Numerical Visual Analogue Scale Research Articles

Rikkosan's Short-Term Analgesic Effect on Burning Mouth Syndrome: A Single-Arm Cohort Study.

Burning mouth syndrome (BMS) is a chronic oral pain disorder. There is a theory that BMS is a form of nociplastic pain. A standard treatment for BMS has not yet been established. Kampo medicine is a traditional oriental medicine. The purpose of this study is to evaluate the effectiveness of Rikkosan-a traditional Japanese herbal medicine (Kampo)-in the treatment of BMS. A single-center retrospective study was conducted on 20 patients who were diagnosed with BMS and treated with Rikkosan alone (total daily dose; 7.5 g) three times daily for approximately 4 weeks (29.5 ± 6.5 days). Rikkosan was dissolved in hot water and taken internally. They had an average age of 63 years, and 90% were being treated for other illnesses, but their medication status was the same during this study period, except for Rikkosan. No adverse events were observed in patients. Numerical rating scale (NRS) or visual analog scale (VAS)/10 scores decreased significantly between the time of the initiation of Rikkosan and one month after (-2.1 ± 1.2, p < 0.05). Rikkosan has a short-term effect of reducing NRS by two levels in BMS patients.

White spot lesion-related perception of aesthetics and treatment satisfaction among orthodontic patients, orthodontists and other dental specialists.

To investigate the impact of various degrees of white spot lesions (WSLs) of maxillary anterior teeth on the aesthetic perception and treatment satisfaction among orthodontic patients, orthodontists and other dental specialists and to evaluate the differences among the three groups. A total of 45 orthodontic patients (OP), 45 orthodontists (OR) and 45 other dental specialists (OS) were recruited. Subjective evaluations of perceived aesthetics and treatment satisfaction were performed towards eight digitally generated photographs of maxillary anterior teeth with incremental degrees of WSLs using a numerical visual analogue scale (VAS) from 0 to 100. Data were collected and analysed with descriptive statistics, repeated one-way analysis of variance and multivariable generalized estimating equations. A total of 135 valid questionnaires were collected. Regarding aesthetic scores for WSLs, OP gave more positive scores than OR and OS (p < .05) towards excessive white spot formation without colouration and were more tolerant than OR (p < .05) towards excessive white spot formation with slight colouration. The level of treatment satisfaction for slight to severe WSLs without cavitation was higher in OP than OR. Patients with higher education levels had more negative scores for aesthetic perception and treatment satisfaction (p < .05). Patients who brushed teeth more frequently scored lower in treatment satisfaction (p < .05). Orthodontists were the most critical when evaluating aesthetics and treatment satisfaction for slight to severe WSLs without cavitation. For orthodontic patients, better oral hygiene habits and higher education levels were associated with more critical attitudes towards WSLs.

The level of agreement between the numerical rating scale and visual analogue scale for assessing pain intensity in adults with chronic pain.

The numerical rating scale and visual analogue scale are used to quantify pain intensity. However, it has not yet been explored whether these scores are interchangeable in adults with chronic pain. Data from the prospective multicentre cross-sectional INTERVAL study were used to evaluate the one-dimensionality and agreement between numerical rating scale scores and visual analogue scale scores in adults with chronic pain. Pain intensity scores using the numerical rating scale and visual analogue scale were provided by 366 patients with chronic pain for current, average, minimal and maximal pain. To evaluate whether pain intensity scales are completed in accordance with each other, the proportion of patients who satisfied the following condition was calculated: minimal pain intensity ≤ maximal pain intensity. A factor analysis confirmed the one-dimensionality of the pain measures. A significant difference was found between numerical rating scale and visual analogue scale scores for average, current, minimum and maximum pain. Intra-class correlation coefficient estimates ranged from 0.739 to 0.858 and all measures failed to show sufficient and acceptable agreement at the 95% level. The strength of agreement between pain severity categories was classified as 'moderate' for average and minimal pain and 'substantial' for current and maximal pain. The proportion of patients who scored minimal pain ≤ maximal pain was 97.5% for the numerical rating scale and 89.5% for the visual analogue scale. This study failed to show an acceptable agreement between the numerical rating scale and visual analogue scale when pain intensity was rated by adults with chronic pain, despite showing both scales measure the same information.

“Low-dose ketamine versus morphine in the treatment of acute pain in the emergency department: A meta-analysis of 15” randomized controlled trials

ObjectiveTo compare the effectiveness and safety of ketamine and morphine in adult patients with acute pain in emergency department (ED) by using a meta-analysis method. MethodsThis study was based on the Cochrane methodology for conducting a meta-analysis. Only randomized controlled trials (RCTs) were eligible for this study, with an experimental group that received low-dose ketamine and a control group that received morphine. The participants were adults who had acute pain in the ED. The primary outcome measures were the numeric rating scale (NRS) and visual analog scale (VAS). The secondary outcome measures were the complete resolution of pain, NRS reduction ≥3 points, NRS reduction ≥50% or 60%, change of NRS score, change of VAS score, rescue analgesia, satisfaction and adverse events. Subgroup analysis was performed for studies with intravenous and intranasal administration of ketamine. The Review Manager Database was used to analyze the included studies. Results15 RCTs involving 1768 patients were included. The ketamine group had lower NRS scores than morphine group at 30 min (MD, −0.77 [95% CI, −0.93 to −0.61]; p < 0.00001), while the morphine had better analgesic effects at 120 min after treatment (MD, 0.33 [95% CI, 0.15 to 051]; p = 0.0003). The subjects of complete resolution of pain in the ketamine group performed better than those in the morphine group at 15 min (RR 3.18, 95% CI 1.75 to 5.78; p = 0.0001). Compared with the morphine group, the ketamine group had a lower incidence of adverse events requiring intervention (RR, 0.34 [95% CI, 0.18 to 0.66]; p = 0.001). Subgroup analysis of intravenous ketamine showed that ketamine had lower VAS score than the morphine group at 30 min. However, also on the 30-min VAS score, intranasal ketamine analgesia was less effective than morphine. ConclusionsKetamine had better analgesic effects in the early stages after treatment, while morphine maintained more durable effects. Compared with morphine, ketamine had a lower incidence of adverse events requiring intervention. The results of subgroup analysis showed that intravenous administration of ketamine was more effective than intranasal administration.

Effective early strategy to prevent olfactory and gustatory dysfunction in COVID-19: A randomized controlled trial.

Olfactory and gustatory dysfunctions (OGDs) are key symptoms of COVID-19, which may lead to neurological complications, and lack of effective treatment. This may be because post-disease treatments may be too late to protect the olfactory and gustatory functions. To evaluate the effectiveness of early use of saline nasal irrigation (SNI), corticosteroid nasal spray, and saline or chlorhexidine gluconate mouthwash for preventing OGDs in COVID-19. This study was a double-blind randomized controlled trial. The study was conducted from May 5 to June 16, 2022. We recruited patients from three hospitals who were admitted with COVID-19 but without OGDs on the day of admission. Olfactory and gustatory functions were evaluated using the Taste and Smell Survey and the numerical visual analog scale. Participants were randomized to the saline, drug, or control groups. The control group received no intervention, saline group received SNI plus saline nasal spray and mouthwash, and the trial group received SNI plus budesonide nasal spray and chlorhexidine gluconate mouthwash. Participants were assessed again on the day of discharge. A total of 379 patients completed the trial. The prevalence of OGDs was significantly lower in the saline (11.8%, 95% CI, 6.6-19.0%; P < 0.001) and trial (8.3%, 95% CI, 4.1-14.8%; P < 0.001) groups than in the control group (40.0%, 95% CI, 31.8-48.6%). Additionally, both interventions reduced the severity of OGDs. We demonstrated effective strategies for preventing COVID-19-related OGDs, and the findings may guide early management of SARS-CoV-2 infection to reduce the incidence of COVID-19-related complications.

Comparison of analgesic effects of pericapsular nerve group block and fascia iliaca compartment block during hip arthroplasty: A systematic review and meta-analysis of randomised controlled trials

Background and Aims: Postoperative pain for patients having hip arthroplasty ranges from moderate to severe. Many regional anaesthesia procedures treat postoperative pain to improve functional ability and quality of life. Evidence comparing the analgesic effects of the pericapsular nerve group (PENG) block and fascia iliaca compartment block (FICB) remains unclear. The analgesic efficacies of PENG and FICB in hip arthroplasty were compared to determine which technique is associated with superior analgesia. Methods: The electronic databases (PubMed, Cochrane Library, Google Scholar and Web of Sciences) were searched for published randomised controlled trials (RCTs) till 5 April 2023 comparing PENG block vs. FICB following hip arthroplasty. The primary outcome was pain scores [numerical rating scale (NRS) or visual analogue scale (VAS)] between 0 and 10 at rest and during movement at 24 h. Secondary outcomes included pain scores at rest and during movement within 30 min, at 6 h and 12 h, time to first rescue analgesia and cumulative postoperative opioid use in 24 h. We assessed the risk of bias using the Cochrane Collaboration Risk-of-Bias 2 tool. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the certainty of the evidence was assessed. Subgroup analysis was performed to explore the source of heterogeneity. Results: We included 12 RCTs examining 644 patients. Pain scores at rest at 24 h (standardised mean differences (SMDs): 0.17; 95% confidence interval (CI): -0.90 to 1.23; P = 0.76, moderate certainty) and during movement at 24 h (SMD: -0.58, 95% CI: -1.53 to 0.38, P = 0.24, moderate certainty) were not different in both PENG block and FICB. Pain scores at rest and during movement within 30 min may be lower with PENG block than FICB. However, the pain score at rest and during movement at 6 h and the time to first rescue analgesia were not different between the two treatment arms. The mean opioid consumption in oral morphine equivalents (mg) in 24 h may be lower with PENG than FICB. Conclusion: We observed no difference between the PENG block and the FICB at 24 h for pain at rest and movement with a moderate degree of certainty. However, PENG block showed improved analgesia within 30 min at rest and during movement, and reduce postoperative opioid consumption in 24 h with moderate certainty of evidence. Further large-scale and high-quality RCTs are required to supplement the present findings.

Use of Numeric Rating Scale (NRS) as Visual Analogue Scale (VAS): Is this Clinically Significant?

Objective: To analyze statistically significant differences between the Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) in low back pain (LBP) patients. Study Design: Prospective longitudinal Study. Place and Duration of Study: Orthopaedic and Spine Department, Combined Military Hospital, Peshawar Pakistan, from Sep 2019 to May 2020. Methodology: The study included two hundred one patients with low back pain presented to the Orthopedic and Spine OPD.All patients were asked to record their pain with a Visual Analogue Scale (VAS) at the start of the visit and a Numerical Rating Scale (NRS) at the exit, at approximately 5-7 minute intervals in the Outpatient Department. Results: Two hundred one patients were included in the study. The mean age of the patients was 41.5 years (range 15-75). Thecomparison of pain measurements with the Numerical Rating Scale (NRS) showed a mean of 7.408(SD1.853), whereas with the Visual Analogue Scale (VAS), it was 6.864 (SD1.954). This showed higher readings with NRS compared to VAS, with a mean difference of 0.544 (p-value was &lt;0.001). Conclusion: The numerical Rating Scale (NRS) tends to produce higher pain readings than the Visual Analogue Scale (VAS). Treatment guidelines should be considered when interpreting studies that have used VAS interchangeably and wrongly reported it as NRS.

A Systematic Review on Long-Term Postsurgical Pain Outcomes; What Is the Effect of Upper Extremity Regional Anesthesia?

Chronic pain is a recognized complication of surgery, and it has been hypothesized that regional anesthesia might reduce the risk of development of chronic pain after upper extremity surgery. A systematic literature review was performed to assess whether in patients undergoing elective upper extremity surgery (P), regional anesthesia (I), compared to general anesthesia (C), would result in lower long-term (>3 months) postoperative pain intensity (O). We included randomized and nonrandomized controlled trials (RCTs). Our primary outcome was numerical rating score or visual analogue scale for pain, at >3 months postoperatively. The Embase, Medline ALL, Web of Science Core Collections, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for all reports assessing pain at >3 months after upper extremity surgery under general versus regional anesthesia. Secondary outcomes were: opioid prescription filling, complex regional pain syndrome (CRPS) incidence, the Mayo Wrist Score (MWS), and scores on the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Quality (or certainty) of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Risk-of-bias was assessed using the Cochrane tool for randomized trials (RoB 2.0) and nonrandomized trials (ROBINS-I). This review included 14 studies, comprising 7 RCTs and 7 nonrandomized studies. Six of the 7 studies (4 RCTs, N = 273; 2 nonrandomized studies, N = 305) using a pain score, our primary outcome, report comparable long-term postoperative pain scores after regional and general anesthesia. Six of the 7 studies using our secondary outcomes report comparable long-term outcomes in terms of opioid prescription filling (2 retrospective cohort studies [RCSs], N = 89,256), CRPS incidence (1 RCT, N = 301), MWS (1 RCT and 1 RCS, N = 215), and DASH score (1 RCT, N = 36). Comparable outcomes were reported in all 7 RCTs (N = 778) and in 5 of the 7 nonrandomized studies, comprising 5 RCSs (N = 89,608). Two prospective observational studies (POSTs), comprising 279 patients, report a statistically significant difference in outcomes, with less pain and better DASH scores after brachial plexus anesthesia. All 14 studies provided moderate to very low certainty evidence, and there was a serious risk of bias due to confounding bias in 5 of the 7 nonrandomized studies (N = 631). The results of this review indicate that upper extremity regional anesthesia, compared to general anesthesia, is unlikely to change pain intensity at >3 months postoperatively.

The Discrepancy and Agreement between Patient-Reported Percentage Pain Reduction and Calculated Percentage Pain Reduction in Chronic Pain Patients

Two derivatives of the numeric rating scale (NRS) and visual analog scale (VAS), namely patient-reported percentage pain reduction (PRPPR) and calculated percentage pain reduction (CPPR), are commonly used when evaluating pain reduction. A small number of studies have attempted to assess the agreement between PRPPR and CPPR. However, they have been limited in their scope by a focus on specific types of pain, or by their focus on specific treatment modalities. As far as the authors of this article are aware, this is the first study to assess the agreement between PRPPR and CPPR in chronic pain patients, as well as the first to assess how the duration of treatment affects the correlations between PRPPR and CPPR. The aim of this retrospective analysis was to determine whether the duration of treatment affects CPPR and PRPPR, and the discrepancy and agreement between the two. Additionally, the study assessed whether individual treatment modalities, or the lack there of, impacted the discrepancy and correlation between PRPPR and CPPR. The mean PRPPR and CPPR for the entire patient population were 59.98 and 40.71, respectively. The mean discrepancy between the two parameters was 19.27. The agreement between PRPPR and CPPR, as measured by the concordance correlation coefficient, was 0.984 (95% C.I., 0.982-0.986).

Comparative evaluation of the effectiveness of intracanal and intraoral cryotherapy on postendodontic pain in patients with symptomatic apical periodontitis: A randomized clinical trial.

There is a rising need for controlling postendodontic pain (PEP) without using analgesics and other conventional methods. The aim of the study is to compare the effectiveness of various cryotherapy applications on controlling PEP in patients with symptomatic apical periodontitis. One hundred and eight patients were selected and preoperative pain and pain on percussion scores were recorded using Numeric Rating Scale (NRS) and Visual Analog Scale (VAS), respectively. After obtaining consent, the access cavity was prepared under local anesthesia. After cleaning and shaping, the patients were randomized into the following groups: Group A: Canals were given final irrigation with 20 mL room temperature saline solution for 5 min, Group B: Canals were given final irrigation with 20 mL cold (2°C-4°C) saline solution for 5 min, and Group C: After obturation and restoration procedures, small ice packs of size 2 cm × 2 cm × 2.5 cm (wrapped in sterile gauze) were placed intraorally on the vestibular surface of the treated tooth. At 6 h, postoperative pain was measured using NRS and at 24 h, pain and pain on percussion were measured using NRS and VAS, respectively. Data were analyzed using SPSS software. There was a significant reduction in postoperative pain in the intracanal and intraoral groups at 6 and 24 h when compared with the control group individually. There was no significant difference in postendodontic between intracanal and intraoral cryotherapy groups at 6 and 24 h. Both intracanal and intraoral cryotherapy applications are effective in reducing PEP in patients with symptomatic apical periodontitis.

Alterations in smell or taste in individuals infected with SARS-CoV-2 during periods of Omicron variant dominance

ObjectivesTo characterize the prevalence, severity, correlation with initial symptoms, and role of vaccination in patients with COVID-19 with smell or taste alterations (STAs). MethodsWe conducted an observational study of patients infected with SARS-CoV-2 Omicron admitted to three hospitals between May 17 and June 16, 2022. The olfactory and gustatory functions were evaluated using the taste and smell survey and the numerical visual analog scale at two time points. ResultsThe T1 and T2 time point assessments were completed by 688 and 385 participants, respectively. The prevalence of STAs at two time points was 41.3% vs 42.6%. Furthermore, no difference existed in the severity distribution of taste and smell survey, smell, or taste visual analog scale scores between the groups. Patients with initial symptoms of headache (P = 0.03) and muscle pain (P = 0.04) were more likely to develop STAs, whereas higher education; three-dose vaccination; no symptoms yet; or initial symptoms of cough, throat discomfort, and fever demonstrated protective effects, and the results were statistically significant. ConclusionThe prevalence of STAs did not decrease significantly during the Omicron dominance, but the severity was reduced, and vaccination demonstrated a protective effect. In addition, the findings suggest that the presence of STAs is likely to be an important indicator of viral invasion of the nervous system.

Posterior superior alveolar nerve block alone in the extraction of upper third molars: a prospective clinical study.

Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction. A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used. In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation. The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.

The effects of Valsalva maneuver on pain intensity and hemodynamic status during short peripheral cannula insertion in adults: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to summarize the randomized clinical trial studies regarding the effects of Valsalva maneuver on the severity of short peripheral cannula insertion pain and hemodynamic status in adults. A systematic search was conducted on PubMed, Web of Science, Scopus databases, Cochrane, ClinicalTrials.gov, and Google Scholar Search Engine using keywords extracted from Medical Subject Headings, such as "Valsalva Maneuver," "Valsalva's Maneuver," "Forced Expiratory," "Balloon Inflation," "Pain," "Ache," "Cannulation," "Peripheral Intravenous Cannulation," "Peripheral Catheterization," "Vascular Access," "Venous Cannulation," "Venous Catheterization," and "Catheterization," from the inception to January 1, 2022. Finally, 12 and 11 articles were included in the qualitative and quantitative analysis of this systematic review and meta-analysis, respectively. Overall, pain intensity based on both the Numeric Rating Scale and Visual Analog Scale resulted in a large clinical effect (Effect Size: -1.20, 95% Confidence Interval: -1.69 to -0.71, p < 0.001). A large clinical effect was observed in a separate study of both scales because clinical effect has been determined in studies based on the Numeric Rating Scale (Effect Size: -1.26, 95% Confidence Interval: -1.90 to -0.62, p < 0.001 (and Visual Analog Scale (Effect Size: -1.09, 95% Confidence Interval: -1.98 to -0.20, p = 0.016). Valsalva maneuver significantly increased the mean heart rate (Weighted Mean Difference: 1.90, 95% Confidence Interval: 1.56-2.24, p < 0.001), decreased the mean arterial pressure (Weighted Mean Difference: 0.73, 95% Confidence Interval: -0.13 to 1.60, p = 0.096), and caused a non-significant decrease in anxiety (Weighted Mean Difference: -1.95, 95% Confidence Interval: -5.24 to 1.34, p = 0.25). The results showed that Valsalva maneuver significantly reduced pain intensity. Therefore, it is recommended that nurses use it as a convenient and low-cost non-pharmacological intervention to alleviate the severity of pain in non-cardiac patients. Also, it is suggested to conduct the studies with a strong methodological design and consider its effects on hemodynamic parameters in future investigations.

Effectiveness of sphenopalatine ganglion block for V1 trigeminal neuralgia secondary to herpes zoster. case report

Introduction: Postherpetic V1 branch trigeminal neuralgia (TN) is a different neuralgia of the maxillary and mandibular divisions. This is usually refractory to conventional management since the involvement of the ophthalmic division can produce obvious autonomic symptoms. Few cases have been described, and conventional therapy is usually ineffective. Multimodal analgesic approaches are required in which regional anesthesia is considered an option, in order to optimize the response and improve the patient's quality of life. Methodology: A clinical case of a previously healthy 43-year-old female with a history of facial Herpes Zoster is reported. She presents TN of the left unilateral ophthalmic division for six months of evolution. The characteristic pain is accompanied by autonomic manifestations, refractory to pharmacological treatment. A sphenopalatine ganglion (SPG) block was performed in the pterygopalatine fossa with an infracygomatic approach. The evolution of pain was recorded on the Numerical Visual Analog Scale (VAS) and the quality of life was reported by the Headache Impact Test (HIT-6) scale on days 1, 15, 30, and 90 after the procedure. It was correlated with what was reported in the literature, finding only three cases related to autonomic trigeminal neuralgia (TN), which were treated with radiofrequency. The strongest evidence lies in the use of sphenopalatine ganglion block, radiofrequency ablation, and neurostimulation for cluster headaches. Results: A decrease in pain was reported on the VAS scale from 10/10 to 0/10 after the procedure, which was maintained during the first month without presenting autonomic symptoms. In the third month, VAS 2/10 is recorded, which is accompanied by tears. According to the HIT-6 scale, there was an improvement in quality of life from 69 points (very severe impact) to 36 points (little or no impact). Discussion: In recent studies, the connection of the ophthalmic nerve with the SPG has been found, in such a way that it is a possible explanation of why the SPG block is effective for pain relief in the ophthalmic nerve area in patients with TN. Conclusion: The present case of TN V1, with SPG blockade, showed analgesic efficacy and improvement in the quality of life reported by the patient. Further research with larger cohorts is required to standardize the procedure for such a diagnosis.

Pain measurement in painful skin conditions and rheumatoid arthritis randomized controlled trials: a scoping review to inform pain measurement in hidradenitis suppurativa.

Pain is the most common and bothersome symptom experienced by people with hidradenitis suppurativa (HS) and has been prioritized as an outcome domain by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). To perform a scoping review of pain measurement in randomized control trials (RCTs) of painful skin conditions (PSCs) and use of the pain numerical rating scale (NRS) and visual analogue scale (VAS) in rheumatoid arthritis RCTs, to inform the efforts of HISTORIC to reach consensus on how to measure pain intensity in HS trials. A search was conducted on several publication databases. Inclusion criteria were RCTs with a minimum of 10 participants that measured pain intensity. Pain NRS and VAS were used in 68% of PSC trials. Respectively, 77% and 87% of PSC and rheumatoid arthritis RCTs did not specify the recall window. The commonest recall window in PSCs when specified was 24 h. In total, 33% of PSC trials assessed maximum pain intensity and 3% average pain intensity, while 87% of rheumatoid arthritis trials did not provide details. Pain data were reported as mean difference by 76% of PSC trials and 75% of rheumatoid arthritis trials. Respectively, 10% and 11% of PSC and rheumatoid arthritis studies reported pain as the percentage of patients reaching a desirable state and only 1% and 2% reported number needed to treat. While pain NRS and VAS are standard methods to measure pain intensity in PSCs, key details such as the recall window are often omitted and there is no consensus on how to report pain NRS data. What is already known about this topic? Pain is the most burdensome symptom experienced by patients with hidradenitis suppurativa and has been prioritized as an outcome domain by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). What does this study add? Our review shows substantial variation in how pain numerical rating scale (NRS) and visual analogue scale are utilized in clinical trials. This variation restricts meta-analysis of pain intensity results. There is a need for consensus regarding the recall window for pain NRS and maximum vs. average pain, and whether current pain should be measured.

Short-term clinical and radiographic outcomes in patients treated with a modern intramedullary nailing system for 2-part proximal humerus fractures

ObjectivesThe optimal surgical treatment of displaced proximal humerus fractures (PHFs) remains controversial. There are advocates for both open reduction and internal fixation with plate and screws (ORIF) and intramedullary nailing (IMN). The purpose this study was to evaluate the early-term clinical and radiographic outcomes of IMN for isolated, displaced 2-part surgical neck PHFs using a modern, straight nail system and to determine the effect of preoperative patient and fracture characteristics on outcome. MethodsThis was a case series of 23 patients with displaced 2-part surgical neck PHFs who were treated with ORIF using a straight IMN with minimum follow-up of 1 year (mean 2.5 years [range, 1.1–4.6]). Patients were identified retrospectively and contacted for measurement of active range of motion (AROM) and patient reported outcome measures (PROMs) including the American Shoulder and Elbow Surgeons (ASES) score, Oxford Shoulder Score (OSS), and Single Assessment Numeric Evaluation (SANE), EuroQol-5D (EQ-5D), and Visual Analog Scale Pain score (VAS Pain). Plain radiographs were evaluated to assess the quality of the reduction and failure of fixation. Complications and reoperations were identified. ResultsReduction was anatomic in 12 (52%) patients, acceptable in 9 (39%), and 2 (9%) were malreduced. There were no differences in reduction quality based on sex (p = 0.37), age at surgery (p = 0.68), calcar comminution (p = 0.68), number of screws in the head (p = 0.99), or medial hinge disruption (p = 0.06). At final follow-up, the mean ASES score was 92 ± 10, OSS was 45 ± 4, SANE was 93 ± 7, EQ-5D of 0.85 ± 0.17, and VAS Pain was 0 ± 1. The mean active forward flexion was 143° ± 16°, active external rotation was 68° ± 20°, and internal rotation was T11 ± 4 vertebrae. Two (9%) patients underwent reoperation and 2 (9%) patients experienced clinical failure not requiring reoperation. ConclusionsStraight IMN is a reliable treatment for displaced 2–part surgical neck PHFs with excellent radiographic and clinical outcomes in early follow-up. The implant facilitated anatomic or acceptable alignment of the fracture in the vast majority of patients.

Exploring nurse-sensitive patient outcomes in Dutch district nursing care: A survey study.

There is a lack of evidence to guide district nurses in using nurse-sensitive patient outcomes as it is unclear how these outcomes are currently used in daily district nursing practice. Therefore, we aimed to explore (1) which nurse-sensitive patient outcomes are measured and how these outcomes are measured, (2) how district nurses use the outcomes to learn from and improve current practice and (3) the barriers and facilitators to using outcomes in current district nursing practice. An exploratory cross-sectional survey study was conducted. The survey was distributed online among nurses working for various district nursing care organisations across the Netherlands. The responses from 132 nurses were analysed, demonstrating that different instruments or questionnaires are available and used in district nursing care as outcome measures. The nurse-sensitive patient outcomes most often measured with validated instruments are pain using the Numeric Rating Scale or Visual Analogue Scale, delirium using the Delirium Observation Scale, weight loss using the Short Nutritional Assessment Questionnaire and caregiver burden using the Caregiver Strain Index or a Dutch equivalent. Falls and client satisfaction with delivered care are most often measured using unvalidated outcome measures. The other nurse-sensitive outcomes are measured in different ways. Outcomes are measured, reported and fed back to the nursing team multiple times and in various ways to learn from and improve current practice. In general, nurses have a positive attitude towards using nurse-sensitive outcomes in practice, but there is a lack of facilitation to support them. Because insight into how nurses can and should be supported is still lacking, exploring their needs in further research is desirable. Additionally, due to the high variation in the utilisation of outcomes in current practice, it is recommended to create more uniformity by developing (inter)national guidelines on using nurse-sensitive patient outcomes in district nursing care.

The Effectiveness of Pharmacopuncture in Patients with Lumbar Spinal Stenosis: A Protocol for a Multi-Centered, Pragmatic, Randomized, Controlled, Parallel Group Study.

PurposeLumbar spinal stenosis (LSS) is a chronic degenerative disease. Non-surgical intervention is recommended, considering the risks and benefits for the affected age group, as well as the characteristics of the disease. However, to date, no studies have compared various non-surgical interventions to ascertain the appropriate first-line non-surgical treatment for LSS. Therefore, the objective of this study will be to assess the efficacy of pharmacopuncture as a non-surgical, conservative treatment for LSS.Patients and MethodsA multi-centered, pragmatic, parallel-group study will be conducted. In total, 98 patients will be recruited at seven institutes; recruitment began in May 2022. After two treatment sessions per week over a period of 12 weeks, follow-up assessments will be held at weeks 13, 25, and 53.ResultsThe efficacy of pharmacopuncture and conservative care will be pragmatically compared in patients radiologically diagnosed with LSS. Pain severity will be measured using the numeric rating scale and visual analog scale. Walking distance will also be evaluated. Patient-centered evaluations will include the Zurich Claudication Questionnaire, Short-Form 12 for Health-Related Quality of Life, EuroQoL 5 Dimension 5 Levels, and Patient Global Impression of Change.ConclusionThe results of this study will confirm the efficacy of pharmacopuncture in comparison to conventional non-surgical treatment and will thus facilitate the prioritization of patient-centered interventions for LSS.Trial registrationThis study was registered at Clinicaltrials.gov (registration identifier: NCT05242497) and CRiS (registration identifier: KCT0007145).

Spinal anesthesia versus general anesthesia for percutaneous nephrolithotomy surgeries - a prospective study

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery for extracting renal and urinary stones, and a choice modality in large, multiple, and stag-horn stones. Anaesthesia for PCNL can be general or regional. Despite good results of PNCL with general anaesthesia, it may cause atelectasis, drug reactions, nausea, and vomiting. General anaesthesia (GA) has its limitations in the form of poor postoperative pain control, greater incidence of nausea and vomiting, prolonged recovery stays and prolonged hospitalizations.Methods: The study was performed in a tertiary care centre. A prospective, randomised study including 60 patients divided into 2 groups. Data collection tools included study proforma, numerical rating scale (NRS) scores and visual analog scale (VAS) scores. Data analysed using science and statistical packaged (SPSS) version 21, independent t tests and z-test for proportion.Results: The demographic data when statistically analysed showed no statistically significant differences between the groups. Haemoglobin percentage (Hb%) was significantly lower in GA group. Spinal anaesthesia (SA) group showed lower VAS and NRS scores hence lower requirement of pain relief and antiemetics. The post-operative complications were insignificant.Conclusions: We concluded that SA is safe and effective method as an alternative method for PCNL surgeries.

Intra-articular Treatment of Digital Osteoarthritis by Radiosynoviorthesis—Clinical Outcome in Long-term Follow-up

This retrospective study analyzed the long-term effects of radiosynoviorthesis (RSO) with special emphasis to local joint pain in patients from 4 different RSO centers in Germany and Austria. A total of 168 finger joints in 147 patients with digital joint OA were investigated. The indication for RSO was based on both clinical complaints and a proven synovitis, despite anti-inflammatory pharmacotherapy and previous intra-articular corticosteroid injections. Radiosynoviorthesis was performed according to international guidelines. A numeric visual analog scale (VAS) before and after treatment was used to measure the outcome. Follow-up was done for at least 2 years after treatment, in some patients even over 10 years. Radiosynoviorthesis resulted in a significant reduction of VAS values in most of the patients, lasting for the whole period of follow-up. Two-thirds of the treated joints showed clinically relevant improvement, if a reduction of 30% in VAS values was defined as a reasonable cutoff. The best results were achieved in thumb base joints. This article confirms that RSO is a suitable treatment option for digital joint OA with a proven synovitis. The analgesic effect is long-lasting and comparable to the success of RSO in patients with rheumatoid arthritis.