Efficacy of Buccal Infiltration with or without Palatal Injection for Posterior Maxillary Teeth Extraction - A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the feasibility of posterior maxillary teeth extraction buccal infiltration with or without the use of palatal injection. Material and Methods: A total of 70 patients underwent extraction of bilateral maxillary posterior teeth under 2% lignocaine hydrochloride with 1:2,00000 adrenaline infiltration in this single-centric split-mouth randomized trial. The test side was administered with a buccal infiltration of 2 mL of anesthetic alone. An extended waiting period of 10 minutes was given before the commencement of the procedure. A standard protocol was followed for the control side. A single operator performed all extractions. Results: A total of 140 posterior maxillary teeth were extracted. Patients marked pain perception on a visual analogue scale in three different instances. During the administration of injections for the test side, the pain score was less than that of the control side and was statistically significant. The overall pain during the extraction procedure was comparable and statistically insignificant. The overall success of the method was 90%. Conclusion: Extraction of posterior maxillary teeth was feasible with a single buccal infiltration without palatal injection in most cases using an extended waiting period. Dentists can attempt extraction without palatal injections with optimal success. However, the alternate technique could be used when there is a necessity for rescue palatal anesthesia.

Efficacy of Higher Gauged Needles or Topical Pre-Cooling for Pain Reduction during Local Anesthesia Injection: A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the efficacy of pre-cooling and the use of higher gauged needles in reducing pain during local anesthetic infiltration. Material and Methods: We conducted a split-mouth randomized controlled trial among 70 patients who require bilateral maxillary local anesthetic (LA) injections for dental treatment. After applying the topical anesthetic, each participant received four local anesthetic injections, two on buccal and two palatal sides. At each visit, the participants received one buccal and one palatal infiltration based on the randomization. On the buccal aspect, participants received LA with a 26G needle injection on one side (control) and a 31G needle (test) on the contralateral side. On the Palatal aspect, participants either received LA with a 31G needle on one side (control). In contrast, the opposite side was preceded by topical ice application (iced cotton swab) before LA with a 31G needle (test). Both the visits were spaced with a gap of 7-10 days based on the participants' feasibility. Participants were asked to rate the pain on a visual analog scale independently for buccal and palatal LA injections. Results: On the Buccal aspect, the mean pain scores were 2.74 ± 1.26 and 2.11 ± 1.26 for control and test groups, respectively (p=0.002). On the Palatal aspect, the mean pain scores were 4.14 ± 1.49 and 4.3 ± 1.80 for control and test groups, respectively (p=0.295). Conclusion: Significant lower pain scores were reported with higher gauge needles (31G) when compared to traditional (26G) needles on the buccal aspect. No significant difference was seen with pre-cooling the injection site on the palatal aspect when used with higher gauged needles (31G).

Psychometric Properties of Pressure Pain Thresholds Measured in 2 Positions for Adults With and Without Neck-Shoulder Pain and Tenderness.

OBJECTIVE: The purpose of this study was to determine the psychometric properties of pressure pain threshold (PPT) testing in adults with and without neck-shoulder pain and tenderness and to compare the differences in PPT measurements between the seated and prone positions. METHODS: Thirty asymptomatic adults and 30 symptomatic patients with intermittent neck-shoulder pain and tenderness completed the study. A pressure algometer was used to assess PPTs at specific points on the middle deltoid, levator scapulae, and upper trapezius muscles of the dominant side of the asymptomatic individuals and the painful side of the patients. Four trials were performed on each muscle in both the seated and prone positions. To determine between-day reliability, a subset of the participants returned to repeat the testing. RESULTS: The intraclass correlation coefficients showed good to excellent within-session reliability and fair to excellent between-day reliability of PPT measurements in both the seated and prone positions for both groups. There were significant differences between groups for all muscles in both positions (P < .05) except for the upper trapezius muscle in the prone position. In addition, significant differences were found between the 2 testing positions for the middle deltoid and upper trapezius muscles in the symptomatic group and for the middle deltoid muscle in the asymptomatic group. CONCLUSION: The results of the study suggest that PPT testing could be useful for distinguishing individuals with and without neck-shoulder pain and tenderness. Further, the patient's position should be considered when testing PPT, specifically at the middle deltoid or upper trapezius muscles.

Assessment of patients' expectations: development and validation of the Expectation for Treatment Scale (ETS).

OBJECTIVE: To develop a short self-report instrument for the assessment of expectations (Expectation for Treatment Scale(ETS)) using acupuncture as a case example. DESIGN: A cross-sectional assessment with retest after 1 week. SETTING: A web-based survey with patients suffering from pain. METHODS: In a three-step approach, we reduced the initially collected number of items from 17 to 9 and to 5, including expectations about coping ability, vitality, physical health and reduction of patient complaints. Items were selected according to internal consistency (Cronbach's alpha); convergent and divergent validities with related constructs (optimism, pessimism, resilience, perceived sensitivity to medicines, depression and others); 1-week retest reliability (intraclass correlation coefficient (ICC)); and exploratory and confirmatory factor analysis (CFA). RESULTS: A total of 102 patients suffering from pain were included, and 54 of these patients completed the retest assessment. The final version of the ETS consisted of five items and had an excellent Cronbach's alpha (0.90), with 72.33% variance on one single factor. Depression, pessimism and perceived sensitivity to medicines showed positive correlations with our expectation measure (r=0.23, r=0.20 and r=0.34, respectively); the correlation between the ETS and optimism was low (r=-0.07) and no correlation between the ETS and resilience was found (r=-0.07). Convergent validity was confirmed with a high correlation (r>0.90) between ETS and a treatment-specific measure of expectations. The retest ICC was 0.86, which showed high stability over 1 week. A CFA (n=439) with data from patients with low back pain confirmed the single-factor structure of the instrument. CONCLUSION: The ETS showed strong psychometric properties and covered a distinct construct. As the next step, the ETS might be implemented in different clinical conditions and settings to investigate psychometrics and its predictive power for treatment outcomes.

Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy.

OBJECTIVE: Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT). METHODS: Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs. RESULTS: Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50% of users for all treatments assessed (range 51-79%). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95% CI = 0.96-0.98) and higher pain disability (OR = 1.01, 95% CI = 1.00-1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95% CI = 1.13-2.84), college graduate or more (OR = 2.02, 95% CI = 1.20-3.40), and higher pain disability (OR = 1.01, 95% CI = 1.01-1.02). CONCLUSIONS: NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.

Intrarater and Inter-rater Reliability of Active Cervical Range of Motion in Patients With Nonspecific Neck Pain Measured With Technological and Common Use Devices: A Systematic Review With Meta-regression.

OBJECTIVES: The purpose of this systematic review was to compare intrarater and inter-rater reliability of active cervical range of motion (ACROM) measures obtained with technological devices to those assessed with low-cost devices in patients with nonspecific neck pain. As a secondary outcome, we investigated if ACROM reliability is influenced by the plane of the assessed movement. METHODS: Medline, Scopus, Embase, the Cochrane Library, CINHAL, PEDro, and gray literature were searched until August 2016. Inclusion criteria were reliability design, population of adults with nonspecific neck pain, examiners of any level of experience, measures repeated at least twice, and statistical indexes on reliability. A device was considered inexpensive if it cost less than €500. The risk of bias of included studies was assessed by Quality Appraisal of Reliability Studies. RESULTS: The search yielded 35 151 records. Nine studies met all eligibility criteria. Their Quality Appraisal of Reliability Studies mean score was 3.7 of 11. No significant effect of the type of device (inexpensive vs expensive) on intraclass correlation coefficient (ICC) was identified for intrarater (ICC = 0.93 vs 0.91; P > .99) and inter-rater reliability (ICC = 0.80 vs 0.87; P > .99). The plane of movement did not affect inter-rater reliability (P = .11). Significant influences were identified with intrarater reliability (P = .0001) of inexpensive devices, where intrarater reliability decreased (P = .01) in side bending, compared with flexion-extension. CONCLUSIONS: The use of expensive devices to measure ACROM in adults with nonspecific neck pain does not seem to improve the reliability of the assessment. Side bending had a lower level of intrarater reliability.

The Effect of Swaddling on Pain, Vital Signs, and Crying Duration during Heel Lance in Newborns.

To determine the effect of swaddling on pain, vital signs, and crying duration during heel lance in the newborn. This was a randomized controlled study of 74 (control: 37, experiment: 37) newborns born between December 2013 and February 2014 at the Ministry of Health Bagcilar Training and Research Hospital. An information form, observation form, and Neonatal Infant Pain Scale were used as data collection tools. Data from the pain scores, peak heart rates, oxygen saturation, total crying time, and duration of the procedure were collected using a video camera. Newborns in the control group underwent routine heel lance, whereas newborns in the experimental group underwent routine heel lance while being swaddled by the researcher. The newborns' pain scores, peak heart rates, oxygen saturation values, and crying durations were evaluated using video recordings made before, during, and 1, 2, and 3 minutes after the procedure. Pain was assessed by a nurse and the researcher. No statistically significant difference was found in the characteristics of the two groups (p > .05). The mean pain scores of swaddled newborns during and after the procedure were lower than the nonswaddled newborns (p < .05). In addition, crying duration of swaddled newborns was found to be shorter than the nonswaddled newborns (p < .05). The average preprocedure peak heart rates of swaddled newborns were higher (p < .05); however, the difference was not significant during and after the procedure (p > .05). Although there was no significant difference in oxygen saturation values before and during the procedure (p > .05), oxygen saturation values of swaddled newborns were higher afterward (p < .05). For this study sample, swaddling was an effective nonpharmacologic method to help reduce pain and crying in an effort to soothe newborns. Although pharmacologic pain management is the gold standard, swaddling can be recommended as a complementary therapy for newborns during painful procedures. Swaddling is a quick and simple nonpharmacologic method that can be used by nurses to help reduce heel stick pain in newborns.

A Vibration Device to Control Injection Discomfort.

Pain from local anesthesia injections can be reduced by distraction and counter-stimulation techniques. This study investigated the DentalVibe® Injection Comfort System (third-generation, DV3), developed to lessen anesthesia pain through pulsed vibration, a form of counter-stimulation. The aim of the study was to evaluate both the efficacy of DV3 in reducing pain and discomfort from intraoral long buccal (LB) and inferior alveolar nerve (IAN) injections and the time needed to achieve complete anesthesia during an IAN block. The study enrolled 60 subjects, 30 men and 30 women, aged 21 to 32 years, who rated both injection pain on a visual analog scale and discomfort, unpleasantness, and difficulty in enduring the injection on a modified symptom severity index. Each subject received bilateral LB injections and an IAN block. Using block design, the third-generation DV (DV3) was randomly assigned to either the first or second LB injection and to 30 subjects on their third injection, the IAN block. No topical anesthesia was applied. Subjects receiving DV3 reported significantly less pain, discomfort, unpleasantness, and difficulty in enduring LB and IAN injections (P < .05), regardless of whether DV3 was used on the first or second LB injection. Time to complete anesthesia was not significantly different (P > .05) when DV3 was used on IAN block injections. The DV3 significantly (P < .02) reduced pain/discomfort from anesthetic injections in this pilot study, in which many subjects were either dental or medical students familiar with performing and enduring injections. More studies are warranted on layperson populations.

Use of the Pain Assessment Screening Tool and Outcomes Registry in an Army Interdisciplinary Pain Management Center, Lessons Learned and Future Implications of a 10-Month Beta Test.

INTRODUCTION: The U.S. Army Comprehensive Pain Management Campaign Plan was launched in 2010 to improve pain outcomes in military populations. Interdisciplinary Pain Management Centers (IPMCs) were established at every Army medical center, each offering a robust array of treatment options including conventional and complementary and integrative medicine (CIM) pain management therapies. The Pain Assessment Screening Tool and Outcomes Registry (PASTOR) was developed to assess and track biopsychosocial aspects of pain management and to identify best treatment practices. METHODS: During a 10-month pilot test of PASTOR at one Army IPMC, active duty patients completed PASTOR at baseline and at significant junctures during their therapeutic course. RESULTS: 322 IPMC patients completed baseline and follow-up PASTOR assessments. The PASTOR outcomes were analyzed for patients who completed a 3- to 6-week CIM program, a 3-week functional restoration program, or both. For most PASTOR domains, a greater proportion of patients who completed both programs reported important improvement compared with patients who completed either program alone. CONCLUSIONS: This pilot test demonstrated the utility of using PASTOR in a military IPMC to track biopsychosocial treatment outcomes. These preliminary data will inform future comparative effectiveness analyses of pain therapies among military and veteran populations.

Percepción del dolor en cistoscopia flexible con el uso de lidocaína intrauretral / Perception of pain in flexible cystoscopy using intraurethral lidocaine

OBJETIVO: La cistoscopia flexible es una técnica utilizada en el diagnóstico de la patología del tracto urinario inferior. El objetivo de este estudio es evaluar la eficacia del anestésico local intrauretral en la percepción del dolor en el paciente. MÉTODOS: Estudio observacional prospectivo no aleatorizado que incluye 142 hombres a los que se realiza cistoscopia flexible. Se dividen en dos grupos en función del uso o no de anestésico local intrauretral (Grupo 1: 70 hombres con anestésico intrauretral [lidocaína 2%]; Grupo 2: 72 hombres sin anestésico intrauretral). Se analiza escala visual analógica y cuestionario del dolor. Análisis estadístico con SPSS 17.0 y significación estadística p≤0,05. RESULTADOS: La edad media del grupo 1 fue de 64,7±10,3 años frente a 66,7±10,8 años en el grupo 2, sin diferencias significativas. La puntuación en la escala visual analógica en el grupo 1 fue 2,23±2,20 frente a 1,69±1,74 en el grupo 2 (p = 0,1). La intensidad del dolor total y actual en el cuestionario del dolor fue de 1,81 ± 0,87 y 1,66 ± 1,65, respectivamente, en el grupo 1 y de 1,72 ± 0,72 y 1,21±1,45, respectivamente, en el grupo 2 (no diferencias significativas). Tras dividir a los pacientes en función de una puntuación en la escala visual analógica ≤ 2, se observa que la causa que motivó la cistoscopia es un factor independiente asociado a la percepción del dolor, incrementando el riesgo de percibir más dolor en 1,89. CONCLUSIÓN: El uso de anestésico local como lubricante previo a cistoscopia flexible no parece disminuir el dolor y consideramos que no está indicado de rutina en esta técnica diagnóstica

OBJECTIVE: The aim of this study is to evaluate the efficacy of a local intraurethral anesthetic on the pain perceived by the patient during flexible cystoscopy. METHODS: An observational, prospective, nonrandomized, study was conducted on 142 males subjected to a flexible cystoscopy. The patients were divided into two groups: Group 1: 70 patients with intraurethral anesthetic (lidocaine 2%), and Group 2:72 patients without intraurethral anesthetic. The results were scored on a visual analog scale and a pain questionnaire and analyzed. The statistical analysis was performed using SPSS 17.0 and with a statistical significance of p ≤ 0.05. RESULTS: The mean age of Group 1 was 64.7 ± 10.3 years compared to 66.7 ± 10.8 years in Group 2, with no significant differences. The score on the visual analog scale in Group 1 was 2.23 ± 2.20 versus 1.69 ± 1.74 in Group 2 (p = 0.1). The overall and current pain intensity in the pain questionnaire was 1.81 ± 0.87 and 1.66 ± 1.65, respectively, in Group 1, and 1.72 ± 0.72 and 1.21 ± 1.45, respectively, in Group 2 (no significant differences). After dividing the patients into groups according to a visual analog scale score ≤ 2, it was observed that the cause that led to cystoscopy was an independent factor associated with the perception of pain, increasing the risk of perceiving more pain by 1.89. CONCLUSIÓN: The use of local anesthetic as a lubricant prior to flexible cystoscopy does not appear to reduce pain, and we consider that its routine use is not indicated

Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho / Impact of a structured aquatic therapy program on patients with knee osteoarthritis

A osteoartrite é uma doença articular degenerativa, reumática crônica, multifatorial de alta prevalência, atinge 10% da população com mais de 65 anos. Afeta igualmente ambos os sexos, sendo que na mulher a incidência é maior após o período da menopausa. Esta doença compreende 65% das causas de incapacidade, atrás somente de doenças cardiovasculares e mentais. A reabilitação do paciente com artrose é um processo complexo que envolve procedimentos especializados Objetivo: Avaliar os efeitos de um programa de hidrocinesioterapia sobre a capacidade de realização de atividades da vida diária em pacientes com osteoartrite. Métodos: Este é um estudo prospectivo, onde vinte e seis pacientes com histórico de osteoartrite de joelho foram submetidos a um programa de tratamento em hidrocinesioterapia, com frequência de duas vezes por semana com duração de 50 minutos cada sessão. O programa consistia de quatro fases, sendo elas: aquecimento, alongamento, fortalecimento e relaxamento. Estes pacientes foram avaliados pré e pós-tratamento. Utilizando como método de avaliação a goniometria, escala de dor EVA e Teste de Caminhada de Seis Minutos. Resultados: Houve melhora significante da amplitude de movimento ao realizar flexão dos joelhos acometidos, também foi visto diminuição significativa da dor e melhora significante na capacidade de realização das atividades de vida diária avaliada por meio da distância percorrida no teste de caminhada de seis minutos. Conclusão: Houve melhora da capacidade de realizar AVD e da capacidade física, assim como redução do quadro álgico e aumento da amplitude de movimento

Osteoarthritis is a pervasive, chronic rheumatic, multifactorial, degenerative joint disease, afflicting 10% of the population over 65 years of age. It affects both genders, and in women the incidence is higher after menopause. This disease comprises 65% of the causes of disability, exceeded only by cardiovascular and mental disorders. The rehabilitation of patients with osteoarthritis is a complex process that involves specialized procedures Objective: To evaluate the effects of a hydrotherapy program on the ability to perform activities of daily living in patients with osteoarthritis. Method: This is a prospective study where twenty-six patients with knee osteoarthritis history underwent a treatment program in aquatic therapy, often twice a week lasting 50 minutes each session. The program consisted of four phases, namely: warming up, stretching, strengthening, and relaxation. These patients were evaluated before and after treatment. Assessments were done with the goniometer, EVA pain scale, and Six Minute Walk Test. Results: There was significant improvement in range of motion when performing flexion of the affected knees, as well as a significant decrease in pain and a significant improvement in the ability to perform the activities of daily living, assessed by the distance walked in the six-minute walk test. Conclusion: There was an improved ability to perform ADLs and inn physical capacity, as well as reduced pain and increased range of motion

Efectos de un programa de prevención de caídas con Ai Chi acuático en pacientes diagnosticados de parkinson / Effects of an Ai Chi fall prevention programme for patients with Parkinson's disease

Introducción: Un síntoma principal de la enfermedad de Parkinson es la alta incidencia en caídas y deterioro en el equilibrio, tanto estático como dinámico. El objetivo de este estudio es determinar el efecto de un programa de entrenamiento de Ai Chi acuático sobre la prevención de caídas en pacientes con Parkinson, mejorando su autonomía funcional y su percepción del dolor físico. Método: Quince pacientes diagnosticados de Parkinson (Hoehn y Yahr, rango: 1-3) participaron en un programa de intervención de Ai Chi acuático de 10 semanas de duración, con sesiones 2 veces por semana. Se emplearon las escalas EVA de dolor, Tinetti de equilibrio y marcha y el test Get up and Go. Resultados: Los resultados se obtuvieron aplicando la prueba de Friedman para 3 muestras relacionadas, en los pacientes antes de la terapia, después de la terapia y al mes de la terapia. Los datos obtenidos mostraron una mejoría significativa (p < 0,001) al comparar los resultados mostrados en las 3 mediciones, donde los valores de percepción de dolor, equilibrio y funcionalidad en marcha han disminuido significativamente, incluso al mes de finalizar las mismas los pacientes seguían mostrando mejoría y mantenimiento en sus resultados. Conclusión: Un programa de Ai Chi en el agua parece ser un tratamiento factible para los pacientes diagnosticados con EP en un grado leve y moderado en el tratamiento del dolor, equilibrio y capacidad funcional

Introduction: One of the main symptoms of Parkinson's disease is the high incidence of falls occurring due to the decline of both static and dynamic balance. The aim of this study is to determine the effect of an Ai Chi programme designed to prevent falls in patients with Parkinson's disease by improving both functional independence and perception of physical pain. Methods: Fifteen patients diagnosed with Parkinson's disease (Hoehn and Yahr stages 1-3) participated in a 10-week Ai Chi programme consisting of 30 to 45-minute aquatic exercise sessions twice a week. The assessment measures used in this study were the pain visual analogue scale (VAS), the Tinetti gait and balance assessment tool, and the Timed Get up and Go test. Results: The results were calculated by applying the Friedman test to 3 related measurements: patients at baseline, at post-treatment (at the end of the 10 week programme) and after one month of follow-up. The data obtained showed a significant improvement (p < .001) in scores for pain perception, balance, and gait function after the treatment programme. Furthermore, patients continued to show significant improvements and the benefits remained at the one-month follow-up visit. Conclusion: Ai Chi is a promising and feasible aquatic treatment for improving pain perception, balance, and functional capacity in patients diagnosed with mild or moderate Parkinson's disease

[Detection of pain thresholds of acupoints for irritable bowel syndrome].

OBJECTIVE: To compare the pain thresholds of acupoints in the meridians related to irritable bowel syndrome(IBS) between IBS patients and healthy people. METHODS: Thirty-four healthy adults were collected into a normal group,and 60 patients with IBS were arranged into an IBS group. Pain thresholds were detected on the acupoints of large intestinal,small intestinal,stomach,spleen,gallbladder meridians and some commone use acupoints for IBS by pain measuring apparatus three times. Bilateral jing-well,xing-spring,shu-stream,jing-river,he-sea,front mu-alarm,lower he-sea,yuan-primary,luo-connecting and back shu-transport points of each meridian were selected as the main acupoints. And pain thresholds of acupoints common used in clinic were compared between the two groups. RESULTS: The thresholds of five shu-transport points and luo-connecting point of the large intestinal meridian in the IBS group were apparently lower than those in the normal group(all P<0.05),with Hegu(LI 4),Tianshu(ST 25),Shangjuxu(ST 37) and Dachangshu(BL 25) more decreasing(all P<0.01). The thresholds of five shu-transport points,front mu-alarm point and yuan-primary point of the small intestinal meridian in the IBS group were obviously lower than those in the normal group(all P<0.05),with Zhizheng(SI 7),Xiajuxu(ST 39) and Xiaochangshu(BL 27) more decreasing(all P<0.01). The thresholds of Zusanli(ST 36),Weishu(BL 21),Yanglingquan(GB 34),Danshu(BL 19),Pishu(BL 20),Neiguan(PC 6),Taichong(LR 3),Taixi(KI 3),Sanyinjiao(SP 6) and Qihai(CV 6) in the IBS group were markedly lower than those in the normal group(all P<0.05). CONCLUSIONS: The pathological changes of IBS often appeared in the stomach,large intestinal,small intestinal,bladder meridians,and some acupoints in the liver,spleen and kidney meridians. When the functions of viscera are abnormal,the pain thresholds of related acupoints tend to decrease,and meridians and acupoints become sensitized from quiet state.

[Design of low-intermediate frequency electrotherapy and pain assessment system].

Aiming at the single treatment and the design separation between treatment and assessment in electrotherapy equipment, a kind of system including low-intermediate frequency treatment and efficacy evaluation was developed. With C8051F020 single-chip microcomputer as the core and the circuit design and software programming used, the system realized the random switch of therapeutic parameters, the collection, display and data storage of pressure pain threshold in the assessment. Experiment results showed that the stimulus waveform, current intensity, frequency, duty ratio of the system output were adjustable, accurate and reliable. The obtained pressure pain threshold had a higher accuracy (< 0.3 N) and better stability, guiding the parameter choice in the precise electrical stimulation. It, therefore, provides a reliable technical support for the treatment and curative effect assessment.

Implementation fidelity of self-administered transcutaneous electrical nerve stimulation (TENS) in patients with chronic back pain: an observational study.

OBJECTIVES: The efficacy of transcutaneous electrical nerve stimulation (TENS) for pain relief has not been reliably established. Inconclusive findings could be due to inadequate TENS delivery and inappropriate outcome assessment. Electronic monitoring devices were used to determine patient compliance with a TENS intervention and outcome assessment protocol, to record pain scores before, during, and after TENS, and measure electrical output settings. METHODS: Patients with chronic back pain consented to use TENS daily for 2 weeks and to report pain scores before, during, and after 1-hour treatments. A ≥ 30% reduction in pain scores was used to classify participants as TENS responders. Electronic monitoring devices "TLOG" and "TSCORE" recorded time and duration of TENS use, electrical settings, and pain scores. RESULTS: Forty-two patients consented to participate. One of 35 (3%) patients adhered completely to the TENS use and pain score reporting protocol. Fourteen of 33 (42%) were TENS responders according to electronic pain score data. Analgesia onset occurred within 30 to 60 minutes for 13/14 (93%) responders. It was not possible to correlate TENS amplitude, frequency, or pulse width measurements with therapeutic response. DISCUSSION: Findings from TENS research studies depend on the timing of outcome assessment; pain should be recorded during stimulation. TENS device sophistication might be an issue and parameter restriction should be considered. Careful protocol design is required to improve adherence and monitoring is necessary to evaluate the validity of findings. This observational study provides objective evidence to support concerns about poor implementation fidelity in TENS research.

Intraexaminer and interexaminer reliability of manual palpation and pressure algometry of the lower limb nerves in asymptomatic subjects.

OBJECTIVE: Nerve palpation is a method of clinically identifying mechanosensitivity of neural tissue by means of pressure algometry and manual palpation. There are few investigations of the reliability of lower limb nerve palpation, and femoral nerve palpation has never been previously reported. The aim of this study was to investigate the reliability of nerve palpation of the femoral, sciatic, tibial, and common peroneal nerves and to report normative values for the femoral nerve. METHODS: The 4 lower limb nerves were palpated in 39 healthy volunteers using pressure algometry and manual digital palpation. Measurements were taken twice by 1 rater (intrarater reliability) and once by a second rater (interrater reliability). RESULTS: Intraclass correlation coefficients for pressure pain thresholds (PPTs) via pressure algometry of the femoral, common peroneal, tibial, and sciatic nerves were 0.69, 0.84, 0.64, and 0.9 for intrarater reliability, respectively, and 0.82, 0.7, 0.56, and 0.75 for interrater reliability. κ Values for manual palpation were 0.59, 0.55, 0.42, and 0.60 for intrarater reliability and 0.30, 0.49, 0.37, and 0.60 for interrater reliability. Males demonstrated significantly higher PPTs than females for the femoral, sciatic, and tibial nerves, and differences in PPTs were present between right and left sides. CONCLUSION: Nerve palpation of the femoral, common peroneal, and sciatic nerves using pressure algometry demonstrated good to excellent reliability, whereas the tibial nerve PPTs showed moderate to good reliability. Manual palpation measurements demonstrated fair to moderate reliability.

Tratamento intensivo do linfedema, pós-tratamento de câncer de mama, em pacientes com lesão neurológica / Intensive treatment of breast cancer-related lymphedema in patients with neurological injuries

O objetivo do presente estudo é relatar o tratamento intensivo do linfedema, após câncer de mama, em paciente com perda da força muscular do membro. Relata-se o caso de uma paciente de 51 anos de idade, que evoluiu com linfedema pós-tratamento do câncer de mama, com mastectomia + esvaziamento axilar + quimioterapia e radioterapia. Após procurar a Clínica Godoy para tratamento em agosto de 2012, foi avaliada com a bioimpedância e volumetria inicial e diária. Realizou tratamento intensivo durante três dias consecutivos, por um período de 6 horas, com Terapia Linfática Manual, Terapia Linfática Mecânica (RA Godoy®) e uso de braçadeira de gorgorão, sendo feitos ajustes diários. Na avaliação inicial, apresentava dor de intensidade 10 (Escala de Dor), parestesia em todo o braço e uma diferença de volume total do edema de 577g em relação ao membro contra-lateral. No primeiro dia de tratamento obteve redução da parestesia com o uso da braçadeira de gorgorão e Terapia Linfática Mecânica; no segundo dia, a dor havia diminuído para a intensidade sete (Escala de Dor); no terceiro dia, a dor diminuiu para intensidade cinco (Escala de Dor) e a diferença de volume total do edema passou a ser de 193g. A paciente retornou para sua casa mantendo as mesmas recomendações e tratamento propostos na clínica. O acompanhamento é feito com avaliações de rotina e orientações sobre a importância do uso da braçadeira de gorgorão e drenagem linfática mecânica.

The aim of this study is to report on the intensive treatment of lymphedema resulting from breast cancer therapy in a 51-year-old patient who experienced loss of muscle strength of the arm. This patient developed lymphedema after a mastectomy, axillary resection, chemotherapy and radiation therapy to treat breast cancer. When the patient arrived at the Clinica Godoy for treatment in August 2012, she was evaluated using bioimpedance and volumetry before and then every day during treatment. Intensive treatment was carried out for six hours per day on three consecutive days employing Manual Lymphatic Therapy, Mechanic Lymphatic therapy (RA Godoy®) and a grosgrain compression sleeve with daily adjustments to the size. In the initial physical examination the patient reported a score for the intensity of pain of 10 (Pain Scale), paresthesia in the entire arm and there was a 577 mL difference in volume due to edema compared to the contralateral limb. On Treatment Day 1 the paresthesia was reduced using the grosgrain sleeve and Mechanical Lymphatic Therapy; on Treatment Day 2, the pain had dropped to an intensity of 7 (Pain Scale); on Treatment Day 3, the pain decreased to an intensity of 5 (Pain Scale) and the difference in the volume of edema was only 193 mL. The patient returned home but followed the recommendations and treatment program used at the clinic. Monitoring was by routine assessments and guidance on the importance of using the grosgrain sleeve and Mechanical Lymphatic Therapy to maintain the results and prevent neurological damage.

Thermal threshold testing for evaluation of analgesics in New Zealand white rabbits.

We adapted a thermal analgesiometric device developed for cats for use in unrestrained rabbits. A probe composed of an electrical element and temperature sensor was held against shaved skin by using an elasticized band placed circumferentially around the thorax. An inflated bladder located between the probe and elastic maintained constant contact between probe and skin. The probe was heated until the rabbit displayed a behavioral reaction or the safety cutoff of 55 °C was reached. Threshold temperatures in unmedicated rabbits were stable over a 5-h period provided that tests were 15 min or more apart. Careful acclimation and testing resulted in no false-negative responses, and sham testing did not produce false-positive results. When compared with baseline values, thermal thresholds were significantly increased from 30 to 240 min, but not 300 min, after the administration of morphine at 3 mg/kg. Administration of equivalent volumes of saline via the same route had no effect on thermal threshold. This device may be suitable for investigating analgesic pharmacology in rabbits.

Test-retest reliability, repeatability, and sensitivity of an automated deformation-controlled indentation on pressure pain threshold measurement.

OBJECTIVE: The purpose of this study was to construct a computerized deformation-controlled indentation system and compare its test-retest reliability, repeatability, and sensitivity with a manual algometer for pressure pain threshold (PPT) measurements. METHODS: Pressure pain threshold measurements were made on 16 healthy subjects for 2 sessions on bilateral erector spinae muscles at L1, L3, and L5 spinal levels, consisting of 5 repeated trials each using computerized algometry on one side and manual algometry on the other side. Mean, SD, coefficient of variation, standard error of measurement, minimal detectable change, and intraclass correlation coefficient were calculated for both manual and computerized PPT measurements. Effects of session, level, method, and side on PPT measurements were evaluated using analysis of variance. RESULTS: Manual PPT measurements were significantly larger than computerized PPT measurements (P = .017), and session 2 was significantly larger than session 1 (P = .021). Coefficient of variation, intraclass correlation coefficient, standard error of measurement, and minimal detectable change of the manual and computerized PPT measurements were 10.3%, 0.91, 0.19 kg/cm(2), and 0.54 kg/cm(2) and 15.6%, 0.87, 0.26 kg/cm(2), and 0.73 kg/cm(2), respectively. CONCLUSIONS: Although computerized algometry offers the benefits of eliminating the effects of operator reaction time, operator anticipation, alignment error, and variation in indentation rate on PPT measurements, these results indicate that manual algometry using load-controlled strategy may be better than computerized deformation-controlled algometry in terms of test-retest reliability, repeatability, and sensitivity. Constant load-controlled indentation protocol may be more favorable for PPT measurements. Future computerized instrumentation for PPT measurements should adopt a load-controlled mechanism.