ibuprofen (ibuprofen, OSAT / OSAT ibuprofen)

Comparative effectiveness of therapeutic ultrasound and pharmacotherapy in the management of muscular temporomandibular disorders: a randomized clinical trial.

Subhikshaa M M, Shetty Prathima P, Veena K M KM, Shenoy Prashanth P et al.

Temporomandibular disorders (TMDs) of muscular origin are a common cause of chronic orofacial pain and functional limitation. Conservative management includes pharmacotherapy and physiotherapeutic modalities such as therapeutic ultrasound. However, evidence directly comparing their effectiveness remains limited. This randomized clinical trial compared therapeutic ultrasound and pharmacotherapy in reducing pain intensity and improving mandibular function in patients with muscular TMDs. A prospective, parallel-group randomized clinical trial was conducted among 36 patients diagnosed with muscular TMDs according to Group I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Following ethical approval (YEC-1/2024/038) and CTRI registration (CTRI/2024/12/077788), participants were randomly allocated into two groups (n = 18). Group A received ibuprofen (400 mg), paracetamol (325 mg), and chlorzoxazone (250 mg) twice daily for seven days. Group B received therapeutic ultrasound (1 MHz, 1.0 W/cm², continuous mode) for 10 min daily for seven days. Pain intensity was assessed using the Numerical Rating Scale (NRS), and maximum mouth opening was measured using a Vernier calliper. Data were analysed using paired and independent Student's t-tests (p < 0.05). All participants completed the study. Both groups showed significant reductions in pain intensity and improvements in maximum mouth opening (p < 0.05). Mean NRS scores decreased from 6.31 ± 1.35 to 2.94 ± 1.06 in the pharmacotherapy group and from 5.56 ± 1.97 to 1.69 ± 1.08 in the therapeutic ultrasound group. Mean mouth opening increased from 40.31 ± 3.63 mm to 41.44 ± 2.94 mm and from 40.75 ± 3.55 mm to 43.63 ± 2.55 mm, respectively. Therapeutic ultrasound achieved significantly greater pain reduction (p = 0.002) and greater improvement in mouth opening (p = 0.032). No adverse events were reported. Both treatments were effective for muscular temporomandibular disorders; however, therapeutic ultrasound was associated with greater short-term improvements in pain intensity and maximum mouth opening than pharmacotherapy under the conditions of this study. https://ctri.nic.in/Clinicaltrials/login.php, identifier CTRI/2024/12/077788.

2026 Taiwan guidelines for the acute pharmacologic treatment of migraine in adults.

Lau Chi Ieong CI, Chen Wei-Ta WT, Hou Tsung-Wei TW, Liaw Yi-Chia YC et al.

Since the publication of the Taiwan Headache Society's 2022 Guidelines for the Acute Treatment of Migraine Attacks, advances in headache medicine and the approval of new drugs in Taiwan have necessitated an update. To address clinical needs, the Guideline Committee of the Taiwan Headache Society reviewed evidence for pharmacological and non-pharmacological acute treatments using evidence-based principles. Drawing from the latest European, American, and international guidelines, and through expert consensus, this revision updates treatment roles, grades of recommendation, efficacy, and adverse-effect profiles. Currently, a broad range of medications is available in Taiwan for acute migraine management, categorised into "specific" and "non-specific" agents. Specific treatments include oral and intranasal triptans, and gepants, i.e., oral calcitonin gene-related peptide (CGRP) receptor antagonists. Non-specific agents include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs: diclofenac, ibuprofen, naproxen). Injectable prochlorperazine is also strongly recommended. Ergotamine/caffeine combinations are less effective and are second-line agents, while high-dose aspirin is limited by gastrointestinal risk. Considering the potential risk of dependency, tramadol or tramadol/paracetamol combinations should be reserved until all other agents fail, and should be limited to oral forms. Other opioids, such as morphine, butorphanol, etc., lack evidence and are not recommended. Treatment should follow the principle of stratified care: oral NSAIDs for mild disability, with combination analgesics or parenteral NSAIDs as alternatives, and oral or intranasal triptans for moderate to severe disability, ideally administered early. Antiemetics may be added, and combining triptans with NSAIDs enhances efficacy. Rimegepant can be considered a first-line therapy, particularly for patients who are unresponsive or intolerant to triptans, have cardiovascular contraindications, or are at risk of developing medication overuse. In status migrainosus, parenteral corticosteroids with intravenous fluids are advised. Acetaminophen remains first-line for children and pregnant women. To prevent medication-overuse headache, acute treatments, including NSAIDs, acetaminophen, triptans, ergot derivatives, and combination analgesics, should not exceed two days per week, probably with the exception of rimegepant.

Paediatric Posterior Reversible Encephalopathy Syndrome (PRES) Induced by Ibuprofen Intake: A Case Report.

Bargiacchi Giuditta G, De Marco Oriana O, Petruzzelli Luigi Annicchiarico LA, Tucci Celeste C et al.

Association of Common Anti-Inflammatory Medications with Reduced Risk of Vision-Threatening Diabetic Retinopathy in Type 2 Diabetes.

Bison Henry S HS, Zhu Angela S AS, Borissov Martin M, Jung Hee-Jae HJ et al.

To determine whether adults with type 2 diabetes mellitus (T2DM) using cetirizine, ibuprofen, or prednisone have a reduced incidence of diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Retrospective propensity score-matched cohort study. Adults with T2DM and documented eye-care in the TriNetX US Collaborative Network who had two documented uses of cetirizine, ibuprofen, prednisone, fenofibrate, or gabapentin between January 1, 2005, and March 1, 2025. Each drug cohort was 1:1 propensity score-matched on 44 covariates against non-users; fenofibrate served as a positive control, and gabapentin served as both a negative control and an active comparator. Residual confounding was assessed using eight ophthalmic negative-control outcomes (NCOs) and E-values. Nine sensitivity analyses tested comparison to users of gabapentin, alternative outcome windows, a new-user design, glycemic strata, matching for drug indication, and exposure duration. Incident DME and PDR within 3 years of the index date. Matched-pair counts ranged from 18,762 to 86,846. Cetirizine was associated with reduced DME (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.51-0.74) and PDR (HR, 0.59; 95% CI, 0.46-0.77); ibuprofen with reduced DME (HR, 0.63; 95% CI, 0.56-0.69) and PDR (HR, 0.48; 95% CI, 0.41-0.56); and prednisone with reduced DME (HR, 0.46; 95% CI, 0.41-0.52) and PDR (HR, 0.36; 95% CI, 0.30-0.43). Fenofibrate showed associations of similar magnitude (DME HR, 0.57; 95% CI, 0.48-0.68; PDR HR, 0.59; 95% CI, 0.45-0.77); gabapentin showed no association (DME HR, 0.95; 95% CI, 0.88-1.02; PDR HR, 1.04; 95% CI, 0.93-1.15). Point E-values for the investigational drugs ranged from 2.57 to 4.97 (lower 95% CI bound, 1.93 to 4.06). The NCO panel was near null for cetirizine and ibuprofen and showed mild protective bias for prednisone and fenofibrate. Findings persisted across the nine sensitivity analyses. Cetirizine, ibuprofen, and prednisone were associated with reduced incidence of DME and PDR in adults with T2DM, with effect sizes comparable to those of the fenofibrate positive control. These findings support prospective evaluation of anti-inflammatory medications for the prevention of vision-threatening diabetic retinopathy.