Purpose: To determine the level of adherence to opioid analgesics in patients with cancer pain and to identify factors that may influence the adherence.
Patient and Methods: This was a cross-sectional study conducted from March to June 2018 at two tertiary care hospitals in Malaysia. Study instruments consisted of a set of validated questionnaires; the Medication Compliance Questionnaire, Brief Pain Inventory and Pain Opioid Analgesic Beliefs─Cancer scale.
Results: A total of 134 patients participated in this study. The patients' adherence scores ranged from 52-100%. Factors with a moderate, statistically significant negative correlation with adherence were negative effect beliefs (rs= -0.53, p<0.001), pain endurance beliefs (rs = -0.49, p<0.001) and the use of aqueous morphine (rs = -0.26, p=0.002). A multiple linear regression model on these predictors resulted in a final model which accounted for 47.0% of the total variance in adherence (R2 = 0.47, F (7, 126) = 15.75, p<0.001). After controlling for other variables, negative effect beliefs were the strongest contributor to the model (β = -0.39, p<0.001) and uniquely explained 12.3% of the total variance.
Conclusion: The overall adherence to opioid analgesics among Malaysian patients with cancer pain was good. Negative effects beliefs regarding cancer pain and opioids strongly predicted adherence.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of new formulation of lidocaine topical anaesthetic using palm oil base, HAMIN® and to determine how fast this new formulation produces adequate numbness compared to the currently used EMLA cream, in the University of Malaya Medical Centre (UMMC) set-up.
METHOD: The skin permeation test was conducted by using Franz type diffusion cell and pain assessment was carried out in healthy subject by using Verbal Rating Score (VRS) and Visual Analogue Score (VAS) evaluation.
RESULT: Result of permeation test demonstrated that the cumulative amount of lidocaine released from HAMIN® cream was increased with time and slightly higher than EMLA cream. The clinical study showed that HAMIN® single lidocaine cream can produces numbness through venepuncture procedure and comparable with EMLA cream which is a combination therapy for local anaesthetic (lidocaine and prilocaine).
CONCLUSION: It can be concluded that HAMIN® Lidocaine cream is suitable for cream preparation especially for topical application and it can be regarded as an achievement in palm oil and medical industries.
OBJECTIVE: This 12-week pilot study examines the efficacy of applying low frequency sound wave stimulation (between 16-160 Hz) through both hands and feet on relieving pain and improving functional ability in patients with chronic back pain.
METHODS: Twenty-three participants with chronic shoulder (eleven participants) or low back pain (twelve participants) underwent a 12-week vibration therapy program of three sessions per week. A low frequency sound wave device comprising four piezoelectric vibration-type tactile tranducers enclosed in separate 5-cm diameter circular plates, which generate sinusoidal vibratory stimuli at a frequency of 16-160 Hz, was used in this study. Primary outcome measure was pain sensation measured using the Visual Analogue Scale (P-VAS). The secondary outcome measures were pain-related disability measured using the pain disability index (PDI) and quality of life measured using the SF-12.
RESULTS: At week 12, significant reductions in pain sensation and pain-related disability were observed, with mean reductions of 3.5 points in P-VAS and 13.5 points in the PDI scores. Sixty-five percent of the participants had a reduction of at least 3 points on the P-VAS score, while 52% participants showed a decrease of at least 10 points in the PDI score. Significant improvement was observed in the SF-12 physical composite score but not the mental composite score.
CONCLUSIONS: The preliminary findings showed that passive application of low frequency sound wave stimulation therapy through both hands and feet was effective in alleviating pain and improving functional ability in patients with chronic back pain.
MATERIAL AND METHODS: A single centre, cohort study evaluating 335 women who have undergone unilateral mastectomy between January 2017 and March 2020 in Malaysia. Regional anaesthesia were given pre-operatively via ultrasound guided pectoral and intercostal nerves block (PECSII).
RESULTS: Utilization of regional anaesthesia increased from 11% in 2017 to 43% in 2020. Types and duration of surgeries were comparable. Opiod consumption was 3 mg lower in those who had PECS2 block ((27 [24-30] mg), in comparison with those who received general anaesthesia only (30 [26-34] mg), p pain score (2 [1-3]; 2 [1-3], p=0.719) and post-operative nausea and vomiting (PONV) (32.6-32.5%, p = 0.996) were similar.
CONCLUSION: This study highlights the importance of PECS2 block as a component of ERAS protocol for mastectomy in an Asian hospital. This study also inferred that patients may be safely discharged within 24 h of surgery and therefore, same day surgery may be feasible in selected group of patients undergoing mastectomy and this could imply overall cost benefits.
DESIGN: Randomized Control Trial. Adult Muslim patients who had undergone a laparoscopic cholecystectomy through the Day Surgery Unit were randomly selected using computer-generated sequence into two groups, interventional and control groups.
METHODS: The control group listened to the natural environment and received Fentanyl for pain relief, and the interventional group listened to the Qur'an recitation and received Fentanyl for pain relief. A total of 112 (79.4%) participants completed the study. The level of the pain and anxiety was measured using the Wong-Baker Faces pain scale and Spielberger State-Trait Anxiety Inventory, respectively. Statistical analysis was conducted using SAS version 9.3 (Statistical Analysis System, SAS Institute Inc, Cary, North Carolina).
FINDINGS: This study compared the effects of Qur'an audio therapy on patients' anxiety levels, opioid consumption, pain, and LOS in the PACU. The findings showed that by listening to chosen verses from the Qur'an in the recovery period post-anaesthesia, anxiety scores were significantly reduced (P = .0001), opiate use was reduced (P = .0081), and overall PACU LOS was also reduced (P = .0083).
CONCLUSIONS: Adding the use of listening to the Qur'an as a complementary therapy is a simple and cost-effective measure to reduce the need for narcotics in the PACU, and reduce the overall PACU length of stay. This intervention benefits the patient, the PACU, and reduces health care organization costs.
MATERIALS AND METHODS: This double-blinded RCT enrolled 110 patients who underwent laparoscopic sleeve gastrectomy at Hospital Canselor Tuanku Muhriz UKM from November 2020 to May 2021. Any patients with previous abdominal surgery, chronic kidney disease, or liver disease were excluded. The patients were randomised into two groups: (i) the IPLA group which received ropivacaine intraperitoneal instillation at the dissected left crus and (ii) the placebo group (sterile water instillation). Perioperative analgesia was standardised. The first 24-h postoperative pain was assessed using a VAS. The respiratory effort was assessed using incentive spirometry simultaneously.
RESULTS: Total of 110 patients were recruited. The VAS score was lower with an enhanced recovery of respiratory effort in the local anaesthetic group compared to the placebo group (P < 0.05) within the first 24 h postoperatively. In addition, the placebo group required additional postoperative analgesia (P < 0.05). No side effects were reported with the use of intraperitoneal instillation of ropivacaine.
CONCLUSION: The use of intraperitoneal instillation of ropivacaine in laparoscopic sleeve gastrectomy is recommended as it is safe, effectively reduces acute postoperative pain, and enhances the recovery of respiratory effort postoperatively.
METHODS: The Promoting Independence in Seniors with Arthritis (PISA) study is a longitudinal observational study of individuals with and without knee pain and knee OA recruited from the orthopaedics clinic of the Universiti Malaya Medical Centre and the local hospital catchment. Patients were diagnosed with OA based on the American College of Rheumatology (ACR) criteria, the presence of knee pain, and a history of physician-diagnosed knee OA. Psychosocial parameters were measured using validated measures for social participation, independence, and ability to perform activities of daily living, and life satisfaction.
RESULTS: Of the 230 included participants, mean age was 66.9 years (standard deviation: 7.2) and 166 (72.2%) were women. Kappa agreement between ACR criteria and knee pain was 0.525 and for ACR and physician-diagnosed OA it was 0.325. Binomial logistic regression analysis showed that weight, anxiety, and handgrip strength (HGS) were predictive of ACR OA. Knee pain was only predicted by HGS but not weight and anxiety. Physician-diagnosed OA was predicted by weight and HGS but not anxiety. HGS was predictive of ACR OA, knee pain, and physician-diagnosed OA.
CONCLUSION: Our study showed that the characteristics of patients with OA are different, physically and psychosocially, depending on the criteria used. Poor agreement was observed between radiological diagnosis and the other diagnostic criteria. Our findings have important implications for the interpretation and comparison of published studies using different OA criteria.
AIMS: To evaluate clinical and psychological differences between adults with IBS seen in secondary care in the United Kingdom (UK) and Malaysia.
METHODS: Age- and sex-matched patients with IBS from a single centre in the UK (Leeds) and two centres in Malaysia (Kuala Lumpur and Kota Bharu), who fulfilled Rome III criteria, were recruited prospectively. Demographic characteristics and gastrointestinal and psychological symptoms were compared between both groups.
RESULTS: A total of 266 (133 UK and 133 Malaysian) age- and sex-matched patients with Rome III IBS were recruited (mean age: 45.1 years Malaysia, vs. 46.5 years UK; 57.9% female). UK patients were more likely to consume alcohol than Malaysian patients (54.1% vs. 10.5%, p pain, abdominal bloating, meal-related symptoms (p
MATERIALS AND METHODS: This cross-sectional study recruited women referred to physiotherapy to manage OA. The measurements included fatigue severity (fatigue severity scale); pain level (numerical rating scale); obesity indices (body mass index, fat %, waist circumference); functional performances (upper limb strength, lower limb strength, mobility, exercise capacity and quality of life). A simple linear regression analysis was used to determine which independent variable may be associated with fatigue severity.
RESULTS: Ninety-six women with unilateral KOA participated in this study (Mean age, 55.70, Standard Deviation, SD 6.90) years; Mean fatigue severity, 34.51, SD 14.03). The simple linear regression analysis showed that pain level (β=4.089, p<0.001), fat % (β=0.825, p<0.001) and QoL (β=0.304, p<0.001) were significantly associated with fatigue. After controlling for pain level, only fat % was significantly associated with fatigue (β=0.581, p=0.005).
CONCLUSION: Pain level, fat %, and QoL appear to be associated with fatigue severity in women with KOA. In addition, pain symptoms may interact with factors associated with fatigue severity.
METHOD: This randomized controlled trial was conducted on 80 nulliparous pregnant women who gave birth in four low-risk maternity clinics in Samarinda, Indonesia, from February to May 2022. The women were randomized into intervention (N=40) and control (N=40) groups based on random allocation. Certified midwives performed shiatsu massages following standard protocols. Pain was assessed using the Numeric Rating Scale, and anxiety was assessed using the Hamilton Anxiety Rating Score at three times including before the intervention (T0), the latent phase (T1), and at transition phase (T2). The impact of the intervention was analyzed using repeated measures analysis of variance by SPSS 26. A p-value less than 0.05 was considered statistically significant.
RESULTS: The intervention group showed a significant reduction in labour pain scores from 6.85±1.00 (T0) to 6.13±0.88 (T1) and 4.78±0.83 (T2) (P<0.001), while the control group showed an increase from 6.85±1.00 (T0) to 8.05±0.64 (T1) and 8.85±0.48 (T2) (P<0.001). Anxiety scores in the intervention group decreased from 28.53±4.41 (T0) to 26.15±3.59 (T1) and 20.65±2.69 (T2) (P<0.001), whereas the control group experienced an increase from 25.55±3.16 (T0) to 27.05±3.36 (T1) and 31.73±3.27 (T2) (P<0.001). The between-subject effects in time levels for labour pain and anxiety in the two study groups had a significant impact (P<0.001).
CONCLUSION: Findings showed that shiatsu massage was effective and safe for relieving pain and reducing anxiety during childbirth of nulliparous women. This research suggests that shiatsu massage can be used as an effective alternative method to relieve pain and anxiety during labour in low risk pregnancies, particularly in settings with limited access to pharmaceutical analgesics.Trial Registration Number: IRCT20220317054316N1.