Improvement In Pain Research Articles

Role of Neck Pain in Defining Clinical Trajectories of Outcomes in Patients With Degenerative Cervical Myelopathy: Results of a Novel Machine Learning Algorithm.

Study DesignRetrospective analysis of prospective data.ObjectivesNeck pain represents a crucial factor underscoring a patient's decision to receive surgical intervention for degenerative cervical myelopathy (DCM). However, postoperative pain trajectories are poorly defined. This study aimed to employ machine learning-based trajectory modeling to identify patient subpopulations with distinct pain trajectories after surgery.MethodsWe pooled subjects from three major clinical studies on DCM. Group-based multivariate trajectory (GBMT) modeling was used to classify patients into distinct trajectories based on their neck pain score over one year. Outcome differences were examined with univariate analyses. Predictors of group membership were revealed with multinomial logistic regression.ResultsThree distinct trajectories of neck pain were identified from a total of 968 patients with DCM: "slow pain improvement" (n = 239; 25%), "no pain improvement" (n = 537; 55%), and "fast pain improvement" (n = 192; 20%) groups. Each trajectory exhibited a unique baseline pain profile. The "fast pain improvement" group, comprised of patients experiencing profound neck pain, had the best overall outcomes for pain, NDI, SF-36 PCS, and SF-36 MSC postoperatively. On the other hand, the "no pain improvement" group, consisting of patients with pain and multimodal impairment of moderate severity, had residual pain that remained constant and was least likely to experience functional outcome and quality of life improvement after one year.ConclusionsUnsupervised learning on neck pain identified unique pain recovery trajectories that consist of distinct patient phenotypes. Trajectory grouping offers an important framework to both identify novel DCM subpopulations and predict patterns of pain over time.Clinical Trials Included(1) Assessment of Surgical Techniques for Treating Cervical Spondylotic Myelopathy (CSM); https://clinicaltrials.gov/study/NCT00285337; ClinicalTrials.gov ID NCT00285337. (2) Surgical Treatment of Cervical Spondylotic Myelopathy; https://clinicaltrials.gov/study/NCT00565734; ClinicalTrals.gov ID NCT00565734. (3) Efficacy of Riluzole in Surgical Treatment for Cervical Spondylotic Myelopathy (CSM-Protect) (CSM-Protect); https://clinicaltrials.gov/study/NCT01257828; ClinicalTrials.gov ID NCT01257828.

Comparison of intra-articular ozone and steroid injection in patients with adhesive capsulitis.

Adhesive capsulitis is a disease characterized by a significant decrease in the active and passive range of motion(ROM) of the glenohumeral joint along with pain. Ozone therapy has demonstrated promising results in treating various diseases. This study aims to compare the efficacy of intraarticular ozone administration with steroid injection in treating adhesive capsulitis. Our study is a single-blind, prospective and comparative clinical trial. The study included 40 patients who were randomly assigned to one of two groups. The study group received 8 sessions of intra-articular ozone injection under ultrasound guidance, while the control group received a single intra-articular steroid injection. Patient evaluations were conducted before treatment, as well as 4 and 12 weeks after treatment. The study utilized three evaluation scales: the visual analog scale(VAS) for pain, the Shoulder Pain and Disability Index (SPADI), and ROM measurements. Both treatment groups demonstrated a statistically significant improvement in range of motion, SPADI, and VAS scores compared to their values at baseline and weeks 4 and 12. However, no statistically significant difference was found between the two groups in the magnitude of improvement across these outcomes. The study results demonstrate that ozone injection repeated eight times led to improvements in pain, function, and range of motion that were not statistically different from those observed with a single corticosteroid injection in treating adhesive capsulitis. Although the study was not designed as a non-inferiority trial, the findings suggest that intra-articular ozone administration may be a potentially beneficial alternative treatment option. Key Points • This study demonstrates that intra-articular ozone (O2-O3) injection resulted in significant clinical improvements in pain, function, and range of motion in patients with primary adhesive capsulitis. • Despite differences in injection frequency, both ozone and corticosteroid injections led to improvements, with no statistically significant difference between groups. • This study contributes to the limited literature on ozone therapy for adhesive capsulitis and suggests its potential as an alternative to corticosteroid injection, particularly for patients who may not tolerate steroids. • Further research with longer follow-up periods is warranted to confirm the long-term efficacy and safety of ozone therapy in adhesive capsulitis management.

Evaluation of Discrepancy Between Radiographic Success and Patient Satisfaction in Adult Spinal Deformity Surgery.

Considering the high surgical invasiveness of adult spinal deformity surgery, patient-perceived satisfaction may not necessarily follow good radiographic results. This study investigated the incidence and risk factors for the discrepancy between radiographic success and patient satisfaction after adult spinal deformity surgery. We retrospectively analyzed 195 patients (mean age, 68.3 years) who underwent ≥4 level fusion surgery including the pelvis and achieved radiographic success as assessed by surgeons (that is, optimal alignment, no mechanical complications, and no revision surgery). The patients were divided into two groups according to Scoliosis Research Society (SRS)-22 satisfaction scores: less satisfied (score <4.0) and highly satisfied (score ≥4.0) groups. Preoperative and postoperative 2-year clinical and radiographic variables were analyzed to predict the lower satisfaction. The clinical outcomes, including visual analogue scale, SRS-22, and Shor Form (SF)-36, significantly improved postoperatively, while modified lumbar stiffness disability index (M-LSDI) significantly worsened postoperatively. In bivariate comparisons, the total fusion length was significantly greater in the less satisfied group than in the highly satisfied group (6.9 vs 6.1). Preoperative and 2-year postoperative radiographic parameters were comparable between the groups. The preoperative SF-36 mental component score, 2-year visual analogue scale, 2-year Oswestry disability index, 2-year SRS-22, 2-year SF-36, and 2-year M-LSDI scores were significantly worse in the less satisfied group than in the highly satisfied group. The multivariate regression analysis revealed that the 2-year M-LSDI score was a single independent risk factor for less satisfaction (odds ratio = 1.290, 95% CI = 1.032-1.611, P = .025). A sizable proportion (24.1%) of patients were dissatisfied with the surgical outcomes despite satisfactory radiographic results. Although the patients benefited from surgery for pain and functional improvement, postoperative lumbar stiffness-related functional disabilities adversely affected patient satisfaction. Therefore, before deciding on surgical treatment, patients should be fully informed of this trade-off between pain/disability and lumbar stiffness.

Effect of perioperative intravenous infusion of dexmedetomidine on the quality of early and long-term postoperative recovery in patients undergoing thoracoscopic surgery: a randomized controlled trial.

This study aimed to evaluate the effect of perioperative intravenous infusion of dexmedetomidine on the quality of early and long-term postoperative recovery in patients undergoing thoracoscopic surgery, and to further analyze its potential mechanism. A total of 80 patients were enrolled and randomized to dexmedetomidine group, which received perioperative intravenous infusion of dexmedetomidine and normal saline group, which received equivalent doses of normal saline. The primary outcome was total QoR-15 score on postoperative day 1. Secondary outcomes included total QoR-15 Score on postoperative day 2, day 3, day 7, month 1 and month 3 and the score of dimensions of QoR-15, NRS Score, incidence of moderate to severe pain, physical comfort score, hospital anxiety and depression scale score and adverse reactions on postoperative day 1, day 2, day 3, day 7, month 1 and month 3. The total QoR-15 score of dexmedetomidine group on postoperative day 1 was significantly higher than that of saline group (127.1±7.3 vs. 118.4±9.3, P<0.001), the same as on postoperative day 2, day 3, day 7 and month 1 (all P<0.001). Further analysis of each dimension showed that the enhancement of total QoR-15 score on postoperative day 1, day 2, day 3 in dexmedetomidine group was mainly due to the improvement of pain and physical comfort (all P<0.0.05), which was consistent with NRS score, incidence of moderate to severe pain and physical comfort score (P<0.0.05). The increase of total QoR-15 score on day 7 was mainly due to the combined effect of pain, physical comfort, and emotional dimensions (all P<0.05). The enhancement of total QoR-15 score on postoperative month 1 was mainly due to an improvement in the emotional dimension, which was consistent with hospital anxiety and depression scale score (all P<0.05). In terms of adverse reactions, the incidence of nausea and vomiting on postoperative day 1 and day 2 was significantly reduced in the dexmedetomidine group (48.7% vs. 25.6%, 38.5% vs. 17.9%, both P<0.05), and there was no significance in other aspects (all P<0.05). Perioperative intravenous infusion of dexmedetomidine significantly improved the quality of recovery after thoracoscopic surgery without increasing the occurrence of adverse reactions, and the early enhancement may be mainly through the improvement of pain and physical comfort, the long-term enhancement may be mainly through the improvement of emotional state.

Abdominal Pain Following Total Pancreatectomy with Islet Autotransplantation.

Total pancreatectomy with islet autotransplantation (TPIAT) is increasingly used as an option for treatment of chronic and recurrent acute pancreatitis in selected patients. Studies have shown significant improvements in pain, quality of life, and opioid use postoperatively. However, in long term follow up, over half of patients have episodes of abdominal pain following TPIAT. The aim of this work is to describe the array of causes of abdominal pain in this complex and growing patient population. We conducted multidisciplinary discussions with experts at our institution and reviewed literature where available to identify and describe the diverse causes of abdominal pain following TPIAT. We identify 15 distinct causes of abdominal pain following TPIAT, describing their presentation, workup, and management. As more patients undergo TPIAT, we must plan for and address the associated causes of abdominal pain that result from alterations in anatomy and physiology, both in the short and long term.

Pilot study MOVENDOP protocol - impact on quality of life following postoperative osteopathic abdominal mobilizations in patients operated for endometriosis.

Surgery remains the gold standard for management of endometriosis, offering significant improvement in patient pelvic pain and quality of life (QoL). Postoperative tissue adhesions can however diminish these benefits, limiting the long-term effectiveness of the intervention. Despite the development of strategies and devices to reduce adhesion formation, their efficacy remains inconclusive. This study aims to propose and evaluate a novel approach involving early visceral mobilization and training of patients in abdominal self-mobilization as a means to improve QoL following surgery. This pilot study is a prospective, randomized, phase II superiority trial. Patients undergoing surgery for infiltrating endometriosis will be randomized, with a 2:1 ratio, into two groups. The intervention group (n = 42) will receive six sessions of osteopathic visceral mobilization with training in abdominal self-mobilization techniques, one preoperative, and five postoperative during the first month post-surgery. The control group (n = 21) will receive no osteopathic visceral mobilizations but will be offered an osteopathic session after one year. The primary endpoint is a minimum increase of 20 points (on a 100-point scale) in the Endometriosis Health Profile-30 (EHP-30) global score, at one year. Secondary endpoints include assessment of gastrointestinal quality of life (GIQLI), sexual function (FSFI), urinary symptoms (ICIQ-FLUTS), pain catastrophizing (PCS), as well as scar examination, pelvic pain, abdominal flexibility, use of medical and non-medical care, analgesic and hormonal treatments, pregnancy rate, physical activity, sedentary lifestyle and patient compliance. Statistical analyses will be based on a one-sided α=0.05 and β=0.15, assuming a standard deviation of 25 points in the EHP-30 global score. A total of 42 participants in the intervention group and 21 in the control group are required. This trial aims to demonstrate that early and repeated osteopathic sessions following surgery for endometriosis may significantly improve patient QoL.

Evolution of mobility, pain/discomfort, self-care, and mental health in patients with alpha-mannosidosis: an international caregiver and patient survey

BackgroundAlpha-mannosidosis is a rare recessive lysosomal storage disorder with progressive multi-systemic impacts. In the absence of standardized monitoring protocols, there is insufficient understanding of disease progression over time. This study explored the evolution of the burden of illness and quality of life (QoL) experienced by patients with alpha-mannosidosis via an international patient and caregiver-based survey. The online survey was distributed to adult patients/caregivers of patients ≥ 10 years old. It included visual analogue scales (VAS; timepoints 5 years ago and now), multiple choice, and open text questions. We report a subset of functional and QoL data: walking ability, pain/discomfort, ability to self-care, and mental health.ResultsAnalyses include 51 responses from 18 countries: 26 patients were on velmanase alfa enzyme replacement therapy (ERT), seven had been treated with hematopoietic stem cell transplantation (HSCT) and 18 were untreated patients (UP). Over 5 years, VAS scores showed the least decline in walking ability for HSCT patients (+ 0.1 ± 1.9) compared to patients receiving ERT (+ 0.7 ± 1.2) and UP (+ 1.8 ± 2.0). A trend towards improvement in pain was only observed for those on ERT (-0.2 ± 2.0), both for pediatric and adult patients. Ability to self-care improved for patients treated with HSCT (-1.0 ± 1.8) and slightly improved with ERT (-0.3 ± 1.5) but worsened for UP (+ 0.6 ± 0.9). Similarly, a trend towards improvement in mental health scores was observed for patients on ERT (-0.4 ± 2.2).ConclusionsAlpha-mannosidosis is associated with a substantial and progressive burden in UP, including deterioration in walking ability, pain, self-care and mental health. The survey results suggest that treatment with ERT or HSCT may slow this natural progression of alpha-mannosidosis, with these patients following a different disease trajectory to those solely receiving supportive care. This study could inform the natural pathway of alpha-mannosidosis to recognize patients’ needs, courses of care, and the design of interventional studies.

Safety and Efficacy of Mirogabalin in Lumbar Spinal Stenosis Patients with Peripheral Neuropathic Pain on NSAIDs: Post Hoc Analysis of the MiroTAS Study.

The primary analysis of the MiroTAS study in patients with lumbar spinal stenosis (LSS) taking non-steroidal anti-inflammatory drugs showed that mirogabalin add-on therapy further improved pain and quality of life (QOL) without new safety concerns. This post hoc analysis of the MiroTAS study examined the timing of onset of mirogabalin-related adverse drug reactions (mrADRs) (composite of somnolence, dizziness, edema, and peripheral edema), factors affecting safety and efficacy, and the relationships between baseline numbness severity (by spine painDETECT questionnaire [SPDQ] score), EQ-5D-5L scores, leg pain improvement (by visual analogue scale [VAS]), and patient satisfaction (by Patient Global Impression of Change [PGIC] scores). Among 110 patients, there were no significant differences in the incidence rates of mrADRs by patient characteristics. The mrADRs occurred mainly after the first administration and uptitration period of mirogabalin. EQ-5D-5L scores significantly improved from baseline to week12 in patients with mrADRs vs those without (difference 0.0767; p = 0.0304 by ttest). The proportion of patients with PGIC scores ≤ 3 at week12 was numerically higher in patients with mrADRs vs those without. There were no differences in the percentage of patients with reduced leg pain by VAS score (improvement ≥ 20mm) at week12 by patient characteristics except for spondylolysis/spondylolisthesis as a complication. Baseline SPDQ numbness scores were positively correlated with improvement in EQ-5D-5L at week12 (Spearman's rank correlation coefficient 0.2811, p = 0.0092). Mirogabalin was not related to specific patient characteristics regarding the onset of mrADRs and was effective for LSS regardless of patient characteristics. Caution is needed regarding the onset of mrADRs after first administration and uptitration of mirogabalin, but these may not reduce QOL or patient satisfaction. Patients with high numbness scores may be more likely to benefit from treatment with mirogabalin in terms of QOL. Japan Registry of Clinical Trials (jRCTs021200007).

Impact of honey on post-tonsillectomy pain in children (BEE PAIN FREE Trial): a multicentre, double-blind, randomised controlled trial.

Tonsillectomy, a common childhood surgery, is associated with difficult postoperative recovery. Previous reviews provided low-grade evidence that honey may improve recovery. The BEE PAIN FREE study investigated whether honey alongside multimodal analgesia improved the recovery trajectory in children following tonsillectomy. A prospective randomised controlled trial was conducted across three centres in Western Australia. Children undergoing extracapsular tonsillectomy by coblation were allocated randomly to one of four postoperative treatment groups: standard treatment alone; Marri honey (from Western Australia); Manuka honey (from Western Australia); or placebo. The intervention groups took 5 ml of honey or placebo, six times a day, for at least 7 days, in addition to usual discharge analgesia (standard treatment). Data for daily pain scores, Parents' Postoperative Pain Measure scores, medications and unplanned re-presentations were collected. A total of 400 children were recruited; 20% were lost to follow-up or withdrew. The mean number of honey doses taken varied between 2 and 3 doses per day over 7 days. Treatment with honey at this frequency did not impact postoperative pain scores significantly, with all groups showing similar trajectories. These findings did not alter with as-treated analysis or using imputed models for missing data. Most children experienced significant pain until around postoperative day 8. Children allocated to the honey and placebo groups showed some improved oral tolerance around day 6 but had increased vomiting during earlier days. There were no clinically significant differences in medical re-presentations, simple analgesia or oxycodone usage between groups. Two to three doses daily of oral honey/placebo in children post-extracapsular tonsillectomy for 7 days, in addition to regular paracetamol, ibuprofen and as required oxycodone did not result in a clinical improvement in pain or recovery over a 14-day follow-up period.

Clinicians' Perspectives on Cannabis Use and Cannabis Treatment in Clients Undertaking Opioid Dependence Treatment.

There are no prior studies investigating the perspectives of Opioid Treatment Program (OTP) clinicians on clients' cannabis use. This study examines the perspectives of OTP clinicians on patterns of cannabis use; harms and benefits; current and potential interventions and their confidence in implementing them. Clinicians from six public OTP services in New South Wales completed the survey. Participants included nurses, doctors, pharmacists, allied health and consumer workers. Single-level regression models were used to estimate participants' sex, role and experience effect. A total of 162 participants responded to the survey (estimated response rate 56%). Participants estimated 56.1% (±23.9) of OTP clients had used cannabis in the past month, and 44.9% (±6.5) had cannabis dependence. Clinicians indicated (15.3% ± 17.2%) clients identified problematic cannabis use and (10.7% ± 16.9) sought treatment in the past year. The harms most frequently identified by staff were cannabis dependence (46.5% ± 27.9%), financial issues (37.5% ± 29.2%) and increased tobacco use (33.1% ± 28.2%). The benefits most frequently identified were management of sleep problems (49.7% ± 27.8%), chronic pain symptoms (35.6% ± 24.3%) and improvements in mental health (48.3% ± 25.6%). Sixty-five participants (63.7%) advocated for enhancing efforts to address cannabis use, with none supporting scaling down services. Clinicians prioritised withdrawal services (81%), harm reduction (77.4%), counselling (74%) and medicinal cannabis (59.8%), although the majority had low confidence in delivering most of these interventions. Despite awareness about cannabis use patterns and identification of both harms and benefits, clinicians identified low rates of cannabis interventions and low levels of confidence in delivering interventions.

Effectiveness of Theragun therapy and McKenzie Technique on Pain and Range of Motion in Individuals with Mechanical Low Back Pain.

Abstract Background: Theragun therapy and the McKenzie Technique are popular active treatment approaches for managing mechanical low back pain, combining manual techniques and exercises aimed at symptom reduction and functional improvement. Aim and Objective: To compare the effectiveness of the McKenzie Technique alone versus McKenzie Technique combined with Theragun therapy on pain and range of motion in individuals with mechanical low back pain. Method: Forty-two participants were randomly allocated into two groups (21 each). Group A received McKenzie Technique alone, and Group B received McKenzie Technique combined with Theragun therapy for 15 sessions over 3 weeks. Pain and functional measures were assessed pre- and post-treatment. Results: Both groups demonstrated significant improvements in pain, muscle strength, and lumbar mobility. However, Group B, which received Theragun therapy, showed superior outcomes compared to Group A. Conclusion: A 3-week intervention using the McKenzie Technique combined with Theragun therapy was more effective than the McKenzie Technique alone in reducing pain and improving function in individuals with mechanical low back pain. Keywords: Mechanical Low Back Pain, McKenzie Technique, Theragun Therapy, Range of Motion, Pain Management.

Effectiveness of proprioceptive neuromuscular facilitation pattern on upper extremity and scapula in patients with adhesive capsulitis: a single-centre assessor-blinded randomised controlled trial (RCT)

BackgroundAdhesive capsulitis (AC) is a progressive inflammatory condition of the shoulder that causes functional limitations and leads to long-term disability. The study aimed to elicit the effectiveness of proprioceptive neuromuscular facilitation (PNF) compared to standard physiotherapy approaches on AC.MethodsAn assessor-blinded single-centre randomised control trial (RCT) was carried out on 80 AC patients between May 2022 and December 2023 in Bangladesh. Random assigned and concealed allocated patients were recruited equally (n = 40) to each PNF and conventional capsular stretching group. The experimental group received a PNF approach, and the control group received capsular stretching to the affected shoulder for 24 sessions in 6 weeks. Both groups received electrical modalities as standard treatment. The primary outcome was pain measured by the numeric pain rating scale (NPRS) and range of motion in a universal goniometer. The secondary outcome was functional limitation measured by the shoulder pain and disability index (SPADI). As per the distribution of data, non-parametric tests were employed to analyse the superiority between and within groups with intention-to-treat analysis.ResultsBaseline compatibility was noted in all the key variables (p > 0.05). Both PNF and capsular stretching had a decrease in pain compared to baseline in all capsular pattern positions (p < 0.001), and PNF had more significant improvement compared to control (p < 0.001). Both groups had equal improvement in shoulder ROM (p < 0.001) except abduction (p < 0.05). Both groups had improvements in disability (p < 0.05), and PNF had statistical superiority of improvement (p < 0.001).ConclusionsThe findings of this study support the potential of PNF intervention for 6 weeks as a treatment for shoulder adhesive capsulitis, showing improvements in pain, ROM and functional disability. However, further multicentre trials with a follow-up design are needed to fully understand the superiority of PNF on shoulder AC, encouraging continued engagement in this area of research.Trial registrationThe Australian New Zealand Clinical Trial Registry (ACTRN12621001299897). Registered on 27 September 2021, prospectively registered.

The Effectiveness of closed kinetic chain exercises in individuals with knee osteoarthritis: A systematic review and meta-analysis.

The aims of this review was to investigate the effectiveness of closed kinetic chain exercise (CKCE) on pain, function, and proprioception in individuals with knee osteoarthritis (OA). Nine databases were searched up to December 2023. Randomized controlled trials (RCTs) examining the effects of CKCE in individuals with knee OA were included. The methodological quality was assessed using the PEDro scale, and the level of evidence was evaluated with the GRADE system. A random-effects meta-analysis was conducted to assess differences between treatment groups for the primary outcomes (pain and function). Effect sizes were calculated using standardized mean differences (SMDs) with 95% confidence intervals (CIs). A total of 24 studies were included in the descriptive analysis, and 18 studies were included in the quantitative analysis (meta-analysis). The meta-analysis results indicated that CKCE treatment led to greater improvements in pain (SMD = -0.76; 95% CI: -1.51, -0.01) and function (SMD = -1.25; 95% CI: -1.88, -0.62) compared to no treatment. A subgroup meta-analysis showed that the combined treatment of CKCE and conventional physical therapy (CPT) resulted in greater improvements in pain (SMD = -1.18; 95% CI: -1.70, -0.67) and function (SMD = -1.27; 95% CI: -1.79, -0.75) compared to CPT alone. The risk of bias assessment revealed that two studies were of low quality, nine were of fair quality, and the remaining 13 were of high quality. The GRADE system indicated a low quality of evidence for the effects of CKCE on both pain and function. While CKCE shows promise in reducing pain and improving function in individuals with knee OA, the quality of evidence is considered low according to the GRADE system. Further high-quality RCTs with larger sample sizes are needed to confirm the effectiveness of CKCE in managing knee OA.

Impact of surgery and radiation on radicular pain and myotomic weakness in patients with metastatic spine disease.

Surgery is typically indicated for mechanical pain in metastatic spine disease or severe neurological compromise, but how radicular pain responds to oncological treatment is not well described. The primary aim of this study was to describe how radicular pain responds to oncological treatment, while secondary aims included pain outcomes between patients with mechanical and tumoral pain and motor improvement in patients with weakness due to nerve root compression. Patients treated with surgery and/or radiotherapy for spinal metastases were identified from an international multicenter prospective cohort. The primary outcome was the numeric rating scale (NRS) score for pain at 3 months posttreatment. Motor recovery from radicular compression in patients with myotomic weakness and low-grade epidural compression was also analyzed. Of 284 patients, 129 (45%) had radicular pain ± axial pain and 155 (55%) had axial pain alone. The two groups did not significantly differ in age, comorbidities, tumor characteristics, or treatment. Two hundred two patients (71%) underwent surgery ± radiotherapy, whereas 82 (29%) had radiotherapy alone. The NRS score of patients with radicular pain improved from 6.7 to 3.4 at 3 months, a statistically significantly higher magnitude than in patients with isolated axial pain (p = 0.021). The NRS score at 3 months was similar for both groups (p = 0.876). Patients with radicular pain experienced a larger improvement with surgery compared with radiotherapy alone (p = 0.007) but had higher pretreatment pain (mean NRS score 7.0 vs 5.6, p = 0.013). Twenty-three patients identified with radicular/myotomic weakness (mean American Spinal Injury Association score 96.3 ± 3.2) at baseline improved 2.1 ± 3.8 points at 3 months. The magnitude of pain improvement for patients with radicular pain following surgery and radiotherapy for metastatic spine disease is higher than for patients with axial pain alone. Surgery is associated with a larger improvement in radicular pain than radiotherapy alone. These results will allow clinicians to tailor treatment options for patients with metastatic spine disease.

Surgical management of schwannomas in schwannomatosis: a comprehensive analysis of clinical outcomes and determinants of local recurrence

OBJECTIVE Schwannomatosis is a rare genetic predisposition to develop multiple nonintradermal schwannomas affecting the spine and peripheral nerves, excluding vestibular schwannomas. Schwannomatosis-associated schwannomas can present with pain or motor deficits, prompting resection. In this study, the authors reported the clinical characteristics, surgical interventions, and postoperative outcomes of patients with schwannomatosis-related schwannomas treated with resection. METHODS This was a retrospective cohort study of adult patients with schwannomatosis who had undergone resection of a symptomatic peripheral or spinal schwannoma at the authors’ institution from September 2003 to June 2023. Data were extracted from electronic health records and provider notes. RESULTS A cohort of 85 patients (57.6% women) had a mean follow-up of 68.4 ± 58.2 months after surgery. The mean age at the time of surgery was 44.6 ± 16.5 years. Pain was the most common presenting symptom (94.1%), followed by motor weakness (36.4%) and sensory deficits (32.9%). Just under two-thirds of the patients (64.7%) had undergone prior surgery for schwannoma, 20 (36.4%) of whom had a prior resection in the same exact location. Gross-total resection (GTR) was achieved in 88.2% of cases and en bloc resection in 69.4%. There were significant improvements in pain, motor weakness, and sensory deficits at the last postoperative follow-up visit. There was local tumor recurrence in 14 patients (16.5%), and the overall mortality rate was 4.7%. Univariate and multivariate analyses identified GTR as the strongest predictor of a decreased risk of local recurrence (HR 0.09, 95% CI 0.02−0.48, p = 0.005). CONCLUSIONS Patients with schwannomatosis commonly presented with neurological symptoms of pain, sensory deficits, or motor weakness associated with their schwannomas. Resection significantly improved their preoperative symptoms, and GTR was associated with a decreased risk of local recurrence.

Treatment of headache reduces blood pressure among most patients with migraine and elevated blood pressure.

Treatment of headache reduces blood pressure among most patients with migraine and elevated blood pressure.

Acupressure alleviates pain and clinical symptoms in patients with sickle cell disease.

Sickle Cell Disease (SCD) is a genetic hematological disorder characterized by chronic pain, recurrent vaso-occlusive crises featuring extremely painful episodes, and other co-morbidities. Management of pain in SCD relies on persistent and/or high doses of opioids as the mainstay, which is known to be associated with significant risks of side effects, tolerance, opioid-induced hyperalgesia, and/or lower quality of life (QoL). Moreover, many SCD individuals self-manage their pain at home, which further increases the potential risks of abuse and side effects of medications. Preliminary results from our ongoing RCT demonstrate the feasibility and efficacy of self-administered acupressure as a new telehealth approach in SCD for managing pain and co-morbidities ( ClinicalTrials.gov Identifier: NCT06511453 ). Twenty-three participants with SCD receiving self-administered acupressure every other day for five weeks plus usual care showed progressive (weekly observation during the treatment period) and sustained (monthly observation up to 6 months following the last treatment) improvements in pain, co-morbidities (e.g., physical dysfunction, fatigue, sleep disturbance, and emotional distress) and QoL as compared to the 14 participants with SCD receiving usual care alone. No significant improvements were observed throughout the observational period in individuals with usual care only. No side effects were reported from the participants receiving self-administered acupressure. These results highlight acupressure's potential as a safe and effective telehealth approach for managing pain in SCD. A larger sample size from continuous enrollment is needed to validate these findings.

Physical well-being and burden of care in adults on modulator therapy: A mixed methods study of patient-reported experiences from the Well-ME survey.

Physical well-being and burden of care in adults on modulator therapy: A mixed methods study of patient-reported experiences from the Well-ME survey.

Safety and efficacy of platelet-rich plasma injections in basal thumb osteoarthritis; should we offer it or not?

Safety and efficacy of platelet-rich plasma injections in basal thumb osteoarthritis; should we offer it or not?

Single-fraction versus multifraction stereotactic radiosurgery for spinal metastases: systematic review and meta-analysis.

Stereotactic radiosurgery (SRS) plays an important role in the treatment of spinal metastases by delivering precise, high-dose radiation to the target region while sparing critical structures. Although various dosing and fractionation schemes have been reported, the optimal regimen remains a topic of debate. The aim of this study was to compare single- versus multifraction SRS (≤ 5 fractions) in the treatment of spinal metastases regarding oncological outcome, pain improvement, and complications, with special concern about vertebral compression fracture (VCF). A systematic review was conducted using the PubMed, Scopus, and Embase databases in October 2024 in accordance with PRISMA guidelines. The random-effects model was used for statistical analysis and quality appraisal was assessed using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool. A total of 26 studies comprising 4125 patients and 5408 lesions were included in this study. Single-fraction treatment demonstrated superior local control (HR 0.58, p = 0.023), particularly at doses exceeding 20 Gy (HR 0.28, p < 0.0001). However, overall survival did not differ significantly between the two groups (HR 0.78, p = 0.761). Pain relief was comparable between the groups (OR 0.94, p = 0.63). Although the VCF rate was higher in the single-fraction group (OR 1.32, p = 0.32), the difference was not statistically significant, even at doses greater than 20 Gy. Additionally, no significant differences were observed in overall complication rates (OR 1.98, p = 0.12). This study highlights the superiority of high-dose single-fraction regimen in controlling spinal metastatic tumors compared with multifraction lower doses, with comparable overall survival, complication rates, and VCF incidence. However, prospective randomized studies are necessary to better determine the optimal regimen for different patient populations.