Mean Pain Level Research Articles

Proximal Horizontal Flap Tears of TFCC Diagnosed by Computed Tomography Arthrography: Six Case Series

Background Proximal horizontal tears of the triangular fibrocartilage complex (TFCC) represent the tears at the proximal surface of the articular disk with a normal appearance of the distal surface. Preoperative diagnosis of TFCC flap tears is challenging. Objectives This report aims to present a diagnostic method using computed tomography (CT) arthrography for the proximal horizontal flap tears of the TFCC and to report our clinical outcomes. Patients and Methods Six patients were included who were preoperatively suspected to have proximal horizontal flap tears of the TFCC via CT arthrography. Arthrography was conducted by injecting dye into the distal radioulnar joint (DRUJ), and CT images were obtained immediately following arthrography. We performed arthroscopic or direct flap debridement with concomitant surgeries: ulnar shortening with positive ulnar variance and corrective osteotomy with the malunion following distal radius fracture. Results Preoperative CT arthrography clearly revealed the flaps to be flipped over toward the radiopalmar side of the DRUJ in four cases and a teardrop-shaped dye defect in two. We were able to identify the dislocated flap by arthroscopy avulsed from the proximal aspect of the articular disk within the DRUJ in all six cases. The mean pain level decreased from 10 preoperatively to 0.3 postoperatively on the visual analog scale. The mean patient-rated wrist evaluation score decreased from 43.5 preoperatively to 11.2 postoperatively. Conclusions Our study shows that CT arthrography can be a promising method for diagnosing proximal horizontal flap tears of the TFCC. Debridement of the flaps and concomitant surgeries showed satisfactory clinical results. Level of Evidence This is a Level 4, diagnostic study.

Verbal analgesia is as good as oral tramadol prior to intrauterine device (IUD) insertion, among nulliparous women: A randomized controlled trial

ObjectiveTo compare two pain management strategies: oral tramadol or a verbal analgesia technique during insertion of an intrauterine device (IUD) among nulliparous women. Study designIn this randomized, controlled trial, 54 nulliparous women undergoing insertion of a levonorgestrel-releasing intrauterine device (IUD), from December 2015 to December 2018 were randomized to receive oral tramadol for analgesia or verbal analgesia prior to IUD insertion. Demographic data, clinical symptoms, visual analogue scale (VAS) and complications were reviewed from patient records. ResultsThere was no difference between the two groups regarding gravidity, age, smoking or body mass index. No significant differences were detected between the groups regarding the procedure, including ease of insertion (p = .415), number of insertion attempts (p = .514) and complications during the insertion (p = .150). Mean pain level by VAS was 4.5 ± 1.6 (range 2−8) for the tramadol group and 4.8 ± 2.4 (0−10) for the verbal analgesia group (p = .610). There was no spontaneous ejection of the IUD in either group, and no endometritis or discomfort that resulted in IUD removal. ConclusionThere was no benefit in using oral tramadol for analgesia prior to IUD insertion among nulliparous women. Verbal analgesia can be a suitable technique for this process and clinicians should become more familiar with its use.

Initial treatment for patients with temporomandibular disorders: pain relief and muscle tone relief by photobiomodulation therapy using carbon dioxide laser

PurposeTo investigate the efficacy of photobiomodulation therapy (PBMT) with a CO2 laser (Bel Laser, Takara Belmont, CO. Ltd., Osaka, Japan; wavelength 10.6 μm) (tissue surface absorption effects) in conjunction with mouth opening training in patients with temporomandibular disorders (TMDs).MethodsThis is a retrospective study on TMD patients with pre- and post-treatment assessments. The study included 36 patients (7 men and 29 women, mean age 58.2 years (SD 18.3)) (after excluding 4 patients due to dropouts, loss to follow up or refusal of treatment) with symptoms of pain and muscle tenderness during mouth opening. Treatment included Amfenac sodium (50 mg per day, thrice daily after meals) for 1–2 weeks for acute symptoms. Based on the diagnostic criteria for TMD, we identified the trigger point (muscle contracture site). We implemented muscle massage and stretching therapy as mouth opening training after PBMT. The laser irradiance conditions were as follows: output 1.5 W, on time 0.01 s, off time 0.05 s, and repeat pulse. Distance between the laser source and the skin was approximately 10 cm; irradiation time was 3 min (approximately 56.9 J/cm2). Mouth opening training involved massaging the areas of muscle contracture that were the trigger points, as well as muscle stretching to improve temporomandibular joint flexibility. One PBMT cycle and mouth opening training was conducted per week for four cycles. We determined the effects before and after intervention. A numeric rating scale (NRS; range 0–10) was used to evaluate pain, and maximum mouth opening (MMO) capacity was also assessed. Data were analyzed using the Wilcoxon signed-rank test.ResultsThe mean (SD) pain levels, as determined via NRS, were 4.9(3.6) and 2.7 (3.0) (p < 0.001), before and after four treatment cycles, respectively. The mean (SD) of MMO was 39.6 (5.9) and 44.6 mm (4.8) (p < 0.001), before and after treatment, respectively.ConclusionThe current study suggests that PBMT using a CO2 laser combined with mouth opening training is effective for the treatment of temporomandibular disorders.

Using pharmacogenetics to structure individual pain management protocols in total knee arthroplasty

The purpose of this study was to use pharmacogenetics to determine the frequency of genetic variants in our total knee arthroplasty (TKA) patients that could affect postoperative pain medications. Pharmacogenetic testing evaluates patient DNA to determine if a drug is expected to have a normal clinical effect, heightened effect, or no effect at all on the patient. It also predicts whether patients are likely to experience side effects from medicine. We further sought to determine if changing the multimodal programme based on these results would improve pain control or reduce side effects. In this pilot study, buccal samples were collected from 31 primary TKA patients. Pharmacogenetics testing examined genetic variants in genes OPRM1, CYP1A2, CYP2B6, CYP2C19, CYP3A4, CYP2C9, and CYP2D6. These genes affect the pharmacodynamics and pharmacokinetics of non-steroidal anti-inflammatory drugs and opioids. We examined the frequency of genetic variants to any of the medications we prescribed including celecoxib, hydrocodone, and tramadol. Patients were randomized to one of two groups: the control group received the standard postoperative pain regimen, and the study group received a customized regimen based on the pharmacogenetic results. For the first ten postoperative days, patients recorded pain scores, medication, and side effects. Genetic variants involving one or more medications in the multimodal pain protocol occurred in 13 of the 31 patients (42%). In total, eight patients (26%) had variants affecting more than one of the medications. For the 25 patients who recorded pain and medication logs, the mean pain levels and morphine equivalents (MEQs) consumed in the first ten days were higher in the control group than in the custom-guided group (p = 0.019 for pain and p = 0.655 for MEQ). Overall, 42% of patients had a variant involving one of the pain medications prescribed in our perioperative pain program for TKA. Ongoing research will help determine if using these data to modify a patient's medication will improve outcomes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):73-78.

Gluteus maximus tendon transfer for chronic abductor insufficiency: the Geneva technique.

The treatment options of chronic abductor insufficiency in the setting of muscle degeneration, are limited and technically demanding. We present the outcomes of a salvage technique for unreconstructable, chronic abductor tears performed by a single surgeon. We retrospectively evaluated 38 patients who were surgically managed for chronic abductor insufficiency. Patients without hip implants and patients following primary or revision total hip arthroplasty (THA) were involved. All patients had a Trendelenburg gait, impaired muscle strength of abduction (⩽M4) and fatty degeneration of muscles (Goutallier ⩾3). They underwent transfer of a flap of the anterior third of gluteus maximus to the greater trochanter that was sutured under the slightly mobilised vastus lateralis. The level of pain, functional scores, muscle strength and Trendelenburg gait were re-evaluated at 12 postoperative months. The mean age of patients was 70.2 years. 10 patients received the tendon transfer on a native hip, 6 following primary THA and 22 after revision THA. The mean pain level (3.2 vs. 7, p < 0.001) and Harris Hip Score (80.2 vs. 41.6, p < 0.001) and the median abductor strength (4 vs. 3, p < 0.001) was significantly improved compared to the preoperative scores. 26 patients demonstrated negative and 12 positive Trendelenburg sign at 12 postoperative months. No serious complications were reported. This salvage technique improved the strength of abduction and functional results and reduced the level of pain in 80% of patients with chronic abductor tears. The short-term outcomes of the procedure were favourable; however, further evaluation is needed.

Diagnostic office hysteroscopy with the Storz TrophyScope® versus Cooper surgical Endosee®.

Office hysteroscopy (OH) is becoming increasingly popular. Our objective was to determine the use patterns, reported pain scores, and success rates of OH with the 2.9 mm Storz TrophyScope® and handheld portable Cooper surgical Endosee® device in a clinic without previous office hysteroscopy experience. A prospective cohort study of a hysteroscopy quality improvement database was conducted in a tertiary care center gynecology clinic. Patients undergoing OH with either the Storz TrophyScope® or Cooper Surgical Endosee® device were included. Of the 171 office hysteroscopies, 77 utilized the TrophyScope®, with 8 (10%) being inadequate, while 94 utilized Endosee®, with 13 (14%) being inadequate (P=0.50). Of the 13 inadequate Endosee® hysteroscopies, 4 (31%) were due to visualization, 4 (31%) to patient intolerance, 3 (23%) to cervical stenosis, and 2 (15%) to a combination of these factors. Of the 8 inadequate TrophyScope® hysteroscopies, 7 (87%) were due to patient intolerance and 1 (13%) to cervical stenosis. Of the 150 adequate office procedures performed, 52 cases underwent subsequent procedures in the operating room (OR). Of these, 26 (84%) of 31 Endosee® cases and 18 (86%) of 21 TrophyScope® cases were in agreement with OR procedure findings. A subgroup analysis comparing mean pain levels did not significantly differ between the two hysteroscopes. There was no difference in accuracy with OR pathologic diagnoses, adequacy of procedure, and reported pain scores when comparing the TrophyScope® and Endosee® in this prospective cohort. Larger studies are needed to confirm the sensitivity, and specificity for these newer, disposable office hysteroscopic devices.

Depression level, not pain severity, is associated with smoked medical marijuana dosage among chronic pain patients

BackgroundThe use of medical marijuana (MM) for the treatment of chronic pain is rapidly growing in the United States and Europe; however there is concern regarding the specificity of its therapeutic effects and the motivation underlying its use. While research indicates that among chronic pain prescribed opioids, depression has been associated with increased opioid dosage (regardless of pain levels), the extent to which depression and pain each contribute to MM dose among chronic pain patients is yet unknown. MethodsThis cross-sectional study included 209 chronic pain patients prescribed smoked MM, in flower or other plant form, with no concurrent opioid treatment. Ordinal regression analyses were performed in order to explore the unique contribution of mean pain level (1–10 scale), depression severity (measured by the Patient Health Questionnaire (PHQ-9)) and anxiety severity (measured by the Generalized Anxiety Disorder scale (GAD-7)) to doses of MM, while taking into account additional sociodemographic and clinical factors. ResultsIndividuals with mild depression and those with moderate to severe depression were at significantly increased odds for using higher doses of MM in grams per month(Adjusted Odds Ratio(AOR) = 2.06,95% Confidence Interval(CI) = 1.05–4.01, and AOR = 5.95,95% CI = 1.97–17.98, respectively) compared to those without depression. In addition, individuals with mild depression were at significantly increased odds for smoking more MM joints daily(AOR = 2.07, 95% CI = 1.01–4.23) compared to individuals without depression. Mean levels of pain or anxiety severity were not significantly associated with either dose measures. ConclusionsDepression and MM dose are highly correlated and should be concurrently addressed during chronic pain treatment.

A Selective arthroplasty algorithm contributes to clinical outcome and patient satisfaction in patients with osteoarthritis of the knee

Aims and Objectives:The purpose was to evaluate the clinical outcomes and patient satisfaction of patients with knee osteoarthritis treated within a selective arthroplasty algorithm, using focal metal implants (FMI), unicompartmental (UKA), patellofemoral (PFA), bicompartimental (BKA) and total knee arthroplasty (TKA) in a single center.Materials and Methods:This is a prospective study analyzing a consecutive series of 613 patients treated by two surgeons in a single center. In 283 men and 330 women either partial or total knee replacement were performed. Their mean age at surgery was 63±6,85 years and mean BMI 29,55±5,00 kg/m2. 357 UKA, 178 TKA, 30 PFA, 23 BKA and 25 FMI were performed. Implants were cemented or cementless (UKA) and made of cobalt chrome in partial knee and zirconium oxide in total knee replacement. Demographics and patient reported outcomes (VAS, KOOS, Oxford Knee Score (OKS) and Knee Society Score (KSS Expectations and satisfaction)) were collected preoperatively and 3,6 and 12 months postoperatively. A total of 442 of 457 eligible patients (Compliance = 96,7%) have thus far completed the 12 months follow-up time point.Results:All mean KOOS, OKS, KSS and VAS scores improved significantly 1 year after surgery (p<0.05). Mean preoperative aggregated KOOS improved from 49.8±13,3 to 74,8±16.9 in UKA, from 43,9±13,3 to 65,2±12,4 in PFA, from 46.6±13,1 to 73,8±14,4 in TKA, from 45,2±11,2 to 73,0±9,8 in BKA and 40.9 ± 23.0 to 63.2 in FMI (p<0.05). Mean preoperative aggregated OKS improved from 25,3±7,6 to 38,7±8,4 in UKA, from 22,9±7,6 to 33,3±8,6 in PFA, from 23.3±7.3 to 37,5±7.7 in TKA, from 22,0±7,5 to 39,0±4.0 in BKA and from 22.9 ± 10.0 to 33.4 ± 11.3 in FMI (p<0.05). The mean pain level VAS decreased from pre-treatment to 12 months after surgery in UKA from 5.6 to 1.6, in PFA from 6.2 to 2.8, in TKA from 6.2 to 1.7, in BKA from 6.8 to 1.6 and VAS 5.5 to 2.4. The Mean KSS Expectation/Satisfaction improved at 1 y FU in UKA in expectation 13.7 ± 1.6 and mean KSS satisfaction: 31.1 ± 8.4, in FMI in expectation: 13.5 ± 1.6 and mean KSS satisfaction 26.0 ± 11.4 , in TKA: expectation 13.5 ± 1.8 and mean KSS satisfaction 30.0 ± 7.1, in PFA: expectation 13.7 ± 1.7 and mean KSS satisfaction 26.4 ± 9.2 and BKA: expectation 13.6 ± 1.9 and mean KSS satisfaction 31.2 ± 4.2.Two patients (0.4%) underwent revision (at 3 month for inlay dislocation (UKA) and at 12 Month for desease progression (FMI)).Conclusion:This study shows excellent clinical results and patient satisfaction of patients treated within a selective arthroplasty algorithm. Adherence to strict indications for partial as well as for total knee replacement will lead to a comparable significant improvement of patient reported outcomes, patient satisfaction and a low revision rate one year postoperatively.

Insertion-Related Pain and Short-Term Satisfaction With Two Copper IUDs: A Randomized Trial [22I

INTRODUCTION: Pain during intrauterine device (IUD) insertion is a barrier to uptake. We compared insertion-related pain and short-term satisfaction between two copper (Cu) IUDs. METHODS: We conducted a multicenter, single-blind randomized trial comparing two CuIUDs. Participants were randomized (4:1 ratio) to a smaller (Mona Lisa NT Cu380-Mini [24 mm x 30 mm]) or standard (Paragard TCu380A [32 mm x 36 mm]) CuIUD. Participants recorded maximum pain levels on a 10 cm visual analog scale at nine timepoints (pre- and immediately post-IUD insertion, daily for 7 days). At day 7, participants reported overall satisfaction (5-point scale) and whether they would recommend the product to others. For each timepoint, we computed mean pain level and mean change in pain from baseline, and stratified by parity. We used T-tests and chi-square tests to compare results between products. RESULTS: We enrolled 1,105 women, 84% nulliparous (n=924). Mean pain levels immediately post-insertion were 4.9 cm (SD 2.3) for both the smaller (n=886) and standard (n=219) products. Subsequent pain levels decreased equally across both products, from 2.5 cm (day 2) to 0.7 cm (day 7). Mean pain after baseline adjustment was similar between products. Nulliparous women using either IUD reported higher pain levels at all timepoints than parous women (P&lt;.05). Among nulliparous women, 54% were highly satisfied with the smaller versus 45% with standard IUD (P&lt;.05); over 92% using each product would recommend it. Parous women reported similar satisfaction by product. CONCLUSION: Reported pain was similar between IUDs. Satisfaction among nulliparous women was higher at 7 days with a smaller CuIUD. Longer-term data may elucidate possible differences between products.

Modified arthroscopic anterior myotomy for internal derangement of the temporomandibular joint: clinical and radiological results

The aim of this study was to present the results of a modification of the arthroscopic anterior myotomy for the treatment of internal derangement (ID) of the temporomandibular joint (TMJ): the minimally invasive arthroscopic anterior myotomy (MIAAM). Fifteen joints with Wilkes stages III–IV ID treated with this technique were studied. Clinical data evaluated were pain (visual analogue scale, VAS) and articular movements (preoperatively and at 1, 3, 6, 9, and 12 months postoperative). The position of the disc at 1 year after surgery was compared with the pre-surgical position, using magnetic resonance imaging (MRI). The mean pain level according to the VAS decreased from of 67.8 pre-surgery to 29.0 at the 12-month follow-up (P < 0.001). Functionally, mouth opening increased from a mean 27.8 mm to 36.0 mm (P < 0.001). Evaluation of the MRI images showed statistically significant improvements in disc position in both the closed (P = 0.00002) and open-mouth (P = 0.00001) position. The incidence of re-arthroscopy was 13.3% (2/15). This procedure is an effective method for the improvement of joint function and reduction of pain in patients with ID of the TMJ. However, MIAAM is moderately effective in regards to repositioning of the disc.

Efektivitas langkah-langkah peregangan (stretching) untuk menurunkan nyeri dismenore di wilayah Sleman Yogyakarta

Dysmenorrhea is an imbalance of the hormone progesterone in the blood, causing pain to arise. Women have experienced 90% of dysmenorrhea, this disturbs 50% of women of reproductive age and 60-85% in adolescence, which results in many absences in schools and offices. Non-pharmacological solutions are seen as safer, one of which is stretching which aims to make muscles and joints flexible and elastic. This is due to increased levels of endorphins, epinephrine, dopamine and serotonin produced by the brain due to exercise. This study aims to determine stretching steps to reduce dysmenorrhea pain in the Sleman region. The method of this research is a different test study with a cross sectional type of research. The research sample was 60 female students. The sampling technique was purposive sampling, bivariate analysis techniques using the Mann Whitney statistical test using SPSS software. The results of the Mann Whitney test in the control group and the intervention group showed a p-value of 0,000 (ɑ &lt;0.05) indicating that there were differences between the control and intervention groups in decreasing the level of pain in dysmenorrhea where the mean pain level of dysmenorrhea was 4 50 while in the intervention group the average is only 0.13 so that it gets ∆ mean of -4.37. This proves that stretching is more influential in decreasing the level of pain in dysmenorrhea than in stretching.

Imagined Examples of Painful Experiences Provided by Chronic Low Back Pain Patients and Attributed a Pain Numerical Rating Score.

ObjectiveThe pain numerical rating scale (NRS) is widely used in pain research and clinical settings to represent pain intensity. For an individual with chronic pain, NRS reporting requires representation of a complex subjective state as a numeral. To evaluate the process of NRS reporting, this study examined the relationship between reported pain NRS levels and imagined painful events reported by study subjects.DesignA total of 149 subjects with chronic low back pain characterized by the NIH Research Task Force Recommended Minimal Dataset reported current pain NRS and provided imagined examples of painful experiences also attributing to these an NRS. We present a quantitative and qualitative analysis of the 797 pain examples provided by the study subjects.ResultsStudy subjects tended to be able to imagine both highly painful 10/10 events and non-painful events with relative agreement across subjects. While NRS for the pain examples tended to increase with example severity, for many types of examples there was wide dispersion around the mean pain level. Examination of pain examples indicated unexpected relationships between current pain and the intensity and nature of the imagined painful events.ConclusionsOur results indicate that the pain NRS does not provide a reliably interpretable assessment of current physical pain intensity for an individual with chronic pain at a specific moment.

Evaluation of the Effect of Platelet-Rich Fibrin on Wound Healing at Split-Thickness Skin Graft Donor Sites: A Randomized, Placebo-Controlled, Triple-Blind Study.

Split-thickness skin grafting (STSG) is widely used to heal wounds resulting from trauma, burns, and chronic wounds. This study aimed to determine the true effect of platelet-rich fibrin (PRF) on patients with burn wounds requiring STSG during treatment of donor wounds. This randomized, triple-blind clinical trial was conducted on patients who referred to the burn ward of Vasei Hospital of Sabzevar, Iran, from May 2017 to May 2018. The donor site was randomly divided into 2 groups: PRF and control (Vaseline petrolatum gauze) using Vaseline gauze. In the intervention group, the PRF gel was applied to the wound and covered with Vaseline gauze and wet dressing. Conversely, only Vaseline gauze and wet dressing were applied to the control group. Outcome evaluation was conducted using paired t test and Wilcoxon signed rank-sum test, as appropriate, on days 8 and 15. The mean age of the patients was 33.10 ± 2.60 years, and 51.50% were male. The mean wound healing time in the PRF and control groups was 11.80 ± 3.51 and 16.30 ± 4.32 days, respectively (P < .001). The PRF group showed significantly higher wound healing rates than the control group at 8 and 15 days dressing (P < .001 and P < .001, respectively). Moreover, the mean wound healing for all wound healing indices diagnosed by 2 specialists in PRF was higher than control group on days 8 and 15 (P < .001). We found a statistically significant difference on days 8 and 15 regarding the mean pain levels between the 2 groups (P < .001). The findings showed that PRF can significantly increase the time and rate of donor wound healing compared with conventional treatment and also reduce the severity of pain.

Effects of micro-osteoperforations on intraoral miniscrew anchored maxillary molar distalization : Arandomized clinical trial.

The aim was to study the effects of micro-osteoperforations (MOPs) on miniscrew-supported maxillary molar distalization. As part of asingle center, split-mouth, randomized clinical trial, 20eligible subjects were randomly recruited from patients who had applied to the orthodontics department of auniversity dental hospital. In the experimental group, subjects were randomized to receive MOPs to either the left or right maxillary molar region (n = 10). The control group (n = 10) and the contralateral sides of the experimental group (n = 10) did not receive any MOPs. In both groups, distalization of the maxillary molars was performed by miniscrew-supported distalization appliances. Using 3D models, maxillary molar distalization at 3, 6, 9, and 12weeks was measured. Pain, discomfort, eating difficulty, and speech problem levels were assessed using avisual analog scale (VAS 0-10). Periodontal evaluations were performed. In all, 18subjects completed the study. The mean amount of tooth movement was significantly greater on the MOP side compared to contralateral side of the experimental group at all time points. After 12weeks, the maxillary molars on the MOP side moved 1.17-fold more than those on the contralateral side. No significant differences were found regarding amount of tooth movement between the control group and the MOP and contralateral sides of the experimental group. The rates of tooth movement in the MOP sides of the experimental group, contralateral sides of the experimental group, and the control group were 0.029, 0.025, and 0.028 mm/day, respectively. Pain VAS scores after intervention were significantly increased on the MOP side compared with the contralateral side of the experimental group but not at any other time point. No differences in periodontal scores between the groups were observed. A1.17-fold increase in the rate of tooth movement in the MOP group compared with the contralateral side was recorded. However the accelerating effect of MOPs was lower than expected. The mean pain level was statistically greater in the MOP group compared to the contralateral side only on the first day of application.

Pain assessment during mandibular nerve block injection with the aid of dental vibe tool in pediatric dental patients: a randomized clinical trial.

This study aimed to evaluate the effectiveness of DentalVibe in pain reduction during local anesthetic injection compared to traditional injection in pediatric patients. This cross-over randomized controlled clinical trial included a sample of 60 children, aged 5 to 7 years, who were selected based on the need for local anesthesia for bilateral mandibular pulpotomy treatment. They were randomly allocated into two groups. Each group received two mandibular nerve block injections, with a 2-week interval as the washing out period. At first appointment, mandibular nerve block injection was performed either with vibration using DentalVibe at the injection site or benzocaine gel 20% applied before local anesthetic injection; the alternative technique was used at the second appointment. In each visit subjective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and objective pain was evaluated using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Assessment using the Wong-Baker FACES Pain Rating Scale showed that the mean pain levels in DentalVibe and traditional injection groups were 0.80 ± 1.34 and 2.60 ± 3.22, respectively. The mean pain levels according to the FLACC scale were 2.20 ± 2.04 and 3.13 ± 2.30 in the DentalVibe and traditional injection groups, respectively. Both scales showed statistically significant differences between the two groups in favor of DentalVibe (P < .001). A positive significant correlation between the two scales in the two interventions was recorded, where the Spearman rho was 0.41 for the DentalVibe group, and 0.52 for traditional injection group (P < .001). Compared to the traditional approach, DentalVibe reduced pain sensation during mandibular nerve block injection in pediatric patients.

Distraction-based relief of pain associated with peripheral intravenous catheterisation in adults: a randomised controlled trial.

This study aimed to determine the effect of methods of distraction to relieve pain associated with the peripheral intravenous catheter (PIC) insertion procedure, thus improving patient satisfaction. Specifically, we examined such effect by playing 3D videos with virtual reality goggles and showing pictures to the patient containing distractive optical illusions. In the literature, although the efficacy of various pharmacological methods for reducing pain associated with the insertion of PIC has been evaluated in adults, studies on nonpharmacological methods are limited. The research was conducted with a randomised controlled single-blind experimental study. The sample consisted of 120 patients. While nothing is applied to the control group, cards containing distractive optical illusion pictures and playing 3D videos with VR goggles during PIC insertion is applied for distraction groups. The data collection form consisted of items that measured the sociodemographic characteristics of the patients and a visual analog scale. The CONSORT checklist was followed in reporting this study. This study is registered with ClinicalTrials.gov. No. NCT03945929. The mean pain level was 4.72±3.15 in the control group and 3.41±2.81 in the distraction groups and the difference was found to be statistically significant (p=.02). When the mean satisfaction level between the groups was compared, it was found to be 5.12±3.41 in the control group and 8.07±2.67 in the groups undergoing distraction methods. The difference between them was statistically significant (p=.01). This study found that the use of cards containing distractive optical illusion pictures and playing 3D videos with VR goggles during PIC insertion in adult patients were both effective. These distraction methods may be used to reduce pain due to PIC insertion in nonurgent and less urgent adult patients in the emergency department.

Clinical and radiological outcomes of 40 cases of SLAC and SNAC wrist treated by four-corner arthrodesis with locking plate

The treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist varies. No clear consensus exists on surgical indications. Scaphoid excision and four-corner arthrodesis with locking plate is one of preferred treatments for these lesions. The purpose of this study was to assess the clinical and radiological outcomes of locking plates for treating SNAC and SLAC wrist after a mean follow-up of 5 years and to compare these outcomes with the results reported in the literature. A retrospective study was conducted in two hospitals, involving 40 patients who underwent scaphoid excision and four-corner arthrodesis with locking plate between January 2006 and September 2016. All patients were reviewed as outpatients with clinical and radiographic measurements. At the last follow-up, the mean pain level on visual analog scale (VAS) was 2.5/10 [0–7] (SD: 1.7). Patients had a mean flexion of 46% and a mean extension of 46% compared to the contralateral side. An 18% gain was observed in grip strength. The mean postoperative QuickDASH score was 30 [0–57] (SD: 15.3). Seventy percent of patients were satisfied with the operation. Complete (all four joint interfaces) joint space fusion was achieved in 55% of patients. Only one patient (2.5%) had no joint fusion. The joint between the lunate and the capitate was fused in 38 patients (95%). Nine patients suffered complications; eight of them required surgical revision (20%). Four-corner arthrodesis with locking plate is a valuable surgical technique for treating SLAC and SNAC wrist because it preserve satisfactory range of motion and grip strength (64% compared to the non-operated side), maintains the height of the carpus and prevents the premature appearance of radiocarpal osteoarthritis, as long as the technical challenges of this procedure are mastered.

Ten-year radiological and clinical outcomes of capitolunate arthrodesis with scaphoid and triquetrum excision for advanced degenerative arthritis in the wrist: Single-center, retrospective case series with 10 patients

The aim of this study was to evaluate the long-term outcomes of capitolunate arthrodesis for treating advanced wrist osteoarthritis. The arthrodesis procedures were performed in three women and seven men having a mean age of 59years (range, 20–70). Eight of the patients were manual laborers. The dominant hand was operated on in seven patients. The osteoarthritis was attributed to scapholunate dissociation (SLAC) in six patients and scaphoid nonunion (SNAC) in four patients. The arthrodesis site was stabilized with two vertical compression screws. Patients were reviewed after an average follow-up of 122months (80–172). The clinical and radiological outcomes consisted of measuring pain on a visual analog scale (VAS), determining the QuickDASH and PRWE scores, the patients’ satisfaction, the radiolunate and capitolunate angles, carpal height, radiolunate joint condition, and fusion of the arthrodesis site. The mean pain level was reduced from 5 to 1 (P<0.05). The range of motion improved by 20° in flexion-extension and 10° in radioulnar deviation, while strength improved by 8kg relative to the preoperative measurements (P<0.05). The QuickDASH was 15points (±12) and the PRWE was 20 (±32). Relative to the preoperative values, the radiolunate angle was reduced by 4.5° and the capitolunate angle by 6.5°. Carpal height was 6.5mm less on average (P<0.05). None of the patients had a nonunion or deterioration of the radiolunate joint. One patient developed Type II complex regional pain syndrome. The nine other patients were able to return to work. Capitolunate arthrodesis provided pain relief and good function in 9 of the 10patients in our case series. The results was maintained over time, both in terms of mobility and pain relief, which were clearly improved after the surgical treatment. We found no signs of deterioration of the radiolunate joint over 10years. There are very few published studies describing the long-term outcomes of this procedure. Our findings are consistent with those in the literature, which makes capitolunate arthrodesis with scaphoid and triquetrum excision a highly satisfactory and reliable technique in the long term for the treatment of advanced osteoarthritis in the wrist. Level of evidenceIV

Caregiver-Delivered Foot Reflexology: Effects on Patients and Caregivers.

The aim of this study was to evaluate the effects of caregiver-delivered foot reflexology on patients with cancer and their caregivers. A 2-group pre- and posttest design was used in this study, and the study was conducted in an oncology hospital between January 2016 and February 2018. The study included 60 patients and 60 caregivers. Caregivers performed interventions once a day for 15 days. Patients in the experimental group received reflexology, and patients in the control group were included in the reading session. Mean pain, anxiety, and fatigue levels significantly decreased for the patients who received foot reflexology from their caregivers for 15 days compared with patients in the control group. The mean care burden score of the caregivers in both groups decreased. Clinicians should teach caregiving practices such as foot reflexology and know that these practices are a positive influence on both patients and caregivers.

Complications and Long-Term Outcomes of Open Reduction and Plate Fixation of Proximal Humeral Fractures.

The optimal treatment of complex proximal humeral fractures in adults remains controversial. We evaluated the risk of complications and the long-term outcomes in patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus treated with open reduction and plate fixation (ORIF). Between 1995 and 2012, 5,897 consecutive patients with a proximal humeral fracture were referred to a specialist shoulder clinic for surgical assessment. Indications for surgery included anterior or posterior fracture-dislocation, substantial tuberosity involvement with >1 cm of displacement in a Neer 3 or 4-part fracture configuration, disengagement of the head from the shaft, or severe varus or valgus deformity of the head. All patients who met the surgical criteria and had been followed for 2 years were included, and standardized clinical and radiographic assessments of outcomes were performed. At a median of 10.8 years (range, 5 to 22 years) after ORIF, all surviving cognitively intact patients completed a patient-reported questionnaire assessing functional outcomes and satisfaction. Three hundred and sixty-eight patients (6.2%) met the inclusion criteria and had the appropriate follow-up. The study population had a high rate of complex fracture configurations; 77.2% had tuberosity involvement, 54.1% had complete head-shaft disengagement, and 44.0% had a dislocated head. Eighty-seven patients (23.6%) had postoperative stiffness, 25 (6.8%) had fixation failure/nonunion, and 16 (4.3%) had late osteonecrosis/posttraumatic osteoarthritis; these complications were the reason for the majority of the reoperations in the cohort. The survivorship until any reoperation was 74% at 10 years, but when reoperations for stiffness were excluded, the survivorship was 90% during the same time period. The patients' mean levels of pain, function, and satisfaction with treatment were good to excellent. Our results support the use of primary ORIF in medically fit patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus in centers where the expertise to carry out such treatment exists. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.