Articles: pain-clinics.
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Dysmenorrhoea (period pain) is a common condition with a substantial impact on the well-being and productivity of women. Primary dysmenorrhoea is defined as recurrent, cramping pelvic pain that occurs with periods, in the presence of a normal uterus, ovaries and fallopian tubes. It is thought to be caused by uterine contractions (cramps) associated with a high level of production of local chemicals such as prostaglandins. The muscle of the uterus (the myometrium) responds to these high levels of prostaglandins by contracting forcefully, causing low oxygen levels and consequently pain. Nifedipine is a calcium channel blocker in widespread clinical use for preterm labour due to its ability to inhibit uterine contractions in that setting. This review addresses whether this effect of nifedipine also helps with relief of the uterine contractions during menstruation OBJECTIVES: To assess the effectiveness and safety of nifedipine for primary dysmenorrhoea. ⋯ The evidence is insufficient to confirm whether nifedipine is a possible medical treatment for primary dysmenorrhoea. The trials included in this review had very low numbers and were of low quality. Notably, there was a large imbalance in numbers randomised between placebo and treatment groups in one of the two trials with data available for analysis. While there was no evidence of a difference noted in adverse effects between groups, more data from larger participant numbers are needed for this outcome. Larger, more well-conducted trials are required to elucidate the potential role of nifedipine in the treatment of this common condition, as it could be a useful addition to the therapeutic options available if shown to be well tolerated and effective. The safety of nifedipine in women of reproductive age is well established from trials of its use in preterm labour, and clinicians are accustomed to off-label use for this indication. The drug is inexpensive and readily available. Other options for relief of primary dysmenorrhoea are not suitable for all women; NSAIDs and the oral contraceptive pill (OCP) are contraindicated for some women, and the OCP is not suitable for women who are trying to conceive. In addition, the trials examined suggest there may be a participant preference for nifedipine.
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Review Case Reports
Recurrent thoracic duct cyst of the left supraclavicular fossa: A retrospective study of 6 observational case series and literature review.
The transient occlusion of the terminal thoracic duct is a rare disease responsible for renitent supraclavicular cysts. The aim of this study was to describe the clinical characteristics, evolution, and treatment. A retrospective multicenter study and literature review was carried out. ⋯ Thoracic duct imaging was performed in all cases to detect abnormalities or extrinsic compression as well as to eliminate differential diagnoses. A painless, fluctuating, noninflammatory, and recurrent swelling of the left supraclavicular fossa in patients evoking an intermittent obstruction of the terminal portion of the thoracic duct was identified. A low-fat diet was found as safe and effective treatment.
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Migraine is a chronic paroxysmal neurovascular disease in which pain on one or both sides of the head is the main manifestation and is accompanied by other neurological manifestations. Clinical practice has shown that cutting therapy as a complementary alternative medicine can play a role in relieving migraine attacks. However, there is no consensus on the efficacy of cutting treatment in the treatment of migraine. The aim of this study was to conduct a meta-analysis to systematically evaluate the efficacy and safety of cutting therapy in the treatment of migraine. ⋯ The results of this systematic evaluation will provide an objective evidence-based framework for judging the effectiveness and safety of cutting therapy in the treatment of migraine.
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Observational Study
Epidemiology of Meckel's diverticulum: A nationwide population-based study in Taiwan: Characteristics of the cases from surgery between 1996 and 2013.
The diverse presentation of Meckel's diverticulum (MD) is a diagnostic challenge for clinicians and most previous studies consist of single institutional case series. The aim of this study was to review the related diagnoses of MD and to investigate the epidemiological characteristics using Taiwan's National Health Insurance Research Database. We conducted an observational study using a population-based database. ⋯ Among the symptomatic MD patients, intestinal obstruction was present in 583 (48%), acute appendicitis was present in 464 (38%), and gastrointestinal bleeding was present in 283 (23%) patients. Intestinal obstruction was the most common preoperative diagnosis in the 0 to 10 years and >20 years' age groups, and acute appendicitis (acute abdominal pain) was the most common diagnosis in the 11 to 20 years' age group. This population-based 18 years' epidemiologic study described the distributions of MD symptoms among different age groups, which may help clinicians gain a better understanding of this diagnostically challenging gastrointestinal anomaly.
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Randomized Controlled Trial
Efficacy of moxibustion in diabetes peripheral neuropathy.
Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus. The main clinical manifestations of DPN include pain, numbness, paraesthesia, and weakness of the lower limbs which often leads to diabetic foot ulceration, eventually resulting in amputation. Based on Traditional Chinese Medicine theory, moxibustion has a great effect on treating and preventing DPN. However, randomized clinical trials done to evaluate the efficacy of this treatment are still lacking. Hence, this study is carried out to evaluate the effectiveness and safety of moxibustion therapy on diabetic peripheral neuropathy. ⋯ We hope that this trial will provide valuable insights on the efficacy of moxibustion in the management of diabetic peripheral neuropathy.