Pain Assessment Questionnaire Research Articles

Evaluating Postoperative Pain Management using the Detroit Interventional Pain Management tool after fracture surgery: How well are we really doing?

To assess patients' opioid prescription usage and pain management satisfaction after fracture surgery. Design : An IRB-approved prospective prognostic cohort study for postoperative fracture patients was conducted. Patients were evaluated by an independent observer at two weeks, six weeks, three months, and six months postoperatively where they were given Detroit Interventional Pain Assessment (DIPA) questionnaires regarding their postoperative pain and opioid usage. Opioid prescriptions were verified by Michigan Automated Prescription System. All patients were divided into major fractures (tibia, femur, acetabulum, pelvis, calcaneus, talus, and polytrauma) and minor fractures (scapula, clavicle, humerus, radius, ulna, scaphoid, carpal/metacarpal, patella, fibula, ankle, and metarsal) and were followed for two years. Single-Center Level One Trauma Center. Patients presenting to clinic over a six month period were invited to participate in this study. Patients who did not consent were excluded. Outcome measures were the amount of prescribed opioids in daily Milligram Morphine equivalents (MMEs), opioid usage, DIPA pain scores, pain management efficiency (percentage of patients reporting no pain or tolerable pain with their regimen). Prescribed MMEs, pain management efficiency scores, and the percentage of patients using opioids were compared across all postoperative periods. For 201 fracture patients, the average age was 47.8 ± 16.3 SD (18-87 years) and there were 116 males (57.8%) and 85 females (42.2%). The percentage of patients using opioids and their daily prescribed MMEs significantly decreased from two weeks (48.2%, 21.6 MMEs) to six months (10.3%, 8.13 MMEs) (P < 0.001). Fifty-one percent of patients were off opioids at two weeks, 64.5% at six weeks, 84.2% at three months, and 89.7% at six months. All opioid prescriptions at six months and two years were prescribed to polytrauma patients who underwent sequential surgeries and these prescriptions originated from outside prescribers. Pain management efficiency scores were worst at two weeks (67.2%) but improved at three months (82.6%). As patients transitioned further from their surgical date, there was a decrease in opioid prescriptions and patient reported opioid usage. Despite the opioid tapering practices by surgeons, polytrauma patients still received prescriptions from outside prescribers for orthopaedic aftercare after three months, signaling the necessity for patients to see outside prescribers for their pain management after this time. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Prescription of non-steroidal anti-inflammatory drugs for patients with inflammatory arthritis decreases with the initiation of tumour necrosis factor inhibitor therapy: results from the ICEBIO registry

Objective To study the impact of tumour necrosis factor-α inhibitor (TNFi) therapy on the use of non-steroidal anti inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) in Iceland. Method This registry cohort study used data from the nationwide database on biologics in Iceland (ICEBIO) and the Icelandic Prescription Medicines Register on disease activity, and filled prescriptions for NSAIDs, to study the period from 2 years before to 2 years after initiation of a first TNFi. Five randomly selected individuals from the general population matched on age, sex, and calendar time for each patient served as comparators. Results Data from 940 patients and 4700 comparators were included. Patients with arthritis were prescribed 6.7 times more defined daily doses of NSAIDs than comparators (149 vs 22 per year). After TNFi initiation, NSAID use decreased to a mean of 85 DDD per year, or by 42% in RA, 43% in PsA, and 48% in axSpA. At TNFi initiation, the quintile of axSpA patients who used most NSAIDs reported significantly worse pain (mean ± sd 66 ± 21 vs 60 ± 23 mm), global health (70 ± 20 vs 64 ± 23 mm), and Health Assessment Questionnaire score (1.21 ± 0.66 vs 1.02 ± 0.66) than the other patients, whereas no significant differences were observed in the groups with peripheral arthritis. Conclusion Patients with inflammatory arthritides requiring TNFi therapy use more NSAIDs than matched comparators, and consumption decreased following TNF initiation. Patient-reported measures are not associated with high NSAID use in patients with peripheral arthritis.

Pengaruh Footbath Therapy Terhadap Penurunan Skala Nyeri Pada Pasien Post Sectio Caesarea

Childbirth through cesarean section can cause discomfort for the mother, one of which is pain arising from the abdominal incision wound. Footbath therapy is one of the methods that can be used to alleviate this pain. The purpose of this study is to evaluate the effectiveness of footbath therapy in reducing pain intensity in patients who have just undergone a cesarean section. This research uses a descriptive method with a case study design in the context of nursing care. The subjects of this study are two patients who have just undergone a cesarean section and are experiencing mild to moderate pain. The instruments used in this study are an observation sheet in the form of a PQRST pain assessment questionnaire, NRS (Numerical Rating Scale) pain scale measurement, and standard footbath therapy procedures. The research was carried out from 14 May 2024 to 15 May 2024 for the first respondent and for the second respondent it was carried out from 17 May to 18 May 2024 with implementation for 2 days and in 1 day it was carried out for 20 minutes. The results of this study showed that both respondents experienced a decrease in pain after giving footbath therapy. So this therapy has proven to be effective for post-cesarean section patients who experience pain.

Sleep disorders in rheumatoid arthritis patients

Aim of the workTo determine the frequency of sleep disturbances in patients with rheumatoid arthritis (RA) and to identify associated factors. Patients and methodsThis study included 100 RA patients. The disease activity score (DAS28), tender joint count (TJC), swollen joint count (SJC), Visual Analog Scale (VAS)-pain and Health Assessment Questionnaire (HAQ) were assessed. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess sleep quality. ResultsThe patients were 89 females and 11 males, mean age 53.2 ± 11.2 years (21–76 years) and disease duration was 11.1 ± 8.9 years (1–40 years).The meanTJC was 8.5 ± 7.9 (0–24), SJC 4 ± 4.8 (0–24) and VAS 51 ± 21 mm (10–90 mm). Their mean DAS28 was 3.9 ± 1.1 (1–6.15) and HAQ 1.3 ± 0.7 (0–2.9). The ESS was 7.9 ± 5.6 (0–24). 28 % of patients had signs of daytime sleepiness (ESS ≥ 11 points) with a significant association with female sex (p = 0.03), TJC (p = 0.03), SJC (p = 0.02), DAS28 (p = 0.05), VAS (p = 0.04) and HAQ (p < 0.01). The mean Pittsburgh score was 6.9 ± 5.1 (0–19). 51 % of patients had disturbed sleep (PSQI > 5.5 points). The most disturbed components were respectively sleep latency (1.5 ± 1.1), subjective sleep quality (1.25 ± 0.8) and sleep disorders (1.19 ± 0.8). Disturbed sleep assessed by PSQI had a significant association with TJC (p < 0.01), SJC (p < 0.01), C-reactive protein, nocturnal awakening (p < 0.01), DAS28 (p < 0.01), VAS-pain (p < 0.01), HAQ (p < 0.01), and corticosteroid intake (p = 0.01). ConclusionHalf of the patients had sleep disorders with a significant association with disease activity parameters which underline the importance of ensuring remission or low level of activity to improve the quality of sleep of patients.

The effect of exercise on quality of life, fatigue, and pain management in older women: A cross-sectional study in Greece

Background: Frequently, the contribution of exercise to the elderly and the associated benefits of such activities are discussed. Aim: This paper deals with the contribution of exercise to the levels of quality of life, fatigue, and pain management. Method: Then, quantitative and cross-sectional research is carried out to investigate the contribution of physical exercise to the levels of quality of life, fatigue, and pain management in women over 60 years of age. For the data collection, the questionnaire used consisted of the Missoula—VITAS Quality of Life Index (MVQOLI), the Pain Assessment Questionnaire (PSeQ), and the Fatigue Assessment Scale (FAS). Results: From the statistical analysis made between exercise and quality of life, fatigue, and pain management of the women over 60 who participated in the research, it follows that women undergoing exercise show a better quality of life and less fatigue, while no statistically significant difference was detected in terms of pain management. Conclusion: It seems that exercise affects positively quality of life and fatigue. Potential implications must be addressed in order to organize more exercise programs, particularly for older people.

Feasibility interventional study investigating PAIN in neurorehabilitation through wearabLE SensorS (PAINLESS): a study protocol

IntroductionMillions of people survive injuries to the central or peripheral nervous system for which neurorehabilitation is required. In addition to the physical and cognitive impairments, many neurorehabilitation patients experience pain,...

Psychotherapy and chronic pain management: a quantitative study evaluating the contribution of psychotherapy to quality of life and treatment compliance in chronic disease patients.

The psychology of pain is an important field of study that focuses on understanding the psychological factors associated with pain and developing effective approaches to its management. Pain is a complex sensation that affects a person's physical and mental well-being, and psychological factors can have a significant impact on the perception, response and coping with pain. This research study examines the contribution of psychotherapy in managing chronic pain and improving quality of life and treatment adherence. The sample consisted of 87 participants who completed the McGill Pain Assessment Questionnaire, SF-36 Quality of Life questionnaire, and the Morisky Medication Adherence Scale (MMAS-8) questionnaire. Two groups were created: one group received psychotherapy to manage pain and illness, while the other group either did not receive psychotherapy or had no contact with this therapeutic method. The results showed that patients who received psychotherapy had higher scores in the dimensions of mental health, vitality, general health, physical pain, physical functioning, and social functioning compared to patients who did not receive psychotherapy. Statistical analysis confirmed significant differences between the two groups. Additionally, psychotherapy was associated with higher treatment adherence, as indicated by the mean scores of patients receiving psychotherapy compared to those who did not. This suggests that psychotherapy can contribute to increased treatment adherence. The results clearly show that patients who received psychotherapy have significantly higher levels of mental health, vitality, general health and functioning compared to patients who did not receive psychotherapy.

Pain assessment in women with or without endometriosis during the IVF process: a prospective study

Research questionHow does the typology and effect of pain vary between infertile patients with or without endometriosis during the different stages of the IVF process? DesignA prospective, monocentric, observational cohort study was conducted at Lille University Hospital between November 2019 and June 2021. The study was proposed to all patients starting an IVF cycle. Pain assessment questionnaires using validated scales (about type of pain, without specific location), were completed by patients at key points during IVF: before starting treatment, at the end of stimulation and on the day of oocyte retrieval. ResultsA total of 278 patients were analysed: 73 patients with endometriosis and 205 without. At the start of the IVF process, patients with endometriosis had higher pain scores than disease-free women (mean numerical scale score 3.47 versus 1.12 [P < 0.0001]) and 17.81% of patients with endometriosis had neuropathic pain. For mental disorders before starting treatment, 22% of patients with endometriosis had suspected or confirmed depression, and 33% had anxiety compared with 8% and 20% in patients without endometriosis, respectively. During IVF, for patients without endometriosis, pain increased significantly between the baseline, the end of stimulation and on the day of retrieval (P ≤ 0.05). In patients with endometriosis, however, pain did not significantly vary during these times. ConclusionEndometriosis is associated with higher pain scores, but no increase in pain was observed during IVF for these patients. It seems essential to screen and characterize pain phenotypes in all patients before starting treatment and during stimulation to improve pain management.

Long-Term Maintenance of Clinical Responses by Individual Patients With Polyarticular-Course Juvenile Idiopathic Arthritis Treated With Abatacept.

To investigate the frequency and trajectories of individual patients with polyarticular-course juvenile idiopathic arthritis (JIA) achieving novel composite end points on abatacept. Data from a clinical trial of subcutaneous abatacept (NCT01844518) and a post hoc analysis of intravenous abatacept (NCT00095173) in patients with polyarticular-course JIA were included. Three end points were defined and evaluated: combined occurrence of low disease activity (LDA) measured by the Juvenile Arthritis Disease Activity Score; 50% improvement in American College of Rheumatology criteria for JIA (ACR50); and patient-reported outcomes. Patient-reported outcomes included visual analog scale score of minimal pain (pain-min) and Childhood Health Assessment Questionnaire disability index score of 0 (C-HAQ DI0). In this post hoc analysis, maintenance of month 13 and 21 end points (LDA+pain-min, LDA+C-HAQ DI0, and ACR50+pain-min) in those who achieved them at month 4 was determined. Composite end points (LDA+pain-min, LDA+C-HAQ DI0, and ACR50+pain-min) were achieved at month 4 (44.7%, 19.6%, and 58.9% of the 219 patients treated with subcutaneous abatacept, respectively). Of those who achieved LDA+pain-min at month 4, 84.7% (83 of 98) and 65.3% (64 of 98) maintained LDA+pain-min at months 13 and 21, respectively. The proportions of patients meeting LDA+pain-min outcomes increased from 44.7% (98 of 219) at month 4 to 54.8% (120 of 219) at month 21. The frequency of patients who met an LDA+C-HAQ DI score of 0 increased from 19.6% (43 of 219) at month 4 to 28.8% (63 of 219) at month 21. Among individual patients with polyarticular-course JIA treated with abatacept who achieved 1 of the combined clinical and patient-reported outcomes composite end points, many maintained them over 21 months of abatacept treatment.

Pain - ways to determine the intensity and the choice of the appropriate form of treatment

Introduction and purpose of the study: The problem of pain occurs in many patients, and its perception is a subjective aspect. This is a big problem because it negatively affects not only the patient's health but also many aspects of his life: physical activity, social relations, mental and emotional state. Physicians of many specialties face the problem of treatment both in doctor's offices and in hospital rooms. The choice of the appropriate form of therapy can be facilitated by scales and pain assessment questionnaires. This paper presents ways to determine the severity of pain that can be used in contact with both children and the elderly. Proper determination of the degree of pain intensity enables the selection of the appropriate threshold of the analgesic ladder.&#x0D; Materials and methods: The review was based on the analysis of materials collected in the "PubMed" database and WHO guidelines. The work uses the latest scientific works, review articles. The search was carried out using the keywords: "pain management", "analgesic ladder", "pain management scales", "pain management questionnaires", "neuropathic pain", "opioids".&#x0D; Summary: Treatment is a big challenge because each patient feels pain differently, which means that each patient must be approached individually. In order to facilitate and systematize the treatment to some extent and, above all, to choose the best therapeutic method for the patient, pain scales and questionnaires should be used to assess pain intensity and observe the results of the treatment. The variety of methods of imaging the pain intensity scale allows us to choose the most appropriate one for a given patient, depending on his cognitive abilities and age. The choice of treatment method should be based on the analgesic ladder. It is necessary to take into account both the patient's condition, his diseases, treatment and side effects of the introduced treatment.

A pilot study to improve pain phenotyping in head and neck cancer patients.

Pain associated with head and neck cancer (HNC) is difficult to manage and reduces quality of life. It has been increasingly recognized that HNC patients exhibit a wide range of pain symptoms. Here we developed an orofacial pain assessment questionnaire and conducted a pilot study to improve pain phenotyping in HNC patients at the diagnosis. The questionnaire captures the following pain characteristics: pain intensity, location, quality, duration, and frequency; the impact of pain on daily activities; changes in smell and food sensitivities. Twenty-five HNC patients completed the questionnaire. 88% patients reported pain at the site of tumor; 36% reported multiple pain sites. All patients with pain reported at least one neuropathic pain (NP) descriptor, 54.5% reported at least two NP descriptors. The most common descriptors were "burning" and "pins and needles". Most patients reported increased pain to sour or hot/spicy food/drinks, and to food with coarse/hard textures. Patients exhibited impaired oral function, especially chewing, talking, mouth/jaw opening, and eating. Tumor progression has a significant impact on pain. Nodal metastasis is linked to pain at multiple body sites. Patients with advanced tumor staging experience greater pain at the primary tumor site, when exposed to hot or spicy food/drinks or food with hard/coarse texture, or when eating or chewing. We conclude that HNC patients experience a wide range of pain symptoms with altered mechanical, chemical, and temperature sensation. Improved phenotyping and stratification of pain in HNC patients will help address the underlying etiology, which may enable personalized therapeutic approaches in the future.

Translation, and Validation of Perceived Obstacles to Pain Assessment and Management Practices Questionnaire among Vietnamese Nurses

Introduction: Barriers ralated to patients, physian, nurses, and health system were the mostly responded by nurses as factors influencing them in pain management for patients. So, the valiable and riliable questionnaire is verry importence to measure the perception of Vietnamese nurses about pain management barriers The study objective: was to translate, adapt and conduct initial psychometric validation of the Vietnamese version of Perceived Obstacles to Pain Assessment and Management Practices questionnaire (V-POPAMP). Material and method: Translation, adaptation, and validity and reliability testing were performed . 6 expert panels evaluated content validity, and I-CVI, SCVI were applied to measured the content validity. The Cronbach alpha and ICC were used to measured for intenal consistence and stable reliability of V- POPAMP, respectively. A sample of 30 nurses was sellected in prepilot testing, and 30 other nurses participted in pilot testing. Results: The study found that I-CVI of each item ranged from 0.83-1 and S-CVI =0.96, indicating the V- POPAMP is good content validity. In addition, the V- POPAMP is good reliability, with Cronbach alpha for each subscale of 0.729 and more, and ICC for total score was 0.952 and for each subscale ranges from 0.822 to 0.984(p=.000) Conclusion:The V-POPAMPQ has good psychometric properties. It can be used to measure the perception of nurses about pain management barriers in Vietnam.

Translation, and Validation of Perceived Obstacles to Pain Assessment and Management Practices Questionnaire among Vietnamese Nurses

Translation, and Validation of Perceived Obstacles to Pain Assessment and Management Practices Questionnaire among Vietnamese Nurses

Patient-Reported Outcomes Among Patients Ages Two to Seventeen Years With Polyarticular-Course Juvenile Idiopathic Arthritis Treated With Subcutaneous Abatacept: Two-Year Results From an International Phase III Study.

To describe longitudinal changes in patient-reported outcomes (PROs) in children with polyarticular-course juvenile idiopathic arthritis (pJIA) treated with subcutaneous abatacept. Secondary analysis of a single-arm, open-label 24-month study of patients ages 6-17 years and 2-5 years. PROs included Childhood Health Assessment Questionnaire-Disability Index (CHAQ-DI), parent global assessment of child well-being (PaGA), pain assessment, and Activity Limitation Questionnaire (ALQ). Clinical outcomes included 50% or greater improvement in JIA American College of Rheumatology (ACR) criteria, clinically inactive disease, and Juvenile Arthritis Disease Activity Score. For the 6- to 17-year-old (n=173) and 2- to 5-year-old (n=46) cohorts, respectively, median (Q1, Q3) changes from baseline in CHAQ-DI at months 4 and 24 were -0.3 (-0.8, 0.0) and -0.5 (-1.0, -0.1), and -0.4 (-0.8, 0.0) and -0.5 (-1.0--0.1). Median pain scores were below cutoff threshold for clinically relevant pain (<35 mm) by month 1 (6 to 17 years, 32.3 mm; 2 to 5 years, 25.7 mm), reaching a nadir at month 24 (6 to 17 years, 6.0 mm; 2 to 5 years, 2.0 mm). For the 6- to 17-year-old and 2- to 5-year-old cohorts, respectively, median PaGA scores were 47.8 (n=172) and 42.1 (n=46) at baseline and 6.3 (n=107) and 2.0 (n=37) at month 24. In both cohorts, ALQ components improved from baseline to month 4 and were largely maintained to month 24. Clinical outcomes improved through to month 24. Early and sustained PRO improvements were reported in this phase III, open-label trial of subcutaneous abatacept in patients with pJIA.

Topical Cannabidiol in the Treatment of Digital Ulcers in Patients with Scleroderma: Comparative Analysis and Literature Review

To explore the effect of topical cannabidiol (CBD) in treating digital ulcers in patients with systemic sclerosis (SSc). In total, 45 patients with SSc who had digital ulcers were consecutively enrolled between January 2019 and December 2019. Of the participants, 25 were treated with CBD during surgical debridement and 20 were treated with standard local therapy. A numeric rating scale for pain and Health Assessment Questionnaire Disability Index were administered at the baseline and at the end of treatment. Local treatment with CBD was significantly associated with lower pain scores, higher health assessment scores, and an increase in participants' total hours of sleep. Patients in the control group more frequently required additional analgesic therapy. Topical CBD may be a valuable tool to treat pain related to digital ulcers in patients with SSc.

UTILIZAÇÃO DO SISTEMA uCentrum NO TRATAMENTO CIRÚRGICO DAS DOENÇAS DA COLUNA VERTEBRAL

ABSTRACT Objectives: Evaluate the treatment outcome and the performance of the uCentum spinal fixation system in treating traumatic, degenerative, and tumoral diseases of the spine. Methods: This is a therapeutic study to investigate treatment outcomes and level of evidence III, including twenty-three adult patients of both sexes undergoing surgical treatment of degenerative (13 patients), traumatic (04 patients), or tumor diseases (06 patients). Patients were prospectively evaluated using clinical parameters: pain (visual analog scale), clinical and functional assessment questionnaires (SF-36, Oswestry and Roland-Morris), and radiological criteria (arthrodesis consolidation, loosening, breakage or deformation of the implants). Results: Twenty patients were followed for a period of 01 month to 12 month (mean 6,5±7,77). Three patients died due to complications unrelated to the primary disease (traumatic brain injury, septicemia, and lung tumor). Improvements were observed in clinical parameters and scores of the evaluation questionnaires used. No implant-related complications (breakage, loosening, deformation) were observed. Conclusion: the uCentum fixation system showed great versatility for performing the surgical treatment, allowing the performance of open, percutaneous procedures, the introduction of acrylic cement inside the implants, and conversion of polyaxial screws into monoaxial screws intraoperatively. Level of Evidence III; Therapeutic Studies - Investigating the Results of Treatment.

Trigeminal Neuralgia Treatment Outcomes Following Gamma Knife Stereotactic Radiosurgery

Trigeminal neuralgia (TN) is a chronic pain condition causing lancinating pain in the distribution of one or more divisions of the trigeminal nerve. Gamma knife stereotactic radiosurgery (GKSRS) is a surgical option for TN refractory to medical therapy. To report our experience and to analyze the reasons for the variance in radiosurgery outcomes between patients in our diverse population, we conducted a retrospective analysis of a prospectively created database. The 178 patients completed a pain assessment questionnaire before surgery, and at 1 and 2 year follow-ups. We used the “Trigeminal Neuralgia Gamma Knife Outcome Scale” (TN GKOS) to report the response. At 1-year, 35.4% of patients had grade 1A outcome (pain-free and off all pain medications), 24.7% had grade 1B (pain-free on pain medications), 24.2% had grade 1C (some pain but improved with radiosurgery), 12.9% had grade 2 (same as before radiosurgery) and 2.8% had grade 3 (worse pain compared to before radiosurgery). At 2 years, 42.3% had grade 1A, 20.5% had grade 1B, 19.2% had grade 1C, 14.1% had grade 2 and 3.8% had grade 3 outcome. Remarkably, a statistically significant association was found between GKOS and age, racial background and obesity.

P48 Service evaluation of disease burden of, and damage caused by, wrist arthritis in a single centre paediatric cohort of JIA

Introduction/BackgroundWrist synovitis is associated with more severe disease and less drug-free remission periods, therefore, the objective of this study was to investigate the demographic, disease course, and complexity of wrist disease in children being treated for Juvenile Idiopathic Arthritis (JIA).Description/MethodA single-centre, retrospective case note review of all children and adolescents diagnosed with JIA, who received steroid joint injections of their wrists from 2014 to 2019. All patients received standard therapy and underwent regular follow-up at Birmingham Children’s Hospital. Inclusion criteria were those with an established diagnosis of any JIA-subtype according to the International League of Associations for Rheumatology (ILAR) classification. Patients were excluded if (i) the data were incomplete, (ii) they were over the age of 16y at diagnosis, or (iii) the eventual diagnosis was not JIA. Clinical information was gathered from case notes, departmental databases and hospital clinical systems on to a standardised proforma. Information collected were demographics, JIA subtype, immunology, age at diagnosis, disease duration, number of wrist injections and outcome of every wrist MRI performed. All treatments including intraarticular injections were administered by a paediatric Rheumatologist while MRIs were reviewed by an experienced senior Radiologist.Discussion/ResultsOf all 94 eligible patients, 88 (94%) were included in this study; 71 girls, with a mean age at diagnosis of 6 years (0-15 years). Wrist arthritis was more common in seronegative polyarthritis (40%) and extended oligoarthritis (23%) but least pronounced in Enthesitis-related arthritis (2%). 85 (95.6%) received Methotrexate therapy with a mean of 10 months from time of diagnosis. 77 patients (88%) required a step-up from MTX, with Etanercept (88%) being the most popular option as a first-line biologics, followed by Adalimumab (11%). All patients who had Adalimumab as a first biologics had evidence of uveitis.Wrist disease was present at diagnosis in 60/88 (68%) of our cohort. 66 patients (75%) had bilateral wrist disease. Over one-quarter of patients who developed wrist arthritis within the first year of diagnosis were young children (0-2 years). A second predominate group was adolescent (10-15 years) accounting for 33% of our cohort. The mean (IQR) duration between diagnosis and first clinical evidence of wrist synovitis was 15 months (1–17). Patients had a median of 3 years from diagnosis until development of first radiological evidence of erosive changes.12 children (14%) from this cohort underwent a laparoscopic synovectomy for their wrist damage between 2017 and 2021, out of which 9 had polyarticular involvement while two had extended and one had persistent oligoarticular arthritis. Half of the patients reported improvement in pain and Health Assessment Questionnaire (HAQ) scores after synovectomy, while three remained stable at 0 score, and 3 had insufficient data.Key learning points/ConclusionTreatment of wrist arthritis can be challenging to both professionals and health care systems, emphasizing the need for clear steps to improve early recognition and treatment. Wrist disease at presentation was relatively common in our cohort and damage once occurred was irreversible with patients continuing to have ongoing disease activity despite optimization of their treatment. Furthermore, MRI as shown in our analysis, can accurately detect early erosive changes and inform management decision.

Mirror peripheral neuropathy and unilateral chronic neuropathic pain: insights from asymmetric neurological patterns in leprosy.

Leprosy-related multiple mononeuropathy offers a pattern of impairment where neuropathy with and without neuropathic pain (NeP) are present in the same individual, thus allowing to investigate peripheral sensory and innervation in both conditions. This cross-sectional study collected data on clinical and neurological examination, pain assessment questionnaires, quantitative sensory test, and intraepidermal nerve fiber density of patients with leprosy and divided the cohort into 2 groups: with NeP (P+) and without NeP (P-). Furthermore, we assessed mirror body areas in the same NeP individuals with bilateral neuropathy also presenting unilateral NeP. Pain-free patients having unilateral neuropathy were controls. A total of 37 P+ and 22 P- patients were evaluated. Limb areas with NeP had signs of C-fiber dysfunction and hyperesthesia on quantitative sensory testing compared with limb areas having neuropathy without NeP. Skin denervation was found in all patients with leprosy. Comparisons of limbs with and without neuropathy and with and without NeP revealed that higher heat pain thresholds (HPTs) were associated with neuropathic pain areas, whereas less altered HPT was correlated with higher fiber density. Furthermore, a relationship was found between time of leprosy treatment termination and more intense neuropathy, expressed by HPT increasing 0.03°C each month. As expected, interindividual comparisons failed to show differences in intraepidermal nerve fiber density and subepidermal plexus areas between P+ and P- patients ( P = 0.2980, P = 0.9044; respectively). Higher HPT and lower mechanical detection threshold were related to NeP. This study pointed out the relevance of intraindividual comparisons including mirror areas when assessing local changes in peripheral NeP.

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study.

Purpose: Two-stage tissue expander (TE) to implant breast reconstruction is commonly performed by plastic surgeons. Prepectoral implant placement with acellular dermal matrix (ADM, e.g., AlloDerm®) reinforcement is evidenced by minimal postoperative pain. However, the same is not known for TE-based reconstruction. We performed this study to explore the use of complete AlloDerm® reinforcement of breast pocket tissues in women undergoing unilateral or bilateral mastectomies followed by immediate, two-stage tissue expansion in the prepectoral plane.Methods: Patients (n = 20) aged 18-75 years were followed prospectively from their preoperative consult to 60 days post-TE insertion. The pain visual analog scale (VAS), Patient Pain Assessment Questionnaire, Subjective Pain Survey, Brief Pain Inventory-Short Form (BPI-SF), postoperative nausea and vomiting (PONV) survey, BREAST-Q Reconstruction Module, and short-form 36 (SF-36) questionnaires were administered. Demographic, intraoperative, and 30- and 60-day complications data were abstracted from medical records. After TE-to-implant exchange, patients were followed until 60 days postoperatively to assess for complications.Results: Pain VAS and BPI-SF pain interference scores returned to preoperative values by 30 days post-TE insertion. Static and moving pain scores from the Patient Pain Assessment Questionnaire returned to preoperative baseline values by day 60. The mean subjective pain score was 3.0 (0.5 standard deviation) with seven patients scoring outside the standard deviation; none of these seven patients had a history of anxiety or depression. Median PONV scores remained at 0 from postoperative day 0 to day 7. Patient-reported opioid use dropped from 89.5% to 10.5% by postoperative day 30. BREAST-Q: Sexual well-being scores significantly increased from preoperative baseline to day 60 post-TE insertion. Changes in SF-36 physical functioning, physician limitations, emotional well-being, social functioning, and pain scores were significantly different from preoperative baseline to day 60 post-TE insertion. Five participants had complications within 60 days post-TE insertion. One participant experienced a complication within 60 days after TE-to-implant exchange.Conclusions: We describe pain scores, opioid usage, patient-reported outcomes data, and complication profiles of 20 consecutive patients undergoing mastectomy followed by immediate, two-stage tissue expansion in the prepectoral plane. We hope this study serves as a baseline for future research.