RESUMEN
Objective: Postherpetic neuralgia (PHN) is a clinical puzzle, especially in patients who still suffered from moderate and severe pain after standard treatment. This single-center, double-blinded, randomized controlled, prospective, and non-inferiority study observed the safety and effectiveness of the epidural application of morphine or hydromorphone, trying to provide an alternative method for those patients with refractory PHN. Methods: Eighty PHN patients with a visual analogue scale (VAS) still greater than 50 mm after routine management were randomly divided into two groups according to 1:1, respectively. One group received epidural morphine (EMO group), and the other group received epidural hydromorphone (EHM group). VAS, the number of breakthrough pain, quality of life (QOL), and anxiety/depression assessment (GAD-7 and PHQ-9 scores) were also observed before treatment, at 1, 3, 7, 14, 21, 28, 60, and 90 days after treatment, as well as side effects. Opioid withdrawal symptoms (OWSs) were also measured from 3 to 28 days after treatment. Results: The EHM group was non-inferior to the EMO group in terms of the VAS decrease relative to baseline (VDRB) after 1-week treatment. The VAS of the two groups on all days after treatment was significantly lower than the corresponding baseline findings (p < 0.05). The breakthrough pain (BTP) decreased significantly after treatment and lasted until 14 days after treatment (p < 0.05). There was no significant difference in BTP between the two groups at each time point (p > 0.05). In terms of the QOL, GAD-7, and PHQ-9 outcomes, those were significantly improved after treatment (p < 0.05), and there was no difference between the two groups (p > 0.05). No significant AE difference across the two groups was observed in this study. Few reports of OWS were found in this trial, and there were no significant differences between the two groups (p > 0.05). Conclusion: EHM was non-inferior to EMO in terms of the VDRB after 1-week treatment. For patients with VAS still greater than 50 mm after standard treatment, short-term application of EMO or EHM can ameliorate intractable pain, improve the quality of life, and have no obvious side effects. Short-term epidural opioid application will not lead to the appearance of OWS.
RESUMEN
Objective To investigate the effect of Kinesio Taping on interleukin-1β(IL-1β),tumor necrosis factor α(TNF-α)and matrix metalloproteinase-3 (MMP-3)in synovial fluid of patients with knee osteoarthritis in early and middle stage.Methods A total of 84 patients with knee osteoarthritis who met the inclusion/exclusion criteria were randomly selected and divided into the control group treated with placebo(kinesiology tape without elasticity)and the experimental group treated with Kinesio Tape.Both two tapes were changed every two days,with 15 times of changes as a course of treatment.Synovial fluid sample was drawn before and one week after treatment,and was used for measuring Levels of 1L-1β,TNF-α and MMP-3 by enzyme-linked immunosorbent assay (ELISA).and knee function was evaluated before and 1 week after treatment.Results Compared with pre-treatment,the levels of IL-1β,TNF-α and MMP-3 in synovial fluid were significantly decreased in the experimental group after treatment [(20.07 ± 6.94) ng/Lvs.(38.12 ± 5.93) ng/L,(42.42±8.76)ng/Lvs.(58.23±9.54)ng/L,(11.28±1.99)μg/L vs.(15.67±2.21)μg/L,t =12.81,7.91 and 9.57,all P＜0.05].The levels of IL-1β,TNF-α and MMP-3 in synovial fluid were lower in the experimental group after treatment than before treatment[(20.07±6.94)ng/L vs.(38.12±5.93)ng/L,(42.42±8.76)ng/L vs.(58.23±9.54)ng/L,(11.28 ±1.99)μg/L vs.(15.67±2.21)ng/L,t =12.81,7.91 and 9.57,all P＜0.05],and were lower in the experimental group after treatment than in control after treatment[(20.07±6.94)ng/L vs.(37.97±6.21)ng/L,(42.42±8.76)ng/L vs.(57.04 ±8.73)ng/L,(11.28± 1.99)μg/Lvs.(15.01± 2.56)μg/L,t =12.46,7.66 and 7.46,all P＜0.05]Lysholm score was significantly higher in the experimental group after treatment than before treatment[(74.5 ± 2.6) vs.(44.7 ± 2.8),t =50.54,P ＜0.05],and was also higher in the experimental group after treatment than in the control group after treatment[(74.5±2.6) vs.(50.2± 2.3),t =45.37,P＜0.05].Conclusions Kinesio Taping can significantly reduce the levels of IL-1β,TNF-α and MMP-3 in synovial fluid of patients with knee osteoarthritis through inhibiting the inflammatory response in articular cavity.