10-point Pain Scale Research Articles

Evaluation of Chronic, Noncancer Pain Management Initiative in a Multidisciplinary Pain Clinic

BackgroundChronic pain management is a major challenge for primary care providers (PCPs). PCPs manage many patients with chronic pain and other comorbidities including mental health problems like post-traumatic stress disorder (PTSD) and depression. Chronic pain and opioid problems are a national crisis, particularly among veterans (U.S. Department of Veterans Affairs, 2019). There are many veterans with chronic non-cancer pain who are being treated with opioids. Chronic opioid use has contributed to an epidemic of opioid-related adverse events (VA, 2017). Opioids not only result in poor pain control, but have associated risks such as misuse, overdose, and diversion which may be fatal (Frieden & Houry, 2016). AimsThe aim of this project was to evaluate chronic non-cancer pain management of veterans using an advanced practice registered nurse (APRN)-led multidisciplinary team approach to incorporate non-opioid and non-pharmacologic modalities to affect self-reported pain and use of prescribed opioids. MethodsA retrospective quality improvement (QI) project was conducted in the multidisciplinary pain (MDP) clinic. The APRN used a biopsychosocial approach for chronic pain management guided by the Plan, Do, Study, Act (PDSA) cycle framework. Thirty-four patients who were utilizing opioids for pain management were included using convenience sampling from the MDP clinic. The APRN educated and treated patients with non-opioid medications and non-pharmacolog therapies. A 10-point pain scale and morphine equivalent daily dose (MEDD) were utilized pre- and post-intervention to evaluate the MDP clinic. ResultsParticipants were predominantly male (91.8%), with a mean age of 63.18 ± 15.39 years, and 36.4% of whom were retired. Only 20.6% of the participants reported the use of opioids for <12 months. Low back pain (93%) was the most common pain location. The mean baseline MEDD was 41.04 and the post tapered MEDD was 23.05; this revealed a significant decline in MEDD (p < .0001). A decline was also found between pre- and post-pain scores (ranges 0-8). There was a significant reported decline in pain scores with a baseline of 6.11 to post tapering pain of 3.1 (t = 4.99, df = 28, p < .0001). Participants preferred non-opioid medications 94% and non-pharmacologic therapy 86%, like physical therapy, yoga, and acupuncture. Fifty-one percent of patients were referred for injections and 46% were referred to primary care behavior health, which includes pain school, sleep hygiene classes, and cognitive behavior therapy. ConclusionsAPRNs are in a key position to assess and treat patients based on current evidence while facilitating opioid titration. This initiative highlights that safe tapering of opioids is possible when utilizing a multidisciplinary approach for chronic pain management. Findings support the use of non-pharmacologic and non-opioid therapy for chronic pain management which can result in reduced patient-reported pain. Further research is warranted to examine both pharmacologic (non-opioid) and non-pharmacologic strategies that promote pain management while tapering opioids.

THE EFFECT OF COVID-19 PANDEMIC ON SARCOPENIA, QUALITY OF LIFE AND PAIN: A ONE-YEAR FOLLOW-UP STUDY

Introduction: This study evaluated the effect of coronavirus disease 2019 pandemic on sarcopenia, quality of life and pain severity in elderly patients and investigated which patients were affected more from this pandemic (sarcopenic or not, males or females, and physically active or inactive). Materials and Methods: A total of 225 elderly patients with SARC-F, visual analogue scale-musculoskeletal pain scores, handgrip strength, chair stand test, short form-36, demographic data and phone number records in July 2020 were included in this study. Follow-up was conducted in June 2021 with telephonic interviews. During follow-up, SARC-F, 10-point Likert pain scale, Short Form-36 and physical activity were evaluated. Results: After one year of the COVID-19 pandemic, almost all short form-36 scores decreased;however, the pain and SARC-F scores did not show a significant change. Decrease in short form-36 scores were higher in patients without sarcopenia than in those with sarcopenia. Decrease in Short Form-36 scores were higher in women than in men. Increase in pain scores (active: p=0.851, inactive: p=0.005) and decrease in Short Form-36 scores, were higher in physically active patients than in physically inactive patients. SARC-F scores did not change in any of the study groups. Conclusion: After one-year follow-up in elderly patients, quality of life decreased, severity of pain increased in physically inactive, and SARC-F was unaffected. Females, non-sarcopenic, and physically inactive patients were found to be more affected by the COVID-19 pandemic.

Assessment of quality of life of patients with colon cancer depending on the type of perioperative anesthetia

The purpose of the study. Assess the quality of life of patients with colon cancer in the perioperative period, depending on the chosen method of anesthesia.&#x0D; Materials and methods. In the period from January to August 2020, an analysis of the results of anesthesia in 32 patients with colon cancer was performed on the basis of the Department of Anesthesiology and Intensive Care of KNP «ZPC» ZOR. Two groups of patients were formed in a randomized manner. The difference between the groups was the difference in drug combinations and dosages of anesthesia. Subjective pain assessment studies in patients were performed using a visual analog scale (VAS) questionnaire. The EQ 5D scale (5-point pain scale) was used to assess quality of life. The Hamilton scale was used to assess the patient's psycho-emotional state. Student's mean T test was used to compare pain levels before and after surgery, and p &lt; 0,05 was considered statistically significant.&#x0D; Results. There was a statistically significant difference between cortisol levels after surgery in patients of groups I and II (p = 0,0001). When comparing insulin and blood glucose, it was found that the results of biochemical parameters are lower in group II patients, indicating a lower level of pain or its absence in the first 6 hours after surgery (p = 0,0001). Patients in groups I and II had an increase in the VAS scale, but in patients who used only general anesthesia, the rates were twice as high as in the group of patients who used a combination of epidural anesthesia (p = 0,0001).&#x0D; Evaluating the results of the questionnaire on the EQ 5D scale, a similar picture was established as when evaluating on the VAS scale where in the second group of patients statistically significantly lower pain rates than in the first group (p = 0,0001). The level of anxiety in patients who underwent epidural anesthesia decreased slightly in the postoperative period compared with baseline (p = 0,005).&#x0D; Conclusions. The quality of life of patients in the second group is higher than in patients of group I according to the questionnaire scale EQ 5D (p = 0,0001). The level of anxiety in patients of group I is higher in the first 6 hours after surgery than in patients of group II where epidural anesthesia is used (p = 0,0001).

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

The Effectiveness of Thermal Neuromodulation Using Precise Heat in the Treatment of Chronic Low Back Pain Over 60 Days: An In-Home User Trial.

PurposeTwo previous independent double-blind randomized studies demonstrated that thermal neuromodulation using high temperature pulsed heat reduced pain in subjects with chronic low back pain. The present study examined the effects of high temperature pulsed heat via an experimental device in a real-world In-Home Use Trial (IHUT) over a sixty-day period.Materials and MethodsThis in-home study recruited 34 subjects with chronic low back pain, provided them with an experimental device that delivered treatment session of high temperature pulsed heat up to 45°C, and followed them for eight weeks. Subjects were allowed to use the device as needed. Primary outcome was pain rating as measured by the 11-point Numeric Pain Scale at baseline, four and eight weeks of treatment. The secondary outcome measures were the interference with daily living components of the Brief Pain Inventory at baseline versus eight weeks of treatment.ResultsThirty-two subjects completed the study. Pain levels were 5.81 at baseline, 2.79 at four weeks and 2.25 at eight weeks. All changes in pain levels between baseline and four weeks, baseline, and eight weeks and between four and eight weeks were statistically significant (p < 0.05). At eight weeks, the seven components of pain interference with activities of daily living and pain interference with walking were statistically reduced (P < 0.05). About 72% of subjects reported a single 30-minute treatment session produced over 3 hours of pain relief.ConclusionAn eight-week in-home trial of high-temperature thermal modulation devices produced significant reductions in pain and pain interference with activities of daily living, an important measure of function. Efforts were made to control and reduce study contamination. This study provides important initial data for long-term outcome studies of thermal neuromodulation using high temperature pulsed heat to treat low back pain and to improve subject function and demonstrated that individuals with chronic pain can effectively self-manage pain.

A cross-sectional study of breast pain in a diverse population of breast cancer patients.

Background:Breast cancer is the most common cancer in women, and postoperative breast pain has been reported to be anywhere from 25% to 60%. However, there is sparse data regarding racial/ethnic differences in breast pain among breast cancer patients.Methods:We performed a cross-sectional anonymous survey of breast cancer patients from the Hawaii Cancer Consortium over a 6-week period between 2019 and 2020. The 237 breast cancer participants were ages 29 to 98, 74% Asian, and mainly from outpatient oncology clinics. We evaluated the prevalence of breast pain in a diverse group of breast cancer patients and characterized the pain using a modified short-form McGill pain questionnaire (sfMPQ).Results:Eighty-fourrespondents(35.4%) reported breast pain. On univariable analysis, we found significant racial/ethnic differences in the amount of breast pain, where Chinese and Japanese participants reported significantly less pain compared to White participants on a 10-point pain scale. We found differences in breast pain according to age and endocrine therapy use as well as survey location, however, no differences were seen according to chemotherapy, radiation, or breast surgery. Based on the sfMPQ, the most common descriptors of breast pain were sensory (throbbing, shooting, and stabbing) compared to affective (tiring-exhausting, sickening, fearful, and punishing-cruel) characteristics. Although they were described as mild and intermittent, in women with breast pain, 33.4% reported the breast pain affected their sleep, 16.7% their work, and 15.4% their sexual activity.Conclusions:Breast pain is a significant problem in our breast cancer community. This survey assessment has informed our understanding of breast pain in our diverse population. In turn, we are developing culturally appropriate pain management strategies to treat this challenging symptom common in breast cancer survivors.

Use of negative pressure wound therapy as a bolster over skin grafts in patients with severe burn injuries at a tertiary care burn centre in India

BackgroundManagement of deep burn requires aggressive debridement of non-viable burnt tissue and closure with skin grafts or flaps but challenge is to manage wound exudates and patient discomfort and to avoid shear force and pain cause by frequent dressing changes. This observational case series assessed outcomes of negative pressure wound therapy (NPWT) use as a bolster in pilot surgery (primary surgery) over skin grafts in patients with severe burns in a burn center in Indore, India in term of wound healing, pain, caregivers and nurses workload. MethodsPatients with extensive burns (≥30% total body surface area [TBSA]) were admitted to the burn unit between January and December 2020. Acute burn victims (burns present <24 h from burn injury) and patients over the age of 18 were included in this study. All patients received primary standard burn care including debridement of non-viable tissue, wound closure with homograft or autografts, and application of NPWT as a bolster in first sitting (Pilot surgery). NPWT dressings were changed every three to four days. Skin graft healing was monitored during dressing changes. Patient reported pain was recorded using the 10-point Likert pain scale. ResultsThirteen patients with an average TBSA of 42.6% (range 30–63%) underwent treatment. A total of 8 patients suffered from flame burns, 4 from electrical burns, and 1 from scald burns. The average length of hospital stay was 18.1 ± 6.2 days with wound closure in 9.1 ± 4.3 days. An average of 3.5 ± 1.3 dressing changes occurred. All patients were discharged without requiring re-grafting. No complications were observed, except small non-healing burn wounds in four patients that required further standard wound care to reach complete re-epithelisation. The overall patient reported pain was 3.4 ± 1.2. ConclusionsUse of NPWT as a bolster in patients with severe burns resulted in decreased wound healing time, pain score, workload of nursing staff and caregivers and early rehabilitation of survivor.

Effect of Acupuncture in Pain Management of Head and Neck Cancer Radiotherapy: Prospective Randomized Unicentric Study.

This prospective randomized open-label trial aimed to evaluate the role of acupuncture in the treatment of pain related to curative and adjuvant (chemo)radiotherapy of head and neck cancer. Patients in two arms (30 patients in each arm) underwent standard oncology therapy and standard supportive care with or without acupuncture. The stratification factors were the type of treatment and chemotherapy indication. The toxicity assessed was represented by pain rated on a 10-point pain scale and analgesic use. Average pain (AP) and the worst pain during the day (WP) were significantly lower in the acupuncture arm during radiotherapy (AP median 0.16 vs. 1.36, p < 0.001; WP median 0.90 vs. 1.96, p < 0.001) and three months after radiotherapy (AP median 0.07 vs. 0.50, p < 0.001; WP median 0.30 vs. 0.83, p = 0.002). The analgesic consumption between arms was statistically significantly different. A median of the proportion of days when the patients used analgesics was 8% and 32.5% during radiotherapy (p = 0.047) and 0% and 20.8% during three months after radiotherapy (p = 0.006) for the acupuncture and control arm, respectively. Results point out lower analgesic consumption and milder pain in acupuncture arm. Acupuncture consequently offers another alternative to standard treatment leading to a reduction in the toxicity of oncological treatment.

Investigation of The Pain and Disability Situation of The Individuals Working "Home-Office" At Home At The Covid-19 Isolation Process

The aim of our study is to examine pain and disability in low back, knee and shoulder regions of individuals working at home during COVID-19 isolation process. In our study, 87 volunteers were included in digital media by questionnaire with data collection method. Individuals who worked in the office before COVID-19 isolation but started working from home during the isolation were included in our study. In addition to the socio-demographic characteristics of the individuals, their situation about the working environment at home was questioned. In addition, pain in the low back, knee and shoulder regions was evaluated with an 11-point pain scale (EPPS). In order to determine the level of disability, individuals were asked to fill in the Oswestry Disability Index (for the lumbar region), Lysholm Knee Score (for the knee region) and the Disability of Arm, Shoulder and Hand Questionnaire (DASH) (for the shoulder region). It was seen that 86.2% preferred desk environment more frequently as home working environment and 65.5% spent 3 to 8 hours in this environment. During the home isolation process, the highest pain was observed for low back pain (50.6%) in individuals (EPPS:4-5), then shoulder pain (44.8%) (EPPS:5) and knee pain (35.6%) (EPPS:4-5). When the levels of disability were evaluated, the Oswestry score was found 13.08±11.98, the Lysholm score was found 91.20±12.23 and the DASH score was found 9.61±16.78. It has been observed that individuals working at home during COVID-19 isolation process may develop shoulder and knee pain, and mostly in the low back region, and all these pain are defined as moderate severity pain. However, when we look at the levels of disability, it was seen that low back pain, knee pain or shoulder pain did not pose a significant problem in the life of the patient and the level of disability was low.

Effects of patient-preferred live music on positive and negative affect and pain with adults on a post-surgical oncology unit: A randomized study

Surgery is often the first treatment following a cancer diagnosis. In accordance with recommendations from the American Cancer Society related to emotional wellbeing, engaging post-operative oncology inpatients in psychosocial interventions may alleviate symptoms and elevate affective states. Therefore, the purpose of this single-session randomized study was to determine the immediate effects of patient-preferred live music (PPLM) on positive and negative affect and pain in adults hospitalized on a post-surgical oncology unit. Participants (N = 44) were randomly assigned to experimental or wait-list control conditions via a computer program. Experimental participants received a single PPLM session. Participants completed the Global Mood Scale and an 11-point Likert-type pain scale at pre- and posttest. Results indicated significant between-group differences in posttest measures of positive and negative affect, with the experimental group having more favorable scores. Although the between-group difference in posttest pain was not significant, the experimental group had a greater decrease in pain. Despite the temporal challenges associated with the short-term setting, a single PPLM session can be an effective nonpharmacological intervention for immediately addressing affect and pain in patients on a post-surgical oncology unit. Implications for clinical practice, limitations, and suggestions for future research are provided.

Is the only buccal infiltration anesthesia enough for extraction of mandibular anterior incisors and premolar teeth? A split-mouth randomized clinical trial

The issue of needing additional lingual injection in extractions of mandibular premolar and incisors is still not clarified. The aim of this study is to investigate whether it is necessary to perform lingual injection in addition to buccal infiltration anesthesia in mandibular incisors and premolar teeth extractions. Sixty-six patients who admitted to our clinic for the removal of bilateral mandibular anterior teeth were included in the present study. Patients were divided into two groups. The experimental group received only 1.5 ml of 2% lidocaine with 1:80,000 epinephrine by injection into the buccal vestibule of the tooth. The control group received 1.5 ml of 2% lidocaine with 1:80,000 epinephrine by buccal injection into the buccal side and 0.3 ml same lidocaine solution injected into the lingual side of the tooth. After 5 min, tooth was extracted and each patient was asked to record the intensity of injection and extraction pain by 0-100 mm and a 10-point Visual Analogue Scale (VAS) and six-pointed Face Pain Scale (FPS). The injection pain scores were significantly higher in terms of the VAS 0-10 point and 0-100 mm and FPS in the control group to which additional lingual injections were applied than the experimental group (p < 0.05). No statistically significant differences were found in all three scales between the groups in terms of extraction pain (p > 0.05). The mean extraction pain scores were lower in the experimental group according to the three scales. No additional anesthetic injection and post-operative complications were observed in all patients. The extraction of mandibular incisors and premolar teeth can only be done with only the buccal infiltration. In the extraction of mandibular anterior teeth, it can be performed with less anesthetic amount without the need for an additional lingual injection.

Improving the quality of life of patients with rheumatoid arthritis after rehabilitation irrespective of the level of disease activity

Due to the exacerbation of the disease, the rehabilitation of patients with rheumatoid arthritis is often limited. The aim of the study was to analyze the impact of a comprehensive rehabilitation on a subjective perception of pain and quality of life in patients with rheumatoid arthritis depending on the level of disease activity. The study involved 58 women with rheumatoid arthritis aged 18–60, who underwent a 4-weeks comprehensive rehabilitation program. The assessment included the disease activity level on the DAS28 scale, pain intensity on the 10-point pain scale (VAS) and the value of the CRP protein. The HAQ-DI and KALU questionnaire were used to assess the quality of life. In both groups (group A—DAS28 < 4.2, group B—DAS28 ≥ 4.2) the statistically significant effects in decreasing the level of pain and improvement of quality of life were observed. This indicates the need and effectiveness of rehabilitation regardless of the level of activity of rheumatoid arthritis according to the DAS28 scale. There were no significant changes in the CRP protein level. In conclusion, the rehabilitation of patients with moderate to high disease activity is effective and the success of comprehensive rehabilitation is demonstrated by the decrease of the DAS28 score and the pain level reported by patients, as well as improving self-assessment of health and quality of life.

Which factors predict discordance between a patient and physician on a gout flare?

To investigate the factors associated with discordance between patient and physician on the presence of a gout flare. Patients' self-reports of current gout flares were assessed with the question, 'Are you having a gout flare today?' which was then compared with a concurrent, blinded, physician's assessment. Based on agreement or disagreement with physicians on the presence of a gout flare, flares were divided into concordant and discordant groups, respectively. Within the discordant group, two subgroups-patient-reported flare but the physician disagreed and physician-reported flare but the patient disagreed-were identified. The factors associated with discordance were analysed with multivariable logistic regression analysis. Of 268 gout flares, 81 (30.2%) flares were discordant, with either patient or physician disagreeing on the presence of a flare. Of the discordant flares, in 57 (70.4%) the patient reported a flare but the physician disagreed. In multivariable logistic regression analysis adjusted for demographics, disagreement among patients and physicians on the presence of a gout flare was associated with lower pain scores at rest [odds ratio (OR) for each point increase on 0-10 point pain scale 0.81 (95% Wald CI 0.73, 0.90), P < 0.0001] and less presence of joint swelling [OR 0.24 (95% CI 0.10, 0.61), P = 0.003] or joint warmth [OR 0.39 (95% CI 0.20, 0.75), P = 0.005]. Although patients and physicians generally agree about the presence of gout flare, discordance may occur in the setting of low pain scores and in the absence of swollen or warm joints.

Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study.

PurposeOlder adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program.Patients and MethodsA retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p≤0.01 was considered as statistically significant.ResultsThe TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p<0.01). There was no difference between groups for delta scores for TUG (p=0.14), BBS (p=0.03), 10-meter walk test (p=0.54), 6-minute walk test (p=0.94) and SMAF (p=0.23). Pearson correlation coefficients were weak between initial pain intensity and changes in functional outcome scores between T1 and T2 (r= −0.16 to 0.15, all p-values >0.10).ConclusionThese results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program.

Comparison of Clinical Outcomes of Different Rates of Infusion in Caudal Epidural Steroid Injection: A Randomized Controlled Trial.

Study DesignProspective randomized controlled equivalence trial.PurposeTo compare the clinical outcomes between patients with lumbosacral radiculopathy that received caudal epidural steroid injection (CESI) at injection rates of 40 mL/min (fast rate) and 20 mL/min (slow rate) and to identify the complications associated with these different CESI rates.Overview of LiteratureCESI is widely used for chronic low back pain with lumbar radiculopathy. However, the influence of CESI rates on clinical outcomes has not been well studied.MethodsNinety patients were randomized into two CESI groups. Two patients did not complete the study. Eighty-eight were included in the final analysis: 44 patients were in the fast infusion group, and 44 patients were in the slow infusion group. Intragroup and intergroup comparisons were conducted with regard to the Visual Analog Scale (VAS), Roland 5-point pain scale, standing tolerance test, walking tolerance test, and patient satisfaction scale at pre-injection, 2 weeks, 6 weeks, and 12 weeks post-injection. Complications associated with the different rates were recorded.ResultsBoth groups demonstrated clinical improvement in all parameters, except for VAS, after injection. There were no statistically significant differences in any outcomes at each time point between the two groups. One patient in the fast rate group and no patients in the slow rate group experienced nausea and vomiting after injection (p=0.320). Eight patents in the fast rate group and two patients in the slow rate group experienced pain at the injection site (p=0.044).ConclusionsAlthough there were no significant differences between injection rates in the short-term clinical improvement outcomes, the fast injection rate group experienced more pain at the injection site, suggesting that the use of the slow injection rate may be considered.

Counterpoint: Conventional Fluoroscopy-Guided Selective Cervical Nerve Root Block-A Safe, Effective, and Efficient Modality in the Hands of an Experienced Proceduralist.

The conventional fluoroscopy-guided (CF) selective cervical nerve root block (SCNRB) is being used commonly as a treatment for cervical radicular pain as well as a diagnostic tool. This study aimed to identify any major complications and determine the safety and clinical utility of CF-SCNRB performed in a university hospital and associated outpatient clinics. Two-hundred fifty-four conventional fluoroscopy-guided selective cervical nerve root blocks were retrospectively identified from 2011 to 2018 using a radiology report search tool. Each procedure was performed by an experienced neuroradiologist performing spinal injections on a full-time basis in clinical practice. A 10-point pain scale was used for pre- and postprocedural pain-level assessment. Successful conventional, fluoroscopy-guided, selective cervical nerve root block was defined as a patient-reported pain scale reduction of at least 50% and/or alleviation of numbness or paresthesia at ≥2 weeks postinjection. All clinically important immediate and delayed complications were also recorded. Two-hundred fifty-four conventional fluoroscopy-guided selective cervical nerve root blocks were performed via an anterolateral approach with an average fluoroscopy time of 24.3 seconds for all cases. There were no aborted procedures and no major or permanent complications. There were 14 minor complications; 12 of these were periprocedural and resolved by the 2-week follow-up visit. One-hundred eighty-five patients (75.2%) reported pain improvement of >50% from baseline at 15 minutes postinjection. Overall, 172 patients (67.7%) reported >50% pain scale reduction or alleviation from paresthesia at least 2 weeks postinjection. Conventional fluoroscopy-guided selective cervical nerve root block is an efficacious, efficient, and safe outpatient procedure when performed by a skilled and experienced proceduralist.

Whole body vibration improves symptoms of diabetic peripheral neuropathy

Whole Body Vibration (WBV) is an innovative therapy that may be effective for reducing chronic pain associated with diabetic peripheral neuropathy (DPN), Current treatments for DPN pain have demonstrated questionable efficacy and significant risk of adverse events. Preliminary research has indicated that WBV may be effective for controlling chronic pain symptoms of DPN. METHODS: 20 participants (9 male, 11 female), 58.51 ± 10.69 years old, and BMI of 33.60 ± 8.20 kg/m2 were randomly assigned to a sham-treatment (n = 8) or WBV treatment (n = 12) group in a pre-post design. Pain was assessed with a 10-point verbal analog pain scale (VAS). Treatment consisted of three sessions/week with at least one day between sessions, 12 min/session (four bouts of 3 min), for four weeks. Control was established with a sham vibration protocol for two weeks in which the participants were blinded to the treatment. RESULTS: VAS scores of the treatment group decreased significantly at both 2 and 4 weeks (p = 0.019). The treatment group was found to have a significantly lower VAS score than the controls at two weeks (p = 0.033). After cessation of WBV vibration treatment, participants reported reduced DPN-related pain from 1 to 5 weeks later. ConclusionWBV is effective for reducing DPN-associated pain over a two- and four-week interval. This was the first study to demonstrate this using a sham vibration control. We further saw a persistence in pain reduction beyond the day of treatment, indicating a potential chronic effect of WBV treatment.

Ultrasound Evaluation of a Single Treatment With a Temperature Controlled Multi-Frequency Monopolar Radio Frequency Device for the Improvement of Localized Adiposity on the Abdomen and Flanks

BACKGROUND AND OBJECTIVES: Energy modalities used for fat reduction include cryotherapy, focused and unfocused ultrasound, radiofrequency, and laser. Two devices have been proven to reduce fat layer thickness using ultrasound as measurement after a single treatment. We hypothesized that a novel, high frequency monopolar radiofrequency device could increase the fat temperature enough to reduce its thickness as measured by ultrasound, without excessively increasing the temperature of the skin, leading to a safe, tolerable, and clinically relevant reduction of fat. STUDY DESIGN/MATERIALS AND METHODS: A high frequency monopolar radiofrequency platform was used to treat twelve patients on the abdomen or flanks (truSculpt® 3D, Cutera, Brisbane, CA). Each patient received one treatment session, consisting of 15-minute increments for four areas (60 minutes total). Each area (approximately 144 cm2) was treated with a gliding handpiece technique to a skin temperature of 44-45˚C, correlating to in vivo measurements of the subcutaneous layer of >45˚C. Patients were evaluated at eight- and twelve-weeks following treatment. Clinical efficacy was measured using 360˚ positioned clinical photography. Fat layer reduction was measured with ultrasound. Safety was assessed by the treating physician; patient comfort was assessed during treatment via a 10-point pain scale. RESULTS: All patients responded to treatment. Ultrasound measurements indicated mean fat layer reduction of 4.6 mm, which correlated with a 24% reduction in fat layer thickness at 12 weeks. A significant improvement was noted between the 8-week and the 12-week follow up. A high level of inter-patient consistency was achieved with most patients (10/12= 83%) having an average fat thickness reduction of >20%. No adverse events were observed, and pain scores during the treatment session ranged from 2 to 4 out of 10. CONCLUSION: High frequency monopolar radiofrequency device produced consistent and statistically significant fat thickness reduction from a single 60-minute treatment session, with minimal discomfort and no demonstrated side effects. Results are comparable to other hypo- and hyper-thermic fat treatment technologies. KEY WORDS: fat reduction, radiofrequency, monopolar RF, fat thickness reduction, body sculpting J Drugs Dermatol. 2020;19(1):28-34. doi:10.36849/JDD.2020.4568

Impact of Periocular Vibration on Pain Perceived during Intravitreal Injections

Abstract Purpose The gate theory of pain hypothesizes that the application of vibration can inhibit transmission of afferent pain receptors. The purpose of this study was to evaluate the impact of periocular vibration on pain perceived during intravitreal injections. Design Prospective, cross-sectional, randomized clinical trial. Subjects Non-treatment naive patients with neovascular age-related macular degeneration (nAMD). Methods Masked subjects with neovascular age-related macular degeneration (nAMD) were randomized to undergo standardized intravitreal injections of anti-vascular endothelial growth factor agents with or without periocular vibration anesthesia. Topical anesthetic was used in all study eyes before each treatment. Perceived patient pain was measured with a standardized 10-point pain scale. Main Outcome Measures The primary outcome measure was perceived patient pain as measured with a standardized 10-point pain scale. Results Eighty eyes of 80 patients with a mean age of 81.2 years were enrolled. Treatments with periocular vibration anesthesia (N=41) were associated with significantly lower pain scores than those without vibration anesthesia (N=39) (1.54 +/- 1.58 versus 2.49 +/-1.90; P=0.01). Conclusion In patients with nAMD, periocular vibration anesthesia reduces pain experienced during intravitreal injections.

Preemptive pain-management program is associated with reduction of opioid prescriptions after benign minimally invasive foregut surgery

ObjectiveThe opioid crisis is partly due to opioids prescribed after elective surgery. We sought to determine if a preemptive pain-management program would be associated with opioid-free discharge after benign foregut surgery. MethodsA retrospective case-control study of prospectively collected data was conducted at a single institution of patients who underwent elective minimally invasive benign foregut surgery. We compared the outcomes among patients who were managed with standard care (control), enhanced recovery after surgery alone, or a preemptive pain-management program with enhanced recovery after surgery. ResultsAmong 414 patients, there were significantly fewer opioid medication prescriptions at discharge (9.6% vs 85.2% vs 87%, P < .001) and fewer postoperative complications (3.2% vs 14.8% vs 15.1%, P = .004) in the preemptive pain-management group (n = 94), enhanced recovery after surgery alone (n = 81), and the control group (n = 239), respectively. Multivariable logistic regression analysis showed that the preemptive pain-management program was a factor associated with a decrease in opioid medication prescriptions at discharge (odds ratio, 0.01; 95% confidence interval, 0.01-0.03; P < .001), as well as a decrease in complications after surgery (odds ratio, 0.22; 95% confidence interval, 0.06-0.79; P = .02). Moreover, in the preemptive pain-management group, average self-reported pain level in a subset of patients at 30 days after surgery was 0.9 ± 1.4 on a 0- to 10-point pain scale. ConclusionsThe preemptive pain-management program was associated with opioid-free discharge after minimally invasive foregut surgery. This study provides a strategy to reduce opioid prescriptions after foregut surgery and, if implemented nationally, could decrease the amount of opioids used in the community.