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Abstract
Chronic pain can be a frustrating condition for patient and clinician. The integrative medicine approach to pain can offer hope, adding safe complementary and alternative medical (CAM) therapies to mitigate pain and suffering. Such CAM therapies include nutrition, supplements and herbs, manual medicine, acupuncture, yoga, and mind-body approaches. The evidence is heterogeneous regarding these approaches, but some evidence suggests efficacy and confirms safety. The integrative medicine approach can be beneficial in a patient with chronic pain.
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Mazzardo-Martins L, Martins DF, Marcon R, Dos Santos UD, Speckhann B, Gadotti VM, Sigwalt AR, Guglielmo LGA, Santos ARS. High-intensity extended swimming exercise reduces pain-related behavior in mice: involvement of endogenous opioids and the serotonergic system. THE JOURNAL OF PAIN 2010; 11:1384-93. [PMID: 20488763 DOI: 10.1016/j.jpain.2010.03.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 03/11/2010] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED The present study examined the hyponociceptive effect of swimming exercise in a chemical behavioral model of nociception and the mechanisms involved in this effect. Male mice were submitted to swimming sessions (30 min/d for 5 days). Twenty-four hours after the last session, we noticed that swimming exercise decreased the number of abdominal constriction responses caused by acetic acid compared with the nonexercised group. The hyponociception caused by exercise in the acetic acid test was significantly attenuated by intraperitoneal (i.p.) pretreatment of mice with naloxone (a nonselective opioid receptor antagonist, 1 mg/kg), ρ-chlorophenylalanine methyl ester (PCPA, an inhibitor of serotonin synthesis, 100 mg/kg once a day for 4 consecutive days), and by bilateral adrenalectomy. Collectively, the present results provide experimental evidences indicating for the first time that high-intensity extended swimming exercise reduces pain-related behavior in mice. The mechanisms involve an interaction with opioid and serotonin systems. Furthermore, endogenous opioids released by adrenal glands probably are involved in this effect. PERSPECTIVE Our results indicate that high-intensity extended exercise endogenously controls acute pain by activation of opioidergic and serotonergic pathways. Furthermore, these results support the use of exercise as a nonpharmacological approach for the management of acute pain.
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Affiliation(s)
- Leidiane Mazzardo-Martins
- Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade, Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, Brazil
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53
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Abstracts. PHYSICAL THERAPY REVIEWS 2010. [DOI: 10.1179/174328810x12719009060146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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54
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Novel strategies for the treatment of inflammatory hyperalgesia. Eur J Clin Pharmacol 2010; 66:429-44. [DOI: 10.1007/s00228-010-0784-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 01/11/2010] [Indexed: 12/24/2022]
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55
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Asmundson GJG, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety 2010; 26:888-901. [PMID: 19691031 DOI: 10.1002/da.20600] [Citation(s) in RCA: 473] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The purpose of this article is to describe the current state-of-the-art regarding the co-occurrence of the anxiety disorders and chronic pain. First, we describe the core characteristics of chronic pain and its co-occurrence with the anxiety disorders. Second, we review data on the prevalence of co-occurrence. Third, we describe the mutual maintenance and shared vulnerability models, both of which have been offered to explain the co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain and may have applicability to various other anxiety disorders. Fourth, we provide an integrative review of available research addressing the postulates of these models specific to the mechanisms of anxiety sensitivity, selective attention to threat, and reduced threshold for alarm. We conclude with general recommendations for improving assessment and treatment of patients who present with an anxiety disorder accompanied by clinically significant pain. Given that most of the available evidence has come from studies of PTSD and chronic pain, we provide a detailed agenda for future investigation of the co-occurrence of chronic pain and other anxiety disorders.
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56
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Sutherland EG, Ritenbaugh C, Kiley SJ, Vuckovic N, Elder C. An HMO-based prospective pilot study of energy medicine for chronic headaches: whole-person outcomes point to the need for new instrumentation. J Altern Complement Med 2009; 15:819-26. [PMID: 19678772 PMCID: PMC3191377 DOI: 10.1089/acm.2008.0592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate an energy healing treatment for possible inclusion as a Kaiser Permanente Northwest (KPNW) Pain Clinic provided therapy, and to identify the appropriate number of treatment sessions for a Pain Clinic protocol, should the intervention prove successful. In addition, our intent was to document the full range of outcomes experienced by patients undergoing energy healing, including whole-person and transformative outcomes should they occur. SETTING The setting for this study was Kaiser Permanente Northwest Pain Clinic. PARTICIPANTS Thirteen (13) patients with chronic headache who were members of the KPNW Health Plan were recruited through flyers or mailings. METHODS Thirteen (13) participants received at least three energy healing sessions at approximately weekly intervals. Assessments were based on pre- and post-treatment qualitative interviews. INTERVENTION The treatment consisted of three Healing Touch sessions provided by a Certified Healing Touch Practitioner. Treatments contained elements common to all sessions, and elements that were tailored to the individual subject. RESULTS Twelve (12) of 13 participants experienced improvement in frequency, intensity, or duration of pain after three treatments. In addition, 11 of 13 participants experienced profound shifts in their view of themselves, their lives, and their potential for healing and transformation. These changes lasted from 24 hours to more than 6 months at follow-up. CONCLUSIONS Energy healing can be an important addition to pain management services. More in-depth qualitative research is needed to explore the diversity of outcomes facilitated by energy healing treatments. Furthermore, the development of new instrumentation is warranted to capture outcomes that reflect transformative change and changes at the level of the whole person.
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Affiliation(s)
- Elizabeth G Sutherland
- Helfgott Research Institute, National College of Natural Medicine , Portland, OR 97201, USA.
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57
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Alford L. Unveiling the physical therapies. S Afr Fam Pract (2004) 2009. [DOI: 10.1080/20786204.2009.10873871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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58
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The effects of high-velocity low-amplitude thrust manipulation and mobilisation techniques on pressure pain threshold in the lumbar spine. INT J OSTEOPATH MED 2009. [DOI: 10.1016/j.ijosm.2008.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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59
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Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial. THE JOURNAL OF PAIN 2009; 10:601-8. [PMID: 19380259 DOI: 10.1016/j.jpain.2008.12.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 11/14/2008] [Accepted: 12/06/2008] [Indexed: 12/15/2022]
Abstract
UNLABELLED We investigated the effectiveness of cupping, a traditional method of treating musculoskeletal pain, in patients with carpal tunnel syndrome (CTS) in an open randomized trial. n = 52 outpatients (58.5 +/- 8.0 years) with neurologically confirmed CTS were randomly assigned to either a verum (n = 26) or a control group (n = 26). Verum patients were treated with a single application of wet cupping, and control patients with a single local application of heat within the region overlying the trapezius muscle. Patients were followed up on day 7 after treatment. The primary outcome, severity of CTS symptoms (VAS), was reduced from 61.5 +/- 20.5 to 24.6 +/- 22.7 mm at day 7 in the cupping group and from 67.1 +/- 20.2 to 51.7 +/- 23.9 mm in the control group [group difference -24.5mm (95%CI -36.1; -2.9, P < .001)]. Significant treatment effects were also found for the Levine CTS-score (-.6 pts: 95%CI -.9; -.2, P = .002), neck pain (-12.6mm; 95%CI -18.8; -6.4, P < .001), functional disability (DASH-Score) (-11.1 pts; 95%CI -17.1; -5.1, P < .001), and physical quality of life (.3; 95%CI .0; .3, P = .048). The treatment was safe and well tolerated. We conclude that cupping therapy may be effective in relieving the pain and other symptoms related to CTS. The efficacy of cupping in the long-term management of CTS and related mechanisms remains to be clarified. PERSPECTIVE The results of a randomized trial on the clinical effects of traditional cupping therapy in patients with carpal tunnel syndrome are presented. Cupping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.
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Abstract
Unfortunately, many physicians and patients only seek pharmacologic treatments to aid in pain relief; however, many nonpharmacologic interventions exist with excellent potential for pain treatment. This article reviews several of these strategies with an emphasis on clinical indications and expected outcomes. The topics of chronic pain psychology and prescription writing also are reviewed. As a medical provider, it is important to remain open minded to alternative approaches to pain control.
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Licciardone JC, King HH, Hensel KL, Williams DG. OSTEOPAThic Health outcomes in chronic low back pain: The OSTEOPATHIC Trial. OSTEOPATHIC MEDICINE AND PRIMARY CARE 2008; 2:5. [PMID: 18439282 PMCID: PMC2386783 DOI: 10.1186/1750-4732-2-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 04/25/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND Osteopathic manipulative treatment (OMT) and ultrasound physical therapy (UPT) are commonly used for chronic low back pain. Although there is evidence from a systematic review and meta-analysis that OMT generally reduces low back pain, there are no large clinical trials that specifically assess OMT efficacy in chronic low back pain. Similarly, there is a lack of evidence involving UPT for chronic low back pain. METHODS The OSTEOPAThic Health outcomes In Chronic low back pain (OSTEOPATHIC) Trial is a Phase III randomized controlled trial that seeks to study 488 subjects between August 2006 and June 2010. It uses a 2 x 2 factorial design to independently assess the efficacy of OMT and UPT for chronic low back pain. The primary outcome is a visual analogue scale score for pain. Secondary outcomes include back-specific functioning, generic health, work disability, and satisfaction with back care. CONCLUSION This randomized controlled trial will potentially be the largest involving OMT. It will provide long awaited data on the efficacy of OMT and UPT for chronic low back pain. TRIAL REGISTRATION http://www.clinicaltrials.gov, NCT00315120.
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Affiliation(s)
- John C Licciardone
- The Osteopathic Research Center, University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX 76107, USA.
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He J, Wu B, Jiang X, Zhang F, Zhao T, Zhang W. A New Analgesic Method, Two-minute Sciatic Nerve Press, for Immediate Pain Relief: A Randomized Trial. BMC Anesthesiol 2008; 8:1. [PMID: 18221518 PMCID: PMC2262881 DOI: 10.1186/1471-2253-8-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 01/25/2008] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Current analgesics have drawbacks such as delays in acquisition, lag-times for effect, and side effects. We recently presented a preliminary report of a new analgesic method involving a two-minute sciatic nerve press, which resulted in immediate short-term relief of pain associated with dental and renal diseases. The present study investigated whether this technique was effective for pain associated with other disease types, and whether the relief was effective for up to one hour. METHODS This randomized, placebo-controlled, parallel-group trial was conducted in four hospitals in Anhui Province, China. Patients with pain were sequentially recruited by participating physicians during clinic visits, and 135 patients aged 15 - 80 years were enrolled. Dental disease patients included those with acute pulpitis and periapical abscesses. Renal disease patients included those with kidney infections and/or stones. Tumor patients included those with nose, breast, stomach and liver cancers, while Emergency Room patients had various pathologies. Patients were randomly assigned to receive a "sciatic nerve press" in which pressure was applied simultaneously to the sciatic nerves at the back of both thighs, or a "placebo press" in which pressure was applied to a parallel region on the front of the thighs. Each fist applied a pressure of 11 - 20 kg for 2 minutes. Patients rated their level of pain before and after the procedure. RESULTS The "sciatic nerve press" produced immediate relief of pain in all patient groups. Emergency patients reported a 43.5% reduction in pain (p < 0.001). Significant pain relief for dental, renal and tumor patients lasted for 60 minutes (p < 0.001). The peak pain relief occurred at the 10 - 20th minutes, and the relief decreased 47% by the 60th minutes. CONCLUSION Two minutes of pressure on both sciatic nerves produced immediate significant short-term conduction analgesia. This technique is a convenient, safe and powerful method for the short-term treatment of clinical pain associated with a diverse range of pathologies. TRIAL REGISTRATION Current Controlled Trials ACTRN012606000439549.
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Affiliation(s)
- Jiman He
- Biomedicine (TC), Chinese Academy of Sciences, Beijing, 100080 China & Rhode Island Hospital, Brown University, RI 02903, USA
| | - Bin Wu
- Renal Department, Anhui Province Hospital, Anhui Medical University, Hefei, 230001, China
| | - Xianrong Jiang
- Department of Biology, Hefei Teachers College, Hefei, 230061, China
| | - Fenglin Zhang
- Department of Oncology, Maanshan People Hospital, Maanshan, 243000, China
| | - Tao Zhao
- Department of Emergency, Anhui Province Hospital, Hefei, 230001, China
| | - Wenlon Zhang
- Department of Dentistry, Chuzou Zhongxiyi Hospital, Chuzou, 239000, China
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63
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Kuphal KE, Fibuch EE, Taylor BK. Extended Swimming Exercise Reduces Inflammatory and Peripheral Neuropathic Pain in Rodents. THE JOURNAL OF PAIN 2007; 8:989-97. [PMID: 17890162 DOI: 10.1016/j.jpain.2007.08.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 08/06/2007] [Accepted: 08/12/2007] [Indexed: 11/28/2022]
Abstract
UNLABELLED Physical exercise is often recommended to patients who have chronic pain. However, only a small number of studies report exercise-induced analgesia in the setting of inflammatory pain, and even fewer relate long-term exercise to reductions in neuropathic pain. To address these questions, we evaluated the effect of extended swimming exercise in animal models of inflammatory (intraplantar injection of dilute formalin) and neuropathic (partial peripheral nerve injury) pain. We found that 9 days of swimming exercise in 37 degrees C water for 90 min/d decreased licking and flinching responses to formalin, as compared with nonexercised control animals. In addition, 18 to 25 days of swimming decreased nerve injury-induced cold allodynia and thermal hyperalgesia in rats, and 7 days of swimming decreased nerve injury-induced thermal hyperalgesia in mice. Our data indicate that swimming exercise reduces behavioral hypersensitivity in formalin- and nerve injury-induced animal models of persistent pain. PERSPECTIVE Surprisingly, few animal studies have investigated the effects of extended exercise on chronic pain. Our results support the use of exercise as a nonpharmacological approach for the management of peripheral neuropathic pain.
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Affiliation(s)
- Karen E Kuphal
- Department of Physical Therapy and Rehabilitation Science, Kansas University Medical Center, Kansas City, Kansas, USA
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64
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He J, Wu B, Zhang W, Ten G. Immediate and short-term pain relief by acute sciatic nerve press: a randomized controlled trial. BMC Anesthesiol 2007; 7:4. [PMID: 17504543 PMCID: PMC1887521 DOI: 10.1186/1471-2253-7-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 05/16/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite much research, an immediately available, instantly effective and harmless pain relief technique has not been discovered. This study describes a new manipulation: a "2-minute sciatic nerve press", for rapid short-term relief of pain brought on by various dental and renal diseases. METHODS This randomized, single-blind, placebo-controlled trial ran in three hospitals in Anhui Province, China, with an enrollment of 66 out of 111 solicited patients aged 16 to 74 years. Patients were recruited sequentially, by specific participating physicians at their clinic visits to three independent hospitals. The diseases in enrolled dental patients included dental caries, periodontal diseases and dental trauma. Renal diseases in recruits included kidney infections, stones and some other conditions. Patients were randomly assigned to receive the "2-minute sciatic nerve press" or the "placebo press". For the "2-minute sciatic nerve press", pressure was applied simultaneously to the sciatic nerves at the back of the thighs, using the fists while patients lay prone. For the "placebo press", pressure was applied simultaneously to a parallel spot on the front of the thighs, using the fists while patients lay supine. Each fist applied a pressure of 11 to 20 kg for 2 minutes, after which, patients arose to rate pain. RESULTS The "2-minute sciatic nerve press" produced greater pain relief than the "placebo press". Within the first 10 minutes after sciatic pressure, immediate pain relief ratings averaged 66.4% (p < 0.001) for the dental patients, versus pain relief of 20% for the placebo press, and, 52.2% (p < 0.01) for the renal patients, versus relief of 14% for the placebo press, in median. The method worked excellently for dental caries and periodontal diseases, but poorly for dental trauma. Forty percent of renal patients with renal colic did not report any pain relief after the treatment. CONCLUSION Two minutes of pressure on both sciatic nerves can produce immediate significant conduction analgesia, providing a convenient, safe and powerful way to overcome clinical pain brought on by dental diseases and renal diseases for short term purposes. TRIAL REGISTRATION ACTR 12606000439549.
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Affiliation(s)
- Jiman He
- Biomedicine (TC), Chinese Academy of Sciences, Beijing, 100080 China & Rhode Island Hospital, Brown University, 02903 USA
| | - Bin Wu
- Renal Department, Anhui Province Hospital, Anhui Medical University, Hefei, 230001 China
| | - Wenlong Zhang
- Department of Dentistry, Chuzou Zhongxiyi Hospital, Chuzou, 239000 China
| | - Guangping Ten
- Department of Medicine, Tongling People Hospital, Tongling, 244000 China
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Tsao JCI. Effectiveness of massage therapy for chronic, non-malignant pain: a review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2007; 4:165-79. [PMID: 17549233 PMCID: PMC1876616 DOI: 10.1093/ecam/nel109] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 12/04/2006] [Indexed: 11/28/2022]
Abstract
Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.
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66
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End-of-Life Care. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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67
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Yip YB, Tse HMS, Wu KK. An experimental study comparing the effects of combined transcutaneous acupoint electrical stimulation and electromagnetic millimeter waves for spinal pain in Hong Kong. Complement Ther Clin Pract 2006; 13:4-14. [PMID: 17210506 DOI: 10.1016/j.ctcp.2006.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 08/23/2006] [Accepted: 08/24/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To compare the efficacy of combined transcutaneous acupoint electrical stimulation (TAES) and electromagnetic millimeter wave (EMMW) therapy as an add-on treatment for pain relief and physical functional activity enhancement among adults with sub-acute non-specific spinal pain in either the low back or neck. DESIGN A non-blinded study with data obtained before, immediate, one week and three months after intervention. SETTING The Telehealth Clinic and Community Centre, Hong Kong. PARTICIPANTS Forty-seven subjects with either sub-acute neck or low back pain. INTERVENTION Subjects were randomly allocated to either an intervention group (n=23) or a control group (n=24). These groups were then divided into subgroups according to the site of their spinal pain-neck or back. The intervention group had eight treatments over a three-week period of TAES and EMMW. OUTCOME MEASURES Changes from baseline to the end of treatment were assessed at intervals of one week and three months on either neck or low back pain intensity [by Visual Analogue Scale (VAS)]; stiffness level; stress level; neck or low back lateral flexion and forward flexion in cm, and interference with daily activities. RESULTS The baseline VAS scores for the intervention and control groups were 5.34 and 5.18 out of 10, respectively (P value=0.77). At the one week and three month assessments, there were no significant differences between the groups-VAS (P value=0.09 and 0.27, respectively). A further subgroup of chronic pain sufferers (n=31) was identified and these had significantly reduced pain intensity at the one week assessment (P value=0.04) but this was not sustained at post three months after treatment (P value=0.15). Improvements in stiffness level, stress level, and functional disability level in the intervention group were not significant. CONCLUSIONS Our study shows that there was a reduction in pain intensity, stress and stiffness level immediately after the eight sessions of treatment (TAES and EMMW), though the effect is not sustained after a week. No pain relief was found with the neck pain subgroup. However, the reduction in subjective average pain intensity among the chronic pain subgroup was sustained at the post one week assessment for the intervention group but not at the post three month assessment.
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Affiliation(s)
- Y B Yip
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, PR China.
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68
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Abstract
Treatment with defocused CO2 laser can have a therapeutic effect on equine injuries, but the mechanisms involved are unclear. A recent study has shown that laser causes an increase in equine superficial tissue temperature, which may result in an increase in blood perfusion and a stimulating effect on tissue regeneration. However, no studies have described the effects on equine tissue perfusion. The aim of the present study was to investigate the effect of defocused CO2 laser on blood perfusion and to correlate it with temperature in skin and underlying muscle in anaesthetized horses. Differences between clipped and unclipped haircoat were also assessed. Eight horses and two controls received CO2 laser treatment (91 J/cm2) in a randomised order, on a clipped and unclipped area of the hamstring muscles, respectively. The significant increase in clipped skin perfusion and temperature was on average 146.3 ± 33.4 perfusion units (334%) and 5.5 ± 1.5°C, respectively. The significant increase in perfusion and temperature in unclipped skin were 80.6 ± 20.4 perfusion units (264%) and 4.8 ± 1.4°C. No significant changes were seen in muscle perfusion or temperature. In conclusion, treatment with defocused CO2 laser causes a significant increase in skin perfusion, which is correlated to an increase in skin temperature.
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Affiliation(s)
- A Bergh
- Department of Anatomy and Physiology, Swedish University of Agricultural Sciences, Uppsala, Sweden
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69
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Mancinelli CA, Davis DS, Aboulhosn L, Brady M, Eisenhofer J, Foutty S. The effects of massage on delayed onset muscle soreness and physical performance in female collegiate athletes. Phys Ther Sport 2006. [DOI: 10.1016/j.ptsp.2005.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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70
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Yip YB, Tse SHM. An experimental study on the effectiveness of acupressure with aromatic lavender essential oil for sub-acute, non-specific neck pain in Hong Kong. Complement Ther Clin Pract 2005; 12:18-26. [PMID: 16401526 DOI: 10.1016/j.ctcp.2005.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the efficacy of acupressure using an aromatic essential oil (lavender) as an add-on treatment for pain relief and enhancing physical functional activities among adults with sub-acute non-specific neck pain. DESIGN Experimental study design. SETTING The Telehealth clinic and the community centre, Hong Kong. INTERVENTION A course of 8-session manual acupressure with lavender oil over a 3 week period. OUTCOME MEASURES Changes from baseline to the end of treatment were assessed on neck pain intensity [by Visual Analogue Scale (VAS)]; stiffness level; stress level; neck lateral flexion, forward flexion and extension in cm, and interference with daily activities. RESULTS The baseline VAS score for the intervention and control groups were 5.12 and 4.91 out of 10, respectively (P = 0.72). One month after the end of treatment, compared to the control group, the manual acupressure group had 23% reduced pain intensity (P = 0.02), 23% reduced neck stiffness (P = 0.001), 39% reduced stress level (P = 0.0001), improved neck flexion (P = 0.02), neck lateral flexion (P = 0.02), and neck extension (P = 0.01). However, improvements in functional disability level were found in both the manual acupressure group (P = 0.001) and control group (P = 0.02). CONCLUSIONS Our results show that eight sessions of acupressure with aromatic lavender oil were an effective method for short-term neck pain relief.
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Affiliation(s)
- Y B Yip
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, PR China.
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71
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Abstract
The gastropathy associated with the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain disorders has contributed to significant morbidity and mortality. The distinction between the cyclooxygenase 1 and 2 enzymatic properties lead to the development of selective cyclooxygenase-2 inhibitory NSAIDs with the prospect of reducing NSAID-related gastropathy while maintaining anti-inflammatory properties. Initial studies of the efficacy and safety of the selective cyclooxygenase-2 inhibitors seemed promising. Larger clinical trials were carried out to reinforce the efficacy and safety of the cyclooxygenase-2 anti-inflammatory medications (coxibs). Further analysis of these trials raised concern with regard to both the efficacy and safety of this class of drugs. The most recent clinical trials of the coxibs have demonstrated significant cardiovascular thrombogenic potential, particularly at higher doses. Clinical investigators and regulatory agencies have questioned whether these findings mitigate the efficacy of coxibs and NSAIDs in general in the prophylaxis of colonic polyps, Alzheimer's disease, and more saliently, musculoskeletal pain disorders. This article addresses the current controversy of the efficacy and safety of the coxibs and NSAIDs in general based on recent clinical trials and review by healthcare consortiums. This article also provides guidelines regarding the use of NSAIDs, including the diminishing armamentarium of the coxibs, and the alternative therapeutic options available to the physiatrist in managing musculoskeletal pain disorders.
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Affiliation(s)
- Robert J Kaplan
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
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Bement MKH, Sluka KA. Low-intensity exercise reverses chronic muscle pain in the rat in a naloxone-dependent manner. Arch Phys Med Rehabil 2005; 86:1736-40. [PMID: 16181935 DOI: 10.1016/j.apmr.2005.03.029] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Revised: 03/21/2005] [Accepted: 03/24/2005] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the effects of low-intensity exercise on chronic muscle pain and potential activation of the endogenous opioid system. DESIGN Randomized placebo-controlled trial. SETTING Animal laboratory. ANIMALS Sixty-three male Sprague-Dawley rats. INTERVENTIONS Rats performed a low-intensity exercise protocol for 5 consecutive days after the induction of chronic muscle pain. In a separate experiment, naloxone or saline was administered systemically before 5 low-intensity exercise sessions. MAIN OUTCOME MEASURE Mechanical hyperalgesia was measured using von Frey filaments to determine the mechanical withdrawal threshold. RESULTS Low-intensity exercise increased mechanical withdrawal threshold in the chronic muscle pain model. Naloxone attenuated the antihyperalgesic effects of low-intensity exercise. CONCLUSIONS Low-intensity exercise reversed mechanical hyperalgesia in the chronic muscle pain model through activation of the endogenous opioid system.
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Affiliation(s)
- Marie K Hoeger Bement
- Physical Therapy Department, Integrative Neuroscience Research Center, College of Health Sciences, Marquette University, Milwaukee, WI 53201, USA.
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73
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Abstract
Chronic nonmalignant pain requires evaluation and treatment different from acute pain. The pathophysiology is different, and there is commonly some degree of psychosocial dysfunction. Opioids tend to be much less effective as analgesics for chronic pain, and may increase the sensitivity to pain when given long-term. Because they are self-reinforcing, opioids may be sought and be reported to improve chronic pain, even when they may make the condition worse over time. There are many effective alternatives to opioids for the treatment of chronic pain, but their use is complicated and may require considerable time and effort to determine which ones work. Patients, particularly those who have already been prescribed opioids, may resist these alternatives. An extensive physical and psychosocial evaluation is required in the management of chronic pain, which is difficult if not impossible to achieve in the emergency or urgent care settings. Consequently, emergency and urgent care physicians should work closely with the patient's pain management specialist or personal physician. Systems should be set up in advance to identify those patients whose frequent use of acute care services for obtaining opioids may be compromising their long-term management, putting themselves at risk for psychological and tolerance-induced adverse effects of frequent opioid use. Opioids may be used in carefully selected patients in consultation with their pain management specialist or personal physician, but care must be exercised not to initiate or exacerbate psychological or tolerance-related complications of chronic pain.
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Affiliation(s)
- George R Hansen
- Department of Emergency Medicine, Sierra Vista Regional Medical Center, 1010 Murray Avenue, San Luis Obispo, CA 93405, USA.
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74
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An integrative treatment approach of a patient with cervical radiculitis: A case report. J Chiropr Med 2005; 4:97-102. [DOI: 10.1016/s0899-3467(07)60119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2004] [Indexed: 11/19/2022] Open
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Abstract
Tennis elbow or lateral epicondylitis is one of the most common lesions of the arm with a well defined clinical presentation, which significantly impacts on the community. Many treatment approaches have been proposed to manage this condition. One is Cyriax physiotherapy. The effectiveness and reported effects of this intervention are reviewed.
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76
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Sran MM, Khan KM. Physiotherapy and osteoporosis: practice behaviors and clinicians’ perceptions—a survey. ACTA ACUST UNITED AC 2005; 10:21-7. [PMID: 15681265 DOI: 10.1016/j.math.2004.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Revised: 04/19/2004] [Accepted: 06/28/2004] [Indexed: 11/18/2022]
Abstract
Physiotherapists typically use a variety of modes to treat their clients, including manual therapy. The literature cautions against the use of manual therapy in individuals with osteoporosis, (Musculoskeletal Manipulation: Evaluation of the Scientific Evidence, Charles C Thomas Publisher, Springfield, IL; Common Vertebral Joint Problems, 2nd Edition, Churchill Livingstone, New York; Maitland's Vertebral Manipulation, 6th Edition, Butterworth-Heinemann, Boston; Br. J. Sports Med. 37 (2003) 195-196) yet clinical experience (Br. J. Sports Med. 37 (2003) 195-196) and published cases (J. Manip. Physiol. Ther. 15(7) (1992) 450-454) suggest that these techniques are still being used by at least some clinicians. The purpose of this study was to measure the most common treatment modes used by a random sample of physiotherapists practicing in the province of British Columbia (BC) in the treatment of individuals with osteoporosis. To assess whether physiotherapists in BC have concerns about the use of manual therapy in individuals with osteoporosis, particularly whether physiotherapists have concerns about fracture as a complication of treatment. This cross-sectional study of 171 physiotherapists in BC used a questionnaire developed by the physiotherapist in the Osteoporosis Program at the BC Women's Health Centre (a part of the Children's & Women's Health Centre of BC). The response rate (67/171) was 39%. Ninety-seven per cent of respondents reported using strength exercises and postural reeducation, while 45% reported using manual therapy in this population. Ninety-one per cent of respondents reported having concerns about the use of manual therapy. Vertebral fracture and rib fracture were the most commonly reported concerns. These findings suggest that most physiotherapists practicing in BC, Canada use evidence-based methods (i.e. strength training) when treating individuals with osteoporosis, a large number use manual therapy, and most have concerns about its use. Physiotherapists are most concerned about fractures, in particular vertebral fracture, but injury to other musculoskeletal tissues is also of concern. Studies of safety and effectiveness of manual therapy in this population are needed to guide clinical practice.
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Affiliation(s)
- Meena M Sran
- Osteoporosis Program, Children's & Women's Health Centre of British Columbia, Vancouver, Canada.
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77
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Hurley DA, McDonough SM, Dempster M, Moore AP, Baxter GD. A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain. Spine (Phila Pa 1976) 2004; 29:2207-16. [PMID: 15480130 DOI: 10.1097/01.brs.0000142234.15437.da] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multicenter assessor-blinded randomized clinical trial was conducted. OBJECTIVES To investigate the difference in effectiveness of manipulative therapy and interferential therapy for patients with acute low back pain when used as sole treatments and in combination. SUMMARY OF BACKGROUND DATA Both manipulative therapy and interferential therapy are commonly used treatments for low back pain. Evidence for the effectiveness of manipulative therapy is available only for the short-term. There is limited evidence for interferential therapy, and no study has investigated the effectiveness of manipulative therapy combined with interferential therapy. METHODS Consenting subjects (n = 240) recruited following referral by physicians to physiotherapy departments in the (government-funded) National Health Service in Northern Ireland were randomly assigned to receive a copy of the Back Book and either manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), or a combination of manipulative therapy and interferential therapy (CT; n = 80). The primary outcome was a change in functional disability on the Roland Morris Disability Questionnaire. Follow-up questionnaires were posted at discharge and at 6 and 12 months. RESULTS The groups were balanced at baseline for low back pain and demographic characteristics. At discharge all interventions significantly reduced functional disability (Roland Morris scale, MT: -4.53; 95% CI, -5.7 to -3.3 vs. IFT: -3.56; 95% CI, -4.8 to -2.4 vs. CT: -4.65; 95% CI, -5.8 to -3.5; P = 0.38) and pain (McGill questionnaire, MT: -5.12; 95% CI, -7.7 to -2.5 vs. IFT: -5.87; 95% CI, -8.5 to -3.3 vs. CT: -6.64; 95% CI, -9.2 to -4.1; P = 0.72) and increased quality of life (SF-36 Role-Physical, MT: 28.6; 95% CI, 18.3 to 38.9 vs. IFT: 31.4; 95% CI, 21.2 to 41.5 vs. CT: 30; 95% CI, 19.9 to 40; P = 0.93) to the same degree and maintained these improvements at 6 and 12 months. No significant differences were found between groups for reported LBP recurrence, work absenteeism, medication consumption, exercise participation, or healthcare use at 12 months (P > 0.05). CONCLUSIONS For acute low back pain, there was no difference between the effects of a combined manipulative therapy and interferential therapy package and either manipulative therapy or interferential therapy alone.
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Affiliation(s)
- Deirdre A Hurley
- School of Physiotherapy, University College Dublin, Mater Misericordiae Hospital, Dublin, Republic of Ireland.
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Ferguson RJ, Seville J, Cole B, Hanscom B, Wasson JH, Johnson DJ, Ahles T. Psychometric update of the Functional Interference Estimate: a brief measure of pain functional interference. J Pain Symptom Manage 2004; 28:389-95. [PMID: 15471657 DOI: 10.1016/j.jpainsymman.2004.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2004] [Indexed: 11/21/2022]
Abstract
The Functional Interference Estimate (FIE) is a brief, 5-item self-report measure that assesses the degree to which pain interferes with daily functioning. While the FIE has demonstrated reliability and validity with a small normative sample, not much is known about its reliability and validity with a broad sample of individuals with pain. The current study presents FIE score means, variability estimates, reliability and validity data based on a large sample (n = 1,337) of primary care patients who report problematic pain. The FIE has excellent internal consistency and appears to have strong convergent validity with other well-established measures of function (e.g., SF-36 and Dartmouth COOP Charts). Because of its brevity and flexibility, the FIE may be a useful self-report measure of pain functional interference in clinical research on pain.
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Affiliation(s)
- Robert J Ferguson
- Department of Psychiatry, Behavioral Medicine Section, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA
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Yip YB, Tse SHM. The effectiveness of relaxation acupoint stimulation and acupressure with aromatic lavender essential oil for non-specific low back pain in Hong Kong: a randomised controlled trial. Complement Ther Med 2004; 12:28-37. [PMID: 15130569 DOI: 10.1016/j.ctim.2003.12.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To assess the effect of acupoint stimulation with electrodes combined with acupressure using an aromatic essential oil (lavender) as an add-on-treatment on pain relief and enhancing the physical functional activities among adults with sub-acute or chronic non-specific low back pain. DESIGN Randomised controlled trial. SETTING The community centre, Old-Aged Home and Women Workers Association, Hong Kong. INTERVENTION 8-session relaxation acupoint stimulation followed by acupressure with lavender oil over a 3-week period. The control group received usual care only. OUTCOME MEASURES Changes from baseline to the end of treatment were assessed in pain intensity (by Visual Analogue Scale) and duration; lateral fingertip-to-ground distance in centimetres; walking time and interference on daily activities. RESULTS The baseline VAS scores for the intervention and control groups were 6.38 (S.E.M. = 0.22) and 5.70 (S.E.M. = 0.37) out of 10, respectively ( P=0.24 ). One week after the end of treatment, the intervention group had 39% greater reduction in VAS pain intensity than the control group ( P=0.0001 ), improved walking time ( P=0.05 ) and greater lateral spine flexion range ( P=0.01 ). CONCLUSIONS Our results show that 8-sessions of acupoint stimulation followed by acupressure with aromatic lavender oil were an effective method for short-term LBP relief. No adverse effects were reported. To complement mainstream medical treatment for sub-acute LBP, the combined therapy of acupoint stimulation followed by acupressure with aromatic lavender oil may be one of the choices as an add-on therapy for short-term reduction of LBP.
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Affiliation(s)
- Y B Yip
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, PR China.
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81
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Paungmali A, Vicenzino B, Smith M. Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance. THE JOURNAL OF PAIN 2003; 4:448-54. [PMID: 14622665 DOI: 10.1067/s1526-5900(03)00731-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous studies have demonstrated that the initial hypoalgesic effect of spinal manipulative therapy was not antagonized by naloxone and did not exhibit tolerance with repeated applications. The implication is that endogenous opioid mechanisms of pain relief are probably not at play in spinal manipulative therapy. The role of endogenous opioid peptides in manipulation of the peripheral joints has not been investigated. The aim of this study was to evaluate whether the initial hypoalgesic effect of a peripheral manipulative technique (mobilization-with-movement treatment for the elbow) demonstrated a tolerance to repeated applications (ie, reduction in magnitude of effect over repeated applications). Twenty-four participants with unilateral chronic lateral epicondylalgia participated in the study. A repeated measures study was conducted to examine the effect of repeated applications of the mobilization-with-movement treatment for the elbow on 6 separate treatment occasions at least 2 days apart. Pain-free grip strength and pressure pain threshold were chosen as the pain-related outcome measures. Changes in the percent maximum possible effect scores of measures of hypoalgesia were evaluated across the 6 treatment sessions by using linear trend analysis. The results showed no significant difference for the hypoalgesic effect of the treatment technique between sessions (P >.05). This peripheral manipulative therapy treatment technique appeared to have a similar effect profile to previously studied spinal manipulative therapy techniques, thereby contributing to the body of knowledge that indicates that manipulative therapy most likely induces a predominant non-opioid form of analgesia.
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Affiliation(s)
- Aatit Paungmali
- Musculoskeletal Pain and Injury Research Unit, Department of Physiotherapy, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, The University of Queensland, St Lucia, Australia
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Bertin P, Béhier JM, Noël E, Leroux JL. Celecoxib is as efficacious as naproxen in the management of acute shoulder pain. J Int Med Res 2003; 31:102-12. [PMID: 12760313 DOI: 10.1177/147323000303100206] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study compared the analgesic efficacy and safety of the cyclo-oxygenase-2 specific inhibitor celecoxib with the non-specific non-steroidal anti-inflammatory drug, naproxen, in patients with acute shoulder pain. Adult patients with shoulder pain, onset within the previous 14 days and shoulder pain of > or = 40 mm on a 100 mm visual analogue scale (VAS), were treated with oral doses of celecoxib or naproxen for 14 days and followed by a visit at day 42 in a double-blind, randomized study. The primary efficacy assessment was change in maximum pain at rest on a 100 mm VAS at day 14 compared with baseline. In addition, secondary efficacy pain and functional assessments were analysed at baseline, day 14 and day 42. A total of 202 patients were included in the trial (99 celecoxib 400 mg/day; 103 naproxen 1 g/day). The difference in change from baseline at day 14 in maximum pain at rest was not statistically significant between the two treatment groups, but was numerically higher for celecoxib than for naproxen (-47.9 +/- 2.5 versus -42.3 +/- 2.5, respectively). According to the limits of the 95% confidence interval of the difference between groups (-12.52; 1.38), celecoxib appeared to be at least as effective as naproxen. All secondary efficacy measures followed the same pattern, showing similarity between the two treatments with a trend in favour of celecoxib. The incidences of adverse events were similar for both groups. Fewer patients experienced epigastric pain with celecoxib (seven patients versus 14 with naproxen). This adverse event led to discontinuation in two patients receiving celecoxib and five receiving naproxen. Celecoxib 400 mg/day was at least as effective as naproxen 1 g/day in managing pain in this condition.
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Affiliation(s)
- P Bertin
- Department of Rheumatology, Dupuytren Hospital, Limoges, France.
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84
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Laakso EL, Robertson VJ, Chipchase LS. The place of electrophysical agents in Australian and New Zealand entry-level curricula: is there evidence for their inclusion? THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY 2003; 48:251-4. [PMID: 12443519 DOI: 10.1016/s0004-9514(14)60164-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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van Dijk KRA, Scherder EJA, Scheltens P, Sergeant JA. Effects of transcutaneous electrical nerve stimulation (TENS) on non-pain related cognitive and behavioural functioning. Rev Neurosci 2003; 13:257-70. [PMID: 12405228 DOI: 10.1515/revneuro.2002.13.3.257] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An extensive search through nine electronic bibliographic databases (PubMed, Cochrane Library, Web of Science, ERIC, PsychINFO, Psyndex, Cinahl, Biological Abstracts, Rehabdata) was performed in order to review the effects of Transcutaneous Electrical Nerve Stimulation (TENS) on non-pain related cognitive and behavioural functioning. Eight studies were identified on neglect due to stroke, six studies on Alzheimer's disease (AD), one study on aging, and two studies on coma due to traumatic brain injury. The results of the various studies revealed that TENS has a variety of effects. These consist of enhancement of somatosensory functioning, visuo-spatial abilities and postural control in neglect, improved memory, affective behaviour and rest-activity rhythm in AD and acceleration of awakening in coma. Effectiveness of TENS is discussed in relation to various stimulation parameters: duration, frequency, pulse width and intensity. It is argued that arousal may underlie the beneficial influence of TENS in various conditions. Finally, suggestions are offered for future research.
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Affiliation(s)
- Koene R A van Dijk
- Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands.
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Taylor AG, Galper DI, Taylor P, Rice LW, Andersen W, Irvin W, Wang XQ, Harrell FE. Effects of adjunctive Swedish massage and vibration therapy on short-term postoperative outcomes: a randomized, controlled trial. J Altern Complement Med 2003; 9:77-89. [PMID: 12676037 DOI: 10.1089/107555303321222964] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the effects of adjunctive postoperative massage and vibration therapy on short-term postsurgical pain, negative affect, and physiologic stress reactivity. DESIGN Prospective, randomized controlled trial. The treatment groups were: (1) usual postoperative care (UC); (2) UC plus massage therapy; or (3) UC plus vibration therapy. SETTING The University of Virginia Hospital Surgical Units, Gynecology-Oncology Clinic, and General Clinical Research Center. SUBJECTS One hundred and five (N = 105) women who underwent an abdominal laparotomy for removal of suspected cancerous lesions. INTERVENTIONS All patients received UC with analgesic medication. Additionally, the massage group received standardized 45-minute sessions of gentle Swedish massage on the 3 consecutive evenings after surgery and the vibration group received 20-minute sessions of inaudible vibration therapy (physiotones) on the 3 consecutive evenings after surgery, as well as additional sessions as desired. OUTCOME MEASURES Sensory pain, affective pain, anxiety, distress, analgesic use, systolic blood pressure, 24-hour urine free cortisol, number of postoperative complications, and days of hospitalization. RESULTS On the day of surgery, massage was more effective than UC for affective (p = 0.0244) and sensory pain (p = 0.0428), and better than vibration for affective pain (p = 0.0015). On postoperative day 2, massage was more effective than UC for distress (p = 0.0085), and better than vibration for sensory pain (p = 0.0085). Vibration was also more effective than UC for sensory pain (p = 0.0090) and distress (p = .0090). However, after controlling for multiple comparisons and multiple outcomes, no significant differences were found. CONCLUSIONS Gentle Swedish massage applied postoperatively may have minor effects on short-term sensory pain, affective pain, and distress among women undergoing an abdominal laparotomy for removal of suspected malignant tissues.
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Affiliation(s)
- Ann Gill Taylor
- Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, Charlottesville, VA 22903, USA.
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Hanada EY. Efficacy of rehabilitative therapy in regional musculoskeletal conditions. Best Pract Res Clin Rheumatol 2003; 17:151-66. [PMID: 12659826 DOI: 10.1016/s1521-6942(02)00096-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This chapter reviews the best evidence for the rehabilitation of regional musculoskeletal conditions. Evidence-based efficacy of different modalities for treatment of musculoskeletal pain is presented, and the value of the patient's active participation in the rehabilitation programme is emphasized. The following modalities are commonly included in the holistic approach to patient-centred care and are reviewed: exercise therapy, thermotherapy, transcutaneous electrical nerve stimulation (TENS), and alternative therapies such as acupuncture, massage and yoga. A review of cognitive-behavioural strategies in pain management to prevent or treat fear-avoidance behaviour is also presented. Furthermore, the application of biomechanics in treating and preventing musculoskeletal disorders is illustrated. Moreover, the evidence for pain self-management to improve symptoms, health status and decrease the utilization of health care resources and cost is outlined. Finally, an overview will be presented, concerning the application of the evidence for treatment modalities to patient care, with focus on patient-centred, holistic treatment in a supportive setting. The following key questions/issues are addressed. What are the relevant therapeutic modalities for musculoskeletal pain disorders? What is the evidence of efficacy of these modalities in regional musculoskeletal conditions? What is the importance of understanding biomechanics? What is the importance of understanding fear-avoidance beliefs? What is the evidence for 'alternative' therapies such as acupuncture, massage or yoga? What is the evidence for 'pain self-management?' How does one apply the evidence for rehabilitation in regional musculoskeletal conditions into clinical practice?
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Affiliation(s)
- Edwin Yoshiyuki Hanada
- Department of Rehabilitation Medicine, Mount Sinai Hospital, 600 University Avenue, Room 1171, Toronto, Ontario, Canada M5G 1X5.
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Chesterton LS, Barlas P, Foster NE, Lundeberg T, Wright CC, Baxter GD. Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects. Pain 2002; 99:253-62. [PMID: 12237203 DOI: 10.1016/s0304-3959(02)00118-5] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transcutaneous electrical nerve stimulation (TENS) is a popular form of electrostimulation. Despite an extensive research base, there remains no consensus regarding the parameter selection required to achieve maximal hypoalgesic effects. The aim of this double blind, sham-controlled study was to investigate the relative hypoalgesic effects of different TENS parameters (frequency, intensity and stimulation site) upon experimentally induced mechanical pain. Two hundred and forty participants were recruited in order to provide statistical analysis with 80% power at alpha = 0.05. Subjects were randomised to one of the six TENS groups, a control, and a sham TENS group (n = 30, 15 males, 15 females, per group). TENS groups differed in their combinations of stimulation; frequency (4 or 110 Hz), intensity ('to tolerance' or 'strong but comfortable') and stimulation site (segmental--over the distribution of the radial nerve or, extrasegmental--over acupuncture point 'gall bladder 34', or a combination of both segmental and extrasegmental). Pulse duration was fixed at 200 micros. Stimulation was delivered for 30 min and subjects were then monitored for a further 30 min. Mechanical pain threshold (MPT) was measured using a pressure algometer and taken from the first dorsal interosseous muscle of the dominant hand, ipsilateral to the stimulation site. MPT measures were taken, at baseline, and at 10-min intervals for 60 min. Difference scores were analysed using repeated measures and one-way ANOVA and relevant post hoc tests. Low frequency, high intensity, extrasegmental stimulation produced a rapid onset hypoalgesic effect, which increased during the stimulation period (P < 0.0005 control and sham) and was sustained for 30 min post-stimulation (P < 0.0005(control), P = 0.024(sham)). Whilst high frequency, 'strong but comfortable' intensity, segmental stimulation produced comparable hypoalgesic levels during stimulation, this effect was not sustained post-stimulation. Stimulation at a combination of the two sites did not produce any greater hypoalgesic effects. These results may have implications for the clinical use of sensory stimulation.
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Affiliation(s)
- Linda S Chesterton
- Department of Physiotherapy Studies, Keele University, Staffordshire ST5 5BG, UK
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