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

scholarly journals PLATELET-RICH PLASMA INJECTION THERAPY FOR REFRACTORY COCCYDYNIA: A CASE SERIES

2018 ◽  
pp. 183-188
Author(s):  
Fergie-Ross Montero-Cruz
Keyword(s):  
Pain Relief ◽  
Conservative Management ◽  
Rating Scale ◽  
Platelet Rich Plasma ◽  
Case Series ◽  
Small Sample ◽  
Rapid Weight Loss ◽  
Post Injection ◽  
Retrospective Case ◽  
Retrospective Case Series

Background: Coccydynia is pain in the coccyx region. The most common cause of coccydynia is trauma, either from a direct axial force such as during a fall onto the coccyx or from cumulative trauma as a result of poor sitting mechanics. Risk factors include obesity, female gender and rapid weight loss. The anatomy of the region is not well vascularized, and consists of the coccyx bones, and supporting ligaments and tendons. For a majority of patients, conservative management may be successful but for the remainder of patients, pain relief may only be transient and pain can become debilitating. What has yet to be fully explored is the possible beneficial effect of local injection of platelet-rich plasma (PRP) for the treatment of refractory coccydynia. PRP injections have been successful in treating a variety of chronic tendon, ligament and bone injuries by inducing an inflammatory response to promote or re-initiate healing. In addition, local injections of PRP to the coccyx would be a less invasive option than surgery for patients who have exhausted all other treatment options and continue to struggle with the debilitating effects of coccydynia. Objectives: To demonstrate the important role of PRP therapy in treating coccydynia refractory to traditional conservative management. Study Design: Retrospective case series. Methods: Three patients with coccygeal pain for greater than 6 months who presented to an outpatient pain management office in New York from 2014 until 2016, and failed conventional treatments. When the pain was deemed refractory for the patient, offering for PRP was done. This was presented with the option to repeat once again at the 6-8 week mark if needed. All patients underwent PRP with fluoroscopic injection, and the use of the same PRP commercially available system; Magellan-Arteriocyte. The patients were evaluated with a numerical rating scale, and percentage of pain relief at 6-8 week post-injection, 6 months post-injection, 12 months post-injection, and 24 months post-injection was recorded. Percentage of pain relief was then calculated. Results: Overall the patient series demonstrated significant improvement in numeric pain scale, as well as percentage of pain reduction. At the 6-8 week follow-up for all the post-PRP injections, there was an average of 75% improvement in overall pain. At 6 months, 1 patient had no change, while 2 patients maintained the same reduction in pain at the 12- and 24-month follow-ups. Limitations: This retrospective case series is only a small sample size of pat i e n t s w i t h r e f r a c t o r y c o c c y d y n i a . Conclusions: Here we discuss the first case series of PRP for coccydynia. The results of the 3 patients in this case series are encouraging.

scholarly journals Sublingual Buprenorphine/Naloxone and Multi-Modal Management for High-Risk Chronic Pain Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 973
Author(s):  
Shane Kaski ◽  
Patrick Marshalek ◽  
Jeremy Herschler ◽  
Sijin Wen ◽  
Wanhong Zheng
Keyword(s):  
Chronic Pain ◽  
High Risk ◽  
Pain Score ◽  
Rating Scale ◽  
Pain Treatment ◽  
Pain Clinic ◽  
Sublingual Buprenorphine ◽  
Significant Downward Trend ◽  
Chronic Pain Patients ◽  
Pain Patients

Patients with chronic pain managed with opioid medications are at high risk for opioid overuse or misuse. West Virginia University (WVU) established a High-Risk Pain Clinic to use sublingual buprenorphine/naloxone (bup/nal) plus a multimodal approach to help chronic pain patients with history of Substance Use Disorder (SUD) or aberrant drug-related behavior. The objective of this study was to report overall retention rates and indicators of efficacy in pain control from approximately six years of High-Risk Pain Clinic data. A retrospective chart review was conducted for a total of 78 patients who enrolled in the High-Risk Pain Clinic between 2014 and 2020. Data gathered include psychiatric diagnoses, prescribed medications, pain score, buprenorphine/naloxone dosing, time in clinic, and reason for dismissal. A linear mixed effects model was used to assess the pain score from the Defense and Veterans Pain Rating Scale (DVPRS) and daily bup/nal dose across time. The overall retention of the High-Risk Pain Clinic was 41%. The mean pain score demonstrated a significant downward trend across treatment time (p < 0.001), while the opposite trend was seen with buprenorphine dose (p < 0.001). With the benefit of six years of observation, this study supports buprenorphine/naloxone as a safe and efficacious component of comprehensive chronic pain treatment in patients with SUD or high-risk of opioid overuse or misuse.

scholarly journals Effect of Low-Dose (Single-Dose) Magnesium Sulfate on Postoperative Analgesia in Hysterectomy Patients Receiving Balanced General Anesthesia

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Arman Taheri ◽  
Katayoun Haryalchi ◽  
Mandana Mansour Ghanaie ◽  
Neda Habibi Arejan
Keyword(s):  
Single Dose ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Magnesium Sulfate ◽  
Pain Score ◽  
Normal Saline ◽  
Low Dose ◽  
Rating Scale ◽  
Controlled Trial ◽  
Control Group

Background and Aim. Aparallel, randomized, double blinded, placebo-controlled trial study was designed to assess the efficacy of single low dose of intravenous magnesium sulfate on post-total abdominal hysterectomy (TAH) pain relief under balanced general anesthesia.Subject and Methods. Forty women undergoing TAH surgery were assigned to two magnesium sulfate (N=20) and normal saline (N=20) groups randomly. The magnesium group received magnesium sulfate 50 mg·kg−1in 100 mL of normal saline solution i.v as single-dose, just 15 minutes before induction of anesthesia whereas patients in control group received 100 mL of 0.9% sodium chloride solution at the same time. The same balanced general anesthesia was induced for two groups. Pethidine consumption was recorded over 24 hours precisely as postoperative analgesic. Pain score was evaluated with Numeric Rating Scale (NRS) at 0, 6, 12, and 24 hours after the surgeries.Results. Postoperative pain score was lower in magnesium group at 6, 12, and 24 hours after the operations significantly (P<0.05).Pethidinerequirement was significantly lower in magnesium group throughout 24 hours after the surgeries (P=0.0001).Conclusion. Single dose of magnesium sulfate during balanced general anesthesia could be considered as effective and safe method to reduce postoperative pain and opioid consumption after TAH.

Escitalopram in Treatment of Sleep Disturbances in Major Depressive Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
N. Zivkovic ◽  
G. Djokic ◽  
D. Pavicevic ◽  
V. Ilic
Keyword(s):  
Major Depressive Disorder ◽  
Adverse Effects ◽  
Depressive Disorder ◽  
Sleep Disturbances ◽  
Rating Scale ◽  
Statistical Significance ◽  
Control Group ◽  
Major Depressive ◽  
High Statistical Significance ◽  
Experimental Group

Major depressive disorder (MDD) is common and severe affective disorder with sleep disturbances and non-bizarre delusions which are organized in permanent and unshakeable delusional system. Neurobiological basis of MDD is still completely unknown, but significant role has serotoninergic and noradrenergic neuronal systems. Escitalopram is highly potent and highly selective serotonin re-uptake inhibitor.Purpose of this study was to estimate efficacy of the escitalopram in treatment of sleep disturbances in MDD.Methods:This prospective clinical study included 95 patients diagnosed by ICD-10 criteria for MDD, who are randomly divided into control (30 patients) and experimental group (65 patients). Patients were observed for 6 months in hospital and outpatients conditions, according to specially designed protocol, which included Hamilton Depression Rating Scale (HAMD) and Leeds Sleeping Evaluation Questionnaire (LSEQ). Control group was treated with maprotiline (75-150 mg/24h) and experimental group with escitalopram (10-20 mg/24h).Results:Escitalopram therapy influenced on HAMD score with high statistical significance vs. maprotiline, p=0.000. Escitalopram therapy improves LSEQ score after 6 months in comparison to maprotiline therapy with high statistical significance p=0.000. Percentage of adverse effects is significantly lower in escitalopram (10.76%) than in maprotiline (26.67%) group.Conclusion:Escitalopram has significantly better efficacy and lower adverse effects rate in treatment of depressive symptoms and sleep disturbances in MDD patients comparing to maprotiline.

Regional anaesthesia for postoperative pain management after liver resection

2012 ◽  
Vol 19 (3) ◽  
pp. 126-129
Author(s):  
Darius Trepenaitis ◽  
Tadas Česnaitis ◽  
Andrius Macas
Keyword(s):  
Pain Management ◽  
Liver Resection ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Wound Infiltration ◽  
Adequate Treatment

Background. Pain is the most common complication in the postoperative period. If adequate treatment is not taken, it can transform to chronic pain. Postoperative pain brings a lot of social, psychological and financial problems for patients and their families. Materials and methods. This prospective study included 30 patients after laparatomic liver resection operation. Patients were randomly assign­ ed to Infiltrated or Control groups. An infiltration of 40 ml levobupivacaine 0.25% solution to the operation cut edges was performed to the Infiltrated group. The pain was evaluated using the numerical rating scale after 2, 5, 12, 24, 48 hours and 1 month after the operation. Our aim was to determine the effect of local anesthesia in the operation wound. The total usage of morphine and any side effects were registered. Results. A statistically significant reduction in pain was observed in the Infiltrated group in all evaluation periods. Opioids usage was higher in the Control group almost by 4 times and adverse effects were 9 to 1 compared to the Infiltrated group. Conclusions. Surgical wound infiltration with local anesthetic for postoperative pain management after liver resection operations has a positive effect on postoperative pain reduction and leads to lesser usage of opioid analgetics. As a result, there is a less chance of opioids induced adverse effects.

scholarly journals Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy

2019 ◽  
Vol 22 (2) ◽  
pp. 61-69
Author(s):  
Ho-Won Lee ◽  
Kyung-Ho Choi ◽  
Jung-Youn Kim ◽  
Ik Yang ◽  
Kyu-Cheol Noh
Keyword(s):  
Rotator Cuff ◽  
Conservative Treatment ◽  
Rating Scale ◽  
Platelet Rich Plasma ◽  
Constant Score ◽  
Statistical Significance ◽  
Clinical Results ◽  
Control Group ◽  
Significant Difference ◽  
Rotator Cuff Tendinopathy

Background: The purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP.Methods: Inclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure.Results: There was a statistically significant difference in ΔASES<sub>3months</sub> (ASES<sub>3months</sub>-ASES<sub>first</sub>) score between the control and PRP groups (<i>p</i>=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (<i>p</i>>0.05).Conclusions: This study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

scholarly journals Perioperative Intravenous Patient-Controlled Analgesic Efficacy of Morphine with Combined Nefopam and Parecoxib versus Parecoxib in Gynecologic Surgery: A Randomized, Double-Blind Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Varinee Lekprasert ◽  
Lapuskorn Yapanan ◽  
Wichai Ittichaikulthol ◽  
Rungrawan Buachai ◽  
Phimol Soisod ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Analgesic Efficacy ◽  
Morphine Consumption ◽  
Gynecologic Surgery ◽  
Control Group ◽  
Double Blind Study ◽  
Postanesthetic Care Unit

Background. Nefopam is a non-NSAIDs and opioid sparing centrally acting drug which is effective for a multimodal postoperative analgesia. The present study aimed to evaluate the analgesic efficacy of nefopam combined with parecoxib for gynecologic surgery. Methods. This randomized double-blinded control trial recruited participants (n = 72) who underwent gynecologic surgeries and divided them into either a nefopam or control group. The study group received parecoxib 40 mg plus nefopam 20 mg, while the control group received parecoxib 40 mg plus normal saline solution intravenously during open abdominal gynecological surgery. Both groups then received either nefopam or normal saline every 6 hours postoperatively for 24 hours. Intravenous patient-controlled analgesia with morphine was given for breakthrough pain within 24 h. The participants were evaluated for morphine consumption within 24 hours and postoperative pain using a verbal numerical rating scale (VNRS) at a postanesthetic care unit, at 6-, 12-, and 24-hour postoperative periods. Adverse effects were recorded. Results. Morphine consumption within 24 hours and adverse effects were not significantly different between both groups. Mean difference and 95% confident interval of morphine consumption between both groups was 1.00 (−4.56, 4.76), P = 0.97 . The VNRS on movement at 6 hours after surgery of the nefopam group was significantly different from that of the control group [mean (SD), 4.14 (2.11) vs. 5.14 (1.80), P = 0.04 ]. The VNRS of the nefopam group at 12 hours after operation during resting and on movement was significantly different from that of the control group ([mean (SD), 1.47 (1.80) vs. 2.54 (2.15), P = 0.03 ], [mean (SD), 3.22 (1.84) vs 4.17 (1.74), P = 0.03 ]), respectively. Conclusions. The combined administration of nefopam and parecoxib during gynecologic surgery slightly reduced the VNRS at 6 and 12 hours postoperatively more than treatment with parecoxib.

scholarly journals Tennis Elbow, study protocol for a randomized clinical trial: Needling With and Without Platelet-rich Plasma After Failure of Up-to-date Rehabilitation

2020 ◽  
Author(s):  
ADRIEN J-P SCHWITZGUEBEL ◽  
Mitko Bogoev ◽  
Viktor Nikolov ◽  
Freddy Ichane ◽  
Alexandre Laedermann
Keyword(s):  
Success Rate ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Intervention Group ◽  
Case Series ◽  
Rehabilitation Program ◽  
Saline Control ◽  
Control Group ◽  
Lesion Pattern ◽  
Study Results

Abstract Background: The conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial. Methods: This study is a single-center, randomized double-blind controlled trial, preceded by a case series. All the 232 planned patients of the case series will undergo an up-to-date comprehensive rehabilitation program, including focused extracorporeal shock waves therapy. This rehabilitation program is expected to have a maximum success rate 75%. It is therefore aimed to allocate a minimum of 58 patients with rehabilitation failure into the 1:1 randomized trial. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo an ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (Control group). The primary endpoint will be the pain improvement from baseline (month 0) at 3 months on a 0-10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The main secondary endpoints will include the rehabilitation success rate and improvements from baseline at 3, 6 and 12 months of the following outcomes: (i) Single Assessment Numeric Evaluation (SANE) score, (ii) Patient-Rated Tennis Elbow Evaluation (PRTEE) score, (iii) maximal grip strength on Jamar test, and (iv) the ultrasonographic evaluation of the US of the epicondylar tendons.Discussion: The study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol. Trial registration: ClinicalTrials.gov: NCT03987256, registered 20 August 2019

Benefits of EEG-Neurofeedback on the Modulation of Impulsivity in a Sample of Cocaine and Heroin Long-Term Abstinent Inmates: A Pilot Study

2020 ◽  
Vol 64 (12) ◽  
pp. 1275-1298
Author(s):  
M. Corominas-Roso ◽  
I. Ibern ◽  
M. Capdevila ◽  
R. Ramon ◽  
C. Roncero ◽  
...  
Keyword(s):  
Pilot Study ◽  
Clinical Improvement ◽  
Rating Scale ◽  
Treated Group ◽  
Small Sample ◽  
Anxiety And Depression ◽  
Control Group ◽  
Potential Range ◽  
Significant Clinical Improvement

The aim of this pilot study was to assess whether neurofeedback (NFB) can be useful in the treatment of impulsive behavior in long-term abstinent cocaine and heroin addicts. A single-blind sham-controlled NFB protocol was carried out to assess the effects of NFB on impulsivity in 20 (10 + 10) cocaine and heroin long-term abstinent addicts ( Diagnostic and Statistical Manual of Mental Disorders [4th ed., text rev.; DSM-IV-TR]). Psychotic and neurologic diseases were excluded. Participants underwent 40 NFB sessions based on the very slow cortical potential range. Inhibitory deficits were specifically addressed through right and left prefrontal training. Clinical improvement was measured with Likert-type scales, the Hamilton Depression Rating Scale, and the State–Trait Anxiety Inventory, and impulsivity was assessed using the Barratt Impulsiveness Scale and the Continuous Performance Test. Although the results are preliminary due to the small sample size, the NFB-treated group showed a significant clinical improvement, including symptoms of anxiety and depression, with two differentiated time periods. No significant clinical improvement was found in the control group. A significant decrease in the post- versus pre-treatment measures of global impulsivity, nonplanning impulsivity, and error commission measures was found in the NFB-treated group; effect size ( dKorr) in the pre–post control design was moderate. No significant change was found in the control group. Despite the limitations of this study, the results suggest that NFB is better than placebo in improving impulsivity and clinical symptoms of anxiety and depression in long-term abstinent cocaine- and heroin-dependent individuals.

Paliperidone in the treatment of delirium: results of a prospective open-label pilot trial

2011 ◽  
Vol 23 (4) ◽  
pp. 179-183 ◽  
Author(s):  
Ho-Kyoung Yoon ◽  
Yong-Ku Kim ◽  
Changsu Han ◽  
Young-Hoon Ko ◽  
Heon-Jeong Lee ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Rating Scale ◽  
Small Sample Size ◽  
Pilot Trial ◽  
Small Sample ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Before And After ◽  
The Status

Yoon H-K, Kim Y-K, Han C, Ko Y-H, Lee H-J, Kwon D-Y, Kim L. Paliperidone in the treatment of delirium: results of a prospective open-label pilot trial.Objective: Delirium is a life-threatening neuropsychiatric syndrome characterised by disturbances in consciousness, attention, cognition and perception. Antipsychotics are considered the drugs of choice in managing the symptoms of delirium. Paliperidone is a benzisoxazole derivative and the principal active metabolite of risperidone. In this study, we aimed to evaluate the efficacy of paliperidone for the treatment of delirium.Methods: A prospective open-label study of paliperidone for delirium treatment was performed with 6-day follow-up. Fifteen patients who met Diagnostic and Statistical Manual of Mental disorders, Fourth Edition criteria for delirium and had a score of 13 on the Delirium Rating Scale were recruited. The starting dose was 3 mg once a day and the dose was adjusted depending on the status of delirium. Daily assessments of the severity of delirium were evaluated using Memorial Delirium Assessment Scale (MDAS).Results: The mean daily maintenance dose of paliperidone was 3.75 ± 1.06. The MDAS scores before and after treatment (day 7) were 23.60 ± 6.31 and 11.33 ± 5.45 (t = 6.78, p < 0.001), respectively. The intensity of delirium showed a statistically significant reduction in MDAS scores from the first day of treatment. No serious adverse effects were observed, and none of the patients discontinued paliperidone because of adverse effects.Conclusions: This study shows that low-dose paliperidone is effective in reducing behavioural disturbances and symptoms in delirium and is well tolerated in delirious patients. This trial is an open-label study with a small sample size, and further controlled studies will be necessary.

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