Preoperative Pain Intensity Research Articles

Predictors of Postoperative Persistent Low Back Pain Following Lumbar Fusion in Patients Older than 75 Years: An Analysis of a Minimum 2-Year Follow-Up

PurposeThis study aimed to evaluate pre- and perioperative predictors associated with persistent low back pain (LBP) following lumbar fusion in patients aged > 75 years. MethodsThis single-center retrospective study examined 310 patients aged > 75 years who underwent lumbar fusion for lumbar degenerative disease (104 males, 206 females; mean age, 79 [75–90] years). The visual analog scale (VAS) score for LBP was examined preoperatively and 2-year postoperatively. The persistent LBP group comprised patients with a 2-year postoperative LBP-VAS score ≥ 3. The demographic and preoperative radiographic parameters were also reviewed. A multivariate stepwise logistic regression analysis was performed of variables with values of P < 0.2 on the univariate analysis. ResultsNinety-nine patients (32%) experienced persistent postoperative LBP. Multivariate logistic regression analysis revealed that age < 82 years, history of previous lumbar decompression, and greater preoperative VAS score for LBP were associated with greater postoperative persistent LBP after lumbar fusion, whereas other factors, such as gender, body mass index, osteoporosis, diabetes mellitus, depression, symptom duration, operative time, estimated blood loss, and spinopelvic sagittal parameters, were not. ConclusionsThis study showed that a relatively younger age, history of preoperative lumbar decompression, and greater preoperative VAS score for LBP were preoperative predictors of postoperative persistent LBP following lumbar fusion in elderly patients. In contrast, preoperative spinopelvic sagittal parameters were not associated with persistent postoperative LBP. Although lumbar fusion is expected to improve LBP, surgeons should pay attention to age, surgical history, and preoperative back pain intensity.

Cordotomy for pain control and opioid reduction in cancer patients: A cancer center 11-year experience

BackgroundPercutaneous lateral cervical cordotomy (PLCC) is a treatment option for predominantly nociceptive pain of oncological origin that is refractory to conservative methods, with unilateral distribution, particularly in the lower trunk or lower limbs of patients with a life expectancy of less than one year. ObjectiveThe aim of this study was to assess the analgesic efficacy and opioid utilization alteration in patients undergoing PLCC. MethodsWe retrospectively collected data from patients undergoing PLCC between 2011 and 2021 at the AC Camargo Cancer Center in São Paulo, Brazil. ResultsSixty-three patients and their respective surgical outcomes were analyzed. The mean preoperative pain intensity, as assessed by the mean numerical rating scale (NRS), was 8.4 (range: 4–10), while postoperatively, it decreased to 0.78 (range: 0–8). Lower postoperative NRS scores were observed for pain in the lower limbs and abdomen compared to the lower thorax. The mean preoperative oral morphine equivalent (OME) consumption was 231.0 mg (range: 30.0–1015.2). At 30 days postoperative, the mean consumption of OME was 120.2 mg (range: 0.0–705.0). Twelve months after surgery, the average consumption of OME was 98.3 mg (range: 0.0–396.0). ConclusionPLCC is a valuable therapeutic intervention for patients experiencing cancer pain that is unresponsive to conservative treatments. The anticipated analgesic outcomes are generally favorable, particularly in cases where the pain is localized unilaterally in the abdomen or lower body segments.

Description of pain associated with persistent postoperative pain after total knee arthroplasty

After total knee arthroplasty (TKA), approximately 20% of patients experience persistent postoperative pain (PPP). Although preoperative and postoperative pain intensity is a relevant factor, more detailed description of pain is needed to determine specific intervention strategies for clinical conditions. This study aimed to clarify the associations between preoperative and postoperative descriptions of pain and PPP. Fifty-two TKA patients were evaluated for pain intensity and description of pain preoperatively and 2 weeks postoperatively, and the intensities were compared. In addition, the relationship between pain intensity and PPP at 3 and 6 months after surgery was analyzed using a Bayesian approach. Descriptions of arthritis (“Throbbing” and “aching”) improved from preoperative to 2 weeks postoperative. Several preoperative (“Shooting”, “Aching”, “Caused by touch”, “Numbness”) and postoperative (“Cramping pain”) descriptors were associated with pain intensity at 3 months postoperatively, but only “cramping pain” at 2 weeks postoperatively was associated with the presence of PPP at 3 and 6 months postoperatively. In conclusion, it is important to carefully listen to the patient’s complaints and determine the appropriate intervention strategy for the clinical condition during perioperative pain management.

Treatment outcomes of pulpotomy versus pulpectomy in vital primary molars diagnosed with symptomatic irreversible pulpitis: protocol for a non-inferiority randomised controlled trial

BackgroundPulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period.Methods/designThis clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4–9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions.DiscussionThis trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars.Trial registrationClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.

Spinal Cord Stimulator Paddle Lead Revision and Replacement for Misplaced or Displaced Electrodes

ObjectivesSpinal cord stimulators (SCS) are commonly implanted via a laminotomy or laminectomy. Revision surgery may be necessary in instances of hardware failure or loss of efficacy. It is uncommon for leads to have been initially misplaced in a suboptimal position, and revision in these cases necessitates additional dissection for appropriate repositioning. Accordingly, there is concern with a more extensive revision for a potentially higher risk of associated complications. This study aims to describe a series of patients with failed paddle SCS electrodes due to misplacement who underwent revision and replacement. MethodsPatients who underwent SCS paddle replacement for misplaced paddles between 2021 and 2023 were identified. Medical charts were reviewed for demographic data, operative details, and incidence of complications. ResultsSixteen patients underwent thoracic SCS paddle revision and replacement. The mean age was 59.6±12.6 years, with 11 females and 5 males. Misplaced paddles were too lateral (n=12), too high (n=2), or incompletely within the epidural space (n=2). The mean duration from initial implantation to revision surgery was 44.8±47.5 months. The mean operative duration was 126.1±26.9 minutes, and all patients required a “skip” laminectomy or laminotomy. No complications were encountered. The mean length of follow-up was 18.4±7.3 months. Mean preoperative pain intensity was 7.9±1.5, and at last follow-up was 3.6±1.7 (p<0.001). All but one patient continued to use their device in follow-up. ConclusionThe revision and replacement of misplaced paddle SCS electrodes is a feasible and durable revision strategy, even in long-term implants with extensive scarring.

GAMBARAN MANAJEMEN NYERI AKUT PASKA OPERASI PADA PASIEN YANG MENJALANI TINDAKAN OPERASI ELEKTIF DI RSU HAJI MEDAN

Profile of nutritional status and eating behavior of doctors in their work To determine the description of acute post-operative pain management in patients undergoing elective surgery at RSU Haji Medan. This research is a descriptive study with a cross-sectional research design on elective post-operative patients. In this study, the number of respondents who participated was 66 people, with the largest gender being 37 people (56.1%), the average age was 40 years, and the majority of respondents were Javanese, namely 25 people (37.9%) . The highest preoperative pain intensity was moderate pain, amounting to 41 people (62.1%). The majority of pain intensity in the first 8 hours after surgery was moderate pain, in the second 8 hours the majority was mild pain and in the third 8 hours the majority was no pain. The majority of post-operative analgesic regimens use a combination of intravenous injection of ketorolac 30 mg and paracetamol 1 gram per 8 hours. The majority of the side effects felt by respondents after surgery were nausea.

Intensity of Preoperative Pain is a Predictive Factor of Postoperative Pain Following Root Canal Treatment

The aim of this study was to determine whether the intensity of preoperative pain was a predictive factor for the prevalence and intensity of postoperative pain, considering demographic and clinical variables. The study involved́ 80 teeth with pulpal or periapical pathologies. Root canal treatment was performed in one or two sessions. Pain intensity was assessed using the visual analogue scale before treatment and then 6h, 12h, 24h, 48h, 72h and one week after root canal treatment. The sample consisted of 46 women and 34 men. This study showed́ that postoperative pain was statistically associated with female gender (p=0.05), tooth types (p=0.006), and its location on the mandibular arch (p=0.03). The main finding was that patients with a higher intensity of pre-operative pain had a higher incidence of post-operative pain (p&lt;0.05). In the group of patients who had no pre-operative pain, 63% (17/27) of patients remained asymptomatic after root canal treatment, while only 7.4% (2/27) had severe post-operative pain with a significant difference (p&lt;0.05). However, in the group with severe pre-operative pain, 100% of patients had post-operative pain, of which 75% (15/20) of patients had high levels of pain requiring analgesics.

Outcomes of Odontoid Process Fracture Surgery

Background. Odontoid fractures are found in two age groups. In younger patients, they occur following traffic accidents, falls from a height and during sports. In older patients with poor bone quality, they are usually caused by falls from one’s own height. Most fractures are stable and do not require surgical treatment. Unstable, severely displaced fractures with neurological deficits require surgical treatment. The aim of the study was to evaluate the surgical and functional outcomes of treatment of odontoid fractures with a cannulated screw. Materials and methods. The study enrolled 20 patients that underwent surgery in the years 2020-2022. The patients were divided into two groups: below 60 (group A) and over 60 years of age (group B). Patients were assessed at one day pre-op, one day post-op, 6 weeks following surgery and 3 months following surgery. Imaging studies were performed to assess the angulation and degree of displacement of bone fragments. After the fracture was surgically fixed with a cannulated screw, bone union and the stability of fracture fixation were assessed. Preoperative and postoperative pain intensity as per a VAS, functional status assessed with the NDI questionnaire, quality of life (EQ-VAS) and neurological status (ASIA scale) were compared. Results. Good functional and surgical results were obtained in both groups of patients. Performance and quality of life improved, while pain intensity decreased in all patients. In 3 patients with post-traumatic paresis, the dysfunctions gradually subsided. No general medical or perioperative complications were observed. Bone union of the fracture was achieved in 40% of patients in group B and in 80% in group A. Achieving union did not determine the functional status of patients. On functional radiographs, all places of fixation were stable. Conclusions. 1. Odontoid fracture fixation with a single cannulated screw is a safe method of treatment. It provided a high union rate and good stability of the fracture. 2. Fracture non-union was noted more often in the group of older patients, but it did not negatively impact quality of life and performance.

Early and late results of direct superior approach versus direct lateral approach in total hip arthroplasty – single-center, prospective study

Introduction. Total hip arthroplasty (THA) is an established treatment for severe hip osteoarthritis (OA ). Traditionally, surgical approaches involved extensive soft tissue damage. New, less invasive approaches were introduced, facilitating fast recovery, reducing postoperative pain and incision length. Aim. Comparative analysis of postoperative pain and long-term results in patients undergoing total hip arthroplasty (THA) utilizing direct superior approach (DSA) and direct lateral approach (DLA). Materials and methods. Sixty-one patients scheduled for primary THA were included in the study. THA was performed utilizing the approach chosen by experienced orthopedic surgeons. After the procedure, pain intensity and use of analgesics were recorded daily. Patients were contacted 18 months following surgery to collect data on SF-36 score, pain intensity and complications (dislocations, infections, periprosthetic fractures, and revision surgeries). Fifty-two patients were included in the final analysis. Group A (DSA) consisted of 27 patients, whereas group B (DLA) consisted of 25 patients. Results. There were no significant differences between groups in terms of demographic parameters, preoperative pain intensity, Harris Hip Score, and SF-36 score. Significant differences were observed in pain intensity during the first three days post-operation. The use of non-opioid analgesics did not differ; however, the use of tramadol was lower in group A on the 1st and 2nd day post-operation. No significant differences were found in SF-36 score and pain intensity after 18 months post-surgery. Conclusions. DSA approach in THA is superior in comparison with the direct lateral approach in terms of early postoperative pain intensity and use of analgesic drugs. Late results of both approaches are comparable.

Incidence of opioid use and early postoperative pain intensity after primary unilateral inguinal hernia repair at a single-center specialty hospital.

This research examined opioid use, pain intensity, and pain management after primary unilateral inguinal hernia repair (PUIHR) at a single-center specialty hospital. After research, ethics board approval, and informed consent, pain scores (0-10 numerical rating scale [NRS]) were obtained from survey-based questionnaires administered at the pre- and 3-day postoperative timepoints. Descriptive results are presented as frequency, mean, standard deviation, range, median, and interquartile ranges, as appropriate. Significance tests were conducted to compare participants who did and did not receive opioids after surgery. p-value <0.05 is considered statistically significant. As the standard of care, participants received nonopioid multimodal analgesia (acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)) and opioids, when necessary. A total of 414 and 331 participants completed the pre- and 3-day postoperative questionnaires, respectively. Out of the 414 participants, 38 (9.2%) received opioids during the postoperative stay. There was no significant difference between pain frequency or mean preoperative NRS pain intensity scores of those who did and did not receive opioids. Mean NRS pain intensity scores on day 3 after surgery were significantly higher for participants who received opioids (3.15±2.08) than those who did not (2.19±1.95), p=0.005. Most participants did not receive opioids after PUIHR and had lower mean postoperative NRS pain intensity scores compared to those who did, most likely reflecting the need for opioids among the latter. Opioids were discontinued by day 3 for all participants who received them. Therefore, for most patients undergoing PUIHR, effective pain control can be achieved with nonopioid multimodal analgesia in the early postoperative period.

Microcannular liposuction in tumescent anesthesia in lipedema patients: an analysis of 519 liposuctions

This is aretrospective analysis of all lipedema patients treated by tumescent liposuction at our department in the years 2007-2021: We performed 519 liposuctions in 178patients with amean age of 45 ± 15.5years. By the stage of lipedema the mean age increased significantly, what underlines the concept of lipedema as achronic progressive disorder. Three-thirds of patients reported at least one comorbidity. The most common were arterial hypertension (32.58%), obesity (24.16%), and hypothyroidism (20.79%). We removed amean lipoaspirate volume of 4905 ± 2800 mL. Amajor target for treatment is pain reduction. All patients reported at least a50% pain reduction after liposuction, while 96achieved apain reduction ≥ 90%. The pre-operative pain intensity (p = 0.000) and the lipedema stage (p = 0.032) exerted asignificant impact on absolute pain reduction. There was no association of pain reduction to volume loss. The post-operative rate of adverse events was 2.89%. Liposuction in tumescent anesthesia is an effective and safe method to reduce both pain and volume in patients with lipedema.

(088) Fractional Area of Positive CD117 and PGP9.5 Immunostaining of Vestibular Tissue in Patients with Congenital and Acquired Neuroproliferative Vestibulodynia

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is a form of provoked vestibulodynia associated with an increased density of positive CD117 immunostaining (consistent with mast cells) and positive PGP9.5 immunostaining (consistent with nerves) in the vestibule. Genetic factors underlie the pathophysiology of NPV. Vestibular fibroblasts from NPV patients versus age matched controls produce higher proinflammatory cytokine levels of interleukins (IL) when provoked with Candida albicans in vitro that may lead to proliferation of C-afferent nociceptors. Two variants of NPV have been described. Congenital NPV (CNPV) is associated with a history of painful vaginal penetration by anything and positive umbilical hypersensitivity. Acquired NPV (ANPV) is associated with new onset entrance dyspareunia that persists, typically after an allergic reaction to a topical agent or after severe/recurrent candidiasis. A new computer-assisted approach using ImageJ can objectively assess both CD117 and PGP9.5 percent area of positive immunostaining (PAPI) in vestibular tissue. Objective This study compares for the first time immunohistochemical staining with CD117 and PGP9.5 in vestibular tissue from patients with CNPV and ANPV using ImageJ. This may help us better understand any fundamental pathophysiologic differences between the two variants. Methods Vestibular tissue samples from patients with CNPV (n=12) and ANPV (n=13) were formalin-fixed, paraffin-embedded, sectioned (10 μm) and subjected to immunostaining protocols with antibodies to CD117 or PGP9.5. Photomicrographs were obtained using 200x and 400x magnification and fractional area of positive immunostaining was determined using Image J; 3 measurements were performed for each photomicrograph. Pre-operative pain intensity (0 – 10) was assessed in both cohorts with cotton-tipped swab testing throughout the entire vestibule. Duration of symptoms, pain intensity scores, and PAPI between CNPV and ANPV patients were compared by Mann-Whitney test. Aggregate data are reported as median (interquartile range). Results At the time of complete vestibulectomy surgery, median ages of the CNPV and ANPV groups were 22 years (21 – 25) and 28 years (25 – 33), respectively. Median duration of symptoms in ANPV patients was 4.0 years (3.0 – 6.5), significantly shorter than CNPV patients (p&amp;lt;0.0001). Median pain intensity scores were 7.7 (6.5 – 8.2) and 5.4 (3.9 – 8.0) in the CNPV and ANPV groups, respectively (p = 0.0503). PAPI was similar for both PGP9.5 (0.314% vs 0.424%) and CD117 (0.680% vs 0.797%) in CNPV and ANPV patients, respectively. Conclusions In our patients, the density of immunostaining reflective of nerves and mast cells was similar in patients with congenital and acquired forms of NPV despite the median duration of symptoms being approximately 5 times longer in the congenital group. Self-reported pain intensity was nominally higher in CNPV patients but did not reach statistical significance. ANPV may occur later in life but the suspected underlying regional elevation in cytokines in the vestibule of these patients that leads to the increased density of mast cells and the proliferation of C-afferent nociceptors appears likely to be the same in both variants. Future studies should examine potential differences in pain perception between CNPV and ANPV patients. Disclosure No

MP48-01 THE EFFECT OF OPIATES ON PATIENT REPORTED OUTCOMES AFTER URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023MP48-01 THE EFFECT OF OPIATES ON PATIENT REPORTED OUTCOMES AFTER URETEROSCOPY Andrew Higgins, Russell Becker, Stephanie Daignault-Newton, Golena Fernandez Moncaleano, John Ludlow, Hector Pimentel, Brian Seifman, David Wenzler, Bronson Conrado, Karla Witzke, and Khurshid Ghani Casey Dauw Andrew HigginsAndrew Higgins More articles by this author , Russell BeckerRussell Becker More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , John LudlowJohn Ludlow More articles by this author , Hector PimentelHector Pimentel More articles by this author , Brian SeifmanBrian Seifman More articles by this author , David WenzlerDavid Wenzler More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Karla WitzkeKarla Witzke More articles by this author , and Khurshid Ghani Casey DauwKhurshid Ghani Casey Dauw More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The outcomes of kidney stone surgery have long been focused on stone-free rates and safety, yet patient reported outcomes (PRO) are often lacking. In 2018 the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) group initiated a pain optimization pathway using an opioid-free multi-modal pain regimen. This has resulted in a decline in opioid prescription rates after ureteroscopy (86 to 19%). We used a comprehensive PRO system to understand the initiative’s impact on patients’ experiences of treatment pain and satisfaction. METHODS: MUSIC ROCKS instituted its patient-reported outcomes (PRO) program in 2020 which included an assessment of patient pain (PROMIS Pain Intensity short form and Pain Interference short form) and overall treatment satisfaction (ICIQ-S). This system is automated and distributes questionnaires preoperatively and at 7-10 days and 4-6 weeks following ureteroscopy (URS). We compared patients who were prescribed opiates after URS to those who were not. After adjusting for observed demographic differences (age, gender, pre-stent status, stone location/size, and preoperative pain), we evaluated PRO pain intensity and interference with linear mixed models. A clinically meaningful difference in PROMIS scores is 2.5-3.5 points. Treatment satisfaction scores were compared with Wilcoxon rank tests. RESULTS: A total of 292 patients completed all questionnaires (258 non-opioid and 34 opioid). There was no significant difference between non-opioid and opioid cohorts with regards to age (60 vs 59 years), gender (50 vs 53% male), pre-stenting status (76 vs 65%), stone location (64 vs 59% ureteral), and stone size (8.0 vs 7.2 mm). After adjustment, there was no significant difference in preoperative pain intensity scores between the groups at pre-URS (p=0.06), 7-10 days postop (p=0.87), and 4-6 weeks postop (p=0.99, Figure). Pain interference followed a similar pattern, with no significant differences observed at any timepoint. There was no difference in satisfaction scores, as measured both 7-10 days (p=0.46) and 4-6 weeks (p=0.47) after URS. CONCLUSIONS: Rates of opiate prescription have declined after URS in Michigan. Using a novel PRO system, we confirmed that utilization of opioid-free pathways has not resulted in increased pain nor decreased patient satisfaction. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e654 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Higgins More articles by this author Russell Becker More articles by this author Stephanie Daignault-Newton More articles by this author Golena Fernandez Moncaleano More articles by this author John Ludlow More articles by this author Hector Pimentel More articles by this author Brian Seifman More articles by this author David Wenzler More articles by this author Bronson Conrado More articles by this author Karla Witzke More articles by this author Khurshid Ghani Casey Dauw More articles by this author Expand All Advertisement PDF downloadLoading ...

Is Presurgical Pain Intensity Related to Postoperative Recurrence of Post-Traumatic Trigeminal Neuropathic Pain?

Post-traumatic trigeminal neuropathic pain (PTTNp) is a challenging condition to treat, and equally as challenging is the identification of surgical outcome variables to guide treatment. The study purpose was to determine if preoperative pain intensity was related to postoperative recurrence of PTTNp. This retrospective cohort study assessed subjects with preoperative PTTNp of either the lingual or inferior alveolar nerves who underwent elective microneurosurgery at a single institution. Two cohorts were established as follows: No PTTNp at 6months (group 1); presence of PTTNp at 6months (group 2). The primary predictor variable was the preoperative visual analog scale (VAS) score. The primary outcome variable was PTTNp (recurrence or no recurrence at 6months). The demographic and injury characteristics of the groups were compared to assess whether they were similar using Wilcoxon rank analysis. Two-tailed Student's t-test was performed to analyze the difference in preoperative mean VAS scores. Multivariate multiple linear regression models were used to determine the association between the covariates on the outcomes of the primary predictor variable and the primary outcome variable. A P value of <.05 was considered statistically significant. Forty-eight patients were included in the final analysis. There were 20 patients with no pain at 6months and 28 with recurrence at 6months following surgery. There was a significant difference in mean preoperative pain intensity between the two groups (P value .04). The mean preoperative VAS score in group 1 was 6.31 (standard deviation, 2.65), while the mean preoperative VAS score in group 2 was 7.75 (standard deviation, 1.95). Regression analysis showed that one covariate, the type of nerve injured, explained some variability of preoperative VAS score, but by only 16% (P value .005). Regression analysis also showed that two covariates, Sunderland classification and time to surgery, explained some of the variability of PTTNp at 6months, by approximately 30% (P value .001). This study showed that presurgical pain intensity level was related to postoperative recurrence in the surgical treatment of PTTNp. In patients with recurrence, the preoperative pain intensity was higher. Other factors, including time interval from injury to surgery, were also related to recurrence.

Factors influencing the long-term outcomes of instrumentation surgery for degenerative lumbar spondylolisthesis: a post-hoc analysis of a prospective randomized study

BACKGROUND CONTEXTLumbar spinal canal stenosis caused by degenerative lumbar spondylolisthesis is one of the most common indications for spinal surgery. However, the factors that influence its long-term (>10 years) outcomes remain unknown. DESIGNThis is a post-hoc analysis of a prospective randomized study. PURPOSEThis study aimed to determine factors that influence the long-term outcomes of instrumentation surgery for lumbar spinal canal stenosis due to degenerative lumbar spondylolisthesis. PATIENT SAMPLEPatients aged ≤75 years with single L4/5 level lumbar canal stenosis caused by degenerative lumbar spondylolisthesis prospectively underwent instrumentation surgery at two hospitals between May 1, 2003, and April 30, 2012; the final follow-up examination was on May 20, 2021. OUTCOME MEASURESThe following data were collected: modified Japanese Orthopedic Association (JOA) score, JOA score recovery rate, visual analog scale (VAS) score for lower back and leg pain, and scores from eight short-form 36 (SF-36) subscales preoperatively and at the final follow-up examination. METHODSSpearman's correlation analysis and univariate and multivariate regression analyses were used to examine preoperative factors that affect the JOA score recovery rate in patients who underwent instrumentation surgery for lumbar spinal canal stenosis at the L4/5 level due to degenerative lumbar spondylolisthesis. RESULTSA total of 42 patients who underwent instrumentation surgery for degenerative lumbar spondylolisthesis and had a long-term follow-up period were included. Of these, 25 and 17 underwent posterolateral fusion and Graf stabilization, respectively. The mean postoperative follow-up duration was 12.5 years. Spearman's correlation analysis revealed that the long-term recovery rate was correlated with the preoperative VAS score for low back pain. In the univariate regression analysis, sex, preoperative VAS score for low back pain, and the SF-36 general health score were significantly associated with the long-term recovery rate. Meanwhile, the multiple stepwise regression analysis identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate. CONCLUSIONSThis study identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate following instrumentation surgery for degenerative lumbar spondylolisthesis. Therefore, when performing posterolateral fusion or Graf stabilization for degenerative lumbar spondylolisthesis, attention should be paid to the intensity of preoperative low back pain and considerations should be given to whether these procedures can improve the patient's symptoms in the long term.

New Perspectives in Peripheral Nerve Surgery for Neuropathic Pain

Background and Aims: Neuropathic pain can occur following intentional or unintentional peripheral nerve injury. The purpose of this review was to determine in patients who have post-traumatic trigeminal neuropathic pain or required ablative mandibular operations with transection of the nerve, do those who undergo immediate or early surgical interventions, when compared to those whose nerves are not repaired or delayed, have a decreased or increased risk for resolving neuropathic pain? Methods: Two single-site and one multi-site retrospective observatory studies of patients who had neuropathic pain prior to operative treatment of the injured nerve and in patients who underwent resection of the mandible for benign or malignant disease with either no repair or immediate repair were analyzed for the presence or absence of neuropathic pain at 6 months post-surgery. The primary predictor variable in the surgical treatment of neuropathic pain pre-existing surgery was the time from injury to repair and the preoperative pain intensity rated by Visual Analogue Scale (VAS). The primary predictor variable in the study of intentional transected nerve was the immediate repair or no repair of the nerve at the time of resection. Results: There was statistically significant difference in the primary outcome based on time from injury to repair. When the time to surgery was less than 200 days, the percentage of patients with no neuropathic pain was greater than 60%. There was a significant difference in mean VAS between those who had no neuropathic pain (6.4,SD 2.68) and those with recurrence (7.75,SD 1.95). Following mandibular resection there was statistically significant difference between the immediate repair and no repair group. Post-hoc logistic regression modeling showed an inverse relationship between the immediate repair and the incidence of chronic postoperative pain and neuropathic pain with an odd ratio &lt;1. Conclusions: In patients with neuropathic pain, earlier diagnosis and treatment, including peripheral nerve surgery, should be considered with the best outcomes when operative interventions occur within 200 days of the injury and pain intensity are mild or moderate on VAS scales. The immediate repair of an intentionally transected trigeminal nerve appears to reduce and possibly eliminate the development of neuropathic and chronic postoperative pain compared to avoiding nerve repair.

A combination of high preoperative pain and low radiological grade of arthritis is associated with a greater intensity of persistent pain 12 months after total knee arthroplasty.

Despite new technologies for total knee arthroplasty (TKA), approximately 20% of patients are dissatisfied. A major reason for dissatisfaction and revision surgery after TKA is persistent pain. The radiological grade of osteoarthritis (OA) preoperatively has been investigated as a predictor of the outcome after TKA, with conflicting results. The aim of this study was to determine if there is a difference in the intensity of pain 12 months after TKA in relation to the preoperative radiological grade of OA alone, and the combination of the intensity of preoperative pain and radiological grade of OA. The preoperative data of 300 patients who underwent primary TKA were collected, including clinical information (age, sex, preoperative pain), psychological variables (depression, anxiety, pain catastrophizing, anticipated pain), and quantitative sensory testing (temporal summation, pressure pain thresholds, conditioned pain modulation). The preoperative radiological severity of OA was graded according to the Kellgren-Lawrence (KL) classification. Persistent pain in the knee was recorded 12 months postoperatively. Generalized linear models explored differences in postoperative pain according to the KL grade, and combined preoperative pain and KL grade. Relative risk models explored which preoperative variables were associated with the high preoperative pain/low KL grade group. Pain 12 months after TKA was not associated with the preoperative KL grade alone. Significantly increased pain 12 months after TKA was found in patients with a combination of high preoperative pain and a low KL grade (p = 0.012). Patients in this group were significantly more likely to be male, younger, and have higher preoperative pain catastrophizing, higher depression, and lower anxiety (all p ≤ 0.05). Combined high preoperative pain and low radiological grade of OA, but not the radiological grade alone, was associated with a higher intensity of pain 12 months after primary TKA. This group may have a more complex cause of pain that requires additional psychological interventions in order to optimize the outcome of TKA.Cite this article: Bone Joint J2022;104-B(11):1202-1208.

Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double-blind single-centre clinical trial.

The aim of this study was to assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation. Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6ml 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4ml 4% articaine hydrochloride with 1:100 000 adrenalin (n=165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point Numerical Rating Scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need for supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analysed using Mann-Whitney U- and Chi-squared (χ2 ) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure were calculated. The effect of pre-disposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects. Baseline variables were balanced between groups (p > .05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p > .05). IOP intensity was associated with preoperative pain intensity and tooth type (p < .05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p > .05) with a relative risk of failure [95% CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p > .05; RR [95% CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia. 2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

Responder Analysis of Pain Relief After Surgery for the Treatment of Spinal Metastatic Tumors.

Central tendency analysis studies demonstrate that surgery provides pain relief in spinal metastatic tumors. However, they preclude patient-specific probability of treatment outcome. To use responder analysis to study the variability of pain improvement. In this single-center, retrospective analysis, 174 patients were studied. Logistic regression modeling was used to associate preoperative characteristics with rating the Brief Pain Inventory (BPI) worst pain item 0 to 4. Linear regression modeling was used to associate preoperative characteristics with minimal clinically important improvement (MCI) in physical functioning defined by a 1-point decrease in the BPI Interference Construct score from preoperative baseline to 6 months postoperatively. Patient-level analysis revealed that 60% of patients experienced an improvement in pain. At least half experienced a decrease in pain resulting in MCI in physical functioning. Cutpoint analysis revealed that 48% were responders. Increasing scores on the preoperative pain intensity BPI items, the MD Anderson Symptom Inventory (MDASI) Core Symptom Severity Construct, the MDASI Spine Tumor-Specific Construct, the presence of preoperative neurologic deficits, and postoperative complications were associated with lower probability of treatment success while increasing severity in all BPI pain items, and MDASI constructs were associated with increased probability of MCI in physical function. Significant mortality and loss to follow-up intrinsic to this patient population limit the strength of these data. Although patients with milder preoperative symptoms are likely to achieve better pain relief after surgery, patients with worse preoperative symptom also benefit from surgery with adequate pain relief with an improvement in physical function.

Information needs scales and Preoperative Anxiety Levels Increase Postoperative Pain Intensity

Excessive preoperative anxiety can increase the occurrence of postoperative pain complications with severe intensity. The phenomenon in a private Hospital Surabaya there are still patients who tend to feel excessive fear and anxiety before surgery. The purpose of this study was to analyze the correlation between the level of anxiety preoperative patients and the pain intensity of postoperative. The study used correlation study with a cohort design with 34 respondents taken using consecutive sampling techniques. The level of preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety Information Scale (APAIS) questionnaire and postoperative pain intensity was assessed using Visual Analog Scale (VAS). Statistical analysis relationship between preoperative anxiety levels and postoperative pain intensity using Spearman Rank test with p value= 0,000, and rs value +0.622. Relationship between the level of preoperative anxiety and the intensity of postoperative pain using the Spearman Rank with a value of p = 0.000, and a value of rs +0.804.