麻酔学および疼痛研究ジャーナル

Gabapentinoids, pregabalin (LyricaTM) and gabapentin (NeurontinTM) are anticonvulsants that have been approved for chronic pain conditions such as diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, and are also widely prescribed off-label for chronic low back pain. Prescriptions for gabapentinoids have increased rapidly in the last five years, however, the evidence for its efficacy can be conflicting and will be analyzed for each of these chronic pain conditions. The adverse event rates and safety profile will be examined, including case reports of the occurrence of serious adverse events, to ascertain whether gabapentinoids have the potential to cause harm above the benefit of providing effective pain relief. Further case reports documenting serious withdrawal syndromes will add to the body of evidence to weigh the benefits over the risks and will identify areas where research is lacking. From the analysis of evidence on efficacy, adverse events and withdrawal there will be resulting recommendations for practice when considering gabapentinoid treatment for chronic pain.

Investigating clinical and electrophysiological activity of manual body acupuncture therapy on patients with mild and moderate CTS diagnosis was aimed. In this study, patients diagnosed with mild-moderate level CTS by the clinic and Electromyography (EMG) in first 2 weeks, 3 sessions were performed followed by 2 sessions for 2 weeks and each session was for 30 minutes, a total of 10 sessions of acupuncture practice were performed. In acupuncture therapy, dry needling was practiced using PC-3, PC-6, and PC-7 points. Patients were evaluated by electrocardiographic parameters, paresthesia (numbness, tingling), Visual Analog Scale (VAS), Boston Scale (Symptom Severity and Functional Capacity), Tinnel and Phalen test before and at the first and third months of treatment. Out of 40 patients meeting the participation criteria, 37 were able to complete the study and were evaluated for the result. After the treatment, on the symptoms of numbness and tingling, statistically, significant improvements in Phalen test positivity were compared to pre-treatment (p<0.05). Compared to pre-Acupuncture therapy, the VAS score and Boston Symptom Severity scale in the 1st and 3rd month after treatment showed significant improvements (p<0.01). Among electrophysiological parameters, median nerve distal motor latency (mMDL) was significantly healed in 3rd month after the treatment in respect to before treatment (p=0.01). As a result, the effect of acupuncture therapy practiced using PC-3, PC-6, PC-7 points in mild-moderate level CTS treatment on clinical findings was more apparent compared to electrophysiological findings. Acupuncture treatment in mild to moderate CTS may be a reliable symptomatic treatment option in patients with pain and paresthesia complaints.