Changes In Visual Analog Scale Scores Research Articles

The use of virtual reality during extra-amniotic balloon insertion for pain and anxiety relief—a randomized controlled trial

Background: Induction of labor with extra-amniotic balloon (EAB) catheter is a procedure commonly associated with maternal discomfort, pain, and anxiety. Objective(s): We aimed to investigate the distractive effect of virtual reality (VR) technology on pain and anxiety- in pregnant patients who undergo Induction of labor with EAB.Study design: In this randomized controlled trial, pregnant patients intended for Induction of labor with EAB at term, for various obstetric indications, were recruited and randomized in a 1:1 ratio into two groups. Patients in the VR group were exposed to a VR technology clip (using SootheVR All-In-One VR care system for pain and anxiety) during the entire EAB insertion while patients in the control group received the institutional standard care for EAB insertion. Pain scores expressed by Visual Analog Scale (VAS) and maternal hemodynamic parameters, were obtained before, during, and after EAB insertion. Anxiety was evaluated by the validated State-Trait Anxiety Inventory Scale (STAI-S) before and after the procedure. Maternal satisfaction from the VR technology was also recorded. The primary outcome was the change in VAS score before and during EAB insertion. Among the secondary outcomes was the change in Anxiety levels before and after EAB insertion. The study was powered to detect a 25% decrease in the primary outcome.Results: A total of 132 pregnant patients were recruited (66 in each group). There were no differences between groups in terms of age, BMI, gestational age at enrollment, indication for Induction of labor, and pre-procedural VAS score and anxiety levels. The change in VAS score (maximal VAS score during the procedure subtract the initial VAS score before the procedure, i.e the primary outcome) was significantly lower in the VR group compared to the control group (2.78±3.0 vs 4.09±2.99, p=0.01). In addition, the VR group benefited a higher rate of anxiety relief expressed by the difference between pre-procedure and post-procedure STAI score, (-6.46 ± 9.6 vs -2.01 ± 9.11, P=0.007). Patients in the VR group reported an overall very high (94%) satisfaction score.Conclusions: In this randomized controlled trial, we demonstrated that the use of VR technology in patients undergoing Induction of labor with EAB was associated with lower VAS scores during the procedure and significant anxiety reduction compared to patients who received standard care. There was also a very high satisfaction rate from the use of VR technology.

The correlation between FCER2 gene polymorphism and the efficacy of inhaled corticosteroids in patients with chronic rhinosinusitis

Objective:To investigate the correlation between FCER2（2206A>G） gene polymorphism and the efficacy of inhaled corticosteroids（ICS） in patients with chronic rhinosinusitis（CRS）. Methods:A total of 208 CRS patients were routinely treated with functional endonasal sinus surgery and postoperative ICS. DNA extraction, PCR amplification and gene sequencing were performed to observe the FCER2（2206A>G） gene polymorphism and calculate the allele frequency. The visual analog scale（VAS） score, Lund-Kennedy score, and computed tomography（CT） Lund-Mackay score were determined 6 months after surgery among patients with different genotypes. Moreover, the polymorphism frequency was compared among different subgroups（chronic rhinosinusitis with nasal polyps versus chronic rhinosinusitis without nasal polyps, eosinophilic chronic rhinosinusitis versus non-eosinophilic chronic rhinosinusitis）. Results:There were FCER2（2206A>G） gene polymorphism in patients with CRS, and the phenotypes included 3 genotypes, AA, AG and GG, with distribution frequencies of 68（32.7%）, 116（55.8%） and 24（11.5%） cases, respectively. No significant differences were found in age, VAS score, nasal endoscopic Lund-Kennedy score and CT imaging Lund-Mackay score among patients with CRS of each genotype before surgery. In patients with the AA genotype, the changes in VAS score（5.74±1.10）, Lund Kennedy score（5.92 ± 1.14）, and CT imaging Lund-Mackay score（13.26±4.26） were significantly higher than in patients with the AG（4.37±0.86, 5.37±1.24, 10.82±3.77） and GG（4.26±0.80, 5.18±1.56, 10.10±3.53） genotype（P<0.05）. However, there were no marked difference between patients with the AG genotype and those with the GG genotype（P>0.05）. Compared with patients with non-eosinophilic sinusitis, Among them, the differences between the GG genotype and AG /AA genes were more significant in eosinophilic sinusitis compared to non-eosinophilic sinusitis（P<0.01）. Conclusion:The FCER2（2206A>G） gene in patients with CRS has genetic polymorphism and is associated with the recovery of CRS patients after surgery, individual corticosteroid sensitivity, and subgroup variability.

Frontal EEG response to alcohol craving elicited by individually tailored video cues.

Most findings on the pathophysiology of alcoholism are based on studies using resting-state electroencephalography (EEG). There are few studies on cue-induced craving and on its utility as an electrophysiological index. We examined quantitative EEG (qEEG) activities in alcoholics and social drinkers exposed to video cues and compared their association with subjective alcohol craving and other related psychiatric symptoms, including anxiety and depression. This is a between-subjects design. Adult male alcoholics (n=34) and healthy social drinkers (n=33) participated. In a laboratory, EEGs were recorded while the participants were presented with craving-inducing video stimuli. Measures used were the Visual Analog Scale (VAS) for subjective alcohol craving, Alcohol Urge Questionnaire (AUQ), Michigan Alcoholism Screening Test (MAST), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) scores. One-way analysis of covariance with age showed that alcoholics had significantly increased beta activity in the right DLPFC region (F4) (F=4.029, p=0.049), compared to social drinkers when craving-inducing stimuli were presented. Beta activity at the F4 electrode was positively correlated with AUQ (r=.284, p=0.021), BAI (r=.398, p=0.001), BDI (r=.291, p=0.018), and changes in VAS (r=.292, p=0.017) scores in both alcoholics and social drinkers. In alcoholics, beta activity was significantly correlated with BAI (r=.392, p=0.024). These findings imply functional importance of hyperarousal and negative emotions upon exposure to craving-inducing cues. Frontal EEG indices with beta power could serve as an objective electrophysiological index of craving induced by individually tailored video cues in alcohol consumption behavior.

Comparison of triamcinolone and methylprednisolone efficacy and steroid flare reaction rates after shoulder corticosteroid injection: a prospective interrupted time series study.

A corticosteroid flare reaction is a well-described phenomenon that causes significant pain and dysfunction. The paucity of literature impedes decision making regarding which corticosteroid to use for shoulder injection. The purpose of this study was to compare methylprednisolone acetate (MPA) and triamcinolone acetonide (TA) injections in the glenohumeral joint and/or subacromial space in terms of efficacy and the incidence of steroid flare reactions. In this prospective, interrupted time series, parallel study, patients received injections in the glenohumeral joint and/or subacromial space. MPA and TA were used during 2 discrete 3-month periods. The injections consisted of 2 mL of lidocaine, 2 mL of bupivacaine, and 80 mg of either MPA or TA. Visual analog scale (VAS) pain scores were recorded immediately before injection; 1-7 days after injection; and 3, 6, and 12 months after injection. The primary outcome was the incidence of a steroid flare reaction, defined as a post-injection increase in the VAS score by ≥2 points. The secondary outcome was injection failure, defined as a post-injection VAS score greater than the baseline score or the need for another intervention. We used linear mixed models with a patient-level random intercept to identify the mean VAS score change for TA injections in the first week after injection. MPA or TA shoulder injections were administered in 421 patients; of these patients, 15 received bilateral-joint injections whereas 406 received a single-joint injection, for a total of 436 injections (209 MPA and 227 TA injections). Pain scores in the first week after injection were available for 193 MPA and 199 TA injections. Significantly more patients in the MPA cohort reported flare reactions compared with the TA cohort (22.8% vs. 4.0%, P<.001) during the first week after injection. In the first week after injection, the mean VAS score of patients receiving TA injections was 1.05 (95% confidence interval, 0.47-1.63) lower than that of patients receiving MPA injections when adjusted for age, sex, race, pain type, surgeon type, and injection site. At 3 months, surveys for 169 MPA and 172 TA injections were completed, with no significant difference in the rate of injection failure for MPA vs. TA (42.6% vs. 36.1%, P=.224). Treatment failure rates were significantly higher for MPA than for TA at 6 months (78.44% vs. 62.5%, P<.001) but not at 12 months (81.18% vs. 81.42%, P=.531.) CONCLUSION: TA injections resulted in a >5-fold reduction in steroid flare reactions, with statistically superior 6-month efficacy rates, compared with MPA injections. This study supports TA as a more viable corticosteroid option for shoulder injection.

Comparison of the Functional Outcomes of Arthroscopic Debridement and Repair of Bursal-side Partial-thickness Rotator Cuff Tears

Background: To compare the clinical and functional scores of arthroscopic debridement and repair (conversion to full thickness) surgeries in patients with bursal-side partial-thickness rotator cuff tears (BPTRCT). Materials and Methods: A single-center retrospective study was conducted to compare the arthroscopic debride-ment and arthroscopic repair for BPTRCT performed between March 2017 and September 2021. Arthroscopic debridement patients were grouped as Group 1 and the repair group as Group 2. A total of 98 patients with an average age of 57.5 years (range 29-83 years), including 41 male and 57 female patients, met the inclusion criteria. VAS (Visual Analogue Scale) and UCLA (University of California Los Angeles) shoulder scores applied in the preopera-tive period and in the 12th month of the postoperative clinical follow-ups were evaluated. In addition to the pre-operative and postoperative comparison of both scores, their improvement of these scores was also compared. Results: The mean age of the repair group and the debridement group was 64.4 ±11.02 and 52.6 ±11.24, respective-ly. No significant difference between the two groups was observed in terms of demographic characteristics (p˃0.05). The mean operation time was 91.46 ±16.44 min in the repair group and 49.82 ±13.46 min in the debridement group. The VAS score dramatically improved, from preoperative 5.10±1.23 to postoperative 3.68±1.33 points in the deb-ridement group and from preoperative 5.17±1.35 to postoperative 3.58±1.16 points in the repair group. The two groups had no statistically significant difference in postoperative VAS scores (p=0.991). Preoperative and postopera-tive VAS score improvement was also compared between the groups, however, there was also no statistically signifi-cant difference in terms of VAS score changes (p=0.132). The UCLA scores also dramatically improved, from pre-operative 17.14±4.19 to postoperative 24.57±5.04 points in the debridement group and from preoperative 17.46±5.05 to postoperative 25.48±5.61 points in the repair group. No statistically significant difference was ob-served between the two groups in terms of postoperative UCLA scores (p=0.361). In the postoperative first-year follow-up, no re-tears were observed either in the debridement or in the repair group. Conclusions: Both arthroscopic debridement and arthroscopic repair surgeries provide clinically comparable suc-cessful results and high satisfaction for patients with bursal-side rotator cuff tears. No statistically significant differ-ence was observed between these two methods. Easier early postoperative rehabilitation seems to be the main advantage of the debridement method.

Changes in Transversus Abdominis Muscle Thickness, Low Back Pain, and Standing Balance after Foam Roller Exercise in Female Adults: A Randomized Controlled Trial

Objectives: The purpose of this study was to compare transversus abdominis muscle thickness and exercise performance before and after foam roller exercise (FRex).Methods: This was a randomized controlled trial (RCT). Twenty-four adult female subjects were randomly divided into two groups: (1) an intervention group that underwent FRex, and (2) a control group that remained in the supine position for the same period. Transversus abdominis muscle thickness, modified Star Excursion Balance Test (mSEBT) score, and degree of back pain experienced during daily work were measured before and after the intervention in each group using a visual analog scale (VAS), and a within-group comparison was conducted for each value. The amount of change before and after the intervention was calculated, and the correlation between each measurement item was examined.Results: Pre-intervention and post-intervention comparisons in the intervention group revealed significantly greater values for transversus abdominis lower fiber thickness and mSEBT scores, and significantly lower values for low back pain after the intervention. A moderate negative correlation was found between changes in lower back pain VAS scores and changes in transversus abdominis lower fiber thickness and mSEBT scores. Moreover, a moderate positive correlation was noted between changes in the transversus abdominis lower fiber thickness and mSEBT scores.Conclusions: These results suggest that FRex may be beneficial for preventing low back pain and improving balance.

Individualized Homeopathic Medicines in the Treatment of Painful Diabetic Peripheral Neuropathy: A Single-Arm, Pre–Post Comparison Trial

AbstractPainful peripheral neuropathy is one of the most common microvascular complications of long-continued, uncontrolled diabetes mellitus. The role of individualized homeopathic treatment has not been well evaluated in managing such cases earlier. This aim of this study was to assess the impact of individualized homeopathic treatment on pain intensity in patients with painful diabetic peripheral neuropathy (PDN) through an open-label, single-arm, pre–post comparison clinical trial. A total of 39 patients diagnosed with PDN were included in the trial. The visual analog scale (VAS) for pain and the 36-Item Short Form Survey (SF-36) were utilized as outcome measures and administered at baseline and after 3 months of intervention. Homeopathic medicines were prescribed using a precision-guided approach based on individualized principles. The changes in VAS score and SF-36 domains were analyzed using the Wilcoxon matched pairs signed rank test. Statistically significant reduction in neuropathic pain (median: 8.0; interquartile range [IQR]: 7.0–9.0) compared with baseline (median: 6.0; IQR: 5.0–7.0) were observed (Z = −5.34; p &lt; 0.001). Moreover, improvements were seen in various SF-36 domains related to physical and emotional well-being, social functioning, pain, general health, and health change after 3 months of treatment. The frequently prescribed medicines included Lycopodium clavatum (15.4%), Natrum muriaticum (15.4%), Causticum (15.4%), Medorrhinum (12.8%), and Sulphur (12.8%). Individualized homeopathic treatment significantly reduced pain and enhanced the quality of life in individuals suffering from PDN. However, further randomized trials with improved methodological rigor are needed to strengthen the conclusions drawn from this study. Trial Registration CTRI/2018/10/016196; UTN: U1111–1221–7664.

Investigatıon of the effect of weight loss after laparoscopic sleeve gastrectomy on cobb angle, waist and back pain: a prospective study

BackgroundIn many studies, it has been stated that obesity causes severe increases in the risks of disc degeneration, vertebral fracture, low back, and back pain. One of the most effective treatment options for obesity is bariatric surgery. ObjectivesIn this study, the effect of weight loss on these parameters was investigated by evaluating the Cobb angle, low back, and back pain. SettingUniversity Hospital MethodsA total of 89 patients were included in the study. Laparoscopic sleeve gastrectomy (SG) was performed on all patients. In addition, Cobb angle, height, weight, and body mass index (BMI) measurements were recorded at each visit. Investigating the quality and quantity of low back pain and the loss of function caused by the patients; visual analog scale (VAS), Oswestry Low Back Pain Disability Questionnaire (OLBPDQ), Roland-Morris Disability Questionnaire (RMDQ), and SF-36 Quality of Life Questionnaire (SF36) were administered. ResultsAccording to the preoperative Cobb angles, the decrease in the 6th month (P = .029) and 12th month (P = .007) measurements after the operation was found to be statistically significant (P < .05), but it was found to be clinically insignificant. When the changes in RMDQ, OLBPDQ, VAS, and SF-36 scores were examined, the decrease in the 6th month (P = .001) and 12th month (P = .001) scores after the operation was found to be significant compared to the preoperative scores (P < .01). ConclusionsIn this study, weight loss after SG improved for patients with chronic low back and back pain and significantly improved their quality of life.

Effects of a virtual reality-based motivational reinforcement + desensitization intervention program on psychological craving and addiction memory in female MA-dependent young adults.

The aim of this study was to explore the effects of a virtual reality (VR)-based motivational reinforcement + desensitization intervention program on psychological craving and addiction memory in female methamphetamine (MA)-dependent young adults. We recruited 60 female MA-dependent young adults in a compulsory isolation drug rehabilitation facility in Sichuan Province, and randomly assigned them to intervention (mean age = 23.24 ± 2.06) and control groups (mean age = 23.33 ± 2.09). The intervention group received a VR-based motivational enhancement + desensitization intervention (total of eight sessions over a 4-week period), while the control group received regular detoxification management during the same period. Assessments were conducted before, immediately after, and 1 month after the intervention, with a visual analogue scale (VAS) being used to assess subjective craving, electronic sphygmomanometer employed to measure physiological parameters, and the Addiction Memory Intensity Scale (AMIS) applied to assess addiction memory intensity. Generalized estimating equation analysis showed significant main effects of group on changes in heart rate difference, systolic blood pressure difference, VAS and AMIS scores (all p < 0.01), and a significant time main effect on changes in diastolic blood pressure difference, VAS and AMIS scores (all p < 0.01), and a significant group × time interaction effect on changes in the difference values of three physiological parameters, VAS and AMIS scores (p < 0.01 or p < 0.05). After the intervention, the differences in three physiological parameters, and the VAS and AMIS scores, were significantly lower in the intervention than in the control group (all p < 0.05), and the difference between the two groups remained significant 1 month after the end of the intervention (both p < 0.01). VAS scores, heart rate difference, and diastolic blood pressure difference in the intervention group were significantly lower than baseline scores, both at the end of the intervention and 1 month thereafter (all p < 0.01); the systolic blood pressure difference in the intervention group was significantly lower at the end of the intervention than at baseline (p < 0.05); AMIS scores in the intervention group were significantly lower than the baseline scores 1 month after the end of the intervention (p < 0.01). Our VR-based motivational reinforcement + desensitization intervention program can effectively reduce psychological craving and physiological reactivity for drugs, and the intensity of addictive memories in female MA-dependent young adults, even after 1 month.

The Effect of Clinical Pilates Exercises and Prenatal Education on Maternal and Fetal Health.

The mental, physical and sexual health of women as well as maternal and fetal health should be considered during the prenatal and postnatal periods. Investigating the effect of clinical Pilates exercises and prenatal education (CPE & PE) on obstetric and neonatal outcomes as well as the mental, physical, and sexual health of women was intended. In the second trimester, mothers with singleton pregnancies who attended (n=79, study group) or did not attend (n=80, control group) CPE & PR were recruited to this prospective cohort study, and were evaluated in the prenatal and postnatal periods. Depression was assessed with Beck Depression Inventory (BDI), sexual functions with Female Sexual Function Index (FSFI), muscle strength with Gross Muscle Scales (GMS), and labor pain with Visual Analogue Scale (VAS). In addition, the presence of low back pain (LBP) was questioned. No significant association of CPE & PE with obstetric outcomes such as cesarean rates, preterm birth, and neonatal outcomes such as birth weight and Apgar scores were identified. Changes in VAS scores, the incidence of perineal trauma, and episiotomy were not associated with CPE & PE. However, CPE & PE was associated with lower BDI scores, a gradual increase in the total scores of FSFI, increased GMS, and reduced LBP. CPE & PE had no adverse effects on obstetric and neonatal outcomes and was associated with improved mental, physical, sexual health scores during pregnancy and postpartum.

Does low-back pain improve after decompressive spinal surgery? A prospective observational study from the British Spine Registry.

Lumbar spine decompression surgery, in the form of laminectomy or discectomy, is known to be effective in improving symptoms of radiculopathy and neurogenic claudication. However, it is less clear how it impacts coexisting low-back pain (LBP). The aim of this study was to quantify the change in LBP after lumbar decompression. This study analyzed data from the British Spine Registry on patients who underwent lumbar decompression surgery. LBP severity was assessed using the visual analog scale (VAS), and the primary outcome was the change in VAS score at 1 year, with secondary outcomes measuring the change in score at 6 weeks, 6 months, and 2 years. The minimal clinically important difference (MCID) was defined as a 30% reduction in pain. Of the 25,349 patients included in the study, 92.2% reported significant back pain at baseline. Of the entire cohort, 12,951 (55.4%) patients had follow-up data for 6 weeks, 9066 (38.8%) for 6 months, 7926 (33.9%) for 1 year, and 5517 (23.6%) for 2 years; 17,304 (68.3%) patients had follow-up data for at least one time point. Sixty-two percent of patients attained the MCID (VAS score ≥ 30%) in back pain reduction, with 51% reporting a substantial improvement (VAS score ≥ 50%). This improvement was observed by 6 weeks postoperation and was mostly maintained at 2 years. Patients with back pain predominance were more likely to attain the MCID compared with those with leg pain predominance (63.6% vs 60.1%; OR 1.16, 95% CI 1.02-1.34; p = 0.0291). Severity of baseline back pain did not reduce the proportion attaining the MCID. Regardless of pain presentation, LBP improves in approximately 62% of patients who undergo lumbar decompressive surgery, with 51% experiencing substantial improvement. Patients undergoing lumbar decompression can be advised on the chance of a meaningful improvement in back pain postsurgery.

Effect of Mifepristone vs Placebo for Treatment of Adenomyosis With Pain Symptoms

Adenomyosis is a common chronic gynecological disorder, and its treatment is an unmet need. New therapies need to be developed. Mifepristone is being tested for adenomyosis treatment. To determine whether mifepristone is effective and safe for adenomyosis treatment. This multicenter, placebo-controlled, double-blind randomized clinical trial was conducted in 10 hospitals in China. In total, 134 patients with adenomyosis pain symptoms were enrolled. Trial enrollment began in May 2018 and was completed in April 2019, and analyses were conducted from October 2019 to February 2020. Participants were randomized 1:1 to receive mifepristone 10 mg or placebo orally once a day for 12 weeks. The primary end point was the change in adenomyosis-associated dysmenorrhea intensity, evaluated by the visual analog scale (VAS) after 12 weeks of treatment. Secondary end points included the change in menstrual blood loss, increased level of hemoglobin in patients with anemia, CA125 level, platelet count, and uterine volume after 12 weeks of treatment. Safety was assessed according to adverse events, vital signs, gynecological examinations, and laboratory evaluations. In total, 134 patients with adenomyosis and dysmenorrhea were randomly assigned, and 126 patients were included in the efficacy analysis, including 61 patients (mean [SD] age, 40.2 [4.6] years) randomized to receive mifepristone and 65 patients (mean [SD] age, 41.7 [5.0] years) randomized to received the placebo. The characteristics of the included patients at baseline were similar between groups. The mean (SD) change in VAS score was -6.63 (1.92) in the mifepristone group and -0.95 (1.75) in the placebo group (P < .001). The total remission rates for dysmenorrhea in the mifepristone group were significantly better than those in the placebo group (effective remission: 56 patients [91.8%] vs 15 patients [23.1%]; complete remission: 54 patients [88.5%] vs 4 patients [6.2%]). All the secondary end points showed significant improvements after mifepristone treatment for menstrual blood loss, hemoglobin (mean [SD] change from baseline: 2.13 [1.38] g/dL vs 0.48 [0.97] g/dL; P < .001), CA125 (mean [SD] change from baseline: -62.23 [76.99] U/mL vs 26.89 [118.70] U/mL; P < .001), platelet count (mean [SD] change from baseline: -28.87 [54.30]×103/µL vs 2.06 [41.78]×103/µL; P < .001), and uterine volume (mean [SD] change from baseline: -29.32 [39.34] cm3 vs 18.39 [66.46] cm3; P < .001). Safety analysis revealed no significant difference between groups, and no serious adverse events were reported. This randomized clinical trial showed that mifepristone could be a new option for treating patients with adenomyosis, based on its efficacy and acceptable tolerability. ClinicalTrials.gov Identifier: NCT03520439.

Efficacy of percutaneous kyphoplasty on vertebral compression fractures with different bone mineral densities: a retrospective study

BackgroundThis study was performed to investigate the clinical efficacy of percutaneous kyphoplasty (PKP) for vertebral compression fractures with different bone mineral densities (BMD).MethodsWe performed a retrospective analysis of 232 patients with single-segment vertebral compression fractures who underwent PKP. Patients were divided into the normal BMD, osteopenia, and osteoporosis groups according to their average lumbar BMD before surgery. The visual analog scale (VAS) was used to compare differences in pain relief before and after surgery in each group. Corrections of the wedge angle and kyphotic angle before and after surgery were observed using anteroposterior and lateral radiographs and compared among the groups, as was the incidence of bone cement leakage.ResultsPatients were followed up for 6–12 months, with an average follow-up time of 9.12 ± 1.68 months. The VAS score, wedge angle, and kyphotic angle of the three groups of patients decreased significantly at the end of the follow-up (P < 0.05). The changes in VAS score and wedge angle correction in the osteoporosis group were significantly larger than those in the normal BMD and osteopenia groups (P < 0.05). There were no significant differences among the three groups in terms of kyphotic angle correction or bone cement leakage rates (P > 0.05).ConclusionsPKP has a positive effect on vertebral compression fractures with different BMD, and is especially suitable for osteoporotic vertebral compression fractures.

An open-label, multicenter, phase 2 study of a food enriched with docosahexaenoic acid in adults with sickle cell disease

Sickle cell disease (SCD) induces red blood cell sickling, which causes debilitating symptoms including vaso-occlusion and inflammation. We investigated a food enriched with omega-3 fatty acids to determine its effect on certain factors: blood cell membrane fatty acid composition (including anti-inflammatory elements—docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)—and the pro-inflammatory, arachidonic acid (AA)); the inflammation biomarker, C-reactive protein (CRP); and vaso-occlusive crisis (VOC) pain. Ten adults with SCD ingested the food, daily, for 28 days. Evaluated measures included blood cell membrane fatty acid ratios (AA vs omega-3 (DHA+EPA)), CRP (mg/L) levels, and Visual Analogue Scale (VAS) scores (a VOC assessment). The food was well tolerated and led to a statistically significant CRP reduction (39%). However, changes in omega-3 fatty acid ratios and VAS scores were not significant. Overall, while the omega-3-enriched food reduced inflammation, larger, blinded studies are needed to assess its effectiveness on other measures.

Comparison of the Clinical Results of Platelet-Rich Plasma, Steroid and Autologous Blood Injections in the Treatment of Chronic Lateral Epicondylitis

The aim of our study is to compare the efficacy of PRP, steroids, and autologous blood injection in patients with chronic lateral epicondylitis. A total of 120 patients comprised our study. Three groups of 40 patients each received only one of the following: PRP, steroids, or autologous blood injections. Thereafter, VAS (visual analog scale), DASH (Disabilities of the Arm, Shoulder, and Hand), and Nirschl scores of those treated were evaluated in the second week, the fourth week, the third month, and the sixth month. The baseline evaluation revealed no significant change in VAS, DASH, and Nirschl scores among the three groups (p > 0.050). At the second week evaluation, patients treated with steroids showed significant improvement compared to patients treated with PRP and autologous blood (p < 0.001). The fourth-week evaluation revealed the VAS, DASH, and Nirschl scores of the patients treated with steroids to have improved more significantly than those of patients treated with PRP and autologous blood (p < 0.001). The third month, when the results of all three groups were compared, revealed similar results (p > 0.050). The sixth-month evaluation, when the results of all three groups were compared, revealed the autologous blood and PRP applications provided significantly better results than the group treated with steroids (p < 0.001). We concluded that steroid administration is effective in the short term, while PRP and autologous blood applications are more effective than steroid administration in the long term.

Bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane block reduces early postoperative pain after laparoscopic cholecystectomy: A prospective, single-blind, randomized study.

To investigate the efficacy of bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane (BLTAP) block in laparoscopic cholecystectomy (LC). This study was carried out at Private Medicabil Hospital, Bursa, Turkey, between September 2021 and March 2022. Patients were randomly divided into 4 groups (n=40, each): i) the standard analgesia (SA) group received the block and port-site infiltration with normal saline (NS); ii) the local anesthetic group received the block with NS and port-site infiltration of bupivacaine; iii) the unilateral laparoscopic-assisted transversus abdominis plane (ULTAP) block group received 2-quadrant block with bupivacaine on the right and NS on the left and port-site NS infiltration; and iv) the BLTAP block group received bilateral bupivacaine and port-site NS infiltration. Postoperative 1-, 3-, 6-, 12-, and 24-hours visual analog scale (VAS) pain scores at rest and during cough, opioid requirement, presence of nausea and vomiting, and satisfaction scores were recorded. The one-hour VAS score at rest was lower in the BLTAP block group than in the SA and ULTAP block groups. The change in VAS score was higher in the SA group than in the BLTAP block group. During cough, the one-hour VAS score was lower in the BLTAP block group than in the SA group. There were no differences among groups in other parameters. Bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane block technique is more effective than SA, local anesthetic infiltration, and ULTAP block in preventing early postoperative pain after LC.Clinicaltrials.gov No.: NCT04641403.

Revisiting the impact of serial therapeutic phlebotomy in polycythaemia on laboratory and clinical parameters using a fixed interval and fixed volume protocol.

Therapeutic phlebotomy allows for a controlled and gradual decrease in red cell mass leading to improved blood flow and symptomatic relief in polycythaemia. The present study was aimed to determine the impact of serial fixed volume and fixed interval therapeutic phlebotomy protocol on the laboratory and clinical parameters in patients of polycythaemia. This prospective longitudinal study was conducted over 18months. The desired haematocrit for polycythemia vera and secondary polycythemia was 45% and 52% respectively. A fixed volume of 350ml phlebotomy was performed every-three days till the achievement of desired haematocrit. Complete blood count was performed before and after each procedure and iron studies were done at the time of enrolment and after the achievement of desired haematocrit. Post-procedure symptomatic relief was assessed by a 10-point visual analogue scale (VAS). Of the 29 patients enrolled in the study, 3 patients were lost to follow up and data of 26 patients was analyzed. Mean Hb declined from 17.84±1.88 gdL-1 to 14.67±1.14 gdL-1 (p<0.001) and mean haematocrit decreased from a baseline of 57.11±5.47% to 46.27±3.763% (p<0.001) upon achievement of desired haematocrit. There was a significant decline in serum iron from the baseline of 132.85±94.136μg dL-1 to 69.41±58.643μg dL-1 at desired haematocrit. A significant change in VAS score of almost all clinical parameters was observed. Post phlebotomy hematocrit correlated negatively with the number of procedures (p=0.015). Our protocol yielded rapid and marked improvement in patients of primary and secondary polycythemia with minimal adverse events and significant amelioration of clinical parameters.

Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial

To evaluate the efficacy and safety of acupuncture in the treatment of endometriosis-associated pain. A multicenter, randomized, single-blind, placebo-controlled trial. Four tertiary hospitals in Jiangxi and Hainan Provinces. Women with endometriosis-associated pain aged between 20 and 40 years. Subjects were assigned randomly to receive either acupuncture or sham acupuncture treatment for 12 weeks, starting one week before each expected menstruation and administered as a 30-minute session once per day, 3 times a week. During the menstruation period, acupuncture was administered daily when pelvic pain associated with endometriosis occurred. After acupuncture or sham acupuncture treatment, the subjects were followed for another 12 weeks. Changes in maximum pain as assessed with the visual analog scale (VAS) for various pelvic pain, duration of dysmenorrhea, and scores on the Multidimensional Pain Inventory, Beck Depression Inventory, Profile of Mood States, and Endometriosis Health Profile from baseline to week 12 and week24. A total of 106 women were assigned randomly to the acupuncture and sham groups. In the acupuncture group, the reduction in the dysmenorrhea VAS score was significantly greater after treatment, but not at the end of the trial, compared to the sham group. The duration of pain was significantly shorter in the acupuncture group. All test scores were improved to a significantly greater extent in the acupuncture group than in the sham group at week 12 but not at week 24. Changes in nonmenstrual pelvic pain and dyspareunia VAS scores were not different between the groups. No severe adverse events or differences in adverse events were recorded. Acupuncture is an effective and safe method of relieving dysmenorrhea, shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain, although its efficacy fades after treatment is discontinued. NCT03125304.

Effect of age of gravida on post-cesarean section pain: An observational study

Objective: Preoperative identification of women at greater risk of post-cesarean pain might allow more intensive analgesic interventions. This study aimed to assess the effect of age of a parturient on post-cesarean section (CS) pain. Methods: 100 pregnant females were enrolled and divided into 4 groups: group A (age 18–24 years), group B (25–30 years), group C (31–35 years), and group D (≥36 years). Patient-controlled epidural analgesia was started postoperatively in all patients. Pain on a 0- to 10-point visual analog scale (VAS), a number of attempts tried for patient-activated dose delivery of ropivacaine, and successful delivery of patient-activated dose of ropivacaine were recorded for 72 hours. Breastfeeding was initiated as early as possible. The effect of breastfeeding on post-CS pain was observed for 72 hours in terms of increase, decrease, or no change in VAS scores with breastfeeding. Results: The peak VAS scores over 72 hours were 4.10 ± 0.60, 4.00 ± 0.67, 3.75 ± 0.45, and 3.42 ± 0.67, respectively, in groups A, B, C, and D, showing a significant declining trend (P = 0.007). The mean VAS scores decreased from 4.08 to 1.69 (group A, P < 0.0001), from 4.00 to 1.64 (group B, P < 0.0001), from 3.67 to 1.25 (group C, P < 0.0001), and from 3.33 to 1.50 (group D, P < 0.0001) over 72 hours. A statistically significant decline in patient-activated rescue drug delivery attempts, the number of times the rescue analgesic was delivered, and 24-h cumulative ropivacaine dose requirement was seen. Conclusions: In this study, it was found that post-cesarean pain decreases significantly with increasing age, as evidenced by reduced pain scores, reduced attempts at rescue drug delivery, and reduced rescue analgesic requirements.

Effectiveness of extracorporeal shock wave therapy according to plantar calcaneal spur types

Objective: The aim of this study is to group patients with plantar heel pain and calcaneal spurs detected via lateral foot x-rays based on the angle between the spur and the calcaneus and compare the efficacy of an Extracorporeal shock wave therapy (ESWT) treatment between these groups. Materials and Methods: The patients were divided into three groups based on the measurement the angle between the plantar calcaneal spur and the calcaneus. Those with a measured angle of &lt;30° were classified as Group 1, ranging between 30–60° as Group 2, and &gt;60° as Group 3. Demographic characteristics, spur length, visual analog scale (VAS) and foot function index score (FFI), and pain and function evaluation were used as the pre-and posttreatment data in each group. Results: Out of the 170 patients, 96 (56.5%) were included in Group 1, 65 (38.2%) were in Group 2, and 9 (5.3%) in Group 3. The posttreatment VAS and FFI scores of the patients were significantly lower than the pretreatment scores (p &lt; 0,001). It was determined that the highest and lowest VAS and FFI score changes in the posttreatment period was in Group 3 and Group 1, respectively. In the correlation analysis, a positive correlation was found between the measured angle value and pretreatment VAS and FFI scores, age, and spur length. Conclusion: ESWT is an effective treatment method for calcaneal spurs, but further studies are needed on PCS classifications and the efficacy of the treatment selected based on these classifications.