ABSTRACT
Background: Avoidant paruresis is a common clinical condition in urology and psychosomatic medicine. However, it has limited treatment options that are safe and effective with few side effects. Aims: Our study aimed to investigate the effectiveness and safety of the Chinese herbal Yangxin Tongquan decoction combined with cognitive-behavioural therapy (CBT) for avoidant paruresis. Methods: Sixty-eight patients with avoidant paruresis were divided into a treatment group (33 patients) and a control group (35 patients). The control group was assigned 10 weeks of CBT and systematic desensitisation. In addition to CBT and systematic desensitisation, the treatment group was given the Chinese herbal Yangxin Tongquan decoction during the 10-week study. The Shy Bladder Syndrome Scale (SBS) and the Self-rating Anxiety Scale (SAS) were administered before and after treatment to measure any change. Results: The overall efficacy in the treatment group (n=30) was 80.0% vs 62.5% in the control group (n=33). Comparing pretreatment and post-treatment measures, both groups showed improvement in SBS scores and SAS scores (treatment group: t(SBS) =8.397, p(SBS) <0.001, t(SAS) =8.216, p(SAS)<0.001; control group: t(SBS) =6.802, p(SBS) <0.001, t(SAS)=5.171, p(SAS) <0.001). Moreover, both groups' SBS and SAS scores changed significantly over time (SBS scores: Ftime =118.299, p<0.001; SAS scores: Ftime =92.114, p<0.001). However, the treatment group performed better than the control group (SBS scores: Ftime*group =5.709, p=0.020; SAS scores: Ftime*group =7.235, p=0.009). Conclusions: The Chinese herbal Yangxin Tongquan decoction combined with cognitive-behavioural psychotherapy positively affects the treatment of avoidant paruresis without significant adverse effects.
ABSTRACT
OBJECTIVE: Our study aimed to investigate the feasibility and effectiveness of preoperative electroacupuncture (EA), delivered 24hours before surgery, on postoperative nausea and vomiting (PONV) and postoperative pain in patients undergoing gynecologic laparoscopic surgery. METHODS: In this randomized controlled trial, 40 patients scheduled for elective gynecologic laparoscopic surgery were randomly assigned to the usual care (UC) group and the EA group (n = 20 each). Both groups received the routine treatment consisting of intravenous dexamethasone (5mg) after induction of anesthesia and intravenous tropisetron (5mg) before the end of the operation. The patients in the EA group received EA at bilateral neiguan (PC6) and zusanli (ST36) within 24hours prior to the surgery. The incidence and severity of PONV and pain were recorded at 6hours, 12hours, and 24hours after the operation. Time to first flatus passage was also recorded. Bonferroni-corrected independent sample t-tests were used to analyze the data. RESULTS: In the first six hours after surgery, 15% and 20% of the patients experienced postoperative nausea in the EA and the UC groups, respectively. The incidences of postoperative vomiting were 5% for the EA group and 20% for the UC group. PONV reduced to zero over 12hours in both groups and there was no statistically significant difference in PONV between the two groups at any time point. The EA group rated their postoperative pain statistically significantly lower than the UC group did at six hours postoperative (EA: 1.9 ± .8; UC: 2.9 ± .9, P = .001). The two groups did not differ in pain at 12 and 24hours. The EA group had a shorter time to pass first flatus than the UC group did (EA: 20.3hours ± 6.1; UC: 26.4 ± 5.2, P = .002). The common EA-related adverse effects were minor, and did not require medical attention. The patients tolerated the EA treatment well. CONCLUSION: It is feasible and safe to deliver one-session EA treatment within 24hours preoperatively to preempt postoperative pain. One-session preoperative EA may also accelerate motility of the gastrointestinal track. Properly powered studies are needed to further test the effectiveness of preoperative EA on PONV.
