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1.
Medicine (Baltimore) ; 100(12): e24997, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761655

RESUMEN

BACKGROUND: Knee osteoarthritis is a common chronic progressive disease, which seriously affects the quality of life of the middle-aged and elderly, and even leads to disability. More and more evidence shows that acupoint injection is beneficial to the clinical treatment of knee osteoarthritis, but there are differences in the efficacy of different acupoints and injection drugs, and there is no systematic review to assess this therapy at present. The purpose of this study is to systematically evaluate the efficacy and safety of acupoint injection in improving pain and joint function in patients with knee osteoathrosis. METHODS: According to the retrieval strategy, we will search from CNKI, Wanfang, VIP, Chinese Biomedical Science, PubMed, Embase, Web of Science and the Cochrane Library for randomized controlled trials of acupoint injection in the treatment of knee osteoarthritis from the establishment of the database to February 2021. The study will be screened according to the inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the study. Revman 5.4 software is used for meta-analysis. RESULTS: This study will evaluate the efficacy of acupoint injection in the treatment of knee osteoarthritis by evaluating the total effective rate, the degree of pain relief, joint function score, adverse reactions, and so on. CONCLUSION: This study will provide reliable evidence-based basis for the clinical application of acupoint injection in the treatment of knee osteoarthritis. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.OSF Registration number-doi: 10.17605/OSF.IO/M5FTK.


Asunto(s)
Puntos de Acupuntura , Analgésicos/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Metaanálisis como Asunto , Osteoartritis de la Rodilla/tratamiento farmacológico , Manejo del Dolor/métodos , Revisiones Sistemáticas como Asunto , Humanos , Osteoartritis de la Rodilla/fisiopatología
2.
Medicine (Baltimore) ; 100(12): e25201, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761704

RESUMEN

BACKGROUND: None of review has been conducted to compare the efficacy of interscalene blockade (ISB) with that of local infiltration analgesia (LIA) in patients undergoing total shoulder arthroplasty (TSA). We thus conduct a high-quality meta-analysis of randomized controlled trials (RCTs) to investigate which analgesic provides better pain relief. METHODS: A comprehensive search of the published literature in PUBMED, Scopus, EMBASE, and Cochrane Library databases will be performed. Only RCTs evaluating LIA versus ISB in TSA are included in this study. The primary outcome was pain score. Secondary outcome measures included opioid consumption, postoperative adverse event, and length of stay. The Cochrane risk of bias tool is used to evaluate the risk of bias of included RCTs by 2 independent reviewers. RESULTS: The results of this research will be delivered in a peer-reviewed journal. CONCLUSIONS: This study expects to provide credible and scientific evidence for the efficacy and safety of ISB and LIA for early postoperative pain control after TSA. SYSTEMATIC REVIEW REGISTRATION NUMBER: 10.17605/OSF.IO/S3MBP. ETHICAL APPROVAL: Since this study is on the basis of published or registered RCTs, ethical approval and informed consent of patients are not required.


Asunto(s)
Anestésicos Locales/administración & dosificación , Artroplastía de Reemplazo de Hombro/efectos adversos , Metaanálisis como Asunto , Bloqueo Nervioso/efectos adversos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Revisiones Sistemáticas como Asunto , Plexo Braquial , Humanos , Músculo Esquelético , Manejo del Dolor/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación
3.
Bone Joint J ; 103-B(3): 542-546, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641429

RESUMEN

AIMS: The aim of this study was to investigate the efficacy of coccygectomy in patients with persistent coccydynia and coccygeal instability. METHODS: The Danish National Spine Registry, DaneSpine, was used to identify 134 consecutive patients who underwent surgery, performed by a single surgeon between 2011 and 2019. Routine demographic data, surgical variables, and patient-reported outcomes, including a visual analogue scale (VAS) (0 to 100) for pain, Oswestry Disability Index (ODI), EuroQol five-dimension questionnaire (EQ-5D), and the Physical Component Score (PCS) and Mental Component Score (MCS) of the 36-Item Short-Form Health Survey questionnaire (SF-36) were collected at baseline and one-year postoperatively. RESULTS: A total of 112 (84%) patients with a minimum follow-up of one year had data available for analysis. Their mean age was 41.9 years, and 15 (13%) were males. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for the mean VAS for pain (70.99 to 35.34), EQ-5D (0.52 to 0.75), ODI (31.84 to 18.00), and SF-36 PCS (38.17 to 44.74). A total of 78 patients (70%) were satisfied with the outcome of treatment. CONCLUSION: Patients with persistent coccydynia and coccygeal instability resistant to nonoperative treatment may benefit from coccygectomy. Cite this article: Bone Joint J 2021;103-B(3):542-546.


Asunto(s)
Cóccix/fisiopatología , Cóccix/cirugía , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/cirugía , Adolescente , Adulto , Anciano , Dinamarca , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Dimensión del Dolor , Sistema de Registros , Encuestas y Cuestionarios
4.
Medicine (Baltimore) ; 100(9): e24923, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655955

RESUMEN

ABSTRACT: Recent research has suggested that 6 cm of cervical dilation should be the threshold for the active labor phase, and it has confirmed that epidural analgesia (EA) is a safe method of pain relief during labor. However, the evidence provided for these findings comes mainly from randomized controlled clinical trials (RCTs), which suffer from the limitation of real-world generalizability.To test the generalizability of the conclusions from these previous RCTs, we conducted a prospective cohort, real-world study (RWS) on 400 Chinese term nulliparas. A total of 200 of the participants (the EA group) received EA upon request. The participants in the EA group were further subdivided as follows according to their cervical dilation when the EA administration was initiated (CDE): [EA1 group (CDE < 3 cm), EA2 group (3 cm ≤ CDE < 6 cm), and EA3 group (CDE ≥ 6 cm)]. We compared the labor duration of the EA group versus the non-EA (NEA) group, and the NEA group versus the 3 EA subgroups. We also compared delivery outcomes between the EA and NEA groups.The median total labor duration for the EA group [676 (511-923) minutes] was significantly longer than that of the NEA group [514 (373-721) minutes] (P < 0.001). The median durations of both the first- and second-stages of labor for the EA group [600 (405-855) minutes, 68 (49-97) minutes] were longer than those of the NEA group [420 (300-630) minutes, 50 (32-85) minutes] (P < .001, P < .001)]. In addition, the median total labor durations in both the EA1 [720 (548-958) minutes] and EA2 groups [688 (534-926) minutes] were longer than in the NEA group (P < .001 and P < .001, respectively), and the first- and second-stage labor durations of these subgroups were similar to their total labor durations. A Cox regression analysis showed that EA was associated with longer first-stage labor [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.42-0.71, P < .001] and longer second-stage labor (HR 0.66, 95% CI 0.51-0.85, P = .001). The delivery modes and neonatal outcomes between the EA and NEA groups were not statistically different, however.Our findings suggest that EA administered before a cervical dilation of 6 cm may be associated with longer total, first-, and second-stage labor durations compared with no EA, while later EA administration is not. In addition, though EA prolongs labor duration, it does not impact delivery outcomes. These results confirm the significance of a 6 cm cervical dilation threshold in real-world labor settings.


Asunto(s)
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Trabajo de Parto , Manejo del Dolor/métodos , Adulto , China , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Paridad , Embarazo , Estudios Prospectivos , Valores de Referencia
5.
Pain Physician ; 24(2): 165-173, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33740352

RESUMEN

BACKGROUND: Worldwide, the COVID-19 pandemic has a significant impact on daily life. First studies describe a negative impact of pandemic stressors even on individuals without previous mental illnesses. The home lockdown and the shutdown of pain clinics make it difficult for all patients to get the healthcare they need. OBJECTIVES: The aim of this study was to investigate to what extent patients with chronic pain felt affected by the pandemic and its consequences on pain treatments, focussing on the beginning of the outbreak. STUDY DESIGN: A prospective noninterventional study. SETTING: Medical University Center . METHODS: One-hundred and forty-nine patients, suffering from chronic pain, treated at a large German interdisciplinary pain center, were studied over a period of 2 months at the beginning of the pandemic. Data from patient charts and questionnaires were evaluated. Patients were asked about postponements or cancellations of pain therapy, the possible effect on pain levels, depression, anxiety and stress, and the impact of intensified hygiene measures. Results were compared to those from standardized and validated questionnaires from the same patients (German version of the depression, anxiety, and stress scale = DASS) at the time of the first contact in the pain clinic. RESULTS: Eighty-four (56.4%) patients reported cancelled or postponed treatments during the pandemic. Those chronic pain patients with delayed or cancelled treatments reported significantly more pain and psychological distress. The delay or discontinuation of treatments resulted in a deterioration of symptoms. From the patients' point of view this deterioration was unrelated to the timing of treatment and not secondary to increased hygiene measures. In both groups, patients showed a significant amelioration of the DASS values compared to the values they had at the beginning of treatment, despite the negative effects of the COVID-19 pandemic on care structures. The majority of the patients do not think that the quality of pain treatment was significantly affected by the intensified hygiene requirements. LIMITATIONS: The limitations of the study are the small number of patients because of the limitation to a short period of time at the beginning of the pandemic and the return rate of 40.2% of the study consents. CONCLUSIONS: Even in the event of a pandemic-related restriction of the care structures, patients with chronic pain benefit from pain therapy. Limitations such as the increased hygiene measures caused by the pandemic were not considered detrimental to the therapeutic measures.


Asunto(s)
Dolor Crónico/psicología , Dolor Crónico/terapia , Prioridad del Paciente , Adulto , Ansiedad/psicología , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Estudios Prospectivos , Encuestas y Cuestionarios
6.
Medicine (Baltimore) ; 100(10): e24941, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725856

RESUMEN

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.


Asunto(s)
Terapia por Acupuntura/efectos adversos , Artroplastia de Reemplazo de Rodilla/rehabilitación , Osteoartritis de la Rodilla/cirugía , Manejo del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Terapia por Acupuntura/economía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/economía , Terapia Combinada/efectos adversos , Terapia Combinada/economía , Terapia Combinada/métodos , Análisis Costo-Beneficio , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/economía , Manejo del Dolor/efectos adversos , Manejo del Dolor/economía , Dimensión del Dolor/estadística & datos numéricos , Dolor Postoperatorio/economía , Dolor Postoperatorio/etiología , Dolor Postoperatorio/rehabilitación , Proyectos Piloto , Años de Vida Ajustados por Calidad de Vida , República de Corea , Resultado del Tratamiento
7.
Allergol. immunopatol ; 49(1): 58-61, ene.-feb. 2021. tab, graf
Artículo en Inglés | IBECS | ID: ibc-199226

RESUMEN

BACKGROUND: Allergen-specific immunotherapy is a potentially disease-modifying therapy that is effective for the treatment of patients with allergic diseases. Although the pain caused by the administration of subcutaneous immunotherapy with allergens (SCITA) is considered to be minimal, no studies assessing that pain for the treatment of only pediatric patients have been reported. OBJECTIVES: This research aimed to evaluate the pain associated with SCITA for pediatric patients followed at our Immunoallergology Department. METHODS: During four consecutive weeks, the nurse who administered the injection completed a questionnaire recording the child's assessment of the pain associated with SCITA; these questionnaires were randomized before any analyses were done. Two different pain evaluation scales were used, with the choice of scale being determined based on the child's age: the self-reporting faces scale (score: 0-10; 5 to 8 years old) and the numeric scale (score: 0-10; >8 years old). Demographic and clinical data, as well as any adverse reactions, were documented. RESULTS: We included 46 pediatric patients (mean age: 12.3±2.6 years; 69.5% male), most of whom were suffering from rhinitis/rhinoconjunctivitis and undergoing subcutaneous immunotherapy with mites. Seven local adverse reactions were recorded, and all were mild. Ten patients did not mention any pain associated with SCITA. Of the 36 patients who mentioned some pain, 33 mentioned mild pain (scores between 1 and 3); only three mentioned moderate pain (scores between 4 and 6). For both scales, the median score obtained was 1. The maximum pain reported had a score of 6. No significant differences were observed between different groups of patients. CONCLUSIONS: In this study, SCITA was shown to be a mildly painful procedure that is associated with only a few local reactions. Therefore, SCITA should be considered as a safe option for the treatment of most pediatric patients suffering from allergies


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Desensibilización Inmunológica/métodos , Alérgenos/uso terapéutico , Inmunoterapia/métodos , Manejo del Dolor/métodos , Inyecciones Subcutáneas/métodos , Encuestas y Cuestionarios , Rinitis/inmunología , Rinitis/terapia , Asma/inmunología , Asma/terapia , Dimensión del Dolor/métodos
8.
Am J Phys Med Rehabil ; 100(3): 243-249, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33595936

RESUMEN

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


Asunto(s)
Dolor Crónico/terapia , Crioterapia/métodos , Dolor de la Región Lumbar/terapia , Manejo del Dolor/métodos , Calidad de Vida , Estimulación Eléctrica Transcutánea del Nervio/métodos , Adulto , Terapia Combinada , Femenino , Humanos , Masculino , Dimensión del Dolor , Educación del Paciente como Asunto , Método Simple Ciego , Encuestas y Cuestionarios , Adulto Joven
9.
Medicine (Baltimore) ; 100(6): e23859, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578513

RESUMEN

BACKGROUND: We aimed to examine the feasibility of our newly-developed, integrated, and high-intensity individual cognitive behavioral therapy (CBT) protocol for treatment-resistant chronic pain. METHODS: We conducted an open-labeled prospective single-arm trial for patients aged 18 years and above, suffering from chronic pain, and diagnosed with somatic symptom disorder with predominant pain. We provided 16 weekly sessions of CBT, each lasting for 50 minutes, which included 4 new strategies: attention shift, memory work, mental practice, and video feedback. For comparison, the study had a pre-test post-test design. The primary outcome was the change from baseline (week 1) to 16, as indicated by the Numerical Rating Scale and Pain Catastrophizing Scale. In addition, we evaluated depression, anxiety, disability, and quality of life as secondary outcomes. RESULTS: Sixteen patients with chronic pain underwent our CBT program. Though there was no reduction in pain intensity, catastrophic cognition showed statistically significant improvement with a large effect size. Depression, anxiety, and disability demonstrated statistically significant improvements, with small to moderate effect sizes. No adverse events were reported. CONCLUSION: Our newly integrated CBT program for chronic pain may improve catastrophic cognition, depression, anxiety, and disability. Large-scale randomized controlled studies are necessary to investigate the program's effectiveness in the future.


Asunto(s)
Dolor Crónico/terapia , Terapia Cognitivo-Conductual/métodos , Manejo del Dolor/métodos , Adulto , Anciano , Ansiedad/etiología , Ansiedad/terapia , Dolor Crónico/complicaciones , Dolor Crónico/psicología , Terapia Cognitivo-Conductual/estadística & datos numéricos , Depresión/etiología , Depresión/terapia , Evaluación de la Discapacidad , Estudios de Factibilidad , Femenino , Humanos , Japón/epidemiología , Masculino , Síntomas sin Explicación Médica , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento
10.
J Healthc Eng ; 2021: 8831114, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33604012

RESUMEN

The coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic since March 2020. Although most patients complain of moderate or severe pain, these symptoms are generally underestimated and appropriate treatment is not applied. This study aims to guide physicians in selecting and ranking various alternatives for the treatment of pain in COVID-19 patients. However, the choice of treatment for pain requires the consideration of many different conflicting criteria. Therefore, we have studied this problem as a multicriteria decision-making problem. Throughout the solution procedure, first, the criteria and subcriteria affecting the preferences are defined. Then, weight values are determined with respect to these criteria, as they have different degrees of importance for the problem. At this stage, hesitant fuzzy linguistic term sets (HFLTSs) are used, and thus, experts can convey their ideas more accurately. In this first phase of the study, an HFLTS integrated Analytic Hierarchy Process (AHP) method is utilized. Subsequently, possible treatment alternatives are evaluated by using the Vise Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method. According to the results obtained by considering expert evaluations, the most preferred treatment is the administration of paracetamol, followed by interventional treatments, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs), respectively. With this study, it is ensured that a more accurate method is followed by eliminating possible mistakes due to the subjective evaluations of experts in the process of determining pain treatment. This method can also be used in different patient and disease groups.


Asunto(s)
Toma de Decisiones , Lógica Difusa , Lingüística , Manejo del Dolor , Dimensión del Dolor , Humanos , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Pandemias
11.
Medicine (Baltimore) ; 100(4): e24488, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530266

RESUMEN

BACKGROUND: To evaluate the effectiveness and safety of thermal mineral waters therapy for pain relief, and functional improvement, and quality of life (QoL) in patients with osteoarthritis (OA). METHODS: Cochrane Library, Web of science, EMBASE, ClinicalTrials.gov and PubMed were systematically searched for randomized controlled trials. Study inclusion criteria included assessment of the visual analog scale and Western Ontario and McMaster Universities scores and the lequesne index to evaluate the effects of thermal mineral waters on pain relief and functional improvement. Also, studies that used the European quality of life 5-dimension scale and health assessment questionnaire to assess the impact of thermal mineral waters therapy on improving QoL were included. RESULTS: Sixteen studies were included. A meta-analysis showed that thermal mineral waters therapy could significantly reduce pain as measured visual analog scale and Western Ontario and McMaster Universities assessments (P < .001). Thermal mineral waters significantly reduced the lequesne index (P < .001) and improved joint function. Finally, compared with a control group, European quality of life 5-dimension scale and health assessment questionnaire improved significantly in patients with OA receiving thermal mineral waters therapy (P  < .05). There is no evidence that thermal mineral waters is unsafe for treating OA. CONCLUSION: Thermal mineral waters therapy is a safe way to relieve pain, improve physical functions, and QoL in patients with OA.


Asunto(s)
Balneología/métodos , Aguas Minerales/uso terapéutico , Osteoartritis/rehabilitación , Manejo del Dolor/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
12.
JAMA ; 325(7): 646-657, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33591346

RESUMEN

Importance: Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis or whether it may worsen knee symptoms. Objective: To determine whether high-intensity strength training reduces knee pain and knee joint compressive forces more than low-intensity strength training and more than attention control in patients with knee osteoarthritis. Design, Setting, and Participants: Assessor-blinded randomized clinical trial conducted at a university research center in North Carolina that included 377 community-dwelling adults (≥50 years) with body mass index (BMI) ranging from 20 to 45 and with knee pain and radiographic knee osteoarthritis. Enrollment occurred between July 2012 and February 2016, and follow-up was completed September 2017. Interventions: Participants were randomized to high-intensity strength training (n = 127), low-intensity strength training (n = 126), or attention control (n = 124). Main Outcomes and Measures: Primary outcomes at the 18-month follow-up were Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) knee pain (0 best-20 worst; minimally clinically important difference [MCID, 2]) and knee joint compressive force, defined as the maximal tibiofemoral contact force exerted along the long axis of the tibia during walking (MCID, unknown). Results: Among 377 randomized participants (mean age, 65 years; 151 women [40%]), 320 (85%) completed the trial. Mean adjusted (sex, baseline BMI, baseline outcome values) WOMAC pain scores at the 18-month follow-up were not statistically significantly different between the high-intensity group and the control group (5.1 vs 4.9; adjusted difference, 0.2; 95% CI, -0.6 to 1.1; P = .61) or between the high-intensity and low-intensity groups (5.1 vs 4.4; adjusted difference, 0.7; 95% CI, -0.1 to 1.6; P = .08). Mean knee joint compressive forces were not statistically significantly different between the high-intensity group and the control group (2453 N vs 2512 N; adjusted difference, -58; 95% CI, -282 to 165 N; P = .61), or between the high-intensity and low-intensity groups (2453 N vs 2475 N; adjusted difference, -21; 95% CI, -235 to 193 N; P = .85). There were 87 nonserious adverse events (high-intensity, 53; low-intensity, 30; control, 4) and 13 serious adverse events unrelated to the study (high-intensity, 5; low-intensity, 3; control, 5). Conclusions and Relevance: Among patients with knee osteoarthritis, high-intensity strength training compared with low-intensity strength training or an attention control did not significantly reduce knee pain or knee joint compressive forces at 18 months. The findings do not support the use of high-intensity strength training over low-intensity strength training or an attention control in adults with knee osteoarthritis. Trial Registration: ClinicalTrials.gov Identifier: NCT01489462.


Asunto(s)
Articulación de la Rodilla/fisiología , Osteoartritis de la Rodilla/terapia , Manejo del Dolor/métodos , Entrenamiento de Resistencia/métodos , Anciano , Índice de Masa Corporal , Fuerza Compresiva , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/fisiopatología , Dolor/etiología , Dolor/rehabilitación , Dimensión del Dolor , Método Simple Ciego
13.
Medicine (Baltimore) ; 100(4): e23684, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530169

RESUMEN

BACKGROUND: The present evidence is insufficient for evaluating the impact of exclusive music therapy on anxiety and pain control in extracorporeal shock wave lithotripsy (ESWL). METHODS: A systematic review and meta-analysis was conducted to explore the efficacy of music therapy in reducing pain and anxiety in patients undergoing ESWL. PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomized controlled trials assessing music therapy in reducing pain and anxiety in patients undergoing ESWL. The search strategy and study selection process were managed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. RESULTS: Five randomized controlled trials were included in the meta-analysis. Overall, music intervention groups experienced significant reductions in pain (risk ratios = -1.20, 95% confidence intervals = -1.95 to -0.45, P = .002) and anxiety (risk ratios = -3.31, 95% confidence intervals = -4.97 to -1.84, P < .0001) compared with control groups during ESWL. Music therapy gave patient more satisfaction with the treatment and a willingness to repeat the therapy was reported. However, there was no significant difference in the stone clearance rate. CONCLUSIONS: Listening to music can reduce patient's pain and anxiety significantly with increased therapy satisfaction and willingness to repeat.


Asunto(s)
Ansiedad/terapia , Litotricia/efectos adversos , Musicoterapia/métodos , Manejo del Dolor/métodos , Dolor Asociado a Procedimientos Médicos/terapia , Adulto , Ansiedad/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Asociado a Procedimientos Médicos/etiología , Satisfacción del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Resultado del Tratamiento
15.
BMJ ; 372: n102, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-33568363

RESUMEN

OBJECTIVE: To evaluate the risk of first trimester exposure to prescription opioids for major congenital malformations, previously reported to be associated with such exposure. DESIGN: Population based cohort study. SETTING: Nationwide sample of publicly and commercially insured pregnant women linked to their liveborn infants, nested in the Medicaid Analytic eXtract (MAX, 2000-14) and the MarketScan Research Database (MarketScan, 2003-15). PARTICIPANTS: 1 602 580 publicly insured (MAX) and 1 177 676 commercially insured (MarketScan) pregnant women with eligibility from at least three months before pregnancy to one month after delivery; infants with eligibility for at least three months after birth. INTERVENTIONS: Use of prescription opioids was ascertained by requiring two or more dispensations of any opioid during the first trimester. MAIN OUTCOMES MEASURES: Major malformations overall, cardiac malformations overall, ventricular septal defect, secundum atrial septal defect/patent foramen ovale, neural tube defect, clubfoot, and oral cleft, defined based on validated algorithms. Propensity score stratification was used to adjust for potential confounders and/or proxies for confounders. Estimates from each database were combined using meta-analysis. RESULTS: 70 447 (4.4%) of 1 602 580 publicly insured and 12 454 (1.1%) of 1 177 676 commercially insured pregnant women had two or more dispensations of an opioid during the first trimester. Absolute risk of malformations overall was 41.0 (95% confidence interval 39.5 to 42.5) per 1000 pregnancies exposed to opioids versus 32.0 (31.7 to 32.3) per 1000 unexposed pregnancies in the MAX cohort, and 42.6 (39.0 to 46.1) and 37.3 (37.0 to 37.7) per 1000, respectively, in the MarketScan cohort. Pooled unadjusted relative risk estimates were raised for all outcomes but shifted substantially toward the null after adjustment; for malformations overall (relative risk 1.06, 95% confidence interval 1.02 to 1.10), cardiovascular malformations (1.09, 1.00 to 1.18), ventricular septal defect (1.07, 0.95 to 1.21), atrial septal defect/patent foramen ovale (1.04, 0.88 to 1.24), neural tube defect (0.82, 0.53 to 1.27), and clubfoot (1.06, 0.88 to 1.28). The relative risk for oral clefts remained raised after adjustment (1.21, 0.98 to 1.50), with a higher risk of cleft palate (1.62, 1.23 to 2.14). CONCLUSIONS: Prescription opioids used in early pregnancy are not associated with a substantial increase in risk for most of the malformation types considered, although a small increase in the risk of oral clefts associated with their use is possible.


Asunto(s)
Anomalías Inducidas por Medicamentos/epidemiología , Analgésicos Opioides/efectos adversos , Complicaciones del Embarazo/tratamiento farmacológico , Anomalías Inducidas por Medicamentos/etiología , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Recién Nacido , Manejo del Dolor/métodos , Manejo del Dolor/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/epidemiología , Primer Trimestre del Embarazo , Riesgo
16.
Biomed Res Int ; 2021: 7190808, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33521131

RESUMEN

Background: Neck pain (NP) is a common work-related disorder, with high prevalence in the profession of teaching. The daily duties of a school teacher involve head-down postures while reading and writing, which expose them to the risk of developing NP. Deep cervical flexor (DCF) muscles have been reported to have lower endurance in patients with cervical impairment, which has additionally been associated with disability. There is limited evidence regarding the efficacy of training of DCF muscles in occupational NP. The objective of this study was to investigate the effects of DCF muscle training on pain, muscle endurance, and functional disability using pressure biofeedback in school teachers with NP. Methods: Sixty-five teachers (age, 25-45 years) with more than 5 years of teaching experience participated in this study. They were randomly divided into two groups: the experimental (E) and control (C) groups. In the E group, the subjects underwent DCF muscle training using pressure biofeedback in addition to conventional exercises for neck pain, while those in the C group underwent conventional exercises only. Pain, muscle endurance, and disability were measured at day 0 (before the treatment) and days 14 and 42 after the treatment. Endurance of DCF muscles was measured by the craniocervical flexion test using pressure biofeedback, pain intensity was measured using the numeric pain rating scale, and functional disability was assessed using the neck disability index questionnaire. This study was performed in accordance with CONSORT guidelines. Results: On day 0, there were no significant differences in the age, pain, muscle endurance, and disability levels between the groups. After initiating the intervention, although there were improvements in both groups, there was a statistically significant improvement in muscle endurance, pain, and disability in subjects who received additional training with pressure biofeedback. Conclusions: Besides increasing muscle endurance, specific training of DCF muscles in addition to conventional exercises can improve neck pain and functional disability. These results should be further correlated clinically. A dedicated time for exercises at school could help prevent the development of NP in teachers. This trial is registered with ClinicalTrials.gov NCT03537300 May 24, 2018 (retrospectively registered).


Asunto(s)
Terapia por Ejercicio/métodos , Músculos del Cuello/fisiopatología , Dolor de Cuello/fisiopatología , Enfermedades Profesionales/fisiopatología , Maestros , Adulto , Biorretroalimentación Psicológica , Dolor Crónico/terapia , Personas con Discapacidad , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Postura
17.
Curr Urol Rep ; 22(3): 17, 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33534030

RESUMEN

PURPOSE OF REVIEW: To review the most recent literature citing opioid-sparing multimodal analgesic strategies used to manage perioperative pain in patients who underwent inflatable penile prosthesis (IPP) surgery and to provide the penile implant surgeon a variety of non-opioid-based pain management strategies for IPP management. RECENT FINDINGS: Interventions performed in the pre-operative, intraoperative, and post-operative arenas have all been shown to effectively lower pain scores and reduce opioid consumption. Certain surgical techniques performed during IPP surgery have helped with post-operative discomfort patients may feel after surgery. Multimodal analgesia (MMA) protocols adopted from other surgical fields and other urologic subspecialties that are implemented in IPP surgery have promising results with regard to post-operative pain control and opioid consumption. Protocols that implement a combination of refined surgical technique and multimodal analgesia offer substantial benefit to patients undergoing IPP surgery. Further work is needed to assess long-term pain control and opioid use in patients that undergo IPP surgery using these innovative strategies.


Asunto(s)
Analgésicos no Narcóticos/uso terapéutico , Implantación de Pene , Prótesis de Pene , Analgésicos Opioides/uso terapéutico , Humanos , Masculino , Manejo del Dolor/métodos , Dolor Postoperatorio/etiología , Implantación de Pene/efectos adversos , Implantación de Pene/métodos , Estudios Retrospectivos
18.
Vet Clin North Am Food Anim Pract ; 37(1): 17-31, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33541697

RESUMEN

Small ruminants are increasing in popularity as production and companion animals in the United States, and among sheep, goats, and camelids there are many disease processes and management techniques that have the potential to result in painful or noxious stimuli. In these species, many medications and therapeutic techniques can be used to reduce or eliminate the long-term consequences of pain. In this second portion of the review, we focus on the application of pain management in these species. These strategies include mono- and multimodal and the use of precision pain management, such as epidural drug administration, regional perfusions, and transdermal applications.


Asunto(s)
Camélidos del Nuevo Mundo , Enfermedades de las Cabras/tratamiento farmacológico , Manejo del Dolor/veterinaria , Dolor/veterinaria , Enfermedades de las Ovejas/tratamiento farmacológico , Analgesia/métodos , Analgesia/veterinaria , Animales , Cabras , Dolor/tratamiento farmacológico , Manejo del Dolor/métodos , Rumiantes , Ovinos , Estados Unidos
19.
Medicine (Baltimore) ; 100(3): e23978, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545983

RESUMEN

BACKGROUND AND PURPOSE: Medial compartment femoro-tibial osteoarthritis (OA) is a common disease and opening-wedge high tibial osteotomy (OWHTO) is the common surgical procedure carried out for these patients. While most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the pain control effect of femoral nerve block (FNB) for OWHTO patients. METHODS: In this prospective, single-center, randomized controlled trial (RCT) study, 41 patients were operated on by OWHTO for OA during 2017 to 2018. Twenty of them (group A) accepted epidural anesthesia with FNB and 21 patients (group B) only had their single epidural anesthesia. All blocks were successful and all the 41 patients recruited were included in the analysis and there was no loss to follow-up or withdrawal. Systematic records of visual analog scores (VAS), quadriceps strength, mean number of times of patient-controlled intravenous analgesia (PCIA), using of additional opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), and complications were done after hospitalization. The Student t test and Chi-Squared test was used and all P values ≤.05 were considered statistically significant. RESULTS: VAS scores at rest (3.48 ±â€Š1.0 vs 4.68 ±â€Š1.1) and on movemment (4.51 ±â€Š0.6 vs 4.97 ±â€Š0.8) decreased more in group A than group B with significance at follow-up of 12 hours. The quadriceps strength, consumption of additional opioids or NSAID injections and mean number of times that the patients pushed the PCIA button didnot differ significantly within each group. CONCLUSION: This RCT study shows that FNB in patients undergoing OWHTO for unicompartmental osteoarthritis of the knee could result in significant reduction in VAS scores at 12 hours postoperatively.Research registry, Researchregistry4792. Registered April 7, 2019 - Retrospectively registered, http://www.researchregistry.com.


Asunto(s)
Nervio Femoral/efectos de los fármacos , Bloqueo Nervioso/normas , Manejo del Dolor/normas , Tibia/cirugía , Femenino , Nervio Femoral/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Bloqueo Nervioso/estadística & datos numéricos , Osteotomía/efectos adversos , Osteotomía/métodos , Manejo del Dolor/métodos , Manejo del Dolor/estadística & datos numéricos , Estudios Prospectivos , Tibia/efectos de los fármacos
20.
Medicine (Baltimore) ; 100(7): e24680, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607808

RESUMEN

BACKGROUND: To explore the effectiveness of platelet-rich plasma (PRP) injection regarding functional recovery, pain relief, and range of motion (ROM) of shoulder compared with the corticosteroid injection in patients with rotator cuff lesions treated non-operatively. METHODS: An electronic literature search was performed by 2 authors in the PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant randomized controlled trial (RCTs) that were published up to July 20, 2020. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) were applied to calculate the pooled effect sizes. RESULTS: Six RCTs were included in this systematic review. Meta-analysis revealed that corticosteroid injection yielded statistically significant superior functional recovery (SMD = -0.80; 95% CI, -1.42 to -0.18; P = .01) and pain relief (MD = 1.59; 95% CI, 0.30-2.89; P = .02) compared with PRP injection for rotator cuff lesions during the short-term follow-up period. However, at the medium-term and long-term follow-up, no statistically significant difference was identified between the 2 groups. Regarding the ROM of shoulder, no statistically significant difference was found between the 2 groups during the whole follow-up period. CONCLUSIONS: The current clinical evidence revealed short-term efficacy of corticosteroid injection and no significant medium- to long-term difference between corticosteroid and PRP injection in the treatment of rotator cuff lesions. Additional studies with longer follow-ups, larger sample sizes, and more rigorous designs are needed to draw more reliable and accurate conclusions.


Asunto(s)
Corticoesteroides/administración & dosificación , Tratamiento Conservador/métodos , Plasma Rico en Plaquetas/fisiología , Lesiones del Manguito de los Rotadores/terapia , Corticoesteroides/uso terapéutico , Adulto , Estudios de Casos y Controles , Manejo de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Plasma Rico en Plaquetas/química , Ensayos Clínicos Controlados Aleatorios como Asunto , Rango del Movimiento Articular , Recuperación de la Función , Resultado del Tratamiento
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