Average Pain Duration Research Articles

Use of Transverse Abdominis block for Post Operative pain management in Patients undergoing Emergency Cesarean Sections : a prospective study

INTRODUCTION Postoperative pain management is an essential aspect of perioperative care for patients undergoing emergency Cesarean sections. Adequate pain control not only improves patient comfort and satisfaction but also facilitates early mobilization, reduces the risk of complications, and shortens hospital stays. Transverse abdominis plane (TAP) block is a well-established technique for providing analgesia to the anterior abdominal wall, which can significantly reduce postoperative pain. In recent years, ultrasound guidance has been increasingly used to improve the accuracy and safety of TAP block. This research article aims to review the use of ultrasound-guided TAP block for postoperative analgesia in patients undergoing emergency Cesarean Sections. Methodology : A total of 60 patients who underwent Emergency Cesarean Sections were included in the study. All received bilateral US-guided TAP blocks with either ropivacaine 0.5% 20 ml on each side i. e. 40 ml total or saline. All participants received a spinal anaesthetic with bupivacaine, followed by postoperative acetaminophen, non-steroidal anti-inflammatory drugs, and patient-controlled i.v. tramadol . Each patient was assessed 24 h after delivery for PCA Tramadol usage, average pain score, nausea, vomiting, itch and duration of hospital stay. Results and Conclusion Out of the total 60 patients , 30 were in the study group and 30 in placebo group. Total PCA Tramadol use in 24 h was reduced in the study group compared with the placebo group ( P<0.05). The active group reported improved satisfaction with their pain relief measured by visual analogue scale as compared with the placebo group ( P=0.008). There were no local complications attributable to the TAP block. Transverse abdominis plane block was effective in providing analgesia with a substantial reduction in tramadol use during 24h after cesarean section when used as adjunctive to standard analgesia.

Predictors of Persistent Pain after Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is an orthopedic procedure performed on patients with severe knee pain and advanced knee conditions, such as osteoarthritis and rheumatoid arthritis, in order to restore joint function. Despite the procedure’s high success rates, persistent postoperative pain (PPP) remains a significant complication, affecting a substantial proportion of patients. Identifying predictors of PPP is crucial for improving patient outcomes and satisfaction. Methods: A retrospective analytic study was conducted, reviewing the medical records of patients who underwent unilateral or bilateral TKA at King Abdulaziz Medical City. The data collection focused on demographics, comorbidities, clinical presentations, surgical details, and postoperative outcomes. Data were analyzed using JMP software. A p-value of less than 0.05 was considered statistically significant. Results: This study included 838 patients, predominantly female (71.5%), with an average age of 65.4 years. Osteoarthritis was the primary reason for surgery (98.3%). The mean preoperative pain score was 3.4, and the average pain duration prior to surgery was 6.2 years. We identified dyslipidemia as a significant predictor of PPP (OR 1.40, p = 0.042), while we found younger age to be a significant predictor (OR 0.979, 95% CI 0.967–0.991, p = 0.001). Other factors such as gender, diabetes, hypertension, cardiovascular disease, anxiety disorder, mood disorder, tobacco use, chronic kidney disease, chronic lung disease, and BMI were not significant predictors of PPP. Conclusion: This study identifies younger age and dyslipidemia as significant predictors of persistent postoperative pain and improved outcomes following total knee arthroplasty Further research is needed to validate these results in diverse populations and settings, with the objective should be to refine preoperative counseling and postoperative pain management protocols.

Assessment of decision-making autonomy in chronic pain patients: a pilot study

BackgroundPatient decision-making autonomy refers to the patients’ ability to freely exert their own choices and make their own decisions, given sufficient resources and information to do so. In pain medicine, it is accepted that appropriate beneficial management aims to propose an individualized treatment plan shared with the patients, as agents, to help them live as autonomously as possible with their pain. However, are patients in chronic pain centers sufficiently autonomous to participate in the therapeutic decisions that concern them? As this question still remains unanswered, a pilot study was set up to that aim.MethodsOver a 2-month period, first-time patients within a tertiary multidisciplinary pain center underwent a systematic evaluation of their autonomy using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), considered the benchmark tool for measuring a patient’s ability to consent to treatment. Demographic data and pain characteristics of the patients were collected and their respective attending pain physicians were asked to clinically assess their patients’ degree of autonomy. Another physician, who had not participated in the initial patient evaluation, subsequently administered the MacCAT-T questionnaire to the same patients.ResultsTwenty-seven patients were included during the study period (21 women and 6 men), with an average age of 50 years. The average duration of pain was 8 years. Based on their clinical experience, the 4 different pain physicians in charge of these patients considered that out of 25 assessed patients, 22 of them (89%) had full decision-making capacity, with no deficit in autonomy. According to the MacCAT-T results, only 13 of these 25 patients (48%) had no deficit, while 7 (26%) had a major deficit in autonomy. The only patient characteristic that appeared to be related to autonomy was pain type, specifically nociplastic pain. The average time taken to complete the test was 20 min, and patients were very satisfied with the interview.ConclusionResults from the present pilot study suggest that patients suffering from chronic pain do not appear to be entirely autonomous in their decision to consent to the proposed treatment plan according to the MacCAT-T questionnaire, and physicians seem to find it difficult to properly assess this competence in a clinical setting. Further studies with larger samples are needed to better evaluate this concept to improve the complex management of these patients.

Factors Influencing the Self-Management Stages of Older Patients With Chronic Pain: A Cross-Sectional Study

PurposeTo investigate the current status and related influencing factors of self-management stages in older patients with chronic pain. DesignA cross-sectional study. MethodsA total of 326 older patients with chronic pain were selected as the study subjects in five city districts from December 2022 to June 2023. We used a general information survey form, a numerical rating scale, a pain stages of change questionnaire, a health literacy assessment instrument for patients with chronic pain, and a psychological inflexibility in pain scale to collect relevant information from participants. Univariate analysis and multiple ordinal logistic regression analysis were conducted to identify the relevant influencing factors of the self-management stages. ResultsThe self-management stages of older patients with chronic pain were as follows: precontemplation stage (n = 52; 16.0%), contemplation stage (n = 103; 31.6%), action stage (n = 62; 19.0%), and maintenance stage (n = 109; 33.4%). Regression results showed that average monthly household income, smoking history, pain duration, health literacy, and psychological inflexibility were the influencing factors for the self-management stages of older patients with chronic pain. ConclusionsIn this study, the self-management stages of older patients with chronic pain still needed to be improved. Suitable personalized pain self-management strategies should be developed based on identified factors affecting patients to improve their self-management stages. Clinical ImplicationsNursing professionals can use research survey findings to identify patients at low levels of self-management stage and develop personalized intervention strategies based on various influencing factors. For example, nurses can provide practical smoking cessation guidance to assist older chronic pain patients in improving their lifestyle. Nurses can also seek support from family members to collectively offer better medical care and nursing services for the patient if financially feasible. Secondly, as our study has demonstrated, patients' health literacy and psychological flexibility were poor. Nurses can utilize available clinical resources to offer educational materials, such as portable handbooks and online videos, covering pain-related knowledge, managing pain medication, and coping strategies like massage and exercise. Combining this approach with mental health education, such as relaxation therapy, can help patients better understand their pain and actively participate in their self-management. In addition, nursing staff should pay more attention to the self-management stages of older chronic pain patients, and the assessment of self-management stages can be included in clinical pain management for patients. Regular assessment will help track more patients needing attention and make timely adjustments to their pain management plans.

Anxiety and depression among patients with chronic sciatica

IntroductionSpinal radicular syndromes are currently a significant healthcare concern in society. A common manifestation of these syndromes is sciatic pain, characterized by severe pain radiating along the course of the sciatic nerve. In many patients, chronic pain can lead to psychological problems.ObjectivesThe aim of this study was to assess the frequency of anxiety and depression disorders in patients with sciatica and their impact on functional capacity.MethodsWe conducted a cross-sectional study, including patients suffering from documented common sciatic pain evolving for more than 3 months. The study was conducted in a rheumatology department over a period of 3 years. We used the Hospital Anxiety and Depression Scale (HADS) questionnaire, supplemented with information about the study group, pain location, and patients’ occupations. Additionally, the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) were applied.Results The study included 104 patients (71 women and 33 men, with a male-to-female sex ratio of 0.46). The mean age of our patients ranged from 23 to 74 years. The most frequent etiology of sciatic pain was a herniated disc, followed by lumbar spinal stenosis and spondylolisthesis. The root path was L5 in 74 cases and S1 in 30 cases. The average duration of sciatic pain was 6.4 months. The mean Oswestry score was 25 (ranging from 15 to 38). The mean VAS score was 7.4 (ranging from 4 to 9). The mean Work Ability Index (WAI) was 25.2 (ranging from 15 to 38). Depression was noted in 53 patients (50.9%) with a mean HADS depression score of 10.8 (ranging from 4 to 16). Anxiety was noted in 8 patients (7.6%) with a mean HADS anxiety score of 6.40 (ranging from 3 to 16). In univariate analysis, anxiety was associated with the low educational level of patients and with the duration of sciatic pain (p < 0.05). There was a significant association between depression and anxiety (p = 0.000). However, there was no relationship between these psychiatric disorders and functional status (p > 0.05).Conclusions Among patients with sciatic pain, there is a high prevalence of psychiatric disorders, including anxiety and depression. Regular screening for these disorders should be conducted by healthcare providers.Disclosure of InterestNone Declared

Relationship between perfectionism, overactivity, pain severity, and pain interference in individuals with chronic pain: A cross-lagged panel model analysis.

Overactivity is a characteristic of individuals with chronic pain. Previous cross-sectional studies demonstrated a relationship between perfectionism and overactivity. Therefore, the present study used a longitudinal design to determine whether pain severity and pain interference were exacerbated by overactivity and whether overactivity was exacerbated by perfectionism. Participants with chronic pain were recruited using crowdsourcing. The participants completed the questionnaires at three time points: T1, T2, and T3 (September, October, and November 2021, respectively). The questionnaire assessed overactivity, perfectionistic strivings, perfectionistic concerns, pain severity, and pain interference. We created cross-lagged panel models to examine the hypothesized relationships among pain, overactivity, and perfectionism. After excluding ineligible participants and invalid response sets, we analyzed the questionnaires completed by 666 participants at T1, 560 at T2, and 554 at T3. The average duration of chronic pain at T1 was 36.35 ± 53.53 months. Perfectionistic strivings were partially linked to overactivity, and pain interference was partially related to overactivity. Contrary to our expectations, overactivity did not predict pain severity or pain interference. The hypotheses that perfectionism exacerbates overactivity and that overactivity exacerbates pain severity and pain interference were not supported. These results may have been affected by the quality of the assessment of overactivity. Therefore, further research with a refined evaluation of overactivity is required.

Efficacy of Core-Strengthening and Intensive Dynamic Back Exercises on Pain, Core Muscle Endurance, and Functional Disability in Patients with Chronic Non-Specific Low Back Pain: A Randomized Comparative Study.

Chronic back pains are progressively disabling working individuals, including 60-80% of the general population, for which their diagnosis is challenging to healthcare workers worldwide, thereby becoming a burden to nations. The study aimed to investigate the efficacy of core strengthening exercise (CSE) and intensive dynamic back exercise (IDBE) on pain, core muscle endurance, and functional disability in patients with chronic non-specific low back pain (LBP). The study was based on a three-arm parallel-group randomized control design. Forty-five participants with chronic non-specific LBP were recruited and randomly divided into the CSE, IDBE, and Control groups. The CSE and IDBE groups received CSE and IDBE, respectively. However, the Control group received no intervention. Numeric pain rating scale, Oswestry Disability Index, core flexors, extensors, and side bridge tests assessed pain intensity, functional disability, and endurance of core muscles. Outcome scores for the dependent variables were collected at baseline (pre-intervention) and six-week post-intervention. There were no follow-up measurements in this study. A one-way multivariate analysis of covariance (MANCOVA) was used to analyze the intervention effects on the outcomes within groups and between groups, respectively; keeping the significance-level alpha at 95%, i.e., p < 0.05. A univariate F-test was performed to observe the superiority of one treatment over another. Pearson's correlation coefficient test was conducted to determine a relation between the dependent variables. In all statistical analyses, the level of significance α was kept at 0.05. All forty-five out of sixty-three participants with chronic non-specific low back pain (male, 32 and female, 23; average age, 20.24 ± 1.46 years; average pain duration, 19.6 ± 5.42 weeks) completed the study and their data were analyzed. The MANCOVA test showed a significant difference between the treatment groups on the combined multiple endurance tests for the core muscles (flexors, extensors, side bridge tests to the right and left), Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores after controlling for baseline scores of all the dependent variables: F (6, 12) = 23.381; p < 0.05; Wilks' Λ = 0.033; partial η2 = 0.819. A post hoc pair-wise comparison followed by a univariate F-test indicated that a significant improvement was found between the CSE vs. IDBE vs. Control groups on the post-test scores of all the dependent variables except VAS and EET (CSE vs. IDBE only). A Pearson's correlation coefficient test revealed a notable relation between the dependent variables. The experimental group CSE was found to be more effective than IDBE on improving functional disability, cores' flexors, and side bridges' endurance tests than IDBE. The magnitude of this improvement exceeded the minimal clinically important difference (MCID), suggesting a clinically relevant enhancement in functional disability, core flexors, and side bridge endurance for participants engaged in CSE. However, CSE vs. IDBE revealed non-significant differences on reducing pain and core extensors' endurance. The absence of statistically significant differences suggests that the observed changes did not exceed the established MCID for pain intensity and core extensors' endurance. In addition, partial eta-squared value revealed the superiority of CSE over IDBE and Control groups. This suggests that the observed differences between the two interventions are not only statistically significant, but also clinically relevant, surpassing the established MCID.

Characteristics and impact of pain from root-filled teeth. A practice-based cross-sectional study comparing painful teeth with and without signs of inflammatory dental disease

To compare pain characteristics, impact of pain and characteristics of patients with painful root-filled teeth with and without signs of inflammatory dental disease. This cross-sectional study was performed in the Public Dental Health services, Region Örebro County, Sweden. Adult patients with ≥1 root-filled tooth identified at their regular check-up were included and assigned to one of two groups; those with ≥1 sign of inflammatory dental disease (DD+) and those without any such sign (DD−). Patients/teeth were compared regarding pain characteristics (intensity, frequency, duration, quality and provoking factors), impact of pain (medication intake, impact on life) and patient characteristics as background factors (general health, other bodily and orofacial pain). Statistics included descriptive data (frequency tables) and group comparisons (Chi-square, Fisher’s Exact and Mann-Whitney U-tests). The DD+ group included 27 participants (30 teeth) and the DD− group 22 participants (23 teeth). On average, pain intensity was mild, the frequency most often recurrent, and the impact was low. Average pain duration since onset exceeded 2 years in both groups. The only observed between-group differences were average pain intensity; 3.1 (0–10 Numerical Rating Scale (NRS)) in DD− group compared to 1.6 for DD+ (p = 0.030), and tenderness to apical palpation; only reported in the DD+ group. The similarities in clinical presentation between the two groups underscore the difficulties in correctly distinguishing between pain of odontogenic and non-odontogenic origin in root-filled teeth with a standard clinical investigation. Additional diagnostic methods need to be investigated for their ability to differentiate between tooth pain or discomfort of different origins.

CT-Guided Radiofrequency Ablation Targeting the Herniation Edge of the Cervical Disc for the Treatment of Neck Pain: A Retrospective Study.

Sinuvertebral nerve overactivation is one of the mechanisms of neck pain caused by cervical disc herniation. Radiofrequency ablation (RFA) of sinuvertebral nerves has shown efficacy for the treatment of discogenic low back pain. However, relatively few studies evaluated the efficacy of RFA of sinuvertebral nerves for the treatment of chronic neck pain caused by cervical disc herniation. Clinical data were retrospectively collected from 168 patients diagnosed with cervical disc herniated neck pain from January 1, 2019, to September 1, 2022, who were treated with computed tomography (CT)-guided cervical disc RFA of at the Pain Medicine Center of Zhejiang Provincial People's Hospital. A 22-G RFA needle (Inomed, Emmendingen, Germany) was inserted between the carotid artery and trachea to the intervertebral disc under the direction of CT the scanner. Depending on the position of the protruding nucleus pulposus or the rupture of the annulus fibrosus, the needle was inserted into the posterior side of the intervertebral disc until the tip of the needle reached the target position. The numeric rating scale (NRS) score, pain relief and appearance of complications after RFA were evaluated. A total of 168 patients underwent CT-guided RFA for cervical disc herniation. The average duration of pain was 67.07 ± 70.42months. At 6months of follow-up, the median preoperative NRS score decreased significantly from preoperative 5.41 ± 1.08 to postoperative 1.341 ± 1.25 at 1month, 1.4 ± 1.38 at 3months and 1.72 ± 1.41 at 6months after RFA (p < 0.01). The numbers of patients with ≥ 50% of their neck pain relieved were 84% (141/168), 87% (147/168), 87% (147/168) and 79% (133/168) at 1day, 1month, 3months and 6months after RFA, respectively. No serious complications related to treatment or long-term complications were observed. This study highlights that CT-guided RFA targeting the edge of cervical disc herniation to destroy the sinuvertebral nerves can effectively relieve neck pain, and the computed tomography (CT)-guided RFA treatment strategy has the advantages of having few complications.

P059 Sleep and Fibromyalgia: Identifying and Managing Sleep Disorders.

Abstract Introduction Little is known about the presentation and management of sleep problems in patients with fibromyalgia [FMS]. This pilot study aims to 1) characterise sleep/wake patterns and sleep disorders in participants with FMS, and 2) assess changes in sleep and FMS symptoms with individualised sleep disorder treatment. Methods Women with FMS were recruited from the Rheumatology Unit at The Queen Elizabeth Hospital, South Australia. Participants recorded their sleep and activity for two-weeks using an under-mattress sleep sensor (Withings), sleep diaries and a wrist accelerometer. Questionnaires included Berlin Sleep Questionnaire (OSA); Epworth Sleepiness Scale; Flinders Fatigue Scale; Restless Legs Syndrome (RLS) Screener, Sleep Condition Indicator, and Fibromyalgia Impact Questionnaire. Results Preliminary data from 7 women (aged 49.3±12.8years, BMI 30.9±7.8kg/m2, average pain duration 14.1±9.4 years) were investigated. Sleep efficiency was low (65.9%±11.9). Five women were ‘high-risk’ for a sleep disorder (3 RLS, 3 OSA, 3 insomnia, 3 circadian rhythm disorders). Two were ‘high-risk’ for &amp;gt;2 sleep disorders. Two women had delayed, and one had advanced, circadian rhythms. Average self-reported sleep time in ‘high-risk’ women was shorter than the two women not at risk (6.2±1.1 vs 7.8±0.4hours). (6.2±1.1 vs 7.8±0.4hours). Fatigue Scores exceeded those commonly observed for respondents living with a medical condition (25.2±2.4 vs. 20.4 + 6.2). Participants are currently undergoing sleep disorder treatments and preliminary results will be reported. Conclusion Identifying and managing sleep disorders, using cognitive behavioural therapy for insomnia and chronotherapeutic approaches may be an important therapeutic target for FMS patients to improve sleep quality, daytime functioning, and FMS symptoms.

Factors Associated with Low Back Pain in Coffee Pickers from Chinchiná and Palestina (Colombia)

Objective. The objective of the study was to determine the prevalence of low back pain and associated risk factors among coffee pickers. Methods. The participants completed a survey and underwent tests to determine flexibility and V̇ O2max. Results. Among 98 coffee pickers with an average age of 44.7 (±13.7), 58.2% had experienced low back pain. The average duration and intensity of low back pain in the patients were 6.0 ± 6.5 years and 47.1 ± 21.0 mm/100 mm respectively. The average values of body fat and V̇ O2max were 13.2 ± 2.8% y 32.5 ± 8.6 ml.kg-1.min-1 respectively. Regression analysis showed that for a higher V̇ O2max value decreased the probability of experiencing low back pain, while a higher body fat content increased the probability of suffering from low back pain. Conclusions. There is a high prevalence of low back pain among coffee pickers from Chinchiná and Palestina. Higher body fat content increases the likelihood of experiencing lumbar pain, while elevated levels of V̇ O2max decrease it.

Development of the Chronic Pain Cognition Scale: A Culture-Sensitive Pain Measurement in Chinese.

People with pain problems are highly vulnerable to cultural disparities, and it is imperative to reduce these inequalities. This cross-sectional study aimed to develop a culturally sensitive Chronic Pain Cognition Scale (CPCS) for Chinese-/Chinese dialect-speaking populations and investigate its psychometric properties. Adult patients with chronic low back pain or chronic neck pain who visited pain clinics at a medical center in northern Taiwan were enrolled. Participants completed the demographic, intensity of pain, and two other related sensations, "Sng ()" and "Ma ()", often reported in Chinese-speaking populations, CPCS, Chronic Pain Acceptance Questionnaire-8, and Pain Self-Efficacy Questionnaire. 200 patients were included. Patients' mean age was 64.84 ± 14.33, 126 (63.0%) were female, and 83 (41.5%) had 13+ years of education. The average duration of pain was 77.25 ± 97.46 months, the intensity of pain was 6.04 ± 2.50, Ma was 3.43 ± 3.24, and Sng was 4.54 ± 3.14. The CPCS comprised four factors: pain impact (how pain impact one's life), losing face (how one being disrespected due to pain), helplessness, and avoidance, with good structural validity and adequate reliability (Cronbach α, 0.60-0.81) and satisfactory criterion-related validity. Moreover, losing face, an essential concept in Chinese relationalism, was significantly related to pain, Sng, and Ma (r = 0.19, 0.15 and 0.16), but not to pain acceptance or self-efficacy, indicating a culturally specific element in pain measurement. The CPCS has good psychometric properties and is suitable for evaluating chronic pain in the clinical setting, and might be generalizable to other Chinese-/Chinese dialect-speaking populations.

Audit of Diagnostic Laparoscopy in Tertiary Care Hospital

Objective: To conduct a thorough audit of laparoscopy as a diagnostic and therapeutic modality in patients with chronic pain abdomen.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Multan, from Jul 2015 to Dec 2021.&#x0D; Methodology: One hundred fifty-three patients with chronic abdominal pain were included in this study. The cause of pain in all patients was unknown despite undergoing thorough history, examination and appropriate investigations. Laparoscopy was performed in all patients, and findings were recorded accordingly.&#x0D; Results: A total of 153 patients were included in this study 67(43.8%) patients were male, and 86 (56.2%) were female. The mean age was 33.268±12.171 years (ranging from 15 to 60 years). The average duration of pain was 10.23±2.204 weeks. The diagnosis was confirmed laparoscopically in 143 patients (93.33%). Ten patients remain undiagnosed (6.66%). The most common cause was chronic appendicitis in 68(44.4%), followed by ovarian disorders 35(22.9%). There was a significant improvement in mean pain scores between the pre-and post-operatively periods [6.765±1.116 Vs. 2.961±1.572 (p-value&lt; 0.001)].&#x0D; Conclusion: Diagnostic laparoscopy has a higher diagnostic and therapeutic accuracy in patients with chronic abdominal pain. It significantly improves post-operative pain.

Simultaneous interventions in surgical gastroenterology and herniology: prediction and prevention of complications

The aim of the study - to improve the results of simultaneous surgical treatment of patients with large ventral hernias and incisional hernias W3 and concomitant surgical pathology of the abdominal organs. Material and methods. The article analyzes the results of surgical treatment of 450 patients with primary and postoperative hernias of the abdominal wall. 95 (21.1%) patients were urgently operated on. In 76 (16.9%) patients with large ventral and incisional W3 hernias, posterior separation hernioplasty was performed using TAP technology. In the presence of concomitant surgical pathology of the abdominal organs, simultaneous surgical interventions were performed. Results. In sublay and IPOM groups, 14 (3.7%) patients underwent laparoscopic sleeve resection of the stomach, 16 (4.3%) patients - laparoscopic cholecystectomy, and 4 (1.1%) patients -TAPP hernioplasty. In TAR group, 9 (11.8%) patients underwent open cholecystectomy, 12 (15.8%) - transverse abdominoplasty, 3 (3.9%) - open sleeve resection of the stomach, 2 (2.6%) - closure of the colostomy. The average duration of pain in the postoperative period was 4.5±0.9 days. The average duration of hospitalization was 9.7±1.1 days. In the postoperative period, 2 patients developed surgical site infection. There was no mortality. Conclusions. Modern simultaneous interventions in surgical gastroenterology and herniology with risk stratification of specific and nonspecific complications are an actuale social, medical and economic problem. An individual and differentiated approach to choice of simultaneous surgical intervention method taking into surgical and anesthetic risks and patients comorbidity, can reduce the percentage of postoperative complications and improve patient’s life quality.

Prevalence of pain among adult patients living with HIV in Uyo, South-South, Nigeria

Background: HIV infection is a major global public health issue. Pain is a common and debilitating symptom of HIV disease which is gravely underestimated and treated.&#x0D; Patients And Methods: This was a cross-sectional survey conducted at the HIV Clinic of the University of Uyo Teaching Hospital, after obtaining approval from the Research Ethical Committee. Data was obtained using a Data Sheet and Brief Pain Inventory (BPI) questionnaire. Information obtained included demographic characteristics, duration of infection, clinical stage and treatment. The BPI asked patients to report if they experienced pain, pain score, treatment and interference with their quality of life.&#x0D; Results: A total of 210 patients participated in the study, 60 males and 150 females, the prevalence of pain was 29.5%, and the average duration of pain was 4-9 months. The commonest site of pain was waist (39.3%), followed by headache (13.1%), neck (11.5%) and Knee (11.5%). Majority of the patients (53.4%) rated their average pain between 1 – 4 on the numerical rating scale. Most of the patients received over the counter analgesics (29.5%) while 27.9% did not take any medication at all. Majority of the patients with pain had mild interference with their quality of life.&#x0D; Conclusion: The Prevalence of pain among adult HIV Patients is high and grossly undertreated. Training of health workers in pain management may improve the situation.

Treatment of patients with chronic nonspecific lumbalgia with various pain triggers

To evaluate the effectiveness of complex therapy in patients with chronic nonspecific lumbalgia associated with various pain triggers. There were 121 patients with chronic nonspecific lumbalgia (average duration of pain 8.0±5.0 months) aged 22 to 59 years (average age 42.1±10.5). The lesion of the facet joints (24.8%), sacroiliac joint (23.2%), muscles (16.5%) or their combined lesion (35.5%) was established as pain triggers of lumbalgia. The patients underwent complex therapy, including medications, kinesiotherapy and cognitive therapy. Before and after the course of therapy (on average 3 weeks), a digital rating scale for pain assessment, the Oswestry Disability Index and the Hospital Anxiety and Depression Scale (HADS) were used. After treatment, there was a significant (p<0.01) decrease in pain (6.1±1.1 to 1.13±0.37 points, p<0.01), disability (40.09±3.56 to 22.15±13.20%), anxiety (8.98±0.50 to 6.46±0.34 points) and depression (8.72±0.17 to 6.02±0.26 points). A significant improvement in the condition was found in all pain triggers of chronic lumbalgia. The duration of chronic lumbalgia, the severity of life limitations on the Oswestry Disability Index and anxiety on HADS were the reliable predictors of the low effectiveness of complex therapy. Complex therapy, including medications, kinesiotherapy and cognitive therapy, is effective for various pain triggers of chronic lumbalgia.

A Comprehensive Treatment Protocol for Endometriosis Patients Decreases Pain and Improves Function.

The purpose of this paper is to evaluate the efficacy of a multimodal, outpatient neuromuscular protocol in treating remaining sensitization and myofascial pain in endometriosis patients post-surgical excision. A retrospective longitudinal study was conducted for women aged 22 to 78 with a history of surgically excised endometriosis. 60 women with an average duration of pain of 8.63 ± 7.65 years underwent a treatment protocol consisting of ultrasound guided trigger point injections, peripheral nerve blocks, and pelvic floor physical therapy for 6 weeks. Concomitant cognitive behavioral therapy once weekly for a total of 12 weeks was also undertaken. Pain intensity and pelvic functionality were assessed at new patient consults and 3-month follow ups using Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS). At new patient consults, average VAS and FPPS were 7.45 ± 2.11 (CI 6.92-7.98) and 14.35 ± 6.62 (CI 12.68 -16.02), respectively. At 3-month follow ups, average VAS and FPPS decreased to 4.12 ± 2.44 (CI 3.50-4.73; p < 0.001) and 10.3 ± 6.55 (CI 8.64-11.96; p < 0.001), respectively. Among FPPS categories, sleeping, intercourse, and working showed the highest statistical significance. Data suggests the multimodal protocol was effective in treating the remaining underlying sensitization and myofascial pain seen in Endometriosis patients post-surgical excision, particularly in decreasing pain and improving function during work and intercourse.

Effect of neuropathic pain on sphenopalatine ganglion block responses in persistent idiopathic facial pain

ABSTRACT Objectives Management of persistent idiopathic facial pain (PIFP) can be challenging. Sphenopalatine ganglion (SPG) has been the target for the interventional treatment of many facial pain syndromes. However, possible factors that may affect SPG block success are unknown. It was aimed to investigate the effect of neuropathic pain on SPG block outcomes in PIFP, which includes a heterogeneous patient group. Methods All of the patients underwent fluoroscopy-guided SPG block with an injection of 40 mg of 2% lidocaine and 8 mg of dexamethasone. The patients were assigned to 2 groups according to existence of neuropathic pain determined with the DN4 questionnaire score: 19 patients with neuropathic pain (Group 1) and 15 patients without neuropathic pain (Group 2). Preprocedural and postprocedural Visual Analog Scale (VAS) scores were compared between the 2 groups. Results The mean age of the patients was 47.65 ± 6.50 years. The average pain duration was 52.95 ± 34.81 weeks. A significantly greater decrease was detected in the VAS scores at 1 week (p = 0.036) and 1 month (p < 0.001) in Group 1 when compared to Group 2. Moreover, the proportion of patients with >50% improvement in the VAS scores at 1 week (p = 0.012) and 1 month (P = 0.017) was significantly lower in Group 1 than in Group 2. Discussion SPG block appears as a safe, effective, and rapid method to treat PIFP, especially in cases with neuropathic pain. Neuropathic pain may be a predictor for pain relief in interventional procedures targeting SPG in the treatment of PIFP.

Evaluation of the Efficacy of Paracetamol in the Control of Pain After Adenotonsillectomy in the Pediatric Population.

Introduction Adenotonsillectomy is a common surgical procedure in otolaryngology. Over the years, several techniques have been developed and modified in order to reduce mortality and morbidity. Postoperative pain control remains controversial. The aim of this study was to evaluatethe efficacy of paracetamol alone in the control of postoperative pain. Methods A prospective study was conducted between May 2018 and February 2019,including 76 pediatric patients (age < 18 years), who underwentadenotonsillectomy. The surgeries were performed by the lead author with the same surgical technique. Patients were evaluated one week and one month after surgery through the application of the visual analog pain scale and the number of days of pain was assessed by the need for medication. Results Seventy-sixtotal adenotonsillectomy were performed, with a total of 152 tonsils removed. The majority of patients were male (n=39, 51.3%), with an average age of 6.9 years (min 5, max 15 years). The most frequent surgical indication was sleep breathing disorders, present in 86.9% of the cases. The average duration of postoperative pain was 3 days, with no significant difference between groups (p>0.05). The average intensity of postoperative pain was 3.36 and was higher in patients with infectious criteria as surgical indications (p<0.05). Postoperative bleedingoccurred in 3.9% (n=3) of the children, self-limited, without the need for readmission or surgical revision. Conclusion Pain after adenotonsillectomy was more intense in patients undergoing surgery for infectious criteria. Paracetamol used in monotherapy has shown safety and efficacy in controlling postoperative pain.

Diagnostic Accuracy of Doppler Ultrasonography for the Testicular Torsion in Patients with Acute Scrotum taking Intraoperative Findings as Gold Standard

Objective: To analyze the diagnostic accuracy of Doppler ultrasonography in detecting acute testicular torsion in patients presenting with acute scrotal pain against the surgical findings as Gold Standard. Material and methods; Cross-sectional study was conducted at the Department of surgery and Radiology of Indus Hospital, Lahore Watim Medical College, Rawalpindi and Niazi Medical and dental college, Sargodha over 6 months. Total 111 males of age 15-45 years having acute scrotal pain (12-48 hours) and testicular torsion diagnosed clinically were enrolled using non-probability-purposive sampling. Doppler ultrasonography was performed on every patient by single radiologist, by using TOSHIBA Just Vision USG machine equipped with curvilinear probe and Doppler USG facilities. Then patients were referred for surgery which was performed by one team, and per-operative findings were documented. Results: Mean age of patients was 29 ± 6.52 years. Average duration of scrotal pain 18.12 ±5.03, average scrotal pain was 7.17 ± 1.50. Forty-three (38.7%) patients had moderate pain, 68 (61.3%) had severe pain. On doppler ultrasonography testicular swelling was seen in 106(95.5%), decreased echogenicity was absent, 100 (90.1%) patients had decreased blood flow. The sensitivity and specificity of doppler ultrasonography was 98.06% and 87.5%, respectively taking surgical findings as gold standard. Positive and negative predictive value of doppler ultrasonography were 99.02% and 77.78% respectively, diagnostic accuracy of Doppler ultrasonography was 97.3% taking surgical findings as gold standard Conclusion: Our finding suggest, this modality of Doppler ultrasonography can be used to detect testicular torsion in patients having acute scrotum as it has reliable sensitivity (98.06%), specificity (87.5%) as well as high diagnostic accuracy (97.3%). Keywords: Scrotal pain, Echogenicity, Testicular swelling, Doppler ultrasonography, Torsion