Common Pain Research Articles

The role of psychosocial factors in the interprofessional management of women with chronic pelvic pain: A systematic review.

Chronic pelvic pain (CPP) is a common pain disorder in women associated with negative biopsychosocial consequences. The multifactorial etiology and maintaining aspects of CPP logically require an interprofessional treatment approach. However, the effects of interprofessional treatment strategies on psychosocial factors remain unclear. The study aims to investigate how interprofessional therapy helps to treat psychosocial factors in women with CPP. The systematic review summarizes the current evidence of interprofessional treatment in women with CPP. A systematic literature review was performed in six databases (Medline, Web of Science, Cochrane Library, PEDro, CINAHL, and PsycINFO) until February 2023. Studies were selected in a two-step approach applying as inclusion criteria the search combinations of Chronic Pelvic Pain and CPP, synonyms for interprofessional therapies, and for female patients. Studies were excluded if they were not quantitative primary research published in English, if CPP was not defined appropriately, if the study population was not female adult patients, if the interprofessional intervention was not operationalized appropriately, if they were single case studies, and if outcomes did not include at least one of the psychosocial factors pain, depressive symptoms, pain catastrophizing, fear, or anxiety. Risk of bias of the included studies was rated with the McMaster Critical Review Form. Studies were summarized narratively. The review is registered in PROSPERO (CRD42023391008). Five studies with a total sample size of n = 186 women were included, three of them were uncontrolled retrospective before-after chart review. Only one study used a randomized controlled design, the other study used a non-randomized controlled group. The studies' methodological quality is adequate with perspective of study design. The multiprofessional treatment approaches used in the studies differed with regard to professions involved, therapy methods, and modalities. Psychosocial outcome measures were pain (five studies), depressive symptoms (three studies), and anxiety symptoms (four studies). Although interprofessional treatment strategies for women with CPP are recommended in existing guidelines, available evidence is scarce and does not allow for identification of the best interprofessional treatment approach. The effect on psychosocial factors remains unclear. More research is needed determining the best practice interprofessional treatment option for women with CPP.

Bibliometric Analysis of Research Articles on Virtual Reality in the Field of Pain Medicine Published from 1993 to 2022.

This study aims to analyze global and regional (China, Japan, and South Korea) research on virtual reality (VR) in the field of pain medicine over the past 30 years. Specifically, we quantify VR-related publications, examine the distribution of research topics on chronic and acute pain, and identify trends and future directions. The Web of Science Core Collection (WoSCC) database was used for bibliometric analysis. This study included articles written in English between 1993 and 2022. The search strategy used predefined terms related to VR and pain. Based on the articles' titles and abstracts, two pain physicians independently reviewed and classified them as acute or chronic pain. Quantitative data on countries, institutions, journals, and research categories were analyzed. VOSviewer software was used for keyword mapping and clustering. We analyzed 808 VR-related articles on pain medicine. Over the past three decades, the number of publications in this field has increased steadily. The United States of America (n = 259) had the highest number of publications. Moreover, China (n = 42), Japan (n = 18), and South Korea (n = 24) also contributed continuously. Acute and chronic pain research accounted for 44.2% and 37.9% of the articles, respectively. The most common acute pain topic was procedure-related (n = 129, 16.0%), whereas the most common chronic pain topic was neuropathic (n = 104, 12.9%). Keywords clustered around neuroscience, pediatric pain management, and chronic pain management. Our study revealed academic achievements and growing interest in VR-related research in pain medicine. Researchers worldwide have shown balanced interest in applying VR technology to acute and chronic pain, with specific contributions from China, Japan, and South Korea. Harnessing VR technology is promising for improving pain management and enhancing patients' quality of life in the field of pain medicine.

27 Neuropsychiatric Sequela of COVID-19 Among Persons with MS

Objective:To evaluate changes in neuropsychiatric symptoms among patients with multiple sclerosis (MS) following coronavirus disease of 2019 (COVID-19) infection using the National COVID Cohort Collaborative (N3C). The N3C represents the largest cohort of COVID-19 cases, through the unification of electronic health records from over 60 medical centers.Participants and Methods:Out of 5,631,225 COVID-19 confirmed positive patients, we identified a cohort of patients with MS who were diagnosed with COVID-19. Conditions were searched using terms denoting common neuropsychiatric comorbid diagnoses, including anxiety, depression, pain, sleep disorders, fatigue, and cognitive disorders. We examined descriptively the percentages of patients who were newly diagnosed with each comorbid condition after COVID-19 infection. Additionally, we searched for various patient-reported outcome measures in the N3C dataset; only the Patient Health Questionnaire-9 (PHQ-9) had an adequate sample size in our cohort for analysis. To control for variability due to non-COVID-19 factors, we only included PHQ-9 scores that were reported one year before and after COVID-19 infection. A repeated-measures analysis of variance (ANOVA) was conducted to analyze the difference between PHQ-9 scores before and after COVID-19 diagnosis among MS patients.Results:In our final dataset, there were 40,690 patients who were diagnosed with MS and COVID-19. Among patients without pre-existing anxiety conditions, 9.18% were diagnosed with an anxiety disorder after COVID-19 infection. Among those who did not have a pre-existing cognitive disorder, 1.73% had such diagnoses after COVID-19 infection. Among those without previous depressive disorders, 8.89% were diagnosed with a depressive disorder after COVID-19 infection. Of those without fatigue conditions prior to COVID-19 in their medical records, 8.81% had documented fatigue in their records after contracting COVID-19. Of those without pain conditions in their medical records, 11.37% had documented pain in their records after COVID-19 infection. Finally, among patients without pre-existing sleep disorders, 8.71% were diagnosed with sleep disorders after COVID-19 infection. Regarding PHQ-9 scores, 50 patients had documented scores before their COVID-19 diagnosis and 50 after COVID-19 diagnosis (17 had scores for both before and after COVID-19 diagnosis). There was no significant difference in PHQ-9 scores before and after COVID-19 diagnosis (F(df) = 0.326, p = 0.572; meanbefore = 8.77, meanafter = 9.32).Conclusions:Approximately 2-11% of MS patients developed new neuropsychiatric conditions after COVID-19 infection, with pain being the most common, followed by anxiety, fatigue, depression, and sleep disorders. Cognitive disorders were the least prevalent new onset neuropsychiatric sequelae of COVID-19 in this cohort. Additionally, there was a non-significant increase in severity of depressive symptoms, as indicated by a 1.36-point increase in PHQ-9 scores. These results suggest that patients with MS who have also been diagnosed with COVID-19 may be at risk for developing newly onset neuropsychiatric symptoms.

Woodfordia fruticosa (L. Kurz): An Evidence-based Study of Its Phytochemical and Pharmacological Activity

Abstract: Woodfordia fruticosa (L.) Kurz, a member of the 'Lythraceae' family, has been used in traditional medicine to cure common diseases since ancient times. It is traditionally used to treat a variety of maladies such as the common cold, toothache, blood infection, leprosy, dysentery, wounds, rheumatic pain, fever, urinary issues, inflammation, antifertility, and menstrual problems. The huge potential and impacts of this plant have been thoroughly confirmed in in vitro and in vivo studies. The most current research on the plant Woodfordia fruticosa is critical for identifying the bioactive components responsible for its medicinal efficacy. Phytochemical studies reveal the existence of several chemicals extracted from various components of the plant, including glycosides, terpenes, flavonoids, tannins, sterols, phenolics, and essential oils. According to pharmacological studies, the plant has many medicinal properties, such as hypoglycemic, antioxidant, analgesic, hepatoprotective, antibacterial, gastric protective, and wound healing. Most of the pharmacological effects of raw extracts of this plant have been described. Only a few researchers have reported the activity of chemicals isolated from this plant. Therefore, this research will help to discover the many different medicinal properties of the plant as well as its pharmacological effects on various diseases and will show that further research is needed to explore its practical applications.

THU126 SARS-CoV-2 Infection And Vaccination In Patients With Pituitary Diseases: A Pilot Study

Abstract Disclosure: M.C. Silva: None. L.M. Del Corso: None. C.L. Boguszewski: None. Introduction: The COVID-19 pandemic caused by the SARS-CoV-2 virus brought several questions globally. Among patients with pituitary diseases, there are few data in the literature about prevalence of SARS-CoV-2 infection, vaccination and their possible consequences and adverse events. Aim: To evaluate the prevalence and characteristics of SARS-CoV-2 infection, and the prevalence, efficacy and safety of vaccination in adult patients with pituitary diseases. Methods: Observational, cross-sectional study of adult patients with pituitary diseases followed in a reference center. Clinical data were collected and a questionnaire about SARS-CoV-2 infection, vaccination and its possible adverse effects was applied. The severity definitions used for COVID-19 disease were based on the World Health Organization: Mild – symptoms of infection without pneumonia; Moderate – presence of pneumonia; Severe – severe pneumonia (respiratory rate greater than 30 breaths per minute, severe respiratory distress or oxygen saturation less than 90% on room air). Results: We have studied 116 consecutive patients, 59 women (50.9%), with a median age of 47.5 years (range 39-59). The cause of pituitary disease was tumoral in 82 cases (70.7%) and non-tumoral in 34 (29.3%), the most prevalent etiologies were prolactinoma (n=31; 26.7%), idiopathic hypopituitarism (n=30; 25.9%) and acromegaly (n=23; 19.8%). Among hypopituitary patients (n=65; 56%), thirty (46.2%) had ACTH deficiency and all were on glucocorticoid replacement. The median time of pituitary disease was 14 years (range 6-23) and the median age at diagnosis was 32 years (range 18.5-45). SARS-CoV-2 infection was confirmed in 33 patients [28.4%; 17 before vaccination; 21 women; prolactinoma (n=12), acromegaly (n=9), non-tumoral disease (n=8); ACTH deficiency (n=6)]. The median age of infected patients was 47.5 years (range 29.5-57). In 20 cases (60.6%) the infection was mild, in 8 (24.2%) was moderate and in 5 (15.2%) was severe. All severe cases required hospitalization, although one patient refused. All but one of the participants were vaccinated against COVID-19, mostly Oxford-AstraZeneca (41.7%) and Pfizer-BioNTech (35.8%). Among those vaccinated, 64 (55.7%) reported on some adverse events, the most common pain at the site of vaccine shot (28.3%), fever (19.5%) and headache (9.7%), with a median duration of 1.5 days (range 1-3). In 61 cases, the reversal of symptoms was spontaneous (95.3%), two patients required outpatient care, and in one permanent alopecia developed. Conclusions: The prevalence of SARS-CoV-2 infection in patients with pituitary diseases was 28.4%, with 5% of severe cases requiring hospitalization. The vaccination was almost universal among our patients, being safe and effective in preventing severe cases of SARS-CoV-2 infection. Presentation: Thursday, June 15, 2023

Lengthening sleep reduces pain in childhood arthritis: a crossover randomised controlled trial

ObjectivesJuvenile idiopathic arthritis (JIA) is a common chronic childhood disease and chronic pain is a debilitating feature. A strong link has been shown between poor sleep and pain in JIA....

Research on the Teaching Improvement Strategy of Marxist Classical Original Work Course Based on the Students' Perspective

In order to effectively improve the teaching effect of Marxist classic original works in the new era, better stimulate students' interest in reading Marxist classic original works. This paper is based on the perspective of students, student-based, taking Das Kapital as an example. The survey collected some information about 500 college students reading and studying Das Kapital. Through the cross-analysis of the collected data, the common pain points in the process of learning Das Kapital are analyzed, and the targeted suggestions are put forward based on the specific learning situation, educational elements of the new era, educational situation and curriculum examination situation. It is hoped to stimulate the interest of college students in reading Marxist classics such as Das Kapital, so as to improve the teaching effect of Marxist classic original course.

Racial and Ethnic Disparities in Inpatient Interventional Pain Management for Lumbar Radiculopathy

BACKGROUND: Chronic pain is a common reason adults seek care; patients often feel that their pain is inadequately managed. Spine-related pain is the most common chronic pain concern, and lumbar radiculopathy is often the cause. Racial and ethnic disparities in the pharmacologic management of pain are well described, but less is known about these disparities regarding interventional procedures. OBJECTIVE: To study the utilization rates of physical therapy, epidural steroid injection, surgery, and spinal cord stimulation in hospitalized patients with lumbar radiculopathy across different races, ethnicities, and genders. STUDY DESIGN: A retrospective cross-sectional study design. METHODS: The National Inpatient Sample was used to identify 252,790 patients with lumbar radiculopathy, after sample weighting, from 2016-2019. Independent variables were race, ethnicity, age, gender, insurance, geography, year, and severity. Dependent variables were physical therapy, epidural steroid injection, spinal cord stimulator, or surgery (reference group). Conservative management was defined as nonoperative treatment ranging from physical therapy to epidural steroid injection. Data were analyzed with a logistic regression for complex surveys. Regressions were adjusted for age, insurance, geography, and other socioeconomic factors. RESULTS: Most patients were white (78.3%) and received surgery (95.0%). Severe disease was most common among African Americans (9.3%), but was similar across other races, ethnicities, and genders. Medicaid was more common among African Americans and Hispanics. An adjusted analysis showed that African Americans and Hispanics received more epidural steroid injections (odds ratio [OR] = 1.52; 95%CI, 1.3 – 1.8) and (OR = 1.43; 95%CI, 1.1 – 1.8) respectively; and physical therapy (OR = 1.65; 95%CI, 1.1 – 2.5) and (OR = 1.83; 95%CI, 1.2 – 2.8) respectively, than whites compared to surgery. African Americans received a spinal cord stimulator less often than whites compared to surgery (OR = 0.63; 95%CI. 0.4 – 0.9). Women received an epidural steroid injection more frequently than men compared to surgery (OR = 1.29; 95%CI, 1.2 – 1.4). LIMITATIONS: Generalizability is limited because conservative therapies are often outpatient treatments. CONCLUSION: Disparities were observed in lumbar radiculopathy treatment after independent variable adjustment. African Americans received conservative therapy more often than whites despite increased disease severity. Hispanics and women had similar disease severity compared to whites and men, respectively, but received more conservative therapies. Further investigation in outpatient settings is needed to definitively describe these disparities. KEY WORDS: Chronic pain, pain management, back pain, lumbar radiculopathy, epidural steroid injection, spinal cord stimulation, low back surgery, physical therapy, racial disparities, gender disparities

Association Between Pain and Fall Worry Among Community-Dwelling Older People With Cognitive Impairment in the United States.

Previous studies have found that pain is associated with fall worry among community-dwelling older people. However, both pain and fall worry are poorly understood and underaddressed among community-dwelling older people with cognitive impairment (CI). It is essential to examine the association between pain and fall worry, and how sociodemographic and health characteristics may shape fall worry among this subgroup. We used data from the 2015 National Health and Aging Trends Study (analytic sample: n = 1150 community-dwelling older people with CI; were self-interviewed; mean age: 81; age range: 65-107). The number of pain sites in the prior month was assessed by presenting a card listing common pain sites (eg, back, knees). Two questions assessed past-month fall worry, "did you worry about falling down" and "did this worry ever limit your activities." Following descriptive statistics, we fit multinomial logistic regression models to examine the associations between different pain characteristics (number of sites, severity, location) and non-activity-limiting and activity-limiting fall worry. Non-activity-limiting fall worry was endorsed by 21.1% and activity-limiting fall worry by 13.6% of community-dwelling older people with CI. After adjusting for sociodemographic characteristics and fall-worry-related covariates, multinomial logistic regression analysis found that a greater number of pain sites (relative risk ratio [RRR] = 1.22, 95% Confidence Interval [95% CI] = 1.12-1.33, p <.001) and severe pain (RRR = 2.05, 95% CI = 1.12-3.75, p = .020) was associated with activity-limiting fall worry. Both lower body (knee, foot, and leg) and upper body (hand, wrist, shoulder, neck, and stomach) pain were found to be associated with a high risk of activity-limiting fall worry. These findings suggest pain and fall worry are common among community-dwelling older people with CI and can be elicited directly from those who are communicative. Fall prevention for this population should prioritize pain management to mitigate activity-limiting fall worry because activity limitation increases the risk of falls.

Targeted Therapies for Previously "Undruggable" KRAS-Mutated Non-Small Cell Lung Cancer: A Review of Sotorasib and Adagrasib.

To evaluate the safety and efficacy of the novel KRAS-targeting agents, sotorasib and adagrasib, in treating KRAS G12C-mutated non-small cell lung cancer (NSCLC). A comprehensive English-based literature search of PubMed and Clinicaltrials.gov between January 2000 and July 2023 was conducted using the terms sotorasib, Lumakras, AMG 510, adagrasib, Krazati, and MRTX849. Relevant prescribing information, clinical trials, and treatment guidelines were evaluated. Sotorasib and adagrasib received accelerated US Food and Drug Administration (FDA) approval following pivotal phase I/II clinical trials. Sotorasib, a first-in-class KRAS inhibitor, demonstrated an overall response rate (ORR) of 41% and a progression-free survival (PFS) of 6.3 months. In a phase III confirmatory trial, sotorasib showed significantly longer PFS compared with docetaxel (5.6 vs. 4.5 months; P = 0.0017). Adagrasib produced an ORR of 42.9% and a PFS of 6.5 months. Both drugs present unique safety profiles, with common toxicities, including diarrhea, musculoskeletal pain, fatigue, and hepatotoxicity. With KRAS mutations being among the most common oncogenic alterations in NSCLC, sotorasib and adagrasib offer new therapeutic avenues for this previously "undruggable" target. Current treatment guidelines list sotorasib and adagrasib as second-line options in patients with confirmed KRAS G12C-mutated NSCLC. Additional studies are required to further differentiate the safety and efficacy profiles of these 2 agents and identify their optimal place in therapy. Sotorasib and adagrasib demonstrated promising outcomes in targeting the constitutively active KRAS G12C oncogenic driver, underscoring the need for further research to optimize their therapeutic application in this high-risk population.

Real-world data: how is paracetamol prescribed in low back pain and osteoarthritis in general practice in France?

Common low back pain (LBP) and osteoarthritis (OA) can significantly impact patients’ quality of life and thus require an adequate pain management. In France, paracetamol remains the first-line analgesic according to the national recommendations, but it is challenged by the international guidelines. Prescription patterns in 27 559 patients presenting with OA- or LBP- and receiving paracetamol during the GP visit were retrieved from the IQVIA French database. Paracetamol was prescribed first line and alone in 57% of LBP and 78% of OA patients and remains the pivotal analgesic in both indications in France.

A cross-sectional survey study on impact of sitting postures in Trikashoola w.s.r. to Low Back Pain among Information Technology Professionals

Occupational health aims at the promotion and maintenance of highest degree of physical, mental and social well being of workers in all occupations. Now, around world the occupational health personnel are witnessing the emergence of health related problems in computer users. Sadathura, the person who are continuously exposed to illness because of their professions. Panyajivi is one among them. 21st century integrates technology where computer’s plays an important role in people’s life, which makes them to sit for long hours. Trikashoola is one among the Vatavyadhi. Vata Dosha is considered to be main reason for pain. Low back pain is a disease of modernization due to desk jobs and the sitting position, poor work station design (desk), bad postures, type of chair and use of foot rest. Back pain is the second most frequent reason for visiting a physician and the common pain syndrome in developed and in developing countries. Ergonomics is concerned with human engineering. Bengaluru is the India’s largest I.T hub, also called as Silicon Valley of India and home for large number of Information Technology Professionals. 311 subjects were included in this survey study. The diagnosis was done through Oswestry disability index scale.

Postherpetik Nevraljili Hastaların Eğitimi İçin YouTube'un Kalitesini Değerlendirmek

Introduction: Postherpetic neuralgia (PHN) is one of the common complications of herpes virus and is the most common neuropathic pain syndrome after an infectious disease. YouTube is a widely used source for information, but the quality of YouTube videos in terms of medical content is questionable. Therefore, our aim was to evaluate the PHN-related quality of YouTube videos. &#x0D; Materials and Methods: This study was carried out by evaluating YouTube videos up to April 2023. A total of 65 videos were evaluated. The number of views and duration of the videos, the number of likes and views, the number of comments, the age of the videos and the source of the videos were recorded. We evaluated all videos for overall educational quality and creator bias. Content creators were categorized as physicians, health-related websites, and patients, and we compared overall DISCERN scores and bias scores between creator type and search term.&#x0D; Results: The average view count of the videos was 119224.62. The mean DISCERN and DISCERN Bias Scores were 2.01 and 2.14 respectively. Most of the videos were uploaded by the physicians. The DISCERN and DISCERN Bias scores were significantly higher in the videos uploaded by physicians (p

Obesity and temporomandibular joint disorders: a systematic review and meta-analysis

BackgroundTemporomandibular joint disorders (TMD) is the most common non-dental pain complaint in the maxillofacial region, which presents a variety of symptoms and signs, including temporomandibular joints (TMJ) and masticatory muscle pain, joint noise, tinnitus, headaches, irregular or restricted mandibular function, masticatory difficulty, and restricted mouth opening. When comes to the relationship between obesity and TMD, it has remained controversial and inconsistent, therefore, we first conducted this meta-analysis to estimate the unclear relationship between obesity and TMD.MethodsSearches were conducted in PubMed, Web of Science, Embase, and Cochrane Library. Subjects were divided into five groups according to BMI level in this study, including the normal weight group: 18.5 ≤ BMI < 25, overweight group: 25 ≤ BMI < 30, obesity group: BMI ≥ 30, control group: BMI < 25, and overweight and obesity group: BMI ≥ 25. Statistics analyses were conducted using Stata (15.0). The number of PROSPERO was CRD42022368315.ResultsEight studies were included in this study, and six articles with a total of 74,056 participants were synthesized for meta-analysis. Compared to normal weight individuals, overweight and obesity together decreased the risk of TMD (OR = 0.66, 95% CI = 0.46–0.95), and it was significantly decreased by obesity alone (OR = 0.58). Moreover, it was lower in obesity compared with control subjects (OR = 0.83, 95% CI = 0.73–0.94). Furthermore, in overweight and obese individuals, it was much lower in obesity than in overweight (OR = 0.82, 95% CI = 0.71–0.94).ConclusionsObesity is not a risk factor for TMD, and maybe a protective factor for TMD, of which patients with larger BMI are less likely to suffer from TMD pain. Therefore, the value of BMI should be taken into consideration in the assessment of TMD.

Temperature-Sensitive Hydrogels as Carriers for Modulated Delivery of Acetaminophen.

The purposes of this study are the polymerization of temperature-sensitive copolymers based on N-isopropyl acrylamide and 10 mol % of 2-hydroxypropylmethacrylate, characterisations of their thermal, morphological and swelling properties, as well as the analysis of potential application in drug-delivery systems. Acetaminophen, the representative of non-steroidal anti-inflammatory drugs, was used as a model drug in this study. It is a common pain relief drug, which is also used for fever treatment. However, oral administration comes with certain health risks, mainly the overdose and frequent administration of up to four times a day. The goal of applying temperature-sensitive hydrogel is to enable extended administration once a day, depending on the body temperature. The swelling behavior of the obtained poly(N-isopropyl acrylamide-co-2-hydroxypropylmethacrylate) (p(NIPA/HPMA)) hydrogels and their temperature-sensitivity, kinetics and order of swelling processes at 18 and 38 °C were analyzed. The thermal properties of these hydrogels were observed by the DSC method, and the obtained thermograms showed both melting and glass transitions. The drug delivery system of p(NIPA/HPMA) hydrogels with loaded acetaminophen was analyzed using scanning electron microscopy and Fourier transform infrared spectroscopy methods. Structural analysis of FTIR spectra indicates that non-covalent intermolecular interactions of the type of hydrogen bonds were formed among functional groups of acetaminophen and side-chains of p(NIPA/HPMA) hydrogels. The surface structure of p(NIPA/HPMA) hydrogels after drug loading indicates the acetaminophen presence into the pores of the hydrogel network, and their loading efficiency was higher than 92%. Qualitative and quantitative analysis of acetaminophen, determined by the high-pressure liquid chromatography method, showed that about 90-99% of the loaded amount was released from p(NIPA/HPMA) hydrogels within 24 h. Kinetic parameters of the acetaminophen release under simulated gastrointestinal conditions were determined. Based on obtained results, the drug delivery system of temperature-sensitive p(NIPA/HPMA) hydrogels with loaded acetaminophen could be suitable for additional investigation for modulated drug administration, e.g., for extended drug administration.

Color Flow Doppler in Spinal Ultrasound: A Novel Technique for Assessment of Catheter Position in Labor Epidurals

(Reg Anesth Pain Med 2022;47:775–779) Epidural analgesia is one of the most common pain relief treatments during labor and delivery and is usually very effective. In a small percentage of epidurals, misplacement of the epidural catheter can cause inadequate anesthetic effects. To reduce instances of insufficient pain relief, it would be beneficial to be able to assess the position and flow of the catheter before administering medication. This study was designed to visualize flow in the epidural space using a structured color flow Doppler assessment, and to describe the location of the flow relative to the catheter insertion site. The primary outcome was the visualization of flow in the epidural space by color flow Doppler ultrasound. Secondary outcomes were visualization of catheter flow at the interspace of insertion, and at the interspaces above and below insertion, as well as visibility from unilateral or bilateral view, and visibility of flow on injection of saline only or an injection of a saline and air mixture.

EEG signatures of low back and knee joint pain during movement execution: a short report.

Chronic musculoskeletal pain has a high prevalence between European citizens, affecting their quality of life and their ability to work. The plastic changes associated with the occurrence of chronic musculoskeletal pain are still not fully understood. The current short report investigated the possible changes in brain activity caused by pain during movement in two of the most common musculoskeletal pain disorders in Denmark, knee pain and low back pain. Electroencephalography (EEG) was recorded from 20 participants (5 participants with knee pain, 5 with low back pain and 10 healthy controls). Participants with pain performed a movement that evoked pain in the area of interest, and the healthy controls performed the same movement. Electromyographic (EMG) signals were also collected to identify movement initiation. No differences were observed in brain activity of participants with pain and healthy controls during rest. During movement execution, though, participants with pain showed significantly higher event related synchronization in the alpha and beta bands compared to healthy controls. These changes could be related to higher cognitive processing, possibly due to the attempt of suppressing the pain. These results highlight the importance of assessing cortical activity during movement to reveal plastic changes due to musculoskeletal pain. This adds to our knowledge regarding plastic changes in cortical activity related to musculoskeletal pain in different locations. Such knowledge could help us identify neurophysiological markers for clinical changes and contribute to the development of new treatment approaches based on neuromodulation such as neurofeedback.

Perioperative pain protocols following surgery for adolescent idiopathic scoliosis: a snapshot of current treatments utilized by attending orthopedic surgeons.

Perioperative management after adolescent idiopathic scoliosis (AIS) surgery varies extensively between surgeons and institutions. We devised a questionnaire to assess surgeon baseline characteristics, practice settings, and pain regimens to assess what factors contribute to perioperative pain protocols. A multiple-choice questionnaire including 130 independent variables regarding baseline characteristics, practice environments, and pain regimen protocols was distributed to elicit information among surgeons performing AIS fusion surgery. Pairwise bivariate analysis between practice location, length of practice, and practice environment vs. type of post-operative analgesia was completed using two-tailed Fisher's exact test. 85 respondents participated, all identified as practicing orthopedic surgeons. The largest group of respondents reported 20-40% of their total practice was dedicated to AIS (36%). Respondents were predominantly hospital-employed academic physicians (67%). The most common pain medication administered preoperatively was gabapentin (54%). Postoperative regimens were highly varied. Discharge pain regimens most commonly included short-acting opiates (89%), acetaminophen (86%), antispasmodics (59%), and NSAIDs (51%). Bivariate analysis revealed that fentanyl PCA was significantly associated with practice location (p < 0.05). Utilization of NSAIDs was significantly associated with length in training, with older physicians utilizing anti-inflammatories more regularly than younger physicians (p < 0.05). This study identifies common perioperative regimens utilized in AIS surgery. Of interest, younger surgeons are less likely to prescribe NSAIDs post-operatively than surgeons who have been in practice for longer periods of time, which may represent a bias against anti-inflammatory medications in younger surgeons.

Alternative medicine - a replacement or an adjunctive for conventional therapy of chronic pain

Introduction and purpose: &#x0D; Many people worldwide suffer from chronic pain. It is a very inconvenient condition on its own, not only an accompanying symptom of other diseases. Conventional drug treatment may be insufficient in some cases or may even cause serious side effects in the long term. In response to this, we aim to demonstrate the diversity of alternative pain management techniques in this review and identify conditions where such techniques may be beneficial to patients.&#x0D; State of knowledge:&#x0D; This paper evaluates some of the most common alternative pain management methods (acupuncture, massage, chiropractic, mind body therapies, herbal medicine, music therapy) and their application in specific cases of chronic pain. We also describe the possible mechanisms of action involved in the effectiveness of these techniques, based on contemporary studies.&#x0D; Summary:&#x0D; In conclusion, there are conditions where alternative medicine may be beneficial for patients suffering from chronic pain. The studies taken into account showed the best effects for chronic musculoskeletal pain treated with methods such as acupuncture and massage. Mind-body therapies may reduce stress levels and symptoms of depression associated with chronic pain, consequently improving the quality of patients' lives. However, alternative methods should not yet be considered as replacements for conventional drug therapy. More studies are needed to evaluate whether alternative therapies will play a significant role in chronic pain management in the future.

Assessment of common extensor tendon vascularization using superb microvascular imaging: a potential tool in the evaluation of extracorporeal shock wave therapy and therapeutic ultrasound effectiveness in lateral epicondylitis.

Lateral epicondylitis, also known as tennis elbow, is the most common elbow pain in the adult age group. To evaluate common extensor tendon (CET) vascularity with superb microvascular imaging (SMI) before and after extracorporeal shock wave therapy (ESWT) and ultrasound (US) treatment in patients with lateral epycondylitis and to compare the effects of two different treatments on tendon vascularity. Patients with lateral epycondylitis were divided into two groups; 30 patients were treated with ESWT (group 1) and 30 patients were treated with therapeutic US (group 2). We performed a high-frequency (14-MHz) linear array transducer to evaluate tendon anatomy and vascularity before and after treatment in both groups. The decrease in Patient-Rated Tennis Elbow Evaluation (PRTEE) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). Likewise, the decrease in visual analog scale (VAS) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). A significant difference was found between the CET SMI values of group 1 and group 2 after treatment, according to the chi-square test (P < 0.001). In the post-treatment VAS and PRTEE comparison of both groups, the score reduction in group 1 was higher than in group 2, and this decrease was statistically significant (P < 0.001). We can evaluate CET vascularization with the SMI method as a new potential diagnostic tool in comparing the effectiveness of different treatments in cases of lateral epicondylitis.