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Mindfulness-based interventions (MBIs) have demonstrated therapeutic efficacy for various psychological conditions, and smartphone apps that facilitate mindfulness practice can enhance the reach and impact of MBIs. The goal of this review was to summarize the published evidence on the impact of mindfulness apps on the psychological processes known to mediate transdiagnostic symptom reduction after mindfulness practice. A literature search from January 1, 1993, to August 7, 2023 was conducted on three databases, and 28 randomized controlled trials involving 5963 adults were included. Across these 28 studies, 67 outcome comparisons were made between a mindfulness app group and a control group. Between-group effects tended to favor the mindfulness app group over the control group in three psychological process domains: repetitive negative thinking, attention regulation, and decentering/defusion. Findings were mixed in other domains (i.e., awareness, nonreactivity, non-judgment, positive affect, and acceptance). The range of populations examined, methodological concerns across studies, and problems with sustained app engagement likely contributed to mixed findings. However, effect sizes tended to be moderate to large when effects were found, and gains tended to persist at follow-up assessments two to six months later. More research is needed to better understand the impact of these apps on psychological processes of change. Clinicians interested in integrating apps into care should consider app-related factors beyond evidence of a clinical foundation and use app databases to identify suitable apps for their patients, as highlighted at the end of this review.
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This review analyzed the effects of an exercise program on psychoemotional and quality-of-life (QoL) factors in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). Studies were identified from the PubMed and Web of Science databases (from inception to 24 August 2022), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based in turn on the Delphi list. A total of 20 randomized controlled studies were included with 1219 participants. The main result of this systematic review is that exercise program interventions produce improvements on psychoemotional and QoL factors in adult patients with cancer and HSCT or BMT. Moreover, exercise programs may have a beneficial effect on health, maintaining or increasing the patient's QoL. Further, it has a positive effect on the prevention and control of transplant complications in combination with medical treatment.
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Trasplante de Células Madre Hematopoyéticas , Neoplasias , Humanos , Adulto , Trasplante de Médula Ósea , Calidad de Vida , Neoplasias/terapia , Terapia por EjercicioRESUMEN
This study looks at the effects of exercise programs on physical factors and safety in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). A systematic search was performed in the PubMed and Web of Science databases (from inception to 26 August 2021). A review was carried out following the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based, in turn, on the Delphi list. A total of 25 randomized controlled trials studies were included, comprising 1434 patients. The most significant result of this systematic review is that exercise program interventions are safe and produce positive changes in cardiorespiratory fitness, muscle strength, and the functional mobility-state in adult patients with cancer and HSCT or BMT. Only 3 patients from the 711 participants in the exercise interventions (i.e., 0.42%) reported adverse events related to exercise interventions. Moreover, exercise training programs may have a cardiological and muscular protective effect, as well as a healthy effect on the prevention and control of transplant complications, improving health outcomes.
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Trasplante de Células Madre Hematopoyéticas , Neoplasias , Ejercicio Físico , Terapia por Ejercicio , Humanos , Fuerza Muscular/fisiología , Neoplasias/terapia , Calidad de VidaRESUMEN
Recent neuroscience studies demonstrate that a deeper understanding of brain function requires a deeper understanding of behavior. Detailed behavioral measurements are now often collected using video cameras, resulting in an increased need for computer vision algorithms that extract useful information from video data. Here we introduce a new video analysis tool that combines the output of supervised pose estimation algorithms (e.g. DeepLabCut) with unsupervised dimensionality reduction methods to produce interpretable, low-dimensional representations of behavioral videos that extract more information than pose estimates alone. We demonstrate this tool by extracting interpretable behavioral features from videos of three different head-fixed mouse preparations, as well as a freely moving mouse in an open field arena, and show how these interpretable features can facilitate downstream behavioral and neural analyses. We also show how the behavioral features produced by our model improve the precision and interpretation of these downstream analyses compared to using the outputs of either fully supervised or fully unsupervised methods alone.
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Algoritmos , Inteligencia Artificial/estadística & datos numéricos , Conducta Animal , Grabación en Video , Animales , Biología Computacional , Simulación por Computador , Cadenas de Markov , Ratones , Modelos Estadísticos , Redes Neurales de la Computación , Aprendizaje Automático Supervisado/estadística & datos numéricos , Aprendizaje Automático no Supervisado/estadística & datos numéricos , Grabación en Video/estadística & datos numéricosRESUMEN
CRISPR-Cas9 technologies have dramatically increased the ease of targeting DNA sequences in the genomes of living systems. The fusion of chromatin-modifying domains to nuclease-deactivated Cas9 (dCas9) has enabled targeted epigenome editing in both cultured cells and animal models. However, delivering large dCas9 fusion proteins to target cells and tissues is an obstacle to the widespread adoption of these tools for in vivo studies. Here, we describe the generation and characterization of two conditional transgenic mouse lines for epigenome editing, Rosa26:LSL-dCas9-p300 for gene activation and Rosa26:LSL-dCas9-KRAB for gene repression. By targeting the guide RNAs to transcriptional start sites or distal enhancer elements, we demonstrate regulation of target genes and corresponding changes to epigenetic states and downstream phenotypes in the brain and liver in vivo, and in T cells and fibroblasts ex vivo. These mouse lines are convenient and valuable tools for facile, temporally controlled, and tissue-restricted epigenome editing and manipulation of gene expression in vivo.
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Sistemas CRISPR-Cas , Epigénesis Genética , Epigenoma , Edición Génica/métodos , Regulación de la Expresión Génica , Animales , Encéfalo/metabolismo , Femenino , Fibroblastos/metabolismo , Humanos , Hígado/metabolismo , Masculino , Ratones , Ratones Transgénicos , Linfocitos T/metabolismoRESUMEN
New neurons born in the adult brain undergo a critical period soon after migration to their site of incorporation. During this time, the behavior of the animal may influence the survival or culling of these cells. In the songbird song system, earlier work suggested that adult-born neurons may be retained in the song motor pathway nucleus HVC with respect to motor progression toward a target song during juvenile song learning, seasonal song restructuring, and experimentally manipulated song variability. However, it is not known whether the quality of song per se, without progressive improvement, may also influence new neuron survival. To test this idea, we experimentally altered song acoustic structure by unilateral denervation of the syrinx, causing a poor quality song. We found no effect of aberrant song on numbers of new neurons in HVC, suggesting that song quality does not influence new neuron culling in this region. However, aberrant song resulted in the loss of left-side dominance in new neurons in the auditory region caudomedial nidopallium (NCM), and a bilateral decrease in new neurons in the basal ganglia nucleus Area X. Thus new neuron culling may be influenced by behavioral feedback in accordance with the function of new neurons within that region. We propose that studying the effects of singing behaviors on new neurons across multiple brain regions that differentially subserve singing may give rise to general rules underlying the regulation of new neuron survival across taxa and brain regions more broadly.
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Geografía , Neurogénesis , Pliegues Vocales/inervación , Vocalización Animal/fisiología , Envejecimiento/fisiología , Animales , Proteína Doblecortina/metabolismo , Masculino , Neuronas/fisiologíaRESUMEN
It is well established that seizures beget seizures, yet the cellular processes that underlie progressive epileptogenesis remain unclear. Here, we use optogenetics to briefly activate targeted populations of mouse piriform cortex (PCx) principal neurons in vivo. After just 3 or 4 days of stimulation, previously subconvulsive stimuli trigger massive, generalized seizures. Highly recurrent allocortices are especially prone to "optokindling." Optokindling upsets the balance of recurrent excitation and feedback inhibition. To understand how this balance is disrupted, we then selectively reactivate the same neurons in vitro. Surprisingly, we find no evidence of heterosynaptic potentiation; instead, we observe a marked, pathway-specific decrease in feedback inhibition. We find no loss of inhibitory interneurons; rather, decreased GABA synthesis in feedback inhibitory neurons appears to underlie weakened inhibition. Optokindling will allow precise identification of the molecular processes by which brain activity patterns can progressively and pathologically disrupt the balance of cortical excitation and inhibition.
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Estimulación Eléctrica/métodos , Retroalimentación Sensorial , Corteza Piriforme/fisiopatología , Convulsiones/fisiopatología , Sinapsis/metabolismo , Ácido gamma-Aminobutírico/metabolismo , Animales , Electrodos Implantados , Potenciales Evocados/fisiología , Retroalimentación Fisiológica , Femenino , Masculino , Ratones , Neuronas/metabolismo , Neuronas/patología , Optogenética/métodos , Corteza Piriforme/metabolismo , Convulsiones/metabolismo , Técnicas Estereotáxicas , Sinapsis/patología , Transmisión SinápticaRESUMEN
Food consumption is necessary for organisms to maintain metabolic homeostasis. Both extrinsic and intrinsic processes, relayed via intricate neural circuitry, orchestrate the initiation and termination of food intake. More specifically, there are functionally distinct neural circuits that mediate either homeostatic or hedonic suppression of feeding. Notably, being satiated is a positive feeling whereas food aversion is a negative feeling. While significant progress has been made toward elucidating neural circuitry underlying aversive appetite suppression in mice, the circuitry underlying homeostatic satiety is not fully understood. The lateral parabrachial nucleus (PBL) is known as a node that regulates various sensory and visceral processes. Here, we identified and selectively labeled neurons in the caudal lateral region of PBL (PBcl) that are activated by consumption of condensed milk, chocolate Ensure, or peanut butter, which we refer to as PBcl-palatable-food activated neurons (PANs). Specific optogenetic activation of PANs induced positive place preference but decreased the consumption of high-caloric foods such as condensed milk, whereas silencing these cells significantly increased condensed milk consumption in feeding assays. Thus, the PBcl PANs revealed here represent a novel neural substrate regulating caloric-sufficiency mediated satiation.
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Ingestión de Alimentos/fisiología , Conducta Alimentaria/fisiología , Neuronas/citología , Núcleos Parabraquiales/citología , Saciedad/fisiología , Animales , Femenino , Alimentos , Masculino , Ratones , Vías Nerviosas/fisiología , Neuronas/fisiología , Núcleos Parabraquiales/fisiologíaRESUMEN
BACKGROUND: Chia oil possesses a very high content of polyunsaturated fatty acids, mainly α-linolenic acid. This characteristic makes this oil possess beneficial properties to health but gives it a high susceptibility to the oxidation process. Microencapsulation and the addition of natural antioxidants are alternatives to protect chia oil against oxidative deterioration. The aim of this study was to investigate the physicochemical characteristics and the oxidative stability of chia seed oil microencapsulated with different natural antioxidants (Guardian Chelox, which is a commercial blend of extracts from chamomile and rosemary, and essential oils from Origanum vulgare, Origanum x majoricum, and Mentha spicata) by freeze-drying using sodium caseinate and lactose as wall materials. RESULTS: The main physicochemical properties of the microencapsulated chia oil were similar regardless of the presence of antioxidant. The moisture content was 38.1 ± 4.0 g kg-1 ; the microencapsulation efficiency was higher than 85% in all cases. The freeze-drying microencapsulation significantly enhanced (P ≤ 0.05) the oxidative stability of the chia oil. The addition of natural antioxidants conferred chia oil additional protection against lipid oxidation, depending on the type and concentration (500 or 1000 mg kg-1 of the emulsion previous to freeze-drying) of the antioxidant. Among them, Guardian Chelox (1000 mg kg-1 ), presented the highest induction time obtained by the Rancimat accelerated oxidative stability test and the lowest peroxide values after 90 days of storage (33% relative humidity, 25 ± 2 °C). Overall, the microparticles with antioxidants presented a lower degree of yellowing during storage than the control system. CONCLUSION: The use of different natural antioxidants confers freeze-dried microencapsulated chia seed oil additional protection against lipid oxidation. This information is relevant for the application of this oil, which is a rich source of omega-3 fatty acids, in the food industry. © 2018 Society of Chemical Industry.
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Antioxidantes/química , Extractos Vegetales/química , Aceites de Plantas/química , Manzanilla/química , Composición de Medicamentos , Ácidos Grasos Omega-3/química , Liofilización , Origanum/química , Oxidación-Reducción , Rosmarinus/química , Salvia/química , Semillas/químicaRESUMEN
In the version of this article initially published, ORCID links were missing for authors Erica Rodriguez, Koji Toda and Fan Wang. The error has been corrected in the HTML and PDF versions of the article.
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Minorities in the United States such as African Americans and Hispanics may have more severe disease than non-Hispanic whites. Factors contributing to these disparities are reviewed. The variations in disability from non-Hispanic whites may be the result of differences in clinical presentation, genetic underpinnings, and sociocultural factors. Creating awareness and increasing participation in research studies may improve our understanding.
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Disparidades en el Estado de Salud , Esclerosis Múltiple/etnología , Negro o Afroamericano , Femenino , Hispánicos o Latinos , Humanos , Masculino , Estados Unidos , Población BlancaRESUMEN
Humans often rank craniofacial pain as more severe than body pain. Evidence suggests that a stimulus of the same intensity induces stronger pain in the face than in the body. However, the underlying neural circuitry for the differential processing of facial versus bodily pain remains unknown. Interestingly, the lateral parabrachial nucleus (PBL), a critical node in the affective pain circuit, is activated more strongly by noxious stimulation of the face than of the hindpaw. Using a novel activity-dependent technology called CANE developed in our laboratory, we identified and selectively labeled noxious-stimulus-activated PBL neurons and performed comprehensive anatomical input-output mapping. Surprisingly, we uncovered a hitherto uncharacterized monosynaptic connection between cranial sensory neurons and the PBL-nociceptive neurons. Optogenetic activation of this monosynaptic craniofacial-to-PBL projection induced robust escape and avoidance behaviors and stress calls, whereas optogenetic silencing specifically reduced facial nociception. The monosynaptic circuit revealed here provides a neural substrate for heightened craniofacial affective pain.
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Dolor Facial/fisiopatología , Dolor Facial/psicología , Nociceptores , Sinapsis , Afecto , Vías Aferentes/fisiopatología , Animales , Conducta Animal , Condicionamiento Operante , Femenino , Genes fos/genética , Masculino , Ratones , Ratones Endogámicos C57BL , Optogenética , Estimulación FísicaRESUMEN
Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.
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Discapacidades del Desarrollo , Personas con Discapacidad , Accesibilidad a los Servicios de Salud , Discapacidad Intelectual , Disparidades en el Estado de Salud , Humanos , Terapia OcupacionalRESUMEN
We developed a technology (capturing activated neuronal ensembles [CANE]) to label, manipulate, and transsynaptically trace neural circuits that are transiently activated in behavioral contexts with high efficiency and temporal precision. CANE consists of a knockin mouse and engineered viruses designed to specifically infect activated neurons. Using CANE, we selectively labeled neurons that were activated by either fearful or aggressive social encounters in a hypothalamic subnucleus previously known as a locus for aggression, and discovered that social-fear and aggression neurons are intermixed but largely distinct. Optogenetic stimulation of CANE-captured social-fear neurons (SFNs) is sufficient to evoke fear-like behaviors in normal social contexts, whereas silencing SFNs resulted in reduced social avoidance. CANE-based mapping of axonal projections and presynaptic inputs to SFNs further revealed a highly distributed and recurrent neural network. CANE is a broadly applicable technology for dissecting causality and connectivity of spatially intermingled but functionally distinct ensembles.
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Agresión , Conducta Animal/fisiología , Miedo/fisiología , Hipotálamo/citología , Red Nerviosa/fisiología , Neuronas/fisiología , Conducta Social , Animales , Axones/metabolismo , Axones/fisiología , Técnicas de Sustitución del Gen , Hipotálamo/metabolismo , Hipotálamo/fisiología , Ratones , Red Nerviosa/metabolismo , Neuronas/metabolismo , Optogenética , Proteínas Proto-Oncogénicas c-fos/metabolismo , Núcleo Hipotalámico Ventromedial/citología , Núcleo Hipotalámico Ventromedial/metabolismo , Núcleo Hipotalámico Ventromedial/fisiologíaRESUMEN
UNLABELLED: Anatomical studies have identified brainstem neurons that project bilaterally to left and right oromotor pools, which could potentially mediate bilateral muscle coordination. We use retrograde lentiviruses combined with a split-intein-mediated split-Cre-recombinase system in mice to isolate, characterize, and manipulate a population of neurons projecting to both the left and right jaw-closing trigeminal motoneurons. We find that these bilaterally projecting premotor neurons (BPNs) reside primarily in the supratrigeminal nucleus (SupV) and the parvicellular and intermediate reticular regions dorsal to the facial motor nucleus. These BPNs also project to multiple midbrain and brainstem targets implicated in orofacial sensorimotor control, and consist of a mix of glutamatergic, GABAergic, and glycinergic neurons, which can drive both excitatory and inhibitory inputs to trigeminal motoneurons when optogenetically activated in slice. Silencing BPNs with tetanus toxin light chain (TeNT) increases bilateral masseter activation during chewing, an effect driven by the expression of TeNT in SupV BPNs. Acute unilateral optogenetic inhibition of SupV BPNs identifies a group of tonically active neurons that function to lower masseter muscle tone, whereas unilateral optogenetic activation of SupV BPNs is sufficient to induce bilateral masseter activation both during resting state and during chewing. These results provide evidence for SupV BPNs in tonically modulating jaw-closing muscle tone and in mediating bilateral jaw closing. SIGNIFICANCE STATEMENT: We developed a method that combines retrograde lentiviruses with the split-intein-split-Cre system in mice to isolate, characterize, and manipulate neurons that project to both left and right jaw-closing motoneurons. We show that these bilaterally projecting premotor neurons (BPNs) reside primarily in the supratrigeminal nucleus and the rostral parvicellular and intermediate reticular nuclei. BPNs consist of both excitatory and inhibitory populations, and also project to multiple brainstem nuclei implicated in orofacial sensorimotor control. Manipulation of the supratrigeminal BPNs during natural jaw-closing behavior reveals a dual role for these neurons in eliciting phasic muscle activation and in maintaining basal muscle tone. The retrograde lentivirus carrying the split-intein-split-Cre system can be applied to study any neurons with bifurcating axons innervating two brain regions.
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Vías Eferentes/fisiología , Lateralidad Funcional/fisiología , Neuronas Motoras/fisiología , Músculo Esquelético/fisiología , Núcleos del Trigémino/citología , Potenciales de Acción/fisiología , Animales , Channelrhodopsins , Potenciales Evocados Motores/genética , Femenino , Lateralidad Funcional/genética , Glutamato Descarboxilasa/genética , Glutamato Descarboxilasa/metabolismo , Humanos , Técnicas In Vitro , Integrasas/genética , Integrasas/metabolismo , Inteínas/fisiología , Masculino , Ratones Endogámicos C57BL , Neurotransmisores/metabolismo , Ratas , Tiempo de Reacción , Proteínas Recombinantes de Fusión/genética , Proteínas Recombinantes de Fusión/metabolismo , Potenciales Sinápticos/genéticaRESUMEN
Primary pain and touch sensory neurons not only detect internal and external sensory stimuli, but also receive inputs from other neurons. However, the neuronal derived inputs for primary neurons have not been systematically identified. Using a monosynaptic rabies viruses-based transneuronal tracing method combined with sensory-specific Cre-drivers, we found that sensory neurons receive intraganglion, intraspinal, and supraspinal inputs, the latter of which are mainly derived from the rostroventral medulla (RVM). The viral-traced central neurons were largely inhibitory but also consisted of some glutamatergic neurons in the spinal cord and serotonergic neurons in the RVM. The majority of RVM-derived descending inputs were dual GABAergic and enkephalinergic (opioidergic). These inputs projected through the dorsolateral funiculus and primarily innervated layers I, II, and V of the dorsal horn, where pain-sensory afferents terminate. Silencing or activation of the dual GABA/enkephalinergic RVM neurons in adult animals substantially increased or decreased behavioral sensitivity, respectively, to heat and mechanical stimuli. These results are consistent with the fact that both GABA and enkephalin can exert presynaptic inhibition of the sensory afferents. Taken together, this work provides a systematic view of and a set of tools for examining peri- and extrasynaptic regulations of pain-afferent transmission.
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Vías Aferentes/fisiología , Vías Eferentes/fisiología , Red Nerviosa/fisiología , Nocicepción/fisiología , Células Receptoras Sensoriales/fisiología , Asta Dorsal de la Médula Espinal/citología , Animales , Virus Defectuosos/fisiología , Encefalinas/fisiología , Miembro Anterior/inervación , Neuronas GABAérgicas/fisiología , Neuronas GABAérgicas/virología , Ganglios Espinales/citología , Hiperalgesia/fisiopatología , Interneuronas/fisiología , Interneuronas/virología , Proteínas del Tejido Nervioso/análisis , Conducción Nerviosa , Neuronas Aferentes/fisiología , Neuronas Aferentes/virología , Neuronas Eferentes/fisiología , Neuronas Eferentes/virología , Nociceptores/fisiología , Células del Asta Posterior/fisiología , Células del Asta Posterior/virología , Terminales Presinápticos/fisiología , Virus de la Rabia/fisiología , Células Receptoras Sensoriales/clasificación , Células Receptoras Sensoriales/virología , Piel/inervación , Asta Dorsal de la Médula Espinal/fisiología , Asta Dorsal de la Médula Espinal/ultraestructura , Replicación Viral , Ácido gamma-Aminobutírico/fisiologíaRESUMEN
Postnatal and adult subventricular zone (SVZ) neurogenesis is believed to be primarily controlled by neural stem cell (NSC)-intrinsic mechanisms, interacting with extracellular and niche-driven cues. Although behavioral experiments and disease states have suggested possibilities for higher level inputs, it is unknown whether neural activity patterns from discrete circuits can directly regulate SVZ neurogenesis. We identified a previously unknown population of choline acetyltransferase (ChAT)(+) neurons residing in the rodent SVZ neurogenic niche. These neurons showed morphological and functional differences from neighboring striatal counterparts and released acetylcholine locally in an activity-dependent fashion. Optogenetic inhibition and stimulation of subependymal ChAT(+) neurons in vivo indicated that they were necessary and sufficient to control neurogenic proliferation. Furthermore, whole-cell recordings and biochemical experiments revealed direct SVZ NSC responses to local acetylcholine release, synergizing with fibroblast growth factor receptor activation to increase neuroblast production. These results reveal an unknown gateway connecting SVZ neurogenesis to neuronal activity-dependent control and suggest possibilities for modulating neuroregenerative capacities in health and disease.
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Ventrículos Cerebrales/fisiología , Colina O-Acetiltransferasa/fisiología , Neurogénesis/fisiología , Neuronas/enzimología , Acetilcolina/farmacología , Animales , Western Blotting , Proliferación Celular , Células Cultivadas , Ventrículos Cerebrales/citología , Colina O-Acetiltransferasa/genética , Electroforesis en Gel de Poliacrilamida , Fenómenos Electrofisiológicos , Inmunohistoquímica , Ratones , Microscopía Electrónica , Células-Madre Neurales/efectos de los fármacos , Neuroimagen , Optogenética , Técnicas de Placa-Clamp , Receptores de Factores de Crecimiento de Fibroblastos/fisiologíaRESUMEN
UNLABELLED: Oral opioids are potent analgesics that are used to treat acute pain in the emergency department (ED). However, they are associated with adverse events such as sedation that may delay safe patient discharge. OBJECTIVE: To compare the safety and efficacy of a new cyclooxygenase-2 inhibitor, valdecoxib, with those of an oxycodone-acetaminophen combination in patients with acute musculoskeletal pain. METHODS: This was a double-blind, randomized controlled trial at an immediate care section of a suburban university-based ED with an annual census of 75,000. Adults with acute musculoskeletal pain without contraindications to the study medications were included. After recording their initial pain scores, patients were randomized to either oral valdecoxib 40 mg or oxycodone 10 mg with acetaminophen 650 mg. Pain scores were recorded at 30 and 60 minutes, and patients who requested additional pain relief were given an oral analgesic at the physician's discretion. Twenty-four-hour telephone follow-up was performed. The pain severity was recorded at 0, 30, and 60 minutes using a validated 100-mm visual analog scale marked "most" at the high end. The need for rescue medications and the occurrence of adverse events were determined. Study outcomes were compared with Student's t-test, repeated-measures analysis of variance (ANOVA), and chi(2) tests as appropriate. RESULTS: Fifty-one patients were randomized to valdecoxib (26) or oxycodone (25). Mean (+/- SD) age was 36 (+/- 14.7) years; 49% were women. Pain locations included extremities (49%), neck (29%), and back (22%). Baseline patient characteristics and pain severities were similar. There was no between-group difference in pain scores at 30 and 60 minutes. The changes in pain scores over time were also similar in the two study groups (repeated-measures ANOVA, p = 0.32). Patients treated with valdecoxib were less likely to experience sedation/dizziness (15% vs. 44%, p = 0.03) and to require rescue medications within the next 24 hours (44% vs. 74%, p = 0.04). CONCLUSIONS: Valdecoxib is as effective as an oxycodone-acetaminophen combination in treating ED patients with acute musculoskeletal pain at 30 minutes and less likely to cause sedation or the need for rescue analgesia over the next day.