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2.
JMIR Mhealth Uhealth ; 7(7): e12952, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31267979

RESUMO

BACKGROUND: In contrast to the use of traditional unidimensional paper-based scales, a mobile health (mHealth) assessment of pain in children and young people (CYP) with juvenile idiopathic arthritis (JIA) enables comprehensive and complex multidimensional pain data to be captured remotely by individuals. However, how professionals use multidimensional pain data to interpret and synthesize pain reports gathered using mHealth tools is not yet known. OBJECTIVE: The aim of this study was to explore the salience and prioritization of different mHealth pain features as interpreted by key stakeholders involved in research and management of pain in CYP with JIA. METHODS: Pain and rheumatology specialists were purposively recruited via professional organizations. Face-to-face focus groups were conducted for each specialist group. Participants were asked to rank order 9 static vignette scenarios created from real patient mHealth multidimensional pain data. These data had been collected by a researcher in a separate study using My Pain Tracker, a valid and acceptable mHealth iPad pain communication tool that collects information about intensity, severity, location, emotion, and pictorial pain qualities. In the focus groups, specialists discussed their decision-making processes behind each rank order in the focus groups. The total group rank ordering of vignette scenarios was calculated. Qualitative data from discussions were analyzed using latent thematic analysis. RESULTS: A total of 9 pain specialists took part in 1 focus group and 10 rheumatology specialists in another. In pain specialists, the consensus for the highest pain experience (44%) was poorer than their ranking of the lowest pain experiences (55%). Conversely, in rheumatology specialists, the consensus for the highest pain experience (70%) was stronger than their ranking of the lowest pain experience (50%). Pain intensity was a high priority for pain specialists, but rheumatology specialists gave high priority to intensity and severity taken together. Pain spread was highly prioritized, with the number of pain locations (particular areas or joints) being a high priority for both groups; radiating pain was a high priority for pain specialists only. Pain emotion was challenging for both groups and was only perceived to be a high priority when specialists had additional confirmatory evidence (such as information about pain interference or clinical observations) to validate the pain emotion report. Pain qualities such as particular word descriptors, use of the color red, and fire symbols were seen to be high priority by both groups in interpretation of CYP pain reports. CONCLUSIONS: Pain interpretation is complex. Findings from this study of specialists' decision-making processes indicate which aspects of pain are prioritized and weighted more heavily than others by those interpreting mHealth data. Findings are useful for developing electronic graphical summaries which assist specialists in interpreting patient-reported mHealth pain data more efficiently in clinical and research settings.


Assuntos
Manejo da Dor/instrumentação , Dor/classificação , Reumatologistas/psicologia , Adulto , Artrite Juvenil/complicações , Artrite Juvenil/psicologia , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/psicologia , Manejo da Dor/psicologia , Manejo da Dor/normas , Medição da Dor/métodos , Pesquisa Qualitativa , Reumatologistas/estatística & dados numéricos , Reumatologia/instrumentação , Reumatologia/métodos , Telemedicina/tendências
3.
BMC Musculoskelet Disord ; 20(1): 264, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151391

RESUMO

BACKGROUND: Foot orthoses are widely used to manage plantar heel pain (PHP). However, the evidence concerning the effect of foot orthoses on PHP is not conclusive. The study aims to identify the characteristics of patients with PHP likely to achieve a positive outcome after customized foot orthoses and to verify the concept that patients who respond positively to anti-pronation taping would achieve a positive prognosis after wearing foot orthoses for six months. METHODS: This is a prospective observational cohort study. Seventy-four patients with PHP underwent a baseline examination and received anti-pronation taping to their painful feet. The taping effects on pain and function were assessed at the 7-day follow-up visit. Then, all patients received an intervention for their PHP with customized foot orthoses for six months. Outcome was assessed with a numeric pain rating scale, the patient-specific functional scale, the foot function index, and the global rating of perceived change. Significant reduction of pain, increase of function, and perception of a meaningful improvement were considered a positive response. RESULTS: Of 74 patients, 49 had a positive response to the customized foot orthosis treatment. Five predictors were identified: (1) the average pain intensity decreased by over 1.5 points with taping, (2) the range of ankle plantarflexion > 54 degrees, (3) the strength of ankle plantarflexors on the symptomatic side was equal to or stronger than that on the other side, (4) the range of hip internal rotation < 39 degrees, and (5) the range of hip external rotation > 45 degrees. The presence of three or more predictors increased the rate of achieving positive outcome from 66 to 89%. CONCLUSIONS: The predictors of customized foot orthosis outcome in patients with PHP are related to several physical measures of a lower extremity. Findings of the study can be used to screen and select patients with PHP for foot orthosis intervention. Moreover, patients who respond positively to anti-pronation taping would also benefit from the customized foot orthoses. However, since there was no control group in the current study, it is inappropriate to draw conclusions about the effectiveness of the foot orthoses treatment. TRIAL REGISTRATION: The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12617000119392 ).


Assuntos
Articulação do Tornozelo/fisiopatologia , Fita Atlética , Órtoses do Pé , Manejo da Dor/instrumentação , Dor/diagnóstico , Adulto , Feminino , Calcanhar , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Medição da Dor , Prognóstico , Pronação/fisiologia , Estudos Prospectivos , Resultado do Tratamento
4.
Neuromodulation ; 22(5): 638-644, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31199547

RESUMO

BACKGROUND: Occipital nerve stimulation (ONS) is widely used for headache syndromes including chronic migraine (CM) and chronic cluster headache (CCH). The paraesthesia associated with tonic stimulation can be bothersome and can limit therapy. It is now clear in spinal cord stimulation that paraesthesia-free waveforms can produce effective analgesia, but this has not been reported in ONS for CM or CCH. MATERIALS AND METHODS: Seventeen patients (12 CM and 5 CCH) were treated with bilateral burst pattern ONS, including 4 who had previously had tonic ONS. Results were assessed in terms of the frequency of headaches (number of headache days per month for CM, and number of attacks per day for CCH) and their intensity on the numeric pain rating scale. RESULTS: Burst ONS produced a statistically significant mean reduction of 10.2 headache days per month in CM. In CCH, there were significant mean reductions in headache frequency (92%) and intensity (42%). CONCLUSION: Paraesthesia is not necessary for good quality analgesia in ONS. Larger studies will be required to determine whether the efficacies of the two stimulation modes differ. Burst ONS is imperceptible and therefore potentially amenable to robustly blinded clinical trials.


Assuntos
Cefaleia Histamínica/terapia , Terapia por Estimulação Elétrica/métodos , Transtornos de Enxaqueca/terapia , Manejo da Dor/métodos , Nervos Periféricos/fisiologia , Adulto , Idoso , Doença Crônica , Cefaleia Histamínica/diagnóstico , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Manejo da Dor/instrumentação , Estudos Retrospectivos
5.
JMIR Mhealth Uhealth ; 7(6): e13501, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31223120

RESUMO

BACKGROUND: For patients with sickle cell disease (SCD), effective management of vaso-occlusive crises (VOCs) is integral to provision of care, as nearly all affected individuals will suffer from VOCs in their lifetime. A recent systematic review of technological interventions to improve self-management in the care of SCD concluded that electronic health has the potential to improve the care of individuals with SCD. OBJECTIVE: The aim of this study was to assess the value of an electronic teaching module (ETM) provided by Emmi Solutions for educating adult SCD patients on VOC self-management and treatment options for SCD. METHODS: A pretest assessed adults with SCD for baseline knowledge with regard to self-management of VOCs. Participants then watched the 35-min ETM and completed a posttest and survey on the ETM. RESULTS: A total of 20 adults enrolled. Their knowledge scores improved (pretest median 66.5% and posttest median 85%; P<.001). In total, 18 participants (18/20, 90%) agreed that they "learned a lot" or "learned something" from the ETM. The most common topic about which they reported learning was hydroxyurea. A total of 12 participants (12/20, 60%) agreed with the statement that they "would recommend the module to a friend or family member with sickle cell disease." CONCLUSIONS: The ETM is associated with an increase in knowledge in patients with SCD. Limitations of the study include small sample size, no assessment of knowledge before premodule questionnaire completion, and no longitudinal follow-up. Identifying patients with SCD who demonstrate affinity for self-education via an ETM may further enhance utility of this tool to educate and empower patients.


Assuntos
Anemia Falciforme/psicologia , Manejo da Dor/instrumentação , Manejo da Dor/normas , Adulto , Anemia Falciforme/terapia , Feminino , Humanos , Masculino , Manejo da Dor/métodos , Medição da Dor/instrumentação , Medição da Dor/métodos , Projetos Piloto , Autogestão/métodos , Inquéritos e Questionários
6.
Trials ; 20(1): 248, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036033

RESUMO

BACKGROUND: Nonspecific neck pain (NSNP) is one of the most common musculoskeletal problems treated by orthopaedic physicians and physiotherapists. Posture has emerged as one of the major risk factors associated with NSNP, but most previous studies ignored correct posturing as an effective treatment. Therefore, one of the major challenges faced by clinicians is how to incorporate 3D posture findings into the treatment plane. The present study will evaluate the feasibility of conducting a larger randomized trial. This pilot study is designed to investigate the hypothesis that a multimodal programme supplemented with the addition of a 3D adjustable cervico thoracic posture corrective orthotic (CTPCO) will yield short- and long-term improvement on NSNP management outcomes. METHODS/DESIGN: This pilot, single-blind, randomized controlled trial will divide 24 patients into two groups (study and control) using block randomization. Both groups will receive conventional treatment consisting of a moist hot pack, soft tissue mobilization, manual therapy and therapeutic exercise. The study group will undergo ambulatory mirror-image functional re-training wearing a 3D adjustable CTPCO. The primary outcome is feasibility, including recruitment (e.g., time to complete enrolment, recruitment rate), patient retention and adherence to treatment allocation (e.g., session attendance, home practice, use of non-study treatments). The secondary outcomes used to assess the effectiveness of the treatment will include neck pain (measures using the visual analogue scale (VAS)) and neck disability (measures using the neck disability index (NDI)), among other outcome measures, compared between the experimental and control groups. Three-dimensional posture parameters of head measurements will be provided by a Global Posture System (GPS). The outcome measures for determining the treatment effect will be assessed at three intervals: pre-treatment, after 10 weeks of intervention and after 3 months at follow-up. DISCUSSION: This randomized controlled pilot trial will inform the design of a future full-scale trial. The outcomes will provide some resources for the incorporation of ambulatory mirror-image functional re-training intervention compared to a control group intervention for neck pain, disability and 3D posture parameters. TRIAL REGISTRATION: Prospectively registered at ClinicalTrials.gov, NCT03331120 . Registered on 22 October 2017.


Assuntos
Braquetes , Terapia por Exercício/instrumentação , Cervicalgia/terapia , Manejo da Dor/instrumentação , Postura , Adolescente , Adulto , China , Avaliação da Deficiência , Desenho de Equipamento , Estudos de Equivalência como Asunto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Cervicalgia/diagnóstico , Cervicalgia/fisiopatologia , Medição da Dor , Projetos Piloto , Recuperação de Função Fisiológica , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 98(20): e15695, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096512

RESUMO

RATIONALE: Neuropathy secondary to diabetes mellitus often does not respond well to conventional therapy. Scrambler therapy may be an alternative treatment for otherwise intractable neuropathy. PATIENT CONCERNS: A 45-year-old female complained of bilateral plantar foot pain. She had been treated for diabetes mellitus for 5 years. Oral analgesics did not resolve her pain. Even nerve block therapy did not adequately relieve her pain. DIAGNOSES: Diabetic peripheral neuropathy. INTERVENTION: Scrambler therapy. OUTCOME: Pain reduction; the treatment effect was based around the location of the scrambler patch. LESSONS: Scrambler therapy is effective for the treatment of diabetic peripheral neuropathy. Moreover, effective pain management can be achieved for patients who complain of general pain of the sole, including the toe, by attaching scrambler patches around the ankle.


Assuntos
Neuropatias Diabéticas/terapia , Pé/inervação , Manejo da Dor/instrumentação , Dor/etiologia , Complicações do Diabetes/epidemiologia , Terapia por Estimulação Elétrica/métodos , Feminino , Pé/patologia , Humanos , Pessoa de Meia-Idade , Dor/diagnóstico , Manejo da Dor/métodos , Medição da Dor/psicologia , Resultado do Tratamento
8.
JMIR Mhealth Uhealth ; 7(5): e12542, 2019 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-31144672

RESUMO

BACKGROUND: The incidence of cancer pain increases in discharged patients because of discontinued standard treatments and reductions in medication adherence. Motivated by the need for better pain management in discharged patients, we developed a mobile phone app (Pain Guard) to provide continuous treatment information and feedback to discharged cancer patients suffering from pain. OBJECTIVE: The aim was to design, construct, and test the Pain Guard app in patients managing cancer pain, evaluate the total remission rate of pain and the improvement in quality of life (QoL) to improve pain management for cancer pain patients, and assess patient acceptance of the app. METHODS: This randomized controlled double-arm study involved 58 patients with cancer pain symptoms. Participants were randomly assigned to a group receiving care through the Pain Guard app (n=31) or to a control group (n=27) who received only traditional pharmaceutical care. In a pretest, participants were rated using a baseline cancer pain assessment and QoL evaluation. During treatment, the consumption levels of analgesic drugs were recorded every week. After a 4-week study period, another round of cancer pain assessment and QoL evaluation was conducted. The system's usability, feasibility, app compliance, and satisfaction were also assessed. Our primary outcome was remission rate of pain, and secondary outcomes were medication adherence, improvements in QoL, frequency of breakthrough cancer pain (BTcP), incidence of adverse reactions, and satisfaction of patients. RESULTS: All participants (N=58) successfully completed the study. There were no significant differences in baseline pain scores or baseline QoL scores between groups. At the end of the study, the rate of pain remission in the trial group was significantly higher than that in the control group (P<.001). The frequency of BTcP in the app group was considerably lower than that in the control group (P<.001). The rate of medication adherence in the trial group was considerably higher than that in the control group (P<.001). Improvements in global QoL scores in the trial group were also significantly higher than those in the control group (P<.001). The incidence of adverse reactions in the trial group (7/31) was lower than that in the control group (12/27), especially constipation, with significant differences (P=.01). The 31 participants in the trial group completed a satisfaction survey regarding Pain Guard: 23 (74%) indicated that they were satisfied with receiving pharmaceutical care by Pain Guard, 5 (16%) indicated that they were somewhat satisfied, 2 (6%) indicated neutral feelings, and 1 (3%) indicated that they were somewhat dissatisfied; no participants indicated that they were very dissatisfied. CONCLUSIONS: Pain Guard was effective for the management of pain in discharged patients with cancer pain, and its operability was effective and easily accepted by patients. TRIAL REGISTRATION: Chinese Clinical Trials Registry ChiCTR1800016066; http://www.chictr.org.cn/showproj.aspx?proj=27153.


Assuntos
Dor do Câncer/terapia , Aplicativos Móveis/normas , Manejo da Dor/normas , Adulto , Dor do Câncer/psicologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Neoplasias/complicações , Neoplasias/psicologia , Manejo da Dor/instrumentação , Manejo da Dor/estatística & dados numéricos , Desenvolvimento de Programas/métodos , Qualidade de Vida/psicologia , Encaminhamento e Consulta , Inquéritos e Questionários
9.
Medicine (Baltimore) ; 98(22): e15937, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145366

RESUMO

BACKGROUND: The aim of this study was to compare the short-term and intermediate-term efficacy of acupuncture plus fire needle therapy with that of acupuncture alone in the treatment of lateral epicondylitis (LE). METHODS: Thirty-eight patients with LE who had persisted for at least 2 months were enrolled in this prospective, assessor-blinded, randomized controlled pilot trial. Twenty-one patients were randomized to the acupuncture plus fire needle group and 17 to the acupuncture-only group. The primary outcome was the visual analog scale pain score for the previous 24 hours and the secondary outcomes were the maximum grip strength, Patient-rated Forearm Evaluation Questionnaire score, and Medical Outcomes Study 36-Item Short-form Health Survey score. The values at baseline (pretreatment), at the end of treatment, and at 3 months after treatment were used to assess the short-term and intermediate-term effects of treatment. The data were analyzed using the Chi-square test and t test. RESULTS: Within-group analyses showed better results for acupuncture plus fire needle therapy in the short term and intermediate term. Differences in the severity of pain and secondary outcomes were significant in the intermediate term in the acupuncture group. At the end of treatment, none of the differences in outcome scores were significant, except for maximum grip strength in the affected hand in the acupuncture group. No significant between-group differences in short-term or intermediate-term outcomes were observed. CONCLUSION: Acupuncture plus fire needle therapy was effective in the short term in patients seeking improvement of LE. Twelve treatments were effective for relieving pain and improving disability in the intermediate term in patients with chronic LE in both study groups. The findings of the pilot study confirm the feasibility of proceeding to a larger randomized controlled study of the longer-term effects of acupuncture plus fire needle therapy in patients with LE.


Assuntos
Terapia por Acupuntura/métodos , Artralgia/terapia , Agulhas , Manejo da Dor/métodos , Cotovelo de Tenista/terapia , Terapia por Acupuntura/instrumentação , Adulto , Artralgia/etiologia , Artralgia/fisiopatologia , Estudos de Casos e Controles , Avaliação da Deficiência , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Medição da Dor , Projetos Piloto , Estudos Prospectivos , Método Simples-Cego , Cotovelo de Tenista/complicações , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento , Adulto Jovem
10.
Rev Assoc Med Bras (1992) ; 65(3): 446-451, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30994846

RESUMO

OBJECTIVE: This study aimed to investigate the effect of virtual reality application on experimental ischemic pain created with a blood pressure instrument in healthy volunteers. METHODS: The research sample consisted of 172 volunteer adult students who conformed to the inclusion criteria. These individuals were assigned into an experimental (n=86) and a control group (n=86) by a simple randomization method. All individuals in the experimental and control groups wereexperimentally subjected to pain for two minutes by applying 260 mmHg of pressure 3-4 cm above the antecubital region of the left arm with an aneroid adult-type blood pressure instrument. During the procedure, the volunteers in the experimental group watched virtual reality images, while those in the control group received no intervention. Immediately after the procedure, the pain levels of the individuals in both groups were assessed with a Visual Analog Scale (VAS). RESULTS: We found that the mean pain score of the individuals in the experimental group was 2.62±1.82, and that of individuals in the control group was 5.75±1.65. Results of the statistical analysis showed a statistically significant difference between the mean pain scores of the individuals in the experimental and control groups (p<0.001). CONCLUSION: This study found that the use of virtual reality was effective in reducing the level of pain in healthy individuals. This method used a smartphone with widespread availability and ease of transportation, which can be used by health professionals as a non-pharmacological method in the management of pain.


Assuntos
Determinação da Pressão Arterial/efeitos adversos , Isquemia/etiologia , Dor/etiologia , Dor/prevenção & controle , Terapia de Exposição à Realidade Virtual/métodos , Realidade Virtual , Adolescente , Determinação da Pressão Arterial/instrumentação , Feminino , Humanos , Isquemia/psicologia , Masculino , Aplicativos Móveis , Dor/psicologia , Manejo da Dor/instrumentação , Manejo da Dor/métodos , Medição da Dor/métodos , Valores de Referência , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Adulto Jovem
11.
J Stroke Cerebrovasc Dis ; 28(6): 1463-1473, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30956057

RESUMO

BACKGROUND: Shoulder pain and subluxation are the commonly encountered problems among subjects with hemiplegia. Rehabilitating the shoulder following stroke is a challenging task among physiotherapists in rehabilitation set up. There is a need to validate the effectiveness of externally applied taping materials in hemiplegic shoulder. OBJECTIVE: This systematic review analyses the efficacy of taping on hemiplegic shoulder in terms of alleviating pain and managing subluxation. METHODS: Systematic review of randomized controlled trials (RCTs) was conducted to determine the effects of taping on hemiplegic shoulder. Articles were electronically searched from the year 2000 to 2017 in the 4 databases, Google scholar, CINAHL, Pubmed, and Pedro. Reviewers graded the papers according to Lloyd-Smith's hierarchy of evidence scale. Papers were quality appraised using a systematic review of RCT tool developed by National Heart, Lung and Blood Institute (United States), named as quality assessment of controlled intervention studies tool. RESULTS: Eight papers were included, totaling 132 participants. All the RCT's included in this review were good quality. There was a significant effect on taping method for reduction of pain and subluxation among subjects with stroke. CONCLUSIONS: This systematic review provides sufficient evidence to suggest taping is a beneficial method for reducing pain and shoulder subluxation among stroke subjects.


Assuntos
Fita Atlética , Hemiplegia/terapia , Manejo da Dor/instrumentação , Luxação do Ombro/terapia , Dor de Ombro/terapia , Reabilitação do Acidente Vascular Cerebral/instrumentação , Acidente Vascular Cerebral/terapia , Fita Atlética/efeitos adversos , Avaliação da Deficiência , Hemiplegia/diagnóstico , Hemiplegia/etiologia , Hemiplegia/fisiopatologia , Humanos , Manejo da Dor/efeitos adversos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Luxação do Ombro/diagnóstico , Luxação do Ombro/etiologia , Luxação do Ombro/fisiopatologia , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Dor de Ombro/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Resultado do Tratamento
12.
Clin Interv Aging ; 14: 265-270, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30787602

RESUMO

Objective: The objective of this study was to evaluate the effectiveness of bracing after percutaneous vertebroplasty (PVP) for thoracolumbar osteoporotic vertebral compression fractures (OVCF). Methods: This is a retrospective study where we recruited 138 patients with single-level thoracolumbar OVCF who underwent PVP from January 2018 to March 2018 without bracing after PVP (Group A). The visual analog score (VAS) and vertebral body compression ratio (VCR) were recorded at preoperation, on the second day, at 2 weeks, 1 month, and 6 months after operation. Oswestry Disability Index (ODI) was recorded at preoperation, 2 weeks, 1 month, and 6 months after operation. Propensity score matching identified 138 historical patients (Group B) as controls, who used rigid brace for 3 weeks after the surgery, from January 2017 to December 2017 using six independent variables (preoperation): age, sex, VAS, ODI, bone mineral density, and body mass index. The indicators and complications were compared between the two groups. Results: Compared with preoperation, VAS and VCR were significantly improved (P<0.05) in both groups on the second day after operation. At 2 weeks, 1 month, and 6 months after PVP operation, ODI, VAS, and VCR were all significantly improved than at preoperation (P<0.05). There were no statistical differences between the two groups in VAS and VCR on the second day, at 1 month and 6 months after PVP (P<0.05). There were no significant differences between Groups A and B in ODI at 2 weeks and 6 months after operation (P<0.05) but ODI for Group B at 1 month after operation was significantly higher than Group A (P<0.05). Eleven cases in Group A and 13 cases in Group B had poor pain relief on the second day after operation, and there were no significant differences in VAS and ODI between the two subgroups at 2 weeks, 1 month, and 6 months after PVP. There were no significant differences in the collapse and refracture rates between the two groups. Conclusion: In summary, in terms of quality of life and complications after operation, postoperative bracing did not result in improved outcomes. Presence or absence of bracing did not relieve postoperative residual pain. In contrast, bracing for 3 weeks after operation reduced the quality of life in the short term.


Assuntos
Braquetes , Fraturas por Compressão/cirurgia , Vértebras Lombares , Manejo da Dor/instrumentação , Dor Pós-Operatória , Qualidade de Vida , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas , Vertebroplastia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/psicologia , Dor Pós-Operatória/terapia , Estudos Retrospectivos , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/instrumentação , Vertebroplastia/métodos
13.
Hormones (Athens) ; 18(2): 207-213, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30805908

RESUMO

BACKGROUND: This study was performed to evaluate the potential clinical usefulness of a new non-invasive electrodermal biofeedback device in reducing perceived pain levels and chronic systemic inflammation. MATERIALS AND METHODS: This multicenter study was designed and coordinated by BioTekna, included 20 general practice medical centers, took place between June 2010 and January 2011, and was validated clinically at the National and Kapodistrian University of Athens, Greece. The study participants were 1015 Caucasian men (401) and women (614), while the placebo-treated controls were 950 Caucasian men (500) and women (450). Patients were aged between 30 and 86 years (average age about 50 years) and all suffered from chronic pain and other medically unexplained symptoms (MUS). The RegMatEx electrodermal biofeedback device (brand BioTekna - Biomedical Technologies, Marcon, Venice, Italy) was used to evaluate the clinical efficacy of electrodermal biofeedback in reducing the level of pain perceived by decreasing the chronic systemic inflammation of the subjects. All subjects received 6 × 30 min sessions of electrodermal or placebo biofeedback given twice a week over 3 weeks. Perceived pain was evaluated using the Numeric Rating Scale (NRS) for pain, while systemic inflammation was examined with measurements of morning circulating C-reactive protein (CRP) concentrations. RESULTS: Perceived pain in the treatment group was significantly lessened in the NRS scale (p < 005), while circulating CRP concentrations were also decreased (p < 0.05). Parallel placebo studies showed no changes in perceived pain or morning serum CRP concentrations. DISCUSSION: Use of the electrodermal biofeedback RegMatEx device was associated with reduced pain perception and decreased chronic systemic inflammation, with stability over time. This did not occur in the placebo-treated group. The symptomatology of the treated patients significantly improved in terms of pain relief as shown on the NRS scale, and this was accompanied by reported improvements in mobility, mood, and quality of life. CONCLUSIONS: The RegMatEx electrodermal biofeedback procedure is a non-invasive and easy to use therapeutic method, free of side effects, with high patient acceptability, excellent efficacy, and duration of effect, and, hence, a valuable tool in the treatment of chronic pain and inflammation.


Assuntos
Biorretroalimentação Psicológica/fisiologia , Dor Crônica/terapia , Equipamentos e Provisões , Resposta Galvânica da Pele/fisiologia , Inflamação/terapia , Manejo da Dor , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/fisiopatologia , Feminino , Grécia , Humanos , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Manejo da Dor/métodos , Percepção da Dor/fisiologia , Resultado do Tratamento
14.
J Orthop Surg Res ; 14(1): 31, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683124

RESUMO

BACKGROUND: Both manual therapy techniques and dry needling have shown to be effective treatment options for the treatment of plantar heel pain; however, in recent years, other techniques based on dry needling (DN), such as percutaneous needle electrolysis (PNE), have also emerged. Currently, PNE is being used in clinical practice to manage myofascial trigger points, despite the lack of studies comparing the effects of this technique over dry needling. Therefore, the aim of this randomized controlled study is to compare the effectiveness of DN versus PNE for improving the level of pain experienced by patients suffering from plantar heel pain provoked by myofascial trigger points. METHODS: A randomized controlled trial will be conducted with blinded participants and outcome assessors. A sample of 94 patients with a medical diagnosis of plantar heel pain will be recruited and divided into two treatment groups. Eligible participants will be randomly allocated to either (a) treatment group with DN and a self-stretching home program or (b) treatment group with PNE and a self-stretching home program. Each group will receive one treatment session per week over a period of 4 weeks. The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire. The secondary outcome measures will be a visual analogue scale for pain (average and highest level of pain experienced during the previous 48 h; level of pain immediately after the treatment session) and health-related quality of life (assessed using the EuroQoL-5 dimensions). Cost-effectiveness data will be extracted based on the EuroQoL-5 dimensions. Follow-up measurements will take place at baseline and at 4, 8, 12, 26, and 52 weeks. DISCUSSION: The justification for this trial is the need to improve current understanding regarding the effectiveness of treatments targeting the rehabilitation of plantar heel pain. This study will be the first randomized controlled trial to directly compare the effectiveness of DN and PNE combined with a specific stretching program for the treatment of plantar heel pain provoked by myofascial trigger points. TRIAL REGISTRATION: Clinical Trials NCT03236779. Registered at clinicaltrials.gov 2 August 2017.


Assuntos
Terapia por Acupuntura/métodos , Eletrólise/métodos , Fasciíte Plantar/terapia , Agulhas , Manejo da Dor/métodos , Medição da Dor/métodos , Terapia por Acupuntura/instrumentação , Adulto , Método Duplo-Cego , Eletrólise/instrumentação , Fasciíte Plantar/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
15.
Eur J Anaesthesiol ; 36(4): 272-278, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30664012

RESUMO

BACKGROUND: The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. OBJECTIVE: The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. DESIGN: A randomised controlled study. SETTING: A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. INTERVENTION(S): Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. MAIN OUTCOME MEASURES: The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. RESULTS: There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] µg kg versus 6 [3.5 to 9] µg kg respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. CONCLUSION: Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378).


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Analgésicos Opioides/administração & dosagem , Feminino , Fentanila/administração & dosagem , Humanos , Bombas de Infusão , Infusões Parenterais/instrumentação , Infusões Parenterais/métodos , Levobupivacaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Nervos Espinhais/diagnóstico por imagem , Nervos Espinhais/efeitos dos fármacos , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção
16.
Neuromodulation ; 22(5): 645-652, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30629320

RESUMO

BACKGROUND: Trigeminal Neuropathic Pain (TNP) is a chronic facial pain syndrome caused by a lesion or disease affecting one or more branches of the trigeminal nerve. It may, for example, result from accidental injury to a branch of the trigeminal nerve by trauma or during surgery; it may also be idiopathic. TNP is typically constant, in contrast to most cases of the commoner trigeminal neuralgia. In some cases, pain may be refractory to pharmacological treatment. Peripheral nerve field stimulation is recognized as an effective minimally invasive surgical treatment option for this debilitating condition. To date, stimulation has used conventional tonic waveforms, which generate paraesthesia in the stimulated area. This is the first report of the use of paraesthesia-free burst pattern stimulation for TNP. METHODS: Seven patients were treated at the John Radcliffe Hospital for TNP from 2016 to 2018. Mean duration of preoperative symptoms was five years. All patients had exhausted pharmacological measures to limited effect. The initial three patients had tonic stimulation with the subsequent four having burst stimulation. Outcome was assessed using the numeric pain rating scale preoperatively and postoperatively at three and six months and one year. Side-effects and complications were also assessed as well as reduction in analgesic medication use. RESULTS: All patients achieved pain reduction of at least 50% at 6 months (range 50-100%, mean 81%, p = 0.0082). Those in the burst stimulation group were paraesthesia free. One patient developed a postoperative infection for which the system had to be removed and is awaiting reimplantation. There were no other complications in either group. CONCLUSION: Burst stimulation conferred similar pain control to tonic stimulation in our small cohort, and there were similar reductions in pain medication use. An additional benefit of burst stimulation is freedom from paraesthesia. Larger scale studies are needed to further evaluate burst stimulation and compare its efficacy with that of tonic stimulation.


Assuntos
Terapia por Estimulação Elétrica/métodos , Neuralgia Facial/terapia , Manejo da Dor/métodos , Nervos Periféricos/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Neuralgia do Trigêmeo/terapia , Adulto , Idoso , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Neuralgia Facial/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento , Neuralgia do Trigêmeo/diagnóstico por imagem
17.
Cyberpsychol Behav Soc Netw ; 22(1): 15-21, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30256662

RESUMO

Virtual reality (VR) pain distraction has been applied across medical, surgical, and behavioral healthcare domains, marking a shift in pain attenuation practices. However, there is little research that has been performed to compare the efficacy of traditional head-mounted displays (HMDs) versus portable VR devices. The present study evaluated 44 outpatients in need of lipoma resection. Randomized into two groups-HMD versus mobile phone VR-participants navigated pain distraction virtual environments while undergoing surgery. Vital signs and subjective pain measurements via a visual analog scale were taken before, during, and after the surgery. Results indicate that the HMD group reported greater pain reduction than the Mobile group. Overall, this study points to the efficacy of nonpharmacological pain attenuation practices. Although both systems reduced pain during surgery, the clinically validated VR environments seen in the HMD group were more effective. This study does show that inexpensive solutions can work in surgical settings. Future research should be performed to identify the most effective VR pain distraction systems.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Telefone Celular , Manejo da Dor , Realidade Virtual , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/métodos , Humanos , Lipoma/cirurgia , Manejo da Dor/instrumentação , Manejo da Dor/métodos , Medição da Dor
18.
A A Pract ; 12(7): 231-234, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30234513

RESUMO

Pain after limb amputation is frequently challenging to adequately treat with local anesthetic-based regional anesthesia techniques due to its relatively long duration. Furthermore, uncontrolled pain in the immediate postoperative period is associated with persistent postsurgical pain, and frequently phantom limb pain. Cryoneurolysis is an alternative regional analgesic method to local anesthesia-based techniques. We report 3 cases in which ultrasound-guided percutaneous cryoneurolysis was performed in the perioperative period of limb amputation. All reported profound analgesia in the postoperative period without persistent postsurgical residual limb or phantom pain in the following months. No adverse events associated with the cryoneurolysis procedure occurred.


Assuntos
Crioterapia/instrumentação , Bloqueio Nervoso/métodos , Manejo da Dor/instrumentação , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Membro Fantasma/terapia , Ultrassonografia/instrumentação , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade
20.
Neuromodulation ; 22(3): 290-294, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30325079

RESUMO

OBJECTIVES: In spinal cord stimulation (SCS), the electrical stimulation of the spinal cord with an implanted lead evokes a tingling peripheral sensation known as paresthesias. Newer stimulation paradigms allow paresthesia-free treatment, but during the implantation of the lead, paresthesias must cover the painful area to achieve optimal treatment effect. The localization of the evoked paresthesias can be difficult to accurately describe for the patient, and furthermore depends on a complex and only partially predictable set of parameters that includes the anatomical localization and the programming of the electrical field. We aimed to optimize SCS implantation procedures by devising a way to aid the patient in making useful descriptions of the evoked paresthesias, then to visually convey the full set of information-anatomical position of the lead, programming parameters, and evoked paresthesias-directly to the implanting physician. MATERIALS AND METHODS: To aid the patient in making accurate descriptions of the evoked paresthesia, we use an app dedicated to creating pain drawings on a tablet. We used Chromecast and Apple TV to project the information from the pain drawing tablet and the programming device to two monitors placed in the implanter's field of vision, right next to the fluoroscopy monitor. RESULTS: The three monitors combined provide a direct visual representation of the dynamic dataset used during SCS implantation: Position, Programming, and Paresthesias, essentially creating the equivalent of the dashboard of a car. CONCLUSIONS: We present an Implanter's Integrated Information (I3) system; a simple, inexpensive solution for gathering, integrating, and conveying the complex set of information necessary for a successful SCS procedure.


Assuntos
Eletrodos Implantados , Imagem Tridimensional/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Manejo da Dor/métodos , Parestesia/diagnóstico por imagem , Estimulação da Medula Espinal/métodos , Integração de Sistemas , Humanos , Imagem Tridimensional/instrumentação , Monitorização Neurofisiológica Intraoperatória/instrumentação , Manejo da Dor/instrumentação , Parestesia/terapia , Estimulação da Medula Espinal/instrumentação
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