Numeric Rating Scale Pain Scores Research Articles

Sufentanil Combined with Nalbuphine via Patient-Controlled Intravenous Analgesia After Cesarean Section: A Retrospective Evaluation.

PurposeThis retrospective study evaluated the efficacy, opioid consumption, and safety profile of two patient-controlled intravenous analgesia (PCIA) regimens (sufentanil combined with nalbuphine vs sufentanil alone) after cesarean section (CS).Patients and MethodsParturients (n = 1808) received sufentanil combined with nalbuphine (SN group) or sufentanil alone (S group) as PCIA after CS. The primary outcome was the numeric rating scale (NRS) pain score with movement (NRS-M) at 24 h after CS. Secondary outcomes were NRS scores at rest (NRS-R) at 24 and 48 h after CS, NRS-M at 48 h after CS, cumulative PCIA bolus times, and opioid consumption during the first 24 and 48 h postoperatively, which was measured in morphine-equivalent doses.ResultsThe population comprised 993 and 815 subjects in the SN and S groups, respectively. At 24 and 48 h after CS, the respective NRS-M scores of the SN group (4.62, 3.37) were each significantly lower than those of the S group (5.18, 4.01; P < 0.01 for both). The corresponding NRS-S scores were similarly lower in the SN group (0.96, 0.19) than in the S group (2.05, 0.92; P < 0.01 for both). After adjusting for covariates, the SN group still had lower NRS-M than the S group at 24 h after CS (estimate adjusted = 0.565, P < 0.001). The PCIA bolus times were significantly lower in the SN group than in the S group. The rates of bradycardia and respiratory depression were lower in the SN group than in the S group. However, the rates of dizziness and postoperative hypotension were slightly higher in the SN group, and those of nausea/vomiting were comparable.ConclusionCompared with sufentanil alone, sufentanil combined with nalbuphine for PCIA provided superior analgesia in parturient women after CS.

S755 Early Symptom Control With Mirikizumab in Patients With Moderately to Severely Active Ulcerative Colitis in the LUCENT-1 Induction Trial

Introduction: Mirikizumab (miri), an anti-IL23/p19 monoclonal antibody, demonstrated efficacy compared with placebo (PBO) in the Phase 3, multicentre, randomized, double-blind LUCENT-1 induction study in patients with moderately to severely active ulcerative colitis (UC, NCT03518086)). This analysis assessed early onset of symptomatic improvement and symptomatic control during induction. Methods: During the 12-week (W) induction study, 1162 adult patients (pts) with inadequate response, loss of response, or were intolerant to conventional therapy or biologic or tofacitinib therapy for UC, received miri IV Q4W (N=868) or PBO (N=294). We evaluated improvement for symptoms of stool frequency (SF), rectal bleeding (RB) and bowel movement urgency (BU), abdominal pain and fatigue. BU Numeric Rating Scale (NRS) change from baseline (BL), BU Clinical Meaningful Improvement (CMI), BU Remission, Fatigue NRS change from BL, Abdominal Pain Improvement, as well as SF Remission, RB Remission, Symptomatic Response and Symptomatic Remission were assessed. Results: As early as W2, miri-treated pts achieved a significantly greater reduction in RB subscores (p=0.001) and in SF subscores (p=0.035). From W2 and W4, a significantly greater percentage achieved SF Remission and RB Remission, respectively compared to PBO. A significantly greater percentage of miri-treated pts achieved Symptomatic Response compared to PBO from W2 (p=0.003) and of Symptomatic Remission compared with PBO from W4 (p< 0.001). Miri-treated pts showed a significantly greater mean reduction in BU NRS scores as early as W2 compared to PBO (p=0.004). From W4, a significantly greater percentage of miri-treated pts achieved BU CMI versus PBO (p=0.044). From W7 onwards, a significantly greater percentage achieved BU Remission (p=0.002). The pts showed a significantly greater mean reduction in Fatigue NRS scores from W2 compared to PBO (p=0.014). As early as W4, a significant reduction of at least 30% in Abdominal Pain NRS score from BL was observed in the miri-treated pts compared with PBO (p=0.007). At W12, a significantly greater proportion of miri-treated pts achieved Symptomatic Response, Symptomatic Remission, RB Remission, SF Remission, BU change from BL, BU CMI and Remission, as well as Fatigue and Abdominal Pain Improvement, compared to PBO (Table). Conclusion: Miri provides rapid control of UC symptoms, including BU and fatigue, as early as W2 compared with PBO in pts with moderately to severely active UC. Table 1. - Assessment of improvement for UC symptomatic components in patients treated with miri vs PBO at W12 Endpoint (W12) PBO IVQ4WN=294 Miri 300 mg IVQ4WN=868 Risk difference vs PBO (95% CI) * P-value RB Remission a , n (%) 129 (43.9) 555 (63.9) 20.6 (14.2, 27.0) < 0.001 SF Remission b , n (%) 117 (39.8) 495 (57.0) 17.1 (10.7, 23.6) < 0.001 Symptomatic Response c , n (%)Symptomatic Remission d , n (%) 154 (52.4)82 (27.9) 625 (72.0)395 (45.5) 20.2 (13.8, 26.6)17.5 (11.4, 23.6) < 0.001< 0.001 BU Clinical Meaningful Improvement e , n (%) N=276** 89 (32.2) N=811** 395 (48.7) 16.2 (9.7, 22.7) < 0.001 BU Remission f , n (%) N=276** 34 (12.3) N=811** 179 (22.1) 9.7 (4.9, 14.5) < 0.001 BU NRS, LSM change from baseline (SE)Fatigue NRS, LSM change from baseline (SE) -1.63 (0.14)-1.29 (0.13) -2.59 (0.08)-1.96 (0.08) -0.95 (-1.47, -0.44)-0.66 (-0.96, -0.37) < 0.001< 0.001 Abdominal Pain NRS ≥30% reduction g , n (%) N=246** 121 (49.2) N=711** 472 (66.4) 17.4 (10.3, 24.6) < 0.001 *The Cochran-Mantel-Haenszel (CMH) test, with missing data imputed as nonresponse, was used to assess the outcomes. Mixed Model for Repeated Measures was used to assess BU NRS. The risk difference and CMH test were both adjusted for the stratification factors of prior biologic or tofacitinib failure, baseline corticosteroid use, region, and baseline modified mayo score.**Baseline population differs according to definition of each endpoint.aRB subscore of 0.bSF subscore 0, or 1 with ≥1-point decrease from BL.cAt least a 30% decrease from BL in the sum of SF and RB subscores.dSF subscore 0, or 1 with ≥1-point decrease from BL, and RB subscore of 0.eBU NRS improvement of ≥3 points pts with BL BU NRS ≥3.fNRS 0 or 1 in pts with BL BU NRS ≥3.gNRS pain score ≥30% improvement from baseline in patients with baseline AP NRS ≥3.Abbreviations: PBO= placebo; miri= mirikizumab; Q4W= every 4 weeks; CI= confidence interval; n= number of patients in the specified category, RB= rectal bleeding; LSM = least square mean; SE= standard error; SF= stool frequency; BU= bowel movement urgency; NRS = numeric rating scale.

Effects of Intraoperative Opioid Administration on Postoperative Pain and Pain Threshold: A Randomized Controlled Study.

Fentanyl and short-acting remifentanil are often used in combination. We evaluated the effect of intraoperative opioid administration on postoperative pain and pain thresholds when the two drugs were used. Patients who underwent gynecological laparoscopic surgery were randomly assigned into two groups (15 patients each) to receive either sufficient (group A) or minimum (group B) fentanyl (maximum estimated effect site concentration: A: 7.86 ng/mL, B: 1.5 ng/mL). The estimated effect site concentration at the end of surgery was adjusted to the same level (1 ng/mL). Patients in both groups also received continuous intravenous remifentanil during surgery. The primary outcome was the pressure pain threshold, as evaluated by a pressure algometer 3 h postoperatively. The pressure pain threshold at 3 h postoperatively was 51.1% (95% CI: [44.4–57.8]) in group A and 56.6% [49.5–63.6] in group B, assuming a preoperative value of 100% (p = 0.298). There were no significant differences in pressure pain threshold and numeric rating scale scores between the groups after surgery. The pain threshold decreased significantly in both groups at 3 h postoperatively compared to preoperative values, and recovered at 24 h. Co-administration of both opioids caused hyperalgesia regardless of fentanyl dose.

Systematic evaluation and meta-analysis of Chinese medicine in the treatment of centrally mediated abdominal pain syndrome.

Background:This study aimed to evaluate the clinical efficacy of Chinese medicine for the treatment of centrally mediated abdominal pain syndrome (CAPS) using a meta-analysis system.Methods:Six databases, including China National Knowledge Infrastructure, Vendor Information Pages, Chinese Biomedical Database, Wanfang, PubMed, and Embase were searched for randomized controlled trials related to the treatment of CAPS with traditional Chinese medicine. The bias risk assessment tool and RevMan5.3 software (Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration) were used to conduct quality assessment and meta-analysis, and the GRADE grading system was used to evaluate the quality of evidence for outcome indicators.Results:Fifteen articles were included in this study. Meta-analysis results showed that the treatment group was more effective in terms of the total effective rate (relative risk = 1.27; 95% confidence interval [CI], 1.19–1.34; P < .00001), Behavioral Rating Scale-6 pain score (mean difference [MD] = −0.79; 95% CI, −0.99 to −0.59; P < .00001), and traditional Chinese medicine (TCM) symptom score (MD = −1.74; 95% CI, −2.23 to −1.26; P < .00001) than the control group (P < .05). However, in terms of numerical rating scale pain score (MD = 0.79; 95% CI, −1.70 to 0.12; P = .09), the efficacy was comparable between the 2 groups, and the difference was not statistically significant (P > .05). In terms of verbal rating scale pain, depression, and anxiety scores, the data could not be combined due to inconsistent scoring criteria, and only descriptive analysis was performed. The results showed that the treatment group was slightly better than the control group in terms of relieving verbal rating scale pain and improving anxiety and depression (P < .05).Conclusion:Chinese medicine can effectively improve the pain and TCM clinical symptoms of patients with CAPS and relieve patients’ anxiety and depression with fewer adverse effects, which has certain therapeutic advantages. However, because of the low methodological quality assessment of the included literature, the quality of GRADE evidence for outcome indicators is of mostly low and very low quality, the strength of recommendation is weak, and the credibility of the conclusion is average. More rigorous, larger sample, and higher-quality clinical trials are required to provide a higher level of evidence-based medicine for the development of TCM treatment standards for CAPS.

Effects of Thoracic Paravertebral Block on Postoperative Anxiety and Depression for Patients Undergoing Thoracoscopic Lung Cancer Radical Surgery.

This study is aimed at investigating the effect of thoracic paravertebral block (TPVB) on the occurrence of chronic postoperative pain, postoperative anxiety, and depression in patients undergoing thoracoscopic radical lung cancer surgery. A total of 120 patients who underwent thoracoscopic radical lung cancer surgery in our hospital from June 2019 to March 2021 were included. There were 62 males and 58 females, with an age of 18-75 years old and a body mass index of 20-28 kg/m2. Patients were divided into two groups using the random number table method, TPVB group (n = 60) and normal saline group (control group, n = 60). Two-point nerve block was performed at T5-6 and T6-7 levels. Patients in the TPVB group received nerve block with 15 mL of 0.375% ropivacaine hydrochloride, while those in the control group received 5 mL of 0.9% normal saline. The numeric rating scale (NRS) scores at rest and during movement at 24 and 48 hours after surgery and the number of times the button on the patient-controlled analgesia pressed at 24 h after surgery in two groups were recorded. All patients were followed up by outpatient visits or phone visits at 1 year after surgery and assessed using Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and Hospital Anxiety and Depression Scale (HADS). According to the inclusion, exclusion, and drop-out criteria, 108 patients were finally included, with 52 patients in the TPVB group and 56 patients in the control group. There was no statistically significant difference between the two groups in terms of age, sex, height, body weight, body mass index, ASA classification, and operation time (P > 0.05). NRS pain scores at 24 h (P = 0.0108) and 48 h (P = 0.0000) after surgery, the number of times pressing patient-controlled analgesia at 24 h after surgery (P = 0.0000), the LANSS scores (P = 0.0000), HADS anxiety score (P = 0.0000), and depression scores (P = 0.0000) at 1 year after surgery in the TPVB group were both significantly lower than those in the control group. To sum up, ultrasound-guided TPVB can effectively relieve pain at 48 hours after thoracoscopic lung cancer radical surgery and chronic postoperative pain at 6 months after V thoracoscopic lung cancer radical surgery.

Efficacy of Su Jok Seed Therapy in Migraine: A Randomized Placebo-Controlled Study

Introduction: Migraine is an important health problem that negatively affects individuals’ activities of daily living. The decrease in the quality of life because of migraine increases the need for the development of new pharmacological and nonpharmacological treatment methods for pain management. Limited studies have reported the application of a traditional therapy, such as Su Jok seed therapy, to prevent or minimize migraine. This study aimed to examine the effect of Su Jok seed therapy on the severity, duration, and frequency of headaches in patients with migraine. Methods: The study was conducted between September 2020 and February 2021 with 47 students diagnosed with migraine. Of these, 24 patients were included in the intervention group and 23 in the placebo control group. Data were collected using a patient information form developed by the researchers, a migraine diary, the Numeric Pain Rating Scale (NPRS), and the Headache Impact Test-6 (HIT-6) questionnaire. Each patient in the intervention and placebo groups received eight sessions of Su Jok seed therapy, twice a week for 4 weeks. Data were evaluated at the 30th, 60th, and 120th min of the therapy using NPRS, before the therapy (pretest), after the therapy (posttest), and 4 weeks after the therapy (follow-up) using a migraine diary and the HIT-6 questionnaire. Results: Descriptive statistics (mean, standard deviation/standard error, and percentages) were used for data analysis. Student’s t, Mann-Whitney U, repeated-measures analysis of variance, Bonferroni, Friedman, Dunn-Bonferroni, and χ² tests were used in this study. Significance was set at p < 0.05. After the administration of Su Jok seed therapy, the difference in mean NPRS scores between the groups was significant (p < 0.05) from the 60th min of the administration. Furthermore, a significant decrease was observed in the severity, duration, and frequency of headaches; the HIT-6 questionnaire scores; and the amount of painkillers consumed by the patients in the intervention group after the therapy and in the follow-up period compared with the pretest data. Additionally, the level of satisfaction of the patients in the intervention group was significantly higher after the therapy than that of those in the placebo group. Conclusion: Su Jok seed therapy reduced the severity, duration, and frequency of migraines, which in turn reduced the amount of painkillers consumed and the HIT-6 scores of patients with migraines.

Kinematic Analysis for Repetitive Peripheral Magnetic Stimulation of the Intrinsic Muscles of the Hand

The intrinsic muscles of the hand are responsible for finger flexion and extension. The purpose of this study was to investigate the usefulness of stimulating the intrinsic muscles of the hand using repetitive peripheral magnetic stimulation (rPMS). We evaluated angular changes in the finger joints by studying active motion and rPMS. Ten healthy adults were instructed to perform the following tests in random order: (1) maximum active metacarpophalangeal joint flexion; (2) maximum active metacarpophalangeal joint abduction; and (3) repetitive peripheral magnetic stimulation for 2 s at maximum stimulation intensity. A three-dimensional motion analysis system was used to measure angular changes. Pain during stimulation was graded on a numerical rating scale (NRS). The maximum flexion and abduction of the metacarpophalangeal joint were not significantly different between active motion and rPMS. The proximal interphalangeal joint (p = 0.009) and distal interphalangeal joint (p = 0.005) were significantly extended by rPMS. The median NRS score for pain during rPMS was 2. rPMS can produce the same extent of metacarpophalangeal joint flexion and abduction as active movement with less pain. This technique can effectively stimulate the intrinsic muscles of the hand and may be used as a treatment for various diseases that cause immobility of the metacarpophalangeal joints.

Does Transcervical Styloidectomy for Eagle Syndrome Improve Quality of Life?

Eagle syndrome is an uncommon disorder that significantly impacts the quality of life (QoL) of patients. No formal QoL study has been carried out on a population of Eagle syndrome patients treated via transcervical approach. We aim to evaluate and analyze the outcomes of the patients with Eagle syndrome treated with transcervical styloidectomy via our modified QoL survey. A retrospective cohort study was utilized for patients with Eagle syndrome who underwent transcervical styloidectomy at our institution from January 2008 until December 2018. Two QoL surveys were sent to subjects. Patients were asked preoperatively and postoperatively about the presence and intensity of pain, alteration of speech, diet or chewing, limitations of daily activity, mobility or recreation, and the presence of anxiety or mood disturbances related to the disease. The styloid length on preoperative computed tomography scans and the length of the surgical specimen were obtained, and correlations with the Numeric Pain Rating Scale (NPRS) were analyzed. Spearman's rank correlation coefficient was used to determine numerical correlation. Data are expressed as mean±standard deviation, and P value less than .05 was considered statistically significant. The study sample comprised 10 patients with Eagle syndrome who underwent transcervical styloidectomy. Eight patients underwent unilateral styloidectomy, and 2 patients were bilateral. Most patients were female (80%) with a mean age of 46.0. Preoperative NPRS score averaged 5.5±2.7 (range 1 to 10) and postoperative NPRS was 2.1±1.4 (range 0 to 4) (P= .008). No correlation was found between preoperative or postoperative NRPS score and preoperative styloid length and length of styloid resected. QoL survey showed a significant improvement in neck mobility and the anxiety felt by the patients. The survey showed that all patients would recommend surgery to a friend or family member with similar symptoms. Seven patients (70%) would recommend the operation as primary treatment, and the rest would recommend it after conservative options fail. Transcervical styloidectomy was associated with a statistically significant decrease in NPRS and positive QoL changes for patients operated for Eagle syndrome at our institution.

Utilization of chiropractic services in patients with osteoarthritis and spine pain at a publicly funded healthcare facility in Canada: A retrospective study.

Osteoarthritis (OA) is one of the most prevalent and disabling musculoskeletal diseases worldwide. There is preliminary evidence from experimental studies and consensus documents that chiropractic management may alleviate spine and/or extremity OA related pain in the short term. This research explores the potential relationship of a pragmatic course of care, including soft tissue therapy, spinal manipulation, and other treatments commonly delivered by chiropractors, to spine and extremity pain in patients with OA. A retrospective analysis of prospectively collected data from the chiropractic program at a publicly funded healthcare facility was conducted. The primary outcome measures for patients diagnosed with spine and/or extremity OA (n= 76) were numeric pain scores of each spinal and extremity region at baseline and discharge, and a change score was determined. Statistically significant improvements that exceed a clinically meaningful difference in pain numeric rating scale scores were demonstrated by point change reductions from baseline to discharge visits. Change scores exceeding a minimally clinically important difference of "2-points" were present in the sacroiliac (-2.91), extremity (-2.84), cervical (-2.73), thoracic (-2.61), and lumbar (-2.59) regions. Patients diagnosed with OA in a socioeconomically disadvantaged community demonstrated reductions in mean pain scores in both a clinically meaningful and statistically significant manner concurrent with a course of chiropractic care.

Nicotine Replacement Therapy Does Not Reduce Headaches Following Subarachnoid Hemorrhage: A Propensity Score-Matched Study.

A significant number of patients admitted for aneurysmal subarachnoid hemorrhage (aSAH) are active smokers and are at risk of developing nicotine withdrawal symptoms (e.g., cravings, irritability, insomnia, headaches, etc.). This study aimed to evaluate the use of nicotine replacement therapy (NRT) regarding headache severity and analgesics consumption. A retrospective study was conducted using prospectively collected data from 2014 to 2019 in the neurointensive care unit of the Hospices Civils in Lyon, France. We performed a propensity score matching analysis. The covariables used were age, sex, initial World Federation of Neurosurgical Societies score, Hijdra sum score, and factors associated with pain following aSAH (history of chronic pain, anxiety, or depression). Smokers received NRT through a transdermal device. The primary end point was headache control. Secondary end points were mean numerical pain rating scale score and analgesics consumption. One hundred and fifty-five patients were included among 523 patients hospitalized for aSAH. Fifty-one patients underwent nicotine substitution and were matched to 51 unsubstituted patients. The headache control rate was not different between the two groups (43.1% vs. 31.4%, p = 0.736). The mean numeric pain rating scale score in the substituted group was 2.2 (1.1-3.5) and 2.4 (1.6-3.1) in the unsubstituted group (p = 0.533). The analgesics consumption (acetaminophen, tramadol, and morphine) was the same in the two groups. The use of NRT in the acute phase of aSAH does not seem to have an impact on the intensity of headaches or analgesics consumption.

Efficacy of oral nystatin treatment for patients with oral mucosal dysesthesia but without objective oral mucosal manifestations and necessity of Candida culture test before oral nystatin treatment

Background/purposePrevious studies have shown that some of the patients with oral mucosal dysesthesia but without objective oral mucosal manifestations (so-called oral dysesthesia patients in this study) may have good responses to oral nystatin treatment. This study evaluated the efficacy of oral nystatin treatment for oral dysesthesia patients and the necessity of Candida culture test before oral nystatin treatment. Materials and methodsThe 147 oral dysesthesia patients were divided into 3 groups: Candida culture (+) group (n = 29), Candida culture (−) group (n = 34), and without Candida culture test group (n = 84), and treated with oral nystatin. The pain improvement was evaluated by the reduction of numeric pain rating scale (NRS) and global perceived effects (GPE). We defined the GPE score ≥4 points as a great improvement. ResultsWe found that 44.8% of 29 patients in the Candida culture (+) group, 47.1% of 34 patients in the Candida culture (−) group, and 47.6% of 84 patients in the without Candida culture test group showed a significant reduction in the NRS score and achieved a great improvement after oral nystatin treatment for 1–4 weeks. Moreover, 72.4% of our 29 patients with Candida culture test achieved a great improvement within one week, and all the 29 patients achieved a great improvement within 4 weeks of oral nystatin treatment. ConclusionA portion of our oral dysesthesia patients are infected by Candida and it is beneficial to our patients to use oral nystatin treatment before the Candida culture test.

Meperidine-Ketorolac Combination Provides Better Analgesia than Meperidine Alone in Postoperative Patients.

Our study objective was to assess if multi-modal analgesia with meperidine-ketorolac combination provides superior analgesia or reduces opioid requirement following surgery compared to Meperidine alone. Double-blind randomized controlled trial. Postoperative pain control in orthopedic ward after spinal anesthesia. American Society of Anesthesiology (ASA) risk I or II (ASA I/II) patients who had lower limb implant surgery (88) at our center from September 2014 to July 2015. Patients were randomly assigned to receive either 1 mg/kg of intravenous (IV) meperidine and 30 mg of IV ketorolac (treatment group) or 1 mg/kg of IV meperidine (control group) post-surgery, administered every hour for the first 6 hours during the first 24 hours post-surgery. In addition, patients received intravenous meperidine on an 'as needed basis' during the first 24 hours of the postoperative period. Outcomes were time-to-first analgesia request postoperatively; cumulative opioid dose in first 24 hours post-surgery; frequency of side effects; and patient satisfaction with pain relief using a Likert scale. Numerical rating scale (NRS) pain scores hourly for the first 6 hours, then the 8th, 12th, 16th, 18th and 24th hour post-surgery were assessed. There was a significant delay in time of first request for analgesia (460 min vs 225 min; P=0.03) and a reduction in opioid consumption in 24 hours (299 mg vs 325 mg; P=0.01) in the meperidine/ketorolac group compared with the meperidine alone group which were both statistically significant. Patient satisfaction with pain relief was better in the treatment group (P=0.01). Additionally, there were fewer side effects in the treatment group than in the control group but this was not statistically significant. Adding ketorolac to meperidine reduced postoperative pain, reduced patient daily opioid requirement, increased patient satisfaction with pain relief, without increasing the frequency of side effects. Therefore, IV ketorolac addition to opioids may be a reasonable option in multimodal analgesic protocol.

Effect of visual feedback during ultrasound-guided hydrodissection for myofascial pain syndrome: An exploratory, prospective, observational clinical trial on the expectations for treatment.

Expectations for treatment have a favorable effect on the subsequent course of pain and behavior in patients. It is not known whether receiving hydrodissection while patients view their ultrasound image with doctors (visual feedback) is associated with positive treatment expectations. This was an exploratory, prospective, observational clinical trial. We explored the possibility that visual feedback immediately after ultrasound-guided hydrodissection increases the expectations for treatment, which could be one of the related factors for pain reduction. Treatment expectations were set as mediators of pain using path analysis. The primary endpoint was the numerical rating scale to assess expectations for treatment immediately after hydrodissection, between with and without the visual feedback. During 2019 and 2020, 136 outpatients received ultrasound-guided hydrodissection for myofascial pain syndrome. Of these, 65 (47.8%) patients received visual feedback during ultrasound-guided hydrodissection. Compared with the non-visual feedback group, the visual feedback group had higher expectations for treatment immediately after hydrodissection, and their expectations were maintained at day 14 of treatment (p < 0.001). A numerical rating scale (NRS) to assess expectations for treatment was similar before hydrodissection and immediately after hydrodissection was 8.4 (standard deviations, 1.6) in the visual feedback and 5.9 (standard deviations, 2.6) in the visual feedback. The proportion of increased expectations immediately after hydrodissection was 90.8% (95% CI: 83.7–97.9) in visual feedback group and 38.0% (95% CI: 26.7–49.3) in non-visual feedback group (p < 0.001). In the visual feedback group, 67.7% of patients showed improvement in pain numerical rating scale score by 50% or more at day 14, whereas such improvement was observed in only 36.6% of the non-visual feedback group (p < 0.001). Based on path analysis, the visual feedback had the greatest influence on pain numerical rating scale reduction at 14 days, indirectly due to increased expectations for treatment as a mediator (β = 0.434). However, the adjusted R2 values, which is the overall fit of the model, was low at 0.298. Visual feedback during ultrasound-guided hydrodissection increases the expectations for treatment immediately after hydrodissection, which could be one of the related factors for pain reduction in patients with myofascial pain syndrome.

Biomarker of Urinary Malondialdehyde and Tumor Necrosis Factor-Alpha with Pain Progress in a Patient with Low Back Pain

Introduction: This study aims to determine the urine concentrations of malondialdehyde (MDA), and tumor necrosis factor-alpha (TNF-α) biomarkers with pain intensity in a patient with low back pain (LBP) compared to healthy controls. Also, the correlation between these biomarkers and clinical findings of pain intensity was determined during 25 weeks to find a molecular diagnostic factor of disease progression. Case Presentation: Participants in this case study are students at Shahed University, Iran. A 22‑year‑old man patient with a three-month history of progressive LBH and gait instability and an age, sex, and body mass index (BMI) matched healthy man was enrolled for 25 weeks. Spinal MRI (Siemens 1.5 T) revealed disc degeneration and displacement. LBP symptoms were diagnosed by a neurologist using ICD-9 diagnostic codes. Other diseases that affect the urine levels of MDA and TNF-α in the patient, such as allergic or infectious diseases, have been ruled out. After collecting demographic information, the facial pain scale (FPS) and numerical rating scale (NRS) for pain and 24-hour urine samples of a healthy person and a patient were collected weekly for 25 weeks. Samples were analyzed for MDA and TNF-α. Conclusions: During the experiment, urinary MDA levels were significantly elevated while TNF-α levels were not changed in LBP patients compared to control individuals (P ≤ 0.001). Furthermore, the assessment of LBP by the FPS and NRS pain scores was only correlated with urinary MDA levels, and urinary TNF-α levels did not change during the experiment. Pearson correlation analysis revealed a positive correlation between pain scores during 25 weeks and urine concentrations of MDA (r = 0.60, P-value &lt; 0.001). According to the present study, chronic LBP patients had higher levels of MDA in their urine than those who did not have chronic LBP. There was a significant positive association between urine MDA level and pain intensity progression.

P67. ERAS protocol associated with improved measurable outcomes in patients undergoing lumbar spinal fusion

<h3>BACKGROUND CONTEXT</h3> Enhanced Recovery After Surgery (ERAS) has been proven to improve clinical outcomes in other major and complex surgeries. Preoperative optimization, multi-modal pain management and preemptive treatment to prevent most common postoperative conditions are key components. In addition, "fast track" protocol strategies (ie, early nutrition, drain removal and ambulation, etc) are believed to facilitate faster recovery and discharge. Shortened length of stay (LOS) has been associated with improved patient satisfaction and an important hospital cost-saving measure. However, concerns have been raised if shorter length of stay has unintended cost-consequences by shifting care from in-patient to post-discharge care (ie, use of rehab centers, home health care or increased hospital readmission). <h3>PURPOSE</h3> The authors sought to evaluate the impact of newly implemented ERAS protocol in measurable clinical outcomes and its consequence with regards to hospital readmission and identify any post-discharge care substitution. <h3>STUDY DESIGN/SETTING</h3> Retrospective Study, Single Institution. <h3>PATIENT SAMPLE</h3> Patients undergoing instrumented lumbar fusion. <h3>OUTCOME MEASURES</h3> LOS, MME, Pain score, Time to ambulation, discharge disposition and readmission. <h3>METHODS</h3> Patients undergoing lumbar spine surgery from Jan-Dec 2018 were included in this retrospective case series. Patient characteristics, surgical time and events, ambulation, Numeric Rating Scale (pain score 0 means no pain, 10 worst pain possible), LOS, discharge disposition and readmission were compared between a group treated under the new ERAS protocol (ERAS) and a control group treated prior to protocol implementation (Pre-ERAS). All opioids administered were collected and doses converted to morphine milligram equivalent (MME). Data was analyzed with t-test (or Kruskal-Wallis test) and Chi-squared test (Fisher's exact test). <h3>RESULTS</h3> A total of 338 patients were included in this analysis (146 ERAS, 192 Pre-ERAS). Patients during the protocol trial period were excluded. Both groups were similar in characteristics: age at surgery, gender, BMI, ASA score and baseline opioid use (all p>0.05). Preoperative baseline pain scores were comparable between ERAS vs Pre-ERAS groups (4.50 vs 4.20, p=0.401). Postoperatively, patients in the ERAS group reported lower average pain scores in recovery room (5.22 vs 6.03, p=0.004); and surgical unit at 0-24 hours (4.70 vs 5.07, p=0.055), at 24-48 hours (4.11 vs 4.76, p80%). Transfer to sub-acute rehabilitation (16.44% vs 18.75%, p=0.58) and hospital readmission were comparable (6.85% vs 6.25%, p=.082). <h3>CONCLUSIONS</h3> Patients treated under a newly implemented ERAS protocol were observed to have lower pain scores, less opioid consumption, early ambulation and shorter hospitalization. No significant post-discharge care substitution was observed; discharge disposition and hospital readmission were comparable. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Transarterial Embolization of Neovascularity for Refractory Nighttime Shoulder Pain: A Multicenter, Open-Label, Feasibility Trial

PurposeTo assess the feasibility of transarterial embolization (TAE) for recalcitrant nighttime shoulder pain in a multicentric study. Materials and MethodsThis prospective, open-label, feasibility trial included 100 patients treated at 5 institutions. TAE was performed in 76 patients with adhesive capsulitis (AC) and 24 patients with symptomatic rotator cuff tears (sRCTs). The ipsilateral radial artery was punctured, and imipenem/cilastatin sodium was infused as an embolic agent. Adverse events, 10 point pain numerical rating scale (NRS), range of motion (ROM) of the shoulder joint, and quality of life (via the EuroQol-5D [EQ-5D]) were evaluated. ResultsAll patients exhibited neovascularity on baseline angiography, and all TAE procedures were performed successfully. No patient experienced a major adverse event. The mean nighttime pain NRS scores at baseline and 1, 3, and 6 months after TAE were 6.4 ± 2.2, 3.4 ± 2.6, 2.3 ± 2.5, and 1.6 ± 2.2, respectively (for all, P < .001). The mean ROM of anterior elevation at baseline and 1, 3, and 6 months after TAE were 97° ± 29°, 119° ± 28°, 135° ± 27°, and 151° ± 17°, respectively (for all, P < .001). The mean EQ-5D scores at baseline and 1, 3, and 6 months after TAE were 0.63 ± 0.17, 0.73 ± 0.16, 0.80 ± 0.17, and 0.84 ± 0.17, respectively (for all, P < .001). There was no significant difference in the clinical success rate between the AC and sRCT groups. ConclusionsTAE for nighttime shoulder pain caused by AC and sRCTs was feasible with sufficient safety and efficacy.

Comparative effect of upper thoracic spine mobilization with mobility exercises and upper cervical spine mobilization with stabilization exercises in mechanical neck pain: a randomized clinical trial

Background &amp; Objective: Neck pain is a very prevalent health condition. Physiotherapists use multiple treatment options for treating mechanical neck pain. We evaluated the effects of upper thoracic spine mobilization and mobility exercise and upper cervical spine mobilization and stabilization exercises in treating patients with mechanical neck pain.&#x0D; Methodology: A randomized clinical trial was conducted comprising of 36 patients recruited from different clinics of Faisalabad, both genders, ages from 20-40 y, and randomly divided into two groups. Group A underwent upper thoracic mobilization and mobility exercise while Group B underwent upper cervical mobilization with stabilization exercises for 2 times a week for 4 weeks. Pain scores on Numerical Pain Rating Scale (NPRS) and cervical range of movements (ROM) scores were measured before treatment and then weekly for 4 weeks, while Neck Disability Index (NDI) was assessed at baseline and at the end of 4th week. SPSS version. 22 was used to analyze the data. Independent sample t-test was used for between group compression and P ≤ 0.05 (95%) was considered as significant.&#x0D; Results: There was significant improvement in mean NPRS scores at 1st week, 2nd week, 3rd week and 4th week post-treatment (P &lt; 0.05). There was significant improvement in mean cervical ROM at 2nd week, 3rd week and 4th week post-treatment readings (P &lt; 0.05) and mean NDI score at 4th week (P &lt; 0.05).&#x0D; Conclusion: Both groups were found effective in improving pain, range of motion and neck function, but significant improvement in outcomes was observed in upper cervical mobilization and stabilization exercises group.&#x0D; Abbreviations: NPRS - Numerical Pain Rating Scale; ROM - Range of movements; NDI - Neck Disability Index; MNP - Mechanical neck pain;&#x0D; Key words: Adult; Cervical Vertebrae / physiopathology; Disability Evaluation; Exercise Therapy / methods; Female; Humans; Male; Manipulation, Spinal / methods; Neck / physiopathology; Neck Pain / physiopathology; Neck Pain / rehabilitation; Pain Measurement; Range of Motion, Articular; Thoracic Vertebrae / physiopathology; Treatment Outcome; Young Adult&#x0D; Citation: Tahir R, Sohail MAA, Ain NU, Aine QU, Mannan H, Maqbool A. Comparative effect of upper thoracic spine mobilization with mobility exercises and upper cervical spine mobilization with stabilization exercises in mechanical neck pain: a randomized clinical trial. Anaesth. pain intensive care 2022;26(4):488-495.&#x0D; DOI: 10.35975/apic.v26i4.1952&#x0D; Received: April 11, 2022; Reviewed: June 23, 2022; Accepted: July 14, 2022

Four Variables Were Sufficient for Low Back Pain: Determining Which Patient-Reported Tools Pain and Disability Improvements.

OBJECTIVE: To predict 30- and 180-day improvements in disability and pain for patients seeking physical therapy care for low back pain (LBP). DESIGN: Longitudinal cohort. METHODS: Baseline assessment was completed by 259 patients with chief complaint of LBP, and the assessment includes psychosocial measures (Keele STarT Back Screening [SBST] and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag [OSPRO-YF] tools), the Optimal Screening for Prediction of Referral and Outcome Review of Symptoms (OSPRO-ROS) and the Review of Symptoms Plus (OSPRO-ROS+) tools, the Charlson Comorbidity Index (CCI), the Area Deprivation Index (ADI), and the National Institute of Health Chronic Pain Criteria (NIH-CP). Using the Modified Low Back Disability Questionnaire (MDQ) and the Numeric Pain Rating Scale (NPRS) as primary outcomes, statistical analysis determined multiple sets of predictor variables with similar model performance. RESULTS: The parsimonious "best model" for prediction of the 180-day MDQ change included 3 predictors (Admit MDQ, NIH-CP, and OSPRO ROS+) because it had the lowest penalized goodness-of-fit statistic (BIC = -35.21) and the highest explained variance (R2 = 0.295). The parsimonious "best model" for 180-day NPRS change included 2 variables (Admit NPRS and OSPRO-ROS+) with the lowest penalized goodness-of-fit statistic (BIC = -18.2) and the highest explained variance (R2 = 0.190). CONCLUSION: There were many model options with similar statistical performance when using established measures to predict MDQ and NPRS outcomes. A potential variable set for a standard predictive model that balances statistical performance with pragmatic considerations included the OSPRO-ROS+, OSPRO-YF, NIH-CP definition, and admit MDQ and NPRS scores. J Orthop Sports Phys Ther 2022;52(10):685-693. Epub: 12 August 2022. doi:10.2519/jospt.2022.11018.

Use of Virtual Reality for Reducing Pain and Anxiety After Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial

AimThe present study aimed to evaluate the effect of virtual reality on pain and anxiety in patients who had undergone laparoscopic sleeve gastrectomy. MethodThe study was conducted between September 1, 2019, and December 31, 2019, in the surgical intensive care unit at a government hospital. The participants were 110 patients who met the inclusion criteria and agreed to participate in the study. According to the study procedure, while the control group received standard care, the intervention group watched a virtual reality video. Data were collected with a personal information form, the Numeric Pain Rating Scale, and the Faces Anxiety Scale. ResultsThe mean post-test Numeric Pain Rating Scale score was significantly lower in the intervention group than in the control group (p < .001). However, the mean Faces Anxiety Scale scores did not differ significantly between the groups (p = .087). ConclusionsVirtual reality can effectively reduce pain and anxiety in patients who have undergone laparoscopic sleeve gastrectomy in intensive care units.

Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis

IntroductionGenicular nerve radiofrequency ablation (GNRFA) is a minimally invasive intervention for patients with chronic knee pain (CKP) not responding to conservative treatments. Few investigations have compared treatment outcomes of cooled-RFA...