Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis

PURPOSE

Chronic post-operative inguinal pain (CPIP) following inguinal hernia repair has been a major sequela affecting 4000-48000 patients annually. Optimal management of CPIP has been a challenge, and pharmacological management particularly with opioids has shown unsatisfactory results. The main objective of this systematic review is to investigate the safety and efficacy of neuromodulation as an alternative intervention for the management of post-operative inguinal pain.

METHODS

A literature search was conducted by three reviewers to identify all relevant studies on the use of neuromodulatory interventions for treating post-operative inguinal pain. Data on study characteristics, neuromodulatory modalities, and patient's clinical data such as pre/post-interventional pain scores and analgesic requirements were extracted and reported.

RESULTS

A total of 389 patients with 357 (95.9%) males and 15 (4.1%) females were evaluated. The mean age of study participants was 47.9 ± 10.4 years. There were 187 (48.1%) and 202 (51.9%) patients allocated to the control and trial groups, respectively. The most common neuromodulation modality was TENS (4, 36.4%), followed by SCS (3, 27.3%), PNS (3, 27.3%), and acupuncture-assisted (2, 18.2%). The overall mean follow-up duration of the entire cohort was 3.8 months. The mean difference between pre-operative and post-operative VAS scores in the trial groups was 4.65 (95% Confidence Interval [CI], 2.97, 6.33), which was statistically significant (P value < 0.05). Patient-reported outcome measures showed significant responsiveness toward their treatments.

CONCLUSION

Nerve stimulation, in its many forms, is a safe and feasible option for the management of post-operative inguinal pain.

Does vitamin D3 supplementation improve glucose homeostasis in overweight or obese women? A double-blind, randomized, placebo-controlled clinical trial

AIMS

Vitamin D deficiency is considered as a risk factor in cardiometabolic disorders, including cardiovascular diseases, hypertension and Type 2 diabetes mellitus. We have investigated the effect of vitamin D3 supplementation on glucose homeostasis in healthy overweight and obese women.

METHODS

In a double-blind randomized placebo-controlled clinical trial, 77 healthy overweight or obese women (mean age 38 ± 8 years; BMI 29.9 ± 4.2 kg/m(2)) were randomly assigned to the vitamin D3 group (25 μg/day as cholecalciferol tablets) or the placebo group. Selected anthropometric indices, glucose, insulin, HbA(1c) and homeostasis model assessment of insulin resistance at baseline and after 12 weeks were measured. Dietary intakes using 24-h food recall and food frequency questionnaires were assessed. Physical activity was assessed by the International Physical Activity Questionnaire. Adjusted mean differences were calculated using analysis of covariance. Correlation coefficients were calculated by Pearson's analysis.

RESULTS

Mean fasting blood glucose concentrations declined in the vitamin D3 and placebo groups (-0.28 ± 0.4 vs. -0.65 ± 0.4 mmol/l, P < 0.001) and the mean percentage of HbA(1c) was decreased (-13 ± 18 vs. -19 ± 17 mmol/l, P = 0.06) in both groups, respectively. Mean 25-hydroxyvitamin D concentrations increased in the vitamin D3 and placebo groups (38.2 ± 32 vs. 4.6 ± 14 nmol/l, P < 0.001), respectively. There was a significant correlation between HbA(1c) and 25-hydroxyvitamin D concentrations (r = -0.271; P = 0.018).

CONCLUSIONS

The results indicate that the vitamin D3 supplement of 25 μg/day had no beneficial effect on glycaemic indices in healthy overweight or obese women.