Comparison of kinesiology tape and cryotherapy on postoperative reaction following third molar extraction: a randomized clinical trial.

OBJECTIVES: To evaluate the effect of kinesiology tape application after mandibular third molar extraction. METHOD AND MATERIALS: Patients with mandibular third molar extraction indications were divided into three groups. The patients in group 1 had kinesiology tape applied after tooth extraction, the patients in group 2 were given an ice pack and intermittent cryotherapy within 24 h of the operation, and the patients in group 3 were not given any additional intervention. All patients were followed up, and the postoperative swelling, pain, mouth opening limitation, and quality of life were recorded and evaluated. Comments on the intervention methods from patients were also collected. RESULTS: Compared to group 3, groups 1 and 2 showed a significant reduction in postoperative swelling, pain, and limitation of mouth opening, and improvement of quality of life. There was no significant difference between groups 1 and 2 in each index, but the patients in group 1 reported fewer problems than those in group 2. CONCLUSIONS: The application of kinesiology tape was helpful in reducing the postoperative inflammatory symptoms of mandibular third molar extraction and improved the patients' postoperative quality of life. These results suggest that kinesiology tape can be used as an auxiliary treatment to cryotherapy or as an alternative intervention after mandibular third molar extraction.

Passive Recovery Strategies after Exercise: A Narrative Literature Review of the Current Evidence.

ABSTRACT: Passive recovery techniques are popular and offer a diverse spectrum of options for athletes and the clinicians providing care for them. These techniques are intended to minimize the negative effects of training or competition, thus enabling the athlete a quicker return to peak performance. Current evidence demonstrates improved athlete recovery with compression garments, cold water immersion, partial body cryotherapy, hyperbaric oxygen, and vibratory therapies. Other popular modalities, such as compression devices, whole body cryotherapy, percussive gun-assisted therapy, neuromuscular electrical stimulation, and pulsed electromagnetic therapy lack convincing evidence concerning athlete recovery. This article seeks to review the current literature and offer the reader an updated understanding of the mechanisms for each modality and the evidence regarding each modality's potential benefit in an athlete's recovery strategy.

A Five-step Systematic Therapy for Treating Plugged Ducts and Mastitis in Breastfeeding Women: A Case-Control Study.

PURPOSE: This study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct. METHODS: This retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST. RESULTS: After a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ2 = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ2 = 25.65, p < .001). CONCLUSION: FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.

Selective Ophthalmic Artery Chemotherapy with Melphalan in the Management of Unilateral Retinoblastoma: A Prospective Study.

PURPOSE: To determine prospectively the efficacy and to assess potential side effects of melphalan selective ophthalmic artery chemotherapy (SOAC) as first-line treatment for unilateral retinoblastoma. DESIGN: Phase 2 nonrandomized, prospective study. PARTICIPANTS: Patients with unilateral retinoblastoma group B, C, or D of the International Classification for Intraocular Retinoblastoma (IRC). Group D eyes with massive vitreous seeding were not eligible. METHODS: Melphalan SOAC associated with diode laser thermotherapy, cryotherapy, or both at 4-week intervals (3-6 cycles). For persistent vitreous seeding, intravitreal melphalan chemotherapy also was used. MAIN OUTCOME MEASURES: The primary outcome was globe preservation rate. Secondary outcomes were tumor relapse rate, occurrence of ocular or systemic adverse events, and measurement of the dose area product (DAP). RESULTS: Between 2012 and 2017, 39 patients (39 eyes) with unilateral retinoblastoma were included prospectively. Three included patients did not receive SOAC (2 catheterization failures and 1 case of viral syndrome) and were considered failures. At diagnosis, IRC groups for the 36 treated patients were: B, n = 4 (11%); C, n = 13 (36%); and D, n = 19 (53%); median age was 21.5 months (range, 3.2-61.6 months). Median number of SOAC cycles was 3.9 (range, 1-6 cycles), and median melphalan dose was 4.9 mg/procedure. The median DAP was 1.24 Gy.cm2/procedure. Median follow-up was 63 months (range, 34-93 months). SOAC was associated with local treatments for 31 patients (86%): diode laser thermotherapy for all of them and cryotherapy or intravitreal chemotherapy for 10 (32%) and 9 patients (25%), respectively. SOAC treatment was interrupted in 5 patients because of severe ophthalmic (ptosis, n = 2; retinal ischemia, n = 2) or systemic (hypotension, n = 1) adverse events. At the cutoff date analysis, all patients were alive without metastasis. The 18-month eye preservation rate was 80% (range, 68.6%-94.6%). After a follow-up of at least 30 months, the ocular preservation rate was 69% (n = 24 preservations). CONCLUSIONS: This first prospective trial demonstrated that SOAC with melphalan alone as first-line treatment for retinoblastoma is efficient and well tolerated with no metastatic events, although ocular ischemic complications were observed.

Concentrations of Ca, Mg, P, Prostaglandin E2 in Bones and Parathyroid Hormone; 1,25-dihydroxyvitamin D3; 17-ß-estradiol; Testosterone and Somatotropin in Plasma of Aging Rats Subjected to Physical Training in Cold Water.

Exposure to low temperatures can be considered a stressor, which when applied for a specific time can lead to adaptive reactions. In our study we hypothesized that cold, when applied to the entire body, may be a factor that positively modifies the aging process of bones by improving the mechanisms related to the body's mineral balance. Taking the above into account, the aim of the study was to determine the concentration of calcium (Ca), magnesium (Mg), and phosphorus (P) in bones, and to examine bone density and concentrations of the key hormones for bone metabolism, namely parathyroid hormone (PTH), somatotropin (GH), 1,25-dihydroxyvitamin D3, 17-ß estradiol, testosterone (T) in plasma, and prostaglandin E2 (PGE2) in the bone of aging rats subjected to physical training in cold water. The animals in the experiment were subjected to a series of swimming sessions for nine weeks. Study group animals (male and female respectively) performed swimming training in cold water at 5 ± 2 °C and in water with thermal comfort temperature (36 ± 2 °C). Control animals were kept in a sedentary condition. Immersion in cold water affects bone mineral metabolism in aging rats by changing the concentration of Ca, Mg, and P in the bone, altering bone mineral density and the concentration of key hormones involved in the regulation of bone mineral metabolism. The effect of cold-water immersion may be gender-dependent. In females, it decreases Ca and Mg content in bones while increasing bone density and 17-ß estradiol and 1,25-dihydroxyvitamin D3 levels, and with a longer perspective in aging animals may be positive not only for bone health but also other estrogen-dependent tissues. In males, cold water swimming decreased PTH and PGE2 which resulted in a decrease in phosphorus content in bones (with no effect on bone density), an increase in 1,25-dihydroxyvitamin D3, and increase in T and GH, and may have positive consequences especially in bones and muscle tissue for the prevention of elderly sarcopenia.

Effect of Pain Education, Cryotherapy, and Transcutaneous Electrical Nerve Stimulation on the Pain, Functional Capacity, and Quality of Life in Patients With Nonspecific Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to analyze the effects of pain education and the combined use of cryotherapy and transcutaneous electrical nerve stimulation on the pain sensation, functional capacity, and quality of life of patients with nonspecific chronic low back pain. DESIGN: This is a randomized controlled and blind clinical trial including patients with nonspecific chronic low back pain in the following 4 groups: control group, cryotherapy group, burst transcutaneous electrical nerve stimulation group, and cryotherapy combined with burst transcutaneous electrical nerve stimulation group. They were evaluated at baseline and after the protocol was concluded using the following: Roland-Morris questionnaire and sit-to-stand test; quality-of-life questionnaire; and pain. The protocol consisted of 10 sessions with pain education associated the combination of the electrophysical agents. RESULTS: There were no statistical differences between groups after the intervention protocol. In the within analysis, all groups presented an improvement in visual analog scale scores, Roland-Morris questionnaire, sit-to-stand test, and pain domain of quality-of-life questionnaire. CONCLUSIONS: This study showed that with pain education, there was no difference between cryotherapy and transcutaneous electrical nerve stimulation alone, combined, or placebo mode in improving pain, functional capacity, and quality of life in patients with nonspecific chronic low back pain.

Reconstruction using a frozen autograft for a skull and humeral lesion of synchronous multicentric osteosarcoma after undergoing successful neoadjuvant chemotherapy: a case report and review of the literature.

BACKGROUND: Synchronous multicentric osteosarcoma (SMOS) is a rare disease characterized by simultaneous multicentricity of intraosseous osteosarcoma without visceral involvement. SMOS, including a skull lesion, which occurs relatively rarely, and reconstruction using a frozen autograft after the excision of a lesion of SMOS has been infrequently reported previously. CASE PRESENTATION: We report an 18-year-old girl with SMOS, with lesions located in the left distal femur, right proximal humerus, and left occipital bone. Her major complaint was pain and swelling around the left knee joint. Asymptomatic lesions of the humerus and skull bone were detected on a systemic bone scan. No visceral organ metastasis was observed. A biopsy of the distal femoral lesion revealed osteosarcoma. Based on the histological findings, multiple bone lesions, and absence of visceral lesion, the clinical diagnosis of SMOS was made. After five courses of neoadjuvant chemotherapy with a regimen of doxorubicin and cisplatin, reconstruction using a tumor prosthesis following wide excision of the left distal femur was performed, and total necrosis was histologically observed in the retracted specimen. Following three cycles of adjuvant chemotherapy, tumor excision and reconstruction with a frozen autograft treated with liquid nitrogen was conducted for both lesions of the humerus and skull, rather than tumor prosthesis or synthetics, in order to retain a normal shoulder function, and to obtain a good cosmetic and functional outcome after treatment of the skull lesion. Further adjuvant chemotherapy could not be administered after the completion of the surgical treatment for all lesions because the adverse events due to chemotherapy were observed. At over 5 years after the diagnosis, she remains clinically disease-free. CONCLUSIONS: An early correct diagnosis, the proper management of chemotherapy, and surgical treatment for all lesions are essential for achieving a good clinical outcome, even in SMOS including a skull lesion. By performing reconstruction using a frozen autograft for a proximal humeral lesion and a skull lesion after confirming the good histological efficacy of neoadjuvant chemotherapy for the primary lesion, the excellent function of the shoulder joint and a good cosmetic outcome at the site of the skull lesion was acquired without complications or recurrence.

Comparing the effect of acupressure with or without ice in LI-4 point on labour pain and anxiety levels during labour: a randomised controlled trial.

The aim of this study was to assess the effect of acupressure with or without ice on reducing pain and anxiety during labour. The anxiety level of mothers was measured before and after study using Spielberger Inventory along with the labour pain. To improve the strength of this study, a meta-analysis was conducted on the effect of acupressure in point LI-4 on anxiety during labour. Ninety women in labour were randomly divided into three groups: acupressure with ice, acupressure without ice and the control group. The result suggested that women receiving both acupressure with ice (p = .005) or without ice (p < .001) experienced less labour pain in comparison with the control group. Also, the labour pain severity in acupressure without ice was lower than the group with ice (p < .001). Acupressure with (p = 1) or without (p = .09) ice was not significantly different from the control group in terms of the anxiety level. However, women in the group of acupressure without ice experienced less anxiety in comparison with acupressure with ice (p = .04). The difference in pain severity before and after treatment with acupressure with (RCI = 2.86) or without ice (RCI = 5.54) was clinically significant. The intervention was not clinically meaningful in terms of anxiety.Impact statementWhat is already known on this subject? Previous trials have exhibited that acupressure with/without ice reduced pain and anxiety during labour.What do the results of this subject add? The results of this research was consistent with previous studies, suggesting that acupressure, with or without ice, is more effective than the control group regarding labour pain. However, the group of acupressure with ice was not different from the control group with respect to the anxiety level.What are the implications of these findings for clinical practice and/or further research? In light of advantages, such as growing preference of women, researcher and health care providers for physiological delivery coupled with its safety and simplicity, it can be used as an effective technique to manage labour pain. Further studies are required to assess the effect of acupressure at L4 on the anxiety level.

Hydrotherapy with hydrogen-rich water compared with RICE protocol following acute ankle sprain in professional athletes: a randomized non-inferiority pilot trial.

We analysed the effects of an experimental novel protocol of intensive hydrotherapy with hydrogen-rich water (HRW) on injury recovery in athletic men who suffered an acute ankle sprain (AAS) and compared it with a RICE protocol (rest, ice, compression, elevation). Professional athletes (age 23.7 ± 4.0 years; weight 78.6 ± 5.7 kg, height 182.5 ± 4.3 cm; professional experience 5.9 ± 3.9 years) who incurred AAS during a sport-related activity were randomly assigned immediately after the injury to either hydrogen group (n = 9) or a conventional RICE treatment group (n = 9). Hydrogen group received six 30-min ankle baths with HRW throughout the first 24 h post-injury, with hydrotherapy administered every 4 hours during the intervention period. RICE group stood off the injured leg, with ice packs administered for 20 min every 3 hours, with the injured ankle compressed with an elastic bandage for 24 hours and elevated at all possible times above the level of the heart. HRW was equivalent to RICE protocol to reduce ankle swelling (2.1 ± 0.9% vs. 1.6 ± 0.8%; P = 0.26), range of motion (2.4 ± 1.3 cm vs. 2.7 ± 0.8 cm; P = 0.60), and single-leg balance with eyes opened (18.4 ± 8.2 sec vs. 10.7 ± 8.0 sec; P = 0.06) and closed (5.6 ± 8.4 sec vs. 3.9 ± 4.2 sec; P = 0.59). This non-inferiority pilot trial supports the use of HRW as an effective choice in AAS management. However, more studies are needed to corroborate these findings in other soft tissue injuries.

Should ice application be replaced with neurocryostimulation for the treatment of acute lateral ankle sprains? A randomized clinical trial.

STUDY DESIGN: Single-blind parallel group randomized clinical trial. OBJECTIVES: To compare the effects of neurocryostimulation (NCS) with those of traditional ice application on functional recovery, pain, edema and ankle dorsiflexion range of motion (ROM) in individuals receiving physiotherapy treatments for acute lateral ankle sprains (LAS). BACKGROUND: Ankle sprain is a very common injury and its management is often costly, with important short- and long-term impacts on individuals and society. As new methods of therapy using cold (cryotherapy) are emerging for the treatment of musculoskeletal conditions, little evidence exists to support their use. NCS, which provokes a rapid cooling of the skin with the liberation of pressured CO2, is a method believed to accelerate the resorption of edema and recovery in the case of traumatic injuries. METHODS: Forty-one participants with acute LAS were randomly assigned either to a group that received in-clinic physiotherapy treatments and NCS (experimental NCS group, n = 20), or to a group that received the same in-clinic physiotherapy treatments and traditional ice application (comparison ice group, n = 21). Primary (Lower Extremity Functional Scale - LEFS) and secondary (visual analog scale for pain intensity at rest and during usual activities in the last 48 h, Figure of Eight measurement of edema, and weight bearing lunge for ankle dorsiflexion range of motion) outcomes were evaluated at baseline (T0), after one week (T1), two weeks (T2), four weeks (T4) and finally, after six weeks (T6). The effects of interventions were assessed using two-way ANOVA-type Nonparametric Analysis for Longitudinal Data (nparLD). RESULTS: No significant group-time interaction or group effect was observed for all outcomes (0.995 ≥ p ≥ 0.057) following the intervention. Large time effects were however observed for all outcomes (p <  0.0001). CONCLUSION: Results suggest that neurocryostimulation is no more effective than traditional ice application in improving functional recovery, pain, edema, and ankle dorsiflexion ROM during the first six weeks of physiotherapy treatments in individuals with acute LAS. LEVEL OF EVIDENCE: Therapy, level 1b. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02945618 . Registered 23 October 2016 - Retrospectively registered (25 participants recruited prior to registration, 17 participants after).

Treatment Modalities for Cherry Angiomas: A Systematic Review.

BACKGROUND: Cherry angiomas are benign vascular proliferations of endothelial cells associated with aging. Currently, no mainstay of treatment for these vascular anomalies exists. OBJECTIVE: To review existing evidence-based therapies for the treatment of cherry angiomas. METHODS: A literature search in May 2019 was performed with PubMed Database and Cochrane Library using the following terms: "cherry angioma," "senile hemangioma," "senile angioma," "cherry hemangioma," and "Campbell de Morgan spots." RESULTS: Ten studies included in this systematic review reported laser therapy and nonlaser therapy as efficacious treatments for cherry angiomas. Among the laser therapies, pulsed dye laser (PDL) was preferred over potassium-titanyl-phosphate (KTP) and electrodessication (ED), based on decreased procedure-related pain. The neodymium-doped yttrium aluminum garnet (Nd:YAG) laser 1064 nm produced less pigmentary complications, whereas KTP and PDL risked pigmentary changes in darker-skinned individuals. Nonlaser therapies included cryotherapy, sclerotherapy, electrosurgery (i.e., ED, electrocoagulation), and radiofrequency ablation. No therapy proved to be superior. CONCLUSION: A variety of therapeutic modalities exist for the treatment of cherry angiomas. However, a limited number of high-quality studies explored the efficacy of treatments and compared treatment modalities. Light-based methods such as argon, KTP, Nd:YAG, intense pulsed light, and PDL, along with non-light-based interventions such as cryotherapy, electrosurgery, and sclerotherapy effectively treated cherry angiomas.

Cryotherapy as a coadjuvant in crotaline snakebite management with F(ab')2 antivenom: A randomized pilot study.

INTRODUCTION: Local cryotherapy induces vasoconstriction, which leads to a reduction in the inflammatory process. However, the effectiveness of local cryotherapy as a coadjuvant in the treatment of snakebite with F(ab')2 antivenom is unknown. OBJECTIVE: To describe the clinical effectiveness of local cryotherapy as a coadjuvant in patients with snakebite treated with F(ab')2 antivenom therapy at the Hospital Juárez de Mexico. MATERIAL AND METHODS: Patients with grade II snakebite envenomation according to the Christopher-Rodning classification system were enrolled from the Clinical Toxicology Service of the Hospital Juárez de México. One group of patients received F(ab')2 antivenom therapy (Antivipmyn®) plus local cryotherapy, and the other group received only F(ab')2 antivenom therapy. RESULTS: Thirty-eight patients were included, of whom 86.8 % were male (n = 33). Approximately 81.5 % of the subjects were injured in an upper extremity, while 18.5 % were injured in a lower extremities; 47.3 % of the subjects reported treatment of the snakebite prior to hospitalization (suction, the application of a tourniquet, incision of the bite site, or the application of traditional medicine). No differences were found concerning edema, swelling, and pain between the groups. The group that received local cryotherapy as a coadjuvant to F(ab')2 antivenom therapy had a shorter hospital stay (Cohen's d = 1.33; 95 % confidence interval [95 % CI] = 0.74-1.62; p < 0.01) and received fewer doses of F(ab')2 antivenom therapy (Cohen's d = 0.69; 95 % CI = 0.19-3.80; p = 0.03). CONCLUSIONS: The use of adequate local cryotherapy as a coadjuvant to F(ab')2 antivenom therapy reduces the length of hospital stay and the number of doses of F(ab')2 antivenom therapy used.

The impact of whole-body cryotherapy on lipid profile: A systematic review and meta-analysis.

PURPOSE: Whole-body cryotherapy (WBC) is an already proven method of supportive therapy in somatic medicine. Emerging evidence suggests that WBC might exert beneficial effects on lipid profile; however, studies in this field have provided mixed findings. OBJECTIVE: We aimed to perform a systematic review and meta-analysis of studies investigating the impact of WBC on lipid profile. METHODS: Electronic databases (the MEDLINE, the ERIC, the CINAHL Complete, the International Pharmaceutical Abstracts as well as the Academic Search Ultimate and the Health Source: Nursing/Academic Edition) were searched from their inception until 25th April 2020. Meta-analysis was performed using random-effects models and Hedges g' was calculated as the effect size estimate. RESULTS: We identified seven eligible studies. Pooled data analysis revealed significantly lower levels of triglycerides after WBC. Sensitivity analysis also demonstrated significantly lower levels of total cholesterol and low-density lipoproteins (LDL) after removing single studies. Meta-regression analysis showed that lower baseline body mass index (BMI) was significantly associated with greater changes in the levels of total cholesterol and LDL during WBC. CONCLUSIONS: Our findings imply that WBC may exert beneficial effects on the lipid profile in terms of lowering the levels of total cholesterol, LDL and triglycerides. Lower BMI may predict a greater improvement of lipid profile during WBC. However, caution should be taken as to the way our results are being interpreted due to low number of studies and considerable methodological heterogeneity of studies included in our meta-analysis.

Comparative Analysis of the Influence of Selected Physical Factors on the Level of Pain in the Course of Temporomandibular Joint Disorders.

Introduction: Temporomandibular joints (TMJs) play a very significant function in the activity of the locomotor system of the masticatory system. But they are often a source of pain, myopathy, myoarthropathy, and malfunction of their surrounding or internal structures. The treatment of a patient's discomfort associated with masticatory system dysfunctions strongly depends on their cause. Aim of the Study. The objective of the study was to evaluate the impact of selected physical factors: LED light therapy with electromagnetic field and cryotherapy for the level of pain, in the treatment of patients suffering from temporomandibular disorders (TMDs). Materials and Methods: The study included 60 patients of both genders with diagnosed TMD in a clinical trial. The participants were randomly divided into two groups. Each group consisted of 30 people and was subjected to separate therapies in which LED light therapy with electromagnetic field (MLT) and cryotherapy (CT) were applied. Results: Having assessed the results of the author's own research in terms of analgesic activity, determined on the VAS scale during the daily routine activity of the mandible and its individual movements, in general, each of the studied groups demonstrated a considerable decrease in the level of the patients' perception of pain (<0.001). Having compared both the therapeutic methods used, a greater reduction in the level of perceived pain was achieved with MLT (p=0.002). The type of therapy used turned out to be the only significant factor for the magnitude of this reduction. Conclusions: Conclusions based on the results of our own research indicate that the selected methods of treatment demonstrate an analgesic effect in terms of the overall discomfort in the course of TMD, and that they may be an alternative pain relief thereby reducing the patient's intake of painkillers.

Effects of Ice Massage Prior to an Iontophoresis Treatment Using Dexamethasone Sodium Phosphate.

CONTEXT: Low current intensity iontophoresis treatments have increased skin perfusion over 700% from baseline potentially altering drug clearance from or diffusion to the targeted area. OBJECTIVE: To determine the effects of a preceding 10-minute ice massage on subcutaneous dexamethasone sodium phosphate (Dex-P) concentration and skin perfusion during and after a 4-mA iontophoresis treatment. DESIGN: Controlled laboratory study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-four participants (male = 12, female = 12; age = 25.6 [4.5] y, height = 173.9 [8.51] cm, mass = 76.11 [16.84] kg). INTERVENTION(S): Participants were randomly assigned into 2 groups: (1) pretreatment 10-minute ice massage and (2) no pretreatment ice massage. Treatment consisted of an 80-mA·minute (4 mA, 20 min) Dex-P iontophoresis treatment. Microdialysis probes (3 mm deep in the forearm) were used to assess Dex-P, dexamethasone (Dex), and its metabolite (Dex-Met) concentrations. Skin perfusion was measured using laser Doppler flowmetry. MAIN OUTCOME MEASURE(S): Microdialysis samples were collected at baseline, at conclusion of treatment, and every 20 minutes posttreatment for 60 minutes. Samples were analyzed to determine Dex-Total (Dex-Total = Dex-P + Dex + Dex-Met). Skin perfusion was calculated as a percentage change from baseline. A mixed-design analysis of variance was used to determine Dex-Total and skin perfusion difference between groups overtime. RESULTS: There was no difference between groups (P = .476), but [Dex-Total] significantly increased over the course of the iontophoresis and posttreatment time (P < .001). Dex-P was measured in 18 of 24 participants with a mean concentration of 0.67 (1.09) µg/mL. Skin perfusion was significantly greater in the no ice treatment group (P = .002). Peak skin perfusion reached 27.74% (47.49%) and 117.39% (103.45%) from baseline for the ice and no ice groups, respectively. CONCLUSIONS: Ice massage prior to iontophoresis does not alter the tissue [Dex-Total] even with less skin perfusion.

Treatments for breast engorgement during lactation.

BACKGROUND: Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. Various treatments have been studied but little consistent evidence has been found on effective interventions. OBJECTIVES: To determine the effectiveness and safety of different treatments for engorgement in breastfeeding women. SEARCH METHODS: On 2 October 2019, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. SELECTION CRITERIA: All types of randomised controlled trials and all forms of treatment for breast engorgement were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for eligibility, extracted data, conducted 'Risk of bias' assessment and assessed the certainty of evidence using GRADE. MAIN RESULTS: For this udpate, we included 21 studies (2170 women randomised) conducted in a variety of settings. Six studies used individual breasts as the unit of analysis. Trials examined a range of interventions: cabbage leaves, various herbal compresses (ginger, cactus and aloe, hollyhock), massage (manual, electromechanical, Oketani), acupuncture, ultrasound, acupressure, scraping therapy, cold packs, and medical treatments (serrapeptase, protease, oxytocin). Due to heterogeneity, meta-analysis was not possible and data were reported from single trials. Certainty of evidence was downgraded for limitations in study design, imprecision and for inconsistency of effects. We report here findings from key comparisons. Cabbage leaf treatments compared to control For breast pain, cold cabbage leaves may be more effective than routine care (mean difference (MD) -1.03 points on 0-10 visual analogue scale (VAS), 95% confidence intervals (CI) -1.53 to -0.53; 152 women; very low-certainty evidence) or cold gel packs (-0.63 VAS points, 95% CI -1.09 to -0.17; 152 women; very low-certainty evidence), although the evidence is very uncertain. We are uncertain about cold cabbage leaves compared to room temperature cabbage leaves, room temperature cabbage leaves compared to hot water bag, and cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. For breast hardness, cold cabbage leaves may be more effective than routine care (MD -0.58 VAS points, 95% CI -0.82 to -0.34; 152 women; low-certainty evidence). We are uncertain about cold cabbage leaves compared to cold gel packs because the CIs were wide and included no effect. For breast engorgement, room temperature cabbage leaves may be more effective than a hot water bag (MD -1.16 points on 1-6 scale, 95% CI -1.36 to -0.96; 63 women; very low-certainty evidence). We are uncertain about cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. More women were satisfied with cold cabbage leaves than with routine care (risk ratio (RR) 1.42, 95% CI 1.22 to 1.64; 152 women; low certainty), or with cold gel packs (RR 1.23, 95% CI 1.10 to 1.38; 152 women; low-certainty evidence). We are uncertain if women breastfeed longer following treatment with cold cabbage leaves than routine care because CIs were wide and included no effect. Breast swelling and adverse events were not reported. Compress treatments compared to control For breast pain, herbal compress may be more effective than hot compress (MD -1.80 VAS points, 95% CI -2.07 to -1.53; 500 women; low-certainty evidence). Massage therapy plus cactus and aloe compress may be more effective than massage therapy alone (MD -1.27 VAS points, 95% CI -1.75 to -0.79; 100 women; low-certainty evidence). In a comparison of cactus and aloe compress to massage therapy, the CIs were wide and included no effect. For breast hardness, cactus and aloe cold compress may be more effective than massage (RR 0.66, 95% CI 0.51 to 0.87; 102 women; low-certainty evidence). Massage plus cactus and aloe cold compress may reduce the risk of breast hardness compared to massage alone (RR 0.38, 95% CI 0.25 to 0.58; 100 women; low-certainty evidence). We are uncertain about the effects of compress treatments on breast engorgement and cessation of breastfeeding because the certainty of evidence was very low. Among women receiving herbal compress treatment, 2/250 experienced skin irritation compared to 0/250 in the hot compress group (moderate-certainty evidence). Breast swelling and women's opinion of treatment were not reported. Medical treatments compared to placebo Protease may reduce breast pain (RR 0.17, 95% CI 0.04, 0.74; low-certainty evidence; 59 women) and breast swelling (RR 0.34, 95% CI 0.15 to 0.79; 59 women; low-certainty evidence), whereas serrapeptase may reduce the risk of engorgement compared to placebo (RR 0.36, 95% CI 0.14 to 0.88; 59 women; low-certainty evidence). We are uncertain if serrapeptase reduces breast pain or swelling, or if oxytocin reduces breast engorgement compared to placebo, because the CIs were wide and included no effect. No women experienced adverse events in any of the groups receiving serrapeptase, protease or placebo (low-certainty evidence). Breast induration/hardness, women's opinion of treatment and breastfeeding cessation were not reported. Cold gel packs compared to control For breast pain, we are uncertain about the effectiveness of cold gel packs compared to control treatments because the certainty of evidence was very low. For breast hardness, cold gel packs may be more effective than routine care (MD -0.34 points on 1-6 scale, 95% CI -0.60 to -0.08; 151 women; low-certainty evidence). It is uncertain if women breastfeed longer following cold gel pack treatment compared to routine care because the CIs were wide and included no effect. There may be little difference in women's satisfaction with cold gel packs compared to routine care (RR 1.17, 95% CI 0.97 to 1.40; 151 women; low-certainty evidence). Breast swelling, engorgement and adverse events were not reported. AUTHORS' CONCLUSIONS: Although some interventions may be promising for the treatment of breast engorgement, such as cabbage leaves, cold gel packs, herbal compresses, and massage, the certainty of evidence is low and we cannot draw robust conclusions about their true effects. Future trials should aim to include larger sample sizes, using women - not individual breasts - as units of analysis.

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain.

Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.

Effects of Contrast Therapy Using Infrared and Cryotherapy as Compared with Contrast Bath Therapy on Blood Flow, Muscle Tone, and Pain Threshold in Young Healthy Adults.

BACKGROUND The aim of this research was to compare the effects of contrast bath therapy (CBT) and contrast therapy (CT) using infrared (IR) and cryotherapy (CR) on blood flow, muscle tone, and pain in the forearm. MATERIAL AND METHODS Twenty healthy individuals participated in this study. Each participant received 2 kinds of CT separated by a week. CBT involved immersion in hot water (38-40°C) for 4 minutes, followed by 1 minute of immersion in cold water (12-14°C) for four rotations. CT using IR and CR was performed in the same manner as CBT. RESULTS The variables measured were blood flow, muscle tone, and pain before and after intervention. Both types of CT produced fluctuations in the blood flow (P<0.05). The pain threshold increased on both therapies; a significant increase was noted with IR and CR (P<0.05) therapies. Muscle elasticity was induced and stiffness was reduced with all therapies (P<0.05). IR and CR resulted in significant changes (P<0.05) in blood flow as compared with the CBT. CONCLUSIONS The results of this study suggest that CT using IR and CR is more effective in improving blood flow than CBT and has the same effect on muscle tone and pain. Nonetheless, using IR and CR is efficient with regard to mobility and maintaining temperature; therefore, it would be convenient to use these in clinical settings. Further studies involving CT should be carried out to determine whether our findings are clinically relevant.

[Cryotherapy chambers and cold-water immersion : therapeutic use and risks]. / Chambres de cryothérapie et immersion en eau froide†: utilisation thérapeutique et risques.

Whole body cryotherapy is mainly performed either by immersion in cold water or in a cryotherapy chamber. Practiced since Antiquity and considered as a «â€…natural ¼ method, cryotherapy is attracting more and more followers. Beneficial health effects have been described in the literature. However, interpretation of its effects is difficult due to low quality of current studies. Cryotherapy could however be useful in addition to conventional therapies in various pathologies and situations, provided that the risks, contraindications and rules of good practice are known.

La cryothérapie du corps entier se pratique principalement soit par immersion en eau froide, soit en chambre de cryothérapie. Pratiquée depuis l'Antiquité et considérée comme une méthode «â€…naturelle ¼, la cryothérapie tend à attirer de plus en plus d'adeptes. Des effets bénéfiques pour la santé ont été décrits dans la littérature. Néanmoins, l'interprétation de ses effets est difficile en raison de la faible qualité des études actuelles. La cryothérapie pourrait toutefois être utile en complément des thérapies classiques dans diverses pathologies et situations, à condition de connaître les risques, les contre-indications et les règles de bonnes pratiques.

Cryotherapy With Mobilization Versus Cryotherapy With Mobilization Reinforced With Home Stretching Exercises in Treatment of Chronic Neck Pain: A Randomized Trial.

OBJECTIVES: The purpose of this study was to compare the effectiveness of cryotherapy with mobilization (CM) vs cryotherapy with mobilization reinforced with home stretching exercises (CMS) on pain and disability. METHOD: A randomized clinical trial with 2-arm parallel design, concealed allocation, assessor blinding, and intention to-treat analysis. Sixty participants were in 2 groups. Group 1 included cryotherapy with mobilization twice per week for 5 weeks. Group 2 included cryotherapy with mobilization plus home stretching exercises 5 times per week for 5 weeks. The evaluations were at baseline and 2 days posttreatment for the numeric pain rating scale, neck disability index, patient-specific functional scale, and global rating of change. RESULTS: The CM and CMS decreased neck pain and disability (P = .000). The statistical significance between the groups' differences favored the CM in the numeric pain rating scale, patient-specific functional scale, global rating of change (P = .000), and neck disability index (P = .004). CONCLUSION: Cryotherapy with mobilization for subjects in this study was more effective in decreasing disability and neck pain than CMS.