Decrease In Pain Score Research Articles

COMBINATION OF ULTRASOUND THERAPY, MUSCLE ENERGY TECHNIQUE, AND SUSTAINED NATURAL APOPHYSEAL GLIDES IN NON-SPECIFIC NECK PAIN – A CASE SERIES

Background: Non-specific neck pain is a common neuromusculoskeletal problem and affects about two thirds of people worldwide. Purpose: To find out the efficacy of the combination therapy in individuals with non-specific neck pain. Case: The intervention was given in 12 sessions (3 times per week for 4 weeks) with the total duration of therapy per session is 20 minutes. The sequence of interventions includes: ultrasound therapy, application of muscle energy techniques, and SNAGs mobilization. Evaluation of therapy in the form of pain was measured by a visual analogue scale and the range of motion of the cervical spine’s lateral flexion was measured by a goniometer. Result: The results of the case series showed a decrease in pain scores from an average of 5.67 to 2.73. In the range of motion of the cervical spine’s lateral flexion there was an increase from an average of 30 degrees to 36 degrees. Conclusion: The combination of ultrasound therapy, muscle energy technique, and sustained natural apophyseal glides provided benefits in reducing pain and increasing the range of motion of the cervical spine’s lateral flexion in individuals with non-specific neck pain. This case series can be used as a preliminary study to develop further research with experimental methods in proving the effectiveness of the combination therapy in treating non-specific neck pain.

Preemptive Analgesic Efficacy of Dexamethasone and Diclofenac in Mitigating Post-surgical Complications After Mandibular Third-Molar Surgery: A Systematic Review.

Mandibular third-molar extraction is a frequently executed minor oral surgical procedure, with a subsequent recovery period lasting several days. Typically, preemptive administration of non-steroid anti-inflammatory drugs (NSAIDs) and steroids has been employed, resulting in a notable decrease in postoperative complications like pain, facial swelling, trismus, and alveolar osteitis. This systematic review's primary goal was to investigate the efficacy of preemptive analgesia with dexamethasone and diclofenac in minimizing the post-surgical complications following the surgical extraction of the mandibular third molars. The systematic search was carried out to identify relevant literature in digital databases including PubMed®, Cochrane Library, Web of Science, and Scopus, from January 1990 to January 2022. The search used specific keywords. The randomized clinical trials assessing the efficacy of dexamethasone and diclofenac or dexamethasone alone compared to diclofenac or placebo as preemptive analgesics were consideredinclusion criteria for this systematic review. Case reports, literature reviews, letters to the editor, and non-English publications were not included. Two authors screened the titles and abstracts, and articles fulfilling the study criteria were included. After reading the full text and data collection, analysis was performed. The included article's bias was evaluated by the Risk of Bias 2 (RoB 2) tool. Adigital database search yielded a total of 207 articles. After excluding duplicates and articles written in languages other than English, 90 were removed. Based on the title and abstract, out of 177, 95 studies were excluded.After full-text reading of 22 articles, 17 were eliminated because they did not meet the inclusion and exclusion criteria. The remaining five studies were found eligible and included in the systematic review. Four studies were of low risk, while one study had some concerns. Two studies evaluated the combination of dexamethasone with diclofenac, while three evaluated dexamethasone alone. Total samples included samples of 436 third-molar surgeries in 420 patients. There was a substantial decrease in the mean pain score and swelling measurement when diclofenac alone was compared with coadministration of diclofenac and dexamethasone. Preemptive administration of dexamethasone and diclofenac has been shown to effectively reduce pain and facial swelling, with the exception of trismus, in third-molar surgeries when compared to diclofenac alone. As a result, it is recommended to administer these drugs prior to the commencement of third-molar extraction. However, further research is mandatory, specifically good quality randomized controlled trials involving large cohorts, in order to assess any significant variations and validate these findings.

Listening to Remotely Monitored Home-based Preferred Music for Pain in Older Black Adults with Low Back Pain: A Pilot Study of Feasibility and Acceptability

BackgroundLow back pain (LBP) is a complex condition that is widespread among older Black adults. Nonpharmacologic interventions are recommended as first-line therapy, but their use in practice is limited, possibly due to misunderstanding of their analgesic characteristics. AimTo determine the feasibility and acceptability of listening to preferred music at home to relieve pain in older Black adults aged 65 years or older with LBP. MethodWe recruited 20 community-dwelling older adults (≥65 years) with LBP to use noise-isolating headphones to listen to their preferred music for 20 minutes twice daily for four days via the MUSIC CARE® app. Feasibility was determined using enrollment, adherence, and attrition rates, and acceptability was determined using the Treatment Acceptance and Preference (TAP) scale. Average pain scores were self-reported using the Numeric Rating Scale (NRS) after the second intervention of the day. Pain scores were evaluated using paired sample t test and repeated-measures ANOVA. ResultsEnrollment, adherence, and attrition rates were 95.25%, 100.00%, and 0.00%, respectively. Most participants rated the TAP scale at ≥3, indicating acceptance. Pain scores decreased significantly from baseline (M = 46.90, SD = 21.47) to post-intervention (M = 35.70, SD = 16.57), t (19) = 2.29, p = .03. Repeated measures ANOVA showed a significant decrease in mean pain scores over time [F (2.36, 44.88) = 5.61, p = .004, η2 = .23]. ConclusionsListening to preferred music for 20 minutes twice a day is a feasible and acceptable intervention that can considerably reduce pain in older Black adults with LBP.

Effectiveness of Squeezing Ball Technique on Reduction of Pain during Insertion of Intravenous Cannulation amongst Hospitalised Toddlers in a Selected Hospital, Kolar

Abstract Background: The hospitalised children undergo painful procedures during their treatment, like intravenous (IV) cannulation, leading to significant stress and discomfort. Accurate assessment and management of pain in children are vital in promoting comfort during hospitalisation. Psychological interventions like distraction techniques have been shown to be useful in reducing pain intensity. Aim: The objectives of the study were to evaluate the effectiveness of the squeezing ball technique in the reduction of pain during IV cannulation amongst hospitalised toddlers in experimental and control groups using the FLACC pain scale and to determine the association of pain score amongst hospitalised toddlers with selected demographical variables in experimental and control groups. Methods: A true experimental post-test-only design was adopted. Using the systematic random selection sampling (block number randomisation) technique, 60 hospitalised toddlers aged between 1 and 3 years undergoing IV cannulation, 30 in the intervention group and 30 in the control group, were included in the study. The pain was assessed using the FLACC pain rating scale. Results: The result showed that there was a significant decrease in the mean pain score of hospitalised toddlers in the experimental group (pain score = 8.26 ± 1.22) compared to the control group (pain score = 9.0 ± 0.87) during IV cannulation. There was no association between the sociodemographic variables and pain scores of hospitalised toddlers. Conclusion: The study reveals that the squeezing ball technique is effective in reducing pain amongst hospitalised toddlers admitted to the children’s ward.

Efficacy of Lidocaine Infusion for Treatment of Chronic Neuropathic Pain: A Case Control Study

Background: Neuropathic pain is a type of chronic pain that is related to nerve damage and is defined by the International Association of Study of Pain (IASP) as “pain caused by a disease or lesion of the somatosensory nervous system”. It remains a challenging clinical problem as pain often can be quite severe and debilitating. The rationale of this study is to find out the efficacy of intravenous lidocaine infusion for neuropathic pain management in our population as there has been no study conducted in Pakistan for this purpose. As our country has a rather low-income population and cheaper options for treatment need to be explored. Objective: To determine the efficacy of lidocaine infusions of 3 mg/kg in managing the chronic neuropathic pain given at 0,1, 2 and 3 weeks in comparison to the placebo infusion. Study Design: Case control study. Settings: The study was conducted in the Sheikh Zayad Hospital Lahore Pakistan. Duration: July 2022 to December 2022. Methods: 100 outdoor patients fulfilling the inclusion and exclusion criteria were enrolled after taking informed written consent and were randomly allocated to Lidocaine group (A) 3 mg/kg, diluted in 50 ml normal saline and placebo group (B) 50 ml intravenously over 30 minutes. The Lidocaine group was injected with lidocaine, intravenously over 30 minutes once a week for 4 weeks. Patients with established diagnosis of neuropathic pain, adults of both genders, age above 18 years were enrolled in this study. Their pain severity was recorded using Numerical rating scale (NRS). The data of both groups was recorded in predesigned proforma and efficacy was also noted as labelled as Yes/No for two points; 1: Decrease in pain score by at least 2 out of 10 and 2: Decrease in oral analgesics intake. Results: There were 50 patients in group A and B with the mean age of 53.82 years and 54.4 years respectively. Patients in group A who received an intravenous infusion of lidocaine reported less severe pain and fewer instances of breakthrough pain. No statistically significant difference (P>0.05) was discovered between NRS ratings before and after infusions in the control group despite the fact that several patients reported lower pain intensity after the infusion. The quantity of opioid used was determined for the Lidocaine and Placebo groups. Opioid in the placebo group was 0.472–0.572 g per patient, but in the Lido group it was only 0.1–0.2 g per patient which is significantly different from placebo group (p=0.0021). Conclusion: Lidocaine intravenous infusion (3 mg/kg daily for 4 weeks) improved short-term results of therapy, decreased the need for analgesic medication, and shortened pain score without causing major adverse effects.

Does Effleurage Massage Reduce Dysmenorrhoea Pain in Adolescents?

Dysmenorrhea, commonly known as menstrual pain or cramps, affects some women and hampers their ability to carry out daily activities. In Indonesia, the incidence of dysmenorrhea among women is reported to be 64.25%, with a significant proportion lacking knowledge regarding its management. Non-pharmacological methods, such as effleurage massage, have been suggested as a viable approach to alleviate dysmenorrhea pain. This study aimed to investigate the impact of effleurage massage on the pain scale associated with dysmenorrhea in adolescents. A quasi-experimental approach utilizing a pre- and post-test for a two-group design was employed. The study population consisted of young women experiencing dysmenorrhea, with a total sample size of 44 respondents divided into intervention and control groups. The research findings revealed a decrease in the mean pain score in the intervention group from 5.1±2.4 to 2.5±1.8 with a p-value of <0.001. Thus, it can be concluded that effleurage massage effectively reduces the intensity of dysmenorrhea pain in adolescents. As a recommendation, adolescents are advised to consider non-pharmacological therapies like effleurage massage as an alternative to pharmacological drugs, and to learn the technique to perform effleurage massage independently at home.

Conservative and Surgical Treatment of Osteochondromas in Children, Particularly with or without Surgical Lengthening of the Ulna.

Prevention of rotatory impairment and radial head dislocation in the forearm is an important aspect when treating children with osteochondromas. Various studies tried to determine the best treatment, describing different surgical techniques. No consensus has been reached yet. This retrospective study compares the treatment outcome of patients with osteochondroma of the radius and ulna after surgical or conservative treatment. Seventeen forearms treated over a period of 20 years were analysed. Outcome parameters were the prospectively collected clinical data and the radiological findings: "relative shortening" of ulna/radius, the "radial articular angle" (RAA) and the "carpal slip" (CS). Our study shows an improvement of the range of motion and cosmetic appearance of the forearm after an operative procedure, with or without bone lengthening. We observed an increase in wrist and elbow mobility with a decrease in pain scores and a confirmed high cosmetic satisfaction in almost 70% of the patients after bone lengthening and up to 85% after simple excision. For patients suffering from functional impairment or pain, an operative approach is beneficial. Multiple and repetitive osteochondroma excisions are recommended during growth to prevent deformity and rotatory motion restriction. Lengthening procedures require a careful indication.

Preoperative Depression Is Associated With Increased Short-term Complications But Equivalent Long-term Outcomes in Total Knee Arthroplasty.

Concomitant depression negatively impacts outcomes following total knee arthroplasty (TKA). Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are validated measures that quantify depression, pain, and physical function. We hypothesized that higher preoperative PROMIS-depression scores would be associated with inferior outcomes following TKA. A total of 258 patients underwent primary TKA at a tertiary academic center between June 2018 and August 2020. PROMIS scores were collected preoperatively and at 6 weeks, 3 months, 1 year, and 2 years postoperatively. Patients with preoperative PROMIS depression scores of 55 or greater were considered PROMIS depressed (PD) and patients with scores less than 55 were considered not PROMIS depressed (ND). The primary outcomes were changes in PROMIS scores. Secondary outcomes included total and daily mean morphine milligram equivalents (MME) received during admission as well as 90-day hospital readmission and 2-year all-cause revision rates. There were 66 (25.58%) patients in the PD group and 192 (74.42%) in the ND group. Patients in the PD group had improved depression scores at all follow-up intervals (P<.001) and decreased pain scores at 1 year (P=.016). Both groups experienced similar changes in function scores at each follow-up interval. Patients in the PD group had higher total (P=.176) and daily (P=.433) mean MME use while admitted. Ninety-day hospital readmissions were higher in the PD group (P=.002). There were no differences in 2-year revision rates (P=.648). Preoperative PROMIS-depression scores of 55 or greater do not negatively impact postoperative function, depression, or pain, and patients with these scores have greater improvement in depression and pain at certain intervals. Patients in the PD group had higher readmission rates. [Orthopedics. 2024;47(1):40-45.].

A Direct Comparison of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces to Prevent Neuroma Pain.

Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) surgeries manage neuroma pain; however, there remains considerable discord regarding the best treatment strategy. We provide a direct comparison of TMR and RPNI surgery using a rodent model for the treatment of neuroma pain. The tibial nerve of 36 Fischer rats was transected and secured to the dermis to promote neuroma formation. Pain was assessed using mechanical stimulation at the neuroma site (direct pain) and von Frey analysis at the footpad (to assess tactile allodynia from collateral innervation). Once painful neuromas were detected 6 weeks later, animals were randomized to experimental groups: (a) TMR to the motor branch to biceps femoris, (b) RPNI with an extensor digitorum longus graft, (c) neuroma excision, and (d) neuroma in situ. The TMR/RPNIs were harvested to confirm muscle reinnervation, and the sensory ganglia and nerves were harvested to assess markers of regeneration, pain, and inflammation. Ten weeks post-TMR/RPNI surgery, animals had decreased pain scores compared with controls ( P < .001) and they both demonstrated neuromuscular junction reinnervation. Compared with neuroma controls, immunohistochemistry showed that sensory neuronal cell bodies of TMR and RPNI showed a decrease in regeneration markers phosphorylated cyclic AMP receptor binding protein and activation transcription factor 3 and pain markers transient receptor potential vanilloid 1 and neuropeptide Y ( P < .05). The nerve and dorsal root ganglion maintained elevated Iba-1 expression in all cohorts. RPNI and TMR improved pain scores after neuroma resection suggesting both may be clinically feasible techniques for improving outcomes for patients with nerve injuries or those undergoing amputation.

EFFECTIVENESS OF MUSICURE TO CONTROL PAIN IN BRONCHOSCOPY AT THE HOSPITAL DR. MOEWARDI SURAKARTA

&lt;p&gt;Background Sampling in bronchoscopy can lead to acute consequences, such as intrabronchial bleeding, bronchospasm, and pneumothorax. Bronchoscopies make patients uneasy because they fear discomfort and difficulty breathing. Hypnotherapy, music therapy, and aromatherapy can help during bronchoscopies. Musicure is considered to assist people to grow well by sending "passive" musical impulses.&lt;/p&gt;&lt;p&gt;Objective The goal of this study was to see how well musicure helped bronchoscopy patients deal with pain.&lt;/p&gt;&lt;p&gt;Methods A quasi-experimental design with a pre-test, post-test, and control group was used. Patients with lung illness will undergo bronchoscopy and consecutive sampling at the Dr. Moewardi Surakarta Hospital in February-March 2020. The study subjects were divided into a treatment group with Musicure and a control group without music. Both groups were assessed with pain visual acuity score (VAS) at baseline and after bronchoscopy.&lt;/p&gt;&lt;p&gt;Results A total of 32 subjects with lung diseases whom bronchoscopy in this study. The treatment group showed a decreased pain VAS scale (-14.71±12.31). The treatment group pre-test pain score obtained 31.76±12.86, and the VAS post-scale average of 17.06±12.63. The changes in the VAS scale post-pretreatment group showed a decrease in average -14.71±12.31. The treatment group (p=0.002) obtained a p&amp;lt;0.05, which means that the treatment group experienced a significant change in the VAS scale. There was a significant difference compared to the control (p&amp;lt;0.05).&lt;/p&gt;&lt;p&gt;Conclusion Musicure is effective in inhibiting perception of pain that it will lower the VAS scale, therefore decreasing pain score. Pain in patients who undergo bronchoscopy will be more controlled, which makes it easier to act and decrease side effects after the action.&lt;/p&gt;

Pengaruh Konsumsi Air Kelapa Hijau dalam Penurunan Intensitas Dismenore di Sumatera Selatan

ABSTRACTBackground: Dysmenorrhea in adolescents usually occurs due to very high prostaglandin hormones on the first day of menstruation. Dysmenorrhea affects productivity such as disruption of learning activities causing a lack of focus in lessons and can even increase absenteeism from school. One effort that can be done to relieve dysmenorrhea is non-pharmacological therapy of green coconut water. Green coconut water contains vitamins and minerals that can stimulate the body to stabilize the prostaglandin hormone so that dysmenorrhea pain decreases.Research Objectives: This study aims to determine the effect of consuming green coconut water (Cocos Nucifera Linn Var. Viridis) on reducing the intensity of dysmenorrhea in young women in Sungai Pinang 1 Village, Ogan Ilir District, South Sumatra.Research Methods: The type of research used is a quantitative research with a quasi-experimental design with a one group pretest and posttest serial design. Total sampling data collection technique obtained. The data analysis used non-parametric statistics because the data were not normally distributed, the Wilcoxon test was used with a significant level of 0.05.&#x0D; Results: there was a decrease in the intensity of pain response before treatment pain score 128 with a mean score of 4.74 (moderate pain) after treatment I, II and III there was a decrease in pain score 72 with a mean score of 2.77 (mild pain). Green coconut water has a significant effect on reducing the intensity of dysmenorrhea with a significant level of p 0.000 Z score -4.633 (Z score table = 107).Conclusion: There is a significant effect on reducing the intensity of dysmenorrhea after consuming green coconut water in young women in Sungai Pinang 1 Village, Ogan Ilir District.Keywords: Green coconut water, dysmenorrhea, pain intensity

Effectiveness of Zingiber montanum Herbal Compress Remedy for Pain Management: An Updated Systematic Review and Meta-Analysis

The Zingiber montanum herbal compress remedy is a type of herbal medicine that can be used as an alternative treatment for improving pain symptoms. This study aimed to evaluate the clinical efficacy of a Z. montanum herbal compress remedy for pain relief. PubMed, Scopus, ScienceDirect, and Thai databases were systematically searched for relevant articles published from inception to December 2022. Only randomized clinical trials (RCTs) wherein the efficacy of the Z. montanum remedy was compared to that of a placebo or non-steroidal anti-inflammatory drugs (NSAIDs) were included. Six RCTs with a total of 812 patients were included in the analysis. The efficacy of the Z. montanum remedy had a significantly decreased pain score compared to the placebo (SMD = −0.63; 95% CI = −1.20, −0.06; I2 = 90%), but there was no significant difference when compared to NSAIDs (SMD = −0.61; 95% CI = −1.41, 0.81; I2 = 73%). Moreover, the efficacy of the Z. montanum remedy in terms of the flexibility score (SMD = 0.59; 95% CI −0.56, 1.74; I2 = 86.0%) and quality of life (SMD = 0.34; 95% CI −0.38, 1.05; I2 = 81.0%) was similar to that of the placebo. This meta-analysis demonstrates that the use of the Z. montanum herbal compress remedy significantly reduces the pain scores reported by patients.

Telehospice for Cancer Patients Discharged from a Tertiary Care Hospital in Western Kenya.

Worldwide, most patients lack access to hospice services. Assess the feasibility of telephone monitoring (Telehospice) in providing symptom management for patients discharged from a tertiary care hospital in Western Kenya. Inclusion criteria included adults with cancer no longer eligible for chemo-radiation and receiving opioid therapy. Thirty patients were enrolled in a weekly monitoring program assessing physical symptoms and patient and caregiver distress. The participants also had access to a 24-hour hotline. Symptom assessment included 18 questions with 8 from the African Palliative Outcome Scale. Participants were followed for eight weeks or until death or admission to an inpatient hospital or hospice. The primary objective was participation in weekly calls, and we obtained 100% participation. A secondary objective was the use of "comfort kits" which contained 30 doses of six medications. Most patients utilized one or more of the provided medications, with high usage of bisacodyl, paracetamol, and omeprazole. While 12% of weekly calls and 24% of hotline calls led to medication changes, participants continued to express worry and there was only a modest decrease in pain scores despite having morphine available throughout the follow-up period. Family confidence in providing care and access to information remained high. At the end of the eight-weeks of observation, eight participants were alive, 10 died at home, and 12 were admitted to an in-patient facility. Patient and family participation in Telehospice is feasible and may provide an interim solution to managing end-of-life patients who lack access to home hospice.

Treatment of Medication-Resistant Neuropathic Pain in a Tetraplegic Patient Using Repetitive Transcranial Magnetic Stimulation (rTMS): A case report (P9-6.009)

<h3>Objective:</h3> N/A <h3>Background:</h3> Transcranial magnetic stimulation (TMS) is a non-invasive method of neuromodulation currently FDA-approved for the treatment of depression, but has also shown promising results in treating neuropathic pain. Given the risks of invasive neuromodulation and the dangers of long-term opioid use, especially in the face of an opioid crisis, it is imperative to find an effective treatment with minimal side effects. <h3>Design/Methods:</h3> The patient is a 74-year old tetraplegic Caucasian man who suffers from severe medication-resistant neuropathic pain following a spinal cord injury. TMS treatment was initiated, using a two-part protocol consisting of high-frequency (10 Hz) stimulation of the left dorsolateral prefrontal cortex (DLPFC) followed by low-frequency (5 Hz) stimulation of the primary motor (M1) cortex. Patient received daily treatment for the first week and decreased in frequency as treatment continued. Pain was measured using the Visual Analog Scale and tracked over 13 weeks (currently ongoing). <h3>Results:</h3> Patient’s pain level before beginning treatment was 6.35/10. Within the first week of treatment, his baseline pain level was reduced to 4.19/10. The lowest pain immediately following treatment was 1.9/10, a 70.1% decrease in pain scores. During the initial week of treatments, the patient reported that pain relief lasted for a few hours immediately following treatment. As treatment continued, he reported experiencing progressively longer relief, and also decreased his dosage of opioids due to the pain relief from the rTMS treatment. <h3>Conclusions:</h3> The pain protocol reduced medication-resistant neuropathic pain in our patient, as measured by the Visual Analog Scale as well as a decrease in opioid usage. Analgesic effects were additive with continual treatment. TMS treatment is non-invasive and could be administered without moving the patient from his wheelchair. The significant, lasting decrease in pain reported by the patient supports the need for further clinical studies of combined M1-rTMS and DLPFC-rTMS treatment for neuropathic pain. <b>Disclosure:</b> Miss Li has nothing to disclose. Dr. Kuluva has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Piedmont Neuroscience Center. Ms. Paras has nothing to disclose. Mr. Mohammad has nothing to disclose.

Radiofrequency Ablation for Adenomyosis.

Adenomyosis is a common benign gynecologic condition characterized by ectopic endometrial glands and stroma in the myometrium causing pain (dysmenorrhea) and abnormal uterine bleeding. New interventional techniques have been introduced over recent years. This study evaluates the treatment success and side effects of radiofrequency ablation. An electronic literature search in the PubMed, Scopus, and ScienceDirect databases was carried out on the outcomes of pain reduction and, secondarily, on abnormal uterine bleeding, reintervention, reproductive outcome, imaging outcome, and complications. There was a mean decrease in dysmenorrhea pain scores by -63.4 ± 9.0% at 12 months. Data on other outcome parameters were sparse. No major complications were reported. Radiofrequency ablation represents a promising minimally invasive and organ-preserving treatment in patients with symptomatic adenomyosis. It is associated with clinically meaningful improvement of adenomyosis-related pain in the short term.

Intraoperative hydromorphone decreases postoperative pain: an instrumental variable analysis

BackgroundIntraoperative administration of short-acting opioids might lead to increased postoperative pain and opioid requirements. There are few data describing the effects of intermediate-duration opioids such as hydromorphone on these outcomes. We have previously shown that a switch from a 2 mg to a 1 mg vial of hydromorphone was associated with decreased intraoperative dose administration. As presentation dose affected intraoperative hydromorphone administration and was unrelated to other policy changes, it could serve as an instrumental variable, assuming significant secular trends were not present during the study period. MethodsIn this observational cohort study of patients who received intraoperative hydromorphone (n=6750), an instrumental variable analysis was used to evaluate whether intraoperative hydromorphone administration affected postoperative pain scores and opioid administration. Before July 2017, hydromorphone was available as a 2-mg unit dose. From July 1, 2017 to November 20, 2017, hydromorphone was only available in a 1-mg unit dose. A two-stage least squares regression analysis was used to estimate causal effects. ResultsA 0.2-mg increase in intraoperative hydromorphone administration caused a decrease in admission PACU pain scores (mean difference, –0.8; 95% confidence interval, –1.2 to –0.4; P<0.001) and decreased maximum and time-weighted mean pain scores over 2 days postoperatively, without increased opioid administration. ConclusionsThis study suggests that intraoperative administration of intermediate-duration opioids does not cause the same effects as short-acting opioids with respect to postoperative pain. Instrumental variables can be used to estimate causal effects using observation data when unmeasured confounding is present.

MP15-10 SYSTEMATIC REVIEW OF ALPHA BLOCKERS FOR THE TREATMENT OF PAIN IN CHRONIC PROSTATITIS

You have accessJournal of UrologyCME1 Apr 2023MP15-10 SYSTEMATIC REVIEW OF ALPHA BLOCKERS FOR THE TREATMENT OF PAIN IN CHRONIC PROSTATITIS Anthony Carona, David Jacobson, and Kevin Rowland Anthony CaronaAnthony Carona More articles by this author , David JacobsonDavid Jacobson More articles by this author , and Kevin RowlandKevin Rowland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a disruptive condition of uncertain etiology with an estimated prevalence of 2-10% of males worldwide and symptoms manifesting heterogeneously as pelvic pain, lower urinary tract symptoms, and overall decreased quality of life. CP/CPPS is associated with a high degree of healthcare utilization and substantial economic costs. Despite ongoing research, no definitive therapy has been established. Because of their effect on urinary symptoms, alpha blockers are frequently utilized in the management of CP/CPPS, while pain symptoms are managed with analgesics of various classes. Since relatively little research exists to support the long-term use of alpha blockers in the management of pelvic pain, further research is required. This review seeks to assess whether alpha blockers are more effective than placebo in reducing pain symptoms longitudinally in males with CP/CPPS. METHODS: A systematic search of randomized placebo-controlled trials evaluating alpha blockers and non-steroidal anti-inflammatory drugs in the treatment of CP/CPPS was conducted and captured all available studies (n=680). After application of exclusion criteria, seven trials were identified as suitable for inclusion. All NSAID trials were excluded for not meeting criteria. Only studies reporting NIH-CPSI pain score (items 1-4) were included. Group means were calculated and compared with t-test to assess differences in pain reduction in alpha blocker and placebo groups at points 0-3 months and greater than 3 months of treatment. RESULTS: Our analysis revealed a mean pain score decrease of 4.3 (+/-1.2) points in those taking alpha blockers for 3 months or less compared to a decrease of 3.4 (+/-1.3) points in the placebo group (p=0.16). For those taking alpha blockers greater than 3 months, a mean decrease in pain of 4.1 (+/-1.7) points was found compared to a decrease of 1.6 (+/-1.4) points in the placebo group (p=0.0067). CONCLUSIONS: Our review demonstrates a statistically significant decrease in pain score for those taking alpha blockers for greater than 3 months, whereas no benefit is noted when taken for 3 months or less compared to placebo. Given this information, the use of alpha blockers for the chronic management of pain symptoms in CP/CPPS is justified. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e195 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Carona More articles by this author David Jacobson More articles by this author Kevin Rowland More articles by this author Expand All Advertisement PDF downloadLoading ...

5609968 REAL-WORLD PATIENT-REPORTED OUTCOMES AND WEARABLE METRIC CORRELATIONS: REMOTE DAILY MONITORING FOR EXPLORATION OF QUALITY OF LIFE IN SICKLE CELL DISEASE

Background/Aims: Sickle Cell Disease (SCD) is a debilitating condition that lacks data on its natural history and quality of life (QoL) beyond limited snapshots through infrequent healthcare contacts. This lack of longitudinal targeted QoL measurement and understanding of the physiological factors that may influence it sees a need for more detail on the impacts key metrics have on patient outcomes. The core objective of this study was to generate real-world evidence tracking changes in live wearable metrics and patient QoL, to better characterise a baseline of key correlations in SCD. Methods: Data was collected from 238 patients over 16 months, using a CE and FDA-cleared wearable (Withings ScanWatch) to automatically record metrics including sleep quality, activity, and heart rate. EQ-5D-5L and pain scores (0-10) were manually entered by patients via a digital patient-reported outcomes (PRO) portal, and a daily cohort average across each metric was calculated. Statistically significant correlations were analysed both at an overall day-to-day level and split by weekday vs. weekend to explore the potential impacts of activities such as work on sleep patterns. Patients provided informed e-consent to participate and for analysis of their de-identified data. Results: Increasing daily EQ-5D-5L scores were found to correlate with increasing numbers of sleep disturbances (p=0.024) and decreasing pain scores (p<0.001). In turn, lower pain scores were associated with lower sleep heart rates (p<0.001) and wake-up durations (p<0.001), as well as lower active heart rates (p<0.001) and higher activity levels (p<0.001).While sleep quality (sleep disturbances) appeared to show a contradictory increase with higher EQ-5D scores, the significance of this correlation was lost following a split by weekdays and weekends. Statistical significance was also lost for the link between pain scores and steps during the weekend, whereas an additional correlation between pain and total sleep duration (p=0.023) was found only during weekdays, and between pain and the number of sleep disturbances (p=0.033) during the weekend. Similarly, a correlation between EQ-5D and active heart rate (p=0.022), as well as duration to wakeup (p=0.017), was seen only during the weekend. Summary-Conclusion: Analysis of putative associations between PROs and real-time metrics, as well as the potential influences of activities such as work, were shown by changes in significance both before and after split by weekdays/weekends. Notably, lower EQ-5D scores were found to correlate with higher levels of pain, in turn linking to lower daily steps. With a correlating increase in both active and sleep heart rates despite these lower activity levels, this may indicate higher detectable stress correlating with increased pain, with paralleled impacts on QoL. As such, these metrics may form points of monitoring when identifying or predicting risks of pain and related complications in SCD patients. Future work will explore potential causality, differences across patient groups, and more granular detail of the impact of specific treatments or healthcare events. Additional investigation into changes at an individual patient level will be conducted to better characterise deviations from patients’ own baselines. This will support ongoing work to improve the understanding of baselines in SCD, and what the key factors in pain and quality of life may be in order to support patient outcomes improvement.

Motor Blockade After Erector Spinae Plane Block for Lumbar Spinal Surgery: A Case Report

BACKGROUND: Regional anesthetic techniques, including the erector spinae plane block (ESPB), decrease pain scores while reducing opioid consumption. Given their high safety profile and analgesic efficacy, ESPBs offer an alternative to neuraxial anesthetic techniques for perioperative analgesia. CASE REPORT: Transient unilateral dense L3 motor weakness occurred as a complication of the ESPB performed intraoperatively for an L2-L5 laminectomy and L2-L3 discectomy at the L3 level. The motor weakness was concerning for spinal cord injury and confounded the postoperative neurologic examination. CONCLUSIONS: Lesson learnt from this case suggests the lumbar ESPB should be performed preoperatively in awake patients to avoid confounding physical exam findings in the postoperative anesthesia care unit; this also reduces the need for further emergent imaging and workup. During a lumbar ESPB, a local anesthetic should be deposited at the tip of the transverse process, and not breach the intertransversarii muscle and ligament to favor the dorsal spread and sparing of ventral rami motor fibers. KEY WORDS: Erector spinae plane block, ultrasound, regional anesthesia, spine surgery

Effect of Posteroanterior Lumber Spine Mobilization Versus McKenzie Prone Push Ups on Pain and Functional Disability in Subjects with Non-Specific Low Back Pain

85% of the population has non-specific back pain. Posteroanterior (PA) lumbar mobilization and Push-up exercises are primarily used in physical therapy for back pain. Objective: To know the outcomes of posteroanterior spinal mobilization and prone push-ups on nonspecific lower back pain. Methods: The randomized clinical trial was done with 30 subjects meeting inclusion criteria and were randomly selected by non-probability/purposive sampling technique from the Department of Physical Therapy, Mayo Hospital Lahore. The 4 weeks study was conducted in which 2 groups with 15 in each group were formed. Group I was treated with PA lumbar glide while group II was treated with prone Push-ups. VAS and functional disability index were used to evaluate pre-treatment and post-treatment. Results: A significant decrease in mean pain score was noted in both groups. Results did not show any statistically significant differences between groups for any parameter. The study has given evidence that supports the use of posteroanterior mobilization and prone push-ups to reduce pain, improve range of movement, and disability reduction in patients with nonspecific low back pain. It also showed that posteroanterior mobilization was more beneficial than prone Push-ups. Conclusion: Both PA mobilization and Push-ups can be used as effective maneuvers for the treant of non-specific low back pain