Numerical Pain Scale Research Articles

Impact of applying different levels of threshold-based artifact correction on the processing of heart rate variability data in individuals with temporomandibular disorder.

Although heart rate variability (HRV) is a valid method to evaluate the behavior of the autonomic nervous system in individuals with temporomandibular disorder (TMD), the measurement can easily be biased by factors involving the analysis methodology, such as the removal of artifacts. Therefore, the objective of this investigation is to evaluate the impact of using different levels of threshold-based artifact correction to process HRV data in individuals with TMD. This cross-sectional observational study. Adults aged 18 to 55 years old with a diagnosis of myogenic TMD, score ≥ 50 on the Fonseca Anamnestic Index (FAI) and pain ≥ 3 on the Numerical Pain Scale (NPS) participated. The HRV was registered in the supine position (short-term) using a Polar S810i. Kubios software was used for HRV analysis using all filters. One-way ANOVA with Tukey-Kramer post-hoc was used to test the differences in HRV using the different Kubios Software artifact correction filters. The effect size was calculated based on the Cohen d. The very strong filter was statistically different (p < 0.05) compared to the no filter in all overview and time domain variables. In the frequency domain, the variables VLF, LF, HF and Total Power showed statistical differences (p < 0.05) when using the very strong filter. The same occurred with the variables SD1, SD2 and DFA α2 of the non-linear analysis (p < 0.05). The most restrictive filter of the Kubios software (very strong) significantly impacts the quantification of HRV parameters in individuals with TMD.

Open-Label Randomized Clinical Trial to Assess the Effects of Preoperative Acupuncture in High Anxiety Patients Undergoing Total Knee or Hip Arthroplasty.

Background: Preoperative state anxiety is a known predisposing factor for enhanced postoperative pain and hindered recovery following total knee or hip replacement. Acupuncture administered preoperatively has been associated with reduced anxiety in surgical studies, yet evidence of its efficacy in the orthopedic surgical setting is limited. Objective: This study investigated the effects of preoperative acupuncture on preoperative anxiety and pain and compared acute postoperative pain between acupuncture and control patient groups. Design: Parallel-arm, open-label, randomized controlled trial. Setting: Bone and Joint Institute, Hartford Hospital, Hartford, CT. Participants: Sixty middle-aged and elderly men and women with clinically validated preoperative anxiety undergoing elective total hip or knee replacement. Intervention: One-to-one randomization to preoperative acupuncture (n = 30) or no acupuncture treatment (n = 30) on the day of surgery. Coprimary outcomes: Anxiety before and after preoperative acupuncture using the visual analog scale and postsurgical pain using the numeric pain scale. Secondary outcomes: Incidence of acupuncture-related complications, pain before and after acupuncture, nausea and vomiting incidence, opioid consumption, anxiolytics and antiemetics use, and patient satisfaction. Results: Patients reported lower anxiety and pain preoperatively following acupuncture compared with before treatment (both p < 0.001). Postoperatively, the acupuncture group reported lower pain in the first 3 h than the control group, although this difference was not statistically significant. No significant differences in postoperative complications or patient satisfaction were observed between the study groups. Most patients were satisfied with the acupuncture treatment and reported a likelihood of considering preoperative acupuncture for future surgeries. Conclusions: These preliminary findings support that preoperative acupuncture is a safe and effective means to reduce perioperative anxiety and pain in patients undergoing total hip or knee replacement surgery. Additional studies should be conducted to best determine the value of preoperative acupuncture in total hip or knee patients presenting with surgically related anxiety. Clinical Trial Registration: ClinicalTrials.gov (10/31/2023, NCT06099223).

Efficacy of Strain Counterstrain Techniques in the Management of Complex Regional Pain Syndrome: A Detailed Case Study of a 42-Year-Old Female Patient

Complex Regional Pain Syndrome (CRPS) is a challenging condition associated with severe pain and functional impairment. This case study provides an in-depth examination of the treatment of a 42-year-old female diagnosed with CRPS following a traumatic injury to her left hand. The treatment protocol employed strain counterstrain techniques, followed by progressive resistive exercises (PRE) aimed at restoring functional capacity in the hand. Over a three-month period, the patient received weekly physical therapy sessions, with the treatment plan adjusted at the six-week mark to include PRE. Assessments were conducted at baseline, 3 weeks, 6 weeks, and 12 weeks, focusing on pain levels, grip strength, and range of motion. The results indicated a significant reduction in pain from 8/10 to 2/10 on the Numerical Rating Pain Scale (NPRS) and an improvement in grip strength from 5 kg to 28 kg. The patient’s active range of motion also improved, and there was a noticeable reduction in muscle atrophy and swelling. These findings suggest that strain counterstrain, in combination with PRE, can be an effective intervention for CRPS. This case study contributes to the limited body of research on physical therapy interventions for CRPS and highlights the need for further studies to explore the broader applicability of these techniques.

Use of Two Pain Assessment Tools to Improve Pain Recognition in Post Stroke Patients: A Quality Improvement Project

Abstract Background Post stroke patients can suffer from a variety of complex pain syndromes. These are often associated with decline in function, cognitive impairment, impaired quality of life and mood disturbances. Pain identification can be challenging in this population, due to stroke deficits that impair communication, and associated medical conditions that can affect the patient’s ability to self-report pain. This Quality Improvement (QI) project aims at implementing two pain assessment tools to support clinicians assess pain in a structured manner, and thereby improve pain management. Methods An initial audit was performed to identify whether post stroke pain (PSP) was being recorded in a reliable manner in St Mary's hospital. A pain assessment proforma was then designed, incorporated in the admission proforma and rolled-out for use. This included two pain assessment tools: the Numerical Pain Scale for patients who could self-report pain, and the Abbey Pain Scale for patients with communication difficulties. A second audit was performed to analyse the compliance to documentation and a qualitative evaluation of its use was also conducted in semi-structured staff interviews. Results The first audit showed pain being under reported with only 25% of patients having formal pain assessment documented on admission. The second audit showed improvement in pain assessment with 72.7% pain documentation. Qualitative evaluation revealed staff expressing challenges with pain identification in post stroke patients and viewed the proforma as a useful prompt. Limitations to the use of observational tools included time constraints, lack of familiarity with tools and potential inaccuracy of scores. Conclusion Identification of PSP is key to optimising treatment, and hence improving function and quality of life of stroke patients. This QI project shows that the use of pain assessment tools, in combination with detailed clinical assessment can help pain assessment. Clinician awareness and continuous training are required to support this challenging task.

Rehabilitative subacute inpatient care-Optimizing posthospital care for geriatric patients with rehabilitation needs: results of the REKUP study

Geriatric patients in subacute inpatient care (SC) with rehabilitation needs after hospitalization seldom utilize rehabilitative services and are often transitioned to long-term care (LTC), suggesting that their care in SC can be optimized. To evaluate the effectiveness of rehabilitative subacute inpatient care (REKUP) in improving the care of geriatric patients in SC with rehabilitation needs after hospitalization. The study was conducted as anonrandomized intervention trial with an historical control group (CG). The intervention group (IG: n = 49) received REKUP (activating therapeutic care, functional rehabilitative therapy, psychosocial services, medical care), while the CG (n = 57) received usual care during SC. Primary outcomes were transition to inpatient rehabilitation, home, and LTC, deteriorated care setting, care level, and mortality within 3months after SC. Secondary outcomes were functional, motor and psychological variables. The transition rate to inpatient rehabilitation (82% vs.37%) and home (86% vs.65%) was higher (p < 0.05) in the IG than in the CG. The proportion of persons utilizing LTC (12% vs.35%) and with deteriorated care setting (35% vs.60%) was lower (p < 0.01) in the IG than in the CG. The Barthel Index, visual analogue scale of the EQ-5D, and numerical pain scale improved (p < 0.05) during the SC stay in the IG but not in the CG. REKUP as anew care model for SC promotes the transition to inpatient rehabilitation, reduces the utilization of LTC and improves the chances of returning home and achieving greater independence in geriatric patients with rehabilitation needs after hospitalization.

A novel opioid/pramipexole combination treatment for the management of acute pain: a pilot study.

Despite their dangerous side effects, opioid drugs remain a standard of care for moderate to severe pain with few alternatives. Strategies to maintain the analgesic effects of opioids while minimizing the associated risks are needed. Pre-clinical studies have shown using a dopamine 3 receptor (D3R) agonist as an adjuvant to morphine provides superior analgesia against painful stimuli compared to morphine alone. Our objective was to test if adjunct treatment with a D3R agonist can lead to a reduction in opioid use while maintaining effective analgesia. This study was set up as a double-blinded, placebo-controlled randomized trial. Enrollment included acute renal colic patients presenting to the emergency department, from which patients were randomized to either the "control" or "study arm". The control group received standard treatment of care (morphine, 0.1 mg/kg; i.v.) and an oral placebo pill. The experimental group received half-dosed morphine and oral pramipexole pill (0.25 mg). Pain measurements including a numerical pain scale and visual analog scale were collected from enrollees at baseline and every subsequent 15 min. A total of 19 patients completed the study, 10 in the experimental arm and 9 in the control arm. During the study period, effective analgesia (50% decrease from baseline) was achieved in 80% of patients in the experimental arm vs. 33.3% in the control arm. Our pilot clinical trial demonstrated that D3R recruitment can serve as an effective adjuvant to low-dose morphine for control of renal colic pain and potentially other acute pain conditions. ClinicalTrials.gov, identifier, (NCT04160520).

Simple Mobility Tests Predict Use of Assistive Devices in Older Adults.

Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members. The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals. Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use. 80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers (P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048). Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD. If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation.

Effect of a comfort scale compared with a pain numerical rate scale on opioids consumption in postanaesthesia care unit: the COMFORT study

BackgroundThe way that pain is assessed in the PACU could impact on postoperative pain and analgesic consumption. However, there is currently no evidence to support this speculation. The authors hypothesised that using a comfort scale reduces postoperative opioid consumption when compared with a standard numerical rating scale (NRS) to evaluate pain in the PACU. MethodsIn this cluster-randomised trial, patients were assessed using either a comfort scale (comfort group) or a pain NRS (NRS group). The primary outcome was the opioid consumption in the PACU. The main secondary outcomes were postoperative pain, nausea and vomiting, length of stay in the PACU, and satisfaction. ResultsOf 885 randomised patients, 860 were included in the analysis. Opioid consumption in the PACU was comparable in the comfort and NRS groups (median [interquartile range [IQR] 0 (0–5) vs 0 (0–6); P=0.2436), irrespective of the type of surgical procedure. The majority of patients did not need any postoperative opioid (59% in the comfort group and 56% in the NRS group, P=0.2260). There was no difference in postoperative pain, nausea and vomiting, time to reach an Aldrete score ≥9 after extubation, and global satisfaction. ConclusionsUsing a comfort scale to assess pain in the PACU did not spare any opioid compared with use of a standard NRS. Further studies focusing on patients at risk of increased postoperative opioid consumption are necessary. Clinical trial registrationNCT05234216.

Effect of Virtual Reality Glasses on Pain During Burn Dressing

Objective: The study was conducted as a randomized controlled experimental study in order to determine the effect of virtual reality glasses on pain during burn dressing in inpatients and outpatients in the burn unit. Methods: The research was carried out in the Burn Unit of Izmir Bozyaka Training and Research Hospital between July and August 2021. The sample size was 60 patients who were selected by random sampling and consented to take part in the study. The cohort was divided into 30 in the experimental group and 30 controls. The patients in the experimental group wore virtual reality glasses with vision and sound before the dressing started. The patients in the control group underwent routine burn dressing. Sociodemographic Data Questionnaire and Numerical Pain Scale were used to collect data. Results: The pain scale mean score of the experimental group (4.17±1.60) was significantly lower than the mean score of the control group (6.17±1.58) (p=0.000). Conclusion: The use of virtual reality glasses during burn dressing, which is usually a very painful procedure, reduced patient perception of pain. It is recommended that the application be started to be used on a regular basis in the burn unit.

Remodeling Pregnancy Exercises with Pelvic Rocking Exercise as Management of Back Pain in Pregnant Women

The discomfort that often arises during the third trimester of pregnancy and is often complained of by pregnant women is back pain. Back pain in pregnant women can be treated with pregnancy exercises. In pregnancy exercises, the 5th movement, namely rocking back arches, can be continued with the Pelvic Rocking Exercise for optimal results. Objective: The aim of this study was to determine the effectiveness of remodeling pregnancy exercises using pelvic rocking exercise on back pain in pregnant women. Method: Quasi Experimental research method with pretest-posttest with control group design. The purposive sampling sample was 20 third trimester pregnant women with back pain, divided into 2 groups, namely the control group (pregnancy exercise only) and the intervention group (remodeling pregnancy exercise with pelvic rocking exercise). The instrument used was the Numerical Rating Scale pain scale observation sheet. Data analysis with a difference test between pre and post. Results: The results of the back pain scale for pregnant women in the control group after being given pregnancy exercises obtained an average of 11.71, while in the intervention group after being given remodeling pregnancy exercises with pelvic rocking exercise the average was 9.46. The results of data analysis using the Mann-Whitney U-Test showed a p value of 0.001 ≤ 0.05, which means the pain scale in the intervention group decreased more than the pain scale in the control group. Conclusion: Remodeling pregnancy exercise with pelvic rocking exercise is more effective in managing back pain in pregnant women.

MyoActivation®, a Structured Assessment and Therapeutic Process for Adolescents With Myofascial Dysfunction and Chronic Low Back Pain: A Case Series.

Introduction Myofascial dysfunction is a significant, but often unrecognized, contributor to chronic low back pain (CLBP). myoActivationis an innovative method that utilizes a structured assessment and therapeutic process to recognize and manage myofascial dysfunction and pain. Since 2017, the British Columbia Children's Hospital Complex Pain Service has used myoActivation as a tool in the interdisciplinary care of adolescents with chronic pain. This case series explores the journey to discharge of patients in whom myoActivation was incorporated as part of their CLBP management. Methods We retrospectively reviewed clinical records of adolescents reporting CLBP who underwent myoActivation between August 2022 and January 2023 and had subsequently been discharged. Information obtained for analysis included preclinical information (medical/injury/pain history, previous investigations, diagnoses, therapies, and quality of life indicators); clinic recommendations, assessment findings, management strategies, and specifics of the myoActivation process; and reported changes at discharge (quality-of-life measures and medication use). Results Eight cases were reviewed: all female, with a median age (range) of 16.5 (15.7-19.5) years. Before admission, patients had experienced chronic pain for a median duration of 4.3 (1-8) years, had self-reported average pain intensity of 7.5 (4-9) on the 0-10 numeric pain scale, with poor quality-of-life impacts including sleep disturbance (8/8, 100%), school absence (8/8, 100%), and low mood (6/8, 75%). Patients attended three (2-5) myoActivation sessions over two (1-10) weeks. The overall duration of their interdisciplinary care was 12 (7-25) months. At discharge, there were improvements in pain (7/8, 88%), physical functioning (5/8, 63%), sleep (6/8, 75%), school attendance (5/8, 63%), and mood (4/6, 67%) and reduced prescription and over-the-counter medication use in most cases. Conclusion This case series suggests that myoActivation may be a useful clinical tool in the assessment and management of adolescents with myofascial dysfunction and CLBP. Prospective longitudinal research is required to establish evidence that confirms the clinical efficacy of myoActivation within interdisciplinary care.

The Effect of Bruxism on the Severity of Temporomandibular Dysfunction and Chewing Functionality: A Cross-Sectional Study

Objective: The study was conducted to investigate the effect of bruxism on Temporomandibular Dysfunction (TMD) severity and chewing functionality in individuals with TMD. Methods: This cross-sectional study was conducted with 91 individuals diagnosed with TMD. TMJ pain was assessed with the Numeric Pain Scale (NPS), maximum mouth opening (MMO) was evaluated with a ruler, TMD severity was assessed with the Fonseca Anamnestic Questionnaire (FAQ), and chewing functionality was considered with the Jaw Functional Limitation Scale-20 (JFLS-20). Results: 65 (71.4%) of the individuals were female, and the median age was 29.0 (20-55) years. Individuals were divided into two groups: self-reported bruxism (Group 1: 63) and non-reported bruxism (Group 2: 28). When the groups with and without bruxism were compared, NPS (p=0.002), MMO (p=0.007) FAQ (p=0.000) and JFLS-20 (p=0.000) results were significantly worse in the group with bruxism. TMD severity was significantly higher in the group with bruxism (p=0.000). The probability of having moderate-severe TMD increased statistically significantly 16.236 times (95% CI: 3.485-75.651) with bruxism (p=0.000). Limitation in chewing functionality was significantly increased 4.364 times (95% CI: 1.127- 16.906) in the presence of bruxism (p=0.033). Conclusion: The study results showed that pain, TMD severity, and chewing functionality limitation were higher in individuals with TMD accompanied by bruxism. It should be considered that knowing the bruxism and its effects that may accompany TMD, which is very common and increasing in number and severity daily, in the evaluation or treatment phase is essential in improving rehabilitation success.

Pharmacogenetic Approach to Tramadol Use in the Arab Population.

Tramdol is one of most popular opioids used for postoperative analgesia worldwide. Among Arabic countries, there are reports that its dosage is not appropriate due to cultural background. To provide theoretical background of the proper usage of tramadol, this study analyzed the association between several genetic polymorphisms (CYP2D6/OPRM1) and the effect of tramadol. A total of 39 patients who took tramadol for postoperative analgesia were recruited, samples were obtained, and their DNA was extracted for polymerase chain reaction products analysis followed by allelic variations of CYP2D6 and OPRM A118G determination. Numerical pain scales were measured before and 1 h after taking tramadol. The effect of tramadol was defined by the difference between these scales. We concluded that CYP2D6 and OPRM1 A118G single nucleotide polymorphisms may serve as crucial determinants in predicting tramadol efficacy and susceptibility to post-surgical pain. Further validation of personalized prescription practices based on these genetic polymorphisms could provide valuable insights for the development of clinical guidelines tailored to post-surgical tramadol use in the Arabic population.

A Double-Blinded Randomized Controlled Trial Assessing the Efficacy of Opioid Disposal Instructions with Parental Education on Proper Opioid Disposal Rates Following Ambulatory Pediatric Urologic Surgery

ObjectivesTo determine if the administration of standardized opioid disposal instructions with focused parental education improves proper disposal of leftover opioid medication among families of children undergoing ambulatory urologic surgery compared to routine postoperative instructions. MethodsA prospective, double-blinded, single-center randomized controlled trial was conducted in children 6-18y undergoing ambulatory urology procedures between October 2021-April 2023. Patients were randomized (1:1) to receive either the Food and Drug Administration (FDA) opioid disposal best practices worksheet plus nursing parental education or routine postoperative instructions alone. All patients were prescribed acetaminophen and ibuprofen and a per-protocol rescue opioid prescription. The primary outcome was rate of proper opioid disposal at 10-14d post-procedure. Secondary outcomes included parents postoperative pain measure (PPPM) scores, numerical pain scale (NPS) scores, and weight-based opioid utilization at 48h and 10-14d. ResultsWe randomized 104 participants (53 intervention, 51 control) with 97% (101/104) complete follow-up data at 10-14d. Patient demographics, procedural characteristics, and analgesia use were similar between groups. We observed no significant difference in proper opioid disposal rates between arms (31% intervention vs. 18% control; estimated difference in proportion 13% [95% CI, -4–29%]; p=0.1). There was no increased odds of proper disposal of leftover opioid medication at 10-14d with the intervention compared to the control (OR 2.0 [95% CI 0.8–5.1]; p=0.1). We observed no differences in PPPM scores, NPS scores, or opioid utilization at 48h or 10-14d. ConclusionsProviding formal opioid disposal instructions with parental education did not improve proper disposal of leftover opioid medication nor did it alter post-discharge opioid utilization after pediatric urologic surgery.

Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient&amp;apos;s sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o&amp;apos;clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). &amp;lt;i&amp;gt;Conclusions:&amp;lt;/i&amp;gt;. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.

Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration

Introduction. Thoracic epidural analgesia or thoracic epidural anaesthesia (TEA) and opioid-based intravenous multimodal analgesia (MMA) provide adequate control of perioperative pain, however, comparative data are still to be gathered. Aim. To compare both anesthesia techniques in terms of stress response during and after robotic-assisted pelvic exenteration (PE). Materials and methods. 112 patients were divided into 2 equal groups A level of serum cortisol was measured at induction of anesthesia and in 2, 24, and 48 hours. The efficacy of analgesia was compared using a 10-point numeric pain scale. Analgesic administration and side effects were reported for 1–3 postoperative days. Results. Cortisol levels increased 2 hours after skin incision in the MMA group and only in 24 hours in the TEA group (p &lt; 0.050). Postoperative cortisol levels were significantly lower in the TEA group (p = 0.001). Numeric pain scores were significantly lower in the TEA group (1.7 [1.0–3.2] vs. 2.7 [2.1–4.2]; 1.9 [1.0–3.3] vs. 3.5 [3.5–5.0]; 3.7 [3.0–4.8] vs. 4.2 [3.7–4.7], respectively; p &lt; 0.050). Patients in the TEA group received less opioid administration (4.3 mg vs. 13.9 mg; 7.0 mg vs. 19.9 mg; 10.9 mg vs. 16.5 mg, respectively; p &lt; 0.050). The two groups of patients were detected with no significant difference in the incidence of respiratory depression. Discussion. According to the study results, perioperative stress response was reduced with TEA being added to the anesthesia protocol. Patients in the TEA group received lower doses of analgesics. Both groups produced similar short-term postoperative outcomes. Conclusion. As compared to opioid-based MMA, TEA provided more effective analgesia and similar side effect profiles. Therefore, TEA appears to be an acceptable method for stress response suppression and pain management in patients undergoing robotic-assisted PE.

Impact of Pre- and Post-therapeutic Exercises in Sarcopenia and Pain in Liver Transplant Patients.

Sarcopenia, a state considered by the loss of muscle function and mass, is progressively recognized as a common complication of advanced cirrhosis and is related to negative clinical consequences. Liver transplantation (LT) is one of the options in the treatment of cirrhosis. This study aimed to evaluate the impact of exercise in newly developed (ND) sarcopenia through measurement of the psoas major muscle at the level of the third lumbar vertebra by abdominal computed tomography (CT) images in liver transplant patients. This analytical case-control longitudinal study was conducted on patients aged between 16 and 70 years at King Fahad Specialist Hospital (KFSH-D) in Dammam, Saudi Arabia. The patients were divided into two groups:an intervention group consisting of liver transplant patients (LTx, n=26) and a control group consisting of end-stage liver disease patients (ESLD, n=23) who were not candidates for LT. All participants were treated with a therapeutic exercise program through three phases. The first phase included pre-operative exercises, the second phase included early post-operative exercises, and the last phase included late post-operative exercises. CT scan of the psoas major muscle was performed pre- and post-LT to assess sarcopenia. Pain was measured with a numerical pain scale before and after exercise to evaluate the impact of exercise on pain. Psoas muscle index (PMI) for post-therapeutic exercises in the control and liver transplant groups showed significant differences for both male and female patients compared with the normal range (p<0.05). The liver transplant group showed a significant difference in mean weight loss, body mass index (BMI), and numerical pain rating scale (NPRS) observed on post-therapeutic exercises compared to baseline data. Conclusion: By and large, the finding revealed a substantial impact of therapeutic exercise on patient outcomes in terms of anthropometric characteristics, abdominal pain, handgrip strength (HGS), and PMI. The mean PMI at post-therapeutic exercises showed a significant increase by measuring the psoas major muscle at the level of the third lumbar vertebra by abdominal CT, which may indicate the extent of improvement and recovery from the ND sarcopenia in LTx.The results emphasize the potential advantages of pre- and post-therapeutic exercise in LTx, including enhancements in muscle strength and mass, as well as pain management associated with liver function and general health. Optimizing patient outcomes and promoting a more comprehensive approach to liver disease treatment may be achieved by including exercise activities in pre- and post-LT care procedures.

Effectiveness of Virtual Reality on Rehabilitation of Chronic Non-Specific Low Back Pain Patients.

Virtual reality (VR) is used extensively for musculoskeletal conditions, but its efficacy in chronic low back pain still needs more investigation. To discuss the effectiveness of VR on selected outcomes in Chronic Non-Specific Low Back Pain (CNSLBP). Thirty-five patients with CNSLBP joined this study. Postural correction exercises using the TBed VR gaming system in addition to hamstring stretching were employed, and moist heat on the low back was applied. Pre- and post-intervention values of pain, ROM, function, and balance (overall stability index) were obtained using the numerical rating pain scale (NPRS), Oswestry Disability Index, back range of motion (BROM), and Biodex system. Satisfaction level on a 1-10 scale and the degree of commitment to the exercise sessions were assessed after the intervention. The patients completed the intervention period and outcome measures sessions. Paired t-tests reported statistically significant improvements and high effect size in pain, ROM, function, and balance after the end of the treatment (p < 0.001, Cohen's d > 0.69). The level of satisfaction was 9.25 ± 0.766, and the commitment to exercise sessions was high (98.75% attendance rate). Applying postural correction using TBed VR gaming in addition to heat and stretching may improve pain, range of motion, function, and balance in patients with chronic low back pain.

Amitriptyline, Pregabalin and Duloxetine for Treatment of Painful Diabetic Peripheral Neuropathy.

Painful diabetic peripheral neuropathy is one of the frequent presenting complaints in diabetes and endocrine clinics. Our main objective was to compare effectiveness of three commonly prescribed drugs: amitriptyline, pregabalin and duloxetine for treatment of painful diabetic peripheral neuropathy. This was a comparative, prospective, observational study conducted among 99 diabetic patients with painful diabetic peripheral neuropathy having numeric rating pain scale ≥ 4. Thirty-three patients in each group were consecutively prescribed amitriptyline, pregabalin and duloxetine in lower dose (10mg/75mg/20mg) for first two weeks to gradually up titrate to higher dose (25mg/150mg/30mg) as per pain response for total duration of eight weeks. At the end of eight weeks, 84.9% in amitriptyline, 78.7% in pregabalin and 60.6% in duloxetine group had adequate pain reduction in form of mild or no pain. Among total patients, 42.5% patients had severe pain at baseline that decreased to 5% by the end of our study. Out of three drugs, 45.5% patients in amitriptyline group had complete resolution of pain as compared to 24.2% in pregabalin and 18.2% in duloxetine group (p value 0.05). Drowsiness (42.4%), dizziness (21.2%) and dry mouth (21.2%) were the commonest side effects among total participants in our study. Amitriptyline, pregabalin and duloxetine were all associated with adequate pain reduction among patients of painful diabetic peripheral neuropathy in our study, however, amitriptyline had more favorable findings with tolerable side effects.

Shoulder proprioception changesin postmastectomy patients: an observational study.

Breast cancer surgery can cause changes in the anatomical structure of the shoulder and in shoulder mobility, leading to the increased possibility of long-term arm morbidity such as lymphedema. This study aims to evaluate the active shoulder joint position sense (AJPS) with and without lymphedema in postmastectomy patients. A total of 66 women, including 22 patients with lymphedema, 22 patients without lymphedema, and 22 healthy controls, were enrolled in the study. Pain severity was evaluated with the Numeric Pain Scale and edema severity was measured with circumferentially at 10cm intervals. The normal range of motion of the shoulder joint was evaluated with the universal goniometer and the AJPS was assessed by active position repetition testing at 55°, 90°, and 125° shoulder flexion targets using the smartphone application "Clinometer." AJPS at 55°, 90°, and 125° shoulder flexion target angles with and without lymphedema were different in all target angles compared to healthy controls (p < 0.01). There was a difference between the absolute error value of AJPS at 55° flexion (p < 0.05), and no difference at 90° and 125° flexion between the with and without lymphedema groups (p > 0.05). This study shows that the AJPS was negatively affected in with and without lymphedema postmastectomy patients compared to healthy controls. This result emphasizes the importance of adding personalized methods for the restoration of joint position sense in addition to rehabilitation programs generally applied to the patient group.