OBJECTIVES: To evaluate the analgesic effect of acupuncture for needle electromyography and to validate a sham acupuncture needle. DESIGN: Randomized, double-blinded, controlled study. SETTING: University-based electrodiagnostics laboratory. PARTICIPANTS: Fifty-one subjects referred for electrodiagnostic evaluation. INTERVENTIONS: Before the electromyography examination, either real acupuncture needles or telescopic sham needles were applied. MAIN OUTCOME MEASURES: Visual analog scale of pain and unpleasantness after 3 muscles were examined with electromyography. Pretest pain was subtracted to give a measurement of pain attributable to the electromyography. Subjects were asked which needle they thought they had received. RESULTS: Twenty-six subjects were randomized to the treatment group and 25 to the sham group. Pain in the treatment group (-.96) was less than in the control group (9.68), but it was not statistically significant (P=.13). Post hoc analysis, excluding 5 subjects known to have been treated by the novice acupuncturist, showed a significant difference of 14.4mm (P=.02). The proportion of subjects who thought they received real needles in the acupuncture group (69%) did not differ from the proportion in the control group (48%) (P=.13). CONCLUSIONS: Acupuncture may represent an effective form of analgesia for electromyography. This is the first study to suggest independently the telescopic sham acupuncture needle as an effective control. 相似文献
Background: Previous studies have demonstrated the efficacy of oxycodone and hydrocodone for the treatment of acute pain. However, to the best of the authors' knowledge, no previous reports have compared the efficacies of these commonly prescribed agents. Objectives: To compare the efficacies of oxycodone and hydrocodone for the treatment of acute pain associated with fractures in emergency department (ED) patients. Methods: This prospective, double‐blind, randomized, controlled trial was conducted at an urban trauma center with an annual census of 65,000. Eligible participants included ED patients over the age of 12 years with fractures who consented to participate. Subjects were randomized to receive either oxycodone (5 mg orally [po]) with acetaminophen, or hydrocodone (5 mg po) with acetaminophen. Measurements included demographic information; pain scores on a verbal numeric rating scale at baseline and at 30 and 60 minutes; vital signs at baseline and at 30 and 60 minutes; and adverse effects. Ninety‐five‐percent confidence intervals (95% CIs) constructed about means and proportions were used to assess differences between the oxycodone and hydrocodone groups in analgesic efficacy and side effects. Results: Seventy‐three subjects were randomized to receive oxycodone or hydrocodone. Sixty‐seven subjects completed the ED study period (n= 35, oxycodone; n= 32, hydrocodone). There was no difference between the two groups in age, weight, gender, ethnicity, diagnoses, baseline pain scores, or vital signs. Patients in both groups had pain relief from baseline to 30 minutes (oxycodone mean change 3.7, 95% CI = 2.9 to 4.6; hydrocodone mean change 2.5, 95% CI = 1.7 to 3.3), and from baseline to 60 minutes (oxycodone mean change 4.4, 95% CI = 3.2 to 5.6; hydrocodone mean change 3.0, 95% CI = 2.1 to 3.9). There was no difference in pain between the patients treated with oxycodone and hydrocodone at 30 minutes (mean difference between groups ?0.6, 95% CI =?1.8 to 0.5) or at 60 minutes (mean difference ?0.5, 95% CI =?2.0 to 1.0). There was no difference between the groups in nausea, vomiting, itching, or drowsiness; however, the hydrocodone patients had a higher incidence of constipation (oxycodone 0%, hydrocodone 21%, difference in proportions 21%, 95% CI = 3% to 39% more with hydrocodone). Conclusions: Treatment with acetaminophen and either oxycodone, 5 mg po, or hydrocodone, 5 mg po, resulted in pain relief among ED patients with acute fractures, and there was no difference between the two agents at 30 and 60 minutes. Adverse effect profiles were similar, with the exception of a higher incidence of subsequent constipation with the use of hydrocodone. These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures. 相似文献
Pain is the predominant symptom that prompts patients to seek medical advice and treatment from physiotherapists. Various treatment modalities such as heat and cold, electrical stimulation (Cheing and Hui-Chan, 1999), ultrasound, manipulative techniques, massage and laser treatment have been demonstrated in varying degrees to be clinically effective for managing pain of different pathologies. However, all these treatments could be assumed to have some placebo elements (French, 1994).
From a research design perspective, the presence of placebo response is undesirable and must be controlled as it complicates the demonstration of ‘real' treatment effect. From a clinical perspective, it is intriguing to note that the condition of patients in the placebo control groups did improve considerably in many of these validation studies, although in the majority the improvement was not so marked as in the treatment groups. Conspicuously, some neuro-physiological and psychological aspects of the placebo effects may have clinical use in enhancing the effect of pain treatments and their outcomes.
Unfortunately, although placebo response has been a subject of continuing interest among some physiotherapy researchers and clinicians, information about placebo analgesia and its clinical utility is seldom discussed. The purpose of this paper is to provide clinicians with an overview of the construct and research related to placebo analgesia as well as a discussion of the potential clinical use of certain components of placebo analgesia to enhance pain rehabilitation outcomes in physiotherapy practice. 相似文献