Comparison of the effect of stretching exercises and mefenamic acid on the reduction of pain and menstruation characteristics in primary dysmenorrhea: a randomized clinical trial

Objectives: Dysmenorrhea is a common gynecologic disorder. Although non-steroidal anti-inflammatory drugs are commonly used, due to their side effects and lack of response in some individuals, other approaches such as exercise have been considered. This study compared the effect of stretching exercises and mefenamic acid on the reduction of pain and menstruation characteristics in primary dysmenorrhea

Methods: In this randomized clinical trial, 122 female students with moderate to severe dysmenorrheal were assessed and were placed in either the exercise or mefenamic acid group. The exercise program was performed for 15 minutes, three times a week and included a five-minute warm up and six belly and pelvic stretching exercises for 10 minutes. The mefenamic acid group received 250 mg capsules every eight hours from the onset of menstruation until pain relief. Both interventions were performed during two consecutive menstrual cycles. Pain intensity was measured using a 10 cm visual analog scale

Results: The mean pain intensity was significantly higher in the exercise group only in the first cycle [p = 0.058]. In the second cycle, the mean difference in pain reduction in the exercise group was higher than the mefenamic group compared to the start of the study [p = 0.056] and the first cycle [p = 0.007]. There was no significant difference in the severity and duration of pain between the groups [p > 0.050]

Conclusions: Stretching exercises were as effective as mefenamic acid in the treatment of primary dysmenorrhea. Our results suggest that the effect of exercise on relieving menstruation pain increases over time

Mefenamic acid-induced bilateral transient myopia, secondary angle closure glaucoma and choroidal detachment.

Drug-induced secondary angle closure is quite common and in the majority of cases simply stopping the medication leads to rapid reversal of the condition and resolution of glaucoma. We describe here a patient who presented with secondary angle closure glaucoma and myopia following mefenamic acid ingestion which was managed successfully by stopping the medication, symptomatic treatment and reassurance.

Randomized controlled trial of mefenamic acid vs paracervical block for relief of pain for outpatient uterine curettage.

OBJECTIVE: To compare the efficacy of mefenamic acid vs paracervical block for pain relief during and after fractional curettage. MATERIAL AND METHOD: Between January 1 and July 31, 2002, the authors enrolled 87 patients with abnormal uterine bleeding, who requested fractional curettage at the Outpatient Gynecologic Clinic, Srinagarind Hospital, Khon Kaen University. A simple randomization procedure was used to distribute the patients into a control group comprising 44 patients given a paracervical block and a treatment group comprising 43 patients given mefenamic acid (500 mg) 2 hours before starting the procedure. OUTCOME MEASURES: Pain was scored using a visual analogue scale (VAS range, 0 to 10). RESULTS: The median pain scores of the treatment types during endocervical, endometrial, immediately after, and 30 minutes after, fractional curettage were 2.5 vs 3.0 (p = 0.42), 6.5 vs 7.5 (p = 0.19), 4.0 vs 3.5 (p = 0.20) and 1.5 vs 1.0 (p = 0.17), respectively. The rate of complications was 6.8% (3 in 44) in the paracervical lignocaine injection group. CONCLUSION: The efficacy of pain relief for fractional curettage using oral mefenamic acid (500 mg) two hours before the procedure was not statistically different from the paracervical block, but there were fewer side effects. Mefenamic acid should be considered an alternate pain relief during fractional curettage.

Eficácia e segurança do uso do inibidor seletivo da COX-2 versus antiinflamatório não esteróide clássico no tratamento sintomático da dismenorréia primária / Efficacy and safety of COX-2 selective inhibitor versus non selective NSAID in the symptomatic treatment of primary dysmenorrhea

Objetivo:Observação da eficácia e segurança do meloxican ( inibidor seletivo da COX-2) com ácido mefenâmico ( AINE clássico), por um periodo de três a cinco dias, durante três ciclos menstruais, para o tratamento da dismenorréia primária. Materiais e Métodos: Multicêntrico, internacional, duplo cego, paralelo, três grupos, randomizado, fase III b, 337 pacientes. AS variáveis contínuas dos grupos comparados foram analisadas através do teste de Kruskal-Wallis e Wilcoxon. Na avaliação da eficácia se utilizou o teste de Fisher e o qui-quadrado. Resultados : Meloxican 7,5 mg, 15 mg exibiu um perfil semelhante na redução da dor e dos sintomas da dismenorreia primário em comparação ao acido mefenamico. Quarenta e nove indivíduos apresentaram eventos adversos. Quase metade desses 49 pacientes eram do grupo que usou acido mefenamico. Não houve diferenças entre os perfis de segurança entre as duas dosagens de meloxican. As anormalidades laboratoriais não se diferenciaram entre os grupos estudados. Este estudo demonstrou que um AINE inibidor seletivo da COX-2 apresenta a mesma eficiência que um AINDE clássico porém com melhor perfil de tolerabilidade gastrintestinal.

Antipyretics in children.

Fever is an important symptom of underlying disease condition and in general is considered harmful in pediatric age group as it may lead to febrile seizures, stupor, dehydration increase work of breathing, discomfort and tachycardia. The increase metabolic demands stress the patient with marginal cardiac and cerebral vascular supply. The hypothalamus controls the body temperature. The fever results due to resetting of the hypothalamus that occur from the prostaglandins produced by the pyrogens. Fever is treated variedly by the pediatricians. The physical therapy offers a simple and cost effective way of lowering the body temperature. The drugs as paracetamol, nimesulide and ibuprofen lower the temperature by inhibiting the prostaglandin synthesis. Paracetamol is considered the safest of all the antipyretic drugs. It is recommended that a combination of physical therapy such as tepid sponging and paracetamol is best way of controlling temperature.

Choice of antipyretic in children.

The objective of this study was to evaluate the relative efficacy of 3 commonly used antipyretics viz. mefenamic acid, ibuprofen and paracetamol. The subjects were randomized to 3 groups to receive either paracetamol 10 mg/kg or ibuprofen 7 mg/kg or mefenamic acid 6.5 mg/kg. Axilla temperature was recorded just prior to drug administration and at hourly intervals for 4 hrs. The mefenamic acid group (n = 29) showed a drop of 3.5 degrees F at the end of 4 hours as compared to the paracetamol group (n = 29) (drop 2.44 degrees F) and ibuprofen group (n = 20) (drop 2.79 degrees F). Analysis of the area under the mean temperature vs. time curve showed that mefenamic acid demonstrated significantly better antipyretic activity compared to paracetamol (P < 0.05) over the entire period of observation and ibuprofen (P < 0.05) in the 2 to 4 hour range. Mefenamic acid continued to show antipyretic activity at the end of 4 hours in contrast to ibuprofen and paracetamol. Since the period of observation was restricted to 4 hours, we were unable to quantify the precise duration of its extended antipyretic efficacy.

Tratamiento de la dismenorrea primaria: estudio comparativo de ibuprofen y ácido mefenámico / Treatment of primary dysmenorrhea: comparative study of ibuprofen and mefenamic acid

Se estudio el efecto terapéutico del ácido mefenámico (Grupo A) y del ibuprofen (Grupo B) en el tratamiento de la dismenorrea primaria severa. Se estudiaron 60 pacientes en base doble ciego en 2 grupos de 30 pacientes seleccionadas al azar. El grado inicial del dolor para el Grupo A fue de 8.6 y 8.5 para el primero y segundo ciclo y para el Grupo B de 8.2 en ambos ciclos. El tratamiento se inició en el momento en que se presentó el cólico menstrual y se administró una tableta del medicamento cada 8 horas durante el tiempo que duró el cólico menstrual. La intensidad del cólico menstrual se registró en la escala visual análoga (0 = no dolor, 10 = dolor incapacitante) en el momento del inicio del dolor y a las 2 horas de tomar la primera tableta del medicamento después de registró cada 8 horas antes de tomar la tableta correspondiente. La disminución del dolor se inició después de haber tomado la segunda tableta en ambos grupos siendo progresiva con el uso del medicamento. El número de tabletas tomadas fue en promedio 5.0 y 4.8 para el Grupo A y de 4.3 y 4.2 para el Grupo B. El promedio de la duración del dolor fue para el Grupo A 23.4 y 21 horas y para el Grupo B de 20 y 18.9 horas para el primero y segundo ciclos respectivamente

Therapy of symptomatic patent ductus arteriosus in preterms using mefenemic acid and indomethacin.

Mefenemic acid (MA) was given in three doses of 2 mg/kg/dose at 12 hourly intervals in 16 cases clinically suspected of having symptomatic patent ductus arteriosus (PDA). All babies were 35 weeks gestation (mean 30.1 weeks) and weighed less than or equal to 1700 g at birth (mean 1320 g), the mean age of administration of MA being 16 days. Of the 16 cases, two did not respond to therapy. One non-responder was subsequently shown to have an endocardial cushion defect without PDA on 2-D Echo and Doppler study. The other was 29 days old at the initiation of therapy. In once case, the ductus reopened after an initial closure, however, it closed on repeating a second course of the drug. Thirty preterms (less than or equal to 34 weeks) who were earlier treated with three doses of indomethacin (0.25 mg/kg/dose) formed the comparative study group. The closure rate of PDA on treatment with indomethacin was 70% and that with MA was 93.3% (p greater than 0.05). Two neonates treated with MA and two treated with indomethacin had feeding intolerance and vomiting, perhaps attributable to the drug therapy. We recommend the use of MA for closure of symptomatic PDA in preterms, especially in those cases where indomethacin is not tolerated or when minute titration of its dosage is impracticable.

Estudo duplo-cego entre a floctafenina, ácido mefenâmico, diclofenac e piroxicam em pacientes com dismenorréia primária / A double blind study with floctafenin, mefenamic acid, diclofenac and piroxicam in patients with primary dysmenorrhea

Foram estudadas 308 pacientes com dismenorréia primária em nove centros nacionais, tratadas sucessivamente, durante quatro meses consecutivos, com floctafenina 200 mg (1 comp. de 8/8 h), ácido mefenâmico 500 mg (1 comp. de 8/8 h), diclofenaco 50 mg (1 comp. de 8/8 h) ou piroxicam 10 mg (1 cápsula de 12/12 h). A tomada dos medicamentos era iniciada aos primeiros sintomas de aparecimento da dismenorréia e continuava enquanto persistissem as queixas, até um máximo de 48 horas de tratamento. As pacientes recebiam um cartäo de acompanhamento onde registravam a intensidade e o tipo de sintoma, dentre outras variáveis. Os resultados foram analisados estatisticamente através das informaçöes obtidas no cartäo de acompanhamento, representados pelo percentual de pacientes que seguiam apresentando as mesmas queixas 48 horas após o início do tratamento. A floctafenina mostrou-se significativamente eficaz sobre a sintomatologia e foi superior aos outros medicamentos estudados em 7 sintomas (dor abdominal, dor lombar, cefaléia, náuseas, diarréia, constipaçäo e sudorese) dos 8 estudados. Do ponto de vista qualitativo, ao se definir um índice obtido pela razäo entre o percentual de pacientes assintomáticos pós e pré-tratamento verificamos que a floctafenina apresentava índices superiores às demais moléculas em 4 sintomas (dor abdominal, sudorese, náuseas e constipaçäo). Com relaçäo à tolerância clínica, os efeitos colaterais foram equivalentes nos produtos testados, à exceçäo da náusea, mais intensa nas pacientes ao fazerem uso do ácido mefenâmico. Concluiu-se que neste tipo de pacientes a floctafenina pode, indiscutivelmente, ser considerada uma alternativa válida no tratamento da dor e outros sintomas associados com a dismenorréia primária

Estudio comparativo de piroxicam versus ácido mefenámico en el tratamiento de la dismenorrea primaria / Comparative study of piroxicam versus mefenamic acid in treatment of primary dipmenorrhea

En este estudio abierto cruzado de 21 pacientes, se comparó la eficacia y la seguridad del piroxicam versus el ácido mefenámico en el tratamiento de la dismenorrea primaria. En los primeros dias del ciclo menstrual, la disminución de la intensidad del dolor fue mayor con el piroxicam (FELDENE). El ácido mefenámico fue superior en aliviar las náuseas. La mayoría de las pacientes e investigadores prefirieron el piroxicam (FELDENE). Ambas drogas fueron igualmente bien toleradas. Estos resultados demuestran que el piroxicam (FELDENE) en el tratamiento de la dismenorrea primaria fue más efectivo en aliviar los síntomas de dolor

Estudio comparativo de piroxicam y ácido mefenámico en el tratamiento de dismenorrea / Comparative study of pyroxicam and mephenamic acid in the treatment of dysmenorrhea

Se llevó a cabo un estudio clínico comparativo cruzado, entre piroxicam y ácido mefenámico en 40 pacientes con dismenorrea primaria. Las dosis utilizadas fueron: piroxicam 20 mg. dosis única diaria, y ácido mefenámico, 500 mg cada 8 horas; ambos durante 5 días. Medido por una escala análoga de 0 a 10 resultados indican claramente que piroxicam fue superior al ácido mefenámico para abolir o disminuir el dolor. Tanto las pacientes como el investigador señalaron su preferencia por piroxicam sobre el ácido mefenámico, así como la comodidad de su administración (una vez al día)