Mean Visual Analogue Scale Values Research Articles

Efficacy of Biosilicate Glass-ceramic and Fluoride Varnish in the Treatment of Dentin Hypersensitivity-A Randomized Controlled Clinical Trial.

The objective of this study was to compare the efficacy of Biosilicate and Duraphat in the treatment of dentin hypersensitivity (DH). This clinical trial was conducted with young adults presenting DH. A visual analogue scale (VAS) was used to assess the level of pain, using volatile and tactile tests. Forty participants presenting two teeth with DH were included, and these teeth were divided into two groups according to the treatment: Biosilicate or Duraphat. Each product was randomly applied on one tooth per participant once a week for 4 weeks and evaluated every 15 days for 60 days after the last application. The mean and standard deviation (SD) of VAS values for the initial volatile sensitivity evaluation were 6.18 (1.99) and 6.08 (1.98) for the Biosilicate and Duraphat groups, respectively, and at the fourth week 0.48 (1.5) and 0.83 (1.58). After 60 days, the volatile sensitivity showed the following values: 0.63 (1.19) for Biosilicate and 1.03 (1.07) for Duraphat. The intragroup comparison showed a significant reduction of mean VAS values for DH-related pain assessed by volatile testing for both groups (p<0.001), and the assessment at the 60-day follow-up showed mean values statistically similar to those obtained at the end of treatment. Initial tactile sensitivity observed was 1.48 (2.39) for the Biosilicate and 1.4 (2.2) for the Duraphat group and at the 60-day follow-up 0.23 (0.73) and 0.15 (0.36), respectively, with significant statistical difference (p<0.002). When the reduction in tactile and volatile sensitivities between both groups was compared, no statistically significant difference was observed. This study indicated that both products were able to promote an important reduction in dentin hypersensitivity with similar results within a 60-day follow-up.

ХРОНИЧЕСКИЕ БОЛЕВЫЕ СИНДРОМЫ В СТАРЧЕСКОМ ВОЗРАСТЕ И РОЛЬ СУБСТАНЦИИ Р. ПРИ ДАННОЙ ПАТОЛОГИИ

ABSTRACT AIM. To investigate chronic pain syndromes in old age and evaluate the clinical significance of substance P in this pathology. MATERIAL AND METHODS. The study enrolled 68 patients over the age of 75 years with the presence of musculoskeletal pain of any origin for at least 3 months. The mean age of the patients reached 81.9 ± 5.8 years (from 75 to 100 years), most of them were women (85.3%). In this study, the severity of pain was assessed using a visual analogue scale (VAS), and the type of pain was analyzed using questionnaires and scales: DN4, PainDetect, Fibromyalgia Identification Questionnaire (FIRST), Central Sensitization Questionnaire, McGill Pain Questionnaire. The blood concentration of substance P was determined by enzyme immunoassay. RESULTS AND DISCUSSION. The severity of pain syndrome on the VAS scale reached 6.3 ± 2.2 points. The mean scores for DN4 were 3.9 ± 2.1 points, and for PainDetect — 14.7 ± 9.4 points. The mean value of the FIRST questionnaire for diagnosing fibromyalgia was 3.5 ± 1.6 points, and the McGill questionnaire was 69.8 ± 43.7 points. The mean value of the central sensitization scale reached 44.3 ± 16.7 points. Pain syndrome was more severe in women: the mean VAS value in women was 6.4 ± 2.3, in men — 5.1 ± 1.2 points (p = 0.02). The severity of the neuropathic component of the pain syndrome in women was also higher: DN4 scores in women were 4.0 ± 2.1, and in men — 2.9 ± 1.7 points (p = 0.08), and PainDetect — 15.7 ± 9.4 and 8.6 ± 6.4 points, respectively (p = 0.02). The mean values of the screening questionnaire for diagnosing fibromyalgia in women reached 3.7 ± 1.5 points, and in men — 2.7 ± 1.5 points (p = 0.07). In the group of women, the mean McGill questionnaire scores were 74.2 ± 45.2, in men — 45.3 ± 23.6 points (p = 0.006). The mean values of the central sensitization questionnaire for women were: 46.1 ± 16.3, and for men — 34.2 ± 15.5 points (p = 0.03). However, no significant differences in the severity of depression were recorded in women and men: 6.2 ± 2.8 and 5.0 ± 3.4 points, respectively (p = 0.3). The mean concentration of substance P in the study group was 222.6 ± 92.9 pg/ml, varying from 74 to 529 pg/ml. In men, the mean blood concentration of substance P reached 267.1 ± 85.2 pg/ml, in women — 214.2 ± 92.7 pg/ml (p = 0.02). An inverse correlation was registered between the blood concentration of substance P and the age of patients (r = −0.31; p = 0.02). No significant relationships were found between the blood concentration of substance P and the values of all pain questionnaires. Significant correlations were registered between VAS and DN4 (r = 0.29; p = 0.01), PainDetect (r = 0.41; p = 0.004), McGill questionnaire (r = 0.53; p &lt; 0.0001) and central sensitization questionnaire (r = 0.3; p = 0.01). There was no significant correlation between the severity of pain according to VAS and the severity of depression (r = 0.16; p = 0.21). The severity of depression correlated with indicators of DN4 (r = 0.31; p = 0.01), FIRST (r = 0.26; p = 0.03), McGill questionnaire (r = 0.29; p = 0.02) and central sensitization questionnaire (r = 0.5; p &lt; 0.0001). There was a direct correlation between the age of patients and indicators of DN 4 (r = 0.24; p = 0.05) and the central sensitization questionnaire (r = 0.25; p = 0.04). CONCLUSION. The study results suggest the presence of severe chronic pain syndrome of various types in old patients and longlivers. Significant relationships were found between pain indicators assessed using different scales and questionnaires. In this study, no significant correlations were established between the blood concentration of substance P and pain parameters. KEYWORDS: pain, old age, substance P, questionnaires, scales, neuropathic, depression

PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY

ObjectiveTo compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery. Materials and MethodsOne hundred patients were randomly divided into four groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure. ResultsThe mean VAS value corresponding to the 2nd-hour pain level of the combined group was statistically significantly lower than the other groups (p=0.003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (p≤ 0.001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (p=0.038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0–2 (p=0.528) and days 0–7 (p=0.129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (p=0.030). ConclusionPreemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these two regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.

Evaluation of intraoperative bleeding in shoulder arthroscopy with preoperative injection of epinephrine saline: a retrospective comparative study.

Several studies report the positive effects of epinephrine saline irrigation in shoulder arthroscopy3,4,15,18,22,23. Cardiovascular adverse effects have been described1,2,5,6,7,9,19. The Wide Awake Local Anesthesia No Tourniquet (WALANT) limits bleeding13,16,24,25. The aim of this study is to evaluate the effects of epinephrine saline infiltrations of the shoulder on arthroscopic visual comfort. We carried out a retrospective comparative study composed of 2 groups. We included all patients admitted to the department for a rotator cuff surgery. Our exclusion criteria were any other surgical indication and patient refusal. The protocol consisted in making 3 preoperative shoulder infiltrations of 20 ml of epinephrine saline at 0.005 mg/mL. Injections were performed in all patients in group 1 and no specific treatment was performed in group 2 (control group). Data collection was performed the same way in both groups. The main judgment criterion was the evaluation of the surgeon's overall visual comfort using the Visual Analogue Scale (VAS) at the end of the procedure. We also evaluated the intraoperative discomfort related to bleeding every 15 minutes by an objective scale (the Visual Numeric Rating Scale VNRS), as well as the cumulative bleeding time, operating time, the quantity of irrigation fluid used, the blood pressure at the times of the bleeding, the mean blood pressure during the surgery and the presence of thromboembolic and cardiovascular adverse events. We included 30 patients in group 1 and 30 patients in the control group. The mean VAS value at the end of the intervention is significantly higher in group 1 than in the control group: VAS = 10 in group 1 versus VAS = 5 in group 2 (p<0.0001) (higher is better). We also observed a significant decrease in VNRS between the two groups: VNRS = 0.25 in group 1 versus VNRS = 1,00 in group 2 (p<0.0001) (lower is better). Bleeding time was significantly lower in patients in group 1 (1min 39s) compared to patients in group 2 (9min 57s) (p<0.0001). No significant difference was demonstrated concerning the operating times, the quantity of irrigation fluid used and the blood pressure data of the two groups. No adverse effects were observed. The infiltration of low doses of adrenaline as performed in WALANT procedures seems effective in improving visualization in arthroscopy by reducing the bleeding. It can be a simple, efficient, and cost-effective technique with no iatrogenic risk to improve the surgeon's comfort in arthroscopic procedures.

The effectiveness of erector spinae plane block in patients with chronic low back pain.

The erector spinae plane block (ESPB) has been widely used as a treatment strategy for a variety of acute and chronic painful conditions. The purpose of this study was to determine the analgesic efficacy of ESPB in patients with chronic low back pain and radicular symptoms who had lumbar disc herniation. Patients aged 18 to 80 years who had chronic low back pain with radicular symptoms associated with pain from lumbar disc herniation and had undergone ESPB were included in the study retrospectively. As part of a routine clinical procedure, the patient's age, gender, weight, height, body mass index, injection site, level of the injection, disc herniation level and visual analog scale score, Oswestry Disability Index, and five-point patient satisfaction questionnaire were recorded before and following the procedure. A total of 96 patients were included in this study. The mean age was 52.28±14.12 and 55 (57.3%) of the patients were female. The mean visual analog scale value and Oswestry Disability Index score were significantly decreased consecutively after the procedure (p<0.05). The mean patient satisfaction questionnaire score increased gradually compared to the baseline scores (p<0.05). Our results suggest that ESPB is an effective strategy to reduce the intensity of chronic low back pain with radicular symptoms in patients with lumbar disc herniation.

Peripheral nerve pulsed radiofrequency for trigeminal neuralgia treatment: Is it an effective method?

Trigeminal neuralgia is a paroxysmal and shock-like pain in the trigeminal nerve area. Various treatment options have been used for trigeminal neuralgia such as medical treatment, interventional procedures, and surgical operations. Pulsed radiofrequency (PRF) is a minimally invasive percutaneous technique which seems to be safer and easier to perform. This retrospective study aims to evaluate the analgesic effect, duration of efficacy, and side effects of PRF procedures in the peripheral branches of the trigeminal nerve. The data of the patients with trigeminal neuralgia who were followed up in our hospital's algology clinic from 2016 to 2018 were reviewed retrospectively. Patients aged between 18 and 70 who did not respond to medical treatment or could not use medication due to side effects were treated with PRF procedure for peripheral branches of trigeminal nerve that was selected for this study. Demographic profile, clinical presentation, pain intensity, duration of efficacy, and complications were evaluated from their files. Twenty-one patients who underwent ultrasonography guided PRF procedures were included the study. Mean visual analog scale value of the patients was found to have decreased from 9.25±0.63 to 1.55±0.88 at the end of the 1st month (p<0.001). The painless period for the patients lasted up to 12 (9-21) months and no complications occurred. PRF procedure seems to be an effective and safe method in patients who respond to block of the peripheral branches of the trigeminal nerve.

Associação entre nível de independência funcional e percepção subjetiva da dor em idosos no pós-operatório de artroplastia de quadril

ABSTRACT Hip replacement (HR) is a surgery that replaces the injured joint with a prosthesis. The postoperative period can reduce functional independence and affect the subjective experience of pain in older adults. This study evaluated the association between the level of functional independence and the subjective experience of pain in older adults who underwent HR. This cross-sectional descriptive quantitative association study used the functional independence measure (FIM) to assess the level of functional independence and the visual analogue scale (VAS) to analyze the subjective experience of pain. Spearman’s correlation test was used to evaluate the association between FIM and VAS and simple linear regression to analyze the influence of one variable on another (p≤0.05). This study evaluated 48 older adults, with a mean age of 71.5±9 years, of which 37.5% (n=18) were men and 62.5% (n=30) were women. The mean VAS and FIM values were 3.5 (±1.6) and 107 (±17.82), respectively, and they had a significant and inverse association (p=0.006; r=−0.389; R2=0.142). This study showed an inversely proportional relationship between the subjective experience of pain and the level of functional independence in older patients who underwent HR. Therefore, health professionals should pay more attention to pain in these patients in order to optimize their functional recovery and increase their functional independence.

Mid-term follow-up results of gradual capitate lengthening for the treatment of stage IIIA Kienbock's disease.

This study aimed to evaluate the mid-term radiological and clinical results of gradual lengthening of capitate for the treatment of stage IIIA Kienbock's disease. We retrospectively reviewed nine patients (five females, four males) with Lichtman stage IIIA Kienbock's disease who underwent gradual capitate lengthening at our hospital. Their clinical (range of motion (ROM), grip strength, visual analogue scale (VAS) value for pain, and Mayo wrist score (MWS)) and radiological outcomes (in terms of progression of arthritis and carpal height ratio) at the last follow-up were compared to the preoperative values. The mean age of the nine patients was 30years (range: 20-38years). The mean follow-up period was 73.8 (60-83) months. The average grip strength increased from 14.3kg preoperatively to 22.3kg at the last follow-up. The mean MWS increased from 58.8 preoperatively to 79.4 postoperatively. The mean VAS values decreased from the preoperative values: from 1.9 to 0.36 at rest, from 3.75 to 1.6 during mild effort, and from 5.35 to 3 during severe effort. The average carpal height ratio changed from 0.38 preoperatively to 0.53 postoperatively. None of the patients had any arthritic changes in their wrists. Gradual lengthening of capitate offers satisfactory mid-term results for treating stage IIIA Kienbock's disease.

Elicitation of Health State Utility Values in Retinitis Pigmentosa by Time Trade-off in the United Kingdom.

Retinitis pigmentosa (RP) is an inherited retinal pathology associated with "night blindness" and progressive loss of peripheral vision, in some cases leading to complete blindness. Health state utility values are required for activities such as modelling disease burden or the cost-effectiveness of new interventions. The current study aimed to generate utility values for health states of varying levels of functional vision in RP, with members of the general public in the UK. Five health states were defined according to standard clinical measures of visual ability. Health state descriptions were developed following interviews with patients with RP in the UK (n=5). Further interviews were conducted for confirmation with healthcare professionals with specific experience of managing patients with RP in the UK (n=2). Interviews with members of the general public in the UK were conducted to value health states. A time trade-off (TTO) process based on the established Measurement and Valuation of Health (MVH) protocol was used. Due to the ongoing COVID-19 pandemic, all interviews were web-enabled and conducted 1:1 by a trained moderator. In total, n=110 TTO interviews were conducted with members of the UK general public. Mean TTO utility values followed the logical and expected order, with increasing visual impairment leading to decreased utility. Mean values varied between 0.78 ± 0.20 ("moderate impairment"), and 0.33 ± 0.26 ("hand motion" to "no light perception"). Supplementary visual analogue scale (VAS) scores also followed the logical and expected order: mean VAS values varied between 47.95 ± 15.38 ("moderate impairment") and 17.22 ± 12.49 in ("hand motion" to "no light perception"). These data suggest that individuals living with RP have substantially impaired quality of life. Utility values for RP have been elicited here using a method and sample that is suitable for economic modelling and health technology assessment purposes.

Arthrodesis in Müller-Weiss disease: is it worth keeping the navicular bone?

Objective: Compare a case series diagnosed with Müller-Weiss disease and whether or not maintaining the diseased navicular bone influences the outcome of the arthrodesis. Methods: A retrospective clinical study that evaluated patients with Müller-Weiss disease (phases 3 and 4 of Maceira’s classification) submitted to surgery. The patients were divided into two groups. Group A included six patients (six feet), in whom all the navicular bone was removed, and a tricortical graft was used to replace it. Group B also included six patients (six feet) without removed navicular bone. The mean follow-up time was 101 months. For evaluation, clinical and radiographic criteria were used, including The American Orthopaedic Foot &amp; Ankle Society (AOFAS) scale for ankle and hindfoot and the Visual Analog Scale (VAS). Results: The mean consolidation time for arthrodesis was 18 weeks in group A and 16 weeks in group B. The radiographic angles in the preoperative and postoperative did not show significant changes. In group A, the preoperative mean AOFAS score was 45 points, and the postoperative was 80 points. In group B, the preoperative mean AOFAS score was 48 points, and the postoperative was 79 points. The mean VAS value was 2.5 in group A and 2.4 in group B. The pseudarthrosis index was the same in both groups, 33.3% (2 of the 6 feet). Conclusion: No significant differences were found between maintaining or replacing the navicular bone by tricortical bone graft in the midfoot arthrodesis in patients with Müller-Weiss disease. Level of Evidence III; Therapeutic Studies - Investigating the Results of Treatment; Retrospective Comparative Study.

Patient-reported outcome measures focusing on the esthetics of implant-compared to tooth-supported single crowns-A systematic review and meta-analysis.

To report a summary of published patient-reported esthetic outcome measures (PROMs) of implant-supported single crowns (SCs) compared with those of tooth-supported SCs. Cochrane, Medline (PubMed), and EMBASE database search was performed by three reviewers on reports with patient-reported esthetic outcomes of tooth- and implant-supported SCs. Clinical studies with at least 12 months of mean follow-up period and a minimum of 10 patients, and English, French, or German reports were included. To compare the subgroups, for aggregate-level data, random-effects meta-regression was used. Two thousand fifteen titles were identified (initial search) and screened independently concluding 53 full-text articles to include in data extraction. Twenty-two studies with 29 study cohorts were included. Patients were satisfied with the esthetics of implant- and tooth- supported crowns Mean visual analogue scale (VAS) value from the PROMs data of 1270 implant-supported SCs evaluated by 1051 patients was 89.6% (80.0%-94.1%). The mean VAS value of patients (n=201), who evaluated the esthetic outcome of 486 tooth-supported SCs was 94.4% (92.3%-96.0%). VAS scores of patients regarding their perception of esthetics did not show any difference among different crown materials or type of implant used. The patients' perception of esthetics focusing on SC had a tendency to be higher when the crowns were supported by teeth, however, no statistical difference was found when compared with implant-supported crowns (p=0.067). Patient perception of esthetics in SCs was not affected by the type of support, crown material, implant, and presence of provisional crown for both implant- and tooth-supported SCs. Despite that patient's expectations are increasing overall Patients are satisfied with with esthetic outcome of implant- and tooth-supported crowns.

Influence of forward head posture on muscle activation pattern of the trapezius pars descendens muscle in young adults

Forward head posture (FHP) is a serious problem causing head and neck disability, but the characteristics of muscle activity during long-term postural maintenance are unclear. This study aimed to investigate a comparison of electromyography (EMG) activation properties and subjective fatigue between young adults with and without habitual FHP. In this study, we examined the changes in the spatial and temporal distribution patterns of muscle activity using high-density surface EMG (HD-SEMG) in addition to mean frequency, a conventional measure of muscle fatigue. Nineteen male participants were included in the study (FHP group (n = 9; age = 22.3 ± 1.5 years) and normal group (n = 10; age = 22.5 ± 1.4 years)). Participants held three head positions (e.g., forward, backward, and neutral positions) for a total of 30 min each, and the EMG activity of the trapezius pars descendens muscle during posture maintenance was measured by HD-SEMG. The root mean square (RMS), the modified entropy, and the correlation coefficient were calculated. Additionally, the visual analogue scale (VAS) was evaluated to assess subjective fatigue. The RMS, VAS, modified entropy, and correlation coefficients were significantly higher in the FHP group than in the normal group (p < 0.001). With increasing postural maintenance time, the modified entropy and correlation coefficient values significantly decreased, and the mean frequency and VAS values significantly increased (p < 0.001). Furthermore, the forward position had significantly higher RMS, correlation coefficient, modified entropy, and VAS values than in the neutral position (p < 0.001). The HD-SEMG potential distribution patterns in the FHP group showed less heterogeneity and greater muscle activity in the entire muscle and subjective fatigue than those in the normal group. Excess muscle activity even in the neutral/comfortable position in the FHP group could potentially be a mechanism of neuromuscular conditions in this population.

Health-related quality of life of young academics: A cross-sectional survey of universities in Wuhan, China.

This study aimed to assess the health-related quality of life (HRQoL) of young academics in Wuhan, China, and its determinants. A multistage stratified cluster sampling strategy was employed to recruit study participants (young academics <40 years old) from 12 universities in Wuhan. A total of 301 respondents returned a self-complete questionnaire that contained the EQ-5D-5L. Multivariate linear and Tobit regression models were established to determine the sociodemographic and job predictors of the visual analogue scale (VAS) score and the EQ-5D utility index, respectively. The study participants reported a mean VAS value of 79.42 (SD = 10.51) and a mean EQ-5D utility index of 0.915 (SD = 0.090). Anxiety/depression was the most frequently reported problem (65.12%), followed by pain/discomfort (43.52%). Transitioning towards a full professorship in national key universities (p < 0.001), lower income (p < 0.05) and too much pressure for academic promotion (p < 0.001) were significant predictors of lower HRQoL; whereas, maintaining routines in physical activities (p < 0.001), sleep (p < 0.001) and meals (p < 0.001), a good relationship with colleagues and family members (p < 0.001), and social activities (p < 0.01) were significant predictors of higher HRQoL. Low HRQoL of young academics in China is evident, as indicated by the 7.08 and 0.049 gap in VAS and utility index, respectively, compared to the general population at the same age. Work and career pressures are associated with the low HRQoL of young academics. The findings of this study highlight the importance of work-life balance in promoting HRQoL of young academics in universities in China.

The impact of intravenously administered dexketoprofen trometamol on analgesia and recovery in ambulatory dilatation and curettage procedures: a retrospective analysis

BackgroundAchieving adequate pain control during and after the uterine D/C (dilatation and curettage) procedure is crucial for a good recovery process and early discharge.The study was conducted to find out whether intravenous dexketoprofen trometamol is more effective than tramadol and paracetamol in easing pain during the D/C procedure as well as to assess its effectiveness in the recovery period.ResultsSignificant differences were determined between the groups regarding the values of Ramsey sedation scores (p=0.048). VAS (visual analog scale) mean values of group T were higher compared to the VAS mean values of group D (p=0.02). A significant difference was found between group P and group D (p=0.016), the mean VAS values of group P were higher than group D.ConclusionsWe found out that preemptive intravenous 25 mg dexketoprofen trometamol administered in the daily D/C procedure provides good quality postoperative analgesia with minimal adverse effects by reducing the need for rescue analgesia, and is more effective in postoperative analgesia than paracetamol and tramadol.

Sacrotuberous Ligament Pain in Patients who Underwent Sacroiliac Joint Arthrodesis: Incidence and Management of Post-Surgical Lower-Buttock Pain.

Most sacroiliac joint (SIJ) disorders are conservatively treated; however, patients with severe pain occasionally require SIJ arthrodesis after failure of continuous conservative management for more than 6 months. We investigated the incidences of preoperative tenderness in the sacrotuberous ligament (STL) and postoperative lower-buttock pain originating from the STL to determine the best way to manage these symptoms to achieve good outcomes. We retrospectively investigated 33 patients (14 men and 19 women) with a mean age of 47.7 years (range: 25-79 years) who underwent SIJ arthrodesis for severe pain confirmed using diagnostic SIJ injections between April 2009 and December 2019. We investigated the pain improvement at or around the posterior superior iliac spine (PSIS) pre- and postoperatively using the visual analogue scale (VAS) values, incidence of tenderness of the STL before surgery, rate of the persisting STL tenderness, incidence of new-onset STL pain, and treatment options for STL pain postoperatively. The mean VAS value at or around the PSIS was significantly relieved postoperatively from 85.6 to 31.5 mm (P<0.001). Preoperative tenderness of the STL was identified in 21 of 33 patients (63.6%). The STL tenderness resolved after surgery in 12 of these 21 patients (57.1%); however, it persisted in nine patients (42.9%), all of whom were women. Of the 12 patients who did not have preoperative STL tenderness, 4 (33.3%) developed lower-buttock pain and had STL tenderness. In total, 9 (27.3%) of the 33 patients whose progress could be followed up after SIJ arthrodesis had pain originating from the STL; the STL pain in 8 of the 9 patients was relieved after the STL injections and physical therapy. The STL pain can occur pre- and postoperatively, and management of both persisting and new-onset STL pain after SIJ arthrodesis should be considered to achieve better outcomes.

One-year results of minimally invasive fusion surgery of the sacroiliac joint as an alternative treatment after failed endoscopic thermal coagulation.

While pain in the severe sacroiliac joint (SIJ) is a common cause of lower back pain, SIJ disease is often overlooked as a diagnosis. This study examines the extent of sufficient long-term pain relief and functional improvement in patients with SIJ syndrome that are treated with thermocoagulation. Some patients treated with thermocoagulation noted initial improvement, but the functionality and pain relief had limited duration and efficacy. Patients with insufficient improvement were recommended to undergo fusion surgery as an option for better and longer lasting results. Patients with a long history of back or pelvic problems were selected for the study. Endoscopic thermal coagulation of the SIJ was carried out. The follow-up examinations took place after 1, 3, 6, 12 months. In patients with insufficient pain relief and functionality after thermocoagulation, a fusion surgery was performed. The results of the fusion surgery were documented over a 12-month follow-up period. To carry out the statistical evaluation visual analog scale (VAS), Oswestry-Disability-Index (ODI) and the consumption of opioids were recorded. Forty-eight patients were included. The mean VAS values 12 months after thermocoagulation were 68.9. The ODI after 12 months was very near or somewhat higher than their baseline prior to the thermocoagulation. Thus, a fusion surgery was recommended. Thirty-three patients agreed to the fusion operation. The VAS values 12 months after fusion surgery decreased to 53.1. Analogous to the VAS values, the Oswestry index (ODI) showed a significant improvement after the fusion operation. The success of surgical intervention in 88% of the SIJ syndrome patients with inadequate results 12 months after thermocoagulation proves the superiority of SIJ fusion surgery. This study showed long-lasting pain relief by an average of 65% and a median improvement in functional impairments of 60%. In view of these results, fusion surgery should be considered for patients without sufficient success of thermocoagulation.

Poster 223: Evidence-Based Opioid Prescribing Guidelines Following Anterior Cruciate Ligament Reconstruction (ACLR)

Objectives:Opioid prescriptions following anterior cruciate ligament reconstruction (ACLR) vary substantially.1-3 Expert panel guidelines recommend up to 50 pills for ACLR with many surgeons refilling 40 or more tablets.1,3 The CDC warns that a five-day supply is sufficient to develop opiate dependence.4 Current recommendations are based on consensus rather than evidence and place a vulnerable population at risk for opiate misuse.2,3 Orthopaedic surgeons do not possess evidence driven regimens for opioid prescriptions following ACLR.5,6 The purpose of this study was to develop evidence-based prescription guidelines for ACLR. We hypothesized that patients would require fewer opioids than traditional guidelines suggest with a high rate of patient satisfaction.1. Beck, J.J., et al., Prospective Study of Acute Opioid Use After Adolescent Anterior Cruciate Ligament Reconstruction Shows No Effect From Patient- or Surgical-Related Factors. J Am Acad Orthop Surg, 2020. 28(7): p. 293-300.2. Wyles, C.C., et al., Implementation of Procedure-Specific Opioid Guidelines: A Readily Employable Strategy to Improve Consistency and Decrease Excessive Prescribing Following Orthopaedic Surgery. JB JS Open Access, 2020. 5(1): p. e0050.3. Stepan, J.G., et al., Development of an Institutional Opioid Prescriber Education Program and Opioid-Prescribing Guidelines: Impact on Prescribing Practices. J Bone Joint Surg Am, 2019. 101(1): p. 5-13.4. Shah A HC, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017:265-269.5. Reider, B. Opioid Epidemic. Am J Sports Med, 2019. 44(5): p. 1039-1042.6. Morris BJ, Mir HR. The opioid epidemic: Impact on orthopaedic surgery. J Am Acad Orthop Surg 2015;23: 267-271.Methods:This multicenter prospective study enrolled 46 patients undergoing ACLR. Subject demographics and opioid prescriptions were recorded at the time of enrollment. All patients were given instructions and education on opiate use. All patients followed the same perioperative, multimodal analgesic regimen (Table 1). Following surgery, patients were given postoperative “Pain Journals” to document visual analog scale (VAS) pain scores and to track their daily opioid consumption for the first 7 postoperative days (PODs) and on postoperative visit (POV) at 14 days. No changes were made to existing prescribing habits, postoperative physical rehabilitation, or surgical methodology.Results:35 patients were included in this analysis. Mean subject age was 39 years old. 46% of patients were male; 54% of patients were female. Patients were prescribed a median of 15 oxycodone 5 mg pills and consumed a median of 2 pills postoperatively. Mean postoperative opioid consumption was 5 pills (range 0 to 31 pills). 42% of patients consumed 0 opioid pills; 77% of patients consumed ≤ 5 opioid pills; 73% of patients discontinued opioid use after POD 2 (Figure 1). Patients reported a mean daily VAS value of 2.5 of 10; mean satisfaction with pain management was high at 4.16/5 on a Likert satisfaction score. Overall, patients consumed a mean 28% of their opioid prescriptions, leaving 230 opioid pills not consumed.Conclusions:This study suggests that current expert panels may be recommending an unrequired volume of opioids. As the third largest prescriber of opiate medication, orthopedic surgeons are charged with reducing the risk of opiate dependence, particularly in the ACLR vulnerable population.6 Based on our findings, patients only require 15 Oxycodone 5mg tablets following ACLR. Despite this lower volume prescription, mean pain scores remained below 3/10, patient satisfaction with pain control remained high, and 72% of opiate medication prescribed was not used.

Vapocoolant Spray for Pain Control in Intramuscular Injection Applications: A Prospective, Randomized Controlled Trial

Abstract Background Many pharmacological and nonpharmacological methods have been investigated along with advances in pain treatment. One of these nonpharmacological methods is the use of vapocoolant spray. Objective This study aimedto demonstrate the effectiveness of vapocoolant spray to reduce pain during intramuscular (IM) injection. Patients and Methods The study included ≥18 years old patients admitted to the emergency department who were asked to undergo IM injection. Patients were randomly divided into two groups as vapocoolant spray and control group. Demographic data, injection side, and visual analog scale (VAS) of the patients were recorded. Results Mean VAS values during IM injection were significantly lower in patients treated with vapocoolant spray compared with the control group. The severity of pain during IM injection was lower in the vapocoolant spray group as both moderate pain (VAS &gt; 3 cm) and severe pain (VAS &gt; 5.4 cm) compared with the control group. Conclusion Vapocoolant spray to be applied before IM injection is effective in reducing pain caused by the injection.

Is there any differences in magnetic resonance imaging findings of painful temporomandibular joint between patients with and without vertigo?

Background/Aim: Temporomandibular disorder (TMD) is an umbrella term and consists of pathological situations about temporomandibular joint (TMJ) internal structure, masticatory muscle and associated structures. Otalgic complaints are included in the group of complaints within TMJ associated structures and are frequently seen with TMD. The aim of this study is to evaluate the magnetic resonance imaging findings (MRI) of patients who had unilateral pain in the preauricular region, diagnosed with vertigo. Material and Methods: The present retrospective and cross-sectional clinical study was carried out on patients presenting with preauricular pain referred to XXX University Faculty of Dentistry Department of Oral and Maxillofacial Surgery between 2018 and 2020. There were 2 groups as vertigo and health groups. MRI findings were the primary predictor variables, while pain was the primary outcome variable, recorded on a visual analog scale (VAS). Results: 120 patients were included in the study. The patients included in both groups are between 19 and 65 years of age and there is no significant statistical difference between mean ages of the groups (p&gt;0.05). The VAS values varies between 6 and 9 in both groups. There is no significant statistical difference between mean VAS values of the groups (p&gt;0.05). On the painful side there is no significant difference between the groups in terms of disc/condyle relation (p&gt;0.05). On the other hand moderate effusion (61.4%) was significantly higher in the healthy group while severe effusion (54%) was significantly higher in the vertigo group (p&lt;0.01). Conclusions: Although both groups had the same pain scale, it was observed that the vertigo group had more dramatic MRI findings in terms of disc/condyle relation and presence of effusion. This study is the first to evaluate the disc/condyle relation and the presence of effusion through MRI in vertigo patients diagnosed with TMD.

Efficacy of Biosilicate Glass-Ceramic and Gluma in the Treatment of Cervical Dentin Hypersensitivity: An Interim Results of Randomised Control Trial

Introduction: Dentin Hypersensitivity (DH) is known to be a relatively common condition that affects a considerable portion of the population, and manifests itself in the form of acute pain, due to the exposure of dentin and open dentinal tubules, after the removal of enamel or root cement. It has a multifactorial aetiology. Aim: To compare the efficacy in DH treatment using Biosilicate and Gluma Desensitiser. Materials and Methods: This randomised clinical trial pilot study with a split-mouth design included seven participants. Two teeth presenting Gingival Recession (GR)-related DH were selected in each participant and allocated to treatment groups by simple randomisation. Gluma® desensitiser (GD) and Biosilicate® (BIO) were applied once a week for four weeks. The pain intensity under a volatile stimulus was measured using a Visual Analogue Scale (VAS) at baseline and after treatment, at 15 days and 6 months follow-up. Data analysis were performed by means of descriptive statistics, Paired t-test for inter-group comparison and Friedman test for intra-group comparison (p-value &lt;0.05). Results: The mean age of seven participants were 19.9 years, from which five were women (71.4%). The GD and BIO groups presented initial mean VAS values of 4.86±2.55 and 6.14±1.57, respectively. Fifteen days after treatment, both groups showed a significant improvement (GD group p-value=0.03 and BIO group p-value=0.02, Wilcoxon test) in pain intensity, with 71.4% teeth without sensitivity (VAS=0). Conclusion: Both treatments resulted in a reduction in painful sensitivity under volatile stimuli 15 days after treatment. BIO group presented a better outcome regarding reduction in DH, without recurrence at the 6th month evaluation, when compared to GD group.