Numeric Rating Scale Pain Scores Research Articles

Ten-Year Follow-up of Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament.

We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL). We retrospectively evaluated 51 patients followed for ≥10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression. A significant improvement was observed in the JOA score from preoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade. Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Outcome of intradiscal condoliase injection therapy for patients with recurrent lumbar disc herniation.

Retrospective cohort study. This study aimed to compare data from patients who received intradiscal condoliase (chondroitin sulfate ABC endolyase) injection for primary lumbar disc herniation (LDH) and recurrent LDH. Chemonucleolysis with condoliase for LDH is a treatment with relatively good results and a high safety profile; however, few studies have reported recurrence after LDH surgery. The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment. Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4). Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method.

Efficacy of Tilt-Angle and Low-Dose CT Scan Guidance in Percutaneous plasma Radiofrequency Treatment for Lumbar 5-Sacrum 1 Disc Herniation.

To investigate the application effect of tilt-angle low-dose ComputedTomography (CT) scanning guidance technology in the plasma radiofrequency treatment of lumbar 5-sacrum 1 (L5-S1) intervertebral disc herniation. A total of 43 patients with L5-S1 disc herniation were included in this study and categorized into vertical-angle-guided CT (Group A, n = 21) and tilt-angle-guided CT (Group B, n = 22) groups. Percutaneous plasma L5-S1 disc radiofrequency treatment was administered. The total number of punctures and scans, operation times, and Numerical Rating Scale (NRS) pain scores (preprocedure and 3 and 30 days postprocedure) were documented. Compared with Group A, punctures and scans were fewer in Group B, and the differences were statistically significant (P = 0.0001). Moreover, the CT scan-guided total surgery time was significantly shorter in Group B than in Group A (P = 0.0001). In addition, the NRS score exhibited a statistically significant difference among preprocedure (T0), 3 day postprocedure (T1), and 30 days (T2) in Groups A (P < 0.05). The NRS score exhibited a statistically significant difference between T0 and T1 and between T0 and T2 in Group B (P < 0.05), but not between T1 and T2 in Group B (P = 0.084). At three time points (T0, T1, T2), there was no statistically significant difference between the two groups (P > 0.05). The tilt-angle low-dose CT scanning technique for L5-S1 disc herniation offers the advantages of high efficiency, low damage, and low radiation, and its clinical application is recommended.

Systematic review and meta-analysis of Neck Disability Index and Numeric Pain Rating Scale in patients with migraine and tension-type headache.

The present study aimed to assess the burden of neck pain in adults with migraine and tension-type headache (TTH), utilizing the Neck Disability Index (NDI) and Numeric Pain Rating Scale (NPRS). A systematic literature search was conducted on PubMed and Embase to identify observational studies assessing NDI and NPRS in populations with migraine or TTH. The screening of articles was independently performed by two investigators (HMA and ZA). Pooled mean estimates were calculated through random-effects meta-analysis. The I2 statistic assessed between-study heterogeneity, and meta-regression further explored heterogeneity factors. Thirty-three clinic-based studies met the inclusion criteria. For participants with migraine, the pooled mean NDI score was 16.2 (95% confidence interval (CI) = 13.2-19.2, I2 = 99%). Additionally, the mean NDI was 5.5 (95% CI = 4.11-6.8, p < 0.001) scores higher in participants with chronic compared to episodic migraine. The pooled mean NDI score for participants with TTH was 13.7 (95% CI = 4.9-22.4, I2 = 99%). In addition, the meta-analysis revealed a mean NPRS score of 5.7 (95% CI = 5.1-6.2, I2 = 95%) across all participants with migraine. This systematic review and meta-analysis shows a greater degree of neck pain-related disability in migraine compared to TTH. Nevertheless, the generalizability of these findings is constrained by methodological variations identified in the current literature.

The erector spinae plane block vs. usual care for treatment of mechanical back pain in the emergency department: a pilot study.

The ultrasound-guided erector spinae plane block (ESPB), traditionally utilized for thoracic regional pain control, has been reported as an effective analgesic option for mechanical back pain, renal colic, and rib fractures in the emergency department (ED). This pilot study aims to compare the effectiveness of the ESPB to usual analgesic treatment for patients presenting to the ED with mechanical back pain. A prospective, single-blind randomized controlled trial was conducted at a Canadian community hospital from March 2020 to December 2022. Adult patients presenting to the ED with mechanical back pain of at least 7 out of 10 on the Numeric Pain Rating Scale (NPRS) were randomized to receive either the ESPB or usual care. The primary outcome was the difference in NPRS score reduction at ED discharge. Secondary outcomes included ED length of stay, ED opiate use, follow-up NPRS and Brief Pain Inventory (BPI) scores, back pain-related return ED visits, and ongoing opiate use. A total of 30 patients were enrolled, with 19 randomized to the ESPB cohort and 11 to the usual care cohort. The mean NPRS reduction at ED discharge was significantly higher in the ESPB group compared to the usual care group (5.4 vs. 2.2), with a difference of 3.2 (95% confidence interval 1.4-5.1). ED opiate use was lower in the ESPB group. The ESPB also resulted in a significant reduction in ED length of stay (160min vs. 235min). There were no reported adverse effects related to the research interventions. This pilot study suggests that the ESPB may be an effective opioid-sparing analgesic option for patients presenting to the ED with mechanical back pain. NCT05982483.

Clinical results of ultrasound-guided intra-arterial embolization targeting abnormal neovessels for plantar fasciitis: 66 cases with up to 4 years of follow-up

BackgroundPlantar fasciitis (PF) is the most common cause of chronic heel pain, affecting young and older patients. MethodsThis retrospective study included patients with PF refractory to conservative treatment who underwent intra-arterial embolization of abnormal neovessels. All patients received temporary embolic material through a needle percutaneously inserted into the posterior tibial artery. The numeric rating scale (NRS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and procedure-related adverse events were evaluated. ResultsBetween January 2020 and February 2022, 66 patients with PF were treated with intra-arterial embolization without major adverse events. The NRS pain score improved significantly, and the AOFAS score increased from 65.8 pre-treatment to 92.8 at 1 year post-treatment. The treatment effect was maintained until the final follow-up (mean duration: 30.9 months). ConclusionsUltrasound-guided intraarterial embolization using temporary embolic material may be effective for PF. Level of evidenceIV.

Evaluation of Postoperative Pain When Adding a Tibial Nerve Block to the Femoral Nerve Block for Total Knee Arthroplasty.

Background: The aim of this study was to compare the postoperative analgesic efficacy when a tibial nerve block was added to the femoral nerve block for total knee arthroplasty (TKA). Methods: A total of 60 patients were randomly assigned to the experimental group (EG) or the control group (CG) in a 1:1 ratio. The thirty patients who formed the CG underwent an ultrasound-guided femoral nerve block together with neuraxial anaesthesia and the administration of opioids and NSAIDs through an intravenous elastomeric pump for the management of the postoperative pain; the other thirty, who formed the EG, underwent neuraxial anaesthesia together with femoral and tibial nerve blocks. The efficacy of the analgesic effect was evaluated based on the numerical pain rating scale (NPRS) and on the need for analgesic rescue at different time intervals within 48 h after surgery. Results: At 24 h, the mean NPRS score in the EG and CG at rest was 1.50 ± 1.19 and 1.63 ± 1.60 [U = 443.5, p = 0.113], respectively. With joint movement, the mean NPRS score was 2.80 ± 1.49 and 3.57 ± 1.79 [U = 345, p = 0.113], respectively. Ten patients in the EG [33.3%] and 24 in the CG [80%] required rescue analgesia [Phi = 0.471, p < 0.001]. At 48 h, the mean NPRS score in the EG and CG at rest was 0.33 ± 0.60 and 0.43 ± 0.72 [U = 428, p = 0.681], respectively. With movement, the mean NPRS score was 1.03 ± 0.99 in the EG and 1.60 ± 1.07 in the CG [U = 315, p = 0.038]. No patient in the EG group required rescue analgesia, while three patients in the CG [10%] did [Phi = 0.229, p = 0.076]. The mean opioid dosage in the CG was 300 mg, whereas in the EG it was 40 mg ± 62.14 [U < 0.05, p < 0.001]. Conclusions: Adding a tibial nerve block to the femoral nerve block in TKA may achieve the same analgesic efficacy within 48 h after surgery and would reduce the systematic use of opioids.

Short-Term Effects of Cold Therapy and Kinesio Taping on Pain Relief and Upper Extremity Functionality in Individuals with Rotator Cuff Tendonitis: A Randomized Study.

Background and Objectives: Rotator cuff tendonitis (RCT) is one of the most common shoulder pathologies. It causes pain, limits shoulder joint movements, and impairs function. Despite various treatment methods, there are currently no specific guidelines regarding the most effective intervention for RCT. To the best of our knowledge, no studies have compared the effects of Kinesio taping (KT) and cold therapy (CT) on individuals with RCT. To this end, this study aimed to investigate and compare the short-term effects of KT and CT on pain relief and upper extremity functionality in individuals with RCT. Materials and Methods: One hundred and fourteen individuals were assessed for eligibility. Fifty-two individuals with RCT who met the inclusion criteria and agreed to participate were randomly allocated into either the KT or the CT group. A standardized home exercise program was given to all the participants. Their pain intensity, upper extremity function, shoulder range of motion (ROM), and grip strength were evaluated initially and after the three days of KT or CT applications. Results: All the assessment values significantly improved in the KT group. In the CT group, only the pain scores (except for the numerical rating scale (NRS) pain score during activity) were significantly improved in the CT group at the end of the third day of application compared to the initial values (p < 0.05). For all the measurement outcomes, the effects of time × group interactions were statistically significant (p < 0.05) in favor of the KT group, except for the resting pain (p = 0.688). Conclusions: The findings suggest that KT and CT could be used as adjunctive modalities to exercise for resting and night pain relief in patients with RCT. KT also had positive effects on the activity pain, function, ROM, and grip strength. The use of KT along with an exercise program could be a more effective therapeutic choice than the use of CT for improving night pain, activity pain, and upper extremity function during the short-term rehabilitation of RCT patients.

Effects of isolated shoulder versus core-shoulder chain exercises on motor control and isokinetic torque in baseball pitchers with shoulder impingement syndrome: A single-blinded randomized controlled trial

ABSTRACT Recent biomechanical evidence suggests that shoulder impingement syndrome (SIS) is closely linked with altered core-shoulder kinetic chain, resulting pain, altered external shoulder muscle activation, and external muscle weakness. We aimed to compare the effects of conventional isolated shoulder exercise (ISE) and core-shoulder chain exercises (CCE) during isokinetic shoulder rotation in baseball pitchers with SIS. Forty male college baseball pitchers with SIS were randomly allocated to ISE and CCE groups and they performed the exercises 3 times a week for 6 weeks. The standardised numerical pain rating scale (NPRS), shoulder pain and disability index (SPADI), electromyography (EMG) amplitude, and concentric (CON) and eccentric (ECC) torques were measured. Substantial improvements in NPRS and SPADI scores were observed after CCE compared to ISE (p ≤ 0.046). Internal oblique/transversus abdominis, rectus abdominis, external oblique, serratus anterior, and infraspinatus muscle activation were significantly higher after CCE than ISE (p ≤ 0.033). CON and ECC torques were higher after CCE than ISE (p ≤ 0.002). The present findings demonstrated superior therapeutic effects of CCE in improving pain, disability level, shoulder muscle activation, and torque (muscle strength) in baseball pitchers with SIS compared to the conventional ISE, highlighting the importance of the chain exercise concept.

Blood pressure is associated with knee pain severity in middle-aged and elderly individuals with or at risks for osteoarthritis: data from the Osteoarthritis Initiative

BackgroundHypertension is a common comorbidity of osteoarthritis (OA). Joint pain is the main clinical manifestation of OA. Knowledge about the relationship between hypertension and OA pain is limited. This study aimed to investigate whether blood pressure parameters are associated with knee pain severity in individuals with or at risks for OA.MethodsOur sample consisted of 2598 subjects (60.7% female, aged 45–79 years) collected from the Osteoarthritis Initiative. Blood pressure parameters included blood pressure stage, systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP). Radiographic evaluation using Kellgren-Lawrence system and pain severity evaluation using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Numeric Rating Scale (NRS) were performed for right knee. Linear regression was used to examine the relationship between blood pressure parameters and knee pain severity.ResultsFor the overall sample, blood pressure stage, SBP, and PP were positively correlated with WOMAC and NRS pain scores when adjusting for age, sex, and body mass index (BMI) (p ≤ 0.024) and were inversely correlated with KOOS score (p ≤ 0.004). After further adjusting for all covariates, PP remained a positive correlation with WOMAC score (p = 0.037) while other associations between blood pressure parameters and pain scores did not reach the statistical significance. In female, higher blood pressure stage, SBP, and PP were significantly associated with increased WOMAC and NRS scores and decreased KOOS score after adjustments of age and BMI (p ≤ 0.018). When adjusting for all covariates, the correlations of PP with WOMAC, KOOS and NRS scores remained significant (p = 0.008–0.049). In male sample, SBP was positively correlated with WOMAC score when adjusting for age and BMI (p = 0.050), but other associations between blood pressure parameters and pain scores were not statistically significant. No significant correlation was observed in male when further adjusting for other covariates.ConclusionsIncreased PP is a risk factor for knee pain and mainly affects females, which suggested that controlling PP may be beneficial in preventing or reducing knee pain in females with or at risks for OA.

Cross-sectional study assessing sleep behavior and musculoskeletal symptoms in elite junior badminton athletes.

Sleep inadequacy has previously been associated with increased risk of injury and reduced performance. It is unclear if sleep disorders are associated with musculoskeletal symptoms, which may be a predictor of serious injury and affect performance. The aim was therefore to assess sleep behavior in elite junior badminton players and its association to musculoskeletal symptoms. In 2018, players at the World Junior Badminton Championship completed the Athlete Sleep Behavior Questionnaire and a modified version of the World Olympic Association Musculoskeletal Health Questionnaire. Participants were categorized with poor or moderate/good sleep behavior as the independent variable. Musculoskeletal symptoms were the primary outcome and was categorized using yes/no questions. Relevant musculoskeletal symptoms were defined as pain higher than 30 mm Numeric Rating Scale pain score or more than 30 minutes of joint stiffness a day. Group comparison was performed using chi-square analysis and logistic regression for primary outcome adjusted for age, sex, ethnicity, previous injury, training load, and resting days. Of the 153 participants, 28% reported poor sleep scores. There was no difference between poor and moderate/good sleep score concerning demographic variables such as sex, age, ethnicity, previous injury, training load, and resting days. There were 27% with current musculoskeletal symptoms but with no difference in groups between poor and moderate/good sleep score (P = .376). This yielded an adjusted odds ratio of 1.23 (95% confidence intervals 0.52; 2.90). Twenty-eight percent of the participants reported poor sleep behavior. Twenty-seven percent experienced current musculoskeletal symptoms. We found no statistical differences in reported musculoskeletal symptoms when comparing athletes with poor sleep behavior to athletes with moderate/good sleep behavior.

Evaluation of ultrasound-guided suprazygomatic maxillary nerve block in functional endoscopic sinus surgery for postoperative pain relief: A randomised controlled trial.

Postoperative pain can impede functional recovery and delay hospital discharge after functional endoscopic sinus surgery (FESS). The study aimed to assess the efficacy of ultrasound (USG)-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain in FESS. Forty-eight adult patients between 18 and 65 years of age with American Society of Anesthesiologists physical status I and II and scheduled to undergo FESS were enroled in this randomised controlled study. Patients were randomly allocated to either receive USG-guided SZMNB with general anaesthesia (n = 24) or general anaesthesia alone (n = 24). The numerical rating scale (NRS) pain score in the immediate postoperative period was recorded as the primary outcome. A total of 24 h postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative haemodynamics, and postoperative complications were noted as secondary outcomes. The median (interquartile range) of the NRS pain score in the immediate postoperative period was 0 (0-0.25)[95% confidence interval (CI): 0, 0.08] in the block group compared to 2 (1.75-3) [95% CI: 1.60, 2.40] in the control group, P < 0.001]. Pain scores were significantly reduced at all time intervals till 24 h after surgery (P < 0.001). None of the patients required rescue analgesia in the block group. In contrast, eight patients required diclofenac 75 mg intravenous as rescue analgesia within 1 h of surgery and ten patients within 1-6 h of surgery in the control group. Other secondary outcomes were comparable between groups (P > 0.05). The USG-guided SZMNB provides excellent postoperative analgesia for patients undergoing FESS without significant side effects.

Effectiveness and safety of multimodal analgesia in open gastrostomy in patients with end-stage head and neck cancer

Objective: To investigate the effectiveness and safety of multimodal analgesia in patients with end-stage head and neck cancer in open gastrostomy surgery. Methods: This was a randomized controlled trial. From June to December 2023, 50 patients with end-stage head and neck cancer who underwent elective open gastrostomy surgery in Beijing Tongren Hospital Affiliated to Capital Medical University were prospectively selected. The patients were divided into multimodal analgesia group and local anesthesia group using the random number table method according to different anesthesia methods, with 25 cases in each group. In multimodal analgesia group, a multimodal analgesia regimen was adopted: ultrasound-guided abdominal wall nerve block (rectus sheath block and transverse abdominis plane block)+intravenous injection of oxycodone+intravenous injection of flurbiprofen axetil and dexamethasone. In local anesthesia group, local infiltration anesthesia with ropivacaine was adopted. The main outcome measure was the incidence of intraoperative pain numeric rating scale (NRS) score>3 points in the two groups. The secondary observation indicators included NRS score and hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)] at various time points during surgery [before anesthesia (T0), at the time of incision (T1), 10 minutes after surgery (T2), during gastric body traction (T3), and at the end of surgery (T4)], incidence of adverse reactions, postoperative patient satisfaction score, as well as the NRS scores at rest and activity (coughing) within 24 hours after surgery. Results: The multimodal analgesia group included 21 males and 4 females, aged (61.4±9.9) years. There were 19 males and 6 females in the local anesthesia group, aged (58.6±10.8) years. The incidence of intraoperative NRS score>3 points and the incidence of salvage analgesia in the multimodal analgesia group were both 12.0% (3/25), which were lower than 60.0% (15/25) in the local anesthesia group, and the differences were statistically significant (all P<0.001); The NRS score [M (Q1, Q3)] at T3 in the multimodal analgesia group was 2 (2, 3) points, which were lower than 5 (3, 6) points in the local anesthesia group (P<0.05). There were smaller variabilities in MAP and HR in the multimodal analgesia group than those in the local anesthesia group (all P<0.05). The incidence of intraoperative tachycardia, surgical traction reaction, and nausea in the multimodal analgesia group was lower than that in the local anesthesia group (all P<0.05). The postoperative satisfaction score of patients in the multimodal analgesia group was (9.25±0.71) points, which were higher than (7.33±0.87) points in the local anesthesia group (P<0.001). NRS score during postoperative activity within 24 hours in the multimodal analgesia group were (2.36±0.75) points, which were lower than (3.03±0.81) points of the local anesthesia group (P=0.005). No adverse reactions such as urinary retention, nausea, vomiting and dizziness occurred in both groups. Conclusion: Compared with local anesthesia, the multimodal analgesic strategy could provide better analgesic effect and longer duration, better hemodynamic stability, and fewer intraoperative adverse reactions in patients with end-stage head and neck cancer undergoing open gastrostomy.

Modified Thoracoabdominal Nerves Block Through Perichondral Approach: A Systematic Review and Meta-analysis

PurposeThis systematic review and meta-analysis aimed to investigate the postoperative analgesic efficacy and safety of the modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) in abdominal surgeries. DesignSystematic review and meta-analysis. MethodsWe searched electronic databases to identify relevant studies comparing M-TAPA with conventional analgesic techniques. The primary outcome was the requirement for rescue analgesia at 12 and 24 hours postsurgery. Secondary outcomes included the 11-point numerical rating scale pain scores at 0, 1, 2, 4, 6, 8, 12, and 24 hours following surgery, global quality of recovery scores, and postoperative adverse events. FindingsFive randomized controlled trials involving 308 patients were analyzed. M-TAPA showed no significant difference in the requirement for rescue analgesia at 12 hours (relative risk [RR]: 0.87; 95% confidence interval [CI]: 0.62, 1.22; P = .424; I2 = 40.7%; Ph = .185) and 24 hours (RR: 0.67; 95% CI: 0.22, 1.99; P = .252; I2 = 90.3%; Ph < .001) postsurgery compared to non-M-TAPA. No significant differences in numerical rating scale pain scores or global quality of recovery scores were found between the two groups (all P < .05). However, M-TAPA was associated with a lower occurrence of nausea (RR: 0.37; 95% CI: 0.22, 0.68; P < .001; I2 = 0%; Ph = .834), vomiting (RR: 0.32; 95% CI: 0.17, 0.62; P < .001; I2 = 0%; Ph = .884), and itching (RR: 0.38; 95% CI: 0.21, 0.70; P = .002; I2 = 0%; Ph = .826). ConclusionsThere was no significant difference in analgesic efficacy and safety between M-TAPA and non-M-TAPA techniques.

Virtual reality reduces anxiety of children in the plaster room: a randomized controlled trial.

Paediatric fractures are highly prevalent and are most often treated with plaster. The application and removal of plaster is often an anxiety-inducing experience for children. Decreasing the anxiety level may improve the patients' satisfaction and the quality of healthcare. Virtual reality (VR) has proven to effectively distract children and reduce their anxiety in other clinical settings, and it seems to have a similar effect during plaster treatment. This study aims to further investigate the effect of VR on the anxiety level of children with fractures who undergo plaster removal or replacement in the plaster room. A randomized controlled trial was conducted. A total of 255 patients were included, aged five to 17 years, who needed plaster treatment for a fracture of the upper or lower limb. Randomization was stratified for age (five to 11 and 12 to 17 years). The intervention group was distracted with VR goggles and headphones during the plaster treatment, whereas the control group received standard care. As the primary outcome, the post-procedural level of anxiety was measured with the Child Fear Scale (CFS). Secondary outcomes included the children's anxiety reduction (difference between CFS after and CFS before plaster procedure), numerical rating scale (NRS) pain, NRS satisfaction of the children and accompanying parents/guardians, and the children's heart rates during the procedure. An independent-samples t-test and Mann-Whitney U test (depending on the data distribution) were used to analyze the data. The post-procedural CFS was significantly lower (p < 0.001) in the intervention group (proportion of children with no anxiety = 78.6%) than in the control group (56.8%). The anxiety reduction, NRS pain and satisfaction scores, and heart rates showed no significant differences between the control group and the intervention group. Subanalyses showed an increased effect of VR on anxiety levels in young patients, females, upper limb fractures, and those who had had previous plaster treatment. VR effectively reduces the anxiety levels of children in the plaster room, especially in young girls. No statistically significant effects were seen regarding pain, heart rate, or satisfaction scores.

Effectiveness of Ultrasonography- and Fluoroscopy-Guided Caudal Epidural Injections in the Management of Chronic Lumbar Disc Disease: A Retrospective Comparative Study.

Lumbar disc disease is one of the common causes of lower back pain caused by a change in the structure of the normal disc. Most of the time, disc disease happens as a result of aging and the normal breakdown that occurs within the disc.Caudal epidural steroid injections are the popular treatment for patients with chronic low back pain that does not respond to conservative management. A retrospective survey was administered to 160 patients whohad received caudal epidural injections forchronic low back pain in the past, but only 74 patients who completed the scheduled follow-ups were included in the study. They were divided into two groups based on the imaging modality used for guiding the caudal epiduralsteroid injections, either ultrasonography or fluoroscopy, and thenassessed for improvement in pain on the Numeric Rating Scale (NRS), forfunctional improvement on theOswestry Disability Index (ODI), and for satisfaction on the North American Spine Society Patient Satisfaction Scale (SSPSS). Mean NRS pain scores improved significantly from baseline at 6.78 and 7.00 in the fluoroscopy and ultrasound groups, respectively, to 2.03 and 2.16 at 12 weeks post-procedure. The difference between the groups was not statistically significant (p > 0.05). The Oswestry Disability Index was completed at baseline and after 12 weeks of follow-up for both groups, and there was no significant difference between the two groups; the fluoroscopy group's mean Oswestry Disability Index scores were 52.4 at baseline and 35.6 at 12 weeks, whereas the scores for the ultrasound group were 50.3 at baseline and 37.9 at 12 weeks. Conversely, patient satisfaction as assessed using the SSPSS rose in both groups up to 12 weeks (p > 0.05). The ultrasound- and fluoroscopy-guided caudal epidural steroid injections proved equally effective in easing the pain, disability, and satisfaction levels of patients with chronic lower back pain.

Correlation Between Blood Levels of Cysteine Protease Caspase-1 (Casp1) and Pain Scores (NRS) Post-surgery: A Prospective Randomized Study of Patients With Cholelithiasis.

Cysteine protease caspase-1 (Casp1) plays a crucial role in the conversion of pro-cytokines to active cytokines (CYTs). The purpose of this work was to determine Casp1 blood levels in a cohort of 114 cholecystectomy patients and assess their association with other CYTs and numeric rating scale (NRS) pain scores, postoperatively. Blood levels of Casp1 and seven CYTs (IL-18, IL-18BP, IL-1ra, IL-6, IL-10, IL-1β, and IL-8) were measured at three time points; before operation, immediately after operation, and six hours after operation in 114 patients with cholelithiasis (Chole). Casp1 blood levels correlated with NRS pain scores at 24 h following surgery (p=0.016). In addition, Casp1 blood levels correlated significantly to IL-18 blood levels (p<0.001). This is the first report to evaluate Casp1 blood levels in Chole patients in correlation with other CYTs. The findings confirm a significant correlation between Casp1 blood levels and NRS pain scores. Moreover, this study provides initial evidence suggesting that inhibition of the activity of Casp1 may reduce postsurgical acute phase immune response possibly through the Casp1/pro-Il-18 pathway.

Midpoint transverse process to pleura block for postoperative analgesia following laparoscopic renal cyst decortication: Two case reports

BACKGROUND The midpoint transverse process to pleura (MTP) block, a novel technique for thoracic paravertebral block (TPVB), was first employed in laparoscopic renal cyst decortication. CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication. To address safety concerns associated with TPVBs, we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication. The MTP block was performed at the T9 level under ultrasound guidance, with 20 mL of 0.5% ropivacaine injected. Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels. Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement, with none exceeding a mean 24 h numeric rating scale &gt; 3. CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.

Repurposing metformin as adjuvant therapy in patients with ulcerative colitis treated with mesalamine: A randomized controlled double-blinded study

BackgroundUlcerative colitis (UC) is a type of inflammatory bowel disease associated with persistent inflammation. Animal studies proved the efficacy of metformin in UC. AimTo investigate the potential role of metformin and its protective pathways in patients with UC. MethodsThis is a randomized, controlled, and double-blinded clinical trial that included 60 participants with mild to moderate UC and was divided randomly into two groups (n = 30). For 6 months, the mesalamine group received 1 g of mesalamine three times daily (t.i.d.). For six months, the metformin group received mesalamine 1 g t.i.d. and metformin 500 mg twice daily. A gastroenterologist evaluated patients at baseline and 6 months after starting the treatment in order to measure serum levels of zonulin, sphingosine 1 phosphate (S1P), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Biopsies from the colon were used to measure gene expression of zonula occuldin-1 (ZO-1), signal transducer and activator of factor-3 (STAT-3), and intracellular adhesion molecule-1 (ICAM-1). The numeric pain rating scale (NRS) and partial Mayo score were also assessed for each patient. ResultsWhen compared to the mesalamine group, the metformin group demonstrated a statistical decrease in serum IL-6, zonulin, TNF-α, SIP, gene expression of ICAM-1 and STAT-3, and a significant increase in colonic ZO-1 when compared to the mesalamine group. The metformin group also showed a significant decrease in NRS and partial Mayo score index in comparison with the mesalamine group. ConclusionMetformin may be a promising additional therapy for UC patients.Trial registration identifier: NCT05553704.

A Study to Compare the Effectiveness of McKenzie Neck Exercise and Contract Relax Stretching in Mechanical Neck Pain

Background: Mechanical neck pain is commonly defined as pain between the superior nuchal line and an imaginary transverse line through the tip of the first thoracic spinous process, extending laterally to the sagittal planes peripheral to the lateral borders of the neck. Neck pain (NP) can be local and/or referred into the head and/or upper limbs. NP is a prevalent musculoskeletal issue worldwide, similar to low back pain (LBP), characterized by episodic occurrences with high recurrence and chronicity rates. It frequently arises insidiously and is multifactorial in origin, with modifiable factors including smoking, poor posture, anxiety, depression, neck strain, and occupational activities. NP is a significant societal burden, particularly prevalent among office workers and computer users. Objective: The objective of this study was to compare the effectiveness of McKenzie neck exercises and contract-relax stretching in alleviating mechanical neck pain. Methods: This quasi-experimental study included 40 participants aged 25 to 50 years from Allied Hospital Faisalabad, selected using purposive sampling. Participants were divided into two groups of 20 each. Group 1 received McKenzie neck exercises, while Group 2 received contract-relax stretching. Both groups underwent treatment three times per week for 6 to 8 weeks. Pain and functional performance were evaluated using the Numeric Pain Rating Scale (NPRS) and Neck Disability Index (NDI). Statistical analysis was conducted using SPSS version 27.0, with the Wilcoxon signed-rank test applied for within-group comparisons and the Mann-Whitney U test for between-group comparisons. Results: In Group 1 (contract-relax stretching), NPRS scores improved from a mean of 2.56 (SD=0.51) to 2.11 (SD=0.47) (Z=-2.828, p&lt;0.05), and NDI scores improved from a mean of 3.78 (SD=0.55) to 0.73 (SD=0.73) (Z=-3.419, p&lt;0.05). In Group 2 (McKenzie neck exercises), NPRS scores improved from a mean of 2.61 (SD=0.50) to 1.72 (SD=0.57) (Z=-2.828, p&lt;0.01), and NDI scores improved from a mean of 3.22 (SD=0.73) to 2.06 (SD=0.94) (Z=-3.391, p&lt;0.05). Between-group comparisons indicated that Group 2 had significantly greater improvements in NPRS (mean rank 15.47 vs. 21.53, p&lt;0.05) and NDI scores (mean rank 13.86 vs. 23.14, p&lt;0.05). Conclusion: Both McKenzie neck exercises and contract-relax stretching effectively reduced pain and improved function in patients with mechanical neck pain. However, McKenzie neck exercises demonstrated significantly greater improvements in pain relief and functional outcomes. Therefore, McKenzie neck exercises may be preferred for managing mechanical neck pain. Keywords: Mechanical Neck Pain, McKenzie Neck Exercise, Contract-Relax Stretching, Numeric Pain Rating Scale, Neck Disability Index