Oral Analgesics Research Articles

FDA approves first genetic test to help identify risk for OUD

On Dec. 19, 2023, the U.S. Food and Drug Administration approved the first test that uses DNA in assessing whether certain individuals may have an elevated risk of developing opioid use disorder (OUD). As part of a clinical evaluation, the AutoGenomics, Inc. AvertD test is intended to be used prior to first exposure to oral opioid pain medications in patients being considered for a 4–30‐day prescription for the treatment of acute pain, such as in patients scheduled to undergo a planned surgical procedure. “The AvertD test, a prescription‐use only genetic laboratory test for patients 18 years and older, is to be used only with patients who consent to the test and have no prior use of oral opioid analgesics,” said Jeff Shuren, M.D., J.D., director of the FDA's Center for Devices and Radiological Health. “The test is administered by a health care provider by swabbing the cheek of a patient to collect a DNA sample that will be used to determine if a patient has a combination of genetic variants that may be associated with an elevated risk of developing OUD. This information should be used as part of a complete clinical evaluation and risk assessment; it should not be used alone to make treatment decisions. The test is not intended to be used in patients being treated for chronic pain. AvertD may help patients who are concerned about being treated with an opioid for acute pain make better informed decisions.” As part of the approval order, AutoGenomic, Inc. must provide training to health care providers to help ensure appropriate use of the test and conduct a large post‐market study assessing device performance in patients, regularly reporting progress made toward completion of that study to the FDA. The primary risks associated with AvertD are false negative and false positive results.

Associations of parecoxib and other variables with recovery and safety outcomes in total knee arthroplasty: insights from a retrospective cohort study.

Early mobilization post-total knee arthroplasty (TKA) significantly affects patient outcomes. While parecoxib is known to reduce postoperative pain and morphine use with a favorable safety profile, its impact on mobilization timing post-TKA remains uncertain. This retrospective study aims to assess parecoxib's influence on postoperative mobilization timing in TKA patients without compromising safety. This study included unilateral TKA patients treated for primary knee osteoarthritis under general anesthesia. We divided the study period into two intervals, 2007-2012 and 2013-2018, to evaluate temporal differences. Both the control group and parecoxib group received standard postoperative oral analgesics and as-needed intramuscular morphine. The control group did not receive parecoxib, while the parecoxib group did. Primary outcomes compared postoperative complications and mobilization timing between groups, with secondary outcomes including length of hospital stay (LOS), Visual Analog Scale (VAS) scores for pain, as-needed morphine use, and postoperative nausea/vomiting. Parecoxib did not increase postoperative complications. Unmatched comparison with patients in controlled group found that patients in parecoxib group had significantly shortened mobilization time (2.2 ± 1.1 vs. 2.7 ± 1.6 days, P < 0.001) and LOS (6.7 ± 2.5 vs. 7.2 ± 2.1 days, P = 0.01). Multivariate analysis linked parecoxib use with faster mobilization (β = -0.365, P < 0.001) but not LOS. Males showed increased mobilization time and LOS compared to females during the period of 2007-2018, but gender had no significant association with LOS during the period of 2013-2018. The 2013-2018 period saw significant reductions in both mobilization time and LOS. Use of a tourniquet and local infiltration analgesia showed no significant impact. ASA classification 1-2 was positively associated with faster mobilization but not LOS. Longer operation times were linked to delayed mobilization and increased LOS. In this study, intravenous parecoxib injection, female gender, and shorter OP time had consistent positive association with shorter time to mobilization after individual multivariate analysis in 2 different period. The use of parecoxib had consistent no significant association with LOS. Only shorter OP time was consistent positive associated with shorter LOS.

Erector Spinae Block for Pain Relief in a Case of Rib Fracture

ABSTRACT Uncontrolled pain in patients with rib fracture leads to atelectasis and impaired cough which can progress to pneumonia and respiratory failure necessitating mechanical ventilation. Of the various pain modalities, regional anesthesia (epidural and paravertebral) is better than systemic and oral analgesics. The erector spinae plane block (ESPB) is a new modality in the armamentarium for the management of pain in multiple rib fractures, which is safer to perform and better viewed under ultrasound guided. We report a case where ESPB helped provide pain relief to a rib fracture patient.

Atraumatic Sport-Related Medial Sesamoid Pain: Conservative Treatment Outcome and Magnetic Resonance Imaging Features.

This study aimed to evaluate the effectiveness of conservative treatment in selected patients with atraumatic medial sesamoid pain (MSP) that developed during sports activities. The secondary aim was to determine the detailed underlying pathology in patients who did not respond to conservative treatment using magnetic resonance imaging (MRI). From March 2015 to August 2022, we prospectively followed 27 patients who presented to our outpatient clinic with atraumatic sports-related MSP. The conservative treatment protocol for MSP included the use of oral analgesics, activity restriction, insole modification, local corticosteroid injections, and boot walker application with crutches. MRI was performed for all patients who experienced persistent pain despite the completion of conservative treatment. After the completion of the conservative treatment protocol, 48.1% of the patients reported a reduction in pain. Patients with younger age at pain onset (p = 0.001), higher body mass index (p = 0.001), and a bipartite medial sesamoid (p = 0.010) were more likely to experience persistent pain after conservative treatment. The type of sports activity was also a factor since running- and dancing-related MSP tended to respond better to conservative treatment compared to MSP originating from golf, futsal, and weightlifting with squatting. On MRI, 42.8% of patients showed no specific abnormal findings, with signal changes in soft tissues such as the subcutaneous fat and bursa being the most common, followed by intraosseous signal changes of the medial sesamoid bone and chondral or subchondral lesions of the medial sesamoid metatarsal joint (28.6% each). Conservative treatment was successful in less than half of the patients who experienced MSP due to sports activity. Practitioners should be aware of the numerous possible causes of conservative treatment failure, such as bursitis, medial sesamoiditis, stress fracture, or chondral lesions between the medial sesamoid and metatarsal. MRI evaluation may be helpful in MSP patients who do not respond to conservative treatment.

66 Oral Analgesia in Fixed-Time Interval vs. On-Demand following Vaginal Delivery: A Randomized Controlled Trial

66 Oral Analgesia in Fixed-Time Interval vs. On-Demand following Vaginal Delivery: A Randomized Controlled Trial

A randomized controlled clinical study to evaluate the efficacy of Yastimadhu Hydrogel in Parikartika vis-a-vis Fissure-in-Ano

Parikartika, commonly known as Fissure-in-Ano, ranks among the prevalent anorectal disorders and represents a painful affliction affecting the anal region. Its clinical presentation bears a striking resemblance to the description of Parikartika in Ayurvedic texts. Contemporary therapeutic approaches involve the application of local soothing agents, oral analgesics, and stool softeners during the initial stages. Surgical interventions, including Lord’s dilation, fissurectomy, and sphincterotomy, are considered in more advanced cases. Ayurveda, on the other hand, advocates the use of various drugs with distinct properties for treating this condition, with Yashtimadhu being recognized for its Vrana Ropan, Mrudukara, Tvak Prasadana, and Pitta-Anila Hara properties. Recognizing the regenerative potential of hydrogels on the skin, our study sought to evaluate and compare the local effects of Yashtimadhu hydrogel and Yashtimadhu Ghrita in the management of Parikartika. A randomized comparative study was conducted involving 60 patients with Fissure-in-Ano, divided into two groups. The trial group (n=30) received Yashtimadhu hydrogel through local application for a period of 3 weeks, while the control group (n=30) underwent treatment with Yashtimadhu Ghrita during the same duration. Assessment of symptoms such as Pain, Bleeding, Constipation, Itching, Discharge, and the size of anal fissure, along with observations on the anal fissure floor and granulation tissue, revealed promising results. Statistical analysis indicated the effectiveness of both Yashtimadhu hydrogel and Yashtimadhu Ghrita in the conservative management of Parikartika. Notably, Yashtimadhu Ghrita emerged as a more potent remedy in the management of anal fissure when compared to Yashtimadhu hydrogel.

Effectiveness of a Novel Temperature-Responsive Hydrogel (PF72) for Postoperative Pain Relief in Breast Augmentation.

Breast augmentation can cause severe postoperative pain, leading to an increased length of hospital stay. Postoperative pain management following breast surgery has traditionally involved intravenous and oral analgesics. However, the misuse of opioids can cause severe complications. As a result, several alternative methods have been suggested. Fifty patients were included in this study. All the patients underwent dual-plane pocket dissection using the transaxillary approach and received smooth-type breast implants. The intervention group included 25 patients who received PF72 combined with ropivacaine, and the control group included 25 patients who received only bupivacaine. The Numerical Rating Scale (NRS) score was used to evaluate each patient's pain. Three hours after the surgery, the average NRS scores of the control and intervention groups were 3.75 and 2.48, respectively. Six hours after the operation, the NRS scores of the control and intervention groups increased to 4.77 and 3.02, respectively. PF72 combined with ropivacaine was more effective than only bupivacaine for pain control in patients who underwent breast augmentations.

Multimodal pain management in a dog with oral fibrosarcoma

AbstractAn 8‐year‐old lurcher presented at the Pain Clinic of the Queen Mother Hospital following a 7‐month history of progressive right‐sided facial pain that was poorly responsive to multimodal oral analgesia. Initial investigations had revealed dental changes. Despite appropriate treatment, the patient's clinical signs had deteriorated, resulting in the inability to chew, behavioural changes, and his owner's being unable to administer oral medication, all resulting in progressive weight loss. Computed tomography imaging revealed marked soft tissue thickening of the upper lip, extending along the infraorbital canal and periorbital inflammation. The biopsy confirmed fibrosarcoma. The patient received a multimodal analgesia approach, with systemic analgesia and electroacupuncture performed perioperatively. Neurolysis of the infraorbital nerve was also attempted using an alcohol solution. Following recovery from anaesthesia, the patient showed improved comfort and ate before leaving the hospital. Initial improvement was seen for a number of days at home; however, following this, the owners reported deterioration.

Implementation of a nonopioid multimodal analgesia protocol significantly reduces opioids prescribed after total shoulder arthroplasty: a retrospective study

BackgroundThe purpose of this study was to evaluate the impact of a nonopioid multimodal pain protocol on the amount of opioids prescribed, pain level, and complications in patients undergoing total shoulder arthroplasty (TSA) compared to a standard opioid regimen. MethodsWe retrospectively reviewed 2 consecutive cohorts who underwent either primary anatomic or reverse TSA by a single surgeon. The opioid cohort included patients from 2016 to 2020 who received an intraoperative periarticular injection (Ropivacaine, Epinephrine, and Ketorolac cocktail) and were prescribed Oxycodone/Acetaminophen 5/325 mg on discharge. The nonopioid cohort included patients from 2020 to 2022, consisting of preoperative oral analgesics (Celecoxib, Pregabalin, and Tramadol); intraoperative intravenous Dexamethasone and Acetaminophen and periarticular injection; and postoperative oral Dexamethasone and oral analgesics (Pregabalin, Tizanidine, Magnesium, Ibuprofen, and Acetaminophen). The nonopioid cohort had the option to ask for an opioid prescription postoperatively if needed. Patient-reported outcomes collected included visual analog scale scores for pain and Patient-Reported Outcome Measurement Information System up to 1 year after surgery. Opioid consumption using Morphine Milligram Equivalents were compared up to 3 months postoperatively. ResultsThere were 232 patients in the opioid and 112 in the nonopioid cohorts, respectively. The nonopioid protocol had lower mean visual analog scale scores at preoperative (6.4 vs. 7.4, P < .05), 10-day (3.5 vs. 4.2, P < .05), and 6-week postoperative time points (2.1 vs. 2.8, P < .05), but no differences between the groups were noted 3 months postoperatively. No differences in Patient-Reported Outcome Measurement Information System–upper extremity, pain interference, or depression were found preoperatively and up to 1 year after surgery. Opioid consumption was lower in the nonopioid cohort at all time periods (P < .01). Patients in the nonopioid cohort had significantly lower Morphine Milligram Equivalents at discharge, 10-day, 6-week, and 90-day time periods (P < .01) when compared to the opioid cohort. When analyzing risk factors for continued opioid prescriptions for the whole cohort, preoperative opioid use within 90 days before surgery (relative risk 4.69 [95% confidence interval 3.18-6.91; P < .01) and current tobacco use (relative risk 2.61 [95% confidence interval 1.50-4.54]; P = .01) were associated with continued refills >30 days. Complications in the perioperative period and 90-day hospital readmissions were not significantly different between the groups. ConclusionA nonopioid postoperative regimen for patients undergoing TSA significantly reduces opioid prescriptions with similar patient-reported outcomes, subjective pain scores, and without increased complication rates compared to an opioid-only regimen.

To study the efficacy of Erandmool Arka in Primary Dysmenorrhea - A Single Case Study

Dysmenorrhea is a clinical condition characterized by severe uterine pain during menstruation. It is one of the most common gynecological complaints observed. It has a high impact on women’s quality of life. Dysmenorrhea is explained as an Udavartini Yonivyapad in Ayurveda. In modern medicine it is treated by oral hormonal pills, NSAIDs and analgesics. Long term use of this produces side effects. Thus, they aren’t the solution to this problem. As per Ayurveda, Vatahar procedure is the main line of treatment for Yonivyapadas. Many herbal preparations are mentioned for the management of Udavartini Yonivyapad. According to Arkaprakash Erandmool Arka (Shwet Eranda) possess Vatahar and Shoolhar properties. Hence, a single case study was taken to evaluate the efficacy of Erandmool Arka in Dysmenorrhea.

Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: A randomized clinical trial on patient-reported outcome measures.

To compare patient-reported outcome measures and additional surgical outcomes after sinus floor elevation (SFE) with osseodensification (OD) versus lateral window (LW), both with simultaneous implant placement. Twenty participants requiring single-implant rehabilitation with residual bone height (RBH) ≤4 mm were enrolled. Pain experience, quality of life (QoL) via the Oral Health Impact Profile-14 (OHIP-14), analgesics intake, and other symptoms were self-reported for a week on a daily basis. Surgery duration, complications, and implant stability quotient at baseline (ISQ T0 ) and after 6 months (ISQ T6 ) were registered. Participants were followed up for 1 year. From Day 0 (day of surgery) to Day 3, pain experience was significantly lower (p < 0.05) in the OD group. OHIP-14 score was significantly lower (p < 0.05) in the OD group on all postoperative days, except on Day 5. Average analgesics intake was significantly lower (p < 0.001) in the OD group. Surgery mean duration was significantly higher (p < 0.001) in LW compared to OD (71.1 ± 10.4 vs. 32.9 ± 5.3 min). After osseointegration period, all implants were successfully restored with screw-retained crowns. Within the limitations of this study, it can be concluded that OD and LW techniques were similarly effective in SFE with simultaneous implant placement when RBH ≤ 4 mm. However, OD significantly outperformed LW in pain experience, impact on self-perceived QoL, surgery duration, postoperative edema, and analgesics intake.

Study on clinical characteristics and surgical methods of bucket-handle meniscal tears

To summarize the clinical features, surgical methods, and prognosis of bucket-handle meniscal tears (BHMTs), and provide guidance for clinical treatment. The clinical data of 91 BHMTs patients (91 knees), who met the selection criteria and were admitted between January 2015 and January 2021, was retrospectively analyzed. There were 68 males and 23 females. Age ranged from 16 to 58 years with an average of 34.4 years. The injury was caused by sports in 68 cases, traffic accident in 15 cases, and falls or sprains in 8 cases. There were 49 cases of left knee injury and 42 cases of right knee injury. The time from the onset of symptoms to the admission ranged from 1 day to 13 months (median, 18 days), including >1 month in 35 cases and ≤1 month in 56 cases. Medial BHMTs occurred in 52 cases and lateral BHMTs in 39 cases. There were 36 cases with ACL rupture and 12 cases with discoid meniscus. The knee extension was limited more than 10° in 55 cases. According to the condition of meniscus injury, the meniscus suture with Inside-out combined with All-inside techniques (54 cases) or meniscoplasty (37 cases) under arthroscopy were selected. ACL reconstruction was performed in all patients with ACL rupture with autogenous hamstring tendon. Postoperative complications were observed. International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were used to evaluate knee function, and clinical failure was recorded. Two patients developed intermuscular venous thrombosis, which improved after oral anticoagulant therapy. No vascular injury, postoperative infection, joint stiffness, or other complications occurred in all patients. All patients were followed up 24-95 months, with a median of 64 months. A total of 12 cases (13.19%) failed the operation and were re-operated or given oral anti-inflammatory analgesics and rehabilitation therapy. At last follow-up, IKDC score and Lysholm score of 91 patients significantly increased when compared with those before operation ( P<0.05), while Tegner score significantly decreased ( P<0.05). The above indexes of patients treated with meniscus suture and meniscoplasty were also significantly different from those before operation ( P<0.05). BHMTs occurs mostly in young men and is one of the important reasons for the limitation of knee extension after trauma. Arthroscopic meniscus suture and meniscoplasty can obtain good effectiveness according to individual conditions of patients. But the latter can better preserve the shape and function of meniscus, and theoretically can obtain better long-term outcomes, which needs to be confirmed by further research with larger sample size.

Supraclavicular Brachial Plexus Block Guided by Ultrasonography in Pediatric Patient: A Case Report

Background: Supraclavicular brachial plexus block has proven to be very useful in upper limb surgeries in pediatric patients. Supraclavicular brachial plexus block is preferred over general anesthesia for pediatric patients undergoing upper limb surgeries. This study aimed to report a procedure of supraclavicular brachial plexus block guided by ultrasonography in a pediatric patient undergoing orthopedic surgery on the upper extremity, which yielded good results, a high success rate, reduced opioid usage, and aided in faster recovery while minimizing complications.&#x0D; Case presentation: The patient was a 14-year-old child with a diagnosis of malunion in the left distal radius after open reduction internal fixation (ORIF) planned for osteoclasis surgery and ORIF with regional anesthesia through supraclavicular brachial plexus block. The patient was monitored during the surgery, and after the surgery, the patient returned to the ward; the patient was given oral analgesics without opioids for pain management.&#x0D; Conclusion: The efficient regional anesthesia procedure option for upper limb surgeries in pediatric patients is the supraclavicular brachial plexus block. Due to lower risks and fewer side effects, the supraclavicular brachial plexus block procedure is preferred over general anesthesia in pediatric patients.

The transit of oral premedication beyond the stomach in patients undergoing laparoscopic sleeve gastrectomy: a retrospective observational multicentre study

BackgroundAntiemetic and analgesic oral premedications are frequently prescribed preoperatively to enhance recovery after laparoscopic sleeve gastrectomy. However, it is unknown whether these medications transit beyond the stomach or if they remain in the sleeve resection specimen, thereby negating their pharmacological effects.MethodsA retrospective cohort study was performed on patients undergoing laparoscopic sleeve gastrectomy and receiving oral premedication (slow-release tapentadol and netupitant/palonosetron) as part of enhanced recovery after bariatric surgery program. Patients were stratified into the Transit group (premedication absent in the resection specimen) and Failure-to-Transit group (premedication present in the resection specimen). Age, sex, body mass index, and presence of diabetes were compared amongst the groups. The premedication lead time (time between premedications’ administration and gastric specimen resection), and the premedication presence or absence in the specimen was evaluated.ResultsOne hundred consecutive patients were included in the analysis. Ninety-nine patients (99%) were morbidly obese, and 17 patients (17%) had Type 2 diabetes mellitus. One hundred patients (100%) received tapentadol and 89 patients (89%) received netupitant/palonosetron. One or more tablets were discovered in the resected specimens of 38 patients (38%). No statistically significant differences were observed between the groups regarding age, sex, diabetes, or body mass index. The median (Q1‒Q3) premedication lead time was 80 min (57.8‒140.0) in the Failure-to-Transit group and 119.5 min (85.0‒171.3) in the Transit group; P = 0.006. The lead time required to expect complete absorption in 80% of patients was 232 min (95%CI:180‒310).ConclusionsPreoperative oral analgesia and antiemetics did not transit beyond the stomach in 38% of patients undergoing laparoscopic sleeve gastrectomy. When given orally in combination, tapentadol and netupitant/palonosetron should be administered at least 4 h before surgery to ensure transition beyond the stomach. Future enhanced recovery after bariatric surgery guidelines may benefit from the standardization of premedication lead times to facilitate increased absorption.Trial registrationAustralian and New Zealand Clinical Trials Registry; number ACTRN12623000187640; retrospective registered on 22/02/2023.

Time-varying treatment effect modification of oral analgesic effectiveness by depressive symptoms in knee osteoarthritis: an application of structural nested mean models in a prospective cohort.

Depressive symptoms are common in knee osteoarthritis (OA), exacerbate knee pain severity and may influence outcomes of oral analgesic treatments. The aim was to assess whether oral analgesic effectiveness in knee OA varies by fluctuations in depressive symptoms. The sample included Osteoarthritis Initiative (OAI) participants not treated with oral analgesics at enrolment (n = 1477), with radiographic disease at the first follow-up visit (defined as the index date). Oral analgesic treatment and depressive symptoms, assessed with the Center for Epidemiological Studies Depression [(CES-D) score ≥16] Scale, were measured over three annual visits. Knee pain severity was measured at visits adjacent to treatment and modifier using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (rescaled range = 0-100). Structural nested mean models (SNMMs) estimated causal mean differences in knee pain severity comparing treatment versus no treatment. The average causal effects of treated versus not treated for observations without depressive symptoms showed negligible differences in knee pain severity. However, causal mean differences in knee pain severity comparing treatment versus no treatment among observations with depressive symptoms increased over time from -0.10 [95% confidence interval (CI): -9.94, 9.74] to -16.67 (95% CI: -26.33, -7.01). Accordingly, the difference in average causal effects regarding oral analgesic treatment for knee pain severity between person-time with and without depressive symptoms was largest (-16.53; 95% CI: -26.75, -6.31) at the last time point. Cumulative treatment for 2 or 3 years did not yield larger causal mean differences. Knee OA patients with persistent depressive symptoms and chronic pain may derive more analgesic treatment benefit than those without depressive symptoms and less pain.

Suspected stonefish envenomation in Queensland over eight years: a retrospective series

Introduction Stonefish envenomation results in localized severe pain and swelling and systemic features, including vomiting, arrhythmia, pulmonary oedema, and possibly death. There are limited data regarding the effectiveness of the available antivenom. The aim of this series is to characterize presentations of patients with suspected stonefish envenomation and investigate treatment, including antivenom. Methods This is a retrospective observational series of suspected stonefish envenomation as reported to the Queensland Poisons Information Centre or Princess Alexandra Hospital Clinical Toxicology Unit from July 2015 to January 2023. Patients were identified through the databases held by both the Centre and Unit, and data on clinical features and investigations were collected from the patient’s electronic medical record. Results There were 87 suspected stonefish envenomations from July 2015 to January 2023. The median age was 26 (range: 5-69) years, and 69 (79 per cent) patients were male. Pain was reported in 85 (98 per cent) with a median peak pain score of 10 (range 4-12; three rated their pain greater than 10/10). A clear wound was documented in 64 (74 per cent), with local swelling in 63 (72 per cent). A foreign body was retained in eight (9 per cent) presentations. Systemic symptoms were rare, with vomiting in four (5 per cent) and dizziness in two (2 per cent) presentations. There were no instances of hypotension, arrhythmia, or pulmonary oedema. Hot water was administered in 72 (83 per cent) presentations. Oral analgesia was given in 55 (63 per cent). Parenteral analgesia was given in 53 (61 per cent), most commonly opioids. Local anaesthetic block was performed in 19 presentations (22 per cent), with effectiveness documented in 16/19 (84 per cent). Five patients received antivenom for intractable pain, and all received subsequent parenteral analgesia or local anaesthetic block. Conclusions Stonefish envenomation is characterized by severe pain. Systemic symptoms were rare and not severe in this series. Local anaesthetic block appeared to be the most effective intervention for severe pain when performed. Antivenom appeared to be ineffective in managing pain.

Dolor ocular. Estrategias diagnósticas, tratamiento y manejo en urgencias

Eye pain is defined as pain in the eye itself, the orbit, or neighboring structures. It is one of the main reasons for emergency ophthalmologic consultations. Not all eye pain has its origin in the eyeball; indeed, these symptoms may be due to disease in the orbit or a neighboring structure. All patients who consult due to eye pain should have a full case history performed that is aimed at defining the pain's characteristics (manner of onset, intensity, location, radiation, circumstances that aggravate or attenuate it). Subsequently, a full ophthalmologic examination that includes visual acuity, an intrinsic and extrinsic ocular motility examination, examination of the anterior segment and ocular adnexa using a slit lamp, intraocular pressure, and an assessment of the eye fundus must be performed. The treatment of eye pain is mainly aimed at treating the underlying etiopathogenic mechanism, although many drugs allow for improving symptoms, such as oral analgesics or topical cycloplegic drugs.

Comparison of Pain Levels With Postoperative Intramuscular Administration of Single-Dose Ketoprofen Versus Diclofenac Sodium in Patients Undergoing Lower Third Molar Surgery.

Background Third molar surgeries are commonly performed in oral and maxillofacial surgery practice. Pain associated with this procedure is usually a frequent reason for patient apprehension and discomfort. Oral analgesics, though effective, do not provide sufficient pain relief in the immediate postoperative period. Aim To assess the postoperative effect on pain levels of single-dose administration of ketoprofen and diclofenac sodium as an injection in patients undergoing third molar removal surgeries. Methods This study was conducted among 30 patients divided into two groups (n=15). Patients in Group K received injection ketoprofen 100 mg and Group D included patients receiving injection diclofenac sodium 75 mg, both intramuscularly postoperatively. The intensity of pain was assessed at 30 minutes, two, six, and eight hours post-surgical removal of the impacted tooth using the visual analogue scale (VAS).The statistical data was analyzed using SPSS for Windows version 23.0 (IBM Corp., Armonk, NY, USA).The comparative statistical test adopted to compare pain scores between the two groupswas the Independent samples t-test. A p-value of <0.05 was considered to be statistically significant. Results Our study results revealed that Group K patient's VAS scores after two hours, six hours, and eight hours were 3.9± 2.7,4.5 ± 3.23,2.93 ± 2.27 respectively. In Group Dpatient's VAS scores aftertwo hours, six hours, and eight hours were 4.83± 2.82, 5.03± 2.9, 3.73 ± 2.91 respectively.Patients who were administered ketoprofen had lower pain levels when compared to patients who were given diclofenac but the difference was not statistically significant at any time point (p=0.172after eight hours). Our results depicted that the pain levels uniformly reached their maximal levels six hours after the procedure and thereafter steadily declined in both groups. Conclusion It can be concluded from the study that both the drugs ketoprofen and diclofenac sodium analyzed in this study can be used interchangeably for the reduction of pain following lower third molar surgery.

A Consumer Study on the Sensory Experience of new Herbal Topical Pain Relief Product in India

Introduction: Pain management for musculoskeletal conditions often requires topical products to be used as adjuncts to oral analgesics. The acceptability of topical medication depends on including sensory characteristics, ease of application, after-feel, and residue, etc. This study was conducted to evaluate the consumer acceptability of the sensory parameters of a novel prototype topical pain relief gel containing boswellic acid, methyl salicylate, menthol, and capsaicin in adults who were regular body pain sufferers. Methods: This was a prospective, quantitative, blinded, monadic-designed, consumer sensory home-use test (HUT), conducted in three cities in India. The study included 320 adults who had musculoskeletal pain or joint pain within the past six months leading up to the study, with the last pain occurring within the preceding four weeks. One group was given the gel formulation of the investigated topical pain relief gel and the other group was given the balm formulation. Participants used the assigned market sample at least three times in a 7-day study period, and then completed a web-based questionnaire on the sensorial aspects of the product. Results: Over 90% of consumers agreed that the gel formulation provided fast cooling at the usual site of pain in 10 seconds, long-lasting cooling, and dual cooling and warming sensation. Furthermore, it was convenient and easy to use, was absorbed quickly, dried quickly, and had a pleasant smell without greasy after-feel, and left no residue. Significant findings were noted for the gel formulation versus the balm formulation for parameters of cooling. Conclusion: The findings of the consumer sensory study demonstrate that a novel herbal gel formulation for pain relief has ideal properties of a topical pain relief formulation, and could be a useful adjunct to the pharmacological management of musculoskeletal pain, without adding to the burden of adverse effects.

THU439 Baby's Coming, Break A Leg! A Case Of Transient Osteoporosis Of The Hip

Abstract Disclosure: A. Khan: None. A. Syeda: None. H.B. Aftab: None. Introduction: Pregnancy-associated osteoporosis (PAO) is a rare condition presenting as fragility fractures usually in the latter part of pregnancy or immediate postpartum period. Vertebral fractures are more commonly reported but femoral fractures have also been described in the literature as a distinct entity: transient osteoporosis of the hip (TOH). We present a case of bilateral (B/L) femoral fractures in a woman during pregnancy and in the postpartum period. Case: A 31-year-old, gravida 1 female developed left leg pain at 26 weeks of gestation. The pain radiated from her left lower back to her left knee. It was severe in intensity resulting in her walking with crutches. Subsequent MRI of the left hip showed subchondral insufficiency fracture of the femoral head with prominent bone marrow edema extending from the head into the femoral neck. She was managed conservatively with non-weight bearing status and oral analgesics. She had an uncomplicated vaginal delivery at 39 weeks of gestation. During the first postpartum week she developed right hip pain. MRI of right hip revealed nondisplaced right femoral head subchondral insufficiency fracture with associated effusion and synovitis. She recovered within the next 3 months with resolution of her pain with conservative management. Other than limited calcium intake in childhood, there were no other identifiable risk factors for osteoporosis. Bone density scan revealed normal Z-scores at the lumbar spine and non-dominant wrist. The hips were not evaluated. Workup for secondary causes of osteoporosis was unremarkable including normal serum calcium, PTH, phosphorus, magnesium, SPEP, tissue transglutaminase antibodies, estradiol, LH, FSH, prolactin levels. However, 24-hour urine calcium level was low at 11 (35-250) mg/24hr. Elevated levels of bone specific alkaline phosphatase and urine N-telopeptide (NTX) were noted at 19.9 (5.3-19.5) mcg/L and 110 (4-64) nM BCE/mM creatinine, respectively. Patient was continued on vitamin D and calcium supplements. She breastfed for the initial 2 months but was advised to stop. At her most recent follow up visit 4 months postpartum patient was doing well. Discussion: TOH is a rare entity, and presentation as B/L femoral fractures is exceedingly rare. During pregnancy and lactation, the skeletal system undergoes bone loss to compensate for the calcium demand of the fetal skeletal system. In TOH, venous stasis from the gravid uterus resulting in bone marrow edema is the proposed mechanism in addition to pregnancy associated bone loss. In our patient, a low 24-hr urine calcium could suggest low calcium intake which could have contributed to the fracture as well. While recurrence of PAO has been described, no recurrence of TOH has been reported in subsequent pregnancies. Our case highlights the importance of keeping this rare entity on the differential in pregnant women presenting with back or hip pain. Presentation: Thursday, June 15, 2023