scholarly journals Treatment of Neuropathic Pain with 5% Lidocaine-Medicated Plaster: Five Years of Clinical Experience

2011 ◽  
Vol 16 (4) ◽  
pp. 259-263 ◽  
Author(s):  
Claire Delorme ◽  
Marie L Navez ◽  
Valérie Legout ◽  
Rodrigue Deleens ◽  
Dominique Moyse
Keyword(s):  
Neuropathic Pain ◽  
General Population ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Initial Assessment ◽  
Experienced Pain ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
Excellent Safety Profile ◽  
One Year

BACKGROUND: Neuropathic pain is often severe and adversely affects patients’ quality of life.OBJECTIVE: To perform a retrospective, observational study investigating the efficacy and safety of treating refractory chronic neuropathic pain with 5% lidocaine-medicated plaster, in patients attending pain centres.METHODS: Medical records from 467 patients treated with 5% lidocaine-medicated plaster were evaluated for efficacy (maximum and minimum pain intensities and coanalgesic consumption) and adverse events. Data from an initial assessment and at least one follow-up visit had to be available, and separate analyses were conducted for the general population and the subpopulation older than 70 years of age.RESULTS: Of the patients enrolled, 25.0% were older than 70 years of age. While 20.6% had postherpetic neuralgia, 76.3% had other types of peripheral pain. Approximately 78.1% of cases of peripheral neuropathic pain followed surgery, and 23% were post-traumatic pain. The time from onset to referral was more than one year in two-thirds of cases. All patients experienced pain of at least moderate severity (mean [± SD] 11-point numerical rating scale score 5.2±2.4 to 8.2±1.6). Treatment with 5% lidocaine-medicated plaster reduced pain intensity by more than 50% in 45.5% of patients, and by at least 30% in 82.2%. Of note, the consumption of analgesics and coanalgesics was significantly reduced. Results were similar in both the general population and the subpopulation older than 70 years of age, at high risk and often receiving multiple medications.CONCLUSIONS: Treatment of refractory neuropathic pain with 5% lidocaine-medicated plaster clearly demonstrated efficacy and an excellent safety profile in patients with refractory neuropathic pain.

scholarly journals A PROSPECTIVE SURVEY OF APPROPRIATENESS OF PAIN PHARMACOTHERAPY MANAGEMENT IN POST-CESAREAN SECTION PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL

2019 ◽  
pp. 280-283 ◽  
Author(s):  
JOHAN ◽  
INSTIATY ◽  
NAFRIALDI ◽  
YUDITIYA PURWOSUNU
Keyword(s):  
Pain Management ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Management Index ◽  
Post Surgery ◽  
Emergency Cesarean ◽  
Experienced Pain ◽  
Chi Squared ◽  
Numerical Rating ◽  
Numerical Rating Scale Score

Objective: In this study, we sought to assess the pattern of analgesic usage, adequacy of pain management, side effects, and analgesic drug interactionsin the post-emergency cesarean surgery setting.Methods: This was a prospective observational study of 80 patients who underwent emergency cesarean surgery at the Obstetrics and GynecologyDepartment of the Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN-CM) between July 2015 and January 2016. Adequacy of painmanagement during the first 3 post-operative days was assessed using Pain Management Index. Relation between pain intensity during activities andrest with patient characteristic was assessed using Chi-squared test and Fischer’s exact test.Results: Nineteen patients (8.7%) were prescribed two types of nonsteroid anti-inflammatory drugs concomitantly, and 41.8% received inappropriateanalgesics at a lower frequency. Most patients experienced pain with numerical rating scale score >3 in the first 24 h post-surgery: 59 patients(73.75%) experienced pain during activities and 7 patients (8.75%) during rest.Conclusion: Post-emergency cesarean surgery pain management at RSUPN-CM was not optimal. Most patients did not receive adequate painmanagement in the first 24 h post-surgery.

scholarly journals Differential response to scrambler therapy by neuropathic pain phenotypes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Young Gi Min ◽  
Hyun Seok Baek ◽  
Kyoung-Min Lee ◽  
Yoon-Ho Hong
Keyword(s):  
Neuropathic Pain ◽  
Treatment Outcome ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Brief Pain Inventory ◽  
Differential Response ◽  
Open Label ◽  
Numerical Rating ◽  
Scrambler Therapy ◽  
Post Hoc

AbstractScrambler therapy is a noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory (NPSI) profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, − 15%; 95% CI − 28% to − 2.4%; p < 0.001). The mean score of Brief Pain Inventory (BPI) interference subdimension was also significantly improved (p = 0.022), while the BPI pain composite score was not. Hierarchical clustering based on the NPSI profiles partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS; p = 0.072, BPI interference subdimension). Treatment response to scrambler therapy appears different depending on the neuropathic pain phenotypes, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy.

scholarly journals Effect of Complex Korean Medicine Treatment on Sacral Insufficiency Fracture: A Case Report

2020 ◽  
Vol 37 (3) ◽  
pp. 187-192
Author(s):  
Ga Hyeon Jung ◽  
Hyun Lee ◽  
Hwa Yeon Ryu ◽  
Jae Hui Kang
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Insufficiency Fracture ◽  
Sacral Insufficiency Fracture ◽  
Korean Medicine ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
History Of ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIF) are a common, but often underdiagnosed source of lower back pain without apparent trauma. This report presents the clinical outcome of a 75-year-old female with SIF, and an underlying medical history of osteoporosis and rheumatoid arthritis. She was treated non-operatively, in-hospital, with Korean medicine. Patient progress was assessed using the numerical rating scale and selfreported symptoms. Post-treatment, the numerical rating scale score for pain in her hip decreased from 7 to 2. At admission, the patient was unable to sit, and could only walk 3 m with assistance. At discharge, she could sit for longer than 1 hour and walk further than 200 m unassisted. On the follow-up visit, the patient was asymptomatic, and x-ray scans showed ossification of the sacral and pubic fractures. These results suggest that, Korean medicine can effectively reduce pain and aid rehabilitation in patients with SIF, without the need for surgery.

scholarly journals Differential Response to Scrambler Therapy by Neuropathic Pain Phenotypes

2021 ◽  
Author(s):  
Young Gi Min ◽  
Hyun Seok Baek ◽  
Kyoung-Min Lee ◽  
Yoon-Ho Hong
Keyword(s):  
Neuropathic Pain ◽  
Treatment Outcome ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Brief Pain Inventory ◽  
Differential Response ◽  
Sensory Profile ◽  
Open Label ◽  
Numerical Rating ◽  
Scrambler Therapy

Abstract Scrambler therapy is a novel noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, −15%; 95% CI, −28% to −2.4%; p < 0.001). The mean score of Brief Pain Inventory (BPI) interference subdimension was also significantly improved (p = 0.022), while the BPI pain composite score was not. Hierarchical clustering partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS; p = 0.072, BPI interference subdimension). Treatment response to scrambler therapy appears different depending on the pain-related sensory profile, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy.

Prevalence of Persistent Pain after Total Knee Arthroplasty and the Impact of Neuropathic Pain

2018 ◽  
Vol 32 (10) ◽  
pp. 1020-1023 ◽  
Author(s):  
Masahiro Hasegawa ◽  
Shine Tone ◽  
Yohei Naito ◽  
Hiroki Wakabayashi ◽  
Akihiro Sudo
Keyword(s):  
Total Knee Arthroplasty ◽  
Neuropathic Pain ◽  
Knee Arthroplasty ◽  
Severe Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Number Of Patients ◽  
Numerical Rating ◽  
Total Knee ◽  
The Impact

AbstractThe present study aimed to define the prevalence of pain persisting after total knee arthroplasty (TKA) and determine the impact of neuropathic pain. Knee pain after TKA was evaluated in 154 patients (222 knees with osteoarthritis) using a numerical rating scale (NRS) and followed up for a mean of 4.7 years. The patients were classified according to whether they had no or mild pain (NRS ≤ 3), or moderate-to-severe pain (NRS > 3), and then assigned to groups with nociceptive, unclear, or neuropathic pain based on responses to painDETECT questionnaires. Risk factors for these types of pain were determined. The ratio of patients with moderate-to-severe pain was 28% (62 knees). Thirteen patients (21 knees; 9%) experienced unclear pain. Patients with moderate-to-severe or unclear pain had malalignment and lower Knee Society knee scores. In conclusion, a significant number of patients experienced moderate-to-severe and unclear pain after TKA. Moderate-to-severe pain was associated with unclear pain.

scholarly journals Efficacy of Ultrasonography Guided Erector Spinae Plane Block for Perioperative Analgesia in Percutaneous Nephrolithotomy

2021 ◽  
Vol 8 (13) ◽  
pp. 830-834
Author(s):  
Srinivas Kalabhavi ◽  
Revanasiddappa A Kanagali ◽  
Bhuvanesa Nanjappa ◽  
Ravi Bhat ◽  
Promod Makanavar
Keyword(s):  
Scale Score ◽  
Percutaneous Nephrolithotomy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Erector Spinae ◽  
Secondary Outcome ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
Group A ◽  
Group B

BACKGROUND Erector spinae block is a paraspinal, fascial block that targets the ventral, dorsal rami and rami communications of spinal nerves. The present study was conducted to know the efficacy of ultrasound guided erector spinae block (ESP) block in preoperative analgesia among patients with percutaneous nephrolithotomy (PCNL) attending a tertiary care hospital. METHODS The study was carried out on 596 patients from Jan 2015 to Jan 2020 who were indicated for PCNL. They were divided into two groups, group A (ESP = 373) and group B (intravenous-IV analgesia = 273). In the group A (N = 373), after induction of general anaesthesia, ESP block with 0.5 % bupivacaine and 1 / 200,000 epinephrine (single shot) was given at lower thoracic level (T10 - 12) and IV analgesia was given in group B. All patients were monitored for supplemental opioid requirement intraoperatively as assessed by their haemodynamic status (baseline change in heart rate-HR & mean arterial blood pressure-MAP). The primary outcome of the study was consumption of tramadol in 24 hrs. Pain assessment every 2-hour pre- and post-operatively using numerical rating (NR) scale was considered as the secondary outcome. Categorical outcomes were compared between study groups using chi-square test / Fisher's exact test; Pvalue of < 0.05 was considered statistically significant using IBM SPSS. RESULTS Most of them in group A were free of pain for 24 hours postoperatively with numerical rating scale score of < 3 and did not require any postop rescue analgesics. Only 1 patient showed numerical rating scale score of 4 around 16 hrs. after the surgery and was given tramadol. Supplemental opioid analgesic was not required by any of the patients during the entire intraoperative period. CONCLUSIONS ESP block is a favourable technique that results in very good analgesic effect preoperatively and also lessens the use of intravenous opioids and other analgesics. KEYWORDS ESP Block, PCNL Surgery, Tramadol, Kidney Stones

scholarly journals Discontinuing Monoclonal Antibodies Targeting CGRP Pathway After One-Year Treatment: An Observational Longitudinal Cohort Study

2021 ◽  
Author(s):  
Fabrizio Vernieri ◽  
Nicoletta Brunelli ◽  
Roberta Messina ◽  
Carmelina Maria Costa ◽  
Bruno Colombo ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Cohort Study ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Longitudinal Cohort Study ◽  
Longitudinal Cohort ◽  
Calcitonin Gene ◽  
Numerical Rating ◽  
Secondary Endpoints ◽  
One Year

Abstract Background: The monoclonal antibodies anti-calcitonin gene-related peptide (mAbs anti-CGRP) pathway revolutionized migraine prevention. However, some drug agencies limited the treatment to one year due to their high costs. This study aimed at evaluating the effect of discontinuing mAbs anti-CGRP on monthly migraine days (MMDs) and disability in high-frequency episodic (HFEM) and chronic migraine (CM) patients. Methods: This observational longitudinal cohort study was conducted at 10 Italian headache centres (November 2019-July 2021). Consecutive adult patients followed up for three months (F-UP1-3) after discontinuation of a one-year erenumab/galcanezumab treatment were enrolled. The primary endpoint was the change in F-UP MMDs. Secondary endpoints included variation in pain intensity (Numerical Rating Scale, NRS), monthly painkiller intake (MPI), and HIT-6 scores. We also assessed from F-UP1 to 3 the ≥50% response rates (RR), relapse rate to CM, and recurrence of Medication Overuse (MO).Results: We enrolled 154 patients (72.1% female, 48.2±11.1 years, 107 CM, 47 HFEM); 91 were treated with erenumab, 63 with galcanezumab. From F-UP1 to F-UP3, MMDs, MPI, NRS, and HIT-6 progressively increased but were still lower at F-UP 3 than baseline (Friedman's analysis of rank, p<.001). In the F-UP 1-3 visits, ≥50%RR frequency did not differ significantly between CM and HFEM patients. However, the median reduction in RR at F-UP3 was higher in HFEM (-47.7% [25th, -79.5; 75th ,-17.0]) than in CM patients (-25.5% [25th, -47.1; 75th ,-3.3]; Mann-Whitney U test; p=.032). Of the 84 baseline CM patients who had reverted to EM, 28 (33.3%) relapsed to CM at F-UP1, 35 (41.7)% at F-UP2, 39 (46.4%) at F-UP3. Of the 64 baseline MO patients ceasing MO, 15 (18.3%) relapsed to MO at F-UP1, 26 (31.6%) at F-UP2, and 30 (42.3%, 11 missing data) at F-UP3. Lower MMDs, MPI, NRS, and HIT-6 and higher RR in the last month of therapy characterized patients with 50% RR at F-UP1 and F-UP3 (Mann-Whitney U test; consistently p<.01).Conclusion: Migraine frequency and disability gradually increased after anti-CGRP mAbs interruption. Most patients did not relapse to MO or CM despite the increase in MMDs. Our data suggest to reconsider mAbs anti-CGRP discontinuation.

scholarly journals Persistent Postsurgical Pain Following Thoracotomy: A Comparison of Thoracic Epidural and Paravertebral Blockade as Preventive Analgesia

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1796-1802
Author(s):  
Jonathon Wong ◽  
Jackie Cooper ◽  
Rik Thomas ◽  
Richard Langford ◽  
Sibtain Anwar
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Short Form ◽  
Postsurgical Pain ◽  
Perioperative Analgesia ◽  
Thoracic Epidural ◽  
Numerical Rating

Abstract Objective Persistent postsurgical pain (PPP) is common following thoracotomy. Thoracic epidural (TEB) and paravertebral blockade (PVB) are both established forms of perioperative analgesia for thoracotomy. There is currently a lack of data on their influence on PPP; this study aims to evaluate both techniques on PPP. Design Observational study, prospectively collected data. Methods Adults who underwent thoracotomy had either TEB or PVB for analgesia and were prospectively interviewed at six months. A numerical rating scale, the short form of the Leeds Assessment of Neuropathic Symptoms and Signs, and the EuroQol-5 dimension (EQ-5D) index were used to assess pain, neuropathic pain, and quality of life. Results Eighty-two patients who underwent a thoracotomy were recruited (TEB N = 36, PVB N = 46). Pain scores had a median (interquartile range [IQR]) of 1 (0 to 4.5) and 1.5 (0 to 4, P = 0.89), presence of PPP was 58.3% (95% confidence interval [CI] = 40.0–74.5%) and 60.9% (95% CI = 45.4–74.9%, P = 0.81), and presence of neuropathic pain was 30.6% (95% CI = 16.3–48.1%) and 28.2% (95% CI = 16.0–43.5%, P = 0.85). Reported quality of life was 0.71 (0.14–0.85) and 0.80 (0.19–0.91, P = 0.21). Patients who had PPP reported worse quality of life measures compared with those who were pain free, with a median (IQR) EQ-5D index of 0.69 (–0.15 to 0.85) and 0.85 (0.72 to 1, P = 0.0007); quality of life was worst when there was a neuropathic component (median = 0.39, IQR = –0.24 to 0.75). Conclusions There was no statistical difference in the development of persistent postsurgical pain between patients who received a TEB or a PVB; however, patients who developed PPP had a significantly lower quality of life, which was worse with a neuropathic component.

scholarly journals Analysis of the factors determining the development of postoperative pain in patients after knee and hip replacement surgery

2021 ◽  
Vol 15 (6) ◽  
pp. 19-25
Author(s):  
K. A. Glemba ◽  
A. E. Karateev ◽  
M. A. Makarov ◽  
S. A. Makarov ◽  
E. I. Bialik ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Hip Osteoarthritis ◽  
Preoperative Pain ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Numerical Rating ◽  
Pain At Rest

Chronic postoperative pain (POP) is a serious complication of total replacement (TR) of the knee (KJ) and hip (HJ) joints.Objective: to determine the factors associated with POP in patients after TR of KJ or HJ.Patients and methods. The study group consisted of 124 patients with knee osteoarthritis or hip osteoarthritis (age 63.6±9.9 years, 63% women and 37% men) who underwent TR of KJ or HJ. POP was defined as pain ≥40 mm on a numerical rating scale persistent for ≥3 months. Its presence was assessed after 3 and 6 months by telephone survey. Comparison of patients with POP and without it was carried out for a number of factors identified before surgery.Results and discussion. The incidence of POP was 27.4%. There was no difference in the incidence of POP in patients after TR of KJ or HJ: 28.1% and 26.9% (p=0.88). POP was statistically significantly associated with parameters such as higher body mass index (BMI); the intensity of pain at rest; general assessment of impairment; WOMAC index pain, stiffness and overall; severity of symptoms of neuropathic pain (PainDETECT); signs of depression and anxiety (HADS).The risk of POP was significantly higher (p<0.05) with BMI >30 kg/m2 (odds ratio, OR 2.755; 95% confidence interval, CI 1.053–7.206), rest pain ≥40 mm on a visual analog scale (OR 1.349; 95% CI 0.478–3.803), PainDETECT scores ≥13 (OR 3.598; 95% CI 1.048–12.36) and HADS depression ≥8 (OR 2.193; 95% CI 0.745–6.454), presence of ≥2 sources of pain (OR 6.996; 95% CI 2.358–20.756).Conclusion. It was found that the risk of POP after TR of KJ and HJ is higher in patients with overweight, severe preoperative pain, signs of neuropathic pain and depression, as well as in the presence of several sources of pain (except for the affected joint, that was replaced surgically).

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