Is pain relief equally efficacious and free of side effects with repeated doses of oral sucrose in preterm neonates?

The aim of the present study was to examine the efficacy and potential side effects of repeated doses of oral sucrose for pain relief during procedures in NICU. Thirty-three preterm neonates were randomly allocated in blind fashion into two groups, the sucrose group (SG = 17) and the control group (CG = 16). The responses of neonates to pain and distress were assessed during blood collection on four consecutive assessment (ass.) days. For the first assessment, the neonates did not receive any solution before the blood collection procedure. During the next three days, the SG received oral sucrose (25%; 0.5 ml/kg) and the CG received sterile water, 2 min before each minor acute painful procedure. The neonates were evaluated during blood collection each morning. The assessment was divided into five phases: Baseline (BL), Antisepsis (A), Puncture (P), Dressing (D), and Recovery (R). The neonates` facial activity (NFCS), behavioral state, and heart rate were evaluated. The data analysis used cut-off scores for painful and distressful responses. No side effects of using sucrose were detected. There were significantly fewer SG neonates with facial actions signaling pain than CG neonates in P (ass.2) and in A (ass.3). We found significantly fewer SG neonates in the awake state than CG neonates in P (ass.2 and ass.4). There were significantly fewer SG neonates crying during A (ass.2), P (ass.2 and ass.4), and D (ass.3). There was no statistical difference between-groups for physiological response. The efficacy of sucrose was maintained for pain relief in preterm neonates with no side effects. (C) 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Relationship among eccentric hip and knee torques, symptom severity and functional capacity in females with patellofemoral pain syndrome

Objective: To determine the relationships between eccentric hip and knee torques, symptom severity and functional capacity in females with patellofemoral pain syndrome (PFPS). Design: Within-subject correlational study. Setting: University biomechanics laboratory. Participants: 10 females diagnosed with PFPS. Main outcome measures: Eccentric strength of the hip abductors and lateral rotators, and knee extensors were assessed using an isokinetic dynamometer. A 10-cm visual analog scale was used to determine usual knee pain in the last week. The Anterior Knee Pain Scale (AKPS) was used to determine the functional capacity of the patients. Results: The study found that the greater the eccentric knee extensor and hip lateral rotator torques, the higher the functional capacity of the patients (p = 0.02, r = 0.72; p = 0.02, r = 0.72). It was also shown that the greater hip lateral rotator torque, the less the usual pain reported in the last week (p = 0.004, r = -0.84). Despite the lack of statistical significance (p = 0.11), it was also found a modest negative relationship between the eccentric knee extensor torque and the usual pain reported in the last week (r = -0.56) that was considered clinically meaningful (d = 1.4). Conclusions: This study showed that eccentric knee extensor and hip lateral rotator torques were associated with functional capacity and pain level in females with PFPS. Further investigations should be carried out to verify the effects of an intervention program focused on the eccentric action of these muscles with respect to the symptoms in patients with PFPS. (C) 2011 Elsevier Ltd. All rights reserved.

Comparison of the effects of tramadol, codeine, and ketoprofen alone or in combination on postoperative pain and on concentrations of blood glucose, serum cortisol, and serum interleukin-6 in dogs undergoing maxillectomy or mandibulectomy

Objective-To compare analgesic effects of tramadol, codeine, and ketoprofen administered alone and in combination and their effects on concentrations of blood glucose, serum cortisol, and serum interleukin (IL)-6 in dogs undergoing maxillectomy or mandibulectomy. Animals-42 dogs with oral neoplasms. Procedures-30 minutes before the end of surgery, dogs received SC injections of tramadol (2 mg/kg), codeine (2 mg/kg), ketoprofen (2 mg/kg), tramadol + ketoprofen, or codeine + ketoprofen (at the aforementioned dosages). Physiologic variables, analgesia, and sedation were measured before (baseline) and 1, 2, 3, 4, 5, and 24 hours after surgery. Blood glucose, serum cortisol, and serum IL-6 concentrations were measured 1, 3, 5, and 24 hours after administration of analgesics. Results-All treatments provided adequate postoperative analgesia. Significant increases in mean +/- SD blood glucose concentrations were detected in dogs receiving tramadol (96 +/- 14 mg/dL), codeine (120 +/- 66 mg/dL and 96 +/- 21 mg/dL), ketoprofen (105 +/- 22 mg/dL), and codeine + ketoprofen (104 +/- 16 mg/dL) at 5, 1 and 3, 5, and 3 hours after analgesic administration, respectively, compared with preoperative (baseline) values. There were no significant changes in physiologic variables, serum IL-6 concentrations, or serum cortisol concentrations. Dogs administered codeine + ketoprofen had light but significant sedation at 4, 5, and 24 hours. Conclusions and Clinical Relevance-Opioids alone or in combination with an NSAID promoted analgesia without adverse effects during the 24-hour postoperative period in dogs undergoing maxillectomy or mandibulectomy for removal of oral neoplasms. (Am J Vet Res 2010;71:1019-1026)

The impact of stress and anxiety on the pressure pain threshold of myofascial pain patients

The purpose of this study was to evaluate the influence of stress and anxiety on the pressure pain threshold (PPT) of masticatory muscles and on the subjective pain report. Forty-five women, students, with mean age of 19.75 years, were divided into two groups: group 1:29 presenting with masticatory myofascial pain (MFP), according to the Research Diagnostic Criteria for Temporomandibular Disorders and group 2: 16 asymptomatic controls. An electronic algometer registered the pain thresholds on four different occasions throughout the academic year. To measure levels of stress, anxiety and pain, the Beck Anxiety Inventory, Lipp Stress Symptoms Inventory and Visual Analog Scale (VAS) were used. Three-way anova and Tukey`s tests were used to verify differences in PPT between groups, times and sites. Levels of anxiety and VAS were compared using Mann-Whitney test, while Friedman`s test was used for the within-groups comparison at different times (T1 to T4). The chi-squared and Cochran tests were performed to compare groups for the proportion of subjects with stress (alpha = 0.05). Differences in PPT recordings between time (P = 0.001) and sites (P < 0.001) were detected. Higher levels of anxiety and lower PPT figures were detected at T2 (academic examination) (P = 0.001). There was no difference between groups for anxiety and stress at any time (P > 0.05). The MFP group also has shown significant increase of VAS at the time of academic examination (P < 0.001). External stressors such as academic examinations have a potential impact on masticatory muscle tenderness, regardless of the presence of a previous condition such as masticatory myofascial pain.

Influence of the menstrual cycle on the pressure pain threshold of masticatory muscles in patients with masticatory myofascial pain

Objective. The aim of this study was to investigate the influence of the menstrual cycle and oral contraceptive (OC) intake on the pressure pain threshold (PPT) of masticatory muscles in patients with masticatory myofascial pain (MFP). Study design. The sample was composed of 36 women, divided into 4 groups, according to the presence of MFP and the intake of OC (15 patients had MFP [7 taking OC] and 21 were pain-free controls [8 taking OC]). The algometer-based PPT of masseter and temporalis, and the record of subjective pain by visual analog scale (VAS) were determined during 2 consecutives menstrual cycles at 4 phases (menstrual, follicular, periovulatory, and luteal). A 3-way ANOVA for repeated measurements, Kruskal-Wallis, Friedman, and Dunn tests, with a 5% significant level analyzed the data. Results. PPT was significantly lower in MFP patients when compared with controls throughout the experiment (P < .001). The menstrual phases did not influence PPT (P > .05), while the intake of OC seems to raise PPT levels for the left temporalis (P = .01) and right masseter (P = .04). VAS was, in general, higher at the menstrual phase Conclusions. Different phases of the menstrual cycle have no influence on PPT values, regardless of the presence of a previous condition, as masticatory myofascial pain, while the intake of OC is associated with decreased levels of reported pain.

Palpation of the lateral pterygoid area in the myofascial pain diagnosis

Objectives. To evaluate the diagnostic value of intraoral palpation at the lateral pterygoid (LP) area as part of the physical examination to detect myofascial pain, according to modified research diagnostic criteria for temporomandibular disorders. Study design. Fouty-four women composed the myofascial pain group, and 33 symptom-free age-matched were the control group. One examiner calibrated and blinded to group distribution performed 2 intraoral bilateral palpations of the lateral pterygoid. Results. The LP area palpation showed sensitivity and specificity values of 79.55% and 77.27%, respectively, and positive and negative likelihood ratios of 3.50 and 0.26, respectively. Conclusions. Palpation at the LP area did not reach acceptable values of specificity, and care must be taken when judging positive response to this procedure.

Comparison of oral versus sublingual piroxicam during postoperative pain management after lower third molar extraction

In this study, 53 patients received piroxicam, administered orally or sublingually, after undergoing removal of symmetrically positioned lower third molars, during two separate appointments. This study used a randomized, blind, cross-over protocol. Objective and subjective parameters were recorded for comparison of postoperative results for 7 days after surgery. Patients treated with oral or sublingual piroxicam reported low postoperative pain scores. The patients who received piroxicam orally took a similar average amount of analgesic rescue medication compared with patients who received piroxicam sublingually (p > 0.05). Patients exhibited similar values for mouth opening measured just before surgery and immediately following suture removal 7 days later (p > 0.05), and showed no significant differences between routes of piroxicam administration for swelling control during the second or seventh postoperative days (p > 0.05). In summary, pain, trismus and swelling after lower third molar extraction, independent of surgical difficulty, could be controlled by piroxicam 20 mg administered orally or sublingually and no significant differences were observed between the route of delivery used in this study.

Low Level Laser Effects On Pain to Palpation and Electromyographic Activity in TMD Patients: A Double-Blind, Randomized, Placebo-Controlled Study

The purpose of this study was to evaluate the effect of diode laser (GaAlAs - 780 nm) on pain to palpation and electromyographic (EMG) activity of the masseter and anterior temporalis muscles. The laser was applied on the temporalis and masseter muscles twice a week (four weeks). Forty-eight (48) patients with myofascial pain were randomly assigned between actual and placebo treatments and between the energetic doses of 25 J/cm(2) and 60 J/cm(2), and were evaluated using VAS before, immediately after the final application, and 30 days after the laser treatment. Surface electromyography was performed with maximum dental clenching before and after laser therapy. The results show there were no significant statistical differences in the EMG activity between the groups before and after laser treatment. With regard to the pain at palpation, although both groups presented a significant difference in the symptoms before and after the treatment, only the active doses showed statistically significant reductions in pain level in all the regions of the palpated muscles. However, there was no significant statistical difference between groups (experimental and placebo). In conclusion, low level laser did not promote any changes in EMG activity. The treatment did, however, lessen the pain symptoms in the experimental groups.