Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients: A systematic review and meta-analysis

Background and purposePatients undergoing continuous hemodialysis experience the arteriovenous fistula puncture-related pain approximately 300 times per year. Pain management is important priorities in painful procedures. Therefore, this systematic review and meta-analysis study was conducted to determine the effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients.MethodsThis systematic review and meta-analysis study was conducted by searching the related article with using the keywords including Cryotherapy, Ice, Punctures, Catheterization, Pain, and Fistula (using AND & OR operators) through Iranian (including SID, and Magiran) and international databases (including Embase, Web of Science, Medline via PubMed, Scopus, and ProQuest). Interventional studies in English or Persian languages were included in the study without time limitation. Finally, after excluding duplicates, screening based on inclusion and exclusion criteria, and quality assessment (based on the JADAD standard checklist), 8 studies entered the systematic review process (Qualitative Synthesis) and 6 studies entered the meta-analysis process (Quantitative Synthesis).ResultsBased on the results of the review, the included studies were conducted between 2008–2017. The total number of participants in all studies obtained through systematic review (8 studies) was 422 with an age of 16 years old and above. The review of studies showed a positive effect of cryotherapy on reducing the arteriovenous fistula puncture-related pain in hemodialysis patients.ConclusionRegarding the positive effect of cryotherapy on arteriovenous fistula puncture-related pain, cryotherapy as a low-risk and uncomplicated procedure seems to be effective and useful in reducing pain and ultimately reducing its unpleasant psychological and physical side effects.     

Comparative evaluation of Low Level Laser Therapy and cryotherapy in pain control and wound healing following orthodontic tooth extraction: A double blind study

PurposeTo compare and evaluate pain and healing following orthodontic tooth extraction using Low Level Laser Therapy [LLLT] and Cryotherapy.Materials and methods62 patients referred for orthodontic extraction of bilateral bicuspids were included. Subjects were alternatively divided into two groups with 31 patients each. One of the bilateral extraction sites was subjected to either intervention, LLLT or Cryotherapy, while the other site was kept as control. Pain was assessed for 7 consecutive days by Visual Analogue Scale and Wound healing on 4^th, 7^th and 14^th days using a modified wound healing scale.ResultsPain scores were generally better for Group I [LLLT] when compared to Group II [Cryotherapy] on all days. The highest mean score for pain observed on the 1^st post-extraction day was 4.00 ± 0.93 and 4.16 ± 0.93 for Group I and Group II respectively [p = 0.42]. It was also observed that LLLT helped in better wound healing as compared to cryotherapy with a significant difference in wound healing on 7^th [mean score for Group I and Group II- 1.16 ± 0.52 and 1.6 ± 0.62 respectively: p = 0.01] and 14^th [mean score Group I and Group II- 0.23 ± 0.43 and 1.0 ± 0.58 respectively: p = 0.00] post-extraction days.ConclusionLLLT has better analgesic and wound healing properties as compared to Cryotherapy, suggesting that LLLT should be preferred over cryotherapy whenever possible.     

The effects of cryotherapy on athletes’ muscle strength,flexibility, and neuromuscular control: A systematic review of the literature

PurposeThis review aimed to investigate the effects of cryotherapy on the functional capacity parameters of athletes, such as muscular strength, flexibility, neuromuscular control, and balance.MethodsA computerized search of EBSCO Host databases, Proquest, Medline, SportDiscus, CinahlPlus, Health Source Nursing/Academic Edition, Academic Search Complete, and GoogleScholar databases was performed to identify clinical trials with a focus on cryotherapy applications in sport. Thekeywords used were “cryotherapy,” “sports,”“strength,”“flexibility,” and “proprioception.”Study selectionRandomized control trials and randomized crossover studies of healthy athletes were included in this review. The methodological quality of the studies was assessed by the validation criteria given by Furlan et al (2009).ResultsA total of 50 randomized controlled trials (RCTs) and randomized crossover studies met the above criteria and were included in the final analysis. The studies available indicate that there is no strong research evidence to suggest that cryotherapy can definitely influence joint strength and neuromuscular control. The only positive effect of cryotherapy appears to be an improvement in joint flexibility.ConclusionsLimited and equivocal evidence is available to address the effect of cryotherapy on muscular function. The only evidence-based positive impact after the applications of cryotherapy is improved joint flexibility. Despite the extensive use of cryotherapy in sports, further research is needed to document the actual effects of cryotherapy applications on athletes' functional performance and rehabilitation parameters.     

Hémorragie cérébrale compliquant une séance de cryothérapie à visée antalgique

IntroductionWhole body cryotherapy is a new therapeutic for pain treatment. Cryotherapy is, so far, a controversial technique challenged for its efficacy and its security.Case reportThis is the case of a 61-year-old woman suffering from a haemorrhagic cerebrovascular accident during a whole-body cryotherapy session. The patient was treated for a psoriatic arthritis and was in remission. The aetiological screening was negative.ConclusionWe hypothesize that the whole-body cryotherapy was responsible for this stroke.     

The effect of cryotherapy on postural stabilization assessed by standardized horizontal perturbations of a movable platform

BackgroundCryotherapy is a frequently used therapy in the acute treatment of sports injuries, although it has possible negative effects on dynamic postural stabilization.Research questionWhat is the effect of cryotherapy on the postural stabilization assessed by imposed platform perturbations?MethodsTwenty-four healthy participants (15 male, 9 female) performed 2 test sessions (before and after cryotherapy) consisting of 4 trials each. Each trial included 30 s single leg stance (SLS) on both legs and 4 testing blocks (2 for each leg) of 30 s for the dynamic testing. A single testing block comprised 4 perturbations. After the first session, cryotherapy was applied to the right leg by placing it in ice water at a temperature between 10 °C and 12 ° for 20 min.Outcome measuresWe assessed the Center of Pressure speed (CoPs) and the mean force variation for both static and dynamic tests. Additionally, the Time To Stability (TTS) was calculated for the perturbations.ResultsIn the static trials there was an interaction between leg and session present for the mean force variation (p = 0.01) with a large η² of 0.24, which shows higher variation of vertical force after application of the cryotherapy on the right leg. During the dynamic trials we found an interaction between leg and session for the TTS suggesting increase of the TTS due to the cryotherapy (p = 0.04), with a large η² of 0.17. No interaction effect was present for the CoPs in the mediolateral and anteroposterior direction (p = 0.62 and p = 0.12, respectively).SignificanceCryotherapy applied to the lower extremity results in a worse postural stabilization when assessed by platform perturbations. This might be the result of an altered balance strategy, due to impaired proprioception from the affected body part. More research is needed to examine the duration of this effect.Level of evidenceLevel 3, associative study     

Cryotherapy in reducing pain,trismus, and facial swelling after third-molar surgery: Systematic review and meta-analysis of randomized clinical trials

Background

The aim of this systematic review and meta-analysis was to evaluate the efficacy of cryotherapy in reducing pain, trismus, and facial swelling in patients undergoing third-molar surgery.

冷冻疗法配合转移因子治疗尖锐湿疣效果观察

目的研究冷冻疗法配合转移因子治疗尖锐湿疣（CA）的效果，比较转移因子注射法和口服法的效果。方法对64例CA病人在冷冻治疗的基础上，予以局部并皮下注射转移因子（A组，32例）或口服转移因子胶囊（B组，32例）治疗。结果A组治愈30例，治愈率为93．8％；B组治愈27例，治愈率为84．3％，两组疗效比较差异无显著性（x^2=1．44，P〉0．05）。结论两种方法治疗CA均具良好效果。     

Underutilization of local salvage therapy after radiation therapy for prostate cancer

ObjectiveTo evaluate the rates at which patients are offered and receive local salvage therapy (LST) after failure of primary radiotherapy for localized prostate cancer, as it is the only potentially curative treatment for localized recurrence but appears to be underutilized when compared with androgen-deprivation therapy (ADT) or observation.Materials and methodsPatients with localized prostate cancer who received primary radiotherapy with curative intent between 1999 and 2000 were identified in the British Columbia Tumour Registry. Exclusion criteria included patient age >72 years, prostate-specific antigen>40 ng/ml, and clinical stage T4 at diagnosis. Data on clinicopathologic features, primary therapy, prostate-specific antigen kinetics, and salvage therapy were collected retrospectively. Radiation failure was defined as biochemical recurrence according to the Phoenix criteria or by initiation of salvage therapy.ResultsOf 1,782 patients treated in the study period, 1,067 met inclusion criteria. Of these, 257 failed radiation therapy. Radiation therapy failure was managed with observation (>12 mo) in 126 patients and ADT in 119. Of the observed patients, 66 subsequently received ADT. Five patients (1.8%) received LST (3 radical prostatectomy and 2 brachytherapy).ConclusionsOnly 2% of patients relapsing after radiation therapy for localized prostate cancer received LST. Although the benefits of LST are unproven, these findings reveal a possible underutilization of LST and indicate a need for enhanced collaboration between specialties to optimize care of this challenging cohort.     

全膝关节置换术后膝周持续冰袋加压冷敷的镇痛效果分析

目的：研究人工全膝关节置换术（ TKA）术后膝周持续冰袋加压冷敷的镇痛效果。方法2011年5月至2012年5月,将本组86例欲行单侧TKA的骨关节炎患者随机分成两组：试验组于TKA术后将毛巾包裹的10％盐水冰袋置于膝前、内、外侧冷敷,持续24 h;对照组给予同等规格的常温软包装盐水袋置于膝前、内、外侧外敷,持续48 h;两组均于术后第2天拔除引流管。术后24 h内两组患者均经静脉镇痛泵滴注吗啡行自控镇痛（PCA）,疼痛难以忍受时予以肌注吗啡5～10 mg。通过比较两组患者术后膝关节静息和活动痛视觉模拟（ VAS）评分、隐性失血量、吗啡使用情况、主动直腿抬高时间、屈膝90°时间、膝关节活动度（ ROM）以及并发症来分析膝周持续冰袋冷敷的镇痛效果。结果 TKA术后膝周持续冰袋冷敷的患者,其术后36 h内各时间段以及总的吗啡消耗量明显减少（P＜0.01）,第一次肌注吗啡的时间亦明显推迟。术后第6、12、24、36 h,试验组静息痛VAS评分显著小于对照组（ P＜0.01）,术后24、36 h活动痛VAS评分亦显著小于对照组（ P＜0.01）。术后24 h引流量间接显示,试验组隐性失血量较对照组少（P＜0.01）,患者主动直腿抬高时间、屈膝90°时间以及术后两周膝关节活动度比较,试验组均优于对照组（ P＜0.01）。两组在术后伤口愈合、感染发生率、血压、心率、皮疹、呼吸抑制和尿潴留的监测等方面进行比较,差异均无统计学意义,但试验组恶心呕吐发生率小于对照组。结论人工全膝关节置换术后膝周持续10％盐水冰袋冷敷,有助于减少术后麻醉镇痛剂消耗量,减轻术后早期疼痛,且可以有效减少隐性出血量,可促进膝关节功能恢复,且没有明显的不良反应。