Duration Of Pain Research Articles

Manual reduction in testicular torsion and subsequent treatment after successful reduction: a series of reports in a single institution.

To explore the factors affecting the success of testicular torsion manual reduction and the safety of subsequent conservative treatment after successful reduction. Clinical data of 66 patients with testicular torsion treated in our emergency department from February 2017 to February 2022 were retrospectively collected. Manual reduction without anesthesia was performed in 19 patients. Patients with successful manual reduction chose different subsequent treatments according to the wishes of themselves and their guardians, including continuing conservative treatment and surgical exploration. Relevant clinical data were collected and analyzed. Manual reduction was successful in 11 patients (11/19). Seven of them chose to continue conservative treatment, and four underwent surgical exploration immediately. Among the 7 patients who were treated conservatively, 3 underwent surgical treatment due to scrotal discomfort or testicular torsion at different stages, and the remaining 4 patients showed no recurrence of torsion during follow-up. Compared with other patients, patients with successful manual reduction had the shorter duration of pain (p < 0.05). The time from visiting our hospital to surgery in patients who attempted manual reduction was slightly shorter than those who underwent surgery directly (p > 0.05). The testes of these 11 patients were all successfully preserved. The short duration of pain may contribute to the success of manual reduction, and manual reduction did not increase the preparation time before surgery. Due to the unpredictable risk of recurrence, immediate surgical treatment is still recommended, or postponed elective surgical treatment should be offered in the next days or weeks.

To Determine the Effectiveness of Conservative Treatment Versus Appendectomy in the Management of Acute Uncomplicated Appendicitis.

Background: The vermiform appendix is considered to be a vestigial organ by the most. Its importance in surgery results only from its tendency for inflammation that results in a clinical syndrome known as acute appendicitis. It is the most common indication for emergency abdominal surgery in patients with acute abdomen with a crude annual incidence of 26 per 10,000 populations.Objectives: To determine the effectiveness of Conservative Treatment Versus appendectomy in the management of AcuteUncomplicated Appendicitis.Material and Methods: This randomized control trial was conducted in Department of General Surgery Saidu Group of Teaching Hospital Saidu sharif, from 1st January 2022 to 31st December 2022. A total of 96 cases were enrolled, that were divided into two groups. Informed written consent was taken from each patient. Patients in Group A were subjected to non-operative management with antibiotics while patients in Group B were subjected to appendectomy. Patients in both groups were evaluated for various parameters such as age, gender, pre- and post-operative duration of pain (group B), Alvarado score. Post stratification chi-square test was applied keeping P Value &lt; 0.05 as significant. Results: Mean and SD for Age, Duration of Stay, Pre &amp; Post Treatment Abdominal Score and Pre and Post Treatment Alvarado Score in Group A was recorded as 35±10.60, 3.0±0.24, 7.0±0.49, 3.0±0.20, 9.0±0.41 and 3.0±1.62 respectively. In the same manner, Mean and SD for Group B was 35±12.53, 5.0±0.41, 7.0±0.35, 3.0±0.35, 3.0±0.20, 9.0±0.41, and 2.5±1.5, respectively. Success rate in Group A was 26 (52%) whereas in Group B it was 36 (72%) patients. Conclusion: Conservative treatment can be applied safely in the majority of cases of the first attack of uncomplicated acute appendicitis, therefore, avoiding appendectomy and its associated morbidity and mortality. Keywords: Acute appendicitis, Alvarado Score, Antibiotic treatment, Acute uncomplicated appendicitis, Success rate.

Relationship between perfectionism, overactivity, pain severity, and pain interference in individuals with chronic pain: A cross-lagged panel model analysis.

Overactivity is a characteristic of individuals with chronic pain. Previous cross-sectional studies demonstrated a relationship between perfectionism and overactivity. Therefore, the present study used a longitudinal design to determine whether pain severity and pain interference were exacerbated by overactivity and whether overactivity was exacerbated by perfectionism. Participants with chronic pain were recruited using crowdsourcing. The participants completed the questionnaires at three time points: T1, T2, and T3 (September, October, and November 2021, respectively). The questionnaire assessed overactivity, perfectionistic strivings, perfectionistic concerns, pain severity, and pain interference. We created cross-lagged panel models to examine the hypothesized relationships among pain, overactivity, and perfectionism. After excluding ineligible participants and invalid response sets, we analyzed the questionnaires completed by 666 participants at T1, 560 at T2, and 554 at T3. The average duration of chronic pain at T1 was 36.35 ± 53.53 months. Perfectionistic strivings were partially linked to overactivity, and pain interference was partially related to overactivity. Contrary to our expectations, overactivity did not predict pain severity or pain interference. The hypotheses that perfectionism exacerbates overactivity and that overactivity exacerbates pain severity and pain interference were not supported. These results may have been affected by the quality of the assessment of overactivity. Therefore, further research with a refined evaluation of overactivity is required.

Predictors for emergency readmission in patients with ureteral calculi: a focus on pain management and stone location.

The management of patients with ureteral calculi in the emergency department (ED) remains challenging due to high revisit rates. To identify predictors of revisits among patients with ureteral calculi in the ED. Data from patients who presented at a tertiary academic hospital in Seoul, Republic of Korea, between February 2018 and December 2019, were analyzed retrospectively. Variables, including the respiratory rate (RR), estimated glomerular filtration rate (eGFR), duration of pain, number of analgesic doses, location of ureteral calculi, and ED length of stay (LOS) were examined using logistic regression. We also examined some additional variables included in the STONE and CHOKAI scoring systems to examine their association with revisit. Significant predictors of revisits included the number of analgesic doses and the location of ureteral calculi. Patients who required multiple analgesic doses or those with proximal or mid-ureteral calculi were more likely to revisit the ED. Although the STONE and CHOKAI scores could predict uncomplicated ureteral calculi, we found that the CHOKAI score is a valuable tool for predicting the likelihood of patient revisits (p = 0.021). Effective pain management and consideration of calculi location are important for predicting patient revisits. More research is required to validate findings, develop precise predictive models, and empower tailored care for high-risk patients. In patients with ureteral calculi in the ED, the number of analgesics given and stone location predict return visits. Proximal ureteral calculi on CT may require early urologic intervention to prevent pain-related revisits.

Comorbidities are not associated with pain symptom or recurrence in patients with pilonidal disease.

Comorbidities can potentially impact the presentation or outcome of patients with pilonidal disease (PD) due to poor wound healing or increased inflammatory response. We hypothesized that certain comorbidities could lead to worse pain or higher recurrence rate. A retrospective study was performed on all PD patients treated with standardized minimally invasive protocol at our clinic 2019-2022. Patients' demographics, comorbidities, initial/follow-up pain score, pain duration, and recurrence were recorded. Data were analyzed by t test and Chi-square test. Of 207 total PD patients (108 male, 99 female), 61 had comorbidities. Mean age was 18.2years. The recurrence rate was 7%, and patients with recurrence were significantly younger. Associated comorbidities included mood/psychiatric disorders (31%), asthma/respiratory illness (30%), obesity-related illness (15%), gastrointestinal disorders (13%), diabetes (10%), thyroid disease (8%), cardiac disease (8%), musculoskeletal/connective tissue disorders (7%), immunologic disease (7%), inflammatory bowel disease (5%), and chest wall disorders (3%). The presence of comorbidities was not associated with PD recurrence. By dividing patients into adolescents (< 18years) and adults (≥ 18years), we found no association between comorbidity and recurrence in either group. 55% of patients had pain as an initial symptom. The initial pain score, pain duration, and pain score at follow-up were not associated with comorbidities. The comorbidities and recurrence were not associated with patient age or sex. Having comorbidities was not associated with pain symptoms or recurrence in PD patients. Even though patients with recurrence were younger, there was no association between comorbidity and recurrence in either adolescents or adults.

(130) Multicenter Study Comparing Stripping vs Ligation of Vas Deferens During Microscopic Denervation of Spermatic Cord in Men with Chronic Orchialgia Across the US

Abstract Introduction Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation while others perfer stripping of the Vas deferens to preserve the vasal artery, hence preserving vasculature to testis and possibly decreasing post operative congestion pain. Objective This multicenter study analyzes outcomes of patients that underwent MSCD by either stripping or ligating the vas deferens. Methods A retrospective chart review of 85 patients who underwent MSCD from 2020–2023 was performed. Patients’ demographics including history of prior surgical procedures was recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain or no improvement in pain. Results 85 patients underwent MSCD with a median (IQR) age of 36 (25.5–46.5) years and median duration of pain of 16 months. 37 patients underwent stripping of vas while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. 21(43.5%) patients had prior inguinal scrotal surgery in ligation group compared to 5 (13.5%) in the stripping group p=0.003. The etiology of pain was similar between the groups. The response to MSCD between the 2 groups was similar (p=0.968), with similar post op complications (Table 1). Conclusions In men with intractable chronic scrotal content with no interest in preserving fertility, ligation or stripping of the vas deferens yields similar outcomes with regards to pain resolution. Both techniques are safe with no reports of any testicular atrophy. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(287) Influence of Severe Chronic Scrotal Pain on Men’s Sexual Activity: An Indication for Surgery?

Abstract Introduction Severe chronic scrotal pain significantly influences numerous aspects of a patient’s life and activities, particularly sexual activity. Objectives This study seeks to explore the clinical characteristics and the effects of chronic scrotal pain on male sexual activity, with a focus on patients with severe chronic scrotal pain who were candidates for microsurgical denervation of the spermatic cord. Methods This is an observational study that encompassed all patients with severe chronic scrotal pain who underwent microsurgical denervation of the spermatic cord at the Department of Andrology, Binh Dan Hospital, from January 1, 2022, to May 31, 2023, after other causes had been excluded. Results Thirty-one patients with chronic scrotal pain underwent surgery, with a mean age of 24.2 ± 4.3 years and a pain duration of 2.3 ± 1.6 years. Pain was located in the scrotum (41.3%), testis-epididymis (47.8%), spermatic cord (24.6%), and inguinal (15.1%), with postepididymitis (45.3%) being the predominant cause. The average Numerical Rating Scale (NRS) pain score before surgery was 6.8 ± 2.3. Thirteen out of thirty-one patients experienced severe pain (NRS = 7-10). The Quality of Life (QOL) scores were 6.75 ± 1.1 for patients with moderate pain and 4.6 ± 4.0 for those with severe pain. A smaller testicle size was observed in 43.5% of patients, and 51.6% had varicose veins on ultrasound, measuring 3.4 ± 1.2 mm. Sixteen out of thirty-one patients reported that scrotal pain impacted their sexual activity. Patients with higher pain scales (NRS 7-10) had significant effects on erectile function compared to those with moderate pain (P &amp;lt; 0.05). Decreased libido was reported in 34.1%, and lowered testosterone levels in 37.5% of the patient group. Sexual activity induced pain in 60.9% of cases, and the incidence of erectile dysfunction was significantly higher in the high pain scale group (P = 0.02). No significant statistical difference was observed between the duration of intercourse and the severity of scrotal pain. Conclusion Chronic scrotal pain, predominantly observed in young patients, has substantial impacts on the quality of life and sexual performance. Therefore, a meticulous consideration of sexual factors is imperative in male patients with chronic scrotal pain. Surgical indications for chronic scrotal pain treatment may be deemed necessary for sexual disorders associated with scrotal pain. Disclosure No.

(131) Microsurgical Denervation of the Spermatic Cord for Chronic Scrotal Pain: Results from a Prospective Case Series

Abstract Introduction Microsurgical spermatic cord denervation (MSCD) is one of the lines of management of chronic scrotal pain refractory to conservative lines of therapy, however, it has not been fully adopted by different centres. Other procedures such as epididymectomy, orchidectomy and vasectomy reversal are being offered instead. Objective To evaluate the safety and efficacy of microsurgical denervation of the spermatic cord in the management of chronic scrotal pain refractory to conservative lines of therapy. Methods Twenty consecutive patients were prospectively enrolled for MSCD over a 24-month period. These patients underwent MSCD after exclusion of any correctable cause of chronic scrotal pain (CSP) and/or poor response to medical treatment. Efficacy of the technique was evaluated by the degree of pain improvement using the Visual Analogue Scale (VAS). Safety was assessed by reporting any intra- or post-operative complications. Results The mean age of the studied population was 51.7 (36–78) years. The mean pain duration was 4.2 (1–20) years. In 8 patients (40%), the aetiology of the chronic pain was idiopathic, 5 patients (25%) the pain occurred after previous scrotal surgery (vasectomy in 2 patients, AUS in 2 and an epididymal cyst excision in 1 patient), 4 patients (20%) post scrotal trauma and 3 patients (15%) post epididymo-orchitis. Ten patients (50%) had complete pain resolution, 8 (40%) had a partial resolution of their pain, the pain remained the same in a one patient (5%), and one patient (5%) had resolution of the scrotal pain but developed pain at the incision site following MSCD. The VAS pain score significantly improved from a mean of 9.7 to 3.7 postoperatively. (p=0.0029). No significant complications have been encountered in this case series. Conclusions Microsurgical denervation of the spermatic cord is a safe and reliable option that should be more widely adopted to treat men with chronic scrotal pain refractory to conservative treatment. Disclosure No.

The enhanced connectivity between the frontoparietal, somatomotor network and thalamus as the most significant network changes of chronic low back pain

The prolonged duration of chronic low back pain (cLBP) inevitably leads to changes in the cognitive, attentional, sensory and emotional processing brain regions. Currently, it remains unclear how these alterations are manifested in the interplay between brain functional and structural networks. This study aimed to predict the Oswestry Disability Index (ODI) in cLBP patients using multimodal brain magnetic resonance imaging (MRI) data and identified the most significant features within the multimodal networks to aid in distinguishing patients from healthy controls (HCs). We constructed dynamic functional connectivity (dFC) and structural connectivity (SC) networks for all participants (n = 112) and employed the Connectome-based Predictive Modeling (CPM) approach to predict ODI scores, utilizing various feature selection thresholds to identify the most significant network change features in dFC and SC outcomes. Subsequently, we utilized these significant features for optimal classifier selection and the integration of multimodal features. The results revealed enhanced connectivity among the frontoparietal network (FPN), somatomotor network (SMN) and thalamus in cLBP patients compared to HCs. The thalamus transmits pain-related sensations and emotions to the cortical areas through the dorsolateral prefrontal cortex (dlPFC) and primary somatosensory cortex (SI), leading to alterations in whole-brain network functionality and structure. Regarding the model selection for the classifier, we found that Support Vector Machine (SVM) best fit these significant network features. The combined model based on dFC and SC features significantly improved classification performance between cLBP patients and HCs (AUC=0.9772). Finally, the results from an external validation set support our hypotheses and provide insights into the potential applicability of the model in real-world scenarios. Our discovery of enhanced connectivity between the thalamus and both the dlPFC (FPN) and SI (SMN) provides a valuable supplement to prior research on cLBP.

Effect of duration of preoperative pain on outcomes of total temporomandibular joint replacement

The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (β = −0.27; 95% CI −0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.

Caregiver Burden Associated With Pediatric Chronic Pain: A Retrospective Study Using the Pediatric Electronic Persistent Pain Outcomes Collaboration Database.

This retrospective, cross-sectional study investigated the nature and extent of burden experienced by caregivers of children and adolescents with chronic pain, and factors associated with increased caregiver burden. The Pediatric Electronic Persistent Pain Outcomes Collaboration database provided prospectively collected data from 1929 families attending 9 pediatric chronic pain services across Australia and New Zealand. Data included demographic information, responses to child pain and functioning measures, caregiver work impairment, and psychosocial functioning. Caregivers of children with chronic pain reported work impairment associated with their child's pain (mean: 15% ± SD 25 absenteeism; 38% ± SD 29 productivity lost), significantly worse than published international population norms (large-scale community survey data), most other caregiver samples of adults and children with other chronic conditions, and adult samples with various pain conditions. Caregivers reported considerable burden in multiple psychosocial functioning domains, particularly leisure functioning, pain-related catastrophizing, and adverse parenting behaviors (with greater pain-related avoidance). Caregiver psychosocial burden was significantly associated with child psychosocial functioning (β = -0.308, P < 0.01), school absenteeism (β = 0.161, P < 0.01), physical disability (β = 0.096, P < 0.05), and pain duration (β = 0.084, P < 0.05), but not pain intensity. Caregiver work productivity loss was significantly associated with school absenteeism (β = 0.290, P < 0.01), child physical disability (β = 0.148, P < 0.01), child health care utilization (β = 0.118, P < 0.05), and worst pain intensity (β = 0.101, P < 0.05). These results highlight the significant and varied impacts experienced by caregivers of children with chronic pain. This work is novel in reporting significant work impairment and confirms psychosocial burden in a larger sample than previous studies.

Postoperative Outcomes of Ovarian Preserving Surgery in Premenopausal Women With Adnexal Torsion

ABSTRACT Adnexal torsion, a state of twisted ovaries and adnexa in the infundibulopelvic and tuboovarian ligaments, can occur in benign masses, malignant neoplasms, and normal ovaries. Definitive diagnosis of this condition is surgical, with an incidence rate of 2%–15% in women undergoing surgery for an adnexal mass. This incidence rate is possibly low in its estimation, due to lack of diagnosis sans surgical observation of the condition. This state occurs most frequently in women of reproductive age, although it can occur at any age. A decrease in ovarian blood supply during adnexal torsion may lead to ovarian ischemia, for which a lack of immediate treatment results in reduced ovarian function and fertility damage. Patients with suspicion of this condition are treated via emergent surgery. The aim of this study was to analyze anti-Müllerian hormone (AMH) level changes in premenopausal women, along with possible postoperative complications after surgery preserving ovaries in the case of adnexal torsion. The authors’ intent was to prove the value of conservative surgery in preservation of ovarian function, even in cases with intraoperative findings or postsurgery ovarian color changes. The retrospective study was performed at Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea, and included women surgically diagnosed with adnexal torsion between January 2015 and December 2020. Excluded were data for women with no adnexal torsion diagnosis, women who had undergone bilateral ovarian cystectomy, patients lacking AMH data (either prior to or after surgery), and menopausal patients. The study included 71 patients, with 15 in the oophorectomy group and 56 in the ovarian preservation group. Data collected included age, body weight, height, abdominal pain duration, time interval between symptoms and surgery, adnexal mass laterality and size based on the preoperative ultrasounds, and laboratory values (hemoglobin, platelet, white blood cells, and AMH levels). Serum AMH levels were determined both 6 months before surgery and 6–24 months after. Also included were data for postoperative fever/complications and duration of admission. There were 23 patients who had an AMH both before the surgery and postoperatively (19 in the preservation group and 4 in the oophorectomy group). In the ovarian preservation group, 21.0% of patients experienced postoperative fever, with none of the oophorectomy group experiencing similar symptoms. However, all of the fever-stricken patients were discharged with no further complications (ie, pneumonia, surgical site infections, etc). Comparison of both the oophorectomy and ovarian preservation group data showed similar preoperative AMH levels. Postoperatively, serum AMH levels decreased in the oophorectomy group, while slightly increasing in the ovary-preservation group. Despite discoloration and suspected ovarian necrosis, preservation of the ovary preserves ovarian function in reproductive-aged women with adnexal torsion. Only 1 patient undergoing emergent surgery experienced complications. Limitations of the study include its retrospective nature and small sample size when considering patients with emergency surgeries for adnexal torsion diagnoses. In addition, the number of cases with comparable before/after AMH level data available was small. Prospective studies for this area are difficult to perform due to low incidence rates and emergency characteristics. Despite these shortcomings, value can be found in the study data, such as the numerical comparison of ovarian function preservation based on AMH levels before and after surgery. In conclusion, the study found that complications in patients with adnexal torsion were not increased via ovarian-preserving surgery, even with suspected necrosis of the ovary. If preservation of the ovary occurs, the ovarian reserve may not be affected by torsion. For women with cystic masses and adnexal torsion, conservative ovarian surgery (detorsing) can be safely performed to preserve productive potential.

Associations of multimorbidity with body pain, sleep duration, and depression among middle-aged and older adults in China.

Multimorbidity, body pain, sleep disturbance, and depression are major clinical and public health challenges. This paper aimed to examine the associations of multimorbidity with body pain, sleep duration, and depression; and whether the associations varied by socioeconomic status. Data was derived from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS), including participants aged 45 years and older in 2011. 12 physical non-communicable diseases and 1 mental chronic disease were used to measure multimorbidity. Educational attainment and annual per-capita household consumption expenditure were employed as proxies for socioeconomic status. Of the 16,931 participants aged 45 + years old, the proportion of people with multimorbidity was 37.87% at baseline. The number of multimorbidity increased with older age and higher socioeconomic status. Multimorbidity was associated with more body pain (incidence rate ratio (IRR) = 1.53, 95% CI = 1.45-1.61), and decreased sleep duration (β = -0.26, 95% CI = -0.36--0.15). Furthermore, multimorbidity was associated with increased depression risks (odds ratio (OR) = 1.54, 95% CI = 1.44-1.64, adjusted for sociodemographic variables), with the mediating effects of the number of body pain and sleep duration. The associations between multimorbidity and depression persisted among different socioeconomic groups. Multimorbidity was associated with increased body pain, decreased sleep duration, and further led to increased depression risks. It is necessary to pay attention to the multimorbidity of middle-aged and older adults, relieve their body pain, guarantee sufficient sleep, so as to reduce depression risks.

Interdisciplinary pain rehabilitation for immigrants with chronic pain who need language interpretation.

To investigate outcomes in patients with chronic pain after participation in an interdisciplinary pain rehabilitation programme with language interpreters, and to investigate the outcomes in women and men separately. Prospective multi-centre cohort study. Ninety-five patients in Sweden with chronic pain who have insufficient knowledge of the Swedish language. Duration and intensity of pain, anxiety and depression, health-related quality of life and fear of movement were evaluated before and after the programme. Patients were compared with a reference group comprising Swedish-speaking patients participating in an ordinary interdisciplinary pain rehabilitation programme. Before the interdisciplinary pain rehabilitation programme with language interpreters, all variables except pain duration differed significantly to the detriment of the studied group. The studied group showed significant improvements after the interdisciplinary pain rehabilitation programme with language interpreters, with regards to pain intensity, depression and fear of movement. The reference group improved significantly for all variables.The women in the studied group showed significant improvements for the same variables as the whole group, while the men in the studied group did not improve in any of the variables. This study indicates that patients with chronic pain, and especially women, who have insufficient knowledge of Swedish seem to benefit from participating in an interdisciplinary pain rehabilitation programme with language interpreters. The result may be of value for the further development of rehabilitation programmes with language interpreters.

Long-term outcomes of Gamma Knife radiosurgery in treating glossopharyngeal neuralgia.

Glossopharyngeal neuralgia (GPN) is an unusual disorder causing severe, brief pain episodes in the areas supplied by the glossopharyngeal nerve. Initial treatment involves medications like carbamazepine, but if these are ineffective or cause side effects, interventional pain management techniques or surgery may be considered. Gamma Knife radiosurgery is becoming popular in managing GPN due to its lower risk of complications than surgical interventions like microvascular decompression or rhizotomy. In this retrospective case series, we examined the outcomes of Gamma Knife radiosurgery in eight patients with GPN. The decision to utilize Gamma Knife radiosurgery was made following specific criteria, including failed surgical interventions, patient preference against surgery, or contraindications to surgical procedures. Patients were administered radiation doses within the range of 80 to 90 Gy, targeting either the cisternal glossopharyngeal nerve or glossopharyngeal meatus of the jugular foramen. Evaluations were conducted before the Gamma Knife radiosurgery; at 3, 6, and 12 months after Gamma Knife radiosurgery; and annually thereafter. Pain severity was assessed using the modified Barrow Neurological Institute scale grades, with patients achieving grade I-IIIa considered to have a good treatment outcome and grade IV-V to have a poor treatment outcome. Pain control and absence of radiosurgery-related complications were primary endpoints. The median age of the patients was 46.5 years, varying from 8 to 72 years. The median duration of pain was 32 months (range, 12-120 months). All patients, except one, were on polydrug therapy. All cases exhibited preoperative grade V pain. The median follow-up duration after Gamma Knife radiosurgery was 54.5 months, varying from 14 to 90 months. The overall clinical assessments revealed a gradual neurological improvement, particularly within the first 8.5 weeks (range, 1-12 weeks). The immediate outcomes at 3 months revealed that all patients (8/8, 100%) experienced pain relief, with 25% (2/8) achieving a medication-free status (Grade I). Three patients (37%) experienced a recurrence during the follow-up and were managed with repeat Gamma Knife radiosurgery (n = 2) and radiofrequency rhizotomy (n = 1). At the last follow-up, 88% (7/8) of patients had pain relief (Grades I-IIIa), with three (37%) achieving a medication-free status (Grade I). No adverse events or neurological complications occurred. The patient who underwent radiofrequency rhizotomy continued to experience inadequately controlled pain despite medication (Grade IV). Gamma Knife radiosurgery is a non-invasive, efficacious treatment option for idiopathic GPN, offering short- and long-term relief without permanent complications.

Impact of preoperative factors and waiting time on post-appendectomy complications: a retrospective study

BackgroundSeveral factors are associated with increased postoperative complications after appendectomies. However, few studies combined these potential factors for comprehensive prediction of surgical outcomes. Whether high-risk patients benefit from a shorter waiting time for surgery remains unclear. This study aimed to explore the impact of surgical waiting time and potential risk factors on postoperative complications.MethodsA total of 1343 patients diagnosed with acute appendicitis requiring an emergent appendectomy were included from 2013 to 2018. The preoperative risk factors associated with postoperative complications were selected and the probability of postoperative complications was calculated by multivariate logistic regression model. Patients were divided into four groups based on the risk (high & low) and time to surgery (> 12 & ≤12 hours). The odds ratios for complications were evaluated between groups.ResultsThe selected risk factors included age, neutrophil-lymphocyte ratio, systemic inflammatory response syndrome and abdominal pain duration. Compared with low-risk patients with time to surgery ≤12 hours, high-risk patients with time to surgery > 12 hours had significant increased overall postoperative complication rate (16.85% vs. 8.16%, p = 0.002) and a trend toward increased surgical site infection rate (10.99% vs. 6.46%, p = 0.058). When operated within 12 hours, there was no difference in outcomes between high- and low-risk patients. On the other hand, time to surgery > 12 hours did not increase complication rate in low-risk patients.ConclusionsThe surgical outcome may be affected by preoperative factors and time to surgery. It is suggested that high-risk patients receive appendectomy within 12 hours to avoid increased postoperative complications.

A prospective study to evaluate the contribution of the pediatric appendicitis score in the decision process.

The objective of this study was to assess the likelihood of acute appendicitis (AA) in children presenting with abdominal symptoms at the emergency department (ED), based on their prior primary care (PC) consultation history. Between February and June 2021, we prospectively enrolled all children presenting at the ED with acute abdominal pain indicative of possible acute appendicitis (AA). Subsequently, they were categorized into three groups: those assessed by a PC physician (PG), those brought in by their family without a prior consultation (FG), and those admitted after a PC consultation without being assessed as such. The primary objective was to assess the probability of AA diagnosis using the Pediatric Appendicitis Score (PAS). Secondary objectives included analyzing PAS and C-reactive protein (CRP) levels based on the duration of pain and final diagnoses. 124 children were enrolled in the study (PG, n = 56; FG, n = 55; NG, n = 13). Among them, 29 patients (23.4%) were diagnosed with AA, with 13 cases (23.2%) from the PG and 14 cases (25.4%) from the FG. The mean PAS scores for AA cases from the PG and FG were 6.69 ± 1.75 and 7.57 ± 1.6, respectively, (p = 0.3340). Both PAS scores and CRP levels showed a significant correlation with AA severity. No cases of AA were observed with PAS scores < 4. There was no significant difference in PAS scores between patients addressed by PG and FG, even though PAS scores tended to be higher for patients with AA. We propose a new decision-making algorithm for PC practice, which incorporates inflammatory markers and pain duration. Institutional Ethics Committee registration number: 447-2021-103 (10/01/2021). ClinicalTrials.gov Identifier: NCT04885335 (Registered on 13/05/2021).

EDUKASI LATIHAN UNTUK NYERI PUNGGUNG BAWAH PADA LANSIA DI RW 17 POSLANSIA MOJOSONGO SOLO

Reduced functional ability followed by decreased physical activity has a relationship with age and gender. men and women are at the same risk, ranging from reduced muscle strength to endurance. One disorder that is a common health problem in the world and affects almost the entire elderly population is low back pain. Low back pain is pain felt in the lower back area, not a disease or diagnosis for a disease but is a term for pain felt in the affected body area with various variations in the duration of pain. The purpose of this counseling activity is to provide knowledge about low back pain and exercise education to reduce pain intensity. The activity method used is counseling using leaflets with low back pain material and exercise education. The main targets were members and cadres of the elderly posyandu in RW 17 Mojosongo Solo. The result of this counseling is an increase in public understanding and knowledge about low back pain and exercises to reduce this pain. This proves that the counseling method using leaflets is quite effective. It can be seen from the results of the pre-test and post-test participants who showed an average increase of 45%.

Efficacy of Injectable Platelet-Rich Fibrin (I-PRF) in Managing Temporomandibular Joint Pain: A Prospective Clinical Study.

Temporomandibular joint (TMJ) pain is a common condition that can significantly impact an individual's quality of life. Current treatment options often fall short of providing long-lasting relief. So, this prospective clinical study aimed to investigate the efficacy of injectable platelet-rich fibrin (I-PRF) in mitigatingTMJpain. A total of 68 participants, aged 18-60 years, clinically diagnosed with TMJ pain, were recruited from dental clinics and specialist referrals. Participants were randomly assigned to either the intervention group (I-PRF injections) or the control group (placebo). Primary outcome measures included TMJ pain intensity and jaw function, assessed using the Visual Analog Scale and functional examinations, respectively. Secondary outcomes comprised patient-reported outcomes (PROs) on quality of life and satisfaction. Data were collected at baseline and six, 12, and 24 weeks post intervention. Baseline characteristics demonstrated successful randomization, with no significant differences in age, gender, or TMJ pain duration between groups. Post intervention, the intervention group exhibited a significant and sustained reduction in TMJ pain intensity compared to controls (p<0.001). Improvements in jaw function were also notable in the intervention group at all follow-up time points (p<0.001). PROs related to quality of life and satisfaction substantially increased in the intervention group compared to controls (p<0.001). I-PRF demonstrated significant efficacy in reducing TMJ pain intensity, improving jaw function, and enhancing PROs. These findings support the consideration of I-PRF as a valuable therapeutic intervention for individuals with TMJ pain.

Tampa Scale for Kinesiophobia in chronic neck pain patients (TSK-neck): structural and construct validity and reliability in a Brazilian population

BackgroundTo date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain.MethodsWe included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach’s alpha to assess internal consistency, and ceiling and floor effects.ResultsThe study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains (“somatic focus” and “activity avoidance”) and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach’s alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed.ConclusionThe TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain.