Comparing Patient-Reported Outcomes From Sham and Saline-Based Placebo Injections for Knee Osteoarthritis: Data From a Randomized Clinical Trial of Lorecivivint

Background: Durable, meaningful symptom responses to intra-articular saline placebo injections are observed in knee osteoarthritis (OA) trials, but it is unclear if these are due to physiological effects. Purpose: To perform a prospective comparison of patient-reported outcome responses among participants with knee OA who underwent intra-articular injection of saline-based placebo or sham (dry needle). Study Design: Randomized controlled trial; Level of evidence, 2. Methods: From a 24-week randomized double-blind trial, participants with moderate to severe knee OA received 2-mL intra-articular injections of saline-based placebo (PBO; 99.45% PBS) or sham (dry needle) to the target knee. Least squares mean differences of changes from baseline to week 24 were compared between the PBO and sham groups for the following: pain Numeric Rating Scale; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function; and patient global assessment. Bang Blinding Index was used to evaluate all-group blinding on day 1 and week 24. Results: In total, 116 and 117 participants were randomized to the PBO and sham groups, respectively. Within the full trial population, the mean ± SD age and body mass index were 59.0 ± 8.5 years and 28.97 ± 4.01, respectively. An overall 406 (58.4%) were female, and 394 (57.3%) had Kellgren-Lawrence grade 3 target knee OA. The PBO and sham groups demonstrated clinically meaningful improvements (≥10%) from baseline in all patient-reported outcomes at all time points (ie, weeks 4-24). Mean differences (95% CI) at week 24 between the PBO and sham groups were as follows: pain Numeric Rating Scale, –0.10 (–0.79 to 0.59; P = .78); WOMAC pain, –2.89 (–9.70 to 3.92; P = .40); WOMAC stiffness, –2.37 (–9.37 to 4.63; P = .51); and WOMAC function, –1.39 (–8.06 to 5.29; P = .68). Bang Blinding Index indicated that blinding was maintained. Conclusion: PBO and sham groups demonstrated equivalent patient-reported outcomes at all time points through week 24, suggesting that responses attributed to saline were contextual (ie, to the procedure) and not physiological. Registration: NCT03122860 (ClinicalTrials.gov identifier).

Effectiveness of Botulinum Toxin on Pain in Stroke Patients Suffering from Upper Limb Spastic Dystonia

This observational study aimed at investigating pain in stroke patients with upper limb spastic dystonia. Forty-one consecutive patients were enrolled. A 0–10 numeric rating scale was used to evaluate pain at rest and during muscle tone assessment. Patients were asked to indicate the most painful joint at passive mobilization (shoulder, elbow, wrist-fingers). The DN4 questionnaire was administered to disclose neuropathic pain. All patients were assessed just before and 1 month after incobotulinumtoxin-A treatment. Pain was present in 22 patients, worsened or triggered by passive muscle stretching. DN4 scored < 4 in 20 patients. The most painful joints were wrist–fingers in 12 patients, elbow in 5 patients and shoulder in the remaining 5 patients. Both elbow and wrist–fingers pain correlated with muscle tone. BoNT-A treatment reduced pain in all the joints, including the shoulder. We discussed that nociceptive pain is present in a vast proportion of patients with upper limb spastic dystonia. BoNT-A treatment reduced both spastic dystonia and pain in all the joints but the shoulder, where the effect on pain could be mediated by the reduction of pathological postures involving the other joints.

Pericapsular Nerve Group Block (PENG Block) and Spinal Anesthesia as Multimodal Analgetic in Patient with Bipolar Hip Arthroplasty: A Case Report

Introduction. Intertrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. Bipolar hip arthroplasty is one of the most common major orthopaedic procedures to improve patient’s functional status and quality of life. Spinal anesthesia is a regional anesthetic technique that is performed by injecting local anesthetic drugs into the subarachnoid space to obtain dermatome-level analgesia and skeletal muscle relaxation. Pain after hip replacement originates mainly from the anterior pelvic capsule. The main target for pelvic analgesia is the anterior capsule which is the most richly innervated part of the joint. PENG block is used to block the articular branches to the pelvis. The patient was assessed with an NRS (numeric rating scale) instrument pre and post operative. Case presentation. A-74 year old woman admitted with complaints of pain in the right hip and diagnosed with a closed fracture of the right intertrochanter and planned for bipolar hip arthroplasty with PENG block and spinal anesthesia. Preoperatively the patient was assessed with an NRS (numeric rating scale) instrument with a score of 6. After the procedure, we reevaluated the pain score using NRS was 2 post operative. Conclusion. Patients receiving a PENG block and spinal anesthesia for intraoperative and postoperative analgesia during hip fracture surgery. Prior to spinal anesthesia, PENG block can be performed as a multimodal analgesia in the patient, PENG block expected to facilitate a sitting position during spinal anesthesia and for postoperative pain management

Pemberian terapi murattal terhadap penurunan nyeri pada pasien kanker kolorektal pre operasi

Salah satu gejala kanker kolorektal yaitu adanya rasa nyeri. Nyeri adalah perasaan tidak menyenangkan baik secara fisik maupun emosional akibat adanya kerusakan jaringan. Mengatasi nyeri dapat menggunakan cara non farmakologis diantaranya terapi murattal Ar-Rahman. Studi kasus ini bertujuan untuk mengetahui penurunan nyeri pada pasien kanker kolorektal pre operasi setelah diberikan terapi murattal Ar-Rahman. Desain studi ini menggunakan deskriptif dengan pendekatan studi kasus berdasarkan penerapan Evidence Based Nursing Practice yaitu terapi murattal terhadap penurunan nyeri. Subjek studi kasus adalah pasien kanker kolorektal yang belum dilakukan tindakan pembedahan, tingkat skala nyeri 2-5, dan beragama Islam. Subjek studi kasus berjumlah 2 pasien. Pengambilan data menggunakan pengukuran skala Numeric Rating Scale (NRS) sebelum dan sesudah dilakukan terapi murattal Ar-Rahman. Hasil studi kasus menunjukkan adanya penurunan nyeri pada kedua subjek penelitian setelah diberikan terapi murattal Ar-Rahman. Subjek studi kasus 1 terjadi penurunan nyeri sebesar 1 skala nyeri. Subjek studi kasus 2 terjadi penurunan nyeri sebesar 2 skala nyeri. Terapi murattal Ar-Rahman mampu menurunkan nyeri pada pasien kanker kolorektal pre operasi.

Penurunan intensitas nyeri luka post-sectio caesarea menggunakan mobilisasi dini

Nyeri merupakan respon sensori tidak menyenangkan yang dialami oleh individu secara unik yang diekspresikan secara berbeda oleh tiap individu serta dapat berdampak terhadap kondisi fisik dan psikis seseorang. Nyeri akibat luka post sectio caesarea dalam rentang ringan hingga berat dapat mengganggu mobilitas fisik, pemenuhan kebutuhan dasar, bahkan sampai mengakibatkan syok neurogenik pada pasien. Studi kasus ini bertujuan untuk mengaplikasikan mobilisasi dini secara bertahap pada pasien post sectio caesarea yang mengalami nyeri akibat luka post sectio caesarea. Penelitian ini menggunakan metode deskriptif dengan pendekatan asuhan keperawatan yang dilakukan pada tiga pasien yang mengalami nyeri intensitas sedang-berat akibat luka post sectio caesarea. Pengukuran intensitas nyeri dilakukan pre dan post mobilisasi dini secara bertahap dengan menggunakan alat ukur Numeric Rating Scale (NRS). Terdapat penurunan intensitas nyeri paska dilakukan mobilisasi dini secara bertahap rata-rata menurun 5 skala. Penurunan intensitas nyeri ini terjadi karena mobilisasi akan menjadikan konsentrasi pasien pada lokasi nyeri berkurang serta dapat meminimalkan transmisi saraf nyeri menuju syaraf pusat. Mobilisasi akan melancarkan sirkulasi darah termasuk sirkulasi yang menuju area luka post sectio caesarea sehingga mampu mengurangi aktivasi mediator kimiawi pada proses peradangan, sehingga intensitas nyeri berkurang. Mobilisasi dini merupakan intervensi yang dapat dilakukan untuk menurunkan intensitas nyeri luka post sectio caesarea pada pasien.

Efektivitas pemberian terapi kompres hangat jahe merah untuk mengurangi nyeri sendi pada lansia

Penyakit sendi yang biasa dikenal masyarakat yaitu penyakit rematik. Namun penyakit sendi yang paling banyak ialah osteoarthritis, remathoid arthrthis, dan gout, penyakit ini dikelompokan berdasarkan diagnose dan keluhan pasien diantaranya nyeri yang disertai dengan kemerahan, bengkak dan kekauan pada sendi. Penelitian ini bertujuan untuk mengetahui efektifitas pemberian kompres jahe merah untuk mengurangi nyeri sendi pada lansia. Metode penelitian deskriptif dengan pendekatan studi kasus proses asuhan keperawatan dilakukan dalam pengelolaan klien nyeri sendi, meliputi pengkajian, diagnosa keperawatan, intervensi keperwatan implementasi dan evaluasi. Pengambilan sampel dilakukan dengan menggunakan tehnik purposive sampling dalam lingkup komunitas wilayah Kelurahan Mangunharjo Kec. Tembalang. Responden sejumlah 2 orang yang diberikan terapi kompres jahe merah di kelola selama 7 hari dengan frekuensi 1 kali/hari di berikan terapi 10-15 menit Penerapan ini untuk mengukur tingkat nyeri dengan menggunakan skala nyeri Numeric Rating Scale (NRS). Pengukuran dilakukan pre-post test. Hasil studi menunjukkan bahwa ada perubahan skala nyeri sebelum dan sesudah dilakukan terapi kompres hangat, baik pada responden pertama maupun responden kedua. Terapi kompres hangat jahe merah dapat menurunkan skala nyeri sendi pada lansia.

Literature Review : Penerapan Senam Hamil Terhadap Penurunan Nyeri Punggung Pada Ibu Hamil Trimester III

Back pain is a problem commonly experienced by pregnant women in the third trimester. One of the effective ways to reduce that pain is pregnancy exercise. This scientific writing aims to describe the implementation of pregnancy exercise to pregnant women who experience back pain based on a literature review. The review was done to three articles from similar journal, which were published during 2018 – 2020. The Numeric Rating Scale (NRS) was used as the instrument. From 39 pregnant women who participated, 97.4% of them were 20-35 years old and 69.2% were fulltime housewives. The result showed that average value of the pain scale before the intervention was 5.42, and after the intervention was 2.70. The conclution of this literature review was that the implementation of pregnancy exercise was effective in reducing the intensity of back pain in pregnancy. Hence, health workers are supposed to encourage pregnant women to do pregnancy exercise, especially in the third trimester.Keywords: Keywords: Pregnancy; Back Pain, Pregnancy Exercise AbstrakKetidaknyamanan nyeri punggung umum dialami oleh ibu hamil Trimester III. Salah satu tindakan untuk menurunkan nyeri punggung yang efektif adalah senam hamil. Karya Tulis Ilmiah ini bertujuan untuk menggambarkan penerapan senam hamil pada ibu hamil yang mengalami nyeri punggung berdasarkan literature review. Subyek literature review yang digunakan yaitu 3 jurnal dengan laman jurnal yang yang sama, terbit tahun (2018-2020). Instrumen pada ketiga artikel ini menggunakan NRS (Numeric Rating Scale). Hasil analisa karakteristik responden dari 3 jurnal menunjukkan dari jumlah responden 39 ibu hamil. Sebagian umur responden adalah 20-35 tahun (97,4%), mayoritas status pekerjaan adalah IRT (69,2%). Nilai rata-rata skala nyeri sebelum intervensi 5,42, setelah intervensi 2,70. Kesimpulkan dari literature review adalah senam hamil efektif dalam menurunkan intensitas nyeri punggung pada kehamilan. Saran bagi pelayan kesehatan hendaknya menigkatkan penerapan senam hamil kepada seluruh ibu hamil terutama trimester III.Kata kunci: Kehamilan, Nyeri Punggung, Senam Hamil

Pain Management Using Nano-Bio Fusion Gel in Fixed Orthodontic Therapy-Induced Gingivitis: A Split-Mouth Design Study

Nanotechnology-based products containing antioxidants may be effective adjuvants in the treatment of periodontal diseases. To assess the treatment effect of nano bio-fusion gel (NBFG) in pain perception (PP) in fixed orthodontic therapy-induced gingivitis (FOTIG). The gel contains propolis, vitamin C, and vitamin E in the form of nanoemulsion. Thirty-two patients were finally selected from the orthodontic clinic after assessments for FOTIG. Patients were allocated randomly into active and placebo-control groups. Patients were evaluated at three intervals (T1, T2, and T3). Pain perception using a numeric rating scale (NRS) was performed at baseline (T1), on the 7th day (T2) and on the 28th day (T3) on his/her visit to an orthodontic clinic. In the T1, T2, and T3 period, patients apply NBFG (active or placebo side) to their gingiva after brushing two times a day for 28 consecutive days. Results: The baseline data between the active or placebo group showed almost similar PP. From T1 to T2 and T3, the active or placebo-control group showed significant improvement in PP over time. Compared to placebo, the active group showed highly significant (p ≤ 0.001, T1 to T2 and T2 to T3) improvement in PP. The use of NBFG is an effective means of improvement in PP of FOTIG cases.

EFEKTIVITAS TEKNIK JARIK SHAKING THE APPLE TREE TERHADAP PERSEPSI NYERI PADA IBU BERSALIN

Ibu bersalin berespon terhadap nyerinya dengan cara yang berbeda-beda. Beberapa ibu mungkin merasa takut dan cemas sementara yang lain nya bersifat toleran dan optimis. Salah satu metode non farmakologi untuk pengendalian rasa nyeri yaitu teknik jarik shaking the apple tree, teknik ini berperan dalam merileksasi otot-otot panggul sehingga memberikan rasa nyaman saat persalinan. Tujuan penelitian ini untuk mengetahui efektivitas teknik jarik shaking the apple tree terhadap persepsi nyeri pada ibu bersalin kala 1 fase aktif di wilayah kerja Puskesmas Pasar Kepahiang. Jenis penelitian ini menggunakan rancangan praexperimental design dengan jenis pre test and post test one group design. Pengambilan sampel menggunakan teknik total sampling dengan jumlah ibu bersalin sebanyak 22 sampel. Skala nyeri dinilai dengan dengan lembar observasi Numeric Rating Scale (NRS ) dan persepsi nyeri dengan lembar kuisioner serta dengan wawancara individu. Uji statistik yang digunakan uji Wilcoxon signed ranks test. Hasil: teknik jarik efektif terhadap penurunan skala nyeri pada ibu bersalin, dengan nilai p 0,000(<0,005), dan Metode jarik shake the apple tree efektif dalam peningkatan persepsi nyeri persalinan sebelum dan sesudah intervensi, dengan nilai p 0.000 (<0.05). Saran bagi ibu yang akan bersalin dapat menggunakan metode jarik shake the apple tree sebagai penanganan nyeri persalinan.