Pain Disability Scores Research Articles

A Study of the Clinical Characteristics of Patients with Low Back Pain at a Single Center in Baghdad

Background: Low back pain is a prevalent and consequential problem in contemporary culture. In the early phases of their careers, many athletes who train particularly hard have considerable low back difficulties Aims of study is to enhance understanding and guide best management practices for those with or at risk of low back pain and to identify diverse aspects of clinical and epidemiological factors in Iraqis for low back pain. Patients and methods: A cohort of 440 individuals diagnosed with Low back pain (LBP) from the rheumatology department at Baghdad Teaching Hospital-Medical City in Baghdad province were involved in the current cross-sectional investigation. The sample consisted of 180 men and 260 women, with an average age of 45.7±14.8 years. The research was carried out from 12/October/2023 to 12 /March/2024. Results: All individuals in this study had LBP. The means age was 45 for the group of patients under consideration. 7 ± 14. 8 years. LBP had the highest incidence in the middle-aged (40-59 years 23%) and the lowest was recorded for the aged above 70 years (7. 5%). Females accounted for 59. 1% of the participants. Most of them; a percentage equivalent to 75. 5% were married. Approximately a third or 30% were employed while, 70.9% of the respondents were jobless. 6 % were overweight people and 77 % were non smokers in the study group. The mean age at the first complaint, visit and diagnosis of the disease were 43. 0 ± 14. 0 years (range: 11–75), 43. 3 ± 14. 2 years (range: McGregor observed that 11% to 78% of patients had some degree of in Continuation of Disturbances: Symptoms, defective vision, and 43. 5 ± 14. 2 years (range: 14–78),respectively. Intervertebral disc prolapse was the most frequent diagnosis among the patients with LBP (49. 8%), while infections were the least frequent (0. 2%). In the following aspects of the Oswestry Low Back Pain Disability Scores, majority participated as follows; 44. 3% with fairly severe pain intensity, 42% who require some help with personal care but mostly manage with it, 39. 5% who lift heavy weights but manage light to medium weights, 34. 1% who are prevented from walking more than 100 yards by their pain, 37. 5 The Analyzed Oswestry Low Back Pain Disability Score mean was 22. 22 ± 7. 26. Conclusion: LPB has a higher frequency among the female population

Influence of App-Based Self-Management on the Quality of Life of Women With Endometriosis.

Endometriosis can significantly impair the quality of life of those affected. Multimodal self-help measures are recommended but are often difficult to access. Smartphone apps have been shown to improve the quality of life for other conditions with chronic pain. The aim of this study was to examine the impact of the Endo-App (Endo Health GmbH, Chemnitz, Germany) on both disease-related quality of life and symptoms of endometriosis affecting it. In the present randomized, controlled pilot study, the impact of utilizing the Endo-App on the quality of life among a sample of 122 women affected by endometriosis is assessed. To measure the changes over a 12-week period, the study incorporates the validated Endometriosis Health Profile (EHP-5 and EHP-30) questionnaire from Oxford University, among other assessment tools. The use of the Endo-App leads to significant changes in the following areas after 12 weeks compared to the control group: pain disability, pain self-efficacy, fatigue, depressive symptoms, and Endometriosis Health Profile scores. The EHP-5 score from T0 to T12 is reduced by -16.76 (p-value of the Mann-Whitney U test (pU) = 0.008), and the EHP-30 score by -15.48 (pU = 0.004). The results remain significant in sensitivity analyses. The effect size of Cohen's d was in the medium range. In summary, the Endo-App improves both physical and psychological symptoms and the patient's self-efficacy. The Endo-App contributes to improving endometriosis care in Germany and enables women suffering from endometriosis to significantly increase their quality of life.

Orthognathic surgery improves quality of life: a survey clinical study

BackgroundThe aim of this study was to evaluate the quality of life (QoL) of patients with dentofacial deformity (n = 107) compared with that of healthy individuals (n = 108) from 2019 to 2020.MethodsOral Health Impact Profile 14 (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ) were administered to the individuals before surgery (T1) and 6 months after surgery (T2).ResultsPreoperative scores (T1) were greater in the surgical group than in the control group in all domains of both surveys (p ≤ 0.001). Postoperative scores (T2) in the surgery group decreased significantly after surgery in all domains in both surveys (p < 0.001). The OHIP-14 scores in the control group at T2 were significantly greater than those in the other domains except for functional limitation at T1. The type of surgery had no effect on quality of life. Class III patients had higher preoperative scores in certain domains. Postoperative physical disability (p = 0.037), physical pain (p = 0.047), and preoperative social disability (p = 0.030) scores of OHIP-14 awareness of dentofacial aesthetics of OQLQ (p = 0.019) were found to be higher in females than in males.ConclusionsThe results showed that orthognathic surgery positively affected quality of life. The control group showed differences in T1 and T2 scores, which can be attributed to their psychological status.

Physical Activity and Pain During Pregnancy

Low back and pelvic girdle pain are prevalent during pregnancy, impacting about 50% of pregnant women. Previous studies conducted on the general population have suggested that physical activity has been associated with reductions in pain levels. Purpose: To determine if women with higher levels of physical activity experience less low back and pelvic girdle pain and lower disability scores than women who are less physically active. Methods: Pregnant women (n=24, 32.2 ± 4.1 years) were recruited between 28- and 32-weeks gestation. Participants reported their weekly physical activity, responded to subjective pain surveys, and underwent a battery of objective pain testing. Spearman’s-rho was used to assess correlations between physical activity scores and each subjective pain measure. Results: Tests for correlation between pregnancy physical activity scores and pain domain measures were not significant (ps&gt;0.05), so no relationship could be determined between physical activity levels and low back/pelvic girdle pain based on this study. Conclusion: This study was not able to identify a significant correlation between physical activity levels and low back/pelvic girdle pain during pregnancy.

Comparison of the Clinical Effects of Unilateral Biportal Endoscopic and Microscopic Lumbar Discectomy

Introduction : Micro discectomy is the surgical procedure of choice for treating lumbar disc herniations. A laminectomy can cause instability, significant epidural fibrosis, continued radiated pain, and surgical site infection, although there is still concern about the dangers of muscle damage, such as to the multifidus, and excessive articular facet resection. Unilateral biportal endoscopic discectomy has been suggested as a less invasive therapeutic approach.Objective: To compare the clinical effects in terms of pain, impairment, and complications associated with percutaneous endoscopic lumbar discectomy with standard micro discectomy for the treatment of disc herniations. Materials and methods: A study of 60 people with disc herniations who were treated with either microdiscectomy or unilateral biportal endoscopic lumbar discectomy. The Oswestry Disability Index and visual analogue score for back and leg pain was evaluated after three, six, and twelve months. Results: In comparison to Group E, Group M's mean operating time was substantially lower (p&lt;0.05). In addition, it took group M more time on average to get back to work. (p&lt;0.05), and the VAS score at 3 showed a statistically significant change (p&lt;0.05). At three months, group M's Oswestry Low Back Pain Disability score was considerably greater than group E's. (p&lt;0.001). Conclusion: In terms of a three-month return to work and wound infections, endoscopic surgery has a little advantage over microscopic surgery. Both techniques are efficient and safe for lumbar discectomy. However, after 6 months of follow-up, the results seem to be comparable. Keywords: Intervertebral Disc Prolapse, Discectomy, Endoscopy, Intervertebral Disc, Micro Discectomy, Visual Analog Scale, Oswestry Low Back Pain Disability Score

PAIN2.0: study protocol for a multicentre randomised controlled trial to evaluate the efficacy of a 10-week outpatient interdisciplinary multimodal pain therapy to manage recurrent pain for patients with risk factors of developing chronic pain in Germany.

Up to 27% of the German population suffers from recurrent or persistent pain (lasting more than three months). Therefore, prevention of chronic pain is one major object of pain management interventions. The aim of this nationwide, multicentre, randomised controlled trial is to evaluate the efficacy of a 10-week ambulatory (outpatient) interdisciplinary multimodal pain therapy (A-IMPT) for patients with recurrent pain and at risk of developing chronic pain. This project was initiated by the German Pain Society (Deutsche Schmerzgesellschaft e.V.) and the public health insurance provider BARMER. It is currently funded by the German Innovation Fund (01NVF20023). The study PAIN2.0 focuses on reducing pain intensity and pain-related disability and investigates whether this intervention can improve physical activity, psychological well-being, and health literacy. PAIN2.0 is designed as a multicentre 1:1 randomised controlled trial with two parallel groups (randomisation at the patient level, planned N = 1094, duration of study participation 12months, implemented by 22 health care facilities nationwide). After 6months, patients within the control group also receive the intervention. The primary outcomes are pain intensity and pain-related impairment, measured as Characteristic Pain Intensity (PI) and Disability Score (DS) (Von Korff), as well as patient-related satisfaction with the intervention. Secondary outcomes are the number of sick leave days, sickness allowance, treatment costs, psychological distress, health-related quality of life, and catastrophizing. The effects of the intervention will be analysed by a parallel-group comparison between the intervention and control groups. In addition, the long-term effects within the intervention group will be observed and a pre-post comparison of the control group before and after the intervention will be performed. Recurrent or persistent pain is common in the German population and causes high costs for patients and society. The A-IMPT aims to improve pain and pain-related impairments in pain patients at risk of chronification, thereby reducing the risk of developing chronic pain with its high socioeconomic burden. This new therapy could easily be integrated into existing therapy programs if positively evaluated. The trial PAIN2.0 has been registered in the German Clinical Trials Register (DRKS) since 21/11/2022 with the ID DRKS00030773 .

Ab. No. 163 Effect of 12 Week Activity-Based Exercise Program on Upper Extremity Function in Patients With Type II Diabetes With and Without Shoulder Dysfunction

Introduction: the study evaluates the effect of 12 week activity-based exercise program(ABEP)on upper extremity(UE)functions in patients with type II diabetes with and without shoulder dysfunction(SD). Participants-88 participants with typeII diabetes with SD(n=44)and without SD(n=44) including both male and female between 40-60 years of age were recruited using convenient sampling method. Methods: The study commenced after the approval from the Institutional Ethics Committee. Outcome measures evaluated were pain intensity, UE range of motion (ROM)and muscle strength, shoulder joint proprioception (JP), grip strength, pinch grip and disability scores. Patients were trained with ABEP for 12 weeks. Treatment outcome was recorded after every 4 weeks up to completion of 12 weeks, post which all the outcome variables were re-assessed to compare the difference. Result: Significant reduction was observed in pain intensity(p=0.00) and disability scores (p=0.0)along with improvement in shoulder joint ROM(p=0.01),muscular strength(p=0.00),shoulder JP(p=0.01)hand grip strength(p=0.02)and pinch grip strength(p=0.00)in patients with SD. There was significant improvement seen in muscular strength(p=0.02) in patients without SD. There was significant reduction seen in HbA1c levels in patients with SD(p= 0.05)and without SD(p=0.02). Conclusion: The study concluded that in individuals with type II diabetes with SD, an ABEP was effective in improving UE functions. It was also observed that patients who did not had SD, demonstrated an improvement in muscle strength and decrease in HbA1c levels. Implications: ABEP as a home exercise program is proved to be beneficial in improving UE functions.

Effects of BMI on SI joint fusion outcomes: examining the evidence to improve insurance guidelines

BACKGROUND CONTEXTObesity is increasing. Previous studies have demonstrated an association between obesity and adverse events after lumbar fusion. There is limited evidence on the effect of obesity on minimally invasive SI joint fusion (SIJF) outcomes. PURPOSEThe purpose of this study was to investigate the impact of obesity on patient-reported outcomes in patients undergoing SIJF surgery using triangular titanium implants (TTI). STUDY DESIGNRetrospective cohort study based on four prospective clinical trials (INSITE [NCT01681004], SIFI [NCT01640353], iMIA [NCT01741025], and SALLY [NCT03122899]). PATIENT SAMPLEAdult patients ≥18 years of age who underwent minimally invasive surgery (MIS) sacroiliac joint (SIJ) fusion between 2012 and 2021. OUTCOME MEASURESVisual analog scale (VAS Pain), Oswestry Disability Index (ODI). METHODSParticipants were classified using the National Institutes of Health body mass index (BMI). Patients with a BMI of 30 to 39 with no significant comorbidity are considered obese, patients with a BMI of 35 to 39 with a significant comorbidity or a BMI of 40 or greater are considered morbidly obese. All subjects underwent either minimally invasive SIJ fusion with TTI or nonsurgical management (INSITE and iMIA studies only). All subjects completed SIJ pain scale scores (measured with a 100-point VAS) and disability scores (measured with ODI) at baseline and at scheduled visits to 24 months. Repeated measures analysis of variance was used to examine the impact of BMI category on score changes. RESULTSIn the SIJF group, mean SIJ pain improved at 24 months by 53.3 points (p<.0001). Over the 24-month follow-up period, BMI category did not impact mean improvement in SIJ pain scale score (repeated measures analysis of variance (ANOVA) p=.44). In the SIJF group, mean ODI at 24 months improved by 25.8 points (p<.0001). BMI category did not impact mean improvement in ODI (ANOVA p=.60). In the nonsurgical management (NSM) group, mean improvements in SIJ pain scale and ODI were clinically small (8.7 and 5.2 points, respectively) and not affected by BMI category (ANOVA p=.49 and .40). CONCLUSIONThis study demonstrates similar benefits and risks of minimally invasive SIJ fusion with TTI across all BMI categories. This analysis suggests that obese patients benefit from minimally invasive SIJ fusion and should not be denied this procedure based solely on elevated BMI.

Efficacy of Allograft Versus Bioactive Glass-Ceramic Cage in Anterior Cervical Discectomy and Fusion: A Randomized Controlled Study.

A randomized controlled trial. The aim of this study is to compare the efficacy of allografts and bioactive glass-ceramic (BG) cages for anterior cervical discectomy and fusion (ACDF) in treating cervical degenerative disc disease. We conducted a single-center, randomized controlled trial between August 2017 and August 2022. Participants were randomized into two groups, and consecutive patients requiring ACDF were randomly assigned to receive either the allograft cage or the BG cage. The surgical outcomes measured included pain levels, neck disability, surgical details, and radiological assessments. Of the 45 assessed, 40 participants were included, with 18 in the allograft cage group and 22 in the BG cage group. By the 12-month follow-up, both groups exhibited significant improvements in pain levels and disability scores, with no notable intergroup differences. Over 85% of patients in both groups were satisfied with their outcomes. Radiological assessments revealed stability in the cervical spine with both cage types post intervention. Although both materials showed a trend toward increased subsidence over time, the difference between them was not statistically significant. Fusion rates were comparable between the groups at 12 months, with BG cage showing a slightly higher early fusion rate at 6 months. No significant differences were observed between the two groups in terms of complications. Both allograft and BG cages are effective in ACDF surgeries for cervical degenerative disc disease, with both contributing to substantial postoperative improvements. Differences in disc height, interspinous motion, and subsidence were not significant in the last follow-up, indicating both materials' suitability for clinical use. Future research with a larger cohort and longer follow-up is needed to confirm these preliminary findings.

The Correlation Between Paraspinal Muscular Morphology, Spinopelvic Parameters, and Back Pain: A Comparative Cohort Study.

The relationship between paraspinal muscle degeneration and low back pain (LBP), disability, and structural changes has been investigated in the literature, but it is still a matter of debate. We differentiated paraspinal muscle magnetic resonance imaging by quality and quantity, focusing on fatty infiltration (FI) and paraspinal muscles cross-sectional area (CSA) from T12 to S1 in patients with and without chronic LBP. We aimed to determine whether paraspinal muscle quantity (CSA) and quality (FI) are positively associated with LBP or degenerative/spinopelvic changes in the spine. Between 2018 and 2021, we prospectively enrolled 205 patients aged between 18 to 65 years, of whom 153 patients had chronic back pain (back pain group) and 52 patients did not have chronic back pain (no back pain group), and collected clinicodemographic, structural, and spinopelvic data. We correlated these data with paraspinal muscle FI and CSA from T12 to S1. Multivariate models were run to highlight associations between pain, disability, or degenerative and spinopelvic parameters. Age was not associated with increased FI but consistently with decreased CSA values. After adjusting for age, sex, and body mass index, FI was associated with an increased risk of back pain (OR, 8.80; 95% CI, 1.9-39.79; P = 0.006) and high disability scores (OR, 3.41; 95% CI, 1.12-10.30; P = 0.030). Decreased CSA was associated with reduced disc height (P < 0.001), while FI and CSA did not associate with abnormal spinopelvic parameters. FI on paraspinal muscle highly correlates with back pain and disability but was not found in structural and degenerative changes in the lower back. Findings from this study are clinically relevant for patient counseling and rehabilitation strategies. 2b.

Long-Term Radiographic and Clinical Outcomes in Patients Undergoing Transforaminal Endoscopic Lumbar Discectomy: A Propensity Score Matching Study.

Our study aims to investigate the long-term clinical and radiographic effects of transforaminal endoscopic lumbar discectomy (TELD) on lumbar disc herniation. Radiographic and clinical data of patients undergoing TELD in our institution from January 2015 to January 2019 were retrospectively collected. LDH outpatients who had not received surgical treatment during the same period were 1:1 matched by propensity score matching as the conservative group. The radiographic parameters of the two groups at baseline and at the last follow-up (≥24 months) were analyzed. The study included 47 patients in the TELD group, matched with 47 patients in the conservative group. The disc height of the TELD group at the last follow-up was lower than that at the baseline (P < 0.001), and lower than that of the conservative group at the last follow-up (P < 0.05). The disc degeneration grade of the TELD group at the last follow-up was greater than that at the baseline, and greater than that of the conservative group at the last follow-up. There was no significant difference in the facet joint degeneration in the TELD group between the baseline and the last follow-up, and between the TELD group and the conservative group at the last follow-up (P > 0.05). The pain intensity and disability score in the TELD group at 3-month follow-up and at the last follow-up were significantly lower than those at the baseline (P < 0.001). Six patients in the TELD group required additional surgery during the follow-up period. Our long-term follow-up data shows that the disc height of the operated level was significantly reduced and the disc degeneration was significantly aggravated in TELD-treated patients; in contrast, the facet joint degeneration did not show significant aggravation.

Effects of Instrument-Assisted Compressive Versus Decompressive Myofascial Release in Patients with Non-Specific Low Back Pain

Non-specific low back pain, a common condition, affects vast majority of the population worldwide and can be treated with soft tissue mobilization either with compression or decompression. Objective: To compare the effects of instrument-assisted compressive versus decompressive myofascial release on pain intensity, lumbar range of motion, and disability in non-specific low back pain. Methods: This quasi-experimental study was conducted at Laeeque Rafiq Hospital from February 2023 to April 2023. Two groups were included: one received instrument-assisted compressive myofascial release (Ergon tool), and the other received decompressive myofascial release with dry cupping. The study followed the patients for three weeks, collecting measurements of pain intensity, lumbar flexion and extension range of motion (ROM), and disability scores of low back pain. Data analysis were performed using SPSS 21.0. Results: There were a total of 44 patients. 23 patients were assigned to the compressive myofascial release technique group and 21 patients to the decompressive myofascial release group. Pain severity and disability score in the decompressive myofascial release group reduced significantly compared to the compressive myofascial release group at the end of the third week and first week respectively (p-value=0.02 and p-value=0.05 respectively). Lumbar flexion and extension ROM improved significantly in the compressive release group as compared to the decompressive release group after 1st and 2nd week respectively (p-value=0.01 and p-value=0.04 respectively). Conclusions: Decompressive myofascial release reduces low back pain and disability, while compressive myofascial release improves lumbar range of motion.

Fear-Avoidance Beliefs Are Associated with Pain Intensity and Shoulder Disability in Adults with Chronic Shoulder Pain: A Cross-Sectional Study.

Shoulder pain is one of the most common musculoskeletal conditions, and for people over 40 years old, it represents the musculoskeletal pain with the greatest impact on quality of life. Psychological factors, such as fear-avoidance beliefs, are associated with musculoskeletal pain, and several studies suggest that they can influence various treatment outcomes. Our objective was to explore the cross-sectional association between fear-avoidance beliefs and shoulder pain intensity and disability in subjects with chronic shoulder pain. A cross-sectional study was conducted, and 208 participants with chronic unilateral subacromial shoulder pain were recruited. The shoulder pain and disability index assessed pain intensity and disability. The Spanish fear-avoidance components scale assessed the presence of fear-avoidance beliefs. The association between fear-avoidance beliefs and pain intensity and disability was analyzed by means of multiple linear regression models and proportional odds models, reporting odds ratios and 95% confidence intervals. Shoulder and pain disability scores were significantly associated with fear-avoidance beliefs (p < 0.0001, adjusted R-square 0.93, multiple linear regression). There was no evidence of an association between sex and age in this study. The regression coefficient for shoulder pain intensity and disability score was 0.67446. The proportional odds model showed an odds ratio of 1.39 (1.29-1.50) for shoulder pain intensity and disability total score. This study suggests that greater levels of fear-avoidance beliefs are associated with greater levels of shoulder pain and disability in adults with chronic shoulder pain.

P180 Minimal disease activity response patterns in bio-naïve patients with psoriatic arthritis treated with guselkumab: a machine learning analysis

Abstract Background/Aims Guselkumab, a human monoclonal antibody targeting the interleukin-23 p19 subunit, demonstrated joint and skin efficacy in patients with PsA in the Phase III DISCOVER-1/-2 trials. MDA, a multi-domain composite outcome, is a clinically relevant measure of therapeutic response in PsA. However, response dynamics and the effect of individual domains on achieving MDA are not well understood. This analysis aimed to characterise MDA response clusters according to domain changes over time and identify potential baseline predictors in patients with PsA receiving guselkumab. Methods Data from bio-naïve patients with active PsA receiving guselkumab 100 mg every 4 or 8 weeks were pooled across DISCOVER-1/-2. Unsupervised machine learning using the time-series K-means clustering algorithm was performed to identify clusters according to MDA domain responses over 52 weeks. Missing data were not imputed. Results This analysis included 571 of 669 patients receiving guselkumab and distinguished four response clusters (C1-4; Table 1). Mean age and body mass index were similar across clusters; C3 had a lower proportion of female patients vs. other clusters. Relative to C3, a high burden of baseline disease was observed in C4 across clinical measures and PROs, and across PROs only in C2. Through Week 52, mean values for all MDA domains showed continuous improvement across clusters (Table 1). MDA response rates were highest in C3, in which all individual domain thresholds were rapidly approached, and lowest in C4. In C1 and C2, improvement in clinical measures paralleled that of C3; both met the PASI threshold and showed substantial reduction in SJC. PROs appeared to take longer to improve but did so earlier in C1 than C2. Improvements were slowest in C4, though still substantial given the high baseline disease burden. Conclusion Machine learning differentiated four clusters of patients with PsA receiving guselkumab based on response patterns in individual MDA domains. Response may differ due to baseline disease burden, especially in patients with high pain, PtGA and functional disability scores. These results offer an innovative, complementary approach to identifying treatment response patterns across diverse clusters of bio-naïve patients with PsA, which may facilitate clinical decision-making. Disclosure A. Zabotti: Member of speakers’ bureau; AbbVie, Amgen, Janssen, Lilly, Novartis and UCB. Grants/research support; Novartis. S. Ohrndorf: Other; Speaker fees or travel expense reimbursements from AbbVie, BMS, Janssen, Novartis and Pfizer. W. Tillett: Other; Research funding, consulting, speaker fees and/or honoraria from AbbVie, Amgen, Celgene, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer and UCB. M. Neuhold: Other; Former employee of Janssen and is now an employee of Takeda Pharmaceuticals International AG. M. van Speybroeck: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson &amp; Johnson. E. Theander: Other; Former employee of Janssen. C. Contré: Other; Former employee of Janssen and is now an employee of Chiesi. M. Sharaf: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson &amp; Johnson. M. Shawi: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson &amp; Johnson. M. Perate: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson &amp; Johnson. A. Kollmeier: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson &amp; Johnson. P. Richette: Other; Received fees from AbbVie, Amgen, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer and UCB.

Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes

ObjectivesIt is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP conditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc). MethodsPatients underwent a standardized assessment of clinical pain, conditioned pain modulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excitability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex- and age-matched healthy volunteers. Results60 patients (42 women, 55.1±9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8±1.3), and Sc (6.4±1.4)] than in those with ns-LBP (4.7±1.0, P<0.001). The same was shown for pain interference (5.9±2.0, 5.9±1.8, 3.2±1.9, P<0.001), disability (16.4±3.3, 16.3±4.3, 10.4±4.3, P<0.001), and catastrophism (31.1±12.3, 33.0±10.4, 17.4±10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8±1.9, -14.1±16.7, respectively) compared to ns-LBP (-25.4±16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group compared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were correlated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS. ConclusionsDifferent types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.

Distal Tibia Fractures: is the Tibia First Technique a Rational Approach?

In this retrospective case-series study we discuss the clinical and radiographic outcomes obtained following the "tibia-first concept" in the treatment of distal tibia fractures, both in patients with fibular comminution and in cases with a simple fibula fracture. We analysed a consecutive series of 64 patients who presented at our emergency department with a distal articular tibial and fibular fracture from January 2015 to September 2020. A total of 22 patients met the inclusion and exclusion criteria and were included in the study. Clinical and radiographic examination were performed at each follow-up. To quantify pain and functional disability, the Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS) were applied. The overall mean age was 52.8 years, and the mean follow-up was 13.18 months. Multiple scales data from the FAOS were as follows: pain score 80.70; symptoms score 81.69; activities of daily living score 87.22; quality of life 76.05. The mean AOFAS ankle-hindfoot score was 74.36. Even though the principles of Rüedi and Allgöwer are still valid, in specific circumstances, the tibia-first concept could be considered as a valid option for the treatment of these demanding fractures. If a good reduction is obtained intra-operatively by ligamentotaxis, we recommend fixing the tibia first, avoiding surgical stress on tissues derived from a previous fibular fixation.

Baseline Knee Pain Predicts Long-Term Response of Intra-Articular Steroid Injection in Symptomatic Knee Osteoarthritis: Data from OAI.

The current study aims to investigate the factors that could predict response to intra-articular corticosteroid injection (IACI) in patients with knee osteoarthritis (KOA). Data of participants were retrieved from the Osteoarthritis Initiative database. Participants with at least one IACI treatment on single or bilateral knees within the first 5 years of follow-up were retrospectively included. Demographic data, clinical and radiographic variables were collected at both baseline and the first follow-up after IACI treatment. Positive response to IACI treatment was defined as >20% reduction of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score from V0 to V1. All the variables with P < 0.2 after the comparison between the response and non-response groups were included in a multivariable logistic regression model to identify independent response predictive patient-specific valuables. Receiver operating characteristic curves were performed to establish the cutoff values of independent predictors. The current study included a total of 385 participants (473 knees), with 155 and 318 knees classified into the response group and non-response group, respectively. Those with satisfied responses to IACI treatment had significantly higher WOMAC pain score (P < 0.001), disability score (P = 0.002), and stiffness score (P = 0.015) at the baseline. Baseline WOMAC pain score showed significant association with positive response to IACI treatment in multivariate logistic analysis and the best cutoff value was 5 points. The rate of analgesics utilization was lower (P = 0.014) in the response group than the non-response group after the IACI treatment. KOA patients with a baseline WOMAC pain score ≥5 are more likely to benefit from IACI treatment.

The Effect of Kinesiological Taping on Pain, Function, and Disability in Subacromial Impingement Syndrome - A Randomized Controlled Study

Objective: Subacromial Impingement Syndrome (SIS) is one of the most common shoulder pathologies that cause pain and lose of function. This study aimed to compare the effects of kinesiological taping and conventional physiotherapy (CP) on pain, functionality, and disability in SIS patients.Materials and Methods: The study was completed with 54 patients aged 18-60 years. By randomization, the participants were divided into two groups: The Intervention Group (IG) and the Control Group (CG). While the CP was performed for ten sessions, kinesiological taping was repeated every three days for the IG. The CG was taken to only ten sessions of CP. The CP was applied for 60x5x2 minutes/day/week. Pain severity, function, and disability were assessed before and after the treatment.Results: There was no difference between the groups in pain severity (p=0.074), function (p=0.565), and disability (p=0.315) scores. On the other hand, there were significant improvements in pain (p=0.001), function (p=0.001), and disability (p=0.005) scores of IG according to intra-group analysis. Similar results were obtained in the CG. However, when the effect sizes of these treatment methods were examined, they did not create a clinically significant superiority compared to each other.Conclusion: Kinesiological taping has been widely used in patients with orthopedic problems. According to our results, kinesiological taping did not have a clinical effect in reducing pain, improving function and disability when applied with CP compared to CP alone. We think that only kinesiological taping may not be sufficient be an alternative to traditional methods in the early term.

A Comparison of Tubular Minimal Invasive Surgery and Conventional Surgery in The Treatment of Patients Suffering from Single Level Lumber Disc Herniation (Short Term Follow Up)

Background: Lumbar disc herniation is frequently-occurring and the most common spine-related disease in orthopedic surgery. However, nearly more than 50% of affected persons usually respond to conservative treatment. Furthermore, there is another group of patients who are suffering from incapacitating low back pain and sciatica although they have been treated for more than 6 weeks or who are suffering from early or progressive neurological impairment that required another approach far from the conservative treatments. Aim of the Study: The present study is designed to unveil the most reliable procedure which should be most adopted for single level lumbar disc herniation in Iraqi patients. Patients and Methods: A total of 40 patients who were suffering from back pain radiated to the lower limb were included in the present investigation. Out of them, 20 patients underwent open discectomy and the other 20 patients underwent tubular discectomy. Results: 1- At the 10th day of postoperatively assessment, an obvious statistically significant decrease in the mean total Oswestry low back pain disability score was recorded in micro-tubular discectomy compared with the open discectomy ( P&lt;0.001). 2- At the 6th month of postoperatively, the mean total Oswestry low back pain disability score was increased in both groups; nonetheless, there has still been a decrease in the micro-tubular discectomy group in comparison with that of open discectomy group (P&lt;0.001).

MDMA-assisted therapy is associated with a reduction in chronic pain among people with post-traumatic stress disorder

Increasing evidence demonstrates 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy (MDMA-AT) may be a safe and effective treatment for post-traumatic stress disorder (PTSD). There is growing interest in MDMA-AT to address a range of other health challenges. Chronic pain and PTSD are frequently comorbid, reciprocally interdependent conditions, though the possible role of MDMA-AT in treating chronic pain remains under-investigated. The present analysis examined the impact of manualized MDMA-AT on chronic pain severity among participants with PTSD who were enrolled in a Phase 2 clinical trial investigating MDMA-AT for PTSD (NCT03282123). Exploratory data from a subset of participants who completed chronic pain measures (n = 32) were drawn from a Phase 2 open-label study sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). Multivariable analysis of variance (ANOVA) was utilized to compare pre- vs. post-treatment Chronic Pain Grade Scale (CPGS) values, adjusting for demographics (age, sex, and ethnicity). K-means clustering was then used to group the sample into three clusters to denote high (n = 9), medium (n = 11), and low (n = 12) baseline pain severity, and the same analysis was repeated for each cluster. Among the 32 participants included in this analysis, 59% (n = 19) were women, 72% (n = 23) were white, and median age was 38 years [interquartile range (IQR) = 31-47]. Overall, 84% (n = 27) reported having pain, and 75% (n = 24) reported disability associated with their pain. Significant reductions in CPGS subscales for pain intensity and disability score, and overall CPGS severity grade were observed among participants in the highest pain cluster (n = 9, p < 0.05), and for pain intensity in the medium pain cluster (n = 11, p < 0.05) post- vs. pre-treatment. Findings demonstrate a high prevalence of chronic pain in this sample of people with severe PTSD and that chronic pain scores among medium and high pain subgroups were significantly lower following MDMA-AT. While these data are preliminary, when considered alongside the frequency of comorbid chronic pain and PTSD and promising efficacy of MDMA-AT for treating PTSD, these findings encourage further research exploring the role of MDMA-AT for chronic pain.