclofenac 75 mg intramuscularly (i.m.) 30 min before the procedure; (ii) diclofenac 75 mg i.m. 30 min before the procedure, together with local infiltration of the cervix with lignocaine 1% (10 mL); (iii) diclofenac 75 mg i.m. 30 min before the procedure together with local infiltration of the cervix with lignocaine 1% (10 mL) and paracervical block with lignocaine 1% (5 mL). There was a significant difference in pain scores during the procedure between groups (i) and (ii) ( P<0.001), and between groups (i) and (iii) ( P<0.001) in pain scores during the procedure. There was no difference in pain score between groups (ii) and (iii) ( P=0.144). Post procedure analysis of pain score also showed significant difference between group (i) on one hand, and groups (ii) and (iii) ( P<0.001), but no significant difference between groups (ii) and (iii)( P=0.029). The local anaesthetic infiltration of the cervix in combination with diclofenac or together with diclofenac and paracervical block provides better pain relief during and after the MVA.

scholarly journals Endoscopic versus Surgical Intervention for Painful Obstructive Chronic Pancreatitis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (12) ◽  
pp. 2636
Author(s):  
Ka Wing Ma ◽  
Hoonsub So ◽  
Euisoo Shin ◽  
Janice Hoi Man Mok ◽  
Kim Ho Kam Yuen ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Meta Analysis ◽  
Small Sample ◽  
Cochrane Library ◽  
Endoscopic Drainage ◽  
Complication Rates ◽  
Surgical Drainage ◽  
Endocrine Insufficiency ◽  
Significant Difference

There is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.

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

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.

A metaanalysis comparing the results of pallidotomy performed using microelectrode recording or macroelectrode stimulation

2002 ◽  
Vol 96 (6) ◽  
pp. 1058-1062 ◽  
Author(s):  
Ravikant S. Palur ◽  
Caglar Berk ◽  
Michael Schulzer ◽  
Christopher R. Honey
Keyword(s):  
Intracranial Hemorrhage ◽  
Rating Scale ◽  
Complication Rates ◽  
Microelectrode Recording ◽  
Content Type ◽  
Medline Search ◽  
Significant Difference ◽  
Active Debate ◽  
Unilateral Pallidotomy ◽  
Fine Print

Object. There is an active debate regarding whether pallidotomy should be performed using macroelectrode stimulation or the more sophisticated and expensive method of microelectrode recording. No prospective, randomized trial results have answered this question, although personnel at many centers claim one method is superior. In their metaanalysis the authors reviewed published reports of both methods to determine if there is a significant difference in clinical outcomes or complication rates associated with these methods. Methods. A metaanalysis was performed with data from reports on the use of unilateral pallidotomy in patients with Parkinson disease (PD) that were published between 1992 and 2000. A Medline search was conducted for the key word “pallidotomy” and additional studies were added following a review of the references. Only those studies dealing with unilateral procedures performed in patients with PD were included. Papers were excluded if they described a cohort smaller than 10 patients or a follow-up period shorter than 3 months or included cases that previously had been reported. The primary end points for outcome were the percentages of improvement in dyskinesias and in motor scores determined by the Unified PD Rating Scale (UPDRS). Complications were categorized as mortality, intracranial hemorrhage, visual deficit, speech deficit, cognitive decline, weakness, and other. There were no significant differences between the two methods with respect to improvements in dyskinesias (p = 0.66) or UPDRS motor scores (p = 0.62). Microelectrode recording was associated with a significantly higher (p = 0.012) intracranial hemorrhage rate (1.3 ± 0.4%), compared with macroelectrode stimulation (0.25 ± 0.2%). Conclusions. In reports of patients with PD who underwent unilateral pallidotomy, operations that included microelectrode recording were associated with a small, but significantly higher rate of symptomatic intracranial hemorrhage; however, there was no difference in postoperative reduction of dyskinesia or bradykinesia compared with operations that included macroelectrode stimulation.

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

Pain Medicine ◽  
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 (&gt;3) in the desmopressin group (P &lt; 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 (&gt;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.

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

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.

Nebulized morphine for analgesia in an emergency setting

2018 ◽  
Vol 5 (1) ◽  
pp. 23 ◽  
Author(s):  
Vincent Bounes, MD ◽  
Jean Louis Ducassé, MD ◽  
Annie Momo Bona, MD ◽  
Florent Battefort, MD ◽  
Charles-Henri Houze-Cerfon, MD ◽  
...  
Keyword(s):  
Pain Relief ◽  
Acute Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Statistical Significance ◽  
A Priori ◽  
Primary Outcome Measure ◽  
Point Estimate ◽  
Emergency Setting ◽  
Significant Difference

Objective: To evaluate the efficacy and safety of inhaled morphine delivered in patients experiencing severe acute pain in an emergency setting.Patients and Methods: Patients were eligible for inclusion if they were aged 18 years or older, with a severe acute pain defined by a numerical rating scale (NRS) score of 60/100 or higher. The intervention involved administering a single dose of 0.2 mg/kg morphine nebulized using a Misty-Neb nebulizer system. NRSs were recorded and were repeated at 1, 3, 5, and 10 minute after the end of inhalation (T10). The protocol-defined primary outcome measure was pain relief (defined by an NRS score of 30/100 or lower) at T10. Secondary outcomes included differences between pain scores at baseline and at T10 and incidence of adverse events.Results: A total of 28 patients were included in this study. No patient experienced pain relief 10 minutes after the end of inhalation, and no adverse effects were recorded. Respective initial and final median NRS scores were 80 (70-90) and 70 (60-80), p < 0.0001. Despite achieving statistical significance, the value of this point estimate is less than the 14 NRS difference that was defined a priori as representing a minimum clinically significant difference in pain severity.Conclusion: 0.2 mg/kg nebulized morphine is not effective in managing acute pain in an emergency setting. In spite of the potential advantages of the pulmonary route of administration, opioids should be intravenous prescribed at short fixed intervals to control severe acute pain in an emergency setting.

scholarly journals Pain Relief due to Transsacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study

Pain Medicine ◽  
2015 ◽  
Vol 16 (7) ◽  
pp. 1278-1281 ◽  
Author(s):  
Osman Hakan Gunduz ◽  
Savas Sencan ◽  
Ozge Kenis-Coskun
Keyword(s):  
Pilot Study ◽  
Pain Relief ◽  
Ganglion Impar Block ◽  
Ganglion Impar
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