Difference In Mean Pain Scores Research Articles

Comparison of intraperitoneal instillation of Bupivacaine vs Normal Saline for postoperative pain relief after laparoscopic cholecystectomy.

Objective: To evaluate whether local irrigation of Bupivacaine reduces post-operative pain after cholecystectomy. Study Design: Prospective, Randomized Controlled Trial. Setting: Department of Surgery, Government Teaching Hospital, Shahdara Lahore. Period: June 2020 to December 2022. Methods: For this study, 86 participants were divided into two groups, each containing 43 participants (Bupivacaine vs. no Bupivacaine). The control group (Group A) received an infiltration of 15 ml of 0.5% bupivacaine in the sub-diaphragmatic region on the right side and at port sites, while normal saline was administered to Group B. The Visual Analogue Pain Score Scale was employed to assess pain levels at 0-3, 3-5, 5-7, and above 7-10 hours post-surgery (VAS). Results: In this study, the total number of included individuals was 86. Moreover, the overall mean and median ages in months for both groups were 47.7 ± 8.97 and 47 (18-60) respectively, with the majority of patients being male (59 individuals, 68.6%). Furthermore, there was a statistically significant mean difference in pain scores on the visual analogue scale at 0–3 hours, 3–5 hours, 5–7 hours, and 7–10 hours (p-value < 0.05). Similarly, there was a statistically significant mean difference in pain scores on the visual analogue scale after more than three to five hours, more than seven hours, and more than ten hours (p-value < 0.05). Conclusion: Consequently, we inferred that intraperitoneal and local infiltration of Bupivacaine following laparoscopic cholecystectomy significantly reduced the level of postoperative discomfort and the requirement for analgesics.

Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial

BackgroundFear of pain associated with intrauterine device placement has been identified as a significant barrier to the adoption of long-acting reversible contraception, contributing to lower utilization of the most effective reversible contraceptive methods. ObjectiveTo assess whether instillation of intrauterine mepivacaine before intrauterine device placement alleviates pain more effectively than a placebo. Study DesignWe conducted a multi-center, double-blind, randomized, placebo-controlled trial involving nulliparous women undergoing intrauterine device placement. An instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride was administrated through a hydrosonography catheter 2 minutes prior to intrauterine device placement. Pain scores were assessed using a 100 mm Visual Analog Scale at pre-specified time points. Primary outcome measured the difference in Visual Analog Scale pain scores between the intervention group and the placebo group during intrauterine device placement. Secondary outcomes included Visual Analog Scale pain scores at instillation and 10 minutes after placement, tolerability of the placement pain, as well as acceptability of the analgesia method. ResultsWe enrolled 151 participants, with 76 assigned to the mepivacaine group and 75 to the placebo group. The mean VAS pain score during IUD placement showed a difference of 13.3 mm (95% CI 5.75-20.87; P<.001): the mepivacaine group had a mean of 53.9 mm (SD 22.8), while the placebo group had a mean of 67.2 mm (SD 22.4). After adjusting for each individual provider’s impact, the difference in mean pain scores remained statistically significant (12.2 mm 95% CI 4.85-19.62; P<.001). A greater proportion of women in the intervention group reported tolerable pain during placement with 70/75 participants (93.3%) compared to 53/66 participants (80.3%) in the placebo group (P=.021). ConclusionThe intrauterine instillation of mepivacaine results in statistically significant reduction in pain score among nulliparous women during intrauterine device placement. Although the precise clinical impact of this pain reduction method remains uncertain, the observed reduction in pain score result in a higher proportion of women reporting tolerable pain. This finding and the high acceptance as a pain reduction method thereby suggests clinical relevance. Intrauterine instillation of mepivacaine is a possible strategy to increase IUD utilization, particularly among nulliparous women who are at high risk of unintended pregnancy.

A Randomized Controlled Trial to Evaluate the Analgesic Effectiveness of Periarticular Injections and Pericapsular Nerve Group Block for Patients Undergoing Total Hip Arthroplasty.

Pericapsular nerve group (PENG) block and periarticular injection (PAI) provide motor-sparing analgesia following hip surgery. We hypothesized that PAI offers non-inferior pain relief compared with PENG block in patients undergoing primary total hip arthroplasty (THA). In this randomized trial, 66 patients who underwent primary THA under spinal anesthesia were assigned to the PENG or PAI groups. The primary endpoint was the resting pain score 24 h postoperatively. The secondary endpoints included pain scores at rest and during movement at 6 and 48 h postoperatively, quadriceps strength at 24 h postoperatively, and opioid consumption at 24 and 48 h postoperatively. The mean difference in pain scores at rest between the two groups was 0.30 (95% confidence interval [CI], -0.78 to 1.39) at 24 h postoperatively. The upper 95% CI was lower than the non-inferiority margin, indicating non-inferior performance. No significant between-group differences were observed in the pain scores at 6 and 48 h postoperatively. Additionally, no significant differences in quadriceps strength and opioid consumption were observed between the two groups. The PAI and PENG blocks provided comparable postoperative analgesia during the first 48 h after primary THA. Further investigation is required to determine the optimal PAI technique and local anesthetic mixture.

Effect of Occlusal Reduction on Alleviating Pain in Symptomatic Apical Periodontitis

OBJECTIVE: To evaluate pain relief in response to occlusal reduction in teeth with symptomatic apical periodontitis METHODOLOGY:A randomized controlled trial was done at department of Operative Dentistry and Endodontics, PIMS Hospital, Islamabad, Pakistan 27th May 2019 to 30th May 2020 on 166 patients suffering from irreversible pulpitis with symptomatic apical periodontitis were included in the study. After consent, Visual Analogue Scale (VAS) was used to document preoperative pain levels. Pulpectomy was done and patients were randomly divided into Group A (without occlusal reduction) and Group B (with 1-1.5mm occlusal reduction). Mean pain scores of Group A and Group B were compared at 24hrs, 72 hours and seventh day using T-test RESULTS: There was a significant difference in mean pain score (p=0.0001) post-pulpectomy between the teeth with and without occlusal reduction. CONCLUSION: The teeth that underwent occlusal reduction after pulpectomy showed lower mean pain levels compared to the non-reduction group. KEYWORDS: Occlusal reduction, apical periodontitis, irreversible pulpitis, pulpectomy, root canal therapy

Preoperative Alcohol Use, Postoperative Pain, and Opioid Use After Coronary Artery Bypass Surgery

ObjectivesChronic alcohol use is associated with chronic pain and increased opioid consumption. The association between chronic alcohol use and acute postoperative pain has been minimally studied. Our objective was to explore the association between preoperative alcohol use, postoperative pain, and opioid consumption after coronary artery bypass grafting (CABG). DesignRetrospective cohort study. SettingSingle academic medical center. ParticipantsPatients having isolated CABG. InterventionsNone Measurements and Main ResultsDemographics, comorbidities, and baseline alcohol consumption were recorded. Primary outcomes were mean pain score and morphine milligram equivalent consumption on postoperative day 0. Among 1,338 patients, there were 764 (57.1%) who had no weekly preoperative alcohol use, 294 (22.0%) who drank ≤ 1 drink per week, 170 (12.7%) who drank 2-7 drinks per week, and 110 (8.2%) who drank 8 or more drinks per week. There was no significant difference in mean pain score on postoperative day 0 in patients who consumed different amounts of alcohol (No alcohol = 5.3 ± 2.2, ≤ 1 drink = 5.2 ± 2.1, 2-7 drinks = 5.3 ± 2.3, 8 or more drinks = 5.4 ± 1.9, P=0.66). There was also no significant difference in median MME use on postoperative day 0 in patients who consumed different amounts of alcohol (No alcohol = 22.5 mg, ≤ 1 drink=21.1 mg, 2-7 drinks = 24.8 mg, 8 or more drinks = 24.5 mg, P=0.14). ConclusionsThere is no apparent association between mild to moderate preoperative alcohol consumption and early postoperative pain and opioid use in CABG patients.

Effectiveness of Advanced Platelet-Rich Fibrin on Postoperative Sequelae for Impacted Mandibular Third Molar Surgery: A Prospective Study.

Introduction Impacted third molar extraction is frequently removed surgically by maxillofacial surgeons, which is mostly associated with postoperative sequelae like pain and swelling. It is essential to minimize the complications and enhance wound healing in the extracted socket of the third molar. Hence, this study aimed to assess the efficiency of advanced platelet-rich fibrin (A-PRF) in wound healing and reducing pain after surgical extraction of the impacted mandibular third molar (IMTM). Materials and methods Thirtyhealthy patients who have been diagnosed with Pell and Gregory class II IMTM were included in this study. In the study group, which comprises 15 patients, extraction sockets were filled with A-PRF extract. In the control group, no material was placed in the extraction sockets. The pain was assessed preoperative and on the third and seventh postoperative days using a visual analog scale (VAS). Wound healing was assessed on the third and seventh postoperative days using a modified laundry scale. SPSS for Windows was used for data analysis. Categorical data was compared between the groups using the Chi-square test. P-value less than 0.05 was considered as statistically significant. Results The study population's mean age was 25.67 ± 2.4 years. Nineteen patients were male, and 11 patients were female. Differences in mean pain scores between the groups were not statistically significant both on the third postoperative day (p=0.59)and the seventh postoperative day (p=0.33). During the seventh day postoperative day, the study group exhibited better wound healing compared to the control group and the results were statistically significant (p=0.01). Conclusion A-PRF is a simple and effective method of reducing postoperative sequela by promoting wound healing after surgical extraction of IMTM. Ithas the advantage of less chance of allergic and anaphylactic reactions, unlike their predecessor platelet concentrates.

Analgesic Efficacy of Pre-operative Pregabalin in Dacryocystorhinostomy Surgery: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.

Dacryocystorhinostomy (DCR) is an effective surgical procedure for addressing lacrimal drainage problems. However, it can be a painful operation that involves incisions both inside and outside the eye, often leading to a high incidence of postoperative nausea and vomiting. Preemptive analgesics can be employed to alleviate this unrelieved pain. Nonetheless, many of the drugs used can induce a wide range of adverse effects. Therefore, the aim of this systematic review and meta-analysis is to assess the current evidence regarding the efficacy of pregabalin in managing postoperative pain following DCR surgery. We conducted a thorough search of five electronic databases, namely, PubMed, Web of Science, Scopus, Cochrane, and Google Scholar, to identify relevant randomized controlled trials (RCTs) published before September 2023. The quality of the included studies was assessed using the Cochrane Risk of Bias tool for RCTs. The outcomes we evaluated included postoperative pain, surgery duration, time to first analgesia, total pethidine consumption, and postoperative nausea and vomiting (PONV). Continues data reported as mean difference (MD), and dichotomous data reported as risk ratio (RR), with 95% confidence interval (CI). A pooled meta-analysis of three RCTs, including 240 patients in both the pregabalin and placebo groups, was conducted. The results revealed that the pooled MD in pain scores was significantly lower in patients treated with pregabalin compared to those receiving a placebo ((MD = -1.35 (95% CI: -1.83 to -0.87, p < 0.00001)). Additionally, the pooled MD of pethidine consumption was significantly lower in patients treated with pregabalin compared to those receiving a placebo (MD = -54.13 (95% CI: -103.77 to -4.50, p = 0.03)). However, there was no statistical significance between both groups in terms of time to first analgesia and duration of surgery (p > 0.05). On the other hand, the pooled RR of PONV was significantly lower in patients treated with pregabalin compared to those receiving a placebo (RR = 0.37 (95% CI: 0.24-0.57, p < 0.001)). This meta-analysis demonstrates that pregabalin is an effective and well-tolerated intervention for reducing postoperative pain and PONV following DCR surgery, without significantly affecting surgery duration or time to first analgesia. These findings support the use of pregabalin in improving patient comfort and outcomes in this surgical context.

Fistulotomy versus fistulotomy with marsupialization, a randomized controlled trial.

Objective: To compare the efficacy of fistulotomy and fistulotomy with marsupialization in the management of simple anal fistula. Study Design: Randomized Controlled study. Setting: Department of Surgery, District Head Quarter Hospital, Mardan, Pakistan. Period: 1st September 2021 to 31st August 2022. Material &amp; Methods: A total of 60 Patients coming to hospital with simple anal fistula were randomized into two equal groups. In group A, 30 patients were treated with fistulotomy, while in group B, 30 patients were treated with fistulotomy with marsupialization. The primary outcome was set as time required for complete wound healing. Secondary outcomes were operation time, postoperative pain, anal incontinence, incidence of recurrence and patient satisfaction. Results: The mean wound healing time after 6 weeks was shorter in group B in comparison to group A (4.7± 0.74 versus 6.4± 0.85 weeks; p=0.0001). There was no significant difference in mean operation time between Group B and Group A. The difference in mean pain score was also not statistically significant. There was no significant difference in the incidence of anal incontinence, incidence of recurrence and patient’s satisfaction among two groups. Conclusion: Fistulotomy with marsupialization is more effective procedure than fistulectomy alone in shape of early wound healing without increase in operation time and therefore can be taken as surgical procedure of choice for the simple anal fistula.

The Relationship Between Hip and Knee Flexibility and Post-coronary Angiography Pain

Purpose: Coronary angiography can cause post-procedural pain, and limited flexibility in the hips and knees may contribute to this discomfort. This study was designed to assess the flexibility of the hip and knee and its relationship with pain after femoral angiography. Methods: This cross-sectional study was conducted on 42 participants (27 men and 15 women, aged 30-85 years) after non-emergency angiography at Dr. Shariati Hospital. Demographic data, employment status, and angiography history were collected through an individual data questionnaire. Muscle flexibility was assessed using a goniometer and tape measure, and visual analog scale (VAS) was applied to evaluate the score of pain. A Spearman correlation coefficient and Kruskal-Wallis tests were used to examine the relationship between variables and pain. Results: The analysis revealed no significant difference in mean pain scores between men and women (P=0.662), employment status (P=0.265), or history of angiography (P=0.262). We observed positive correlations between pain and the modified Thomas test for hip extension, active knee extension test, and forward bending test (rho=0.745, rho=0.594, and rho=0.433; P=0.00, P=0.00, and P=0.04, respectively). Conversely, the modified Thomas test for knee flexion showed a negative correlation with pain (rho=-0.591, P=0.00). No significant differences were found between the sit-and-reach test and pain (rho=0.337, P=0.29). Age demonstrated a positive correlation with pain (rho=0.312, P=0.04). However, weight did not show a significant correlation with pain (rho=-0.074, P=0.64). Conclusion: A relationship was observed between some flexibility tests and pain. Reduced hip and knee flexibility correlated with higher pain levels after femoral angiography. While age showed a positive relationship with pain, weight did not show any relationship with pain. These results emphasize the importance of considering flexibility in managing pain after femoral angiography.

Virtual reality for pain reduction during intravenous injection in pediatrics: a systematic review and meta-analysis of controlled clinical trials.

Intravenous (IV) injections often cause pain, fear, and anxiety in pediatric patients. Virtual reality (VR) is a relatively new intervention that can be used to provide a distraction during or prepare patients for IV injections. To date, no meta-analysis has examined the evidence regarding the effectiveness of VR at reducing pain in pediatric IV injections. The PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases were searched for articles published through August 7, 2022. The methodological quality of the studies was measured using the Delphi checklist. The chi-square test and the I2 statistic were used to assess heterogeneity across studies. A summary measure of the mean difference in pain scores between the VR and control groups was obtained using a random effects model. All statistical analyses were set at a significance level of 0.05 using Stata 14. Nine studies were included in this meta-analysis of VR interventions used during IV injections in pediatric patients. The difference in mean pain score between the intervention and control groups showed significant reductions in the VR group (mean difference, 0.47; 95% confidence interval, 0.3-0.65; I2=9.1%). No interstudy heterogeneity was observed. Our results suggest that VR effectively reduces pain associated with IV injections in pediatric patients. No interstudy heterogeneity was noted among the analyzed studies. The Delphi checklist was used to assess methodological quality.

Effects of German chamomile on symptoms and healing after mandibular third molar surgeries: A triple-blind split-mouth randomised controlled trial

Background and aimSurgical extraction of the impacted lower third molar is one of the most common surgical procedures in dentistry. Postoperative pain usually reaches its intensity 12 h after the procedure and adversely affects the patient's quality of life for many days. Chamomile anti-inflammatory and pain-relieving properties have been introduced in the medical literature. The present study aimed to investigate the efficacy of chamomile gel in reducing postoperative pain and symptoms after impacted lower third molar surgeries. Materials and methodsThis study was a triple-blinded placebo-controlled randomised clinical trial with a split-mouth crossover design. The study included 70 impacted lower third molars in 35 patients (13 males and 22 females) with a mean age of 22.29 (±3.00) years. Participants’ extraction sides were randomly allocated into the study groups. Each participant was enrolled twice, i.e., into the study and control groups with a washout period of 3 weeks between the two surgeries. Postoperative pain, need for analgesics, symptoms severity (PoSSe), and wound healing were evaluated. ResultsGingival healing was significantly better in chamomile group compared to control group (P < 0.001). There were no significant differences in post-extraction alveolar osteitis between chamomile and control group (P = 0.314). VAS results showed significant differences in mean pain scores, with significant decrease in chamomile groups (P < 0.05). Moreover, analgesic consumption was significantly higher in placebo group (P < 0.05). Mean PoSSe scores were 16.8 (±9.4) in the chamomile group, versus 41.1 (±9.9) in the control. ConclusionsWithin the limitations of the present study, it was concluded that intra-socket application of chamomile gel might effectively improve healing, and reduce pain levels, postoperative symptoms severity, and analgesics consumption after surgical extraction of impacted lower third molars.

Mindfulness-Based Interventions for the Reduction of Postoperative Pain in Hip and Knee Arthroplasty Patients: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis is to evaluate the effect of mindfulness-based interventions (MBIs) on post-surgical pain in patients undergoing a total hip replacement (THR) or total knee replacement (TKR). We performed a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A search of multiple databases, including PubMed and EMBASE, was performed for studies from database inception through March 2nd, 2022. Data were extracted, and pooled estimates of standardized mean differences in pain scores were calculated using a random effects model and inverse probability weighting. Two randomized control trials were eligible for inclusion (299 patients). The average ages of participants in each study were similar at 65.5 and 64.8 years, and both studies were predominantly female at 72.4% and 61.9%. The mindfulness intervention ranged from an eight-week program to a 20-minute session. Both individual studies reported statistically significant reductions in postoperative pain for MBI groups. The pooled standardized mean difference in pain scores for the MBI groups compared to the control groups was -1.94 (-3.39; -0.48). There exists preliminary evidence for the beneficial effect of MBIs on reducing the postoperative pain experience in this patient population. Given the significant consequences of postoperative pain and the necessity for non-opioid forms of analgesia, this topic represents a promising area of research that warrants future randomized control trials to better understand the role of MBIs for postoperative analgesia.

Use of Physics Forcep Versus Conventional Forcep in Extraction of Mandibular First Molar

Dental extractions are common. Atraumatic extractions utilizing various technologies are said to protect paradental structures. The new physics forceps can extract the teeth without stress. Objective: To compare the efficacy of physics versus conventional forcep in extraction of mandibular first molar. Methods: Patients aged 18 t0 40 requiring extraction of mandibular first molar were included in the study. The efficacy of extraction was evaluated based on bone loss, soft tissue tear, time required for extraction, postoperative pains, and root fracture. The participants were divided into two groups (Physics forcep and conventional forcep) using block randomization technique, and the pain and time between both groups were compared using independent samples t-test. Results: The two groups had a mean age of 2.85 ± 0.355 years. Physics Forceps (n=1, 6.7%) caused less soft tissue tears than Conventional Forceps (n=14, 93.3%) (p=0.01). 55.5% of the Physics Forceps group and 44.5% of the Conventional Forceps group took more than 10 minutes to extract (p=0.045). Physics Forceps had a greater rate of complete success (p=0.043) than Conventional forceps (p=0.043). In terms of overall instrument utility, physics forceps scored better than Conventional forces in both good and average scores (p=0.021). The difference in mean pain score in the two groups was statistically significant (p=0.0018) at day 3 and day 7 (p=0.0001) being lower in physic forcep. Conclusions: Physics forceps are a more favorable substitute to traditional forceps for atraumatic tooth extraction.

Efficacy and safety of bromelain: A systematic review and meta-analysis.

Background: Pineapple has an important role in ethnopharmacology and its enzyme, bromelain, has been extensively investigated for its medicinal properties. Aim: This systematic review and meta-analysis aimed to assess clinical evidence concerning the efficacy and safety of bromelain. Methods: A systematic search was conducted from conception to August 2022 using CINAHL Complete, MEDLINE, ScienceDirect, Scopus, and Thai Journal Online (TJO). The risk of bias was assessed using Risk of Bias 2 or ROBIN-I. A random-effect model with inverse variance weighting and DerSimonian and Laird method was used for meta-analysis. The heterogeneity was evaluated by I2 statistics. Results: We included 54 articles for qualitative summary and 39 articles for meta-analysis. The systematic review found that bromelain presented in serum with retained proteolytic activity after oral absorption. Bromelain may be effective against sinusitis but was not effective for cardiovascular diseases. Pain reduction from oral bromelain was slightly but significantly better than controls (mean difference in pain score = -0.27; 95% CI: -0.45, -0.08; n = 9; I2 = 29%). Adverse events included flatulence, nausea, and headache. Topical bromelain significantly reduced the time to complete debridement (mean difference in time = -6.89 days; 95% CI: -7.94, -5.83; n = 4; I2 = 2%). Adverse events may be irrelevant and include burning sensation, pain, fever, and sepsis. Conclusions: Moderate-quality studies demonstrated the potential of oral bromelain in pain control and topical bromelain in wound care. Major health risks were not reported during the treatment with bromelain.

Comparison of a Non-Opioid Multimodal Analgesia Protocol with Opioid-Based Patient-Controlled Analgesia for Pain Control Following Robot-Assisted Radical Prostatectomy: A Randomized, Non-Inferiority Trial.

Opioid use after surgery is a potential contributor to the opioid epidemic. An adequate pain control method after surgery while minimizing opioid exposure is needed. This study aimed to compare the effect of non-opioid multimodal analgesia (NOMA) protocol with opioid-based patient-controlled analgesia (PCA) for pain relief after robot-assisted radical prostatectomy (RARP). This prospective randomized, open, non-inferiority trial included 80 patients scheduled for RARP. The NOMA group received pregabalin, paracetamol, bilateral quadratus lumborum block, and pudendal nerve block. PCA group received PCA. Pain scores, postoperative nausea and vomiting, opioid requirements, and quality of recovery were recorded 48 hours after surgery. We found no significant differences in pain scores. The mean difference in pain score during rest at 24 h was 0.5 (95% CI -0.5 to 2.0). This result demonstrated the non-inferiority of NOMA protocol to PCA at our non-inferiority margin (-1). In addition, 23 patients in the NOMA group did not receive any opioid agonist for 48 h after surgery. Recovery of bowel function was also faster in the NOMA group than in the PCA group (25.0 hours vs 33.4 hours, p = 0.01). We did not evaluate whether our NOMA protocol could decrease the incidence of new continuous opioid use after surgery. NOMA protocol successfully controlled postoperative pain and was non-inferior to morphine-based PCA regarding patient-reported pain intensity. It also promoted recovery of bowel function and decreased postoperative nausea and vomiting.

A meta-epidemiological study on the reported treatment effect of pregabalin in neuropathic pain trials over time.

Pregabalin is a drug used to treat neuropathic pain, and its use has increased substantially since 2007. Early trials found a strong treatment effect on pain for post-herpetic neuralgia and diabetic neuropathy. However more recent studies have failed to replicate these results. This meta-epidemiological study aimed to assess change in the reported effectiveness of pregabalin in neuropathic pain trials over time, and if a change is present, determine any associated factors. We performed electronic searches for published trials in Medline, Embase and Cochrane Central Register of Controlled Trials databases; and unpublished trials on ClinicalTrials.gov, the EU Clinical Trials Register, and the Australia New Zealand Clinical Trials Registry with no restrictions. We included randomized, placebo-controlled trials of pregabalin for treatment of neuropathic pain in adults. Two authors independently extracted study data: sample size and mean baseline, end-point and change in pain scores with measures of variance, trial end year, publication year, clinical indication, funding source, country of study, treatment duration, treatment dose, mean age and percentage male. We defined treatment effect as the mean difference in pain scores between pregabalin and placebo groups at trial end-point and assessed for change over time using a random-effects meta-regression, adjusted for sample size, indication, treatment duration (weeks) and treatment dose. We included 38 randomized published trials (9038 participants) and found that between 2003 and 2020, the reported treatment effect of pregabalin decreased by 0.4 points (95% CI: 0.3 to 0.6; p<0.001) on an 11-point pain scale per 5-year interval, from 1.3 points (95% CI: 1.0 to 1.5) in trials conducted in 2001-2005, to 0.3 (95% CI: -0.1 to 0.7) in trials conducted in 2016-2020. The reported treatment effect was lower than the minimal clinically important difference (MCID) of 1.7 points across all time periods, doses and most indications and was not found to be associated with study characteristics. The reported treatment effect or analgesic efficacy of pregabalin from clinical trials has diminished over time. Clinical recommendations may need to be re-evaluated to account for recent evidence and to consider whether pregabalin therapy is indicated.

The Current Insight of Three Operative Approach for Lateral Epicondylitis: A Systematic Review &amp; Meta-Analysis from 1944 Elbows

Objective: Lateral epicondylitis (LE), also commonly known as tennis elbow, is one of the most common causes of lateral epicondyle pain. Most LE cases can resolve spontaneously or with conservative treatment. However, up to 10% of the patients still do not respond to the conservative treatment, making the operative treatment still needed. Yet, the best approach remains controversial, which leaves the option to the individual surgeon’s experience and ease of the procedure. Our study aims to objectively find the difference in the outcome of the operative modalities qualitatively and quantitatively. Methods: This study was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline where the protocol was registered PROSPERO [ID: CRD42022339650]. OCEBM level I-IV evidence studies were discovered using Boolean search strings that were created according to the patient, intervention, comparison, and outcomes of the study in three databases. Study quality was assessed with the Cochrane RoB tool and MINORS score. The success rate from operative modalities becomes the main outcome of the current study. Results: Forty-six studies were included in the study after a comprehensive literature search was done. From the analysis of 1944 elbows in three different groups, we found that arthroscopic surgery has the highest success rate (91.9%) compared to percutaneous (90.6%) and open (82.7%) lateral epicondylitis surgery with a change in mean pain score of 5.54, 4.90, and 3.63 respectively. The functional outcome improved according to DASH, in the arthroscopic group (51.51 to 15.47), the percutaneous group (44.90 to 10.47), and the open group (53.55 to 16.13). The overall improvement was also found in the MAYO score, in the arthroscopic group (55.12 to 64.70), in the percutaneous group (56.31 to 87.65), and the open group (64 to 93.37). Conclusion: Among the three different modalities of lateral epicondylitis surgery, arthroscopic surgery has the highest rate of success with the highest mean difference in pain score. Every surgical outcome also has an overall improvement in functional outcome scores.

Ability of polymicrobial probiotic and mono-strain probiotic to reduce functional abdominal pain in children: a randomized clinical trial.

Chronic abdominal pain is a common problem in childhood. Due to the prevalence of functional abdominal pain (FAP) and the importance of probiotics, this study aimed to compare the ability of 2 probiotics to reduce and improve FAP in children. This open-label randomized clinical trial included 116 children aged 5-15 years with FAPP who met the ROME-4 criteria and were referred to the gastrointestinal clinic of Amir-Kabir Hospital in Arak in 2020-2021. The children were randomly allocated to receive polymicrobial probiotic (PMP group) or mono-strain probiotic (MSP group) once daily for 4 weeks. The standard Wong-Baker Faces scale was used to assess symptom severity. Of the 116 subjects, 62 (53.5%) were boys; the mean participant age was 7.39 years (standard deviation, 3.4 years). A significant intergroup difference (P=0.003) was observed in pain severity; 10.34% of children in the PMP group had no pain, while all patients in the MSP group reported low-degree pain. There was no intergroup difference in mean pain score (P=0.466), but it decreased over time in both groups (P= 0.001). Although significantly more children were painless in the PMP versus MSP group, no significant intergroup difference in pain score was noted and symptom severity decreased in both groups. A future study with a placebo group is recommended to validate our findings.

Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis.

Osteoid osteoma (OO) is a primary benign tumor that affects mainly young patients. Ten percent of all OO are located in the vertebral column. Treatment of spinal OO is challenging and there is no consensus in the literature on the best operative approach. The aim of this systematic review and meta-analysis was to determine safety and efficacy of radiofrequency ablation (RFA) versus surgical excision for the treatment of spinal OO. A literature search was performed on PubMed, Web of Science, and Embase from inception up to 22 March 2022. Studies addressing surgical excision or RFA for the treatment of spinal OO were included. The main outcomes evaluated were pain before and after intervention, the treatments success rate, defined as complete pain relief with no recurrence until the last follow-up, and the number and type of complications. Thirty-one studies (749 patients) were included. For patients who underwent surgical excision, 19 studies reported a mean treatment success rate of 85.6%, while in the RFA treatment group, 18 studies reported a mean success rate of 88.6%. At last follow-up, the pooled mean difference in pain scores from baseline on a 0-10 scale was 5.8 points in the surgical excision group and 6.7 points in the RFA group. Recurrences were observed in 5.6% of the patients who underwent surgical excision and in 6.7% of the patients treated with RFA. The complication rate was 7.8% in the surgical excision group and 4.4% in the RFA group. This meta-analysis found high global success rates for both surgical and RFA treatments. Both treatments were efficient in pain relief and presented a low rate of recurrences. The complication rate was low for both treatments. Compared to surgical excision, RFA is a less invasive procedure which proved to be a safe and as effective option for the treatment of spinal OO.

Pericapsular nerve group (PENG) block for hip arthroscopy: a randomized, double-blinded, placebo-controlled trial

IntroductionArthroscopic hip surgery is associated with significant postoperative pain. Femoral nerve blocks have been shown to improve postoperative analgesia at the expense of quadriceps weakness. The pericapsular nerve group (PENG)...