Analogue Scale Pain Intensity Research Articles

Clinical efficacy of spa therapy (balneotherapy) for chronic low back pain: A randomized single-blind trial

IntroductionThe effect of spa therapy, a non-pharmacological treatment for chronic low back pain (CLBP) has been evaluated by several randomized clinical trials. This randomized controlled trial was conducted to compare the effect of balneotherapy alone versus balneotherapy with physical exercise. MethodsParticipants (n = 60) with low back pain for more than 6 months and attending a musculoskeletal clinic were recruited into this study. They were randomized to either the balneotherapy group (immersion in thermo-mineral water) or to a balneotherapy + exercise group (group exercises delivered in addition to balneotherapy). ResultsBefore intervention and 3 and 6 months after intervention, statistically significant decreases were observed according to a visual analog scale of pain intensity (p < 0.05). Improvements recorded on a health assessment questionnaire lasted up to 6 months in both groups; however, values were not statistically significant. Fingertips-to-floor distance and Schober’s Index measurements showed significant decreases in the balneotherapy + exercise group after treatment and at 3 months and only after treatment in the balneotherapy alone group. The Waddell Disability Index showed better recovery for the balneotherapy group at the end of the treatment and at the 3rd month. When the two groups were compared using the Waddell evaluation, the balneotherapy group was found to be superior (p < 0.047). ConclusionAlthough two weeks of spa therapy was beneficial in improving pain and physical function in patients with CLBP, there was no difference between balneotherapy combined with physical exercise therapy and balneotherapy alone. However, this therapeutic approach seemed advantageous in improving mobility and flexibility in these patients.

Pain Quality by Location in Outpatients with Cancer

BackgroundThe McGill Pain Questionnaire (MPQ) pain quality descriptors have been analyzed to characterize the sensory, affective, and evaluative domains of pain, but have not been differentiated by pain location. AimTo examine MPQ pain quality descriptors by pain location in outpatients with lung or prostate cancer. DesignCross sectional. SettingsEleven oncology clinics or patients’ homes. Subjects264 adult outpatients (80% male; mean age 62.2 ± 10.0 years, 85% White). MethodsSubjects completed a 100 mm visual analogue scale of pain intensity and MPQ clinic or home visit, marking sites where they had pain on a body outline and circling from 78 verbal descriptors those that described their pain. A researcher noted next to the descriptor spontaneous comments about sites feeling like a selected word and queried the subjects about any other words to obtain the site(s). ResultsPain quality descriptors were assigned to all 7 pain locations marked by ≥ 20% of 198 lung or 66 prostate cancer patients. Four pain locations were marked with pain quality descriptors significanlty (p < .05) more frequently for lung cancer (53% chest–aching, burning; 58% back–aching, stabbing; 48% head–aching, sharp; and 19% arms–aching, stabbing) than for prostate cancer, which had significantly more frequent pain locations in the abdomen (64%–aching, burning) and lower back/buttocks (55%–aching, burning). ConclusionsThis type of pain characterization is innovative and has the potential to help implement targeted treatments for patients with cancer and other chronic pain conditions.

Pregabalin in the reduction of pain and opioid consumption after burn injuries: A preliminary, randomized, double-blind, placebo-controlled study.

Background:The primary objective of the study was to evaluate the efficacy of 300 milligrams (mg) and 600 mg of pregabalin compared to placebo in the reduction of pain in patients with noncritical partial and full thickness burn injuries.Methods:A prospective, randomized, double-blinded, single center, placebo-controlled trial was conducted. Simple randomization method was used in this trial. After subjects met all the inclusion and none of the exclusion criteria, they were randomized and assigned to 1 of the 3 18-day treatments groups: Pregabalin 300 group, Pregabalin 600 group, or Placebo group. Demographics and clinical characteristics were recorded. The severity of pain was assessed by using the visual analog scale for pain intensity at baseline on day 3, day 9 ± 3, day 25 ± 7, day 90 ± 6, and day 180 ± 12.Results:A total of 54 subjects were randomly assigned, and 51 were included in the data analysis. Demographics and clinical characteristics did not differ significantly between the 3 groups. There was a statistically significant difference in pain between the Pregabalin 300 and Pregabalin 600 groups (P-value = .0260). The Pregabalin 300 group had 17.93 units (95% confidence interval: 1.83–34.04) higher pain scores on average than the Pregabalin 600 group, regardless of time. The adjusted P-value comparing 0 to 300 was .1618, while the adjusted P-value for 0 versus 600 was .5304. There was an overall difference in pain across time regardless of study group (P-value = <.0001). An overall difference in opioid consumption (P-value = .0003) and BSHS (P-value = .0013) across time regardless of study group was noted.Conclusions:Pregabalin could be part of a promising multimodal analgesic regimen in noncritical burn population. Future placebo-controlled studies assessing the use of pregabalin in burn victim patients may further endorse our findings.

Effect of Flurbiprofen Axetil on Low-frequency Fluctuation Amplitude of Resting-state Functional Magnetic Resonance Imaging in Trigeminal Neuralgia

Objective To observe the changes of brain function in patients with trigeminal neuralgia after administration of flurbiprofen axetil by using the resting-state functional magnetic resonance imaging(fMRI)and based on the amplitude of low-frequency fluctuation(ALFF). Methods Resting fMRI data of 20 patients with trigeminal neuralgia before and after treatment with flurbiprofen axetil were collected by 1.5T magnetic resonance imaging system.The resting fMRI data were pretreated by Statistical Parametric Mapping and DPABI(a toolbox for Data Processing and Analysis for Brain Imaging)software,and the difference of low-frequency oscillation amplitude of brain spontaneous activity before and after treatment with flurbiprofen axetil was analyzed by ALFF. Results The Visual Analogue Scale of pain intensity after flurbiprofen axetil injection was significantly lower than that before administration,and the pain relieved significantly(P=0.000).The ALFF values of right dorsolateral prefrontal lobe,bilateral medial prefrontal lobe,and right middle cingulate gyrus in patients treated with flurbiprofen axetil at rest were significantly lower than those before administration(P=0.000). Conclusions The analgesic effect of flurbiprofen axetil is exerted on the central system.This agent can inhibit the abnormal brain function caused by chronic pain stimulation and thus reduce pain.However,the specific mechanism needs further investigations.

Effect of integrated complimentary therapies on physical and psychological variables of patients suffering from knee osteoarthritis: A pilot feasibility study

Background: Recent studies have shown beneficial effects of complementary and alternative therapies such as Yoga, Ayurveda, and Naturopathy on osteoarthritis (OA), but combining these therapies will have any synergistic effect and will be feasible and safe or not is not known. Aim: This study aims to assess feasibility and compare the effect of Ayurveda and Naturopathy as an add-on to Yoga in individuals with knee OA. Materials and Methods: This study involves forty Seven individuals (21 males and 26 females) in the age range of 45.19 ± 3.39, suffering from knee OA since 3.37 years admitted in a residential holistic therapy hospital. They were allocated into one of the three treatment programs based on their preference and clinician's advice: (a) Yoga (n = 16), (b) Yoga + Ayurveda (n = 21), and (c) Yoga + Naturopathy (n = 10). Assessments were done at baseline and after 1 week of respective treatment program using knee injury and OA outcome score (KOOS), perceived stress scale, visual analog scale for pain intensity, and stiffness index. Furthermore, physiological and anthropometric measures were assessed. Data were analyzed using paired t-tests and one-way ANOVA for within and between groups comparison, respectively, using SPSS version 10.0. Results: No side effects were reported by the individuals in any of the groups. Within-group comparisons showed significant improvement in all the variables except blood pressure in all the three groups and body mass index, heart rate (HR), and respiratory rate in Yoga + Naturopathy group. Between-group comparison showed significant improvement in Yoga group as compared to Yoga + Naturopathy group for KOOS subscale - sports function (P = 0.049; F = 3.24) and for HR (P = 0.025, F = 4.014) in Yoga group as compared to Yoga + Ayurveda group. Conclusion: Addition of Ayurveda and Naturopathy to Yoga therapy for short-term treatment was found to be safe and feasible. Seven days of Yoga therapy improved clinical symptoms, anthropometric measures, and psychological states of individuals with knee OA.

A study of the effect of the combined application of a physiotherapeutical program with therapeutic fit balls in cases of chronic pain in the lumbar area.

Objective: To investigate the efficiency of the combined application of a physiotherapeutical program with fit-ball exercises in cases of chronic pain in the lumbar area. Subjects and method: 38 out-patients aged 39 to 67, with chronic pain in the lumbar area (dating back from 5-7 years, with last exacerbation 5-6 weeks prior to the patients? inclusion in the study), participated in the study. The patients were divided into two groups-a test group in whose physiotherapy program fit-ball exercises were included, and a control group performing standard analytical exercise routines. The pain was reported in the Visual Analogue Scale of Pain Intensity (VASPI). Muscular testing was performed at the beginning and at the end of the physiotherapy program. The physiotherapy rehabilitation program was implemented once a day during the out-patients? procedures in medical centres, and three time a week-at home. Results and discussion: At the end of the period of monitoring the condition of the patients, changes in the nature of the pain were reported in both groups: with initial levels of VASPI 3.50 for both groups, at the end of the treatment program the level reported by the test group was VASPI 2.00, and VASPI 3.00-by the control group. The continuous physiotherapy program including fit-balls leads to an improvement of the movements and a reduction of the dysfunction in cases of chronic pain in the lumbar area of the spine. The exercise programs using fit-balls performed at home enhance the functional capacity of the lumbar spine.

Effect of Gabapentin vs Pregabalin on Pain Intensity in Adults With Chronic Sciatica

Optimal pharmacologic treatment for chronic sciatica (CS) is currently unclear. While gabapentin (GBP) and pregabalin (PGB) are both used to treat CS, equipoise exists. Nevertheless, pharmaceutical regulation authorities typically subsidize one drug over the other. This hinders interchange wherever the favored drug is either ineffective or ill-tolerated. To assess GBP vs PGB head to head for the treatment of CS. A preplanned interim analysis of a randomized, double-blind, double-dummy crossover trial of PGB vs GBP for management of CS at half the estimated final sample size was performed in a single-center, tertiary referral public hospital. A total of 20 patients underwent randomization from March 2016 to March 2018, and 2 were excluded with 1 lost to follow-up and the other requiring urgent surgery unrelated to the study. Patients attending a specialist neurosurgery clinic with unilateral CS were considered for trial recruitment. Chronic sciatica was defined as pain lasting for at least 3 months radiating into 1 leg only to, at, or below the knee level. Imaging (magnetic resonance imaging with or without computed tomography) corroborating a root-level lesion concordant with symptoms and/or signs was determined by the trial clinician. Inclusion criteria included patients who had not used GBP and PGB and were 18 years or older. Analyses were intention to treat and began February 2018. Randomly assigned participants received GBP (400 mg to 800 mg 3 times a day) then PGB (150 mg to 300 mg twice daily) or vice versa, each taken for 8 weeks. Crossover followed a 1-week washout. The primary outcome was pain intensity (10-point visual analog scale) at baseline and 8 weeks. Secondary outcomes included disability (using the Oswestry Disability Index) and severity/frequency of adverse events. The total trial population (N = 18) consisted mostly of men (11 [61%]) with a mean (SD) age of 57 (16.5) years. A third of the cohort were smokers (5 [28%]), and more than half consumed alcohol (12 [67%]). Gabapentin was superior to PGB, with fewer and less severe adverse events. Both GBP (mean [SD], 7.54 [1.39] to 5.82 [1.72]; P < .001) and PGB (mean [SD], 7.33 [1.30] to 6.38 [1.88]; P = .002) displayed significant visual analog pain intensity scale reduction and Oswestry Disability Index reduction (mean [SD], 59.22 [16.88] to 48.54 [15.52]; P < .001 for both). Head to head, GBP showed superior visual analog pain intensity scale reduction (mean [SD], GBP: 1.72 [1.17] vs PGB: 0.94 [1.09]; P = .035) irrespective of sequence order; however, Oswestry Disability Index reduction was unchanged. Adverse events for PGB were more frequent (PGB, 31 [81%] vs GBP, 7 [19%]; P = .002) especially when PGB was taken first. Pregabalin and GBP were both significantly efficacious. However, GBP was superior with fewer and less severe adverse events. Gabapentin should be commenced before PGB to permit optimal crossover of medicines. anzctr.org.au Identifier: ACTRN12613000559718.

Using of Birthing Ball during the first Stage of Labor: Its Effect on the Progress of Labor and Outcome among Nulliparous Women

Background: It is beyond argument that women who are about to give natural birth to their babiesneed some physical exercise such as standing, walking around, sitting, or kneeling in order to provide for the “gravity effect” that would help in speeding up the dilation of the cervix. The birth ball used to be utilized in various settings of birth and is highly considered as a powerful, secureand easy method of promoting the progress of labor and relieving pain. The current study aim sat studying the using of the birthing ball during the first stage of labor and its effect on the progress of labor and outcome among nulliparous women. The design: The quasi-experimental design was utilized. A group of 120 laboring women was included by purposive sampling technique; the study subjects randomly assigned into two equal group. Setting: The study was implemented in the maternity Unit located in El-Nabawy El Mohandes Hospital (economical part), Fayoum. Five tools have been employed ingathering the needed data; 1) structure interview schedule questionnaire, 2) Partograph, 3) Visual analog pain intensity scale, 4) State Trait Anxiety Inventory and 5) Satisfaction visual analogue scale. The Findings of the present results revealsa high significant statistical difference between the two groups concerning the improvement of the dilatation of the cervix and fetus head descent that end in decreases duration of the first and second labor stages in the study sample. Also the sample of the study expressed less pain and anxiety score. Conclusion: the using of birthing ball throughout the first stage of labor is associated with positive effect on labor progress and outcome. Recommendation: Encourage women to use birth ball during the first stage of labor as one of the significant modalities to improve labor progress, manage pain, anxiety and attain more satisfactory birthing experience.

Is steroid phonophoresis effective in the treatment of subacromial impingement syndrome? Randomized controlled study

Subacromial impingement syndrome (SIS) is the most common cause of shoulder pain. Although, there are conservative and surgical treatment options for SIS, there isn’t a gold standard therapy. The aim of this study was to evaluate the effectiveness of steroid phonophoresis in patients with SIS. Sixty patients with SIS were participated in this prospective, single-blind randomized controlled study and randomly divided into 2 groups: intervention group (steroid phonophoresis) and control group (sham ultrasound). Hot pack and shoulder exercises including pendulum, range of motion (ROM) and strengthening exercises were given all patients. Steroid phonophoresis was applied with 1% hydrocortisone cream (2 g/session hydrocortisone with 1.5 watt/cm 2 ultrasound for 7 minutes). All participants completed 15 treatment session and were assessed with visual analog scale for pain intensity, shoulder ROM, muscle strength, University of California Los Angeles (UCLA) Shoulder Rating Scale, Shoulder Disability Scale (SDS) and Nottingham Health Profile (NHP) for quality of life at pretreatment, post-treatment and 3rd month of treatment. Baseline demographic characteristics of two groups were found similar except of their ages (the mean age ± SD 49.57 ± 6.73 for intervention group, 53.97 ± 5.81 for control group). Statistically significant improvements were observed in all parameters in both groups at the end of the therapy and 3 months afterwards. There was a statistically significant difference in pain severity, shoulder ROM, UCLA Shoulder Rating Scale, SDS and NHP (pain, energy, sleep, social isolation, mobility) between two groups ( P < 0.05). Steroid phonophoresis can be used as a well tolerated non-invasive therapy option for SIS.

Effects of the suboccipital muscle inhibition technique on pain intensity, range of motion, and functional disability in patients with chronic mechanical low back pain

Background Chronic mechanical low back pain is a common clinical condition encountered by physical therapists. It has a mechanical origin that lasts more than 3 months. Aim The aim of this study was to investigate the effects of the suboccipital muscle inhibition technique on pain intensity, range of motion (ROM), and functional disability in patients with chronic mechanical low back pain. Patients and methods Thirty female patients with a mean age of 23.8±0.86 years who had chronic mechanical low back pain were randomly assigned to two equal groups. Group A received exercise training (stretching and strengthening) and the suboccipital muscle inhibition treatment for five consecutive sessions. Group B received only exercise training (stretching and strengthening) for five consecutive sessions. Both groups were assessed using the visual analog scale for pain intensity, Modified–Modified Schober’s test for ROM of lumbar flexion and extension, and the Oswestary functional disability questionnaire for functional disability. Patients were assessed before and after treatment. Results The results of this study showed that there were significant improvements in pain, ROM in the lumbar region (flexion and extension), and functional disability in both groups A and B (P Conclusion It was concluded that the suboccipital muscle inhibition technique combined with exercises have better clinical effects than exercises alone in patients with chronic mechanical low back pain.

The effects of transcranial direct current stimulation (tDCS) combined with group exercise treatment in subjects with chronic low back pain: a pilot randomized control trial

Objective: To test the efficacy of transcranial direct current stimulation (tDCS) in addition to group exercise on non-specific chronic low back pain. Design: Double-blinded randomized control trial. Subjects: Patients with non-specific chronic low back pain. Methods: A total of 35 subjects were recruited and allocated to real- or sham-tDCS followed by a group exercise protocol. Each patient underwent five sessions of brain stimulation followed by 10 sessions of group exercise. Subjects were evaluated before and after tDCS, after group exercise and one month after the combined treatment. Outcome measures were Visual Analog Scale for pain intensity, Roland Morris Disability Questionnaire, EuroQuol-5 Dimension and Patient Health Questionnaire-9. Results: Significant between-group difference in pain intensity (−27.7 ± 30.4 mm in real-tDCS group compared to −2.2 ± 30.1 mm in sham-tDCS group) and Patient Health Questionnaire-9 (−4.9 ± 4.2 in real-tDCS group compared to −1.1 ± 2.7 in sham-tDCS group) was found one month after the combined treatment (P < 0.05). Conclusion: Our results showed that real-tDCS can induce significant larger effects on pain and psychological well-being, compared to sham-tDCS, when it is associated with a group exercise program. The effects were observed mostly in the follow-up.

Assessment of Severity of Illness and Monitoring Response to Treatment of Odontogenic Space Infection Using Serum Prealbumin.

To assess Serum Prealbumin in the severity of illness and monitor response to treatment in odontogenic space infection. This was a prospective cohort study comprising patients being managed for odontogenic space infection at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. The calculated sample size was 69. Clinical parameters (Swelling Size, Visual Analogue Scale for pain intensity, and Maximal Interincisal Distance) were measured on day 0, day 4, and day 8. Other clinical parameters were Number of Anatomic Spaces Involved, setting of treatment, and Length of Hospital Stay. Serum Prealbumin levels were also serially measured. The relationship between Serum Prealbumin level and the clinical parameters was established using Spearman's correlation test, independent t test, Friedman's test, and linear regression. Significance level was set at .05. The mean Serum Prealbumin level at presentation (day 0) was 19.19 ± 4.61mg/dl, which was significantly lower among inpatients (p = 0.001). On days 0, 4, and 8, Serum Prealbumin negatively correlated with Number of Anatomic Spaces Involved (p < 0.001). Serum Prealbumin levels on days 0, 4, and 8 and response in Serum Prealbumin negatively correlated with Length of Hospital Stay. On each day, Serum Prealbumin negatively correlated with pain intensity and Swelling Size and positively correlated with mouth opening. The response in Serum Prealbumin also positively correlated with response in each of the three clinical parameters. This study suggests that Serum Prealbumin is a reliable tool for grading severity of illness and monitoring response to treatment in odontogenic space infection.

Upright versus recumbent position during first stage of labor among primipara women on labor outcomes

Objective: The aim of this study was to assess the effect of upright versus recumbent position during the active phase of first stage of labor among primipara women on labor outcomes in term of progress, duration of labor, method of delivery, neonatal outcome and maternal satisfaction with assumed position.Methods: Quasi experimental design was used. The study was conducted in the labor unit in obstetric department at Benha University Hospital. A purposive sample of 100 parturient women in 1st stage of labor were recruited in the study, they divided into two groups; upright group (50) and recumbent group (50). Data were collected through four main tools: Structured Interviewing questionnaire sheet, Structured Observational Checklist include (Partograph and Apgar score), Visual analogue pain intensity scale and maternal satisfaction with assumed position questionnaire.Results: It revealed that high statistical significant difference between the upright and recumbent groups in term of decreases interval and increases duration, frequency and intensity of uterine contraction, cervical dilatation and fetal head descent/fifth among the upright group. While the recumbent group showed less progress. Moreover, the recumbent group expressed more pain score, consume longer duration of 1st, 2nd, 3rd stage of labor than the upright group and statistical significant difference in Apgar score of the neonate during both first and fifth minute. In addition, the upright group had higher satisfaction scores compared to those assumed recumbent positions (p &lt; .001).Conclusions: Upright position had positive effect on progress of labor, decreased duration of the three stages of labor, better neonatal outcomes and improving parturient women's satisfaction with assumed position. The study recommended that all parturient women in low-risk labor should be informed about the benefits of assuming upright positions during first stage of labor, and be encouraged and supported to use them.

Ketamine Plus Nitroglycerin Versus Ketamine as Adjuncts to Lidocaine for Intravenous Regional Anesthesia in Adult Patients Undergoing Hand Surgery

Background: Different agents have been used as adjutants to lidocaine for intravenous regional anesthesia (IVRA) to improve the quality of analgesia. Objective: The aim of this double blinded randomized controlled trial is to evaluate if adding nitroglycerin to ketamine is more effective than using ketamine alone as an adjuvant to lidocaine for IVRA. Methods: Fifty adult ASA I-II patients undergoing hand surgery using IVRA were divided into two equal groups: ketamine/nitroglycerin (K/N) group received lidocaine 3mg/kg (maximum 200 mg) with ketamine 0.1 mg/kg (maximum 10 mg) plus nitroglycerin 2 mcg/kg (maximum 200 mcg) and ketamine (K) group received lidocaine 3 mg/kg (maximum 200 mg) with ketamine 0.1 mg/kg (maximum 10 mg). Statistical analysis was done using Student's t test or Chi square analysis whenever appropriate. Results: The two groups were similar in demographic data and patients characteristics. The onset times of sensory and motor blockades were significantly shorter in K/N group. Although the preoperative visual analogue scale for pain intensity (VAS) was comparable, the intra-operative and postoperative VAS, were significantly less in K/N group. The intra-operative fentanyl consumption as an intra-operative analgesia was significantly less in K/N group. Also, the time to call for the first postoperative analgesia was significantly longer in K/N group than K group. However the postoperative analgesics consumption showed no significant difference between the two groups. Conclusion: In comparison to ketamine, adding a combination of ketamine and nitroglycerin to lidocaine for IVRA improved the quality of anesthesia without inducing significant clinical side effects. Key words: Nitroglycerin, ketamine, intravenous, regional, anesthesia.

A multi-center, randomized controlled clinical trial, cost-effectiveness and qualitative research of electroacupuncture with usual care for patients with non-acute pain after back surgery: study protocol for a randomized controlled trial

BackgroundAlthough pain after back surgery is known to be difficult to control, various treatment options are available to patients and physicians. A protocol for a confirmatory randomized controlled trial (RCT) on pain and function after back surgery was designed based on the results of a pilot trial. The aim of this study is to compare the effectiveness and safety of electroacupuncture (EA) with usual care (UC) versus UC alone on pain control and functional improvement after back surgery.Methods/designThis study is a multi-center, randomized, assessor-blinded trial with an active control conducted in conjunction with a cost-effectiveness analysis and qualitative research. Participants with non-acute low back pain with or without leg pain after back surgery who have a Visual Analogue Scale (VAS) pain intensity score ≥ 50 mm will be randomly assigned to either the EA with UC group (n = 54) or the UC group (n = 54). Following randomization, participants in both groups will receive the same UC treatment twice a week for a four-week treatment period. Participants assigned to the EA with UC group will additionally receive EA twice a week for the same four-week period. The primary outcome measure will be assessed using a VAS pain intensity score for low back pain. The secondary outcomes will include the Oswestry Disability Index, EuroQol 5-Dimension score, and drug intake. The primary and secondary outcomes will be measured at one, four, and eight weeks post randomization.DiscussionThe results of this study will provide evidence of the effectiveness and cost-effectiveness of EA in managing postoperative pain following back surgery. In addition, the qualitative research results will help improve the quality of integrative medical interventions.Trial registrationClinical Research Information Service (CRIS), Republic of Korea, KCT0001939. Registered on 8 June 2016.

Appleby operation for carcinoma of the body and tail of the pancreas.

The aim of this study is to evaluate the therapeutic efficacy of Appleby operation for carcinoma of the body and tail of pancreas. From March 2010 to February 2015, Appleby operation was performed in 17 patients with carcinoma of the body and tail of pancreas. The values of fasting plasma blood, body weight (BW), visual analog pain intensity scale (VAS score), and the quality of life indices were evaluated before and 1 day, 1, 2, 6 weeks after surgery. Survival time, tumor recurrence time, hospitalization time, and treatment-related complications were analyzed. There was no hospital mortality. Pancreatic fistula and diarrhea were major and most frequent. The rate of morbidity in general was 47.1%. After operation, all of the patients were completely pain-free. The VAS score decreased more after surgery comparing with before (83.2 ± 8.5 vs. 1.9 ± 3.6, P < 0.05). After operation, patients gained more than their preoperative BW with a mean increment of (4.1 ± 1.3 kg) (68.1 ± 4.3 vs. 64.0 ± 6.7, P < 0.05). A significant rise of the overall quality of life index was observed after surgery (93.8 ± 9.7 vs. 68.6 ± 6.7, P < 0.05). The 1-, 2-, 3-, and 5-year recurrence rates were 22.9%, 58.9%, 72.6%, and 72.6%, respectively. The 1-, 2-, 3-, and 5-year survival rates after operation were 80.4%, 54.2%, 32.5%, and 16.3%, respectively. Appleby operation is both safe and effective with regard to pain relief and improvement of overall quality of life. Appleby operation can also achieve a high survival rate and a long overall survival time.

Improved health-related quality of life, participation, and autonomy in patients with treatment-resistant chronic pain after an intensive social cognitive intervention with the participation of support partners.

Despite the availability of various specific treatments, most patients with chronic pain (CP) consider their pain problem as undertreated. Recently, multiple sclerosis (MS) patients who were given an intensive 3-day social cognitive treatment with the participation of support partners experienced lasting improvements in health-related quality of life (HRQoL) and self-efficacy. In this study, a similar intervention was given to treatment-resistant CP patients with stressors, relational problems with support partner, and distress, anxiety or depression. Before and 1, 3, and 6 months after the intervention, patients completed the Euro-Qol 5 Dimensions 5 Levels (EQ-5D-5L) and Impact on Participation and Autonomy (IPA) questionnaires (primary outcomes), and the Survey Of Pain Attitudes (SOPA), the Four-Dimensional Symptom Questionnaire (4DSQ) (distress, depression, anxiety, and somatization), and Visual Analog Scale for pain intensity, whereas the support partners completed the Caregiver Strain Index (CSI) questionnaire. Differences between baseline and post-treatment were tested via paired t-tests (significance level 0.05). Of the 39 patients who were included, 34 (87.2%) completed the 3-day treatment. At 1, 3, and 6 months, improvements were seen in EQ-5D-5L-Index (+40.6%; +22.4%; +31.7%), Health Today (+61.8%; +36.3%; +46.8%), Control attitude (+45.8%; not significant [NS]; +55.0%) and decreases in IPA-Problems (−14.8%; NS; −20.4%), Harm attitude (−18.9%; −15.0%; −17.7%), Distress (−17.7%; −31.8%; −37.1%), and Depression (−37.4%; −31.4%; −35.7%) scores. The CSI score had decreased by −29.0%, −21.4%, and −25.9%, respectively. In conclusion, after an intensive 3-day social cognitive intervention, treatment-resistant CP patients experienced substantial and lasting improvements in HRQoL and in problematic limitations to participation and autonomy, in association with improvements in pain attitudes, depression, and distress. To assess whether this innovative approach may be an effective treatment for this subgroup of CP patients, future randomized controlled studies are needed.

Effect of ice pack application on pain intensity during active phase of the first stage of labor among primiparaous

Labor pain management is one of the main goals of maternity care. Ice application or cooling has been claimed to be as an effective, safe and non-invasive adjuvant mean for providing pain relief during the first stage of labor. Aim of the study: To evaluate effect of ice pack application on pain intensity during active phase of the first stage of labor among primiparaous. Research design: None-randomized-controlled clinical trial research design was utilized. Setting: The study was conducted at labor and delivery unit of El Shatby Maternity University Hospital affiliated to Alexandria University. Subjects: Convenience sample of 80 pregnant women attending the previously mentioned setting were recruited in the study. They were equally divided into ice application &amp; control groups. Tools: Three tools were used for data collection, namely: Tool (I): Pregnant women basic data structured interview schedule, Tool II: Visual Analogue pain intensity scale (VAS) &amp; Tool III: Present Behavioral Intensity Scale (PBIS) Tool IV: Satisfaction visual analogue scale (SVAS). A high statistically significant difference was observed between the study &amp; control groups in relation to their pain intensity using VAS before and after the intervention (P ≤ .000). In addition, another high statistically significant difference was detected between the study group &amp; control groups in relation to their behavior of labor pain (P = .000) before &amp; after 30 as well as 60 min of intervention. Based on the study findings, it could be concluded that the application of ice pack application during active phase of first stage of labor appeared to have a remarkable effect on labor pain intensity. In service training programs for nurses in labor units about the utilization of non-pharmacological approaches is recommended.

Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis?

This study aimed to compare the short-term effects of kinesiotaping and extracorporeal shock wave therapy (ESWT) along with physiotherapy on pain, functionality, and grip strength in patients with newly diagnosed lateral epicondylitis undergoing rehabilitation. Forty-five voluntary patients (mean age 48years) were randomly assigned to three groups. Patients in all groups received physiotherapy consisting of a cold pack and transcutaneous electrical nerve stimulation five times per week for a total of 15 sessions and a home exercise programme including stretching and eccentric strength exercises. In the second group, patients received kinesiotaping 5days a week for 3weeks. In the third group, ESWT was applied three times for 3weeks. Patients were assessed by visual analogue scale for pain intensity, pain-free grip strength using a hand dynamometer, Cyriax Resisted Muscle Test, and Patient-Rated Tennis Elbow Evaluation Scale. All measurements were collected at baseline and after treatment. There were no significant differences in the demographic characteristics of the patients in all groups at baseline. Intra-group analysis revealed that pain intensity decreased, whereas maximum grip strength and functionality increased in all groups at the end of the treatment (p<0.05). Inter-group analysis revealed that the kinesiotaping group yielded better results in decreasing pain intensity than the other groups (p<0.05). The kinesiotaping group (p<0.001) and ESWT group (p=0.002) yielded better results in improving functionality than the physiotherapy group. There were significant differences in recovering pain-free grip strength in the kinesiotaping group (p<0.05). Kinesiotaping was found to be effective for decreasing pain intensity, recovering grip strength, and improving functionality in patients with lateral epicondylitis undergoing rehabilitation. Therapeutic study, Level II.

Pain and Cognition in Multiple Sclerosis.

The goal of the present study was to examine the relationship between pain and cognition in patients with multiple sclerosis. Cross-sectional. Nursing home and personal environment of the investigators. Two groups of participants were included: 91 patients with multiple sclerosis and 80 matched control participants. The level of pain was measured by the following pain scales: Number of Words Chosen-Affective, Colored Analogue Scale for pain intensity and suffering from pain, and the Faces Pain Scale. Mood was tested by administering the Beck Depression Inventory and the Symptom Check List-90 anxiety and depression subscale. Global cognitive functioning was assessed by the Mini Mental State Examination. Memory and executive functions were assessed by several neuropsychological tests. Multiple sclerosis (MS) patients scored significantly lower than control participants on the majority of the neuropsychological tests. The MS patients experienced more pain compared with control participants, despite the fact that they were taking significantly more pain medication. No significant correlation was observed between cognition and pain in MS patients. Verbal working memory explained 10% of pain intensity (trend). Mood appeared to be a significant predictor of pain in patients with multiple sclerosis. The lack of a relationship between cognition and pain might be explained by the fact that, compared with control participants, patients with multiple sclerosis activate other non-pain-related areas to perform executive functions and memory tasks.