Pain Grade Research Articles

Clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection.

To analyze the clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection, a total of 360 diffuse large B-cell lymphoma patients with disease recurrence or progression after first-line treatment were retrospectively selected from our hospital from January 2021 to July 2022. After standardized nursing, the overall infection rate of lymphoma patients was 2.50% (9/360), which was significantly lower than the overall infection rate of our hospital in 2021 (7.44%, 844/11342) (P < .05). The proportion of 3 kinds of pathogenic bacteria detected were G+ bacteria (33.5%), G- bacteria (53.3%), and fungi (13.2%). The pathogenic bacteria genus with the most G+ bacteria is Enterococcus, the pathogenic bacteria genus with the most G+ bacteria is Enterobacteriaceae, and the pathogenic bacteria with the most fungi is Candida albicans. Female infection rate was significantly higher than male (P < .05). There was no significant difference in nosocomial infection among different marital status/fertility status (P > .05). The nosocomial infection of patients with different hospitalization times was statistically significant (P < .05). The duration of hospitalization in the infected group was significantly higher than that in the non-infected group (P < .05). The clinical effect of standardized nursing for lymphoma patients is significant, and the influencing factors of nosocomial infection include patient gender, hospitalization frequency, and hospitalization duration.

A Phase 2 Randomized Controlled Trial of Single-Agent Hydroxyurea Versus Thalidomide Among Adult Transfusion Dependent β Thalassemia Patients.

The online version contains supplementary material available at 10.1007/s12288-022-01620-3.

Estimating the Dose-Response Relationship for Ocular Pain after Radiotherapy of Head and Neck Cancers and Skull Base Tumors based on the LKB Radiobiological Model.

Radiotherapy is considered a compromise between the amount of killed tumor cells and the damage caused to the healthy tissue. Regarding this, radiobiological modeling is performed to individualize and optimize treatment strategies. This study aimed to determine the normal tissue complication probability (NTCP) of acute ocular pain following radiotherapy. In this prospective observational study, the clinical data were collected from 45 patients with head and neck cancers and skull-base tumors, and dosimetric data were recorded after contouring the eye globe. Acute ocular pain was prospectively assessed with a three-month follow-up. The Lyman-Kutcher-Berman (LKB) parameters were estimated using the Area Under Curve (AUC) of Receiver Operating Characteristic (ROC) maximization and Maximum Likelihood (MLH) methods, and the NTCP of acute ocular pain was then determined using generalized LKB radiobiological model. The model performance was evaluated with AUC, Brier score, and Hosmer-Lemeshow tests. Six out of 45 (13.33%) patients developed acute ocular pain (grade 1 or more). LKB model showed a weak dose-volume effect (n=0.09), tolerance dose for a 50% complication (TD50) of 27.54 Gy, and slope parameter (m) of 0.38. The LKB model showed high prediction performance. The LKB model predicted that NTCP would be less than 25% if the generalized equivalent uniform dose (gEUD) was kept below 20 Gy. The LKB model showed a high performance in determining the NTCP of ocular pain so that the probability of ocular pain will be less than 25% if the eye globe mean dose is kept below 12 Gy.

Efficacy of emotion regulation training on pain intensity and life quality in patients with peptic ulcer disease (PUD).

Because gastric ulcer is a psychosomatic disease involving many psychological factors like assertiveness and cognitive beliefs, this study aimed to investigate the effectiveness of emotion regulation training on pain intensity and quality of life in patients with peptic ulcer disease. Gastric ulcer, a recurrent and common disease worldwide, is associated with gastrointestinal symptoms and lower health-related quality of life. Psychological factors and stress have been recognized as important contributors to the onset and duration of gastric ulcer, highlighting the need for effective psychological interventions to improve pain intensity and quality of life in patients. The research method was semi-experimental and based on the pretest-posttest control group design, with follow-up after three months. The sample included 46 participants selected by a Purposive Sampling method and placed randomly in the experimental and control groups. At first, simultaneously, and under the same conditions, all the participants responded to the Chronic Pain Grade Questionnaire (CPG) and Quality of Life Questionnaire (SF-12). The emotion regulation training was performed on the experimental group. In the end, both groups were evaluated by posttests, and then they were tracked after three months. To analyze data, the ANCOVA test was applied through SPSS 22. Findings showed that emotion regulation training was meaningfully effective in decreasing pain intensity and increasing life quality (p<0.01), but after three months interval, no significant changes were found in the results. Due to the results about emotion regulation training protocol that has successfully reduced pain intensity symptoms in PUD patients and increased life quality, it is suggested that this protocol can be added to other treatments for PUD patients.

Association Between Sleep Quality, Musculoskeletal Pain and Physical and Psychosocial Well-Being Among Employees Working from Home

COVID-19 has perplexed the world into an unexpected state of affairs. With the implementation of nationwide lockdown, people have begun to ‘Work for Home’ in many employment sectors. Though the policy has managed to keep people safe from the devastating effects of the virus, it has, however, imposed most employees into a sedentary lifestyle. The current situation has resulted in disordered sleep, musculoskeletal pain, physical and psychosocial well-being decline due to irregular work hours, and mental health issues due to corona phobia. The current study aims to find the correlation between sleep duration, musculoskeletal pain, and physical and psychosocial well-being in employees working from home during the COVID-19 pandemic lockdown. One hundred fifty-three samples from the North India region were studied in a correlation study. Subjects working from home for at least one month or more and only due to COVID-19 lockdown were excluded, while those with any musculoskeletal, cardiovascular or neurological disorder were excluded. Questionnaires employed were Pittsburg Sleep Quality Index (PSQI) (for sleep quality), Chronic Pain Grade Questionnaire (CPGQ) (for pain intensity), and Short Form-12 (SF-12) Questionnaire (for physical and psychosocial well-being). Scores were calculated, and Pearson’s correlation was found. One hundred fifty-three samples (mean age= 32.73±5.55, mean height=167±9.22, mean weight=67.2±13.7, mean BMI=23.9±3.97) were evaluated, which revealed a higher negative correlation coefficient value between MSK pain intensity and PCS value (-0.535) describing that the pain increased with deterioration in sleep, and sleep quality and MCS value (-0.423) stating that the psychosocial well-being worsened with the decline in sleep quality; while a highly positive correlation was established with the sleep quality and pain intensity scores (0.420) depicting that pain degraded the physical well-being. A weak correlation was reported in the relationship between the intensity of MSK pain with sleep quality (-0.218) and PCS score (-0.323), suggesting no significant impact (significant at the 0.01 level (2-tailed). A significant correlation has been established between sleep quality, the intensity of musculoskeletal pain, and the physical and psychosocial well-being of employees working from home during the COVID-19 pandemic lockdown.

Fibromyalgia syndrome in medical students

Aim of the workTo investigate the frequency of fibromyalgia syndrome (FMS) among medical students and its stratifications. Patients and methodsThe work included 513 medical students from Kafrelsheikh University. The 2010 and 2016 American College of Rheumatology (ACR) fibromyalgia classification criteria were used to determine the presence of FMS. The chronic pain grade questionnaire was used to assess pain severity and impact on daily activities, recreational, social and family activities, and ability to work. ResultsThe students were 296 females (57.7 %) and 217 males (42.3 %). 64 (12.5 %) fulfilled the 2010 criteria (F:M 2.8:1) (p = 0.015). The frequency of female affection was 15.9 % (47/296) compared to 7.83 % (17/217) in male. 37 (7.2 %) fulfilled 2016 criteria and only six cases (9.3 %) were known to have FMS. The frequency of FMS in students of the first 3 years (basic science) and the following 3 years (clinical) was 14.1 % and 9.5 %, respectively. Considering the chronic pain grade, there was a significant difference (p < 0.0001) in all pain items, daily recreational, social, family activities, and ability to work between those with and without FMS. 213 (41.5 %) had knowledge about FMS and the source of their information was from social media (39.4 %), their academic study (26.8 %), web pages (25.4 %) and friends (8.5 %). ConclusionFibromyalgia is highly frequent among medical students, especially females of basic years with a high impact on recreational, social, family activities, and ability to work. Medical students should be considered a “high-risk” group for FMS and should be educated about it and managed accordingly.

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.

A combination of high preoperative pain and low radiological grade of arthritis is associated with a greater intensity of persistent pain 12 months after total knee arthroplasty.

Despite new technologies for total knee arthroplasty (TKA), approximately 20% of patients are dissatisfied. A major reason for dissatisfaction and revision surgery after TKA is persistent pain. The radiological grade of osteoarthritis (OA) preoperatively has been investigated as a predictor of the outcome after TKA, with conflicting results. The aim of this study was to determine if there is a difference in the intensity of pain 12 months after TKA in relation to the preoperative radiological grade of OA alone, and the combination of the intensity of preoperative pain and radiological grade of OA. The preoperative data of 300 patients who underwent primary TKA were collected, including clinical information (age, sex, preoperative pain), psychological variables (depression, anxiety, pain catastrophizing, anticipated pain), and quantitative sensory testing (temporal summation, pressure pain thresholds, conditioned pain modulation). The preoperative radiological severity of OA was graded according to the Kellgren-Lawrence (KL) classification. Persistent pain in the knee was recorded 12 months postoperatively. Generalized linear models explored differences in postoperative pain according to the KL grade, and combined preoperative pain and KL grade. Relative risk models explored which preoperative variables were associated with the high preoperative pain/low KL grade group. Pain 12 months after TKA was not associated with the preoperative KL grade alone. Significantly increased pain 12 months after TKA was found in patients with a combination of high preoperative pain and a low KL grade (p = 0.012). Patients in this group were significantly more likely to be male, younger, and have higher preoperative pain catastrophizing, higher depression, and lower anxiety (all p ≤ 0.05). Combined high preoperative pain and low radiological grade of OA, but not the radiological grade alone, was associated with a higher intensity of pain 12 months after primary TKA. This group may have a more complex cause of pain that requires additional psychological interventions in order to optimize the outcome of TKA.Cite this article: Bone Joint J2022;104-B(11):1202-1208.

Altered brain responses to noxious dentoalveolar stimuli in high-impact temporomandibular disorder pain patients.

High-impact temporomandibular disorder (TMD) pain may involve brain mechanisms related to maladaptive central pain modulation. We investigated brain responses to stimulation of trigeminal sites not typically associated with TMD pain by applying noxious dentoalveolar pressure to high- and low-impact TMD pain cases and pain-free controls during functional magnetic resonance imaging (fMRI). Fifty female participants were recruited and assigned to one of three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Graded Chronic Pain Scale: controls (n = 17), low-impact (n = 17) and high-impact TMD (n = 16). Multimodal whole-brain MRI was acquired following the Human Connectome Project Lifespan protocol, including stimulus-evoked fMRI scans during which painful dentoalveolar pressure was applied to the buccal gingiva of participants. Group analyses were performed using non-parametric permutation tests for parcellated cortical and subcortical neuroimaging data. There were no significant between-group differences for brain activations/deactivations evoked by the noxious dentoalveolar pressure. For individual group mean activations/deactivations, a gradient in the number of parcels surviving thresholding was found according to the TMD pain grade, with the highest number seen in the high-impact group. Among the brain regions activated in chronic TMD pain groups were those previously implicated in sensory-discriminative and motivational-affective pain processing. These results suggest that dentoalveolar pressure pain evokes abnormal brain responses to sensory processing of noxious stimuli in high-impact TMD pain participants, which supports the presence of maladaptive brain plasticity in chronic TMD pain.

Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition.

Pain after an acute Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) condition (post-COVID pain) is becoming a new healthcare emergency. Precision medicine refers to an evidence-based method of grouping patients based on their diagnostic/symptom presentation and then tailoring specific treatments accordingly. Evidence suggests that post-COVID pain can be categorized as nociceptive (i.e., pain attributable to the activation of the peripheral receptive terminals of primary afferent neurons in response to noxious chemical, mechanical, or thermal stimuli), neuropathic (i.e., pain associated with a lesion or disease of the somatosensory nervous system and limited to a “neuroanatomically plausible” distribution of the system), nociplastic (i.e., pain arising from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain), or mixed type (when two pain phenotypes co-exist). Each of these pain phenotypes may require a different treatment approach to maximize treatment effectiveness. Accordingly, the ability to classify post-COVID pain patients into one of these phenotypes would likely be critical for producing successful treatment outcomes. The 2021 International Association for the Study of Pain (IASP) clinical criteria and grading system provide a framework for classifying pain within a precision pain medicine approach. Here we present data supporting the possibility of grouping patients with post-COVID pain into pain phenotypes, using the 2021 IASP classification criteria, with a specific focus on nociplastic pain, which is probably the primary mechanism involved in post-COVID pain. Nociplastic pain, which is usually associated with comorbid symptomology (e.g., poor sleep quality, fatigue, cognitive–emotional disturbances, etc.) and is considered to be more difficult to treat than other pain types, may require a more nuanced multimodal treatment approach to achieve better treatment outcomes.

CYCLIC FEVERS AND PLEURAL EFFUSIONS IN SUSPECTED PULMONARY HISTOPLASMOSIS

CYCLIC FEVERS AND PLEURAL EFFUSIONS IN SUSPECTED PULMONARY HISTOPLASMOSIS

Cam morphology, hip range of motion and hip pain in young skiers and soccer players

ObjectivesTo investigate hip pain, hip range of motion and the presence and size of cam morphology among young soccer players and skiers. DesignCross-sectional study. MethodsThe hip joints of young male soccer players and male and female skiers were examined clinically for hip range of motion (ROM) and with MRI (the presence of cam morphology). All participants answered questions about hip pain, debut age for training/competing and training frequency. ResultsClinical examinations were performed on 135 athletes (60 male soccer players, 40 male skiers and 35 female skiers), of which 93 athletes had additional MRIs. Mean age was 17.7 (SD 1.2) years. Cam morphology (α-angle ≥60°) was significantly less present in female skiers (3%) compared with male skiers (38%, p ​< ​0.001) and male soccer players (33%, p ​= ​0.03). The soccer players had significantly reduced internal and external hip rotation and self-reported hip pain, compared with the skiers. Female skiers had significantly greater hip ROM, compared with both male skiers and soccer players. A low positive correlation was found between cam morphology and hip pain in male skiers (r ​= ​0.42; p ​= ​0.014). ConclusionsFemale skiers had a lower prevalence of cam morphology compared with the male groups while no difference was found between the male skiers and soccer players. Young male soccer players had significantly reduced internal and external hip rotation and a lower grade of self-reported hip pain compared with male and female skiers.

The role of DMSO and MSM in treatment of tendinopathies affection in equine: A comparative study

Superficial digital flexor tendon (SDFT) injury is a main cause of lameness in polo and racehorses inciting long-term lameness and recovery. This study aimed to compare the efficacy of topical dimethyl sulfoxide (DMSO) and Methylsulfonylmethane (MSM) on bowed tendons in horses. Ten client-owned injured horses, aged between 5-15 years with an average age of 8.5 years and weighing approximately 400-500 kg, suffering from chronic tendinitis were selected and allocated into two groups: group A (DMSO) and group B (MSM). The group A animals (n=5) were treated with 60 mL of topical 90% DMSO aqueous solution, while Group B animals (n=5) received 60 mL of topical 90% MSM aqueous solution on the bowed tendon at days 0, 7, 14, 21, 28, 35, and day 42. Clinical examinations were performed to evaluate the severity of pain and lameness grade. Ultrasound scans of the superficial digital flexor tendon were taken at days 0, 21, and day 42. Images were placed in numerical form, and the fiber alignment score of the fibers (FS) and the echogenicity score (ES) of the superficial digital flexor tendon at the maximum injury zone (MIZ) were recorded. Results showed that pain reduction and lameness significantly (P<0.05) reduced from 21d to 42d in the DMSO animals compared with the MSM animals. The echogenicity score didn’t differ between the two groups at 0d, 21d, and 42d (P>0.05) however, it was significantly declined in group A at 42d than 0d (P<0.05). Fiber alignment in group A was (P<0.01) reduced at 42d compared with group B. This study concluded that group A horses showed very effective and long-term improvements compared to the group B horses.

A Case of Monoclonal Immunoglobulin Deposition Disease – on Bortezomib regimen, A Novel strategy in Multisystemic Involvement

Background: Monoclonal immunoglobulin deposition disease (MIDD) is a rare and sporadic phenomenon often manifesting in individuals who are in their 5th – 6th decade of life. MIDD along with restrictive cardiomyopathy and Renal AL amyloidosis as in the present case is also an unaccustomed phenomenon. Often, the patient presents with unusual symptoms and is more prone to misdiagnosis. The congo red (-) deposition of the monoclonal light chain can be frequently noted in multiple organs including the heart and kidney. The light chain deposition can be either isolated lambda or gamma chain and they are classified accordingly. While serum electrophoresis at an early presentation may reveal underlying monoclonal gammopathy, the immunofluorescence and histopathological examination of renal biopsy remain the mainstay diagnostic tool. Objective: The case study was done because of its uniqueness in the usage of a novel strategy in the treatment of MIDD. Results: In the current case, a 52-year-old male presented with chest pain and NYHA grade 3 dyspnea for 8 days along with bilateral lower limb pitting oedema since 3 months. In certain prevailing situations, a patient can be misdiagnosed with ischemic heart disease or acute on chronic renal failure. However, detailed history and time-bound investigation will act as a safeguard. Conclusion: When patients have no co-morbidities and no addictions, and the patient’s investigation reveals heavy proteinuria, the rheumatological and haematological etiologies must be ruled out to establish a final diagnosis for timely treatment. As in our case, the rheumatological work-up was negative but we found an M band spike on serum electrophoresis, which expedited our search for underlying plasma-cell dyscrasia.

Efficacy of Mecobalamin Tablets Combined with Troxerutin in the Treatment of NSCLC Chemotherapy-Induced Peripheral Neuropathy.

Objective To assess the efficacy of mecobalamin tablets combined with troxerutin in the treatment of nonsmall cell lung cancer (NSCLC) chemotherapy-induced peripheral neuropathy (CIPN). Methods From January 2020 to December 2021, 120 NSCLC patients with CIPN treated in our institution meeting the inclusion criteria were enrolled and assigned to receive mecobalamin tablets treatment in the control group, or assigned to receive mecobalamin tablets combined with troxerutin treatment in the research group, with 60 patients in each group. All patients were evaluated for clinical efficacy, neuropathic score, patient-reported CIPN symptoms, neuropathic pain grade, and quality of life after 3 weeks of treatment. Results The clinical treatment effective rate of the patients in the research group was significantly higher than that of the patients in the control group (81.7% vs. 58.3%, P < 0.05). Compared with before treatment, neuropathic score, numbness and tingling score, hot/coldness in hands/feet score, and peripheral neurotoxicity grade in all patients decreased significantly after treatment (P < 0.05). And these reductions were more considerable in the research group compared to the control group (P < 0.05). In addition, the quality of life scores (EORTC QLQ-C30) increased significantly in all patients after treatment, and this rise was more considerable in the research group compared to the control group (P < 0.05). Conclusion Mecobalamin tablets combined with troxerutin in the treatment of NSCLC patients with CIPN is effective and safe, and can significantly improve the symptoms and quality of life of NSCLC patients with CIPN.

A Comparison of Relation between Resilience, Locus of Control, Quality of Relationship and Pain Intensity with Dialysis Adequacy in Patients with Peritoneal and Hemodialysis.

Objective: Mental health in people with chronic diseases undergoes many changes due to conflict with the pain caused by the disease, which can have a reciprocal effect on the course and quality of the patient's treatment. The goal of the present study is to compare the correlation between locus of control, relationship quality, pain intensity and resilience with dialysis adequacy and laboratory indicators in peritoneal dialysis and hemodialysis patients. Method : This causal-comparative study was conducted on 30 hemodialysis (HD) and 30 peritoneal dialysis (PD) patients through the convenience sampling method. The data was collected using Pierce Quality Relationship Inventory (QRI), Conner-Davidson Resilience Scale (CD-RISC), Rotter's Locus of Control Scale (RLOC), and Von Korff's Chronic Pain Grade Scale (CPGS), and experimental data collected through blood and urine sampling and analyzed with Fisher's test and multivariate analysis of variance. Results: Conclusion of the Fisher test evinced that there was a significant difference between quality of relationships with parents and amount of Potassium (K), Phosphorus (P) and Parathyroid Hormone (PTH) as well between quality of relationships with friends and amount of Creatinine (Cr), and between the intensity of pain with K and Albumin (Alb) in patients with PD and HD (P < 0.05, P < 0.01). Conclusion of analysis of variance showed that the mean scores of quality of relationships with friends, K, Blood Urea Nitrogen (BUN), Cr, Alb and PTH in the PD group were significantly lower than the mean scores of HD patients (P < 0.05, P < 0.01). Also, mean of dialysis adequacy in patients with PD was significantly higher (P < 0.01). Conclusion: Based on findings, in order to increase dialysis adequacy of patients, along with medical interventions, psychological variables and mental health improvement of patients should also be considered.

Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder - a prospective randomised study.

Arthroscopic capsular release (ACR) and Manipulation under anaesthesia(MUA) have been widely used in the treatment of frozen shoulder (FS). However, there is only limited Level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a randomised trial comparing ACR versus MUA to assess the difference in outcome, complications and cost-effectiveness of both procedures. From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR (n =44) and MUA (n = 41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement (ROM), pain grading using visual analogue scale (VAS), functional scores- UCLA, CONSTANT and EuroQol-5D scores were measured pre-operatively and post-operatively. MRI was done at three weeks post-operatively for screening complications of either procedure. Quality-adjusted life years (QALY) was used for cost-analysis. Post-operatively, patients had significant improvement in pain, ROM and functional scores in both groups (P < 0.001) with no significant difference between groups at 24weeks of follow-up. Diabetic patients undergoing ACR had lesser improvement in abduction and external rotation when compared to non-diabetic patients. Labral tears in MUA group and bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD. Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique and better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.

Determine the Effect of Tramadol Injection as Adjuvant Anesthetic and Analgesia Following Surgical Removal of Mandibular Third Molar

Objective: To establish the efficacy of mean pain control after submucosal tramadol injection compared to placebo after surgical removal of the impacted third molar.&#x0D; Study Design: Quasi-Experimental Study.&#x0D; Place and Duration of Study: Department of Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Feb to Aug 2018.&#x0D; Methodology: All the patients had symmetrical bilateral impactions of the third molar on an orthopantomogram. The surgical site was randomly selected, and those in Group-T received Tramadol injection submucosally adjacent to the extraction socket immediately after the first tooth extraction, and Group-P received Saline. After the second extraction, Group-T received a Saline injection, and Group-P received Tramadol in the same manner. Patients were followed 24 hours post-operative for pain grading at 2, 4 and 24 hours, frequency and concentration of analgesic intake and duration of anaesthesia.&#x0D; Results: Mean age of participants was 23.80±2.80 years. Means of pain intensity of Group without Tramadol after 2, 4 and 24 hours of extraction are 8.40±0.90, 6.30±0.40 and 2.10 ± 0.40, respectively, and those with Tramadol are 5.90±0.50, 4.50±0.30 and 1.60±0.40 respectively.&#x0D; Conclusion: Our study concluded that Tramadol was more effective in providing analgesia after third molar surgery than local anaesthesia alone.

Encoding edge type information in graphlets.

Graph embedding approaches have been attracting increasing attention in recent years mainly due to their universal applicability. They convert network data into a vector space in which the graph structural information and properties are maximumly preserved. Most existing approaches, however, ignore the rich information about interactions between nodes, i.e., edge attribute or edge type. Moreover, the learned embeddings suffer from a lack of explainability, and cannot be used to study the effects of typed structures in edge-attributed networks. In this paper, we introduce a framework to embed edge type information in graphlets and generate a Typed-Edge Graphlets Degree Vector (TyE-GDV). Additionally, we extend two combinatorial approaches, i.e., the colored graphlets and heterogeneous graphlets approaches to edge-attributed networks. Through applying the proposed method to a case study of chronic pain patients, we find that not only the network structure of a patient could indicate his/her perceived pain grade, but also certain social ties, such as those with friends, colleagues, and healthcare professionals, are more crucial in understanding the impact of chronic pain. Further, we demonstrate that in a node classification task, the edge-type encoded graphlets approaches outperform the traditional graphlet degree vector approach by a significant margin, and that TyE-GDV could achieve a competitive performance of the combinatorial approaches while being far more efficient in space requirements.

Estimating Risk of Chronic Pain and Disability Following Musculoskeletal Trauma in the United Kingdom

Serious traumatic injury is a leading cause of death and disability globally, with most survivors known to develop chronic pain. To describe early variables associated with poor long-term outcome for posttrauma pain and create a clinical screening tool for this purpose. This was a prospective cohort study at a major trauma center hospital in England. Recruitment commenced in December 2018 and ceased in March 2020. Participants were followed up for 12 months. Patients aged 16 years or older who were hospitalized because of acute musculoskeletal trauma within the preceding 14 days were included. Data were analyzed from March to December 2021. Acute musculoskeletal trauma requiring admittance to a major trauma center hospital. A poor outcome was defined as Chronic Pain Grade II or higher and measured at both 6 months (primary time point) and 12 months. A broad range of candidate variables potentially associated with outcomes were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariable models were used to identify the variables most likely to be associated with poor outcome, which were entered into multivariable models. A clinical screening tool (nomogram) was derived from 6-month results. In total, 1590 consecutive patients were assessed for eligibility, of whom 772 were deemed eligible and 124 (80 male [64.5%]; mean [SD] age, 48.9 [18.8] years) were recruited. At 6 months, 19 of 82 respondents (23.2%) reported a good outcome, whereas at 12 months 27 of 44 respondents (61.4%) reported a good outcome. At 6 months on univariable analysis, an increase in total posttraumatic stress symptoms (odds ratio [OR], 2.09; 95% CI, 1.33-3.28), pain intensity average (OR, 2.87; 95% CI, 1.37-6.00), number of fractures (OR, 2.79; 95% CI, 1.02-7.64), and pain extent (OR, 4.67; 95% CI, 1.57-13.87) were associated with worse outcomes. A multivariable model including those variables had a sensitivity of 0.93, a specificity of 0.54, and C-index of 0.92. A poor long-term pain outcome from musculoskeletal traumatic injuries may be estimated by measures recorded within days of injury. These findings suggest that posttraumatic stress symptoms, pain spatial distribution, perceived average pain intensity, and number of fractures are good candidates for a sensitive multivariable model and derived clinical screening tool.