Coenzyme Q10 supplementation alleviates pain in pregabalin-treated fibromyalgia patients via reducing brain activity and mitochondrial dysfunction.

Although coenzyme Q10 (CoQ10) supplementation has shown to reduce pain levels in chronic pain, the effects of CoQ10 supplementation on pain, anxiety, brain activity, mitochondrial oxidative stress, antioxidants, and inflammation in pregabalin-treated fibromyalgia (FM) patients have not clearly elucidated. We hypothesised that CoQ10 supplementation reduced pain better than pregabalin alone via reducing brain activity, mitochondrial oxidative stress, inflammation, and increasing antioxidant levels in pregabalin-treated FM patients. A double-blind randomised placebo-controlled trial was conducted. Eleven FM patients were enrolled with 2 weeks wash-out then randomly allocated to 2 treatment groups; pregabalin with CoQ10 or pregabalin with placebo for 40 d. Then, patients in CoQ10 group were switched to placebo, and patients in placebo group were switched to CoQ10 for another 40 d. Pain pressure threshold (PPT), FM questionnaire, anxiety, and pain score were examined. Peripheral blood mononuclear cells (PBMCs) were isolated to investigate mitochondrial oxidative stress and inflammation at day 0, 40, and 80. The level of antioxidants and brain positron emission tomography (PET) scan were also determined at these time points. Pregabalin alone reduced pain and anxiety via decreasing brain activity compared with their baseline. However, it did not affect mitochondrial oxidative stress and inflammation. Supplementation with CoQ10 effectively reduced greater pain, anxiety and brain activity, mitochondrial oxidative stress, and inflammation. CoQ10 also increased a reduced glutathione levels and superoxide dismutase (SOD) levels in FM patients. These findings provide new evidence that CoQ10 supplementation provides further benefit for relieving pain sensation in pregabalin-treated FM patients, possibly via improving mitochondrial function, reducing inflammation, and decreasing brain activity.

Predictive Factors for a Long Hospital Stay in Patients Undergoing Laparoscopic Cholecystectomy.

Background. Although the advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy are immediately obvious and appreciated, several patients need a postoperative hospital stay of more than 24 hours. Thus, the predictive factors for this longer stay need to be investigated. The aim of this study was to identify the causes of a long hospital stay after LC. Methods. This is a retrospective cohort study with 500 successful elective LC patients being included in the analysis. Short hospital stay was defined as being discharged within 24 hours after the operation, whereas long hospital stay was defined as the need for a stay of more than 24 hours after the operation. Results. Using multivariable analysis, ten independent predictive factors were identified for a long hospital stay. These included patients with cirrhosis, patients with a history of previous acute cholecystitis, cholangitis, or pancreatitis, patients on anticoagulation with warfarin, patients with standard-pressure pneumoperitoneum, patients who had been given metoclopramide as an intraoperative antiemetic drug, patients who had been using abdominal drain, patients who had numeric rating scale for pain > 3, patients with an oral analgesia requirement > 2 doses, complications, and private ward admission. Conclusions. LC difficulties were important predictive factors for a long hospital stay, as well as medication and operative factors.

Alterations of brain activity in fibromyalgia patients.

Fibromyalgia is a chronic pain syndrome, characterized by widespread musculoskeletal pain with diffuse tenderness at multiple tender points. Despite intense investigations, the pathophysiology of fibromyalgia remains elusive. Evidence shows that it could be due to changes in either the peripheral or central nervous system (CNS). For the CNS changes, alterations in the high brain area of fibromyalgia patients have been investigated but the definite mechanisms are still unclear. Magnetic Resonance Imaging (MRI) and Functional Magnetic Resonance (fMRI) have been used to gather evidence regarding the changes of brain morphologies and activities in fibromyalgia patients. Nevertheless, due to few studies, limited knowledge for alterations in brain activities in fibromyalgia is currently available. In this review, the changes in brain activity in various brain areas obtained from reports in fibromyalgia patients are comprehensively summarized. Changes of the grey matter in multiple regions such as the superior temporal gyrus, posterior thalamus, amygdala, basal ganglia, cerebellum, cingulate cortex, SII, caudate and putamen from the MRI as well as the increase of brain activities in the cerebellum, prefrontal cortex, anterior cingulate cortex, thalamus, somatosensory cortex, insula in fMRI studies are presented and discussed. Moreover, evidence from pharmacological interventions offering benefits for fibromyalgia patients by reducing brain activity is presented. Because of limited knowledge regarding the roles of brain activity alterations in fibromyalgia, this summarized review will encourage more future studies to elucidate the underlying mechanisms involved in the brains of these patients.

Incidence and risk factors associated with ipsilateral shoulder pain after thoracic surgery.

OBJECTIVES: This study was designed to determine the incidence and risk factors associated with ipsilateral shoulder pain (ISP) after thoracic surgery and to investigate characteristics, locations, and severity of ISP. DESIGN: A prospective observational study. SETTING: University hospital. PARTICIPANTS: Two hundred five patients who underwent thoracic surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pain at the incisional site and shoulder pain were assessed separately using the numeric rating scale (NRS) during the patients' stay in the postanesthesia care unit. The overall incidence of ISP was 47.3%. The incidence of ISP in thoracotomy patients (58.7%) was substantially higher than in video-assisted thoracoscopic surgery patients (20.9%). ISP was described most often as a dull aching pain (87%). In approximately half of the patients, ISP was located at the posterior side of the shoulder. The severity of ISP was classified as moderate to severe in 67% of patients. The potential risk factors associated with ISP were surgery using the thoracotomy approach (risk ratio: 2.12, 95% confidence interval: 1.16-3.86, p=0.014) and surgical duration>120 minutes (risk ratio: 1.61, 95% confidence interval: 1.07-2.44, p=0.023). CONCLUSIONS: The incidence of ISP after thoracic surgery was high and the severity of pain was significant. The thoracotomy approach and the long duration of surgery are potential risk factors for ISP.

Effects of preemptive analgesia in laparoscopic cholecystectomy: a double-blind randomized controlled trial.

BACKGROUND: This study aimed to investigate the effect of preemptive etoricoxib compared with placebo in laparoscopic cholecystectomy. METHODS: This randomized, double-blind, placebo-controlled study enrolled 120 patients requiring elective laparoscopic cholecystectomy. The patients were randomized to receive either etoricoxib 120 mg plus diazepam or placebo plus diazepam. Postoperatively, the visual analog score (VAS) for pain, the rescue morphine requirement, and the side effects were recorded. RESULTS: Between February 2006 and September 2007, 120 patients were enrolled in the study. The demographic data between two groups were similar except for mean age. The mean age of the placebo group was younger (p = 0.007). There were no significant differences in bleeding tendency rating scores, duration times between fentanyl and rescue morphine, number of rescue morphine doses, or length of postoperative hospital stay. But the number of oral analgesic drug usages was significantly less in the etoricoxib group (p = 0.006). The postoperative VAS was lower in the etoricoxib group at hours 10 (p = 0.023), 14 (p = 0.045), and 26 (p = 0.011), and the average VAS also was significantly less in the etoricoxib group (p = 0.013). The two groups did not differ significantly in terms of postoperative shoulder pain (p = 0.065). According to the verbal rating scale, the incidence of postoperative nausea and vomiting did not differ significantly between the two groups (p = 0.797), nor did the drug side effects or treatment complications. CONCLUSION: The authors recommend using etoricoxib as a preemptive analgesia to reduce postoperative pain after laparoscopic cholecystectomy.

Comparison of efficacy and effectiveness between ULTRACET and tramadol/acetaminophen in acute postoperative pain after upper extremity surgery.

OBJECTIVE: To compare the efficacy and effectiveness between ULTRACE, a new analgesic combination of tramadol/ acetaminophen, and tramadol/acetaminophen for acute postoperative pain after upper extremity surgery. STUDY DESIGN: A double blind randomized controlled trial. MATERIAL AND METHOD: One hundred and eighty patients who underwent upper extremity surgery under brachial plexus block were randomized to receive either ULTRACE (n = 87) or tramadol and acetaminophen (n = 93) immediately after surgery in the postanesthetic care unit (PACU). Total morphine requirement, pain score (VRS) and drug adverse effects were compared between those two groups using independent single t-test, Mann-Whitney U-test, Chi-square test and Fisher-exact test respectively. RESULTS: Total morphine requirement was significantly lower in subjects who used ULTRACE when compared with the tramadol and acetaminophen group (0.51 and 0.69 mg in the first 6 hours after the operation, 0.0 and 0.13 mg in hours 6-12 after the operation). Moreover there were fewer side effects in this ULTRACE group too. CONCLUSION: ULTRACET has more efficacy and fewer side effects when compared with tramadol and acetaminophen in acute postoperative pain surgery.