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1.
Medicine (Baltimore) ; 99(44): e22871, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126334

RESUMO

BACKGROUND: Neck pain is a common complaint in the general population. Despite the consistent ongoing pain and the resulting economic burden on affected individuals, there have only been a few studies investigating the treatment of acute neck pain. This study aims to evaluate the effectiveness, safety, and cost-effectiveness of the motion style acupuncture treatment (MSAT) and acupuncture treatment for acute neck pain. METHODS: This 2-armed, parallel, multi-centered randomized controlled trial will be conducted at 4 community-based hospitals in Korea. A total of 128 subjects will be randomly assigned, at a 1:1 ratio, to the MSAT and the acupuncture treatment groups. Treatment will be administered 2 to 3 times a week for 2 weeks. The primary outcome will be the visual analog scale of neck pain on movement. The secondary outcomes will be the numeric rating scale of the neck, neck disability index, Northwick Park questionnaire, patient global impression of change, range of motion of the neck, 5-level EuroQol-5 dimension, 12-item Short-Form Health Survey, and EuroQol visual analogue scale. This protocol has been registered at the Clinicaltrials.gov (NCT04539184). DISCUSSION: To our knowledge, this study is the first well-designed multi-centered randomized controlled trial to evaluate the effectiveness, safety, and cost-effectiveness of MSAT on acute neck pain. The results of this study will be useful for clinicians in primary medical institutions that frequently treat acute neck pain patients and for policymakers working with national health insurance.


Assuntos
Terapia por Acupuntura/métodos , Cervicalgia/terapia , Manejo da Dor/economia , Manejo da Dor/normas , Resultado do Tratamento , Terapia por Acupuntura/economia , Terapia por Acupuntura/normas , Dor Aguda/psicologia , Dor Aguda/terapia , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/psicologia , Manejo da Dor/métodos , Medição da Dor/métodos , República da Coreia , Inquéritos e Questionários
2.
Medicine (Baltimore) ; 99(43): e22895, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120838

RESUMO

BACKGROUND: Traditionally, S1 transforaminal epidural steroid injection (TFESI) has been performed using an anteroposterior (AP) fluoroscopic view. In 2007, the oblique "Scotty dog" (OS) approach was introduced as an alternative technique. We compared passage time of the needle into S1 foramen (Tf) between the anteroposterior (AP) and oblique "Scotty dog" (OS) approach during S1 TFESI. METHODS: In this prospective randomized controlled trial, seventy patients scheduled S1 TFESI were randomly allocated into AP or OS groups. In the AP group, a slight cephalad-caudad tilt was used. In the OS group, the C-arm was rotated ipsilateral oblique degrees to view the S1 Scotty dog. Both groups received injection of steroid mixed with local anesthetics. We measured the passage time of the needle into S1 foramen (Tf), primary outcome, and total procedure time (Tt) between the groups. We also recorded presence of intravascular injection, patients-assessed pain relief for one month and complications. RESULTS: The Tf and Tt were shorter in the OS than in the AP group (24.4 ±â€Š24.0 s vs 47. 8 ±â€Š53.2seconds; 93.3 ±â€Š35.0 seconds vs 160.0 ±â€Š98.7 seconds, P < .001, both). Incidence of intravascular injection (AP, 8 [22.8%]; OS, 4 [11.4%], P = .205), pain score, and complication rates were not statistically different between the two groups. In logistic regression analysis, the body mass index (BMI) was a risk factor for longer Tt (odds ratio [OR] = 1.27, 95% CI: 1.02-1.58, P = .030). CONCLUSION: The passage time of the needle into S1 foramen was shorter in OS approach and the OS approach reduced the procedure time compared with the AP approach during S1 TFESI. The practitioners should note that procedure time can be prolonged in obese patients.


Assuntos
Fluoroscopia/instrumentação , Injeções Epidurais/métodos , Erros Médicos/efeitos adversos , Radiculopatia/terapia , Esteroides/administração & dosagem , Administração Intravenosa/estatística & dados numéricos , Idoso , Anestésicos Locais/administração & dosagem , Índice de Massa Corporal , Feminino , Humanos , Incidência , Injeções Epidurais/efeitos adversos , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Medição da Dor/métodos , Estudos Prospectivos , República da Coreia/epidemiologia , Distúrbios Somatossensoriais/psicologia , Fatores de Tempo
3.
Medicine (Baltimore) ; 99(44): e22896, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126342

RESUMO

Many patients with chronic pancreatitis (CP) undergo a step-up approach with interventional procedures as first-line treatment and resection reserved for later stages. The aim of this study was to identify predictive factors for a significant clinical improvement (SCI) after surgical treatment.All patients operated for CP between September 2012 and June 2017 at our center was retrospectively reviewed. A prospective patient survey was conducted to measure patients postoperative outcome. The primary endpoint SCI was defined as stable health status, positive weight development and complete pain relief without routine pain medication. Additionally, risk factors for relaparotomy were analyzed.A total of 89 patients with a median follow-up of 38 months were included. In most cases, a duodenum-preserving pancreatic head resection (n = 48) or pancreatoduodenectomy (n = 28) was performed. SCI was achieved in 65.3% (n = 47) of the patients after the final medium follow-up of 15.0 months (IQR: 7.0-35.0 months), respectively. Patients with a longer mean delay (7.7 vs 4 years) between diagnosis and surgical resection were less likely to achieve SCI (P = .02; OR .88; 95%CI .80-98). An endocrine insufficiency was a negative prognostic factor for SCI (P = .01; OR .15; 95%CI .04-68). In total, 96.2% of the patients had a complete or major postoperative relief with a mean pain intensity reduction from 8.1 to 1.9 on the visual analogue scale.The results support that surgical resection for CP should be considered at early stages. Resection can effectively reduce postoperative pain intensity and improve long-term success.


Assuntos
Pancreatectomia , Pancreatite Crônica , Complicações Pós-Operatórias , Tempo para o Tratamento/estatística & dados numéricos , Manutenção do Peso Corporal , Tratamento Conservador/métodos , Insuficiência Pancreática Exócrina/epidemiologia , Insuficiência Pancreática Exócrina/etiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Pancreatite Crônica/enzimologia , Pancreatite Crônica/epidemiologia , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(38): e22395, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957421

RESUMO

BACKGROUND: Primary dysmenorrhea (PD) occurs during menstrual cramps, and there is currently no pathological evidence. This disease severely affects the daily lives of young women. Acupuncture (ACU) and moxibustion are an excellent way to relieve the pain of patients with PD. And it has been widely utilizing. However, the effectiveness and safety of ACU and moxibustion in treating patients with PD are not confirmed by a high-quality meta-analysis. This work aims to evaluate ACU's efficacy and safety with or without moxibustion in the management of PD. METHODS: We will make a comprehensive retrieval in 9 databases as following: Embase; Cochrane Library; PubMed; Chinese databases SinoMed (previously called the Chinese Biomedical Database); Chinese National Knowledge Infrastructure; Chinese Scientific Journals Database; Wanfang Data. The time is limited from the construction of the library to August 2020. No restrictions about language and status. Our 2 authors will perform the selection of studies, the extraction of data, and the quality assessment with the risk of bias tool independently. We will use NoteExpressV3.2.0 and Excel2010 software to extract data. The content will be saved in electronic form. We will use the bias risk tool provided by the Cochrane Collaboration to evaluate the quality of the literature using RevMan 5.4 software. The primary outcome is the pain degree evaluation, including visual analog scale, numerical rating scale, Cox retrospective symptom scale, or any other scale used to evaluate the level of pain.Furthermore, the response rate involved an overall reduction in symptoms. The adverse effects and quality of life will be assessed as secondary outcomes. The risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data will be adopted to express the effect and safety of ACU with or without moxibustion for PD. RESULTS: The results of our study expect to provide high-quality, evidence-based recommendations on further treatment for clinicians. TRIAL REGISTRATION NUMBER: INPLASY202080006. CONCLUSION: This study will provide scientific evidence of PD Systematic review.


Assuntos
Dismenorreia/terapia , Moxibustão/métodos , Terapia por Acupuntura/métodos , Feminino , Humanos , Metanálise como Assunto , Medição da Dor/métodos , Qualidade de Vida , Revisões Sistemáticas como Assunto
5.
Medicine (Baltimore) ; 99(36): e21957, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899030

RESUMO

INTRODUCTION: Although there are various therapeutic methods for the treatment of knee osteoarthritis, each has its advantages and shortcomings, and a definitive treatment method is yet to be determined. This pilot study is designed to obtain basic data for a further large-scale trial as well as provide information about the feasibility of thread embedding acupuncture (TEA) with polydioxanone thread in knee osteoarthritis patients. METHODS AND ANALYSIS: This study is a clinical trial to evaluate the efficacy and safety of TEA for knee osteoarthritis. Forty participants will be recruited at the hospital and after randomization into 2 groups of 20 (experimental and control); they will be treated for 6 weeks. The experimental group will receive TEA treatment 6 times (1 time/week) in 6 weeks on 14 defined knee areas, and the control group, acupuncture treatments 12 times (2 times/week) in 6 weeks on 9 defined acupuncture points. The visual analogue scale (VAS) will be used for the primary efficacy assessment and Short-form McGill Pain Questionnaire (SF-MPQ), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) will be used for the secondary efficacy assessment. The follow-ups before clinical trial, 3 weeks after procedure, 6 weeks after procedure, and 4 weeks after the end of procedure will be done to compare the degree of pain with the control group, which received the acupuncture treatment. CONCLUSION: The trial based on this study will provide clinical information on the efficacy and safety of TEA treatment on knee osteoarthritis. TRIAL REGISTRATION NUMBER: KCT0004844.


Assuntos
Terapia por Acupuntura/métodos , Osteoartrite do Joelho/terapia , Terapia por Acupuntura/efeitos adversos , Humanos , Medição da Dor/métodos , Polidioxanona/uso terapêutico , Escala Visual Analógica
6.
Plast Reconstr Surg ; 146(4): 863-871, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970009

RESUMO

BACKGROUND: Patient selection for headache surgery is an important variable to ensure successful outcomes. In the authors' experience, a valuable method to visualize pain/trigger sites is to ask patients to draw their pain. The authors have found that there are pathognomonic pain patterns for each site, and typically do not operate on patients with atypical pain sketches, as they believe such patients are poor surgical candidates. However, a small subset of these atypical patients undergo surgery based on other strong clinical findings. In this study, the authors attempt to quantify this clinical experience. METHODS: Patients were prospectively enrolled and completed pain sketches at screening. One hundred six diagrams were analyzed/categorized by two independent, blinded reviewers as follows: (1) typical (pain over nerve distribution, expected radiation); (2) intermediate (pain over nerve distribution, atypical radiation); or (3) atypical (pain outside of normal nerve distribution, atypical radiation). Preoperative and postoperative Migraine Headache Index was compared between subgroups using unpaired t tests. RESULTS: Migraine Headache Index improvement was 73 ± 38 percent in the typical group, 78 ± 30 percent in the intermediate group, and 30 ± 40 percent in the atypical group. There was a significant difference in Migraine Headache Index between the typical and atypical groups (p = 0.03) and between the intermediate and atypical groups (p < 0.01). The chance of achieving Migraine Headache Index improvement greater than 30 percent in the atypical group was 20 percent. CONCLUSIONS: Patient pain sketches classified as atypical (facial pain, atypical pain point origin, diffuse pain) can predict poor outcomes in headache surgery. As the authors continue to develop patient selection criteria for headache surgery, patient sketches should be considered as an effective, cheap, and simple-to-interpret tool for selecting candidates for surgery.


Assuntos
Cefaleia/cirurgia , Transtornos de Enxaqueca/cirurgia , Medição da Dor/métodos , Pontos-Gatilho/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
7.
PLoS One ; 15(9): e0239505, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991582

RESUMO

Evidence suggests that the application of Kinesio Tape (KT) on patients with chronic non-specific low back pain (CNLBP) is inconclusive. Dynamic tape (DT) is a relatively new treatment technique, which is increasingly being used as an adjunctive method to treat musculoskeletal problems. To our knowledge, no study has investigated the application of DT in individuals with CNLBP. To compare the immediate and short-term effects of DT versus KT and no tape among patients with CNLBP on pain, endurance, disability, mobility, and kinesiophobia. Forty-five patients with CNLBP were randomly assigned to 1 of 3 groups. Outcomes were measured at baseline, immediately, and on the third day post-application of tapes. The primary outcomes of pain, endurance, and disability were measured through the visual analog scale (VAS), Biering-Sorensen test, and Oswestry disability index (ODI), respectively. Secondary outcome measures of mobility and kinesiophobia were measured using the modified-modified Schober test and the Tampa Scale of Kinesiophobia, respectively. No significant immediate and short-term differences were found between DT and KT in pain, disability, mobility, and kinesiophobia. Improved back extensor endurance was observed for the DT group than KT (p = 0.023) and control group (p = 0.006). The application of DT may result in improvements only in back extensor endurance among individuals with CNLBP. This finding suggests that DT controls the processes that lead to back muscle fatigue.


Assuntos
Fita Atlética , Dor Lombar/fisiopatologia , Dor Lombar/terapia , Medição da Dor/métodos , Resistência Física/fisiologia , Adulto , Músculos do Dorso/fisiopatologia , Avaliação da Deficiência , Pessoas com Deficiência , Humanos , Masculino , Fadiga Muscular/fisiologia , Amplitude de Movimento Articular/fisiologia
8.
PLoS One ; 15(9): e0239332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960909

RESUMO

The Low Back Activity Confidence Scale (LoBACS) assesses the self-efficacy to perform activities in individuals with chronic low back pain (CLBP). As self-efficacy appears to directly influence the patient's functional capacity and prognosis, it is important to develop a scale that evaluates this attribute to guide treatment strategy and monitor the clinical course of patients. This study aimed to evaluate the reliability, construct validity, and responsiveness of the Brazilian version of the LoBACS. The scale was applied to 112 male and female patients (age, 18-65 years) with specific and nonspecific CLBP. For evaluating the interobserver reliability, the scale was applied twice on the first evaluation day by two trained evaluators (A and B). Within 48-72 h of the first evaluation, assessor A reapplied the scale to evaluate intraobserver reliability (test-retest), which was analyzed by intraclass correlation coefficient (ICC). The first LoBACS applied in the baseline evaluation was also used to assess the construct validity of the scale by factor analysis. For responsiveness, the scale was applied 5 times at 2-week intervals and the change in scores was analyzed by the repeated measures ANOVA. Although factor analysis indicated three subscales, they did not present acceptable values of convergent and divergent validity. Reliability ranged from good to excellent, with ICC values of .90 (95% CI, .84; .93) and .85 (95% CI, .77; .91) for inter- and intraobserver variability for total score. Moreover, the total score was responsive in all comparisons, with no floor or ceiling effects. Thus, only the total score of the Brazilian version of LoBACS proved to be reliable, valid, and responsive.


Assuntos
Dor Lombar/fisiopatologia , Medição da Dor/métodos , Adolescente , Adulto , Idoso , Análise de Variância , Doença Crônica , Análise Fatorial , Feminino , Humanos , Dor Lombar/psicologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Autoeficácia , Tradução , Adulto Jovem
9.
Lancet Neurol ; 19(9): 784-796, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822636

RESUMO

Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.


Assuntos
Gerenciamento Clínico , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/fisiopatologia , Animais , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Carbamazepina/farmacologia , Carbamazepina/uso terapêutico , Descompressão Cirúrgica/métodos , Humanos , Neuroimagem/métodos , Oxcarbazepina/farmacologia , Oxcarbazepina/uso terapêutico , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Neuralgia do Trigêmeo/classificação , Neuralgia do Trigêmeo/terapia
10.
Intern Med ; 59(15): 1795-1801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32741889

RESUMO

Objective With the advent of endoscopic treatment, the detailed diagnosis of colorectal neoplasms made using magnifying colonoscopy has become increasingly important. However, insertion difficulty causes pain in unsedated colonoscopy. The aim of this prospective observational study was to clarify the factors associated with a patient's pain in unsedated colonoscopy using a magnifying endoscope. Methods Patient pain was assessed using a numerical rating scale (0-10) immediately after the procedure. We defined 5 as mild enough pain that patients would not be reluctant to undergo another colonoscopy. Acceptable pain was defined as 5 or less and severe pain was defined as 8 to 10. Univariate and multivariate linear regression analyses were performed using the pain scale score as a dependent variable. Results A total of consecutive 600 patients undergoing unsedated colonoscopies were evaluated to assess their abdominal pain. The completion rate was 99.5% (597/600). The mean pain scale score was 3.88±2.38. The rate of acceptable pain was 80.5% (483/600). The rate of severe pain was 6.7% (40/600) including the incomplete cases. A comparison of polyp-positive and polyp-negative cases revealed no marked difference in patient pain (3.82±2.24 vs. 3.94±2.49, respectively; p=0.590) or insertion time (6.62±3.98 vs. 6.29±4.21, p=0.090), while more observation time was needed in polyp-positive cases than in polyp-negative ones (16.30±4.95 vs. 13.08±4.69, p<0.01). Univariate and multivariate linear regression analyses revealed that an older age, colectomy, antispasmodic agent use, and a small-diameter endoscope were significant factors associated with less patient pain. In particular, a small-diameter endoscope induces significantly more acceptable pain than a non-small diameter endoscope [85.63% (274/320) vs. 73.93% (207/280), p=0.00003]. Conclusion Unsedated colonoscopy using a magnifying endoscope by an expert may result in acceptable pain levels. The use of an antispasmodic agent, particularly hyoscine N-butyl bromide, and a small-diameter endoscope are recommended for reducing abdominal pain during unsedated colonoscopy.


Assuntos
Dor Abdominal/etiologia , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Idoso , Colonoscopia/instrumentação , Neoplasias Colorretais/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição da Dor/métodos , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença
11.
PLoS One ; 15(8): e0236624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760093

RESUMO

PURPOSE: To compare pain during pars plana vitrectomy (PPV) following topical lidocaine jelly and sub-Tenon anesthesia versus peribulbar anesthesia. METHODS: Prospective, single-center, randomized study. Patients scheduled for PPV for macular hole (MH) or epiretinal membrane (ERM) at the Retina and Vitreous Section of the Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo were randomly assigned to one of two groups in a 1:1 allocation ratio. Patients assigned to Group ST received topical anesthesia with 2% lidocaine jelly followed by sub-Tenon anesthesia with 2-4 ml of 1% ropivacaine. Patients assigned to PB received peribulbar anesthesia with 4-6 ml of 1% ropivacaine. After PPV, patients in both groups were asked to rate the level of pain they felt during the entire procedure (including anesthesia administration and PPV) by pointing at a 0-100 Visual Analogue Pain Scale (VAS). Data regarding demographics, patient characteristics and surgical features were also collected. RESULTS: Fifty-four patients were enrolled in the study (26 in Group ST and 28 in Group PB). Baseline characteristics, including age, gender, and presence of comorbidities, were similar in both groups. The surgery performed was PPV alone in 10 and 14 patients in the ST and PB groups, respectively, and combined phacoemulsification and PPV in 16 and 14 patients in the ST and PB groups, respectively (p = 0.39, Pearson). Surgery duration (mean ± SD minutes) was similar in the two groups (62 ± 12 for ST and 70 ± 20 for PB, p = 0.09, t-Test). No patients needed supplemental topical or intravenous anesthesia during surgery. No sight- or life-threatening complication was observed in either group. VAS score was significantly lower in the ST compared to the PB group (median (interquartile range) was 1 (2.25-0) in the ST group compared to 11.5 (29.75-5) in the PB group, p< 0.0001, Wilcoxon). CONCLUSION: In this study of patients who underwent PPV for MH or ERM, topical followed by sub-Tenon anesthesia was more effective in controlling pain during the whole vitrectomy procedure than peribulbar anesthesia. Compared to peribulbar anesthesia which is administered with a sharp needle, sub-Tenon anesthesia administered with a blunt cannula may be associated with a reduced risk of such adverse events as globe perforation, retrobulbar hemorrhage, and inadvertent injection of anesthesia into the optic nerve sheath.


Assuntos
Anestesia Local , Anestésicos Locais , Injeções/métodos , Lidocaína , Ropivacaina , Vitrectomia , Idoso , Feminino , Humanos , Injeções Intraoculares/métodos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/métodos , Estudos Prospectivos
13.
Medicine (Baltimore) ; 99(32): e21611, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769919

RESUMO

BACKGROUND: Low back pain (LBP) affects approximately 51% to 57% of hospital nurses and nurses' aides in Europe. New high-risk groups include home- and long-term-care nurses and physiotherapists. A number of European countries are experiencing a shortage of healthcare workers. Light therapy has been shown to be an effective treatment for various musculoskeletal disorders, including lateral epicondylitis, temporomandibular joint pain, carpal tunnel syndrome, and delayed-onset muscle soreness. A systematic review and meta-analysis demonstrated that low-level laser therapy is an effective method for relieving non-specific chronic low back pain (NSCLBP). However, the efficacy of light-emitting diode (LED) therapy for NSCLBP is disputed. This study aims to evaluate the effect of LED therapy on NSCLBP. METHODS AND ANALYSIS: We conducted a prospective, double-blind, randomized placebo-controlled trial of 148 patients with NSCLBP. The patients were randomly assigned to 2 groups: intervention group, where patients received LED photobiomodulation therapy 3 times a week for 2 weeks, and the sham group, where patients had sham therapy 3 times a week for 2 weeks. Primary outcome measures included the visual analog scale for pain, lumbar active range of motion assessments, and chair-rising times. Secondary outcome measures included a multidimensional fatigue inventory, fear-avoidance beliefs questionnaire, and the Oswestry disability index. The outcome measures were assessed before therapy and 2weeks, 4 weeks, 8 weeks, 12 weeks, and 6 months after the first interventions were completed. DISCUSSION: This study is a prospective, single-center, double-blind, randomized, controlled study. This study aims to research the efficacy of a 2-week LED program for NSCLBP working nurse. Our results will be useful for patients, working nurses, nurses' aides, and other healthcare workers with chronic low back pain. TRIAL REGISTRATION NUMBER: NCT04424823.


Assuntos
Protocolos Clínicos , Dor Lombar/terapia , Terapia com Luz de Baixa Intensidade/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dor Crônica/terapia , Método Duplo-Cego , Humanos , Terapia com Luz de Baixa Intensidade/instrumentação , Terapia com Luz de Baixa Intensidade/métodos , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor/métodos , Estudos Prospectivos , Inquéritos e Questionários , Escala Visual Analógica
14.
Am J Emerg Med ; 38(9): 1737-1742, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32738469

RESUMO

BACKGROUND: Accurate risk stratification for obstructive coronary artery disease (CAD) and major cardiac adverse events (MACE) is important in emergency departments. We compared six established chest pain risk scores (the HEART score, CAD basic model, CAD clinical model, TIMI, GRACE, uDF) for prediction of obstructive CAD and MACE. METHODS: Patients who presented to the emergency department with chest pain or symptoms of suspected CAD and underwent coronary computed tomographic angiography were analyzed. The primary endpoint was adverse outcomes including the presence of obstructive CAD (≥50% stenosis) and the occurrence of MACE within 6 weeks. We compared the risk scores by the area under the receiver-operating characteristic curve (AUC) and calculated their respective net reclassification index (NRI). RESULTS: Adverse outcomes occurred in 285 (28.4%) out of the 1002 patients included. For the prediction of adverse outcomes, the AUC of the HEART score (0.792) was superior to those of the CAD clinical model (0.760), CAD basic model (0.749), TIMI (0.749), uDF (0.703), and GRACE (0.653). In terms of the NRI, the HEART score significantly improved the reclassification abilities of the uDF (0.39), GRACE score (0.27), CAD basic model (0.11), TIMI (0.10), and CAD clinical model (0.08) (all P < 0.05). The HEART score also had the highest negative predictive value as well (0.893). CONCLUSIONS: The HEART score was superior to other cardiac risk scores in predicting both obstructive CAD and MACE. However, due to the high false-negative rate (11%) of the HEART score, its use for identifying low-risk patients should be considered with caution.


Assuntos
Dor no Peito/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Serviço Hospitalar de Emergência , Medição da Dor/métodos , Medição de Risco/métodos , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco
15.
Medicine (Baltimore) ; 99(27): e21069, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629737

RESUMO

Lumbar disc herniation (LDH) is a common, disabling musculoskeletal disorder. Magnetic resonance imaging has clarified the natural history of lumbar disc lesions and has documented that disc lesions can become smaller and can even be completely resorbed. Previous studies have confirmed that some traditional Chinese medicine (TCM) therapies can promote resorption of the protrusion. However, high-quality research evidence is needed to support the effectiveness of the protocol. OBJECTIVE: This clinical trial aims to establish whether TCM can promote the resorption of LDH and to assess the efficacy of such therapy for LDH, thereby evaluating its clinical effect. METHODS: The present study design is for a single-center, 2-arm, open-label randomized controlled trial. A total of 150 eligible LDH patients will be randomly assigned to either a TCM treatment group or a control group in a 1:1 ratio. Patients in the TCM group will be administered a TCM decoction for 4 weeks. Patients in the conventional drug control group will be instructed to take a specific daily dose of celecoxib. The primary outcome measure is the change from baseline in the volume of the protrusion, as assessed using MR images. Secondary outcome measures include visual analog scale pain scores and Japanese Orthopaedic Association scores assessed at 3 and 6 months. DISCUSSION: The design and methodological rigor of this trial will allow evaluation of the basic clinical efficacy and safety data for TCM in the treatment of patients with LDH. The trial will also assess whether TCM can promote the resorption of LDH. This research will therefore help provide a solid foundation for the clinical treatment of LDH and for future research in TCM therapy. TRIAL REGISTRATION: ChiCTR1900022377.


Assuntos
Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Medicina Tradicional Chinesa/métodos , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos de Casos e Controles , Celecoxib/uso terapêutico , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Medição da Dor/métodos , Remissão Espontânea , Projetos de Pesquisa , Segurança , Resultado do Tratamento , Escala Visual Analógica
16.
Drug Discov Ther ; 14(3): 129-134, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32669521

RESUMO

The aim of this randomized, single-blind, active-controlled pilot study was to investigate the clinical efficacy of oral supplementation with Verbascox®, a proprietary herbal extract capable of inhibiting human cyclooxygenase-2 (COX-2), in patients with mild-to-moderate osteoarthritis (OA) of the knee. Patients in the control group (n = 50) did not undergo any treatment (watchful waiting). Patients in the Verbascox® group (n = 50) received oral supplementation (800 mg/day) with the herbal extract for 2 weeks. The final study group consisted of patients (n = 50) who received celecoxib, a known pharmacological inhibitor of COX-2, 200 mg/day for 2 weeks. Examining physicians and laboratory personnel were blinded to group assignment, whereas patients were unblinded. All participants were evaluated using standard measures of pain relief and improvement in functional capacity at baseline, after 1 week, and at the end of the 2-week treatment course. Moreover, serum levels of substance P (SP), a member of the tachykinin family of neuropeptides involved in pain perception, were measured at the three time points. Both Verbascox® and celecoxib reduced pain, improved functional capacity, and lowered serum SP levels at 2 weeks compared with baseline, without significant inter-arm differences. Both Verbascox® and celecoxib showed a limited number of treatment-emergent adverse events. In summary, oral supplementation with Verbascox® (800 mg/day) in patients with mild-to-moderate OA of the knee is as effective and safe as a standard therapeutic dose of celecoxib in terms of pain relief and improvement in functional capacity after a 2-week treatment course.


Assuntos
Celecoxib/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Preparações de Plantas/uso terapêutico , Adulto , Idoso , Celecoxib/farmacologia , Inibidores de Ciclo-Oxigenase 2/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Preparações de Plantas/farmacologia , Método Simples-Cego , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(28): e21131, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664142

RESUMO

INTRODUCTION: Tumor necrosis factor alpha (TNF-α) mediated inflammation has been implicated, in knee osteoarthritis, despite being a predominantly degenerative condition. PATIENT CONCERNS: A 56-year old female, a case of left knee pain not responding to conventional conservative strategies. DIAGNOSIS: A diagnosis of primary osteoarthritis of the left knee, grade 3 osteoarthritis as per the Kellgren-Lawrence Scale was established. INTERVENTIONS: She was administered an intra-articular injection of 10 mg of Adalimumab, a commonly used anti-TNF agent. OUTCOMES: The patient was evaluated at baseline, 1 month, 3 months, and at 6 months. There was a marked improvement in pain intensity (visual analog scale) and quality of life, despite no objective change on the parameters seen on ultrasound of the knee. CONCLUSION: Injection of adalimumab via the intra-articular route into the knee joint in primary osteoarthritis yields promising results.


Assuntos
Adalimumab/administração & dosagem , Artralgia/diagnóstico , Osteoartrite do Joelho/tratamento farmacológico , Medição da Dor/métodos , Antirreumáticos/administração & dosagem , Artralgia/tratamento farmacológico , Artralgia/etiologia , Feminino , Humanos , Injeções Intra-Articulares , Articulação do Joelho , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores
18.
Am J Physiol Regul Integr Comp Physiol ; 319(3): R366-R375, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32726157

RESUMO

We have tested the feasibility of thermal grills, a harmless method to induce pain. The thermal grills consist of interlaced tubes that are set at cool or warm temperatures, creating a painful "illusion" (no tissue injury is caused) in the brain when the cool and warm stimuli are presented collectively. Advancement in objective pain assessment research is limited because the gold standard, the self-reporting pain scale, is highly subjective and only works for alert and cooperative patients. However, the main difficulty for pain studies is the potential harm caused to participants. We have recruited 23 subjects in whom we induced electric pulses and thermal grill (TG) stimulation. The TG effectively induced three different levels of pain, as evidenced by the visual analog scale (VAS) provided by the subjects after each stimulus. Furthermore, objective physiological measurements based on electrodermal activity showed a significant increase in levels as stimulation level increased. We found that VAS was highly correlated with the TG stimulation level. The TG stimulation safely elicited pain levels up to 9 out of 10. The TG stimulation allows for extending studies of pain to ranges of pain in which other stimuli are harmful.


Assuntos
Resposta Galvânica da Pele/fisiologia , Temperatura Alta , Limiar da Dor/fisiologia , Dor/fisiopatologia , Sensação Térmica/fisiologia , Adulto , Temperatura Baixa , Feminino , Voluntários Saudáveis , Humanos , Medição da Dor/métodos
19.
Niger J Clin Pract ; 23(7): 934-943, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620722

RESUMO

Aims: This study establishes the reliability and validity of pain pressure threshold (PPT) in evaluating pain for older adults with knee arthritis, and explores the importance of using a standard tool to measure pain in older adults. Methods: The study consisted of a group of 31 older adult patients with bilateral symptomatic knee osteoarthritis, intra- and inter-rater reliability, and concurrent validity that were assessed for PPT and were compared with standard visual analogue scale (VAS). Physical therapy intervention was provided to combat the pain. Results: The PPT showed excellent intra-assessor reliability by not only meeting acceptable standards but also representing very high values. The intra-assessor reliability between test sessions was excellent. The inter-assessor agreement was also very high before treatment. The highest ICC showed very good agreement (0.860) during the initial treatment for pain pressure measurement. The study also established concurrent validity of VAS and PPT (before treatment and after treatment), where the rho correlation was high (-0.708 and -0.625) and significant, indicating that PPT is adequately sensitive for detecting changes over time. Conclusion: PPT is a reliable and valid tool for measuring pain, and it helps clinicians understand the prognostic effect of the intervention, especially in older adults. The tool is consistent at measuring pain and is a valid tool compared to subjective pain scoring.


Assuntos
Osteoartrite do Joelho , Medição da Dor/métodos , Limiar da Dor , Dor , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite do Joelho/fisiopatologia , Medição da Dor/normas , Modalidades de Fisioterapia , Reprodutibilidade dos Testes , Arábia Saudita , Escala Visual Analógica
20.
PLoS One ; 15(7): e0235545, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645045

RESUMO

The automatic detection of facial expressions of pain is needed to ensure accurate pain assessment of patients who are unable to self-report pain. To overcome the challenges of automatic systems for determining pain levels based on facial expressions in clinical patient monitoring, a surface electromyography method was tested for feasibility in healthy volunteers. In the current study, two types of experimental gradually increasing pain stimuli were induced in thirty-one healthy volunteers who attended the study. We used a surface electromyography method to measure the activity of five facial muscles to detect facial expressions during pain induction. Statistical tests were used to analyze the continuous electromyography data, and a supervised machine learning was applied for pain intensity prediction model. Muscle activation of corrugator supercilii was most strongly associated with self-reported pain, and the levator labii superioris and orbicularis oculi showed a statistically significant increase in muscle activation when the pain stimulus reached subjects' self -reported pain thresholds. The two strongest features associated with pain, the waveform length of the corrugator supercilii and levator labii superioris, were selected for a prediction model. The performance of the pain prediction model resulted in a c-index of 0.64. In the study results, the most detectable difference in muscle activity during the pain experience was connected to eyebrow lowering, nose wrinkling and upper lip raising. As the performance of the prediction model remains modest, yet with a statistically significant ordinal classification, we suggest testing with a larger sample size to further explore the variables that affect variation in expressiveness and subjective pain experience.


Assuntos
Eletromiografia/métodos , Expressão Facial , Medição da Dor/métodos , Adulto , Músculos Faciais/fisiologia , Feminino , Humanos , Masculino , Limiar da Dor
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