Decrease In Visual Analog Scale Research Articles

Efficacy of gabapentin phonophoresis on post mastectomy intercostobrachial neuralgia

Aim. To investigate the efficacy of gabapentin phonophoresis for neuropathic pain management in intercostobrachial neuralgia cases. Material and methods. Fifty-seven females with intercostobrachial neuralgia were randomly collected then allocated into two groups, Study group (gabapentin phonophoresis) and Control group (gabapentin gel). Study group: received gabapentin phonophoresis 4 times/week for 4 weeks (a total of 16 sessions) using continuous ultrasound (1 MHz, 1.5 W/cm², for 5 minutes). Control group: received topical 6% w/w gabapentin gel three times per day for 4 weeks on the affected site. The methods of assessment included visual analogue scale (VAS) and Neuropathic pain scale (NPS). All measurements were collected before the beginning of the study and after the end of the treatment (after 4 weeks). Results. There was no significant difference between both groups in VAS (= 0.43) and NPS (= 0.46) pre-treatment. Comparison between groups post treatment revealed a significant decrease in VAS and NPS of study group compared with that of control group (p < 0.001). The percentage of decrease in VAS of study group and control group was 51.32% and 43.03% respectively while the percent of decrease in NPS was 50.79% and 45.05% respectively. Conclusion. It was concluded that conduction of gabapentin gel topically or by using phonophoresis is safe and effective method for neuropathic pain management and can alleviate pain intensity; however, phonophoresis achieved better results and was superior to traditional gel application.

Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss.

In previous animal studies, sound enhancement reduced tinnitus perception in cases associated with hearing loss. The aim of this study was to investigate the efficacy of sound enrichment therapy in tinnitus treatment by developing a protocol that includes criteria for psychoacoustic characteristics of tinnitus to determine whether the etiology is related to hearing loss. A total of 96 patients with chronic tinnitus were included in the study. Fifty-two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment. There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p<.01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p<.01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p<.05) and at all months for VAS-1 (tinnitus severity) (p<.05) and VAS-2 (tinnitus discomfort) (p<.05). In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55dB HL in a relatively short period of 1 month.

The influence of exercise on pain, disability and quality of life in office workers with chronic neck pain: A systematic review and meta-analysis

BackgroundExercise is recommended for office workers with neck pain. However, recent reviews evaluated the effectiveness of workplace interventions only. ObjectivesTo evaluate the effect of exercise on pain, disability, and quality of life (QoL) in office workers with chronic neck pain. DesignSystematic review with meta-analysis. MethodsElectronic databases were searched from inception to April 30, 2022, to identify studies in which participants were adults aged ≥18 years undergoing any form of neck exercises (e.g., strengthening, motor control) or physical activity (e.g., aerobic exercise) performed for a minimum of two-weeks without any other additional treatment besides advice or education. Two reviewers independently screened papers and determined the certainty of the evidence. ResultsEight randomised controlled trials met the eligibility criteria. Seven studies reported a significant decrease in Visual Analogue Scale (VAS) scores for neck pain intensity and five studies reported a significant decrease in Neck Disability Index (NDI) scores following strengthening exercises. Only one study assessed the effect of strengthening exercises on QoL and reported no significant effect. All eight included studies had a high risk of bias and the overall certainty of evidence was low. Meta-analyses demonstrated a significant decrease of neck pain intensity and disability for strengthening exercises compared to a control (p < 0.01). ConclusionThere is low certainty of evidence that strengthening of the neck, shoulder and scapular musculature is effective at reducing neck pain and disability in office workers. Further research evaluating the effect of exercise on QoL is required.

Potassium-Competitive Acid Blocker Versus Proton Pump Inhibitor: A Pilot Study on Comparable Efficacy in the Treatment of Gastroesophageal Reflux-Related Cough.

Acid inhibitors have been considered in treating gastroesophageal reflux-related cough (GERC). Compared to proton pump inhibitors (PPIs), potassium-competitive acid blockers (P-CABs) have more potent and durable effects on anti-acid secretion. However, whether vonoprazan and esomeprazole have different therapeutic effects on GERC remains unknown. Patients diagnosed with GERC were enrolled in our study and randomly treated with vonoprazan (20 mg, once daily, P-CAB) or esomeprazole (20 mg, twice daily, PPI) for two months. A prokinetic agent was also administered. Patients were followed up once a month. Cough severity visual analogue scale (VAS) was measured as the primary outcome, while cough symptom score (CSS) and scores for cough-related quality-of-life or reflux-related symptoms were the secondary endpoints. A total of 50 patients completed the study, with 25 patients in each group. P-CAB and PPI groups showed similar decreases in cough severity VAS and CSS scores after the 2-month treatment (all P < 0.001). For quality-of-life, the Leicester Cough Questionnaire (LCQ) score increased significantly from baseline in both groups, but the P-CAB group had greater improvement and a higher LCQ score in month 2 (all P ≤ 0.05). For reflux-related symptoms, the Hull Airway Reflux Questionnaire (HARQ) score declined substantially over time in the P-CAB group, while the reflux symptom index (RSI) score decreased in both groups. The P-CAB group tended to have a lower HARQ (P = 0.051) and RSI (P = 0.069) scores in month 2. In conclusion, vonoprazan may be comparable to esomeprazole in cough symptom relief in GERC during the 2-month treatment period, but possibly provides better gains on classic reflux symptoms and quality-of-life. The long-term efficacy of P-CABs on GERC may be worth further exploration. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2200067089.

US-guided percutaneous irrigation of extra-shoulder calcific tendinitis.

To investigate the efficacy and safety of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) applied out of the shoulder, comparing its effectiveness to US-PICT of the rotator cuff. Patients subjected to US-PICT for extra-shoulder calcific tendinitis (Case Group) were compared to those subjected to US-PICT of the rotator cuff (Control Group). We had pre-procedure Visual Analogue Scale (VAS) pain score, 1- and 3-month VAS of patients of the Case Group, pre-procedure and 3-month VAS of patients of the Control Group. The Case Group consisted of 41 patients (27 women; mean age: 45 ± 9years): 26 gluteus medius, 5 patellar tendon, 3 rectus femoris, 2 gluteus maximus, 2 common extensor tendon, 1 extensor carpi radialis longus, 1 pes anserinus, and 1 peroneus longus. The Control Group included 41 patients (27 women; mean age: 47 ± 11 years). The mean pre-procedure VAS of the Case Group was 8.8 ± 0.7 with a significant (P < .001) drop at 1 month (4.5 ± 0.6) and 3 months (3.6 ± 0.6). The mean pre-procedure VAS of the Control Group was 8 ± 1.4 and dropped to 3.1 ± 1.6 after 3 months (P < .001). Post-treatment VAS at 3 months was not significantly different between two Groups (P = 0.134). Similarly, the decrease of VAS from baseline to 3 months was not significantly different between the two Groups (P = 0.264). US-PICT is a safe and effective procedure that can be used out of the shoulder. This study demonstrated the safety and effectiveness of US-PICT as a valuable therapeutic option for extra-shoulder calcific tendinitis, with similar clinical outcome to the same procedure performed in the rotator cuff. The technique must be adapted in some deeply located calcifications by means of the use of different needles and by thoroughly planning the access point for the procedure.

Is Teriparatide Superior in Treating Osteoporotic Vertebral Compression Fractures in Comparison to Bisphosphonates Treatment Alone: A 2-Year Retrospective Analysis.

Retrospective cohort study. This study aimed to compare the efficacy of bisphosphonates and teriparatide in the management of osteoporotic vertebral compression fractures with regard to pain management, prevention of nonunion, and radiological as well as clinical outcomes. Osteoporosis refers to a skeletal disorder characterized by decreased bone strength caused by poor bone density and quality causing fragility, resulting in long periods of pain-related immobilization. In a 24-month follow-up retrospective study, 191 patients with osteoporotic vertebral compression fractures were randomly assigned to the bisphosphonate group (n=104) or the teriparatide group (n=87), with patients opting for their treatment between January 2016 and October 2020. Demographic data and patient-reported outcomes scores, including the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), union rates, and kyphosis progression, were assessed at baseline, 6 months, 1 year, and 2 years after treatment. Both groups had a significant decrease in VAS, from 8.38±0.74 to 3.15±1.40 in the bisphosphonate group and from 8.49±0.73 to 1.11±0.31 in the teriparatide group. The ODI scores reduced significantly at 2-year follow-ups, recording 25.02±13.94 and 15.11±2.17 in the bisphosphonate and teriparatide groups, respectively. Risks of nonunion development were slightly higher at 11.53% in the bisphosphonate group and 8.63% in the teriparatide group required operative intervention. The kyphosis progression angles were also significantly lower in the teriparatide group (4.97°±0.78°) than in the bisphosphonate group (8.09°±1.25°). Over time, numerous studies have demonstrated the efficacy of bisphosphonates and teriparatide in ameliorating pain. In this study, the efficacy of teriparatide surpassed that of bisphosphonates in certain aspects, such as the initial 6-month union rates and reduction in the progression of segmental kyphosis. However, bisphosphonates and teriparatide yield similar and favorable union rates at 1 year and final follow-up.

P201: Effect of Virtual Reality-based Biofeedback in Highly Stressed People

Objective:Virtual Reality (VR)-based Biofeedback (BF), a relatively new intervention, is rapidly increasing for the treatment of mood disorders. However, research on whether VR-based BF is more effective than traditional BF is still lacking.Methods:A total of 131 adults from the community enrolled in the study. Participants scored ≥10 on Patient Health Questionnaire-9 (PHQ-9) or ≥9 on Panic Disorder Severity Scale (PDSS) were randomly assigned to VR or BF group. Those who have not met the criteria of PHQ-9 and PDSS were classified as the control group. All participants visited three times across 3 months and received either VR-based or conventional BF intervention. The control group received the same treatment as the VR group. Also, on each visit, the participants completed Montgomery-Asberg Depression Rating Scale (MADRS), State-Trait Anxiety Inventory (STAI), and Visual Analogue Scale (VAS).Results:The analysis included 118 participants in total (VR: 40, BF: 38, Control: 40). There was no significant difference in demographic variables among the 3 groups. After the treatment, VR and BF groups exhibited significant decreases in MADRS, PHQ-9, STAI, and VAS compared to the baseline within each group (p&lt;0.005). Importantly, compared to the BF group, the VR group showed a significantly greater decrease in STAI (p&lt;0.05). Further analyses revealed that scores of MADRD, PHQ-9, STAI, and VAS also significantly decreased in highly stressed group compared to the control group.Conclusion:Findings suggest that the application of VR-based BF was effective in reducing anxiety and depressive symptoms in highly stressed people. Compared to conventional BF, VR-based BF can be a cost-effective treatment option especially for relieving anxiety.

The Effect of Waiting for a Primary Total Hip Arthroplasty on the Overall Hip Function and Quality of Life

BackgroundThe primary aim was to determine whether time spent awaiting primary total hip arthroplasty (THA) affects patient-reported outcome measures (PROMs) using the Oxford Hip score, Harris Hip Score, and visual analogue scale (VAS) pain. The secondary aim was to assess whether patients have worsening HRQoL, while awaiting THA using the European Quality of Life Five Dimension (EQ-5D) index and EQ-5D health VAS. MethodsThis was a single center cross-sectional study of 190 patients awaiting THA. Patients were divided into waiting “more than 6 months” and “less than 6 months.” Baseline and current scores were compared. Multivariate regression analyses were performed to identify predictors of PROM change. ResultsNo significant intergroup differences were observed for change in preoperative Oxford Hip score, Harris Hip Score, and VAS pain from index consultation to time of study. The EQ-5D index and EQ-5D health VAS decreased significantly further in patients waiting more than 6 months (P = .043, P = .004). Time awaiting THA was significantly associated with a decrease in EQ-5D index and EQ-5D health VAS in multivariate regression (P = .013, P < .001). ConclusionsWaiting more than 6 months is not associated with a decrease in hip-specific PROMs and longer waiting times are not associated with changes in hip-specific PROMs. Waiting time was associated with a decrease in health-related quality of life and patients waiting more than 6 months had significantly higher decreases in EQ-5D scores. This suggests that living longer with hip osteoarthritis leads to a decrease in QoL, not necessarily through perceived osteoarthritis progression. Level of evidenceLevel III cross-sectional study.

The effect of nerve gliding on clinical outcome in batik workers of Yogyakarta with carpal tunnel syndrome

Background: The carpal tunnel syndrome (CTS), if left untreated, handicaps the manual workers and incurs heavy financial loss to them due to loss of their productivity and the cost on treatment. The nerve gliding exercises can speed up the rehabilitation process in these patients and improve their function. We aimed to observe the clinical efficacy of nerve gliding in reducing pain enhancing productivity in batik workers.&#x0D; Methodology: This study is a quasi-experimental and the subject were batik workers in Yogyakarta, Indonesia. Subjects who met the criteria were divided into Group I (n = 18) received nerve gliding with mecobalamin 3x500 μg and Group II (n = 17) as controls received 3x500 μg mecobalamin only. The pain relief was observed in the form of Visual Analog Scale (VAS) score and Boston Carpal Tunnel Questionnaire (BTCQ) score consisting of BTCQ symptom severity scale and functional status scale (FSS).&#x0D; Result: In paired t-test we found significant decrease in VAS scores in Group II on week 2 and 3. From the Wilcoxon test we found significanly decreased VAS scores on week I, 2 and 3 in Group I. From the Wilcoxon test we found significanly reduced BTCQ scores on week 3 in Group II, and significanly reduced BTCQ scores in Group I at week I, 2, and 3. The decrease in VAS and BTCQ was significantly higher in the Group I than Group II. Based on the multivariate analysis of model I, the nerve gliding gave significant effect on VAS (P = 0.001) and BTCQ (P = 0,000) scores.&#x0D; Conclusion: There is significant clinical improvement by using nerve gliding and mecobalamin for 3 weeks to batik workers in Yogyakarta.&#x0D; Abbreviations: BTCQ - Boston Carpal Tunnel Questionnaire; CTS - Carpal Tunnel Syndrome; FSS - Functional Status Scale; NSAIDS - Nonsteroidal Anti-Inflammatory Drugs; PO – Per Orum; ROM - Range of Motion; VAS - Visual Analog Scale&#x0D; Key words: Carpal Tunnel Syndrome; Clinical Outcome; Nerve Gliding; Safe Working Environment; Human&#x0D; Citation: Srie Setyaningrum CT, Hidayati HB, Astuti, Ayu Puspamaniar V, Indrihapsari EF. The effect of nerve gliding on clinical outcome in batik workers in Yogyakarta with carpal tunnel syndrome. Anaesth. pain intensive care 2023;27(5):579−584.&#x0D; DOI: 10.35975/apic.v27i5.2319&#x0D; Received: November 23, 2021; Reviewed: January 07, 2022 ; Accepted: January 08, 2022 -----

"SCULP" study: The benefits of skin graft pellets on the pain of sickle cell leg ulcers (SCLU).

Leg ulcers associated with major sickle cell disease (SCLU) are a chronic, painful complication, often treated by autologous skin graft. The analgesic effect of skin grafting in SCLU is poorly studied. The aim of this study was to evaluate the effect of skin grafting on the pain and healing of SCLU. Patients hospitalized for SCLU skin grafting were included in a retrospective and prospective observational cohort, between 2019 and 2023: 53 autologous pinch grafts were performed on a total of 35 SCLUs in 25 sickle cell patients. The primary endpoint was the evaluation of the analgesic effect of the skin graft, measured by visual analog scale (VAS) and weekly cumulative analgesic consumption between day (D)0, D7 and D30. Wound healing was assessed by variation in wound areas between D0 and D30. Twenty-five patients with a median age range of 45.5years old were included, 68% were men, SS genotype was present in 96% of the cases. At D7, a significant decrease in VAS and consumption of analgesics of all classes was observed. At D30, only a significant decrease in VAS and consumption of mild opioids was present, as well as a significant reduction in wound surface area compared with D0. Pinch grafts have a significant early analgesic effect in the management of patients with SCLU, and significantly notice reduction of wound surface area within one month.

Instrument Assisted Soft Tissue Mobilization versus Integrated Neuromuscular Inhibition Technique in Nonspecific Chronic Neck Pain: Single-blinding Randomized Trial

ObjectiveThis study aimed to compare the effects of instrument-assisted soft tissue mobilization (IASTM) vs integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, neck disability, and electrophysiological properties in nonspecific chronic neck pain. MethodsWe performed a pre-post prospective randomized controlled trial on 90 participants with nonspecific chronic neck pain. The participants were chosen randomly from physical therapy out-patient clinics in the Giza governorate and allocated randomly by permuted block to the following 3 groups: Group A received INIT on the upper trapezius in addition to supervised traditional therapy (STT) as hot pack, stretching and strengthening exercises, Group B received IASTM on the upper trapezius in addition to STT, and Group C received STT only. Treatment was 3 times per week for 4 weeks. Pain intensity by visual analog scale (VAS), pressure pain threshold (PPT) by commander algometer, neck disability by Arabic Neck Disability Index (ANDI), and electrophysiological properties in the form of muscle amplitude by root mean square (RMS), and fatigue by median frequency (MDF) were measured at baseline and after 4 weeks. ResultsIn the within-group analysis, there was a statistically significant decrease in VAS, ANDI, and RMS% values within each group with favor to INIT. In PPT and MDF, there was a significant increase within each group with regard to INIT as P value <.05. In the between-group analysis at posttreatment, the results reported a statistically significant difference between INIT and STT, and also between IASTM and STT in all variables. Between INIT and IASTM, there was no statistically significant difference in VAS and NDI, but there was a statistically significant difference in PPT, RMS%, and MDF. The post hoc test reported improvement in all variables in all groups, with more favor to the INIT group in PPT and electrophysiological properties only. ConclusionIn this study, we found no statistically significant differences between INIT and IASTM in VAS and ANDI posttreatment, but there were differences between INIT and STT group and IASTM and STT group.

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.

Hematolojik Parametrelerin Transforaminal Epidural Steroid Enjeksiyonu Sonrası Ağrı Azalması Üzerine Etkisi

Objective: Since inflammation plays an important role in radiculopathies, and that neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratios (PLR) are known to be associated with inflammation, the effects of these values on transforaminal epidural steroid injections (TFESI) in patients with lumbar radiculopathy were investigated. Methods: A total of 101 patients, who were diagnosed with lumbar radiculopathy and underwent TFESI, were retrospectively analyzed. Therapeutic success was considered to be a ≥ 50% decrease in visual analog scale (VAS) scores one month after TFESI. The patients in the study were placed in two groups according to whether their treatment was successful or unsuccessful, according to this criteria, and hemogram parameters in the two groups were then compared. Results: The study included 46 female and 55 male patients with a mean age of 49.43 ± 13.29. The median duration of symptoms was 3.0 (3.0-8.0) months. It was found that there was no significant difference between the groups in terms of neutrophil, lymphocyte, monocyte, platelet counts, mean plazma volümü (MPV), kırmızı hücre dağılım genişliği (RDW), platelet/ lenfosit oranı (PLR), sistemik inflamatuar indeks (SII), sedimentation, and C-reactive protein (CRP), although it was observed that there were significant increases in NLR in the successful group [2.34 (1.70-3.17)], as compared to the unsuccessful group [1.79 (1.51-2.57)] (p=0.026). Conclusion: Neutrophil/lymphocyte ratio is able to predict the response to TFESI treatment in patients with lumbar radiculopathy, in that patients with a higher NLR demonstrate a better response. Keywords: Hemogram parameters, inflammation, neutrophil to lymphocyte ratio, lumbar disc herniation, lumbar radiculopathy

Previous Lumbar Spine Surgery Decreases the Therapeutic Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency in Patients with Chronic Lumbosacral Radicular Pain.

Chronic lumbosacral radicular pain (CLRP) as a possible adverse consequence of lumbar spine surgery represents a serious medical challenge. Pulsed radiofrequency of dorsal root ganglion (PRF-DRG) treatment is known to be effective in alleviating CLRP. This retrospective study compares the efficacy of a single CT-guided PRF-DRG procedure in the treatment of unilateral CLRP between patients without (non-PSS) and with (PSS) previous lumbar spine surgery. Non-PSS and PSS groups included 30 and 20 patients, respectively. Outcomes (pain intensity and disability) were evaluated by means of the visual analog scale (VAS) and Oswestry disability index (ODI) immediately after the procedure (VAS), as well as three and six months after the procedure, respectively. Non-PSS group showed a significant (p ˂ 0.001) decrease of VAS (median) at all follow-up intervals (from 6 to 4; 4; 4.5 points, respectively). The PSS group showed a significant yet transient VAS (median) decrease (from 6 to 5 points) immediately after the procedure only (p < 0.001). The decrease of VAS was more pronounced in the non-PSS group after three and six months (p = 0.0054 and 0.011, respectively) in intergroup comparison. A relative decrease of VAS ≥ 50% during follow-up was achieved in 40%; 43.3%; 26.7% (non-PSS), and 25%; 5%; 0% (PSS) of patients. ODI (median) significantly decreased in the non-PSS group (from 21.5 to 18 points) at three and six months (p = 0.014 and 0.021, respectively). In conclusion, previous lumbar spine surgery decreases the therapeutic efficacy of PRF-DRG procedure in CLRP patients.

Initial Experience With Subchondral Stabilization for Grade II Stress Fractures of the Midfoot and Forefoot

Stress fractures of the foot are often preceded by magnetic resonance imaging evidence of bone marrow edema. While new evidence suggests intraosseous injection of calcium phosphate ("subchondral stabilization") can alleviate symptoms associated with bone marrow edema, no data yet exist regarding its use in developing mid- and forefoot stress fractures. Fifty-four patients who underwent subchondral stabilization of various midfoot/forefoot bones in our practice were observed over a 5-year period. All patients were unresponsive to standard nonoperative measures for at least 6 weeks, and all had clinical exams and advanced imaging consistent with a Kaeding-Miller Grade II stress fracture. Forty patients were included with a mean age of 54.3 ± 14.9 years and mean follow-up of 14.1 ± 6.9 months. Patients saw a significant decrease in visual analog scale (VAS) pain as early as 1 month postoperatively (p < .05). Mean postoperative VAS at 12 months was 2.11 ± 2.50, and mean reduction in VAS pain from preoperative to 12 months postoperative was -5.00 (95% CI -3.44 to -6.56, p < .05). Fourteen patients (34%, 14/41) were entirely pain free at 12 months. Higher preoperative VAS pain scores (unadjusted odds ratio [OR] 2.13 [95% CI 1.20-3.77], p=.010) and treatment of more than 1 bone (unadjusted OR 6.23 [95% CI 1.39-27.8], p=.017) were associated with a greater likelihood of not achieving a pain free status at 12 months. Our initial experience with subchondral stabilization suggests the procedure may be safe and effective for use in many Kaeding-Miller Grade II stress fractures of the mid- and forefoot.

Rapid and successful effects of combining dupilumab with ultraviolet B radiation therapy in the treatment of Papuloerythroderma of Ofuji.

Papuloerythroderma of Ofuji (PEO) is an uncommon disease characterised by widespread erythroderma composed of intensely pruritic solid papules coalescing into plaques sparing the skin folds (deck-chair sign). The pathogenesis of PEO remains unclear, although T helper (Th) 2 and Th22 cells may play an important role. Dupilumab is an interleukin (IL)-4 receptor α-antagonist that effectively reduces Th2 responses, which has drawn increasing attention in the treatment of PEO patients. Here, we reported a successful case of dupilumab treatment in combination with ultraviolet B (UVB) radiation therapy, which is well known and effective for chronic itch. The patient had a significant decrease in visual analogue scale (VAS) score and eosinophil after only 1 week of treatment, which may be due to the combination effect.

Effects of the TENS device, Exopulse Mollii Suit, on pain related to fibromyalgia: An open-label study

Fibromyalgia is characterized by diffuse and chronic pain, that is often only partially alleviated by the available pharmacological treatments. Therefore, nonpharmacological interventions such as transcutaneous electrical stimulation (TENS) are highly needed to improve the quality of life of this population. However, the classical TENS devices offer a limited number of electrodes and are not adapted to this diffuse painful condition. For these reasons, we aimed to assess the effects of a new TENS device, the Exopulse Mollii Suit, that can stimulate up to 40 muscle groups integrated into pants and jackets and connected to a control unit. We report the data of 50 patients who received one session of active stimulation (pulse intensity 2 mA, and pulse frequency 20 Hz). Pain intensity was evaluated by means of the visual analogue scale (VAS), before (T0) and after the session (T1), and 24 h later (T24). Compared to baseline scores, a significant decrease in VAS was observed after the session (p<0.001), and 24 h later (p<0.001). T1 scores were significantly lower than T24 scores (p<0.001). Therefore, this new system seems to exert analgesic effects whose mechanisms primarily evoke the theory of "gate control". The effects were transient and started to decrease the following day, highlighting the need for additional studies to better evaluate the long-term effects of this intervention on pain, mood, and quality of life.

Low Level Laser Versus Transcutaneous Electrical Nerve Stimulationon Post Herpetic Neuralgia

Background: Post herpetic neuralgia (PHN), a common neuropathic pain syndrome, usually occurs in patients with acute herpes zoster after resolving skin eruption. Persistent severe pain has a huge impact on a patient's physical function, mental health, and social communication ability, and also places a heavy burden on patients' families and on society. Objective: The current study was conducted to compare the efficacy of low level laser therapy (LLLT) versus transcutaneous electrical nerve stimulation (TENS) in the treatment of post-herpetic neuralgia Subjects and Methods: Fifty patients suffering from pain post herpetic neuralgia .Their ages ranged from 40 to 80 years.They were selected randomly from outpatient clinic in Deraya university referred by dermatologist then divided into two equal groups. Group (A) composed of 25 patients with post herpetic neuralgia and they received low level laser therapy LLLT in addition to traditional medical treatment and Group (B) composed of 25 patients with post herpetic neuralgia and they received Transcutaneous electrical nerve stimulation in addition to traditional medical treatment .Both modalities were applied once daily, 3 times a week for 20 minutes for 4 successive weeks. Visual analog scale (VAS) and pain pressure threshold (PPT) had been assessed before and after interventions. Results: There was a significant decrease in VAS and a significant increase in PPT post treatment compared with that pre treatment in group A and B (p &gt; 0.001). The percent of change in VAS and PPT in group A was 88.97 and 522.22% respectively, while that in group B was 82.39 and 462.79% respectively. Conclusion: Both LLLT and TENS were effective improving the post-herpetic neuralgia but LLLT was more effective. Keywords: Low level laser therapy, transcutaneous electrical nerve stimulation, post herpetic neuralgia, visual analog scale and pain pressure threshold

CRITICAL EVALUATIONS OF INTRA-ARTICULAR PLATELET RICH PLASMA ALONE OR COMBINATION WITH MEDIAL BRANCH RADIOFREQUENCY NEUROTOMY IN PATIENTS WITH LUMBAR FACET JOINT ARTHROPATHY: A PROSPECTIVE OUTCOME STUDY

Background: Common cause of chronic low back pain is lumbar facet joint arthropathy. Radiofrequency ablation (RFA) of medial branch currently preferred treatment in facet joint pain syndrome. Platelet-rich plasma (PRP) is known to initiate mesenchymal tissue healing by concentration of several fundamental protein growth factors. Our aim in this study is to evaluate the effect of co-administration of autologous PRP in lumbar facet and RFA of the medial branch of the dorsal ramus for lumbar facet arthropathy. Methodology: This was a prospective randomised study with a blind assessor. Eighty-one consecutive patients who complained of low back pain secondary to lumbar facet joint arthropathy were randomly allocated into three-groups: Group RF: only RFA done. Group PR: received both PRP plus RFA. Group PL: received only PRP. Primary outcome of the study was assessment of pain intensity using visual analogue scale (VAS). Result: The patients who had both RFA and PRP therapy had significant decrease in VAS score as compared to its baseline in the immediate and long term follow up period ([Formula: see text] &lt; 0.001). However, for those who received only PRP, the decrease in VAS was more significant at 1 and 4 months. Similarly, there was a significant improvement in ODI score in patients who received both RFA and PRP ([Formula: see text] &lt; 0.001). There was a gradual improvement in ODI in PRP group at 4-month interval. Rescue analgesics requirement was reduced and patients were better satisfied in those who received both RFA and PRP therapy. ([Formula: see text] &lt; 0.05). Conclusion: The combined administration of RFA and PRP proved to provide better analgesia in both short-term follow up and long-term follow up than treatment with either method in patients with lumbar facet syndrome.

Effects of 6 weeks of ankle stability exercises on pain, functional abilities, and flexibility in patients with chronic non-specific low back pain: a randomized controlled trial

BackgroundDue to delayed activation of the deep trunk muscles, patients with chronic non-specific low back pain use different adjustment strategies to maintain postural control. Patients with chronic non-specific low back pain maintain a quite standing posture during pain episode and challenging activities by using signals from other joints, mainly the ankle joint. Since proprioceptive signals from the ankle joint reduce postural control variability in patients with chronic non-specific low back pain, this study explored whether ankle stability exercises added to traditional physical therapy exercises would improve the intensity of pain, functional disabilities and lumbar flexion range of motion in patients with chronic non-specific low back pain.MethodsSixty patients with chronic non-specific low back pain participated in the current study. Patients were randomly assigned into two groups: group A and group B. Patients in group A received traditional physical therapy exercises for low back pain. Patients in group B received the same traditional physical therapy exercises as patients in group A, plus ankle stability exercises. The intensity of pain, functional disability, and lumbar flexion range of motion were assessed twice before and after a 6-week period during which each group received their interventions.ResultsMixed design MANOVA revealed a significant decrease in visual analog scale and Oswestry Disability Index in group B compared to group A post treatment (p < 0.05). Moreover, there was a significant increase in the lumbar flexion range of motion in group B compared with group A post treatment (p < 0.05).ConclusionThe findings of this study revealed that adding ankle stability exercises to the traditional physical therapy exercises significantly improved pain, Oswestry Disability Index, and lumbar flexion range of motion in patients with chronic non-specific low back pain. Thus, ankle strengthening and proprioceptive exercises may be beneficial in the management of chronic non-specific low back pain.