Mean Visual Analog Scale Pain Score Research Articles

Popliteal sciatic nerve block in the endovascular management of critical limb ischaemia: a UK single-centre experience

Objective: This study aims to assess the safety and efficacy of the use of popliteal nerve block (PNB) in the endovascular management of patients with critical limb threatening ischaemia. Design: Single-centre retrospective observational study. Methods: All patients with rest pain who received PNB from March 2018 to August 2021 were included. Pain scores were recorded before and after block using a visual analogue scale (VAS). Requirements for analgesia or sedation, complications related to nerve block, and level of intervention were recorded. Results were compared with a historical cohort of patients prior to implementation of nerve blocks. Results: 68 nerve blocks were performed in 63 patients (M:F 46:17) of mean age 71.7 years (range 43–91). All patients were Fontaine classification III–IV. Sonographically, all nerve blocks were technically successful. The mean VAS pain score was 8.2 pre-block, reducing to 0.3 (p<0.0001) post-block. There were no complications related to the block. Four patients required supplementary analgesia for breakthrough ischaemic pain. Compared with the historical comparison group of patients (n=62), there was a statistically significant reduction in the requirement for conscious sedation (p=0.004) and no procedures were abandoned due to pain compared with three in the historical comparison group (p=0.034). Conclusion: Popliteal sciatic nerve block is safe and effective in patients with critical limb threatening ischaemia undergoing lower limb endovascular intervention, significantly reducing the need for conscious sedation and risk of procedural abandonment.

Oxygen-Ozone Therapy in Cervicobrachial Pain: A Real-Life Experience.

This prospective, open-label clinical study was carried out to evaluate both the efficacy and safety of intramuscular paravertebral injections of an oxygen−ozone (O2−O3) mixture in patients with cervicobrachial pain. We enrolled 540 subjects affected by cervicobrachial pain referred to the Ozone Therapy Ambulatory at the Mater Domini Hospital of Catanzaro (Italy) and to the Center of Pain in Taurianova (Reggio Calabria, Italy). All the subjects (n = 540) completed the treatment and the follow-up visits. The subjects received a mean of 11 cervical intramuscular treatments with an O2−O3 mixture (5 mL) with an O3 concentration of 10 μg/mL bis a week. The improvement of pain was measured by a change in the mean of the Visual Analog Scale (VAS) score from baseline to the end of treatment and during follow-ups. Patient satisfaction was assessed at the end of treatment using the SF-36 Questionnaire. The development of adverse drug reactions was recorded. The mean (±standard deviation) VAS pain score at baseline, at the end of treatment, and during follow-ups showed a significant reduction in pain over time (p < 0.001). All the patients who were enrolled (n: 540) were pain-free after one year. According to the pain distribution, all subjects showed a significant reduction in pain over time in each group (p < 0.05). No significant differences were observed with respect to sex or age. No adverse events were observed during the study. In conclusion, we documented that the intramuscular injection of an O2−O3 mixture is an effective and safe treatment option for patients with cervicobrachial pain.

Clinical and radiographic outcomes of stand-alone oblique lateral interbody fusion in the treatment of adult degenerative scoliosis: a retrospective observational study

BackgroundOpen fusion and posterior instrumentation has traditionally been the treatment for adult degenerative scoliosis (ADS). However, minimally invasive treatment such as oblique lateral interbody fusion (OLIF) technique was developed as a new therapeutic method for the treatment of ADS. In addition, it is associated with decreased blood loss and shorter operative time without posterior instrument. The purpose of this study was to evaluate the efficiency of stand-alone OLIF for the treatment of ADS in terms of clinical and radiological results.MethodsA total of 30 patients diagnosed with ADS who underwent stand-alone OLIF in our hospital from July 2017 to September 2018 were enrolled in the study. Scores from the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) obtained preoperatively and at the final follow-up were compared. Radiography and computed tomography were performed preoperatively and at the final follow-up. The coronal cobb angle, lumbar lordosis, disc height, sacral slope, pelvic incidence and Pelvic tilt were recorded at each time point.ResultsThe study cohort comprised 30 patients with a mean age of 64.5 ± 10.8 years and mean follow-up of 19.3 ± 4.2 months. The mean operative time was 96.8 ± 29.4 minutes and the mean estimated blood loss volume was 48.7 ± 9.4 ml. The mean coronal Cobb angle was corrected from 15.0° ± 3.7° preoperatively to 7.2° ± 3.1° postoperatively and 7.2° ± 3.3° at final follow-up (P < 0.0001). Lumbar lordosis significantly improved from 32.2° ± 11.3° preoperatively to 40.3° ± 11.8° postoperatively and 40.7° ± 11.0° at final follow-up (P < 0.01). The respective mean sacral slope and pelvic tilt improved from 26.1° ± 8.1° and 25.1° ± 6.9° preoperatively to 34.3° ± 7.4° and 19.2° ± 5.7° at final follow-up (P < 0.001). The mean disc height (defined as the mean of the anterior and posterior intervertebral disc heights) increased from 0.7 ± 0.3 cm preoperatively to 1.1 ± 0.2 cm at final follow-up (P < 0.0001). The interbody fusion rate on CT was 93.3%. The mean VAS pain score improved from 5.3 ± 0.6 before surgery to 2.3 ± 0.6 at final follow-up (P < 0.001). The mean ODI improved from 29.9% ± 6.8% preoperatively to 12.8% ± 2.4% at final follow-up (P < 0.001).ConclusionsStand-alone OLIF is an effective and safe option for treating ADS in carefully selected patients.Trial registrationThe study was registered in the Chinese Clinical Trial Registry (ChiCTR2100052419).

Effects of Intra-articular Platelet Rich Plasma on Cartilage Thickness, Clinical and Functional Outcomes in Knee Osteoarthritis.

Osteoarthritis of the kneeis one of the most common degenerative diseases and the fourth leading cause of years lived with disability at the global level. This study assessed the efficacy of platelet-rich plasma (PRP) in osteoarthritis of knees as to changes in cartilage thickness and clinical and functional outcomes. Thirty participants with Kellgren-Lawrence grade two and grade three osteoarthritis knee who satisfied the inclusion and exclusion criteria were enrolled in this prospective interventional study after taking written informed consent. Each participant received three doses of two ml intraarticular platelet-rich plasma at an interval of seven days. Clinical assessment was determined using the Visual Analogue Scale (VAS) and Knee Osteoarthritis Outcome Score (KOOS) on Day 0, Day 90, and Day 180. Cartilage thickness (femoral and trochlear cartilage) was measured pre (Day 0) and post-PRP (Day 180) under ultrasound guidance. The mean VAS score for pain was 7.4 before treatment which changed to 5.3 (p= <0.0001) on Day 90 and 3.37 (p= <0.0001) on Day 180 post-PRP. The mean total KOOS was 19.16 ± 10.73 before treatment which improved to 37.42 ± 9.88 (p= <0.0001) and 49.98 ± 8.82 (p= <0.0001) at 90 days, and 180 days post-injection, respectively. The mean cartilage thickness (femoral and trochlear cartilage) improved from baseline (day 0) to final follow-up on day 180, which was statistically significant and implied cartilage repair following PRP administration. This study supports the efficacy of PRP in the management of osteoarthritis knee by improvement in pain, joint stiffness, and activities of daily living, as well as aids in the repair and regeneration of articular cartilage.

Long-term outcomes after humeral head replacement and total shoulder replacement for osteonecrosis of the humeral head: a mean follow-up of 8years.

The purpose of this study was to compare the outcomes and complications after humeral head replacement (HHR) and total shoulder replacement (TSR) in patients with osteonecrosis of the humeral head (ONHH). Twenty-six patients who underwent shoulder replacement (13 HHRs and 13 TSRs) for nontraumatic ONHH were included. The mean follow-up period was 96.4months. The visual analog scale (VAS) pain score, the University of California at Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeon (ASES) score, and range of motion (ROM) at the final follow-up evaluation were used for the assessment of clinical outcomes. The mean VAS pain score, UCLA score, and ASES score showed significant improvement from 6.3, 11.6, and 35.0 before surgery to 2.2, 28.9, and 82.6 at the final follow-up evaluation (all p < 0.001). No significant differences regarding all clinical scores and ROMs were observed between the HHR group and the TSR group, except that a greater abduction angle was observed in the HHR group compared with the TSR group (123.1° versus 96.9°, p = 0.014). Two patients in the TSR group underwent multiple reoperations due to periprosthetic joint infection. No revision surgeries were performed for glenoid erosion following HHR or aseptic glenoid loosening following TSR. The findings of this study showed satisfactory clinical and radiological outcomes with implant longevity for both HHR and TSR in patients with nontraumatic ONHH. The HHR group had a greater abduction angle compared with the TSR group.

The Effect of Progressive Muscle Relaxation on Abdominal Pain and Distension in Colonoscopy Patients

PurposeThis study was conducted to examine the effect of progressive muscle relaxation on abdominal pain and distension in colonoscopy patients. DesignA randomized controlled experimental design. MethodsThe experimental group was informed about progressive muscle relaxation (PMR) and an audio recording was provided. After the colonoscopy, abdominal pain (Visual Analogue Scale (VAS) pain) and distension (VAS distension) scores were assessed, then PMR was applied for 30 minutes and pain scores were determined again. VAS pain and VAS distension scores of the control group were determined after colonoscopy and 30 minutes later. VAS abdominal pain and VAS distension scores were evaluated at the 2nd, 4th, 8th, 12th, 16th, and 24th hour after the procedure on all patients. The day after the colonoscopy, post-test data were collected. FindingsThe pretest VAS pain and VAS distension mean scores were similar in the intervention and control groups (P > .05). The mean VAS pain and VAS distension scores decreased significantly in the intervention group post procedure (P < .05). ConclusionsPMR was determined to be effective in reducing abdominal pain and distension after colonoscopy.

Treatment of Symptomatic Subfibular Ossicle by Excision and Modified Broström Procedure for Skeletally Immature Patients.

Ossicle resection combined with ligament repair using the modified Broström procedure (MBP) is generally associated with favorable results in adults with symptomatic subfibular ossicles; however, the surgical results of this approach in skeletally immature patients remain unclear. The purpose of this study was to investigate the midterm clinical outcomes and radiographic outcomes including leg length and physeal growth of skeletally immature patients after this procedure. Twenty-six consecutive skeletally immature patients who underwent ossicle resection combined with the MBP were retrospectively evaluated. Clinical scores were evaluated using the visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Karlsson-Peterson score, and Tegner score. The talocrural angle, fibular length on radiographs, and tape-measured leg length between the 2 ankles were also measured at the final follow-up. Time of return to sports and postoperative complications were also evaluated. Fourteen girls (53.8%) and 12 boys (46.2%) had surgery at a mean age of 12.7±2.4 years. Mean postoperative follow-up time was 40.0±10.8 months. Mean VAS pain score improved from 4.1 preoperatively to 0.5 at final follow-up (P < .05). Mean AOFAS score, Karlsson score, and Tegner score all improved from 62.0, 54.0, and 2.8 preoperatively to 95.5, 94.0, and 5.4 (P < .05), respectively, at final follow-up. Median time of return to sports was 17.0 weeks. Mean talocrural angle, fibular length, and tape-measured leg length of the injured ankle were not significantly different from those of the contra-side at the final follow-up. All patients were satisfied with the results; repeat ligamentous injury occurred in 2 patients (7.7%). We had no cases of wound infection, nerve injury, compartment syndrome, or any other complications. Ossicle resection combined with the MBP performed in skeletally immature patients with symptomatic subfibular ossicles resulted in improved clinical outcomes without disruption of fibular physeal growth by an average of 3.3-year follow-up. Level IV, case series.

Comparison of Clinical and Radiographic Outcomes Between Modified Lapidus and Proximal Reverse Chevron Metatarsal Osteotomy in Hallux Valgus Concomitant with Metatarsus Adductus

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Operative treatment of hallux valgus (HV) in the setting of metatarsus adductus (MA) is reported to be difficult and poorer radiographic outcomes. Reduced space between the first and second metatarsals makes it difficult to translate the first metatarsal head laterally. This study aimed to compare the clinical and radiographic outcomes between HV with MA patients treated with modified Lapidus procedures and those with reverse proximal chevron metatarsal osteotomy (PCMO). Methods: The study included the patients of HV with MA (58 feet). 16 feet (Group 1) had been treated with modified Lapidus procedures by the senior author from December 2012 to November 2019. 42 feet (Group 2) had been treated with PCMO from February 2012 to March 2017. For the clinical assessment, visual analog scale (VAS) pain scores, AOFAS scores, and patients' postoperative satisfaction were evaluated. Radiographic assessment was performed with HV angle (HVA), intermetatarsal angle (IMA), and the first- to fifth-metatarsal width (1-5 MTW). Results: The mean follow-up duration was 16.8 (range, 12-54) months in Group 1, and 31.8 (range, 24-62) months in Group 2. The mean pain VAS score and AOFAS score improved from preoperative to the final follow-up in both group, however, Group 1 showed more significant improvement in clinical outcomes (ΔVAS: 6.0+-1.9 (Group 1) vs 5.1+-2.1(Group 2) (p=0.024), ΔAOFAS: 40.8+-11.5 (Group 1) vs 30.0+-11.3 (Group 2) (p=0.031)). As to radiographic assessment, Group 1 also showed more significant improvement in HVA and IMA (ΔHVA: 39.1+-9.1 (Group 1) vs 27.5+-9.8 (Group 2) (p&lt;0.001), ΔIMA: 13.1+-3.0 (Group 1) vs 9.4+-4.5 (Group 2) (p=0.004). Conclusion: This study demonstrated that the HV patients with concomitant MA that treated with modified Lapidus procedures showed more significant clinical and radiographic improvement than those with PCMO. For the management of the HV patients accompanying MA in the setting of large preoperative HVA, modified Lapidus procedures would be good surgical option.

Evaluation of the effect of the photobiomodulation therapy on the pain related to dental injections: A preliminary clinical trial.

Pain from dental injections is a common reason why people fear dentistry and avoid dental treatment. Thus, researchers have attempted to find methods to decrease dental injection pain. Considering the analgesic effect of the photobiomodulation therapy (PBMT), the aim of this study was to evaluate the effects of PBMT on the pain caused by dental anesthetic injections. This randomized, split-mouth, triple-blind clinical trial evaluated 60 bilateral canine teeth in 30 dental students. After the random selection of the test (laser) quadrant, the injection site was irradiated with a 940 nm diode laser. Buccal infiltration anesthesia was then administered by injecting lidocaine plus epinephrine with a short needle. The level of pain experienced during the injection was determined using a 100-millimeter visual analog scale (VAS). The same procedure was performed for the control (no laser) quadrant, with the difference being that the laser handpiece was turned on, but no radiation was administered. The 2 groups were compared using the non-parametric Wilcoxon signed-rank test. The mean VAS pain scores were 21.2 ±15.7 for the laser quadrant and 27.9 ±18.9 for the control quadrant; this difference was statistically significant (p = 0.030), but did not seem to be clinically relevant. The photobiomodulation therapy prior to dental anesthetic injections has no clinical advantage for reducing injection pain.

A Regenerative Interventional Approach to the Management of Degenerative Low Back Pain

Objective: Low back pain has been strongly related to the degenerative process of the spine, especially the degeneration of the intervertebral disc and facet joints. The main procedures for the management of low back pain are no intended to slow down or reverse the degenerative process. Platelet Rich Plasma (PRP), an orthobiologic product, has been the subject of several studies in the management of low back pain. Methods: A prospective case series study presenting the clinical results of 23 patients treated with PRP injections performed following clinical a interventionist protocol called PerMuTIS – Personalized Multi Target Biologic Injection of the Spine. The method to obtain the platelet concentrate was the Simple Double Spin technique, a low-cost double spin that produces Leucocyte Rich PRP. Baseline scores of pain and disability using the Visual Analog Scale (VAS) and Roland-Morris Disability Questionnaire (RMDQ) were recorded. Results: Mean VAS pain score across the cohort decreased by approximately 62%, while the Roland-Morris disability score decreased by about 60% at 52 weeks. There was no report of adverse events. The Leucocite and Monocite Rich PRP product showed concentration of 4.3X above baseline, with monocites concentration of 3.2X baseline. Conclusion: The concept of application in multiple targets using a simple and low-cost preparation technique proved to be feasible and without reports of serious side effects that compromise its indication. The PerMuTIS – Personalized Multi Target Biologic Injection in the Spine Technique using Simple Double Spin protocol demonstrated safety and feasibility in this prospective study of patients with low back pain who failed conservative treatments. Large scale, multicenter randomized clinical trial will provide an appropriate level of evidence to assist in clinical practice.

Clinical Score Application for Abdominopelvic Computed Tomography Used in the Diagnosis of Renal Colic Patients

Abstract Background To develop risk scoring for the use of computed tomography (CT) imaging using the visual analog scale (VAS), physical examination, and laboratory findings of renal colic patients admitted to the emergency department (ED). Materials and Methods This is prospective observational study. Among the patients who presented to the ED with abdominal or flank pain, patients who were scheduled for CT imaging for urolithiasis were included in the study. The mean VAS pain scores, physical examination findings, laboratory parameters, and macroscopic and microscopic values in urinalysis were compared between the two groups with and without stones on CT. Results Of the 196 urolithiasis patients included in the study, 165 had ureteral stones, 76 had renal stones, and 45 had renal and ureteral stones. While the difference between the urine erythrocyte averages of the two groups was borderline significant (p = 0.04), there was a high difference between the urinary hemoglobin amounts (p &lt; 0.001). In patients with urinary system stone disease, hydronephrosis, and ureteral dilatation, hemoglobin ++ and above were more significant (p &lt; 0.001). For ureteral stones, pain intensity increased as the size increased (r = 0.34 p &lt; 0.001). White blood cells &gt; 10,000 103/mL, and C-reactive protein (CRP) ≤ 5 mg/L were more significant in patients with acute renal colic. Conclusions Although we cannot develop a clinical scoring system for renal colic patients, the meaningful results we found for urinary stone disease can be used in a newly developed scoring system. It can be used in new scoring systems in the ED using a high VAS score, presence and amount of urine hemoglobin, CRP) ≤ 5 mg/L, and creatinine value.

Open Repair of Complete Proximal Hamstring Avulsions in Workers’ Compensation Patients

Background:Several studies have reported excellent results after surgical repair of proximal hamstring avulsions. However, the effect on these patients of receiving workers’ compensation has not yet been explored.Hypothesis:Workers’ compensation patients undergoing proximal hamstring repair of complete tears will have similar outcomes when compared with a matched control group of non–workers’ compensation patients.Study Design:Cohort study; Level of evidence, 3.Methods:Workers’ compensation patients who underwent complete proximal hamstring avulsion open repair between 2010 and 2019 were identified (WC group). A control group was matched by age (±3 years), sex, and body mass index (BMI; ±3). Demographics and patient-reported outcome measures were compared, including standard and custom Marx activity rating scale (MARS), standard and custom lower extremity functional scale (LEFS), and visual analog scale (VAS) for pain. Rate and time to return to work were recorded.Results:The WC group was composed of 20 patients (8 men, 12 women) with a mean age of 52.3 years and BMI of 32.4. The 20 matched controls (8 men, 12 women) who underwent repair had a mean age of 50.6 years and a mean BMI of 31.2. There was no difference between the groups regarding age (P = .924), sex (P > .999), or BMI (P = .330). The WC group reported similar mean MARS (3.3 vs 5.4; P = .174), custom MARS (87.5 vs 97.0; P = .215), and VAS pain (3.3 vs 3.8; P = .698) scores compared with controls. However, the WC group had significantly lower standard LEFS (69.1 vs 94.1; P < .001) and custom LEFS (62.3 vs 87.9; P < .001) scores, returned to work at a lower rate (70.0% vs 94.1%; P = .039), and required more time to return to work after repair (4.3 vs 3.5 months; P = .029) compared with controls.Conclusion:Workers’ compensation patients who underwent open proximal hamstring repair for complete avulsions experienced inferior patient-reported outcomes, required more time to return to work, and returned to work at a lower rate than a matched control group.

Clinical and radiographic outcomes of revision with autogenous "structured" bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study.

To assess the efficacy of autogenous "structured" bone grafting (ASBG), it was combined with superior plate (SP) revision operations for recalcitrant clavicular midshaft aseptic nonunion (CMAN). This retrospective study included 12 patients who suffered from failure of autologous cancellous bone grafting (ACBG) and SP fixation because of CMAN. Visual analogue scale (VAS) data for pain and disabilities of arm, shoulder, and hand (DASH) scores of patients who underwent these procedures from January 2019 to December 2020, obtained before surgery and at the final follow-up time, were analysed. The average time between primitive fracture and this operative treatment was 29months (15-38months). The average duration of surgery was 153minutes (range, 115-230min), and the average blood loss was 560ml (range, 350-860ml). Complications occurred in two cases (16.67%): one was persistent pain at the donor site, and the other was a calf muscle vein thrombosis. No tissue infection was observed during follow-up. The mean follow-up time was 18months (range, 12-30months). All fractures progressed to osseous healing at a mean time of 14weeks (range, 12-16weeks). The mean pain VAS score significantly improved, from 4.8 ± 1.7 pre-operatively to 1.9 ± 1.1 at the final follow-up (P = 0.01). The mean DASH score improved significantly from 30.1 ± 11.2 pre-operatively to 7.8 ± 4. 2 at the final follow-up (P < 0.01). ASBG combined with SP revision surgery achieved excellent clinical outcomes in patients with recalcitrant CMAN.

Fluctuation of visual analog scale pain scores and opioid consumption before and after total hip arthroplasty.

BACKGROUNDPatients who undergo orthopedic procedures are often given excess opioid medication. Understanding the relationship between pain and opioid consumption following total hip arthroplasty (THA) is key to creating safe and effective opioid prescribing guidelines. AIMTo evaluate the association between the quantity of opioid consumption in relation to pain scores both pre-and postoperatively in patients undergoing primary THA.METHODSWe retrospectively reviewed patients who underwent primary THA from November 2018-May 2019 and answered both the visual analog scale (VAS) pain and opioid medication questionnaires pre-and postoperatively. Both surveys were delivered daily for 7-days before surgery through the first 30 postoperative days. Survey results were divided into preoperative, postoperative days 1-7, postoperative days 8-14, and postoperative days 15-30 for analysis. Mean opioid pill consumption and VAS pain scores in each time period were determined and compared to patients’ preoperative status using hierarchical Poisson and linear regressions, respectively.RESULTSThere were 105 patients included. Mean VAS pain scores were the highest preoperatively 7.41 ± 1.72. However, VAS pain scores significantly declined in each successive postoperative category compared to preoperative scores: postoperative day 1-7 (5.07 ± 1.79; P < 0.001), postoperative day 8-14 (3.60 ± 1.64; P < 0.001), and postoperative day 15-30 (3.15 ± 1.63; P < 0.001). Mean opioid pill consumption preoperatively was 0.68 ± 1.29 pills. Compared to preoperative opioid consumption, opioid use was significantly greater between postoperative days 1-7 (1.51 ± 1.58; P = 0.001) and postoperative days 8-14 (1.00 ± 1.27; P = 0.043). Opioid consumption declined below preoperative levels between postoperative days 15-30 (0.35 ± 0.72; P = 0.160) which correlates with a VAS pain score of 3.15. CONCLUSIONAll patients experienced significant benefit and pain relief from having undergone THA. Average postoperative opioid consumption decreased below preoperative consumption between postoperative days 15-30, which was associated with a VAS pain score of 3.15. These results can be used to appropriately guide opioid prescribing practices and set patient expectations regarding pain management following THA.

Repeated magnetic resonance imaging at 6 follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis.

The efficacy of platelet-rich plasma (PRP) for lateral epicondylitis has been demonstrated. However, the healing process monitored by repeated magnetic resonance imaging (MRI) is unclear. The purpose of this study was to evaluate sequential changes using MRI in patients with lateral epicondylitis treated by PRP injection at 6 follow-up visits over a 2-year period. Thirty patients who underwent PRP treatment for lateral epicondylitis and sequential MRI evaluation were prospectively enrolled. The MRI scores (ranging from 0 to 3) and clinical scores, including the visual analog scale (VAS) pain score and Patient-Rated Tennis Elbow Evaluation (PRTEE) score, were measured at baseline (before treatment) and 1, 3, 6, 12, 18, and 24 months after the procedure. Sequential changes in the MRI scores and clinical scores during the treatment period were evaluated. In addition, the associations between MRI scores and clinical scores were assessed. The mean MRI score at baseline was 2.30, and the mean MRI scores at 1, 3, 6, 12, 18, and 24 months after the procedure were 1.97, 1.77, 1.13, 0.73, 0.60, and 0.33, respectively. Significant improvements in the MRI scores occurred by 3 months and continued over a period of 24 months. Regarding the clinical scores, the mean VAS pain scores were 72 at baseline, 48 at 1 month, 34 at 3 months, 28 at 6 months, 15 at 12 months, 14 at 18 months, and 11 at 24 months and the mean PRTEE scores were 56, 36, 26, 18, 8, 9, and 6, respectively. Significant improvements in the VAS pain score and PRTEE score occurred by 1 month and continued over a period of 12 months. There was little association between the MRI scores and clinical scores. Continuous tendon recovery assessed by MRI was found during a 2-year period after PRP treatment. Improvements in the MRI scores followed and continued longer than improvements assessed by the clinical scores.

Effect of the Application of Virtual Reality on Pain Reduction and Cerebral Blood Flow in Robot-Assisted Gait Training in Burn Patients.

Burn injuries and their treatment are extremely painful. This study aimed to determine whether virtual reality (VR) could reduce pain during robot-assisted gait training (RAGT) in burn patients by analyzing the cerebral blood flow (CBF) in the prefrontal cortex over time using functional near-infrared spectroscopy (fNIRS). The patients included in this study complained of a pain score ≥5 on a visual analog scale (VAS) during RAGT, which was performed 10 times for 2 weeks. Each session consisted of 15 min of VR application, with a 2-min break, and 15 min without VR. The average values of oxyhemoglobin and deoxyhemoglobin concentrations in the prefrontal cortex on fNIRS were calculated at four stages: temporal delay time with only RAGT, RAGT without VR, temporal delay time with RAGT and VR, and RAGT with VR. The pain scores and CBF were evaluated in sessions 1, 5, and 10 of the RAGT. The mean VAS pain scores were significantly lower (p < 0.05) in the experimental condition than in the control condition. Oxyhemoglobin in the prefrontal lobe significantly increased when RAGT was performed with VR. In conclusion, VR may be a strong nonpharmacological pain reduction technique for burn patients during physical therapy.

Outcomes analysis of anterior and lateral approach for open repair of hip abductor tendons.

Gluteal tendons tears are increasingly being recognised as a cause of recalcitrant trochanteric pain, but there is a paucity of robust studies analysing the type of tears, results and predictors of outcome. Patients with gluteal tendon tears resistant to conservative treatment who underwent isolated open repair (IR) or total hip arthroplasty and concomitant repair (THA+repair) with a minimum 1-year follow-up were retrospectively assessed separately. Type of tear, surgical approach, and fixation methods were registered. Complications and postoperative outcomes were analysed: visual analogue scale (VAS) of pain, VAS satisfaction, and activity level. Univariate regressions and multivariable models were developed. 90 cases were included: 62 cases underwent IR and 28 cases THA+repair, with an average follow-up of 3.9 years and 2.6 years, respectively. 13 complications were found (n = 5 IR, n = 8 THA+repair), including 9 re-operations (n = 4 IR, n = 5 THA+repair). Mean VAS pain score was 3.02 (SD 2.74) for the IR and 2.32 (SD 2.43) for THA+repair group. Mean VAS satisfaction was 7.09 (SD 3.07) and 7.68 (SD 2.71) for the IR and THA+repair group, respectively. In the IR group 61.4% returned to all pre-injury activities, whereas in the THA+repair group 79% did. Full-thickness tears had higher VAS pain scores (p = 0.0175), and there was trend (p > 0.05) towards higher complications, re-tears and lower VAS satisfaction in this type of tears in both groups. No statistically significant differences were found in outcomes when comparing THA+repair through direct anterior (DAA) with lateral approach (LA). Isolated gluteal tendon repair or THA+repairs seem to be safe procedures with high levels of satisfaction at short- to mid-term follow-up. The presence of a full-thickness tear is a predictor of inferior outcomes.

Enhanced Recovery after Surgery Protocol to Improve Racial and Ethnic Disparities in Postcesarean Pain Management.

The objective of this study was to assess the efficacy of an enhanced recovery after surgery (ERAS) protocol and determine its effect on racial/ethnic disparities in postcesarean pain management. We performed an institutional review board-approved retrospective cohort study of scheduled cesarean deliveries before and after ERAS implementation at a single urban academic institution. Pre-ERAS, all analgesic medications were given postoperatively on patient request. The ERAS protocol included preoperative acetaminophen and celecoxib. Postoperatively, patients received scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Oral oxycodone was available as needed, and opioid patient-controlled analgesia was eliminated from the standard order set. The primary outcome was total opioid use in the first 48 hours after cesarean, pre- and post-ERAS, reported in total milliequivalents of intravenous morphine (MME). A secondary analysis of opioid use and pain scores by racial groups was also performed. Chi-square, independent t-tests, analysis of variance, Mann-Whitney U, and Kruskal-Wallis tests were used depending on variable and data normality. Pre-ERAS and post-ERAS groups included 100 women each. Post-ERAS, total opioid use in 48 hours was less (40.8 vs. 8.6 MME, p < 0.001) and visual analog scale (VAS) pain scores were lower on postoperative day 1 (POD1) and 2 (POD2) (POD1 maximum at rest: 6.7 vs. 5.3, p < 0.001). Pre-ERAS pain scores differed by race with non-Hispanic Black (NHB) patients reporting the highest mean and max VAS pain scores POD1 and POD2 (POD1, maximum VAS at rest: NHB-7.4, non-Hispanic White-6.6, Hispanic-5.8, Asian-4.4, p = 0.006). Post-ERAS, there were no differences in postoperative pain scores between groups with movement on POD1 and POD2. A standardized ERAS protocol for postcesarean pain decreases opioid use and may improve some racial disparities in postcesarean pain control. · ERAS protocols improve postoperative pain control and lower postoperative opioid use.. · Studies show that there are racial and ethnic disparities in postpartum pain control.. · Protocols standardize care and may decrease the effects of provider implicit bias..

Comparaison of Efficacy and Safety of Fentanyl Transdermal Patch with Oral Ketorolac for Pain Management in Dry Socket: A Randomized Clinical Trial.

The aim of this study was to compare the efficacy and safety of transdermal Fentanyl patch with oral Ketorolac for pain management in dry socket patients. Sixty patients who were diagnosed with dry socket (VAS > 40mm) were recruited in this prospective randomized controlled trial. Patients were divided into two groups. Group1 (n = 30) Transdermal Fentanyl patch (25mcg/hr) was given and in Group 2 (n = 30) Ketorolac 10mg Oral tablet was prescribed for pain management. The primary endpoint was the mean pain scores within 72h evaluated by visual analog scale (VAS). Secondary measures included the safety and tolerability, amount of rescue medication (analgesic and antiemetic) and effectiveness of treatment interventions by Brief Pain Inventory Questionnaire (BPI). The mean VAS pain scores were significantly less in group 1 (Fentanyl) as compared to group 2 (ketorolac) on all follow-up days. Significant difference was noted in the mean amount of rescue analgesic medication. It was 2.16 + 1.53 in group 1 and 8.50 + 3.98 in group 2. Side effects were seen in both the groups. Nausea (46%) and vomiting (43%) were reported in group 1 while headache (36.6%) and epigastric pain (53.3%) in group 2. Thus, transdermal Fentanyl was better in pain control than Ketorolac with less need for rescue analgesic medication in dry socket.

OUTCOME OF USING PLATELET, PLASMA AND GROWTH FACTORS AS AN ORTHOBIOLOGIC DERIVATIVE TO AVOID INVASIVE SURGICAL PROCEDURES FOR TREATING KNEE OSTEOARTHRITIS AMONG ELDERLY PATIENTS

Background: The application of platelet, plasma and growth factors (PP&amp;GF) is an intra-articular orthobiologic intervention that has been proven to be safe, having less systemic complications compared with conventional treatments and could constitute an option for treating elderly patients with knee osteoarthritis (OA). However, an intermediate result of using PP&amp;GF has yet to be well established.&#x0D; Objectives: This study aimed to report the survival analysis of 24-month follow-up treatment using PP&amp;GF among elderly patients with knee OA as primary outcome. The secondary outcomes were functional improvement in terms of international knee documentation committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score and visual analog scale (VAS) pain score.&#x0D; Methods: A prospective cohort study was performed among patients with knee OA (Kellgren and Lawrence (KL) grade I-IV), aged more than 65 years who did not respond to conservative treatments. All patients received intra-articular PP&amp;GF treatment and were followed up to 24 months. Primary outcome was recorded as any surgical treatment at any time point post-PP&amp;GF injection. Secondary outcomes including IKDC, WOMAC and VAS pain score were also assessed.&#x0D; Results: A total of 184 participants were enrolled in this study. The overall survival rate of patients not undergoing any surgical procedures during 24-month follow-up was 87.50%±2.44%. The mean IKDC, WOMAC and VAS pain scores were 39.59±0.58, 55.9±1.09 and 6.63±0.13, respectively at baseline while those at 24-month follow-up were 46.77±0.81, 38.32±1.33 and 4.92±0.13, respectively. The mean platelet concentrations before and after centrifugation were 1.85x105 cells/μL (1.20-3.36x105 cells/μL) and 1.4x106 cells/μL (5.80x105-3.5 x106) cells/μL, respectively, which showed final PP&amp;GF products contained 6-10 times higher platelet concentration than those in the peripheral blood.&#x0D; Conclusion: Intra-articular injection of PP&amp;GF is a potential treatment for severe knee OA especially among elderly patients. This method provided 87.50% survivorship from surgical intervention at 24-month follow-up. Most patients improved both pain and functional outcomes. We propose that the optimal preparation technique for PP&amp;GF is the key step for improving patients’ clinical outcomes and regaining their quality of lives.