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1.
Compend Contin Educ Dent ; 41(9): 466-473; quiz 474, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33001657

RESUMO

It is well-known that there is an opioid crisis in the United States. Prescription opioid analgesics contribute to this crisis; in 2012, dentists ranked second to family care physicians as the top prescribers. The medical and dental literature demonstrates that dental prescribing practices have been excessive, resulting in leftover medication that could then be diverted, misused, or abused. A multimodal analgesic approach is highly valuable in targeting pain along various points on the peripheral and central pain pathways and includes the use of long-acting local anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, the last of which are generally reserved for the most severe pain only. The Dental Impaction Pain Model demonstrates that NSAIDs are the frontline drugs for postoperative dental pain. Opioids have their role in postoperative analgesia but should be reserved for severe breakthrough pain or in situations where NSAIDs may be contraindicated.


Assuntos
Analgésicos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Estados Unidos
2.
Medicine (Baltimore) ; 99(38): e22162, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957340

RESUMO

BACKGROUND: Patients with spinal fusion often have opioid tolerance and chronic pain, which makes it difficult to control postoperative pain. In this double-blind, randomized, prospective study, we assessed the safety and efficacy of intravenous low-dose ketamine for the treatment of pain in patients undergoing the lumbar spinal fusion. METHODS: This randomized, prospective, double-blind and placebo-controlled study was approved via the hospital institutional review committee. Patients were registered with signed written consent. All the floor nurses, recovery room and surgeons, patients, statisticians as well as research assistants were unaware of the grouping. The patients were randomly divided into ketamine group and control group by random number table. Nausea, vomiting or vomiting, the intensity of pain, adverse events, cumulative morphine consumption, as well as the amount of extra antiemetics or analgesics were evaluated at 6 hours, 12 hours, 24 hours, 36 hours, and 48 hours after the operation. P < .05 was considered to be the statistically significant. The Statistical Package for the software of Social Sciences 20.0 was utilized for statistical analysis. CONCLUSIONS: For the present trial, we assumed that intravenous ketamine could improve the satisfaction of patient by reducing the total consumption of morphine equivalent and the pain scores. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5896).


Assuntos
Analgésicos/uso terapêutico , Ketamina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Fusão Vertebral , Método Duplo-Cego , Humanos , Medição da Dor , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
BMJ Case Rep ; 13(9)2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32958554

RESUMO

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


Assuntos
Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/fisiopatologia , Dor Lombar/fisiopatologia , Debilidade Muscular/fisiopatologia , Parestesia/fisiopatologia , Pneumonia Viral/complicações , Analgésicos/uso terapêutico , Betacoronavirus , Encéfalo/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Feminino , Gabapentina/uso terapêutico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Radiculopatia/diagnóstico , Medula Espinal/diagnóstico por imagem
5.
Lancet ; 396(10255): 909-917, 2020 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-32979978

RESUMO

BACKGROUND: Chronic pelvic pain affects 2-24% of women worldwide and evidence for medical treatments is scarce. Gabapentin is effective in treating some chronic pain conditions. We aimed to measure the efficacy and safety of gabapentin in women with chronic pelvic pain and no obvious pelvic pathology. METHODS: We performed a multicentre, randomised, double-blind, placebo-controlled randomised trial in 39 UK hospital centres. Eligible participants were women with chronic pelvic pain (with or without dysmenorrhoea or dyspareunia) of at least 3 months duration. Inclusion criteria were 18-50 years of age, use or willingness to use contraception to avoid pregnancy, and no obvious pelvic pathology at laparoscopy, which must have taken place at least 2 weeks before consent but less than 36 months previously. Participants were randomly assigned in a 1:1 ratio to receive gabapentin (titrated to a maximum dose of 2700 mg daily) or matching placebo for 16 weeks. The online randomisation system minimised allocations by presence or absence of dysmenorrhoea, psychological distress, current use of hormonal contraceptives, and hospital centre. The appearance, route, and administration of the assigned intervention were identical in both groups. Patients, clinicians, and research staff were unaware of the trial group assignments throughout the trial. Participants were unmasked once they had provided all outcome data at week 16-17, or sooner if a serious adverse event requiring knowledge of the study drug occurred. The dual primary outcome measures were worst and average pain scores assessed separately on a numerical rating scale in weeks 13-16 after randomisation, in the intention-to-treat population. Self-reported adverse events were assessed according to intention-to-treat principles. This trial is registered with the ISRCTN registry, ISCRTN77451762. FINDINGS: Participants were screened between Nov 30, 2015, and March 6, 2019, and 306 were randomly assigned (153 to gabapentin and 153 to placebo). There were no significant between-group differences in both worst and average numerical rating scale (NRS) pain scores at 13-16 weeks after randomisation. The mean worst NRS pain score was 7·1 (standard deviation [SD] 2·6) in the gabapentin group and 7·4 (SD 2·2) in the placebo group. Mean change from baseline was -1·4 (SD 2·3) in the gabapentin group and -1·2 (SD 2·1) in the placebo group (adjusted mean difference -0·20 [97·5% CI -0·81 to 0·42]; p=0·47). The mean average NRS pain score was 4·3 (SD 2·3) in the gabapentin group and 4·5 (SD 2·2) in the placebo group. Mean change from baseline was -1·1 (SD 2·0) in the gabapentin group and -0·9 (SD 1·8) in the placebo group (adjusted mean difference -0·18 [97·5% CI -0·71 to 0·35]; p=0·45). More women had a serious adverse event in the gabapentin group than in the placebo group (10 [7%] of 153 in the gabapentin group compared with 3 [2%] of 153 in the placebo group; p=0·04). Dizziness, drowsiness, and visual disturbances were more common in the gabapentin group. INTERPRETATION: This study was adequately powered, but treatment with gabapentin did not result in significantly lower pain scores in women with chronic pelvic pain, and was associated with higher rates of side-effects than placebo. Given the increasing reports of abuse and evidence of potential harms associated with gabapentin use, it is important that clinicians consider alternative treatment options to off-label gabapentin for the management of chronic pelvic pain and no obvious pelvic pathology. FUNDING: National Institute for Health Research.


Assuntos
Analgésicos/efeitos adversos , Analgésicos/uso terapêutico , Dor Crônica/tratamento farmacológico , Gabapentina/efeitos adversos , Gabapentina/uso terapêutico , Dor Pélvica/tratamento farmacológico , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Uso Off-Label , Resultado do Tratamento , Adulto Jovem
7.
J Headache Pain ; 21(1): 115, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32972360

RESUMO

BACKGROUND: Since the declaration COVID-19 as a pandemic, healthcare systems around the world have faced a huge challenge in managing patients with chronic diseases. Patients with migraine were specifically vulnerable to inadequate medical care. We aimed to investigate the "real-world" impact of COVID-19 pandemic on migraine patients, and to identify risk factors for poor outcome. METHODS: We administered an online, self-reported survey that included demographic, migraine-related, COVID-19-specific and overall psychosocial variables between July 15 and July 30, 2020. We recruited a sample of patients with migraine from headache clinic registry and via social media to complete an anonymous survey. Outcomes included demographic variables, change in migraine frequency and severity during the lockdown period, communication with treating physician, compliance to migraine treatment, difficulty in getting medications, medication overuse, symptoms of anxiety and/or depression, sleep and eating habits disturbance, screen time exposure, work during pandemic, use of traditional medicine, effect of Botox injection cancellation, and overall worries and concerns during pandemic. RESULTS: A total of 1018 patients completed the survey. Of the respondents, 859 (84.3%) were females; 733 (71.9%) were aged 20 to 40 years, 630 (61.8%) were married, and 466 (45.7%) reported working during the pandemic. In comparison to pre-pandemic period, 607 respondents (59.6%) reported increase in migraine frequency, 163 (16%) reported decrease in frequency, and 105 (10.3%) transformed to chronic migraine. Severity was reported to increase by 653 (64.1%) respondents. The majority of respondents; 626 (61.5%) did not communicate with their neurologists, 477 (46.9%) reported compliance to treatment, and 597 (58.7%) reported overuse of analgesics. Botox injections cancellation had a negative impact on 150 respondents (66.1%) from those receiving it. Forty-one respondents (4%) were infected with COVID-19; 26 (63.4%) reported worsening of their headaches amid infection period. Sleep disturbance was reported by 794 (78.1%) of respondents, and 809 (79.5%) reported having symptoms of anxiety and/or depression. CONCLUSIONS AND RELEVANCE: COVID-19 pandemic had an overall negative impact on patients with migraine. Several risk factors for poor outcome were identified. Long-term strategies should be validated and implemented to deliver quality care for patients with migraine, with emphasis on psychosocial well-being.


Assuntos
Infecções por Coronavirus/epidemiologia , Transtornos de Enxaqueca/fisiopatologia , Pneumonia Viral/epidemiologia , Uso Excessivo de Medicamentos Prescritos/estatística & dados numéricos , Adulto , Analgésicos/uso terapêutico , Ansiedade/psicologia , Betacoronavirus , Toxinas Botulínicas Tipo A/uso terapêutico , Comunicação , Depressão/psicologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Internet , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Transtornos de Enxaqueca/psicologia , Fármacos Neuromusculares/uso terapêutico , Pandemias , Relações Médico-Paciente , Fatores de Risco , Sono , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Inquéritos e Questionários , Adulto Jovem
8.
J Oral Sci ; 62(4): 387-392, 2020 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-32893197

RESUMO

The cause of burning mouth syndrome (BMS) is unknown. Although no effective treatment has been established, BMS patients frequently chew gum to alleviate pain. To identify the cause and new treatments for BMS, this study investigated the psychophysical and pharmacological properties of gum chewing to better understand its pain-relieving effects. In this prospective, blinded study, plasma catecholamine and serotonin levels and Profile of Mood States (POMS) scores were assessed after gum chewing or simulated chewing in 40 women (20 BMS patients and 20 age-matched controls). Visual analogue scale (VAS) scores for pain decreased significantly in BMS patients after gum chewing and simulated chewing. Moreover, resting VAS scores of BMS patients were significantly positively correlated with plasma adrenaline level. Furthermore, gum chewing was significantly correlated with lower plasma adrenaline level, VAS score, and tension-anxiety score. These results suggest that adrenaline is important in the pathogenesis of BMS pain and that the analgesic effect of gum chewing is induced through the potential effects of anxiety reduction, although this effect might not be specific to BMS. In addition, the analgesic effect of gum chewing was not induced solely by chewing motion.


Assuntos
Síndrome da Ardência Bucal/tratamento farmacológico , Síndrome da Ardência Bucal/terapia , Analgésicos/uso terapêutico , Goma de Mascar , Feminino , Humanos , Mastigação , Estudos Prospectivos
9.
Medicine (Baltimore) ; 99(36): e22113, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899094

RESUMO

OBJECTIVE: Effective analgesia during delivery can not only decrease pain, but also have a significant function in ensuring the safety of baby and mother. Sufentanil is generally used opioid with ropivacaine in epidural anesthesia in labor pain management; however it can cause some adverse reaction. Dexmedetomidine is an a2-adrenoceptor agonist with high selectivity. It possesses opioid-sparing and analgesic effects and it is suitable for the long-term and short-term intraoperative sedation. The purpose of this present study is to compare the analgesic effect of ropivacaine with dexmedetomidine against ropivacaine with sufentanyl in epidural labor. METHODS: This is a single center, placebo-controlled randomized trial which will be performed from May 2020 to May 2021. It was authorized via the Institutional Review Committee in the first medical center of Chinese PLA General Hospital (S2018-211-0). One hundred sixty full-term protozoa are included in this work. They are randomly divided into four groups (n = 40 per group): the RD1 group (with the epidural administration of 0.125% ropivacaine + dexmedetomidine of 0.5 µg/mL), and the RD2 group (with the epidural administration of 0.08% ropivacaine + dexmedetomidine 0.5 µg/mL), the RS1 group (with the epidural administration of 0.125% ropivacaine + sufentanil of 0.5 µg/mL), as well as RS2 group (with the epidural administration of 0.08% ropivacaine + sufentanil of 0.5 µg/mL). Clinical outcomes are pain score, a modified Bromage scale, the Ramsay Sedation Scale, and adverse reactions during analgesia. All the needed analyses are implemented through utilizing SPSS for Windows Version 20.0. RESULTS: The first table shows the clinical outcomes between these four groups. CONCLUSION: This current work can provide a primary evidence regarding the clinical outcomes of dexmedetomidine versus sufentanil for labor epidural analgesia. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5877).


Assuntos
Analgesia Obstétrica/métodos , Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Dexmedetomidina/uso terapêutico , Ropivacaina/uso terapêutico , Sufentanil/uso terapêutico , Analgesia Epidural/métodos , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Gravidez , Ropivacaina/administração & dosagem , Ropivacaina/efeitos adversos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos
10.
Medicine (Baltimore) ; 99(35): e21684, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871884

RESUMO

Ultrasound-guided interscalene block (US-ISB) and nerve stimulator-guided interscalene block (NS-ISB) have both been commonly used for anesthesia in shoulder arthroscopic surgery.This study aims to compare which method provides surgical block as a sole anesthesia. In this retrospective study, 1158 patients who underwent shoulder arthroscopic rotator cuff tear repair surgery under ISB between October 2002 and March 2018 were classified into either the US-ISB or NS-ISB anesthesia groups. Demographic and anesthetic characteristics and intraoperative medications were analyzed after propensity score matching and compared between the 2 groups.There was a 0.5% rate of conversion to general anesthesia in the US-ISB group and a 6.7% rate in the NS-ISB group (P < .001). The volume of local anesthetics used for ISB was 29.7 ±â€Š8.9 mL in the US-ISB group versus 38.1 ±â€Š4.8 mL in the NS-ISB group (P < .001). The intraoperative use of analgesics and sedatives such as fentanyl, midazolam and propofol in combination was significantly lowered in the US-ISB group (P < .001).US-ISB is a more effective and safer approach for providing intense block to NS-ISB because it can decrease the incidence of conversion to general anesthesia and reduce the use of analgesics and sedatives during arthroscopic shoulder surgery.


Assuntos
Artroscopia , Bloqueio Nervoso/métodos , Lesões do Manguito Rotador/cirurgia , Ultrassonografia de Intervenção , Analgésicos/uso terapêutico , Anestesia Geral , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Pain Physician ; 23(4S): S311-S318, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942791

RESUMO

BACKGROUND: The COVID-19 pandemic has emerged and has challenged us to look for alternatives to bring about a paradigm shift in interventional chronic pain management. As the disease lowers the body's immune system, the use of medications that suppress the immune system are not recommended during the COVID-19 pandemic. OBJECTIVE: The purpose of this study was to review medications other than steroids used for interventional pain management and the emphasis on mitigation of the untoward consequences of steroid injections on the immune system during the COVID-19 pandemic. LITERATURE SEARCH: The literature was searched for articles in English with key words COVID-19, immunity, steroid for pain management injections with steroid, local anesthetics, dextrose water, normal saline, pain and genetic medicine, pain, and regenerative medicine. The sources of articles were PubMed, Embase, and open Google search. LITERATURE REVIEW: The medications used for interventional pain management include steroids and opioids. The side effects of these medications are well known but have never been looked at as critically as they are now. Many other medications have been used for interventional pain procedures to relieve pain, such as dextrose water, normal saline solution, local anesthetics, and many adjuvants. Regarding regenerative therapy, despite plenty of evidence in literature, we have not yet considered it as a routine therapy for chronic pain injections. It is now time to move on beyond steroids and consider other types of medications and treatment options.The use of these medications in clinical practice is less auspicious, and thus more research is needed on the practical applications. Further areas for research include studies to determine definitive efficacy and safety assessment and determine whether or not the analgesic effects of these drugs are duration or dose-dependent. The optimal identification of candidates, volume, concentration, and intervals of injection are essential for routine application in interventional chronic pain practice. CONCLUSIONS: The future of interventional pain practice is trending toward regenerative medicine and genetic research. Numerous scientific studies have been conducted to investigate the genetic basis of phenotypic variability in individuals with different ethnic groups in terms of susceptibility to chronic pain, as well as response to treatment for the personalized medicine model. Despite the preliminary data on genetic variations, there is no evidence for the use of a pharmacogenomics-based approach to personalized medicine for patients with chronic pain. The field of medicine therefore needs further research in pharmacogenetics, including large-scale prospective studies that focus on pain pathways. However, recent research, including larger studies and larger-scale genomic perspectives, may yield more promising findings in the future. The COVID-19 pandemic proved the need for medications with the most impact and least complications.


Assuntos
Analgésicos/uso terapêutico , Infecções por Coronavirus , Manejo da Dor/métodos , Manejo da Dor/tendências , Pandemias , Pneumonia Viral , Betacoronavirus , Dor Crônica/tratamento farmacológico , Humanos
12.
Anesthesiology ; 133(3): 611-627, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32788559

RESUMO

BACKGROUND: Voltage-gated sodium channel Nav1.7 has been validated as a perspective target for selective inhibitors with analgesic and anti-itch activity. The objective of this study was to discover new candidate compounds with Nav1.7 inhibitor properties. The authors hypothesized that their approach would yield at least one new compound that inhibits sodium currents in vitro and exerts analgesic and anti-itch effects in mice. METHODS: In silico structure-based similarity search of 1.5 million compounds followed by docking to the Nav1.7 voltage sensor of Domain 4 and molecular dynamics simulation was performed. Patch clamp experiments in Nav1.7-expressing human embryonic kidney 293 cells and in mouse and human dorsal root ganglion neurons were conducted to test sodium current inhibition. Formalin-induced inflammatory pain model, paclitaxel-induced neuropathic pain model, histamine-induced itch model, and mouse lymphoma model of chronic itch were used to confirm in vivo activity of the selected compound. RESULTS: After in silico screening, nine compounds were selected for experimental assessment in vitro. Of those, four compounds inhibited sodium currents in Nav1.7-expressing human embryonic kidney 293 cells by 29% or greater (P < 0.05). Compound 9 (3-(1-benzyl-1H-indol-3-yl)-3-(3-phenoxyphenyl)-N-(2-(pyrrolidin-1-yl)ethyl)propanamide, referred to as DA-0218) reduced sodium current by 80% with a 50% inhibition concentration of 0.74 µM (95% CI, 0.35 to 1.56 µM), but had no effects on Nav1.5-expressing human embryonic kidney 293 cells. In mouse and human dorsal root ganglion neurons, DA-0218 reduced sodium currents by 17% (95% CI, 6 to 28%) and 22% (95% CI, 9 to 35%), respectively. The inhibition was greatly potentiated in paclitaxel-treated mouse neurons. Intraperitoneal and intrathecal administration of the compound reduced formalin-induced phase II inflammatory pain behavior in mice by 76% (95% CI, 48 to 100%) and 80% (95% CI, 68 to 92%), respectively. Intrathecal administration of DA-0218 produced acute reduction in paclitaxel-induced mechanical allodynia, and inhibited histamine-induced acute itch and lymphoma-induced chronic itch. CONCLUSIONS: This study's computer-aided drug discovery approach yielded a new Nav1.7 inhibitor that shows analgesic and anti-pruritic activity in mouse models.


Assuntos
Analgésicos/uso terapêutico , Desenho de Fármacos , Canal de Sódio Disparado por Voltagem NAV1.7/efeitos dos fármacos , Neuralgia/tratamento farmacológico , Prurido/tratamento farmacológico , Bloqueadores do Canal de Sódio Disparado por Voltagem/uso terapêutico , Animais , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL
13.
Lancet Child Adolesc Health ; 4(10): 750-760, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32735783

RESUMO

Background Increasing numbers of neonates are undergoing painful procedures in low-income and middle-income countries, with adequate analgesia seldom used. In collaboration with a multi-disciplinary team in Kenya, we aimed to establish the first evidence-based guidelines for the management of routine procedure-related neonatal pain that consider low-resource hospital settings. METHODS: We did a systematic review by searching MEDLINE, Embase, CINAHL, and CENTRAL databases for studies published from Jan 1, 1953, to March 31, 2019. We included data from randomised controlled trials using heart rate, oxygen saturation (SpO2), premature infant pain profile (PIPP) score, neonatal infant pain scale (NIPS) score, neonatal facial coding system score, and douleur aiguë du nouveau-né scale score as pain outcome measures. We excluded studies in which neonates were undergoing circumcision or were intubated, studies from which data were unextractable, or when pain was scored by non-trained individuals. We did a narrative synthesis of all studies, and meta-analysis when data were available from multiple studies comparing the same analgesics and controls and using the same outcome measures. 17 Kenyan health-care professionals formed our clinical guideline development panel, and we used the Grading of Recommendations, Assessment, Development and Evaluation framework and the panel's knowledge of the local health-care context to guide the guideline development process. This study is registered with PROSPERO, CRD42019126620. FINDINGS: Of 2782 studies assessed for eligibility, data from 149 (5%) were analysed, with 80 (3%) of these further contributing to our meta-analysis. We found a high level of certainty for the superiority of breastfeeding over placebo or no intervention (standardised mean differences [SMDs] were -1·40 [95% CI -1·96 to -0·84] in PIPP score and -2·20 [-2·91 to -1·48] in NIPS score), and the superiority of oral sugar solutions over placebo or no intervention (SMDs were -0·38 [-0·61 to -0·16] in heart rate and 0·23 [0·04 to 0·42] in SpO2). We found a moderate level of certainty for the superiority for expressed breastmilk over placebo or no intervention (SMDs were -0·46 [95% CI -0·87 to -0·05] in heart rate and 0·48 [0·20 to 0·75] in SpO2). Therefore, the panel recommended that breastfeeding should be given as first-line analgesic treatment, initiated at least 2 min pre-procedure. Given contextual factors, for neonates who are unable to breastfeed, 1-2 mL of expressed breastmilk should be given as first-line analgesic, or 1-2 mL of oral sugar (≥10% concentration) as second-line analgesic. The panel also recommended parental presence during procedures with adjunctive provision of skin-to-skin care, or non-nutritive sucking when possible. INTERPRETATION: We have generated Kenya's first neonatal analgesic guidelines for routine procedures, which have been adopted by the Kenyan Ministry of Health, and have shown a framework for clinical guideline development that is applicable to other low-income and middle-income health-care settings. FUNDING: Wellcome Trust Research Programme, and the Africa-Oxford Initiative.


Assuntos
Cuidado do Lactente/métodos , Método Canguru/métodos , Manejo da Dor/métodos , Dor/prevenção & controle , Analgésicos/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Quênia , Masculino , Dor/tratamento farmacológico , Flebotomia/efeitos adversos , Guias de Prática Clínica como Assunto , Punções/efeitos adversos
14.
J Neurovirol ; 26(5): 800-801, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32779108

RESUMO

A woman in her forties with asthma and COPD was admitted to a general medical floor with respiratory symptoms, body aches, and anosmia. Reverse transcription polymerase chain reaction detected severe acute respiratory syndrome coronavirus-2. Admission labs, including biomarkers of the systemic immunological dysfunction seen in many cases of coronavirus disease 2019 (COVID-19), were within normal ranges. On the second day of admission, she developed neck and back pain that was constant, burning in quality, and exacerbated by light touch and heat. Wearing clothing caused pain and interfered with her sleep. The area was tender to light finger stroke. The patient was given acetaminophen, NSAIDs, and opioids with no relief of pain. However, gabapentin was effective. At follow-up 1 month later, her symptoms were improved and still relieved by gabapentin. Neuropathic pain was seen in over 2% of COVID-19 patients in one observational study. The pain seen in our case was bilateral, involved an area innervated by multiple levels of spinal nerves, and was limited to the back. While it is rare, a significant number of COVID-19 patients are afflicted by neuropathic pain, and our case illustrates that gabapentin may be effective.


Assuntos
Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/complicações , Dor nas Costas/complicações , Infecções por Coronavirus/complicações , Cervicalgia/complicações , Transtornos do Olfato/complicações , Dor/complicações , Pneumonia Viral/complicações , Acetaminofen/uso terapêutico , Analgésicos/uso terapêutico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/tratamento farmacológico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/patologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/virologia , Dor nas Costas/tratamento farmacológico , Dor nas Costas/patologia , Dor nas Costas/virologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Feminino , Gabapentina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico , Cervicalgia/patologia , Cervicalgia/virologia , Transtornos do Olfato/tratamento farmacológico , Transtornos do Olfato/patologia , Transtornos do Olfato/virologia , Dor/tratamento farmacológico , Dor/patologia , Dor/virologia , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(32): e21580, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769907

RESUMO

BACKGROUND: We aim to perform a network meta-analysis (NMA) to quantify and rank-order the efficacy and safety of analgesic medications for ambulatory surgery. METHODS: We will search MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar databases to identify all randomized controlled trials (RCTs) of analgesics, beginning from their inception to February 2020. The primary endpoints will be pain score measured using a visual analog scale (VAS) or a numerical rating scale (NRS) at 3 different time points: Phase I recovery, phase II recovery, and recovery at home. Adverse events, including nausea, vomiting, headache, dizziness, arrhythmia, and respiratory depression, will be also assessed.We will conduct NMA and use surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of analgesic medication. A comparison-adjusted funnel plot will be used to assess the presence of small study effects. The quality of the included studies will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE version 15.0. RESULTS: The results of this systematic review and NMA will be published in a peer-reviewed journal. CONCLUSION: This systematic review and NMA will provide comprehensive and convincing evidence regarding analgesic medication for pain after ambulatory surgery. TRIAL REGISTRATION NUMBER: CRD42018100000.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Analgésicos/normas , Protocolos Clínicos , Analgésicos/uso terapêutico , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Escala Visual Analógica
16.
Maturitas ; 138: 26-35, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32631585

RESUMO

INTRODUCTION: Primary dysmenorrhea (PD) is a common gynecological disorder that usually begins in adolescence, and affects patients' daily activities and quality of life. Non-steroidal anti-inflammatory drugs (NSAIDS) are considered the first-line treatment, and hormonal contraceptives are also recommended for PD, but both are prone to side-effects. The Chinese herbal formula Siwutang (SWT) and its derivative formulas are a common treatment for PD in China. This review assessed the efficacy and safety of SWT for the treatment of PD. METHODS: PubMed, EmBase, Cochrane CENTRAL, CNKI, Wanfang and CBM were searched. We included randomized controlled trials (RCTs) that investigated SWT for PD, compared with no intervention, placebo, or conventional Western medicine. The outcome measurements included pain intensity measured by visual analogue scale (VAS) or other validated scales, the Cox Menstrual Symptom Scale (CMSS), quality of life, response rate and adverse events. The Cochrane Collaboration's tool was used to assess the risk of bias. RevMan V.5.3 was used for data synthesis and meta-analysis. Risk ratio (RR) with 95 % confidence intervals (CIs) or mean difference (MD) with 95 % CIs was calculated for dichotomous data or continuous data, respectively. Heterogeneity among studies was evaluated using both a chi-square test and an I2 test. RESULTS: A total of 38 RCTs involving 3982 participants were identified. The methodological quality of the included trials was generally poor. Moreover, the results for SWT compared with placebo were unclear, as there was only 1 RCT. SWT improved pain intensity measured by VAS (3 RCTs, n = 220, MD:-2.61, 95 % CI:-3.72 to -1.51) when compared with conventional medicine, and these results were statistically significant. The meta-analysis showed the superior effect of SWT (including derivative formulas) on response rate (35 RCTs, n = 3,695, RR: 1.28, 95 % CI: 1.22-1.34) with medium heterogeneity (I2 = 48 %). Both original SWT and its derivative formula XFSWT had a higher response rate than conventional medicine (23 RCTs, n = 2,493, RR: 1.28, 95 % CI: 1.23-1.33) (11 RCTs, n = 1,076, RR: 1.36, 95 % CI: 1.20-1.53). These results were statistically significant. No trial reported on quality of life or CMSS. Adverse events were reported by 5 studies, and meta-analysis showed SWT may be safer than conventional medicine in terms of the incidence of adverse events (3 RCTs, n = 236, RR: 0.17, 95 % CI: 0.07-0.38, I2 = 0%). CONCLUSION: In conclusion, the included trials showed favorable effects of SWT for treating primary dysmenorrhea when compared with conventional medicine. SWT may be safer than conventional medicine, but insufficient data was reported. The level of evidence is low because of the high risk of bias. Thus, further well-designed clinical trials with large sample sizes are warranted. REGISTRATION NUMBER: CRD42019136230 in PROSPERO 2019.


Assuntos
Analgésicos/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Dismenorreia/tratamento farmacológico , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Toxicon ; 185: 164-173, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32698026

RESUMO

Mirror pain represents pain with complex pathophysiological background experienced at both sides of the body, usually after unilateral injury. Although observed almost 10 years ago, the phenomenon of bilateral antinociceptive effect of botulinum toxin type A (BoNT/A) following its unilateral administration in experimental mirror-image pain (MP) models remains challenging and intriguing task to explain. Data generated so far using MP models and mechanisms behind this unique feature of BoNT/A might influence the overall understanding of its mechanism of antinociceptive action. Here we review the effects contributing to BoNT/A's bilateral antinociceptive action observed in experimental MP models.


Assuntos
Analgésicos/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Dor/tratamento farmacológico , Animais , Humanos
19.
Neurology ; 95(5): e469-e479, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32636324

RESUMO

OBJECTIVE: To assess efficacy and tolerability of 1-year erenumab treatment in patients with episodic migraine. METHODS: Patients were randomized (n = 955; 1:1:1) during the 24-week double-blind treatment phase (DBTP) to monthly subcutaneous placebo or erenumab 70 or 140 mg. At week 24, 845 patients were rerandomized (1:1) to erenumab 70 or 140 mg during the 28-week dose-blinded active-treatment phase (ATP). Monthly migraine days (MMD), achieving ≥50%, ≥75%, and 100% reduction in MMD, and safety/tolerability were assessed. RESULTS: Mean MMD at DBTP baseline was 8.3. At week 52, mean changes (SE) from pre-DBTP baseline/week 24 (pre-ATP baseline) in MMD were -4.2 (0.2)/-1.1 (0.2) (70 mg) and -4.6 (0.2)/-1.8 (0.2) (140 mg) irrespective of treatment during the DBTP. For patients reducing dose from 140 (DBTP) to 70 mg (ATP), change in MMD from week 24 to 52 was -0.1 (0.3), and for those increasing from 70 (DBTP) to 140 mg (ATP), -1.8 (0.3). At week 52, 61.0%, 38.5%, and 19.8% of patients on erenumab 70 mg, and 64.9%, 40.8%, and 21.2% on erenumab 140 mg, achieved ≥50%, ≥75%, and 100% reduction in MMD from DBTP baseline, respectively. Among erenumab-treated patients in DBTP who showed ≥50% reduction in MMD during the last 3 months of DBTP and completed ATP, 86% showed sustained responses at ≥50% during the last 3 months of ATP. Safety of erenumab in ATP was similar to DBTP; exposure-adjusted incidence rates of adverse events were similar for either dose. CONCLUSION: Over 52 weeks, erenumab provided sustained efficacy in episodic migraine; the safety profiles were similar between erenumab dose groups in the presence of dose blinding. CLINICALTRIALSGOV IDENTIFIER: NCT02456740. CLASSIFICATION OF EVIDENCE: Class II evidence that 52 weeks of treatment with erenumab 70 and 140 mg subcutaneously monthly results in sustained reductions in monthly migraine days and similar dose tolerability for patients with episodic migraine.


Assuntos
Analgésicos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
J Clin Apher ; 35(4): 378-381, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32629539

RESUMO

As the COVID-19 pandemic continues to claim lives across the globe, insufficient data exists regarding the optimal treatment. It is well known that patients 55 years of age or older and patients with certain chronic diseases are at higher risk of severe illness, including acute respiratory distress syndrome and death. A potentially fatal pulmonary complication of sickle cell disease, acute chest syndrome, can be precipitated by acute infections, including respiratory viruses. We report the case of a patient with sickle cell disease (HbSC) who developed COVID-19 pneumonia and acute chest syndrome who was treated with emergent red blood cell exchange in order to avoid endotracheal intubation.


Assuntos
Anemia Falciforme/complicações , Betacoronavirus , Infecções por Coronavirus/complicações , Transfusão de Eritrócitos/métodos , Intubação Intratraqueal , Pandemias , Pneumonia Viral/complicações , Insuficiência Respiratória/terapia , Síndrome Torácica Aguda/etiologia , Síndrome Torácica Aguda/terapia , Adulto , Analgésicos/uso terapêutico , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , Terapia Combinada , Contraindicações de Procedimentos , Infecções por Coronavirus/tratamento farmacológico , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Oxigenoterapia , Pneumonia Viral/tratamento farmacológico , Respiração Artificial , Insuficiência Respiratória/etiologia
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