Improvement In Pain Levels Research Articles

Insertional Achilles tendinopathy

Objective: Retrospectively analyze surgical procedures performed on patients with insertional Achilles (calcaneal tendon) tendinopathy, focusing on outcomes and the impact on the patients’ functional quality. Methods: A descriptive, retrospective, case series study drawn up by collecting data directly from the patients’ medical records. For the functional analysis of patients, we used the questionnaire of the adapted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). An assessment was carried out on each of the patients who underwent surgery at our hospital from 2010 to 2019, using the surgical technique described in this article, i.e., resection of the affected portion of the tendon with its subsequent reinsertion. Results: All surgical patients achieved an improvement in their AOFAS score and in pain levels, with good functional performance only three months into the postoperative period, from 50.1 to 83.75 (p<0.001). Conclusion: The use of the technique proved very effective, particularly in terms of the maintenance of foot function and important improvement in pain levels, thus producing a relevant increase in function among patients. Level of Evidence IV; Therapeutic Study; Case Series.

Immediate Effects of Exercise and Behavioral Interventions for Pelvic Floor Dysfunction and Lumbopelvic Pain

Background: Over the next 30 years chronic health problems associated with pelvic floor dysfunction are projected to increase by 50%. Objective: To determine the efficacy of a noninvasive, pain-free procedure of behavioral modifications and a specialized exercise program to improve pain levels and quality of life. Study Design: A quantitative, longitudinal study was conducted. Methods: Forty-one women aged 43.2 ± 9.5 years (mean ± SD) with symptoms of pelvic floor dysfunction and pelvic organ prolapse were introduced to a protocol that included eight 45-minute live group sessions and a home exercise program to be performed at least 3 times per week. The participants were reassessed after completion of the protocol intervention. IBM SPSS Version 24 statistical programming was used, and Wilcoxon nonparametric analyses were applied to compare the pre- and poststudy data to determine whether significant relief from pain and/or dysfunction occurred. Results: The procedure significantly improved lower back pain (Oswestry, z(41) = −4.068, P < .05), quality of life as related to pelvic floor disorder symptoms (Pelvic Floor Distress Inventory Questionnaire—Short Form 20, z(41) = −5.317, P < .05), life impact of pelvic floor disorder symptoms (Pelvic Floor Impact Questionnaire—Short Form-7, z(41) = −3.825, P < .05), diastasis recti separation (z(41) = −4.806, P < .05), pelvic floor muscle activation (z(41) = −5.583, P < .05), and pelvic alignment (z(41) = −3.207, P < .05). Conclusion: The noninvasive, pain-free procedure provided significant relief from symptoms of pelvic floor dysfunction and lower back pain.

Forgiveness and chronic pain: a systematic review.

Forgiveness is becoming increasingly recognized for its role in healthcare, having shown promising effects in patients suffering myriad diseases, from coronary artery disease to HIV to breast cancer. To review the current literature examining forgiveness and its relationship specifically to chronic pain. In July 2019, a search was carried out of electronic databases (Academic Search Complete, AMED, Biomedical Reference Collection, General Science, Medline, PsycArticles, PsycInfo, Social Sciences Full Text and SPORTDiscus). Further results were obtained from reference lists. Inclusion and exclusion criteria were applied using PRISMA guidelines for systematic reviews. The initial search yielded 354 results, and after duplicates were removed and inclusion and exclusion criteria applied, the final result was seven papers to be reviewed. Of the seven papers reviewed, five showed a relationship between lower levels of forgiveness and either increased experience or decreased tolerance for pain. One paper showed higher levels of empathy improving pain levels and suggests that forgiveness could enhance this experience of empathy. One study resulted in a higher level of pain among patients with higher forgiveness scores, although it was qualified that this particular patient population had a higher attachment anxiety, which may have impeded their ability to utilize forgiveness therapy. There is an association between the capacity to forgive and the experience of chronic pain. Further research should examine forgiveness as an intervention in a population of chronic pain patients to explore this relationship further.

A Retrospective Study of Stromal Vascular Fraction Cell Therapy for Osteoarthritis.

BackgroundOsteoarthritis (OA) is progressive degenerative damage to articular cartilage. Current therapeutic options are reduced to control the OA-associated symptoms, leaving the degenerative changes to progress until a joint replacement becomes mandatory. Therefore, therapeutic alternatives are warranted to improve the patient’s quality of life. Cell-based therapy is a developing therapeutic modality, showing promising results in the regeneration of injured cartilage and reduction of on-going inflammation within the affected joint. The current retrospective chart review study was aimed to analyze changes in pain and mobility of subjects with OA after stromal vascular fraction (SVF) cell therapy.MethodsThree hundred fifty subjects with hip and knee OA, treated with autologous SVF cells at the Malacky Hospital (Bratislava, Slovakia) in the period from 2015 to 2018, were included in the retrospective chart review study.ResultsSeven days after SVF cell therapy, 45.2% of subjects experienced improved pain levels and mobility. Three, 6, and 12 months after therapy, improvement in pain levels reached 75.3%, 84.4%, and 84.9%, and improvement in mobility reached 75.2%, 84.4%, and 84.9%.ConclusionsOur study of 350 subjects with hip and knee OA showed a significant improvement in pain levels and mobility 3, 6, and 12 months compared to 7 days after autologous SVF cell administration. The treatment demonstrated a strong safety profile with no severe adverse events or complications reported. The results of the study are showing that SVF cell therapy was more effective in subjects with arthritis stage III compared to arthritis stages I, II, and IV.

Short-Term Efficacy of Kinesiotaping versus Extracorporeal Shockwave Therapy for Plantar Fasciitis: A Randomized Study.

Background:Plantar fasciitis is a degenerative condition that is one of the most common causes of heel and foot pain. Among noninvasive management of plantar fasciitis, extracorporeal shockwave therapy (ESWT) has been extensively studied and found to be effective, but few studies have assessed the effectiveness of kinesiotaping (KT) method.Objective:This study aimed to show the effectiveness of KT compared with ESWT in the management of plantar fasciitis.Methods:A total of 84 patients with plantar fasciitis were enrolled from a single center and randomized into KT and ESWT treatment groups in a 1:1 ratio (i.e., 42 patients in each group); only one foot was considered for each patient. Both KT and ESWT were applied once a week for 6 weeks. Patients' pain, functional status and quality of life were evaluated with the visual analog scale (VAS), Foot Function Index (FFI) and the Short-Form-36 (SF-36) health survey, respectively. Patients' fat pat and plantar fascia thickness were measured using ultrasonography. All evaluations were performed before and immediately after the 6-week intervention.Results:In the KT group, six patients were lost to follow-up; therefore, the final analysis only included 36 patients. After the intervention, there was a statistically significant improvement in the VAS and SF-36 scores of both groups (P = 0.001), but the FFI score improvement was statistically significant only in the KT group (P = 0.001). In both groups, the mean thickness of plantar fascia decreased after treatment and the mean thickness of the fat pat increased; however, the change was not statistically significant (P = 0.935 and P = 0.832, respectively).Conclusion:Both KT and ESWT treatments improved pain levels and quality of life in patients with plantar fasciitis, but KT also improved functionality. Multicentered studies with larger sample size and longer follow-ups are required to further validate these findings.

Current Trends in Pediatric Spine Deformity Surgery: Multimodal Pain Management and Rapid Recovery.

Study Design:Narrative review.Objectives:The purpose of this article is to perform a review of the literature assessing the efficacy of opioid alternatives, multimodal pain regimens, and rapid recovery in pediatric spine surgery.Methods:A literature search utilizing PubMed database was performed. Relevant studies from all the evidence levels have been included. Recommendations to decrease postoperative pain and expedite recovery after posterior spinal fusion in adolescent idiopathic scoliosis patients have been provided based on results of studies with the highest level of evidence.Results:Refining perioperative pain management to lessen opioid consumption with multimodal regimens may be useful to decrease recovery time, pain, and complications. Nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentin, neuraxial blockades, and local anesthesia alone offer benefits for postoperative pain management, but their combination in multimodal regimens and rapid recovery pathways may contribute to faster recovery time, improved pain levels, and lower reduction in total opioid consumption.Conclusion:A rapid recovery pathway using the multimodal approach for pediatric scoliosis correction may offer superior postoperative pain management and faster recovery than traditional opioid only pain protocols.

Hip abductor repair improves patient outcome, function, and satisfaction in patients without and with total hip arthroplasty

PurposeDetermine whether patient pain and function are similar following hip abductor repair in patients without and with total hip arthroplasty (THA). MethodsPatients who underwent hip abductor repair were categorized as to whether they had a THA or not. Pre- and postoperative pain and Harris Hip Score (HHS) were recorded and compared between groups. ResultsThere were no differences in improvement in pain level, improvement in HHS, satisfaction with surgery. ConclusionsHip abductor repair leads to similar pain, function, and satisfaction in patients without and with THA.

Mets and oscillating energy manual therapy in chronic lateral epicondylosis: a comparative study.

Lateral Epicondylitis (LT) term was used previously thinking that it as an inflammatory condition, but it is tendinosis of Common extensor tendons of the forearm due to overuse. The incidence of the condition is about 4000 - 7000 per year in the general population in the United States. Conventional treatments practiced on the concept of inflammation have shown forty to eighty percent of unsuccessful results. Individuals with lateral epicondylosis may have symptoms like pain during activity, weakness, swelling and functional disability. The primary objective of the study is to find out the effectiveness of oscillating energy manual therapy (OEMT) compared with muscle energy technique (MET) on functional outcome in subjects with lateral epicondylosis. Total of 30 subjects with unilateral lateral epicondylosis was selected and was divided into two groups of 15 each in a group. Group A (received oscillating energy manual therapy) and Group B (received muscle energy technique). NRS (Numerical Rating Scale), Grip Strength and PRTEE (Patient Rated Tennis Elbow Evaluation) scale were measured pre and post-treatment for both the groups and also at follow up of the sixth week. Muscle energy technique group showed improvement in pain levels, muscle strength and functional activities. The statistical analysis demonstrated that results were more significant in group B at 4th week and also at follow up with a mean difference of (2.3) for NRS, (57.4) for PRTEE and (5.9) for grip strength than group A.

Effect of enhanced recovery after surgery (ERAS) pathway on the postoperative outcomes of elbow arthrolysis: A randomized controlled trial.

Enhanced recovery after surgery (ERAS) protocols aim to improve perioperative outcomes and facilitate recovery for the patient through multimodal pathways. While implementation of ERAS has improved outcomes in numerous surgical specialties, benefits specific to elbow arthrolysis have not been investigated. The purpose of this study was to determine the effects of an evidence-based ERAS pathway on: (1) reducing pain intensity and postoperative complications compared to conventional care, and (2) improving range of motion (ROM) and function of the elbow after open arthrolysis. A randomized controlled study was performed between September 2017 and January 2018. Fifty patients with post-traumatic stiff elbow scheduled for surgery were randomly divided into ERAS group (25 patients) and conventional care group (25 patients). Duration of surgery, pre- and post-surgery ROM, Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) pain scores at rest and in motion were measured postoperatively at 1 through 5 days, 6-weeks, and 6-months. Complications were recorded 6-months postoperatively. VAS pain score values at rest and in motion in the ERAS group were consistently significantly lower than those in the conventional care group at 1 through 5 postoperatively days (P < 0.05). At 6-weeks and 6-months after surgery, pain score values at rest and in motion were similar between the 2 groups (P > 0.05). ROM was consistently significantly better in the ERAS group compared with the conventional care group (P < 0.05). No significant differences in MEPS or complications were found between the 2 groups (P > 0.05). ERAS pathway is feasible to implement in elbow arthrolysis and can result in clinically meaningful improvements in levels of pain (at rest and in motion) and ROM without an increase in the rate of postoperative complications.

Effects of Whole-Body Vibration in Older Adult Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to determine the effects of whole-body vibration training on metabolic abnormalities, mobility, balance and aerobic capacity in older adult patients with type 2 diabetes mellitus. We searched PubMed, Cochrane Library, PEDro, LILACS and SciELO (from the earliest date available to March 2018) for controlled trials that evaluated the effects of whole-body vibration on the health-related outcomes of patients with type 2 diabetes. Two reviewers independently selected the studies and performed statistical analyses of the studies. Weighted mean differences, standard mean differences and 95% confidence intervals (CIs) were calculated. In total, 7 studies, involving 279 patients who had type 2 diabetes, that compared whole-body vibration with other exercises and/or controls were included. Individual studies suggested that whole-body vibration was associated with improvements in pain levels, blood flow in the legs, glycated hemoglobinlevels and fasting blood glucose levels. Whole-body vibration improved mobility weighted mean differences (-.24 seg; 95% CI -2.0, -0.5; n=96); balance standard mean differences (2.34; 95% CI 1.16, 3.5; n=57); and aerobic capacity standard mean differences (0.7; 95% CI 0.2, 1.3; n=59). Whole-body vibration could be a useful strategy in the management of the symptoms and disabilities associated with type 2 diabetes; however, it is necessary to perform further studies to reinforce the reported findings.

Treatment of chronic scapholunate instability: Results with three-ligament tenodesis vs. scapholunate and intercarpal ligamentoplasty

In this retrospective case control/comparison study, we compared the clinical and radiological outcomes in patients with chronic scapholunate dissociation treated with three-ligament tenodesis (3 LT) versus scapholunate and intercarpal ligamentoplasty (SLICL). Twenty patients with a mean age of 43 years were treated with the 3 LT procedure and 26 patients with a mean age of 44 years with the SLICL procedure. All patients had chronic reducible scapholunate dissociation without chondral lesions. The two groups of patients were operated on by senior surgeons, at the same facility, over two different time periods. All patients were evaluated (pain, motion, strength, function, X-rays) with a mean follow-up of 28 months (12–49) in the 3 LT group and 36 months (12–54) in the SLICL group. In the both groups, we found a significant improvement in pain levels, grip strength and functional scores (DASH and PRWE). The SLICL group had significantly less pain and greater grip strength than the 3 LT group. Patients in the SLICL group had a greater improvement in their DASH and PRWE Scores. The mean range of motion in flexion–extension was 82° (102° preoperative) in the 3 LT group and 113° (115° preoperative) in the SLICL group. In the 3 LT, there was no significant improvement in the mean static and dynamic scapholunate gaps (3.6 and 4.8 mm postoperatively versus 3.9 and 4.9 mm preoperatively), or the scapholunate angle (75° versus 72°). In the SLICL group, the mean static and dynamic gaps improved significantly (2.3 and 3.0 mm postoperatively versus 3.2 and 4.6 mm preoperatively), as did the scapholunate angle (62° versus 73°). In the 3 LT group, 4 patients developed osteoarthritis. In conclusion, the SLICL procedure for scapholunate ligament reconstruction led to better clinical and early radiological results than the 3 LT technique.

Ultrasound-Guided Microwave Ablation for the Management of Inguinal Neuralgia: A Preliminary Study with 1-Year Follow-up

PurposeTo evaluate the feasibility and efficacy of ultrasound-guided microwave ablation for the treatment of inguinal neuralgia. Materials and MethodsA retrospective review of 12 consecutive ultrasound-guided microwave ablation procedures was performed of 10 consecutive patients (8 men, 2 women; mean age, 41 years [range, 15–64 years]), between August 2012 and August 2016. Inclusion criteria for inguinal neuralgia included clinical diagnosis of chronic inguinal pain (average, 17.3 months [range, 6–46 months]) refractory to conservative treatment and a positive nerve block. Pain response—reduction of pain level and duration and percent pain reduction using a 10-point visual analog scale (VAS) at baseline and up to 12 months after the procedure—was measured. Nine patients had pain after the inguinal hernia repair, and 1 patient had pain from the femoral artery bypass procedure. The microwave ablation procedure targeted the ilioinguinal nerve in 7 cases, the genitofemoral nerve in 4 cases, and the iliohypogastric nerve in 1 case. ResultsAverage baseline VAS pain score was 6.1 (standard deviation, 2.5). Improved pain levels immediately after the procedure and at 1, 6, and 12 months were statistically significant (P = .0037, .0037, .0038, .0058, respectively). Also, 91.7% (11/12) of the procedures resulted in immediate pain relief and at 1 month and 6 months. At 12 months, 83.3% (10/12) of patients had an average of 69% ± 31% pain reduction. Percent maximal pain reduction was 93% ± 14% (60%–100%), and the average duration of clinically significant pain reduction was 10.5 months (range, 0–12 months.). No complications or adverse outcomes occurred. ConclusionsUltrasound-guided microwave ablation is an effective technique for the treatment of inguinal neuralgia after herniorrhaphy.

The effect of an individualised functional retraining intervention on pain, function and biomechanics in participants with patellofemoral pain: a series of n of 1 trial.

[Purpose] To determine the effect of an individualised functional retraining intervention on pain, function, kinematics and self-reported recovery in participants with PFP. [Participants and Methods] Thirty-one participants with unilateral PFP between the ages of 14–40 were included. Data collection and treatment sessions were conducted at the Tygerberg 3D Motion Analysis Laboratory and Physiotherapy Clinic at the University of Stellenbosch Medical School in Cape Town, South Africa. Participants underwent motion analysis testing pre- and post-intervention and attended physiotherapy weekly for a 6-week individualised intervention. [Results] Thirty of the thirty-one participants (96.8%) demonstrated improved pain levels (NPRS) post intervention. Participants demonstrated a statistically significant improvement in function (AKPS) immediately post intervention and continued to improve with greater functional scores at 6-month follow up. Fifteen participants (48.4%) rated themselves as fully recovered on a 7-point Likert scale at 6-month follow up. Nineteen of the 31 participants (61.3%) demonstrated a clinically significant improvement in their priority kinematic outcome post intervention. [Conclusion] Individualised functional retraining may improve pain, function, kinematics and long-term recovery in participants with PFP presenting with kinematic contributing factors. Clinicians need to be educated on common biomechanical contributing factors and how to tailor treatment accordingly.

The effect of paraffin bath therapy versus extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized clinical trial

Plantar fasciitis (PF) is the most common cause of painful heel. The etiology is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. Physical therapy interventions such as contrast bath, ultrasonography and iontophoresis help in resolution of symptoms. According to our current knowledge the efficacity paraffin bath therapy (PBT) is ambiguous. This prospective, randomized controlled study aims to compare the efficacy of PBT and extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis. Seventy patients were randomized into either the PBT (12 men, 23 women; mean age 39.12 ± 7.15 years) or ESWT (14 men, 21 women; mean age 38.37 ± 8.87 years) groups. Four patients in PBT group and five patients in ESWT group were lost to follow-up. Groups were similar regarding age, sex, and body mass index (all P > 0.05). PBT group had paraffin bath therapy (5 times per week, for 3-week duration) for affected foot while ESWT was applied twice a week for three weeks. As outcome measures patients’ pain and functional status were evaluated with Visual Analog Scale (VAS), Heel Tenderness Index (HTI), Foot and Ankle Outcome Score (FAOS) and ultrasonographic thickness of the plantar fascia recorded. The study parameters were administered at baseline, immediately after treatment and after 12 weeks. Statistically significant improvement was observed in several studied parameters after the treatment and during the follow-up study in the both groups. The PBT significantly improved the VAS, HTI and FAOS but not in thickness of the plantar fascia, even in the long-term. Both PBT and ESWT treatments improved pain levels and function and quality of life in individuals with plantar fasciitis. But ESWT method was superior according to PBT in treating plantar fasciitis.

Efficacy of a non-image-guided diagnostic hip injection in patients with clinical and radiographic evidence of intra-articular hip pathology.

ABSTRACTThe purpose of this study was to determine the likelihood of pain relief, as a measure of accurate diagnosis of intra-articular hip pathology and correct needle placement, with a non-image-guided intra-articular hip injection performed bedside in the clinic. A retrospective study of prospectively collected data was performed in a consecutive cohort of patients diagnosed with symptomatic intra-articular hip pathology who underwent a non-image-guided intra-articular injection in the clinic. All patients had clinical and radiographic evidence of hip impingement, hip instability, chondrolabral pathology, or other causes of intra-articular hip pain. A previously described technique for a non-image-guided hip injection was performed using 7–10 ml of 1% lidocaine for diagnostic evaluation with some patients receiving 2 ml of Kenalog®-40 if clinically indicated. Ten minutes following each injection, the patient was asked to report the percent improvement in pain (from 0 to 100%) while physical examination and provocative tests were repeated. The final study cohort comprised 142 patients (161 injections). In three cases, patients were either unable to assess or quantify any change in pain level 10 min following the injection. In the remaining 158 hip injections, pain relief was noted in 156 cases (156/158, 98.7%), with at least 70% improvement in pain level noted in 152 cases (152/158, 96.2%). Average pain relief among all 158 injections was 89 ± 16%. A non-image-guided diagnostic intra-articular hip injection yields reliable short-term pain relief, simultaneously endorsing accurate diagnosis of hip pathology and intra-articular needle placement.

Outcomes of rotator cuff augmentation surgery with autologous fascia lata

ObjectiveTo evaluate whether augmentation grafts using autologous fascia lata improve functional results for rotator cuff repairs and reduce the retear rate compared to those without augmentation. Material and methodsThis is a prospective evaluation comprising 20 patients with a complete symptomatic rotator cuff tear. The operations were carried out from a superior approach performing a total cuff repair, for 10 patients we used a suture augmented with an autologous graft taken from their own fascia lata while unaugmented sutures were used for the other 10 patients. The follow-up period lasted for one year post-intervention. We measured variables for tear type, functionality and pain, both baseline and at 6 and 12-month follow ups. We evaluated retear incidence in each group as well as each group's pain and functionality response. ResultsThe improved pain levels in the non-graft group evolved gradually over time. Conversely, in the group with the augmentation grafts, average Constant–Murley shoulder outcome scores at six months were already above 10 and were maintained at 12 months. One retear occurred in the graft group and 2 in the group without grafts, thus presenting no significant differences. There were no significant changes in pain and function values at the one year follow up in either group. ConclusionOur preliminary results regarding rotator cuff augmentation surgery with autologous fascia lata showed a significant improvement in pain levels after 6 months compared to the patients with no augmentation, who required 12 months to reach the same values. After a year of follow up, there were no differences between the mean Constant and pain scores in either intervention group The number of retears in the non-graft group was greater than that in the group with grafts although the difference was not significant.

Resultados de la cirugía de refuerzo del manguito rotador con fascia lata autógena

ObjectiveTo evaluate whether augmentation grafts using autologous fascia lata improve functional results for rotator cuff repairs and reduce the retear rate compared to those without augmentation. Material and methodsThis is a prospective evaluation comprising 20 patients with a complete symptomatic rotator cuff tear. The operations were carried out from a superior approach performing a total cuff repair, for 10 patients we used a suture augmented with an autologous graft taken from their own fascia lata while unaugmented sutures were used for the other 10 patients. The follow-up period lasted for one year post-intervention. We measured variables for tear type, functionality and pain, both baseline and at 6 and 12-month follow ups. We evaluated retear incidence in each group as well as each group's pain and functionality response. ResultsThe improved pain levels in the non-graft group evolved gradually over time. Conversely, in the group with the augmentation grafts, average Constant-Murley shoulder outcome scores at six months were already above 10 and were maintained at 12 months. One retear occurred in the graft group and 2 in the group without grafts, thus presenting no significant differences. There were no significant changes in pain and function values at the one year follow up in either group. ConclusionOur preliminary results regarding rotator cuff augmentation surgery with autologous fascia lata showed a significant improvement in pain levels after 6 months compared to the patients with no augmentation, who required 12 months to reach the same values. After a year of follow up, there were no differences between the mean Constant and pain scores in either intervention group The number of retears in the non-graft group was greater than that in the group with grafts although the difference was not significant.

The Combination of Probiotic Complex, Rosavin, and Zinc Improves Pain and Cartilage Destruction in an Osteoarthritis Rat Model.

Osteoarthritis (OA), a degenerative disorder, induces pain, joint inflammation, and destruction of the articular cartilage matrix. Probiotic complex, rosavin, and zinc have been used as dietary supplements that exhibit anti-inflammatory and antioxidant properties. However, there is no evidence demonstrating a synergic effect in OA. This study aims to determine whether combination with probiotic complex, rosavin, and zinc decreases progression of monosodium iodoacetate (MIA)-induced OA rat model. The combination improved pain levels by preventing cartilage damage. The expression of proinflammatory cytokines and catabolic factors was reduced by the combination within the joint tissue. However, the combination increased anti-inflammatory cytokines as well as the anabolic factor production. The gene level of catabolic factors was decreased with treatment of the combination in chondrocytes isolated from OA patients. These results suggest that the combination can improve MIA development through the inhibition of proinflammatory cytokines and cartilage destruction, thus playing a key role as a therapeutic candidate for OA treatment.

Improvement in Scoliosis Research Society-22R Pain Scores After Surgery for Adolescent Idiopathic Scoliosis.

Longitudinal cohort. To investigate whether patients with painful adolescent idiopathic scoliosis experience pain relief with surgical treatment. Adolescent idiopathic scoliosis (AIS) was previously thought to be a painless condition, but recent studies have shown that a significant proportion of patients have pain. Little information is available regarding pain relief with surgical treatment for AIS. Patients enrolled in a prospective database of surgically treated AIS were divided into two groups based on their preoperative Scoliosis Research Society (SRS)-22R pain domain score. Patients with a preoperative pain domain score of 4 or more (N = 1005) were classified as nonpainful. If the preoperative pain domain score was less than 4 (N = 505), they were classified as painful. Demographics, SRS total and domain scores, and changes with treatment were compared for the two groups. The two groups had similar demographics and preoperative coronal curve magnitude. Patients with painful scoliosis experienced significant improvement in SRS-22R pain scores, from 3.29 preoperatively to 4.03 postoperatively (P < 0.000). Eighty-one percent of these patients reached the minimum clinically important difference threshold (0.20) for improvement in pain score. Painful scoliosis patients also had greater 2-year improvement in total and all domain scores than the nonpainful scoliosis patients (P < 0.000). Absolute values of SRS-22R total and domain scores were all greater at 2 years in the nonpainful group than the painful group. Patients with AIS with substantial back pain can be cautiously counseled to expect significant improvement in pain level with surgical correction of their deformity, even if curve progression is the primary indication for surgery. Although these patients achieve greater improvements in health-related quality of life compared with patients with mild or no pain, 2-year SRS-22R scores were still better in patients with mild or no pain preoperatively. 2.

Progressive resistance training in patients with hip dysplasia: A feasibility study.

To examine whether progressive resistance training is feasible in patients with symptomatic hip dysplasia scheduled for periacetabular osteotomy. A secondary objective was to investigate patient-reported outcomes, functional performance and hip muscle strength. Feasibility study. Seventeen patients (median age 28 years, range 22-40 years) performed 8 weeks (20 sessions) of supervised sessions of progressive resistance training. Training-adherence, number of dropouts and adverse events, and visual analogue scale scores on pain were registered. Patients completed the Hip and Groin Outcome Score, performed 2 hop-tests, and hip peak torque was assessed by isokinetic dynamometry. Training-adherence was 90.3±9%. Few and minor adverse events were observed, one patient dropped out and acceptable pain levels were reported during the intervention. Scores on 4 out of 6 subscales on patient-reported outcome improved (p <0.05), as did standing distance jump (12.2%, 95% confidence interval (CI) [1.3, 23.0]), countermovement jump (25.1%, 95% CI [1.3, 48.8]). Isokinetic concentric hip flexion peak torque showed significant improvements (16.6%, 95% CI [4.6, 28.6]) on the affected side while isometric hip flexion (10.9%, 95% CI [0.3, 21.6]) improved on the non-affected side. Supervised progressive resistance training is feasible in patients with hip dysplasia. The intervention may improve pain levels, patient-reported outcomes, functional performance and hip flexion muscle strength.