Mean Numeric Rating Scale Research Articles

A phase 2 study of oral difelikefalin in subjects with chronic kidney disease and moderate-to-severe pruritus

Chronic pruritus is burdensome for patients with chronic kidney disease (CKD). We evaluated difelikefalin efficacy and safety in reducing itch in subjects with non-dialysis-dependent CKD and those undergoing hemodialysis (HD). This phase 2, double-blind, randomized, placebo-controlled, dose-finding study enrolled non-dialysis-dependent CKD (stage 3-5) and HD subjects with moderate-to-severe pruritus. Subjects were equally randomized to oral difelikefalin (0.25, 0.5, or 1.0mg) or placebo once daily for 12weeks. The primary end point was the change in the weekly mean Worst Itching Intensity Numeric Rating Scale (WI-NRS) score at week 12. Two hundred sixty-nine subjects were randomized (mean [SD] baseline WI-NRS: 7.1 [1.2]). Difelikefalin 1.0mg significantly reduced weekly mean WI-NRS scores versus placebo at week 12 (P=.018), with numerical reductions observed with difelikefalin 0.25 and 0.5mg. At week 12, 38.6% of subjects receiving difelikefalin 1.0mg achieved a complete response (WI-NRS 0-1) versus 14.4% receiving placebo. Difelikefalin resulted in ∼20% improvement in itch-related quality-of-life measures. The most common treatment-emergent adverse events were dizziness, fall, constipation, diarrhea, gastroesophageal reflux disease, fatigue, hyperkalemia, hypertension, and urinary tract infection. Study duration was 12weeks. Oral difelikefalin significantly reduced itch intensity in stage 3-5 CKD subjects with moderate-to-severe pruritus, supporting continued development for this condition.

Pain resolution and functional outcomes of total mesh excision: a case series.

The objective was to assess the impact of total excision of polypropylene midurethral slings (MUS) on patient pain levels and to report on functional outcomes including recurrent/de novo stress urinary incontinence (SUI), sexual function, and quality of life measures. This is a retrospective analysis of patients who underwent total MUS excision from March 2017 to December 2019. The primary outcome was the impact on pain assessed by a Numeric Rating Scale (NRS). Questionnaires analyzed were: Pain Catastrophizing Scale, Pelvic Floor Distress Inventory Short Form-20, Female Sexual Function Index, and McGill Pain Index questionnaires. Thirty-two women underwent total mesh excision within the inclusion period; with follow-up data available for 31 out of 32; 14 (43.8%) had previously undergone one or more partial vaginal mesh excision procedures. Types of MUS removed were: 14 (43.8%) transobturator midurethral slings, 12 (37.5%) retropubic midurethral slings, 4 (12.5%) mini-slings, and 2 (6.3%) mesh slings placed by laparotomy. Pain was the main reason for referral in 31 patients (96.9%). Mean pain NRS reduced from 6.1 pre-operatively to 3.3 post-operatively, with paired comparison showing a significant difference (p<0.01). Qualitatively, complete symptoms resolution was observed in 10 out of 31 (32.3%), another 9 out of 31 (29.0%) patients experienced clinically significant improvement, 2 out of 31 (6.5%) did not experience improvement in pain, and 10 out of 31 (32.3%) reported new/worsening pain. Post-operative complications occurred in 9 (29.0%) patients; all were Clavien-Dindo grade II. Nineteen (61.3%) reported de novo/recurrent SUI post-operatively. Total MUS mesh excision yields high complication and SUI recurrence rates, counter-balanced by a 61.3% pain resolution/improvement rate. These data are pertinent for patient counseling.

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.

A real-world observational study of dupilumab treatment in adult patients with prurigo nodularis

BackgroundPrurigo nodularis (PN) is a chronic inflammatory skin condition that has a significant unmet needs for effective treatment options. ObjectiveTo assess the efficacy and safety of dupilumab in adult patients with PN refractory to traditional therapies. MethodsThis ongoing, real-life study examined dupilumab treatment in 8 adult patients diagnosed with PN for at least 6 months. The included patients were prescribed 300 mg dupilumab biweekly for at least 16 weeks. Efficacy was the primary outcome by means of multiple standardized scale measurements while safety was also reported. ResultsPN patients treated with dupilumab showed notable clinical improvement. After 16 weeks of dupilumab treatment, the mean Investigator Global Assessment (IGA) score reduced from 3.75 to 1.50. Patients mean Numerical Rating Scale Itch Intensity (NRSI), Dermatology Life Quality Index (DLQI), and Hospital Anxiety and Depression Scale (HADS) ratings reduced from 8.625, 15.13, and 14.50 to 1.563, 4.625, and 1.000 respectively. The majority of the patients (87.5%) reported dupilumab as effective while no adverse events have been reported. Study limitationsThis study was limited to a small cohort of adult PN patients and a short-time observation period. ConclusionsDupilumab is effective and tolerable in adult PN patients with significant improvement in skin lesions, itching, and quality of life.

A Case Series on Pain Accompanying Photoimmunotherapy for Head and Neck Cancer

One of the most severe side effects of photoimmunotherapy (PIT) for head and neck cancer is pain. As there are presently no detailed reports on pain and pain management in PIT, we conducted a retrospective case series study. We conducted a retrospective study of five patients who had received PIT at the National Cancer Center Hospital East between January 2021 and June 2022 using medical chart data. All patients experienced pain, evidenced by an increased numerical rating scale (NRS) after PIT, regardless of the illumination method. The daily change in mean NRS rating shows that the pain was highest on the day of PIT, with ratings of 6.8 and 7.8 for the frontal and cylindrical diffuser methods, respectively; it dropped the following day quickly. Four of the five patients received fentanyl injections for postoperative pain management beginning on postoperative day (POD) 0. All patients who underwent therapy using a cylindrical diffuser required postoperative pain management with opioid drugs. Pain after PIT tended to be most intense immediately after or one hour after illumination and declined the following day, suggesting the need to have a pain relief plan in place in advance.

Effect of autologous platelet-rich plasma (PRP) on low back pain in patients with prolapsed intervertebral disc: A randomised controlled trial.

Prolapsed intervertebral disc (IVDP) is a major cause of low back pain. Platelet-rich plasma (PRP) has emerged as a viable option for these patients, with fewer adverse effects and long-term sustainability of pain relief. This double-blinded, randomised study aimed to evaluate the effect of autologous PRP on low back pain in patients with IVDP. A total of 42 patients with IVDP were randomised either to the autologous PRP (n = 21) group or control (epidural local anaesthetics with steroids; n = 21) group. Change in pain was assessed using the Numeric Rating Scale (NRS). Impact of treatment was assessed using the Global Perceived Effect (GPE) scale. All the patients were followed up for six months. Data was compared using Chi-square, independent sample t, and Mann-Whitney U tests. The two groups were similar in their demographic and clinical profile. The baseline mean NRS ± standard deviation (SD) was 6.91 ± 0.94 in the PRP group and 7.38 ± 1.16 in the control group (P = 0.099). At six months, the mean NRS ± SD was 1.43 ± 0.75 in the PRP group compared to 5.43 ± 0.75 in the control group (P < 0.001). The GPE score was also found to be significantly higher in the PRP group, compared to the control group in the final assessment (P < 0.001). During the course of the study, the PRP group showed a consistent decline in NRS, whereas the control group showed an initial decline followed by consistent increase in NRS. PRP provided sustained relief from low back pain due to IVDP and can be recommended as a safe and promising alternative to epidural local anaesthetics and steroids.

Is dorsal root entry zone lesioning effective and safe for managing continuous versus paroxysmal pains post-brachial plexus avulsion?

Patients with brachial plexus avulsion (BPA) experience chronic deafferentation pain characterized by two patterns: continuous background pain and electrical shooting paroxysmal attacks. The authors' aim was to report the effectiveness and safety of dorsal root entry zone (DREZ) lesioning in relieving the two forms of pain over short and long periods. All patients who underwent DREZ lesioning performed by the senior author for medically refractory BPA-related pain between July 1, 2016, and June 30, 2020, in Johns Hopkins Hospital were followed up. The intensity levels for continuous and paroxysmal pains were evaluated using the numeric rating scale (NRS) preoperatively and at 4 time points postsurgery, including the day of discharge, with a mean hospital stay of 5.6 ± 1.8 days; first postoperative clinic visit (33.0 ± 15.7 days); short-term follow-up (4.0 ± 1.4 months); and long-term follow-up (3.1 ± 1.3 years). The percent of pain relief according to the NRS was categorized into excellent (≥ 75%), fair (25%-74%), and poor (< 25%). A total of 19 patients were included, with 4 (21.1%) lost to long-term follow-up. The mean age was 52.7 ± 13.6 years; 16 (84.2%) were men, and 10 (52.6%) had left-sided injuries. A motor vehicle accident was the most common etiology of BPA (n = 16, 84.2%). Preoperatively, all patients had motor deficits, and 8 (42.1%) experienced somatosensory deficits. The greatest pain relief was observed at the first postoperative and short-term follow-up visits, with the lowest proportions of patients having continuous pain (26.3% and 23.5%, respectively) and paroxysmal pain (5.3% and 5.9%, respectively). Also, the highest reductions in mean NRS scores were observed for first postoperative and short-term follow-up visits (continuous 1.1 ± 2.1 and 1.1 ± 2.3; paroxysms 0.4 ± 1.4 and 0.5 ± 1.7, respectively) compared to the preoperative symptomatology (continuous 6.7 ± 3.0; paroxysms 7.9 ± 4.3) (p < 0.001). Most patients had excellent relief of continuous pain (82.4% and 81.3%) and of paroxysms (90.9% and 90.0%) at the first postoperative visit and short-term follow-up visit, respectively. The pain relief benefits had diminished by 3 years after surgery but remained significantly better than in the preoperative assessment. At the last evaluation, the proportion of patients achieving excellent relief of paroxysmal pain (66.7%) was double that for continuous pain (35.7%) (p < 0.001). New sensory phenomena were observed among 10 patients (52.6%), and 1 patient developed a motor deficit. DREZ lesioning is an effective and safe option for relieving BPA-associated pain, with good long-term outcomes and better benefits for paroxysmal pain than for the continuous pain component.

Free Fillet Flap of Lower Extremity: 38 Amputations with Seven Examples of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces.

Extremely high-level lower extremity amputations are rare procedures that require significant soft-tissue and bony reconstruction. This study describes the use of fillet flaps for oncologic reconstruction and the incorporation of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNIs) for chronic pain prevention. The authors performed a retrospective review of patients who underwent lower extremity fillet flaps at MD Anderson Cancer Center from January of 2004 through April of 2021. Surgical outcomes were summarized and compared. Numeric rating scale and patient-reported outcomes measures were collected. Thirty-eight fillet flaps were performed for lower extremity reconstruction. Extirpative surgery included external hemipelvectomy (42%), external hemipelvectomy with sacrectomy (32%), and supratrochanteric above-knee amputation (26%). Median defect size was 600 cm 2 , and 50% included a bony component. Twenty-one patients (55%) experienced postoperative complications, with 16 requiring operative intervention. There was an increased trend toward complications in patients with preoperative radiotherapy, although this was not significant (44% versus 65%; P = 0.203). Seven patients underwent TMR or RPNI. In these patients, the mean numeric rating scale residual limb pain score was 2.8 ± 3.4 ( n = 5; range, 0 to 4/10) and phantom limb pain was 4 ± 3.2 ( n = 6; range, 0 to 7/10). The mean Patient-Reported Outcomes Measures Information Systems T scores were as follows: pain intensity, 50.8 ± 10.6 ( n = 6; range, 30.7 to 60.5); pain interference, 59.2 ± 12.1 ( n = 5; range, 40.7 to 70.1); and pain behavior, 62.3 ± 6.7 ( n = 3; range, 54.6 to 67.2). Lower limb fillet flaps are reliable sources of bone, soft tissue, and nerve for reconstruction of oncologic amputation. TMR or RPNI are important new treatment adjuncts that should be considered during every amputation. Therapeutic, IV.

Clinical and sonographic impact of oral contraception in patients with deep endometriosis and adenomyosis at 2 years of follow-up

Nowadays, combined oral contraceptives (COCs) are successfully employed for the treatment of endometriosis (END) and adenomyosis (AD) in a large proportion of patients. However, literature focusing on the clinical and sonographic response to treatment in the long-term follow-up of patients with deep endometriosis (DE) and AD is scarce. The aim of this study was to evaluate the changes in the symptoms and the sonographic exams at 12 and 24 months of follow-up in patients who had received a flexible extended COC regimen containing 2 mg of dienogest/30 μg ethinyl estradiol. This prospective, longitudinal, observational study included women diagnosed with DE and AD presenting no surgical indication and were candidates to treatment with COCs. The presence and severity of dysmenorrhea, non-menstrual pelvic pain, deep dyspareunia, dyschezia and dysuria were evaluated using the Numerical Rating Scale (NRS) at baseline, and at 12 and 24 months of treatment. Transvaginal ultrasound was also performed at these check points searching for criteria of AD and reporting the size of the DE nodules and ovarian endometriomas (OE). Sixty-four patients were included. A significant decrease in the number of patients with severe dysmenorrhea and non-menstrual pelvic pain was reported during follow-up. The mean NRS score for dysmenorrhea, non-menstrual pelvic pain, deep dyspareunia, dyschezia and dysuria was also significantly lower at follow-up. There was a significant reduction in the sonographic number and type of AD criteria during follow-up after treatment. Similarly, a significant decrease in the size of OE and uterosacral ligament involvement in DE was observed at the 12-month follow-up, with a further, albeit not statistically significant, decrease in the 12- to 24-month follow-up. Additionally, torus and rectosigmoid DE decreased in size, although the reduction was not statistically significant at any study point. This prospective study suggests a clinical and sonographic improvement after a flexible extended COC regimen in DE and AD patients, which was significant at 12 months of follow-up. The improvement was more evident in AD and OEs compared with DE. Further research with a longer follow-up, larger sample size and comparison with other treatments is needed.

Occupational and Functional Outcomes following Patellofemoral Arthroplasty in U.S. Military Servicemembers.

The functional outcomes in patients undergoing patellofemoral arthroplasty (PFA) with high occupational demands have not been fully examined. This study assessed return to work and conversion to TKA rates following PFA in a young, military cohort. Patient demographics, pain scores, and surgical information were retrospectively collected for all active-duty military members who underwent PFA over a 4-year period. The data were then analyzed to calculate return to work, conversion to TKA, and perioperative complications rates. A total of 48 servicemembers with 60 total PFAs (36 unilateral, 12 bilateral) were included, with a mean follow up of 2.2 years. At the final follow-up, 83% of servicemembers returned to military service or completed their service obligation after PFA. Conversion to TKA occurred in three (6.2%) patients at an average of 2.4 years after PFA, resulting in a PFA annual revision rate of 2.3%. The mean numeric rating scale for pain improved from 4.9 ± 2.6 at baseline to 2.5 ± 2.0 postoperatively (p < 0.001). Servicemembers with at least one prior ipsilateral knee procedure had a significantly decreased odds ratio (OR) for both occupational outcome failure (OR, 0.03; 95% confidence interval [CI], 0-0.29) and overall failure (OR, 0.13; 95% CI, 0.02-0.78). At an average of 2 years following PFA, 83% of military members returned to duty, with a low rate of revision to TKA. Prior ipsilateral knee procedure decreased the probability of medical separation. LEVEL OF EVIDENCE: IV.

The impact of distance education on the neck pain among teachers in times of COVID-19.

In the course of the COVID-19 pandemic the format of education was forced to change from formal to distance in a considerably short time. The study aimed to analyze the changes in the prevalence and the severity of neck pain among teachers during the pandemic. The study analyzed the Neck Disability Index (NDI), a self-report questionnaire designed to assess the individual's neck pain experience in daily life and rate a disability score due to neck pain, and numerical rating scale (NRS) report pairs completed by teachers. The mean age of the participants was 41.67±9.57. The majority were female (67.9 %) and were employed for less than 20 years in teaching (68.9%). The survey results collected at the beginning and at the end of the first year of the pandemic showed that: the mean session hours per week were 21.19±9.21 and 21.61±9.45, the mean NDI scores were 11.61±6.17 and 12.65±7.76, and the mean NRS scores were 3.05±2.96 and 4.75±3.13. The female participants scored significantly higher disability scores (p<0.001). The NRS scores were increased in both genders (p<0.001). The NDI scores, the disability grouping, and NRS were significantly associated with weekly session hours (p=0.011, p<0.001 and p<0.001, respectively). The NRS scores were increased in all age groups (p<0.001). The increase in weekly session hours was related to the NRS scores (p<0.001). In one year during the pandemic, despite unchanged telework hours, a significant increase in neck pain incidence and pain severity was noted among teachers. Unexperienced employees in the line of distance working should receive adequate training to avoid not only musculoskeletal disorders but other physical and psychological unwanted effects.

Evaluation of the Effectiveness of Topical Anaesthetic Gel and Needle Free Jet Anaesthesia in Root Planing: A Cross-sectional Study

Introduction: Although traditional local anaesthetic technique by injection is considered as gold standard for dental procedure, the resultant pain and anxiety caused by the needle prick makes the patient less compliant for further treatment. Many alternatives have been developed by the researchers in the last two decades. Jet anaesthesia and the topical gel are the commonly used alternatives to anaesthetise the local area. Aim: To evaluate and compare the effectiveness of topical anaesthetic gel (MucopainR gel) and jet anaesthesia (Sure ShotR needle free jet injection) during root planing. Materials and Methods: After taking consent, 20 patients who required root planning in the maxillary quadrant bilaterally were recruited for this study. A split mouth study was planned where one quadrant was anaesthetised with benzocaine 20% (MucopainR) gel, whereas sure shotR jet anaesthesia was used on the adjacent quadrant. The side and order of placement of topical gel and jet anaesthesia were randomised. The same operator delivered anaesthesia on both the sides. The root planning was carried out by another operator at two sittings and pain was assessed immediately using Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) and Verbal Response Scale Statistical . Results: The mean NRS score of the jet injection group was 1.50±1.54 and that for the gel group was 3.15±2.16. Also, the mean VAS score of the jet injection group was 1.50±1.54 and that for the gel was 3.15±2.16. The difference between two groups were statistically significantly (p-value=0.008). Conclusion: Jet anaesthesia was significantly superior to gel in providing anaesthesia during root planing.

Association between Pain, Catastrophic Thinking, and Health-related Quality of Life in Patients with Hand Fractures

: Few reports have investigated the relationship between pain, catastrophic thinking, and health-related quality of life (QOL) in patients with hand fractures. We investigated the correlation between scores of the pain Numeric Rating Scale (NRS) and the Pain Catastrophizing Scale (PCS; rumination, helplessness, and magnification), and between the scores of PCS and health-related QOL based on the Short Form 8 questionnaire (SF-8).: Thirty-seven patients with hand and finger fractures were treated in a public hospital (16 men, 21 women; mean age, 56.5 years) and were treated by an occupational therapist. The relations between NRS, PCS, and SF-8 scores were examined at 4 to 6 months post-treatment. The effects of hand pain on catastrophic thinking and on mental, psychological, and daily role-based factors were analyzed by correlation and partial correlation analyses.The mean NRS score was 2.13. The mean PCS subitem scores were: rumination, 6.00; helplessness, 1.97; and magnification, 2.18. There were significant positive correlations between the NRS and all PCS scores. Relations between the PCS scores and SF-8 subitem scores, excluding items that were not correlated with NRS in partial correlation analysis, indicated significant negative correlations between multiple PCS subitems and SF-8 subitem scores for role physical, bodily pain, vitality, mental health, and physical component summary.Pain and catastrophic thinking were correlated with health-related QOL in patients with hand fractures. In addition to assessing hand pain, therapists should monitor the effects of mental and psychological factors and daily activities in this group of patients.

Pectoral Nerve Blocks for Breast Augmentation Surgery: Comment

By a randomized, double-blind, dual-centered controlled trial in 73 adult female patients undergoing aesthetic breast augmentation surgery under general anesthesia, Aarab et al.1 showed that compared to multimodal analgesic regimen alone, pectoral nerve blocks combined with multimodal analgesia significantly improved postoperative pain control and decreased total opioid consumption over the first 5 postoperative days. In addition to the limitations described by the authors in the discussion, however, we note several issues in the results of this study that deserve further clarification.First, a numerical rating scale score of 3 or less is generally considered as satisfied pain control.2 In this study, other than 0.5 h after extubation, the mean numerical rating scale scores at other time points in the early postoperative period were 3 or less, indicating that most of patients have a satisfied pain control. Patient satisfaction was very good in both groups. In this case, it is difficult for readers to determine whether early postoperative pain control improved by adding pectoral nerve blocks to multimodal analgesia should be considered clinically important.Second, between-group differences in opioid consumption were of questionable clinical significance. Differences in milligram oral morphine equivalents were 3 mg in the first 6 h after extubation and 10.5 mg from 6 to 24 h postoperatively (total, 13.5 mg 0 to 24 h postoperatively, equivalent to about 4.5 mg of intravenous morphine).3 Although the recommendation of 10 mg of intravenous morphine equivalents per 24 h as the minimal clinically important difference was published4 well after the study by Aarab et al.1 was designed and performed, the 4.5-mg difference is nonetheless much less. In addition, the total between-group difference from postoperative days 1 through 5 was 21-mg oral morphine equivalents. Given that duration of pectoral nerve block is limited and the total between-group difference in oral morphine consumption was very small, we question the clinical value of this opioid sparing.Support was provided solely from institutional and/or departmental sources.The authors declare no competing interests.

Effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with chronic spinal stenosis accompanying mild spondylolisthesis: a longitudinal cohort study.

Degenerative lumbar spondylolisthesis (DLS) is frequently associated with lumbar spinal stenosis (LSS) and conservative treatments such as epidural steroid injection do not have long-term benefits in LSS patients with DLS. This study evaluated the effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with LSS and DLS. Patients' sex, age, body mass index, diabetes, hypertension, stenosis grading, pain duration, location, pain intensity, and medications were retrieved from electronic medical records. At 1, 3, and 6 months following the procedure, data on pain severity, medication usage, and physical functional status were analyzed. A generalized estimating equations model was used at the six-month follow-up. Patients were divided into those with DLS (the spondylolisthesis group) and those without DLS (the no spondylolisthesis group) to evaluate whether the effects of percutaneous epidural neuroplasty using a balloon catheter were different. A total of 826 patients were included (spondylolisthesis: 433 patients, 52.4%; no spondylolisthesis: 393 patients, 47.6%). Age, body mass index, hypertension, pain location, and stenosis grading were statistically different between the two groups. The generalized estimating equations analyses with unadjusted and adjusted estimation revealed a significant improvement in the estimated mean numerical rating scale of pain intensities compared to that at baseline in both groups (P < 0.001). Any adverse events that occurred were minor and temporary. Percutaneous epidural neuroplasty using a balloon catheter may be an alternative treatment option for patients with chronic LSS, regardless of accompanying DLS, who have had failed conservative management.

Randomized Double-Blind Comparison of Intravenous Ibuprofen and Dexketoprofen in the Acute Treatment of Tension-Type Headache

Abstract: Non-steroidal anti-inflammatory drugs are used routinely and first choice in the acute treatment of tension-type headaches(TTH). The aim of this study is to compare the analgesic efficacy of parenterally administered single dose dexketoprofen and ibuprofen in the treatment of TTH. Our study was designed in a randomized, double-blind model. Patients with tension headache were randomized to dexketoprofen and ibuprofen groups. Pain scores of the patients were recorded at 0, 15, 30, and 60 minutes with a 10-unit Numeric Rating Scale (NRS). Of these patients, 45 (50%) were included in the group to receive dexketoprofen treatment, and 45 (50%) to receive ibuprofen treatment. In total, 54 of our patients were female and 36 were male. The differences in mean NRS scores in the group treated with analgesic 1 were 2.0, 4.0, 5.22, 6.0 at the end of the 5th, 15th, 30th and 60th minutes, respectively, and 2, 5, 6.36, 7 for analgesic 2, respectively. While there was no significant difference between drug efficacy at all time points except the 30th minute, the efficacy of ibuprofen in reducing pain was more significant at the 30th minute (p=.015). As a result of our study, there was no significant difference between the analgesic efficacy of parenterally administered dexketoprofen 50 mg and ibuprofen 800 mg at the end of the 60th minute, while ibuprofen 800 mg was superior in terms of analgesic efficacy at the 30th minute.

Pain Course after Total Knee Arthroplasty within a Standardized Pain Management Concept: A Prospective Observational Study.

Joint replacement surgeries have been known to be some of the most painful surgical procedures. Therefore, the options for postoperative pain management are of great importance for patients undergoing total knee arthroplasty (TKA). Despite successful surgery, up to 30% of the patients are not satisfied after the operation. The aim of this study is to assess pain development within the first 4 weeks after TKA in order to gain a better understanding and detect possible influencing factors. A total of 103 patients were included in this prospective cohort study. Postoperative pain was indicated using a numeric rating scale (NRS). Furthermore, demographic data and perioperative parameters were correlated with the reported postoperative pain. The evaluation of postoperative pain scores showed a constant decrease in the first postoperative week (mean NRS score of 5.8 on day 1 to a mean NRS score of 4.6 on day 8). On day 9, the pain increased again. Thereafter, a continuous decrease in pain intensity from day 10 on was noted (continuous to a mean NRS score of 3.0 on day 29). A significant association was found between postoperative pain intensity and gender, body mass index (BMI), and preoperative leg axis. The increasing pain score after the first postoperative week is most likely due to more intensive mobilization and physiotherapy in the rehabilitation department. Patients that were female, had a low BMI, and a preoperative valgus leg axis showed a significantly higher postoperative pain scores. Pain management should consider these results in the future to improve patient satisfaction in the postoperative course after TKA.

Introduction of an enhanced recovery program for young adults undergoing posterior spinal fusion surgery for idiopathic scoliosis: a single-centre pilot study evaluating short term outcomes

Background: The large surgical incision and extensive tissue trauma in posterior spinal fusion for adolescent idiopathic scoliosis causes severe acute postoperative pain. Furthermore, posterior spinal fusion is associated with a risk of persistent postsurgical pain. Six months after posterior spinal fusion, the incidence of persistent postsurgical pain is as high as 22% of the patients. Optimizing pain management therefore remains crucial, but challenging. Objective: The study objective is to design and implement an enhanced recovery pathway for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion integrating all aspects of biopsychosocial care. Its outcomes are assessed, including its effect on postoperative pain and early mobilization. Design and settings: A prospective cohort study was performed at the Antwerp University Hospital. Methods: In December 2019, a prospective cohort study was set up in which an enhanced recovery pathway substitutes more than the patient controlled intravenous analgesia containing morphine postoperatively. This pathway consists of m/eHealth based psychological screening questionnaires, patient education, early mobilization, and a multimodal analgesia protocol consisting of preemptive gabapentin, an intraoperatively given single dose of methadone (0.2 mg kg-1), non-steroidal anti-inflammatory drugs, and acetaminophen. Results: We treated 25 adolescents (10 males and 15 females) with the developed enhanced recovery pathway with a mean age of 16.5 years (range 12-22). The mean number of spinal levels fused was 10 (range 6-13). Mean numerical rating scale scores were 4.17 at postoperative day 1, 4.46 at postoperative day 2, and 3.74 at postoperative day 3 in enhanced recovery pathway treated patients. Mean bladder catheterization duration was 3.04 days and enhanced recovery pathway patients stayed in the hospital for an average of 7.4 days. Conclusions: Using an enhanced recovery pathway for patients undergoing posterior spinal fusion could not only reduce the acute and chronic opioid consumption and its side effects, but could also result in less postoperative pain, shorter hospital stay and higher patient satisfaction. Further reevaluation and improvement focused on these variables will likely further improve the effectiveness of enhanced recovery pathways. Trial registration: ClinicalTrials.gov NCT04038229.

ERECTOR SPINAE PLANE BLOCK FOR MINIMALLY INVASIVE MITRAL VALVE SURGERY HAS NO IMPACT ON POSTOPERATIVE OUTCOMES: A DOUBLE-BLIND, PROSPECTIVE RANDOMIZED PLACEBO-CONTROLLED TRIAL

<h3>Objective</h3> Compared to traditional sternotomy, minimally invasive mitral valve surgery (MIMVS) using video-assisted thoracoscopy has been shown to result in an increased incidence of moderate to severe acute postoperative pain.1 The Erector Spinae Plane (ESP) block, a novel fascial plane block, may be an useful and safe option for postoperative analgesia in MIMVS.2 As randomized trials in this field are sparse, we hypothesized that an intermittent ESP block with ropivacaine 0.5% (intervention group) compared to normal saline 0.9% (control group) is effective in reducing postoperative pain after MIVMS.3 <h3>Design & Methods</h3> PPThis single center, double-blind, prospective, randomized, placebo-controlled trial was approved by the local Ethics Committee (S62638 June 4th 2019, EudraCT 2019-001125-27). The trial was supported by the EACTA Research Grant 2020. Primary endpoint was postoperative 24h morphine consumption. Based on pilot data and to have an 80% power to show a 25% reduction in 24h morphine consumption in the intervention-group compared to the control-group, 64 patients had to be randomized (1:1 ratio). A pre-planned sample size recalculation was performed after inclusion of 32 patients. Multiple secondary endpoints were evaluated up to 30-days postoperatively including postoperative pain scores, midaxillary sensory block, rescue treatments for pain and hospital length of stay.3 <h3>Results</h3> Sample size recalculation revealed the need to recruit 4 additional patients in each group. 72 patients were randomized between July 2nd 2019 and November 4th 2021. Regarding our primary outcome, 2 patients in the intervention-group could not be assessed due to reintubation and ischemic cerebral event. In the control-group, we observed 2 epileptic seizures requiring unblinding of the randomization to start appropriate treatment. There were no differences in baseline or procedural characteristics. The median (IQR) 24h morphine consumption was not different between the intervention- and control-group: 41mg [30;55] vs 37mg [29;50], p=0.70, respectively (Table 1). Mean numerical rating scale values for pain showed no significant differences between groups (Figure 1). The number of morphine boli requested each hour by the patient, sensory block, rescue treatments for pain and hospital length of stay were comparable (Figure 2 & Table 1). <h3>Conclusion</h3> In the current placebo-controlled trial following MIMVS, we were unable to demonstrate any benefit from the addition of an intermittent ESP-block to a standard multimodal analgesia regimen.

Observational studies on the efficacy of carbamazepine and ascorbyl palmitate in managing trigeminal neuralgia.

Ascorbyl palmitate is a fat-soluble ester of vitamin C and is used as an antioxidant food additive. While literature reports that ascorbyl palmitate can prevent exacerbation of pain and improve the quality of life of patients suffering from pain, this is not yet supported by clinical trial data. Our study aimed to investigate the effectiveness of ascorbyl palmitate in managing trigeminal neuralgia. This study was carried out in a single-centre clinical trial in which subjects suffering from trigeminal neuralgia (N=11) were included. All patients were on carbamazepine when first included and, after washout period, received Ascorbyl palmitate. Eligible patients had the most severe trigeminal neuralgia pain in the oral cavity or pain on touching trigger zones, aged 20 years or older, were capable of proper assessment of the severity of pain and their condition, and had experienced multiple episodes of intraoral pain for at least 3 months with a pain intensity of more than 4 points on the numerical rating scale. The Brief Pain Questionnaire was used to evaluate patient's quality of life. A total of 11 patients were included with a mean age 55.36±10.67 years (7 males, 4 females). Most patients had compression by the superior cerebellar artery and vascular loops upon magnetic resonance examination. The mean numerical rating scale score for carbamazepine after one month was 7.9±0.56 (95% CI 7.49, 8.30). Similarly, for ascorbyl palmitate was 5.5±1.50 (95% CI 4.42, 6.57) (p<0.001). Ascorbyl palmitate can be used as an adjunct intervention in managing trigeminal neuralgia pain. According to the results, ascorbyl palmitate prevents frequent exacerbation of pain and improves patient quality of life.