Pain Relief
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Author(s):  
Samuel Baek ◽  
Seok Kim ◽  
Myung Ho Shin ◽  
Tae Min Kim ◽  
Seoung-Joon Lee ◽  
...  

Purpose: We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment, and pain control for patients with thoracic outlet syndrome.Methods: Between November 2001 and October 2018, 266 patients were studied retrospectively. To evaluate the efficacy and sustainability, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior to and 1, 12 weeks after the injection. The safety was evaluated by examining side effects for at least 24 hours from the point of injection.Results: NRS was improved from 7.12 to 3.11 at 1 week, and to 3.05 at 12 weeks (p<0.05). NDI was improved from 15.87 to 6.15 at 1 week, and to 6.19 at 12 weeks (p<0.05). There were two cases of convulsion immediately after the injection and were treated with prompt oxygen supply and sedatives. Transient side effects included two cases of dyspnea and one case of nausea and were resolved within 1 hour after. All five cases showed symptoms of side effects on the day of injection and were resolved within a day. A total of 242 patients (91.0%) experienced immediate declines in NRS and 161 patients experienced persistent declines for more than 12 weeks. However, 24 patients (9.0%) showed no improvement and 20 patients (7.5%) experienced increases in NRS.Conclusion: Scalene injection is also effective as a therapeutic method. However, this study suggests that it must be done with monitoring of vital signs in an operating room for any possible complications and side effects.


Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chengfan Zhong ◽  
Rong He ◽  
Xiaomin Lu ◽  
Lilun Zhong ◽  
Ding-Kun Lin ◽  
...  

Abstract Background Enhanced recovery following total knee arthroplasty (TKA) has been advocated to enhance postoperative recovery. Multimodal cocktail periarticular injection (MCPI) use for pain control in TKA has gained wide acceptance. MCPI-containing corticosteroids are believed to be an effective solution owing to their local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence regarding its benefits. This trial aims to compare MCPI with a high dose of corticosteroid, normal dose of corticosteroid, and non-corticosteroid during TKA, to assess the effectiveness of MCPI containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects and provide evidence that high-dose corticosteroids result in prolonged pain control and better recovery following TKA. Methods This is a double-blinded, randomized, placebo-controlled study. A total of 234 patients scheduled for TKA will be recruited. During surgery, before wound closure, 80 ml of the cocktail analgesic will be injected into the muscle and joint capsule for local infiltration analgesia; the participants will be randomly assigned to three groups to receive a high dose of betamethasone MCPI (group H), normal dose of betamethasone MCPI (group N), and non-betamethasone MCPI (group C). The following indices will be recorded and analyzed: the strongest knee pain experienced during 90° flexion at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1 min walking ability; and circumference around the patella at 2, 5, 14, and 30 days after surgery; Knee Society knee score at 14 days and 30 days after surgery; C-reactive protein and blood sedimentation; blood sugar 2, 5, 14, and 30 days following surgery; rescue analgesic consumption; and adverse events. If any participant withdraws from the trial, an intention-to-treat analysis will be performed. Discussion The results of this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and adverse events, as well as provide evidence on the efficacy of high-dose corticosteroids in prolonged pain control and better recovery following TKA. Trial registration Chinese Clinical Trial Registry, ChiCTR2000038671. Registered on September 27, 2020.


2021 ◽  
Vol 0 ◽  
pp. 1-3
Author(s):  
Anand Murugesan ◽  
M. S. Raghuraman

Pleural leiomyosarcomas are rare soft-tissue sarcomas. Neuropathic pain associated with such tumours can be quite debilitating. We present the case of a 62-year-old woman with chronic neuropathic pain refractory to pharmacologic interventions in association with recurrent pleural leiomyosarcoma. Pulsed radio-frequency of the stellate ganglion was performed after due consideration and planning as a palliative measure to provide pain relief. The patient was discharged the same day with pain score 0/10 and followed up for 3 years. The unique features of this case report are: (1) Different approach of the treatment modality and (2) longer follow-up.


Cephalalgia ◽  
2021 ◽  
pp. 033310242110485
Author(s):  
Uwe Reuter ◽  
John H Krege ◽  
Louise Lombard ◽  
Elisa Gomez Valderas ◽  
Judith Krikke-Workel ◽  
...  

Background A significant proportion of triptan users exhibit an insufficient response or inadequate tolerability to a triptan, and some may develop a contraindication. Lasmiditan, a selective 5-HT1F receptor agonist, may be an option for these individuals. We assessed lasmiditan efficacy in a subgroup of patients in CENTURION (Phase 3 migraine consistency study) who exhibited an insufficient response to triptans, including a subgroup with insufficient response due to efficacy only. Methods Patients were randomized to lasmiditan 200 mg for four attacks, lasmiditan 100 mg for four attacks, or placebo for three and lasmiditan 50 mg for one attack. Triptan insufficient responders were pre-defined as patients with insufficient efficacy or tolerability, or who developed a contraindication. Results In triptan insufficient responders, lasmiditan was superior to placebo ( p < 0.05) for pain freedom beginning at 1 h (both doses); pain relief beginning at 0.5 (200 mg) or 1 h (100 mg); migraine-related disability freedom, much/very much better on the Patient Global Impression of Change, and most bothersome symptom freedom at 2 h; sustained pain freedom; and need for rescue medication. Lasmiditan showed benefit for consistency of effect across attacks for 2-h pain freedom and pain relief. Findings were similar in triptan responders and triptan naïve patients and when the triptan insufficient response definition was based on efficacy only. Conclusions Lasmiditan was efficacious across multiple clinically relevant endpoints in the acute treatment of migraine independent of prior response to triptans. Trial Registration: CENTURION (NCT03670810); SAMURAI (NCT02439320); SPARTAN (NCT02605174)


2021 ◽  
Vol 28 (5) ◽  
pp. 4004-4015
Author(s):  
Claudio Pusceddu ◽  
Davide De Francesco ◽  
Luca Melis ◽  
Nicola Ballicu ◽  
Alessandro Fancellu

Aims: The purpose of this study was to assess the effectiveness of a navigational radiofrequency ablation device with concurrent vertebral augmentation in the treatment of posterior vertebral body metastatic lesions, which are technically difficult to access. Primary outcomes of the study were evaluation of pain palliation and radiologic assessment of local tumor control. Materials and Methods: Thirty-five patients with 41 vertebral spinal metastases involving the posterior vertebral body underwent computed tomography-guided percutaneous targeted radiofrequency ablation, with a navigational radiofrequency ablation device, associated with vertebral augmentation. Twenty-one patients (60%) had 1 or 2 metastatic lesions (Group A) and fourteen (40%) patients had multiple (>2) vertebral lesions (Group B). Changes in pain severity were evaluated by visual analog scale (VAS). Metastatic lesions were evaluated in terms of radiological local control. Results: The procedure was technically successful in all the treated vertebrae. Among the symptomatic patients, the mean VAS score dropped from 5.7 (95% CI 4.9–6.5) before tRFA and to 0.9 (95% CI 0.4–1.3) after tRFA (p < 0.001). The mean decrease in VAS score between baseline and one week follow up was 4.8 (95% CI 4.2–5.4). VAS decrease over time between one week and one year following radiofrequency ablation was similar, suggesting that pain relief was immediate and durable. Neither patients with 1–2 vertebral metastases, nor those with multiple lesions, showed radiological signs of local progression or recurrence of the tumor in the index vertebrae during a median follow up of 19 months (4–46 months) and 10 months (4–37 months), respectively. Conclusion: Treatment of spinal metastases with a navigational radiofrequency ablation device and vertebral augmentation can be used to obtain local tumor control with immediate and durable pain relief, providing effective treatment in the multimodality management of difficult-to-reach spinal metastases.


2021 ◽  
Author(s):  
Mindy Ebrahimoff

Abstract BACKGROUND Inter and intra-generational birth cohorts could be particularly useful for predicting the likelihood of labour and birth events for nulliparous women. However, maternal recall of their first childbirth may be imprecise, and hospital records can be inaccurate. Establishing the extent of agreement between mothers’ recall and hospital reports of historical first birth events could be the basis of a prediction tool that could contribute to better health care practices during daughter’s perinatal period. METHODS In 2015, women who had their first baby between 1967 and 1997 were asked to recall gravidity, method of labour onset, type of pain relief, length of labour, birth outcome, and infant’s gender, birthweight and gestational age ≥17 years postpartum. Responses were compared to hospital birth records. Agreement was evaluated using Bland-Altman’s plots and Kappa statistics (k). Logistic regression modeling was used to determine factors influencing discrepant recall. RESULTS Of 150 questionnaires distributed, 101 records were complete. Up to 49 years after birth there was strong agreement for birthweight measured at interval (mean discrepancy -28.69g, SD =170.91g, Bland-Altman 95% limits of agreement (-363.66g, 306.28g)) and category level birthweight k=0.83, good agreement for gestational age (GA) in weeks, at interval level (mean difference=0, SD =0.90, Bland-Altman 95% limits of agreement (-1.766, 1.766)) and at category level GA k=0.56. There was moderate agreement for labour length (≤10hrs/>10hrs) k=0.54; 43% of records did not record this information. For gravidity k=0.43, labour onset k=0.79; any pain relief k=0.61; and birth outcome k=0.91. Univariate logistic regression showed better agreement on infant birthweight in women with higher levels of education, lower agreement for onset of labour method with increasing maternal age at birth, and higher agreement for use of pethidine, but lower agreement for use of epidural in women who had their first babies more recently. CONCLUSIONS Mothers accounts of first birth events generally agree with hospital records. Familial birth data may contribute to more individualised care for nulliparous women, and may limit rising interventions based on population level guidelines. Future research in other settings is warranted before diagnostic criteria may be used in clinical settings.


Author(s):  
John Milner ◽  
Davis Hartnettt ◽  
Steven F. DeFroda

AbstractKnee braces continue to be a widely utilized piece of medical equipment, ranging from simple over the counter sleeves to more complex functional braces, with the ability to provide electrical stimulation to muscle groups. Despite their popularity, alternatives to knee braces exist for patients who find braces to be ineffective, uncomfortable, cumbersome, or overly expensive. While high-quality studies are lacking for modalities such as neoprene sleeves, compression stockings, and kinesiotaping, there is promising evidence that these interventions can confer an element of stability and pain relief for a variety of knee pathologies both with regard to acute and chronic injuries as well as in the postoperative rehabilitation period. While no “holy grail” exists for the ideal brace, or bracing alternative, it is important for providers to be aware of the options available to patients as well as the current evidence for these various modalities, so that the provider can best guide musculoskeletal care.


Biomolecules ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1447
Author(s):  
Laura Micheli ◽  
Mariaconcetta Durante ◽  
Elena Lucarini ◽  
Silvia Sgambellone ◽  
Laura Lucarini ◽  
...  

A3 adenosine receptor (A3AR) agonists have emerged as potent relievers of neuropathic pain by a T cell-mediated production of IL-10. The H4 histamine receptor (H4R), also implicated in pain modulation, is expressed on T cells playing a preeminent role in its activation and release of IL-10. To improve the therapeutic opportunities, this study aimed to verify the hypothesis of a possible cross-talk between A3AR and H4R in the resolution of neuropathic pain. In the mouse model of Chronic Constriction Injury (CCI), the acute intraperitoneal co-administration of the A3AR agonist IB-MECA (0.5 mg/kg) and the H4R agonist VUF 8430 (10 mg/kg), were additive in counteracting mechano-allodynia increasing IL-10 plasma levels. In H4R−/− mice, IB-MECA activity was reduced, lower pain relief and lower modulation of plasma IL-1β, TNF-α, IL-6 and IL-10 were shown. The complete anti-allodynia effect of IB-MECA in H4R−/− mice was restored after intravenous administration of CD4+ T cells obtained from naïve wild type mice. In conclusion, a role of the histaminergic system in the mechanism of A3AR-mediated neuropathic pain relief was suggested highlighting the driving force evoked by CD4+ T cells throughout IL-10 up-regulation.


Author(s):  
S. P. Glyantsev

Since the XVI century until the beginning of the XVII century an operation of limb amputation has undergone changes and improvements that have affected all its aspects: preparation for carrying out, the technique of performing and postoperative treatment of patients. The invention of the ligature (1552) and the tourniquet (1674) became revolutionary. Wet and dry gangrene, extensive trauma to soft tissues and bones, traumatic limb amputation and osteomyelitis were considered of indications for amputation. The deontological and legal framework for amputation was developed, including the patient’s consent to the operation and the awareness of relatives about its outcomes. The article presents an instrumental and dressing apparatus of the XVII century for the operation; medicines used for general and local treatment of the patient before and after truncation of the stump; sedation and pain relief issues; technique of circular and one soft tissue flap (1679) amputation; the choice of tissue dissection level; methods of stopping bleeding (astringents, pressure bandage, cauterization, ligation and stitching of blood vessels); a method of stitching a stump wound, applying a bandage on it and strengthening it; postoperative management (regimen and diet, dressing change, staged wound treatment, complications); the phenomenon and causes of “phantom limbs”.


Author(s):  
Lauren Shelmerdine ◽  
Brenig Llwyd Gwilym ◽  
Graeme Keith Ambler ◽  
David Charles Bosanquet ◽  
Sandip Nandhra
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