Improvement In Pain Perception Research Articles

Autologous Bone Marrow Aspiration Concentrate (BMAC) Therapy for Primary Knee Osteoarthritis-An Observational and Dose Escalation Study.

Anti-inflammatory and anti-fibrotic properties maximize the therapeutic potential of bone marrow aspiration concentrate (BMAC) in osteoarthritis (OA) knee. There is a lack of studies to standardize the treatment procedure to make the studies done across various centers comparable to understand the lacunae better and develop further the deficiency in our understanding of BMAC for OA knee. We aimed to assess the degree of pain relief, functional outcome, and cartilage thickness with different doses of BMAC in primary OA knee. A single-centered prospective observational study was conducted with 80 patients of OA knee who were divided into 4 groups where group A (n = 20), group B (n = 20), group C (n = 20), and group D (n = 20) received intra-articular 1, 2, 5million BMAC cells per kg body weight, and intra-articular saline, respectively. All patients were followed up with Visual Analog Scale (VAS), knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) scores both pre and post-procedurally at 1, 3, 6, and 12months follow-up. The study found no significant differences in demographics or co-morbidities across four participant groups (A, B, C, D). However, clinical outcomes varied markedly: Groups B and C showed significant improvements in pain perception (VAS scores), knee function, and quality of life (KOOS and WOMAC scores), while Group A showed marginal or non-significant changes, and Group D exhibited no significant improvements. These findings suggest that treatments in Groups B and C reached the Minimal Clinically Important Difference, significantly enhancing patient-reported outcomes. A dose of 2million BMAC cells per kg body weight for knee OA serves as the better regenerative modality of choice in cartilage regeneration. With our dose-escalation study, we would be able to standardize the treatment procedure and enable global comparison of the treatment method across various regions of the world.

Oxytocin Modulation in Mindfulness-Based Pain Management for Chronic Pain.

In the context of chronic pain management, opioid-based treatments have been heavily relied upon, raising concerns related to addiction and misuse. Non-pharmacological approaches, such as Mindfulness-Based Pain Management, offer alternative strategies. We conducted a mechanistic clinical study to investigate the impact of an 8-week Mindfulness-Based Pain Management intervention on chronic pain, the modulation of inflammatory markers, stress physiology, and oxytocin, and their interplay with clinical pain symptoms and perception, in comparison to a patient wait-list active control. A total of 65 participants, including 50 chronic pain patients and 15 healthy controls, underwent salivary assays to assess endocrine markers, oxytocin, interleukin (IL)-1b, IL-6, IL-8, tumor necrosis factor (TNF)-a, and dehydroepiandrosterone sulphate (DHEA-S). Psychological assessments were also conducted to evaluate aspects of pain perception, mindfulness, mood, and well-being. Findings revealed significant differences between chronic pain patients and healthy controls in various clinical metrics, highlighting the psychological distress experienced by patients. Following Mindfulness-Based Pain Management, oxytocin levels significantly increased in chronic pain patients, that was not observed in the patient wait-list control group. In contrast, cytokine and DHEA-S levels decreased (not to statistically significant margins) supporting anti-inflammatory effects of Mindfulness-Based Pain Management. The fact DHEA-S levels, a marker of stress, did attenuate but not to statistically meaningful levels, suggests that pain reduction was not solely related to stress reduction, and that oxytocin pathways may be more salient than previously considered. Psychological assessments demonstrated substantial improvements in pain perception and mood in the intervention group. These results contribute to the growing body of evidence regarding the effectiveness of mindfulness-based interventions in chronic pain management and underscore oxytocin's potential role as a therapeutic target.

H-Wave® Device Stimulation for Chronic Low Back Pain: A Patient-Reported Outcome Measures (PROMs) Study.

Chronic low back pain (cLBP) is a problem globally, creating a tremendous economic burden. Since conventional treatments often fail, various forms of electrical stimulation have been proposed to improve function and decrease pain. Patient-reported outcome measures (PROMs) have not been adequately reported in the electrical stimulation literature. A retrospective independent statistical analysis was conducted on PROMs data for users of H-Wave® device stimulation (HWDS) collected by the device manufacturer over a period of 4years. Final surveys for 34,192 pain management patients were filtered for pain chronicity limited to 3-24months and device use of 22-365days, resulting in 11,503 patients with "all diagnoses"; this number was then reduced to 2711 patients with nonspecific cLBP, sprain, or strain. Reported pain was reduced by 3.12 points (0-10 pain scale), with significant (≥ 20%) relief in 85.28%. Function/activities of daily living (ADL) improved in 96.36%, while improved work performance was reported in 81.61%. Medication use decreased or stopped in 64.41% and sleep improved in 59.76%. Over 96% reported having expectations met or exceeded, service satisfaction, and confidence in device use, while no adverse events were reported. Subgroup analyses found positive associations with longer duration of device use, home exercise participation, and working, whereas older age and longer pain chronicity resulted in reduced benefit. Similar analysis of the larger all-diagnoses cohort demonstrated near-equivalent positive outcomes. Treatment outcomes directly reported by cLBP HWDS patients demonstrated profound positive effects on function and ADL, robust improvement in pain perception, and additional benefits like decreased medication use, better sleep, and improved work performance, representing compelling new evidence of treatment efficacy.

VirtualPain. Preliminary findings from a group-based digital therapeutics intervention for fibromyalgia.

Fibromyalgia (FM) is a disorder characterized by chronic pain, with significant medical, psychological, and socio-economic implications. Although there is limited evidence, cognitive-behavioral therapy (CBT) has shown to be effective in improving FM symptoms. An alternative to enhance CBT effectiveness is to incorporate digital therapeutics (DTx). We conducted a pilot study to investigate whether the addition of a DTx intervention (VirtualPain) to cognitive-behavioral group therapy (CBGT) can reduce pain perception and associated symptoms in patients with FM. Ten patients with FM were initially recruited from a public hospital in Barcelona. The treatment consisted of 6 weeks of VirtualPain group sessions and 16weeks of CBGT. Measures of catastrophizing, self-efficacy, and coping were recorded before, during, and after the protocol. In the DTx sessions, pain intensity was recorded before and after each session. The program (DTx and CBGT) showed a significant improvement in pain-related self-efficacy and relaxation measures. Improvement in pain perception was observed only after the DTx intervention. This study provides preliminary results regarding the added value of DTx (VirtualPain) as part of a CBGT for FM. The use of the program has facilitated a significant reduction in pain perception in each of the VirtualPain sessions, which provides further evidence of how this technology can be beneficial for improving FM treatments.

Use of First-Line Oral Analgesics during and after COVID-19: Results from a Survey on a Sample of Italian 696 COVID-19 Survivors with Post-Acute Symptoms.

Background-Analgesics could be used to manage painful symptoms during and after COVID-19. Materials and methods-Persistence of painful symptoms was assessed during and after COVID-19 in a sample of patients admitted to a post-acute COVID-19 outpatient service in Rome, Italy. Data on type and frequency of use of first-line analgesics were collected. Pain severity was evaluated with a numeric rating scale (NRS) from 0 to 10. Results-Mean age of 696 participants was 57.1 ± 20.3 years and 61.7% were women. During COVID-19, the most prevalent symptoms were fever, fatigue, arthralgia, myalgia and headache. Acetaminophen was used by 40% of the sample. Only 6.7% needed to continue analgesic therapy after COVID-19. Frequent causes of analgesics consumption were persistent arthralgia and myalgia. The most common analgesics used amongst those who continued taking analgesics in the post-acute phase of COVID-19 were the following: acetaminophen (31%), ibuprofen (31%) and other non-steroidal anti-inflammatory drug (NSAID) (29.5%); in older subjects the most common analgesic used was acetaminophen (54%). Most of the subjects in this group said there was an improvement in pain perception after taking analgesic therapy (84%). Conclusions-Use of analgesics in the post-acute COVID-19 is common in subjects with persistent arthralgia and myalgia, and common analgesics were acetaminophen and ibuprofen. Further research on the safety and efficacy of those medications in COVID-19 is warranted.

The use of botulinum toxin (BoNT) in urology - review

Introduction and purpose
 Botulinum neurotoxin (BoNT) prevents the release of acetylcholine into the synaptic cleft of the neuromuscular junction, which causes flaccid muscle paralysis. A non-obvious specialization that uses botulinum toxin is urology. The aim of this article is to present a literature review regarding the use of botulinum toxin in the treatment of urological diseases.
 Description of the state of knowledge
 In the overactive bladder syndrome, with resistance to oral medications, an alternative is botox injections into the bladder wall, which reduce the intensity of urgency and pollakiuria.
 Treatment of BPH with botulinum toxin injection may be an alternative to surgical and pharmacological treatment. Intra-articular botox injection causes smooth muscle relaxation and gland atrophy through prostate tissue apoptosis.
 Clinical studies show promising therapeutic effects of using Botox injections in the treatment of intramural cystitis. It reduces the feeling of bladder pain and the worsening of other symptoms.
 Panunzio et al. Presented a meta-analysis of prospective studies that showed a statistically significant improvement in pain perception after injection of botulinum toxin into the pelvic structures, compared with baseline values ​​for CPPS, in all cohorts evaluated.
 Summary
 Urology uses the entire spectrum of botox possibilities, from myocrelation in the bladder hyperresponsiveness syndrome, through neuromodulation and apoptosis induction in benign prostatic hyperplasia, ending with anti-inflammatory and analgesic properties in bladder pain syndrome and chronic pelvic pain syndrome.

Updates in the Surgical Management of Recurrent Clubfoot Deformity: a Scoping Review.

This article focuses on the current advances in surgical management for clubfoot deformity, supported by up-to-date longitudinal studies on each approach. Long-term analysis following primary and repeated soft tissue releases has demonstrated good results in young patients with low relapse rates. Tibialis anterior transfer following the Ponseti method shows no difference in long-term pedographic analysis in comparison to the Ponseti method alone. Furthermore, tibialis anterior transfer following surgical relapses provides good long-term results with improved correction in talus-first metatarsal angle. Bony osteotomies may also play a role in addressing surgical relapses in older children. However, talar neck osteotomy may result in avascular necrosis of the talar dome. Hexapod external fixation may be considered by experienced surgeons to correct rigid clubfoot deformities in older patients with good long-term results and drastic improvements in pain perception. Long-term analysis of anterior distal tibial epiphysiodesis (ADTE) for recurrent equinus deformity following surgical correction has demonstrated statistical improvements in the anterior distal tibial angle (ADTA) and ankle dorsiflexion. Talectomy and naviculectomy are rarely used in today's practice as long-term studies have demonstrated high relapse rates and residual pain impeding patient mobility. Surgical correction following failure of the conservative approaches can be implemented to achieve full correction in clubfoot deformity. It is difficult to achieve a plantigrade feet with pain-free gait with repeated surgical interventions. Therefore, proper choice of the initial surgical technique is essential for achieving satisfactory long-term outcomes.

Pain Management Using Nano-Bio Fusion Gel in Fixed Orthodontic Therapy-Induced Gingivitis: A Split-Mouth Design Study

Nanotechnology-based products containing antioxidants may be effective adjuvants in the treatment of periodontal diseases. To assess the treatment effect of nano bio-fusion gel (NBFG) in pain perception (PP) in fixed orthodontic therapy-induced gingivitis (FOTIG). The gel contains propolis, vitamin C, and vitamin E in the form of nanoemulsion. Thirty-two patients were finally selected from the orthodontic clinic after assessments for FOTIG. Patients were allocated randomly into active and placebo-control groups. Patients were evaluated at three intervals (T1, T2, and T3). Pain perception using a numeric rating scale (NRS) was performed at baseline (T1), on the 7th day (T2) and on the 28th day (T3) on his/her visit to an orthodontic clinic. In the T1, T2, and T3 period, patients apply NBFG (active or placebo side) to their gingiva after brushing two times a day for 28 consecutive days. Results: The baseline data between the active or placebo group showed almost similar PP. From T1 to T2 and T3, the active or placebo-control group showed significant improvement in PP over time. Compared to placebo, the active group showed highly significant (p ≤ 0.001, T1 to T2 and T2 to T3) improvement in PP. The use of NBFG is an effective means of improvement in PP of FOTIG cases.

Functional Changes in Cortical Activity of Patients Submitted to Knee Osteoarthritis Treatment: An Exploratory Pilot Study.

There is evidence that brain plasticity is the central mechanism involved in the functional recovery process of patients with knee osteoarthritis. Studies involving the analysis of central nervous system mechanisms of pain control and recovery could provide more data on future therapeutic approaches. The aim of the study was to explore possible functional changes in cortical activity of patients submitted to knee osteoarthritis standardized pain treatment using electroencephalography. Ten patients with clinical and radiological diagnosis of painful knee unilateral or bilateral osteoarthritis were recruited to participate in clinical (Pain's Visual Analog Scale), radiological (Kellgren-Lawrence Scale), and neurophysiological (electroencephalography) assessments to evaluate cortical activity during cortical pain modulation activity. The clinical and neurophysiological analyses were performed before and after standardized pain treatment. Eight patients participated in this study. A significant improvement in pain perception and relative increase in interhemispheric connectivity after therapies was observed. In electroencephalography analysis, tests with real movement showed a relative increase in density directed at Graph's analysis. Relative increase density directed measures at connectivity analysis in electroencephalography after pain treatment can be possible parameters to be explored in future research with a larger number of patients.

Which factors can influence the perception of pain by veterinarians and animal scientists from Brazil?

Society and animal professionals are increasingly concerned about the pain management during routine husbandry procedures in farm animals. In this paper, we aim to identify the factors that affect Brazilian veterinarians’ and animal scientists’ perceptions about the level of pain cattle experience during castration and horn removal. An online survey was conducted with these professionals, resulting in a sample size of 147 participants. Data were analyzed by descriptive statistics, Chi-squares tests, Fisher exact tests, and Mann-Whitney U tests. The results of descriptive statistics showed that the most frequently, the most and the least painful technique quoted, for castration, was scalpel, burdizzo, and immunocastration, respectively; and for horn removal, hot iron (for newborn and suckled calves) and saw/wires (for adult cattle), knife, and caustic paste, respectively. Women assessed cattle pain higher than men professionals for castration in newborn calves. Higher mean scores for the pain perception were associated to painful indicators: heart and/or respiration rate during castration in newborn and suckled calves; and defensive movements during horn removal in adult cattle. Those respondents who were more likely to perceived high level of pain also scored higher pain for (i) newborn calves when toxic agent or immunocastration were used to castrate; (ii) suckled calves dehorned/disbudded with chemical methods or dehorners; and (iii) all cattle ages when surgical methods or burdizzo were used for castration and amputation techniques or hot iron, for horn removal. Professionals that perceived higher level of pain in both painful procedures agreed more with the statements “Farm animals are not as sensitive to pain as pets” and “If there are no defensive movements, there is no need for pain mitigation use” than those that perceived lower level of pain. The pain estimation is subjective, but our results illustrate the importance of the management and individual/professional aspects on pain perception. Finally, our study highlights that improvement in pain perception by veterinary and animal scientists regarding castration and horn removal in cattle is required.

Management of Urosymphyseal Fistula and Pelvic Osteomyelitis: A Comprehensive Institutional Experience and Improvements in Pain Control

BackgroundUrosymphyseal fistula (USF) is an uncommon but painful and devastating condition typically occurring after radiotherapy for pelvic malignancy, with a delayed diagnosis and a risk of opioid dependence. ObjectiveTo characterize our institutional experience and determine the impact of intervention for USF on pain control and opioid use. Design, setting, and participantsWe evaluated data for 33 adult patients diagnosed with USF and managed at a quaternary institution between 2009 and 2021. Outcome measurements and statistical analysisWe assessed chronic opioid use, pain scores, prior therapy for pelvic malignancy, prior endoscopic procedures, microbiology and histology congruence, and postoperative complications. For comparative analyses we used a χ2 test or Fisher’s exact test for categorical variables and a Wilcoxon signed-rank test for continuous variables. Results and limitationsNearly 94% of the patients had received prior pelvic radiotherapy and >80% occurred in 2016–2021 but were not diagnosed until a median of 10 mo (interquartile range [IQR] 3.5–19.5) following endoscopic procedure(s). Osteomyelitis was suspected in 78.8% of imaging reports and nearly 70% had a positive preoperative urine culture. Over 90% of patients underwent cystectomy, pubic bone debridement or resection, and a soft-tissue pedicle flap. Preoperative urine cultures were concordant with 60% of intraoperative tissue/bone cultures. Histologic osteomyelitis was identified in 85% and concordant with 80% of preoperative imaging. Clavien-Dindo grade ≥3 complications occurred in 15.6%. The median pain score decreased from 4 (IQR 0–8) preoperatively to 0 (IQR 0) postoperatively (p < 0.001). Chronic opioid use decreased from 39.4% to 21.2% (p = 0.02). ConclusionsPelvic osteomyelitis may complicate USF and commonly manifests with severe, persistent pain. USF incidence may be increasing or at least increasingly recognized, but diagnosis is delayed. Definitive management results in significant improvements in pain perception and a decrease in chronic opioid use. Patient summaryWe examined features of urinary fistulas, which are abnormal openings or connections between part of the urinary tract and another structure. Patients with a urinary fistula involving the pelvic bones can present with severe pain, but diagnosis of the condition is often delayed. Removal of some pelvic bone with bladder removal or repair can result in a decrease in long-term pain and in the use of opioid drugs for pain relief.

High-dose short-course oral corticosteroid protocol for treatment of primary frozen shoulder: a retrospective cohort study.

ObjectiveTo evaluate the effect of high-dose prednisolone on the functional outcome of patients with early-stage primary frozen shoulder.MethodsEighteen patients treated with oral prednisolone at an initial dose of 1 mg/kg/day for primary frozen shoulder were retrospectively evaluated. The patients’ range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant–Murley score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale score were recorded at baseline and at 4 weeks and 6 months after treatment.ResultsRapid recovery of shoulder motion was noted at 4 weeks with the exception of abduction, which was maintained at 6 months. Significant improvement in pain perception and the Constant–Murley score was evident at 4 weeks and extended to 6 months. The DASH and ASES scores did not show significant improvement in the first 4 weeks but were significantly improved at 6 months.ConclusionHigh-dose oral prednisolone treatment provides rapid symptom resolution that persists long after drug discontinuation. The early treatment period is characterized by marked reduction in pain and rapid recovery of shoulder motion. Improvements in functional outcomes and disability indices tend to be more subtle in the early period but significantly improve during late treatment.

Efficacy of Suboccipital Release and Stabilization Exercise Training in Type 1 Chiari Malformation Patient Undergoing Surgical Treatment: A Case Report

In Chiari malformation, some symptoms are known to recur after decompression surgery. To our knowledge, this is the first case for symptomatic outcome after suboccipital release and stabilization exercises the patient with type 1 Chiari malformation who has experienced surgery. The present study aims to investigate the efficacy of suboccipital release and stabilization exercise training in a patient with Type 1 Chiari Malformation undergoing surgical treatment. A 47- year-old female patient with Chiari malformation received suboccipital release and stabilization exercise training for 10 weeks. Her symptomatic parameters were evaluated, such as pain, grip and pinch strength, deep cervical flexor strength, balance and gait. After the treatment, there were improvements in pain perception, the score of performance index of deep cervical muscles, grip force, static balance and gait parameters. Suboccipital oscillation and stabilization exercises are thought to be safe and effective in patients with Chiari malformation undergoing decompression surgery

704 The Association of Sleep Disorders in Patients with Chronic Pain Disorders

Abstract Introduction Sleep and pain are interrelated and have a bidirectional relationship. The study was performed to identify the impact of sleep disorders on pain perception. Methods The institutional review board approved the study. Patients evaluated in the Pain Clinic between 1/1/2014 and 12/31/2017 who had polysomnography done were identified by database search. Chart review identified demographics, initial pain score, pain treatments, sleep disorder diagnosis, treatments of sleep disorder and pain scores after sleep treatments. Numerical pain score (NPS) and insomnia severity index (ISI) were used as a measure of pain and sleep quality, respectively. The descriptive statistics were presented by percentages, mean and standard deviations. Regression analysis was performed between initial NPS and ISI. T-test compared change in NPS for compliant and non-compliant subjects, before and after sleep treatments. Linear regression model identified factors associated with changes in pain perception after sleep treatments. Results Of the 320 participants identified, complete data was available for 180 subjects. The average age was 55.9±13.9; 51.41% were female; 60.2% were Caucasian and 26.64% were Hispanic. Initial NPS was 8.8±1.7, average ISI was 15.00±6.41, average BMI was 35.4±10.2. Ninety-five percent had a diagnosis of obstructive sleep apnea (OSA), 27.81% had restless leg syndrome, and 7.19% had complex sleep apnea. Since most patients had OSA, details of positive airway pressure (PAP) treatments were also investigated. Of 84% of subjects treated with PAP, compliance data were available for 53%, which showed 69% (n=55) being complaint with PAP. Initial NPS correlated positively with ISI (R2: 0.064±0.024, p&amp;lt;0.01). No difference in NPS was found in groups based on compliance, before and after PAP treatments. Regression model identified that BMI was the most significant factor in the change in NPS following sleep treatment (R2: 0.083±0.034, p = 0.03). Conclusion The study identified that the severity of pain is associated with poor quality of sleep. While this study failed to identify improvement in pain perception after successful OSA treatment, limited number of subjects in our study were compliant with PAP treatment which may have impacted the results. Future prospective studies are needed to understand the complex association between improvement in sleep quality and pain perception. Support (if any):

Evaluation of the Safety and the Influence of a W Whole Body Cryotherapy on the Level of Pain Perception and Functional Capacity of Patients at Different Age

Introduction: Whole body cryotherapy with kinesitherapy can potentially improve the everyday functioning of patients. The aim of the study was to assess the influence of whole body cryotherapy on the pain perception and functional efficiency of patients with pain syndromes in a different age and to assess the occurrence of adverse effects during treatment. Material and Methods: The study involved 40 patients with pain syndromes aged between 24 and 73 divided into 2 groups: group I (younger) up to 55 years old and group II (older) over 55 years old. The subjects underwent a series of 10 treatments of cryotherapy. The following tests were used to assess functional performance and pain: FTSST (Five Times Sit- to- Stand Test), TUG (Timed Up and Go Test), VAS (Visual Analogue Scale) Modified Pain Questionnaire according to Laitinen. Results: In the group I: the intensity of pain on the VAS scale was reduced after the first treatment (p=0.003); after a series of 10 treatments improvement in pain scales (VAS: p = 0.001, Laitinen Questionnaire: p = 0.002) and functional tests (TUG: p = 0.002, FTSST: p &lt;0.001) was obtained. In the group II: improvement in pain perception at VAS scale after first treatment (p = 0.01) was achieved and after a series of 10 treatments, functional improvement (TUG: p = 0.006, FTSST: p &lt;0.001) and in results in pain scales (VAS: p = 0.04, Laitinen questionnaire: p = 0.05) was obtained. Conclusions: Whole body cryotherapy with kinesitherapy contribute to the reduction of pain after only a single exposure, and after a series of 10 treatments occur to improve performance of functional tests. Cryotherapy may be associated with adverse effects, which are relatively rare, disappear quickly and do not endanger the life or health of patients. The age of patients has no significant effect on the final outcomes of therapy and on the occurrence of adverse effects.

Unravelling the Negative Impact of Pain Problems on Recovering from Psychological Trauma

<i>Background</i>: Pain problems can act as a barrier to individuals recovering from psychological trauma following receiving appropriate psychological therapy. Therefore, it would be prudent of therapists to treat pain problems in clients prior to embarking on trauma informed therapy to increase the chances of therapy being more clinically and cost effective. <i>Objective</i>: This article aims to provide practice-based evidence to demonstrate how a client’s pain problems were affecting her recovery from severe psychological trauma following a serious accident, and how psychological pain management work prior to her starting trauma informed therapy assisted her to overcome the barrier of pain to her recovery. <i>Method</i>: The client was offered psychological pain management intervention based on the gate theory of pain prior to embarking on trauma focussed cognitive behavioural therapy to treat her post trauma symptoms following a serious accident. The gate theory argues that psychological factors have potential to open a gate to the pain system causing an increase in pain perception. According to this model, once these factors are addressed it will lead to improvement in pain perception. <i>Result</i>: Guided imagery techniques were utilised to assist the client to resolve emotional factors in connection with her pain which resulted in further recovery of her pain perception. Following recovery in this the client was able to experience increase emotional capacity as well as mobility to receive trauma focussed cognitive behavioural therapy to reduce her psychological trauma symptoms. Conclusion: This case study was able to demonstrate that treating clients pain problems prior to treating psychological trauma has potential to be clinically and cost effective. It is recommended that further research be done in this area.

Noninvasive brain stimulation over dorsolateral prefrontal cortex for pain perception and executive function in aging

ObjectivesBased on the evidence that the dorsolateral prefrontal cortex (DLPFC) is the main region affected by the aging process, and that tDCS modulates cortical excitability, the aim of the study is to prove the feasibility of tDCS for pain perception and executive function of community-dwelling elderly individuals. MethodsWe performed a double-blind, single-arm trial, including a sham period. 5 consecutive anodal tDCS was applied over DLPFC of twenty-four elderly for 20 min during each intervention periods (in order of Sham-1 mA–2 mA). First, we classified chronic non-inflammatory pain sites into three domain (Neck and upper extremity, low back, lower extremity). Then, we used visual analogue scale, pain self-efficacy scale, Tampa scale for kinesiophobia, and Global perceived Effect scale to observe the change in pain perception, as well as Trailing Making Test and Timed Up and Go (dual) to observe the change in executive function. The changes in maximal grip strength and 12-item Short Form survey were measured secondarily. ResultsIn the results, we observed significant improvement in pain perception and quality of life, while executive function and grip strength did not change significantly. ConclusionOur findings demonstrated the feasibility of tDCS for aging-related pain perception and suggest that further randomized controlled trials with longer duration are necessary to examine the effects on executive function.

Benefits in pain perception, ability function and health-related quality of life in patients with failed back surgery syndrome undergoing spinal cord stimulation in a clinical practice setting

Failed back surgery syndrome (FBSS) represents one main cause of chronic neuropathic or mixed pain, functional disability and reduced Health Related Quality of Life (HRQoL). Spinal Cord Stimulation (SCS) can be a value for money option to treat patients refractory to conventional medical management (CMM). We estimated from real-world data: 1) the amount of reduced levels of HRQoL of target patients compared to general population, 2) the relationship between pain intensity, functional disability, and overall HRQoL, and 3) the improvement of patients’ health from SCS intervention, and 4) we give some insights and make some suggestions on the selection of a battery of patients’ reported health instruments for use in routine clinical practice. At recruitment (before SCS) and every 6 months for 2 years after SCS a battery of questionnaires/tests were completed: the generic EQ-5D and SF-36 for HRQoL, the specific Numerical Rating Scale (NRS) to measure pain intensity, and Oswestry Disability Index (ODI) to measure functional disability. We conducted multilevel regression analyses to investigate the association of HRQoL with the NRS and ODI indexes; multiple regression analyses to compare EQ-5D data with those of the general population adjusted for age, sex and education, and statistical tests to compare the changes of HRQoL, NRS and ODI estimates at baseline with those measured during the follow-up. Eighty patients (40% male, mean age = 58 years) participated. HRQoL was significantly worse in the patients than in the corresponding general population. Pain, functional disability and HRQoL significantly related each other during follow-up, Significant improvements (p < 0.001) in pain intensity, functional capability and HRQoL were reached after 6 months from SCS and generally remained stable during follow-up. Specific instruments provided detailed information on disability and pain, while generic instruments assessed the overall HRQoL and allowed a comparison with the general population’s one. SCS + CMM treatment reaches a statistically significant and probably a clinically relevant improvement in pain perception, functional disability and HRQoL in patients with FBSS refractory to CMM. An appropriate selection of instruments for use in clinical practice is crucial for a routine assessment of health perception in patients, aimed to guide decisions for optimal treatment.

The influence of cranio-cervical rehabilitation in patients with myofascial temporomandibular pain disorders.

The aim of the study was to prove the causality between the craniocervical dysfunction and myofascial pain in the head and neck and to demonstrate the clinical value and usefulness of physiotherapy as one of the therapeutic options for myofascial pain. The group of patients diagnosed with myofascial dysfunctional pain syndrome contained 98 patients out of which 79 patients (81 %) were females and 19 patients (19 %) were males. The majority of the patients were aged between 26 and 35 years; the total age range was 14-77 years with the average of 38 years. Observed patients were subdivided into three groups. Standard therapeutic methods aimed at the temporomandibular joint were provided to the patients of the first group. The second group of the patients received therapy aimed at cervical muscles only. Complex rehabilitation was applied in the third group of patients. The most frequent method used in the evaluation of chronic musculoskeletal pain in clinical studies is the visual analogue scale (VAS). According to our results, all three groups of patients saw an improvement in pain perception, but the overall subjective remission of painful sensations in the third group took place in as many as 88 % of patients. In this group, there was a significant decrease in the tenderness of trigger points in the trapezius and sternocleidomastoid muscles. It was proved that a combination of simple relaxing and stretching exercises of cervical muscles with a standard method used in the therapy of masticatory muscles is significantly more efficient (Fig. 5, Ref. 18).

Comparative study of efficacy and safety of tapentadol versus etoricoxib in mild to moderate grades of chronic osteorthritis of knee

ObjectivesChronic osteoarthritis of knee is very commonly encountered in clinical practice. Pain relief and restoration of physical function are the targets of therapy. This study aims to compare the efficacy and safety of tapentadol with etoricoxib in the management of osteoarthritis of knee. MethodsThis is a randomised, open labelled, controlled study in which patients received either tablet tapentadol (100mg twice daily) or etoricoxib (30mg twice daily) for 12 weeks. Follow-up was done after 2nd, 4th, 8th and 12th weeks of initiation of treatment and also after 2 weeks of treatment completion. Assessment of improvement in pain perception on Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) sub-score for stiffness and physical function were performed. Results108 patients receiving tapentadol and 110 patients receiving etoricoixb were analysed on Intention to Treat basis. Steady improvement was seen in VAS and WOMAC scores in both the groups, though there was no significant difference between the groups. Clinical Global Impression measured by physician showed significant difference between groups with greater number of patients experiencing at least satisfactory response at the end of the study in the tapentadol group (p=0.036). The total number of adverse events was less with tapentadol than etoricoxib. ConclusionsTapentadol is as effective as etoricoxib in the management of mild to moderate grades of chronic osteoarthritis of knee with lower incidences of adverse effects.