Median Visual Analogue Scale Score Research Articles

Nerve allograft reconstruction of digital neuromata

Objective: A symptomatic digital neuroma may have a devastating impact on a person's life. There is no gold standard method of treatment. We hypothesise that the reconstruction of neuroma with nerve allograft will reduce the sensitisation and cortical reorganisation associated with peripheral nerve injury. In this study, we aim to assess the effect of neuroma reconstruction with nerve allograft on patient-reported pain and satisfaction. Methods: We conducted a retrospective review of patients who underwent nerve allograft reconstruction for painful digital neuroma at our unit, from July 2015 to July 2018. We measured pre- and post-operative visual analogue scale (VAS) pain scores, patient satisfaction and patient evaluation measure (PEM) scores. Results: In 10 patients, we reconstructed 12 neuromata. In nine of these patients (11 neuromata), we demonstrated a post-operative reduction in pain, with a change in median VAS score from 7.5 to 1. Patients were satisfied with their operation, with a median satisfaction score of 10/10. The procedure was unsuccessful in two patients, one with a static VAS score and one with a satisfaction score of

Simple percutaneous pinning for management of unstable fifth metacarpal neck fractures

Background The purpose of this prospective study was to evaluate the clinical and radiographic outcomes of our new surgical technique, percutaneous antegrade intramedullary pinning, for the management of unstable displaced fifth metacarpal neck fractures. Patients and methods Between 2010 and 2014, 40 patients who met the inclusion criteria were invited for clinical and radiological follow-up. There were 38 males and two females. The mean age was 28 years. Clinical assessments included active range of motion of the injured fifth metacarpophalangeal (MP) joint; visual analog scale score for pain; grip strength; and disabilities of the arm, shoulder, and hand score. Radiological evaluation included angulation and shortening of the fifth metacarpal. Results The average follow-up duration was 18 months. Regarding clinical outcomes, the mean active range of motions of the fifth MP joints were 87°, the median visual analog scale scores were 0, the mean grip strengths were 95%, the mean disabilities of the arm, shoulder, and hand scores were 3, and mean period for return to work was 6 weeks. Regarding radiological outcomes, all fractures healed at a mean of 5.85 weeks, the mean residual angulation was 4°, and the mean postoperative shortening was 0.5 mm. Conclusion This technique is straightforward, and there is no incisional scar. The wires do not violate the MP joint that makes early joint motion possible. The operative time is relatively short compared with previous techniques. All patients in the study group had satisfactory clinical and radiographic outcomes. Level of evidence: therapeutic level IV, case series.

Impact of degree of stenosis in May-Thurner syndrome on iliac vein stenting

ObjectiveMay-Thurner syndrome (MTS) patients with lifestyle-limiting symptoms undergo stenting of the iliac vein for relief of compressive disease. The impact of degree of stenosis on clinical symptoms and outcomes after stenting is unknown and examined in our study. MethodsRetrospective review of contemporaneously entered data of 202 patients who underwent stenting for MTS between 2005 and 2011 was performed. Classification into three groups based on luminal area obtained by intraoperative intravascular ultrasound interrogation of the involved femoroiliocaval segments was carried out. Normal luminal diameters and areas were defined as 12 mm and 125 mm2, 14 mm and 150 mm2, and 16 mm and 200 mm2 in the common femoral, external iliac, and common iliac veins, respectively. Mild (<60%), moderate (60%-89%), and severe (>90%) compression groups were defined using the normal values noted previously and observed after stenting to evaluate outcomes. Kaplan-Meier analysis was done to assess primary, primary assisted, and secondary patencies. Visual analog scale for pain scores, grade of swelling, and Venous Clinical Severity Score (VCSS) before and after stenting at 6, 24, and 48 months were analyzed using paired t-test and Tukey test. Logistic regression was used to gauge the impact of multiple variables including degree of stenosis on stent reintervention. ResultsThere were 55 patients who had mild, 87 patients who had moderate, and 60 patients who had severe iliac vein compression. Baseline demographic characteristics and comorbidities were similar across all groups. In addition, there was no statistically significant difference in median baseline visual analog scale score, grade of swelling, and VCSS among the groups. Compression was treated with angioplasty and stenting encompassing all areas of disease as determined by intravascular ultrasound. Stent technique involved use of Wallstent (Boston Scientific, Marlborough, Mass) only in 183 patients and Wallstent-Z stent (Cook Medical, Bloomington, Ind) combination in the remainder. No difference in median stent patency was noted on follow-up. Clinically, at 48 months, a statistically significant recurrence of pain, swelling, and worsening of VCSS were noted in the severe stenosis group but not in the other two groups. No variable was noted to have an impact on stent reintervention. ConclusionsSeverity of MTS stenosis is not a predictor of initial clinical symptoms. Long term, patients with ≥90% initial MTS stenosis experience recurrence of symptoms. The degree of iliac venous stenosis does not appear to affect stent patency. Such information will help counsel patients before intervention.

Efficacy of foot orthoses as nonoperative treatment for hallux valgus: A 2-year follow-up study

BackgroundThe purpose of this study was to clarify the 2-year clinical and radiological outcomes of nonoperative treatment using foot orthosis for hallux valgus patients. MethodsPatients who underwent nonoperative treatment using foot orthosis were surveyed prospectively. Foot orthoses were made by one certified orthotist using the standardized method. Pain and quality of life were evaluated using subjective and objective assessment measures at 3, 6, 12, 18, and 24 months. Furthermore, radiological outcomes, patient satisfaction, and adherence to treatment were surveyed. ResultsA total of 53 patients (50 women and 3 men; median age, 63 years) were included for analysis. The pain visual analogue scale score significantly decreased over time, with the lowest score observed at 12 months. The treatment effect was maintained over 24 months (median score, 52, 21, and 27 points at baseline, 12 months, and 24 months, respectively; P < .001). The Japanese Society for Surgery of the Foot hallux scale, American Academy of Orthopaedic Surgeons Foot and Ankle Scale, and 36-Item Short-Form Health Survey bodily pain subscale also improved, although the treatment effects were maximal at 6 months and decreased thereafter. At 24 months, 43 (81%) patients continued to use the orthosis, with the median visual analogue scale score for patient satisfaction of 76 points. The hallux valgus angle and intermetatarsal angle did not change during the 24-month period. ConclusionNonoperative treatment using foot orthoses decreased pain in patients with hallux valgus. The effect of treatment was maintained up to 2 years with a relatively high degree of patient satisfaction. However, treating physicians should inform patients to set realistic expectations and be aware that a limited degree of pain reduction is expected.

Uterine and Tubal Lavage for Earlier Cancer Detection Using an Innovative Catheter: A Feasibility and Safety Study.

ObjectivesPoor survival of high-grade serous pelvic cancer is caused by a lack of effective screening measures. The detection of exfoliated cells from high-grade serous pelvic cancer, or precursor lesions, is a promising concept for earlier diagnosis. However, collecting those cells in the most efficient way while fulfilling all requirements for a screening approach is a challenge. We introduce a new catheter for uterine and tubal lavage (UtL) and the clinical evaluation of its performance.Methods/MaterialsIn study I, the clinical feasibility of the UtL using the new catheter was examined in 93 patients admitted for gynecologic surgery under general anesthesia. In study II, the safety of the UtL procedure was assessed. The pain during and after the UtL performed under local anesthesia was rated on a visual analog scale by 22 healthy women.ResultsIn study I, the UtL was carried out successfully in 92 (98.9%) of 93 cases by 16 different gynecologists. It was rated as easy to perform in 84.8% of patients but as rather difficult in cancer patients (odds ratio, 5.559; 95% confidence interval, 1.434–21.546; P = 0.007). For benign conditions, dilatation before UtL was associated with menopause status (odds ratio, 4.929; 95% confidence interval, 1.439–16.884; P = 0.016). In study II, the pain during UtL was rated with a median visual analog scale score of 1.6. During a period of 4 weeks after UtL, none of the participants had to use medication or developed symptoms requiring medical attention. The UtL took 6.5 minutes on average. The amount of extracted DNA was above the lower limit for a sensitive, deep-sequencing mutation analysis in all cases.ConclusionsOur studies demonstrate that the UtL, using the new catheter, is a safe, reliable, and well-tolerated procedure, which does not require elaborate training. Therefore, UtL fulfils all prerequisites to be used in a potential screening setting.

Vegetarian diet may ameliorate uremic pruritus in hemodialysis patients

Objectives: Systemic inflammation has been reported to be associated with uremic pruritus (UP). Although a vegetarian diet can reduce systemic inflammation in hemodialysis patients, the effect of vegetarian diet on UP is not clear. The purpose of the study was to know the possible effects of vegetarian diet on UP. Methods: A cross-sectional study was done to compare the severity of UP and blood levels of systemic inflammatory markers between vegetarian and non-vegetarian hemodialysis patients. Six non-vegetarian patients with uremic pruritus changed their non-vegetarian diet to vegetarian diet for 2 months. Visual Analogue Scale (VAS) and pruritus score (PS) were used to measure the UP severity. The serum high-sensitivity C-reactive protein (hs-CRP), and interleukin-2 (IL-2) were used as markers of inflammation. Results: Both the median VAS scores (p = .043) and the median PS scores (p < .001) were lower in the Vegetarian than in the non-vegetarian group. The median values of hs-CRP in Vegetarian were lower than that for the non-vegetarian (p = .020). The median value of IL-2 was also lower in Vegetarian than that of the non-vegetarian (p = .016). There were 6 non-vegetarian patients shift to vegetarian for 2 months. The pruritus score improved and IL-2 level decreased after change to vegetarian diet. Conclusion: We concluded that vegetarian diet might be associated with the amelioration of the uremic pruritus severity in hemodialysis patients.

Effectiveness of Percutaneous Intradiscal Decompression Therapy in Thoracic Disc Herniation

Aims: Although there have been many studies about lumbar and cervical ablation procedures, few studies have been performed in the thoracic region. To evaluate the clinical results of a percutaneous disc decompression device in patients with radicular symptoms and/or dorsal pain due to thoracic disc herniation.Methods: Eleven patients with thoracic disc herniation and/or degenerative discs (all in T10-T11, or T11-T12 levels) who did not respond to conservative treatments were undergoing ablation and compression procedures. Pain and radicular symptoms consistent with the thoracolumbar region were confirmed via abnormal magnetic resonance imaging findings after detailed anamnesis and physical examination. All patients were evaluated before and 1, 3, 6, and 12 months after treatment using the visual analog scale score. The patient satisfaction scale was used to evaluate the level of patient satisfaction at the end of the treatment at 12 months. Results: The median visual analog scale score was 7.00&plusmn;0.45 points before treatment and 2.73&plusmn;0.65 points at 12 months post-procedure and were statistically significant (p&lt;0.001). The results of pairwise comparisons using the Bonferroni Corrected Wilcoxon Signed-Rank test showed that there were statistically significant differences. The mean visual analog scale score at the beginning (7.00&plusmn;0.45) was significantly higher than the mean score of other months. Postoperative improvement was significant with a 99% confidence interval. No complications that may cause permanent damage occurred.Conclusion: Percutaneous disc decompression is an effective and safe procedure to treat pain caused by lower thoracic intervertebral disc disease, which did not respond to conservative treatments.

Efficacy of Music Therapy on Immediate Postpartum Episiotomy Pain: A randomized controlled trial

Objectives: To evaluate the effectiveness of music therapy in alleviating immediate postpartum episiotomy wound pain. Material and Methods: A randomized controlled trial was conducted to evaluate the efficacy of music therapy in alleviating immediate pain from an episiotomy wound. Uncomplicated singleton vaginal delivery women with the second degree or less episiotomy wound at Delivery and Postpartum Inpatient Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Thailand were enrolled into the study. Visual analog scale (VAS) scoring was used for comparing pain levels. Results: One hundred postpartum women were enrolled in our study. Baseline characteristics such as age, degree of episiotomy wound tear were similar between both groups. The median pain VAS score was statistically significantly lower in the music group than in the control group at the end of the 2nd hour after finish of episiotomy wound repairing process [24.0 millimeters (8.3-41.5) and 36.5 millimeters (20.0-53.3), p < 0.001]. The median pain VAS score was statistically significantly lower in the music group than in the control group at the end of 6th hour after finish of episiotomy wound repairing process [12.0 millimeters (3.0-21.0) and 22.0 millimeters (15.0-38.0), p < 0.001] Conclusion: Music therapy is effective for reducing the perceived immediate postpartum pain of an episiotomy wound. Keywords: episiotomy pain, music therapy, singleton pregnancy

Avaliação da qualidade da recuperação e do estado de saúde no pós‐operatório de cirurgias eletivas

PurposePostoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery. MethodsThis observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale. ResultsBefore surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months. ConclusionsPatients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.

Improvement of Outcomes During the First Two Years Following Total Ankle Arthroplasty.

Many studies of total ankle arthroplasty (TAA) have focused on the range of motion and functional outcomes at the time of intermediate-term follow-up. The purpose of our study was to analyze the progression of ankle hindfoot range of motion and patient-reported measures through the first 2 years following TAA. The charts of 134 patients who had been treated with a TAA by a single surgeon were retrospectively reviewed, and 107 (109 TAAs) were included in the study. The overall range of motion in the sagittal plane was measured as the change in the position of the tibia relative to the floor on dedicated weight-bearing lateral radiographs made with the ankle in maximum plantar flexion and dorsiflexion preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. In addition, patients completed a visual analogue scale (VAS) for pain, the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports Subscales, and the Short Form-12 (SF-12) Physical (PCS) and Mental (MCS) Component Summary scores at each time interval. The mean overall range of motion in the sagittal plane was 20.7° preoperatively and improved to 28.3°, 34.3°, 33.3°, and 33.3° at 3 months, 6 months, 1 year, and 2 years, respectively (p < 0.001). At each postoperative time point, the median VAS score was improved (p < 0.001) compared with the preoperative VAS score. Similarly, the FAAM and SF-12 scores were improved, compared with the preoperative score, at 6 months and later (p < 0.001). An increased range of motion correlated with a lower VAS score preoperatively (ρ = -0.31, p = 0.035) and at 1 year (ρ = -0.36, p = 0.003) postoperatively. An increased range of motion correlated with a higher FAAM ADL score at 3 months (ρ = 0.50, p = 0.012), 1 year (ρ = 0.26, p = 0.040), and 2 years (ρ = 0.39, p = 0.003) postoperatively. Patients who underwent TAA had improvement, compared with preoperatively, in the overall sagittal plane range of motion up to 6 months and maintained improvement in pain and function scores up to 2 years. Pain scores remained improved throughout the 2-year follow-up period. A better range of motion was correlated with less pain as measured with the VAS. An increased range of motion postoperatively was correlated with better function as measured with the FAAM. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial.

To investigate whether a 20-mL buffered 1% lidocaine paracervical block decreases pain during intrauterine device (IUD) placement. In a randomized, single-blind, placebo-controlled trial, women were assigned to receive either a 20-mL buffered 1% lidocaine paracervical block or no block before IUD placement. The primary outcome was pain with IUD placement measured on a 100-mm visual analog scale. Our sample size had 80% power (α=0.05) to detect a 20-mm difference in visual analog scale scores with a SD of 28 mm. Secondary outcomes included pain with speculum placement, paracervical block administration, tenaculum placement, 5 minutes postprocedure, and overall pain perception. From October 7, 2014, through October 26, 2017, 64 women were enrolled and analyzed (33 in the paracervical block arm, 31 in the no-block arm). There were no differences in baseline demographics between the groups. Women who received the paracervical block reported less pain with IUD placement compared with women who received no block (median visual analog scale score of 33 mm vs 54 mm, P=.002). Pain was significantly less in the intervention group for uterine sounding (30 mm vs 47 mm, P=.005), 5 minutes after placement (12 mm vs 27 mm, P=.005), and overall pain perception (30 mm vs 51 mm, P=.015). Participants who received the paracervical block experienced more pain with block administration compared with placebo (30 mm vs 8 mm, P=.003). There was no perceived pain difference for speculum insertion (10 mm vs 6 mm, P=.447) or tenaculum placement (15 mm vs 10 mm, P=.268). A 20-mL buffered 1% lidocaine paracervical block decreases pain with IUD placement (primary outcome), uterine sounding (secondary outcome), and 5 minutes after placement (secondary outcome). Although paracervical block administration can be painful, perception of pain for overall IUD placement procedure is lower compared with no block. ClinicalTrials.gov, NCT02219308.

Safety and Acceptability of Esophageal Cytosponge Cell Collection Device in a Pooled Analysis of Data From Individual Patients

Diagnosis and surveillance of Barrett's esophagus (BE) and eosinophilic esophagitis (EoE) havebecome emerging public health issues. Cytosponge is a novel, minimally invasive esophageal cell collection device. We aimed to assess the data on safety and acceptability of thisdevice. We performed a patient-level review of 5 prospective trials assessing Cytosponge performance in patients with reflux disease, BE and EoE in primary and secondary care. Acceptability of Cytosponge and subsequent endoscopy were recorded with visual analogue scale (VAS), wherein 0 and 10 denoted lowest and highest acceptability. Median VAS scores were compared using a Mann-Whitney test. The number of attempts, failures in swallowing the device and occurrence of adverse events were analyzed. Risk factors for failure in swallowing were analyzed using a multivariate regression model. In total, 2672 Cytosponge procedures were performed, in 2418 individuals from 2008 through 2017. There were 2 adverse events related to the device: a minor pharyngeal bleed and a case of detachment (<1:2000). The median acceptability score for the Cytosponge was 6.0 (interquartile range [IQR], 5.0-8.0), which was higher than the score for endoscopy without sedation (median 5.0; IQR, 3.0-7.0; P < .001) and lower than the score for endoscopy with sedation (median 8.0; IQR, 5.0-9.0; P < .001). Nearly all patients (91.1%) successfully swallowed the Cytosponge, most on the first attempt (90.1%). Failure to swallow the device was more likely to occur in secondary care (odds ratio, 5.13; 95% CI, 1.48-17.79; P < .01). The Cytosponge test is a safe procedure with good acceptability ratings in a variety of health care settings.

Influence of Medial Support Screws on the Maintenance of Fracture Reduction after Locked Plating of Proximal Humerus Fractures.

Background:Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures.Methods:We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures (PHFs) with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows: 75 patients in the medial cortical support (MCS) group, 26 patients in the medial multiscrew support (MMSS) group, 29 patients in the medial single screw support (MSSS) group, and 51 patients in the no medial support (NMS) group. Clinical and radiographic evaluations included the Constant-Murley score (CM), visual analogue scale (VAS), complications, and revision surgeries. The neck-shaft angle (NSA) was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or Kruskal-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher's exact test was used for categorical data.Results:The mean postoperative NSAs were 133.46° ± 6.01°, 132.39° ± 7.77°, 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found (F = 1.02, P = 0.387). In the final follow-up, the NSAs were 132.79° ± 6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 4.40, P = 0.008). There were marked differences in the NSA at the final follow-up between the MCS and NMS groups (P = 0.004). The median (interquartile range [IQR]) NSA losses were 0.0° (0.0–1.0)°, 1.3° (0.0–3.1)°, 1.5° (1.0–5.2)°, and 4.0° (1.2–7.1)° in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 60.66, P < 0.001). There were marked differences in NSA loss between the MCS and the other three groups (MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P < 0.001; and MCS vs. NMS, Z = 7.34, P < 0.001). There was also significantly less NSA loss observed in the MMSS group compared to the NMS group (Z = −3.16, P = 0.002). However, there were no significant differences between the MMSS and MSSS groups (Z = −1.65, P = 0.225) or the MSSS and NMS groups (Z = −1.21, P = 0.099). The average CM scores were 81.35 ± 9.79, 78.04 ± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 18.68, P < 0.001). The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively (χ2= 29.25, P < 0.001). The median (IQR) VAS scores were 1 (0–2), 1 (0–2), 2 (1–3), and 3 (1–5) points in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 27.80, P < 0.001). Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups (for CM scores: MCS vs. MSSS, P < 0.001; MCS vs. NMS, P < 0.001; MMSS vs. MSSS, P = 0.031; and MMSS vs. NMS, P < 0.001 and for VAS values: MCS vs. MSSS, Z = 3.31, P = 0.001; MCS vs. NMS, Z = 4.64, P < 0.001; MMSS vs. MSSS, Z = −2.09, P = 0.037; and MMSS vs. NMS, Z = −3.16, P = 0.003).Conclusions:Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.

Low-level laser therapy and dry needling for myofascial pain syndrome of the upper trapezius muscle: An interventional study

Myofascial pain syndrome is a frequently encountered musculoskeletal problem characterized by a hypersensitive trigger point. It presents with pain, increased pain threshold, and limited range of motion (ROM). This study compared the effectiveness of low-level laser therapy and dry needling to treat patients with myofascial pain syndrome. Men and women from 20 to 55 years of age with myofascial pain syndrome of the upper trapezius muscle and meeting the study criteria were randomly assigned to 4 weeks of low-level laser therapy three times weekly and dry needling once weekly. Responses were measured with a visual analog scale (VAS), pain threshold meter, and ROM of the cervical spine. Thirty-one patients completed the study, 15 received laser therapy, and 16 received dry needling. The median pretreatment VAS score was 6 in both groups. After 4 weeks of therapy, the severity of pain decreased in both groups. The decrease in VAS score was greater with low-level laser therapy than with dry needling, but the difference was not significant. Post treatment differences in pain threshold and cervical ROM were also not significant. Low-level laser treatment and dry needling were equally effective in reducing pain and increasing the pain threshold and cervical ROM in patients with myofascial pain syndrome of the upper trapezius muscle. Changes in VAS scores, pain tolerance values, and ROM were larger with low-level laser therapy than with dry needling.

Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires.

Radical eradication of deep infiltrating endometriosis (DIE) is associated with a high risk of iatrogenic autonomic denervation and pelvic dysfunction. Our aim was to prospectively analyze peri-operative details and post-operative functional outcomes (in terms of pain relief and bladder, rectal, and sexual function) among women operated for DIE of the posterior compartment with nerve-sparing technique, using the visual analogue scale and validated questionnaires. All women undergoing laparoscopic nerve-sparing eradicative surgery for DIE nodules of the posterior compartment ≥ 4cm ± bowel resection were included. Pain scores [using Visual Analogue Scale (VAS) scores] were collected before surgery and 6 and 12months after surgery. Functional outcomes in terms of bladder, rectal, and sexual function, were evaluated using validated questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered pre-operatively and 6months after surgery. A total of 34 patients were included. Twenty-eight (82.4%) of them had already undergone a previous abdominal surgery for endometriosis. Bowel resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic pain were significantly decreased after surgery both at 6 (median 3, range 0-7 and 2, 0-7, respectively) and at 12months (3, 0-8 and 2, 0-7), compared to pre-operative levels (9, 1-10 and 3, 0-7, respectively) (p < 0.0001). No differences were found in terms of urinary function between pre- and post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0-21) pre-operatively and 2 (0-18) after 6months (p = 0.72). The pre-operative total FSFI score was 19.1 (1.2-28.9) vs. 22.7 (12.2-31) post-operatively (p = 0.004). The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.

Application of spinal cord stimulation in the treatment of persistent pain in failed back surgery syndrome

The study objectiveis to demonstrate our experience of the spinal cord stimulation in the treatment of drug-resistant pain in patients with the failed back surgery syndrome (FBSS) and to evaluate its effectiveness and complications.Materials and methods.Systems for chronic spinal cord stimulation were implanted in 78 patients suffering from FBSS in Federal Neurosurgical Center (Novosibirsk) during 2013–2015. All patients had a drug-resistant neurogenic pain syndrome character and were undergone surgical intervention on the spine. Evaluating of the treatment effectiveness was carried out by visual analogue scale (VAS) and a scale Douleur Neuropathique en 4 Questions (DN4). Catamnesis ranged from 6 to 18 months.Results.The median preoperative VAS score evaluation was 6.7, at hospital discharge – 3.1, after 6 months – 3.2, after 12 months – 3.5, after 18 months – 3.4. Evaluation on a scale DN4 before surgery was 5.3, at hospital discharge – 2.1, after 6 months – 2.4, after 12 months – 2.5, after 18 months – 2.4. Complications in the form of migration, fracture of the electrodes and development of hemorrhage or inflammation at the site of implantation of the system were observed in 12 (15.3 %) cases and required revision surgery.Conclusion.Spinal stimulation is an effective and safe method of treatment of pain in FBSS, but it has specific complications associated with implantable systems.

Evaluation of the quality of recovery and the postoperative health status after elective surgery

PurposePostoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery. MethodsThis observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale. ResultsBefore surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months. ConclusionsPatients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.

Influence of Drain Placement on Postoperative Pain Following Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: Randomized Controlled Trial.

There is currently no evidence to support the routine use of an abdominal drain following laparoscopic Roux-en-Y gastric bypass (RYGB). Our aim was to investigate drain use in laparoscopic RYGB and its effects on postoperative pain. Sixty-six patients were randomly divided into two groups as no-drain (n = 36) and with-drain (n = 30). Intraoperative (time, blood loss, complications) and postoperative outcomes (morbidities, pain scores, hospital stay) were compared. Demographics of both groups were comparable. Three patients in the no-drain group required a drain (8.3%). Median visual analog scale scores for days 1-3 for with-drain and no-drain groups were 4.5 (2-9) vs. 3 (0-8) (p = 0.02), 3 (0-7) vs. 2 (0-7) (p = 0.10), and 2 (0-7) vs. 0 (0-4) (p = 0.0004), respectively. There was no difference between the groups in terms of complications and length of hospital stay. Drain use increased the postoperative pain following laparoscopic RYGB. Drain placement following laparoscopic RYGB should be selective instead of a routine application.

Evaluation of 153 Asymptomatic Subjects Using the Anopress Portable Anal Manometry Device.

Background/AimsThe Anopress device is a new portable manometry system. The aim of this study is to formulate normative data using this new device by recording the anorectal function of asymptomatic subjects. Patient comfort was also assessed.MethodsAnorectal function was assessed in asymptomatic volunteers using the Anopress. All volunteers were examined in a standardized way in accordance with the study protocol. Normative values for the Anopress were obtained from the recorded data and patient comfort was assessed using a visual analogue scale.ResultsWe recruited 153 healthy volunteers. Eighty were female (23 parous; median age 39.5 [interquartile range {IQR}, 28.75–53.00]) and 73 were male (median age 40.5 [IQR, 29.00–52.25]). For the female cohort, the following normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 40.0–103.0 mmHg; squeeze increment 35.0–140.6 mmHg; endurance 1.3–9.0 seconds; involuntary squeeze 41.1–120.8 mmHg; and strain pressure 22.1–77.9 mmHg. Similarly, the following male normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 38.3–99.6 mmHg; squeeze increment 42.5–154.8 mmHg; involuntary squeeze 40.0–123.6 mmHg; endurance 2.0–10.0 seconds; and strain pressure 11.0–72.1 mmHg. The median visual analogue scale scores for discomfort during the measurement was 0.0 (IQR, 0.00–0.00).ConclusionsNormative values for the Anopress device have been calculated by this study. The Anopress appears to be a safe and well tolerated way of measuring pressures from the entire anal canal. Further comparisons with other standard and commonly used manometry tests are, however, required to verify its reliability.

Effectiveness of Extracorporeal Shockwave Therapy in Treating Superior Lateral Brachial Cutaneous Nerve Compression Syndrome

Objective To evaluate the effectiveness of radial extracorporeal shockwave therapy(rESWT) for the treatment of superior lateral brachial cutaneous nerve(SLBCN) compression syndrome.Methods A total of 40 patients with SLBCN compression syndrome who were treated in our department from March 2013 to October 2015 were equally randomized into two groups according to random number table:rESWT group(treated with rESWT for 1 cycle) and control group(treated with local hormone injection for 1 cycle). Visual analogue scale(VAS) and Constant-Murley scale(CMS) were applied to evaluate the shoulder joint function before treatment and 1 month and 1 year after treatment. Results The average CMS scores were(66.7±0.9) and(65.7±1.1)scores in rESWT group and control group,respectively,before treatment(t=0.67,P=0.510) and were(86.9±1.0) and(86.4±1.1)scores one month after treatment(t=0.35,P=0.730);it increased to(89.7±0.7) scores in rESWT group one year later,which was significantly higher than that in control group[(85.3±0.8)scores](t=3.56,P=0.002). The improvement rate was 95% in rESWT group and only 75% in control group. Before treatment,the median VAS score in rESWT group and control group were 5.00(5.00,6.00) and 5.00(4.00,5.75)scores(u=1.13,P=0.29);one month after treatment,the median VAS score in these two groups were 2(1.00,2.75) and 2.00(1.00,2.00)scores(u=0.04,P=0.85);one year later,it was 1.00(0.00,1.00) scores in rESWT group,significantly lower than that in [2.00(1.00,2.00)scores] control group(u=5.09,P=0.02). Conclusion Compared with local hormone injection,rESWT can remarkably alleviate pain and restore shoulder joint function in patients with SLBCN compression syndrome after one year of treatment.