Diabetic neuropathic pain (DNP) is one of the most common and complex complications of diabetes. In recent years, studies have shown that gut microbiota can regulate inflammatory response, intestinal permeability, glucose metabolism, and fatty acid oxidation, synthesis, and energy consumption by regulating factors such as lipopolysaccharides, short chain fatty acids, bile acids, and branched chain amino acids, achieving the goal of treating DNP. This paper summarizes the relevant mechanisms of gut microbiota in the treatment of DNP, the relevant intervention measures of traditional Chinese and western medicine, in order to provide new ideas for clinical treatment of DNP.
Objective To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.
摘要:目的: 探讨深部痛点阻滞在治疗顽固性癌痛患者中的作用。 方法 : 将156例顽固性癌痛患者,随机分为深部痛点阻滞组及对照组,每组78例。深部痛点阻滞组根据疼痛部位,应用软组织外科学理论找出相应压痛点,给予痛点深部阻滞治疗;对照组找出压痛点但仅按三阶梯用药原则给予口服药物治疗。 结果 : 深部痛点阻滞组及对照组两组患者经治疗后疼痛控制均较理想(深部痛点阻滞组VAS13, 对照组VAS17),但是深部痛点阻滞组吗啡用量明显少于对照组(吗啡日平用量深部痛点阻滞组为335mg, 对照组为15287 mg)。便秘的发生率深部痛点阻滞组为5384%,对照组为7692%。 结论 : 深部痛点阻滞能较好的控制顽固性癌痛,同时可明显减少吗啡的用量,副作用相对发生要少。Abstract: Objective: To investigate the effect of the deeppressed pain points injection on the refractory cancer pain and provide reference for relieving the cancer pain. Methods : One hundred and fiftysix patients with refractory cancer pain were diagnosed by the soft tissue surgery,finding the pain point by pressing deeply,the patients with deeppressed pain points were divided into deeppressed pain points injection group and control group randomly, The patients in deeppressed pain points injection group were treated with deeppressed pain points injection; the patients in control group were treated with drugs according with the WHO analgesic ladder. Results : The patients in deeppressed pain points injection group got the same pain relief as those in control group (VAS 13 in deeppressed pain points injection group, 17 in control group ),but the daily dose of morphine in deeppressed pain points injection group was less than that incontrol group (morphine 335mg/day in deeppressed pain points injection group,15287mg/day in control group ) significantly. There was 5384% patients with constipation in deeppressed pain points injection group, 7692% in control group. Conclusion : The refractory cancer pain can be controlled effectively by the deeppressed pain point injection and the daily dose of morphine to control the cancer pain is decreased significantly. The side effect in deeppressed pain points injection group was less than that in control group.
ObjectivesTo systematically review the efficacy of yoga treatment for low back pain.MethodsWeb of Science, BBSCO Academic Source Complete, Elsevier ScienceDirect, Scopus, PubMed, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of yoga intervention for low back pain from inception to November 4th, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 14 RCTs involving 1 684 patients were included. The results of meta-analysis showed that: compared with conventional treatment, the RMDQ scores of yoga treatment for low back pain was statistically significant lower (MD=–1.86, 95%CI –2.39 to –1.33, P<0.000 01). The results of subgroup analysis showed that the exercise frequency, low back pain degree, low back pain cause, intervention period and sample size had not altered efficacy of yoga.ConclusionsCurrent evidence shows that yoga can achieve superior results in low back pain. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo compare postoperative patient-controlled epidural analgesia (PCEA) and intravenous patient-controlled analgesia (PCIA) on maternal low back pain after caesarean section. MethodsSixty cases of American Society of Anesthesiology gradeⅠ-Ⅱ single-birth full-term elective caesarean delivery primiparae chosen between July to September 2012 were divided into 3 groups randomly, 20 in each group. Group A accepted sufentanil 1 μg/mL and ropivacaine 1 mg/mL PCEA; group B had sufentanil 1.5 μg/mL PCEA; group C was given sufentanil 1.5 μg/mL and ondansetron 0.16 mg/mL PCIA. Background dose was 2 mL/h, patient-controlled analgesia dose was 2 mL, and locking time was 20 min. Visual analogue pain score was used to assess the effect of postoperative analgesia, and we recorded analgesia pump usage, adverse reactions, and at the same time investigated the onset of maternal low back pain. ResultsNo obvious postoperative pain was found, and the analgesic effect was good in all the three groups, and the differences were not statistically significant (P>0.05). All three groups of women had a certain proportion of low back pain, and the differences were not statistically significant (P>0.05). After operation, group A had 5 cases of leg numbness, group B had 1, and group C had none. Leg numbness occurred significantly more in group A than in group B and C (P<0.05). Group B had one case of nausea and vomiting, while none occurred in group A and C (P>0.05). ConclusionWith the same effect of postoperative analgesia, compared with PCIA, PCEA does not increase postoperative low back pain incidence after caesarean section.
Objective To analyze the effectiveness of endoscopic calcaneoplasty (ECP) for treating hindfoot pain in patients with Haglund’s deformity by comparing with conservative treatment. Methods According to the included standard, 64 hindfoot pain patients (77 feet) with Haglund’s deformity treated between January 2007 and October 2013 were enrolled. Based on the patient’s sports habit, 39 patients (49 feet) who had no requirement on sports were given conservative treatment (control group) and 25 patients (28 feet) who had stable sports habit were given ECP (ECP group). There was no significant difference in age, gender, disease duration, disease side, Fowler-Philip angle, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 2 groups (P > 0.05). Results The patients were followed up 16-44 months (mean, 33.7 months) in ECP group, and 12-40 months (mean, 37.5 months) in control group. In control group, the syndrome in 34 cases (43 feet) disappeared after 2 weeks; pain was improved in 5 cases (6 feet), and pain disappeared at 3 weeks after orthesis immobilization; hindfoot pain recurred in 24 cases (30 feet) during following-up, 11 cases (13 feet) underwent ECP after 1 year. In ECP group, all incisions healed by first intention without nerve injury; no edema or pain was observed during follow-up. AOFAS ankle-hindfoot score was significantly improved in 2 groups when compared with score at pre-treatment (P < 0.05). With time, AOFAS ankle-hindfoot score gradually decreased in control group, but it gradually increased in ECP group. The AOFAS ankle-hindfoot score of ECP group was significantly higher than that of control group after treatment (P < 0.05). According to Ogilvie-Harris score system at 12 months, the results were excellent in 9 cases, good in 12 cases, and poor in 4 cases, with the excellent and good rate of 84.00% in ECP group; and the results were excellent in 8 cases, good in 14 cases, and poor in 17 cases, with the excellent and good rate of 56.41% in control group. There was significant difference in the excellent and good rate between 2 groups (Z=-2.194, P=0.028). Conclusion Under the premise of strict control of surgical indications, the ECP can bring satisfactory effectiveness for treatment of hindfoot pain in patients with Haglund’s deformity.
By reviewing the current status of chronic pain and combining with the new definition of pain revised by the International Association for the Study of Pain in 2020, firstly a prevention-based approach, self-management of pain, and multidisciplinary collaboration based on the integration of bio-psycho-social-environmental factors is proposed. The medical mode will greatly improve the treatment effect of chronic pain and the quality of life of patients. Secondly, the importance of strengthening humanistic care and paying attention to health education, as well as improving medical staff’s awareness of chronic pain and the level of diagnosis and treatment are pointed out. Finally, it is clarified that innovative non-drug treatments and the establishment of digital pain management platforms are the future of chronic pain.
Non-specific neck pain is the most common type of neck pain. Without timely and effective treatment, majority of patients might develop chronic non-specific neck pain. In addition to pain, patients also suffer multiple dysfunctions. Considering the individual differences of patients, strategies of targeted exercise therapy based on the specific dysfunction of patients have attracted attention. In this paper, exercise therapies for common dysfunctions of patients with chronic non-specific neck pain, such as decreased mobility of cervical and thoracic spine, insufficient activation of deep cervical flexors, poor muscle strength and endurance, abnormal breathing pattern, and impaired proprioception are introduced, in order to provide clinical guidance for individual rehabilitation.
OBJECTIVE: To provide a better treatment method of lumbar stenosis and root pain resulting from simple hypertrophy of ligamentum flavum. METHODS: By studying the records of 143 lumbar pain cases, we found 5 cases caused by simple hypertrophy of ligamentum flavum. All the patients were old man with a long progressed history. There was little difference of clinical features between the disc herniation and hypertrophy of ligamentum flavum. All cases accepted resection of ligamentum flavum. RESULTS: All the symptoms were relieved postoperatively. The patients could walk. CONCLUSION: The degeneration of lumbar ligamentum flavum can cause lumbar stenosis and root pain. Resection of ligamentum flavum can relieve the symptom.
ObjectiveTo systematically review the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain. MethodsDatabases such as The Cochrane Library (Issue 1, 2014), PubMed, Web of Science, CNKI, VIP, CBM and WanFang Data were searched for randomized controlled trials (RCTs) on the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain up to January 2014. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1.0 software. ResultsA total of 35 RCTs involved 3 406 patients were included. The results of meta-analysis showed that, there was no significant difference in effectiveness between transdermal fentanyl and oral morphine for moderate/severe cancer pain (OR=1.00, 95%CI 0.80 to 1.27, P=0.99). Compared with oral morphine, transdermal fentanyl was better in lowering the incidences of constipation, nausea and vomiting, lethargy and urinary retention; but transdermal fentanyl increased the incidences of skin rashes and itch (P < 0.05). ConclusionTransdermal fentanyl is as effective as oral morphine in the treatment of moderate/severe cancer pain, and transdermal fentanyl causes less side effects. Due to poor quality of the included studies, the above conclusion should be verified by further conducting more high quality RCTs.