Mean Numeric Rating Scale Pain Research Articles

Assessment of Pain in Glaucoma Patients Undergoing Micropulse Transscleral Laser Therapy

This study aimed to assess the pain experienced during micropulse transscleral laser therapy (MPTLT) and overnight thereafter and explore the factors associated with the pain. This prospective study included 100 eyes of 81 glaucoma patients undergoing MPTLT under retrobulbar anesthesia. All patients were asked to rate both types of pain using a numerical rating scale (NRS). The risk factors were explored using multivariable mixed-effects ordinal logistic regression. The mean (SD) NRS pain score during the procedure was 3.57 (3.41) (range 0-10), which included no, mild, moderate, and severe pain in 30 (30%), 33 (33%), 17 (17%), and 20 (20%) eyes, respectively. The mean (SD) NRS score of overnight pain was 2.99 (2.28) (range 0-9), which included no, mild, moderate, and severe pain in 17 (17%), 59 (59%), 17 (17%), and 7 (7%) eyes, respectively. Twenty-seven (27%) eyes reported worse pain overnight than during the procedure. Increased age, initial intraocular pressure, and pain during the procedure were significantly associated with increased overnight pain (p < 0.05). Up to a fourth of eyes had worse pain after discharge. Older age, initial intraocular pressure, and pain during the procedure were risk factors for higher levels of overnight pain.

Patient-Reported and Radiographic Outcomes After Revision Sacroiliac Joint Fusion.

Sacroiliac joint fusion (SIJF) has been established as an effective treatment for sacroiliac joint dysfunction. However, failure necessitating revision has been reported in up to 30% of cases. Little is known regarding outcomes of revision SIJF. We retrospectively reviewed all revision SIJF at a single academic center between 2017 and 2020. Revision surgery was performed using the principles of joint decortication, bone grafting, compression, and rigid internal fixation. Outcomes were assessed at 6 months and 1 year after surgery using the Oswestry Disability Index (ODI), Numeric Pain Rating Scale (NPRS), and Single Assessment Numeric Evaluation (SANE) scale. Fusion was assessed using computed tomography at 12 months postoperatively. Eighteen revision SIJFs in 13 patients were included. The mean age was 55.8 years (range 35-75). Mean body mass index was 27.9 (range 21.7-36.7). Sixty-two percent of the patients were women. The indications for revision were pseudarthrosis without fixation failure in 14 cases (77.8%), hardware failure (loosening) in 3 cases (16.7%), and continued pain after partial fusion in 1 case (5.6%). ODI and NPRS scores demonstrated significant statistical and clinical improvements at all timepoints. Mean (SD) ODI scores improved from 53.8 (19.9) preoperative to 37.5 (19.8) at 6 months and 32.9 (21.7) at 12 months. Improvement in ODI was found in 15 joints (83.3%), and the minimal clinically important difference (MCID) was achieved in 12 joints (66.7%). Mean (SD) NPRS scores improved from 6.5 (1.4) preoperative to 3.2 (2.8) at 6 months and 3.4 (2.6) at 12 months. Improvement in NPRS was also identified in 17 joints (94.4%), and 10 joints (55.6%) achieved MCID for NPRS. Mean (SD) SANE score was 72.0% (30.8) at 6 months and 70.0% (33.8) at 12 months. There were no radiographic lucencies, implant subsidence, or implant fractures at final follow-up. We identified an 88.9% fusion rate with definitive bridging bone across the sacroiliac joint. Utilizing a principles-based technique of joint decortication, compression, and rigid internal fixation, revision SIJF showed an improvement in patient-reported outcomes as well as high rate of fusion at 12 months. The most common indications for revision SIJF are symptomatic pseudarthrosis and implant loosening. This is the largest series of revision SIJF to date.

Does transcutaneous Vagus Nerve Stimulation (tVNS) reduce pain intensity in chronic low back pain patients? A randomized controlled pilot study

Background: Low back pain, if poorly treated, is responsible for a decline in patients’ quality of life. In addition to medication and exercise therapy, transcutaneous vagus nerve stimulation (tVNS) emerges as one of the modalities for chronic pain. Currently, studies on the effect of tVNS on pain intensity, particularly in chronic low back pain cases, are still scarce. This study aims to examine the effect of tVNS in addition to exercise treatment on patients with chronic low back pain. Methods: Twenty-two patients were randomly assigned to one of two groups: the control group, which included eleven patients who received only exercise therapy, and the intervention group, which included eleven patients who received exercise therapy with tVNS as an additional therapy. The demographic data of the participants and the results of the Numerical Pain Rating Scale (NPRS) were used as outcome measures. Data were collected before and after the two-week treatment period. Safety and adverse events were monitored throughout the study. Results: The mean NPRS decreased in both groups, with the intervention group decreasing from 5.45 to 1.73 (p &lt; 0.001) and the control group decreasing from 5.82 to 3.27 (p &lt; 0.001). Although the intervention group's average NPRS score decreased more than the control groups, no significant difference was found (p=1.04). Following Cohen's D, the effect size of the intervention group was more significant (2.22) than that of the control group (1.62). Conclusion: These findings imply that tVNS should be considered an additional therapy for chronic low back pain patients. During the study, no side effects were discovered.

Efficacy and Safety of Cervical and High-Thoracic Dorsal Root Ganglion Stimulation Therapy for Complex Regional Pain Syndrome of the Upper Extremities

ObjectivesThe purpose of this study was to evaluate analgesic and safety considerations for high thoracic and cervical dorsal root ganglion (DRG) neuromodulation for complex regional pain syndrome (CRPS). We hypothesized that DRG neuromodulation would provide sustained analgesia with complications like that of low thoracic or lumbar electrode implantation. Materials and MethodsA single-center, retrospective study was conducted of patients with CRPS I or II of the upper extremities, refractory to previous therapies, who were treated with DRG neuromodulation in the upper thoracic and cervical spine. The primary outcome was successful DRG therapy, defined as ≥ 50% pain relief on a Numeric Rating Scale (NRS) 0 to 10 pain scale at six months after implantation. A secondary outcome was a reduction in daily opioid use after DRG therapy. ResultsAfter a DRG stimulation trial, 17 of 20 patients (85%) had ≥ 50% improvement in NRS pain and underwent a permanent pulse generator implant, with 100% endorsing ≥ 50% pain relief at six months. Mean NRS pain scores before DRG neuromodulation were 9.3 ± 1.1, with a mean reduction of 5.5 (95% CI, 4.5–6.6; p < 0.001) at six months. Ten patients were taking opioids at baseline; the median (interquartile range) dose was 45 mg (23 to 120) morphine equivalents (MME), which was reduced to 20 MME (15 to 40) at six months. The median reduction in daily MME use was −25 (95% CI, −100 to 20; p = 0.099). Six of 20 patients (30%) experienced a complication: three had lead migration; two experienced paresthesias; and one had a reduction in shoulder mobility. One patient had symptoms of a reversible spinal cord compression immediately after implant, requiring emergent electrode removal. ConclusionsDRG neuromodulation for patients with CRPS of the upper extremities produced clinically important analgesia and reduced opioid use for ≥ six months but was associated with one serious complication.

Prevalence and severity of Bertolottis syndrome in Malaysia: A common under diagnosis.

Bertolotti's syndrome (BS) is defined as the presence of low back pain (LBP), radiculopathy or both with a dysplastic transverse process (TP) of the fifth lumbar vertebra that is articulated or fused with the sacral base or iliac crest. This study aimed to investigate the prevalence and severity of BS to promote awareness of this disease. A retrospective review of anteroposterior lumbosacral plain radiographs was conducted between 1 January and 31 December 2017. Patients were recruited via systematic randomised sampling and were then interviewed and examined. The severity of BS was measured objectively using the numerical pain rating scale (NPRS) and Oswestry disability questionnaire (ODQ). Data were analysed using IBM SPSS for Windows version 22. The prevalence of BS was 9.6% (16/166). Age significantly affected the severity of BS. The older and younger groups had a mean ODQ score of 42.86% and 24.08%, respectively (P=0.006). There was no significant relationship found between the prevalence of BS and age (P=0.126). Only one patient was diagnosed with BS during medical consultation. The mean NPRS score was 5.5. The majority of the BS cases were of moderate severity (43.8%), followed by those of minimal severity (31.2%) and severe disability (25%). Early diagnosis of BS and orthopaedic referral are crucial to halt its progression. BS should be considered in patients presenting with LBP during assessments of lumbosacral radiographs.

Efficacy of Su Jok Seed Therapy in Migraine: A Randomized Placebo-Controlled Study

Introduction: Migraine is an important health problem that negatively affects individuals’ activities of daily living. The decrease in the quality of life because of migraine increases the need for the development of new pharmacological and nonpharmacological treatment methods for pain management. Limited studies have reported the application of a traditional therapy, such as Su Jok seed therapy, to prevent or minimize migraine. This study aimed to examine the effect of Su Jok seed therapy on the severity, duration, and frequency of headaches in patients with migraine. Methods: The study was conducted between September 2020 and February 2021 with 47 students diagnosed with migraine. Of these, 24 patients were included in the intervention group and 23 in the placebo control group. Data were collected using a patient information form developed by the researchers, a migraine diary, the Numeric Pain Rating Scale (NPRS), and the Headache Impact Test-6 (HIT-6) questionnaire. Each patient in the intervention and placebo groups received eight sessions of Su Jok seed therapy, twice a week for 4 weeks. Data were evaluated at the 30th, 60th, and 120th min of the therapy using NPRS, before the therapy (pretest), after the therapy (posttest), and 4 weeks after the therapy (follow-up) using a migraine diary and the HIT-6 questionnaire. Results: Descriptive statistics (mean, standard deviation/standard error, and percentages) were used for data analysis. Student’s t, Mann-Whitney U, repeated-measures analysis of variance, Bonferroni, Friedman, Dunn-Bonferroni, and χ² tests were used in this study. Significance was set at p < 0.05. After the administration of Su Jok seed therapy, the difference in mean NPRS scores between the groups was significant (p < 0.05) from the 60th min of the administration. Furthermore, a significant decrease was observed in the severity, duration, and frequency of headaches; the HIT-6 questionnaire scores; and the amount of painkillers consumed by the patients in the intervention group after the therapy and in the follow-up period compared with the pretest data. Additionally, the level of satisfaction of the patients in the intervention group was significantly higher after the therapy than that of those in the placebo group. Conclusion: Su Jok seed therapy reduced the severity, duration, and frequency of migraines, which in turn reduced the amount of painkillers consumed and the HIT-6 scores of patients with migraines.

Comparative effect of upper thoracic spine mobilization with mobility exercises and upper cervical spine mobilization with stabilization exercises in mechanical neck pain: a randomized clinical trial

Background &amp; Objective: Neck pain is a very prevalent health condition. Physiotherapists use multiple treatment options for treating mechanical neck pain. We evaluated the effects of upper thoracic spine mobilization and mobility exercise and upper cervical spine mobilization and stabilization exercises in treating patients with mechanical neck pain.&#x0D; Methodology: A randomized clinical trial was conducted comprising of 36 patients recruited from different clinics of Faisalabad, both genders, ages from 20-40 y, and randomly divided into two groups. Group A underwent upper thoracic mobilization and mobility exercise while Group B underwent upper cervical mobilization with stabilization exercises for 2 times a week for 4 weeks. Pain scores on Numerical Pain Rating Scale (NPRS) and cervical range of movements (ROM) scores were measured before treatment and then weekly for 4 weeks, while Neck Disability Index (NDI) was assessed at baseline and at the end of 4th week. SPSS version. 22 was used to analyze the data. Independent sample t-test was used for between group compression and P ≤ 0.05 (95%) was considered as significant.&#x0D; Results: There was significant improvement in mean NPRS scores at 1st week, 2nd week, 3rd week and 4th week post-treatment (P &lt; 0.05). There was significant improvement in mean cervical ROM at 2nd week, 3rd week and 4th week post-treatment readings (P &lt; 0.05) and mean NDI score at 4th week (P &lt; 0.05).&#x0D; Conclusion: Both groups were found effective in improving pain, range of motion and neck function, but significant improvement in outcomes was observed in upper cervical mobilization and stabilization exercises group.&#x0D; Abbreviations: NPRS - Numerical Pain Rating Scale; ROM - Range of movements; NDI - Neck Disability Index; MNP - Mechanical neck pain;&#x0D; Key words: Adult; Cervical Vertebrae / physiopathology; Disability Evaluation; Exercise Therapy / methods; Female; Humans; Male; Manipulation, Spinal / methods; Neck / physiopathology; Neck Pain / physiopathology; Neck Pain / rehabilitation; Pain Measurement; Range of Motion, Articular; Thoracic Vertebrae / physiopathology; Treatment Outcome; Young Adult&#x0D; Citation: Tahir R, Sohail MAA, Ain NU, Aine QU, Mannan H, Maqbool A. Comparative effect of upper thoracic spine mobilization with mobility exercises and upper cervical spine mobilization with stabilization exercises in mechanical neck pain: a randomized clinical trial. Anaesth. pain intensive care 2022;26(4):488-495.&#x0D; DOI: 10.35975/apic.v26i4.1952&#x0D; Received: April 11, 2022; Reviewed: June 23, 2022; Accepted: July 14, 2022

Efficacy of telerehabilitation for spine pain during the Coronavirus pandemic lockdown: a retrospective propensity score-matched analysis

Purpose Despite increased usage of telemedicine to deliver treatment during the coronavirus disease 2019 (COVID-19) pandemic, the efficacy of telerehabilitation for spine pain is unknown. This study aimed to investigate the effect of telerehabilitation on pain and disability in patients with spine pain treated during the COVID-19 pandemic and compare the results to in-clinic rehabilitation. Materials & Methods In this propensity score-matched analysis, 428 patients with spine pain who underwent telerehabilitation during the 6 months of COVID-19 pandemic lockdown and 428 patients who underwent in-clinic multimodal rehabilitation treatment during the 6-month period prior to lockdown were compared. Propensity score matching was done based on gender, age, pre-treatment pain, and disability. Post-treatment numerical pain rating scale (NPRS), Oswestry or Neck disability index (ODI or NDI), and minimal clinical important difference (MCID) achieved for NPRS and ODI/NDI scores were compared between the 2 groups. Results Post-treatment, the mean NPRS (mean difference − 1, p < 0.0001) and ODI/NDI (mean difference − 5.8, p < 0.0001) scores, were significantly lower in the telerehabilitation group when compared to control group. Similarly, the percentage of patients who achieved MCID of ≥ 2 for NPRS (mean difference − 6%, p = 0.0007) and MCID of ≥ 10 for ODI/NDI (mean difference − 7.5%, p = 0.005) scores were significantly higher in the telerehabilitation group. Conclusions Telerehabilitation achieved significant reduction in pain and disability among patients with spine pain, better than in-clinic rehabilitation. These encouraging results during the COVID-19 pandemic indicate the need to further explore and test the efficacy and wider application of telerehabilitation for treating spine pain. IMPLICATIONS FOR REHABILITATION Telerehabilitation can help achieve significant reduction in pain and disability among patients with spine pain. These encouraging results indicate the need to further explore a wider application of telerehabilitation for treating patients with spine pain during non-pandemic times.

Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis

IntroductionGenicular nerve radiofrequency ablation (GNRFA) is a minimally invasive intervention for patients with chronic knee pain (CKP) not responding to conservative treatments. Few investigations have compared treatment outcomes of cooled-RFA...

Efficacy of Three Desensitizing Agents to Reduce Cervical Dentin Hypersensitivity: A Randomized Clinical Trial

Introduction: Dentin hypersensitivity (DH) is a commonly encountered dental complaint, management of which is often challenging to dentists. It occurs when dentinal tubules are patent both at the pulpal and the oral surface. It is widely accepted that DH affects function and quality of life. Thus, it is necessary for dentists to manage it properly. Objective: The objective of this study was to assess the efficacy of VivaSens and Propolis in comparison to Gluma in reducing cervical dentin hypersensitivity. Methods: A randomized clinical trial, double-blinded, parallel-group study was conducted among forty-five patients. They were randomly allocated into three different groups (n=15): Gluma (positive control), VivaSens, and Propolis. Tactile and evaporative methods were used to assess pain using the Numeric Pain Rating Scale (NPRS) in patients with cervical abrasion, with a complaint of dentin hypersensitivity. Pain score was recorded preoperatively, immediately after application, at one week and one month postoperatively. Data were analyzed using SPSS version 11.5 and Microsoft Excel version 2010. Mean NPRS scores were calculated. Results: All three desensitizing agents significantly reduced DH scores from baseline to all subsequent follow-ups (p&lt;0.001). Kruskal–Wallis test elicited no significant differences in the mean difference in DH scores among positive control and test groups for both stimuli at all-time intervals (p &lt; 0.05). Conclusions: Gluma, VivaSens, and Propolis desensitizing agents were effective in relieving cervical DH. No statistically significant difference was found in relieving DH among the agents in all subsequent follow-ups.

Comparison Of the Effectiveness of Maitland Manipulation of Thoracic Spine Versus Grade I And II Maitland Mobilization of Cervical Spine on Pain Intensity and Functional Status in Patients of Cervical Radiculopathy

Cervical radiculopathy (CR) is a most reported pathological problem mainly due to herniated disc material causing nerve compression or the formation of osteophytes. This impingement specifically causes cervical pain radiating to arm, numbness, and sensory deficit. It also affects the motor function of the neck and upper extremities. Objectives: To evaluate the comparative effectiveness of Maitland manipulation of thoracic spine versus grade I and II Maitland mobilization of cervical spine on Pain, intensity, and functional status in patients of cervical radiculopathy. Methods: Total 32 patients suffering from cervical radiculopathy were randomly assigned to receive Maitland manipulation on thoracic spine along with Conventional Physiotherapy (intermittent cervical traction, strengthening exercises) in Group A(n=16) and Maitland mobilization on cervical spines along with Conventional Physiotherapy in Group B (n=16). Total treatment sessions given to each group was 9 (3 sessions per week). To measure outcome numeric pain rating scale (NPRS) and neck disability index (NDI) questionnaire was used. Data collection was done at the beginning and post-treatment. Results: The study revealed that the mean age of patients was 47.59 with a range minimum of 27 years to a maximum of 59 years. Comparison of post-treatment of both groups showed mean NPRS score in group A (Maitland thoracic spine manipulation) was 4.56± 1.031 and group B (Maitland cervical spine mobilization) was 6.12± 0.50, while post-treatment NDI score group A was 22.44± 10.09 and group B was 36.88± 8.437 with p=0.000 that was p&lt;0.05. Conclusion: The study concluded that both Maitland thoracic spine manipulation and Maitland cervical spine mobilization techniques have similar effects in reducing cervical radiculopathy and increasing active range of motion. However, Maitland thoracic spine manipulation showed better results in neck pain reduction and improved functional status on the comparison.

Analgesic Efficacy and Safety of Spinal Oxycodone in Total Hip Arthroplasty: A Preliminary Study.

The aim of this study was to assess the analgesic efficacy and safety of 1 mg and 0.5 mg oxycodone administration in a spinal block procedure for a total hip arthroplasty (THA). Forty-two THA patients aged 59-81 with American Society Anesthesiology (ASA) II-III were included. All patients received anesthesia using spinal blockade, with bupivacaine 0.5% spinal heavy 2.5 ml, with 0.5 ml oxycodone hydrochloride 1.0 mg (group A; n = 28) or 0.5 mg (group B; n = 14). During surgery, each patient was sedated with 2-4 mg/kg/h intravenous propofol infusion. They received 100 mg intravenous ketoprofen at the end of the surgery at 8 pm and 8 am, with recommended doses every 12 h thereafter. Subcutaneous morphine 5 mg was used as a rescue analgesic, and the time to morphine use was recorded. After surgery, pain intensity (at the moment of patient report) was assessed using an 11-point numerical rating scale (NRS). The incidence of adverse effects was monitored. Blood samples were taken for assays of serum oxycodone, noroxycodone and bupivacaine levels. The time to rescue analgesia was 9.6 ± 5.6 h in group A and 7.3 ± 1.9 h in group B, and it did not differ between patient groups (P = 0.179). The mean NRS pain score was 4.5 in group A and 4.2 in group B. Three group A patients had detectable oxycodone levels: two < 7.1 ng/ml and in 1 spinal block induced anesthesia was unsuccessful and so he/she underwent general anesthesia (this patient was excluded from the analysis). Four group B patients had single values < 5 ng/ml. Noroxycodone levels were in all patients undetectable, and bupivacaine levels were 70-300 ng/ml. Regarding adverse effects, one patient had hypotension, one had bradycardia, and one had pruritus. Oxycodone in spinal block prolongs analgesia period, does not cause serious adverse effects and seems to be safe and effective opioid for patients undergoing THA.

Effect of ischemic compression performed by family caregivers on myofascial pain syndrome and the care burden of the families of patients: a multicenter open-label randomized comparative study.

Ischemic compression is a manual therapy technique for myofascial pain. This study aimed to verify the effect of ischemic compression performed by family caregivers on myofascial pain syndrome (MPS) in patients and on the family's care burden. This multicenter, open-label, randomized, comparative study included patients with myofascial pain and their family caregivers who were randomized into the following groups: ischemia compression (performed by a family caregiver), sham ischemia compression, or untreated control. The effectiveness and safety of ischemic compression and the burden on family caregivers were evaluated. The primary endpoint was the rate of 50% or more improvement in the patient's mean numerical rating scale pain score in the previous 24 hours, 14 days after starting the intervention. The secondary endpoint was the rate of change in the family caregivers' reaction assessments. A total of 75 patients and caregivers (70 patients with cancer and family caregivers) who received home medical care were enrolled at three facilities. The study completion rate was 94.7%, and there were no adverse events. The rate of 50% or more improvement in the numerical rating scale score was 64.0% in the ischemic compression group, 16.0% in the sham ischemic compression group, and 4.0% in the control group (P<0.001). Caregivers' self-esteem was significantly lower in the ischemic compression and sham ischemic compression groups than in the control group. However, there was no significant difference between the two groups (P=0.370). Ischemic compression for myofascial pain in patients performed by family caregivers can increase the analgesic effect in patients and self-esteem in family caregivers. The University Hospital Medical Information Network Clinical Trials Registry (approval number: UMIN000036605).

Prevalence of Cannabinoid (CBD) Use in Orthopaedic Sports Medicine Patients.

Background:Although there is some evidence that cannabinoid (CBD) products may provide a therapeutic effect for musculoskeletal pain, little is known about the usage patterns or their prevalence of use in orthopaedic sports medicine patients.Purpose:To report the prevalence and perceived self-efficacy of CBD products in patients evaluated in an orthopaedic sports medicine clinic.Study Design:Descriptive epidemiology study. Level of evidence, 2.Methods:The study population consisted of new patients who visited an orthopaedic surgery sports medicine clinic at a large academic center for consultation with a surgeon between August 2020 and March 2021. All patients were asked to complete a survey that assessed perceived pain and effectiveness of CBD products and other nonsurgical treatment modalities using the Single Assessment Numeric Evaluation score (range, 0-100) and the Numeric Pain Rating Scale (NRS). Descriptive factors were collected via chart review. Descriptive statistics were used to characterize the data.Results:Overall, 823 patients completed the survey (45.4% female; mean age, 51 years [range, 18-87 years]; mean body mass index, 28.9 [range, 17.2-58.4]). Body areas involved included 285 shoulders, 44 elbows, 76 hips, 276 knees, 58 ankles, and 77 other. Of these patients, 19% (152/823) endorsed the use of CBD products before their initial evaluation. The mean NRS for pain was significantly different between non-CBD users and CBD users (5.6 vs 6.1; P = .029). CBD users were significantly more likely to have tried other nonoperative modalities compared with nonusers, including nonsteroidal anti-inflammatory drugs (79.6% vs 69.8%; P = .032), bracing (44.7% vs 34.6%; P = .024), steroid injections (38.8% vs 21.6%; P < .001), and physical therapy (54% vs 36.1%; P < .001). In addition, 30.9% of CBD utilizers reported marijuana use compared with 2.8% of non-CBD users (P < .001) for management of their pain.Conclusion:In the current study, 19% of patients had used CBD products to manage joint-related issues. Sports medicine providers should be aware of this high incidence of usage and the potential interactions CBD products may have with other treatment modalities. Further studies are needed to assess the effectiveness of CBD as a therapeutic agent and the specific interactions it has with other drugs and other forms of treatment.

Efficacy of 10 kHz spinal cord stimulation in complex regional pain syndrome: A retrospective analysis

IntroductionWe examine the clinical efficacy of High Frequency 10 kHz (HF10) spinal cord stimulation (SCS) CRPS patients. Materials and methodsThis is a retrospective cohort study of SCS-naïve patients with CRPS treated with HF10-SCS after a successful trial. Patients were evaluated at 2 weeks, 6 weeks, 3 months, and 6 months post-operatively. Outcomes included mean numeric pain rating scale (NRS), mean NRS reduction, NRS percentage improvement (PI), patient reported subjective pain PI (Pain PI), and patients reporting > 50% benefit in symptoms. Pre and post-operative NRS were compared by ordinal regression analysis accounting for the patient’s response to the SCS trial. Results20 patients met inclusion criteria. 75% were female. Mean age 51 years. Baseline mean NRS was 6.1 for the cohort (1.7). Post-operatively, mean NRS decreased to 4.5 at 2 weeks (p = 0.077), 3.8 at 6 weeks (p = 0.034), 3.7 at 3 months (p = 0.307), and 4.4 at 6 months (p = 0.832). Mean NRS reduction and NRS PI is reported within. Pain PI was 25% at 2 weeks, 55% at 6 weeks, 54% at 3 months, and 53% at 6 months. Greater than 50% reduction in symptoms was reported in 25% of patients at 2 weeks, 85% at 6 weeks, 87% at 3 months, and 64% at 6 months. ConclusionsHF10 SCS may represent an effective treatment option for reducing objective and subjective symptoms in CRPS that warrants further study.

CT-Guided Percutaneous Vertebroplasty for Vertebral Non-union Following Posterior Fixation: A Preliminary Retrospective Study

Traumatic thoracolumbar vertebral fractures are frequently treated with posterior fixation (PF) and vertebral augmentation. Sometimes, it is deemed too risky to offer vertebral augmentation under fluoroscopic guidance alone. Adjuvant CT/fluoroscopy-guided percutaneous vertebroplasty (PVP) could be offered in certain scenarios. The aim was to evaluate feasibility, safety and effectiveness of PVP in patients presenting with vertebral non-union (VNU) following PF performed without concomitant vertebral augmentation. All patients treated in our institution with PVP between July 2015 and July 2020 were retrospectively reviewed. Patients treated with CT/fluoroscopy-guided PVP under local anesthesia for symptomatic VNU following PF were selected. Three criteria were established to assess cement distribution, considering vertebral filling of: (1) fracture cleft, (2) anterior two-thirds of the vertebral body, (3) from superior to inferior endplates. Numeric pain rating scale (NPRS) assessing grade of discomfort (0 = no pain; 10 = worst pain) and complications were evaluated before and 1month after PVP. Ten patients were identified (mean age 53 ± 12y). Mean time between PF and PVP was 9.6 [2-35] months. Two patients required further cement injection with a second PVP. Eight patients had satisfactory vertebral filling according to the three criteria. Mean NPRS reduction was 2.7(-42%, p < 0.05). No significant complications occurred. Combined CT/fluoroscopy guidance seems a useful tool to perform PVP in VNU following PF, even in presence of orthopedic metalwork. Interventional radiologists may help in these scenarios, performing an adjuvant PVP under local anesthesia. In this small series, the procedure seems safe and effective and could be taken in consideration as alternative to revision surgery.

Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation.

There has been increasing interest in the use of spinal anesthesia (SA) for spine surgery, especially within Enhanced Recovery After Surgery (ERAS) protocols. Despite the wide adoption of SA by the orthopedic practices, it has not gained wide acceptance in lumbar spine surgery. Studies investigating SA versus general anesthesia (GA) in lumbar laminectomy and discectomy have found that SA reduces perioperative costs and leads to a reduction in analgesic use, as well as to shorter anesthesia and surgery time. The aim of this retrospective, case-control study was to compare the perioperative outcomes of patients who underwent minimally invasive surgery (MIS)-transforaminal lumbar interbody fusion (TLIF) after administration of SA with those who underwent MIS-TLIF under GA. Overall, 40 consecutive patients who underwent MIS-TLIF by a single surgeon were analyzed; 20 patients received SA and 20 patients received GA. Procedure time, intraoperative adverse events, postoperative adverse events, postoperative length of stay, 3-hour postanesthesia care unit (PACU) numeric rating scale (NRS) pain score, opioid medication, and time to first ambulation were collected for each patient. The two groups were homogeneous for clinical characteristics. A decrease in total operating room (OR) time was found for patients who underwent MIS-TLIF after administration of SA, with a mean OR time of 156.5 ± 18.9 minutes versus 213.6 ± 47.4 minutes for patients who underwent MIS-TLIF under GA (p < 0.0001), a reduction of 27%. A decrease in total procedure time was also observed for SA versus GA (122 ± 16.7 minutes vs 175.2 ± 10 minutes; p < 0.0001). No significant differences were found in intraoperative and postoperative adverse events. There was a difference in the mean maximum NRS pain score during the first 3 hours in the PACU as patients who received SA reported a lower pain score compared with those who received GA (4.8 ± 3.5 vs 7.3 ± 2.7; p = 0.018). No significant difference was observed in morphine equivalents received by the two groups. A difference was also observed in the mean overall NRS pain score, with 2.4 ± 2.1 for the SA group versus 4.9 ± 2.3 for the GA group (p = 0.001). Patients who received SA had a shorter time to first ambulation compared with those who received GA (385.8 ± 353.8 minutes vs 855.9 ± 337.4 minutes; p < 0.0001). The results of this study have pointed to some important observations in this patient population. SA offers unique advantages in comparison with GA for performing MIS-TLIF, including reduced OR time and postoperative pain, and faster postoperative mobilization.

A Safety Study for Long-Time Use of a Novel Pain Management Device, AT-04

Abstract Fibromyalgia is a common chronic pain disorder characterized by widespread pain and tenderness in mostly tendon attachments with unknown etiology. Treatment of fibromyalgia is mainly drug and other treatments, especially cognitive behavioral therapy and exercise therapy combined. However, drugs for fibromyalgia have, in general, broad adverse effects. Thus, an unmet medical need remains for effective therapeutic modalities for fibromyalgia. We have recently developed a new magnetic medical device (project code “AT”) that has alternating magnetic fields and stimulates the affected area for pain relief. In the pilot study, AT treatment (twice daily for 10 min) tended to reduce the mean NRS (Numerical Rating Scale) pain score. Moreover, we demonstrated long treatment (30 min) suppressed LPS-induced (Lipopolysaccharide-induced) mRNA IL-6 expression compared with 10-min treatment in vitro. These results assumed that long treatment has high efficiency. To evaluate the safety of long time (120 min/day) AT treatment for 12 weeks. Single center, prospective, open-label, single-arm, intervention study to demonstrate the safety of long-time use of AT in 5 healthy Japanese volunteers to 12 weeks. During the intervention period, all of the adverse events were measured. The represents of AT treatment was 99.8 % in 5 subjects. The average and median exposure time of the study device was 135 min per day and 132 min per day, respectively. There were 3 nonserious adverse events and no serious adverse events during this study. This study tested long-time use of AT among 5 healthy subjects in Japan and showed that it did not pose any significant safety concerns. Because there are in-house in vitro data suggesting that the longer exposure of AT achieves a greater effect, the result of this study may allow us to conduct further studies to confirm more effectiveness and safety of long-time use of AT in a larger scale of clinical trial.

Comparative Study to Evaluate Efficacy and Safety for Management of Neuropathic Pain with Gabapentin, Pregabalin, and Amitriptyline

Background: Current treatments for neuropathic pain (NeP) are tricyclic antidepressants (TCA), such as pregabalin and gabapentin are first-line drugs for the management of NeP complaints. Current treatment for the management of neuropathic pain is often sub-standard. Methods: It's a three-arm, prospective, comparative, open-label study. A total of 270 patients with persistent lumbar radiculopathy were randomized into three groups based on clinical examination, symptoms, X-rays, and MRI scans of the lumbosacral spine. Patients in Groups A and B got Gabapentine 300 mg, Pregabaline 75 mg, and Amitriptyline 75 mg, respectively. Results: The mean NPRS score at two months was 3.72 ± 2.65 for Group A, 3.63 ± 2.65 for Group B, and 5.21 ± 2.65 for Group C. The F-value was 6.63, and the p-value was 0.001, which was statistically significant. As compared to the other two treatment groups, the subjects in Group 3 saw a significant difference. ‎ The adverse effects reported occurrence of dizziness was significantly more in group B with 21 patients (23.33%) as compared to group A with 11 patients (12.22%) and group C with 4 patients (4.44%), [p=0.041). The sedation occurred in 28 patients of group B (31.11%), which was significantly more than group A i,e, in 23 patients (25.55%) and group C, i.e., 22 patients (24.44%), [P=0.036]. Conclusions: In patients with NeP Thus, in conclusion, three groups Gabapentine, Pregabaline, and Amitriptyline, are equally efficacious in relieving pain in NeP. Pregabalin has advantages in terms of Numeric pain rating scale (NPRS) score over the Gabapentine and Amitriptyline. Gabapentine has fewer reported adverse effects and hence better patient compliance on long-term use. Keywords: Gabapentine, Amitriptyline, Pregabalin, Neuropathic pain

Ketamine administration for acute painful sickle cell crisis: Arandomized controlled trial.

ObjectiveThe objective was to evaluate the efficacy and safety of single‐dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC).MethodsThis study was a parallel‐group, prospective, randomized, double‐blind, pragmatic trial. Participants were randomized to receive a single dose of either ketamine or morphine, infused over 30 min. Primary outcome was mean difference in the numerical pain rating scale (NPRS) score over 2 h. NPRS was recorded every 30 min for a maximum of 180 min and secondary outcomes were cumulative dose of opioids, emergency department (ED) length of stay, hospital admission, change in vital signs, and drug‐related side effects. Authors performed the analysis using intention‐to‐treat principle.ResultA total of 278 adults with SCD and who presented with acute sickle VOC participated in this trial. A total of 138 were allocated to the ketamine group. Mean (±standard deviation [SD]) NPRS scores over 2 h were 5.7 (±2.13) and 5.6 (±1.90) in the ketamine and morphine groups. The ketamine group received significantly lower cumulative doses of morphine during their ED stay (mean ± SD = 4.5 ± 4.6 mg) than of the morphine group (mean ± SD = 8.5 ± 7.55 mg). Both groups had similar rates of hospital admission: 6.3% in the ketamine group had drug‐related side effects compared to 2.2% in the morphine group.ConclusionEarly use of ketamine in adults with VOC resulted in a meaningful reduction in pain scores over a 2‐h period and reduced the cumulative morphine dose in the ED with no significant drug‐related side effects in the ketamine‐treated group.