Mean Pain Severity Score Research Articles

The prevalence and predictors of discharge opioid overprescribing in opioid-naïve patients after breast, gynecologic, and head and neck cancer surgery: a prospective cohort study.

The management of pain following cancer-related surgeries involves the use of opioid analgesics. Nevertheless, there is little evidence characterizing the utility and prescription patterns of opioids after these procedures. Our primary aim was to identify patients from three types of cancer surgery who were overprescribed with opioids. The secondary aim was to determine the potential predictors of overprescribing in the same period. We conducted the study at a single cancer referral hospital. Opioid-naïve patients with breast, gynecologic, or head and neck cancer were studied. Patients were considered opioid-naïve if they had a history of opioid use ≤ 30mg oral morphine equivalent daily dose for less than seven days in the preceding three months before surgery. We recruited eligible participants by convenience sampling on the wards until at least 102 patients were included in the final analysis. After discharge, we followed up on the participants on day 7 via telephone using a structured proforma including questions to identify the last date and amount of opioid dose taken. The equivalent days of opioid use were calculated by their 24-hr use before discharge and the number of doses prescribed for discharge. Our primary outcome was the prevalence of overprescribing in the three surgical specialties defined as the number of patients taking less than 50% of discharge opioids within the first seven days after discharge. We examined the predictors on incidents of overprescribing using multivariable Poisson regression as the secondary outcome. We recruited 119 patients, and 107 patients were included in the final analysis. There were 59/107 (55%) patients found to be overprescribed with opioids. At discharge, they exhibited lower mean numerical rating scale pain scores, lower mean pain severity scores, higher equivalent days of opioids prescribed, and not used opioids in the last 24hr before discharge. The incidence of overprescribing was 2.4 times greater for patients prescribed with opioids without 24-hr opioid use (relative risk [RR], 2.38; 95% confidence interval [CI], 1.30 to 4.35; P = 0.005). Similarly, the incidence of overprescribing was 1.7 times greater for patients who had opioids 24hr before discharge and were supplied with opioids for five equivalent days or more at the time of discharge (RR, 1.67; 95% CI, 1.09 to 2.56; P = 0.02). Our study shows that the majority of recruited patients undergoing breast, gynecologic, or head and neck cancer surgery were overprescribed opioids. Individualized assessments on patients' 24-hr opioid requirements before discharge and supplying for less than five days are important considerations to reduce overprescribing in opioid-naïve patients after cancer surgery.

Transcutaneous electrical acupoint stimulation for alleviating pain in patients with advanced pancreatic cancer.

Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related deaths globally, with a five-year survival rate of only 5%. Pancreatic ductal adenocarcinoma is often fatal because of the lack of specific early symptoms and effective early screening tools. Therefore, 80%-85% of patients are usually diagnosed in the advanced stages. This study aimed to investigate the analgesic effect of transcutaneous electrical acupoint stimulation in patients with advanced pancreatic cancer. Eighty patients with advanced pancreatic cancer were recruited from the Integrative Medicine Department of our hospital between June 2017 and October 2018 and randomly divided into the experimental group ( n = 40) and the control group ( n = 40). The experimental group received transcutaneous electrical acupoint stimulation combined with analgesic medication for 3 consecutive days, while the control group received only analgesic medication. The pain scores of the two groups before and after intervention were compared. The mean pain severity score was significantly lower in the experimental group than in the control group on day 1 ( P < 0.001), day 2 ( P < 0.001), day 3 ( P = 0.005), and day 4 ( P = 0.043). Transcutaneous electrical acupoint stimulation therapy effectively alleviates the pain of patients with advanced pancreatic cancer with a high degree of safety and minimal adverse effects, and is worthy of clinical application.

Investigating home-based opioid use among youth with sickle cell disease using ecological momentary assessment.

Opioids are a common and essential treatment for acute sickle cell disease (SCD) pain. However, opioids carry well-known adverse side effects, including potential development of hyperalgesia and nociplastic pain. We characterized opioid use in youth with SCD using ecological momentary assessment (EMA) data, and investigated the relationships between home-based opioid use, pain, and a range of biopsychosocial factors. Eighty-eight youth with SCD (aged 8-17years) completed EMAs assessing home-based opioid use, pain, and related factors. Analyses consisted of descriptive and multilevel logistic regression to predict daily home opioid use. Youth averaged 3.64weeks of EMAs. Approximately 35% of the sample (n=31) took an opioid during the EMA period, and used them on only 24% of reported pain days. Youth who took opioids reported a higher percentage of pain days (t=-2.67, p<.05) and mean pain severity scores (t=-2.30, p<.05) than youth who did not take opioids. Multilevel logistic regression analyses indicated that high daily pain severity (odds ratio [OR]=1.02, p<.01), older age (OR=1.324, p<.01), and low positive affect (OR=0.91, p<.01) were each related to an increased likelihood of opioid use. Youth with SCD take opioids appropriately in response to their pain, based on daily self-report. Beyond daily pain severity, age, and daily variation in positive affect were related to home-based opioid use. This suggests that behavioral interventions that enhance positive affect may promote reduced opioid use among youth with SCD.

Relationship of pain relief with catastrophizing following interventional pain procedures for low back pain

IntroductionCatastrophizing is associated with worse pain outcomes after various procedures suggesting its utility in predicting response. However, the stability of pain catastrophizing as a static predictor has been challenged. We...

Use of Myeloma Patient Outcome Scale (MyPOS) to gauge the effectiveness of palliative management in patients with multiple myeloma: Experience from a large tertiary academic center in India.

e24137 Background: A diagnosis of Multiple Myeloma (MM) can carry significant physical, social, functional and emotional repercussions. There is a lack of data on Baseline Quality of Life (QOL) in patients with MM and effectiveness of palliative management in the Indian context, especially after the advent of newer chemo-immunotherapeutic agents and autologous stem cell transplant (ASCT). Myeloma Patient Outcome Scale (MyPOS) is the first questionnaire developed specific for MM patients. Objectives and Methods: To evaluate symptom burden and quality of life in MM patients admitted to the medical oncology ward. To assess change in quality of life and symptoms as well as analgesic requirements on telephonic follow up after one and three months from index admission. After institutional ethical clearance, MM inpatients were prospectively enrolled. Clinical and treatment related details were recorded. MyPOS questionnaire was administered as well as a detailed pain assessment using Brief Pain Inventory (BPI) was carried out at baseline, 1 and 3 months. Results: 82 out of 100 MM patients consented for recruitment (Mean age- 52 +/- 9yrs; Male- 55%). Mean duration of the disease since diagnosis was less than 1 year (0.86 years), with a mean International staging system (ISS) score of 2. Up to half (37/82, 45%) of the patients received ASCT in addition to chemotherapy. The baseline Global MyPOS Score was 58 +/- 8.8 while the mean Pain severity (MPS) and interference (MPI) scores were 25+/-8 and 43+/-10 respectively. The most painful region was the back. Only Tramadol was sufficient for a small minority (6/82, 7.4%), most required oral morphine. Most patents had significant interval improvement in their pain and QOL scores with a p less than 0.01 on follow-up (MyPOS at 1 month and 3 month were 81+/-6 and 78+/-5, MPS were 21+/-13 and 17+/-1.1, MPI were 38+/-2.2 and 37+/-2.1 respectively). Conclusions: Adequate pain management can significantly improve quality of life in MM patients. Use of standardized questionnaires such as MyPOS is a quintessential tool for the palliative specialist in order to gauge therapeutic efficacy.

Clinical and Healthcare Resource Use Outcomes between Dual-plane and Prepectoral Techniques in Implant-based Breast Reconstruction: A Multicenter Retrospective Study.

Medical records were selected for patients at five sites undergoing immediate one-stage direct-to-implant (first hospitalization) or two-stage IBR (first and second hospitalization) using either DP or PP. Inverse probability of treatment weighting was used to adjust for potential confounders. Complications and healthcare resource use were assessed with logistic regression; pain severity was assessed with ordinary least-squares regression. After inverse probability of treatment weighting, data from 255 patients (DP = 130, PP = 125) and 441 breasts (DP = 226, PP = 215) were analyzed. Mean pain severity scores were lower with PP versus DP immediately after IBR for first (P = 0.0002) and second hospitalizations (P = 0.0145), and before discharge for first (P < 0.0001) and second hospitalizations (P = 0.0002). A greater proportion of PP versus DP patients had a shorter hospital length of stay (≤ 23 hours) for first hospitalization (P = 0.0052); proportions were similar for second hospitalization (P = 0.5499). Intravenous narcotics were prescribed less frequently to PP versus DP patients during first (61.1% versus 69.8%, respectively; P = 0.1486) and second (37.5% versus 55.3%, respectively; P = 0.0172) hospitalizations. Complication rates were low in both groups after first hospitalization discharge (DP: 13.6%, PP: 12.5%, P = 0.7225). This retrospective study suggests that the PP technique in IBR may offer benefits related to clinical outcomes and health resource utilization; however, larger studies, including randomized controlled trials, are needed to confirm.

Effect of Islamic Dhikr on Pain Severity and Quality During Dressing Change in Patients with Burns

Background: Pain is a process of daily burn dressing changes. Evidence shows the effect of God’s name on reducing pain. Objectives: This study aimed to evaluate the effect of Islamic dhikr on pain severity and quality of burn dressing change. Methods: This clinical trial was performed on 71 patients with burns in 2017. Patients were selected by convenience sampling and randomly assigned to intervention and control groups. Then, 10 minutes before the start of the dressing change, the participants were asked to repeat the praises of Hazrat Fatima (PBUH). Patients in the control group received routine care. Pain severity was measured in patients before and 15, 30, 45, and 60 minutes after the dressing change with the Visual Analog Scale (VAS). The pain quality of patients was measured 15 minutes after the dressing change with the modified McGill Pain Questionnaire (MPQ). Data were analyzed using SPSS version 22 software with descriptive and analytical statistics. Results: The independent t-test showed a statistically significant difference between the experimental and control groups in terms of mean pain severity 15, 30, and 45 minutes after the dressing change (P = 0.001, P = 0.04, and 0.007, respectively). Also, the repeated-measures analysis showed that the variation of the mean pain severity scores was statistically significant across all phases of the study (F = 30.42, P &lt; 0.001). The results showed a statistically significant difference in the mean scores of sensory and emotional dimensions and the total score of pain quality between the two groups (P = 0.003, P = 0.07, and P = 0.047, respectively). Conclusions: Islamic dhikr can reduce pain during burn dressing changes.

The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center

IntroductionThe novel pericapsular nerve group (PENG) block has recently been reported to provide effective motor-sparing local anesthetic-based analgesia to the hip joint. We aimed to evaluate the analgesic efficacy and...

The effect of eucalyptus inhalation on pain and the quality of life in rheumatoid arthritis

Problem consideredPain is one of the most significant symptoms of rheumatoid arthritis that reduce the quality of life. The purpose of the study was to determine the effect of eucalyptus on pain and the quality of life in patients with rheumatoid arthritis. MethodsIn this randomized clinical trial, 70 patients with rheumatoid arthritis were selected by random sampling. In the eucalyptus group, 1 mL of eucalyptus oil was inhaled for 5 min, 3 times a day, for one month. The control group received placebo inhalation. Both groups used routine treatments. Data were collected using a questionnaire of demographics, the numerical pain rating scale (NRS), and Quality of Life (SF-12). Statistical analysis was done using 19th edition SPSS software and applied on paired t-test, chi-square, Fisher's exact test, and analysis of covariance. ResultsThe mean score of pain severity in the eucalyptus group significantly decreased in comparison with the control group (P < 0.001). The severity of pain there was no statistical difference in both groups before, the first, and the second weeks after the intervention, (p > 0.05); however, in the third and fourth weeks after the intervention, the mean severity of pain in the eucalyptus group was lower than in the control group, and these differences were statistically significant between the two groups (p < 0.05). Also, the patients' quality of life in the eucalyptus group was increased significantly (P < 0.001). ConclusionThe eucalyptus leads to pain reduction, and consequently, improves the quality of life of patients with rheumatoid arthritis. Trial registrationIRCT20160110025929N15 Registration date: 2018-10-07; https://en.irct.ir/trial/33573.

The Effect of Preoperative Sublingual Melatonin on Postoperative Pain Severity in Patients Undergoing Colorectal Surgery: A Triple-Blinded Randomized Trial.

Background: Postoperative pain has detrimental physiologic and psychologic effects on patients’ outcomes, such as increased postoperative morbidity, delayed recovery, and reduced patient satisfaction. This study aimed to determine the effect of preoperative sublingual melatonin on pain severity after colorectal surgery. Methods: We performed a randomized, placebo-controlled, triple-blinded study to test the efficacy of 6 mg of sublingual melatonin or placebo 1 hour preoperative on pain severity and sedation of 60 patients after colorectal surgeries. Pain and sedation were assessed by numerical verbal response (NVR) and the Ramsey sedation score, respectively, at the baseline, 1, 2, 6, 12, and 24 hours after surgery. The repeated measures analysis of variance was used to assess group × time interaction, and the Bonferroni adjustment was used for between-group comparisons. Results: A total of 60 patients with a mean ± SD age of 49.35 years were equally randomized to the study groups. There was no significant difference between groups with respect to the baseline characteristics. The mean score of pain severity of patients in the melatonin group was significantly lower compared with the placebo group at 2, 6, 12, and 24 hours after surgery. The total mean pain score for the first 12 hours (mean difference [MD] [SE], 0.41 [0.12]; 95% CI, 0.17-0.65; [P = 0.012]) and the mean score of pain in 24 hours after surgery were significantly lower in the melatonin group in comparison with the placebo group (MD [SE], 0.44 [0.13]; 95% CI, 0.19-0.69; [P = 0.001]). Compared with the placebo group, the percent of patients who were cooperative, aware, and calm was significantly higher in the melatonin group at the baseline (43.3% vs 53.3%) and at 1 (36.7% vs 60%) and 2 hours (33.3% vs 80%). Conclusion: The use of 6 mg preoperative melatonin sublingual tablet in patients with colorectal surgeries could reduce the severity of postoperative pain, patients’ restlessness and anxiety, and increase patients' cooperation and calmness. Therefore, it seems that sublingual melatonin is an effective drug in controlling postoperative pain.

Explanatory Factors Of Pain Among Patients With Heart Failure Transported By Emergency Medical Services

<h3>Introduction</h3> Pain is a common symptom in heart failure (HF) that often causes patients to activate emergency medical services (EMS). However, the factors associated with pain presence and severity remains unknown among patients with HF. The aims of this study were to determine explanatory factors of (1) presenting to EMS with a primary complaint of pain and (2) a higher severity of pain. <h3>Methods</h3> This study analyzed cross-sectional point of care data from EMS electronic health records of 6,982 HF patients who were transported by EMS within a midwestern US county. These data were previously collected in a parent study. Multiple linear regression and logistic regression were used to evaluate factors associated with presenting with a primary complaint of pain and higher pain severity. Demographic explanatory factors were age, sex, and self-reported race. Clinical explanatory factors were vital signs, number of medications, and comorbid conditions. <h3>Results</h3> The sample was 57.6% female and 42.4% male. Self-reported race was 57.7% Black, 41.4% White, and 0.9% other. Mean age was 64.2 years (SD 14.5). Of the 6,982 patients, 1,494 patients (21.4%) presented to EMS with a primary complaint of pain. Pain severity was recorded for 405 patients who presented with a primary complaint of pain using a scale of 0-10 (10 being the worst possible pain) and mean pain severity scores in this subsample was 6.8 (SD 3.04). For aim 1, statistically significant factors associated with presenting to EMS with a primary complaint of pain were female sex (OR=1.14, p=0.04), younger age (OR=0.97, p<0.001), history of coronary artery disease (OR=1.34, p=0.002), myocardial infarction (OR=2.22, p<0.001) or coronary artery bypass graft (OR=1.31, p=0.05), and absence of shortness of breath (OR=0.76, p<0.001). Race, number of medications, presence of a pacemaker, and atrial fibrillation were not statistically significant. For aim 2, statistically significant factors associated with higher pain severity included younger age (beta=-0.47, p<0.001), female sex (beta=1.17, p=0.001), Black race (beta=-1.1, p=0.002), and higher systolic blood pressure (beta=0.13, p=0.012). Other vital signs, comorbid conditions, number of medications, and devices were not statistically significant. <h3>Conclusions</h3> Among patients with HF, younger age, female sex, and history of heart conditions (i.e., coronary artery disease, myocardial infarction, coronary artery bypass graft) were associated with activation of EMS services for pain, and Black race was associated with lower pain severity. History of myocardial infarction was the largest explanatory factor of presenting with pain. Longitudinal research is needed to explore if these factors can predict pain presence and severity, and if pain is associated with multiple transports.

The relationship between pain beliefs and pain severity in liver transplant patients

BackgroundThis study was descriptive, prospective, and correlational conducted to evaluate the investigate the relationship between pain beliefs and postoperative pain severity in liver transplant patients. MethodsThe study included 118 liver transplant patients. Pain beliefs in the preoperative period were assessed by the Pain Beliefs Scale. Pain intensity was evaluated using the Numerical Rating Scale in postoperative 24–72 h. Multiple normal distribution and homogeneity of variance in the analyses were checked using the SPSS 25 package program, and Structural Equation Modeling was established. Whether the severity of pain and pain beliefs were affected by sociodemographic, disease, and pain characteristics was assessed. ResultsIt was found that the mean pain severity of the patients was low. Mean psychological belief value was higher than the organic belief value. It was observed that there was a moderate positive correlation between the patients' mean pain severity score and pain belief total and sub-dimension score means (p < 0.05). In the Structural Equation Modeling established, it was found that psychological beliefs were more effective than organic beliefs on pain severity. ConclusionThe results of our study show that pain beliefs and pain severity are related. This study suggests a new perspective on the role of clinical and demographic factors on postoperative pain and shows that determining pain beliefs is important in pain control.

Prevalence of Dysmenorrhea and Determinants of Pain Intensity Among University-Age Women.

The study was conducted to determine the prevalence of dysmenorrhea and investigate factors associated with dysmenorrhic pain among university students in Lahore, Pakistan. A cross-sectional study was conducted across various public and private sector universities in Lahore. A self-administered structured questionnaire was used to collect data from 600 randomly selected female university students. The prevalence of dysmenorrhea was 91.5%. Age at menarche (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.10-3.50) was the only significant factor associated with dysmenorrhea. The mean pain severity score among dysmenorrhic students was 5.62 ± 2.28. Most of the participants (65.8%) were experiencing moderate/severe pain. Univariate analysis showed that irregular cycle (OR [95% CI] = 1.62 [1.13-2.33]), age at menarche of ≤14 years (OR [95% CI] = 1.46 [1.05-2.04]), duration of menses of more than 5 days (OR [95% CI] = 1.42 [1.02-1.99]), stress (OR [95% CI] = 2.16 [1.54-3.03]), moderate meat/protein consumption (OR [95% CI] = 1.55 [1.08-2.21]), and medical specialization (OR [95% CI] = 1.72 [1.17-2.52]) were significantly associated with pain severity among dysmenorrhic female students. Multivariate binary logistic regression analysis revealed that medical specialization (OR [95% CI] = 1.83 [1.22-2.73]), age at menarche (OR [95% CI] = 0.603 [0.42-0.86]), regularity of menses (OR [95% CI] = 1.52 [1.04-2.22]), moderate meat/protein consumption (OR [95% CI] = 1.69 [1.16-2.45]), and stress (OR [95% CI] = 1.87 [1.32-2.66]) were independent predictors of moderate/severe dysmenorrhic pain. The study revealed an alarmingly high prevalence of dysmenorrhea among university students. High levels of stress and early menarche were the potent determinants of moderate/severe dysmenorrhea that disturbs quality of life.

Venlafaxine Extended Release in the Treatment of Post Herpetic Neuralgia: A Quasi-Experimental Study

Background: Anti depressant drugs are sometimes used to treat neuropathic pain like Postherpetic Neuralgia (PHN) however, their analgesic efficacy is unclear. Venlafaxine is a reasonably well tolerated anti depressant and is a Serotonin Norepinephrine Reuptake Inhibitor (SNRI) and weak noradrenaline reuptake inhibitor. Although not licensed for the treatment of chronic or neuropathic pain in most countries, it is sometimes used for this indication. The present study evaluated the efficacy, tolerability and Quality of Life (QoL) of venlafaxine use for 12 weeks in patients with PHN.&#x0D; Materials and methods: This quasi-experimental (Pretest-posttest design) was conducted in the department of Neurology, Dhaka Medical College Hospital, from July 2012 to June 2013. Four hundred and fifty two patients were included in the study and Venlafaxine extended release tablet (75 to 150 mg) were administeredfor 12 weeks. Pain severity score, pain interference score and QoL score were assessed by a self-rated questionnaire before treatment and at 12 weeks follow-up.&#x0D; Results: Majority of the patients were male (63.7%) with a mean age of 48.1 years. After 12 weeks of Venlafaxine treatment, 330 (73%) patients reported at least 50% relief in pain, whereas three (0.7%) patients did not report any pain relief. Pain was relieved completely in 32 (7.0%) patients. There was a significant decrease in the mean pain severity score, (5.8±2.0 versus 3.6±2.2) and meanpain interference score (4.5±2.0 versus 3.1±1.9) from baseline to 12 weeks. The mean QoL scale score improved significantly from 5.9±1.6 at baseline to 8.0±1.7 at week 12. Only 2.8% (13/452) patients experienced at least one adverse effect during the study period.&#x0D; Conclusion: Venlafaxine was found to be effective, safe and well tolerated in the patients of PHN for relieving pain and improving QoL. Further double blinded randomize study is needed to validate these findings.&#x0D; JCMCTA 2021 ; 32 (1) : 31-34

Treatment response in dogs with naturally occurring grade 3 elbow osteoarthritis following intra-articular injection of 117mSn (tin) colloid

The radionuclide 117mSn (tin-117m) embedded in a homogeneous colloid is a novel radiosynoviorthesis (RSO) device for intra-articular (IA) administration to treat synovial inflammation and mitigate osteoarthritis (OA) in dogs. A study to evaluate tin-117m colloid treatment response in dogs with OA was conducted at two centers, the School of Veterinary Medicine at Louisiana State University, and at a referral practice in Houston, Texas. The tin-117m colloid was administered per-protocol to 14 client-owned dogs with radiographically confirmed, grade 3 OA in one or both elbow joints. Dog owners and attending clinicians assessed the level of pain at baseline (BL) and the post-treatment pain response at 90-day intervals for one year. Owners assessed treatment response according to a pain severity score (PSS) and a pain interference score (PIS) as defined by the Canine Brief Pain Inventory. Clinicians reported a lameness score using a 0-5 scale, from no lameness to continuous non-weight bearing lameness, when observing dogs at a walk and a trot. The rate of treatment success as determined by improved mean PSS and PIS scores reported by dog owners was >70% at all time points. Clinicians reported an improved mean pain score from BL at post-treatment Days 90 (p<0.05), 180, and 270. The dog owner and clinician assessments of treatment success were significantly correlated (p>0.05) at Day 90 and Day 180 time points. Results indicated that a single IA dose of tin-117m colloid provided a significant reduction in pain and lameness and improved functionality for up to a full year, with no adverse treatment related effects, in a high percentage of dogs with advanced, clinical OA of the elbow joint.

Stable Lateral Meniscal Posterior Root Tears Left In Situ at Time of Anterior Cruciate Ligament Reconstruction Are of Minimal Long-Term Clinical Detriment

The purpose of this study was to compare long-term patient-reported outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction with untreated stable lateral meniscal posterior root (LMPR) tears to those with an intact meniscus. Four hundred ninety-two subjects were followed for a minimum of 15-years post-ACL reconstruction and evaluated by an International Knee Documentation Committee questionnaire. The integrity of the meniscus was classified at surgery. Patients were grouped as either untreated injury to LMPR "with stable tear" (WST) group (n= 52) or intact lateral meniscus "no tear" (NT) group (n= 440). WST group included tears where those with a root avulsion within 9 mm of insertion and parrot beak tears with the integrity of the root attachment maintained. Outcomes were compared between groups. ACL graft rupture occurred in 10% in the WST group and in 11% in the NT group (P= .78). For participants with an intact graft (n= 440), the mean International Knee Documentation Committee scores were 82, in the WST group, and 87, in the NT group (P= .03), with a small effect size of .32. The WST group had a worse mean pain severity score (P= .04) and higher frequency of pain (P= .03) than the NT group, but the effect size was small (P < 0.3). There was no difference in the overall knee function (P= .209) or International Knee Documentation Committee activity level (P= .882). There was no adverse clinical outcome to leaving a stable LMPR tear in situ at the time of ACL reconstruction. LMPR tears left in situ were of minimal clinically significant long-term detriment, with outcomes similar to having an intact meniscus. There is an innate desire to fix the broken, but posterior meniscal root avulsions and stable parrot beak tears within 9 mm of insertion may not require intervention. At 15 years postinjury, most patients with a stable tear left in situ continue to enjoy an active lifestyle with a pain-free knee. Level III, retrospective comparative study.

Prospective Study of Pain Outcomes Associated With Breast Surgery in Women With Nonhereditary Breast Cancer.

To assess pain severity and interference with life in women after different types of breast cancer surgery and the demographic, treatment-related, and psychosocial variables associated with these pain outcomes. Data are conflicting regarding pain outcomes and quality of life (QOL) among women who undergo different types of breast surgery. Women with nonhereditary breast cancer completed the brief pain inventory before surgery and at 1, 6, 12, and 18 months postsurgery. We assessed associations between pain outcomes and CPM status and mastectomy status using multivariable repeated measures models. We assessed associations between pain outcome and QOL and decision satisfaction. Of 288 women (mean age 56 years, 58% non-Hispanic White), 50 had CPM, 75 had unilateral mastectomy, and 163 had BCS. Mean pain severity scores were higher at one (2.78 vs 1.9, P = 0.016) and 6 months (2.79 vs 1.96, P = 0.031) postsurgery in women who had CPM versus those who did not, but there was no difference at 12 and 18 months. Comparing mastectomy versus BCS, pain severity was higher at 1 and 12 months. There was a significant interaction between pain severity and time point for CPM ( P = 0.006), but not mastectomy status ( P = 0.069). Regardless of surgery type, Black women had higher pain severity ( P = 0.004) than White women. Higher pain interference was associated with lower QOL ( P < 0.001) and lower decision satisfaction ( P = 0.034). Providers should counsel women considering mastectomy about the potential for greater acute pain and its impact on overall well-being. Racial/ethnic disparities in pain exist and influence pain management in breast surgical patients.

Treatment Response in Dogs with Naturally Occurring Grade 3 Elbow Osteoarthritis Following Intra-Articular Injection of 117mSn (Tin) Colloid: ARevie

The radionuclide 117mSn (tin-117m) embedded in a homogeneous colloid is a novel Radio Synovi Orthesis (RSO) device for Intra-Articular (IA) administration to treat synovial inflammation and mitigate Osteo Arthritis (OA) in dogs. A study to evaluate tin-117m colloid treatment response in dogs with OA was conducted at two centers, the School of Veterinary Medicine at Louisiana State University, and at a referral practice in Houston, Texas. The tin-117m colloid was administered per-protocol to 14 client-owned dogs with radio graphically confirmed grade 3 OA in one or both elbow joints. Dog owners and attending clinicians assessed the level of pain at Base Line (BL) and the posttreatment pain response at 90-day intervals for one year. Owners assessed treatment response according to a Pain Severity Score (PSS) and a Pain Interference Score (PIS) as defined by the Canine Brief Pain Inventory. Clinicians reported a lameness score using a 0-5 scale, from no lameness to continuous non-weight bearing lameness, when observing dogs at a walk and a trot. The rate of treatment success as determined by improved mean PSS and PIS scores reported by dog owners was >70% at all-time points. Clinicians reported an improved mean pain score from BL at post-treatment Days 90 (p<0.05), 180, and 270. The dog owner and clinician assessments of treatment success were significantly correlated (p>0.05) at Day 90 and Day 180 time points. Results indicated that a single IA dose of tin-117m colloid provided a significant reduction in pain and lameness and improved functionality for up to a full year, with no adverse treatment related effects, in a high percentage of dogs with advanced, clinical OA of the elbow joint.

The Effects of Inhalation Aromatherapy on Postoperative Abdominal Pain: A Three-Arm Randomized Controlled Clinical Trial

PurposeThis study compares the effects of inhalation aromatherapy using essential oils of sweet orange and damask rose on postoperative abdominal pain. DesignA randomized three-arm controlled trial. MethodsIn this randomized double-blinded, and parallel-group controlled trial, a total of 120 patients who underwent open abdominal surgeries were enrolled using a sequential sampling method. Participants were then randomly assigned to three groups of sweet orange, damask rose, and placebo (distilled water) using the permuted block randomization. When the patients regained full consciousness, a clean gauze impregnated with four drops of either distilled water or essential oils of sweet orange or damask rose were attached to the collar of the patients, and they were asked to inhale the aroma through normal breathing for 30 minutes. Abdominal pain severity was recorded using the visual analog scale at four time points including before the intervention (baseline) and 4, 8, and 12 hours after the intervention. FindingsPain reduction after sweet orange inhalation was significantly greater than placebo (at 8 and 12 hours after the intervention) and damask rose (at 12 hours after the intervention). The differences in the mean score of pain severity between all before-and-after observations were statistically significant in the three groups, except in the placebo group between the baseline score of pain severity and the pain severity score at 4 hours after the intervention. ConclusionsInhalation aromatherapy using sweet orange seems to be more effective than the damask rose in reducing pain severity after open abdominal surgeries.

Acute Total Knee Replacement in Rheumatoid Arthritis Patients with Proximal Tibial Fractures: A Case Series.

Management of proximal tibial fractures is a challenging issue in patients with rheumatoid arthritis (RA). In the present study, we aimed to describe our experience of acute total knee replacement in RA patients. This case series included 11 RA patients with simultaneous insufficiency fractures of the proximal tibia, who were treated by acute total knee replacement. Midterm functional results, severity of pain, Hospital for Special Surgery (HSS), and Knee Society Score (KSS) parameters were evaluated in this study. The patients were followed up for 24 months. Eleven women with proximal tibial fractures and history of RA (mean age: 54.3 ± 4.7 years) were enrolled in this study. The mean score of Tegner activity scale was 2.2 ± 1.4 preoperatively, which significantly improved to 4.3 ± 1.4 postoperatively (p < 0.001). The two sections of KSS (knee and function section) averaged 88.7 ± 5.4 and 59.4 ± 8.2, respectively. There wasn't poor outcome and excellent result was in knee section 54.5% and function section 36.3% based on KSS. The mean score of pain severity during normal activity before fracture was 65.2 ± 12.3, which significantly reduced to 35.5 ± 11.3 in the final follow-up (p = 0.02). The score of HSS scale improved from 42 (range: 16-58) in the preoperative stage to 78 (range: 72-91) after surgery (p < 0.001). In the 6-month follow-up, deep vein thrombosis was reported in two patients. The time required to return to normal activity was 5.5 ± 2.3 months. Based on the findings, total knee replacement therapy in patients with RA and proximal tibial fractures produced excellent clinical outcomes, which led to rapid return to normal activity. This is a Level IV, therapeutic study.