Local Pain Intensity Research Articles

Clinical Significance of a Pain Scoring System for Deep Endometriosis by Pelvic Examination: Pain Score.

Endometriosis-associated pain is an essential factor in deciding surgical indications of endometriosis. However, there is no quantitative method to diagnose the intensity of local pain in endometriosis (especially deep endometriosis). This study aims to examine the clinical significance of the pain score, a preoperative diagnostic scoring system for endometriotic pain that can be performed only with pelvic examination, devised for the above purpose. The data from 131 patients from a previous study were included and evaluated using the pain score. This score measures the pain intensity in each of the seven areas of the uterus and its surroundings via a pelvic examination using a numeric rating scale (NRS) which contains 10 points. The maximum value was then defined as the max pain score. This study investigated the relationship between the pain score and clinical symptoms of endometriosis or endometriotic lesions related to deep endometriosis. The preoperative max pain score was 5.93 ± 2.6, which significantly decreased to 3.08 ± 2.0 postoperatively (p = 7.70 × 10-20). Regarding preoperative pain scores for each area, those of the uterine cervix, pouch of Douglas, and left and right uterosacral ligament areas were high (4.52, 4.04, 3.75, and 3.63, respectively). All scores decreased significantly after surgery (2.02, 1.88, 1.75, and 1.75, respectively). The correlations between the max pain score and dysmenorrhea, dyspareunia, perimenstrual dyschezia (pain with defecation), and chronic pelvic pain were 0.329, 0.453, 0.253, and 0.239, respectively, and were strongest with dyspareunia. Regarding the pain score of each area, the combination of the pain score of the pouch of Douglas area and the VAS score of dyspareunia showed the strongest correlation (0.379). The max pain score in the group with deep endometriosis (endometrial nodules) was 7.07 ± 2.4, which was significantly higher than the 4.97 ± 2.3 score obtained in the group without (p = 1.71 × 10-6). The pain score can indicate the intensity of endometriotic pain, especially dyspareunia. A local high value of this score could suggest the presence of deep endometriosis, depicted as endometriotic nodules at that site. Therefore, this method could help develop surgical strategies for deep endometriosis.

Assessment of local pain and analgesia in envenoming by wandering spiders (Phoneutria spp.)

Phoneutrism (bites by wandering spiders of the genus Phoneutria) frequently results in local pain. We describe a retrospective cohort study of a case series of phoneutrism admitted to our Emergency Department (ED), in which we used the Numeric Pain Rating Scale (NPRS 0-10) to assess the intensity of local pain upon admission, and recorded the analgesic measures used to control this pain. Other criteria for inclusion were: (1) An age ≥8 years, (2) Treatment exclusively at our ED, and (3) Visualization or photographing the spider at the time of the bite and/or bringing the spider for identification. The patients were classified into three groups based on the intensity of pain at admission: group 1 - mild or no pain (NPRS: 0-3), group 2 - moderate pain (NPRS: 4-6), and group 3 - intense or severe pain (NPRS: 7-10). Fifty-two patients fulfilled the inclusion criteria (n=11, 14 and 27 in groups 1, 2, and 3, respectively), with a median age of 37 years. The median NPRS upon admission was 7 (interquartile range: 5-8). In patients with an NPRS <7 (groups 1 and 2), only dipyrone was used to alleviate the pain, with six cases in group 1 requiring no analgesia. Most of the cases in group 3 (19/27) were treated with a local anesthetic infiltration (2% lidocaine), in association with analgesics given i.v. in 16 cases (dipyrone, 14; tramadol, 2); additional analgesic treatment was required in seven cases, six of which were treated with tramadol i.v. The median time spent in the ED was 18, 58 and 120min for groups 1, 2 and 3, respectively. These findings show that most cases of envenoming by Phoneturia spp. involved intense local pain (NPRS ≥7), with local anesthetics being used only in these cases, often in association with dipyrone i.v.

The Efficacy in the Treatment of Acute Closed Soft Tissue Injury by Using Acupuncture and Diclofenac in Football Players

This study was aim to investigate the clinical treatment of acupuncture combined with diclofenac in the treatment of acute soft tissue injury in football players. This paperdivided100 patients with acute closed soft tissue injury caused by football into control group and treatment group randomly, 50 cases in each group. The control group was usually treated with PRICE, and the treatment group use PRICE combined with acupuncture and diclofenac to cure. One course for two weeks, treatment requires two courses. Before and after the patient was included in the study, record the scores of dynamic pain intensity, static pain intensity, local pain intensity and local sensitivity, and local swelling assessment. Improve clinical outcomes and record the treatment results after 3 days, 8 days, and 15 days. The results showed that there was a significant difference in the degree of symptomatic relief between the control group and the treatment group on days 3, 8 and 15 after treatment (P < 0.05). The difference between the two groups has statistically significant. The good rate and effective indicators of the treatment group were 65.6% and 92.1%, which was better than the control group (P <0.05) significantly. The results showed that acupuncture combined with diclofenac treatment can improve the pain symptoms of patients with soft tissue injury significantly, and its clinical superiority and overall efficacy are better than conventional PRICE treatment.

New approaches for prevention of complications after Lichtenstein surgery

To describe the new approaches for prevention of complications after hernia repair. We have proposed the method of combined hernia repair including 2 new techniques to prevent complications after Lichtenstein surgery. The results of 100 surgeries over 5 years (2017-2021) for oblique inguinal hernias were analyzed. Patients were divided into 2 groups by 50 patients depending on surgical technique. We assessed the incidence and severity of postoperative complications, as well as duration of inpatient treatment. According to visual-analogue scale of pain syndrome, local pain intensity in the main group was 1.3 times less than in the control group in 1 hour after surgery, after 1 day - almost 2 times less, after 5 days - 1.7 times less. After 3 months, 1 (2%) patient in the control group had persistent local pain. In the main group, no patient had chronic pain (p<0.05). In the control group, ultrasound of postoperative wound area revealed serous fluid in the mesh area in 36 (60%) patients by the 6th day after surgery. In the main group, there were no ultrasound signs of seroma in any case. Incidence of complications was significantly lower in the main group (p<0.05). Mean length of hospital-stay was significantly less in the main group (6.2±1.1 and 7.1±1.2 days, respectively), p<0.05. The proposed new modification of Lichtenstein procedure is an effective method for prevention of the most common postoperative complications.

Pain referral area is reduced by remote pain.

Endogenous pain inhibitory mechanisms are known to reduce pain intensity, but whether they influence the size and distribution of pain referral is unclear. This study aimed to determine if referred pain is reduced by applying a remote, conditioning painful stimulus. Twenty-four healthy men participated in this randomized, crossover study with a control and conditioning session. Referred pain was induced from the infraspinatus muscle (dominant side) by a painful pressure for 60s. When applying pressure, the intensity was adjusted to a local pain intensity of 7/10 on a numerical rating scale. In the conditioning session, tonic painful pressure was simultaneously applied to the non-dominant leg during induction of referred pain. The area of referred pain was drawn onto a digital body chart and size extracted for data analysis. For the total group and in a subgroup with distinct patterns of referred pain (n=15/24), the pain area perceived in the back and front+back was smaller during the conditioning compared with the control (p<0.05). No significant difference was found between sessions in a subgroup only demonstrating local pain (n=9/24). Engaging the descending noxious inhibitory control reduced the size of pain areas predominately when distinct pain referral was present. Assuming a conditioning effect of descending inhibitory control acting on dorsal horn neurons, these findings may indicate that mechanisms underlying pain referral can be modulated by endogenous control. The findings may indicate that referred pain may be a useful proxy to evaluate sensitivity of central pain mechanisms as previously suggested. The current results indicate a link between endogenous inhibition and pain referral. Descending inhibitory control effects on pain referral support a spinal mechanism involved in pain referral. Future studies should investigate whether the spatial characteristics of referred pain (e.g. size, frequency of affected body regions and distribution away from the primary nociceptive stimulus) can useful to evaluate the efficiency of endogenous pain modulation.

Differences in stabilometric correlates of pain relief after wearing postural insoles for six weeks between chronic nociceptive and neuropathic foot pain. An open-label pilot study

ObjectiveThe aim of this study was to determine if the use of postural insoles could result in a noticeable reduction in the foot pain intensity in patients with a chronic pain condition, either nociceptive (ankylosing spondylitis, AS) or neuropathic (small fiber neuropathy, SFN). MethodIn this open-label pilot study, patients were asked to wear postural insoles for a continuous period of 6 weeks. The primary endpoint was the mean daily pain intensity at foot mobilization measured using a visual analogue scale (VAS). The secondary endpoints included global pain intensity scores (at rest or under mobilization), clinical questionnaires on pain and daily functioning (including the Brief Pain Inventory (BPI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Neuropathic Pain Symptom Inventory (NPSI) and the DN4 questionnaire), and posturo-podiatric variables assessed on clinical examination or using a baro-stabilometric platform. ResultsThe study was completed by 17 patients with AS and 12 patients with SFN. After wearing postural insoles for 6 weeks, a significant improvement was observed on the primary endpoint (decrease in VAS pain score at the foot during mobilization) in both groups of patients (from 6.4 ± 2.4 to 3.6 ± 2.6 (p = 0.0004) in the AS group and from 5.7 ± 2.2 to 2.4 ± 1.6 (p = 0.0003) in the SFN group). Improvement was also observed for all other pain and activity scores (global pain at rest or during mobilization (VAS), BDI, and BASDAI for the AS group or NPSI and DN4 for the SFN group), as well as for posturo-podiatric clinical variables. However, we did not find any difference in any clinical pain score whether the posturo-podiatric clinical outcomes were positive or not. Regarding the stabilometric measures, the only significant change after the intervention was a reduced mean velocity of center of pressure displacement in the AS group only (mVel in mm/s: from 7.4 ± 2.0 vs. 6.7 ± 1.9, p = 0.017). In addition, the reduction in mVel correlated to that of the BPI score (r = 0.48, p = 0.0496). ConclusionIn both groups of patients, wearing postural insoles for 6 weeks led to a significant decrease in local pain intensity at foot level and to more global analgesic effects and positive posturo-podiatric changes. However, these latter changes did not appear to be strongly associated with pain relief. Nevertheless, an index of a better postural control, i.e. mVel decrease, was found to be related to a reduction of pain interference in daily life activities in AS patients, but not in SFN patients. Therefore, in the context of neuropathic pain, mechanisms other than postural changes likely contribute to the analgesic effects of wearing postural insoles, in contrast to nociceptive pain due to spinal osteoarthritis.

Effects of Thermo-spinal massage treatment in a Patient with Rheumatism patient with Autonomic nervous system Dysfunction : A Case Report

Rheumatoid arthritis (“RA”), whose characteristics are chronic inflammation and chronic pain, accompanies autonomic nervous system(ANS) dysfunction. In particular, ANS dysfunction in patients with chronic musculoskeletal pain was found to have increased the local pain intensity while lowering the pain threshold, thereby negatively influencing pain. It is reported that thermo-spinal massage affects relief of chronic pain and recovery of ANS in patients with chronic musculoskeletal pain. Therefore, we report a case of rheumatoid patients with chronic pain and ANS dysfunction, who experienced recovery of ANS dysfunction and pain reduction by applying thermo-spinal massage treatment.

Comparison of postoperative morbidity between conventional cold dissection and bipolar electrocautery tonsillectomy: which technique is better?

IntroductionTonsillectomy is one of the most common surgeries in the head and neck worldwide. This operation is carried out by different methods, the most frequent of which are the cold dissection and bipolar electrocautery techniques. ObjectiveThis study was conducted to assess and compare postoperative morbidity between cold dissection and bipolar electrocautery. MethodsThis prospective randomized clinical trial was performed on 534 patients who underwent tonsillectomy in Vali-e-Asr Hospital of Birjand, east of Iran from October, 2013 to October, 2015. The patients were systematically selected for cold dissection technique or bipolar electrocautery technique groups. Time of surgery, amount of intraoperative blood loss, postoperative hemorrhage, the intensity of local pain 4 and 24hours after operation and nausea and/or vomiting were recorded and compared in the two groups to decide which technique is better. The data were analyzed in SPSS software (ver-22). The p-value less than 0.5 was considered significant. ResultsIn this study, 51.7% of the cold dissection technique patients and 50.6% of the bipolar electrocautery technique participants were male. Compared to the cold dissection technique, the average intraoperative blood loss was significantly lower (p<0.001) in the bipolar electrocautery technique group, while the intensity of local pain 4 and 24hours after the operation was significantly higher (p<0.001). Other variables showed no significant differences between the two groups. ConclusionBased on the findings of the present investigation, the bipolar electrocautery technique is suggested for tonsillectomy in children, while the cold dissection technique is preferred for adult patients.

Effectiveness of transarticular lateral soft tissue release of the 1st metatarsophalangeal joint

The purpose of the present study was to investigate the effect of Positional Release Therapy (PRT) in computer users via latent trigger points (LTrPs) of the upper trapezius muscle.Twenty-eight women with the upper trapezius MTrPs participated in this study. Subjects were randomly classified into two groups (14 in each group): the subjects in the Group 1 received PRT in shortened position while those in the group 2 received sham control in the neutral position of the upper trapezius muscle. They received three therapy sessions every other day for one week. The local pain intensity and Pressure pain threshold (PPT) were measured via Visual Analogue Scale (VAS) and algometry, respectively, before interventions and repeated 5 min after the first and third treatment sessions in each group.One-way ANOVA was used for data analysis. After treatment, between groups comparison revealed that for PPT and VAS, there were significant differences between the two groups (VAS and PPT; P < 0.05).Both groups (PRT and sham control) showed alleviation of pain and increase in PPT during three sessions of therapy although PRT showed to be more effective in these patients.

Percutaneous endoscopic discectomy in the treatment of patients with degenerative diseases of the lumbosacral spine

to evaluate the efficacy of percutaneous endoscopic discectomy in the treatment of herniated lumbar discs in patients with radicular pain syndrome. We conducted a cohort retrospective study that included 69 patients who underwent herniated disc removal using the percutaneous endoscopic technique. Surgery was performed through two approaches: the intralaminar approach was used in 44 patients, and the transforaminal approach was used in 25 patients. To assess the efficacy of surgery, we used a visual analogue scale (VAS) of pain: the intensity of local pain (VAS1) and the intensity of radicular pain (VAS2). Changes in the quality of life and ability to work were assessed by using the Oswestry scale; patient satisfaction with treatment was assessed by using the MacNab scale. The mean follow-up period after surgery was 24 months. An analysis of changes in the pain syndrome (VAS1 and VAS2) before surgery and in the early postoperative period demonstrated a significant regression of pain regardless of the approach type (r=0.25). Patients' survey (MacNab scale) in the long-term postoperative period revealed no unsatisfactory results; excellent, good, and satisfactory results were observed in 21 (30%), 32 (46%), and 16 (24%) patients, respectively. Percutaneous endoscopic discectomy is an effective surgical treatment for degenerative diseases of the lumbosacral spine, providing excellent and good treatment outcomes in most operated patients.

Comparison Between the Effects of Passive and Active Soft Tissue Therapies on Latent Trigger Points of Upper Trapezius Muscle in Women: Single-Blind, Randomized Clinical Trial

ObjectiveThe purpose of this study was to investigate the effects of passive versus active soft tissue therapies on pain and ranges of motion in women with latent myofascial trigger points. MethodsForty-two female patients, aged 18 to 64 years, with a history of neck pain and latent myofascial trigger points in the upper trapezius muscle were randomly assigned to 3 groups: group A received passive soft tissue therapy, group B received active soft tissue therapy, and a control group C received a sham procedure. The treatment consisted of 3 sessions in a 1-week period with 1-day break between each session. The local pain intensity, measured with a visual analog scale and pain pressure threshold (PPT) using algometry, and active cervical contralateral flexion (ACLF) measured with goniometry, were obtained at baseline, after the third session, and a week after the third session. ResultsThe results indicated a significant decrease in local pain intensity on the visual analog scale within each group (A and B) compared with the control group (C) (P < .05). The passive group had significant improvement in PPT compared with the control group (P < .05). There were no significant differences in ACLF after treatment between the 3 groups (P > .05). ConclusionBoth passive and active soft tissue therapies were determined to reduce pain intensity and increase ACLF range of motion, although passive therapy was more effective in increasing PPT in these patients compared with the control group.

The influence of Positional Release Therapy on the myofascial trigger points of the upper trapezius muscle in computer users

The purpose of the present study was to investigate the effect of Positional Release Therapy (PRT) in computer users via latent trigger points (LTrPs) of the upper trapezius muscle. Twenty-eight women with the upper trapezius MTrPs participated in this study. Subjects were randomly classified into two groups (14 in each group): the subjects in the Group 1 received PRT in shortened position while those in the group 2 received sham control in the neutral position of the upper trapezius muscle. They received three therapy sessions every other day for one week. The local pain intensity and Pressure pain threshold (PPT) were measured via Visual Analogue Scale (VAS) and algometry, respectively, before interventions and repeated 5min after the first and third treatment sessions in each group. One-way ANOVA was used for data analysis. After treatment, between groups comparison revealed that for PPT and VAS, there were significant differences between the two groups (VAS and PPT; P<0.05). Both groups (PRT and sham control) showed alleviation of pain and increase in PPT during three sessions of therapy although PRT showed to be more effective in these patients.

Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial.

BACKGROUND: Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions. OBJECTIVE: The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control. METHOD: Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (α=0.05). RESULTS: There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032). CONCLUSION: EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly.

Changes in the Spatiotemporal Expression of Local and Referred Pain Following Repeated Intramuscular Injections of Hypertonic Saline: A Longitudinal Study

Intramuscular injection of hypertonic saline produces a dull ache that is felt in the muscle belly but also often refers into distal structures. We have previously observed in 2 subjects that the pattern of pain referral alters during painful stimuli separated by a week. In this investigation, we tested the hypothesis that the intensity and area of pain in the local and referred regions exhibits plasticity when an identical noxious stimulus is delivered to the same site over sequential trials. Bolus 1 mL intramuscular injections of 5% hypertonic saline were made into the same site of the tibialis anterior (TA) muscle on the same day each week for 4 consecutive weeks. Twenty-one subjects mapped the areas of local and referred pain and rated the intensities on a visual analog scale every 30 seconds until the cessation of pain. Over 4 weeks there was a progressive reduction in the area and intensity of local pain and a reciprocal increase in the expression of referred pain. We conclude that the decrease in perceived local pain and increase in perceived referred pain reflects plastic processes occurring centrally. What happens to the intensity of pain induced by repeated noxious stimuli over time? Does it stay the same, increase or decrease? Here we show that weekly injections of hypertonic saline into the tibialis anterior cause decreases in local but increases in referred pain, suggesting central changes in processing noxious inputs.

Hypoalgesia in the Referred Pain Areas After Bilateral Injections of Hypertonic Saline Into the Trapezius Muscles of Men and Women: A Potential Experimental Model of Gender-Specific Differences

The study was to assess the local pain intensity, referred pain patterns, and changes in the pressure pain thresholds of the local and referred pain areas following bilateral injections of hypertonic saline into trapezius muscles and to delineate gender differences in pain profile and the possible modulation of pressure pain thresholds. Fifteen healthy men and women each participated. Pain intensity and areas were assessed after bilateral injections. The pressure pain thresholds in the trapezius and posterolateral neck muscles (referred pain areas) were measured before and 7.5 and 15 minutes postinjection. The time to maximal pain intensity was significantly shorter after the second injection than after the first injection. Patients exhibited a bilaterally symmetrical distribution of pain areas that included the neck to shoulder angle and the posterolateral neck. Bilateral injections significantly elevated pressure pain thresholds in the right and left posterolateral neck muscles 7.5 and 15 minutes postinjection. In men but not women, the pressure pain thresholds measured in the posterolateral neck muscles 7.5 and 15 minutes after the second injection were higher than those after the first injection and also higher than those after the second injection in women, men tolerated more pressure than women at all time points. These findings indicate that both excitatory and inhibitory mechanisms modulate pain response characteristics in bilateral neck-shoulder pain conditions and suggest that there may be a more potent inhibitory control mechanism in men than women. This experimental model may be potentially used to detect gender differences in descending inhibition.

Less local pain on intravenous infusion of a new propofol emulsion

Local pain at the site of intravenous (iv) injection of propofol remains a considerable problem in clinical anaesthesiology, and particularly so in infants. The aim of the present study was to compare the influence of two different emulsions of propofol on local pain following iv administration. Eighty adult patients (ASA I-II) scheduled for ear-nose-throat or plastic surgery were randomly allocated into two study groups: A and B. A 1.0-mm teflon cannula (BD, Helsingborg, Sweden) was inserted into a dorsal vein on each hand. Each patient was given two 3.0-ml iv bolus injections of two different propofol emulsions of 10 mg ml(-1) over 2 s, one in each cannula, at 5-min intervals. The first study drug administered was Diprivan (AstraZeneca, Södertälie, Sweden) in group A (n = 34) and Propofol-Lipuro (Braun, Melsungen, Germany) in group B (n = 39). Each patient was then asked by a blinded investigator to score maximal pain intensity on a visual analogue scale (VAS). The maximal intensity of propofol-induced local pain was significantly (P < 0.0001) lower after Propofol-Lipuro than after Diprivan--median 1 (25th percentile: 0; 75th percentile: 2) range 0-6 vs. 3 (0; 5) 0-9 VAS units. The considerably lower intensity of local pain found to be associated with iv administration of the new drug formula Propofol-Lipuro indicates that emulsions of propofol based on medium- and long-chain triglycerides have a clinical advantage over traditional ones for induction of anaesthesia.

Chronic spinal pain syndromes: A clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation

Objective: To compare needle acupuncture, medication (tenoxicam with ranitidine), and spinal manipulation for managing chronic (>13 weeks duration) spinal pain syndromes. Design: Prospective, randomized, independently assessed preintervention and postintervention clinical pilot trial. Setting: Specialized spinal pain syndrome outpatient unit at Townsville General Hospital, Queensland, Australia. Subjects: Seventy-seven patients (without contraindication to manipulation or medication) were recruited. Interventions: One of three separate, clearly defined intervention protocols: needle acupuncture, nonsteroidal anti-inflammatory medication, or chiropractic spinal manipulation. Main Outcome Measures: Main outcome measures were changes (4 weeks vs initial visit) in the scores of the (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity. Results: Randomization was successful. After a median intervention period of 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements (all expressed as percentages of the original scores) with (1) a reduction of 30.7% on the Oswestry scale, (2) an improvement of 25% on the neck disability index, and (3) reductions on the visual analogue scale of 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P < .001). Neither of the other interventions showed any significant improvement on any of the outcome measures. Conclusions: The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine. (J Manipulative Physiol Ther 1999;22:376–81)