Efficacy of Dry Needling and Acupuncture in the Treatment of Neck Pain

All Palliative Care Should Be Integrative Palliative Care

Integrative medicine and palliative care are philosophically similar, with a focus on whole person care and wellbeing. Integrative medicine provides a large toolbox of evidence-informed treatment modalities but doesn't prioritize the care of seriously ill people. Palliative care takes a holistic approach to reducing the suffering of seriously ill people, their families, and their caregivers, but the available treatment toolbox is often limited to pharmaceuticals, procedures, and radiation. The ideal care of families facing serious illness employs the philosophy and conventional expertise of palliative care clinicians coupled with an evidence-supported expanded treatment toolbox provided by the field of complementary and integrative medicine. This emerging field is called integrative palliative care. Reducing physical, emotional, and spiritual suffering is the fundamental goal of palliative care and all available effective tools should be employed toward this aim. Therefore, all palliative care should be integrative palliative care.

Clinical aspects of mastication myalgia-an overview

Mastication myalgia is the most common cause of non-odontogenic pain in the orofacial region and is often associated with a reduced quality of life. The purpose of this review is to provide an overview of the clinical aspects of myalgia based on available research. The review includes epidemiological, diagnostic, and etiological aspects. In addition, the potential risk factors related to the transition from acute to chronic myalgia are explored and treatment strategies are presented for its management. As a result, this review may increase clinical knowledge about mastication myalgia and clarify strategies regarding prevention, diagnostics, and management to improve prognosis and reduce patient suffering.

Effect of dry needling and instrumental myofascial release on masticatory, facial, and cervical muscles of patients with temporomandibular disorders of muscular origin

Background

To evaluate the effectiveness of dry needling (DN) and instrumental myofascial release (IMR) therapies in the cervico-cranio-mandibular system through pain, bite force, and distribution of occlusal contacts in patients with muscular temporomandibular disorders.

Material and Methods

Thirty patients were divided into treatment groups: DN (n=15) and IMR (n=15). Therapeutic efficacy regarding pain perception and tolerance of masticatory, facial, and cervical muscles, bite force, and distribution of occlusal contacts were analyzed in this observational longitudinal clinical study pre/post-intervention and pre/post one month of therapeutic intervention. The data were tabulated and statistically analyzed (repeated measures and Bonferroni post-hoc test, p<0.05).

Results

There was a statistically significant difference in pain between the groups in the comparison of pre- and post-intervention with effect on time versus intervention in the head and neck. Pain perception and tolerance showed a statistical effect of time on the temporal, suboccipital, sternocleidomastoid, mental (right and left), right masseter, and left trapezius muscles. There was a statistically significant effect of the intervention on the mentalis, supraorbital, and infraorbital (right and left) muscles. There was a statistically significant effect of the interaction on the upper masseter (right and left), anterior temporal (left), suboccipital, sternocleidomastoid, and mentalis (left) muscles. There was an increase in post-intervention molar bite force in the groups, with a statistical effect on time versus intervention in the right and left regions. Contact of occlusal forces at the maxilla/mandible interface showed a difference between the mean times on teeth 26-36 after versus 1 month after the intervention.

Conclusions

The two therapeutic techniques are viable for the treatment of muscular temporomandibular disorders; however, IMR proved to be more effective immediately after the intervention and after one month. Key words:Temporomandibular disorders, pain, masticatory muscles, facial muscles, cervical muscles, dry needling, instrumental myofascial release.

Acupuncture as Part of Multimodal Analgesia for Chronic Pain

Background

Chronic pain is a multifactorial condition that is afflicting populations worldwide causing an increasing economic, physical, mental, and emotional burden. Treatments range from medications to interventional procedures to complementary and alternative medicine (CAM), such as acupuncture. This review aims to discuss the use of acupuncture in the treatment of chronic pain, proposed mechanisms, indications, and efficacy for various chronic pain conditions.

Results

Evidence is varied on the efficacy and quality of data on the use of acupuncture in the treatment of chronic pain. Recent studies have demonstrated promising results in the support of acupuncture for the use in the treatment of cancer, neck, and back pain, functional dyspepsia, and various chronic abdominal pain syndromes.

Conclusion

Acupuncture, deemed well-tolerated and safe to use, has been increasingly studied and is regarded as effective in clinical practice, but its efficacy is limited by the lack of well-conducted, high-quality clinical trials, lower quality evidence, and conflicting study results. Additionally, the exact analgesic mechanism of acupuncture remains to be fully elucidated. Increasing evidence supports the role of acupuncture as therapy in the treatment of cancer, neck, and back pain and functional dyspepsia. Further rigorous studies are needed to fully assess the use of acupuncture in various chronic pain conditions, determine its indications, and optimal treatment schedule. Overall, future studies could benefit from better designed experimental studies, larger groups, and more objectives ways to measure pain reduction and symptom improvement.

Mirogabalin as a Novel Gabapentinoid for the Treatment of Chronic Pain Conditions: An Analysis of Current Evidence

: Neuropathic pain is a challenge for physicians to treat and often requires a multimodal approach with both pharmacologic and lifestyle interventions. Mirogabalin, a potent, selective ligand of the α2δ-1 and α2δ-2 subunits of voltage-gated calcium channels (VGCCs), provides analgesia by inhibiting neurotransmitter release at the presynaptic end of the neuron. Mirogabalin offers more sustained analgesia than its gabapentinoid counterparts in addition to a wider safety margin for adverse events. Recent clinical trials of mirogabalin have demonstrated both efficacy and tolerability of the drug for the treatment of diabetic peripheral neuropathic pain and postherpetic neuralgia, leading to its approval in Japan. While still not yet FDA approved, mirogabalin is still in its infancy and offers potential into the treatment of neuropathic pain and its associated comorbidities.

Conolidine: A Novel Plant Extract for Chronic Pain

Pain, the most common symptom reported among patients in the primary care setting, is complex to manage. Opioids are among the most potent analgesics agents for managing pain. Since the mid-1990s, the number of opioid prescriptions for the management of chronic non-cancer pain (CNCP) has increased by more than 400%, and this increased availability has significantly contributed to opioid diversion, overdose, tolerance, dependence, and addiction. Despite the questionable effectiveness of opioids in managing CNCP and their high rates of side effects, the absence of available alternative medications and their clinical limitations and slower onset of action has led to an overreliance on opioids. Conolidine is an indole alkaloid derived from the bark of the tropical flowering shrub Tabernaemontana divaricate used in traditional Chinese, Ayurvedic, and Thai medicine. Conolidine could represent the beginning of a new era of chronic pain management. It is now being investigated for its effects on the atypical chemokine receptor (ACK3). In a rat model, it was found that a competitor molecule binding to ACKR3 resulted in inhibition of ACKR3's inhibitory activity, causing an overall increase in opiate receptor activity. Although the identification of conolidine as a potential novel analgesic agent provides an additional avenue to address the opioid crisis and manage CNCP, further studies are necessary to understand its mechanism of action and utility and efficacy in managing CNCP.