Moderate Effectiveness Shown After 6-Day Continuous Peripheral Nerve Block for Phantom Limb Pain
The participants were patients with an upper or lower limb amputation and established phantom pain. The multicenter trial enrolled these participants from 5 academic centers. Each patient received a single-injection ropivacaine peripheral nerve block and perineural catheter insertion. Subsequently, they were randomized to receive a 6-day ambulatory perineural infusion of either ropivacaine 0.5% or normal saline in a double-masked fashion.
The researchers contacted the participants for follow-up telephone calls at 1, 7, 14, 21, and 28 days after the infusion started, with pain measured using the Numeric Rating Scale. Treatment effects were assessed using the Wilcoxon rank-sum test at each time point. Adjusting for 4 time points (days 1, 7, 14, and 21), P < 0.0125 was deemed statistically significant.
On day 1, average phantom, and residual limb pain intensity was lower in patients receiving local anesthetic (n = 71) versus placebo (n = 73): median [quartiles] of 0 [0-2.5] versus 3.3 [0-5.0], median difference (98.75% confidence interval [CI]) of -1.0 (-3.0 to 0) for phantom pain (P = 0.001) and 0 [0-0] versus 0 [0-4.3], and median difference 0.0 (-2.0 to 0.0) for residual limb pain (P < 0.001).
The interference of pain with physical and emotional functioning improved during the infusion on day 1 for patients receiving local anesthetic versus placebo: 0 [0-10] versus 10 [0-40], median difference (98.75% CI) of 0.0 (-16.0 to 0.0), P = 0.002.
At day 6, when the infusion was stopped, a few differences were found between the active and placebo treatment groups between days 7 and 21. Phantom and residual pain gradually increased after catheter removal, but more slowly in the treatment group.
By day 28, no differences were detected.
The authors suggest that the findings indicate a continuous peripheral nerve block decreases phantom and residual limb pain during the infusion, although few improvements were detected up to 3 weeks after catheter removal. (See Ilfeld BM, Khatibi B, Maheshwari K, et al. Immediate effects of a continuous peripheral nerve block on postamputation phantom and residual limb pain: secondary outcomes from a multicenter randomized controlled clinical trial [published online ahead of print July 27, 2021]. Anesth Analg. doi:10.1213/ANE.0000000000005673.)
Chuna Manual Therapy Shown Effective for Chronic Neck Pain
In a randomized clinical trial of 108 patients (73 women and 35 men), mean age 38.4 years, researchers found that, compared with usual care, Chuna manual therapy was more effective in terms of pain and functional improvements at week 5 and year 1 after randomization and in terms of cumulative 1-year results.
"The current form of Chuna manual therapy is developed based on the traditional Chuna techniques with a theoretical basis in Korean medicine. The therapy has evolved and developed through integrated use and implementation of Tuina of China, chiropractic and osteopathic manipulations of the US, and Japanese manipulation techniques," the authors write.
The study involved a multicenter, assessor-blinded, pragmatic, randomized clinical trial, conducted between October 18, 2017, and June 28, 2019. This intention-to-treat analysis included 108 patients with chronic neck pain persisting for at least 3 months. Patients were recruited from 5 hospitals in Korea. During 10 sessions (2 sessions per week for 5 weeks), patients were prescribed either Chuna manual therapy or usual care (electrotherapy and oral medication). The authors considered the difference in visual analog scale (VAS) score for chronic neck pain.
At 5 weeks after randomization, manual therapy showed statistically superior results compared with usual care in terms of pain (difference in chronic neck pain VAS, 16.8 mm; 95% confidence interval [CI], 10.1-23.5 mm), function (difference in Neck Disability Index, 8.6%; 95% CI, 4.2%-13.1%), and quality of life (difference in the European Quality of Life-5 Dimension 5 Levels (EQ-5D-5L) scores, -0.07 points; 95% CI, -0.11 to -0.02 points).
At 1-year follow-up, cumulative values were measured using area under the curve analyses, and superior outcomes were attained in the manual therapy group in terms of the numerical rating scale for chronic neck pain (1.3 points; 95% CI, 0.5-2.0 points), Neck Disability Index (6.7%; 95% CI, 2.5%-10.9%), Neck Pain Questionnaire (7.4%; 95% CI, 2.3%-12.6%), and EQ-5D-5L scores (-0.03 points; -0.07 to 0.00 points).
The authors conclude that the results support the need to consider recommending manual therapies as primary care treatments for chronic neck pain. (See Lee J, Cho J-H, Kim K-W, et al. Chuna manual therapy vs usual care for patients with nonspecific chronic neck pain: A randomized clinical trial. JAMA Netw Open. 2021;4(7):e2113757. doi:10.1001/jamanetworkopen.2021.13757.)
Trial registrationhttp://ClinicalTrials.gov identifier: NCT03294785