Numeric Rating Scale Pain Scores Research Articles

Real-world evidence evaluation on consumer experience and prescription journey of diclofenac gel in Sweden.

The aim of this study was to understand profiles of topical Voltaren gel diclofenac (VGD) 2.32 and 1.16% consumers through analyzing prescription patterns and to characterize treatment satisfaction, functional impairment, and pain relief after over-the-counter (OTC) VGD use in Sweden under real-world conditions. This observational, real-world study conducted in Sweden had retrospective and prospective segments. The retrospective secondary data segment utilized 12-month diclofenac gel prescription data from the Swedish eHealth Agency (E-hälsomyndigheten). The prospective segment included electronic surveys completed at baseline and weeks 4 and 12 by adult consumers who purchased OTC VGD to treat their pain. Secondary data analyses (n = 12,145) showed that 56.7% of patients receiving diclofenac gel were females ≥70 years old. Most patients did not switch pain treatments; the mean time between diclofenac gel refills was about 2.5 months. From the surveys (n = 264), VGD provided pain relief, indicated by improvement in 11-point pain numeric rating scale scores. Average pain severity at baseline was 5.8 - improving by a mean of 1.3 and 1.9 points at weeks 4 and 12, respectively. The majority of consumers reported improvement in daily functioning (i.e., health-related quality of life [HRQoL]), and most were at least somewhat satisfied with VGD treatment results. This real-world study provides important insights into the prescription patterns of diclofenac gel and the consumer experience with OTC VGD in Sweden. Patients rarely switched to other topical nonsteroidal anti-inflammatory drugs, and VGD consumers reported pain relief and improved HRQoL compared to baseline - resulting in treatment satisfaction.

Comparison of surgical outcomes for cervical radiculopathy by nerve root level

Cervical radiculopathy might affect finger movement and dexterity. Postoperative features and clinical outcomes comparing C8 radiculopathies with other radiculopathies are unknown. This prospective multicenter study analyzed 359 patients undergoing single-level surgery for pure cervical radiculopathy (C5, 48; C6, 132; C7, 149; C8, 30). Background data and pre- and 1-year postoperative neck disability index (NDI) and numerical rating scale (NRS) scores were collected. The C5–7 and C8 radiculopathy groups were compared after propensity score matching, with clinical significance determined by minimal clinically important differences (MCID). Postoperative arm numbness was significantly higher than upper back or neck numbness, and arm pain was reduced the most (3.4 points) after surgery among the C5–8 radiculopathy groups. The C8 radiculopathy group had worse postoperative NDI scores (p = 0.026), upper back pain (p = 0.042), change in arm pain NRS scores (p = 0.021), and upper back numbness (p = 0.028) than the C5–7 group. NDI achieved MCID in both groups, but neck and arm pain NRS did not achieve MCID in the C8 group. In conclusion, although arm numbness persisted, arm pain was relieved after surgery for cervical radiculopathy. Patients with C8 radiculopathy exhibited worse NDI and change in NRS arm pain score than those with C5–7 radiculopathy.

Time Course Effects of Kinesio Taping in Knee Osteoarthritis Patients

Background: Knee osteoarthritis is a common musculoskeletal disorder in the elderly, characterized by cartilage loss leading to pain, stiffness, and restricted movement. Kinesiotaping has been suggested as a therapeutic approach to reduce pain and improve functional outcomes in knee osteoarthritis patients. Objective: This study aimed to compare the effects of quadriceps and patellar kinesiotaping applied for different durations (24, 48, and 72 hours) on pain, balance, and functional performance in patients with knee osteoarthritis. Methods: A randomized clinical trial was conducted from March to September 2020 at the Railway General Hospital, Rawalpindi, and Abasyn Rehabilitation Center, Islamabad. Forty-eight patients with knee osteoarthritis (grades 2-3) were randomly assigned to three groups: Group A (kinesiotaping for 24 hours), Group B (kinesiotaping for 48 hours), and Group C (kinesiotaping for 72 hours). All participants also received conventional therapy, including hot pack application, quadriceps strengthening exercises (15 repetitions × 3 sets), and stretching exercises (5 repetitions with a 10-second hold × 3 sets). Pain, balance, and functional performance were assessed at baseline, post-intervention, and one week later using the Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Functional Reach Test (FRT), and Time Up and Go Test (TUG). Data were analyzed using SPSS version 25, with intragroup comparisons conducted using the Wilcoxon signed-rank test and intergroup comparisons using the Kruskal-Wallis test. A p-value of less than 0.05 was considered statistically significant. Results: Significant reductions in pain were observed across all groups (p < 0.05), with the most notable improvement in Group C (72 hours), where NPRS scores decreased from a median of 2 (IQR 1.75) at baseline to 1 (IQR 1) at follow-up (p < 0.05). However, no significant improvements were noted in balance or functional performance across the groups, as indicated by FRT, WOMAC, and TUG scores (p > 0.05). Conclusion: Kinesiotaping significantly reduces pain in knee osteoarthritis patients, particularly when applied for 72 hours, but does not appear to significantly impact balance or functional performance. These findings suggest that kinesiotaping is effective for short-term pain management, though additional interventions may be necessary to improve functional outcomes.

The prevalence and predictors of discharge opioid overprescribing in opioid-naïve patients after breast, gynecologic, and head and neck cancer surgery: a prospective cohort study.

The management of pain following cancer-related surgeries involves the use of opioid analgesics. Nevertheless, there is little evidence characterizing the utility and prescription patterns of opioids after these procedures. Our primary aim was to identify patients from three types of cancer surgery who were overprescribed with opioids. The secondary aim was to determine the potential predictors of overprescribing in the same period. We conducted the study at a single cancer referral hospital. Opioid-naïve patients with breast, gynecologic, or head and neck cancer were studied. Patients were considered opioid-naïve if they had a history of opioid use ≤ 30mg oral morphine equivalent daily dose for less than seven days in the preceding three months before surgery. We recruited eligible participants by convenience sampling on the wards until at least 102 patients were included in the final analysis. After discharge, we followed up on the participants on day 7 via telephone using a structured proforma including questions to identify the last date and amount of opioid dose taken. The equivalent days of opioid use were calculated by their 24-hr use before discharge and the number of doses prescribed for discharge. Our primary outcome was the prevalence of overprescribing in the three surgical specialties defined as the number of patients taking less than 50% of discharge opioids within the first seven days after discharge. We examined the predictors on incidents of overprescribing using multivariable Poisson regression as the secondary outcome. We recruited 119 patients, and 107 patients were included in the final analysis. There were 59/107 (55%) patients found to be overprescribed with opioids. At discharge, they exhibited lower mean numerical rating scale pain scores, lower mean pain severity scores, higher equivalent days of opioids prescribed, and not used opioids in the last 24hr before discharge. The incidence of overprescribing was 2.4 times greater for patients prescribed with opioids without 24-hr opioid use (relative risk [RR], 2.38; 95% confidence interval [CI], 1.30 to 4.35; P = 0.005). Similarly, the incidence of overprescribing was 1.7 times greater for patients who had opioids 24hr before discharge and were supplied with opioids for five equivalent days or more at the time of discharge (RR, 1.67; 95% CI, 1.09 to 2.56; P = 0.02). Our study shows that the majority of recruited patients undergoing breast, gynecologic, or head and neck cancer surgery were overprescribed opioids. Individualized assessments on patients' 24-hr opioid requirements before discharge and supplying for less than five days are important considerations to reduce overprescribing in opioid-naïve patients after cancer surgery.

A description and outcome evaluation of sacrococcygeal joint radiofrequency neurotomy for treatment of chronic coccydynia – A dorsal approach

BackgroundCoccydynia is a condition characterized by pain and tenderness in the coccyx region of the spine. Chronic coccydynia (≥3-months) management remains a clinical challenge. Radiofrequency neurotomy (RFN) targeting the sacrococcygeal joint (SCJ) and/or 1st intercoccygeal joint (ICJ) margins has emerged as an alternative, minimally invasive intervention for refractory coccydynia. ObjectiveThe objective of this study was to evaluate the safety and effectiveness of an RFN technique targeting the dorsal aspect of SCJ and/or 1st ICJ for treatment of patients with chronic coccydynia. MethodsRetrospective analysis of prospective outcomes for patients with chronic coccydynia (≥3-months) who underwent RFN to dorsal SCJ and/or 1st ICJ between 2009 - 2023. RFN technique was a dorsal approach targeting the distal sacrum and proximal coccyx, which form the SCJ or 1st ICJ margins. Numerical rating scale (NRS) and Pain Disability Quality-of-Life Questionnaire-Spine (PDQQ-S) scores were completed pre- and 3-months post-RFN. Successful RFN was defined as ≥50% reduction or minimal clinical important difference (MCID) in PDQQ-S and NRS pain scores. The primary outcome measures were the proportion of patients achieving ≥50% reduction in NRS pain and PDDQ-S scores following primary and repeat RFN to SCJ and/or 1st ICJ. Secondary outcomes included the proportion of patients achieving MCID on NRS pain and PDQQ-S scores following RFN, as well as mean NRS and PDQQ-S scores pre- and 3-months post-RFN, and magnitude of improvement for patients following successful RFN procedures. ResultsA total of 52 RFN procedures (n = 30 primary, and n = 22 repeat procedures) were performed on 30 patients (female = 25, male = 5, mean age 55.1 ± 13.0yrs). Ten patients (33.3%; 95% CI = 17.3–52.8) reported ≥50% pain reduction as measured by NRS pain and PDQQ-S scores following primary SCJ and/or 1st ICJ RFN at 3-months follow-up. Fifteen patients (50%; 95% CI = 31.3–68.7) reported MCID NRS pain reduction and 12 patients (40.0%; 95% CI = 22.7–59.4) reported MCID PDQQ-S scores at 3-months following primary RFN. The mean magnitude of improvement for patients with primary successful RFN, as defined as ≥50% reduction in either NRS pain or PDQQ-S scores, was 77.4% (±SD 21.4%) and 74.9% (±SD = 19.9%), respectively. Similarly, the mean magnitude of improvement for patients with successful RFN, as defined by MCID reduction in NRS pain or PDQQ-S scores, was 62.6% (±SD = 28.2%) and 69.3% (±SD = 22.3%), respectively. At 3-months follow-up, 14 patients (63.6%; 95% CI = 40.7–82.8) reported ≥50% pain reduction as measured by either NRS pain and PDQQ-S scores following repeat RFN. Nineteen patients (86.4%; 95% CI = 65.1–97.1) reported MCID NRS pain reduction and 16 patients (72.7%; 95% CI = 49.8–89.3) reported MCID PDQQ-S scores at 3-months following repeat RFN. Statistically significant differences were observed between pre- and post-RFN NRS pain and PDQQ-S scores (p < 0.005) in both primary and repeat procedures. Discussion/conclusionThis study represents an introductory step in evaluating the efficacy of a dorsal approach RFN technique targeting the SCJ and/or 1st ICJ as a treatment option for chronic coccydynia. Primary RFN demonstrated pain reduction and improvement in function at 3-months in 33.3% of patients. Several limitations remain, including heterogeneity in patient population, small sample size, and no control groups. Future detailed investigations include cadaveric studies to clarify sensory innervation and enhance reliability of our targets during RFN. Larger prospective studies of long-term outcomes, including comparison with control groups, are required to further evaluate the efficacy of our dorsal RFN approach.

Comparison of Myofascial Release Technique and Manual Therapy for the Management of Plantar Fasciitis

Background: Plantar fasciitis (PF) is the most common cause of inferior heel pain, affecting up to 10% of the general population over a lifetime. It accounts for 8% to 15% of foot complaints in both athletic and non-athletic individuals. Objective: This study aimed to compare the effectiveness of the myofascial release technique and manual therapy in the management of plantar fasciitis. Methods: Thirty patients diagnosed with plantar fasciitis were enrolled in the study and randomly divided into two groups. Group A received myofascial release (MFR) therapy, while Group B underwent manual therapy. Each treatment was administered three times a week for four weeks, with a minimum one-day gap between sessions. Each session lasted 30 minutes and targeted the affected side. Outcome measures included the Foot Function Index (FFI) and the Numerical Pain Rating Scale (NPRS), recorded at baseline (Week 1), post-intervention (Week 4), and follow-up (Week 12). Statistical analysis was performed using SPSS version 25, with paired and independent t-tests used to evaluate within-group and between-group differences. Results: Both groups showed significant improvement in pain and function. Group A's mean NPRS score decreased from 8.00 (SD = 1.06) to 1.13 (SD = 1.06), while Group B's score decreased from 9.13 (SD = 0.63) to 4.20 (SD = 0.56), with a p-value of 0.00 for both groups. For the FFI, Group A's mean score decreased from 52.80 (SD = 4.36) to 11.46 (SD = 3.20), while Group B's score decreased from 58.53 (SD = 1.35) to 39.46 (SD = 4.61), also showing a p-value of 0.00. Conclusion: Both myofascial release and manual therapy effectively managed plantar fasciitis. However, myofascial release demonstrated superior outcomes in pain reduction and functional improvement. These findings suggest that myofascial release should be considered a primary treatment option for plantar fasciitis to enhance patient recovery and quality of life.

THE IMPACT OF IMMERSIVE VIRTUAL REALITY ON PAIN PROCESSING AND PATIENT-REPORTED OUTCOME MEASURES IN PEOPLE WITH PERSISTENT LOW BACK PAIN: PRELIMINARY RESULTS

BackgroundEmbodiment- and distraction-based approaches to immersive virtual reality (IVR) show promise in treating persistent low back pain (PLBP). However, which approach is more effective is unclear. This study aims to evaluate the impact of distraction- and embodiment-based IVR on pain processing and patient-reported outcome measures in PLBP.MethodIndividuals with PLBP were randomised to receive eight sessions of either distraction- or embodiment-based IVR over two weeks. Outcome measures were evaluated at baseline and after the eighth session. Pain processing was evaluated using conditioned pain modulation (CPM) and temporal summation (TS).ResultsThree participants (n=2 embodiment, n=1 distraction) have completed all eight IVR sessions. Preliminary results indicate a decrease from pre to post-intervention in Numerical Pain Rating Scale score (pre: 5/10, 6/10, 5/10; post: 2/10, 5/10, 2/10) and Pain Catastrophising Scale score (pre: 34/52, 11/52, 38/52; post: 11/52, 8/52, 12/52), with no clear trend in other self-reported measures (Hospital Anxiety and Depression scale, Oswestry low back disability questionnaire, fear-avoidance beliefs questionnaire, Tampa scale of kinesiophobia). Preliminary results suggest a potential increase in NPRS absolute values from pre- to post-intervention in CPM (pre: -2.7, -2.3, -2.0; post: -3.3, -2.0, -4.3) and TS (pre-1.2, 2.5, 2.4; post: 1.4, 2.5, 3.1).ConclusionEight sessions of IVR may reduce pain severity and pain catastrophising in people with PLBP and may increase the efficacy of endogenous pain modulatory systems. Data collection is ongoing to compare the effect of distraction- and embodiment-based IVR.Conflicts of InterestThere are no conflicts of interest.Sources of FundingThis project is funded by the Saudi Arabia Cultural Bureau.

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.