Assessment Of Pain Relief Research Articles

Safety and efficacy of combined acetabular reconstruction and microwave ablation in the treatment of periacetabular metastatic disease: a retrospective clinical evaluation

IntroductionThe periacetabular bone defects caused by metastatic disease often necessitate acetabular reconstruction and various techniques have been employed with varying degrees of success. The purpose of this study was to evaluate the efficacy and safety of acetabular reconstruction in conjunction with adjuvant microwave ablation as a surgical intervention for patients with periacetabular metastases.MethodsBetween January 2019 and September 2023, 17 consecutive patients with different tumor subtypes required surgical intervention for periacetabular metastases. The acetabular reconstruction was performed by utilizing an acetabular reconstructive cage and cement total hip arthroplasty with microwave ablation. A retrospective review was performed to assess pain relief, intraoperative details and postoperative complications. Functional status following procedures was determined by the 1993 Musculoskeletal Tumor Society (MSTS) score and the overall survival of patients was estimated by Kaplan-Meier analysisResultsIn total, 8 males and 9 females were included with an average age of 48.6 years (range 34-66). Patients reported a significant improvement in the level of pain and the mean VAS score declined from 7.7 preoperatively to 2.2 postoperatively. Of the 17 patients, 16 could ambulate either independently (6 patients) or using a walking aid (10 patients) with a mean MSTS score of 18.9. The median follow‐up was 9.0 months. Nine patients were alive at the most recent follow-up with overall survival of 40.9% at 12 months and 30.7% at 36 months, respectively.ConclusionIn selected patients with periacetabular metastasis, the utilization of an acetabular cage and cement total hip arthroplasty presents a less invasive reconstruction technique. The incorporation of adjuvant microwave ablation has shown promise in providing long-lasting pain relief, reducing intraoperative bleeding, and improving local tumor control. However, further research and extended follow-up are necessary to establish the effectiveness of this procedure.

Evaluating Synergistic Effects of Hyaluronic Acid, Human Umbilical Cord-Derived Mesenchymal Stem Cells, and Growth Hormones in Knee Osteoarthritis: A Multi-Arm Randomized Trial.

Knee osteoarthritis (OA) significantly affects quality of life and imposes economic burdens due to its prevalence and the disability it causes. The efficacy of current treatments is limited to alleviating the symptoms, and they cannot be used for regenerative purposes. This study aims to evaluate the efficacy and safety of combining hyaluronic acid (HA), human umbilical cord-derived mesenchymal stem cells (hUC-MSCs), and synthetic human growth hormone (somatotropin) in the treatment of knee OA, assessing pain relief, functional improvement, and cartilage regeneration. A four-arm, double-blind randomized trial was conducted with 51 knees from 28 subjects aged ≥50 with primary knee OA. The treatments involved were HA alone, HA with hUC-MSCs, HA with somatotropin, and a combination of all three. Efficacy was measured through the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog score (VAS), and MRI T2 mapping of cartilage was conducted on pre-implantation at the 6th and 12th month. All treatment arms showed improvements in the VAS and WOMAC scores over 12 months, suggesting some pain relief and functional improvement. However, MRI T2 mapping showed no significant cartilage regeneration across the groups. While the combined use of HA, hUC-MSCs, and somatotropin improved symptoms of knee OA, it did not enhance cartilage regeneration significantly. This study highlights the potential of these combinations for symptom management but underscores the need for further research to optimize these therapies for regenerative outcomes.

Anterior percutaneous full-endoscopic transcorporeal decompression for cervical disc herniation: a finite element analysis and long-term follow-up study

ObjectiveThe purpose of this study was to investigate the long-term consequences on the cervical spine after Anterior transcorporeal percutaneous endoscopy cervical discectomy (ATc-PECD) from the biomechanical standpoint.MethodsA three-dimensional model of the normal cervical spine C2-T1 was established using finite element method. Subsequently, a disc degeneration model and degeneration with surgery model were constructed on the basis of the normal model. The same loading conditions were applied to simulate flexion, extension, lateral bending and axial rotation of the cervical spine. We calculated the cervical range of motion (ROM), intradiscal pressure, and intravertebral body pressure under different motions for observing changes in cervical spine biomechanics after surgery. At the same time, we combined the results of a long-term follow-up of the ATc-PECD, and used imaging methods to measure vertebral and disc height and cervical mobility, the Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to assess pain relief and neurological functional recovery.ResultsThe long-term follow-up results revealed that preoperative JOA score, neck VAS score, hand VAS score, IDH, VBH, and ROM for patients were 9.49 ± 2.16, 6.34 ± 1.68, 5.14 ± 1.48, 5.95 ± 0.22 mm, 15.41 ± 1.68 mm, and 52.46 ± 9.36° respectively. It changed to 15.71 ± 1.13 (P < 0.05), 1.02 ± 0.82 (P < 0.05), 0.77 ± 0.76 (P < 0.05), 4.73 ± 0.26 mm (P < 0.05), 13.67 ± 1.48 mm (P < 0.05), and 59.26 ± 6.72° (P < 0.05), respectively, at 6 years postoperatively. Finite element analysis showed that after establishing the cervical spondylosis model, the overall motion range for flexion, extension, lateral bending, and rotation decreased by 3.298°, 0.753°, 3.852°, and 1.131° respectively. Conversely, after establishing the bone tunnel model, the motion range for these actions increased by 0.843°, 0.65°, 0.278°, and 0.488° respectively, consistent with the follow-up results. Moreover, analysis of segmental motion changes revealed that the increased cervical spine mobility was primarily contributed by the surgical model segments. Additionally, the finite element model demonstrated that bone tunneling could lead to increased stress within the vertebral bodies and intervertebral discs of the surgical segments.ConclusionsLong-term follow-up studies have shown that ATc-PECD has good clinical efficacy and that ATc-PECD can be used as a complementary method for CDH treatment. The FEM demonstrated that ATc-PECD can lead to increased internal stresses in the vertebral body and intervertebral discs of the operated segments, which is directly related to cervical spine degeneration after ATc-PECD.

Results of cement-augmented pedicle screw surgery in the treatment of thoracic and lumbar spine collapse in severe osteoporosis patients

Objective: This 2023 study aimed to assess pain relief, functional recovery, and kyphosis correction following pedicle screw surgery with cement augmentation in severe osteoporosis patients with vertebral collapse. Methods: Seventy-one patients underwent surgery and were evaluated for postoperative pain reduction (VAS score), functional improvement (ODI score), vertebral kyphosis angle, pre- and postoperative spinal curvature angles, and complications. Results: The study included 71 participants (13 males, 58 females; mean age 67.6±6.7 years). Trauma sources included falls (47.9%), heavy lifting (17%), and unclear mechanisms (35.2%). Mean hospital stay was 12±6.5 days. Preoperative, postoperative, and 1/6-month VAS scores were 8.7, 2.2, 1.5, 0.9 respectively (p&lt;0.001). ODI scores were 77.6, 52.8, 43.0, 37.9 respectively (p&lt;0.001). Kyphotic angle (vertebral body) decreased from preop 12.9° to postop 9.9°, 1/6 months 10.1° (p&lt;0.001); at surgical site, preop 15.4° to 1/6 months 11.9° (p&lt;0.001). Cement leakage occurred in 36.6% of cases, mostly asymptomatic, with distribution in the disc space (2.8%), blood vessels (8.5%), around vertebral body (12.7%), spinal canal (14.1%), and lungs (2.8%). Conclusion: Pedicle screw fixation with enhanced cement augmentation effectively manages severe osteoporotic vertebral compression fractures, providing significant pain relief, improved postoperative function, and spinal alignment. Symptomatic cement leakage is rare.

Diagnostic Capability of Intra-Articular Injections for Femoroacetabular Impingement Syndrome: A Systematic Review.

To review and critically appraise available literature concerning the diagnostic capability of intra-articular injections for femoroacetabular impingement (FAI) syndrome. Systematic review. N/A. N/A. N/A. Studies assessing pain relief following intra-articular injections for the diagnosis of FAI syndrome, compared with arthroscopy as diagnostic reference standard, were considered eligible. Searches were performed across 8 databases, and the risk of bias was evaluated through the Quality Assessment of Diagnostic Accuracy Studies tool. From 489 articles identified, 4 were included for analysis. Intra-articular injections were composed of anesthetic agents (such as lidocaine, bupivacaine, and ropivacaine), combined or not with corticosteroids (triamcinolone and betamethasone). All studies were judged as "at risk of bias", and a substantial heterogeneity was found considering assessment methods and pain relief thresholds for a positive response to intra-articular injections. Overall, 2 studies reported that intra-articular injections presented a high accuracy in determining the presence of FAI syndrome. However, the remaining 2 studies indicated that intra-articular injections might present restricted diagnostic capability to discriminate FAI syndrome from healthy individuals or those with other hip pathologies. Based on limited evidence, the diagnostic capability of intra-articular injections for FAI syndrome cannot be supported. It remains unclear which pain relief thresholds are related to a higher diagnostic capability. The combination of anesthetics with corticosteroids should also be further explored, including multiple pain assessments for evaluation of prolonged effects.

Cyberknife Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single-Institution Retrospective Analysis of Clinical Outcomes

Abstract Introduction: CyberKnife stereotactic radiosurgery (CKSRS) is recognized as a highly efficient intervention for refractory trigeminal neuralgia (TN). Our study aims to evaluate the clinical outcomes of CKSRS in treating medically refractory TN. By assessing these results, we aim to understand CKSRS efficacy and its potential as an alternative for nonresponsive patients to traditional medical treatments. Methods: In a retrospective study carried out at my institution, 25 patients with refractory TN were treated between 2018 and 2020. Clinical outcomes, including pain control and hypoesthesia/numbness, were assessed at 6, 12, and 24 months after CKSRS. The study employed the Barrow Neurological Institute pain intensity and facial numbness scores acquired through a telephone questionnaire to assess pain relief and the onset of facial hypoesthesia, thus establishing the effectiveness of the treatment. Results: There were 14 male and 11 female patients. Among all the patients, 44% experienced relief from pain and were not on any medication for pain, whereas 52% reported occasional pain that did not require medication at the end of the study period. The adverse effect of CKSRS, facial numbness, was observed in 58% of patients as mild facial numbness and in 44% as bothersome facial numbness. Moreover, a higher dose of CKSRS administered to the trigeminal nerve was associated with statistically significant pain control (P &lt; 0.05). Conclusion: The study concludes that CKSRS is a safe and effective treatment option for refractory TN. It is worth noting that the occurrence or progression of facial hypoesthesia posttreatment was identified as a predictor of prolonged pain relief.

Viscosupplementation with High Molecular Weight Hyaluronic Acid for Hip Osteoarthritis: a Systematic Review and Meta-Analysis of Randomised Control Trials of the Efficacy on Pain, Functional Disability, and the Occurrence of Adverse Events.

Hip osteoarthritis (OA) has a prevalence of around 6.4% and is the second most commonly affected joint. This review aims to assess the clinical outcomes of intra-articular high molecular weight hyaluronic acid (HMWHA) in the management of hip osteoarthritis. We conducted a comprehensive search across PubMed, Google Scholar, and the Cochrane Library for randomised trials investigating the effectiveness of high molecular weight hyaluronic acid (HMWHA) in the treatment of hip osteoarthritis. Quality and risk of bias assessments were performed using the Cochrane RoB2 tool. To synthesise the data, we utilised the Standardised Mean Difference (SMD) for assessing pain relief through the Visual Analogue Scale (VAS) and the Lequesne index (LI) for evaluating functional outcomes. Risk Ratio (RR) was calculated to assess the occurrence of complications. A total of four studies involving HMWHA and control groups were included. The standardised mean difference (SMD) for the Visual Analogue Scale (VAS) (SMD -0.056; 95% CI; -0.351, 0.239; p = 0.709) and the Lequesne index (SMD -0.114; 95% CI; -0.524, 0.296; p = 0.585) were not statistically significant. Analysis for complications demonstrated an overall relative risk ratio (RR) of 0.879 (95% CI; 0.527, 1.466; p = 0.622), and was not statistically significant. Intra-articular HMWHA in hip OA can significantly reduce pain and improve functional recovery when compared with the condition before treatment. However, there is no significant difference between HMWHA, or saline, or other therapeutic treatments. Currently, available evidence indicates that intra-articular HMWHA in hip OA would not increase the risk of adverse events. hip osteoarthritis, hyaluronic acid, intra-articular, molecular weight, viscosupplementation.

FUNCTIONAL OUTCOME OF PATIENTS WITH OSTEOARTHRITIS KNEE TREATED BY INTRAARTICULAR INJECTIONS OF PLATELET-RICH PLASMA

Objectives: The aims and objectives of the study are (1) to assess pain relief and functional outcome in knee osteoarthritis (OA) cases treated by intra-articular injection of platelet-rich plasma (PRP) and (2) to study the complication in patients treated by intra-articular injection of PRP. Methods: This was a prospective study conducted in the department of orthopedics of a tertiary care medical institute. 60 patients with Grade 2 and Grade 3 OA of knee were included in this study on the basis of a pre-defined inclusion and exclusion criteria. All patients were treated by intra-articular injection of PRP. Patients were followed up for 6 months. During follow-up visits, assessment of severity of pain and functional outcome was done by Visual Analog Scale (VAS) Score and Japanese Orthopedic Association (JOA) Score. Patients were also assessed for complications. p&lt;0.05 was taken as statistically significant. Results: Out of 60 studied cases, there was a female preponderance with a M: F ratio of 1:0.62. The mean age of affected cases was found to be 65.84±11.86 years and mean duration of symptoms was found to be 2.52±1.26 years. Majority of the patients were either overweight (45.00%) or obese (36.67%) and only 11 (18.33%) patients had a healthy weight. 38 (63.33%) patients were having Grade 3 OA whereas 22 (36.67%) patients were having Grade 2 OA. There was a significant reduction in pain and significant functional improvement at the time of final follow-up as compared to VAS and JOA scores at the time of presentation (p&lt;0.0001). Complications were seen in any of the cases. Conclusion: Patients with Grade 2 and Grade 3 OA of knee treated by intra-articular injection of PRP show excellent outcome in terms of pain relief and functional outcome with no significant complications.

Satisfaction and dissatisfaction with pain relief and birth experience among induced and spontaneous-onset labours ending in vaginal birth: A prospective cohort study.

To assess pain relief and overall birth experience in induced vs. spontaneous-onset labours and to clarify variables among induced parturients determining satisfaction and dissatisfaction. A prospective study of 2042 women. 575 women with induced and 1467 with spontaneous-onset labour answered multiple questions in a questionnaire regarding the experience of birth giving. Satisfaction was numerically assessed via a visual analogue scale (VAS 0-10). Induction of labour (IOL) did not worsen the average experience of pain relief, but the proportion of women dissatisfied with pain relief was slightly higher after IOL compared with spontaneous-onset labour (SOL). IOL was associated with lower satisfaction with overall birth experience compared with SOL (VAS 8.0 vs. 8.4; p<0.001). Among IOL parturients incorrect timing of pain relief was strongly associated with dissatisfaction with pain relief, as were deficient information and induction with misoprostol. Epidural blockade was the most important factor preventing dissatisfaction with pain relief. Unsatisfactory overall experience of birth was associated with deficient pain relief, its incorrect timing or deficient information, as well as vacuum extraction as the mode of delivery. Induction of labour is a risk factor of dissatisfaction regarding pain relief and overall birth experience. The strongest impact on dissatisfaction among induced parturients concerning pain relief was delayed timing of effective labour analgesia. Poor pain relief, its incorrect timing and deficient information on pain relief were strong predictive factors of dissatisfaction with the overall birth experience.

Comparison of Effectiveness and Safety in Treating Acute Acromioclavicular Joint Dislocation with Five Different Surgical Procedures: A Systematic Review and Network Meta-Analysis.

This network meta-analysis aims to evaluate the comparative effectiveness and safety of suture anchors (SA), tendon grafts (TG), hook plates (HP), Tight-Rope (TR), and EndoButton (EB) in the treatment of acute acromioclavicular joint (ACJ) dislocation. The Embase, PubMed, and Web of Science databases were searched from their inception date to June 3, 2022. Studies included all eligible randomized controlled trials (RCTs) and cohort studies with the comparison of five different fixation systems among SA, TG, HP, TR, and EB were identified. All studies were reviewed, performed data extraction, and assessed the risk of bias independently by two reviewers. The primary outcomes are Constant-Murley score (CMS) improvement for assessing clinical efficacy, and complications. The second outcomes are visual analog scale (VAS) for assessing pain relief and the coracoclavicular distance (CCD) for assessing postoperative joint reduction. Version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) were used to assess the RCTs and non-randomized trials, respectively. The continuous outcomes were presented as mean differences (MD), and risk ratios (OR) were used for dichotomous outcomes, both with 95% confidence intervals (CI). Surface under the cumulative ranking curves (SUCRA) results were calculated to offer a ranking of each intervention. We identified 31 eligible trials, including 1687 patients in total. HP showed less CMS improvement than TR and EB in both the Network Meta-analysis (NMA) and pairwise meta-analysis. HP also showed less CMS improvement than SA in NMA. For pain relief, HP performed worse than TR both in pairwise meta-analysis and NMA. No significant differences were found for the measured value of CCD. Both TR and EB showed a lower incidence of complications than HP in pairwise meta-analysis. The rank of SUCRA for CMS improvement was as follows: SA, TR, EB, TG, and HP; for pain relief: TR, EB, TG, SA, and HP; for CCD: HP, TR, SA, EB, and TG. For complications, HP showed the highest rank, followed by TG, EB, TR, and SA. SA shows better clinical effectiveness and reliable safety in the treatment of acute ACJ dislocation. Although HP is the most widely used surgical option currently, it should be carefully taken into consideration for its high incidence of complications.

Pain Reduction in Adult Patients with Limb Spasticity Following a Single IncobotulinumtoxinA Injection: an Analysis of Pooled Data from Phase 2 and 3 Studies (P14-11.008)

<h3>Objective:</h3> To assess pain relief in a large cohort of incobotulinumtoxinA-treated pts with spasticity-associated pain (SAP) using pooled data from mostly placebo-controlled phase 2/3 studies. <h3>Background:</h3> IncobotulinumtoxinA (incoA) has shown pain-relieving benefits in patients (pts) with limb spasticity in individual studies; data from large pt cohorts are lacking. <h3>Design/Methods:</h3> Pain severity was assessed with the Disability Assessment Scale (DAS; 0–3) in adults with upper limb SAP. A ≥1 point reduction in the DAS pain score from baseline [BL] to 4 weeks was defined as response. Between-treatment group response rates (overall and by BL pain severity – DAS mild, moderate, severe) and the proportion of pts with complete pain relief (DAS pain score=0) at 4 weeks after 1 injection of incoA (total dose ≤400U) or placebo were analyzed using <i>χ</i>² test. Overall between-group response rate differences were analyzed using logistic regression (presented as odds ratio [OR] and 95% confidence interval [CI]). <h3>Results:</h3> 542 (incoA: 413, placebo: 129) pts reported SAP at BL. At 4 weeks, a significantly higher proportion of incoA- vs placebo-treated pts achieved a response (52.1% vs 28.7%; p&lt;0.0001). IncoA-treated pts were more likely to achieve pain response vs placebo-treated pts (OR 2.7 [95% CI: 1.6–4.3]; p&lt;0.0001). Irrespective of BL pain severity, significantly higher response rates were observed with incoA vs placebo at 4 weeks (p&lt;0.02 all comparisons). Complete pain relief was achieved by significantly more incoA- vs placebo-treated pts at 4 weeks (26.9% vs 12.4%; p=0.0007). <h3>Conclusions:</h3> Pts receiving incoA vs placebo are significantly, by 2.7 times, more likely to achieve reduced upper limb SAP, irrespective of baseline pain severity, at 4 weeks post-injection thus supporting use of incoA in this setting. <b>Disclosure:</b> Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merz. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merz. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Ipsen. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Dr. Camoes-Barbosa has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MERZ, ABBVIE, IPSEN. Dr. Camoes-Barbosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MERZ, ABBVIE, IPSEN. Mr. Comes has received personal compensation for serving as an employee of Merz Pharmaceuticals GmbH. Michael Althaus has received personal compensation for serving as an employee of Merz Pharmaceuticals. Astrid Scheschonka has received personal compensation for serving as an employee of Merz Therapeutics. Dr. Simpson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Allergan. Dr. Simpson has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz.

Benefit of Multiple IncobotulinumtoxinA Injections for Pain Reduction in Adult Patients with Limb Spasticity: an Analysis of Pooled Data from Phase 2 and 3 Studies (P12-11.009)

<h3>Objective:</h3> To assess pain relief after multiple incobotulinumtoxinA (incoA) injections in a large sample of patients (pts) with limb spasticity-associated pain (SAP) using pooled data from six phase 2/3 studies (four placebo-controlled). <h3>Background:</h3> Repeated treatment with incoA has shown pain-relieving benefits in pts with limb spasticity in individual studies. <h3>Design/Methods:</h3> Adults with upper limb SAP received up to 4 incoA injections (total dose ≤400U) administered at 12- to 14-week intervals (injection cycles [ICs] 1–4; total observation period up to 56 weeks). Only IC 1 was placebo-controlled. Pain severity was assessed at control visits (CVs; 4 weeks after each injection) using the Disability Assessment Scale (DAS; pain scores ranging from 0 [no pain] to 3 [severe pain]). The proportions of pts with a response (defined as a reduction by ≥1 point in the DAS score from baseline to each CV) and with a complete response (DAS pain score=0) were assessed at every CV. Data were descriptively analyzed. As placebo-treated pts in IC 1 received incoA in subsequent cycles, they contributed data to the appropriate incoA CVs 1–4. <h3>Results:</h3> 515 pts with SAP at baseline were included in this analysis (515, 297, 263, and 181 pts at CVs 1–4, respectively). Response rates increased over time, being 53.0%, 63.3%, 66.9%, and 72.4% at CVs 1–4, respectively. Likewise, the proportion of pts with complete response increased over time, being 27.6%, 38.4%, 39.5%, and 43.6% at CVs 1–4, respectively. <h3>Conclusions:</h3> In pts with upper limb SAP, treatment response rates were sustained and showed a cumulative effect over 56 weeks after multiple incoA injections, with a complete pain relief in &gt;40.0% of pts. Results support the use of incoA in reducing upper limb SAP in affected adults. <b>Disclosure:</b> Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merz. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merz. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Ipsen. Jorg Wissel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Dr. Camoes-Barbosa has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MERZ, ABBVIE, IPSEN. Dr. Camoes-Barbosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MERZ, ABBVIE, IPSEN. Mr. Comes has received personal compensation for serving as an employee of Merz Pharmaceuticals GmbH. Michael Althaus has received personal compensation for serving as an employee of Merz Pharmaceuticals. Astrid Scheschonka has received personal compensation for serving as an employee of Merz Therapeutics. Dr. Simpson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Allergan. Dr. Simpson has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz.

A design of a targeted puncture trajectory applied to unilateral extrapedicular percutaneous vertebroplasty

ObjectiveIn this study, we introduced a design of a targeted puncture trajectory applied to unilateral extrapedicular percutaneous vertebroplasty.Methods62 individuals with osteoporotic vertebral compression fractures (OVCF) were included in this research at the Tongling People’s Hospital, from January 2019 to December 2020. Percutaneous Vertebroplasty (PVP) was performed on all patients using a targeted unilateral extrapedicular puncture technique guided by G-arm fluoroscopy. The operating time, volume and dispersion of bone cement, and cement leak were all evaluated. The oswestry disability index(ODI) and the visual analog scale (VAS) were used to assess pain relief and quality of life (QOL).ResultsThe targeted puncture trajectory for unilateral extrapedicular PVP was used to successfully treat a total of 62 fractured vertebrae without any apparent clinical issues. In comparison to their equivalent preoperative values, the VAS and ODI values after surgery were considerably lower (P < 0.01). The bone cement not only could be across the midline of the targeted vertebrae but also appeared in both the bilateral pedicle and the center projection region on the anteroposterior X-ray film, according to radiologic results in all injured vertebrae. There were 3 cases of leakage at the anterior border of the vertebral body and 2 cases of leakage into the intervertebral region without significant clinical manifestations. Furthermore, no bone cement leaked into the vessels or spinal canal.ConclusionThe design of the targeted puncture trajectory used in unilateral extrapedicular PVP not only ensures that the bone cement injector transcends the midline of the vertebral body, but it also improves the accuracy of the injector arriving at the contralateral pedicle projection area. As a result, this approach can increase well-distributed bone cement diffusion while preventing cement leakage into the spinal canal.

Big data is being generated—What opportunities are being missed?

Chondrolysis is a rare complication after shoulder arthroscopy leading to early joint destruction. Shoulder arthroplasty may be considered for end-stage chondrolysis, but concerns exist about implant survivorship, given the younger age of this population. This study aimed to assess pain relief, function, and survivorship of shoulder arthroplasty for chondrolysis and to assess risk factors for failure.Between January 2000 and January 2013, 26 consecutive shoulders with chondrolysis were treated at our institution with shoulder arthroplasty. All shoulders had a prior arthroscopic procedure that predated a phase of rapid joint destruction. Twenty-three shoulders were followed up for a minimum of 2 years or until reoperation (mean, 4.0 years; range, 0.7-8.6 years). The mean age of the patients was 40 years (range, 21-58 years). Outcome measures included pain, range of motion, postoperative modified Neer ratings, American Shoulder and Elbow Surgeons scores, complications, and reoperations.At most recent follow-up, only 14 of 23 shoulders had no or mild pain. Overall pain scores improved from 4.7 to 2.6 points. Abduction and external rotation improved significantly. Five shoulders required reoperation, 2 for glenoid loosening and 1 each for infection, instability, and stiffness. Subjectively, 8 patients rated their shoulder as much better, 7 as better, 4 the same, and 4 worse. Most recent American Shoulder and Elbow Surgeons scores averaged 64 points (range, 20-95 points).Shoulder arthroplasty for the treatment of chondrolysis improves pain and range of motion. However, patient satisfaction is variable. Early follow-up shows a higher than expected rate of reoperation (25%). Patients undergoing shoulder arthroplasty for chondrolysis should be counseled appropriately about expectations after surgery.

Ganglion Impar Block For Chronic Coccydynia.

Coccydynia is also known as coccygodynia or coccygeal neuralgia. Coccyx is a triangular bone located within the vertebral column. The cause of coccydynia is unknown in the literature; however, it is found to be common among obese individuals, particularly females. The probability of women having coccydynia is five times higher than among men, which may result from larger pressure during pregnancy and child delivery. It is treated well with ganglion impar block. The aim of our study was to assess pain relief after Ganglion Impair Block with subsequent improvement in quality of life. A single-arm study was done in the department of Pain Medicine, Fauji Foundation Hospital, Rawalpindi from July 2021 to June 2022. A total of 50 patients with ≥3 months' coccygeal pain of either gender aged between 20-60 years unresponsive to analgesics & anti-inflammatory medications with no laboratory abnormalities were included. Fluoroscopic guided trans-sacro‑coccygeal ganglion impair block was done with alcohol neurolysis. The patients were observed for 1 hour in the recovery room to record post-intervention complications that may occur like hypotension, bradycardia, signs, and symptoms of cardiotoxicity or neurotoxicity etc. and evaluated for pain scores on the basis of the numeric rating scale (NRS). Data collected was analyzed using the statistical package for social scientists (SPSS) version 21. The quantitative data, i.e., age and NRS score were analyzed using mean and standard deviation and compared between pre and post-intervention periods. The data from 50 patients who completed the follow-up period were used for analysis. The average age of the patients was 42.9±8.39 years, with a range of 38-60 years. Based on the data obtained, 30% of the patients experienced trauma (that is falling on the coccyx region). The mean score from NRS before intervention was 7.80±0.16 which decreased to 0.96±0.35, respectively, and this difference was statistically significant (p-value, <0.001). Ganglion Impar neurolysis is highly effective in the treatment of chronic coccydynia.

Total Elbow Arthroplasty from Indian Perspective: A Systematic Review.

Total elbow arthroplasty (TEA) provides satisfactory pain relief and restores elbow range of motion and function in patients with end-stage arthritis. Due to advances in implant design and surgical techniques, the indications for surgery have expanded to include various other conditions affecting the elbow. The previous studies and systematic reviews reported satisfactory mid-term and long-term clinical outcomes after TEA with relatively stable complication and revision rates. However, there is lack of information in the literature about the results of TEA in Indian patients. Two reviewers performed a comprehensive literature search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in three online databases-Pubmed/MEDLINE, Google scholar and the Cochrane database for clinical trials. Only original studies published in the English literature reporting outcomes of primary TEA in Indian patients were included for analysis. Using pre-defined inclusion and exclusion criteria, articles were screened and the relevant articles identified. Data were extracted with the primary objective to assess pain relief and functional outcome after TEA in Indian patients, and secondary objective to identify indications for surgery, complication rates and incidence of implant removals. A total of 212 TEAs (210 patients) from ten articles were included in this systematic review. All the TEAs were done using Baksi's semi-constrained sloppy-hinged elbow prosthesis. The most common indication of TEA was post-traumatic sequelae (124 elbows, 58.5%), followed by comminuted intra-articular fracture distal humerus (53 elbows, 25%). At a weighted mean follow-up of 7.5years, 80.7% cases had complete pain relief. The weighted mean flexion, extension restriction, supination and pronation were 122.6°, 20.8°, 57.3°, and 48.6°; respectively. The weighted mean Mayo Elbow Performance Score was 92.1 points with excellent outcome. Overall, a total of 68 complications were reported (32%) and the implants needed to be removed in 14 elbows (6.6%) including two revisions. This systematic review found that the functional outcome and pain relief obtained with TEA using Baksi's sloppy-hinged prosthesis in Indian patients were satisfactory overall. The complication rates and implant removal rates were lower than those reported with other patient populations.

Combining Awake Anesthesia with Minimal Invasive Surgery Optimizes Intraoperative Surgical Spinal Cord Stimulation Lead Placement.

Spinal cord stimulation (SCS) is an effective and validated treatment to address chronic refractory neuropathic pain in persistent spinal pain syndrome-type 2 (PSPS-T2) patients. Surgical SCS lead placement is traditionally performed under general anesthesia due to its invasiveness. In parallel, recent works have suggested that awake anesthesia (AA), consisting of target controlled intra-venous anesthesia (TCIVA), could be an interesting tool to optimize lead anatomical placement using patient intra-operative feedback. We hypothesized that combining AA with minimal invasive surgery (MIS) could improve SCS outcomes. The goal of this study was to evaluate SCS lead performance (defined by the area of pain adequately covered by paraesthesia generated via SCS), using an intraoperative objective quantitative mapping tool, and secondarily, to assess pain relief, functional improvement and change in quality of life with a composite score. We analyzed data from a prospective multicenter study (ESTIMET) to compare the outcomes of 115 patients implanted with MIS under AA (MISAA group) or general anesthesia (MISGA group), or by laminectomy under general anesthesia (LGA group). All in all, awake surgery appears to show significantly better performance than general anesthesia in terms of patient pain coverage (65% vs. 34–62%), pain surface (50–76% vs. 50–61%) and pain intensity (65% vs. 35–40%), as well as improved secondary outcomes (quality of life, functional disability and depression). One step further, our results suggest that MISAA combined with intra-operative hypnosis could potentialize patient intraoperative cooperation and could be proposed as a personalized package offered to PSPS-T2 patients eligible for SCS implantation in highly dedicated neuromodulation centers.

Modified Kenalog Protocol for Perianal Fissures- A Quasi Experimental Trial

Objective: To ascertain the role of triamcinolone injection at the base of an anal fissure and its effect on healing and pain relief. Methodology: A quasi-experimental study was conducted from November 2021 to February 2022. Under aseptic measures, a 1ml Triamcinolone 40mg/ml injection was administered at the base of the anal fissure using a 1cc insulin syringe. This was injected in four positions around the base of the fissure. Patients were followed for one week to assess pain relief and improvement in quality of life. Patients were assessed for quality of life improvement and satisfaction with treatment. Patients were offered lateral internal sphincterotomy at the end of one week and again on follow up after two weeks given they were not satisfied with pain relief or symptom recurrence occurred. Results: Twenty five patients were enrolled and analysed. All fissures were seen to have a red inflamed base at enrollment. At one week after treatment, a paler base with less signs of inflammation was observed. Patients reported a mean 70% improvement in their symptoms. A mean change of 16.45 points was seen in Brief Pain Inventory scores at one-week follow up. 25% underwent a lateral internal sphincterotomy. The number needed to treat was 2.5. 5 patients were lost to follow-up after the initial one week follow-up. Conclusion: Injection of Triamcinolone at the base of an anal fissure may have a role as an adjunct to standard management in treatment. It has been shown to decrease pain and enhance healing of the fissure thus decreasing the need for surgical intervention.

Relative safety and efficacy of topical and oral NSAIDs in the treatment of osteoarthritis: A systematic review and meta-analysis.

Osteoarthritis (OA) often affects the hands, knees, and hip joints, causing considerable pain and disability, and often affecting the patient's quality of life. Non-steroidal anti-inflammatory drugs (NSAIDs) are common pain relievers often applied as first line therapies for OA. However, prolonged NSAIDs application can have unwanted side effects. Given this, this study was designed to systematically evaluate the efficacy and safety of topical and oral NSAIDs for the treatment of OA. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for relevant papers from their inception dates to May 2021. Our study only included randomized controlled trials comparing topical and oral NSAIDs and all data were analyzed using Review Manager version 5.3 (RevMan version 5.3). We identified 8 RCTs (2096 patients with OA), for evaluation and revealed that, in general, topical and oral NSAIDs presented with similar efficacies for the treatment of OA. The Western Ontario and McMaster Osteoarthritis Index for assessing pain relief in OA patients was (standardized mean difference [SMD] 0.07; 95%CI -0.02, 0.17) and visual analog scale was (SMD -0.01; 95%CI -0.02, 0.18), and improved stiffness in OA patients (SMD 0.09; 95%Cl 0.03, 0.20). Topical NSAIDs are as effective as oral NSAIDs for the treatment of OA and both topical and oral NSAIDs are equally effective in reducing pain and improving physical function in OA patients. In terms of safety, a larger number of samples are still needed to determine if there are any differences in the safety profile of topical or oral NSAIDs. INPLASY 2021110009.

Effectiveness and Safety of CT-Guided Facet Joint Cyst Rupture for Radicular Pain as First Choice Therapy: A Retrospective Analysis.

To evaluate effectiveness and safety of computed tomography (CT)-guided cyst rupture with intraarticular contrast-enhanced injection of steroid and local anesthetic as first choice therapy in patients with facet joint cyst-induced radicular pain. Retrospective data set analysis. University hospital. One hundred and twenty-one patients suffering from radicular pain attributable to facet joint cysts were included. The rate of patients without following surgery was assessed and defined as surrogate to measure effectiveness. Patients' characteristics, procedure-associated complications, technical aspects, and imaging findings on magnetic resonance imaging (MRI) were analyzed. A subgroup of 65 patients (54%) underwent telephone interview to assess pain relief and clinical outcome measured by Numeric Rating Scale and Oswestry Disability Index. Analyses between the groups with and without surgery were performed by Fisher exact test and two-sample unpaired t-test, respectively. The effectiveness of CT-guided cyst rupture was found to be 66.1%. Procedure-induced pain yielded in premature abort in two cases (1.7%). The detection of epidural contrast agent was statistically significantly associated with no need for surgery (P = .010). The cyst level was associated with the status of following surgery (P = .026), that is, cysts at lower lumbar spine were easier to rupture than cysts at other locations (cervical, thoracic, or upper lumbar spine). No further significant association was found. CT-guided cyst rupture as the first-choice therapy in patients with cyst-induced radicular pain was safe and effective. Successful cyst rupture was associated with no need for surgery. Cysts at lower lumbar spine revealed the highest success rate.