Efficacy of the LED Red Light Therapy in the Treatment of Temporomandibular Disorders: Double Blind Randomized Controlled Trial

Background. Temporomandibular dysfunction syndrome (TMD) is a common disease among dental patients. It occurs as a consequence of malfunction of the tempromandibular and/or surrounding facial muscles. LED red light therapy is not been well established, and it is important to find out the role of this technique in the treatment of temporomandibular disorders. Aim of the Study. To evaluate the efficacy of the LED red light in the treatment of the tempromandibular dysfunction syndrome. Material and Methods. Fifty students of the College of Dentistry/University of Baghdad with myofacial pain associated with Tempromandibular Disorder volunteered to participate in this study and be evaluated during both treatment and follow-up periods. They were 40 (80%) females and 10 (20%) males. Patients were divided into 2 groups: Group A treated by TenDlite® Medical Device model 204 with a LED’s of wavelength 660 nm (red light) and Group B given placebo (no treatment at all) by just putting the TenDlite device near the tender points without battery and turning ON the device. Results. The changes in the pain value and number of the tender muscles in both groups were highly significant, only placebo group less but with no significant differences. Conclusions. This study showed that red LED therapy could be useful in improving patient’s symptoms regarding pain, clicking, and number of tender muscles. In addition, this study showed the importance of the psychological part of treatment of those patients. This trial is registered with TCTR20190406002.

Factors Associated with Postoperative Pain among Patients after Cardiac Surgery in the Tertiary Care Teaching Hospital of Karachi, Pakistan

Background. Pain is the subjective feeling of an individual, which affects the overall recovery of patients after cardiac surgery. Postoperative pain is the most inadequately managed symptom of cardiac surgery. Subsequently, there are many factors that can either hinder or facilitate pain management, including patients' beliefs, cultural values, physiological features, hospital policies, and healthcare providers' knowledge and beliefs. The purpose of this research was to identify factors associated with postoperative pain and its management, after cardiac surgery, among patients in a tertiary care hospital in Karachi, Pakistan. Methods. Quantitative correlational study design was employed to attain the study purpose. Data were collected from 136 adult cardiac surgery patients admitted in the Cardiothoracic Surgery (CTS) Department, of tertiary care hospital. A self-developed questionnaire tool was used to gather information from patients. Data was then analyzed on SPSS version 19. Mann-Whitney U, Kruskal Wallis, and Spearman tests were applied to find the associations between the pain levels and of the independent variables. Results. The mean pain scores of the first, second, and third postoperative days were found to be 2.98, 2.96, and 2.98, respectively. The findings also showed that BMI and the types of surgery were significantly associated with postoperative pain. Patients' beliefs regarding drug dependency, fear of adverse effects, and postoperative physical activities were also associated with pain. Furthermore, the nurses’ education level and reluctance in medication administration due to fear of adverse effects were found to be significant too. Conclusion. The study identified some of the important factors that were associated with postoperative pain. The results suggest the need for the enhancement of patients' education on drug dependency, adverse effects, and physical activity, before cardiac surgery. The nurses should be educated on pain management keeping the patients’ culture and other perceptions of pain in mind.

Lornoxicam with Low-Dose Ketamine versus Pethidine to Control Pain of Acute Renal Colic

Objectives. This study was established to compare single-dose lornoxicam 8 mg (NSAID) in addition to 0.15 mg.kg−1 ketamine with single-dose pethidine 50 mg, both administered intravenously (IV), on the quickness and extent of analgesia, disadvantage, and consequence on utilitarian situation. Patients and Methods. One hundred and twenty patients with acute renal colic pain received in emergency room were included in this prospective, randomized, and double blind clinical study. They were aimlessly designated into one of two groups using a computer-generated table. Group L received lornoxicam 8 mg IV plus 0.15 mg.kg−1 ketamine and Group P received pethidine 50 mg IV. Parameters were noticed at baseline and after 0, 15, 30, and 45 minutes and 1 hour after drug administration. The efficiency of the drug was determined by observing: patient rated pain, time to pain relief, rate of pain recurrence, the need for rescue analgesia, adverse events, and functional status. Results. The visual analogue scale was significantly lower in Group L after 30 minutes in comparison to Group P. In addition, there was statistically significant increase in Group P regarding their need for rescue analgesia after 30 min in comparison to Group L. Group P showed nonsignificantly increased sedation score compared to Group L. Conclusion. Patients receiving lornoxicam-ketamine attained greater reduction in pain scores and less side effects with better functional state and also are less likely to require further analgesia than those administered pethidine to control acute renal colic pain.

Cryotherapy Reduced Postoperative Pain in Gynecologic Surgery: A Randomized Controlled Trial

Objective. To examine the effectiveness of cryotherapy for reducing postoperative pain in patients who underwent exploratory laparotomy for gynecologic surgery. Materials and Methods. Patients who had indication for an exploratory laparotomy gynecologic procedure were selected by attending physicians to undergo abdominal surgery via low transverse skin incision. The participants were randomized into study and control groups with simple random sampling methods. Cold packs were applied at two hours after operation for 6 hours. The visual analog scale (VAS) score was recorded at two, 6, and 12 hours after operation. Result. One hundred cases were recruited and then divided into study and control groups equally. The mean age of both groups was 43 years. There was no difference in demographics data of both groups. Half of the participants in both groups underwent hysterectomies. At two hours after surgery, both groups had similar VAS scores. The study group had a lower VAS score at 6 and 12 hours after surgery than the control group with statistical difference. Morphine consumption within 24 hours after surgery in both the study and control groups was 2.8±3.4 and 3.0±4.4 mg, respectively, with no statistical difference. However the registration time of the first morphine requirement in the study group was statistically more prolonged than that of the control group. The lengths of hospital stay in both groups were similar. There was no complication reported in this study. Conclusion. Cryotherapy can reduce postoperative pain. In this presented study the patients who underwent gynecologic surgery had improved pain relief and prolonged time for the first dose of the analgesic drug.

Challenges in the Analysis of Longitudinal Pain Data: Practical Lessons from a Randomized Trial of Annular Closure in Lumbar Disc Surgery

Purpose. To analyze leg pain severity data from a randomized controlled trial (RCT) of lumbar disc surgery using integrated approaches that adjust pain scores collected at scheduled follow-up visits for confounding clinical events occurring between visits. Methods. Data were derived from an RCT of a bone-anchored annular closure device (ACD) following lumbar discectomy versus lumbar discectomy alone (Control) in patients with large postsurgical annular defects. Leg pain was recorded on a 0 to 100 scale at 6 weeks, 3 months, 6 months, 1 year, and 2 years of follow-up. Patients with pain reduction ≥20 points relative to baseline were considered responders. Unadjusted analyses utilized pain scores reported at follow-up visits. Since symptomatic reherniation signifies clinical failure of lumbar discectomy, integrated analyses adjusted pain scores following a symptomatic reherniation by baseline observation carried forward for continuous data or classification as nonresponders for categorical data. Results. Among 550 patients (272 ACD, 278 Control), symptomatic reherniation occurred in 10.3% of ACD patients and in 21.9% of controls (p < 0.001) through 2 years. There was no difference in leg pain scores at the 2-year visit between ACD and controls (12 versus 14; p = 0.33) in unadjusted analyses, but statistically significant differences favoring ACD (19 versus 29; p < 0.001) in integrated analyses. Unadjusted nonresponder rates were 6.0% with ACD and 6.7% with controls (p = 0.89), but 15.7% and 27.8% (p = 0.001) in integrated analyses. The probability of nonresponse was 16.4% with ACD and 18.3% with controls (p = 0.51) in unadjusted analysis, and 23.7% and 31.2% (p = 0.04) in integrated analyses. Conclusion. In an RCT of lumbar disc surgery, an integrated analysis of pain severity that adjusted for the confounding effects of clinical failures occurring between follow-up visits resulted in different conclusions compared to an unadjusted analysis of pain scores reported at follow-up visits only.

Motor Cortex Function in Fibromyalgia: A Study by Functional Near-Infrared Spectroscopy

Previous studies indicated changes of motor cortex excitability in fibromyalgia (FM) patients and the positive results of transcranial stimulation techniques. The present study aimed to explore the metabolism of motor cortex in FM patients, in resting state and during slow and fast finger tapping, using functional Near-Infrared Spectroscopy (fNIRS), an optical method which detects in real time the metabolism changes in the cortical tissue. We studied 24 FM patients and 24 healthy subjects. We found a significant slowness of motor speed in FM patients compared to controls. During resting state and slow movement conditions, the metabolism of the motor areas was similar between groups. The oxyhemoglobin concentrations were significantly lower in patients than in control group during the fast movement task. This abnormality was independent from FM severity and duration. The activation of motor cortex areas is dysfunctional in FM patients, thus supporting the rationale for the therapeutic role of motor cortex modulation in this disabling disorder.

Neuropathic Pain Prevalence of Older Adults in an Urban Area of Iran: A Population-Based Study

Background. Pain prevalence would increase as the population grows older, but the exact prevalence rate is not apparent in Iran. Objectives. This study, therefore, set out to reveal the prevalence of pain, especially neuropathic type and explore its associated comorbidities among Iranian older adults in a large urban population-based survey. Methods. 5326 older people, aged ≥ 60 years, were randomly chosen by a multistage, cluster sampling method. The selected people then were interviewed by using the following instruments: a standard questionnaire about pain, questions of interview part of Douleur Neuropathique 4 Questions (DN4) and its comorbidities, GHQ-28, and a sociodemographic checklist. Descriptive statistics and multiple regression analysis were conducted to analyze the gathered data. Results. The average of the participants’ age was 68.92 ± 7.02 years. Of 5326 participants, 2529 (47.5%) of participants were male. About one-third of this population had chronic pain. Chronic neuropathic pain prevalence was 13.7% and nociceptive in 30%. Knee pain (20.6%) and feet dysesthesia (7.8%) were the most common sites of nociceptive and neuropathic pain, respectively. Results of multiple regression analysis revealed that the major comorbidities of chronic pain were osteoporosis, disability, diabetes mellitus, and stroke. Neuropathic pain experiences were significantly associated with GHQ-28 scores (t=-11.42, P<0.001). Conclusions. In addition to neuropathic pain, other subtypes of pain prevalence and the comorbidities are determined in the community-dwelling elder adults. This study highlights the importance of neuropathic pain and its adverse consequences and can be used to manage this populations’ needs in Iran effectively.

Knowledge on Nonpharmacological Methods of Pain Management among Nurses at Bindura Hospital, Zimbabwe

This study is a quantitative descriptive study, which was conducted with an aim to assess the knowledge on nonpharmacological methods of pain management among registered general nurses at Bindura Hospital. This is because most nurses focus more on pharmacological pain management than nonpharmacological therapies which are given less attention or accord. This study used a descriptive study design, which is a nonexperimental research design so as to obtain information about registered nurses knowledge on nonpharmacological pain management. A convenience sampling technique was utilised to select a sample of seventy-five participants. Data were collected by the researcher who distributed self-administered questionnaires to available registered nurses after obtaining informed consent at Bindura Provincial Hospital. The mean knowledge score for this study was 48.6% and was below a pass mark of 50% and far below 80% which is the minimal acceptable level of knowledge on the Nurses Knowledge and Attitude Scale. A minimum knowledge score of 16% was obtained from participants showing lack of knowledge on indications of nonpharmacological pain therapies and a maximum knowledge score of 97.3% was shown on knowledge on nonpharmacological techniques. The following conclusion was drawn from the research findings; the study showed that the nurses have poor knowledge regarding nonpharmacological pain management as indicated by mean knowledge score of 48.6%. The researcher therefore recommends that the nursing practice should take an initiative in ensuring that all practicing nurses practice the highest possible pain management nursing care and that opportunities should be made available for nurses to be educated in effective pain management utilising nonpharmacological therapies.

Effectiveness of Subconjunctival 0.5% Bupivacaine for Postoperative Analgesia after Intravitreal Silicon Oil Removal Surgery

Background. Intravitreal silicon oil removal surgery can cause mild-to-moderate postoperative pain and discomfort in most patients. Postoperative pain can be managed by using many methods, including a local anesthetic drug. One of the common local anesthetic drugs is 0.5% bupivacaine. The application techniques also vary, such as subconjunctival application. It was a good alternative for postoperative analgesia in the ophthalmic surgery because of its minimal risks and complications. The purpose of this research was to measure the effectiveness of subconjunctival 0.5% bupivacaine for postoperative analgesia in silicon oil removal surgery. Method. This was a double-blind randomized clinical study in patients undergoing elective intravitreal silicon oil removal surgery at Cipto Mangunkusumo Hospital. Thirty consecutive patients, enrolled from October 2016 to February 2017, were randomized to receive subconjunctival 0.5% bupivacaine or subconjunctival placebo (0.9% NaCl) at the end of the surgery. The primary outcome was the pain score 24 hours after surgery, using a 100 mm Visual Analogue Scale (VAS). Intravenous injection of tramadol 50 mg was given if the VAS >4. Secondary outcomes were the time to first analgesic requirement and the incidence of nausea/vomiting. Statistical analysis was conducted to measure the difference between 24 h pain score in the bupivacaine group (B) and that in the placebo group (NS). Result. The overall 24 hours’ postoperative pain score was significantly different between the bupivacaine group and the placebo group (p=0.001). In the 24 hours after surgery, there were only five patients needing additional analgesia in the placebo group. The time to first analgesic requirement was significantly different between the two groups (p=0.042). Nausea/vomiting only happened in the placebo group with proportions 6% and 3%, respectively. Conclusion. Subconjunctival 0.5% bupivacaine was effective for postoperative analgesia in intravitreal silicon oil removal surgery.

Assessment of Acute Pain Management and Associated Factors among Emergency Surgical Patients in Gondar University Specialized Hospital Emergency Department, Northwest Ethiopia, 2018: Institutional Based Cross-Sectional Study

Background. Adequate pain management has led to increased comfort in emergency patients, reducing morbidity and improving long term outcomes. Different pain management modalities have been applied in the emergency department among which systemic analgesia is commonly used by preceding a nerve block. Several factors have been associated with poor pain management in low resource setting areas. We aimed to determine pain management modalities and associated factors among emergency surgical patients. Patients and Methods. After obtaining ethical approval from Ethical Review Committee, 203 volunteer patients were enrolled. Institutional based cross-sectional prospective study was conducted from April to May 2018 in Gondar University Specialized Hospital Emergency Department. The severity of pain was measured through Numerical Rating Scale and statistical analysis was performed using SPSS statistical package version 23. Descriptive statistics cross-tab and binary logistics were performed to identify factors related to pain management in emergency department. Results. A total of 203 patients, 138 (68%) males and 65 (32%) females with response rate of 94%, participated in this study. Among them, 66% patients received analgesia within two hours of ED presentation with a mean ± SD of 61.0 ± 34.1 minutes. 70.4 % of patients complained of moderate and severe pain after receiving analgesia. There was a significant difference between trauma and nontrauma patients in mean time of analgesia receiving and residual pain severity (p < 0.001). Age, trauma, physician pain assessment, and severity of pain were the predicting factors for analgesia delivery. Conclusion. The overall practice of pain management in Gondar University Specialized Hospital Emergency Department was not adequate. Therefore, it is vital to implement an objective pain assessment method and documentation of the pain severity to improve pain management practice.