Changes In Numeric Rating Scale Scores Research Articles

Influence of Brain Metastasis on Analgesia-Related Outcomes in Patients with Lung and Breast Cancers Treated with Naldemedine: A Propensity Score-Matched Analysis.

Naldemedine is structurally designed to prevent passage across the blood-brain barrier (BBB), resulting in the attenuation of opioid-induced constipation without interfering with the analgesic effects of opioids. However, the influence of brain metastasis (BM), as one indicator of BBB disruption, on the analgesic effects of opioids in patients treated with naldemedine remains unclear. To examine whether the analgesic effects of opioids following naldemedine treatment are lower in patients with BM than in those without BM, we surveyed inpatients with lung and breast cancers treated with naldemedine at Fujita Health University Hospital between April 2017 and March 2022. Changes in the numeric rating scale (NRS) scores, morphine milligram equivalents (MMEs), and the number of rescues were assessed as analgesia-related outcomes during the first 7 days of naldemedine treatment in patients with or without BM, matched by the propensity score. In total, 172 patients were enrolled. After propensity-score matching, 30 patients with BM and 60 patients without BM were included in the analysis. Changes in NRS scores, MMEs, and the number of rescues did not differ between patients with and without BM. In the linear mixed-effects model, the coefficient of interaction between patients with or without BM and the days for each outcome was not statistically significant. BM does not influence the analgesic effect of opioids in patients with lung and breast cancers treated with naldemedine. Naldemedine may be useful for treating BM.

Comparison of modified thoracoabdominal nerve block through perichondral approach and subcostal transversus abdominis plane block for pain management in laparoscopic cholecystectomy: a randomized-controlled trial.

The modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) is a novel regional analgesic technique that can provide analgesia for both the lateral and anterior abdominal walls. This study aimed to compare the analgesic effect of M-TAPA with that of the subcostal transversus abdominis plane block (TAPB) in patients undergoing laparoscopic cholecystectomy (LC). Sixty patients scheduled to undergo elective LC were randomly assigned to receive either M-TAPA or subcostal TAPB during anesthesia induction. The primary outcome was the maximum pain intensity during movement within the first 12 hours postoperatively, measured using an 11-point numeric rating scale (NRS). Secondary outcomes included changes in NRS scores during rest, coughing, and movement, which were assessed at 1, 2, 4, 6, and 12 hours postoperatively and immediately before discharge. Additionally, postoperative nausea and vomiting, and patient satisfaction were recorded as secondary outcomes. Data from 56 patients were analyzed, and no significant difference was observed in the primary outcome between the two groups (M-TAPA: 5.5 [interquartile range (IQR): 5-7] vs . subcostal TAPB: 5 [IQR: 4-7], median difference: 0, 95% confidence interval: -1 to 1, P = 0.580). Furthermore, no significant differences in secondary outcomes were observed between the two groups. No significant difference was observed in the analgesic effect between the two techniques. Consequently, further research is necessary to compare the efficacy of M-TAPA with other well-established regional analgesic techniques.

The Analysis of Preoperative Roussouly Classification on Pain Scores and Radiological Data in Lateral Lumbar Interbody Fusion for Patients with Lumbar Degenerative Disease

A retrospective observational study. The type of sagittal profile defined by Roussouly has affected spinal degeneration and surgical outcome. This study aimed to investigate the effect of preoperative Roussouly classification on pain intensity and radiological data of lumbar degenerative disease (LDD) patients who underwent indirect decompression with lateral lumbar interbody fusion (LLIF). We retrospectively investigated 102 patients who underwent LLIF without direct decompression. Patients were subdivided into four groups according to the Roussouly classification determined from preoperative full-length and lateral spine X-rays, and classified according to Roussouly types I, II, and IV in the nonstandard group and Roussouly type III in the standard group. The nonstandard group showed improved sagittal vertical axis and lumbar lordosis after LLIF surgery, but the midsagittal canal diameter and axial central canal area of the thecal sac using T2-weighted sagittal and axial MRI were smaller than that in the standard group. On the other hand, each numeric rating scale (NRS) score one year after surgery improved in all patients. Changes in NRS scores in low back pain, leg pain, and numbness were not statistically significant between Roussouly classification types. These results suggest that the nonstandard group may have less indirect decompression effect from LLIF than the standard group. In the short term, we show for the first time after LLIF surgery that preoperative sagittal spinal alignment and the pelvic position may not significantly impact pain improvement.

Analgesic Efficacy of Curcuma longa (Curcumin) after Surgical Periodontal Therapy.

To compare the analgesic efficacy of orally administered Curcuma longa (curcumin) and mefenamic acid (MA) after surgical periodontal therapy (SPT). Seventy-six periodontitis patients were randomly divided into two groups. In the test group, patients received curcumin capsules (200 mg), and in the control group, patients received MA (500 mg). All patients underwent post-operative antibiotic therapy using 500 mg amoxicillin and 400 mg metronidazole for 7 days. Post-operative pain and discomfort were evaluated using the numerical rating scale (NRS) and verbal rating scale (VRS), respectively. Evaluation were performed after 24 (T1), 48 (T2), and 72 h (T3). Group comparisons were done using Student's t-test and the Mann-Whitney U-test. The level of statistical significance was established at p < 0.05. All patients had stage 3/grade C periodontitis. The mean age of individuals in the test and control groups were 58.4 ± 7.3 and 57.2 ± 5.2 years, respectively. A family history of periodontal diseases was reported by 37.5% and 47.4% individuals in the test and control groups, respectively. In the test and control groups, the total mean duration of periodontal surgery was 168.2 ± 12.2 and 173.4 ± 10.7 min, respectively. There was no statistically significant difference in the mean NRS and VRS scores among patients in the test and control groups. In both groups, there was no statistically significant difference in the change in NRS scores at any time point. Compared with MA, curcumin is ineffective for pain and discomfort management after SPT. The possibility of the results being biased due to lack of operator blinding cannot be overlooked.

Comparison of the Efficacy of Ultrasound-guided Pectoral versus Erector Spinae Plane Blocks for Postoperative Analgesia in Patients undergoing Modified Radical Mastectomy: A Randomised Controlled Trial

Introduction: Postmastectomy pain is more common following carcinoma breast surgery. Preventive analgesia for breast carcinoma includes administration of local infiltration or regional anaesthesia in the form of a paravertebral block, epidural, pectoral nerve block or intercostal block. Interfascial blocks, such as ultrasound guided pectoral nerve (PECS II) and Erector Spinae Plane (ESP) block have been shown to provide effective analgesia for mastectomy surgeries. Aim: To compare the postoperative analgesic efficacy of PECSII block and ESP block following mastectomy surgeries. Materials and Methods: The present study was a doubleblinded randomised controlled study. Patients scheduled for an elective unilateral modified radical mastectomy surgery of age 18-70 years, American Society of Anaesthesiologists (ASA) physical status I-II, were endrolled in the study. Sixty patients (ASA I-II) were divided into two groups. (30 in the PECS II group and 30 in the ESP group). The patients received respective blocks under ultrasound guidance after general anaesthesia. The primary outcome measured was the time of first request analgesia between groups. The secondary outcomes were postoperative Numeric Rating Scale (NRS) at eight different time-points (0.5, 1st, 2nd, 4th, 6th, 8th 12th and 24th hour) and intraoperative fentanyl requirement and haemodynamics (heart rate and mean arterial pressure). Total postoperative intravenous paracetamol consumption and rescue analgesic requirement in the first 24 hours postoperatively were noted. Statistical analysis was conducted by using Statistical Package for the Social Sciences (SPSS) version 20.0. Pearson’s Chi-square test was performed to compare ratios, and categorical variables were compared using Fisher’s exact test. A p-value value &lt;0.05 was taken as statistically significant. Results: The time of first request analgesia was prolonged and significant in ESP block (255.5±48.76 minutes) than PEC II (197.5±31.35 minutes) (p=0.000347). In the postoperative ward, NRS scores at the 30th min, first and second hour were significantly lower in ESP block than PECS II group (2.3±0.4 vs. 5.2±0.8; 3.2±0.4 vs. 4.4±0.3, 3.7±0.4 vs. 5.2±0.4); p=0.041 p=0.047, p=0.037 respectively. From the second postoperative hour to the end of the observation period, there were no significant changes in NRS scores among groups. Postoperative paracetamol consumption was significantly higher in PECS II than ESPB (1.25±0.5 grams vs 2.33±1.2 grams, p&lt;0.043824). There was no change in intraoperative fentanyl consumption and haemodynamics between groups. Conclusion: ESP block had better pain control, reduced postoperative pain scores and rescue analgesia than PECS II when given as preventive analgesia in mastectomy surgeries.

Facial expression differences indicate pain improvement at the emergency department

Purpose: Pain is a major symptom for patients to seek medical services, but limited evidence supports the applicability and usage of facial expressions as a pain measurement strategy in the emergency department (ED). In this study, we explored possible differences in facial expressions before and after pain management and compared these differences with those in a self-reported pain scale. Methods: In this observational study, convenience sampling of patients admitted to the ED was conducted. Two video sessions of facial expressions were recorded for each participant, and participants rated their painon a self-reported numeric rating scale (NRS). A total of 25 facial parameters were extracted per frame. The main outcome measurements were the differences in facial parameters, and their correlation with changes in NRS scores was examined. Results: This study included 163 participants. A stronger reduction in NRS scores was associated with differences in systolic blood pressure (sBPr = 0.247, P = 0.011) and the following changes in facial features: eye opening (left: r = -0.210, P = 0.007; right: r = -0.206, P = 0.008), eye aspect ratio (left: r = -0.382, P &lt; 0.001; right: r = -0.305, P &lt; 0.001), and head rotation angle (r = 0.218, P = 0.005). Pain improvement (a difference of ≥ 4 in NRS scores) was associated with differences in BP (sBP, odds ratio [OR] = 0.973, 95%confidence interval [CI]: 0.949-0.998, P = 0.034; dBP, OR = 1.078, 95% CI: 1.026-1.113, P = 0.003), eye aspect ratio (Left: β = 5.613, 95% CI: 2.234-14.104, P &lt; 0.001; Right: β = 2.743, 95% CI: 1.395-5.391, P = 0.003), and nasolabial fold variation (β = 0.548, 95% CI: 0.306-0.982, P = 0.043), after adjustment for variables Conclusions: Intraindividual changes in facial expressions can be used to track clinically relevant differences in pain. Facial expressions alone cannot be used as a pain measurement strategy in the ED.

Prediction of Opioid Analgesic Efficacy by Measurement of Pupillary Unrest.

Pupillary unrest under ambient light (PUAL) is the fluctuation in pupil diameter in time around a mean value. PUAL is augmented by light and diminished by administration of opioids. We hypothesized that, because pupillary unrest is a marker of opioid effect, low levels of PUAL may be associated with reduced opioid efficacy, as measured by changes in the numerical rating scale (NRS) pain scores of patients in the postanesthesia care unit (PACU). We used an infrared pupillometer to measure PUAL in patients recovering from ambulatory surgery at 2 different institutions. At both sites, PUAL was quantified using spectral analysis of the Fourier transform of pupil diameter versus time. We measured PUAL and pain scores before and after opioid administration. Protocols for total capture time and lighting conditions varied between the 2 sites. Correlations between PUAL and change in NRS scores were examined using significance testing of Pearson correlation coefficients. Correlations between change in PUAL and change in NRS scores were also examined. Patients were divided into high and low PUAL groups, and high and low response to opioid. A Fisher exact test was used to determine whether there was a significant association between PUAL and opioid response. For patients with pain in the PACU, low levels of pupillary unrest before opioid therapy were associated with minimal or no reduction in pain scores after opioid administration. We noted a significant correlation at both sites between PUAL and pain score reduction with opioids (r = 0.59, P = .0053, and r = 0.57, P = .022.) The Fisher exact test confirmed that patients with PUAL levels above the mean had a more beneficial analgesic effect from opioids than those with low PUAL levels (P = .018). We also noted that change in PUAL was significantly correlated with change in pain score at both sites (r = 0.56, P = .03 and r = 0.55, P = .01). We observe that the pretreatment magnitude of PUAL is correlated with the analgesic response to opioid therapy, and that patients who exhibit higher levels of PUAL change after opioid administration have a more beneficial analgesic effect from opioids. Larger studies with uniform measurement protocols are required to confirm these preliminary results.

The effects of ultrasound-guided corticosteroid injection for the treatment of hemiplegic shoulder pain on depression and anxiety in patients with chronic stroke

ABSTRACTPurpose: We attempted to investigate whether ultrasound (US)-guided intra-articular or subacromial bursa corticosteroid injections can potentially influence the severity of depression and anxiety in patients with chronic stroke with hemiplegic shoulder pain (HSP). Methods: Thirty patients with chronic stroke with HSP received US-guided corticosteroid injections. Numeric rating scale (NRS) scores, passive shoulder range of motion (ROM), Beck Depression Inventory (BDI) scores and Spielberger State-Trait Anxiety Inventory (STAI) scores were evaluated before the injection, and one and two months after the injection. Results: NRS, passive shoulder ROM, BDI and STAI scores were significantly lower one and two months following the injection. Changes in NRS scores were significantly correlated with changes in psychological outcomes (BDI and STAI). Conclusion: US-guided intra-articular or subacromial bursa corticosteroid injections might be a beneficial treatment option for relieving depression and anxiety symptoms in patients with chronic stroke with HSP. Also, US-guided injections appear to be helpful for reducing shoulder pain and increasing shoulder ROM.

Functional Outcome of Nerve Transfers for Traumatic Global Brachial Plexus Avulsion

Objective: We sought to combine Medical Research Council (MRC) grading with the Disability of the Arm, Shoulder and Hand (DASH) questionnaires and Numerical Rating Scale (NRS) for pain to evaluate the functional outcome of patients who suffered complete brachial plexus avulsion before and after nerve transfers. Methods: The author carried out a retrospective review of 37 patients with global avulsion of the brachial plexus from 2010 to 2012. All of them underwent nerve transfers in Hua Shan Hospital in Shanghai. They were followed up for over 3 years for physical examination and responding to the questionnaires of DASH, NRS, as well as the satisfaction with the surgery. Results: The mean time to surgery was less than 6 months and the mean follow-up period was 4.59 years. The effective motor recovery rate was 54%, 86%, 46%, and 43%, respectively, in supraspinatus, biceps, triceps, and finger flexor. Patients who underwent nerve transfers scored consistently better on the DASH score and NRS score than those before surgery. There was also a significant correlation between the change in NRS scores and patient satisfaction. Conclusion: This study validated the effect of nerve transfers for global brachial plexus avulsions from objective MRC grading combining with patients’ self-assessments. Neurolysis after neurotizations correlated positively with functional outcomes.

The Course of Headache in Patients With Moderate-to-Severe Headache Due to Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cross-Sectional Study.

The purpose of this study was to evaluate the course of headache in patients with moderate-to-severe headache due to aneurysmal subarachnoid hemorrhage (aSAH) and to identify its predisposing factors. Little is known about the long-term course of headache in patients with aSAH. Since September 2009, patients with aSAH have had their headaches prospectively rated using a numeric rating scale (NRS). From this database containing 838 patients, 217 were included and all included patients met the following criteria: (1) presence of ruptured intracranial aneurysms on computed tomography angiography or magnetic resonance angiography; (2) alert consciousness (Glasgow Coma Scale 15); (3) newly onset moderate-to-severe headache (NRS ≥ 4) due to ruptured intracranial aneurysms; and (4) good clinical outcome at discharge (modified Rankin Scale 0, 1, or 2). We observed the changes in NRS scores from initial to 12-month follow-up and identified the predisposing factors of NRS changes. Of the 217 patients, 182 (83.9%) experienced improvement in NRS score ≤ 3 upon discharge. The NRS scores at discharge were significantly lower than those on admission (P < .001). The independent predisposing factors for headache improvement included previous stroke (odds ratio [OR] = 0.141; 95% CI 0.051-0.381; P < .001), previous headache treated with medication (OR = 0.079; 95% CI 0.010-0.518; P = .008), and endovascular treatment (EVT; OR = 2.531; 95% CI 1.141-5.912; P = .026). The NRS scores tended to decrease continuously until the 12-month follow-up. EVT and symptomatic vasospasm were independently associated with a decrease of NRS in the follow-up periods. The course of headache in patients with aSAH continuously improved during the 12 months of follow-up. Headache improvement might be expected in patients who were treated with EVT and in those who did not have previous stroke or headache.

Low-dose ketamine vs morphine for acute pain in the ED: a randomized controlled trial

ObjectivesTo compare the maximum change in numeric rating scale (NRS) pain scores, in patients receiving low-dose ketamine (LDK) or morphine (MOR) for acute pain in the emergency department. MethodsWe performed an institutional review board–approved, randomized, prospective, double-blinded trial at a tertiary, level 1 trauma center. A convenience sample of patients aged 18 to 59 years with acute abdominal, flank, low back, or extremity pain were enrolled. Subjects were consented and randomized to intravenous LDK (0.3mg/kg) or intravenous MOR (0.1mg/kg). Our primary outcome was the maximum change in NRS scores. A sample size of 20 subjects per group was calculated based on an 80% power to detect a 2-point change in NRS scores between treatment groups with estimated SDs of 2 and an α of .05, using a repeated-measures linear model. ResultsForty-five subjects were enrolled (MOR 21, LDK 24). Demographic variables and baseline NRS scores (7.1 vs 7.1) were similar. Ketamine was not superior to MOR in the maximum change of NRS pain scores, MOR=5 (confidence interval, 6.6-3.5) and LDK=4.9 (confidence interval, 5.8-4). The time to achieve maximum reduction in NRS pain scores was at 5minutes for LDK and 100minutes for MOR. Vital signs, adverse events, provider, and nurse satisfaction scores were similar between groups. ConclusionLow-dose ketamine did not produce a greater reduction in NRS pain scores compared with MOR for acute pain in the emergency department. However, LDK induced a significant analgesic effect within 5 minutes and provided a moderate reduction in pain for 2 hours.

On the relationship between pain intensity and postural sway in patients with non-specific neck pain

Increased center of pressure excursions are well documented in patients with non-specific neck pain. While a linear relationship between pain intensity and postural sway has been described in low back pain patients, no such investigation has been conducted in adults with non-specific neck pain. Seventy patients with non-specific neck pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90 sec duration each with eyes closed on a force platform. The pain intensity was assessed by a numeric rating scale (NRS), an equal number of patients (n=10) was enrolled per pain score. The results confirmed an increased postural sway in pain sufferers compared to healthy controls. In addition, a significant and linear increase in postural sway was observed with higher pain ratings. Statistically significant changes in sway were reached with an incremental change in NRS scores of two to three points. Mean velocity and sway area are closely related to self-reported pain scores in neck pain patients. This relationship has implications for clinical applications such as an objective monitoring tool for patients under treatment or rehabilitation.

Intra-Articular Cortisone Injection Has Limited Clinical Benefit for Non-Operative Treatment of Femoral Acetabular Impingement with Labral Pathology (SS-29)

Intra-articular cortisone injection of the hip is commonly performed both as a confirmatory diagnostic test and also as a therapeutic treatment modality in patients with femoral acetabular impingement (FAI). However, to our knowledge, there is no published data documenting the clinical benefit of these injections in patients with FAI. Therefore, the purpose of our study is to assess the efficacy of intra-articular cortisone injection in patients with FAI and associated labral tear prior to hip arthroscopy. We hypothesize that intra-articular cortisone injection does not provide significant therapeutic benefit for the non-operative treatment of FAI with associated labral tear. The records of patients undergoing hip arthroscopy for FAI at our institution between January 2008 and October 2012 who agreed to participate in research were reviewed. A cohort of patients was identified that underwent a pre-operative ultrasound or fluoroscopic guided intra-articular cortisone injection. Inclusion criteria were a diagnosis of FAI with labral tear, Tonnis grade 0 or 1, and minimum 50% pain relief during the anesthetic phase of the intra-articular injection. Exclusion criteria were patients with concomitant osteoarthritis as defined as Tonnis grade 2 or 3. Numerical rating scale (NRS) pain scores were prospectively recorded pre-injection, immediately post-injection, and at 14 day follow-up. An absolute change of 2 points on the NRS score at 14 days was considered the minimal amount of clinically significant pain relief. The type of steroid used was documented. 35 patients met our inclusion criteria and included 29 females (83%) and 6 males (17%) with a mean age of 34.4 ± 12.9 years. 7 patients had Tonnis grade 0 (20%) and 28 had Tonnis grade 1 (80%). Patients received anesthetic combined with methylprednisolone (21 patients), triamcinolone (12 patients), or betamethasone (2 patients) during the intra-articular injection. Median pre-injection NRS score was 6 (range 2-10). Median immediate post-injection NRS score was 2 (range 0-6). Median 14 day post-injection NRS score was 4 (range 0-10). Median absolute change in NRS score at 14 days was 0 (range 0-8) with 23 patients reporting no change (66%) and 11 patients (31%) reporting a change of ≥ 2 points. There was no significant difference in pain reduction between the different steroid preparations. In patients with symptomatic FAI and associated labral pathology, our data indicates that intra-articular cortisone injection has limited clinical benefit in two-thirds of patients as a therapeutic non-operative treatment modality.

Functional outcome of nerve transfers for traumatic global brachial plexus avulsion

BackgroundThe treatment of global brachial plexus avulsion is a demanding field of hand and upper extremity surgery. The recent development of functional and quality-of-life (QOL) assessment tools has improved quantifying these functional outcomes after surgery. ObjectiveWe sought to combine Medical Research Council (MRC) grading with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaires and Numerical Rating Scale (NRS) for pain to evaluate the functional outcome of patients who suffered complete brachial plexus avulsion before and after nerve transfers. MethodsThe author carried out a retrospective review of 37 patients with global avulsion of the brachial plexus between 2000 and 2007. All of them underwent nerve transfers in Hua Shan Hospital in Shanghai. They were followed up for over 3 years for physical examination and responding to the questionnaires of DASH, NRS, as well as the satisfaction with the surgery. ResultsThe mean time to surgery was less than 6 months and the mean follow-up period was 4.59 years (range: 3–9 years). The effective motor recovery rate was 54%, 86%, 46% and 43%, respectively, in supraspinatus, biceps, triceps and finger flexor. Patients who underwent nerve transfers scored consistently better on the DASH score and NRS score than those before surgery. There was also a significant correlation between the change in NRS scores and patient satisfaction. ConclusionThis study validated the effect of nerve transfers for global brachial plexus avulsions from objective MRC grading combining with patients’ self-assessments. Neurolysis after neurotisations correlated positively with functional outcomes.