The effect of music therapy on chronic pain, quality of life and quality of sleep in adolescents after transthoracic occlusion of ventricular septal defect.

OBJECTIVE: To investigate the effect of music therapy on chronic pain, quality of life, and quality of sleep in adolescent patients after transthoracic occlusion of ventricular septal defects. METHODS: Patients were divided into 2 groups based on whether they received music therapy: a control group and a music group. The music group received 30 minutes of music therapy every day for 6 months after surgery. Patients in the control group received standard treatment and had 30 minutes of quiet time every day for 6 months after surgery. The short-form McGill pain questionnaire (SF-MPQ), the SF-36 scale and the Karolinska Sleep Questionnaire (KSQ) was used as the evaluation tool for chronic pain, quality of life, and quality of sleep, respectively. RESULTS: In terms of the degree of postoperative chronic pain, the Pain Rating Index (PRI) emotion item score in the SF-MPQ evaluation of the music group was significantly lower than that of the control group (1.6 ± 1.1 versus 2.2 ± 0.9). The role emotional (RE) scores of the SF-36 in the music group were significantly higher than that in the control group (77.35 ± 18.55 versus 42.66 ± 22.63). KSQ scores were significantly higher in the music group than in the control group for sleep status (4.1 ± 1.0 versus 3.3 ± 0.9), falling asleep (3.9 ± 1.1 versus 3.1 ± 1.0), and not feeling refreshed by sleep (3.6 ± 1.3 versus 2.7 ± 0.9) (P < .05). CONCLUSION: This study preliminarily showed that music therapy could effectively reduce patients' chronic pain and improve quality of life and sleep after surgery. These results suggest that music therapy may be an essential therapy worth considering in managing patients' postoperative recovery after cardiovascular surgery.

Comparison of the Effectiveness of Music Video Therapy and Music Therapy on Pain after Cardiothoracic Surgery in Preschool Children.

OBJECTIVE: To explore the effects of music video therapy on pain among preschool children after cardiothoracic surgery. METHODS: Patients in the music video therapy (MVT) group received a 30-min music video intervention, while patients in the music therapy (MT) group received a 30-min musical intervention. Both groups were given their respective therapy three times a day for three days. Patients in the control group did not receive MVT or MV. Measures, including pain scores, vital signs (heart rate, mean arterial pressure, respiratory rate, and oxygen saturation), and other postoperative indicators were recorded and analyzed. RESULTS: The MVT group showed a statistically significant decrease in heart rate, mean arterial pressure, and respiratory rate at the first day after surgery and pain scores at the first and second day after surgery compared to the MT group, but no significant difference was identified in oxygen saturation. The postoperative indicators including cumulative capacity of sufentanil use, the length of intensive care unit (ICU) stay, and the length of hospital stay in the MVT group were significantly lower than those in the control group. CONCLUSION: The findings provide further evidence to support the practice of music video therapy as a non-pharmaceutical intervention to reduce postoperative pain, reduce  the dosage of analgesics, shorten the length of ICU and hospital stay in preschool children after the cardiothoracic surgery.

Efficacy and safety of acupuncture treatment as an adjunctive therapy after knee replacement: Single-center, pragmatic, randomized, assessor blinded, pilot study.

INTRODUCTION: Total knee replacement (TKR) is a surgical procedure that is being increasingly performed as a result of population aging and the increased average human life expectancy in South Korea. Consistent with the growing number of TKR procedures, the number of patients seeking acupuncture for relief from adverse effects, effective pain management, and the enhancement of rehabilitative therapy effects and bodily function after TKR has also been increasing. Thus, an objective examination of the evidence regarding the safety and efficacy of acupuncture treatments is essential. The aim of this study is to verify the hypothesis that the concurrent use of acupuncture treatment and usual care after TKR is more effective, safe, and cost-effective for the relief of TKR symptoms than usual care therapy alone. METHODS/DESIGN: This is an open-label, parallel, assessor-blinded randomized controlled trial that includes 50 patients with TKR. After screening the patients and receiving informed consent, the patients are divided into two groups (usual care + acupuncture group and usual care group); the patients will then undergo TKR surgery and will be hospitalized for 2 weeks. The patients will receive a total of 8 acupuncture treatments over 2 weeks after surgery and will be followed up at 3, 4, and 12 weeks after the end of the intervention. The primary outcome is assessed using the Korean version of the Western Ontario and McMaster Universities Arthritis Index (K-WOMAC), and the secondary outcome is measured using the Numerical Rating Scale (NRS), Risk of Fall, and Range of Motion (ROM). Moreover, the cost per quality-adjusted life years (QALYs) is adopted as a primary economic outcome for economic evaluation, and the cost per NRS is adopted as a secondary economic outcome. ETHICS AND DISSEMINATION: This trial has received complete ethical approval from the Ethics Committee of Catholic Kwandong University International St. Mary's Hospital (IS17ENSS0063). We intend to submit the results to a peer-reviewed journal and/or conferences. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03633097.

Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: A double-blinded, randomized trial.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive modality which may be used to reduce acute postoperative pain. Intense perioperative pain within the first few days after hip fracture surgery is common and is related to negative consequences such as restricted and delayed ambulation. OBJECTIVE: The objective of the present study was to examine the effect of incorporating TENS treatment on pain intensity, and mobility, with standard rehabilitation care during the acute post-operative phase following Gamma-nail surgical fixation of extracapsular hip fractures. MATERIALS AND METHODS: Forty-one patients were randomly assigned to a supplement of 30 mins of active TENS or sham TENS. The standard rehabilitation care included five daily 30 mins physical therapy treatments beginning 24 hrs after surgery. Outcome measures were: pain intensity at rest, at night and during ambulation (assessed with the Numeric Rating Scale; Functional Ambulation Classification instrument; time to complete five sit-to-stand tests; and two-minute walk test). Data were analyzed with Wilcoxon score rank tests. Significance was set at p≤0.05. RESULTS: Significantly greater pain reduction during walking was noted in the active TENS group compared to sham TENS group (differences between the fifth and the second days: 2.55±1.37 vs 1.06± 1.11, respectively; p=0.0011). Additionally, advantage of active TENS was demonstrated in greater increase in walking distance on the fifth day and higher level of mobility compared to the sham TENS group. No additional effects of active TENS were noted on pain intensity at rest and at night and on five times sit-to-stand performance. CONCLUSION: Addition of TENS to the standard care of elderly patients in the early days following Gamma nail surgical fixation of extracapsular hip fracture is recommended for pain management while walking and functional gait recovery. The effect of TENS on long-term functional outcomes should be explored in future studies. TRIAL REGISTRATION: The trial was registered at the ISRCTN registry: ID ISRCTN32476360.

Efficacy of acupressure on quality of recovery after surgery: Randomised controlled trial.

BACKGROUND: Acupressure therapy is associated with favourable efficacies on postoperative nausea, pain and sleep disturbance, although the quality of the evidence is generally low. No randomised clinical trial has yet assessed the effect of acupressure on postoperative quality of recovery (QoR). OBJECTIVE: The objective was to study acupressure efficacy on patient-reported postoperative recovery. DESIGN: We conducted a single centre, three-group, blind, randomised controlled, pragmatic trial assessing acupressure therapy on the PC6, LI4 and HT7 acupoints. PATIENTS: Postoperative patients expected to stay in hospital at least 2 days after surgery. INTERVENTIONS: In the acupressure group, pressure was applied for 6 min (2 min per acupoint), three times a day after surgery for a maximum of 2 postoperative days during the hospital stay. In the sham group, extremely light touch was applied to the acupoints. The third group did not receive any touch. MAIN OUTCOME MEASURES: The primary outcome was the change in the QoR, using the QoR-15 questionnaire, between postoperative days 1 and 3. Key secondary outcomes included patients' satisfaction, postoperative nausea and vomiting, pain score and opioid (morphine equivalent) consumption. Assessors for the primary and secondary endpoints were blind to the group allocation. RESULTS: Overall, 163 patients were randomised (acupressure n=55, sham n=53, no intervention n=55). The mean (SD) postoperative change in QoR-15 did not differ statistically (P = 0.27) between the acupressure, sham and no intervention groups: 15.2 (17.8), 14.2 (21.9), 9.2 (21.7), respectively. Patient satisfaction (on a 0 to 10 scale) was statistically different (P = 0.01) among these three groups: 9.1 (1.5), 8.4 (1.6) and 8.2 (2.2), respectively. Changes in pain score and morphine equivalent consumption were not significantly different between the groups. CONCLUSION: Two days of postoperative acupressure therapy (up to six treatments) did not significantly improve patient QoR, postoperative nausea and vomiting, pain score or opioid consumption. Acupressure, however, was associated with improved patient satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02762435.

Music therapy following cardiac surgery-is it an effective method to reduce pain and anxiety?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In patients undergoing cardiac surgery, is postoperative music therapy effective in reducing pain and anxiety? Altogether, 153 papers were found using the reported search method, of which 7 represented the best evidence to answer the clinical question. Six of the included studies were randomized trials, with 1 further non-randomized trial. The specific music protocols utilized widely varied, ranging from 1 short session on day 1 postoperatively to multiple sessions per day over a 72-h period. Most therapies involved music of a relaxing type, typically between 50 and 60 dB. All 7 studies reported on pain, with 4 demonstrating significant differences in pain score; however, 3 of these were not associated with reduction in analgesia requirements. Five studies reported on anxiety, with 2 demonstrating a statistically significant improvement in levels of anxiety. These results need to be contextualized by the small number of participants within each study and the heterogeneity in the therapy protocols utilized. The current best available evidence fails to support the benefits of music therapy as an effective non-pharmacological option in reducing pain and anxiety following open-heart surgery. While there is scarce evidence demonstrating efficacy, the current literature contains very small-sample-sized studies in utilizing music therapy protocols which in turn have wide range of variability in terms of duration, frequency, timing in the postoperative period and specific choice of music utilized in each protocol.

Can postoperative massage therapy reduce pain and anxiety in cardiac surgery patients?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'In patients undergoing cardiac surgery, is postoperative massage therapy effective in reducing pain, anxiety and physiological parameters?' Altogether, 287 papers were found using the reported search, of which 7 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and the results of these papers are tabulated. The specific therapy protocols widely varied between studies, with differences in frequency, specific timing in the postoperative period, techniques used and experience of therapy provider. These variations limit the generalization and transferability of the conclusions. The effect of massage therapy on anxiety levels was reported in 5 studies. All but one demonstrated a significant improvement in anxiety. Pain was also reported in 5 studies, with significant improvement demonstrated in 4 studies. Importantly, a number of these studies failed to report on analgesic requirements nor demonstrate a reduction in opioid requirements, thus limiting the validity of the drawn conclusions. There is significant heterogeneity in randomized trials reporting on the effects of massage therapy. Although there is evidence to suggest that massage therapy reduces pain and anxiety following cardiac surgery, there are often caveats to the conclusions drawn with other studies reporting no significant difference. Therefore, in light of this, it would not be logical to recommend massage therapy as an effective therapy. There is no current evidence to suggest that massage therapy improves physiological parameters, including the onset of atrial fibrillation postoperatively.

The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study.

PURPOSE: The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty. Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries. Yet, whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study. METHOD: Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test. RESULTS: The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed. CONCLUSION: Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future. Implications for rehabilitation   Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty: • Enhances quadriceps strength. • Alleviates pain. • Enhances range of motion. • Does not have any effect on basic functional mobility. • Does not have any effect on knee girth.

The Effect of Music Listening on Pain, Heart Rate Variability, and Range of Motion in Older Adults After Total Knee Replacement.

The purpose of this study was to investigate the effects that listening and not listening to music had on pain relief, heart rate variability (HRV), and knee range of motion in total knee replacement (TKR) patients who underwent continuous passive motion (CPM) rehabilitation. We adopted a single-group quasi-experimental design. A sample of 49 TKR patients listened to music for 25 min during one session of CPM and no music during another session of CPM the same day for a total of 2 days. Results indicated that during CPM, patients exhibited a significant decrease in the pain level ( p < .05), an increase in the CPM knee flexion angle ( p < .05), a decrease in the low-frequency/high-frequency ratio (LF/HF) and normalized LF (nLF) of the HRV ( p < .01), and an increase in the normalized HF (nHF) and standard deviation of all normal-to-normal intervals (SDNN; p < .01) when listening to music compared with no music. This study demonstrated that listening to music can effectively decrease pain during CPM rehabilitation and improve the joint range of motion in patients who underwent TKR surgery.

Adding high-frequency transcutaneous electrical nerve stimulation to the first phase of post anterior cruciate ligament reconstruction rehabilitation does not improve pain and function in young male athletes more than exercise alone: a randomized single-blind clinical trial.

PURPOSE: Knee ligamentous trauma and the following pain is one of the most prevalent athletic injuries. Transcutaneous electrical nerve stimulation is one of the conservative approaches in controlling pain which is low cost, noninvasive, and safe with low complications. Our purpose was to study whether transcutaneous electrical nerve stimulation (TENS) could help athletes perform better during the first phase of rehabilitation (0-4 weeks) after anterior cruciate ligament (ACL) reconstruction surgery and until the follow-up. METHODS: This randomized single blind (exercise instructor and assessor) clinical trial was performed on 70 male athletes, undergone ACL surgery. After the surgery, patients were randomly divided into two groups: the first group received semi-supervised exercise plus high-frequency TENSTENS for 35 min a day and the second group only performed exercises. Treatment duration continued for 20 sessions, 4 weeks. The visual analog scale (VAS) score (100 mm), International Knee Documentation Committee (IKDC) questionnaire and knee flexion Range of motion (ROM) were evaluated for all patients after the surgery (before commencing the rehabilitation program), after 4 weeks and 14 weeks from the surgery. RESULTS: Mixed ANOVA was used to explore the interaction effects of time and group on outcome measures and post hoc additional tests were performed on the data. The VAS, IKDC questionnaire score and knee flexion ROM increased in both groups over time, but the amount of improvement did not differ between the two groups, implying no additional improvement in the group receiving TENS along with exercises. CONCLUSION: The findings of the present trial shows that adding TENS to a specific protocol of semi-supervised exercise in the first phase of rehabilitation after ACL reconstruction is not efficient on improving knee function and pain more than exercise alone. Implications for Rehabilitation Injury to the anterior cruciate ligament of the knee is a common injury specifically in athletes. Incorporating effective pain relieving strategies during the post anterior cruciate ligament reconstruction surgery rehabilitation could lead to improvement in regaining the range of motion and function of the knee which is of crucial importance after the surgery. Applying transcutaneous electrical nerve stimulation alongside a specific protocol of semi-supervised exercise in the first phase of rehabilitation after anterior cruciate ligament reconstruction did not have any additional effect to exercise alone.

The Effect of Foot Massage on Pain Intensity and Anxiety in Patients Having Undergone a Tibial Shaft Fracture Surgery: A Randomized Clinical Trial.

OBJECTIVE: To determine the effect of massage therapy on pain intensity and anxiety in patients who have undergone tibial shaft fracture surgery. DESIGN: This study was a randomized clinical trial with a pre-post design. As the study included 2 treatment groups, it was a parallel study. SETTING: Khatam-Al-Anbia Hospital in Zahedan, Iran, between July and August 2017. PATIENTS: In all, 66 patients who underwent a tibial shaft fracture surgery were enrolled and randomly assigned to intervention and control groups (33 patients each). INTERVENTION: The intervention included a 10-minute foot massage (5 minutes per leg) using sweet almond oil, the most common lubricant used in massage therapy. MAIN OUTCOME MEASUREMENTS: Data were collected using pain numeric rating scale and Spielberger State-Trait Anxiety Inventory before and after intervention. RESULTS: After intervention, the mean scores for pain intensity, and anxiety in the intervention and control groups were 4.72 (0.97) and 5.72 (0.91), and 42.84 (6.50) and 58.36 (10.37), respectively. A significant difference was noted between the intervention and control groups concerning pain intensity and anxiety. CONCLUSIONS: The results indicated that massage therapy reduced pain intensity and anxiety in patients who underwent tibial shaft fracture surgery. Therefore, using massage as a noninvasive and acceptable intervention is suggested in orthopaedic surgery, especially after tibial shaft fracture surgeries. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cold forced open-water swimming: a natural intervention to improve postoperative pain and mobilisation outcomes?

Postoperative neuropathic pain exacerbated by movement is poorly understood and difficult to treat but a relatively common complication of surgical procedures such as endoscopic thoracic sympathectomy. Here, we describe a case of unexpected, immediate, complete and sustained remission of postoperative intercostal neuralgia after the patient engaged in an open-water swim in markedly cold conditions. Though an incidental chance association is possible, the clear temporal proximity linking the swim with pain remission makes a causal relationship possible. We discuss plausible mechanisms that may underlie the relationship and discuss the potential implications for postoperative pain management and patient-centred mobilisation. We recommend further evaluation of cold forced open-water swimming as a mobility-pain provocation challenge to see if the observed unexpectedly positive outcome can be replicated. With the poor response to traditional management, there is a need for novel, curative interventions for postoperative neuropathic pain and associated impaired mobility.

No Effect of Acupuncture as Adjunctive Therapy for Patients with Total Knee Replacement: A Randomized Controlled Trial.

Objective: Acupuncture is a low risk option in pain management following total knee replacement as an alternative to opioid analgesics. Therefore, the benefit of acupuncture as adjunct to an exercise program was investigated. Furthermore, the modifying effect of previous benefit from acupuncture was explored. Design: Three weeks postoperatively, eligible patients were randomized to acupuncture and exercises or exercises alone. Setting: An outpatient rehabilitation centre in the municipality of Copenhagen, Denmark. Subjects: A total of 172 patients were included. Methods: Main outcome was proportion of patients that reported a clinically important change in pain at night following each treatment. Secondary outcomes were change in disability measured after termination of the course of treatment and at three months follow-up. Also consumption of medication and walking distance after termination of the course of treatment were assessed. Results: No additional benefit of acupuncture was found on any of the main outcomes. Between-group differences were non-significant in proportions of patients with a clinically important reduction of night pain (Relative Risk: 0.98; 95% Confidence Interval (CI): 0.86-1.11) or evening pain (Relative Risk: 0.94; 95% CI: 0.81-1.0. Conclusions: Our results do not support the addition of acupuncture to routine rehabilitation. Previous benefit from acupuncture was not able to identify those likely to respond to acupuncture. Future studies to investigate whether subgroups of patients would benefit from acupuncture are needed.

Managing Postoperative Pain After Minimally Invasive Gynecologic Surgery in the Era of the Opioid Epidemic.

In this review, we examine the evidence behind nonopioid medication alternatives, peripheral nerve blocks, surgical techniques, and postoperative recovery protocols that can help minimize and effectively treat postoperative pain after minimally invasive gynecologic surgery (MIGS). Because of the depth and heterogeneity of the data, a narrative review was performed of reported interventions. A comprehensive review was performed of PubMed, Embase, and the Cochrane Database with a focus on randomized controlled trials. In the absence of literature specific to benign gynecology, similar specialty or procedural data were reviewed. A variety of nonopioid medications, surgical techniques, and postoperative recovery protocols have shown significant improvements in postoperative pain after gynecologic surgery. Nonopioid medication options that are beneficial include acetaminophen, nonsteroidal anti-inflammatories, and antiepileptics. Incision infiltration with local anesthesia also significantly reduces pain. Surgically, minimally invasive approaches, reducing the laparoscopic trocar size to <10 mm, and evacuating the pneumoperitoneum at the end of the case all have significant benefits. Lastly, enhanced recovery pathways show promise in reducing pain after MIGS. By using a multimodal approach, minimally invasive gynecologic surgeons can help to minimize and manage postoperative pain with less reliance on opioid pain medications.

Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture.

BACKGROUND: Several new rehabilitation modalities have been proposed after anterior cruciate ligament (ACL) reconstruction. Among these, trigger point dry needling (TrP-DN) might be useful in the treatment of myofascial pain syndrome associated with ACL reconstruction to reduce pain intensity, increase knee flexion range and modify the mechanical properties of the quadriceps muscle during late-stage rehabilitation. To date, this is the first randomized clinical trial to support the use of TrP-DN in the early rehabilitation process after ACL reconstruction. The aim of this study was to determine the pain intensity, range of motion (ROM), stability, and functionality improvements by adding quadriceps vastus medialis TrP-DN to the rehabilitation protocol (Rh) provided to subacute ACL reconstructed patients. METHODS: This randomized, single-blinded, clinical trial (NCT02699411) included 44 subacute patients with surgical reconstruction of complete ACL rupture. The patients were randomized into 2 intervention groups: Rh (n = 22) or Rh + TrP-DN (n = 22). Pain intensity, ROM, stability, and functionality were measured at baseline (A0) and immediately (A1), 24 hours (A2), 1 week (A3), and 5 weeks (A4) after the first treatment. RESULTS: Comparing statistically significant differences (P ≤ .001; Eta = 0.198-0.360) between both groups, pain intensity (at A1), ROM (at A1, A2, and A3), and functionality (at A2, A3, and A4) were increased. Nevertheless, the rest of measurements did not show significant differences (P > .05). CONCLUSION: Quadriceps vastus medialis TrP-DN in conjunction with a rehabilitation protocol in subacute patients with surgical reconstruction of complete ACL rupture increases ROM (short-term) and functionality (short- to mid-term). Although there was an increase in pain intensity with the addition of TrP-DN, this was not detected beyond immediately after the first treatment. Furthermore, stability does not seem to be modified after TrP-DN.

Dry Needling Combined With Physical Therapy in Patients With Chronic Postsurgical Pain Following Total Knee Arthroplasty: A Case Series.

Study Design Case series. Background This case series describes a combined program of dry needling and therapeutic exercise in a small group of patients with persistent pain following total knee arthroplasty (TKA). Case Description Fourteen patients who underwent TKA had persistent postsurgical pain and myofascial trigger points that were nonresponsive to treatment with conventional physical therapy and/or medication. The patients received a weekly dry needling treatment in combination with therapeutic exercises for 4 weeks. Pain perception was assessed preintervention and postintervention with a visual analog scale and function was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index, 6-minute walk test, timed up-and-go test, 30-second chair-stand test, and knee joint range of motion. Outcomes After TKA, the patients had a mean ± SD symptom duration of 6.3 ± 3.1 months. Subsequent to dry needling, patients reported a significant mean ± SD decrease in pain intensity from 55.6 ± 6.6 to 19.3 ± 5.6 (P<.001) and improvements in Western Ontario and McMaster Universities Osteoarthritis Index scores from 10.1 ± 0.8 to 4.9 ± 1.0 for pain (P<.001), from 5.3 ± 0.4 to 2.4 ± 1.2 for stiffness (P<.001), and from 36.7 ± 2.0 to 20.1 ± 3.2 for function (P<.001). Knee flexion increased from a mean ± SD of 82.7° ± 5.2° to 93.3° ± 4.3° (P<.001), and joint extension improved from 15.8° ± 2.9° to 5.3° ± 2.4° (P<.05). The 6-minute walk test also showed improvement in postintervention values from a mean ± SD of 391.4 ± 23.7 to 424.7 ± 28.4 m (P<.05). Discussion After dry needling combined with therapeutic exercises, patients who had chronic pain following TKA showed clinically significant improvements in pain, range of motion, function, and myofascial trigger points. Future randomized clinical trials should further investigate the effectiveness of this protocol under similar conditions. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2017;47(3):209-216. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7089.

Acupuncture in posttonsillectomy pain : A prospective, double-blinded, randomized, controlled trial.

BACKGROUND: Postoperative swallowing pain is one of the most unpleasant after-effects of tonsillectomy. During recent years, the demand for alternatives to drug-based pain therapy has continued to grow, although the topic has received little research attention until now. MATERIALS AND METHODS: A total of 46 patients were randomized into verum acupuncture, control acupuncture, and drug-based treatment groups. All patients received nonsteroidal antirheumatic drugs (NSAIDs). One hour after drug intake, the verum group also received acupuncture according to classical acupuncture rules (S34, S44 and PC5). The control group had acupuncture needles placed at nonspecific acupuncture points in the midaxillary line. Acupuncture was performed by a blinded acupuncturist, who had learnt exclusively these techniques in the run up to the study. Patients were asked to evaluate their pain before, and at intervals of 20 min, 1 h, 2 h, and 3 h after drug intake/acupuncture treatment using a visual analog scale (VAS). RESULTS: The analgesic effect of acupuncture was significant up to 3 hours in the verum group (p < 0.05). The analgesic effect in the control acupuncture group was significant for up to 1 h after acupuncture (p < 0.05). With reference to the time point before acupuncture, the differences between both acupuncture groups and the drug group were significant (p < 0.01) over the whole time. CONCLUSION: Acupuncture is an effective complement to NSAIDs in the treatment of posttonsillectomy pain. Particularly patients with allergies, drug intolerance, or reduced response to the commonly administered drugs may benefit from acupuncture.

Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.

BACKGROUND: Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated to reduce pain in different clinical contexts, suggesting its potential utility after cardiac surgery. The aim of this open-label, controlled study is to assess whether OMT contributes to sternal pain relief and improves postoperative outcomes. METHODS: Eighty post-sternotomy adult inpatients were randomly allocated one to one to receive a standardized cardiorespiratory rehabilitation program alone (control group) or combined with OMT. Pain intensity and respiratory functional capacity were quantified by the Visual Analogue Scale score and by a standardized breathing test, at the start and end of rehabilitation. RESULTS: At the start of rehabilitation, the control group and the OMT group had similar Visual Analogue Scale median scores (controls 4, interquartile range [IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean inspiratory volumes (controls 825 ± 381 mL; OMT 744 ± 291 mL; p = not significant). At the end of rehabilitation, the OMT group had a lower Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1 to 2; p < 0.01) and higher mean inspiratory volume (controls 1,400 ± 588 mL; OMT 1,781 ± 633 mL; p < 0.01). The analgesic drug intake was similar in the two groups. The hospitalization was shorter in the OMT group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days; p < 0.05). CONCLUSIONS: The combination of standard care with OMT is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy.

The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy.

BACKGROUND: Coccydynia is a challenging disorder that often is refractory to treatments such as medications and injections. Physical therapy for coccydynia rarely has been studied. OBJECTIVE: To evaluate the efficacy of pelvic floor physical therapy for reducing pain levels in patients with coccydynia. DESIGN: Retrospective chart review. SETTING: The pelvic floor rehabilitation clinic of a major university hospital. PATIENTS: A total of 124 consecutive patients over age 18 with a chief complaint of coccydynia between 2009 and 2012. A subgroup of 17 of the 124 patients had previously undergone coccygectomy with continued pain postoperatively. METHODS OR INTERVENTIONS: The primary treatment intervention was pelvic floor physical therapy aimed at pelvic floor muscle relaxation. Secondary treatment interventions included the prescription of baclofen for muscle relaxation (19% of patients), ganglion impar blocks (8%), or coccygeus trigger point injections (17%). MAIN OUTCOME MEASURES: Primary outcome measures included final minimum, average, and maximum pain numeric rating scales. A secondary outcome measure was the patient's subjective percent global improvement assessment. Baseline demographics were used to determine which pretreatment characteristics were correlated with treatment outcomes. RESULTS: Of the 124 patients, 93 participated in pelvic floor physical therapy and were included in statistical analysis. For the 79 patients who completed treatment (with a mean of 9 physical therapy sessions), the mean average pain ratings decreased from 5.08 to 1.91 (P < .001) and mean highest pain ratings decreased from 8.81 to 4.75 (P < .001). The mean percent global improvement was 71.9%. Mean average pain ratings in postcoccygectomy patients improved from 6.64 to 3.27 (P < .001). Greater initial pain scores and a history of previous injections were correlated with P < .001 pain scores on completion of physical therapy. Pain duration and history of trauma did not affect treatment outcomes. CONCLUSIONS: Pelvic floor physical therapy is a safe and effective method of treating coccydynia. LEVEL OF EVIDENCE: III.

Epidural analgesia combined with a comprehensive physiotherapy program after Cytoreductive Surgery and HIPEC is associated with enhanced post-operative recovery and reduces intensive care unit stay: A retrospective study of 124 patients.

BACKGROUND: Although Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) confers health benefits in peritoneal carcinomatosis (PC) treatment, it is associated with significant postoperative morbidity and mortality rate with increased length of hospital stay. The goal of this study is to determine whether a new comprehensive physiotherapy program including epidural loco-regional analgesia can improve the quality of care and patients recovery. METHODS: Between 2009 and 2013, 124 patients with PC were operated for CRS and HIPEC procedures. These patients were analyzed and divided in 2 groups by means of time. No Physio group included patients operated from 2009 to 2011 (n = 57) having a thoracic patient controlled epidural analgesia (PCEA) but no preoperative physiotherapy program. The Physio group included patients operated from 2012 to 2013 (n = 67) having both a PCEA with a preoperative physiotherapy program. RESULTS: The mortality rate was 1.6% (n = 2). The median length of stay in the intensive care unit (ICU) was lower in the Physio group, 2 days vs. 0 for No Physio group (p < 0.0001). The first time of mobilization after surgery was shorter in the Physio group (day 3 vs. 2, p = 0.0043). The overall satisfaction in the Physio group was achieved in 93% of patients, helping in decreasing fear of surgery and mobilization in 70% and 84% of cases respectively. CONCLUSION: Our study demonstrates that a clear pre-operative information and education by a physiotherapist, associated with a PCEA-pain management significantly benefits the patient's post-operative recovery and reduces the length of stay in the ICU.