Comparison of preoperative pain and medication use in emergency patients presenting with irreversible pulpitis or teeth with necrotic pulps.

OBJECTIVE: This retrospective study compared differences in preoperative pain and medication use in patients with moderate to severe pain who sought emergency endodontic care for teeth with irreversible pulpitis and for symptomatic teeth with necrotic pulps. STUDY DESIGN: A total of 323 patients seeking emergency endodontic treatment completed questionnaires regarding their biographical information, pain, pain history, and medications. Teeth were tested for vitality, mobility, percussion, and palpation pain. Lymphadenopathy was also evaluated. RESULTS: Patients with irreversible pulpitis waited significantly (P <.05) longer before seeking emergency care (9 days vs 4 days) than patients with symptomatic teeth with necrotic pulps. No differences (P >.05) were found between the groups in terms of analgesic or antibiotic use and pain relief from preoperative narcotic medications. Nonnarcotic analgesics were reported to significantly reduce pain more often in patients with symptomatic teeth with necrotic pulps. There were sex differences in the group of patients with irreversible pulpitis: More women than men were taking analgesic medications and, in the group having symptomatic teeth with necrotic pulps, more men than women reported pain relief from their analgesic medications. CONCLUSION: Patients with irreversible pulpitis wait longer to seek emergency treatment. A majority (81%-83%) of emergency patients with moderate to severe pain will have taken some type of medication(s) to help control their pain, and more women than men with irreversible pulpitis will take an analgesic. By taking their preoperative medication(s), this group of patients will get relief 62% to 65% of the time; furthermore, more men than women with symptomatic teeth with necrotic pulps will experience pain relief.

Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression.

BACKGROUND: Microvascular decompression has been widely used as the first choice in treating trigeminal neuralgia, but in a few patients, facial pain cannot be effectively controlled by microvascular decompression. We sought to clarify the important factors for good operative outcomes. METHODS: We reviewed 62 patients with trigeminal neuralgia treated by microvascular decompression during the period 2000 through 2002, including clinical presentation, operative findings, techniques, and outcomes. Neurovascular conflicts were divided into single contact, contact and indentation, single adhesion, adhesion and indentation, and trigeminal nerve atrophy. Operative outcomes were graded into immediate postoperative complete pain relief (excellent), delayed postoperative complete pain relief (better), significant pain relief (good), and no response to microvascular decompression (poor). RESULTS: All patients' presentations were typical at the time of pain onset, but the symptom in 17 patients changed to atypical before surgery. During operation, single contact and single adhesion was found in 14 patients and 15 patients, respectively; contact or adhesion in combination with indentation was found in 7 patients and 18 patients, respectively; atrophy occurred in 8 patients. Postoperatively, immediate and delayed complete pain relief was achieved in 32 (51.6%) patients and 17 (27.4%) patients, respectively; 11(17.7%) patients got significant pain relief; and 2 patients showed no response. The overall rate of complete pain relief in patients with shorter duration, typical presentation, artery compression and complete decompression was higher than that in patients with longer duration, atypical presentation, venous compression, and incomplete decompression. CONCLUSIONS: Shorter duration, typical presentation, single artery compression, and complete decompression are the positive factors for better operative outcomes with microvascular decompression. Worse outcomes are usually related to venous compression, longer duration, and atypical presentation.

Intravenous infusion of fosphenytoin produces prolonged pain relief: a case report.

The objective of this case report is to emphasize the analgesic effect of antiepileptic drugs in those with neuropathic pain, confirm that fosphenytoin possesses these analgesic properties, and to highlight that intravenous administration of fosphenytoin for 24 hours can produce good quality pain relief that lasts for many weeks. A 37-year-old woman with a neuroma (caused by surgical intervention for an endometrial sarcoma) producing neuropathic pain unresponsive to opiates was successfully treated with intravenous infusion of 1,500 phenytoin equivalent units fosphenytoin for 24 hours. The pain relief after this and subsequent infusions persisted for between 3 and 14 weeks and was associated with a reduced opiate requirement and an increase in activities of daily living. Fosphenytoin infusion can give good quality pain relief in the patient with neuropathic pain.

The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy.

In a prospective controlled trial on 46 patients undergoing lumbar discectomy, three classes of variables (medical data including MRI-identified morphological abnormalities, general psychological factors and psychosocial aspects of work) were analyzed with regard to their predictive value for the outcome of lumbar disc surgery at 2 year follow-up. Multiple regression analyses were used to identify the best predictor variables of four different outcome measures (i.e. pain relief, reduction of disability in daily activities, return to work and surgical outcome). MRI-identified nerve root compromise and social support from the spouse were independent predictors of pain relief 2 years after surgery (R2 = 0.40, P < 0.01). Return to work 2 years after surgery was best predicted by depression and occupational mental stress (R2 = 0.36, P < 0.001). MRI-identified extent of herniation and depression were significant predictors of a good surgical outcome after lumbar discectomy (R2 = 0.61, P < 0.001). This study has demonstrated that the outcome of discectomy is critically dependent on which outcome variables are selected and that different sorts of predictor variables have a distinct influence on the various outcome variables. Obvious morphological alterations (i.e. disc extrusions, nerve root compromise) proved to be significant predictors of postoperative pain relief and improvement of disability in daily activities justifying a surgical treatment approach in these cases. The most important finding of this study was that return to work was not influenced by any clinical findings or MR-identified morphological alterations, but solely by psychological factors (i.e. depression) and psychological aspects of work (i.e. occupational mental stress).

Comparisons of pain relief mechanisms between needling to the muscle, static magnetic field, external qigong and needling to the acupuncture point.

pain relief mechanisms of needling to the pain-producing muscle, application of a static magnetic field or external qigong, and needling to the acupuncture point were investigated in an experimentally designed pain producing muscle of animals. Single isometric twitch height in situ was reduced gradually by 10 Hz tetanic stimulation for one hour of the gastrocnemius muscle of guinea pigs. This reduction of twitch height was recovered by injection of 0.3-1 ml saline to the artery of this muscle, or of injection of a vasodilator, isoproterenol dissolved in 0.1 ml saline. Hence, reduction of twitch height could be induced by reduction of circulation in the muscle and recovery of it could be induced be recovery of circulation. Since it is easily considered that a pain substance might be accumulated in a muscle under reduced circulation, and such an accumulated substance might be eliminated by recovery of circulation, the reduction of twitch height after tetanic stimulation could be estimated as the pain-producing muscle and recovery of twitch, as the pain relieving muscle. 1) Needling to the pain muscle, 2) application of a static magnetic field or external qigong to the muscle, and 3) needling to the acupuncture point recovered the reduced twitch height due to tetanic stimulation. Atropine abolished this effect induced by the above 1, 2 and 3 procedures. Hence, the cholinergic vasodilator nerve might be involved in the induction of this effect. A sciatic nerve cut did not influence the effect of 1), but abolished the effect of 3). Denervation and capsaicin abolished the effect of 1). Substance P and a calcitonin gene- related peptide (CGRP) recovered the reduced twitch height, and atropine blocked the effect of CGRP, but did not block that of substance P. The effect of 2) was equivalent to that of anticholinesterase. A rostral lesion of the contralateral anterior hypothalamus did not abolish the effect of 3, but a caudal lesion of this region did. Electrical stimulation of this region produced an effect similar to that of 3). From these results, it was concluded that muscle pain relief by these procedures might be induced by recovery of circulation due to the enhanced release of acetylcholine as a result of activation of the cholinergic vasodilator nerve endings innervated to the muscle artery. However, manners of activation of the cholinergic nerve was different in effects of 1), 2) and 3). 1) might be induced by axon reflex of the CGRP nerve, 2) might be induced by inhibition of cholinesterase and 3) might be induced by a somato-autonomic reflex. The reflex center of this might be in the anterior hypothalamus.

Development of cancer pain relief and palliative care in the Philippines.

The article describes the development and progress of cancer pain relief and palliative care in the Philippines from 1986 onwards. The strategy employed was a stepwise progression that began with the establishment of government policy, followed by measures to improve availability and accessibility to oral morphine, and finally, continuing nationwide professional education. Key elements to successful implementation were the presence of a national cancer control programme; the active participation of the World Health Organization, the Department of Health, the Philippine College of Surgeons, and the Philippine Cancer Society Inc; and research development and utilisation. Data from three clinical studies are also presented, which showed the efficacy of the WHO Method of Cancer pain relief among samples of Philippine patients, and that cancer pain relief alone did not significantly improve overall quality of life, demonstrating the need for comprehensive palliative care.

Study on Application of Static Magnetic Field for Adjuvant Arthritis Rats.

In order to examine the effectiveness of the application of static magnetic field (SMF) on pain relief, we performed a study on rats with adjuvant arthritis (AA). Sixty female Sprague-Dawley (SD) rats (age: 6 weeks, body weight: approximately 160 g) were divided into three groups [SMF-treated AA rats (Group I), non-SMF-treated AA rats (Group II) and control rats (Group III)]. The SD rats were injected in the left hind leg with 0.6 mg/0.05 ml Mycobacterium butyrium to induce AA. The rats were bred for 6 months as chronic pain model. Thereafter, the AA rats were or were not exposed to SMF for 12 weeks. We assessed the changes in the tail surface temperature, locomotor activity, serum inflammatory marker and bone mineral density (BMD) using thermography, a metabolism measuring system and the dual-energy X-ray absorptiometry (DEXA) method, respectively. The tail surface temperature, locomotor activity and femoral BMD of the SMF-exposed AA rats were significantly higher than those of the non-SMF-exposed AA rats, and the serum inflammatory marker was significantly lower. These findings suggest that the pain relief effects are primarily due to the increased blood circulation caused by the rise in the tail surface temperature. Moreover, the pain relief effects increased with activity and BMD of the AA rats.

Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia.

OBJECTIVE: To compare responses to trigger point (TrP) injection between patients having both myofascial pain syndrome (MPS) caused by active TrPs and fibromyalgia syndrome (FMS) and patients with MPS due to TrPs but without FMS. DESIGN: Prospective design blinded measurement, before- after trial. SETTING: A pain control medical clinic. PATIENTS: Group 1: MPS + FMS; Group 2: MPS only. All patients (9 in each group) had active TrPs in the upper trapezius muscle. INTERVENTION: Myofascial TrP injection with 0.5% xylocaine. MAIN OUTCOME MEASURES: Subjective pain intensity (PI), pain threshold (PT), and range of motion (ROM) were assessed before, immediately after, and 2 weeks after TrP injection. RESULTS: In a comparison of preinjection measures to immediate postinjection measures, only ROM was significantly improved (p < .05) in Group 1 patients; all three parameters were significantly improved (p < .05) in the Group 2 patients who had only MPS. Two weeks after injection, both groups showed significant improvement (p < .05) in all three measured parameters as compared to preinjection measurements. In a comparison of the two groups, the immediate effectiveness of TrP injection was significantly less (p < .05) in Group 1 than in Group 2 for all three parameters. Two weeks after injection, the degree of improvement in PT or ROM (but not PI) was not significantly different between two groups. Postinjection soreness (different from myofascial pain) was more severe, developed sooner, and lasted longer in Group 1 than in Group 2. CONCLUSION: Trigger point injection is a valuable procedure for pain relief for patients in both group. Patients with FMS are likely to experience significant but delayed and attenuated pain relief following injection of their active TrPs compared to myofascial pain patients with similar TrPs but without FMS. Also, FMS patients are likely to experience significantly more postinjection soreness for a longer period of time.

(214) Rofecoxib Provides Superior Relief of Pain in Osteoarthritis (OA) Compared to Celecoxib.

We performed a randomized, double-blind, clinical trial to evaluate pain relief efficacy of rofecoxib and celecoxib at highest indicated once daily doses in osteoarthritis. 1082 patients meeting entry criteria for OA, responsive to NSAIDs, were randomized 3:3:1 to treatment with rofecoxib 25 mg QD (n = 471), celecoxib 200 mg QD (n = 460) or placebo (n = 151). Efficacy was assessed over the first 6 days of therapy and at weeks 2, 4 and 6 by WOMAC questionnaire and patient global assessment of response to therapy (PGART). Demographics were well balanced. Significantly more patients on placebo discontinued prematurely compared to both active groups (p < 0.001) mainly due to lack of pain relief efficacy. Rofecoxib provided statistically superior relief of night pain (p = 0.023), morning stiffness (p = 0.002), rest pain (p = 0.023), and walking pain (p = 0.005) compared to celecoxib. Rofecoxib was significantly superior to celecoxib on all WOMAC subscales including pain (p = 0.008), stiffness (p = 0.001) and physical function (p = 0.01). Rofecoxib was superior to celecoxib in % of patients with good or excellent PGART over 6 weeks (p = 0.014) and provided quicker onset of pain relief as assessed by time to first report of good or excellent response (p < 0.001). Both active groups were superior to placebo on efficacy endpoints. Incidence of clinical AEs, drug related AEs, serious AEs, and discontinuations due to AEs was similar between active groups. In this study, once daily doses of rofecoxib provided superior relief of pain and other related symptoms in OA compared to celecoxib and placebo. All treatments were generally well tolerated.

pain relief by high-dose medroxyprogesterone acetate in advanced prostatic cancer

The effect of high-dose medroxyprogesterone acetate was studied in 7 patients with advanced prostatic cancer. Results in 7 patients were no change (NC) in 5 (71%) and progressive disease (PD) in 2 patients (29%). However, pain relief was obtained in 6 of the 7 patients (86%). As side effects, 2 patients (29%) showed moon-face and 2 patients weight gain (29%). These results indicate that treatment of high-dose medroxyprogesterone acetate is useful for pain relief in patients with advanced prostatic cancer.