M. Tech. / Cervical Facet Syndrome is a condition characterised by neck pain and decreased mobility of the cervical spine (Bovim et al., 1994). It is essentially the dysfunction of the posterior joints in the neck where muscle hypertonicity causes the ligaments to shorten (Gatterman, 1995). There is a high prevalence of Cervical Facet Syndrome in industrialised countries leading to a loss in productivity and costly expenditure in terms of treatment (Jordan et al., 1998). The aim of this research study was to assess the efficacy of treatment with injectables of the Anthroposophical medicine Disci comp. cum Argento on the symptoms of Cervical Facet Syndrome. These symptoms include pain and a decrease in range of motion. Pain was assessed using two questionnaires, namely the Visual Analogue Scale for Pain (Annexure D) and the Vernon Mior Neck Pain Disability Index (Annexure E). Range of motion was measured using the Cervical Range of Motion Goniometer (Annexure F). This was a double-blind, placebo-controlled trial. Thirty participants, male and female between the ages of 18 and 40 who had been pre-diagnosed with Cervical Facet Syndrome were recruited to participate in the research study. The study was conducted over a period of three weeks. On day one, participants were requested to complete a Consent Form (Annexure B), a Participant Profile (Annexure C), and the two questionnaires used to assess pain. Range of motion was measured by the researcher. The group was then randomly divided into two groups with 15 participants per group. The experimental group received subcutaneous injections of Disci comp. cum Argento and the control group received subcutaneous injections of saline. These injections were administered by the researcher and repeated three times a week for two weeks so that each participant received a total of six injections. A final assessment without treatment was completed in the third week. The two questionnaires and range of motion measurements were repeated at the third, sixth and seventh or final assessment. . The results of this study indicated that although both the remedy and placebo groups showed improvements, there was no significant difference in these improvements between the groups for the results obtained for the Visual Analogue Scale for Pain, Vernon Mior Neck Pain Disability Index and measurements of flexion, left rotation and left lateral flexion. There was however, significant differences in improvement between the visits in favour of the remedy group for measurements of extension, right rotation and right lateral flexion.

研究背景：肩痛是临床的常见症状，常因不正确姿势、受凉、外伤、运动劳损等引发，多被诊断为局关节周围炎、属部的肌臆炎等’带来的疼痛和肢体活动障碍都严重影响正常生活。针灸治疗盾痛效果显著’传统中医在眉痛的诊疗中已有详尽论边，而近年西方医学提出的激痛点疗法，在治疗痛症上也有明确的疗效。总结局痛的激痛点针刺取穴方案，探讨其与传统针灸的失系’对发展当代针灸有十分重要的理论意义和临床价值。研究目的：初步总结盾痛的激痛点针刺取穴方案，探讨激痛点和传统针灸的相关性, 为临床提供新思路。研究方法：文献研究。结论：眉痛的激痛点针刺取穴方案为：盾前痛取胸大肌锁骨部、胸小肌、肱二头肌、喙肱肌、背阔肌、冈下肌、前三角肌、前斜角肌、中斜角肌激痛点；属后痛取大圆肌、小圆肌、肩胛下肌、肱三头肌长头第一、下斜方肌第三、后三角肌激痛点；肩外侧疼痛取中三角肌、冈上肌激痛点。此法优势在于理论系统与诊疗过程明确、操作规范、疗效显著，是属痛的治疗的新思路。对比发现，激痛点理论与经筋理论相似。激痛点针刺取穴与中医整体辨证论治的结合, 势必有助提高临床疗效，值得深入探索。關键字：肩痛激痛点针刺取穴文献研究

published_or_final_version / Behavioral Health / Master / Master of Social Sciences

Submitted in partial compliance with the requirements for the Master's degree in technology in Technology : Homeopathy, Durban University of Technology, Durban, South Africa, 2015. / Introduction There is no proper definition of acute mechanical neck pain (AMNP) but it has been theorized that it has a sudden onset pain and lasts for a relatively short time. It occurs with or without injury and presents with pain in the shoulder and upper arm. Acute mechanical neck pain should not be accompanied by an inflammatory disease, neurological disease, fracture, dislocation, neoplasm or infection AIM The purpose of this study was to compare the relative effectiveness of homoeopathic Simillimum against Traumeel® (a commercial homoeopathic complex) in the treatment of acute mechanical neck pain using the neck disability scale, range of motion measurements and a subjective observation. METHODOLOGY This study was a double blind, quantitative, comparative; clinical trial that involved two treatment groups: Half the participants received the homoeopathic Simillimum and the other half received oral Traumeel® drops. Patients self-selected homoeopathic treatment. Patients were screened and only those who fit the inclusion criteria of suffering from AMNP of maximal two weeks duration, were English conversant and between the ages of 18 and 55 were included. Those suffering with AMNP were required to sign an informed consent form after the procedure was explained thoroughly. Each patient read through the procedure of the clinical trial and were informed that their participation was on a voluntary basis and they could withdraw at any time. Convenience sampling was utilised in which an independent person, using a simple sampling method, randomly allocated the patients into the respective groups. Of the 30 patients, 15 received Traumeel® and 15 received homoeopathic Simillimum. It was hypothesized that the homoeopathic Simillimum treatment would be more effective in the treatment of acute mechanical neck pain than oral Traumeel®. The treatment protocol consisted of three homoeopathic consultations within a seven day period, with the consultations scheduled on days one, three and seven. Subjective and objective measurements were taken at each of the three consultations, Durban University of Technology Homoeopathic Day Clinic, Steve Biko Campus. A Simillimum treatment was prescribed for every patient based on full homoeopathic case history. This Simillimum was confirmed by the co-supervisor. Half of the patients were dispensed the Simillimum and the other half received Traumeel® according to the randomisation list. At the first follow up, on day three, the patients were reassessed according to their progress, perception and their range of motion, and the progress of the patient was analysed. In the last consultation on day seven, the progress of the patient was analysed using the perceptive questionnaire of the Neck Disability Index and the objective cervical range of motion. Full physical examinations were carried out during all three consultations. Upon collection of data, the statistical package SPSS 22.0 was used to record and analyse the data. Non parametric statistical tests were used as the data were non parametric - it does not follow any distribution, was ordinal (not relying on numbers but rather a ranking order of sorts). Inter-group comparisons were made using Mann-Whitney U-test. RESULTS The effectiveness of Traumeel® and homoeopathic Simillimum was measured firstly, in terms of the patients’ perception of the responses to the treatment applying the Neck Disability Index and secondly the increase in degree of movement in the range of motion of the cervical region. When applying an ANOVA with repeated measures with a Greenhouse-Geisser correction, the mean scores between groups were statistically not significantly different (p = 0.112). CONCLUSION Both the Traumeel® and Simillimum treatments were effective in the treatment of acute mechanical neck pain, but there was no evidence that one treatment was more beneficial than the other. The p-values (sig.) reported were greater than 0.05, thus implying that there is no significant difference between the groups.

The present study investigated pharmacological properties of Capsicum frutescens-derived capsaicin, including its analgesic, anti-inflammatory and coagulatory properties. The effects of capsaicin on gastrointestinal and myocardial muscles, as well as on myocardial ischaemic-reperfusion, were also investigated. Capsaicin pre-treatment in neonatal rats has been found to abolish the development of thermal hyperalgesia produced in a model of neuropathic pain in rats (Toth-Kasa et al., 1986). In addition, capsaicin sensitivity has been found to be dependent on continued presence of nerve growth factor (NGF), whose concentration increases in inflamed tissues (Bevan and Winter, 1995). By stimulating the release of excitatory amino acids (EAA); such as glutamate and neuropeptides [(CGRP, neurokinin A (NKA) and Substance P (SP)] from both the peripheral and central terminals of sensory neurones by two mechanisms (Kroll et al., 1990; Del Bianco et al., 1991; Lou et al., 1992; 1994; Woolf et al., 1994); capsaicin has been shown to produce a longer-term inhibitory effect. This is one likely mechanism for capsaicin analgesic and anti-inflammatory actions (Bleakman et al., 1990). Within the gastro-intestinal tract, SP and NKA are involved in the physiological control of several digestive functions, such as motility, fluid and electrolyte secretion, blood flow, and tissue homeostasis (Otsuka, 1993; Holzer et al., 1997). Consistent with this finding, upsurge of SP in irritable bowel syndrome (IBD) was confirmed by Mantyh et al, (1988). Pre-treatment of rats with either capsaicin or NK-1R antagonists dramatically reduced fluid secretion, mucosal permeability, and intestinal inflammation in animal models of acute and chronic inflammation (McCafferty et al, 1994; Pothoulakis et al., 1994). Capsaicin can modulate endocrine and paracrine activities, immune responses, as well as gastro-intestinal and cardiovascular functions. Moreover, up-regulation of Substance P receptors was found to be associated with chronic inflammatory conditions (De et al., 1990). Stimulation of transient receptor potential vanilloid 1 also results in the activation of nociceptive and neurogenic inflammatory responses (Rigoni et al., 2003). vi The pharmacodynamic effects of capsaicin on the cardiovascular system remain elusive. Some actions of capsaicin on the heart were attributed to an interaction at K+ channels (Castle, 1992), or liberation of neuropeptides, most notably calcitonin-gene-related-peptide (CGRP) from the vanilloid-sensitive innervation of the heart (Franco-Cereceda et al., 1988; 1991). The possibility of a direct effect of capsaicin on the heart via a cardiac vanilloid receptor (VR), or through interaction of vanilloid receptors with purinergic receptors, and subsequent release of nitric oxide (NO), leading to vasodilatation were considered. Evidence abound in the literature that Ca2+ ions are released through 1, 4, 5 inositol phosphatase by the release of phospholipase C, or through interaction of the vanilloid receptors with cannabinoids. In an earlier study, Jaiarj et al. (1998) found that capsaicin acting on the heat-sensitive vanilloid receptors, had thrombolytic effects. Though weak evidence, Jaiarj et al. (1998) observed that individuals who consume large amounts of Capsicum have lower incidence of thromboembolism. Following ethical approval, the study reported in this thesis was conducted in phases. Identification of Capsicum frutescens (facilitated by a botanist in the Department of Botany, Westville campus of the University of KwaZulu Natal). Chromatographic extraction of capsaicin from Capsicum frutescens was followed by Nuclear Magnetic Resonance (NMR) analysis of the extract. Animal studies were conducted using capsaicin extract (CFE) and/or a reference capsaicin (CPF), using „hot plate. and „acetic acid. test methods to investigate the role of capsaicin on analgesia. Fresh egg albumin-induced inflammation was used to investigate the role of capsaicin in inflammation, following pre-treatment with CFE and CPF. Concentraton-response curves of increasing concentrations of capsaicin, acetylcholine and other agonist drugs with specific antagonists on strips of chick oesophagus, guinea-pig ileum, and rabbit duodenum were constructed following investigations on gastrointestinal (GIT) smooth muscles. The effect of capsaicin on coagulation was assessed by measuring international normalized ratio (INR) of animals that were exposed to different concentrations of capsaicin (CFE and CPF). Furthermore, parallel control studies were conducted in each of these investigations using distilled water or saline as placebo-control or specific-prototype agonists. negative-control. Cardiovascular investigations included studies on the effects of capsaicin on the heart rate, inotropy, vii coronary perfusion pressure, and ischaemic-reperfusion injury, using Langendorf.s rat heart models. Collated data were triangulated by manual hand-written and PowerLab data acquisition, or computerised capture. Statistical analysis were performed by either one or two of the following: Student.s t-test, ANOVA (repeated or single–use modes), facilitated and confirmed by Graph Pad Prism, Microsoft Excel or CPSS software(s). Reproducibility and relevance to the stated objectives of the various studies were confirmed by assessing which of the Null or Alternative hypothesis is validated by the results from the test. Treatment with CFE or CPF at all doses significantly (p<0.01) increased MRT. By comparison with control, writhing responses to acetic acid were significantly reduced following pre-treatment with various doses of CFE or CPF. The results in both parallel groups of CFE and CPF in the hot plate and acetic acid tests had Pearson correlation of one (1). Compared to the diclofenac (DIC) group, the degree of inhibition of paw oedema by CFE and CPF was statistically significant (P<0.05-0.001), best in the first 4 hours of treatment. The results of the in vitro laboratory animal study indicate that relatively low concentration of CPF (20 or 40 .g) produced significant (p.0.05), concentration-related inhibitions of acetylcholine (0.1-5 .g)-induced contractions of the chick isolated oesophagus, guinea-pig isolated ileum and rabbit isolated duodenum. Biphasic effects, which were noticed at low concentrations, consisted of initial brief contractions, followed by longer-lasting relaxations and reductions of the contractile amplitudes of the muscle preparations. Percentage inhibitions of the smooth muscle contractions by CFE or CPF were concentration-dependent, ranging from 20-70% (p<0.02). / Thesis (Ph.D.)-University of KwaZulu-Natal, Westville, 2012.

Submitted in partial compliance with the requirements for the Master’s degree in technology in Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2017. / Background: According to Picavet and Schouten (2003) the incidence of neck pain is increasing at a greater rate than other spine problems (Hoving et al. 2004). Furthermore, chronic neck pain is a substantial burden to society with chronic neck pain being the fourth leading cause of disability worldwide (Hoy et al. 2014). Chronic mechanical neck pain (CMNP) has been defined as localised, asymmetrical neck pain with restricted range of motion and dysfunctional musculature (Grieve, 1988). Treatments for those suffering with chronic pain, which are non-surgical, appear to be the most beneficial for patients according to Haldeman et al. (2008). Giles and Müller (1999) have stated that spinal manipulation is the most effective method of treating spinal pain on its own. However, the literature suggests that there is benefit in combining manipulation with an “anti-inflammatory type” drug (Crawford 1988; Oberbaum 1998; Serrentino 2003). Many studies have been successfully conducted on Homoeopathic complexes to treat neck pain (Fisher 1986; Bohmer and Ambrus 1992; Hepburn 2000; Soeken 2004) however no study has yet to been carried out on the combination of Homoeopathic Simillimum (single remedy) and spinal manipulation for CMNP. Objective: The aim of this study was to determine if spinal manipulation and Homoeopathic Simillimum in combination are more relatively effective than spinal manipulation alone in the treatment of chronic mechanical neck pain. Methodology: This study was a randomised, blinded placebo controlled quantitative trial with a comparative clinical trial design. Thirty consenting participants with CMNP who met the inclusion criteria were randomly distributed between two treatment groups. Group A received spinal manipulation as well as Homoeopathic Simillimum and group B received spinal manipulation with placebo medication. Each participant received three treatments over a period of a week; with subjective and objective readings taken at every consultation. The subjective tools included the Numerical Pain Rating Scale and Canadian Memorial College of Chiropractic Neck Disability Index. Objective tools included the Algometer and CROM-II Goniometer. All data captured was analysed using SPSS version 24.0. Inferential and non-parametric analysis of the data were also be performed. Results: The results showed that no statistically significant differences were observed between the two groups in terms of subjective and objective measurements. However, there were statistically significant improvements seen in both groups equally in terms of ANOVA subjective and objective measurements i.e. both groups showed improvement. Conclusion: The results of this study concluded that no statistical or clinically significant changes were noticed between the groups and therefore the Homoeopathic Simillimum added no statistical significant improvements in those who received it over those participants who received placebo in the treatment of chronic mechanical neck pain. / M

The purpose of this current study is to examine the impact of non-pharmacologic pain interventions administered by trained Child Life professionals in an emergency department on pain perception in children. Results showed no significant decrease in children's pain report during the medical procedure compared to before the medical procedure. However, pain after the medical procedure is significantly less than pain during the medical procedure.

Since the first so-called “medical marijuana” legislation was passed in California in 1996, a total of twenty states and the District of Columbia have passed laws permitting limited use of cannabis. Despite the changes in state laws, cannabis remains illegal for any purpose under federal law. Changes in state laws have coincided with a renewed interest in the substance for the treatment of a variety of conditions. There has been a significant increase in published data over the past twenty years examining the efficacy of cannabis as an appetite stimulant, antiemetic agent, and analgesic adjuvant. The purpose of this meta-analysis was to synthesize published data on cannabis use as an analgesic agent. Five studies meeting inclusion criteria were located through searches of online databases, review of reference lists, author correspondence, and review of clinical trials databases. Meta-analysis was conducted using fixed-effects modeling. The overall effect of mean reduction of pain intensity was -4.895 (Z-score) with an associated p value of 0.003. The combined standardized mean difference (SMD) was -0.362 (CI -0.507 to -0.217), indicating on average a moderate significant reduction in pain intensity for patients with chronic pain. As the legal status of the substance evolves, additional research is needed to establish evidence-based clinical recommendations regarding the use of medicinal cannabis in pain management.