Global Pain Research Articles

High-intensity laser therapy on pain relief in symptomatic knee osteoarthritis: A systematic review and meta-analysis.

Osteoarthritis is one of the leading causes of global disability and pain. To investigate whether High-Intensity Laser therapy has superior pain-relieving effects in individuals with symptomatic knee osteoarthritis. Searches were conducted using CENTRAL, MEDLINE, CINAHL, EMBASE, Web of Science, PEDro, and related reference lists with language limed to English. Clinical trials investigating the effectiveness of High-Intensity Laser therapy compared to other laser therapies, conventional therapies or exercises on knee osteoarthritis pain were included. The screening and selection of studies, data extraction, and methodological quality assessment were performed by two independent researchers. Studies were quantitatively integrated using the Review Manager Software and qualitative analysis using the criteria recommended by the Cochrane Collaboration. Nine studies meeting the eligibility criteria were identified, among which only one study was identified as excellent methodology quality, six was marked as good quality, and the remaining two studies were regarded as fair or poor quality. All studies reported positive effects of High-Intensity Laser therapy on knee osteoarthritis pain. Two studies (136 people) gave indication that there was moderate evidence that High-Intensity Laser therapy could be a promising new possibility in pain relief among patients with knee osteoarthritis compared with sham laser therapy in a short-term treatment (MD, -2.04, 95% CI, -2.12 to -1.96; Z= 51.01, P< 0.01). Four studies (160 people) showed that High-Intensity Laser therapy could be an effective modality on treating pain compared to conventional physiotherapies in decreasing visual analog scale score (MD, -0.98, 95% CI, -1.19 to -0.76; Z= 9.02, P< 0.01). Three studies (123 people) demonstrated that High-Intensity Laser therapy combined with exercises was more effective than placebo laser or lower-intensity laser combined with exercises in alleviating pain in patients with knee osteoarthritis (MD, -1.54, 95% CI, -1.84 to -1.24; Z= 10.06, P< 0.01). High-Intensity Laser therapy could be a promising and recommended modality in alleviating knee osteoarthritis pain, especially when it was implemented in combination with exercises.

Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries.

Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease affecting the musculoskeletal system, skin and nails. The aim is to characterize sociodemographic and clinical patient profiles documented in dermatologic and rheumatologic care. Data of 704 patients with PsA from the dermatological Psoriasis Registry PsoBest (PB) and 1066 patients from the rheumatological disease registry RABBIT-SpA (RS) were analyzed. Comparable anamnestic and clinical variables were identified and descriptively analyzed. The mean age was 51.7 years in PB and 51.9 in RS. Disease duration of psoriasis was longer, mean cutaneous severity was higher in PB. However, more patients in RS vs. PB had tender joints and swollen joints. Mean Dermatology Life Quality Index was higher in PB and mean Health Assessment Questionnaire in RS. Patient reported global disease activity and pain were lower in PB. IL-23 inhibitors were used more frequently in PB, and TNF inhibitors in RS. Clinical specialization was associated with different clinical and treatment patterns of PsA. This may indicate a selection by dominant manifestation of psoriatic disease and potentially by effects of health care access. Psoriatic arthritis should be treated in a multidisciplinary approach considering all facets of this complex disease.

Predictors of Pain Management Strategies in Adults with Low-Back Pain: A Secondary Analysis of Amazon Mechanical Turk Survey Data.

Objective: To evaluate the associations between baseline demographics, health conditions, pain management strategies, and health-related quality-of-life (HRQoL) measures with pain management strategies at 3-month follow-up in respondents reporting current low-back pain (LBP). Study design: Cohort study of survey data collected from adults with LBP sampled from Amazon Mechanical Turk crowdsourcing panel. Methods: Demographics, health conditions, and the Patient-Reported Outcomes Measurement Information System (PROMIS)-10 were included in the baseline survey. Respondents reporting LBP completed a more comprehensive survey inquiring about pain management strategies and several HRQoL measures. Bivariate then multivariate logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for the association between baseline characteristics and pain management utilization at 3-month follow-up. Model fit statistics were evaluated to assess the predictive value. Results: The final cohort included 717 respondents with completed surveys. The most prevalent pain management strategy at follow-up was other care (n = 474), followed by no care (n = 94), conservative care only (n = 76), medical care only (n = 51), and medical and conservative care combined (n = 22). The conservative care only group had higher (better) mental and physical health PROMIS-10 scores as opposed to the medical care only and combination care groups, which had lower (worse) physical health scores. In multivariate models, estimated ORs (95% CIs) for the association between baseline and follow-up pain management ranged from 4.6 (2.7-7.8) for conservative care only to 16.8 (6.9-40.7) for medical care only. Additional significant baseline predictors included age, income, education, workman's compensation claim, Oswestry Disability Index score, and Global Chronic Pain Scale grade. Conclusions: This study provides important information regarding the association between patient characteristics, HRQoL measures, and LBP-related pain management utilization.

How do symptoms of each joint contribute to global pain, disease activity and functional disability in rheumatoid arthritis?-A comprehensive association study using a large cohort.

Established assessment tools for patients with rheumatoid arthritis (RA), including disease activity scores (DASs), disease activity indexes (DAIs), visual analog scales (VASs), and health assessment questionnaires (HAQs), are widely used. However, comparative associations between joint involvement and disease status assessment tools have rarely been investigated. We included a dataset of 4016 patients from a large RA cohort from 2012 to 2019. The tenderness and swelling of each joint were counted as a symptom, with 70 and 68 affected joints throughout the body, respectively. The relative contribution of various joints to the disease status assessment tools, VAS scores, and functional disability indexes was analyzed using multiple regression analysis. The wrist showed the most significant contribution overall, especially in DASs and VASs, while the metacarpophalangeal and proximal interphalangeal joints made significant contributions to DASs and DAIs, but not to VASs and HAQs. The shoulder and the elbow significantly contributed to HAQs, but only the shoulder did to the VASs. The knee universally contributed to all of the tools, but the ankle played a minor but important role in most assessment tools, especially in HAQs. Similar but different contribution ratios were found between the sets of DASs, DAIs, VASs, or HAQs. Each joint makes a unique contribution to these assessment tools. The improvement or aggravation of symptoms in each joint affects the assessment tools in different manners.

Anti-inflammatory-antioxidant modifications and synbiotics improved health-related conditions in patients with progressive forms of multiple sclerosis: A single-center, randomized clinical trial

Background and purposeThere is growing evidence that dietary modification can improve clinical manifestations in multiple sclerosis (MS) patients. This study aimed to assess the impact of synbiotics and anti-inflammatory-antioxidant-rich diet on fatigue, pain, gut and bladder status, and sexual function in patients with progressive forms of MS. Materials and methodsIn this single-center, single-blind, randomized, controlled clinical trial, seventy participants with three forms of progressive MS (primary-progressive, secondary-progressive, and progressive-relapsing) were randomly assigned to receive either synbiotics supplement and anti-inflammatory-antioxidant-rich diet or a placebo along with their usual diet for a duration of four months. Modified fatigue impact scale (MFIS), global pain scale (GPS), bladder control scale (BLCS), bowel control scale (BWCS), and sexual satisfaction scale (SSS) were assessed at baseline and at the end of the trial. ResultsSixty-nine participants successfully completed the trial, resulting in a 98% adherence rate to the diet, and no reports of serious side effects. Significant mean changes were observed in fatigue (Δ for experimental group = −10.5 ± 10.8 vs. Δ for control group = −0.08 ± 4.1; P < 0.001), pain (−14.1 ± 19.0 vs. 0.9 ± 10.3; P < 0.001), bladder (−0.76 ± 2.1 vs. 0.3 ± 1.1; P = 0.013) and bowel (−6.6 ± 3.2 vs. −0.05 ± 2.3; P < 0.001) control, as well as sexual function (−1.0 ± 2.3 vs. 0.51 ± 0.21; P < 0.001). ConclusionThe anti-inflammatory-antioxidant-rich diet and synbiotics co-supplementation demonstrated improvements in fatigue, pain, sexual function, and bowel/bladder status among patients with progressive MS.

Heat-stone massage for patients with chronic musculoskeletal pain: a protocol for multicenter randomized controlled trial.

Chronic musculoskeletal pain bothers the quality of life for approximately 1.71 billion people worldwide. Although pharmacological therapies play an important role in controlling chronic pain, overuse of opioids, persistent or recurrent symptoms, and pain-related disability burden still need to be addressed. Heat-stone massage is using the heated stone to stimulate muscles and ligaments followed by massage for relax, which can potentially treat the chronic musculoskeletal pain. To determine the efficacy and safety of heat-stone massage for patients with chronic musculoskeletal pain is needed. This multicenter, 2-arm, randomized, positive drug-controlled trial will include a total of 120 patients with chronic musculoskeletal pain. The intervention group will receive a 2 week heat-stone massage, 3 times per week, whereas the control group will receive the flurbiprofen plaster twice per day for 2 weeks. The primary end point is the change in Global Pain Scale from baseline to the end of the 2 week intervention. The secondary outcomes include the pain severity (Numerical Rating Scale), pain acceptance (Chronic Pain Acceptance Questionnaire), self-management (Health Education Impact Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), quality of life (Short Form-36). The intention-to-treat dataset will be used for analysis. The pain management remains the research topic that patients always pay close attention to. This will be the first randomized clinical trial to evaluate whether heat-stone massage, a non-pharmacological therapy, is effective in the chronic musculoskeletal pain management. The results will provide evidence for new option of daily practice. World Health Organization Chinese Clinical Trial Registry [ChiCTR2200065654; https://www.chictr.org.cn/showproj.html?proj=185403]; International Traditional Medicine Clinical Trial Registry [ITMCTR2022000104; http://itmctr.ccebtcm.org.cn/en-US/Home/ProjectView?pid=51776b6f-77b8-4811-9b5a-a0fec10f2cee].

Everyday Pain in Middle and Later Life: Associations with Daily and Momentary Present-Moment Awareness as One Key Facet of Mindfulness.

This study investigated everyday associations between one key facet of mindfulness (allocating attention to the present moment) and pain. In Study 1, 89 community-dwelling adults (33-88 years; Mage = 68.6) who had experienced a stroke provided 14 daily end-of-day present-moment awareness and pain ratings. In Study 2, 100 adults (50-85 years; Mage = 67.0 years) provided momentary present-moment awareness and pain ratings three times daily for 10 days. Multi-level models showed that higher trait present-moment awareness was linked with lower overall pain (both studies). In Study 1, participants reported less pain on days on which they indicated higher present-moment awareness. In Study 2, only individuals with no post-secondary education reported less pain in moments when they indicated higher present-moment awareness. Findings add to previous research using global retrospective pain measures by showing that present-moment awareness might correlate with reduced pain experiences, assessed close in time to when they occur.

E19 Gamma-glutamyl transpeptidase level is correlated with disease activity in oligoarticular and polyarticular Juvenile idiopathic arthritis

Abstract Introduction Gamma-glutamyl transpeptidase (GGT) level was found to be correlated with disease activity indexes in rheumatoid arthritis [1]. This association was not yet investigated in children with oligoarticular and polyarticular Juvenile idiopathic arthritis (JIA). Objectives The present study aims to investigate the correlation between GGT level and disease-related parameters in oligoarticular and polyarticular JIA. Methods We performed a retrospective study including patients with oligoarticular and polyarticular JIA responding to the 2001 International League of Associations for Rheumatology (ILAR) classification. Sociodemographic, disease-related parameters (age of onset, disease duration, patient global assessment (PGA), Pain Visual Analogue Scale (VAS), C-Reactive protein (CRP) level, Erythrocyte Sedimentation Rate (ESR), disease activity assessed using the Juvenile Arthritis Disease Activity Score (JADAS) based on ESR), and GGT level were collected. Continuous variables were expressed with median and Interquartile range (IQR). Spearman correlation was used to assess the association between GGT levels and disease-related data. Results Eleven patients were included with a median age of 12 (IQR: 10–15) years and 8 females. Median disease duration was 4 (IQR: 4–7) years and median age of onset was 8 (IQR: 5–10) years. Five patients had oligoarticular JIA, 3 had a polyarticular with positive Rheumatoid Factor (RF) form, 2 had a polyarticular with negative RF form and one had an undifferentiated JIA. Median JADAS was 3.6 (IQR: 0–9). Median ESR, CRP, and GGT levels were 14 (10–19) mm/H, 1.8 (2–6.4) mg/l, and 14 (12–16) IU/l, respectively. A strong positive correlation was found between GGT level and JADAS (r = 0.749, P = 0.008). Level of CRP and ESR were not correlated with GGT level. Besides, patient global assessment and pain VAS were positively correlated with GGT level (r = 0.670, P = 0.049; r = 0.814, P = 0.014, respectively). No correlation was found between GGT level and disease duration and number of tender or swollen joints. Conclusion The GGT level was significantly higher in patients with more active disease, higher pain, and global assessment. This suggests that GGT level can be used as a marker of disease activity as in JIA. References 1 Vergneault H, Vandebeuque E, Codullo V, Allanore Y, Avouac J. Disease Activity Score-28 using γGT permits a dual evaluation of joint activity and cardiovascular risk. J Rheumatol 2020.

Dental anxiety and oral health-related quality of life before and after non-surgical periodontal treatment.

To (1) investigate dental anxiety (DA) and oral health-related quality of life (OHRQOL) before and after non-surgical periodontal treatment (NSPT) and (2) determine correlations between these patient-reported measures. Demographics, smoking habits, dental pain, Modified Corah's Dental Anxiety Scale (MDAS), and Oral Health Impact Profile (OHIP-14) were assessed in eighty-two participants. Mean age was 48.3years ± 11.5. At baseline, 8.5% reported being active smokers. Of non-smokers, 11% reported being an ex-smoker. After NSPT, 11.0% reported smoking. Patients' maximal pain in the last month decreased after therapy. Before treatment, participants reported higher DA. Extreme DA was observed in 8.5% of participants before therapy. Afterwards, 2.4% of participants reported extreme DA. Fear of having a foreign object in the mouth decreased after NSPT. All OHIP-14 scores, except functional limitation, improved post-treatment. Higher DA was associated with worse OHRQoL before treatment. After treatment, total MDAS score was associated with OHIP-14 global score, physical pain, psychological disability, and social disability. Worse MDAS sub-scores were associated with a higher OHIP-14 global score. Individuals with "normal/slight anxiety" had a significant improvement in OHRQoL, whereas people in the "moderate and extreme anxiety" group did not report a significant improvement. Patients diagnosed with generalized periodontitis (GP) stage III grade B and GP stage IV grade B reported less anxiety after NSPT. Associations of MDAS subcategories with OHIP-14 domain scores were found before and after therapy. DA decreases and OHRQoL enhances after NSPT in patients with "normal/slight" anxiety to dental treatment. Dental practitioners should plan strategies to cope with anxiety to dental treatment and prevent decreases in OHRQoL. Within the limitations of this study, DA and OHRQoL were positively correlated in patients with periodontitis, before and after NSPT, using the MDAS and OHIP-14 questionnaires. The results of our study suggest that treatment is effective in terms of alleviating DA and improving oral health, along with quality of life, in patients that report "normal/slight" anxiety to dental treatment. Nonetheless, results must be interpreted with caution since patients are generally anxious before any type of dental treatment. DA may not just be confined to NSPT per se. According to our results, evaluation of both outcomes should be an integral part of routine periodontal clinical evaluation and periodontal reevaluation of initial therapy. It is important that clinicians learn to identify patients that suffer from anxiety and take time to explain the treatment procedures to the patient, to strive for patient's emotional well-being before, during, and after dental care services. The use of specific questionnaires for both DA and OHRQoL may be more appropriate to demonstrate the psychological and quality of life differences due to periodontal disease and NSPT.

Effectiveness and Safety of Glucosamine in Osteoarthritis: A Systematic Review.

Knee osteoarthritis is the most popular type of osteoarthritis that causes extreme pain in the elderly. Currently, there is no cure for osteoarthritis. To lessen clinical symptoms, glucosamine was suggested. The primary goal of our systematic review study is to evaluate the effectiveness and safety of glucosamine based on recent studies. Electronic databases such as PubMed, Scopus, and Cochrane were used to assess the randomized controlled trial (RCT). From the beginning through March 2023, the papers were checked, and if they fulfilled the inclusion criteria, they were then examined. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Visual Analog Scale (VAS) scales were considered the main outcome measures. A total of 15 studies were selected. Global pain was significantly decreased in comparison to placebo, as measured by the VAS index, with an overall effect size of standardized mean difference (SMD) of -7.41 ([95% CI] 14.31, 0.51). The WOMAC scale confirmed that pain, stiffness, and physical function had improved, however the effects were insufficient. A statistical update also revealed that there were no reports of serious medication interactions or significant adverse events. To summarize, glucosamine is more effective than a placebo at reducing pain in knee osteoarthritis patients. In long-term treatment, oral glucosamine sulfate 1500 mg/day is believed to be well tolerated.

Association of smoking history on health-related quality of life in patients undergoing radical cystecomy.

Radical cystectomy (RC) has the potential to impact health-related quality of life (HRQOL). Many patients who undergo RC are current or former smokers. To better inform preoperative patient counseling, we examined the association between smoking status and HRQOL after RC. A secondary analysis was performed on a prospective, longitudinal study (2008-2014) examining HRQOL in patients undergoing RC for bladder cancer. We analyzed 12 validated patient-reported outcome measures that focused on functional, symptomatic, psychosocial, and global HRQOL domains. Measures were collected pre-operatively and 3-, 6-, 12-, 18-, and 24-months postoperatively. For each HRQOL domain, we estimated the mean domain scores using a generalized estimation equation linear regression model. Each model included survey time, smoking status, and time-smoking interaction as covariates. Pairwise comparisons of current, former, and never smokers were estimated from the models. Of the 411 patients available for analysis, 29% (n = 119) never smoked, 59% (n = 244) were former smokers, and 12% (n = 48) were current smokers. Over the follow-up period, never smokers compared to current smokers had better global QOL scores (mean difference = +8.9; 95% CI 1.3-16; p = 0.023) and lower pain levels (mean difference = -10; 95% CI -19 to -0.54; p = 0.036). Compared to current smokers, former smokers had marginal improvements in global QOL (+6.9 points) and pain (-7.5 points) during the follow-up period. Current smokers reported worse HRQOL recovery in the 24-months after RC. These findings can be used to counsel patients who smoke on recovery expectations.

Efficacy and safety of curcumin in patients with metabolic phenotype of osteoarthritis: A pilot study

The aim of this study was to assess efficacy and safety of curcumin in metabolic syndrome- associated osteoarthritis (MetS-OA). All patients provided written informed consent. Knee OA was diagnosed according to American College of Rheumatology criteria; MetS was diagnosed according to Russian Scientific Society of Cardiology Guidelines. The study had before-and-after design. The main inclusion criteria were presence of knee OA and MetS, levels of global health assessment and pain assessment more than 50 mm using 0-100 visual analogue scale (VAS). The main outcome was VAS global. The other outcomes were VAS pain, Knee injury and Osteoarthritis Outcome Score (KOOS) consisting of five subscales: pain (KOOS pain), other symptoms (KOOS symptoms), activities in daily living (KOOS ADL), function in sport and recreation (KOOS Sport/Rec) and knee related Quality of life (KOOS QoL). The level of depression was measured using PHQ- 9. For pain, proportion of patients achieving minimal clinically important improvement (MCII) was assessed using the cut-offs of (a) 15 of 100 for absolute improvement and 20% for relative improvement.The treatment consisted of C. longa extract 1000 mg/day for 4 weeks. The assessments were performed on baseline and 4 weeks thereafter. Eighteen women with MetS-OA of the knee were included in the study.At the end of treatment, there were significant improvements in the VAS global scale by an average 33.9 mm (p = 0.001), VAS pain by 25 mm (p = 0.001). There was a trend towards improvement in PHQ-9 by 2.9 (p = 0.05). The mean improvement in KOOS pain was 11 (p = 0.001). KOOS symptoms improved by 9 (p = 0.025), KOOS ADL - by 12.4 (p = 0.001), KOOS Sport/Rec by 10.3 (p = 0.044), and KOOS QOL by 14.4 (p = 0.009). The proportion of patients achieving clinically significant improvement (MCII) were nine (56%) for both global health and pain. There were no adverse events during the study. The findings of this study suggest clinical efficacy and safety of C. Longa in MetS-associated knee OA. There is a need for large controlled studies to confirm these results.

The quality of life in nasopharyngeal carcinoma radiotherapy: A longitudinal study

ObjectiveThis article aims to longitudinally compare nasopharyngeal carcinoma (NPC) patients' quality of life (QoL) during radiotherapy (RT) and identify QoL correlates. MethodsThis study included 98 patients, with 85 completing full follow-up. Data were collected at baseline (T1), midpoint of RT (T2), and RT completion (T3), between October 2021 and November 2022. QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). RIOM severity was evaluated by the toxicity criteria of Radiation Therapy Oncology Group (RTOG). The nutritional status was evaluated using the Nutritional Risk Screening 2002 (NRS 2002), body mass index (BMI), and the Patient-Generated Subjective Global Assessment (PG-SGA). The generalized estimating equation described the QoL evolution and correlated it with RIOM, nutritional status, and other influential factors. ResultsSignificant deterioration was observed in various subscales of EORTC QLQ-C30 during RT, including global health status (GHS), physical function, role function, emotional function, fatigue, nausea/vomiting, pain, insomnia, appetite loss, and constipation (all P ​< ​0.05). Substantial deterioration was also observed in RIOM, nutritional status, and part of hematological indexes (all P ​< ​0.05). The decline of QoL was associated with gender, age, education level, chemotherapy regimen, Karnofsky performance status (KPS) score, RIOM severity, NRS 2002 score, PG-SGA score, and lymphocyte level (all P ​< ​0.05). ConclusionsQoL declined during RT and were associated with certain factors. Healthcare professionals should focus on alleviating treatment-related complications and identifying individuals at high risk of malnutrition early to improve outcomes for patients with NPC.

P035 Patient-reported outcome measures for rheumatoid arthritis disease activity: using Rasch measurement theory to achieve more meaningful measurement

Abstract Background/Aims Disease activity (DA) monitoring is a standard of care in rheumatoid arthritis (RA), and there is demand for achieving this through patient-reported outcome measures (PROMs). A systematic review of PROMs for RA DA following COSMIN guidelines demonstrated a lack of sufficient evidence for content validity for the 10 existing PROMS, thus none could be recommended for use. The aim of this study was to use Rasch measurement theory (RMT) to develop a valid item pool for measurement of DA in RA. Methods Paper questionnaires were sent to people aged 18 or over with RA from four South Wales University Health Boards between September 2020 and November 2021. The questionnaire included 268 individual RA DA items extracted from the 10 PROMs identified by the systematic review, another four PROMs and a non-measurement group of items. Further items suggested by patient feedback were incorporated, including a Pain Activity Scale, discomfort when walking, standing, and exercising, plus fear of falling when walking. Items were grouped into domains established by OMERACT: tenderness and swelling, patient global, pain, fatigue, physical functioning; and additionally stiffness, swelling, discomfort/fear and mood. Exploratory factor analyses (EFA) were used to indicate which items from which domains loaded onto factors together. For each separate domain, psychometric properties were assessed by RMT analyses. This provided results on targeting, model fit, internal consistency, local dependency, unidimensionality and item threshold ordering. Results A test dataset of n = 398 and a validation dataset of n = 293 were available. EFA of the test dataset showed that 30 items from across the tenderness and swelling, patient global, pain, fatigue, physical functioning and stiffness domains loaded together. RMT analyses of these items in the test dataset indicated that the patient global domain comprised two distinct domains, which followed a clear content difference of general health and disease activity items. In assessing the best items to measure the now 7 domains, 12 items were discarded. These 7 domains were confirmed in the validation data. Subtest analyses indicated that patient global general health and fatigue did not measure the same overall construct as the other 5 domains, and instead worked together to measure a separate construct. This structure was confirmed using bi-factor model confirmatory factor analyses in the validation data. Conclusion Patient global items relating to general health and disease activity were two separate domains. RA DA can be measured using tenderness and swelling, patient global disease activity, pain, physical functioning and stiffness items, whilst fatigue and patient global general health items measure a health-related quality of life construct. The next steps are to undertake cognitive interviews to establish content validity and to develop a computer adaptive test based on anchored locations calculated using these data. Disclosure T. Pickles: None. M. Horton: None. K.B. Christensen: None. R. Phillips: None. D. Gillespie: None. N. Mo: None. E. Choy: None.

Wide Awake Local Anesthesia No Tourniquet (WALANT) technique improves the efficiency of distal nerve blocks for carpal tunnel release

BackgroundAxillary block is the standard for carpal tunnel release (CTR), providing effective anesthesia, and tolerance of tourniquet. Conversely, distal blocks are less used due to poor tolerance of tourniquet. Wide Awake Local Anesthesia No Tourniquet (WALANT), proposed for hand and wrist surgeries, avoids its use. This study assesses the benefits of the addition of WALANT to distal blocks during endoscopic CTR (eCTR). MethodsThis randomized, open-label, controlled trial prospectively enrolled 60 patients scheduled for eCTR. Patients were randomized to receive distal blocks at the wrist combined to either a high arm tourniquet (Distal block group) or a WALANT in the area of surgery (Distal + Walant group). The primary endpoint was the global pain score summing pain scores related to puncture, local anesthetic injection, pneumatic tourniquet, surgical procedure, tourniquet deflation, and residual sensitivity after surgery. ResultsMean global pain score was significantly reduced in the Distal + Walant group (0.5 ± 1.4 vs. 2.2 ± 2.4; p < 0.001). No need for an additional anesthetic procedure was required in the Distal + Walant group. Even if the quality of visualization was high in both groups, it was better in the Distal block group (5 [5–5] vs. 4 [4–5]; p < 0.001). No rescue tourniquet was necessary for the Distal + Walant group. The rate of hematoma 15 days post-surgery was significantly reduced in the Distal + Walant group (20% vs. 57%; p < 0.01). ConclusionsThe addition of WALANT to distal blocks is adapted for eCTR. This combined technique decreases perioperative pain scores, provides good surgery conditions, and reduces the risk of postoperative hematoma. Clinical trial number and registry URLThe trial was registered on ClinicalTrials.gov (NCT04494100) on July 31, 2020 https://clinicaltrials.gov/ct2/show/NCT04494100?term=CMC+ambroise+pare&cntry=FR&draw=4&rank=28.

Clinical characteristics of flares in patients with rheumatoid arthritis after total hip and total knee arthroplasty.

Clinical characteristics of flares in patients with rheumatoid arthritis after total hip and total knee arthroplasty.

Arthroscopic popliteal tenotomy grants satisfactory outcomes in total knee arthroplasty with persistent localised posterolateral pain and popliteus tendon impingement.

The purpose was to estimate the prevalence of popliteus tendon impingement following TKA, and to describe the characteristics and the differential diagnosis protocol for this rare condition. The hypothesis was that arthroscopic popliteal tenotomy in TKA patients with suspected popliteus tendon impingement would relieve pain and improve satisfaction. Of 741 TKAs performed over three years, eight (1.1%, all women) had suspected popliteus tendon impingement, of which seven had severe localised posterolateral knee pain and one global knee pain. Upon confirmation of popliteus tendon impingement, arthroscopic popliteal tenotomy was performed, and outcomes (Pain on visual analogue scale (pVAS; best, 0; worst, 10), Oxford Knee Score (OKS; best, 48; worst, 0) and satisfaction (best, 100%; worst, 0%) assessed at mean 18-month follow-up. At four to 30months after TKA, arthroscopic exploration revealed popliteus tendon impingement in all eight knees. Six reported complete pain relief (pVAS, 0) the day following arthroscopic popliteal tenotomy, whilst one reported some residual pain (pVAS, 2). The remaining patient with global pain reported no pain relief, and required revision TKA at 12months. Excluding the revised TKA, OKS was between 19 and 43, and satisfaction was rated ≥ 80% in five of the remaining seven patients. Arthroscopic popliteal tenotomy relieved symptoms in TKA patients with persistentlocalised posterolateral pain and a positive popliteus test. These findings suggest that the popliteus test is reliable to diagnose popliteus tendon impingement following TKA, which could be treated by arthroscopic popliteal tenotomy. Level IV, Small case series.

Abstract P4-07-24: Circulating tumor cells enumeration and Health Related Quality of Life of patients treated with first-line chemotherapy for HER2 negative metastatic breast cancer

Abstract Background: In patients with metastatic breast cancer (mBC), Circulating Tumor Cells (CTC) counts have a strong prognostic impact on progression free survival (PFS) and overall survival (OS). Changes 4 weeks after the start of a new line of therapy, inform on treatment efficacy. Despite improvements in systemic treatment, metastatic BC remains mainly uncurable with alteration of health-related quality of life (HRQOL) during the course of the disease. The aim of this work was to assess impact of clinical factors and biological factors as CTC on HRQOL. Methods: The French cohort COMET is a prospective study including first line HER2 negative patients receiving weekly paclitaxel and bevacizumab according to EMA approved combination. The aim of this cohort was to evaluate clinical, biological and radiological parameters associated with patients’ outcome (CTC, CEC, serum markers, ctDNA, pharmacogenomic polymorphisms, metabolomic parameters, visceral fat assessed by initial CTscan, serum estradiol level, and quality of life). HRQOL was assessed at baseline, at every cycle until progression and then every 3 months up to death using the EORTC QLQ-C30 questionnaire and its breast cancer specific module, the EORTC QLQ-BR23. Five dimensions of HRQOL were analyzed for the primary analyses: Global health status (GHS), physical functioning (PF), Emotional functioning (EF), fatigue (FA) and pain (PA). Time until definitive deterioration (TUDD) in HRQOL was defined as the interval between inclusion and the first decrease in HRQOL score ≥ 5 compared to baseline HRQOL score with no further improvement or in case of death. CTC counts were determined using the standard CellSearch system [Menarini Silicon Biosystems]. Results: Out of 510 patients included in COMET study, 432 patients with available HRQOL data were analyzed in this study. At baseline, patients reported a mean score for GHS of 57.6 (SD=22.7), for PF of 75.8 (23.2), for EF of 62.2 (25.8), for FA of 42.2 (29.60) and for PA of 38.1 (31.5). The Median TUDDs for the 5 targeted dimensions was 10.1 months [7.5-16.9] for GHS, 6.1 months [4.1-8.9] for PF, 21.6 [18.7-31.2] for EF, 10.8 [6.2-16.6] for FA and 13.6[10.1-22.5] months for PA. CTC counts were available in 261 patients at base line and in 229 patients after 4 weeks of treatment, before second cycle of chemotherapy. CTC high count was independent of main clinical and biological characteristics except lobular subtype. We confirmed the poor outcome of patients with high CTC count at base line and after one cycle of treatment with the threshold of &amp;gt; 4CTC/7.5 ml of blood. Out of the 5 dimensions of HRQOL, TUDD of EF was significantly correlated with a high CTC level at base line (p=0.0262) and even more with still an elevated count of CTC after one cycle of chemotherapy(p=0.0137). There was no association of CTC with the other dimensions of HRQOL. Conclusion: This is the first study ever reporting an analysis of QoL and CTC. We observed an association of high CTC count with one component of HRQOL scale. This suggests that CTC could be complementary to clinical factors that could influence HRQOL in HER2 negative metastatic BC treated with first line chemotherapy. Citation Format: Jean-Yves Pierga, Oumar Billa, Sandrine Dabakuyo, Jérôme Lemonnier, Frédérique Berger, Olivier Trédan, William Jacot, Anthony Gonçalves, Marc Debled, Christelle Levy, Christelle Jouannaud, Marie-Ange Mouret-Reynier, Jean-Marc Ferrero, Florence Dalenc, Fatima-Zohra Toumi, Franck Bonnetain, Francois-Clement Bidard, Shufang Renault. Circulating tumor cells enumeration and Health Related Quality of Life of patients treated with first-line chemotherapy for HER2 negative metastatic breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-24.

Abstract P4-07-54: Health related quality of life of patients treated with bevacizumab and paclitaxel as first-line treatment for HER2 negative metastatic breast cancer: impact of clinical factors

Abstract Background: Advances in screening and treatment have led to increase in breast cancer (BC) survival in recent years but prognoses for metastatic BC remain poor with poorer outcomes as health-related quality of life (HRQOL). Treatment as bevacizumab and paclitaxel for metastatic BC, although that can increase time to progression of disease, often carry toxicity and is not curative but rather palliative in intent with the goal to improve or maintain HRQOL. The aim of this work was to assess impact of clinical factors such as disease progression, toxicity on HRQOL. Methods: COMET study is a multicenter prospective single-arm cohort study in France whose main objective was to identify biological factor that could predict the clinical benefit of bevacizumab-paclitaxel combination therapy as first treatment in HER2 negative metastatic BC. HRQOL was assessed at baseline, at every cycle (every for 4 weeks) until progression and then every 3 months up to death using the EORTC QLQ-C30 questionnaire and its BC specific module, the EORTC QLQ-BR23. In this ancillary study, we targeted 5 dimensions HRQOL for the primary analyses: Global health status (GHS), physical functioning (PF), Emotional functioning (EF), fatigue (FA) and pain (PA). The primary endpoint was time until definitive deterioration (TUDD) in HRQOL scales that defined as time between inclusion and the first decrease HRQOL score ≥ 5 points compared to baseline score, with no further improvement of at least 5 points. Multivariable Cox model with time dependent covariate was performed to assess clinical factors associated with TUDD for each of the 5 target dimensions HRQOL. We performed 3 models for each dimension: model 1 including all covariate with p&amp;lt; 0.10 in univariable; model 2 including model 1 and adjusted on cancer subtype and model 3 included model 1 stratified by cancer subtype. P value &amp;lt; 0.01 were considered statistically significant. Results: Out of 510 patients included in COMET study, 432 patients with available HRQOL data were analyzed in this study. Median age at inclusion was 58 years (range: 29-83), and 24.4% of patients had triple negative tumor subtype. About 79 % of cancers were invasive ductal carcinoma and 43 % patients had least 3 metastasis sites at baseline. At baseline, patients reported a mean score for GHS of 57.6 (SD=22.7), for PF of 75.8 (23.2), for EF of 62.2 (25.8), for FA of 42.2 (29.60) and for PA of 38.1 (31.5). The Median TUDDs for the 5 targeted dimensions was 10.1 months [7.5-16.9] for GHS, 6.1 months [4.1-8.9] for PF, 21.6 [18.7-31.2] for EF, 10.8 [6.2-16.6] for FA and 13.6[10.1-22.5] months for PA. In multivariable analyses, Disease Progression was associated with TUDD of GHS (HR [99%CI] =2.4 [1.2-4.9] and TUDD of PF (2.1 [1.1-3.7]). After adjusted on cancer subtype, association persisted with TUDD of GHS (p=0.009). Performance Status was associated with TUDD of PF (1.6 [1.2-2.3]), and TUDD of Pain (1.6 [1.1-2.3]). Performance Status association with TUDD of PF continued after adjustment on cancer subtype (p=0.0003). Prior endocrine therapy was associated with TUDD of pain in patients with tumor with positive hormone receptor (HR+) (2.4 [1.2-4.7]). There was no factor associated with TUDD of EF and TUDD of FA. Conclusion: Results of this study have shown that among the 5 targeted dimensions HRQOL, Physical Functioning was deteriorated in the shortest time. Disease progression, base line performance status and prior endocrine therapy for HR+ subtype, are clinical factors that could influence HRQOL in HER2 negative metastatic BC treated with first line chemotherapy. Citation Format: Oumar Billa, Sandrine Dabakuyo, Marion Chevrier, Franck Bonnetain, Isabelle Desmoulins, William Jacot, Olivier Trédan, Marc Debled, Christelle Levy, Anthony Gonçalves, Jean-Marc Ferrero, Florence Dalenc, Christelle Jouannaud, Marie-Ange Mouret-Reynier, Mireille Mousseau, Julien Grenier, Jean-Philippe Jacquin, Fatima-Zohra Toumi, Frédérique Berger, Jérôme Lemonnier, Jean-Yves Pierga. Health related quality of life of patients treated with bevacizumab and paclitaxel as first-line treatment for HER2 negative metastatic breast cancer: impact of clinical factors [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-54.

Abstract MP38: Higher Childhood Cardiovascular Risk Score is Associated With Worse Physical, Social and Emotional Functioning in Adulthood

Introduction: Childhood cardiovascular risk factors have been associated with increased risk of adult cardiovascular disease, but how they are associated with adult physical, emotional and social functioning is not well understood. Hypothesis: We addressed the hypothesis that the International Childhood Cardiovascular Cohort (i3C) Consortium childhood risk score would be associated with worse physical, social and emotional functioning in adulthood. Methods: The i3C childhood combined risk score is the average of five childhood risk factors (body mass index, systolic blood pressure, youth smoking, total cholesterol and triglycerides) on the z-score scale. Self-reported measures of physical (e.g., pain, functioning, fatigue), social (e.g., social isolation, satisfaction with social role) and emotional functioning (e.g., anxiety, depression) were assessed in adulthood in a subset of two i3C cohorts, the NHLBI Growth and Health Study (NGHS) and the Princeton Lipid Research Study (PLRS). Potential covariates included cohort (as a proxy for age, given no overlap in ages between cohorts), sex, race (Black vs. White), own education, parental education, marital status, and self-reported hypertension, diabetes and cancer. Interactions between the i3C risk score and cohort (age) were evaluated. Results: Ninety-two NGHS (100% female, 46% Black, mean±SD age 44.5±0.6 years) and 75 PLRS (77% female, 31% Black, 60.6±3.4 years) participants were included in analyses. In adjusted models, a higher i3C risk score was associated with worse physical functioning, global pain score, pain interference with everyday activities, and fatigue in the older PLRS participants, but only with global pain score in the younger NGHS participants (all p[int]&lt;0.05 except global pain). Higher i3C childhood risk score was associated with greater sleep-related impairment in PLRS, but with less impairment in NGHS participants (p[int]=0.03). Higher i3C childhood risk score was also associated with higher depression scores and less satisfaction with social roles in PLRS participants but not NGHS participants (p[int]=0.02 and 0.04, respectively). There was no significant relationship of i3C risk score with sleep quality, friendships, social isolation or anxiety. Conclusions: In conclusion, higher childhood cardiovascular risk factors are associated with worse physical, social and emotional health in adulthood, even in this limited sample of predominantly Black and White women followed from childhood. These effects are more prominent in older than younger adults, when issues such as pain and sleep problems become more prevalent.