Cybermedlife - Therapeutic Actions Prevent Pain

Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder.

Abstract Title: Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder. Abstract Source: Med Care. 2014 Dec ;52(12 Suppl 5):S57-64. PMID: 25397825 Abstract Author(s): Charles C Engel, Elizabeth H Cordova, David M Benedek, Xian Liu, Kristie L Gore, Christine Goertz, Michael C Freed, Cindy Crawford, Wayne B Jonas, Robert J Ursano Article Affiliation: Charles C Engel Abstract: BACKGROUND: Initial posttraumatic stress disorder (PTSD) care is often delayed and many with PTSD go untreated. Acupuncture appears to be a safe, potentially nonstigmatizing treatment that reduces symptoms of anxiety, depression, and chronic pain, but little is known about its effect on PTSD. METHODS: Fifty-five service members meeting research diagnostic criteria for PTSD were randomized to usual PTSD care (UPC) plus eight 60-minute sessions of acupuncture conducted twice weekly or to UPC alone. Outcomes were assessed at baseline and 4, 8, and 12 weeks postrandomization. The primary study outcomes were difference in PTSD symptom improvement on the PTSD Checklist (PCL) and the Clinician-administered PTSD Scale (CAPS) from baseline to 12-week follow-up between the 2 treatment groups. Secondary outcomes were depression, pain severity, and mental and physical health functioning. Mixed model regression and t test analyses were applied to the data. RESULTS: Mean improvement in PTSD severity was significantly greater among those receiving acupuncture than in those receiving UPC (PCLΔ=19.8±13.3 vs. 9.7±12.9, P<0.001; CAPSΔ=35.0±20.26 vs. 10.9±20.8, P<0.0001). Acupuncture was also associated with significantly greater improvements in depression, pain, and physical and mental health functioning. Pre-post effect-sizes for these outcomes were large and robust. CONCLUSIONS: Acupuncture was effective for reducing PTSD symptoms. Limitations included small sample size and inability to parse specific treatment mechanisms. Larger multisite trials with longer follow-up, comparisons to standard PTSD treatments, and assessments of treatment acceptability are needed. Acupuncture is a novel therapeutic option that may help to improve population reach of PTSD treatment. Article Published Date : Nov 30, 2014
Therapeutic Actions Prevent Pain

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Association of Varus Knee Thrust during Walking with Worsening WOMAC Knee Pain: The Multicenter Osteoarthritis Study.

Related Articles Association of Varus Knee Thrust during Walking with Worsening WOMAC Knee Pain: The Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken). 2018 Sep 22;: Authors: Wink AE, Gross KD, Brown CA, Lewis CE, Torner J, Nevitt MC, Tolstykh I, Sharma L, Felson DT Abstract OBJECTIVE: To investigate the two-year association of varus knee thrust observed during walking to the odds of worsening WOMAC knee pain in older adults with or at risk of OA. METHODS: Video recordings of self-paced walking trials of Multicenter Osteoarthritis Study (MOST) participants were assessed for the presence of varus thrust at baseline. Knee pain was assessed using the WOMAC questionnaire at baseline and at two years. Logistic regression was used to estimate the odds of worsening (defined as either any increase in WOMAC score or clinically-important worsening) knee pain, adjusting for age, sex, race, BMI, clinic site, gait speed, and static knee aligment. Analyses were repeated stratified by baseline radiographic OA status and among the subset of knees without baseline WOMAC pain. RESULTS: 1623 participants contributed 3204 knees. Varus thrust was observed in 31.5% of knees. Knees with varus thrust had 1.44 times (95% CI: 1.19, 1.73) the odds of any and 1.37 times (95% CI: 1.11, 1.69) the odds of clinically-important worsening WOMAC pain compared to knees without thrust. Knees with thrust without baseline WOMAC pain had 2.01 (95% CI: 1.47, 2.74) times the odds of incident total pain. CONCLUSION: Results indicate that varus thrust is a risk factor for worsening and incident knee pain. Targeting varus thrust through non-invasive therapies could prevent development or worsening of knee pain in older adults with or at risk for knee OA. This article is protected by copyright. All rights reserved. PMID: 30242985 [PubMed - as supplied by publisher]

Impact of oversedation prevention in ventilated critically ill patients: a randomized trial-the AWARE study.

Related Articles Impact of oversedation prevention in ventilated critically ill patients: a randomized trial-the AWARE study. Ann Intensive Care. 2018 Sep 21;8(1):93 Authors: SRLF Trial Group Abstract BACKGROUND: Although oversedation has been associated with increased morbidity in ventilated critically ill patients, it is unclear whether prevention of oversedation improves mortality. We aimed to assess 90-day mortality in patients receiving a bundle of interventions to prevent oversedation as compared to usual care. METHODS: In this randomized multicentre trial, all adult patients requiring mechanical ventilation for more than 48 h were included. Two groups were compared: patients managed according to usual sedation practices (control), and patients receiving sedation according to an algorithm which provided a gradual multilevel response to pain, agitation, and ventilator dyssynchrony with no specific target to alter consciousness and no use of sedation scale and promoted the use of alternatives to continuous infusion of midazolam or propofol (intervention). RESULTS: Inclusions were stopped before reaching the planned enrolment. Between 2012 and 2014, 584 patients were included in the intervention group and 590 in the control group. Baseline characteristics were well balanced between groups. Although the use of midazolam and propofol was significantly lower in the intervention group, 90-day mortality was not significantly lower (39.4 vs. 44.2% in the control group, p = 0.09). There were no significant differences in 1-year mortality between the two groups. The time to first spontaneous breathing trial and time to successful extubation were significantly shorter in the intervention group than in the control group. These last results should be interpreted with precaution regarding the several limitations of the trial including the early termination. CONCLUSIONS: This underpowered study of severely ill patients was unable to show that a strategy to prevent oversedation could significantly reduce mortality. Trial registration NCT01617265. PMID: 30242747 [PubMed]

Transglutaminase-catalyzed preparation of crosslinked carboxymethyl chitosan/carboxymethyl cellulose/collagen composite membrane for postsurgical peritoneal adhesion prevention.

Related Articles Transglutaminase-catalyzed preparation of crosslinked carboxymethyl chitosan/carboxymethyl cellulose/collagen composite membrane for postsurgical peritoneal adhesion prevention. Carbohydr Polym. 2018 Dec 01;201:201-210 Authors: Cai X, Hu S, Yu B, Cai Y, Yang J, Li F, Zheng Y, Shi X Abstract Peritoneal adhesion is a general complication following pelvic and abdominal surgery, which may lead to chronic abdominal pain, bowel obstruction, organ injury, and female infertility. Biodegradable polymer membranes have been suggested as physical barriers to prevent peritoneum adhesion. In this work, a transglutaminase (TGase)-catalyzed crosslinked carboxymethyl chitosan/carboxymethyl cellulose/collagen (CMCS/CMCL/COL) composite anti-adhesion membrane with various proportions of CMCS, CMCL, and COL (40/40/20, 35/35/30, 25/25/50) was developed. After crosslinking by TGase, the composite anti-adhesion membranes shown enhanced mechanical properties and improved biodegradability. Meanwhile, the high cytocompatibility of anti-adhesion membranes was proved by in vitro cell culture study. Moreover, the anti-adhesion membrane with the proportion of 25/25/50 was implanted between the artificially defected cecum and peritoneal wall in rats and following by general observation, histological examination, and inflammatory factors assay. The results indicated that the anti-adhesion membrane can significantly prevent peritoneal adhesion with negligible immunogenicity. Therefore, the composite membrane crosslinked by TGase had satisfactory anti-adhesive effects with high biocompatibility and low antigenicity, which could be used as a preventive barrier for peritoneal adhesion. PMID: 30241812 [PubMed - in process]

The Role of Endotherapy in Recurrent Acute Pancreatitis.

Related Articles The Role of Endotherapy in Recurrent Acute Pancreatitis. Gastrointest Endosc Clin N Am. 2018 Oct;28(4):455-476 Authors: Guo A, Poneros JM Abstract Patients with recurrent acute pancreatitis (RAP) have few treatment options available to them to manage their symptoms or prevent progression to chronic pancreatitis. At present, endotherapy is typically pursued as a means to achieve symptom remission and reduce rates of recurrence, hospitalization, abdominal pain, narcotic use, and surgical intervention. However, evidence that endotherapy effectively alters the natural history of disease remains limited. This article reviews the recent literature on the efficacy of endoscopic intervention in the treatment RAP with a focus on high-quality prospective randomized controlled studies. Additional studies are needed to corroborate these findings. PMID: 30241638 [PubMed - in process]