Difference In Numerical Rating Scale Research Articles

Perioperative ketamine to reduce and prevent acute and chronic post-thoracotomy pain: a randomized, double-blind, placebo-controlled clinical trial.

Moderate to severe postoperative pain is common among patients following thoracotomy and serves as a risk factor for developing chronic post-thoracotomy pain (CPTP). This randomized controlled trial evaluated the effects of pre-emptively administered ketamine compared to placebo and standard care on both acute postoperative pain and CPTP. Two hundred patients were enrolled in this prospective, randomized trial. The presence and severity of pain were assessed before surgery, first 6 hours after surgery, on postoperative days (PODs) 1-8, 30, and 90. For documentation of neuropathic pain, the Leeds Assessment Score for Neuropathic Symptoms and Signs (LANSS) was used pre- and postoperatively. The incidence and severity of CPTP was assessed by a telephone survey, the self-assessment LANSS (S-LANSS) 30 and 90 days after surgery. There was significant difference in numeric rating scale (NRS) pain scores when coughing in the first 6 hours after surgery, with less pain in the ketamine group. No difference was seen in NRS pain scores at rest and coughing between the ketamine and placebo group on PODs 1-8. There was no difference in the opioid consumption between the two groups. Thirty-four (18.7%) of the patients had a S-LANSS score ≥12 30 days following surgery, 12 (12.8%) in the ketamine group vs. 22 (25%) in the placebo group (P=0.001). Thirty-three (18.2%) of all patients had a S-LANSS score ≥12 90 days following surgery 8 (8.5%) in the ketamine group vs. 25 (28.4%) in the placebo group (P<0.001). In summary, pre-emptive ketamine does not reduce opioid consumption and NRS scores after thoracotomy but more importantly it lowers significantly the incidence of chronic postoperative pain, especially neuropathic pain. The study was registered at ClinicalTrials.gov (NCT03105765).

Intrathecal Drug Delivery System in Prepontine Cistern for Patients with Intractable Craniofacial Cancer Pain: A Multicenter Retrospective Study.

Patients with craniofacial cancer frequently suffer from severe pain. The traditional intrathecal, oral, or intravenous analgesics could only provide insufficient pain relief with many side effects. Thus, a more effective analgesia approach is required. This study aimed to investigate the safety and efficacy of placing the catheter of an intrathecal morphine pump in the prepontine cistern for the treatment of craniofacial cancer pain. We performed a retrospective study of patients with primary or metastatic craniofacial cancer pain who received the catheter placement of an intrathecal morphine pump into the prepontine cistern in eleven medical centers from September 2019 to December 2023. Friedman test and pairwise signed-rank test were used to evaluate the difference in numeric rating scale (NRS) scores, the number of breakthrough pain episodes, dose of intrathecal morphine, and dose of systemic morphine equivalents (oral, patch, intravenous) from preoperative period to postoperative days 1, 7, and 30. P values were corrected for multiple comparisons using Bonferroni test. The study included 33 patients. The median (interquartile range [IQR]) of NRS scores at days 1, 7, and 30 postimplant were 2.0 (1.0-3.5), 2.0 (1.0-2.0), and 1.0 (1.0-2.0), respectively, which was significantly lower than that before surgery (median, 8.0; IQR, 7.0-10.0; all P < .001). Compared to baseline number/d of breakthrough pain episodes (median, 6.0; IQR, 4.5-10.0), there was a progressive decrease in the number/d of breakthrough pain episodes at day 1, day 7, and day 30 postimplant, and the median (IQR) were 1.0 (0.0-3.0), 2.0 (0.0-3.0), and 0.0 (0.0-1.2), respectively (all P < .001). Approximately 78.8% and 96.7% of patients reported pain relief >50% at days 1 and 30 postimplant, respectively. Compared with that at day 1 postimplant, the proportion of patients with a pain relief rate >75% at day 30 postimplant also increased with continued intrathecal treatment. Compared to the dose of baseline systemic morphine equivalents (median, 228 mg.d-1; IQR, 120-408 mg.d-1), the dose of systemic morphine equivalents reduced significantly from 0(0-120) mg.d-1 at day 1 postimplant (P = .001), to 0 (0-0) mg.d-1 at days 7 and 30 postimplant (both P < .001). Few patients reported perioperative adverse events, including nausea, constipation, hypotension, urinary retention, dry mouth, headache, and sedation. No severe adverse events occurred. Placing the catheter tip of an intrathecal morphine pump into the prepontine cistern could effectively relieve refractory craniofacial cancer pain with an extremely low total morphine dose requirement and few adverse events. This procedure could be considered in patients with severe refractory craniofacial cancer pain.

Prehospital analgesia in suspected hip fracture patients: adherence to national prehospital pain management guidelines.

Patients with hip fractures frequently present at the emergency department (ED). Despite high pain scores, prehospital pain management is often inadequate and insufficient. In the Netherlands, the emergency medical services (EMS) exhibit a high level of training, supported by a comprehensive pain treatment protocol. This study aimed to assess adherence to the protocol and hypothesized that prehospital pain management in hip fracture patients was both sufficient and adequate. This was a retrospective observational cohort study of patients with suspected hip fractures. The median differences in numerical rating scale (NRS) pain scores between the initial score in the ambulance and upon arrival at the ED were compared. Furthermore, adherence to the ambulance pain protocol was studied. From September 2016 to March 2021, 436 ambulance-transported hip fracture patients were included, of whom 81% received analgesics by EMS. The median initial pain score measured by EMS was 8; this number decreased to 5 at ED presentation, a significant decrease (ρ < 0.001). In case a prehospital NRS pain score was assessed, 66.5% of the patients were treated according to the protocol. In 80% of patients, the protocol was not followed correctly, primarily due to missing NRS pain scores. In suspected hip fracture patients, initial prehospital pain scores were high and most patients received analgesics from EMS. This resulted in a significant decrease in pain. In nearly 67% of patients in whom an NRS pain score was assessed in the prehospital phase, pain management was according to protocol. However, in 80% of the total population the pain protocol was not adhered to, mainly due to missing NRS pain scores.

Long-term follow-up of inpatients with traumatic fractures who received integrative Korean Medicine treatment: A retrospective analysis and questionnaire survey study.

Previous studies have reported pain reduction after Korean medicine (KM) treatment in patients with fractures. However, these studies were limited by small sample sizes and short observation periods. To address these limitations, we aimed to analyze the outcomes of patients with traumatic fractures who received integrative KM treatment and investigate their long-term progress through follow-up observations. This study was a retrospective analysis and questionnaire survey conducted at a multi-center inpatient care setting in Korea. A total of 1150 patients who had traumatic fractures and received at least 5-day inpatient care at one of 5 KM hospitals. Finally, 339 patients completed the follow-up survey. The questionnaire survey was administered 3 months post discharge. The primary outcome was the difference in numeric rating scale (NRS) scores at admission and discharge for fracture-related pain. The secondary outcomes were EuroQol 5-Dimension 5-Level (EQ-5D-5L) score, Oswestry Disability Index, Neck Disability Index, Western Ontario and McMaster Universities Arthritis Index, Shoulder Pain and Disability Index, and Patient Global Impression of Change (PGIC) score. The follow-up questionnaire survey included questions on surgery and imaging before admission and after discharge and treatment within the past 3 months. The mean NRS score at follow-up showed a significant decrease of 4.41 points compared with that at admission (P < .001). The mean EQ-5D-5L score at follow-up showed a significant increase of 0.18 points compared with that at admission (P < .05). In the follow-up survey on PGIC, 307 participants (90.56%) were "minimally improved" or better. Integrative KM treatment can help improve pain, functional impairment, and long-term quality of life in patients with traumatic fractures.

Comparison of the efficacy of pericapsular nerve group block (PENG) block versus suprainguinal fascia iliaca block (SFIB) in total hip arthroplasty: A randomized control trial.

Hip replacement surgery is a commonly performed surgery with the aim of improving mobility in patients suffering from hip conditions. Though the modified suprainguinal approach of fascia iliaca block (SFIB) is commonly used, the analgesic efficacy is moderate and is associated with quadriceps weakness. The pericapsular nerve group (PENG) block has been used to block the sensory articular branches of the hip joint in various hip surgeries. This study aimed to compare SFIB with PENG block in terms of pain relief, opioid consumption and their adverse effects in patients undergoing primary total hip arthroplasties. (THA). Seventy ASA I/II patients undergoing primary THA were enrolled in this double-blinded, randomized trial. Patients were randomly allocated to one of the two groups: Group P: ultrasound (US)-guided PENG block and Group S: patients received the US-guided SFIB. Postoperatively, there was statistically significant difference in numerical rating scale (NRS) scores at all-time intervals. Total morphine consumption in 24 hours and 48 hours was statistically more in SFIB group. Five patients had quadriceps weakness in the SFIB group. There was no difference in any other adverse effects. US-guided PENG block significantly reduces perioperative morphine consumption and pain scores in THA patients when compared to SFI block. It is not associated with quadriceps weakness as seen in SFIB.

Effects of Pregabalin as Preemptive Analgesia for Pain Score, Sedation Score, and Cortisol Level after Caesarean Section Under Spinal Anesthesia

INTRODUCTION: Cesarean section (C-section) is an increasingly common method of delivery, so optimal management of anesthesia and post-operative pain is essential for better outcomes. Preemptive analgesia is an effective method for preventing post-operative pain, with the benefits of pregabalin specifically being much studied and debated. This study aimed to determine the side effects and efficacy of different pregabalin doses for pain management and prevention of stress response in C-section patients under spinal anesthesia. MATERIALS AND METHODS: This double-blind randomized trial study examined 30 patients who underwent elective C-section under spinal anesthesia with 0.5% hyperbaric bupivacaine 10 mg + adjuvant fentanyl 25 mcg, who were divided into three equal groups which received oral placebo or pregabalin (75 or 150 mg). Pain scores, sedation scores, and cortisol levels and changes were analyzed, the former two using Mann–Whitney tests, cortisol levels using one-way Analysis of variance (ANOVA) tests, and cortisol level changes using repeated-measures ANOVA tests on SPSS software version 20. Results were considered significant when p &lt; 0.05. RESULTS: There were significant differences in numerical rating scale between the placebo and pregabalin groups at rest and movement after surgery (p &lt; 0.05), and in sedation scores between the placebo and 150 mg groups and between the 75 mg and 150 mg groups at 2 and 6-h post-surgery (p &lt; 0.05), as well as cortisol level changes between all groups (p &lt; 0.05). CONCLUSIONS: Preemptive administration of pregabalin 75 mg is recommended for C-section surgery because it may reduce post-operative pain with minimal side effects.

Dexmedetomidine versus tramadol as adjuvant to bupivacaine in intra-articular injection after knee arthroscopy: A prospective control randomized trial.

Evaluating the time to the first request of rescue analgesic after adding either dexmedetomidine or tramadol to intraarticular bupivacaine. A prospective, randomized, control, double-blinded study. Operating room at Tanta University Hospital. Sixty adult patients were enrolled and scheduled for knee arthroscopic surgery. Post-operative intra-articular injection of dexmedetomidine 1 µg/kg or tramadol 100 mg compared with a control group receiving intra-articular bupivacaine alone. The time to the first request of rescue analgesic, total consumption of analgesic, and post-operative numeric rating scale at 1, 3, 6, 9, 12, and 24 hours post-operatively. The time to the first request of analgesia was comparable between group D and group T with p value 0.84, but it was significantly shorter in group T and group D in comparison with group C, with p value 0.001 for both. Post-operative 24 hours morphine consumption was also comparable between group D and group T with p value 0.17, but it was significantly lower in group T and group D in comparison with group C, with p value 0.001 for both. There was also no significant difference in numeric rating scale between dexmedetomidine group and tramadol group over the 24 hours of the study, but numeric rating scale values were significantly higher in the control group. The incidence of nausea and vomiting was comparable among the three groups. All patients displayed a stable hemodynamic profile. Adding either dexmedetomidine or tramadol as a single dose to intra-articular bupivacaine resulted in the prolongation of the time to the first request of analgesic and reduced the incidence of post-operative pain and post-operative morphine requirement, when compared with the groups receiving intra-articular bupivacaine alone.

Decreasing leakage during continuous femoral nerve catheter fixation using 2-octyl cyanoacrylate glue (Dermabond\xae): a randomized controlled trial

BackgroundContinuous peripheral nerve catheters (CPNCs) have been used for postoperative pain relief. A common problem encountered with CPNCs is pericatheter leakage, which can lead to dressing adhesive failure. Frequent dressing changes increase the risk of catheter dislodgement and infections. Adhesive glue is effective in securing the peripheral nerve catheter and decreasing leakage around the catheter insertion site. This study aimed to evaluate the incidence of pericatheter leakage with fixation using 2-octyl cyanoacrylate glue (Dermabond®) as compared to sterile strips.MethodsThirty patients undergoing unilateral total knee arthroplasty (TKA) with continuous femoral nerve catheter for postoperative analgesia were randomized into the catheter fixation with 2-octyl cyanoacrylate glue (Dermabond®) group or the sterile strip group. The primary outcome was the incidence of pericatheter leakage. Secondary outcomes included the frequent of catheter displacement, the difficulty of catheter removal, pain score and patient satisfaction.ResultsThe incidence of pericatheter leakage at 24 and 48 h was 0% versus 93 and 0% versus 100% in the Dermabond® and sterile strip groups, respectively (P < 0.001). The incidence of displacement at 24 and 48 h was 6.7% versus 93.3 and 6.7% versus 100% in the Dermabond® and sterile strip, respectively (P < 0.001). There was no difference in numeric rating scale, difficulty of catheter removal, or satisfaction scores between groups.ConclusionsCatheter fixation with 2-octyl cyanoacrylate glue (Dermabond®) decreased the incidence of pericatheter leakage, as well as catheter displacement, over 48 h as compared to sterile strip fixation.Trial registrationThis trial was registered on Thai clinical trial registry: TCTR20200228002, registered 24 February 2020- Retrospectively registered.

Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial

Previous randomized trials on cuff repair have included mainly degenerative tears, but studies on acute traumatic tears are lacking. We aimed to compare early surgical repair with nonoperative treatment for traumatic supraspinatus tears. We did a 2-center randomizedcontrolled trial of patients with small rotator cuff tears mainly involving supraspinatus, comparing surgical repair (n = 32) and physiotherapy (n = 26). The primary outcome was a group difference in the Constant-Murleyscore at 12-monthfollow-up. Secondary outcomes were differences in the Western Ontario Rotator Cuff index, pain (Numerical Rating Scale 0-10), and Euro quality-of-life-visual analog scale. We used magnetic resonance imaging to assess retear rate, tear progression, fatty infiltration, and atrophy. The mean age was 59.7 years (range, 44-77 years), median sagittal tear size was 9.7 mm (range, 4-21 mm), and baseline characteristics were well balanced between the 2 groups. The repair group had a median Constant-Murley of 83 (25 quartile range[QR]) and the physiotherapy group 78 (QR, 22) at 12 months, with the between-group difference in medians of 4.5 (-5 to 9, 95% confidence interval; P = .68). The corresponding values for the Western Ontario Rotator Cuff index were 91% (QR, 24) vs. 86% (QR, 24), with the between-group difference of 5.0 (-4 to 9, 95% confidence interval; P = .62). There was no difference in Numerical Rating Scale or in Euro quality-of-life-visual analog scale. Retear was found in 6.5% of repaired patients and tear progression >5 mm in 29.2% of unrepaired patients. We found no significant differences in clinical outcomes between cuff repair and nonoperative treatment at 12-monthfollow-up. Approximately one third of unrepaired patients had a tear enlargement of more than 5 mm.

Effectiveness of Simulated Horseback Riding for Patients With Chronic Low Back Pain: A Randomized Controlled Trial.

A simulated horseback riding (SHR) exercise is effective for improvement of pain and functional disability, but its comparative effectiveness with the other is unknown. The authors aimed to demonstrate the effect of a SHR exercise in people with chronic low back pain. A randomized controlled trial. Community and university campus. A total of 48 participants with chronic low back pain were divided into 2 groups, and SHR exercises (n = 24) or stabilization (STB) exercises (n = 24) were performed. The exercises were performed for 30 minutes, 2 days per week for 8 weeks. Numeric rating scale, functional disabilities (Oswestry disability index and Roland-Morris disability), and fear-avoidance beliefs questionnaire (FABQ) scores were measured at baseline and at 4 weeks, 8 weeks, and 6 months. A 2-way repeated analysis of variance identified that between-group comparisons showed significant differences in the FABQ related to work scale (F = 21.422; P = .01). There were no significant differences in the numeric rating scale (F = 1.696; P = .21), Oswestry disability index (F = 1.848; P = .20), Roland-Morris disability (F = 0.069; P = .80), and FABQ related to physical scale (F = 1.579; P = .24). In within-group comparisons, both groups presented significant differences in numeric rating scale (both SHR and STB after 4wk), Oswestry disability index (both SHR and STB after 6mo), and Roland-Morris disability (SHR after 6mo and STB after 8wk) compared with baseline values. In FABQ-related physical (SHR after 4wk) and work scales (SHR after 6mo), there were only significant differences in the SHR compared with baseline values. SHR exercise for 8 weeks had a greater effect than STB exercise for reducing work-related FABQ. The SHR exercise performed in a seated position could substantially decrease pain-related fear disability in young adults with chronic low back pain.

Effectiveness of Balloon Kyphoplasty in Patients with Painful Vertebral Compression Fractures

We performed a case series study on the effectiveness of balloon kyphoplasty (BKP) for painful vertebral compression fractures in 60 patients with acute axial lumbar and/or thoracic spinal pain due to osteoporosis, trauma or cancer, who were referred to the pain center of a general hospital. The pain intensity levels appeared to be statistically significant different between the pain level at baseline (T0) and the three moments of measurement (T1, T2, T3) after the procedure, p<0.001. No statistically significant difference in Numerical Rating Scale (NRS) for pain was found between the three moments of measurement after the procedure. No statistically significant difference in NRS for pain was found between the patients with osteoporosis and those with cancer between T0 and T1 (p=0.48). This study shows that in patients with painful (non) malignant vertebral compression fractures BKP can result in a statistically and clinically significant pain reduction lasting at least one year. There is a need for new high quality studies to define the place of BKP in patients with acute axial back pain due to vertebral compression fractures.

Comparison of Ultrasound-Guided Lumbar Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Hip and Proximal Femur Surgery: A Prospective Randomized Feasibility Study.

Study Objective:Lumbar Erector spinae Plane block (L-ESPB) is a modification of a recently described block. Both L-ESPB and Transmuscular Quadratus Lumborum block (QLB-T) have been reported to provide effective postoperative analgesia in hip and proximal femur surgery. Herein, we compare the effectiveness of L-ESPB and QLB-T in providing postoperative analgesia in patients undergoing hip and femur operations.Design:Double-blinded, prospective, randomized, feasibility study.Setting:Tertiary university hospital, postoperative recovery room and ward.Methodology:A total of 72 patients (American Society of Anesthesiology physical status classification II-III) were recruited. After exclusion, 60 patients were allocated to three equal groups (control, L-ESB and QLB-t).Interventions:Standard multimodal analgesia was performed in the control group while L-ESPB or QLB-T was performed in the block groups.Measurements:Pain intensity between groups was compared using Numeric Rating Scores. Furthermore, tramadol consumption and additional rescue analgesic requirement was measured.Results:There was no difference between demographic data or type of surgery. While there was no difference in Numeric Rating Scale (NRS) score at any hour between the block groups; NRS scores at the 1st, 3rd and 6th h, tramadol consumption during the first 12 h and total tramadol consumption, the number of patient required rescue analgesic in 24 h were significantly higher in the control group compared to both block groups.Conclusion:While L-ESPB and QLB-T have similar effect, they improve analgesia quality in patients undergoing hip and proximal femoral surgery when compared to standard intravenous analgesia regimen.

Effectiveness of a Decision-Making Protocol for the Surgical Treatment of Lumbar Stenosis with Grade 1 Degenerative Spondylolisthesis.

Addition of fusion to decompression for stenosis with grade 1 degenerative spondylolisthesis is a controversial topic, and the question remains if fusion provides any benefit to the patient that warrants the increased health care utilization and perioperative morbidity. There is no consensus on indications for use of fusion over decompression alone. Patients received fusion or decompression according to a decision-making protocol based on their pattern of complaints, location of the compression, and facet angles and effusion as proven predictors of postoperative instability. Propensity score matching of patients was done for baseline data. The study comprised 102 patients in 2 equally sized groups. No intergroup differences in numeric rating scale and Oswestry Disability Index were detected at any follow-up point (all P > 0.05). Duration of surgery, length of stay, estimated blood loss, and radiation doses were higher in the fusion group (all P < 0.001). Cumulative reoperation rate was similar with 6% for fusion and 8% for decompression (P > 0.05), as was the complication rate (8% vs. 6%, P > 0.05). Postoperative iatrogenic progression of spondylolisthesis requiring fusion surgery was seen in only 2% in the decompression group. Use of a decision-making protocol led to a low rate of iatrogenically increased spondylolisthesis after decompression, while retaining outcomes. These data suggest that a decision-making protocol based on clinical history, location of nerve root compression, and proven radiologic predictors of postoperative instability assigns patients to fusion or decompression in a safe and effective manner.

Isometric Exercise Above but not Below an Individual's Pain Threshold Influences Pain Perception in People With Lateral Epicondylalgia.

To examine the acute effects of isometric exercise of different intensities on pain perception in individuals with chronic lateral epicondylalgia. Participants performed 3 experimental tasks completed in a randomized order on separate days: control (no exercise) and isometric wrist extension (10×15 s) at load 20% below (infrathreshold), and 20% above (suprathreshold) an individual's pain threshold. Self-reported pain intensity (11-point numeric rating scales), pressure pain threshold, and pain-free grip were assessed by a blinded examiner before, immediately after, and 30 minutes after task performance. Relation analysis between pain ratings and clinical variables, including pain and disability and kinesiophobia was performed. Twenty-four individuals with unilateral lateral epicondylalgia of median 3-month duration participated. Pain intensity during contraction was significantly higher during suprathreshold exercise than infrathreshold exercise (mean difference in numeric rating scale 1.0; 95% confidence interval, 0.4-1.5; P=0.002). Pain intensity during suprathreshold exercise was significantly correlated with pain and disability (R=0.435, P=0.034) and kinesiophobia (R=0.556, P=0.005). Pain intensity was significantly higher immediately after performance of suprathreshold exercise, compared with infrathreshold exercise (P=0.01) and control (P<0.001) conditions, whereas infrathreshold exercise and control conditions were comparable. Thirty minutes later, pain levels remained significantly higher for suprathreshold exercise compared with infrathreshold exercise (P=0.043). Pressure pain threshold and pain-free grip showed no significant effects of time, condition, or time×condition (P>0.05). Individuals with lateral epicondylalgia demonstrated increased pain intensity after an acute bout of isometric exercise performed at an intensity above, but not below, their individual pain threshold. Further investigation is needed to determine whether measurement of an individual's exercise induced pain threshold may be important in reducing symptom flares associated with exercise.

Gender differences in pain levels before and after treatment: a prospective outcomes study on 3,900 Swiss patients with musculoskeletal complaints

BackgroundCurrent studies comparing musculoskeletal pain levels between the genders focus on a single point in time rather than measuring change over time. The purpose of this study is to compare pain levels between males and females before and after treatment.MethodsEleven different patient cohorts (3,900 patients) included in two prospective outcome databases collected pain data at baseline and 1 month after treatment. Treatments were either imaging-guided therapeutic injections or chiropractic therapy. The Mann–Whitney U test was used to calculate differences in numerical rating scale (NRS) median scores between the genders for both time points in all 11 cohorts.ResultsFemales reported significantly higher baseline pain scores at 4 of the 11 sites evaluated (glenohumeral (p = 0.015), subacromial (p = 0.002), knee (p = 0.023) injections sites and chiropractic low back pain (LBP) patients (p = 0.041)). However, at 1 month after treatment there were no significant gender differences in pain scores at any of the extremity sites. Only the chiropractic LBP patients continued to show higher pain levels in females at 1 month.ConclusionsIn these 11 musculoskeletal sites evaluated before and after treatment, only 3 extremity sites and the chiropractic LBP patients showed significantly higher baseline pain levels in females. At 1 month after treatment only the LBP patients had significant gender differences in pain levels. Gender evaluation of change in pain over time is likely to be more clinically important than an isolated pain measurement for certain anatomical sites.