Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 111
Filtrar
1.
Pain Med ; 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33260215

RESUMO

OBJECTIVE: Recently, there has been growing interest in the gut-brain axis because it is emerging as a player influencing the health status of the host human. It is a known fact that the gut microbiome (GM) through the gut-brain axis has been implicated in numerous diseases. We previously reported that stool condition was associated with pain perception. Stool consistency and constipation are known to be associated with GM composition. Thus, we imagine that GM composition could influence pain perception. The aim of this study was to investigate the correlations between GM composition and pain perception and psychological states in young healthy male subjects. SUBJECTS: A total of 42 healthy young male volunteers completed the present study. METHODS: The volunteers' pain perceptions were assessed by pressure pain threshold, current perception threshold, temporal summation of pain, and conditioned pain modulation, and a questionnaire on psychological state was obtained. During the current perception threshold examination, we used 5, 250, and 2,000 Hz to stimulate C, Aδ, and Aß fibers. In addition, GM composition was evaluated by using 16S rRNA analysis. RESULTS: Pressure pain threshold showed a significant and negative correlation with Bacteroidetes phylum, in contrast to a significant and positive correlation with Firmicutes phylum. Current perception threshold of Aδ and Firmicutes phylum showed a significant correlation. There was a negative correlation between anxiety state and Bifidobacterium genus. In contrast, there was no significant correlation between psychological states and pain perceptions. CONCLUSION: The present study showed that acute pain perception was associated with GM composition in young healthy males.

2.
Physiol Behav ; 229: 113251, 2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33220328

RESUMO

Juvenile and adult rats emit two affectively different types of ultrasonic vocalizations (USVs), namely aversive 22-kHz and appetitive 50-kHz USVs. Aversive 22-kHz USVs are considered to be alarm calls that communicate negative affective states to conspecific receivers. Although the alarming effects of playback of 22-kHz USVs were reported recently, behavioral data showing those effects are still not abundant. Appetitive 50-kHz USVs are considered to communicate positive affective states to conspecific receivers, to pace and coordinate social behavior. In line with this, playback of 50-kHz USVs has been found to initiate behavioral activation and induce approach behavior in receiver rats. However, most of these playback studies have used male 50-kHz USVs; thus, it seems to remain unclear whether female 50-kHz USVs exert a similar social attractant effect on male rats. To investigate these issues, we performed modified open-field tests, during which USVs were continuously presented for 15 min to male receivers. In these tests, if negative affective changes are evoked in subject rats, the time spent in the open arena decreases, while the time spent on defensive behaviors increases. In contrast, when positive affective changes are evoked, the opposite phenomenon is observed. Playback of male aversive 22-kHz USVs induced anxiety-related defensive responses in receivers. However, playback of female appetitive frequency-modulated (FM) 50-kHz USVs increased opposite, appetitive pattern of exploratory behavior with increased exploration. The results indicate that playback of male aversive 22-kHz and female appetitive 50-kHz USVs might induce behavioral responses probably associated with negative and positive affective states in male rats, respectively, suggesting the validity of rat USVs as an animal model of vocal communication of emotion.

3.
Eur J Pain ; 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33108042

RESUMO

BACKGROUND: The purpose of this investigation was to undertake a hypothesis-generating study to identify candidate variables that characterize people with knee osteoarthritis who are most likely to experience a positive response to exercise. METHODS: One hundred and fifty participants with knee osteoarthritis participated in this observational, longitudinal study. All participants received a standard exercise intervention that consisted of 20-min sessions two to three times a week for three months. The classification and regression tree methodology (CART) was used to develop prediction of positive clinical outcome. Positive pain and disability outcomes (dependent variables) were defined as an improvement in pain intensity by >50% or an improvement of five or more on the Oxford knee score, respectively. The predictor variables considered included age, sex, body mass index, knee osteoarthritis severity (Kellgren/Lawrence grade), pain duration, use of medication, range of knee motion, pain catastrophizing, self-efficacy and knee self-perception. RESULTS: Fifty-five participants (36.6%) were classified as responders for pain intensity and 36.6% were classified as responders for disability. The CART model identified impairments in knee self-perception and knee osteoarthritis severity as the discriminators for pain intensity reduction following exercise. No variables predicted reduction of disability level following exercise. CONCLUSIONS: Such findings suggest that both body perception and osteoarthritis severity may play a role in treatment outcome with exercise. It also raises the possibility that those with higher levels of disrupted body perception may need additional treatment targeted at restoring body perception prior to undertaking exercise. SIGNIFICANCE: Regardless age, sex, body mass index, pain duration, use of medication, knee range of motion, pain catastrophizing and self-efficacy, participants with knee osteoarthritis who report low levels of body perception disruption (a FreKAQ score ≦ 17) and minimal structural changes (KL grade I) demonstrate significantly better outcomes from exercise therapy than other participants.

4.
Exp Anim ; 2020 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-33100276

RESUMO

Apart from self and conspecific odors, odors from other species also influence the affective states in laboratory mice (Musmusculus musculus) in their home cages and during experimental procedures, possibly inducing confusion and inconsistency in experimental data. Thus, it is important to detect the types of animal odors associated with housing, husbandry, and laboratory practice that can arouse different types of affective changes in mice. Here, we aimed to test the effectiveness of the acoustic startle reflex (ASR) in detecting changes in the affective states of laboratory mice due to animal-derived-odor as it has a non-zero baseline, and can be enhanced or attenuated by positive or negative affective shifts, respectively. We used ASR to examine the affective changes in mice that were induced by bedding odors and an alarm pheromone. The odor of bedding obtained from the mice' home cages significantly attenuated the ASR, suggesting positive affective shifts in the test mice, whereas that from bedding obtained from rat cages significantly enhanced the ASR, suggesting negative affective shifts. No significant changes in ASR were observed in mice presented with the odor of bedding obtained from cages of unfamiliar conspecifics. In contrast, there was significant ASR enhancement in mice exposed to volatile components of alarm pheromones trapped in water, suggesting negative affective shifts. Thus, our findings show that ASR may be a valuable tool in assessing the effects of odors on the affective states in laboratory mice.

5.
Clin Drug Investig ; 40(11): 1071-1084, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32965598

RESUMO

BACKGROUND AND OBJECTIVES: The guidelines for osteoarthritis (OA) treatment recommend different therapies including pharmacotherapy, and several analgesic options are available for pain management. In Japan, research on hip and knee OA treatment trends is scarce and OA-related healthcare costs are unknown. Therefore, this study aimed to examine the treatment and healthcare cost trends among Japanese patients with hip or knee OA. METHODS: This was a cross-sectional study held between 2013 and 2019, using a medical claims database. The demographic and treatment characteristics of hip or knee OA patients for each year were descriptively analyzed and the medians for healthcare utilization and all-cause healthcare costs were calculated. RESULTS: The yearly mean age of 59,218 hip OA and 270,722 knee OA patients ranged from 66.3 to 68.6 years and 71.1 to 73.1 years, respectively. The prevalence of comorbidities was higher in knee OA than hip OA. In both groups, > 70% of patients were female, and the most common treatment was pain-related medication. In hip OA, topical and systemic nonsteroidal anti-inflammatory drugs (NSAIDs) were mostly used throughout the study period (34.1-41.4% and 32.0-40.3%, respectively). Similarly, in knee OA, topical and systemic NSAIDs were used in 58.3-63.3% and 36.5-46.0% patients, respectively. Increase in the use of acetaminophens (10.9% in hip OA and 10.2% in the knee OA) and weak opioids (3.7%, and 3.4%, respectively) from 2013 to 2019 were observed. Most patients were treated as outpatients in both groups. The median all-cause healthcare costs were approximately 35,000 JPY for hip OA and 74,000 JPY for knee OA. CONCLUSIONS: Although a considerable change in total healthcare cost was not observed in our study, the contents of medical treatment and cost breakdown were greatly altered due to the treatment and cost for OA itself, and the treatment and cost for comorbidities. Similar studies to investigate such a trend may help predict necessary resources and social needs. Thus, further investigation utilizing other databases is needed.

6.
Anesth Pain Med ; 10(2): e97758, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32754428

RESUMO

Background: Several behavioral tests have been devised to assess pain in rodent models, one of which is the Chronic constriction injury (CCI) model of the sciatic nerve, including the sensitivity of the paw evaluated through reflex reactions to heat or mechanical stimuli. However, because of their high restless activity and responsiveness to humans, it is tough to give the moving animals consistent stimuli to get consistent and reliable reactions. Methods: Experiments were performed on male C57BL/6J mice (aged eight weeks) and prairie voles (aged eight weeks). Sham animals (five mice and six prairie voles) and CCI animals (six mice and seven prairie voles) were tested before surgery, four days after, and seven days after surgery. Each animal was rated using a modified rating scale for the scoring of nociceptive behavior. The mechanical threshold test was administered by applying arterial clips to the base of toes under isoflurane-induced sedation. Results: The right hind paw of the CCI administered side showed significant increases in the scores of nociceptive behavior on day 4 and day 7. The right hind paw of the CCI-administered side showed significant reductions in the mechanical threshold test on day 4 and day 7. Conclusions: The results of the mechanical threshold test were consistent with those of the scoring of nociceptive behavior in CCI model animals, and the method of using arterial clips under sedation was useful for the mechanical threshold test.

7.
Pain ; 2020 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-32694387

RESUMO

The current International Association for the Study of Pain (IASP) definition of pain as "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" was recommended by the Subcommittee on Taxonomy and adopted by the IASP Council in 1979. This definition has become accepted widely by health care professionals and researchers in the pain field and adopted by several professional, governmental, and nongovernmental organizations, including the World Health Organization. In recent years, some in the field have reasoned that advances in our understanding of pain warrant a reevaluation of the definition and have proposed modifications. Therefore, in 2018, the IASP formed a 14-member, multinational Presidential Task Force comprising individuals with broad expertise in clinical and basic science related to pain, to evaluate the current definition and accompanying note and recommend whether they should be retained or changed. This review provides a synopsis of the critical concepts, the analysis of comments from the IASP membership and public, and the committee's final recommendations for revisions to the definition and notes, which were discussed over a 2-year period. The task force ultimately recommended that the definition of pain be revised to "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage," and that the accompanying notes be updated to a bulleted list that included the etymology. The revised definition and notes were unanimously accepted by the IASP Council early this year.

8.
Spine Surg Relat Res ; 4(2): 164-170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32405564

RESUMO

Introduction: The present study aimed to investigate the association between trunk muscle strength, lumbar spine bone mineral density (BMD), lumbar scoliosis angle (LSA), and appendicular skeletal muscle mass index (ASMI) and the severity locomotive syndrome (LS) using dual-energy X-ray absorptiometry (DXA) technology in elderly individuals. Methods: In this cross-sectional study, we enrolled 168 individuals aged >60 years. We measured their trunk muscle strength (flexion and extension) and BMD, LSA, and ASMI using DXA. We defined degenerative lumbar scoliosis (DLS) as LSA ≥ 10° by the Cobb method using the DXA image. The locomotor function was evaluated using the timed up-and-go (TUG) test and the 25-question Geriatric Locomotive Function Scale (GLFS-25) score. Normal locomotor function, LS-1, and LS-2 were defined as a GLFS-25 score of <7, ≥7 and <16, and ≥16, respectively. We compared the three groups, analyzing the associations between all variables and the locomotor function using univariate and multivariate analyses. Results: Although there was no significant difference in sex ratio, BMD, ASMI, and trunk-flexor strength, significant differences were observed in age (p < 0.01), the prevalence of DLS (p = 0.02), trunk-extensor strength (p < 0.01), and trunk-extensor/flexor strength ratio (p < 0.01) among the three groups. In multiple regression analyses, the significant risk factors of the TUG test were age (ß = 0.26), body mass index (ß = 0.36), LSA (ß = 0.15), ASMI (ß = -0.30), and trunk-extensor strength (ß = -0.19), whereas the significant factor of the GLFS-25 score was trunk-extensor strength (ß = -0.31). Conclusions: The results indicate that it is clinically important for LS to pay careful attention not only to BMD but also to lumbar scoliosis when DXA examination of the lumbar spine is routinely conducted. Moreover, it is essential to note that trunk-extensor strength is more important than trunk-flexor strength in maintaining locomotor function in elderly individuals.

9.
PLoS One ; 15(4): e0232246, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353030

RESUMO

INTRODUCTION: Observational gait analysis is a widely used skill in physical therapy. Meanwhile, the skill has not been investigated using objective assessments. The present study investigated the differences in eye movement between professionals and trainees, while observing gait analysis. METHODS: The participants included in this study were 26 professional physical therapists and 26 physical therapist trainees. The participants, wearing eye tracker systems, were asked to describe gait abnormalities of a patient as much as possible. The eye movement parameters of interest were fixation count, average fixation duration, and total fixation duration. RESULTS: The number of gait abnormalities described was significantly higher in professionals than in trainees, overall and in limbs of the patient. The fixation count was significantly higher in professionals when compared to trainees. Additionally, the average fixation duration and total fixation duration were significantly shorter in professionals. Conversely, in trunks, the number of gait abnormalities and eye movements showed no significant differences between groups. CONCLUSIONS: Professionals require shorter fixation durations on areas of interest than trainees, while describing a higher number of gait abnormalities.


Assuntos
Movimentos Oculares/fisiologia , Marcha/fisiologia , Feminino , Fixação Ocular/fisiologia , Análise da Marcha/métodos , Humanos , Masculino , Apoio ao Desenvolvimento de Recursos Humanos/métodos
10.
PLoS One ; 15(4): e0231077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282836

RESUMO

INTRODUCTION: This study aimed to investigate the differences in the Injustice Experience Questionnaire (IEQ) scores during the early period after the diagnosis of Whiplash-associated disorder (WAD) between Japanese and Canadian samples, and the associations between the IEQ scores and treatment terms in Japanese patients with acute WAD. METHODS: We used secondary data for the IEQ scores of Canadian patients with acute WAD. In Japan, we collected data from 85 consecutively enrolled patients with acute WAD, and their treatment terms were collected; these referred to the number of days between the date of injury and the closure date of the insurance claim and the number of treatment visits. Before treatment, the Numeric Rating Scale, Neck Disability Index, Hospital Anxiety and Depression Scale, IEQ, and Euro Quality of Life five-dimensional questionnaire were administered. The variables were subjected to multivariate analysis with each treatment term. RESULTS: The IEQ scores were higher in Japan than in Canada. Through multiple regression analysis, IEQ scores were independently correlated with treatment terms. The optimal cutoff point of the IEQ scores for a prolonged treatment term was 21 and 22 points, respectively. CONCLUSIONS: The IEQ scores were associated with treatment terms in patients with acute WAD in Japan.


Assuntos
Depressão/epidemiologia , Mialgia/epidemiologia , Dor/epidemiologia , Traumatismos em Chicotada/epidemiologia , Canadá/epidemiologia , Depressão/fisiopatologia , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Seguro , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Mialgia/psicologia , Mialgia/terapia , Dor/fisiopatologia , Dor/psicologia , Manejo da Dor , Análise de Regressão , Inquéritos e Questionários , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/psicologia , Traumatismos em Chicotada/terapia
11.
Expert Opin Pharmacother ; 21(8): 983-991, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32252557

RESUMO

BACKGROUND: Chronic pain is often difficult to treat, and many patients are not satisfied with analgesic treatment. The authors assessed patient satisfaction with oral analgesics in patients with chronic pain in Japan. RESEARCH DESIGN AND METHODS: This was an observational cross-sectional study conducted in dispensing pharmacies. A patient satisfaction questionnaire survey was conducted in 781 patients prescribed one nonsteroidal anti-inflammatory drug (NSAID) or neuropathic pain (NeP) drug for at least 90 consecutive days. The primary endpoint was patient satisfaction with analgesics. The secondary endpoints were pain relief, activity of daily living (ADL) improvement and doctor-patient communication. RESULTS: The proportions of patients who answered 'satisfied if anything' or better for patient satisfaction in the NSAID and NeP drug groups were 70.0% and 65.2%, respectively, whereas those of patients who answered 'satisfied' were 43.3% and 29.4%, respectively. The proportions of patients with improved pain relief, ADL improvement, and good doctor-patient communication were numerically higher than those of patients who answered 'satisfied if anything' or better. CONCLUSIONS: Approximately two-thirds of the patients were satisfied with current analgesics. Patient satisfaction with oral analgesics could be influenced by multiple factors. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000036456.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Crônica/tratamento farmacológico , Neuralgia/tratamento farmacológico , Manejo da Dor/métodos , Satisfação do Paciente , Atividades Cotidianas , Administração Oral , Adulto , Idoso , Analgésicos/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Medição da Dor , Inquéritos e Questionários
12.
PLoS One ; 15(3): e0229228, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32126108

RESUMO

Low back pain (LBP) is the most common cause of chronic pain. Numerous clinical scales are available for evaluating pain, but their objective criteria in the management of LBP patients remain unclear. This study aimed to determine an objective cutoff value for a change in the Pain Intensity Numerical Rating Scale (ΔPI-NRS) three months after LBP treatment. Its utility was compared with changes in six commonly used clinical scales in LBP patients: Pain Disability Assessment Scale (PDAS), Pain Self-Efficacy Questionnaire (PSEC), Pain Catastrophizing Scale (PCS), Athens Insomnia Scale (AIS), EuroQoL 5 Dimension (EQ5D), and Locomo 25. We included 161 LBP patients treated in two representative pain management centers. Patients were partitioned into two groups based on patient's global impression of change (PGIC) three months after treatment: satisfied (PGIC = 1, 2) and unsatisfied (3-7). Multivariate logistic regression analysis was performed to explore relevant scales in distinguishing the two groups. We found ΔPI-NRS to be most closely associated with PGIC status regardless of pre-treatment pain intensity, followed by ΔEQ5D, ΔPDAS, ΔPSEC, and ΔPCS. The ΔPI-NRS cutoff value for distinguishing the PGIC status was determined by ROC analysis to be 1.3-1.8 depending on pre-treatment PI-NRS, which was rounded up to ΔPI-NRS = 2 for general use. Spearman's correlation coefficient revealed close relationships between ΔPI-NRS and the six other clinical scales. Therefore, we determined cutoff values of these scales in distinguishing the status of ΔPI-NRS≥2 vs. ΔPI-NRS<2 to be as follows: ΔPDAS, 6.71; ΔPSEC, 6.48; ΔPCS, 6.48; ΔAIS, 1.91; ΔEQ5D, 0.08; and ΔLocomo 25, 9.31. These can be used as definitive indicator of therapeutic outcome in the management of chronic LBP patients.


Assuntos
Dor Lombar/terapia , Medição da Dor/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Autoavaliação Diagnóstica , Avaliação da Deficiência , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
13.
J Orthop Res ; 38(9): 1942-1951, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32068299

RESUMO

Hyaluronan (HA) has been shown to play crucial roles in the tumorigenicity of malignant tumors. Chondrosarcoma, particularly when low-grade, is characterized by the formation of an extracellular matrix (ECM) containing abundant HA, and its drug/radiation resistance has become a clinically relevant problem. This study aimed to evaluate the effects of a novel hyaluronidase, KIAA1199, on ECM formation as well as antitumor effects on chondrosarcoma. To clarify the roles of KIAA1199 in chondrosarcoma, mouse KIAA1199 was stably transfected to Swarm rat chondrosarcoma (RCS) cells (histologically grade 1). We investigated the effects of KIAA1199 on RCS cells in vitro and an autografted model in vivo. HA binding protein (HABP) stainability and ECM formation in KIAA1199-RCS was markedly suppressed compared with that of control cells. No significant changes in messenger RNA expression of Has1, Has2, Has3, Hyal1, or Hyal2 were observed. KIAA1199 expression did not affect proliferation or apoptosis but inhibited migration and invasion of RCS cells. In contrast, the expression of KIAA1199 significantly inhibited the growth of grafted tumors and suppressed the stainability of alcian blue in tumor tissues. Although there was no direct inhibitory effect on proliferation in vitro, induction of KIAA1199 showed the antitumor effects in grafted tumor growth in vivo possibly due to changes in the tumor microenvironment such as inhibition of ECM formation. Forced expression of KIAA1199 exhibits antitumor effects on low-grade chondrosarcoma, which has chemo- and radio-therapy resistant features. Together, KIAA1199 could be a novel promising therapeutic tool for low-grade chondrosarcoma, mediated by the degradation of HA.

14.
Spine Surg Relat Res ; 3(4): 319-326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31768451

RESUMO

Introduction: In this study, we defined chronic neuropathic pain (NeP) in patients with diseases associated with spinal cord damage, such as spinal cord-related pain syndrome, and performed a nationwide survey investigating the prevalence, actual status, and features of this syndrome in Japan in order to gather basic information needed for planning control measures. Methods: In this nationwide epidemiologic survey, a mail-in questionnaire was sent to 3,206 institutions throughout Japan certified by the Japanese Orthopaedic Association (2,065 institutions) and the Japan Neurosurgical Society (1,141 institutions). The survey included the number of patients, frequency, and type of allodynia, concomitant diseases, and types of and responses to treatment. Results: Valid responses were obtained from 552 institutions on 3,401 patients. Of these, 1,719 (50.5%) patients experienced no pain, and thus the study involved the analysis of data of the remaining 1,682 patients with pain. The most frequent underlying conditions were cervical spondylotic myelopathy (26.7%), spinal cord injury (17.4%), and ossification of the posterior longitudinal ligament (OPLL) of the cervical spine (14.1%). Among the 1,682 patients, 62.5% reported at-level pain, among which 43.0% presented with allodynia. On the other hand, 38.7% presented with below-level pain. The majority of patients (73.4%) used nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants (46.6%). The effectiveness of treatment was significantly higher in patients using anticonvulsants (31.1%) than in those using other medications. About a third of the patients stopped the treatment for either lack of effect or adverse effects. Conclusions: The characteristics of NeP in patients with spinal cord-related pain syndrome varied according to its level in relation to the affected spinal segment (at-level and/or below-level). Unfortunately, medications are sometimes ineffective and have potential adverse effects. Further classification of allodynia is needed for effective symptom-based treatment.

16.
Pain Res Manag ; 2019: 4867904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565109

RESUMO

Local bone denervation by magnetic resonance-guided focused ultrasound (MRgFUS) is a promising tool for alleviation of pain in patients with painful bone metastasis (BM). Considering the underlying mechanism of pain alleviation, MRgFUS might be effective for various bone and joint diseases associated with local tenderness. This study was conducted to clarify the therapeutic effect of focused ultrasound in patients with various painful bone and joint diseases that are associated with local tenderness. Ten patients with BM, 11 patients with lumbar facet joint osteoarthritis (L-OA), and 19 patients with knee osteoarthritis (K-OA) were included. MRgFUS treatment was applied to the bone surface with real-time temperature monitoring at the target sites. Pain intensity was assessed using a 100 mm numerical rating scale (NRS) at various time points. Pressure pain threshold (PPT) was evaluated on the sonication area and control sites. Compared to baseline, the pain NRS scores significantly decreased in all groups 1 month after treatment, and PPT at the treated sites significantly increased in all groups 3 months after treatment. The percentage of patients who showed a ≥ 50% decrease in pain NRS scores at 1 month after treatment was 80% in BM, 64% in L-OA, and 78% in K-OA groups. PPTs were significantly higher after treatment at all evaluation time points. This study indicated that MRgFUS is effective in reducing pressure pain at the site of most severe tenderness in patients with painful bone and joint diseases. Treatment response was comparable between patients with BM, L-OA, and K-OA.


Assuntos
Dor do Câncer/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Osteoartrite do Joelho/terapia , Osteoartrite da Coluna Vertebral/terapia , Idoso , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite da Coluna Vertebral/complicações
17.
Asian J Anesthesiol ; 57(2): 37-54, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31382324

RESUMO

The overall burden of chronic musculoskeletal pain in Asian countries will continue to increase as the population ages, as will the demand for safe and effective pain management. Currently available Asian guidelines are mostly outdated and targeted only to primary care. Implementation of international guidelines may be unsuitable for Asian patients due to cultural, local economic and regulatory factors. With the aim of developing Asian-specifi c consensus recommendations for the pharmacological management of osteoarthritis (OA) pain and chronic low back pain (cLBP), we convened to review and discuss recent available evidence for pharmacotherapy, clinical experiences, and current practice challenges they face in the region, including challenges in opioid use. Taking these into consideration, we provided general recommendations for the overall assessment and management of OA pain and cLBP. The strength of the recommendations regarding the use of pharmacological agents was assessed using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. Where evidence is confl icting or limited, we made no recommendation pending the availability of further evidence. We recommend topical non-steroidal anti-infl ammatory drugs (NSAIDs) as a fi rst-line pharmacological treatment of OA pain, while oral NSAIDs should be considered as a fi rst-line pharmacological treatment of cLBP. Acetaminophen has been commonly used as the fi rst-line treatment for OA pain and cLBP, but its long-term use is not recommended based on recent evidence. These consensus recommendations are not prescriptive, and serve as a guide for decision-making in clinical practice. The optimal management of OA pain and cLBP should ultimately be individualized to each patient.


Assuntos
Dor Crônica/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Acetaminofen/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Consenso , Quimioterapia Combinada , Humanos
18.
Expert Opin Pharmacother ; 20(16): 2041-2052, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31422709

RESUMO

Background: Information on prescriptions of oral analgesics for the treatment of pain is beneficial. However, there have been few reports on the prescription status of oral analgesics from a nation-wide, large-scale prescription database in Japan. Research design and methods: The authors analyzed the prescription data of 2,042,302 patients prescribed oral analgesics in 2017. The numbers/proportions of patients prescribed oral analgesics, adherence with approved doses, co-prescription patterns, dose changes, drug adherence, and treatment-discontinuation rates were evaluated. Results: Loxoprofen was prescribed to 32.5% of the patients, followed by celecoxib, prescribed to 16.0% of patients. Acetaminophen and pregabalin were prescribed to 10.5% and 9.4% of patients, respectively. Many analgesics were prescribed at lower doses than the approved doses. The most frequently used concomitant medication was pregabalin. For duloxetine and pregabalin, high proportions of patients were prescribed these drugs for > 90 days. Conclusions: Loxoprofen was the most prescribed of the non-steroidal anti-inflammatory drugs in Japan. The information obtained provides an overview of prescribed oral analgesics in Japan and could be useful for potential research into prescribed oral analgesics in the future.


Assuntos
Analgésicos/uso terapêutico , Dor/tratamento farmacológico , Prescrições/estatística & dados numéricos , Administração Oral , Adolescente , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Japão , Masculino , Pessoa de Meia-Idade , Fenilpropionatos/uso terapêutico , Estudos Retrospectivos , Adulto Jovem
19.
Biomed Res Int ; 2019: 5021914, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31119173

RESUMO

Objective: Virtual reality (VR) is an advanced technology that can be used to attenuate pain. The present study aimed to investigate which method was more effective for pain management: VR combined with exercise imagery or VR distraction. Methods: Fifty-two healthy students participated in this randomized cross-over controlled trial. One VR-based task aimed to passively use the imagery of driving a car as a distraction intervention (the driving group), whereas the other VR-based task aimed to use exercise imagery (running) to actively engage the participants in movement (the running group). The mechanical pressure pain thresholds of the quadriceps and forearm and the heat pain threshold of the hand of each subject were measured before, during, and after each VR task. The differences between the values at each time point and the differences between the groups were analyzed. Results: The pressure and heat pain thresholds were significantly greater during VR task than those before VR task in both driving and running groups. The changes in the pressure pain thresholds that occurred during VR task were significantly higher in the running group than in the driving group. The difference between groups gradually declined after VR task. Conversely, there was no significant difference in the changes in the heat pain thresholds between the groups both during VR task and after VR task. Conclusions: VR combined with exercise imagery has a greater effect on pressure pain thresholds, but not heat pain thresholds, than VR distraction.


Assuntos
Medição da Dor , Percepção da Dor/fisiologia , Dor/prevenção & controle , Realidade Virtual , Adulto , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Humanos , Imagens, Psicoterapia , Masculino , Dor/fisiopatologia , Limiar da Dor , Análise e Desempenho de Tarefas , Interface Usuário-Computador , Adulto Jovem
20.
PLoS One ; 14(5): e0216857, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31086388

RESUMO

INTRODUCTION: Only a few, large population-based studies, have reported on whiplash-associated disorder (WAD). However, none of them have investigated the influence of crash severity on WAD outcome. In the present study, we aimed to determine whether crash severity predicts outcomes among patients with no-fault government insurance for acute WAD. METHODS: We utilized data from a compulsory, no-fault government automobile liability insurance agency in Japan. Individuals involved in a car accident between April 2001 and June 2015 with residual disabilities reported at the end of the treatment between October 2014 and September 2015 were included. Crash severity was assessed based on property damage costs, size of the other vehicle (large car, medium car, small car, or two-wheeled vehicles), and collision types (rear-end collision, contact with vehicle moving in the same direction, or in the opposite direction). Outcomes included the time to claim closure and the number of treatment visits. RESULTS: We analyzed data for a total of 52,251 individuals (28,571 male and 23,680 female) with a median age of 44 years (range: 2-95 years). The median time to claim closure was 220 days (range: 1-4,938 days), and the median number of treatment visits was 102 (range: 1-2,492). There was no significant association between outcomes and property damage costs or size of the other vehicle. Collision types exhibited no consistent association with outcomes. However, older age and affected body parts, in addition to the neck, were independent risk factors for delayed claim closure and a large number of visits, although, all odds ratios were low (often less than 2.0). CONCLUSIONS: There was no obvious association of outcomes with property damage costs, size of the other vehicle, or collision types in acute WAD patients. Further studies should investigate the influence of psychological factors, compensation systems, and cultural conditions.


Assuntos
Acidentes de Trânsito , Traumatismos em Chicotada/epidemiologia , Acidentes de Trânsito/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Compensação e Reparação , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Traumatismos em Chicotada/terapia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA