Can Naloxegol Therapy Improve Quality of Life in Patients with Advanced Cancer?

This observational study aims to evaluate the efficacy of naloxegol therapy in resolving opioid-induced constipation (OIC) and in improving the quality of life in a home palliative care cancer setting. Advanced cancer patients with OIC (Rome IV criteria) not relieved by laxatives started a naloxegol therapy 25 mg/day for 4 weeks. Quality of life was evaluated by Patient Assessment of Constipation Quality-of-Life (PAC-QoL) at day 0 and day 28; background pain by Numerical Rating Scale, number of weekly spontaneous bowel movements and Bowel Function Index (BFI) were evaluated at day 0 and every week. Seventy-eight patients who completed the 4-week study improved all four PAC-QoL dimensions (physical and psychological discomfort, worries/concerns and satisfaction level). Weekly spontaneous bowel movements increased and BFI improved. Background pain reduced after seven days and remained lower during the following weeks. Seventy-two patients dropped out the study before day 28 with a reduced survival compared to patients completing the study. Even in these patients, an improvement of bowel function was observed after two weeks. Naloxegol was effective in improving the quality of life, resolving OIC and reducing overall pain in patients with advanced cancer.

Usefulness of infrared thermography in diagnosing and evaluating severity of carpal tunnel syndrome

Background: Pain and autonomic dysfunction are prominent symptoms in some patients with carpal tunnel syndrome (CTS). Infrared thermography (IRT) has been used to evaluate CTS by measuring the cutaneous temperature and sympathetic vasomotor function.Methods: This study enrolled the 66 hands of 33 subjects, some of which had clinical CTS and the others were healthy. The enrolled patients completed the Boston Carpal Tunnel Questionnaire (BCTQ) and Historical-Objective scale, and underwent nerve conduction studies (NCSs) and IRT. Skin temperature was measured at the fingertips and the thenar and hypothenar regions in each hand. We analyzed (1) the correlations between self-reported severity, physician-assessed severity, and test results, and (2) the sensitivity and specificity of IRT in diagnosing CTS.Results: No significant correlation was observed between the results of the BCTQ, NCS, and IRT. IRT had a low sensitivity and high specificity in diagnosing CTS.Conclusions: IRT cannot replace NCS in diagnosing CTS, nor did it provide an advantage in combination with NCS. However, lower temperatures at the median nerve in some hands with moderate-to-severe CTS suggested the involvement of sympathetic nerve fiber function. Follow-up studies with a larger-scale and complementary design are required to elucidate the relationships.

Application Of Diadynamic Currents To Reduce Pain

Background: Pain has become a separate complaint or disease, not only as a means of protecting the body or a symptom of other diseases. With increasing age, a person will experience a decrease in physiological functions that can affect the system in the body. Diadynamic currents are part of electrecal stimulation which has a low frequency function to reduce pain.Methods:This is an experimental research with a quantitative approach. The sampling technique used nonprobability sampling based on the inclusion and exclusion criteria. The data analysis used was non-parametric statistics, namely by using the Wilcoxon signed rank test.Results: Based on the result of the Wilcoxon test showed that the value. Sig. is 0.000, which is less than 0.05. By giving a diadynamic current, the pain felt by someone will be reduced.Conclusion: diadynamic currents can be used to reduce pain

Effectiveness of tramadol compared to pentazocine in pain management during labour

Background: Pain and agony during childbirth is quite often unbearable and at times beyond description. Pain relief can help in removing curb due to pain. To determine the efficacy of intramuscular tramadol hydrochloride as an analgesic during labor compared to those of pentazocine.Methods: This randomized controlled trial conducted at Jinnah post graduate medical center, ward 8 (Gynaecology and obstetrics) between 2nd December 2013 to 1st June 2014 after approval from the ethical committee of the hospital. Pregnant women aged 15 to 45 years, parity ≥1 with Gestational age between 37 to 42 weeks with a single fetus were included in this study. The subjects fulfilling inclusion criteria were enrolled after informed consent. Women were allocated randomly to pentazocine or tramadol. Labour pain was assessed immediately by 4-point visual rating scale before, at 30, and 60 minutes after injection of the trial drug and mean score was calculated. The data was analysed using SPSS version 20.Results: A total of 128 patients were randomized to ether tramadol or pentazocine. The mean age of enrolled participants is 30±7.01 years and 53.1% participants were below 30 years of age. Of 64 patients who received tramadol, 53 (82.8%) had pain relief compared to 39 (60.9%) in patient who received pentazocine (p=0.005).Conclusions: It is concluded from this study that tramadol is more effective in reducing labor pain

Pain management and bupivacaine

Background: Pain is an unpleasant experience associated with tissue damage. Peripheral tissue injury results in functional disturbances in the nervous system. Modern anaesthesiologists are not only concerned about preoperative and intraoperative care of the patient but also with postoperative welfare of the patient.Methods: In present study we have compared the efficacy of injection bupivacaine 0.25% infiltration preoperatively versus postoperatively on duration of postoperative analgesia, VAS (visual analogue scale) at the onset of pain, total analgesia requirement in 24 hours. 150 patients belonging to ASA (American society of anesthesiologists) class I and II between the age of 15 and 75 who underwent lower abdominal surgeries belonging to either sex were included in the study. The patients were randomly allocated to three groups. Control group (C) received 20 ml normal saline, preoperative group (A) received 0.25% bupivacaine before incision, postoperative group (B) received 0.25% bupivacaine before closure.Results: Duration of analgesia, VAS score at the time of first request of analgesia and total doses of analgesia over 24 hours were recorded. The total analgesia requirement was reduced over 24 hours in the group B in which the infiltration was done postoperatively.Conclusions: The postoperative infiltration with 0.25% bupivacaine produces longer duration and better quality of analgesia as compared to preoperative infiltration.

Pain as Defining Feature of Health Status and Prominent Therapeutic Target in Patients with Hidradenitis Suppurativa

Background. Pain is one of the main aspects of hidradenitis suppurativa that strongly affects the quality of life of patients. We explored the relationship between pain and clinical severity as well as its role in defining the health status in patients with HS. Methods. Pain was defined by three measures: (a) question 1 (“my skin hurts”) of the Skindex-17; (b) Bodily Pain (BP) scale of the SF-36; and (c) Visual Analog Scale (VAS). Clinical severity of HS was assessed by the Hurley staging, the Sartorius HS Score, and the International HS Severity Score System. Results. The study population included 341 HS patients with complete data for the VAS pain, 316 for question 1 of the Skindex-17, and 294 for BP. Clinical severity was positively associated with pain. This result was observed for all three severity scores and all three pain evaluation methods. In addition, the number of fistulae, abscesses, and nodules were significantly associated with the three severity measures of pain, while the association with scars was not observed for question 1 of the Skindex-17 and BP. Conclusions. Pain may be a good proxy of clinical severity and efficacy of a treatment in HS and therefore a crucial hallmark of patients’ health status.

The Role of Neurologists in Pain Management – Based on the Survey Conducted by the Korean Neurological Association in 2020

Background: Pain is one of the most common chief complaints in neurological field. Authors try to inform the current situation of pain medicine in neurological practice and present an effective method for pain-related education during neurology residency and for practicing neurologists.Methods: A survey was conducted from November 16 to November 27, 2020 for members of the Korean Neurological Association, and the results were analyzed.Results: About two-thirds of neurologists replied that more than 25% of their patients were suffered from diverse pain including headache, spine pain or neuropathic pain. Despite many patients are visiting to neurologist for pain treatment, most neurologists are aware that they have not received sufficient practical pain education in the past and present. Therefore, they want more educational opportunities in pain medicine including interventional pain management and physical and pharmacologic therapies for more effective treatment.Conclusions: More follow-up studies on pain treatment and education should be conducted. It is also essential that the members of the society continue to interest and participate in the change of the pain education program.

Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery

Background: Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternative is remifentanil. We compared the efficacity of remifentanil vs morphine -metamizole for post cardiac surgery pain relief. Methods; Twenty patients undergoing on-pump coronary artery bypass surgery, receiving standardized propofol–fentanyl and propofol based anesthesia, remifentanil group (Group R, n = 10) and fentanyl (Group F, n = 10). Postoperative analgesia was provided in R group initially with remifentanil and later with morphine-metamizole and in F group immediately after operation. Pain was controlled by visual observation, questioning, in rest and during coughing, with a score (0-3). Results; There is no difference in time of extubation between groups but, pain score was much higher in F (3-9) group in first hour compared with R group (0-4). Morphine requirements was higher in (R) after remifentanil was stopped, in a first hour, but was lower after 24 hours compared with F group. Conclusion: Use of remifentanil is associated with lower scale of pain in postoperative period and lower morphine requirement after 24 hours, when analgesia treatment was changed.

Assessing the Knowledge of Analgesic Drugs Utilization during Pregnancy among Women in Saudi Arabia: A Cross-Sectional Study

Background: Pain is a common compensation mechanism in pregnant women that they may face during gestation due to physiological changes. Paracetamol and non-steroidal anti-inflammatory drugs are the most administered analgesic drugs worldwide. Therefore, safety and efficacy are important measures for the use of analgesics during pregnancy. Objective: Assess the knowledge of analgesic drug utilization among Saudi pregnant women. Method: We conducted a self-administered survey with an electronic questionnaire via Google Drive among a sample of 406 Saudi women. Results: About half of the respondents took analgesics during the first trimester, and 52.5% of women have used analgesics at least once without any medical advice during their gestation. Most participants agreed that paracetamol is the safest and effective analgesic drug during pregnancy, yet 61.8% of women are not aware that analgesics could be detrimental to the fetus if inappropriately administered in the third trimester. Conclusion: Participants have a good perception of the safest and most effective analgesic drug during pregnancy, but they have poor knowledge about analgesics’ side effects.