Female Pain Patients Research Articles

Electromagnetic stimulation to reduce the hypertonia of the pelvic floor muscles and improve chronic pelvic pain in women.

The increased hypertonicity or activity of pelvic floor muscles can lead to chronic pelvic pain (CPP). It represents an aspecific and persistent pain with no apparent clinical reason, affecting an estimated 6% to 16% of women worldwide. This study aimed to evaluate with validated questionnaires the efficacy and the safeness of a new device that uses Top flat Magnetic Stimulation for the management of muscular hypertonia in women with CCP. All patients underwent 8 treatments with a non-invasive electromagnetic therapeutic device. The device produces a TOP Flat Magnetic Stimulation with a uniform profile so, the muscle work aims to reduce pain while also inhibiting muscle activity. The PISQ-12 questionnaire was used for the evaluation of improvements. Side effects were monitored. The PISQ-12 total mean score decreases from 29,2 (±3.3) to 17 (±2). Regarding the behavioural-emotive items (1-4), a decrease from 12 (±2) to 7 (±0.9) was visible. Physical items (5-9) decrease from 10,6 (±1.8) to 6 (±1.4) and the Partner Related items (10-12) from 6,6 (±1.6) to 3,9 (±0.4). Conclusions: The device we used in this research demonstrated to be a valid solution for the treatment of chronic pelvic pain in female patients.

Virtual reality exposure reduce acute postoperative pain in female patients undergoing laparoscopic gynecology surgery: A Randomized Control Trial (RCT) study

Study objectiveFew studies have focused on the effect of virtual reality (VR) exposure on postoperative acute pain in adult female patients undergoing gynecology surgery. DesignA randomized control trial (RCT) study. SettingAt Beijing Fuxing Hospital. Patients115 patients aged between 20 and 60 years, American Society of Anesthesiologists (ASA) physical status I - II were consecutively enrolled and randomly divided into VR group (n = 58) or control group (n = 57). InterventionsPatients in the VR group received 15 min of VR video viewing before surgery. MeasurementsThe primary outcome was acute postoperative pain at 8 h which was measured by the Visual Analogue Scale (VAS) scores. The secondary outcomes including the use of analgesic drugs, the incidence of moderate pain and postoperative recovery which were recorded 24 h after surgery. The Hospital Anxiety and Depression Scale (HADS) was also used to evaluate patients' emotional status before surgery. Main resultsThe VAS scores at 30 min [2 (1,2) vs. 3 (2,3)], 2 h [2 (2,3) vs. 4 (3,4)], 4 h [3 (2,4) vs. 4 (4,5)], 8 h [3 (2,4) vs. 4 (4,5)], 12 h [2 (2,3) vs. 4 (3,4)], 24 h [1 (1,2) vs. 3 (2,3)] after surgery. Generalized estimation equation (GEE) indicated that VR intervention was negatively correlated with postoperative VAS values (β = −0.830, S.E = 0.199, 95%CI (−1.220,-0.439), Wald χ2 = 17.359, p<0.05), in the meanwhile, VR also lower the incidence of moderate pain (VAS > 4) at 8 h postoperatively (12.1% vs 31.0%, p = 0.013). However, the 24 h tramadol usage remained unchanged. Patients in the VR group had better sleep quality (6.33 ± 2.3 vs. 4.12 ± 2.5, p < 0.001) and lower incidence of nausea (43.1% vs. 63.2%, p < 0.05), dizziness (0% vs. 14.0%, p < 0.05), and headache (12.1% vs. 29.8%, p < 0.05). VR could reduce the median HADS scores (9.81 ± 6.1 vs 3.14 ± 3.9, p < 0.001) and blood pressure preoperatively. ConclusionsVR intervention can reduce acute postoperative pain with better postoperative recovery and lower preoperative anxiety level in adult female patients undergoing laparoscopic gynecology surgery.

Kinesio Taping as an alternative therapy for limited mandibular mobility with pain in female patients with temporomandibular disorders: A randomized controlled trial.

Kinesio Taping (KT) is a non-invasive therapy commonly used in physiotherapy (PT). However, the available data on its effectiveness in patients with symptomatic temporomandibular disorders (TMD) remains scarce and contradictory. The aim of the study was to evaluate the analgesic and myorelaxant effects of KT in TMD patients with limited mandibular mobility. A single-blind randomized controlled trial was conducted among female patients aged 20-45 years with Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) group Ib, using a parallel group design and equal randomization (1:1). All patients underwent surface electromyography (sEMG) of the masseter muscle (MAS), pain intensity was assessed using a Numeric Rating Scale (NRS), and temporomandibular joint mobility was measured before and after 6 and 12 days of treatment. The Perceived Stress Scale (PSS-10) questionnaire was administered on the first and last days of treatment. Statistical analysis was performed using analysis of variance (ANOVA). Mauchly's sphericity test determined changes over time and between groups for variables with a normal distribution. Bonferroni's correction was used for post hoc multiple comparisons. Variables with a non-normal distribution were analyzed using the nparLD package and multiple comparison post hoc test, while correlations were assessed using Spearman's coefficient. Each treatment had a significant effect on the bioelectrical sEMG parameters (p = 0.05). Kinesio Taping had a superior analgesic effect compared to the controls (p < 0.001). The combination of KT with therapeutic exercise (TE) proved to be a more effective therapy for improving the maximal mouth opening (MMO) and reducing perceived stress than monotherapy (p < 0.001). Minimally significant clinical differences were observed for sEMG, MMO and PSS-10 parameters after both therapies. Kinesio Taping combined with TE may be considered an effective complementary noninvasive treatment modality for TMD, either as a stand-alone or as part of the therapeutic process in patients experiencing pain and limited mandibular ROM. Additionally, the use of KT and TE was found to have a beneficial effect on perceived stress levels.

The Effectiveness of Islamic Spiritual Therapy on the Perception of Pain Intensity and Catastrophic Pain in Female Patients with Chronic Pain

Background Chronic pain is an important medical problem that is associated with significant negative effects in many aspects of life. Based on prior studies, certain religious behaviors and having religion-based beliefs help coping with chronic diseases. this research aimed to investigate the effectiveness of Islamic spiritual therapy on the perception of pain intensity and catastrophizing of pain in patients with pain. Methods The research population included all female patients suffering from chronic pain who referred to physiotherapy and pain clinics in Shiraz in 2022; finally, 30 female patients were selected from 3 clinics using available sampling method. After meeting the inclusion criteria, they entered into the treatment process. In the pretest stage, research questionnaires including Pain catastrophizing questionnaire (pcs) (1995) and Pain Intensity Perception Questionnaire were completed and randomly assigned. The participants underwent 10 sessions of Islamic spirituality therapy, each lasted 45 min; during this time, the control group did not receive any intervention. After the end of the treatment program, the questionnaires were administered again to both groups in the form of a post-test. The data were analyzed using multivariate analysis of covariance (MANCOVA) in SPSS version 22. Result the average values of pain intensity and pain catastrophizing exhibited a reduction in the post-assessment in contrast to the pre-assessment. This disparity demonstrated statistical significance within the experimental cohort, whereas the difference between the mean values of the pre- and post-assessment in the control group were not statistically significant. It affirmed the efficacy of the intervention on the experimental group. Conclusions Based on the findings of this study, Islamic spiritual therapy approaches decrease pain intensity and pain catastrophizing in women with chronic pain and represents new horizons in clinical interventions and thus could be used as an effective interventional method to reduce psychosocial problem and increase pain tolerance.

The effect of physical therapy rehabilitation on fatigue and pain in female patients with fibromyalgia

This study aimed to examine the impact of physical therapy rehabilitation program on fatigue, pain and quality of life in female patients with fibromyalgia. It was designed as a single-blinded, randomized, pre and post-test controlled trial. Eighty female patients, aged 25 to 45, diagnosed with fibromyalgia were selected from the Kasr Al Ainy rheumatology outpatient clinic. The participants were allocated into two equal groups using a randomization procedure. Group (A) (control group, n=40) received transcutaneous electric nerve stimulation (TENS), moist heat, core muscle retraining, and manual therapy for trigger points, 3 times/week, for 4 weeks. Group (B) (study group, n=40) received the same treatments as Group A, plus aerobic exercises, flexibility exercises, and cognitive behavioural therapy (CBT), 3 times/week, for 4 weeks. Both groups were assessed before and after treatment using the Fatigue Severity Scale (FSS) and the Fibromyalgia Impact Questionnaire (FIQ). Statistically significant improvements were observed in FSS and FIQ scores for both groups post-treatment (p&lt;0.05). When the two groups were compared after therapy, the study group (B) showed significantly greater improvement in FSS and FIQ (p&lt;0.05). These findings suggest that physical therapy rehabilitation can effectively reduce fatigue, pain, and improve the quality of life for women with fibromyalgia.

The role of peroxisome proliferator-activated receptors in endometriosis.

Endometriosis constitutes the most common cause of chronic pelvic pain in female patients and is associated with infertility. Although there is no known cause for the disease, it is a heritable condition that is determined by numerous genetic, epigenetic, and environmental aspects. Peroxisome proliferator-activated receptors (PPARs) represent nuclear receptor proteins that control gene expression. By using the MEDLINE and LIVIVO databases we conducted a literature review in order to look into the role of PPARs in the endometriosis pathophysiology and succeeded in revealing 36 pertinent publications between 2001 and 2022. In regards to PPAR expression in endometriosis, PPARγ seems to represent the most studied PPAR isoform in endometriosis and to influence various pathways involved in the disease onset and progression. It's interesting to note that diverse treatment agents targeting the PPAR system have been identified as innovative, effective therapeutic alternatives in the context of endometriosis treatment. In conclusion, PPARs appear to contribute an important role in both endometriosis pathophysiology and therapy.

Effect of a low-carbohydrate diet on pain and quality of life in female patients with lipedema: a randomized controlled trial.

The primary objective of this study was to evaluate the effect of a low-carbohydrate diet (LCD) compared with a control diet on pain in female patients with lipedema. The secondary objectives were to compare the impact of the two diets on quality of life (QoL) and investigate potential associations of changes in pain with changes in body weight, body composition, and ketosis. Adult female patients with lipedema and obesity were randomized to either the LCD or control diet (energy prescription: 1200 kcal/day) for 8 weeks. Body weight and body composition, pain (Brief Pain Inventory measured pain), and QoL (RAND 36-Item Health Survey [RAND-36], Impact of Weight on Quality of Life [IWQOL]-Lite, and Lymphoedema Quality of Life [LYMQOL]) were measured at baseline and at postintervention. A total of 70 female patients (age, mean [SD], 47 [11] years; BMI 37 [5] kg/m2) were included. The LCD group had greater weight loss (-2.8 kg; 95% CI: -4.1 to -1.0; p < 0.001) and larger reduction in pain now (-1.1; 95% CI: -1.9 to -0.3; p = 0.009) compared with the control group. No association was found between changes in pain now and weight loss. Both groups experienced improvements in several QoL dimensions. Diet-induced weight loss in women with lipedema can improve QoL. An energy-restricted LCD seems to be superior to a standard control diet in reducing pain.

Association Between Eye Color and Postoperative Pain in Female Patients With Symptomatic Irreversible Pulpitis in Mandibular Molars: A Prospective, Parallel-Group, Observational Study.

Background: Current evidence indicates that some phenotypic characteristics, such as eye or hair color, might be associated with the experience of pain. We, therefore, compared the anesthetic success rate of inferior alveolar nerve block (IANB) and postoperative pain scores between light eyes and dark eyes in female patients who experienced symptomatic irreversible pulpitis (SIP) in a mandibular molar. Methods: This prospective, parallel-group, observational study was registered with ClinicalTrials.gov (NCT06206304). A total of 110 adult female patients who experienced moderate or severe pain with SIP participated in this study. All patients received IANB with 4% articaine with 1:100.000 epinephrine. Endodontic access cavity preparation was initiated after confirmation of IANB. Pain during treatment was recorded by using a Visual Analog Scale. Anesthetic success was recorded as "none" or "mild" pain. Root canal treatment was performed, with standardized protocols. Postoperative pain scores were also recorded at 24, 48, and 72 h and 7 days after treatment. Statistical analyses of the data were performed using the independent t-test, repeated measures ANOVA test, and Pearson's chi-square test. The statistical significance level was set at 0.05. Results: No significant differences were found in the success rate of IANB and postoperative pain scores between light- and dark-eyed patients at any time point (p > 0.05). The success rate of IANB was 72.73% and 67.27% for light- and dark-eyed patients, respectively. Conclusion: Pain scores decreased significantly after RCT in both groups on all days (p < 0.05). No significant differences were found in the success rate of IANB and postop pain scores between light- and dark-eyed female patients who experienced SIP in a mandibular molar. Trial Registration: ClinicalTrials.gov identifier: NCT06206304.

Analysis of clinical and psychological characteristics in 250 patients with fibromyalgia

To analyze the clinical and psychological characteristics of fibromyalgia (FM), so as to further understand and improve the capability of identifying FM. The clinical data of 250 FM patients diagnosed in the outpatient clinic of the Department of Rheumatology, the First Medical Center, Chinese PLA General Hospital, from December 2019 to September 2021, were collected and analyzed. The patients aged 40 (31.0, 52.3) years, including 188 female patients (75.2%) and 62 male patients (24.8%). There was a statistically significant difference in age comparison between female [42.5 (33.0,54.0) years] and male patients [32.5 (27.8,43.5) years] (P<0.001). The score of pain degree was 6 (4, 8), and [7 (5, 8)] of female patients was higher than [6 (4, 7)] of the male patients (P=0.040). The widespread pain index (WPI) was 13 (10,15). The regions with high pain incidence were left shoulder girdle (87.2%, 218/250), right shoulder girdle (86.8%, 217/250), upper back (86.4%, 216/250), neck (79.6%, 199/250) and lower back (77.6%, 194/250) and etc. The incidence of chest pain in female patients (55.3%, 104/188) was lower than that in male patients (75.8%, 47/62) (P=0.004). The symptom severity scale (SSS) score was 8 (7-10). 74.6% (185/248) suffered from anxiety and 77.5% (193/249) suffered from depression in 249 patients. Female patients were more common in FM patients than male patients, the median age of female patients was older than that of male patients, and the median score of pain severity of female patients was higher than male patients. Shoulders girdle, upper back, neck and lower back were the most frequently reported pain regions, and the incidence of chest pain in female patients was lower than that in male patients. The incidence of major non-painful symptoms was high and the proportion with anxiety or depression was high. The above clinical features are very helpful for early diagnosis of FM.

Comparison of Visual Analog Scale (VAS) between Pulsed and Thermal Radiofrequency Ablation of Ganglion Impar in Patients of Chronic Pelvic Pain

The present study was done to compare theVisual Analog Scale (VAS) score between Thermal and Pulsed radiofrequency ablation in Ganglion Impar block for treatment of chronic pelvic pain in female patients. Material and Methods: The present study was prospective, randomized, single blinded study and was based on series of 30 patients presenting with chronic pelvic pain, having already failed conservative medical management, presenting in Pain clinic if IGMC Shimla. The patients were divided into 2 groups of 15 patients. Patients in Group A(n=15) were given thermal radiofrequency ablation where as patients in Group B were given pulsed radiofrequency ablation.Results: Mean Pre-procedural VAS score of the patients in Group A was 7.93 ± 0.704 where as mean Pre-procedure VAS score in patients of group B was 8.00 ± 0.655.( P =0.790).Mean 24 Hours Post Procedural VAS Score of the patients in Group A was 2.53 ± 0.516 where as mean 24 Hours Post Procedural VAS Score in patients of group B was 3.53 ± 0.640.( P= 0.000). Mean 1 week Post Procedural VAS Score of the patients in Group A was 2.60 ± 0.507 where as mean 1 week Post Procedural VAS Score in patients of group B was 3.40 ± 0.507. (P= 0.000) Mean 2 week Post Procedural VAS Score of the patients in Group A was 2.33 ± 0.507 where as mean 2 week Post Procedural VAS Score in patients of group B was 3.31 ± 0.564. (P=0.000) .Mean 3 week Post Procedural VAS Score of the patients in Group A was 2.31 ± 0.415 where as mean 3 week Post Procedural VAS Score in patients of group B was 3.29 ± 0.516.( P =0.000). Conclusion: Present study showed that mean Post Procedural VAS Score(24 Hours, 1,2 and 3 week) was significantly lower in group A as compared to group B. we can conclude that thermal radiofrequency ablation of ganglion impar for chronic pelvic pain produces prolonged pain free period in the patients as compared to patients who were treated with pulsed radio frequency ablation.

Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial.

Chronic low back pain that lasts more than 12 weeks causes mental and physical distress. This study investigated the effects of pain neuroscience education combined with lumbar stabilization exercises on strength, pain, flexibility, and activity disorder index in female patients with chronic low back pain. Thirty-five female patients with chronic low back pain were randomly divided into two groups: the pain neuroscience education (PNE) combined with lumbar stabilization exercises (LSEs) group (n = 18, experimental group) and the lumbar stabilization exercises alone group (n = 17, control group). The experimental group underwent PNE combined with LSEs for 30 min per session, twice per week for 8 weeks, and the control group underwent LSEs only. The primary outcomes were strength (sit-up and back-up movements), Numerical Pain Rating Scale (NPRS), Korean Pain Catastrophizing Scale (K-PCS), and Tampa Scale of Kinesio-phobia-11 (TSK-11) for pain. The secondary outcomes were modified–modified Schober’s test (MMST) and finger to floor test (FFT) for flexibility and activity disorder (Roland–Morris Disability Questionnaire index). A significant difference was observed in the primary outcomes after intervention in the abdominal muscle strength (group difference, mean, −7.50; 95% CI, −9.111 to –5.889, F = 9.598; ANCOVA p = 0.005), the back muscle strength (group difference, mean, −9.722; 95% CI, −10.877 to –8.568, F = 7.102; ANCOVA p = 0.014), the NPRS (group difference, mean, 1.89; 95% CI,1.65 to 2.12, F = 24.286; ANCOVA p < 0.001), K-PCS (group difference, mean, 7.89; 95% CI, 7.02 to 8.76, F = 11.558; ANCOVA p = 0.003), and TSK-11 (group difference, mean, 16.79; 95% CI, 13.99 to 19.59, F = 13.179; ANCOVA p = 0.014) for pain. In the secondary outcomes, there was a significant difference in the FFT (group difference, mean, −0.66; 95%CI, −0.99 to −0.33, F = 4.327; ANCOVA p = 0.049), whereas the difference in flexibility (MMST) and activity disorder index of the secondary outcomes did not reach significance. Therefore, this study confirmed that PNE combined with LSEs is an effective intervention compared to LSE alone in improving muscle strength and pain in female patients with chronic low back pain.

Modulation effect of acupuncture treatment on chronic neck and shoulder pain in female patients: Evidence from periaqueductal gray-based functional connectivity.

AimsChronic neck and shoulder pain (CNSP) is a common neurological disorder, which females are more likely to suffer from. The periaqueductal gray (PAG) plays a key role in the descending modulation of pain. This study aimed to investigate altered PAG‐based functional connectivity (FC) in female patients with CNSP related to healthy controls (HCs) and the effect of acupuncture for female patients with CNSP using PAG‐based FC biomarkers.MethodsPAG‐based FC value was calculated based on resting‐state functional images and then compared between patients with CNSP at pre‐acupuncture, post‐acupuncture, and HCs. Then, correlational analyses were performed to examine the relationships between increased PAG‐based FC strength and improved clinical parameters in patients after acupuncture treatment.ResultsBefore acupuncture treatment, compared to HCs, patients with CSNP showed altered PAG‐based FC with widely distributed brain regions, including the left medial superior frontal gyrus, bilateral posterior insula (pIns), and cingulate gyrus. After treatment, patients with CNSP exhibited specially improved PAG‐pIns FC compared to that before treatment, and no significant difference was observed in the increased PAG‐pIns FC strength between HCs and patients with CNSP after treatment. Furthermore, pain catastrophizing reduction was significantly correlated with the increased PAG‐pIns FC strength in patients after treatment.ConclusionThe effect of acupuncture treatment may relate to the increased PAG‐pIns FC, which significantly correlated with pain catastrophizing reduction after treatment. These findings shed important mechanistic information on the role of therapeutic approaches in treating chronic neck and shoulder pain.

Efficacy of a small-caliber colonoscope for pain in female patients during unsedated colonoscopy: a randomized controlled study.

Background and study aims Female sex has been identified as a factor increasing patients’ pain during colonoscopy. The aim of this randomized controlled study was to investigate the efficacy of a small-caliber colonoscope, PCF-PQ260 L, for limiting pain in women during unsedated colonoscopy. Patients and methods Women who underwent unsedated colonoscopy were randomly allocated to either the small-caliber or standard colonoscope group. The primary outcome was overall pain and secondary outcomes were maximum pain and procedural measures. In addition, the effects of colonoscope type were analysed using analysis of covariance and logistic regression with adjustment for stratification factors, age and prior abdomino-pelvic surgery. Results A total of 220 women were randomly assigned to the small-caliber (n = 110) or standard (n = 110) colonoscope groups. Overall and maximum pain scores were significantly lower in the small-caliber colonoscope group than the standard colonoscope group (overall pain, 20.0 vs. 32.4, P < 0.0001; maximum pain, 28.9 vs. 47.2, P < 0.0001). The small-caliber colonoscope group achieved a superior cecal intubation rate (99 % vs. 93 %, P = 0.035). The rate of patient acceptance of unsedated colonoscopy in the future was higher in the small-caliber colonoscope group than in the standard colonoscope group (98 % vs. 87 %, P = 0.003). In addition, the small-caliber colonoscope was superior with respect to reducing pain and improving the rate of patient acceptance of unsedated colonoscopy with adjustment. Conclusions This study demonstrates the efficacy of the small-caliber colonoscope for reducing pain in women and improving their rate of acceptance of unsedated colonoscopy.

Efficacy of Laser Therapy in Reducing Swelling and Pain Following Alveolar Bone Grafting: A Randomized Controlled Trial

This randomized controlled trial aimed to explore the efficacy of laser therapy in reducing swelling and pain in female patients after alveolar bone grafting in the hope of providing a new method for the treatment of patients with swelling after alveolar bone grafting. From August 2019 to June 2020, 82 female patients with soft tissue swelling after alveolar bone grafting in our hospital were enrolled in this prospective blinded randomized controlled trial. The patients were randomized divided into the study group (receiving laser therapy) and the control group (receiving routine postoperative intervention). Swelling and pain were evaluated at postoperative day (POD) 1, 3, and 5, and the quality-of-life at POD 1 and 5. The healing success rate and postoperative satisfaction were evaluated at 3 months postoperatively. The pain severity in the study group was lower than that in the control group at POD 3 and 5 (P<.05). The study group had significantly higher scores of general health, vitality, bodily pain, social functioning, physical functioning, role-physical, role-emotional, and mental health than the control group at POD 5 (P<.05). In addition, the scores of general health, vitality, bodily pain, social functioning, physical functioning, role-physical, role-emotional, and mental health of the 2 groups were higher at POD 5 versus POD 1 (P<.05). The study group had a significantly higher healing success rate and postoperative satisfaction rate than the control group at 3 months postoperatively (P<.05). Laser therapy can effectively reduce swelling and pain and improve the quality-of-life of female patients after alveolar bone grafting.

Gender Biases in Estimation of Others’ Pain

Caregiving and other interpersonal interactions often require accurate perception of others’ pain from nonverbal cues, but perceivers may be subject to systematic biases based on gender, race, and other contextual factors. Such biases could contribute to systematic under-recognition and undertreatment of pain. In 2 experiments, we studied the impact of perceived patient sex on lay perceivers’ pain estimates and treatment recommendations. In Experiment 1 (N = 50), perceivers viewed facial video clips of female and male patients in chronic shoulder pain and estimated patients’ pain intensity. Multi-level linear modeling revealed that perceivers under-estimated female patients’ pain compared with male patients, after controlling for patients’ self-reported pain and pain facial expressiveness. Experiment 2 (N = 200) replicated these findings, and additionally found that 1) perceivers’ pain-related gender stereotypes, specifically beliefs about typical women's vs. men's willingness to express pain, predicted pain estimation biases; and 2) perceivers judged female patients as relatively more likely to benefit from psychotherapy, whereas male patients were judged to benefit more from pain medicine. In both experiments, the gender bias effect size was on average 2.45 points on a 0–100 pain scale. Gender biases in pain estimation may be an obstacle to effective pain care, and experimental approaches to characterizing biases, such as the one we tested here, could inform the development of interventions to reduce such biases.Perspective: This study identifies a bias towards underestimation of pain in female patients, which is related to gender stereotypes. The findings suggest caregivers’ or even clinicians’ pain stereotypes are a potential target for intervention.

Assessment of small fiber neuropathy in patients carrying the non-classical Fabry variant p.D313Y.

The pathophysiological significance of the Fabry-related, non-classical variant p.D313Y still remains to be solved. This study assesses the involvement of the peripheral nervous system with respect to small fiber neuropathy and neuropathic pain in female patients carrying p.D313Y. This study examined nine females carrying the Fabry-related p.D313Y variant by obtaining skin punch biopsies above the right lateral malleolus. Intraepidermal nerve fiber density was determined for each patient and compared to reference values matched for the patient's decade of life and sex. Moreover, each patient was characterized by a detailed neurological examination and by pain assessment via questionnaire. Compared to sex-matched lower fifth percentile reference values per decade, intraepidermal nerve fiber density was decreased in seven out of nine patients. Four patients reported acral paresthesias and neuropathic pain with an average visual analogue scale score of 7 out of 10 points. Two patients experienced acute pain crises. Six out of seven patients diagnosed with small fiber neuropathy had a their medical history of hypo- and/or hyperhidrosis. The diagnosis of small fiber neuropathy was made in seven out of nine females carrying the non-classical variant p.D313Y. Moreover, neuropathic pain and symptoms indicative of autonomic nervous system dysfunction seem to be common findings that may be of clinical significance and may warrant therapeutic intervention.

A randomized clinical trial on the effect of a lidocaine patch on shoulder pain relief in laparoscopic cholecystectomy

The incidence of laparoscopy-related shoulder pain reaches 90% in women. We evaluated the effect of lidocaine patch 5% on the shoulder pain after laparoscopic cholecystectomy (LC) in female patients. Total 63 female patients were randomly allocated to patch group (n = 31) and control group (n = 32). Patch group received lidocaine patch 5% and dressing retention tape on both shoulder, and control group received only dressing retention tape. Abdominal and shoulder pains were evaluated with rating on numeric rating scale (0 = no pain and 10 = the worst pain) at baseline and at 30 min, 6 h, 24 h, and 48 h after surgery. There were no significant differences in patient characteristics and operation details. The overall incidence of shoulder pain was significantly lower in patch group than in control group (42% vs. 78%, P = 0.005). The severity of shoulder pain also was significantly reduced in patch group compared to control group at 24 h and 48 h after surgery (P = 0.01 and P = 0.015, respectively). Complications related to lidocaine patch were not found except nausea. Lidocaine patch 5% reduced the incidence and severity of postoperative shoulder pain in female patients undergoing LC without complications.

Heel pain in female patients with early knee osteoarthritis

BackgroundMultiple lower limb joint involvement is one of the most common and debilitating musculoskeletal conditions, while the complaints from both heel and knee pain are considered the most frequent. For that reason, in this cross-sectional study, the association between heel pain (HP) and early knee osteoarthritis (EKOA) was investigated; the most painful site and side of HP, the prevalence, and risk factors for disabling HP in patients with EKOA were identified.ResultsBilateral HP (56%) and posterior HP (54%) were found to be the most prevalent complaints, and 66% of patients reported the HP to be non-disabling. There was a very high positive statistically significant correlation between the Manchester Foot Pain Disability Index (MFPDI) and both the Health Assessment Questionnaire (HAQ) and the total Western Ontario and McMaster University Osteoarthritis (WOMAC) score (p ≤ 0.001), while there was a high negative statistically significant correlation between MFPDI and quadriceps angle of the most affected knee (p = 0.002). A higher total WOMAC score (OR 1.077, 95% CI 1.014 to 1.145) significantly increases the risk of developing disabling HP, while wearing 2–3-cm heels during the past month was found to be protective against the development of disabling HP (odds ratio < 1).ConclusionDisabling HP was present in a third of patients with EKOA and HP, and it was associated with flat shoe wear as well as a high total WOMAC score. Also, it had a statistically significant correlation with varus knee mal-alignment. Furthermore, decreased functional ability in the presence of HP was found to lead to significant disability. Moreover, a striking finding in this study was the longer mean duration of HP compared to the duration of knee symptoms.

Pelvic Congestion Syndrome

Pelvic congestion syndrome (PCS) is often an underdiagnosed cause of chronic pelvic pain in female patients with radiology detection of gonadal vein dilatation and parauterine varices. It may occur either alone or in combination with vulvar varicosities and/or lower extremity venous insufficiency. Although transcatheter venography represent the gold standard for PCS diagnosis, it is performed after inconclusive noninvasive imaging such as Doppler Ultrasound, CT scan, and MRI. Once diagnosis has been confirmed, management of PCS include medical, surgical, and endovascular therapy. Medical and surgical treatments have been shown to be less effective than transcatheter pelvic vein embolization. This latter has been proven to be a safe, effective, and durable therapy for the treatment of PCS. Numerous studies have shown their results in PCS endovascular treatment, but neither of them has been subjected to an adequate randomized controlled trial. A well-designed randomized controlled trial is urgently needed to assess transcatheter embolization clinical success.

Yaşlı kadınlarda kas-iskelet sistemi ağrısıyla D vitamini düzeyleri arasındaki ilişki

Introduction: Pain is a common symptom of aging. Vitamin D is an effective pre-prohormone with ubiquitous receptors in many tissues, including the musculoskeletal system. Vitamin D deficiency is known to cause pain, proximal muscle weakness in lower extremities, skeletal mineralization defects, balance disorders, increased risk of fall and fracture, and reduced functional capacity. This study aimed to evaluate the relationship between vitamin D levels and the musculoskeletal pain in female patients aged 65 years or over. Methods: This descriptive cross-sectional study included 120 female patients aged 65 years and over who were admitted to physical therapy and rehabilitation outpatient clinic. The participants were administered a questionnaire consisting of demographic data (age, education, occupation, sun exposure, physical activity levels, intake of calcium-rich foods), musculoskeletal pain, and location of the pain. The levels of 25(OH) vitamin D (vitamin D), calcium, phosphorus, alkaline phosphatase, and parathormon in the serum were recorded from the hospital database. Results: Of the participants, 101 (84%) had vitamin D deficiency or insufficiency, 83 (69%) had musculoskeletal pain, and 37 (31%) had no pain at all. Serum vitamin D levels were significantly lower in those who had pain (p=0.008). Sixty-two (75%) of the patients with musculoskeletal pain (n=83) had vitamin D deficiency or insufficiency. Among those with musculoskeletal system pain and vitamin D deficiency or insufficiency (n=62), the pain was most frequently localized to the lower back (41%) and upper back (32%). Conclusion: It is important to evaluate serum 25(OH) vitamin D levels particularly in elderly female patients admitted with musculoskeletal pain. Vitamin D deficiency should be kept in mind for female patients suffering from the lower and upper back pain. Considering the role of vitamin D on the musculoskeletal system, assessment of vitamin D levels and, in case of deficiency, supplementation therapy is recommended for elderly women.