scholarly journals Medical cannabis for the treatment of fibromyalgia syndrome: a retrospective, open-label case series

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Manuela Mazza
Keyword(s):  
Side Effects ◽  
Conventional Therapy ◽  
Fibromyalgia Syndrome ◽  
Rating Scale ◽  
Case Series ◽  
Depression Scale ◽  
Pain Clinic ◽  
Medical Cannabis ◽  
Paired Data ◽  
Oil Extract

Abstract Background The use of cannabis for treating fibromyalgia syndrome (FMS) has not been comprehensively investigated. Thus, we have assessed the efficacy and adverse events (AEs) of short- and long-term medical cannabis (MC) treatment for FMS. Methods Data were obtained from medical reports archived in the pain clinic of Ponderano (Italy; retrospective study). FMS patients, who were resistant to conventional therapy, received licensed MC with various Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) content, as powdered whole flowers (decoction or vaporization) or oil extracts. Demographic and clinical parameters, including Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scale, Widespread Pain Index (WPI), Severity Score (SyS), and side effects, were obtained after 1, 3, and 12 months. Data were analyzed with Wilcoxon signed-rank tests for paired data. Results Thirty-eight patients were included. Thirty, 18, and 12 patients continued therapy for 1, 3, and 12 months, respectively. Significant improvements (p < 0.01) were observed in NRS, ODI, WPI, and SyS at 1 month; in NRS, ODI, and WPI at 3 months; and in NRS, ODI, and SyS at 12 months. Therapy was interrupted by 17 patients (48.6%) owing to nonserious AEs according to the FDA. The most common side effects were mental confusion (37%), dizziness (14%), nausea/vomiting (14%), and restlessness/irritation (14%). The median daily dose of milled flowers administered as THC-dominant MC and hybrid MC (with similar THC/CBD ratio) was 200 mg/day and 400 mg/day, respectively. After 3 months of titration, the median content of THC administered with THC-dominant MC cultivars was 46.2 mg, and of THC + CBD administered as a hybrid MC cultivar, was 23.6 mg + 38 mg. At 3 months, median THC content administered in the oil extract of the THC-dominant MC cultivars was 9.7 mg, while that of THC + CBD administered in the oil extract of the hybrid MC cultivars was 1.8 mg + 2 mg. Conclusions MC may represent an alternative treatment for patients with FMS who are unresponsive to conventional therapy. However, its application may be limited by the incidence of nonserious AEs.

scholarly journals The Effect of the Treatment at a Pain Clinic on the Patients’ Assessment of Their Pain Intensity and the Incidence of Mental Disorders in the form of Anxiety, Depression, and Aggression

2019 ◽  
Vol 16 (4) ◽  
pp. 586
Author(s):  
Dariusz Kosson ◽  
Marcin Kołacz ◽  
Robert Gałązkowski ◽  
Patryk Rzońca ◽  
Barbara Lisowska
Keyword(s):  
Mental Disorders ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Depression Scale ◽  
Emotional Disturbances ◽  
Pain Clinic ◽  
Pain Clinics ◽  
Pain Symptoms ◽  
Anxiety Depression

The aim of the study was to analyze the effect of the treatment given to patients in a pain clinic on their assessment of pain intensity and the incidence of emotional disturbances in the form of anxiety, depression, and aggression. The study was conducted from January 2014 to April 2018 among patients under the care of two Warsaw pain clinics. The study tools were the Hospital Anxiety and Depression Scale—Modified Version (HADS-M) and the Numerical Rating Scale (NRS). The project enrolled 325 patients, with women comprising 60.62% of patients, and the age bracked of 65–79 years comprising 39.38% of patient. The major reasons for attending the pain clinic were osteoarticular pain (44.92%) and neuropathic pain (42.77%). The therapy applied lowered the patients’ pain intensity (4.98 vs. 3.83), anxiety (8.71 vs. 8.12), aggression (3.30 vs. 3.08), and the overall HADS-M score (18.93 vs. 17.90), which shows that the treatment of both the pain symptoms and the associated emotional disturbances in the form of anxiety and aggression was effective. Sex is a factor affecting pain intensity. The level of mental disorders was influenced by the sex and age of the patients and how long they had been treated in the pain clinics.

scholarly journals Pain Outcomes after Platelet-Rich Plasma Application in Chronic Tibialis Anterior Pain: A Retrospective Case Series Analysis

2020 ◽  
pp. 9-13
Author(s):  
Calvin Rong Chen
Keyword(s):  
Regenerative Medicine ◽  
Adverse Effects ◽  
Pain Score ◽  
Tibialis Anterior ◽  
Rating Scale ◽  
Platelet Rich Plasma ◽  
Case Series ◽  
Small Sample ◽  
Pain Clinic ◽  
Control Group

Background: Platelet-rich plasma (PRP) has become a main component of regenerative medicine. It is used in various musculoskeletal tendinous and skeletal injuries, however, literature regarding PRP’s use in chronic anterior ankle pain is limited. Objectives: To determine the effectiveness of PRP in treating tibialis anterior (TA) tendon pain in patients who have failed traditional conventional therapeutic treatments. Study Design: Retrospective chart review. Setting: Outpatient interventional pain clinic at an academic center. Methods: Adults (n = 10), aged 18 and older, with greater than 6 months of TA tendon pain who failed conservative therapies. Patients who had undergone previous regenerative injections were excluded. PRP injection was administered with ultrasound guidance. Change in pain score was assessed using the Numeric Rating Scale (NRS-11: 0 = no pain, 10 = excruciating pain), and patient’s self-reported reduction in pain (percentage), pre- and postprocedure. There was a reduction in opioid dosage postprocedure. Adverse effects were recorded. Results: Average pain score at baseline was 8 ± 1.5 on the NRS-11 scale. The average percent change in pain between baseline and 8 weeks posttreatment was a 36% ± 23.2% reduction in pain. This was a significant reduction in pain score at 8 weeks post-PRP treatment when compared with baseline, P = 0.008. Average reduction in opioid dose between baseline and 8 weeks posttreatment was 17% ± 21.2%, P = 0.063. No patients experienced adverse effects. Limitations: Small sample size, and no doubleblind randomization with control group. Conclusions: PRP use in chronic TA pain 8 weeks post-PRP treatment significantly improved chronic TA pain. There is also a tendency toward lower opioid pain medication dosages after 8 weeks post-PRP treatment, although this was not statistically significant. Key words: Platelet-rich plasma, regenerative medicine, pain, ultrasound

A Comparative Trial of Depot Pipothiazine

1986 ◽  
Vol 14 (2) ◽  
pp. 72-77 ◽  
Author(s):  
J Steinert ◽  
A Neder ◽  
E Erba ◽  
C R Pugh ◽  
C Robinson ◽  
...  
Keyword(s):  
Side Effects ◽  
Rating Scales ◽  
Rating Scale ◽  
Statistical Significance ◽  
Depression Scale ◽  
Psychotic Symptoms ◽  
Biochemical Tests ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Flupenthixol Decanoate

Thirty-nine chronic schizophrenic patients were selected for a 12-month double-blind evaluation of the effectiveness of pipothiazine palmitate (PPT) and flupenthixol decanoate (FPX) in the maintenance management of their illness. Allocation was at random and, in order to allow constant injection intervals, the patients typically received every 2 weeks either 40 mg of flupenthixol decanoate or alternating injections of 100 mg of pipothiazine palmitate and placebo. At monthly intervals the patients were assessed using both a battery of rating scales (which included the Brief Psychiatric Rating Scale (BPRS), the Extrapyramidal Symptoms Rating Scale (EPS)) and a general side-effects evaluation. At 3-monthly intervals they were also rated on the Comprehensive Psychiatric Rating Scale (CPRS) and the Zung Depression Scale. Haematological and biochemical tests were performed every 3 months. Both drugs provided good control of psychotic symptoms and side-effects were not troublesome. No substantial difference was detected on the CPRS and the Zung scales. There was a trend in favour of PPT on the BPRS survey, detectable at 6 months and reaching statistical significance by 12 months. We conclude that the PPT regime is at least as effective as the FPX treatment and probably more so. It is possible that even longer periods of control could be obtained with PPT.

scholarly journals The effectiveness of sphenopalatine ganglion blockade in chronic migraine resistant to medical treatment

2021 ◽  
Vol 26 (4) ◽  
pp. 737-741
Author(s):  
Nermin Tepe ◽  
Oktay Faysal Tertemiz
Keyword(s):  
Side Effects ◽  
Medical Treatment ◽  
Chronic Migraine ◽  
Alternative Treatment ◽  
Conventional Therapy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Sphenopalatine Ganglion ◽  
Treatment Methods ◽  
Numerical Rating

Objective: To assess the effectiveness of sphenopalatine ganglion blockade (SPGB) as an alternative treatment for patients with chronic migraine resistant to medical treatment. Methods: In total, 23 patients with chronic migraine resistant to medical treatment underwent 4 sessions of bilateral transnasal SPGB bi-weekly, and the monthly number of headache days, duration, and numerical rating scale (NRS) response results were recorded. Results: Compared with before SPGB, the frequency of migraine attacks per month (23.66 ± 9.8 vs. 10.5 ± 11.9 days), duration of headaches (31.3 ± 16.8 vs. 18.4 ± 9.8 h), and NRS score (9 ± 0.99 vs. 5.1 ± 2.1) all improved significantly (p < 0.05) eight weeks after intervention. Conclusion: Transnasal SPGB is an alternative to conventional therapy because it benefits patients with chronic migraine resistant to medical treatment, is easy to administer, and has few side effects.

scholarly journals Simplicity Radiofrequency Ablation Demonstrates Greater Functional Improvement Than Analgesia: A Prospective Case Series

2021 ◽  
pp. E185-E190
Keyword(s):  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Pain Clinic ◽  
Functional Improvement ◽  
Data Points ◽  
Prospective Case Series

BACKGROUND: Pain originating from the posterior sacroiliac complex is notoriously difficult to effectively treat due to its complex anatomy and variable innervation. Data on radiofrequency ablation (RFA) is limited. The Abbott Simplicity probe creates 3 monopolar lesions along the medial aspect of the sacroiliac joint and 2 bipolar lesions between the active portions of the probe. This device has been studied previously with improvement of pain-associated disability and pain reduction, but insufficient data is present to determine its utility at this time. Using the most recent literature for the potential innervation of the posterior sacroiliac joint, it is reasonable to explore this novel device and its ability to treat sacroiliac joint pain. OBJECTIVES: Identify the percentage of improved posterior sacroiliac complex pain and improved function in patients who completed posterior sacroiliac complex radiofrequency ablation using the Simplicity probe. STUDY DESIGN: Prospective case series. SETTING: A single outpatient pain clinic. METHODS: This prospective case-series occurred at an outpatient pain clinic. Data were analyzed after completion of follow-up appointments. Inclusion criteria included 2 successful lateral branch blocks. Fourteen patients with posterior sacroiliac complex pain were examined and completed sacroiliac ablation with the Simplicity probe. The numeric rating scale and the Modified Oswestry Disability Index were used as outcome measures for pain and function, respectively. The primary outcome measures were improvement in the numeric rating scale score by a reduction of 2.5 points and an improvement in Modified Oswestry Disability Index by 15% based upon previous studies demonstrating these values as the minimal clinical important difference . Patients were followed at a 3 to 6 month interval and 12 month interval (an average of 88 and 352 days, respectively). RESULTS: In total, 14 patients were examined. At the first follow-up, 29% of patients had analgesia and 38% functionally improved. At the second follow-up, 15% of patients had analgesia and 31% functionally improved. LIMITATIONS: Considering data were collected retrospectively, this study relied on completed charts. Therefore, data points of interest were limited to what was previously documented, which included multiple answers or the absence of numerical data points. In addition, patients were disproportionately female (71.4%). Data were also affected by patients lost to follow-up. Also, this study examined a relatively small number of patients, therefore the results should be carefully considered. CONCLUSIONS: Radiofrequency ablation of the posterior sacroiliac complex with the Simplicity probe resulted in more functional improvement than analgesia. This study provides more data for clinicians to utilize in managing posterior sacroiliac complex pain. IRB: Protocol number 20170342HU. Not registered in clinical trials. KEY WORDS: Posterior sacroiliac complex, sacroiliac pain, chronic low back pain, radiofrequency denervation, functional improvement, strip lesion, multi-lesion, Simplicity probe

scholarly journals Single Arm Prospective Multicenter Case Series on the Use of Burst Stimulation to Improve Pain and Motor Symptoms in Parkinson’s Disease

2020 ◽  
Author(s):  
Krishnan V. Chakravarthy ◽  
Rahul Chaturvedi ◽  
Takashi Agari ◽  
Hirokazu Iwamuro ◽  
Rajiv Reddy ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Mood State ◽  
Case Series ◽  
Depression Scale ◽  
Motor Symptoms ◽  
Timed Up And Go ◽  
Disease Rating ◽  
Vas Scores

Abstract Background: In this study we analyze new clinical data in the use of spinal cord stimulation (SCS) for the treatment of pain and motor symptoms in patients with Parkinson’s Disease (PD), as both a singular bioelectric therapy and as a salvage therapy after deep brain stimulation (DBS).Methods: 15 patients were recruited and had percutaneous electrodes implanted at the level of the thoracic or cervical spine. Participants were set to one of three stimulation modes: continuous tonic stimulation, continuous Burst DR stimulation (40Hz, 500Hz, 1000μs), or cycle mode (on time of 10-15 sec, off time of 15-30 sec) with Burst DR (40Hz, 500Hz, 1000μs). Patients completed the Visual Analogue Scale (VAS), Unified Parkinson’s Disease Rating Scale, Self-Rating Depression Scale, Hamilton Depression Rating Scale, Profile of Mood State, 10-meter walking test, and the Timed Up and Go (TUG).Results: All patients experienced significant improvement in VAS scores. 73% of patients experienced improvement in the 10-meter walk, with a mean improvement of 12%. 82% of patients experienced improvements in the TUG, with a mean improvement of 15%.Conclusions: This study points to the utility of SCS to address both pain and motor symptoms in PD patients who have and have not received DBS therapy.

scholarly journals Single arm prospective multicenter case series on the use of burst stimulation to improve pain and motor symptoms in Parkinson’s disease

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Krishnan V. Chakravarthy ◽  
Rahul Chaturvedi ◽  
Takashi Agari ◽  
Hirokazu Iwamuro ◽  
Rajiv Reddy ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Case Series ◽  
Depression Scale ◽  
Motor Symptoms ◽  
Burst Stimulation ◽  
Average Improvement ◽  
Vas Scores ◽  
40 Hz

Abstract Background In this study we analyze new clinical data in the use of spinal cord stimulation (SCS) for the treatment of pain and motor symptoms in patients with Parkinson’s Disease (PD), as both a singular bioelectric therapy and as a salvage therapy after deep brain stimulation (DBS). Methods Fifteen patients were recruited and had percutaneous electrodes implanted at the level of the thoracic or cervical spine. Participants were set to one of three stimulation modes: continuous tonic stimulation, continuous Burst stimulation (40 Hz, 500 Hz, 1000 μs), or cycle mode (on time of 10–15 s, off time of 15–30 s) with Burst (40 Hz, 500 Hz, 1000 μs). Patients completed the Visual Analogue Scale (VAS), Unified Parkinson’s Disease Rating Scale, Self-Rating Depression Scale, Hamilton Depression Rating Scale, Profile of Mood State, 10-meter walking test, and the Timed Up and Go (TUG). Results All patients experienced significant improvement in VAS scores with a mean reduction of 59% across all patients. Patients who chose the cycling burst stimulation parameter had an average 67% reduction in VAS scores, as compared to the continuous burst parameter group, which had an average 48% reduction in VAS scores. Seventy-three percent of patients experienced improvement in the 10-meter walk, with an average improvement of 12%. Sixty-four percent of patients experienced clinically relevant improvements in the TUG, with an average improvement of 21%. Conclusions This study points to the potential utility of SCS to address both pain and certain aspects of motor symptoms in PD patients who have and have not received DBS therapy.

Efficacy of Erenumab in the Treatment of Trigeminal Neuralgia: A Retrospective Case Series

2021 ◽  
pp. 10.1212/CPJ.0000000000001075
Author(s):  
Eliot Parascandolo ◽  
Kelsey Levinson ◽  
Paul Rizzoli ◽  
Roni Sharon
Keyword(s):  
Monoclonal Antibody ◽  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Rating Scale ◽  
Antibody Therapy ◽  
Case Series ◽  
Primary Objective ◽  
Retrospective Case ◽  
Refractory Pain ◽  
Reduced Frequency

AbstractBackground:Trigeminal neuralgia is a chronic, often refractory, pain condition which adversely impacts the lives of patients. Current treatments are only mildly effective. Anti-CGRP monoclonal antibodies have been successfully studied in the treatment of migraines. CGRP plays a role in both trigeminal neuralgia (TN) and migraine. It is prudent to attempt CGRP monoclonal antibody therapy in TN. Erenumab, a human Anti-CGRP monoclonal antibody medication, modulates CGRP, which is elevated in TN patients. The primary objective of this study was to evaluate the efficacy of erenumab for patients with TN.Methods:Retrospective analysis was performed on data collected from 10 patients diagnosed with TN and treated with erenumab for 6 months. Pain was tracked using a numeric pain rating scale (NPRS) from 0 to 10. The effect of erenumab on NPRS after 6 months’ time was the primary endpoint. Secondary endpoints included side effects to therapy, improvement in headache frequency in those with comorbid migraine, evaluating mood following therapy, and global mood improvement using scale (worse, no change, improved).Results:Nine out of ten patients (90.0%) reported improvement in pain severity and in global mood improvement. Three patients reported resolution of anxiety, and/or depression. Side effects were minimal with three patients reporting constipation, injection site reactions or both.Conclusions:Based on these results, erenumab appears to be an efficacious treatment option for patients with refractory trigeminal neuralgia. Patients experienced improvement in pain, reduced frequency of headache, and improvement in mood. Treatment was well tolerated with only mild side effects reported.Classification of Evidence:This study provides class IV evidence that Erenumab increase the probability of improved pain control in patients with medication resistant trigeminal neuralgia.

scholarly journals Single Arm Prospective Multicenter Case Series on the Use of Burst Stimulation to Improve Pain and Motor Symptoms in Parkinson’s Disease

2020 ◽  
Author(s):  
Krishnan V. Chakravarthy ◽  
Rahul Chaturvedi ◽  
Takashi Agari ◽  
Hirokazu Iwamuro ◽  
Rajiv Reddy ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Mood State ◽  
Case Series ◽  
Depression Scale ◽  
Motor Symptoms ◽  
Timed Up And Go ◽  
Disease Rating ◽  
Vas Scores

Abstract Background: In this study we analyze new clinical data in the use of spinal cord stimulation (SCS) for the treatment of pain and motor symptoms in patients with Parkinson’s Disease (PD), as both a singular bioelectric therapy and as a salvage therapy after deep brain stimulation (DBS). Methods: 15 patients were recruited and had percutaneous electrodes implanted at the level of the thoracic or cervical spine. Participants were set to one of three stimulation modes: continuous tonic stimulation, continuous Burst DR stimulation (40Hz, 500Hz, 1000μs), or cycle mode (on time of 10-15 sec, off time of 15-30 sec) with Burst DR (40Hz, 500Hz, 1000μs). Patients completed the Visual Analogue Scale (VAS), Unified Parkinson’s Disease Rating Scale, Self-Rating Depression Scale, Hamilton Depression Rating Scale, Profile of Mood State, 10-meter walking test, and the Timed Up and Go (TUG). Results: All patients experienced significant improvement in VAS scores. 73% of patients experienced improvement in the 10-meter walk, with a mean improvement of 12%. 82% of patients experienced improvements in the TUG, with a mean improvement of 15%. Conclusions: This study points to the utility of SCS to address both pain and motor symptoms in PD patients who have and have not received DBS therapy.

A Comparison of the Therapeutic and Cardiovascular Effects of a Single Nightly Dose of Prothiaden (Dothiepin, Dosulepin) and Lentizol (Sustained-Release Amitriptyline) in Depressed Elderly Patients

1981 ◽  
Vol 9 (2) ◽  
pp. 108-112 ◽  
Author(s):  
A U Khan
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Sustained Release ◽  
Rating Scale ◽  
Depression Scale ◽  
Comparative Trial ◽  
Check List ◽  
Night Time ◽  
Self Rating ◽  
Symptom Check List

This was a single-blind 4-week parallel group comparative trial in fifty depressed patients. Twenty-five patients received 50 mg of Lentizol, a sustained-release form of amitriptyline, and twenty-five received 75 mg of Prothiaden. Both groups took their drugs as a single night-time dose. Patient response was measured on a symptom check-list which was completed by the doctor and a self-rating depression scale. Tolerance was assessed by recording volunteered and observed side-effects and also by taking the pulse, blood pressure and an electrocardiogram before treatment and after 2 and 4 weeks. A statistically better response was seen with Prothiaden at each follow-up assessment (1, 2 and 4 weeks) compared to Lentizol as measured by both the symptom check-list and the self-rating scale. Less side-effects were also seen with Prothiaden. Minor changes were seen in the ECG records of two patients on Prothiaden and three on Lentizol. These changes were not associated with any clinical change in the patients' cardiovascular state. No consistent changes of any clinical significance were seen in the pulse and blood pressure recordings.

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