Decrease In VAS Scores Research Articles

Comparison of active release technique and post-isometric relaxation in treatment of plantar fasciitis among traffic police wardens: a quasi-experimental study

BackgroundPlantar fasciitis (PF) is a common cause of chronic foot pain that leads to functional limitations in individuals. There has been recent research on plantar fasciitis, but no studies have compared the effects of the active release technique and post-isometric relaxation in patients to determine which manual therapy technique improves foot pain and function.ObjectiveThis study aimed to compare the effectiveness of the active release technique and post-isometric relaxation on proximal foot pain and functional status and to assess muscular tightness among patients with traffic police wards and plantar fasciitis.MethodsA quasi-experimental study (pre-test, post-test) was conducted in the Physiotherapy Department of Police Hospital, Gujranwala, Pakistan, between October 2022 and April 2023. We included 30 consecutively aged 25- to 60-year-old symptomatic police wardens diagnosed with planter fasciitis, who complained of pain on walking and standing for more than 3 months and met the inclusion criteria. They were equally assorted into two groups (n = 15 in each group) using convenient sampling. Group A received an active release exercise technique, group B received a post-isometric relaxation technique, and the participants in both groups received a similar baseline treatment protocol that consisted of calf stretching and stretching of the plantar fascia (5 repetitions and holding for 15 s). In the outcome measures, we included the Foot Function Index to assess the function of the foot and the Visual Analog Scale to examine the pain intensity measured during rest. The participants in both groups performed the selective protocol 3 days per week for 3 weeks, and we calculated the results at baseline and on the third day of the third week. We analyzed the data using SPSS software version 24 (IBM Corp., Armonk, NY). We compared within-group differences in the VAS score and FFI using paired t tests and analyzed between-group differences in the VAS score and FFI before and after performing the ART and PIR using independent t tests.ResultsThe 8-week intervention therapy revealed a demographic age mean and standard deviation of 36.60 ± 6.11 for group A and 35.60 ± 4.85 for group B. Within-group analysis demonstrated a significant decrease in VAS (pain) score following ART intervention (1.80 ± 0.862, p < 0.01) compared to PIR (6.07 ± 0.884). Between-group analysis indicated a significant reduction in FFI (disability) scores for group A (30.33 ± 3.200, p < 0.03) compared to group B (56.93 ± 4.773). Moreover, ART intervention exhibited significant improvement in VAS scores (p < 0.05), with 95% CI [1.49, 2.11]. The mean difference in FFI scores was substantially greater in the ART group (86.00 to 30.33) compared to the PIR group (p > 0.05), suggesting non-significant differences.ConclusionThe active release exercise intervention is more effective than post-isometric relaxation in improving pain and foot function disability in patients with plantar fasciitis. The present study aimed to help physical therapists choose the most efficient manual therapy exercise intervention to improve functional limitations.

Relationship between the healing rate of post-extraction sites and the quantity of platelets present in the blood: a retrospective observational study.

In daily surgical practice, the dentist deals with various types of oral surgery. At the first visit, the patient fills out a questionnaire about their state of health. If the questionnaire does not reveal any particular hematological problems, no special tests are usually required to determine the platelet count. The aim of this prospective study was to evaluate the healing process of patients and its correlation with platelet levels before surgery. A total of 50 patients were included in whom blood chemistry tests were performed with special attention to the platelet count and before their mandibular eights were extracted .The type of healing (EHI) and pain on the second day (VAS) were assessed using methods validated in the literature. After the EHI and VAS scores were noted in the medical records, envelopes containing the platelet scores of the previously requested blood samples, which were not read at the time of observation, were opened. An increase in EHI scores and a decrease in VAS scores was observed that were statistically significantly correlated with increasing platelet scores. These results suggest that the dentist should request chemistry tests on preoperative blood, especially if the patient is to undergo a particularly demanding oral surgical procedure, such as implants, guided bone regeneration or complex extractions.

Comparative Study of Morphine, Fentanyl or Nalbuphine Patient Controlled Analgesia (PCA) for Mucositis Pain in Pediatric Patients Undergoing Cancer Therapy. A Prospective Randomized Clinical Trial

Abstract Background Cancer treatment may cause several side effects, including severe oral mucositis (SOM). Oral mucositis is an inflammation of the oral mucosa that causes severe pain and ulceration. Children and adolescents are more prone to develop chemotherapy-induced SOM. Opiates have been the cornerstone of pain management for moderate to severe oral mucositis. The effective use of opiates requires balancing the desired effects of pain relief with undesired adverse effects Aim of the Work We evaluated the efficacy and safety of Nalbuphine (agonist – antagonist) in comparison with the pure agonist opioids (Morphine and Fentanyl) when used for oral mucositis pain in pediatric patients undergoing cancer therapy. Primary outcomes measures were Pain intensity self- assessment by using VAS, Number of active and total pushes of PCA buttons, Total opioid consumptions for each patient, and Patient satisfaction at the end of the 7 days using Patient Satisfaction Score PSS were assessed using a linear scale where 0 = very satisfied; 10 = very dissatisfied. Secondary outcomes measures were Adverse events including Respiratory depression, Bradycardia, Hypotension, Over sedation, Nausea and vomiting, Pruritus, Urinary retention. Patients and Methods This was a Randomized Clinical Trial conducted on 90 Pediatric patients who were diagnosed with cancer, admitted to Children Cancer Hospital -Egypt (CCHE-57357) and underwent cancer therapy that was complicated with Mucositis grade 3 and 4 (severe oral mucositis) according to the WHO scale for oral mucositis. Patients were randomly allocated into 3 equal groups each included 30 patients using of: PCA Morphine (Group M), PCA Nalbuphine (Group N) and PCA Fentanyl (Group F). Using equipotent doses of the three medications. Results Highly significant decrease in VAS score (7th day) and total opioid consumption (7th day), in Nalbuphine and Morphine groups; compared to Fentanyl group (p &amp;lt; 0.01 respectively). Significant increase in patient satisfaction score PSS in Nalbuphine drug group; compared to other drug groups (p = 0.032). Highly significant decrease in serious side effects (especially respiratory depression and sedation problems), in Nalbuphine and Morphine groups; compared to Fentanyl group (p = 0.0004). Conclusion Nalbuphine proven to be adequately effective, not inferior to Morphine in terms of improving pain relief, decreasing opioid consumptions in pediatric PCA users. However patients reported less satisfaction with Nalbuphine than Fentanyl or Morphine. In terms of safety profile, Nalbuphine had less adverse effects in pediatric patients with oral mucositis related to cancer therapy in comparison to Fentanyl or morphine.

Comparative Study between Ultrasound Guided Intraarticular Injection of Corticosteroids and Ultrasound Guided Genicular Nerve Block in Patients with Chronic Knee Pain

Abstract Background Chronic knee pain represents a major cause of disability and a burden on healthcare systems worldwide, being more prevalent in middle-aged and elderly patients. It can take a toll on patients’ daily life, keeps them from their favorite activities, saps of productivity, and diminishes overall quality of life. It can be caused by degenerative conditions, such as osteoarthritis (the most common cause), rheumatoid arthritis, crystalline arthritis and gout. lifestyle modification, pharmacologic management, and injections are the mainstay of therapy for elderly patients having chronic symptomatic knee pain with multiple medical comorbidities who do not wish/fit for surgical options. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate chronic knee pain and was traditionally performed blindly depending only on anatomical land marks. Recently, Genicular nerve block (GNB) has recently emerged as a novel alternative treatment for chronic knee pain. Both Intra-articular corticosteroid injection (IACSI) and Genicular nerve block (GNB) can be carried out under Ultrasound guidance as a safer, cheaper and more feasible imaging modality for guidance as it provides real-time imaging for the knee structures in a dynamic manner giving the ability to do interventional procedures and providing more effective clinical results when compared to blind injections. Aim of the Work Illustrate the technical aspects, the indications and the methodology of local therapies for chronic knee pain performed by interventional radiologists and provide current evidence. Assess the efficacy of Ultrasound (US) guided intraarticular corticosteroids injection and Genicular nerve block to control moderate and advanced chronic knee pain. Compare the immediate and short-term symptomatic and functional improvement obtained after both techniques. Patients and Methods The study was carried out on 30 patients of symptomatic chronic knee pain with radiologically proven knee joint arthritis (26 of them had osteoarthritis, 3 had gout arthritis and one patient had rheumatoid arthritis), all of them were not responding to medical treatment. They were divided into two groups (intraarticular corticosteroids injection group and Genicular nerve block one) both procedures were performed under ultrasound guidance to identify target points for injection. GNB target points for injection where close to the superior lateral, superior medial and inferior medial genicular arteries while target point for the IACSI group was the suprapatellar bursa. All procedures were performed with a spinal needle (22 G) introduced under ultrasound guidance till reaching the desired target points at both groups. Then injection of a mixture of Lidocaine, Bupivacaine hydrochloride and Triamcinolone Acetonide was done. Results In our study, in IACSI group the mean of initial VAS was 80.7±10.3 compared to 81.3±7.7 in GNB group. The mean VAS significantly dropped to be 20.7±5.3 in IACSI group compared to 18.3±5.9 in GNB group. After 2 weeks, it was 34.3±8.4 and 27.7±8.2 respectively. After 4 weeks, it increased to 40±8.7 and 33.7±9.3 respectively. At 8 weeks, it was obviously increased to 75.3±10.3 and 66.7±11.4 respectively and the effect returned gradually till nearly the baseline at 8 weeks. In our study, in IACSI group the mean of initial OKS was 48.6±7.4 compared to 50.1±7.6 in GNB group. After 2 weeks, it was markedly decreased to 25.5±3.9 and 22.7±6.8 respectively. After 4 weeks, it increased to 31.1±3.5 and 27.±6.9 respectively. At 8 weeks, it was obviously increased to 44.1±7.1 and 39.3±6.1 respectively and the effect returned gradually till nearly the baseline at 8 weeks. Conclusion Ultrasound guided genicular nerve block with a mixture of corticosteroid and local anesthetic is an effective, radiation free method to alleviate chronic knee pain and improve knee joint function. US guided intra-articular corticosteroid injection through suprapatellar approach is also an effective method to relive chronic knee pain and inflammation and to improve knee joint functional capacity. Both procedures are effective in alleviation of chronic knee pain for up to 4 weeks with marked decrease in VAS score after 2 weeks and slight increasing trend towards 4 weeks. The favorable effect returned gradually till nearly the baseline at 8 weeks. Genicular nerve block is more effective than intra-articular corticosteroid injection in both pain alleviation and improving knee joint function. The earlier the Kellgren- Lawrence score is, the more reduction in chronic knee pain and the more improvement of joint function is achieved after both procedures.

Onychocryptosis: a retrospective study of clinical aspects, inflammation treatment and pain management using Ozoile as a hydrogel and cream formulation.

Ingrown toenails account for roughly 20% of all foot problems in primary care. It is most common in young men, with nail care habits and footwear being major contributors. Onychocryptosis is typically caused by self-treatment attempts to cure the condition in its early stages. Its clinical features are frequently confused with other osseous and soft tissue abnormalities. The goal of this study was to provide perspectives on the management of pain and inflammation in Onychocryptosis using an Ozoile-based hydrogel formulation in a semi-occlusive bandage for 14 days, while incorporating natural pharmacological solutions into established protocols. The primary outcomes measured were pain reduction on NRS and stadiation according to the Al Kline Classification. The reduction was statistically significant, with a mean decrease in VAS score from 10 to 4 (p < 0.05), and Al Kline classification decreased by an average of 1.6 stages. 42% of patients recovered within the first 15 days of treatment, and 93% by the end of the scheduled treatment.

Investigating of Minimally Invasive Approaches in the Treatment of Temporomandibular Joint Disorders.

Minimal intrusive TMJ operations have been recommended as a substitute for conservative therapy when conservative measures fail to relieve significant acute pain, chronic discomfort, inflammation, and/or degenerative illness, specifically in TMD cases. This study was conducted to investigate minimally invasive approaches (TMJ arthrocentesis and TMJ arthroscopy) in the treatment of temporomandibular joint (TMJ) disorders. It was a prospective study which included 30 clinically and radiographically diagnosed cases of TMDs. The study participants underwent two main therapy was carried out: TMJ arthrocentesis and TMJ arthroscopy. There was assessment of pain through VAS scale and maximum mouth opening (MMO) 1 month preoperatively as well as 3 months postoperatively. There was statistically significant decrease in mean VAS score and increase in MMO in patients treated with TMJ arthrocentesis and TMJ arthroscopy. When there is comparison between TMJ arthrocentesis and TMJ arthroscopy, then there was more reduction in pain and increase in MMO in TMJ arthroscopy; however, the difference was non-significant statistically at both preoperative and postoperative situations. Minimally invasive approaches like TMJ arthrocentesis and TMJ arthroscopy can be useful in the treatment of TMJ disorders.

Comparison of pain relief among patients with chronic plantar fasciitis treated with intralesional platelet-rich plasma injection versus corticosteroid injection in a tertiary care centre in Kerala - a prospective study

Background: Aim of the study was to compare pain relief and functional outcome and between intralesional autologous platelet rich plasma injection (PRP) versus corticosteroid injection in the treatment of plantar, and fasciitis by using visual analogue score and American Orthopaedic Foot and Ankle Society (AOFAS) score. Methods: The sample size for the study was 30 patients attending Dr. Somervell Memorial CSI Medical College. Patients were divided into two groups (PRP versus steroid) of 15 each. The study follows a prospective observational design with follow up at 2 weeks, 2 months and 3 months post procedure. The functional outcome of patients in each group was assessed using the visual analog scale and AOFAS score. Results: Post-procedure, a significant decrease in VAS score was seen in patients treated with PRP injection (8.73 to 2.27) than those treated with Steroid injection (8.8 to 3.53). Also, there was a significant improvement in the AOFAS score from 72.73 to 88.67 while for those patients treated with steroid injection, the AOFAS score was comparatively low (65.87 to 82.2). Conclusions: Plantar fasciitis is a prevalent condition in our community, and many treatment options typically offer only temporary relief from symptoms. Intralesional PRP injection emerges as a dependable treatment method that fosters the healing process of the affected fascia, resulting in improved functional outcomes. Our study indicates that a singular administration of platelet-rich plasma injection for plantar fasciitis yields substantial pain relief compared to the local steroid injection.

From injury to rehabilitation: How kinesiology taping helps patients with first metatarsophalangeal joint sprain (turf toe) in pain reduction, gait parameters and functional ability improvement. A randomized clinical trial

ObjectiveTurf toe is a common sports injury that may affect mobility and functional ability. For complete recovery, rehabilitation modalities are required to overcome these issues. This study investigated whether kinesio taping (KT) would reduce pain, improve gait performance, and enhance the functional capacity of turf toe patients undergoing physical therapy. Methodssixty patients with grade II turf toe (age; 25–30 years) assigned randomly into three treatment groups; KT applied alongside an exercise program conducted three times/week for 12 successive weeks. (KT group; n = 20), placebo taping plus exercise (Placebo group; n = 20), or exercise only (Control group; n = 20). Pain, gait parameters, and functional ability assessed using VAS, 3D gait analysis, and 6MWT respectively pre- and post-treatment. ResultsThere was a significant post-treatment decrease in VAS score in the KT group lower than the control or placebo group and a significant increase in 6MWT distance in the KT group higher than the control or placebo group (p < 0.001). Additionally, there was a significant post-treatment increase in step length, stride length, cadence and velocity of KT group higher than control and placebo group (p < 0.05). There was no significant difference in gait parameters between control and placebo groups post treatment (p > 0.05). ConclusionsThe findings of the study demonstrated that KT is a useful complementary modality to exercise in patients with turf toe, as it may result in more favorable improvements to pain, gait characteristics, and functional abilities. Further studies should be conducted to assess the long-term effects, different KT application methods, and tailored treatment protocols on turf toe.

Investigation of the Relationship of Functional Improvement and Body Mass Index in Breast Reduction Patients.

Due to macromastia, center of gravity changes and neck, shoulder, back pain become prominent. Macromastia and obesity separately cause pain and an increase in curves of vertebra. The aim of this study is to compare the functional benefits of reduction mammoplasty between obese and non-obese patients. Data of this retrospective study were collected from archives and include preoperative/postoperative thoracic Cobb angles, preoperative/postoperative VAS scores, BMI and resected breast tissue weight of patients who underwent reduction mammaplasty operations between August 2017 and April 2019 in Plastic, Reconstructive and Aesthetic Surgery Department. This study shows that reduction mammoplasty enables significant decrease both in thoracic kyphosis angles and in neck, shoulder and back VAS scores. However, no significant difference was found in preoperative/postoperative values and mean amount of changes of thoracic kyphosis angles between obese and non-obese patients. Decreases in neck, shoulder and back VAS scores were not found statistically significant between two groups. The breast resection amount was not related to correction of kyphosis, but it enabled only a significant decrease in neck VAS scores. Functional improvement was not related to body mass index in reduction mammoplasty patients. Functional benefits were observed similarly in both obese and non-obese patients. A precise threshold value for body weight, body mass index and amount of breast tissue could not be defined as an indication for functional reduction mammoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PROSPECTIVE STUDY OF COMPLETE ACROMIOCLAVICULAR JOINT DISLOCATION REPAIR BY DOUBLE ENDOBUTTON METHOD

Objectives: Double-endobutton technique offers a better treatment for dislocation when compared to conventional method for the acromioclavicular (AC) joint disturbance treatment. Hence, we have planned to assess the experimental outcomes of complete AC joint dislocation through double endobutton method. Methods: Thirty subjects among 20–68 years with a complete AC joint dislocation were studied. Diagnosis has been made by radiograph of both clavicle anteroposterior stress view and all subjects were subjected to Double Endobutton practice. Outcome was assessed using visual analog score, disabilities of the arm, shoulder, and hand, coracoclavicular, and constant shoulder score. Results: Among 30 subjects, male subjects were found to be 18 subjects with 34.43±7.65 years as the mean age between them. There was a substantial decrease in VAS score and DASH score from pre-operative to post-operative. A substantial development in the subjective shoulder value (28.4% vs. 98.12%; p=0.001) and Constant–Murley score (32.43% vs. 96.76%; p=0.005) from pre-operative to post-operative was observed with the subjects. At final follow-up, 28 patients showed excellent outcome and fair outcome in two patients. Further, no subjects were reported with any additional difficulties. Conclusion: This practice offers a modest, affordable, single-stretch surgical procedure that re-establishes coraco-clavicular interval and sustains until the native ligaments rebuild. This technique also demonstrates to be an outstanding alternate modal in rectifying whole AC joint dislocation.

Effectiveness of the Cunningham technique for shoulder dislocation reduction and its role in providing analgesia and muscle relaxation as an adjunctive method

BackgroundShoulder dislocation, particularly anterior dislocation, is a common orthopedic injury often presenting in emergency care settings, characterized by significant pain and muscle spasms. Prompt reduction is essential to alleviate symptoms and restore function. The Cunningham technique employs gentle pulling and massage motions targeted at the muscles and has emerged as a promising method for reducing anterior shoulder dislocations. However, its reported success rates vary widely across studies, and questions remain regarding its efficacy, particularly in cases of failure. This study aims to evaluate the effectiveness of the Cunningham technique for reducing anterior shoulder dislocations and its potential role in providing analgesia and muscle relaxation as an adjunctive method. MethodsA retrospective study was conducted on patients presenting with acute anterior shoulder dislocation at a single center. Reduction using the Cunningham technique was performed initially, followed by the external rotation technique if unsuccessful. Procedural sedation and analgesia were administered if the reduction was still not achieved, and shoulder dislocation reduction was performed again through the external rotation method. The patients’ VAS scores were recorded and evaluated the Cunningham technique's effectiveness in reduction and whether it increases the effectiveness of other techniques applied for reduction by lowering the VAS score, even in cases where it is not effective. ResultsA total of 61 patients were included in the study. The reduction was performed using the Cunningham technique in 34.4% (21/61) patients, the external rotation technique in 47.5% (29/61) patients, and the external rotation technique with PSA in 18% (11/61) patients. Significant differences were observed in the duration of hospital stay among the three techniques, with ER with PSA resulting in the longest stay. VAS scores showed significant improvements from initial presentation to post-reduction in all three groups. A significant decrease in pre-reduction VAS scores was observed during the transition from the Cunningham technique to other techniques. ConclusionThe Cunningham technique showed effectiveness in reducing anterior shoulder dislocations, providing analgesia, and muscle relaxation. It demonstrated favorable outcomes as an initial reduction technique, with the external rotation technique used as a subsequent option. Further studies comparing the success rates and complications of the Cunningham technique with other reduction methods are warranted to establish its role in clinical practice.

THE IMPACT OF SCAPULAR MOBILIZATION ON THE EFFECTIVENESS OF ROM EXERCISES IN PATIENTS WITH ADHESIVE CAPSULITIS

Objective: Adhesive capsulitis is a condition characterized by shoulder pain and limited motion. It primarily affects women and can be secondary or idiopathic. Risk factors include diabetes, rotator cuff impairment, and cardiovascular disease. Nevasier first identified the pathology and differentiated it from periarthritis.&#x0D; Methods: Adhesive capsulitis has a prevalence of 2-5% in the general population of India, with the highest occurrence in the mid-50s. A study reported an annual incidence of shoulder pain of 14.7 per 1000 individuals and a lifetime prevalence of up to 70%. The exact cause of adhesive capsulitis is uncertain, but it is associated with systemic disorders and underlying conditions such as trauma, avascular necrosis, osteoarthritis, diabetes, hyperthyroidism, and rheumatoid arthritis. Other clinical diseases, reflex sympathetic dystrophy, and age between 40 and 65 are also linked to the condition.&#x0D; Results: Our study provides showed in Group A, consisting of 9 males and 6 females, and Group B consisting of 8 males and 7 females. Overall, the study group comprised 17 males and 13 females. Additionally, the analysis of pre-test and post-test values of SPADI and VAS scores revealed significant improvements in Group A, with a significant decrease in SPADI scores from 70.0 to 41.73 (p = 0.037). However, the decrease in VAS scores from 5.8 to 3.2 was not statistically significant (p = 0.35). In Group B, although there were reductions in both SPADI and VAS scores, the changes were not statistically significant.&#x0D; Conclusion: Adhesive capsulitis is a common condition characterized by shoulder pain and limited motion. It primarily affects women and can be secondary or idiopathic. The exact cause is unknown, but it is associated with systemic disorders and underlying conditions. Diagnosis is clinical, with imaging used for additional information. Treatment includes oral NSAIDs, steroid injections, and physiotherapy. Scapular mobilization techniques may improve outcomes. Further research, such as randomized controlled trials, is needed to evaluate their effectiveness.

Poster 180: A prospective randomized comparative study between isolated eccentric versus conventional exercise therapy in athletes with rotator cuff tendinopathy

Objectives: To compare the effectiveness of an isolated Eccentric exercise program versus Conventional exercise program in athletes with rotator cuff tendinopathy. Methods: The study included 80 athletes with rotator cuff (RC) tendinopathy (diagnosed on Magnetic resonance imaging) presenting to author’s tertiary level institute. Patients were randomized into two groups of 40 each. The eccentric exercise group (n = 40, mean age = 26.4years ) received an isolated eccentric training combined with stretching, while the conventional exercise group received scapular stabilization exercises, concentric RC strengthening exercises and stretching. (n = 40, mean age = 25.2years). Patients in both groups fulfilled 12 week daily home based exercise program and received treatments twice a week for 3 months. Primary outcome measures were shoulder pain (a 0–100mm Visual Analog Scale; VAS) and function measured with the Constant Murley score and Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcome measures were isometric abduction strength in 45° in the scapular plane (Hand held dynamometer) and shoulder range of motion (forward elevation, abduction and external rotation). All measurements were taken at baseline, at 12, and 24weeks. There was no statistically significant difference in pre-intervention scores between two groups. The study was approved by Institutional Review Board. Results: After 24 weeks, both groups showed a significant decrease in VAS scores and DASH score and a significant increase in the Constant Murley score. No statistically significant differences were found between the groups for any of the evaluated outcome measures. In the EE group, there was a slight deterioration in both CM and VAS scores between 12 and 24 weeks, but this did not reach statistical significance. Both groups also had a significant increase in isometric muscle strength between baseline and 24 weeks. Conclusions: A 12 week isolated eccentric training program of the rotator cuff is as effective (but not superior to) as conventional exercise program for the rotator cuff tendinopathy in athletes.

The AAHKS Clinical Research Award: Oral Dexamethasone Following Total Knee Arthroplasty: A Double-Blind, Randomized Controlled Trial

BackgroundIntravenous dexamethasone has been shown to reduce pain in total joint arthroplasty. This double-blind, randomized, placebo-controlled trial investigated the postoperative effects and safety of oral dexamethasone as a potential augment to multimodal pain management in outpatient knee arthroplasty. MethodsThe authors prospectively randomized 109 consecutive patients undergoing primary total knee arthroplasty. Patients assigned to Group A (57 patients) received 4 mg of dexamethasone by mouth twice per day starting postoperative day (POD) 1 for 4 days and those assigned to Group B received placebo capsules. All healthcare professionals and patients were blinded to group allocation. The primary outcome was defined as postoperative pain scores. Secondary outcomes included 90-day postoperative complications, nausea and vomiting, daily opioid usage, assistance for ambulation, difficulty sleeping, and early patient reported outcomes. Demographics were similar between groups. ResultsThe patients who received dexamethasone had a statistically significant decrease in VAS scores when averaging POD 1 to 4 (P = .01). The average VAS scores among individual days were significantly lower with dexamethasone on POD 2, 3, and 4. While taking dexamethasone, morning and mid-day VAS scores were significantly lower. There was no difference between the groups with opioid use, nausea or vomiting, 90-day complications, ability to walk with/without assistance, difficulty sleeping, and early patient reported outcomes. ConclusionThis double-blind, randomized, placebo-controlled trial demonstrated that oral dexamethasone following primary total knee arthroplasty can reduce postoperative pain. This may be a beneficial option in ambulatory surgery where intravenous limitations exist, but larger series are needed to further evaluate the safety profile in this population.

Comparison of rectal suppository and intramuscular morphine for management of patients with renal colic referred to the emergency department: A randomized double-blinded controlled trial

Objectives: To compare the analgesic effects of rectal suppository morphine (RSM) with intramuscular morphine (IMM) in patients suffered from renal colic referred to emergency ward (EW).&#x0D; Methods: In a controlled, randomized, clinical trial, 74/90 patients with renal colic referred to the EW between March 2016 and March 2017 were randomly enrolled into two groups of RSM (10 mg) and IMM (10 mg/mL). Vital signs and severity of pain were recorded at admission time (0), 15, 30 and 60 min after treatment.&#x0D; Results: The results showed that there was a significant decrease in VAS score of RSM group compared to IMM group after 30 and 60 min of administration (P˂0.05). Furthermore, no significant difference was recorded in vital signs, except there was a significant decrease in heart rate (15 and 60 min) and respiratory rate (60 min) of RSM group compared to IMM group (P˂0.05) and no side effects were recorded during the investigation.&#x0D; Conclusion: In conclusion, the use of rectal route of morphine had higher efficiency compared to the IM route of morphine in relieving pain of patients with renal colic. Although, decreased heart and respiratory rates were recorded, the values were in normal range. As well, no major complications were recorded for each method.

No difference in quality of life between persons with severe haemophilia A and B.

Good health-related quality of life (HRQoL) is an important goal in the treatment of persons with haemophilia B (PwHB). Studies focusing on this population are limited, however, and data are insufficient. To assess the HRQoL in PwHB and to compare this to data on persons with haemophilia A (PwHA), as well as to evaluate the impact of joint health on HRQoL and to identify areas of insufficient care. The B-NORD study enrolled persons with severe haemophilia B and matched controls with haemophilia A. HRQoL was assessed using the EQ-5D-3L questionnaire and joint health using Haemophilia Joint Health Score 2.1 (HJHS). The EQ-5D-3L was completed by 63 PwHB and 63 PwHA. Mobility problems were reported by 46% of PwHB and 44% of PwHA, pain/discomfort by 62% and 56%, and anxiety/depression by 33% and 17%, respectively. No significant difference was observed between PwHA and PwHB in EQ-5D profiles, level sum score, EQ-5D index (PwHB mean .80, PwHA mean .83, p=.24), or EQ VAS score (PwHB: mean 70, PwHA: mean 77, p=.061). Linear regression adjusted for age demonstrated that an increase in HJHS score was associated with a significant decrease in both EQ-5D index (B -.003, R2 .22) and EQ VAS score (B -.37, R2 .17). Despite the majority of patients being treated with prophylaxis, impaired HRQoL was reported in both PwHB and PwHA. No differences in HRQoL were found between the two groups. Impaired joint health had a significant negative impact on HRQoL.

Is dienogest a convenient treatment option for cesarean scar endometriosis or should it be treated surgically?

ObjectivesEndometriosis-related conditions such as subcutaneous endometriosis have been frequently seen in recent years, and dienogest or surgical excision is generally preferred as a treatment option. Our aim in this study is to determine which treatment option will be more effective in reducing the symptoms of patients with cesarean scar endometriosis.Study designThis prospective study was performed with 21 patients diagnosed with cesarean scar endometriosis. The demographic features of the patients, lesion sizes before and after medical and surgical treatment, VAS scores and Ca-125 levels were recorded. VAS scores and lesion sizes were compared before-after medical treatment and before-after surgery in same group. ResultsA total of 18 women were identified, with a mean age of 32.3 ± 5.7 years. No significant decrease in lesion size was observed in the 1st and 6th-month controls after the use of dienogest (p > 0,05), while a significant decrease in VAS scores was detected (p < 0,05). After surgery, the decrease in both lesion size and VAS scores was found statistically significant (p < 0,05). ConclusionDienogest, which is frequently used in the medical treatment of pelvic and ovarian endometriosis, reduces pain minimally in cesarean scar endometriosis but does not provide a change in lesion size. Therefore, surgical treatment of cesarean scar endometriosis seems to be more effective in reducing pain and decreasing the size of the lesions.

Does preventive single dose of intravenous dexketoprofen reduce pain and swelling after orthognathic surgery? A prospective, randomized, double blind clinical trial.

The purpose of this study was to evaluate the effect of a single-dose intravenous dexketoprofen administration for preventive analgesia on postoperative pain and reducing swelling in double jaw surgery. The authors designed a prospective, randomized, and double-blind cohort study. Patients who have Class III malocclusion were randomly divided in two groups. 50 mg intravenous dexketoprofen trometamol were administrated 30 minutes before incision in treatment group, while intravenous sterile saline was administrated 30 minutes before incision in placebo group. The primary predictor variable was treatment group. Primary outcomes were pain, swelling and 24-hour opioid intake. Patient- controlled analgesia with tramadol was given for management of postoperative pain. Other variables were demographic and operation related parameters. Visual analogue scale was used to evaluate postoperative pain. 3dMD Face System (3dMD, USA) was used to measure postoperative swelling. Data were analysed using two independent samples t test and Mann Whitney U test. The study sample was composed of 30 patients with a mean age of 20,63 years and 21 were female. Preemptive dexketoprofen administration decreased postoperative tramadol consumption by 25.9% compared to placebo group, and there was a statistically significant decrease in VAS scores (p<0,05). There was no statistically significant difference between the groups in terms of swelling (p>0,05). Preventive administration of intravenous dexketoprofen provides adequate analgesic effect in the postoperative 24-hour period and reduces opioid consumption in orthognathic surgery.

Short term results of single shot epidural steroid administration in patients with lumbar canal stenosis

Background: Lumbar spinal canal stenosis (LSCS) is one of the many reasons of persistent back pain. Spinal canal narrowing due to disc degeneration, osteophytes, and arthritic facet joints is what's known as LSCS. The purpose of this research is to examine the efficacy of epidural steroid administration (ESI) in reducing pain experienced by people with LSCS. Methods: This is a prospective clinical trial conducted on 25 cases from 20 to 70 years old suffering from LSCS with pain and radiculopathy symptoms.They have persistent symptoms for at least 6 months despite medication use & physiotherapy and refused surgery. All the administrations were performed by a single spine surgeon at the same center. A solution containing triamcinolone acetate 40 mg (1 ml), xylocaine 2% (1 ml)) and saline 10 ml as flushing agent. Results: VAS score was significantly decreased at day one, after one and three months of follow up compared to pre-treatment. VAS was also significantly decreased after the first and the third month compared to day one. VAS score was significantly lower in mild and moderate LSCS cases compared to severe LSCS cases after one day, one and three months of epidural steroid administration. The percentage of decrease in VAS score after one day, one and three months of epidural steroid administration from pretreatment VAS were significantly higher in mild and moderate LSCS cases than severe LSCS cases. Conclusions: In situations of spinal canal stenosis, ESI might be regarded as an effective technique for the relief of pain and alleviation of disability.

Effectiveness of muscle strengthening exercises on the clinical outcomes of patients with knee osteoarthritis: A randomized four-arm controlled trial.

Knee osteoarthritis (OA) is one of the major causes of dysfunction that reduces patients' quality of life. The aim of current study was to investigate the effectiveness of muscle strengthening exercises on the clinical outcomes of patients with knee OA. We conducted a single-blind clinical trial on 96 patients with mild to moderate knee osteoarthritis. Patients were randomly assigned to 4 groups with 24 patients and followed-up for 8 weeks. Quadriceps, hamstring and both hamstring and quadriceps strengthening exercises were received by the first (G1), second (G2) and third (G3) groups, respectively. The fourth group (G4) was the control group and did not receive any intervention. The main outcome variables were pain, physical function and morning stiffness. This study was retrospectively registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20220206053950N2, 2022-09-07. Our findings demonstrated a significant impact of interventions on VAS score, pain, and stiffness (All, p < 0.001). Nonetheless, the effect of interventions was not significant for physical function (P = 0.78). After adjusting for the potential confounders, similar results were observed. Besides, the results of Dunnett post hoc test showed that either G1 or G3 had the most decrease in VAS and WOMAC-morning stiffness scores compared to G2 and G4. Based on the evidence from the present study, we can recommend a combination of quadriceps and hamstring strengthening exercises as the most effective intervention to reduce pain and morning stiffness in patients with OA.