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Aim and objectives To describe young children's experiences of valuable support in managing their fears about treatment for acute lymphoblastic leukaemia. The focus was specifically on support from parents and healthcare professionals. Design The study had a qualitative descriptive longitudinal design. Methods The study analysed 35 interviews with 13 children at three different times during their treatment period. Data were analysed using a matrix‐based method. The Consolidated criteria for reporting qualitative research (COREQ) guidelines have been followed. Results Parents and healthcare professionals provide important support to children undergoing treatment for acute lymphoblastic leukaemia, although their roles differ. Children valued their parents’ closeness and advocacy, being able to participate in their own care, and being given pain relief during procedures known to create pain. Valued support from healthcare professionals changed over time, from providing information and showing the tools that would be used in procedures, to paying attention to the child's needs and desires. It was more important for children to be able to choose between different alternatives in medical procedures than deciding on major treatment issues.

INTRODUCTION: The optimal definitive radiotherapy (RT) scheme in cutaneous squamous cell carcinoma (cSCC) remains controversial, especially in elderly patients. METHODS: Data of elderly patients with cSCC lesion(s) treated with weekly hypofractionated RT (8 Gy per week per 7-8 weeks) were analyzed. RESULTS: Eighteen patients (median age 89 years) with 23 cSCC lesions have been identified including nine males (50%) and nine females (50%). The most common tumor localization was the head and neck region (n = 21; 91.3%), and the majority of lesions (n = 15; 65.2%) was stage ≥ III. At diagnosis, pain and bleeding were ascribed in 13 (56.5%) and eight (34.8%) cSCC, respectively. Compliance with weekly hypofractionated RT was excellent. The overall response rate at 12 weeks after treatment was 95.7%. Bleeding and pain relief were achieved in all cases. Severe toxicity was not recorded. The 1-year overall survival was 66.0%. The 1-year progression-free survival was 58.7%. CONCLUSIONS: Weekly hypofractionated RT provides a safe, efficient, and cost-effective treatment in elderly cSCC patients with minimal side effects.

BACKGROUND Orthodontic treatment is the main treatment approach for malocclusion. Orthodontic pain is an inevitable undesirable adverse reaction during orthodontic treatment. It is reported orthodontic pain has become one of the most common reason that patients withdraw from orthodontic treatment. Therefore, understanding the underlying mechanism and finding treatment of orthodontic pain are in urgent need. AIMS This article aims to sort out the mechanisms and treatments of orthodontic pain, hoping to provide some ideas for future orthodontic pain relief. MATERIALS Tooth movement will cause local inflammation. Certain inflammatory factors and cytokines stimulating the trigeminal nerve and further generating pain perception, as well as drugs and molecular targeted therapy blocking nerve conduction pathways, will be reviewed in this article. METHOD We review and summaries current studies related to molecular mechanisms and treatment approaches in orthodontic pain control. RESULTS Orthodontics pain related influencing factors and molecular mechanisms has been introduced. Commonly used clinical methods in orthodontic pain control has been evaluated. DISCUSSION With the clarification of more molecular mechanisms, the direction of orthodontic pain treatment will shift to targeted drugs.

In recent years, the delivery of health services has undergone a major paradigm shift towards expanded outpatient services and widespread use of telemedicine. Post-herpetic neuralgia (PHN) is a treatment recalcitrant neuropathic pain condition referring to pain persisting more than three months from the initial onset of an acute herpes zoster. QUTENZA® (capsaicin 8% patch) is a single 1-hr localized treatment for PHN and can provide several months of pain relief per application. However, patient access to capsaicin 8% patch is limited due to sensitive handling protocols that require the patch application to occur under physicians or healthcare professionals under the close supervision of a physician. Herein, we describe a successful treatment of PHN at-home, using capsaicin 8% patch, performed under full supervision and instruction from a physician using video telehealth services. SIGNIFICANCE: This is a case report of the successful treatment of post-herpetic neuralgia at-home using Capsaicin 8% patch. The procedure was performed under full supervision and instruction from a physician using video telehealth services. Not only did the patient tolerate the procedure and have significant efficacy, she voiced preference to repeat treatment in this manner versus going back to the office.

Repeatable measures of pain in ruminants following husbandry procedures are required to validate responses to pain relief. This study tested the hypotheses that facial action units, activity and time spent with dam can be used to assess the efficacy of pain relief in lambs following mulesing. Merino lambs (n = 120) were allocated to one of six treatments implemented at mulesing: (1) lambs that were not mulesed or lambs that were mulesed and administered (2) no pain relief, (3) meloxicam 15 min before mulesing, (4) Tri-Solfen®, (5) a combination of meloxicam 15 min before mulesing and Tri-Solfen after mulesing and (6) meloxicam at mulesing. Facial action units detected a difference in pain between mulesed and non-mulesed lambs at 1 and 5 h post-mulesing (P = 0.005 and

To investigate childbearing women's views, experiences and decision-making related to epidural analgesia in labour.Mixed-methods systematic review.A comprehensive literature search was implemented across Medline, CINAHL and EMBASE from 2000 to September 2018. The literature search was undertaken in January 2018 and updated in September 2018. Thirty papers were selected.Four overarching synthesized findings were identified: (a) choice; (b) pain management experience; (c) lack of information; and (d) information provision and consent.Quality appraisal was conducted using JBI levels of evidence and other established tools. NVivo was used to independently dual code and thematically synthesize qualitative data. A narrative synthesis of the quantitative findings from the included studies was undertaken. The GRADE-CERQual approach was used to assess confidence in the review findings based on the qualitative data. A set of integrated mixed-methods synthesized findings was produced.Recommendations for practice based on the systematic review findings are that midwives should dedicate time to discuss epidural with women and birth partners, ideally during the second or third trimester of pregnancy, asking women what coping strategies or pain relief they have been considering, if any. The factors which may influence the woman's choice of epidural, including pain threshold, ability to cope with pain, timing of epidural and length of labour should be continuously evaluated during labour. The midwife should remain with women after an epidural has been sited, demonstrating understanding of the woman's choice and providing an opportunity for discussion of plans for the remaining labour and birth.The findings of this systematic review can inform both healthcare professionals and service users on various aspects of the decision-making process about the use of epidural analgesia in labour. Data can be transferable to similar settings in high-income countries.目的: 调查育龄妇女对分娩时硬膜外镇痛的看法、经验和决策。 设计: 混合法系统评价。 数据来源: 2000年至2018年9月期间,在数据库Medline、CINAHL和EMBASE上实施了全面的文献检索。文献检索于2018年1月进行,2018年9月更新。选取了30篇论文。 结果: 确定了四项主要综合调查结果:(a)选择;(b)疼痛管理经验;(c)缺乏信息;以及(d)信息提供和同意。 审查方法: 利用JBI证据等级和其他既定工具进行质量评价。使用NVivo分析软件对定性数据进行独立的对偶码和主题综合。对纳入的研究中的定量结果进行了叙述性综合。采用GRADE-CERQual方法评估基于定性数据的审查结果的置信水平。编制了一套综合的混合法综合调查结果。 结论: 根据系统评价调查结果提出的实践建议是,助产士应专门抽出时间与妇女和分娩陪护人员讨论硬膜外麻醉,最好是在怀孕的第二个月或第三个月,询问产妇一直考虑的应对策略或疼痛减轻措施(如有)。在分娩过程中应持续评估可能影响产妇选择硬膜外镇痛的因素,包括疼痛阈值、应对疼痛的能力、硬膜外镇痛时间和分娩时间。在硬膜外麻醉已到位后,助产士应继续陪在产妇身边,对产妇的选择表示理解,并提供机会讨论后续分娩和生产计划。 影响: 本系统评价的调查结果可以为医疗保健专业人员和服务用户提供关于分娩时使用硬膜外镇痛的决策过程的各个方面的信息。在高收入国家的类似环境中,此类数据亦可转用。.

Background High-frequency 10-kHz spinal cord stimulation (10-kHz SCS) has shown promise in multicenter prospective trials for the management of chronic back and leg pain. Traditional spinal cord stimulation (t-SCS) has a long history of effectiveness in chronic neuropathic syndromes but not uncommonly can fail to provide long-term relief, leaving a significant group of patients with unsatisfactory outcomes. There is mounting evidence that 10-kHz SCS may offer relief in this subset of patients. Methods The purpose of this retrospective analysis was to report a single-institution long-term experience of 10-kHz SCS in patients who did not get adequate pain relief with prior t-SCS devices. A temporary trial of 10-kHz SCS was carried out for 7 days, and those experiencing an average of 50% reduction in pain intensity underwent implantation. Patients were classified as moderate responders if relief was 31% to 50% and excellent responders if pain relief exceeded 50%. Results Thirty-one patients who had experienced failed t-SCS primarily from poor paresthesia coverage underwent a trial of 10-kHz SCS and 29 underwent implantation. Twenty-eight patients were available for analysis, with 57.1% experiencing 30% response and 46.4% experiencing excellent response at a median follow-up of 21.2 (±8.4) months. Conclusions This small single-institution study suggests that a significant proportion of patients with previously failed t-SCS may achieve clinically meaningful and durable pain relief with 10-kHz SCS.

Aim To explore the educational needs of nurses on children's pain management. Design A descriptive qualitative study. Methods Individual and group interviews were conducted among 28 nurses and four nurse managers at four hospitals in the Ashanti region of Ghana. The recorded interviews were later transcribed verbatim and thematically analysed based on a conceptual interest in the educational needs on paediatric pain management. Results Nurses were acquainted with pain assessment of children who can verbally communicate. They mainly used drugs in treating pain and were familiar with the use of some non‐pharmacological interventions. Notwithstanding, they desired to know more about pain assessment for children with non‐functional speech. Additionally, they were interested in learning more about both drug and nondrug pain relief methods for children. The sampled nurses and nurse managers indicated diverse preferences on the nature of the paediatric pain educational programme based on their personal choices and working dynamics.

Background and aims Alveolar osteitis (AO) is the most common painful post‐operative complication after tooth extraction. The common modalities used in the management of AO are lavage, placement of medicated dressings, analgesics, and antibiotics. The present study was undertaken to compare platelet‐rich fibrin (PRF) and zinc oxide eugenol (ZOE) for pain relief in AO. Methods All cases meeting the eligibility criteria received two different treatment modalities over a span of 18 months. At the analysis stage, the final sample size comprised 70 patients, with 35 patients appropriated in each group. Group A patients received ZOE and Group B received PRF. Pain scores were measured on “1st, 3rd, 5th, and 7th” days based on a visual analogue scale (VAS) and compared in both groups of patients. The collected data were analyzed using the chi‐square test, t test, and Mann‐Whitney U test. Results In patients treated with ZOE dressing, the average VAS scores observed were 7.4 ± 1.5, 5.1 ± 1.1, 3.4 ± 0.9, and 2.1 ± 0.7, respectively, on the “1st, 3rd, 5th, and 7th” follow‐up days. In patients treated with PRF, the average VAS score observed were 4.1 ± 1.2, 2.6 ± 0.9, 1.7 ± 0.9, and 0.8 ± 0.8 respectively. Conclusion Both ZOE and PRF were effective in pain control during the follow‐up period. However, the pain intensity measured as a pain score using VAS was, lower in the PRF group than in the ZOE group on all follow‐up days.

Caudal regression syndrome is an extremely rare clinical entity. It is a challenge to anesthesiologist due to its multisystem involvement. Regional anesthesia literature on caudal regression syndrome is scarce. We report three cases where optimal use of ultrasonography aided in providing satisfactory peri-operative pain relief. Furthermore, a cogent and a logical review of the decision-making processes for the regional blockade in children with caudal regression syndrome are presented.

Background We investigated the efficacy of hyperbaric oxygen (HBO), low-intensity laser (LIL), and platelet-rich plasma (PRP) in the management of medication-related osteonecrosis of the jaws (MRONJ). Methods A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two examiners independently assessed eligibility and risk of bias and extracted data. Results There was improvement in 75.6% of the 41 patients submitted to HBO, with positive effects on pain relief and decreased size and number of lesions at a faster rate, with better effects when the drug was discontinued. For LIL, 158 (64.2%) of the 246 patients/sites improved the symptoms and 98 (39.8%) healed completely. Fourteen (17.3%) of the 81 patients treated with PRP significantly improved the symptoms and 65 (80.2%) completely healed. Conclusions These therapies served as safe and effective adjuvant modalities for MRONJ treatment. The lack of randomized clinical trials evidences the need for more high-quality investigations on the subject.

Aims Effective methods for relieving pain in inserting a needle for chemotherapy in cancer patients have been studied. This study examined the pain relief effects during needle insertion into the implanted venous access chemoport by comparing three methods. Methods This randomized controlled trial included 120 cancer patients who were randomly assigned. The experimental groups received applications of lidocaine cream (n = 30), cryotherapy (n = 30) and cutaneous stimulation therapy (n = 30); the control group (n = 30) received routine care. Premeasurements and postmeasurements were evaluated using a visual analogue pain scale and nurses' careful observations of patients' pain behaviour checklists during needle insertion. Results Pain levels were reduced by all three interventions, with the level of relief depending on the type of application. All experimental groups showed significant reduction in pain compared with the control group. Lidocaine cream had the strongest effect, followed by cryotherapy and then cutaneous stimulation. Conclusion Lidocaine cream, cryotherapy and cutaneous stimulation therapy all reduced cancer patients' pain levels during insertion of an implanted central venous access chemoport needle. Nurses can apply cryotherapy and cutaneous stimulation therapy independently to reduce the pain associated with this procedure. Future studies should consider using these methods to control for any individual differences that may exist.

This journal recently published a paper entitled "A virtual reality system for pain and anxiety management during outpatient hysteroscopy - A randomized-control trial." (Fouks et al., 202*). In this study involving 82 patients, the authors failed to evidence any superiority of immersive virtual reality (VR) vs. care-as-usual (CAU), while other published studies, such as several ones in paediatrics (Eijlers et al. 2019; Lambert et al. 2020), were in favour of VR. Either so-called "negative" or "positive", any new trial is important to increase our knowledge about this emergent therapy.

The IWGDF 2019 Updated Guidelines for prevention of foot ulcers in diabetes advise that nerve decompression surgery not be considered. This nerve decompression option has similar scientific supporting evidence to other surgeries which are recommended. The sanction ignores a large body of non-Level 1 evidence demonstrating various beneficial outcomes of ND including pain relief, DFU prevention, and protection from recurrence and amputation.

Aim We compared the effect of two different doses of sucrose on neonatal pain scores during venepuncture. Methods This randomised crossover study focused on neonates born weighing more than 1000 g from December 2014 to June 2016, who received neonatal intensive care at two hospitals: one in Empangeni, South Africa, and one in Trondheim, Norway. During two consecutive venepuncture procedures, 27 neonates from South Africa and 26 neonates from Norway were randomised to receive 0.2 mL or 0.5 mL sucrose. Half was administered two minutes before venepuncture and the rest immediately before the procedure. South Africa used 25% sucrose and Norway 24%. Pain scores were measured twice using the Premature Infant Pain Profile-Revised: during skin puncture and after the needle was removed. Results The mean pain scores during skin puncture were significantly lower with 0.5 mL sucrose than with 0.2 mL (5.3 versus 6.8, p=0.008), but the mean pain scores after the needle was removed were similar with both doses (4.7 versus 5.4, p=0.29). We found no significant association between weight and pain scores. Conclusion We showed that neonates received better pain relief from 0.5 mL than 0.2 mL sucrose during venepuncture but not after the needle was removed.

BACKGROUND A vast majority of women who choose nitrous oxide for labor report high satisfaction despite variable analgesic effectiveness. We analyzed comments provided by women who used nitrous oxide for labor, to identify determinants of satisfaction in this population, and to better understand reasons for continuing with nitrous oxide despite variable analgesic effectiveness. METHODS We conducted qualitative content analysis of comments in a quality improvement database of routine follow-up assessments of women who delivered vaginally, using nitrous oxide as the sole labor analgesic. An inductive grounded approach was used and emergent themes and subthemes were identified. RESULTS Of 6507 vaginal deliveries over 34 months in 2011-2014, 753 (12%) used nitrous oxide as their sole analgesic. Analysis of 264 clarifying comments yielded six emergent themes. Parturients cited nonanalgesic benefits of nitrous oxide use (relaxation, distraction, focus on breathing), as well as partial analgesic effects that they deemed to be sufficient, or consistent with their expectations. Numerous women described their nitrous oxide experience as consistent with their birth plan, including 14 who equated it with natural childbirth. Several comments described nitrous oxide as a vital component of the parturients' birth experience. Some described using nitrous oxide when neuraxial analgesia was not possible. Side effects were identified, as were difficulties using the apparatus/mask. Analysis highlighted importance of timely administration upon request and attention to technical aspects. CONCLUSIONS Among parturients who choose nitrous oxide as their sole labor analgesic, determinants of satisfaction are more variable than previously understood, and extend beyond analgesia.

Aim To identify the association between primary dysmenorrhea (PD) and body mass index (BMI). Methods This cross sectional study was conducted on 370 female students (aged 18-25 years) of Immam Abdulrahman Bin Faisal University Dammam, from March 2016 till March 2017. Pretested dysmenorrhea questionnaire was filled by the students. Weight and heights of the subjects were measured, and BMI was calculated. Based on BMI, subjects were divided into four groups (underweight [UW], normal weight, overweight and obese [OB]). Subjects were also categorized into mild, moderate and severe dysmenorrhic groups based on numeric pain relating scale. SPSS version 20.0 was used to analyze the data. Results This study showed that 85.7% of the students were suffering from PD, out of which 12.7% had mild, 65.6% had moderate and 8.4% had severe dysmenorrhea. In total, 54.5% of the students mentioned that dysmenorrhea interferes with their daily activities. Whereas 55.8% of the students mentioned that they got pain relief by using non-steroidal anti-inflammatory drugs. Pair wise comparison of dysmenorrhea between different BMI groups showed a statistically significant difference in the frequency of moderate and severe dysmenorrhea between UW and OB subjects (P values 0.003 and 0.06) respectively, indicating that UW females are at a higher risk of having PD. Conclusion This study indicates a higher prevalence of moderate and severe dysmenorrhea in UW as compared to the OB subjects. We recommend further studies to explore the underlying pathophysiological mechanisms responsible for this association.

Aim The abdominal incision for specimen extraction could trigger postoperative pain after laparoscopic colorectal resections (LCRs). Continuous wound infusion (CWI) of ropivacaine may be a valuable option for postoperative analgesia. This study was undertaken to evaluate the potential benefits of ropivacaine CWI on pain relief, metabolic stress reaction, prevention of wound hyperalgesia and residual incisional pain after LCR. A subgroup with intravenous lidocaine infusion (IVL) was added to discriminate between the peripheral and systemic effects of local anaesthetic infusions. Method Patients were randomly allocated to three subgroups: CWI (0.2% ropivacaine 10 ml/h for 48 h); IVL (lidocaine 1.5% at 4 ml/h for 48 h); control group. Results In all, 95 patients were randomized (86 patients analysed). Postoperative pain intensity did not differ significantly between groups. Within the first 24 h after surgery, morphine requirement was significantly lower in the CWI group compared with the IVL group, but there was no significant difference compared with the control group (P = 0.02 and P = 0.15, respectively). The area of hyperalgesia did not differ significantly between subgroups, nor did the hyperalgesia ratio which was 1.2 cm (0.0-6.7) vs 1.9 cm (0.4-4.0) vs 2.0 cm (0.5-7.0) in the CWI, IVL and control groups respectively (P = 0.35). The number of patients reporting residual incisional pain after 3 months (3/26 vs 4/23 vs 4/23 in the CWI, IVL and control groups respectively) did not differ significantly between the groups, nor did their metabolic stress reactions. Conclusion Ropivacaine CWI at the site of the abdominal incision did not provide any significant benefit either on analgesia or on the prevention of wound hyperalgesia after LCR.

Background Confusion remains over the definition of breakthrough cancer pain (BTcP) potentially leading to delayed diagnosis and treatment. Methods An on-line survey was conducted in four EU countries among relevant healthcare professionals and cancer patients diagnosed with BTcP. The roles of healthcare professionals (HCPs) were examined and their knowledge and use of available medications recorded. Patients were questioned on how BTcP affected their lives and on the medications they had received/were receiving. Results There was a 'time lag' of 58 and 13 weeks in Germany and Spain respectively between the initial diagnosis of BTcP and its treatment. Four in ten oncologists across the four countries considered themselves not fully confident in their choice of the appropriate therapy. A quarter of patients in Germany, Italy and Spain and four in ten in France were treated only with increased dosages of the therapy already prescribed for their background pain - often morphine. Almost another quarter received morphine in addition to their treatment for background pain. Oncologists indicated a need for faster-acting treatments revealing a potential lack of awareness of rapid onset oral opioids and patients expressed a desire for more effective pain relief and better psychological support. Conclusions There is a need for a universal definition of BTcP to facilitate earlier and more accurate diagnosis. It is essential that BTcP is treated immediately on diagnosis with therapies that more closely mirror its temporal characteristics to ensure that patients' desire for more effective pain relief is fulfilled. Significance Many cancer patients suffered episodes of BTcP needlessly over many months due to missed diagnosis. Even after diagnosis, many physicians were not fully confident in their choice of 'rescue' therapy which perhaps is not surprising given the very low level of awareness of treatment guidelines, both national and international.

Electronic patient records of dogs attending practices participating in the VetCompass Programme were assessed against selection criteria used to define RTA cases. Cases identified as RTAs were identified and manually verified to calculate prevalence. Univariable and multivariable logistic regression methods were used to evaluate associations between risk factors and RTA. The prevalence of RTA was 0.41%. Of the RTA cases, 615 (74.9%) were purebred, 322 (39.2%) were female, and 285 (54.8%) were insured. The median age at RTA was 2.5 years. After accounting for the effects of other factors, younger dogs had increased odds of an RTA event: dogs aged under 3 years showed 2.9 times the odds and dogs aged between 6–9 years showed 1.8 times the odds of an RTA event compared with dogs aged over 14 years. Males had 1.4 times the odds of an RTA event compared with females. Overall, 22.9% of cases died from a cause associated with RTA. Of dogs with information available, 34.0% underwent diagnostic imaging, 29.4% received intravenous fluid‐therapy, 71.1% received pain relief, 46.0% were hospitalized, and 15.6% had surgery performed under general anesthetic.

Both medical and nonmedical (misuse or abuse) use of prescription opioids have been declining among adolescents, according to a study published in the April 2017 issue of Pediatrics. However, prescription opioid exposure is still common, with adolescents who reported both medical and nonmedical use more likely to have started with medical use. Medical use of prescription opioids among teens peaked in 1989 and 2002 and stayed level until a decline that began in 2013.

Aim Conventional haemorrhoidectomy is still considered the reference standard for the management of severe or recurrent haemorrhoids. Pain is reported by patients to be the most common postoperative complication. Although the literature lacks a consensus on its effectiveness, metronidazole is often used to reduce postoperative pain. We have performed a meta-analysis of all randomized controlled trials (RCTs) that investigated the use of metronidazole for pain relief after haemorrhoidectomy. Method A systematic review was undertaken in accordance with the PRISMA protocol using the MESH headings ‘haemorrhoidectomy’, ‘hemorhoidectomy’, ‘hemorrhoidectomy’, ‘haemorrhoid’, ‘metronidazole’, ‘Flagyl®’ ‘antibiotic’ and ‘pain’. The search returned 421 articles of which eight were RCTs suitable for inclusion in the review with a total population of 437 patients. The outcomes of interest were postoperative pain intensity on days 1, 2 and 7 and on first defaecation as measured using a visual analogue scale. Results The meta-analysis demonstrated a significant reduction in postoperative pain for patients treated with metronidazole with a reduced mean difference for the metronidazole group on day 1 of −1.42 (95% CI: −2.14 to −0.69, P = 0.0001), on day 2 of −1.43 (95% CI: −2.45 to −0.40, P = 0.006) and on day 7 of −2.40 (95% CI: −3.10 to −1.71, P

Inhibitors of the cyclooxygenases (COXs), the nonsteroidal antiinflammatory drugs (NSAIDs), relieve inflammatory pain, but are associated with gastrointestinal and cardiovascular complications. Given the widespread use of NSAIDs, there has been a longstanding interest in optimizing their risk-benefit ratio, for example by reducing their gastrointestinal risk. More recently, the focus has shifted toward the cardiovascular complications of NSAIDs and very large prospective studies have been performed to compare cardiovascular risk across distinct NSAIDs. Surprisingly, much less attention has been paid to the efficacy side of the risk-benefit ratio. There is marked variability in the degree of pain relief by NSAIDs due to the complex interplay of molecular mechanisms contributing to the pain sensation, variability in the disposition of NSAIDs, and imprecision in the quantification of human pain. Here we discuss how NSAIDs relieve pain, how molecular mechanisms relate to clinical efficacy, and how this may inform our interpretation of clinical trials.

Background and Objectives We examined use of non-pharmacological treatments for pain in addiction treatment patients. Methods Patients in addiction treatment with chronic pain (N = 501) were classified based on use of non-pharmacological pain treatments. Demographic and clinical correlates were compared. Results A total of 49% (N = 243) of patients used a non-pharmacological treatment in the past year versus 72% (N = 361) who used opioids. Non-pharmacological treatment users were more likely to use opioids and other pain medications. Conclusions Non-pharmacological treatments are less commonly used than opioids by addiction treatment patients. Scientific Significance Findings highlight the need to better understand pain treatment decision-making among addiction treatment patients. (Am J Addict 2017;26:564–567)

Most Korean women who experience menstrual pain have reported taking pain medicine and making use of complementary alternative therapies. However, because some interventions may cause side effects, more effective pain-relieving measures need to be identified. This study using a non-equivalent group design, evaluated the effects of near-infrared rays on dysmenorrhea among Korean women. The experimental group wore a near-infrared ray abdominal belt for the duration of one menstrual cycle until the end of the menstrual period, while the control group used hot packs. The level of menstrual pain, menstrual pain duration, and pain medicine use were measured. The menstrual pain, average menstrual pain duration, and use of analgesics were reduced in the near-infrared rays group. The results of this study indicate that the near-infrared ray LED belt was effective in reducing menstrual pain, menstrual pain duration compared to the use of analgesics in Korean women with dysmenorrhea. Therefore, near-infrared rays may be used to relieve menstrual pain and improve the quality of life of women with dysmenorrhea in Korea.

Background C-tactile (CT) afferents are unmyelinated low-threshold mechanoreceptors optimized for signalling affective, gentle touch. In three separate psychophysical experiments, we examined the contribution of CT afferents to pain modulation. Methods In total, 44 healthy volunteers experienced heat pain and CT optimal (slow brushing) and CT sub-optimal (fast brushing or vibration) stimuli. Three different experimental paradigms were used: Concurrent application of heat pain and tactile (slow brushing or vibration) stimulation; Slow brushing, applied for variable duration and intervals, preceding heat pain; Slow versus fast brushing preceding heat pain. Results Slow brushing was effective in reducing pain, whereas fast brushing or vibration was not. The reduction in pain was significant not only when the CT optimal touch was applied simultaneously with the painful stimulus but also when the two stimuli were separated in time. For subsequent stimulation, the pain reduction was more pronounced for a shorter time interval between brushing and pain. Likewise, the effect was more robust when pain was preceded by a longer duration of brush stimulation. Strong CT-related pain reduction was associated with low anxiety and high calmness scores obtained by a state anxiety questionnaire. Conclusions Slow brushing – optimal for CT activation – is effective in reducing pain from cutaneous heating. The precise mechanisms for the pain relief are as yet unknown but possible mechanisms include inhibition of nociceptive projection neurons at the level of the dorsal horn as well as analgesia through cortical mechanisms. Significance Slow brushing stimuli – optimal for activation of C-tactile fibres – can reduce pain from cutaneous heating. No such effect was seen with fast brushing or vibration. These observations indicate the role of C-tactile fibres in pain modulation.

A case is presented of a patient with painful bilateral mandibular florid osseous dysplasia without infection. The patient was edentulous. Surgical removal of the lesion led to total pain relief. To avoid long-term drug abuse, surgical treatment might be an option to treat painful florid osseous dysplasia in selected cases especially in edentulous areas.

Background and aim Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach. Methods All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure. Results A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P

Background and Purpose: Mulligan's mobilization with movement was shown to be effective when implemented in multimodal therapy for knee osteoarthritis. However, no study has evaluated the Mulligan's technique in isolation and compared the relative effectiveness with sham-controlled interventions. Hence, the present study examined the immediate effects of Mulligan's techniques with sham mobilization on the numerical pain rating scale (NPRS) and timed up and go (TUG) test in individuals with knee osteoarthritis. Methods: Thirty participants (mean age: 55.3 ± 8.3 years) with symptoms at the knee and radiographic diagnosis of knee osteoarthritis were randomized into sham (n = 15) and intervention (n = 15) groups. The intervention (I) group received Mulligan's mobilization glides that resulted in relative pain relief for three sets of 10 repetitions. For the sham (S) group, the therapist's hand was placed over the joint surfaces mimicking the pain-relieving glides, without providing the gliding force. The outcome measures NPRS and TUG were recorded by a blinded assessor pre- and post-intervention. Results: Statistically significant differences were identified between the groups in post-intervention median (interquartile range) NPRS (I group: 4.00 [2.00–5.00]; S group: 6.00 [4.00–7.00]) and TUG scores (I group: 10.9 [9.43–10.45]; S group: 13.18 [10.38–16.00]) with the intervention group demonstrating better outcomes (p < .05). Within-group, the post-intervention scores of NPRS and TUG were significantly lower (p < .05) compared to the pre-intervention scores in the intervention group. In the sham group, a statistically significant pre–post change was noticed only in the NPRS scores but not in theTUG scores. Conclusion: Mulligan's techniques were effective in improving pain and functional mobility in individuals with knee osteoarthritis. The underlying mechanisms for observed effects must be examined further, as participants reported pain relief following sham mobilization.