BACKGROUND: Chronic shoulder pain draws the attention of doctors since it is a very common and serious disease at primary care level. The patients with this pain usually have a tendency to see many doctors, to take an abundance of medication, and sometimes to even suffer from depression. The pain and the symp- toms thereof often disable the patients in their every day lives. This study aims to seek the most efficient way of treatment between two therapies, namely, the existing drug therapy based on NSAID and the intramuscular stimulation(herein after IMS) therapy, which has re- cently been introduced, by comparing them in accordance with the following method. METHODS: The two therapies were applied for 3 weeks to female patients aged between 50 and 70 who had visited a hospital over a period of more than 3 months due to this type of pain. The patients were randomly given each therapy although the treatment and monitoring was done by the same physiotherapist. The monitoring was performed four times, the day before the start of treatment, 1 week, 2 weeks and 3 weeks after respectively. It measured the following elements: (1) pain scale by VAS(Visual Analogue Scale), (2) Sleep hygiene scale by VAS, (3) ROM(Range of Motion), Repeated measure ANOVA was used for analysis. RESULTS: While both therapies reduced the pain significantly during the 3 weeks, the study showed that IMS was more effective than the drug therapy in every element monitored(p<0.05). IMS turned out to be more effective the 1st week in every measured element, however, the drug therapy was more effective the 3rd week if compared to the 2nd week in terms of Sleep VAS score. CONCLUSION: IMS is more effective in easing chro nic shoulder pain since it has better results than NSAID in pain VAS score, sleep VAS score and ROM.
Chronic Pain ; Depression ; Drug Therapy ; Female* ; Humans ; Hygiene ; Physical Therapists ; Primary Health Care ; Shoulder Pain* ; Shoulder*

OBJECTIVETo provide an evidence-based overview regarding the efficacy of Ashi points stimulation for the treatment of shoulder pain.

METHODSA comprehensive search [PubMed, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Chongqing Weipu Database for Chinese Technical Periodicals (VIP) and Wanfang Database] was conducted to identify randomized or quasi-randomized controlled trials that evaluated the effectiveness of Ashi points stimulation for shoulder pain compared with conventional treatment. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. RevMan 5.0 was used for data synthesis.

RESULTSNine trials were included. Seven studies assessed the effectiveness of Ashi points stimulation on response rate compared with conventional acupuncture. Their results suggested significant effect in favour of Ashi points stimulation [odds ratio (OR): 5.89, 95% confidence interval (CI): 2.97 to 11.67, P<0.01, heterogeneity: χ(2) =3.81, P=0.70, I (2) =0% ]. One trial compared Ashi points stimulation with drug therapy. The result showed there was a significantly greater recovery rate in group of Ashi points stimulation (OR: 9.58, 95% CI: 2.69 to 34.12). One trial compared comprehensive treatment on the myofascial trigger points (MTrPs) with no treatment and the result was in favor of MTrPs.

CONCLUSIONSAshi points stimulation might be superior to conventional acupuncture, drug therapy and no treatment for shoulder pain. However, due to the low methodological quality of included studies, a firm conclusion could not be reached until further studies of high quality are available.

Acupuncture Points ; Acupuncture Therapy ; Humans ; Publication Bias ; Randomized Controlled Trials as Topic ; Risk Factors ; Shoulder Pain ; drug therapy ; therapy ; Trigger Points

Despite acknowledgment that pain is likely to be a major problem for many older adults, it is difficult to estimate the frequency of pain problems for this population. The main purpose of this study was to identify the various characteristics of chronic pain in the elderly by gender. It examines by gender, pain frequency, pain intensity, number of chronic pain sites, localization of pain, impact on activities, methods of pain management, and effects of chronic pain management. The subjects were 189 elderly people(65 years and older) living in an urban area. They were surveyed at their homes. They were surveyed by interview using a closed-ended questionnaire. The survey was done from Nov. 6th. to Dec. 6th. 1997. Descriptive statistics were used to determine all of the reported pain variables. Chi-square tests were used to determine crude differences between pain intensity and gender. T-test was used to determine differences in number of pain sites between men and women. The findings are as follows ; Of the 189 subjects, 83.6% reported experiencing pain, and men reported a lower prevalence(69.5%) than women(89.2%). Women had significantly more severe pain than did men(p=.001). Lower back pain(20.2%) and leg pain(20.2%) were the most prevalent, followed by knee pain(17.4%), arm pain(13.3%), neck and shoulder pain(11.6%), and headache(9.9%). Women experienced more multiple localizations of pain(p=.0001). The greatest impact was on movement(83.5%), followed by usual activities(60.8%), sleep(49.4%), visiting(29.1%), and hobbies and recreations(50.0%). No differences were observed between men and women in the proportion of subjects reporting a negative impact on each of these activities. The methods of pain management were hospital visit(70.9%), drug store medication(46.7%), oriental medicine clinic(32.9%), endurance(13.3%), self-management(6.3%). Drug therapy was the most effective pain management strategy(94%), followed by physical therapy(63%) and accupuncture byssocausis(55%). The conclusion: Pain is a symptom of great clinical importance that is often associated with disability, loss of independence, and reduced quality of life. In this study chronic pain symptoms were common but unevenly distributed in men and women. The results further advance understanding of the experience and impact of pain by gender. Future studies should incorporate questions that gather systemic and more detailed information on the characteristics of pain, expecially by gender and by age.
Adult ; Aged* ; Arm ; Chronic Pain ; Drug Therapy ; Female ; Hobbies ; Humans ; Knee ; Leg ; Male ; Medicine, East Asian Traditional ; Neck ; Pain Management ; Quality of Life ; Surveys and Questionnaires ; Shoulder

Adhesive capsulitis is a common cause of shoulder pain and limited movement. The objectives of this review were to assess the efficacy and safety of corticosteroid injections for adhesive capsulitis and to evaluate the optimum dose and anatomical site of injections. PubMed and CENTRAL databases were searched for randomised trials and a total of ten trials were included. Results revealed that corticosteroid injection is superior to placebo and physiotherapy in the short-term (up to 12 weeks). There was no difference in outcomes between corticosteroid injection and oral nonsteroidal anti-inflammatory drugs at 24 weeks. Dosages of intra-articular triamcinolone 20 mg and 40 mg showed identical outcomes, while subacromial and glenohumeral corticosteroid injections had similar efficacy. The use of corticosteroid injections is also generally safe, with infrequent and minor side effects. Physicians may consider corticosteroid injection to treat adhesive capsulitis, especially in the early stages when pain is the predominant presentation.
Adrenal Cortex Hormones ; pharmacology ; Bursitis ; complications ; drug therapy ; therapy ; Female ; Humans ; Injections ; Male ; Pain ; complications ; Physical Therapy Modalities ; Primary Health Care ; Randomized Controlled Trials as Topic ; Shoulder ; physiopathology ; Shoulder Joint ; physiopathology ; Treatment Outcome ; Visual Analog Scale

OBJECTIVETo evaluate clinical therapeutic effect of post-stroke shoulder pain treated by acupuncture combined with Tuina.

METHODSThree hundred cases of post-stroke shoulder pain were randomly divided into an acupuncture and Tuina group and a rehabilitation group by double-center randomized controlled clinical trial method. In acupuncture and Tuina group, normalized electroacupuncture and Tuina therapy were applied, that was electroacupuncture at main points, such as Chize (LU 5), Quze (PC 3), Shaohai (HT 3), Jianyu (LI 15), Jianliao (TE 14) and Jianjing (GB 21),etc., combined with traditional Tuina manipulations; in rehabilitation group, the rehabilitation methods such as the electrostimulation through nervus cutaneus and the squeezing and stabilizing manipulations of Proprioceptive Neuromuscular Facilitation (PNF), etc. were applied. The treatment courses of both groups were 6 weeks. The main therapeutic effect indices were the Assessment Face Scale (AFS) for pain when shoulder was in passive motion and the Fugl-Meyer Motor Assessment for upper limbs active function; the secondary indices were the moditied Rankin Scale (mRS) and the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia.

RESULTSAfter 6 weeks treatment and 12 weeks follow-up, AFS score, Fugl-Meyer motor assessment of upper limbs active function and mRS evaluation in acupuncture and Tuina group were more obviously improved than those in rehabilitation group (P < 0.05, P < 0.01). Although the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia in acupuncture and Tuina group was equal to those in rehabilitation group [3.55% (5/141) vs 8.45% (12/142), 1.42% (2/141) vs 5.63% (8/142), both P > 0.05], the data indicated that there was a superiority tendency in acupuncture and Tuina group.

CONCLUSIONThe combined therapy of electroacupuncture and Tuina is a normative manipulation, and the therapeutic effect is satisfying for post-stroke shoulder pain, superior to that of comprehensive rehabilitation treatment.

Aged ; Amobarbital ; Combined Modality Therapy ; Drug Combinations ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Secobarbital ; Shoulder Pain ; etiology ; physiopathology ; therapy ; Stroke ; complications

Adult ; Aged ; Artemisia ; chemistry ; Female ; Humans ; Male ; Massage ; Middle Aged ; Oils, Volatile ; therapeutic use ; Plant Oils ; therapeutic use ; Shoulder Pain ; drug therapy ; therapy ; Young Adult

BACKGROUNDPreoperative incisional local anaesthesia with ropivacaine is a common method of providing post-laparoscopy pain relief. The pulmonary recruitment manoeuvre also provides pain relief, but the combined effect of these two methods on pain following laparoscopic procedures has not been reported. We investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and laparoscopy.

METHODSThis prospective, randomized, controlled study involved 60 patients divided into two groups (n = 30, each). Group 1 received 20 ml of 0.5% ropivacaine injected peri-incisionally preoperatively, with intra-abdominal carbon dioxide removed by passive deflation. Group 2 received 20 ml of 0.5% ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of surgery. The last inflation was held for 5 seconds. The intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0, 2, 4, 8, 12, 24 and 48 hours postoperatively by an independent blinded anaesthesiologist. Tramadol was given postoperatively for analgesia.

RESULTSCompared with group 1, incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour, 4 hours, and 24 hours postoperatively (4.1 ± 2.2 vs. 2.1 ± 1.9, P = 0.002; 2.7 ± 2.7 vs. 1.2 ± 1.3, P = 0.035; and 3.5 ± 2.1 vs. 2.1 ± 1.8, P = 0.03, respectively). Static incisional pain was significantly relieved at 0 hour, 2 hours, and 24 hours postoperatively (3.1 ± 1.7 vs. 1.6 ± 1.3, P = 0.001; 1.4 ± 1.3 vs. 0.5 ± 0.8, P = 0.012; and 2.3 ± 1.9 vs. 1.0 ± 1.5, P = 0.038, respectively). Group 2 had more patients without shoulder pain (P < 0.05) and fewer requiring tramadol (P < 0.05).

CONCLUSIONRopivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and laparoscopy.

Adolescent ; Adult ; Amides ; therapeutic use ; Anesthetics, Local ; pharmacology ; Female ; Humans ; Hysteroscopy ; methods ; Laparoscopy ; methods ; Middle Aged ; Pain, Postoperative ; drug therapy ; Positive-Pressure Respiration ; Shoulder Pain ; drug therapy ; Young Adult

The primary melanoma of spinal cord was rarely reported in the literatures. The authors report a case of primary spinal maligmant melanoma in the cervical spinal cord. A 41-year-old man presented several months history of right shoulder pain and right hemiparesis. Plain X-ray of the cervical spine, myelography, computerized tomography and magnetic resonance imaging showed intradural mass from third to fifth cervical spine level. The operation was performed, and intradural intra-and extramedullary brownish black tumor, which focally infiltrated to the dura and inner surface of lamina, was removed and the histological diagnosis was maligmant melanoma. And then chemotherapy with vincristine, bleomycin, cisplatine, followed by whole central nervous system radiation therapy was performed. The patient was discharged and followed up with no neurological interval change. The pertinent literature of spinal cord melanoma is reviewed and its rareness is discussed.
Adult ; Bleomycin ; Central Nervous System ; Cisplatin ; Diagnosis ; Drug Therapy ; Humans ; Magnetic Resonance Imaging ; Melanoma* ; Myelography ; Paresis ; Shoulder Pain ; Spinal Cord* ; Spine ; Vincristine

OBJECTIVE: To investigate the type of upper limb dysfunctions and to determine major dysfunctions influencing on the quality of life (QoL) in the early phase after mastectomy. METHOD: Among the female patients with mastectomy after diagnosed as breast cancer followed by chemotherapy and/or radiation therapy, 38 patients who had shoulder pain or arm edema were selected. Visual analog scale (VAS) for pain at rest and during activity, range of motion of shoulder and arm circumference were measured. Disabilities of Arm, Shoulder and Hand (DASH) and Short form-36 v2 questionnaire were used to assess the functional disability and health-related QoL. RESULTS: Lymphedema (31.6%), limitation of motion (31.6%) and shoulder pain (26.3%) were major dysfunctions. Patients who had limited motion showed more severe dysfunctions. The cases with shoulder pain showed low level of QoL in mental component. VAS during activity and activity of daily living (ADL) domain of DASH were major impact factors on QoL related to physical functioning. In mental component, social domain of DASH was the most influencing factor on QoL. CONCLUSION: Pain during activity, limited ADL and social activity were major problems lowering QoL in patients with breast cancer. The proper managements for these problems is needed.
Activities of Daily Living ; Arm ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Edema ; Female ; Hand ; Humans ; Lymphedema ; Mastectomy ; Quality of Life* ; Surveys and Questionnaires ; Range of Motion, Articular ; Shoulder ; Shoulder Pain ; Upper Extremity* ; Visual Analog Scale

Acyclovir ; therapeutic use ; Aged, 80 and over ; Anti-Bacterial Agents ; therapeutic use ; Antiviral Agents ; therapeutic use ; Blister ; chemically induced ; etiology ; Female ; Floxacillin ; therapeutic use ; Herpes Zoster ; diagnosis ; drug therapy ; Humans ; Irritants ; adverse effects ; Shoulder Pain ; drug therapy ; etiology