Factors affecting the results of analgesic therapy. Results of the Russian multicentre study of NOTE (NSAID: Open-label Trial of Efficacy)

Non-steroidal anti-inflammatory drugs (NSAIDs) are most popular medications for the treatment of pain in common musculoskeletal diseases such as osteoarthritis (OA) and non-specific low back pain (LBP). However, the factors affecting the effectiveness of these drugs have not been determined fully. Aim: to identify factors affecting the effectiveness of NSAIDs in patients with OA and LBP. Materials and methods. An observational study was conducted to evaluate the effectiveness of a 2-week course of NSAIDs in OA and LBP in real clinical practice. The study group consisted of 3604 patients with OA and LBP (60.6% women and 39.4% men, mean age 55.0±13.4 years). According to the study design, aceclofenac (Airtal) and other NSAIDs used in the ratio 1:1. The main criterion of effectiveness was the frequency of complete pain relief after 2 weeks of therapy. In addition, the decrease of pain and general health were determined on a 10-point numerical rating scale (NRS). We compared the frequency of complete pain relief in patients who had and did not have the studied factors. The value of the studied factors was determined using OR (95% CI). Results and discussion. Most patients received aceclofenac (54.9%), as well as diclofenac (2.0%), ketoprofen (1.9%), lornoxicam (2.2%), meloxicam (13.7%), naproxen (2.1%), nimesulide (5.8%), celecoxib (5.9%), ethicoxib (7.1%) and other NSAIDs (4.4%); 56.2% of patients received muscle relaxants, mainly tolperisone (74.7%), vitamin B (10.4%), and proton pump inhibitors (42.8%). Complete pain relief was achieved in 54.8% of patients. The pain decrease and general health improvement were (for NRS) 63.9±13.4% and 61.7±14.8%, respectively. The efficacy of aceclofenac was slightly higher than in the whole group: complete pain relief was in 59.9% of patients. Adverse events in aceclofenac use were observed in 2.3% of patients, other NSAIDs-from 2.4 to 14.1%. The frequency of complete pain relief was higher in men: OR 1,239 (95% CI 1.08-1.418; p=0.002), who had the first episode of pain - OR 3.341 (95% CI 2.873-3.875; p=0.000), a good" response " to NSAIDs in history - OR 1.656 (95% CI 1.385-1.980; p=0.000) and received NSAIDs in combination with muscle relaxants - OR 1.218 (95% CI 1.067-1.390; p=0.004). The effect of therapy is lower in patients 65 years and older-OR 0,378 (95% CI 0.324-0.442; p=0,000), with body mass index >30 kg/m² - OR 0.619 (95% CI 0.529-0.723; p=0.000), with severe pain (≥7 points NRS) - OR 0.662 (95% CI 0.580-0.756; p=0.002), with pain at rest, - OR 0.515 (95% CI 0.450-0,589; p=0.000), pain at night - OR 0.581 (95% CI 0.501-0.672; p=0.000) and the presence of stiffness - OR 0.501 (95% CI 0.438-0,573; p=0.000). Treatment results are significantly worse in the cases of combination of LBP and joint pain, as well as pain in the trochanter major and pes anserinus area (p

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Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

Journal of Research in Clinical Medicine ◽

10.34172/jrcm.2020.021 ◽

2020 ◽

Vol 8 (1) ◽

pp. 21-21

Author(s):

Mani Mofidi ◽

Ali Dashti ◽

Mahdi Rezai ◽

Niloufar Ghodrati ◽

Hoorolnesa Ameli ◽

...

Keyword(s):

Pain Management ◽

Pain Relief ◽

Musculoskeletal Pain ◽

Normal Saline ◽

Rating Scale ◽

Numerical Rating Scale ◽

Vital Signs ◽

Categorical Variables ◽

Intravenous Morphine ◽

Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

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Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial

Pain Research and Management ◽

10.1155/2020/5853412 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Mohammad Jafar Eghbal ◽

Ali Haeri ◽

Arash Shahravan ◽

Ali Kazemi ◽

Fariborz Moazami ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Root Canal ◽

Rating Scale ◽

Numerical Rating Scale ◽

Controlled Trial ◽

Mineral Trioxide Aggregate ◽

Preoperative Pain ◽

Multicenter Randomized Controlled Trial ◽

The Mean

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative “Pain Intensity” (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients’ demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P<0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

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Tailoring of neurosurgical ablative procedures in the management of refractory cancer pain

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101566 ◽

2020 ◽

Vol 45 (9) ◽

pp. 696-701

Author(s):

Uri Hochberg ◽

Asaf Berger ◽

Miri Atias ◽

Rotem Tellem ◽

Ido Strauss

Keyword(s):

Pain Relief ◽

Cancer Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Treatment Plan ◽

Metastatic Cancer ◽

Spinothalamic Tract ◽

Pain Syndromes ◽

Intractable Cancer Pain ◽

Ablative Procedures

IntroductionNeurosurgical ablative procedures can offer immediate and effective pain relief for patients suffering from refractory cancer pain. However, choosing the appropriate procedure for each patient may not be straightforward and warrants an interdisciplinary approach. The purpose of the current study was to evaluate the outcome of patients with cancer who were carefully selected for neurosurgical intervention by a dedicated interdisciplinary team composed of a palliative physician and nurse practitioner, a pain specialist and a neurosurgeon.MethodsA retrospective review was carried out on all patients who underwent neurosurgical ablative procedures in our institute between March 2015 and September 2019. All patients had advanced metastatic cancer with unfavorable prognosis and suffered from intractable oncological pain. Each treatment plan was devised to address the patients’ specific pain syndromes.ResultsA total of 204 patients were examined by our service during the study period. Sixty-four patients with localized pain and nineteen patients with diffuse pain syndromes were selected for neurosurgical interventions, either targeted disconnection of the spinothalamic tract or stereotactic cingulotomy. Substantial pain relief was reported by both groups immediately (cordotomy: Numerical Rating Scale (NRS) 9 ≥1, p=0.001, cingulotomy: NRS 9 ≥2, p=0.001) and maintained along the next 3-month follow-up visits.ConclusionsAn interdisciplinary collaboration designated to provide neurosurgical ablative procedures among carefully selected patients could culminate in substantial relief of intractable cancer pain.Trial registration numberIR0354-17.

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Nebulized morphine for analgesia in an emergency setting

Journal of Opioid Management ◽

10.5055/jom.2009.0003 ◽

2018 ◽

Vol 5 (1) ◽

pp. 23 ◽

Cited By ~ 4

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.

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Remifentanil versus combined spinal-epidural technique for labour analgesia in multiparous women: a prospective non-randomized trial

10.21203/rs.2.21366/v2 ◽

2020 ◽

Author(s):

Tatjana Stopar Pintaric ◽

Tea Zagar ◽

Neli Semrl ◽

Nejc Umek ◽

Miha Lucovnik ◽

...

Keyword(s):

Pain Relief ◽

Randomized Trial ◽

Rating Scale ◽

Numerical Rating Scale ◽

Personal Control ◽

Labour Analgesia ◽

High Rate ◽

Combined Spinal Epidural ◽

Multiparous Women ◽

Spinal Epidural

Abstract Background : Remifentanil has a suitable pharmacological profile for labour analgesia. Fast set up, onset, and limited time efficacy may render it useful in multiparas with a faster labour progression. The objective of this prospective, non-randomized trial was to compare the pain relief for vaginal delivery between remifentanil patient-controlled analgesia (RPCA) with that of combined spinal-epidural analgesia (CSEA) in multiparas. Methods : After making an informed choice of either RPCA or CSEA, 162 multiparous women in the active phase of first-stage labour were enrolled in this study. The primary outcome was pain intensity measured during the whole period of labour using an 11-point numerical rating scale. The secondary outcomes were satisfaction with pain-relief, adverse effects, labour progress and outcomes. Results : CSEA provided lower pain scores and a higher satisfaction rate than RPCA [3.9 (0.36) vs 2.6 (1.1), P <0.001]. Also, more patients opted for the CSEA for their next labour [CSEA; 77 (95%) vs. RPCA; 65 (81%), P =0.003]. However, more than 80% of women in the RPCA group graded their satisfaction as good and very good with a high rate of recommendation and no crossovers observed. Remifentanil was associated with desaturation, bradypnea and apnoea in 27 (34%), 17 (21%) and 20 (25%) respective cases. All recovered spontaneously upon verbal or tactile stimulation. No clinically important differences were noted in sedation level, labour progress and outcomes. Conclusions : CSEA provided superior pain relief compared to RPCA in multiparas. Despite that, remifentanil was highly rated, with a high rate of recommendation and no crossovers to CSEA. That can be attributed to the fact that women with previewed shorter labour were more likely to choose a less invasive analgesic option which provided an element of personal control. Thus, given no difference in labour outcomes, remifentanil could be offered as a routine analgesic option provided rigorous adherence to the necessary protocols are ensured. The presence of a midwife is essential for timely management of respiratory depression or other severe outcomes.

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Assessing Pain in a Noninvasive Manner by Measuring Changes in the Microcirculation

10.1101/2020.12.28.424536 ◽

2020 ◽

Author(s):

Dana Shainshein ◽

Louis Shenkman ◽

Ahmed Khashan ◽

Meir Bennun ◽

Ilya Fine

Keyword(s):

Pain Relief ◽

Rating Scale ◽

Chronic Back Pain ◽

Numerical Rating Scale ◽

Epidural Injection ◽

Skin Surface ◽

Medical Intervention ◽

Hemodynamic Parameters ◽

Non Invasive ◽

Before And After

ABSTRACTThe quantitative determination of the level of pain is one of the most challenging clinical problems. This article proposes a method for quantitative assessment of both acute and chronic levels of pain, based on the analysis of hemodynamic patterns measured using a non-invasive sensor. Hemodynamic characteristics were taken from the finger using a sensor measuring the dynamic scattering of light from the skin surface. Changes in hemodynamic parameters in patients with chronic pain were studied. One group of patients with chronic back pain required epidural injection for pain relief. The second group of patients had a Spinal Cord Stimulator implant which was switched off one hour before arriving at the clinic. Optical signals were collected before and after pain relief, either by epidural injection or by turning on the stimulator. Both groups reported their pain level using a standard numerical rating scale. Processing of the results showed that the changes in measured hemodynamic parameters corresponded in most cases to the changes in pain reported by patients following medical intervention. The results suggest that this new non-invasive measurement of pain can be used both for physiological studies and for monitoring various categories of patients suffering from pain.

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Intravenous Butorphanol, Meperidine, and Their Combination Relieve Pain and Distress in Women in Labor

Anesthesiology ◽

10.1097/00000542-200505000-00021 ◽

2005 ◽

Vol 102 (5) ◽

pp. 1008-1013 ◽

Cited By ~ 28

Author(s):

Kenneth E. Nelson ◽

James C. Eisenach

Keyword(s):

Pain Relief ◽

Pain Intensity ◽

Drug Administration ◽

Rating Scale ◽

Numerical Rating Scale ◽

Therapeutic Benefit ◽

Kappa Opioid Receptor ◽

Numerical Rating ◽

Effective Pain Relief ◽

Descriptive Scale

Background Systemic opioids are commonly administered during labor, but their efficacy has been recently questioned. In addition, laboratory and clinical studies provide a strong rationale for combining mu- and kappa-opioid receptor agonists for analgesia. The authors therefore studied, using validated intensity and affective scales and definitions of effective pain relief, the efficacy of intravenous meperidine, butorphanol, and their combination for labor analgesia. Methods Healthy women with singleton term pregnancy requesting analgesia during active labor were studied. Women were randomly assigned to receive 50 mg meperidine, 1 mg butorphanol, or 25 mg meperidine plus 0.5 mg butorphanol (n = 15/group). Pain intensity was assessed using a 0-10 numerical rating scale, and affective magnitude was assessed using a ratiometric descriptive scale before drug administration and between the sixth and seventh uterine contractions after drug administration. Results All three treatments reduced pain intensity equally. Butorphanol alone did not reduce pain affective magnitude, whereas the other treatments did. There was a significant correlation between reduction in pain intensity and affective magnitude in all groups, with greater reductions in affective magnitude than intensity. Overall, 29% of women exhibited clinically meaningful pain relief, with no difference among groups. Groups did not differ in incidence of opioid-induced adverse effects. Conclusions These doses of meperidine and butorphanol do reduce pain intensity and affective magnitude, although a minority of patients achieve meaningful pain relief as defined in multiple patient populations, including laboring women. Combination of these drugs did not improve their therapeutic benefit.

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Endogenous anandamide and self-reported pain are significantly reduced after a 2-week multimodal treatment with and without radon therapy in patients with knee osteoarthritis: a pilot study

International Journal of Biometeorology ◽

10.1007/s00484-021-02095-z ◽

2021 ◽

Author(s):

M. Gaisberger ◽

J. Fuchs ◽

M. Riedl ◽

S. Edtinger ◽

R. Reischl ◽

...

Keyword(s):

Pilot Study ◽

Knee Osteoarthritis ◽

Plasma Levels ◽

Rating Scale ◽

Musculoskeletal Diseases ◽

Numerical Rating Scale ◽

Treatment Options ◽

Endocannabinoid System ◽

Serum Levels ◽

Spa Therapy

AbstractMultimodal therapies comprising spa applications are widely used as non-pharmaceutical treatment options for musculoskeletal diseases. The purpose of this randomized, controlled, open pilot study was to elucidate the involvement of the endocannabinoid system in a multimodal therapy approach. Twenty-five elderly patients with knee osteoarthritis (OA) received a 2-week spa therapy with or without combination of low-dose radon therapy in the Bad Gastein radon gallery. A 10-point numerical rating scale (pain in motion and at rest), WOMAC questionnaire, and the EuroQol-5D (EQ-5D) questionnaire were recorded at baseline, and during treatment period at weeks one and two, and at 3-month and 6-month follow-ups. Plasma levels of the endocannabinoid anandamide (AEA) were determined at baseline and at 2 weeks, and serum levels of several cartilage metabolism markers at all five time-points. A significant and sustained reduction of self-reported knee pain was observed in the study population, but no further significant effect of the additional radon therapy up and above base therapy. This pain reduction was accompanied by a significant reduction of AEA plasma levels during treatment in both groups. No significant differences were seen in serum marker concentrations between the groups treated with or without radon, but a small reduction of serum cartilage degradation markers was observed during treatment in both groups. This is the first study investigating AEA levels in the context of a non-pharmacological OA treatment. Since the endocannabinoid system represents a potential target for the development of new therapeutics, further studies will have to elucidate its involvement in OA pain.

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Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional Paresthesia Based Waveforms: A Pilot Study

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113089 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Amnon A. Berger ◽

Ivan Urits ◽

Jamal Hasoon ◽

Jatinder Gill ◽

Musa Aner ◽

...

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Pain Control ◽

Rating Scale ◽

Pulse Generator ◽

Numerical Rating Scale ◽

Failed Back Surgery

Background: Chronic back and neck pain affects 20% of Americans. Spinal cord stimulation (SCS) is an effective therapy for otherwise refractory chronic pain. Traditional SCS relies on low-frequency stimulus in the 40 - 60 Hz range causing robust paresthesia in regions overlapping with painful dermatomes. Objectives: This study aims to determine the effect of superimposing sub-perception stimulation in patients who previously had good long-term relief with paresthesia. Methods: This is a prospective observational trial examining patients who had previously been implanted with paresthesia based SCS for failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS). These patients presented for implantable pulse generator (IPG) replacement based on battery depletion with an IPG capable of combined sub-perception and paresthesia based SCS therapy. Patients were assessed immediately following the exchange and four weeks later using a telephone survey. Their pain was assessed on each follow up using a Numerical Rating scale (NRS); the primary outcome was the change in NRS after four weeks from the exchange day. Secondary outcomes included paresthesia changes, which included the subjective quality of sensation generated, the overall subjective coverage of the painful region, subjective variation of coverage with positional changes, and global perception of the percentage improvement in pain. Results: Based on our clinic registry, 30 patients were eligible for IPG exchange, 16 were consented for follow up and underwent an exchange, and 15 were available for follow up four weeks following. The average NRS decreased from 7.47 with traditional SCS to 4.5 with combination therapy. 80% of patients reported an improvement in the quality of paresthesia over traditional SCS therapy, and in most patients, this translated to significantly improved pain control. Conclusions: Our findings suggest improved pain relief in patients who had previously had good results with paresthesia based therapy and subsequently underwent IPG exchange to a device capable of delivering combined sub-perception stimulation. The mechanism of action is unclear though there may be an additive and/or synergistic effect of the two waveforms delivered. Larger studies with long-term follow-up are needed to elucidate the durability of pain relief and the precise mechanism by which combined subperception and paresthesia based SCS may improve overall patient outcomes.

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The Use of L2 and L3 Lumbar Sympathetic Blockade for Cancer-Related Pain, an Experience and Recommendation in the Oncologic Population

Pain Medicine ◽

10.1093/pm/pnz142 ◽

2019 ◽

Vol 21 (1) ◽

pp. 176-184 ◽

Cited By ~ 1

Author(s):

Matthew A Spiegel ◽

Lee Hingula ◽

Grant H Chen ◽

Aron Legler ◽

Vinay Puttanniah ◽

...

Keyword(s):

Pain Relief ◽

Local Anesthetic ◽

Rating Scale ◽

Numerical Rating Scale ◽

Leg Pain ◽

Cancer Center ◽

Future Research ◽

Sympathetic Blockade ◽

Scale Scores ◽

Data Points

Abstract Objective The sympathetic nervous system has a recognized role in transmission of pain, and the lumbar sympathetic blockade is intended to provide analgesia. We share our experiences of lumbar sympathetic blockade in the treatment of cancer-related pain. Methods We performed a retrospective analysis of patients with cancer-related pain in the back, abdomen, pelvis, or legs treated at Memorial Sloan Kettering Cancer Center between 2000 and 2018 undergoing lumbar sympathetic blockade at L2 or L3. Blocks were accomplished by injection of local anesthetic or local anesthetic with steroid under fluoroscopy. We measured numerical rating scale scores, percent relief, and relief time. The primary end point was defined as “effective” or “ineffective” pain relief. Effective pain relief was defined as ≥30% relief for at least one day. Results We identified 124 data points of lumbar sympathetic blockade at L2 or L3, of which 57 were with complete data and used for analysis. Peri-injection, 42 data points had active disease whereas 15 were in remission. Lumbar sympathetic blockade was 67% effective in the back pain cohort, 82% effective in the abdominopelvic pain cohort, and 75% effective in the leg pain cohort. Seventeen data points went on to neurolysis, two to neuromodulation, and eight to intrathecal pump implantation. Conclusions Lumbar sympathetic blockade is effective for back, abdominopelvic, and leg pain related to cancer and its treatments. Future research should be aimed at refining its role within multimodal pain management.

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