Effects of ear and body acupressure on labor pain and duration of labor active phase: A randomized controlled trial

ObjectivesThis study sought to compare the effects of multi-point ear and body acupressure on labor pain and the duration of labor active phase.DesignThree-armed randomized controlled trial.SettingKowsar Hospital, Qazvin, Iran.InterventionParticipants in the body acupressure group received acupressure on GB21, GB30, BL32, LI4, and SP6 points, each for two minutes, at cervical dilation of four, six, and eight centimeters. For participants in the ear acupressure group, adhesive auriculotherapy-specific Vaccaria seeds were attached to their auricles on the zero, genitalia, Shen Men, thalamic, and uterine 1 and 2 acupoints. The seeds were compressed every thirty minutes, each time for thirty seconds. Participants in the control group received routine care services.Main outcome measuresLabor pain intensity was assessed using a visual analogue scale at cervical dilation of four and ten centimeters.ResultsWhile there was no significant difference between mean scores of pain among three groups, mean score of labor pain in both acupressure groups was significantly less than that in the control group (P < 0.001). However, the difference between the acupressure groups was not statistically significant (P = 0.12). Moreover, the duration of labor active phase in the ear acupressure group was significantly less than those in the body acupressure and the control groups (P < 0.001).ConclusionEar acupressure was significantly effective in reducing labor pain and shortening labor active phase. However, body acupressure solely reduces labor pain. Therefore, ear acupressure can be used to reduce labor pain and shorten labor active phase.     

Effect of LI4 and BL32 acupressure on labor pain and delivery outcome in the first stage of labor in primiparous women: A randomized controlled trial

ObjectiveThis study examines and compares the effect of LI4 and BL32 acupressure with each other and control group on labor pain and delivery outcomes.DesignIn this randomized controlled trial, 105 primiparous women in active phase of first-stage of labor were equally assigned to two experimental groups [acupressure on LI4 (n = 35) or BL32 (n = 35)] and a control group (n = 35).InterventionsThe experimental groups received routine labor care and acupressure in LI4 or BL32 points in three cervical dilatations (4–5, 6–7, and 8–10 cm). The control group only received routine labor care.Main outcome measuresPain was assessed by numerical rating scale in three cervical dilatations, before and after intervention. Type of delivery (cesarean, vaginal or operative delivery) and neonatal Apgar score were considered as delivery outcomes, these data collected by a check list. Data were analyzed using Repeated Measurement, ANOVA, Chi-Square, Kruskal-Wallis, and Mann-Whitney tests.ResultsPain reduction was significantly greater in LI4 and BL32 groups compared with control in all periods of study. Also, acupressure on BL32 point was superior to LI4 point in pain relief in the first and second but not third intervention. No statistically significant difference was observed in terms of delivery outcomes.ConclusionAcupressure on BL32 and LI4 points are effective in reducing labor pain compared to control group with a slight superiority for BL32 points. Acupressure on these points could apply for relief pain in labor as an inexpensive and easy to administered method.     

Effects of acupressure on the childbirth satisfaction and experience of birth: A randomized controlled trial

BackgroundComplementary and alternative medicines have been used to increase comfort and relaxation in mothers during labor. Comforting and preparing the mother in labor can create a positive birth experience. The aim of this study was to evaluate the effect of acupressure on childbirth satisfaction and the experience of giving birth in women with full-term pregnancy, before the onset of labor.MethodsIn 2016, a randomized clinical trial study was conducted in Shahid Akbar Abadi Hospital, Tehran, Iran, enrolling 120 pregnant women at 39–40 gestational weeks with no signs of the onset of labor. They were divided randomly into acupressure, sham acupressure, and control groups. Acupressure points including SP6, BL 60, and BL 32 were pressured bilaterally. Interventions were performed by the researcher, the mother and her relative (husband). Childbirth satisfaction was measured 24 h after delivery. The collected data were analyzed by SPSS software and comparing tests were Chi-squared, Kruskal-Wallis, ANOVA tests (P ≤ 0.05).ResultsThe total childbirth satisfaction did not differ significantly among the three groups (P = 0.460), but the acupressure group had a higher level of satisfaction than the other two groups. Moreover, statistical tests regarding the expectations of the childbirth experience showed a significant difference among the groups (P = 0.033). The actual birth was closest to the expectations of subjects in the acupressure group.ConclusionThis study demonstrated that acupressure may be used as a method in order to attempt to provide a good birth experience and satisfaction of childbirth.     

Out-of-hospital Auricular Acupressure in Elder Patients with Hip Fracture: A Randomized Double-Blinded Trial

Objectives: Auricular acupressure is known to decrease the level of anxiety in patients during ambulance transport. The purpose of this randomized, double‐blind, sham control study was to determine whether auricular acupressure can decrease not only the level of anxiety but also the level of pain in a group of elder patients with acute hip fracture. Methods: With the assistance of the Vienna Red Cross, 38 patients with acute hip fracture were enrolled into this study. Patients were randomized into two study groups: the true intervention group and the sham control group. Subjects in the true intervention group (n= 18) received bilateral auricular acupressure at three auricular acupressure points for hip pain. Patients in the sham group (n= 20) received bilateral auricular acupressure at sham points. Baseline demographic information, anxiety level, pain level, blood pressure, and heart rate were obtained before the administration of the appropriate acupressure intervention. The level of anxiety, level of pain, hemodynamic profiles, and level of satisfaction were reassessed once the patients arrived at the hospital. Results: Patients in the true intervention groups had less pain (F = 28, p = 0.0001) and anxiety (F = 4.3, p = 0.018) and lower heart rate (F = 18, p = 0.0001) on arrival at the hospital than did patients in the sham control group. As a result, the patients in the true intervention group reported higher satisfaction in the care they received during the ride to the hospital. Conclusions: The authors encourage physicians, health care providers, and emergency rescuers to learn this easy, noninvasive, and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation.     

The effects of acupressure and foot massage on pain during heel lancing in neonates: A randomized controlled trial

ObjectiveTo determine the effects of foot massage and acupressure on pain during heel lancing in neonates.MethodsA randomized controlled trial was performed in a university hospital in Turkey between February and December 2018. The neonates were randomized into three groups as acupressure, massage, and control groups. Acupressure was applied to the neonates in the acupressure group, and massage was given to the neonates in the massage group for 2 min before the heel lancing procedure. Pain responses of the neonates in the groups was evaluated with the Neonatal Infant Pain Scale during and 1 min after the heel lancing procedure.ResultsThe study was completed with 139 neonates including 46 neonates in the acupressure group, 47 neonates in the foot massage group, and 46 neonates in the control group. There were statistically significant differences between the acupressure, massage and control groups in terms of their mean NIPS scores during (4.30 ± 2.25, 3.95 ± 2.63, 6.04 ± 1.26; respectively) and 1 min after the heel lancing procedure (1.46 ± 1.46, 1.66 ± 1.66, 3.85 ± 1.37; respectively). There was a significant difference in NIPS scores between the intervention groups and the control groups (p = 0.001).ConclusionsAcupressure and massage were effective in reducing pain in neonates during the heel lancing procedure. However, there was no statistically significant difference between acupressure and massage. Acupressure and massage techniques can be applied for procedural pain management in the newborn.     

The effect of acupressure on quality of life among female nurses with chronic back pain

BackgroundChronic back pain is one of the most common work-related diseases and most important of musculoskeletal disorders in nursing professionals and because of the physical and psychological effects, has a significant impact on quality of life (QOL). Acupressure is a holistic form of complementary medicine. This study aimed to investigate the effect of acupressure on QOL among female nurses with chronic back pain.Materials and methodsThis randomized single-blind clinical trial was conducted on 50 nurses with chronic back pain working at the selected hospitals in Isfahan, Iran. After convenient sampling, the subjects were randomly allocated, through lottery, to the two groups of experimental (n = 25) and sham (n = 25). In the experimental group, acupressure techniques were performed during 9 sessions, 3 times a week for 14 min for each patient. In the sham group, points within 1 cm of the main points were only touched. Data were collected using the SF36 questioner, before, and immediately, 2 weeks, and 4 weeks after the intervention. Data analysis was performed using SPSS software.ResultsIndependent t-test showed that the mean total score of QOL before the intervention was not significantly different between the two groups before the intervention (P = .68). However, it was significantly higher in the experimental group compared to the Sham group, immediately, 2 weeks, and 1 month after the intervention (P < .001).ConclusionsAcupressure on specific points of the foot and back improves back pain and as a result, increases QOL. Therefore, acupressure can be used as a drug-free and low-cost approach without side effects to improve QOL in nurses with chronic back pain.     

Effects of SP6 acupressure on labor pain and length of delivery time in women during labor

OBJECTIVE: The purpose of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in women in labor. DESIGN: Randomized clinical trial. SETTING/LOCATION: Delivery room in a university hospital. PARTICIPANTS: Seventy-five (75) women in labor were randomly assigned to either the SP6 acupressure (n = 36) or SP6 touch control (n = 39) group. The participants were matched according to parity, cervical dilation, labor stage, rupture of amniotic membrane, and husband's presence during labor. There were no additional oxytocin augmentation or administration of analgesics during the study period. INTERVENTION: The 30-minute acupressure or touch on SP6 acupoint was performed. OUTCOME MEASURES: Labor pain was measured four times using a structured questionnaire, a subjective labor pain scale (visual-analogue scale [VAS]): before intervention, immediately after the intervention, and 30 and 60 minutes after the intervention. Length of delivery time was calculated in two stages: from 3 cm cervical dilation to full cervical dilatation, and full cervical dilatation to the delivery. RESULTS: There were significant differences between the groups in subjective labor pain scores at all time points following the intervention: immediately after the intervention (p = 0.012); 30 minutes after the intervention (p = 0.021); and 60 minutes after the intervention (p = 0.012). The total labor time (3 cm dilatation to delivery) was significantly shorter in the SP6 acupressure intervention group than in the control group (p = 0.006). CONCLUSIONS: These findings showed that SP6 acupressure was effective for decreasing labor pain and shortening the length of delivery time. SP6 acupressure can be an effective nursing management for women in labor.     

Effects of dry needling on pain,pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial

ObjectiveTo determine the changes produced by dry needling in active myofascial trigger points in hip muscles compared to a sham needling on pain intensity, main pain area, pressure pain threshold and psychological distress in patients with hip osteoarthritis.DesignSecondary analysis of a single-centre, randomized, double-blinded, clinical trial.Intervention30 participants with mild to moderate hip osteoarthritis were randomly assigned to DN group (n = 15) or sham DN group (n = 15). DN group received three sessions of penetrating DN, and sham DN group received three sessions of non-penetrating DN in hip muscles.Main outcome measures: Pain intensity (Visual Analogue Scale), main pain area (body chart), pressure pain threshold (algometry), psychological distress (Hospital Anxiety and Depression Scale) and self-reported improvement (Global Rate of Change) were measured before and after treatment.ResultsDN group showed statistically significant improvements with large effect sizes for pain intensity (p < 0.001; E.S: 2.7), pressure pain thresholds (p < 0.05; E.S: 1.3-1.8) and psychological distress (p = 0.002; E.S: 1.5) compared to sham DN group. The DN group described a self-reported improvement categorised as quite a bit, great or very great deal better (n = 12, 80%). No statistically significant differences were found between baseline and postintervention in the sham DN group in any variable (p > 0.05).ConclusionsThree sessions of dry needling were more effective than sham dry needling for improving pain intensity, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis in the short term.     

The effect of treatment regimens on salivary cortisol levels in patients with chronic musculoskeletal disorders

BackgroundIncreased levels of circulating cortisol have been associated with pain severity in patients with chronic musculoskeletal disorders (CMD). Little is known about the potential association between pain management and salivary cortisol alterations in CPM patients treated with different regimens.ObjectivesThis prospective feasibility study aimed to determine the effect of two treatment regimens in comparison with sham therapy on pain intensity and disability and salivary cortisol concentration (SCC) in patients with CMD.MethodsThirty patients were randomly assigned to 3 groups of 10: two experimental groups (A and B) and a control group (C). The experimental groups followed physiotherapy treatment (A) or acupuncture (B), while the control group (C) followed a sham therapy for 10 sessions. Pain data were collected using the Chronic Pain Grade (CPG) questionnaire and SCC was measured by enzyme-linked immunosorbent assay at pre- and posttreatment.ResultsRepeated-measures analysis of variance showed that patients treated with acupuncture experienced greater decreases in pain intensity/pain disability (P < 0.05) than the physiotherapy and sham therapy groups. No statistical differences were found between the three groups for the SCC outcome variable. Bonferroni adjustments showed that the mean values of SCC were significantly decreased at posttreatment (P < 0.05) across the three groups.ConclusionThere was a significant decrease in both pain and cortisol outcomes at posttreatment in patients with CMD. Because of the limitations of this study, we cannot draw conclusions regarding whether the lower SCC could be an indication of pain reduction in patients with CMD.     

Effects of Auricular Acupressure on Hip Flexibility and Pain in Taekwondo Participants: Randomized Controlled Trial

BackgroundIn sports, hip flexibility is essential to reduce injuries and improve performance.AimThis study aimed to examine the effects of auricular acupressure on hip flexibility and pain in Taekwondo participants.MethodThis randomized controlled trial was performed in the Republic of Korea from January 2021 to August 2021. The Numeric Rating Scale for Pain and Hip Flexibility was used. Twenty-one participants received auricular pressure once weekly for six weeks, while 17 participants did not receive any intervention. Auricular acupressure was applied to the hip (AH13), Shinmun, and auricular acupressure points associated with the pain areas reported by the participants.ResultsAuricular acupressure improved hip flexibility (t = 2.67, p = .011) and back pain (t = 2.11, p = .043). The mean difference in post-pretest hip flexibility in the experimental group was 16.24 degrees (±13.63), whereas that in the control group was 4.77 degrees (±15.07). The mean difference in the experimental group's pre-post-test scores of back pain was 1.24 (±2.64), whereas that in the control group was 0.18 (±1.41).ConclusionsThe results of this study showed that auricular acupressure could be used to treat pain and improve hip flexibility.     

The analgesic effect of magnetic acupressure in cancer patients undergoing bone marrow aspiration and biopsy: a randomized, blinded, controlled trial

ContextBone marrow aspiration and biopsy (BMAB) is a frequently performed and painful procedure.ObjectivesTo evaluate the efficacy of magnetic acupressure in reducing pain in cancer patients undergoing BMAB.MethodsCancer patients without previous acupuncture or acupressure experience were stratified by the number of prior BMAB and randomized to having magnetic acupressure delivered to either the large intestine 4 (LI4) acupoint or a sham site. The primary study endpoint was the patient’s pain intensity rating during the procedure using a visual analogue scale (VAS).ResultsSeventy-seven eligible patients received magnetic acupressure: 37 were randomized to treatment at the LI4 site arm and 40 at the designated sham site arm. There was no significant difference between the median pain scores of patients treated at the LI4 site and the sham site (P = 0.87). However, severe pain (VAS ≥ 7) was reported in only one patient (2.7%) treated at the LI4 site compared with eight patients (20%) at the sham site (P = 0.03). No patients experienced significant magnetic acupressure-related toxicities.ConclusionMagnetic acupressure at the LI4 acupoint requires minimal training and expense and is well tolerated. Although its use did not significantly reduce median pain scores in patients undergoing BMAB, it does appear to reduce the proportion of patients with severe pain associated with this invasive procedure.     

Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial

BackgroundFurther research on pulsed electromagnetic field (PEMF) effects on the different conditions of low back pain was warranted due to lack of studies in this area.ObjectivesTo investigate the effects of pulsed electromagnetic field therapy with 50 Hz frequency, with low intensity of 20 Gauss compared to conventional non-invasive treatment modalities in patients with chronic non-specific low back pain.MethodsDesign – A prospective, randomized, patient-blinded, controlled trial. Setting – The study was conducted at Outpatient Physiotherapy Clinic in Cairo, Egypt. The study was conducted between May 2015 and September 2016. Participants – Fifty participants with non-specific low back pain enrolled into experimental and control groups. Interventions – The experimental group received the Conventional physical therapy Protocol as well as magnetic field, while the control group received the same Conventional physical therapy and sham electromagnetic field. Both groups received 12 sessions over 4 weeks’ period. Outcome measures – Primary outcome measures was pain intensity while the secondary outcome measures were disability and lumbar range of motion – ROM. There were no adverse events occurred during the study.ResultsFifty participants with non-specific low back pain (control group n = 25; experimental group n = 25) were randomized. There were significant between-group differences in pain scores (mean difference – MD 1.52; 95%CI −0.34 to 3.35), function disability (MD 8.14; 95%CI 6.5 to 9.96), Range of Motion (ROM) of lumbar flexion (MD −1.27; 95%CI −1.09 to −1.45), ROM of lumbar extension (MD −1.1; 95%CI −0.97 to −1.23), ROM of lumbar right side bending (MD 8.2; 95%CI 6.56 to 9.84) and ROM of lumbar left side bending (MD 10.4; 95%CI 8.81 to 11.99) in favour of the experimental group.ConclusionAdding pulsed electromagnetic field to Conventional physical therapy Protocol yields superior clinical improvement in pain, functional disability, and lumbar ROM in patients with non-specific low back pain than Conventional physical therapy alone.     

Effects of auricular acupressure on pain and disability in adults with chronic neck pain

AimThe aim of this study was to examine the effect of auricular acupressure (AA) on pain, pain threshold (PT), disability, and cervical range of motion in adults with chronic neck pain.BackgroundAbout 30–50% of the world's population suffers from chronic neck pain, and the cost of treatment is increasing.Materials and methodsThis single-blind, randomized sham-controlled study was conducted on 48 adults with chronic neck pain in South Korea. The experimental group (n = 25) received AA on specific acupoints for neck pain, whereas the control group (n = 23) received AA on unspecific acupoints. Participants received 4 weeks of auricular-acupressure intervention. Outcomes were assessed by the visual analog scale (VAS), PT, neck-disability index (NDI), and cervical range of motion. Measurements were taken 3 times: before intervention, 2 weeks into the intervention, and after the intervention.ResultsStatistical differences between the two groups emerged in PT (p = .003), the NDI (p = .033), cervical flexion (p = .004), and left rotation (p = .004), but not on the VAS.ConclusionsThis study showed that AA leads to improvements on PT, neck disability, and cervical range of motion. Therefore, AA can be used as an alternative nursing intervention for chronic neck pain.     

The Effectiveness of Acupressure for the Control and Management of Chemotherapy-Related Acute and Delayed Nausea: A Randomized Controlled Trial

ContextBoth positive and negative results have been reported in the literature from the use of acupressure at the P6 point, providing evidence of highly suggestive but not conclusive results.ObjectivesTo clarify whether acupressure is effective in the management of chemotherapy-related nausea and vomiting.MethodsA randomized, three-group, sham-controlled trial was designed. Patients with cancer receiving chemotherapy were randomized to receive standardized antiemetics and acupressure wristbands, sham acupressure wristbands, or antiemetics alone. Primary outcome assessment (nausea) was carried out daily for seven days per chemotherapy cycle over four cycles. Secondary outcomes included vomiting, psychological distress, and quality of life.ResultsFive hundred patients were randomized. Primary outcome analysis (nausea in Cycle 1) revealed no statistically significant differences between the three groups, although nausea levels in the proportion of patients using wristbands (both real and sham) were somewhat lower than those in the proportion of patients using antiemetics-only group. Adjusting for gender, age, and emetic risk of chemotherapy, the odds ratio of lower nausea experience was 1.18 and 1.42 for the acupressure and sham acupressure groups, respectively. A gender interaction effect was evident (P = 0.002). No significant differences were detected in relation to vomiting, anxiety, and quality-of-life measures.ConclusionNo clear recommendations can be made about the use of acupressure wristbands in the management of chemotherapy-related nausea and vomiting as results did not reach statistical significance. However, the study provided evidence of encouraging signals in relation to improved nausea experience and warrants further consideration in both practice and further clinical trials.Trial RegistrationThis trial is registered with the ISRCT register, number ISRCTN87604299.     

Frailty is associated with pain and cognitive function in older people in post-acute care settings

BackgroundTo describe pain, cognitive function, and frailty of older people in post-acute care settings and examine the association between the three elements.MethodsThis cross-sectional study involved 142 participants from a rehabilitation ward and a geriatric day centre. Pain, cognitive function and frailty were assessed using Brief Pain Inventory, Abbreviated Mental Test, and 5-item Frail Scale respectively.ResultsParticipants were mostly women (51.7%) with a mean age of 76.5 (SD 7.8). Mean scores for pain, cognition, and frailty were 9.0 ± 1.0, 4.0 ± 2.8, and 2.2 ± 1.2, respectively. Cognition had a significant inverse association with frailty (β = −0.160, p = 0.047), and pain had a significant positive association with frailty (β = 5.122, p < 0.001). This linear regression model explained a variance of 0.269.ConclusionsThe study demonstrated the association between pain, cognitive function, and frailty. In predicting frailty, however, more studies are required to determine the predictive value and cut-off points for pain and cognitive measures.     

I. Indices of Pain Intensity Derived From Ecological Momentary Assessments: Rationale and Stakeholder Preferences

Pain assessment that fully represents patients’ pain experiences is essential for chronic pain research and management. The traditional primary outcome measure has been a patient's average pain intensity over a time period. In this series of 3 articles, we examine whether pain assessment can be enhanced by considering additional outcome measures capturing temporal aspects of pain, such as pain maxima, duration, and variability. Ecological momentary assessment makes the assessment of such indices readily available. In this first article, we discuss the rationale for considering additional pain indices derived from ecological momentary assessment and examine which are most important to stakeholders. Patients (n = 32), clinicians (n = 20), and clinical trialists (n = 20) were interviewed about their preference rankings for Average, Worst, and Least Pain, Time in High Pain, Time in No/Low Pain, Pain Variability, and Pain Unpredictability. Each stakeholder group displayed a distinct preference hierarchy for different indices, and there were few commonalities between groups. Patients favored Worst Pain and Time in High Pain, followed by Pain Variability and Unpredictability. Trialists favored Average Pain, whereas clinicians favored Worst Pain. Results suggest that multiple temporal aspects of pain are relevant for stakeholders and should be considered when evaluating the efficacy of pain management.PerspectiveExamining which aspects of pain are most important to measure from the perspective of different stakeholders can facilitate efforts to include all relevant treatment outcomes. Our study suggests that multiple temporal aspects of pain intensity are important to stakeholders. This should be considered when evaluating the efficacy of pain management.     

Effect of Persian acupressure (Ghamz) on Patients with Knee Osteoarthritis: A Single-Blinded Parallel Clinical Trial

BackgroundMany patients choose complementary and alternative medicine (CAM) to treat various conditions. Among osteoarthritis patients, acupressure is a popular CAM treatment. In Iran, Ghamz (a Persian acupressure technique) uses for musculoskeletal ailments like knee pain.AimsTo examine the potential efficacy of Ghamz on osteoarthritis outcomes.DesignClinical Trial.SettingsRandomized, single-blind, sham-controlled clinical trial.Participants/SubjectsEighty patients with diagnosed knee osteoarthritis, age over 35 years old.MethodsEighty adult patients with confirmed knee osteoarthritis from three outpatient clinics were recruited. Participants were randomly assigned either to intervention or placebo groups using sham acupressure. The primary outcomes included Knee injury and Osteoarthritis Outcome Score (KOOS) parameters and pain scores measured using the visual analog scales (VAS).ResultsSeventy-two individuals completed the trial and were included in the analysis. At baseline, there was no difference between the mean scores of both outcomes. After the intervention, the group receiving Ghamz therapy experienced an improvement in KOOS parameters, including symptoms, pain, activity daily livings, sport, recreation function, and quality of life. The mean pain score in the intervention group was significantly decreased from 5.89 at the beginning study to 4.11 at the end of the study, while the pain score did not change substantially in the sham group. These findings remained consistent after adjusting for covariates of age, weight, and pre-treatment.ConclusionsThis study supports evidence that Ghamz therapy provides an effective option for short-term knee pain relief in patients with knee osteoarthritis. Additional studies are recommended to confirm these findings.     

Effects of Vitex agnus and Flaxseed on cyclic mastalgia: A randomized controlled trial

ObjectivesEvidence on the effect of Vitex agnus and Flaxseed on cyclical mastalgia is not enough. This study aimed to assess the efficacy of V. agnus and Flaxseed on cyclical mastalgia.Design and settingThis randomized controlled trial was conducted on 159 women referred to health centers of Tabriz, Iran. Subjects were allocated into three groups (n = 53 per group) using block randomization.Interventions and Main outcome measuresGroup I received 25 g daily Flaxseed powder and placebo of V. agnus; group II received daily 3.2–4.8 mg V. agnus tablet and placebo of Flaxseed and control group received both placebo. Nominal day breast pain was applied at baseline, first, and second month after the intervention. Data was analyzed using general linear model.ResultsThere was no statistical significant difference between the three groups in terms of socio-demographic characteristics and baseline values. The breast pain improved significantly in both intervention groups during the first and second month after intervention. Mean NDBP score was significantly lower than that in the control group at the first month after the intervention in the Flaxseed [adjusted mean difference: −3.1 (95% CI: −4.2 to −2.0)] and V. agnus groups [−3.3 (−4.3 to −2.2)] and the second month after the intervention in Flaxseed [−7.0 (−8.1 to −5.9)] and V. agnus groups [−6.4 (−7.5 to −5.3)].ConclusionFlaxseed and V. agnus are effective in short-term period in decreasing cyclical mastalgia. However, further studies are needed to examine the long-term effectiveness and sustainability of the effects after stopping the treatment in order to decide whether these alternative treatments are suitable to treat mastalgia or not.     

The Effect of Music on Pain in the Adult Intensive Care Unit: A Systematic Review of Randomized Controlled Trials

ContextMultimodal analgesic approaches are recommended for intensive care unit (ICU) pain management. Although music is known to reduce pain in acute and chronic care settings, less is known about its effectiveness in the adult ICU.ObjectivesDetermine the effects of music interventions on pain in the adult ICU, compared with standard care or noise reduction.MethodsThis review was registered on PROSPERO (CRD42018106889). Databases were searched for randomized controlled trials of music interventions in the adult ICU, with the search terms [“music*” and (“critical care” or “intensive care”)]. Pain scores (i.e., self-report rating scales or behavioral scores) were the main outcomes of this review. Data were analyzed using a DerSimonian-Laird random-effects method with standardized mean difference (SMD) of pain scores. Statistical heterogeneity was determined as I² > 50% and explored via subgroup analyses and meta-regression.ResultsEighteen randomized controlled trials with a total of 1173 participants (60% males; mean age 60 years) were identified. Ten of these studies were included in the meta-analysis based on risk of bias assessment (n = 706). Music was efficacious in reducing pain (SMD −0.63 [95% CI −1.02, −0.24; n = 10]; I² = 87%). Music interventions of 20–30 minutes were associated with a larger decrease in pain scores (SMD −0.66 [95% CI −0.94, −0.37; n = 5]; I² = 30%) compared with interventions of less than 20 minutes (SMD 0.10 [95% CI −0.10, 0.29; n = 4]; I² = 0%). On a 0–10 scale, 20–30 minutes of music resulted in an average decrease in pain scores of 1.06 points (95% CI −1.56, −0.56).ConclusionMusic interventions of 20–30 minutes are efficacious to reduce pain in adult ICU patients able to self-report.     

Early Experience of a Multidisciplinary Group Pain Program with Cognitive Behavioural Strategies,Physiotherapy and Peer Support for Patients with Chronic Noncancer Pain

BackgroundChronic non-cancer pain affects about 20% of the population worldwide. The effect of medical treatment in isolation is often limited. A multidisciplinary approach has been strongly advocated to help manage patients' pain more effectively.AimsThe primary purpose was to reduce pain severity, pain interference on patients’daily activities and improve their levels of self-efficacy despite pain. The secondary aim was to evaluate the possible changes in patients’ depression, anxiety, and stress symptoms after amultidisciplinary group pain program. The program content and structure were also evaluated.DesignThis scholarly project used within-subject pre- and post-test design.Settings/SubjectsFifty-six patients were recruited from the project center pain clinic.MethodsAn evidence-based eight-hour multidisciplinary group pain program was implemented. Data was collected before and 3 months after the program.InterventionsThe program covered pain physiology, cognitive behavioural strategies, demonstration of various exercises, self-management skills, medication management, and peer support.ResultsThree months postprogram, there was a statistically significant improvement in patients’ pain severity (β = −0.9, 95% CI: −1.73 to −0.14, p = .023) and self-efficacy (β = 5.6, 95% CI: 0.85 to 10.41, p = .023). Pain interference on their daily activities was also significantly reduced (β = −2.0, 95% CI: −2.90 to −0.83, p = .001). Patients provided positive and encouraging feedback about the program.ConclusionInitial improvements in patients’ ability to cope with pain and to perform daily activities were demonstrated following participation in the brief multidisciplinary group pain program. Future randomized controlled trials are needed to confirm that the results are due to patients’ participation in the program.