Buprenorphine Versus Diclofenac for Pain Relief in Acute Pancreatitis: A Double-Blinded Randomized Controlled Trial

BACKGROUND

Although both nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are used for analgesia in acute pancreatitis (AP), the analgesic of choice is not known. We compared buprenorphine, an opioid, and diclofenac, an NSAID, for analgesia in AP.

METHODS

In a double-blind randomized controlled trial, AP patients were randomized to receive intravenous diclofenac or intravenous buprenorphine. Fentanyl was used as rescue analgesia, delivered through a patient-controlled analgesia pump. Primary outcome was the difference in the dose of rescue fentanyl required. Secondary outcomes were the number of effective and ineffective demands of rescue fentanyl, pain-free interval, reduction in visual analogue scale (VAS) score, adverse events, and organ failure development.

RESULTS

Twenty-four patients were randomized to diclofenac and 24 to buprenorphine. The 2 groups were matched at baseline. The total amount of rescue fentanyl required was significantly lower in the buprenorphine group:130 μg, interquartile range (IQR), 80-255 vs 520 μg, IQR, 380-1065 (P < .001). The number of total demands was 32 (IQR, 21-69) in the diclofenac arm vs 8 (IQR, 4-15) in the buprenorphine arm (P < .001). The buprenorphine group had more prolonged pain-free interval (20 vs 4 hours; P < .001), with greater reduction in the VAS score at 24, 48, and 72 hours compared with the diclofenac group. These findings were confirmed in the subgroup of moderately severe/severe pancreatitis. Adverse events profile was similar in the 2 groups.

CONCLUSIONS

Compared with diclofenac, buprenorphine appears to be more effective and equally safe for pain management in AP patients, even in the subcohort of moderately severe or severe pancreatitis (Trial Registration number: CTRI/2020/07/026914).

Spinous Process-Splitting Laminectomy Approach for Tumor Excision at Conus Medullaris or Cauda Equina Level Results in Satisfactory Clinical Outcomes Without Affecting Global Spinal Sagittal Alignment

STUDY DESIGN

Retrospective comparative study.

OBJECTIVES

The present study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes following tumor resection using spinous process-splitting laminectomy (SPSL) approach without fixation in patients with conus medullaris (CM) or cauda equina (CE) tumor.

METHODS

Forty-one patients with CM or CE tumor (19 males, 22 females, mean age at surgery of 52.9 ± 13.0 years) were included in this study. The variations of outcome variables were analyzed in various GSSA profiles using radiographic outcomes. The clinical outcomes were assessed using Japan Orthopaedic Association (JOA) score and JOA back pain evaluation questionnaire (JOABPEQ).

RESULTS

In all cases, the various GSSA parameters (sagittal vertical axis, C2-7 lordosis, T1 slope, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis [LL; upper, middle, and lower], sacral slope, pelvic incidence, and pelvic tilt) did not significantly change in the 2-years postoperative period. Moreover, age at surgery, the number of resected laminae, preoperative T12-L2 kyphosis, or LL did not affect the postoperative changes in T12-L2 kyphosis or LL, and had no statistically significant correlation among them. The scores of each postoperative JOA domain and the Visual Analogue Scale included in the JOABPEQ were significantly improved. There was no statistical significant group difference in each sagittal profile or clinical outcomes between CM and CE groups postoperatively.

CONCLUSIONS

Tumor resection using SPSL approach did not affected the various GSSA parameters examined and resulted in satisfactory clinical outcomes, indicating that SPSL approach is a suitable surgical technique for patients with CM or CE tumor.

Maxillofacial Soft-tissue Healing Efficacy between Nano-chitosan and Collagen-Chitosan Membrane - A Comparative Study

Introduction

Routine wound management in maxillofacial trauma with soft-tissue injury needs to be addressed in a systematic way to prevent untoward complications. In this study, we examined the effects of a novel surgical dressing material on pain, wound healing and scar and its feasibility to common people. Our aim is to compare the efficacy and potency of the nano-chitosan membrane and collagen-chitosan membrane as surgical dressing materials for soft-tissue wounds in the maxillofacial region.

Materials and Methods

Thirty participants who sustained soft-tissue injury in the maxillofacial region were included in the study. Post-suturing, Group A participants were treated with nano-chitosan membrane impregnated with chlorhexidine, Group B participants were treated with collagen-chitosan membrane impregnated with chlorhexidine and Group C participants had received chlorhexidine powder as conventional wound care management and recalled and evaluated for wound healing, pain and scar at seventh day, one month and three months postoperatively.

Results

The wound healing efficacy of both Group A and B participants was nearly comparable and Group A had better wound healing (P = 0.043) when compared to conventional chlorhexidine dressing material. In relation to pain intensity, Group A was reported with a low intensity of pain and also with better results in scar assessment at the third-month follow-up.

Discussion

This study had proven that even though the wound healing efficacy of both nano-chitosan and collagen-chitosan membranes is nearly comparable, nano-chitosan shows better results on the evaluation of parameters such as wound healing, pain and scar. Nano-chitosan membrane has better wound healing when compared to conventional chlorhexidine dressing material.

Efficiency of interlaminar uniportal endoscopic lumbar discectomy

AIM

Prospective evaluation of the results of endoscopic lumbar discectomy.

METHODS

95 patients were consecutively enrolled in the study between 2017 and 2021. We monitored low back pain and sciatica according to the Visual Analogue Scale (VAS), the limitations in daily activities (Oswestry Disability Index, ODI), overall satisfaction according to a 0-100 % scale, and the rate of surgical complications and reoperations.

RESULTS

Postoperatively, the VAS values of low back pain and sciatica decreased significantly from 5 to 1 point and from 6 to 1 point, respectively, and the pain remained in the tolerable range (VAS 1-2) throughout the follow-up period. The ODI score improved significantly from severe disability (46 %), preoperatively, to moderate disability at discharge and one month after surgery (29 % and 22 %, respectively), down to minimal disability at 3 and 12 months after surgery (12 % and 14 %, respectively). Overall patient satisfaction improved significantly at all follow-up time points (46 %, 70 %, 77 %, 80 %, and 78 %, respectively). Reoperation rate was 6.3 %. Cerebrospinal fluid leakage was observed in one case only (1.1 %). Transient postoperative perianogenital sensory impairment occurred in two patients (2.1 %). There was no evidence of surgical site infection or haematoma.

CONCLUSION

Endoscopic discectomy provides significant pain relief and improves the patient's ability to perform activities of daily living, contributing to greater satisfaction. It is a safe method with a low risk of surgical and neurological complications (Tab. 3, Fig. 3, Ref. 27).

Efficacy of zinc supplementation for the treatment of dysmenorrhoea: a double-blind randomised controlled trial

OBJECTIVES

To determine the efficacy of zinc sulfate supplementation in managing dysmenorrhoea.

METHODS

In total, 103 high school students were randomised into an experimental arm (52 students) and a control arm (51 students) and received 40-mg zinc sulfate or placebo, respectively, over three cycles. Primary outcome measures were the mean Visual Analogue Scale score, which measured pain over three cycles, and the frequency of nausea and vomiting. Secondary outcomes were the use of additional analgesics and the frequency of allergic reactions.

RESULTS

Fifty participants were analysed in each group. Mean pain scores were not significantly different between the groups before administering zinc sulfate therapy. Following the intervention, the mean pain scores for the treatment (2.80 ± 2.28) and placebo (3.48 ± 2.85) groups were not significantly different in the first cycle; however, scores in the treatment group were significantly better in the second (2.56 ± 1.97 vs 3.80 ± 2.77) and third (1.95 ± 1.72 vs 3.95 ± 2.82) cycles. No significant differences were observed between the groups in the nausea and vomiting incidence and the requirement for additional analgesics.

CONCLUSIONS

Zinc sulfate reduces dysmenorrhoea severity with minimal or no adverse effects, especially with more than one cycle of usage.Trial Registration Number: PACTR202105843292338. The trial is publicly available and was registered at www.pactr.org on 25 May 2021.

Comparison of two different delivery methods of home-based exercise on neck pain

AIM

This study aimed to compare the effects of two different home-based exercise delivery methods on compliance, pain, and disability in participants with non-specific neck pain.

MATERIALS & METHODS

The study, which was carried out at Istanbul Arel University between February and May 2018, was carried out with 60 participants from university staff, aged 25-60, suffering from non-specific neck pain. The cases were randomly assigned to two groups. A home exercise method with printed material exercise was given to the patients in Group 1, and a video phone reminder exercise was given to Group 2 for six weeks in both groups. Pain severity and neck disability were evaluated before and after the exercise with the 'Visual Analogue Scale' and the 'Neck Pain and Disability Score.'

RESULTS

Descriptive statistics showed that the video phone reminder exercise group had greater compliance. Neck pain and neck disability assessments improved before and after the exercise in both groups (p < .001). Statistical analysis revealed that video phone reminder exercise scores were significantly higher than those of the control group. Effect sizes were evaluated between the two groups, and the difference between them were found to be clinically significant (d > 0.8).

CONCLUSIONS

The home exercise method with video and telephone reminders, which can be applied instead of the traditional method provided with printed materials, is more effective for compliance, pain severity, and neck disability. Trial registration: NCT04135144. Registered on 21 September 2019. Retrospectively.

Overall childbirth experience: what does it mean? A comparison between an overall childbirth experience rating and the Childbirth Experience Questionnaire 2

BACKGROUND

In clinical settings and research studies, childbirth experience is often measured using a single-item question about overall experience. Little is known about what women include in this rating, which complicates the design of adequate follow-up, as well as the interpretation of research findings based on ratings of overall childbirth experience. The aim of this study was to examine which known dimensions of childbirth experience women include in the rating on a single-item measure.

METHODS

Ratings of overall childbirth experience on a 10-point numeric rating scale (NRS) from 2953 women with spontaneous or induced onset of labour at two Swedish hospitals were evaluated against the validated Childbirth Experience Questionnaire 2 (CEQ2), completed on one of the first days postpartum. The CEQ2 measures four childbirth experience domains: own capacity, perceived safety, professional support and participation. Internal consistency for CEQ2 was evaluated by calculating Cronbach's alpha. NRS ratings were explored in relation to CEQ2 using empirical cumulative distribution function graphs, where childbirth experience was defined as negative (NRS ratings 1-4), mixed (NRS ratings 5-6) or positive (NRS ratings 7-10). A multiple linear regression analysis, presented as beta coefficients (B) and 95% confidence intervals (CI), was also performed to explore the relationship between the four domains of the CEQ2 and overall childbirth experience.

RESULTS

The prevalence of negative childbirth experience was 6.3%. All CEQ2-subscales reached high or acceptable reliability (Cronbach's alpha = 0.78; 0.81; 0.69 and 0.66, respectively). Regardless of overall childbirth experience, the majority of respondents scored high on the CEQ2 subscale representing professional support. Overall childbirth experience was mainly explained by perceived safety (B = 1.60, CI 1.48-1.73), followed by own capacity (B = 0.65, CI 0.53-0.77) and participation (B = 0.43, CI 0.29-0.56).

CONCLUSIONS

In conclusion, overall childbirth experience rated by a single-item measurement appears to mainly capture experiences of perceived safety, and to a lesser extent own capacity and participation, but appears not to reflect professional support. CEQ2 shows good psychometric properties for use shortly after childbirth, and among women with induced onset of labour, which increases the usability of the instrument.

The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial

BACKGROUND

Hip fractures are common in elderly patients. The surgery is usually delayed due to underlying conditions, and pain control is crucial while the patient is cleared for surgery. In this randomized controlled trial (RCT) study, we hypothesized that the application of skin traction in patients with intertrochanteric fracture does not significantly change the Visual Analogue Score (VAS) of pain.

METHODS

This is a prospective, single institution, parallel randomized controlled trial. Two hundred and twenty-nine patients with isolated intertrochanteric fractures were enrolled in the study. Patients with neurologic issues, drug addiction, scars or swelling, or vascular issues at the site of skin traction application were excluded from the study. Patients were divided into two groups: group A included 97 patients, and group B included 95 patients. Skin traction was applied for group A, while only a soft pillow was put beneath the patients' knees in the other group. The VAS score was measured after the diagnosis, two hours before the operation, and 24 h after the surgery. The morphine dosage administered per day was documented for both groups.

RESULTS

After excluding patients with postoperative delirium, 154 patients (55 males and 99 females) with isolated intertrochanteric fractures (69 right-sided and 85 left-sided), and a mean age of 70 ± 10 remained in the study. There were no significant differences between the two groups regarding age, gender, and mean time from injury to admission (P > .05). The mean VAS score measures and morphine dosage administered per day were not significantly different between the two groups (P > .05). Both groups experienced significant pain relief 24 h postoperatively (P < .001).

CONCLUSION

Pre-operative skin traction application affected neither the patients' VAS scores nor the mean morphine dosage per day in patients with isolated intertrochanteric fractures. Our data does not support the routine application of pre-operative skin traction in patients with intertrochanteric fractures.

TRIAL REGISTRATION

The project was registered in the Iranian Registry of Clinical Trials (registration reference: IRCT20180729040636N3, registration date: 01/07/2020).

LEVEL OF EVIDENCE: 1

Assessing speech intelligibility of pathological speech: test types, ratings and transcription measures

Speech intelligibility is an essential though complex construct in speech pathology. In this paper, we investigated the interrater reliability and validity of two types of intelligibility measures: a rating-based measure, through Visual Analogue Scales (VAS), and a transcription-based measure called Accuracy of Words (AcW), through two forms of orthographic transcriptions, one containing only existing words (EWTrans) and one allowing all sorts of words, including both existing words and pseudowords (AWTrans). Both VAS and AcW scores were collected from five expert raters. We selected speakers with various severity levels of dysarthria (SevL) and employed two types of speech materials, i.e. meaningful sentences and word lists. To measure reliability, we applied Generalizability Theory, which is relatively unknown in the field of pathological speech and language research but enables more comprehensive analyses than traditional methods, e.g., the intraclass correlation coefficient. The results convincingly indicate that five expert raters were sufficient to provide reliable rating-based (VAS) and transcription-based (AcW) measures, and that reliability increased as the number of raters or utterances increased. Generalizability Theory has proved effective in systematically dealing with reliability issues in our experimental design. We also investigated construct and concurrent validity. Construct validity was addressed by exploring the correlations between VAS and AcW within and across speech materials. Concurrent validity was addressed by exploring the correlations between our measures, i.e. VAS and AcW, and two external measures, i.e. phoneme intelligibility and SevL. The correlations corroborate the validity of VAS and AcW to assess speech intelligibility, both in sentences and word lists.

Vestibular hyaluronic acid injection in provoked vestibulodynia patients and its effect on pain and sexual function: A preliminary report

OBJECTIVE

Provoked vestibulodynia (PVD) is a challenging and distressing problem for women. The aim of this study was to examine the effect of hyaluronic acid (HA) in the management of this condition.

METHOD

This is a retrospective review of 12 women diagnosed with PVD and treated with HA (19 mg/mL) applied, point-by-point, to the vestibular region at 2 mm intervals and at a depth of 0.5 mm. Women completed a pain VAS and a Female Sexual Function Index (FSFI) before and 45 days after treatment.

RESULTS

An improvement was observed both in mean FSFI scores (17.8 to 23.3; p = 0.003) and mean VAS scores (7.2 to 4.1; p = 0.002) after HA application respectively. However, on a telephone interview 3 months post treatment, five women (41.7 %) complained of recurrence of their dyspareunia.

CONCLUSION

HA is a promising management option in provoked vestibulodynia. However, further larger studies with possible alternative regimens and longer follow-up are required.

[Comparative analysis of the effectiveness of SF-MPQ-2 and VAS for assessing the severity of pain syndrome in dental patients in the postoperative period]

OBJECTIVE

Conducting a comparative analysis of the effectiveness of the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2) and the Visual Analogue Scale (VAS) for assessing the severity of pain syndrome in dental patients in the postoperative period in dynamics.

MATERIAL AND METHODS

The study included 51 patients who received dental surgical treatment. Two groups of patients were formed, depending on the type of surgery and the degree of trauma of the operation. Group 1 - low degree of injury - 28 patients; group 2 - high degree of injury - 23 patients. Patients independently filled out questionnaires at four stages of the study: before surgery, on the 1st, 3rd, and 5th days after surgery as part of scheduled visits.

RESULTS AND DISCUSSION

In patients of group 2, the severity of pain symptoms was higher than in patients of group 1 in terms of pain symptoms on SF-MPQ-2 at all stages of the study, except the day before surgery. At the same time, there were no differences with the indicators of the VAS scale at any of the stages of the study. The most informative indicators of SF-MPQ-2 are the total indicator MPQ-Sum and the constant pain indicator MPQ-Const, which were significantly higher in group 2 on the 1st day after surgery, taking into account the correction for gender and age. The highest level of coincidence of indicators on VAS and the total score on MPQ-Sum was revealed on the 5th day of the operation, regardless of the degree of trauma of the operation.

CONCLUSION

The use of SF-MPQ-2 with a detailed description of pain sensations is the most acceptable way to assess the degree of pain syndrome in operative surgery, especially during the period when the severity of pain symptoms is maximum (in the first days of the postoperative period).

Impact of WALANT Hand Surgery in a Secondary Care Hospital in Spain. Benefits to the Patient and the Health System

Purpose

The aim of this study is to compare patient benefits and economic costs of hand surgeries using the wide-awake local anesthesia no tourniquet (WALANT) technique versus a conventional major outpatient suite and review outcomes and complications in a series of cases of patients operated on using the WALANT technique.

Methods

A prospective cohort study was first conducted comparing 150 cases of ambulatory hand surgery (carpal tunnel syndrome and trigger finger) using the WALANT technique and not requiring an operating room setting with 150 cases of outpatient surgery performed in an operating room involving a preoperative evaluation and the use of sedation and tourniquet. Preoperative, intraoperative, and postoperative pain was monitored, and days requiring postoperative analgesia were recorded. The resources and costs were evaluated. and patient satisfaction was assessed using a specific survey.Subsequently, 580 patient medical records were retrospectively reviewed, including 419 carpal tunnel syndrome and 197 trigger finger interventions (616 WALANT surgeries).

Results

Intraoperative pain was equivalent for both groups, and postoperative pain was significantly lower in the WALANT group, with a reduced need for analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital materials was reduced in the WALANT group, with a total estimated cost savings of 1.019 USD per patient.There were no complications related to the WALANT technique and the lidocaine and adrenaline combination. We found a complication rate of 5.58%, and, in line with the literature, most complications were minor, managed conservatively, and not related to the anesthetic technique.

Conclusions

Procedures such as carpal tunnel and trigger finger surgeries can be safely performed using wide-awake surgery. Patient satisfaction is higher than with the conventional procedure performed in the operating room. Pain control is excellent, especially during the postoperative period.

Clinical relevance

Hand surgery patients benefit from the WALANT technique in terms of comfort and timeliness because there is no need for preoperative tests or evaluations. In addition, it represents significant savings in hospital resources. In our case series, complications were in line with those previously reported with other anesthetic techniques.

A comparison of endotracheal intubation characteristics between Macintosh, CMAC and Smart Trach laryngoscopes; A randomized prospective clinical trial

BACKGROUND

In this study, we compared the performance characteristics of Macintosh laryngoscope, CMAC videolaryngoscope with a recently developed videolaryngoscope called Smart Trach.

RESEARCH DESIGN AND METHODS

: Three hundred seventy-five patients belonging to mixed population without having anticipated difficult airways undergoing elective surgeries were randomly allocated to be intubated using either of the three laryngoscopes (Macintosh, CMAC or Smart Trach). Time needed for successful intubation, number of attempts, Cormack Lehane's (CL) grading, optimisation maneuverers, intubation difficulty score (IDS), subjective ease of intubation (VAS), subjective lifting force and complications were recorded.

RESULTS

: Demographic and anthropometric measurements (sex, height, weight and body mass index) among the groups were comparable. CL grades, lifting force, IDS, VAS and intubation times (seconds) were significantly different whereas need for maneuver, attempts and complications were similar. (p>0.05 each). Intubation times (seconds) were significantly different between Macintosh [36(29-43) seconds] CMAC [30(24-37)] and Smart Trach [35(30-42] groups. (p<0.001). Subjective ease of intubation based on VAS score was lowest in Smart trach group [1(1-2)] (p<0.001).

CONCLUSION

Shortest intubation times were achieved with CMAC with least use of lifting force. First attempt success rates of were similar. Intubation was easiest subjectively using Smart Trach as manifested by lowest VAS and IDS.

TRIAL REGISTRATION

Clinical Trial registry of India (CTRI/2019/09/021279 dated 17/09/2019).

The use of self-report questionnaires in an analysis of the multidimensional aspects of pain and a correlation with the psychological profile and quality of life in patients with Burning Mouth Syndrome: a case control study

Background

The symptomatology in Burning Mouth Syndrome (BMS) is complex and it should be considered in accordance with a biopsychosocial model.

Objectives

To evaluate the multidimensional aspects of pain with a complete battery of tests and to analyse its relationship with potential predictors such as mood disorders, sleep and quality of life.

Methods

Forty patients with BMS versus an equal number of age and sex‐matched healthy controls were enrolled. The VAS, SF‐MPQ, BPI, PD‐Q, BDI‐II, STAI, PSQI, ESS, SF‐36 and OHIP‐14 were administered.

Results

The scores of the VAS, SF‐MPQ, BPI, PD‐Q, BDI‐II, STAI, PSQI, SF‐36 and OHIP‐14 were statistically significantly higher in the BMS patients than the controls (p < .001**). A strongly linear correlation between pain (VAS, SF‐MPQ, BPI and PD‐Q) and disease onset (STAI, BDI‐II, PSQI and sub‐items of SF‐36 and OHIP‐14) was found. In the multiple regression analysis, the contributions of the BDI‐II and OHIP‐14 were found to be statistically significant with the SF‐MPQ, PD‐Q and BPI in terms of severity and interference, while the contributions of the STAI and sleep were found to be statistically significant with the SF‐MPQ and BPI in terms of severity and interference, respectively.

Conclusions

Pain tests are differently correlated with mood and quality of life. Therefore, a complete analysis of the patient requires several tools to better understand the multidimensional aspects of pain in BMS.

Effect of Duration of Symptoms on the Clinical and Functional Outcomes of Lumbar Microdiscectomy: A Randomized Controlled Trial

Objectives

The objective is to determine whether the preoperative duration of symptoms can affect the clinical and functional outcomes after microdiscectomy.

Method

This study is a single blind randomized controlled trial with level 1 evidence. From 3 January 2016 to 15 February 2017, 122 adult patients with symptomatic lumbar disc herniation were divided randomly by computer system into three groups were treated by microdiscectomy at 6 weeks, 3 months and 6 months from onset of symptoms respectively. Ninety‐seven patients, age (19–47) years, 42 males and 55 females, were analyzed at the end of this study with 3 years of follow up. Primary outcome measures are Oswestry Disability Index (ODI), Roland‐Morris Questionnaire (RMQ) and Visual Analogue Scale (VAS) for back pain and leg pain. Secondary outcome measures are post‐operative complications, length of hospital stay and time of return to daily activities.

Results

There was significant difference in VAS for back pain among study groups (P = 0.002) at 2 weeks). There were significant differences in VAS for leg pain among study groups (P < 0.001) at 2 weeks and at 3 months (P = 0.003). There was significant difference in ODI among study groups at 2 weeks, 3, 6 months, 1, 2 and 3 years (P = 0.037 at 2 weeks and P < 0.001 at other periods of assessments) and we found that the mean of ODI in group 6 weeks was better than group 3 months and this was better than group 6 months in all periods of assessment. Group 6 weeks was better than group 3 months and this was better than group 6 months in postoperative improvements regarding RMQ with significant difference at 2 weeks postoperatively (P < 0.001) and at 3 months postoperatively (P < 0.001).

Conclusion

Duration of preoperative symptoms, in patients with lumbar disc herniation, can affect the clinical and functional outcomes after lumbar microdiscectomy as the shorter duration of symptoms resulted in better postoperative clinical and functional outcomes.

A Randomised-Controlled Clinical Study Examining the Effect of High-Intensity Laser Therapy (HILT) on the Management of Painful Calcaneal Spur with Plantar Fasciitis

Calcaneal spur and plantar fasciitis are the most common causes of plantar heel pain. There are many effective physical modalities for treating this musculoskeletal disorder. So far, the are no clear recommendations confirming the clinical utility of high-intensity laser therapy (HILT) in the management of painful calcaneal spur with plantar fasciitis. This study aimed to evaluate the effectiveness of HILT in pain management in patients with calcaneal spur and plantar fasciitis. A group of 65 patients was assessed for eligibility based on the CONSORT guidelines. This study was prospectively registered in the Australian New Zealand Clinical Trial Registry platform (registration number ACTRN12618000744257, 3 May 2018). The main eligibility criteria were: cancer, pregnancy, electronic and metal implants, acute infections, impaired blood coagulation, cardiac arrhythmias, taking analgesic or anti-inflammatory medications, non-experience of heel pain, or presence of other painful foot conditions. Finally, 60 patients were randomly assigned into two groups: study group (n = 30, mean age 59.9 ± 10.1), treated with HILT (7 W, 149.9 J/cm², 1064 nm, 4496 J, 12 min), and placebo-controlled group (n = 30, mean age 60.4 ± 11.9), treated with sham HILT therapy. Both groups received ultrasound treatments (0.8 W/cm², 1 MHz frequency, 100% load factor, 5 min). Treatment procedures were performed once a day, five times per week for three weeks (total of 15 treatment sessions). Study outcomes focused on pain intensity and were assessed before (M1) and after (M2) the treatment as well as after 4 (M3) and 12 (M4) weeks using the Visual Analogue Scale (VAS) and the Laitinen Pain Scale (LPS). According to VAS, a statistically significant decrease in the study group was observed between M1 and M2 by 3.5 pts, M1 and M3 by 3.7 pts, and M1 and M4 by 3.2 pts (p < 0.001). On the other hand, the control group showed a statistically significant decrease (p < 0.001) between M1 and M2 by 3.0 pts, M1 and M3 by 3.4 pts, and M1 and M4 by 3.2 pts. According to LPS, a statistically significant decrease in the study group was observed between M1 and M2 by 3.9 pts, M1 and M3 by 4.2 pts, and M1 and M4 by 4.0 pts (p < 0.001). On the other hand, the control group showed a statistically significant decrease between M1 and M2 by 3.2 pts (p = 0.002), M1 and M3 by 4.0 pts (p < 0.001), and M1 and M4 by 3.9 pts (p < 0.001). However, there were no statistically significant differences between the groups in VAS and LPS (p > 0.05). In conclusion, the HILT does not appear to be more effective in pain management of patients with calcaneal spurs and plantar fasciitis than the conservative standard physiotherapeutic procedures.

Clinical effectiveness of adding probiotics to a low FODMAP diet: Randomized double-blind placebo-controlled study

BACKGROUND

There are various studies showing the relationship between irritable bowel syndrome (IBS) and diet, and some dietary adjustments are recommended to reduce symptoms. In recent years, there is a growing number of studies that show a 4-8 wk low fermentable oligo, di- and mono-saccharides and polyols (FODMAP) diet has a 50%-80% significant effect on symptoms in IBS patients. There is strong evidence suggesting that changes in fecal microbiota have an impact on IBS pathogenesis. Based on this argument, probiotics have been used in IBS treatment for a long time. As is seen, the FODMAP diet and probiotics are used separately in IBS treatment.

AIM

To evaluate the effectiveness of adding probiotics to a low FODMAP diet to control the symptoms in patients with IBS.

METHODS

The patients who were admitted to the Gastroenterology Clinic of Dokuz Eylul University Hospital and diagnosed with IBS according to Rome IV criteria were enrolled into the study. They were randomized into 2 groups each of which consisted of 50 patients. All patients were referred to a dietitian to receive dietary recommendations for the low FODMAP diet with a daily intake of 9 g. The patients were asked to keep a diary of foods and beverages they consumed. The patients in Group 1 were given supplementary food containing probiotics (2 g) once a day in addition to their low FODMAP diet, while the patients in Group 2 were given a placebo once a day in addition to their low FODMAP diet. Visual analogue scale (VAS), the Bristol Stool Scale and IBS Symptom Severity Scale (IBS-SSS) scores were evaluated before and after the 21 d treatment.

RESULTS

The rate of adherence of 85 patients, who completed the study, to the FODMAP restricted diet was 92%, being 90% in Group 1 and 94% in Group 2. The mean scores of VAS and IBS-SSS of the patients in Group 1 before treatment were 4.6 ± 2.7 and 310.0 ± 78.4, respectively, and these scores decreased to 2.0 ± 1.9 and 172.0 ± 93.0 after treatment (both P < 0.001). The mean VAS and IBS-SSS scores of the patients in Group 2 before treatment were 4.7 ± 2.7 and 317.0 ± 87.5, respectively, and these scores decreased to 1.8 ± 2.0 and 175.0 ± 97.7 after treatment (both P < 0.001). The IBS-SSS score of 37 patients (86.04%) in Group 1 and 36 patients (85.71%) in Group 2 decreased by more than 50 points. Group 1 and Group 2 were similar in terms of differences in VAS and IBS-SSS scores before and after treatment. When changes in stool shape after treatment were compared using the Bristol Stool Scale, both groups showed significant change.

CONCLUSION

This study is the randomized controlled study to examine the efficiency of probiotic supplementation to a low FODMAP diet in all subtypes of IBS. The low FODMAP diet has highly positive effects on symptoms of all subtypes of IBS. It was seen that adding probiotics to a low FODMAP diet does not make an additional contribution to symptom response and adherence to the diet.

Cerebral white matter alterations revealed by multiple diffusion metrics in cervical spondylotic patients with pain: A TBSS study

OBJECTIVE

The aims of the present study were to investigate white matter alterations and their associations with the clinical variables in cervical spondylotic (CS) patients with pain.

DESIGN

Cross-sectional study.

SETTING

Chinese community.

SUBJECTS

Forty-two CS patients with pain and 42 matched healthy participants were ultimately recruited from August 2018 to September 2019.

METHODS

Tract-based spatial statistics (TBSS) analysis was performed to investigate the differences of DTI-derived indices (fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD)) between the patients and healthy controls throughout brain white matter. The relationship of the severity of cervical pain and affective disturbance to aberrant DTI indices in the patients was also examined using spearman correlation analyses.

RESULTS

The CS patients with pain showed decreased FA in the genu, body, and splenium portions of corpus callosum (CC), and increased MD and RD along with decreased FA in anterior corona radiata (ACR) compared with healthy controls, whereas no significant difference of AD was observed between groups. Additionally, lower FA of the genu part of CC together with higher MD of the left ACR were statistically correlated with the pain severity in the patient group.

CONCLUSIONS

Decreased FA coupled with increased MD and RD was detected in multiple white matter regions, and several DTI metrics in certain white matter tracts had moderate relationships with the pain severity in the CS patients with pain. These observations may provide alternative imaging clues for the evaluation of the pathophysiological characteristics of CS pain.

The Psychometric Properties of the Visual Analogue Scale Applied by an Observer to Assess Procedural Pain in Infants and Young Children: An Observational Study

PURPOSE

The Visual Analogue Scale applied by an observer (VASobs) is widely used to quantify pain but the evidence to support validity is poor. The aim of this study was to evaluate the psychometric and practical properties of the VASobs used to assess procedural pain in infants and young children.

DESIGN AND METHODS

In an observational study, 26 clinicians applied the VASobs independently to video segments of 100 children aged six to 42 months undergoing a procedure to generate pain and distress scores. Each video segment was scored by four randomly selected reviewers.

RESULTS

Reliability for pain scores was poor to fair (ICC 0.35 to 0.55) but higher for distress scores (ICC 0.6 to 0.89). At a cut-off score of 3, sensitivity and specificity were 84.7% and 95.0%, respectively for pain and 91.5% and 77.5% respectively for distress. Linear mixed modelling confirmed responsiveness. An increase in pain scores (regression slope 4.95) and distress scores (regression slope 5.52) across phases (baseline to procedure) was seen for painful procedures. The correlation between VASobs pain and FLACC scores was good (r = 0.74) and correlations between VASobs distress and FLACC scores were excellent (r = 0.89).

CONCLUSION

VASobs was easily applied and preferred by clinicians. Despite evidence of sensitivity and responsiveness to pain, the reliability results were poor, and this scale cannot be recommended for use.

PRACTICE IMPLICATIONS

The results of this study prevent recommending the VASobs for assessing procedural pain in infants and young children for clinical or research purposes.

The Frequency and Subjective Impact of Painful and Provocative Events on the Acquired Capability for Suicide

BACKGROUND

Leading theoretical explanations for suicide state that for suicide death to occur, a person must have sufficient capability to enact an attempt. Exposure to painful and provocative events is hypothesized to play an important role in acquiring the capability for suicide over a lifetime. Unfortunately, assessment tools for painful and provocative events have focused solely on the frequency of events, neglecting the potential contributions of perceived impact. Further, past measurements have used predetermined items for painful and provocative events thereby neglecting other relevant events. The current study uses visual analog scales (VAS) to assess both the frequency and impact of painful and provocative events and how these contribute to the capability for suicide.

METHOD

Data were collected from 787 adults via Amazon's online platform.

RESULTS

Findings indicated that the frequency VAS and impact VAS both had a moderate correlation with the original Painful and Provocative Events Scale. Greater scores on the frequency VAS were associated with increased capability, whereas lower scores on the subjective impact VAS were associated with increased capability scores. Both VAS independently predicted capability above and beyond the PPES.

LIMITATIONS

Temporal or causal associations are unable to be drawn due to cross-sectional data. In addition, the sample was largely homogenous (White = 72%, female = 63.5%), limiting generalizability.

CONCLUSIONS

These initial findings demonstrate individuals who perceive painful and provocative events as being less impactful may have increased capability, and that VAS may be appropriate to approximate the impact and frequency of painful and provocative events.

Validity and Utility of Four Pain Intensity Measures for Use in International Research

Background

The majority of previous research that has examined the validity of pain intensity rating scales has been conducted in western and developed countries. Research to evaluate the generalizability of previous findings in non-developed countries is necessary for identifying the scales that are most appropriate for use in international research.

Purpose

The aims of the current study were to (1) evaluate the validity and utility of four commonly used measures of pain intensity in a sample of patients with chronic pain from Thailand and (2) compare findings in the current sample with published findings from research conducted in other countries, in order to identify the measure or measures which might be most appropriate for cross-country research.

Methods

Three hundred and sixty patients with chronic pain seen in a hospital in Bangkok, Thailand, were asked to rate their current pain and average, worst, and least pain intensity in the past week using the Visual Analogue Scale (VAS), 6-point Verbal Rating Scale (VRS-6), 0–10 Numerical Rating Scale (NRS-11), and Faces Pain Scale-Revised (FPS-R). We evaluated the utility and validity of each measure by examining the (1) rates of correct responding and (2) association of each measure with a factor score representing the variance shared across measures, respectively. We also evaluated the associations between incorrect response rates and both age and education level, and then compared the findings from this sample with the findings from research conducted in other countries.

Results

The results indicated support for the validity of all measures among participants who were able to use these measures. However, there was variability in the incorrect response rates, with the VAS having the highest (45%) and the NRS-11 having the lowest (15%) incorrect response rates. The VAS was also the least preferred (9%) and the NRS-11 the most preferred (52%) scale. Education and age were significantly associated with incorrect response rates, and education level with scale preference.

Conclusion

The findings indicate that the NRS-11 has the most utility in our sample of Thai individuals with chronic pain. However, when considered in light of the findings from other countries, the results of this study suggest that the FPS-R may have the most utility for use in cross-cultural and international research. Research in additional samples in developing countries is needed to evaluate the generalizability of the current findings.

Quadratus lumborum block (transmuscular approach) versus transversus abdominis plane block (unilateral subcostal approach) for perioperative analgesia in patients undergoing open nephrectomy: a randomized, double-blinded, controlled trial

Study objective

Patients undergoing open nephrectomy surgery experience severe perioperative pain, which is primarily due to incision of several muscles. Abdominal wall blocks are known to reduce pain without causing epidural-associated hypotension. We conducted this study to compare unilateral ultrasound-guided transmuscular quadratus lumborum block and posterior transversus abdominis block in combination with general anesthesia alone in terms of intraoperative and postoperative analgesics and hemodynamics and postoperative complications.

Methods

This was a randomized, double-blinded, controlled trial conducted in the operating room. This study included 48 patients aged 20–60 years, with ASA I and II, and a body mass index ≤ 30 kg.m^-2 who were scheduled for open nephrectomy procedure.The 48 patients scheduled for nephrectomy were randomly allocated into one of the following three groups after induction of general anesthesia: Group A (n = 16) received USG transmuscular QLB; Group B (n = 16) received unilateral USG posterior transversus abdominis plane (TAP) block; and Group C (n = 16; control group) did not receive any blocks. Introperative fentanyl consumption, and hemodynamics (heart rate and mean arterial pressure (MAP)) were recorded after anesthesia induction, at surgical incision, and every 15 min till the end of surgery. Visual Analogue Scale (VAS) was evaluated immediately at 30 min and 1,2,4,6, and 12 hours postoperatively. The time of first analgesic request was also recorded.

Results

Intraoperative fentanyl consumption (μg) was significantly lower in Groups A and B (164.69 ± 27.35 and 190.31 ± 44.48, respectively) than in Group C (347.50 ± 63.64) (p < 0.001). Postoperatively, total pethidine consumption was significantly lower in Groups A and B than in Group C (85.31 ± 6.68, 84.06 ± 4.17 mg, and 152.19 ± 43.43 mg, respectively) (p < 0.001. Time to rescue analgesia was longer in Groups A and B than in Group C (138.75 ± 52.39 min, 202.50 ± 72.25 min, and 37.50 ± 13.42 min, respectively) (p < 0.001). VAS score was significantly lower in Groups A and B than in Group C at 30 min and 1, 2, 4, and 6 hours postoperatively.

Conclusion

Transmuscular quadratus lumborum block and posterior transversus abdominis blocks were effective in providing perioperative analgesia in patients undergoing open nephrectomy. However, quadratus lumborum block provided superior analgesia.

Association of postpartum depression and epidural analgesia in women during labor: an observational study

Background and objectives

Postpartum depression affects women, manifesting with depressed mood, insomnia, psychomotor retardation, and suicidal thoughts. Our study examined if there is an association between epidural analgesia use and postpartum depression.

Methods

Patients were divided into two groups. One group received epidural analgesia during labor while the second group did not. The Edinburgh postnatal depression scale (EPDS) was administered to patients prior to birth and 6 weeks postpartum. Pain severity was assessed by the Visual Analogue Scale (VAS) during labor and at 24 hours postpartum.

Results

Of the 92 patients analyzed, 47.8% (n = 44) received epidural analgesia. We detected significantly higher VAS score during labor (p =  0.007) and 24 hours postpartum (p = 0.0001) in the group without epidural analgesia. At 6 weeks postpartum, a significant difference was observed between the EPDS scores of both groups (p =  0.0001). Regression analysis revealed higher depression scores in patients experiencing higher levels of pain during labor (OR = 0.572, p =  0.039). Epidural analgesia strongly correlated with lower scores of depression (OR = 0.29, p =  0.0001).

Conclusion

The group that received epidural analgesia had lower pain scores. A high correlation between epidural analgesia and lower depression levels was found. Pregnant women giving birth via the vaginal route and having high pain scores could reduce postnatal depression scores using epidural labor analgesia. Pregnant women should opt for epidural analgesia during labor to lessen postpartum depression levels.

Ultrasound-guided interventions during pregnancy for lumbosacral pain unresponsive to conservative treatment: A retrospective review

PURPOSE

Current conventional therapeutic strategies for lumbosacral pain during pregnancy are usually inadequate and data regarding interventional analgesic procedures feasible in pregnant women is scarce. We decided to retrospectively review our experience of ultrasound-guided pain management procedures in pregnant women with lumbosacral pain unresponsive to conservative treatment.

METHODS

Twenty women in the second trimester of pregnancy with lumbosacral pain developed during pregnancy unresponsive to conservative treatments who underwent the following ultrasound-guided pain interventions were included: sacroiliac joint, caudal epidural, interlaminar epidural, and trigger point injections. All patients were followed up until early postnatal period using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores.

RESULTS

All but one patient achieved satisfactory pain control throughout the pregnancy with a single injection. Significant declines in ODI and VAS scores was attained within the first 2 weeks and first week of intervention, respectively, which was maintained thereafter until early postnatal period.

CONCLUSIONS

Injections used for effective interventional pain management in nonpregnant populations seem to represent an effective and safe method also for pregnant women when performed under ultrasound guidance, with rapid onset and enduring duration of action until the time of delivery.

Clinical study on minimally invasive transforaminal lumbar interbody fusion surgery for lumbar spondylolisthesis combined with severe narrowing of the intervertebral space

Objective

To investigate the different clinical characteristics of minimally invasive transforaminal lumbar interbody fusion on treatment of lumbar spondylolisthesis combined with severe narrowing of the intervertebral space or simple grade II lumbar spondylolisthesis.

Methods

Thirty-eight patients were divided into groups A (16 cases combined with severe intervertebral space narrowing) or B (22 cases of simple grade II lumbar spondylolisthesis without intervertebral space narrowing). Differences in preoperative preparation, operation time, blood loss, tool selection, decompression, reduction, pedicle screw, cage size selection, and other aspects were compared. The Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) scores were used to assess the effect of treatment.

Results

The operation time was significantly longer, blood loss was greater, the anatomical reduction rate was lower, and cage size was smaller in group A than in group B. Furthermore, special tools were required for treating the lumbar intervertebral space and the pedicle screws were different between the groups. JOA and VAS scores were similar between the groups

Conclusions

Cases of severe intervertebral space narrowing need to be fully released, with bilateral decompression, and special intervertebral processing tools need to be prepared. Long pedicle screws are conducive to connecting the rod and reducing slippage.

Improvements in Back and Leg Pain Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion

BACKGROUND

Improvement in patient-reported outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is poorly defined. As such, the purpose of this study was to quantify improvements in Visual Analogue Scale back and leg pain, Oswestry Disability Index (ODI), and Short Form-12 (SF-12) Mental and Physical Composite scores following MIS-TLIF.

METHODS

A surgical registry of patients who underwent primary 1-level MIS-TLIF during 2014-2015 was reviewed. Comparisons of Visual Analogue Scale back and leg pain, ODI, and Short Form-12 Mental and Physical Composite scores were performed using paired t tests from preoperative to each postoperative time point. Analysis of variance was used to estimate the degree of improvement in back and leg pain over the first postoperative year. Subgroup analysis was performed for patients presenting with predominant back (pBP) or leg (pLP) pain. Multivariate linear regression was performed to compare patient-reported outcome scores by subgroup.

RESULTS

A total of 106 patients were identified. Visual Analogue Scale back and leg scores, and ODI improved from preoperative scores at all postoperative time points (P < .05 for each). Patients with pBP (n = 68) and patients with pLP (n = 38) reported reductions in both back and leg pain over the first postoperative year (P < .05 for each). In the pBP cohort, patients experienced significant reductions in ODI after the first 6 postoperative weeks (P < .05 for each). In the pLP cohort, patients experienced significant reductions in ODI throughout the first postoperative year (P < .05 for each). Patients with pLP and pBP experienced similar reductions in back pain, whereas patients with pLP experienced significantly greater reductions in leg pain at all postoperative time points (P < .05 for each).

CONCLUSIONS

The current study suggests patients experience significant improvements in back and leg pain following MIS-TLIF regardless of predominant symptom.

CLINICAL RELEVANCE

These results can assist surgeons when counseling their patients on the magnitude of symptom improvement they may experience following MIS-TLIF.

Electronic Continuous Pain Measurement vs Verbal Rating Scale in gynaecology: A prospective cohort study

OBJECTIVE

To compare pain measured with a new electronic device - the Continuous Pain Score Meter (CPSM) - and the Verbal Rating Scale (VRS) during gynaecological procedures in an outpatient setting, and to correlate these outcomes with baseline anxiety and patient (in)tolerance to the procedure.

STUDY DESIGN

This prospective cohort study was undertaken in two centres: a university hospital and a large teaching hospital in The Netherlands. Patients undergoing an outpatient hysteroscopy, colposcopy or ovum pick-up procedure for in-vitro fertilization in one of the two participating hospitals with availability of the CPSM were included. Pain was measured by both the CPSM and the VRS. Patient tolerance to the procedure was reported. Various outcomes of the CPSM were compared with those of the VRS and related to baseline anxiety scores.

RESULTS

Ninety-one of 108 included patients (84 %) used the CPSM correctly during the procedure, and it was possible to analyse the CPSM scores for 87 women (81 %). The CPSM scores were all linearly related to the VRS. The peak pain score on the CPSM (CPSM-PPS) had the strongest correlation with the VRS score for all three procedures. Higher CPSM-PPS was related to patient (in)tolerance to the procedure (p = 0.03-0.002). Anxiety at baseline was not correlated with pain perception, except for VRS during colposcopy (r = 0.39, p = 0.016).

CONCLUSION

The majority of patients were able to use the CPSM correctly, resulting in detailed information on pain perception for each individual pain stimulus during three outpatient gynaecological procedures. The CPSM-PPS had the strongest correlation with the VRS score and patient (in)tolerance to the procedure.

The effect of endometriosis on sexual function as assessed with the Female Sexual Function Index: systematic review and meta-analysis

AIM

To systematically compare sexual function between non-treated women with and without endometriosis.

METHODS

A systematic review was performed on PubMed/Medline, Scopus, EMBASE, Web of Science and Cochrane Library databases searching studies that analyzed sexual function (assessed with the 19-item Female Sexual Function Index [FSFI]), and dyspareunia, chronic pelvic pain and dysmenorrhea (assessed with a visual analogue scale [VAS]) in women with and with endometriosis.

RESULTS

In 4 studies, non-treated women with endometriosis presented a higher risk of female sexual dysfunction (mean total FSFI score ≤ 26.55; OR = 2.38; 95% confidence interval [CI] = 1.12, 5.04). Although mean total FSFI scores were not significantly different between women with and without endometriosis (mean difference [MD] = -2.15; 95% CI -4.96, 0.67); all FSFI domain scores were significantly lower in women with endometriosis (n = 4 studies): desire (MD = -0.43; 95% CI -0.57, -0.19); arousal (MD = -0.66; 95% CI -1.15, -0.17); lubrication (MD = -0.41; 95% CI -0.79, -0.02); orgasm (MD = -0.40; 95% CI -0.73, -0.06); satisfaction (MD = -0.45; 95% CI -0.72, -0.18); and pain (MD = -1.03; 95% CI -1.34, -0.72). Women with endometriosis displayed differences (more severity) in terms of VAS scores (2 studies) for dyspareunia (MD = 1.88; 95% CI 0.38, 3.37) and chronic pelvic pain (MD = 2.92; 95% CI 1.26, 4.58); but not for dysmenorrhea.

CONCLUSION

Non-treated women with endometriosis displayed altered sexual function as evidenced by lower scores in all FSFI domains, and severity of dyspareunia and chronic pelvic pain.

Enforcing Multilabel Consistency for Automatic Spatio-Temporal Assessment of Shoulder Pain Intensity

The standard clinical assessment of pain is limited primarily to self-reported pain or clinician impression. While the self-reported measurement of pain is useful, in some circumstances it cannot be obtained. Automatic facial expression analysis has emerged as a potential solution for an objective, reliable, and valid measurement of pain. In this study, we propose a video based approach for the automatic measurement of self-reported pain and the observer pain intensity, respectively. To this end, we explore the added value of three self-reported pain scales, i.e., the Visual Analog Scale (VAS), the Sensory Scale (SEN), and the Affective Motivational Scale (AFF), as well as the Observer Pain Intensity (OPI) rating for a reliable assessment of pain intensity from facial expression. Using a spatio-temporal Convolutional Neural Network - Recurrent Neural Network (CNN-RNN) architecture, we propose to jointly minimize the mean absolute error of pain scores estimation for each of these scales while maximizing the consistency between them. The reliability of the proposed method is evaluated on the benchmark database for pain measurement from videos, namely, the UNBC-McMaster Pain Archive. Our results show that enforcing the consistency between different self-reported pain intensity scores collected using different pain scales enhances the quality of predictions and improve the state of the art in automatic self-reported pain estimation. The obtained results suggest that automatic assessment of self-reported pain intensity from videos is feasible, and could be used as a complementary instrument to unburden caregivers, specially for vulnerable populations that need constant monitoring.

A comparative evaluation of the efficacy between skeletal traction and skin traction in pre-operative management of femur shaft fractures in Korle Bu Teaching Hospital

OBJECTIVES

This study is to compare the outcomes of pre-operative skeletal and skin traction in adult femoral shaft fractures awaiting surgical fixation within two weeks of presentation to the Accident Center of Korle Bu Teaching Hospital.

METHODS

This study was a clinical trial on 86 recruited patients with closed femoral shaft fractures sustained within 24 hours of presentation grouped into 2 groups. Descriptive and inferential statistics comprising frequency, percentage, Chi-square, independent sample t-test and Mann-Whitney U test were used in analysing the data.

RESULTS

Of the total number of patients involved in the study, 74% (n=64) were males and 26% (n=22) were females with a mean age of 39.49 (SD ±15). There was no statistically significant difference in the mean visual analogue scale (VAS) pain assessment between the Skin traction group and Trans-tibia skeletal traction group after traction. With regards to complications, the difference between the Skin traction group and the Skeletal traction group was statistically significant (P=0.001). Moreover, the mean blood loss compared with the open type of reduction in the Transtibia skeletal traction group was significantly less than the Skin traction group (p=0.000).

CONCLUSION

This study has shown that both Skeletal traction and Skin traction were equally effective in controlling pre-operative pain in adult patients with femoral shaft fractures and does not affect intra-operative blood loss and post-operative management. Therefore, pre-operative Skin traction can be considered a useful and cost-effective method of maintaining alignment and pain relief in adult femoral shaft fractures.

FUNDING

Personal Funding.

Korean Modification of Nasal Provocation Test with House Dust Mites Antigen following EAACI Guidelines

Objectives

We evaluated the usefulness of the standardized nasal provocation test (NPT) protocol recently published by the European Academy of Allergy and Clinical Immunology (EAACI) and compared the utility of several parameters for diagnosing allergic rhinitis (AR) caused by house dust mites (HDM). Subjective parameters were nasal and ocular symptoms measured using a visual analog scale (VAS), and objective parameters were peak nasal inspiratory flow (PNIF), minimal cross-sectional area (MCA), and total nasal volume (TNV).

Methods

Before and after spraying Dermatophagoides pteronyssinus (DP) allergen (1,000 AU/mL, 100 μL) into both nostrils of 13 patients with AR (AR group) and 22 patients with non-AR (NAR group), we used VAS scores to measure nasal symptoms (nasal obstruction, rhinorrhea, sneezing, and itching) and ocular symptoms and assessed PNIF, MCA, and TNV.

Results

The AR group had significantly worse symptoms than the NAR group 15 minutes after DP challenge (P<0.001). After 30 minutes, nasal obstruction and rhinorrhea remained worse in the AR group (P<0.001); a similar but less marked difference was seen for sneezing (P=0.012) and itching (P=0.039). Ocular symptoms, PNIF, MCA, and TNV differed between groups after both 15 and 30 minutes (P<0.05). The area under the receiver operating characteristic curve was higher for nasal obstruction (0.977), rhinorrhea (0.906), and TNV (0.979) than for sneezing (0.755), itching (0.673), and MCA (0.836).

Conclusion

NPT performed according to the EAACI guidelines could help diagnose AR caused by HDM. TNV and VAS changes in nasal obstruction and rhinorrhea had higher diagnostic accuracy than other parameters.

Transfer Physical Therapists Knowledge: A Pre-Test to Minimize the Complexity of Physical Therapists' Quality Assessment of Shoulder Exercise Performance

Exercise therapy aims to restore normal musculoskeletal function or to reduce pain in patients with musculoskeletal shoulder disorders. Especially during long-term treatments, patients perform unsupervised exercises at home. Harmful movement deviations should be identified and avoided. Assistive technologies based on physical therapists' knowledge can support patients. In this paper, we present our approach to minimize the complexity of a physical therapists' quality assessment of a shoulder exercise performance. Four experienced physical therapists assessed the quality of 13 exercise performances shown as video recordings with a visual analogue scale and explained their ratings as free text. In some cases, the resulting assessments differed widely depending on the respective therapeutic goals. The therapists had difficulties to reduce the performances quality to a single value. Despite the existing consensus on exercises' descriptions, a more than one-dimensional scale is needed to evaluate exercises. Therefore, rating categories have to be identified for more detailed assessments.

The Role of Anterior Cervical Discectomy and Fusion on Relieving Axial Neck Pain in Patients With Single-Level Disease: A Systematic Review and Meta-Analysis

STUDY DESIGN

Systematic review and meta-analysis.

OBJECTIVES

This study aims to evaluate the effects of anterior cervical decompression and fusion (ACDF) on axial neck pain in adult patients receiving surgery for myelopathy, radiculopathy, or a combination of both.

METHODS

Two independent reviewers completed a librarian-assisted search of 4 databases. Visual Analogue Scale (VAS) and Neck Disability Index (NDI) scores were extracted preoperatively and at 3, 6, 12, 24, 36, 48, and 48+ months postoperatively for ACDF groups and pooled using a random-effects model.

RESULTS

Of 17 850 eligible studies, 37 were included for analysis, totaling 2138 patients analyzed with VAS and 2477 with NDI score. Individual VAS mean differences were reduced at 6 weeks (-2.5 [95% confidence interval (CI): -3.5 to -1.6]), 3 months (-2.9 [-3.7 to -2.2]), 6 months (-3.2 [-3.9 to -2.6]), 12 months (-3.7 [-4.3 to -3.1]), 24 months (-4.0 [-4.4 to -3.5]), 48 months (-4.6 [-5.5 to -3.8]), and >48 months (-4.7 [-5.8 to -3.6]) follow-up (P < .0001 for all endpoints). Individual NDI mean differences were reduced at 6 weeks (-26.7 [-30.9 to -22.6]), 3 months (-29.8 [-32.7 to -26.8]), 6 months (-31.2 [-35.5 to -26.8)], 12 months (-29.3 [-33.2 to -25.4]), 24 months (-28.9 [-32.6 to -25.2]), 48 months (-33.1 [-37.4 to -28.7]), and >48 months (-37.6 [-45.9 to -29.3]) follow-up (P < .0001 for all endpoints).

CONCLUSIONS

ACDF is associated with a significant reduction in axial neck pain compared with preoperative values in patients being treated specifically for myelopathy or radiculopathy. This influences the preoperative discussions surgeons may have with patients regarding their expectations for surgery. The effects seen are stable over time and represent a clinically significant reduction in axial neck pain.

Proton Pump Inhibitor Use Affects Pseudarthrosis Rates and Influences Patient-Reported Outcomes

STUDY DESIGN

Retrospective cohort review.

OBJECTIVES

Cervical pseudarthrosis is a frequent cause of need for revision anterior cervical discectomy and fusion (ACDF) and may lead to worse patient-reported outcomes. The effect of proton pump inhibitors on cervical fusion rates are unknown. The purpose of this study was to determine if patients taking PPIs have higher rates of nonunion after ACDF.

METHODS

A retrospective cohort review was performed to compare patients who were taking PPIs preoperatively with those not taking PPIs prior to ACDF. Patients younger than 18 years of age, those with less than 1-year follow-up, and those undergoing surgery for trauma, tumor, infection, or revision were excluded. The rates of clinically diagnosed pseudarthrosis and radiographic pseudarthrosis were compared between PPI groups. Patient outcomes, pseudarthrosis rates, and revision rates were compared between PPI groups using either multiple linear or logistic regression analysis, controlling for demographic and operative variables.

RESULTS

Out of 264 patients, 58 patients were in the PPI group and 206 were in the non-PPI group. A total of 23 (8.71%) patients were clinically diagnosed with pseudarthrosis with a significant difference between PPI and non-PPI groups (P = .009). Using multiple linear regression, PPI use was not found to significantly affect any patient-reported outcome measure. However, based on logistic regression, PPI use was found to increase the odds of clinically diagnosed pseudarthrosis (odds ratio 3.552, P = .014). Additionally, clinically diagnosed pseudarthrosis negatively influenced improvement in PCS-12 scores (P = .022).

CONCLUSIONS

PPI use was found to be a significant predictor of clinically diagnosed pseudarthrosis following ACDF surgery. Furthermore, clinically diagnosed pseudarthrosis negatively influenced improvement in PCS-12 scores.

Quality of life of patients operated for lumbar stenosis at the Yaoundé Central Hospital

Introduction: Several studies have been conducted in many African countries on lumbar stenosis but none on the quality of life of patients after surgery. We conducted this study to evaluate the quality of life of patients following surgery indicated for lumbar stenosis.Methods: A cross-sectional study from January 2010 to December 2015 in the neurosurgery department of the Yaoundé Central Hospital. We included all patients operated for lumbar stenosis, whose post-operative follow-up was at least of one year. Sampling was consecutive using operating room registries and archives of the neurosurgery department. We used the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) to evaluate patient's quality of life.Results: We recruited 52 patients. The mean age was 58.13 years. Pre-operatively, 67.3% of patients presented with severe pain (mean VAS of 8.9). At 3 months, 59.6% presented with moderate pain (mean VAS = 4.75). At six months following surgery, 92.3% of patients had mild pain (mean VAS = 2.92). At one year, all patients had only mild pain (mean VAS = 1.05). Pre-operatively, 67.30% of patients presented with severe walking disability; the mean ODI was 77.88% and a third were bedridden. Three months after surgery 61.50% presented with moderate disability and the mean ODI was 38.17%. Six months following surgery, 48.10% of patients presented with moderate disability and 42.30% presented with a mild disability (the mean ODI was 24.80%). At one year, 82% of patients presented with mild disability and the mean ODI was 12.67%.Conclusion: Surgery improved the physical condition of patients.

Effectiveness of music therapy for alleviating pain during haemodialysis access cannulation for patients undergoing haemodialysis: a multi-facility, single-blind, randomised controlled trial

Background

Repeated pain during haemodialysis access cannulations is a serious problem for haemodialysis patients even when prescribed oral or topical analgesics. Although some studies have observed the efficacy of music therapy for improving pain and anxiety, its effectiveness during haemodialysis access cannulations during dialysis is uncertain. The purpose of this study is to investigate the effects of music therapy for pain when cannulating haemodialysis access for haemodialysis patients.

Methods

A prospective, multi-facility, single-blind, crossover, randomised controlled trial will be implemented. The intervention includes listening to Mozart, along with a white noise control condition. One hundred twenty haemodialysis patients will be enrolled across five facilities. Patients will be randomly allocated to either an Early-sequence group or a Later-sequence group. The Early-sequence group will receive cannulation while listening to Mozart’s Sonata for two pianos in D major (K.448) during the second week (Music period) and white noise during the fourth week (White noise period). The Later-sequence group will receive cannulation along with white noise first, followed by Mozart. All patients will also undergo cannulation during a no-sound period (wearing only headphones) during the first and third week (No-sound period). The music or no-music protocol will begin 8 min prior to the cannulating procedure, and participants will finish listening after starting haemodialysis during each period. The primary outcomes that will be assessed include the Visual Analogue Scale (VAS) score for pain during cannulation, and secondary outcomes are blood pressure, heart rate, VAS anxiety score, State-Trait Anxiety Inventory score, and salivary amylase activity. The operators who are in charge of haemodialysis access cannulation will be blind to the listening condition and VAS report.

Discussion

The proposed study has several methodological benefits. First, using white noise is a suitable control condition for addressing the role of sound in pain management. Additionally, using a crossover design with repeated measurements can help control individual differences between participants, which should better distinguish between- and within-participant variability. Overall, music therapy is a safe and inexpensive intervention that does not have the problematic side effects typically associated with pharmacological treatment. If effective, music therapy can be easily implemented for reducing pain and anxiety during cannulation.

Trial registration

This trial was prospectively registered to UMIN Clinical Trials Registry on 1 July 2018 (UMIN 000032850).

Cervical radiculopathy: is a prosthesis preferred over fusion surgery? A systematic review

BACKGROUND

Meta-analyses on the comparison between fusion and prosthesis in the treatment of cervical radiculopathy mainly analyse studies including mixed patient populations: patients with radiculopathy with and without myelopathy. The outcome for patients with myelopathy is different compared to those without. Furthermore, apart from decompression of the spinal cord, restriction of motion is one of the cornerstones of the surgical treatment of spondylotic myelopathy. From this point of view, the results for arthroplasty might be suboptimal for this category of patients. Comparing clinical outcome in patients exclusively suffering from radiculopathy is therefore a more valid method to compare the true clinical effect of the prosthesis to that of fusion surgery.

AIM

The objective of this study was to compare clinical outcome of cervical arthroplasty (ACDA) to the clinical outcome of fusion (ACDF) after anterior cervical discectomy in patients exclusively suffering from radiculopathy, and to evaluate differences with mixed patient populations.

METHODS

A literature search was completed in PubMed, EMBASE, Web of Science, COCHRANE, CENTRAL and CINAHL using a sensitive search strategy. Studies were selected by predefined selection criteria (i.a.) patients exclusively suffering from cervical radiculopathy), and risk of bias was assessed using a validated Cochrane Checklist adjusted for this purpose. An additional overview of results was added from articles considering a mix of patients suffering from myelopathy with or without radiculopathy.

RESULTS

Eight studies were included that exclusively compared intervertebral devices in radiculopathy patients. Additionally, 29 articles concerning patients with myelopathy with or without radiculopathy were studied in a separate results table. All articles showed intermediate to high risk of bias. There was neither a difference in decrease in mean NDI score between the prosthesis (20.6 points) and the fusion (20.3 points) group, nor was there a clinically important difference in neck pain (VAS). Comparing these data to the mixed population data demonstrated comparable mean values, except for the 2-year follow-up NDI values in the prosthesis group: mixed group patients that received a prosthesis reported a mean NDI score of 15.6, indicating better clinical outcome than the radiculopathy patients that received a prosthesis though not reaching clinical importance.

CONCLUSIONS

ACDF and ACDA are comparably effective in treating cervical radiculopathy due to a herniated disc in radiculopathy patients. Comparing the 8 radiculopathy with the 29 mixed population studies demonstrated that no clinically relevant differences were present in clinical outcome between the two types of patients. These slides can be retrieved under Electronic Supplementary Material.

Subcutaneous sumatriptan for the treatment of postcraniotomy pain (SUPS trial): protocol for a randomised double-blinded placebo controlled trial

INTRODUCTION

Postcraniotomy pain protocols use opioids, which are considered suboptimal analgesia following this procedure. Multimodal analgesia components are sparse. Our null hypothesis states that sumatriptan is not different to placebo in addition to usual intravenous opioids, for the treatment of acute postcraniotomy pain.

METHODS AND ANALYSIS

This is a prospective single-centre randomised double-blinded placebo-controlled phase III clinical trial comparing subcutaneous sumatriptan injection in the recovery area with placebo for the treatment of postcraniotomy pain. Eligible adult patients (18 years and older) undergoing craniotomy will be identified preoperatively. Both patient groups will receive a subcutaneous injection at a point where recovery-nursing staff would initiate the usual intravenous opioid analgesia as per standardised pain management protocol. In both groups, further pain management will be followed by the usual intravenous opioid administration. Primary outcome will consist of the difference in pain experienced by the two groups of patients in recovery area 60 min after the study drug administration. Postcraniotomy pain will be measured at regular intervals using the Visual Analogue Scale (VAS) in recovery area. The minimal clinically important difference of 10 mm on the VAS between the two groups will be considered as statistically significant. We will include selected clinical and patient-reported outcomes as secondary endpoints. Univariate regression will be conducted on each one of the clinically plausible potential confounders. We will enrol a total 136 patients, with the study duration of 2 years. This trial will commence recruitment on the 1 July 2019.

ETHICS AND DISSEMINATION

This trial protocol has achieved approval by the Austin Health Research Committee, HREC/17/Austin/596. This trial was prospectively registered with Australian New Zealand Clinical Trials Registry on the 10/05/2018 with a unique trial identifier U1111-1209-9072 and registration Number ACTRN12618000793213P. Findings of this study will be disseminated in peer-reviewed academic journals.

TRIAL REGISTRATION NUMBER

U1111-1209-9072, ACTRN12618000793213P.

Evaluation of the ability of dental clinicians to rate dental anxiety

The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of Östergötland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients' levels of dental anxiety on a Visual Analogue Scale. The correlation (r_s ) between the clinicians' and patients' ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians' and patients' ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians' confidence and their ability to rate a patient's dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self-assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.

Associations Between Bone Mass in Women With Fibromyalgia and Widespread Pressure Pain Hypersensitivity, Tenderness, Perceived Pain Level, and Disability

This study aimed to evaluate the impact of fibromyalgia syndrome (FMS) on bone mass assessed by calcaneal quantitative ultrasound (QUS) in pre- and postmenopausal women and determine whether there are associations between bone status and pressure pain thresholds (PPTs), tender point counts (TPCs), self-reported global pain, or disease severity. Ninety-five women with a diagnosis of FMS and 108 healthy controls matched on menopause status were included in this cross-sectional study. PPT and TPC were measured by algometry pressure. Self-reported global pain and disease severity were evaluated by Visual Analogue Scale and Fibromyalgia Impact Questionnaire, respectively. Bone mass was assessed with calcaneus QUS. Broadband ultrasound attenuation (BUA; dB/MHz) and speed of sound (SOS; m/s) were significantly lower in the FMS patients compared with controls ( p = .027 and p = .003, respectively). Linear regression analysis revealed that all PPTs were significantly associated with the BUA parameter after adjustments for body mass index (BMI), menopause status, and physical activity in women with FMS ( p < .05). TPC was also significantly associated with BUA after adjustments for covariables (β = .241, 95% confidence interval [0.333, 3.754], p = .020). No significant differences were found between any QUS measurements and global pain or disease severity. Calcaneal BUA and SOS values were lower in women with FMS compared to healthy controls, and decreased pain thresholds and higher TPCs were associated with lower calcaneal BUA values. Low pain thresholds might be independent predictors for low bone mass in FMS women.

Comparison of anxiety and pain perceived with conventional and computerized local anesthesia delivery systems for different stages of anesthesia delivery in maxillary and mandibular nerve blocks

Background

Fear of local anesthesia (LA) is a significant impediment to dental care as many patients delay or avoid treatment to avert pain. Computer-controlled local anesthetic delivery system (CCLAD), with constant and controlled rate of flow, present a painless alternative. The present study aimed to compare anxiety and pain perceived with conventional and computerized systems, for different stages of anesthesia delivery when administering various nerve blocks.

Methods

One hundred patients requiring bilateral LA participated in the study. One side was anesthetized using one system and the contralateral side was anesthetized using the other, in two separate appointments. Patients assigned anxiety scores on a 5-point scale and used the visual analogue scale (VAS) for pain determination at needle insertion, during delivery of anesthetic solution, immediately after injection, and at the end of the periodontal procedure. Each patient's preference for the delivery system of future injections was also recorded.

Results

Patients reported significantly lower anxiety levels with CCLAD compared to the syringe. Significantly lower mean VAS scores for anesthesia deposition, pain immediately after, and at the end of the periodontal procedure were also noted. However, pain at needle insertion was comparable between the two systems, with no statistical significance. Overall, 64.4% patients preferred CCLAD for future anesthesia.

Conclusion

Lower pain perceived with CCLAD and higher preference for the system suggest that CCLAD should replace conventional syringes to allow pain-free dental treatment.

Hematoma block for distal radius fractures - prospective, randomized comparison of two different volumes of lidocaine

Objective

This study aimed to compare analgesic efficacy and safety of different volumes of lidocaine injected into a fracture hematoma (hematoma block [HB]) for reducing distal radius fractures.

Methods

Patients were randomly divided into two groups. Group A included patients in whom 10 mL of 2% lidocaine was injected into the fracture site and group B included patients in whom 20 mL of 1% lidocaine was injected. The fracture was manipulated after 15 minutes and the Visual Analogue Scale (VAS) score was recorded during manipulation. Patients were followed up for approximately 1 hour and complications were recorded.

Results

Twenty patients were enrolled in the study (12 women and eight men), with a mean age of 57 years (range, 32–87 years). Demographic findings were similar between the groups. The mean VAS score of group A was 5.50 ± 3.57 and that in group B was 3.09 ± 2.33, with no significant difference between the groups.

Conclusion

VAS scores between HB with 20 mL of 1% lidocaine and HB with 10 mL of 2% lidocaine are not significantly different. However, our study suggests that HB with 20 mL of 1% lidocaine has a better analgesic effect than HB with 10 mL of 2% lidocaine.

Outcome of Percutaneous Transforaminal Endoscopic Lumbar Surgery in >60-Year-Old Patients with Low Back Pain

Study Design

Retrospective study.

Purpose

To evaluate the outcome of percutaneous transforaminal endoscopic lumbar surgery (PTELS) and to evaluate the efficacy of this technique in the treatment of lumbar disc herniation (LDH) and lumbar spine stenosis (LSS) in >60-year-old patients.

Overview of Literature

There has been number of studies done in aspect of PTELS. All those studies focused on overall clinical aspect with no any age specific analysis. This articles deals with the patient >60 years old with low back pain (LBP) treated with the PTELS. This study provides the details of clinical outcome after the surgery in those age group.

Methods

We retrospectively studied 77 patients aged >60 years; out of these, 45 patients presented with LDH and 22 patients with lumbar spinal stenosis who underwent PTELS.

Results

The mean age of the patients who underwent the surgery was 68.33±6.97 years and the mean duration of the surgery and the postoperative duration of hospitalization were 87.31±24.746 minutes and 79±2.711 days, respectively. The pre- and postoperative Oswestry Disability Index were 52.8022±11.98299 and 16.3513±12.97398 (p <0.05), respectively, indicating statistical significance. The pre- and postoperative visual analogue scale scores of the leg and back were 6.27±1.213 and 4.79±1.162 (p <0.05) and 1.40±1.688 and 1.30±1.436, respectively (p <0.05), which showed a significant difference. Based on the MacNab criteria, 76.1%, 10%, and 6% of the patients showed excellent or good, fair, and poor outcomes, respectively. Incomplete removal of content and reherniation were observed in 3% and 7.5% of the patients. No significant difference was found between the clinical outcomes of PTELS between LDH and LSS.

Conclusions

PTELS can be a good technique in spine surgery to relieve symptoms for LBP with satisfactory outcome, short duration of hospitalization, and advantages such as elimination of general anesthesia in elderly patients.

Risk Factors Associated with Pain Severity in Patients with Non-specific Low Back Pain in Southern China

STUDY DESIGN

A prospective cross-sectional study.

PURPOSE

To evaluate the risk factors associated with the severity of pain intensity in patients with non-specific low back pain (NSLBP) in Southern China.

OVERVIEW OF LITERATURE

Low back pain (LBP) is the leading cause of activity limitation and work absence throughout the world, so a firm understanding of the risk factor associated with NSLBP can provide early and prompt interventions that are aimed at attaining long-term results.

METHODS

Participants were recruited from January 2014 to January 2016 and were surveyed using a self-designed questionnaire. Anonymous assessments included Short Form 36-Item Health Survey (SF-36) and Visual Analogue Scale (VAS). The association between the severity of NSLBP and these potential risk factors were evaluated.

RESULTS

A total of 1,046 NSLBP patients were enrolled. The patients with primary school education, high body mass index (BMI), those exposed to sustained durations of driving and sitting, smoking, recurrent LBP had increased VAS and Oswestry Disability Index (ODI) scores with lower SF-36 scores (p <0.01). Workers and drivers compared with waiters and patients who lifted >10 kg objects in a quarter of their work time for >10 years had higher VAS and ODI scores with lower SF-36 scores (p <0.01). Multiple logistic regression showed lower levels of education, LBP for 1-7 days, long-lasting LBP in last year, smoking, long duration driving, and higher BMI were associated with more severe VAS score.

CONCLUSIONS

The severity of NSLBP is associated with lower levels of education, poor standards of living, heavy physical labor, long duration driving, and sedentary lifestyle. Patients with recurrent NSLBP have more severe pain. Reducing rates of obesity, the duration of heavy physical work, driving or riding, and attenuating the prevalence of sedentary lifestyles and smoking may reduce the prevalence of NSLBP.

Analgesic Effect of Topical Nepafenac 0.1% on Pain Related to Intravitreal Injections: A Randomized Crossover Study

PURPOSE

To evaluate the analgesic effect of nepafenac 0.1%, a topical non-steroidal anti-inflammatory agent, in patients undergoing treatment with intravitreal injections (IVIs).

MATERIAL AND METHODS

It is a single center, prospective, randomized, double-blinded, placebo-controlled, crossover interventional study. Fifty-two patients scheduled to undergo IVI of anti-vascular endothelial growth factors were included in the study. Patients were randomized in a 1:1 ratio to receive topical nepafenac 0.1% or placebo 1 h before subsequent IVIs. Using the short form of the McGill Pain Questionnaire (SF-MPQ), pain intensity was assessed with the Visual Analogue Scale (VAS), the Main Component of the SF-MPQ (MC-SF-MPQ), and the Present Pain Intensity (PPI) scores immediately and 6-h post-injection.

RESULTS

The VAS pain score was statistically significant lower immediately and 6-h post-IVI in patients treated with nepafenac (p = 0.001 and < 0.001, respectively). The MC-SF-MPQ scores were also statistically significant lower after nepafenac administration at both time points (p < 0.001). Finally, the PPI score was statistically significant lower when nepafenac was instilled before IVI (p = 0.015 immediately and p < 0.001 at 6-h post-injection).

CONCLUSIONS

A single drop of nepafenac 0.1% before IVI could effectively alleviate the IVI-related pain immediately and up to 6 h after the injection.

Good correlation between visual analogue scale and numerical rating scale in the assessment of nasal obstruction

OBJECTIVE

Results from telephone interviews may be needed to supplement those from mailed questionnaires when response rates are inadequate. This study assessed the correlation between visual analogue scale ratings used in mailed questionnaires and numerical rating scale scores used in telephone interviews.

METHODS

Patients scheduled for nasal septal surgery routinely respond to a visual analogue scale of obstruction during the day and at night. In this study, they were also asked to verbally rate their sense of obstruction using whole numbers.

RESULTS

There was no significant difference between visual analogue scale and numerical rating scale obstruction scores.

CONCLUSION

Ratings of nasal obstruction obtained with a numerical rating scale in telephone interviews are comparable to visual analogue scale scores in mailed questionnaires.

Translation and Linguistic Validation of the Korean Version of the Treatment Satisfaction Visual Analogue Scale and the Overactive Bladder Satisfaction With Treatment Questionnaire

Purpose

This study reports the development of the Korean Version of the Treatment Satisfaction Visual Analogue Scale (TS-VAS) and the Overactive Bladder Satisfaction with Treatment Questionnaire (OAB-SAT-q) based on the original versions, with subsequent linguistic validation by Korean patients with overactive bladder receiving active treatment from a physician.

Methods

Translation and linguistic validation were performed in 2016. The validation process included permission for translation, forward translation, reconciliation, backward translation, cognitive debriefing, and proofreading. The original versions of the TS-VAS and OAB-SAT-q were independently translated into Korean by 2 bilingual translators and were then reconciled into a single version. The third bilingual translator performed a backward translation of the reconciled version into English. A trained interviewer and 5 Korean-speaking patients with OAB carried out the cognitive debriefing.

Results

During the forward translation process, the terms used in the 2 questionnaires were adjusted to use more appropriate expressions in the Korean language than were used in the original versions. During the backward translation process, no changes were made in terms of semantic equivalence. In the cognitive debriefing session, 5 patients were asked to fill in the answers within 8 minutes; most of them reported that the translated questions were clear and easy to understand.

Conclusions

The present study presents successful linguistic validation of the Korean version of the TS-VAS and OAB-SAT-q, which could be useful tools for evaluating treatment satisfaction in patients.

Efficacy of Pre-Medication with Ibuprofen on Post-Operative Pain after Pulpotomy in Primary Molars

INTRODUCTION

Pain management following dental procedures, particularly pulpotomies and extraction, is of great importance in pediatric dentistry. The aim of this study was to investigate the efficacy of pre-treatment with ibuprofen on post-operative pain following pulpotomy of primary molars.

METHODS AND MATERIALS

In a split mouth double-blinded randomized clinical trial, 49 children aging between 6-10 years old were given either ibuprofen or a placebo 45 min prior to the treatment. After pulpotomy and placement of a stainless steel crown (SSC), the pain level was evaluated using the Wong-Baker face visual analogue scale for up to 7 days post-treatment. McNemar and Wilcoxon tests were used for data analysis.

RESULTS

Forty-five patients were eligible to participate in this study. Pre-medication with ibuprofen significantly reduced pain during the first 24 h post-treatment (P=0.032). However, there was no significant difference in the pain levels between placebo and ibuprofen groups at 48 and 72 h post-treatment (P=0.154 and P=0.197, respectively). The number of times patients needed analgesics in ibuprofen group was significantly lower compared to that in the placebo group (P=0.008).

CONCLUSION

Pre-medication with ibuprofen resulted in less pain following pulpotomy and SSC placement in primary teeth.

Monoclonal antibodies against interleukin 13 and interleukin 31RA in development for atopic dermatitis

The interleukin 13 (IL-13) and IL-31 cytokines and inflammatory pathways have been identified as important for the pathophysiology of atopic dermatitis (AD). Monoclonal antibodies against IL-13 have been studied for the treatment of asthma since 2011. More recently, 2 phase 2 trials have been completed with these antibodies in AD treatment. In both trials, significant reductions of Eczema Area and Severity Index scores were seen. IL-31 is thought to play a role transmitting itch sensation to the central nervous system, and blocking IL-31 activity reduces itch in patients with AD. One phase 2 trial has been completed for a humanized antibody against IL-31 receptor alpha, which is 1 subunit of the IL-31 receptor complex. This study showed significant dose-dependent reductions in pruritus, Eczema Area and Severity Index scores, and markers of sleep quality. Initial clinical trials for monoclonal antibodies against IL-13 and IL-31 receptor A all show promise, although long-term safety and efficacy data are lacking. Nevertheless, these medications will likely play a role in the treatment of moderate-to-severe AD.

Comparing the Effectiveness of Patient Control Analgesia Pump and Bolus Morphine in Controlling Pain After Cardiopulmonary Bypass Graft Surgery

Background

Postoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues.

Methods

68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg, lockout time of 15 minutes, and a maximum of 4 bolus of 0.02 mg/kg for one hour and the other group received morphine bolus (group B). Three patients were excluded from the study, and 33 and 32 patients participated in the groups P and B, respectively. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (nausea and vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid consumption, hemodynamic, and sedation status were measured in both groups.

Results

There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complication, sedation score, and hemodynamic status in most of the assessment periods. By assessing the pain severity in the groups at different periods, results showed a significant difference between the groups except at enrollment, and a lower severity of pain was noted in the group P compared to the group B. The consumed opioid was significantly higher in the group P than in the group B. However, higher doses of diclofenac and paracetamol were administered in the group B compared to the group P.

Conclusions

Results showed that higher morphine would be used in patients with PCA pump after extubation following heart surgery, and this increased dose of opioid was associated with better pain control and lack of complication. Therefore, PCA pump with underlying infusion could be effectively used in patients undergoing CABG that are directly assessed in intensive care unite.