Assess Pain Intensity Research Articles

Assessment of quality of life, pain level and disability outcomes after lumbar discectomy

This study aimed to assess the quality of life of 113 Caucasian patients with intervertebral disc (IVD) degeneration of the lumbosacral (L/S) spine who qualified for microdiscectomy during a 12-month period after surgery. Based on magnetic resonance imaging before the surgery, the degree of radiological advancement of the degenerative changes was determined according to the Pfirrmann grading scale from 1 to 5. To assess pain intensity, the Visual Analog Scale (VAS) was used; the Satisfaction with Life Scale (SWLS) was used to evaluate quality of life; and to assess the degree of ability, the Oswestry Low Back Pain Disability Questionnaire (ODI) was employed. The level of pain, assessed using the VAS, significantly changed in the months following the surgery, with the highest values noted before surgery and the lowest a year after. In turn, the results of the SWLS questionnaire revealed a significant increase in satisfaction with life in the subsequent stages of the study. The conducted correlation analysis revealed significant dependencies in terms of quality of life in regard to pain as well as degree of disability. The level of pain and degree of disability were closely related to the degree of radiological advancement of degenerative changes according to the Pfirrmann grading scale.

Reliability of clinical examination methods for postoperative pain after primary root canal treatment

Background/purposeClinical test results may have lower reliability due to the varying range of test stimulation or patient subjectiveness. This study aimed to verify a reliable clinical test method by comparing pain intensity levels of a tooth at rest, during function, and after the clinical tests of percussion and chewing. Materials and methodsA total of 36 asymptomatic necrotic teeth that required root canal treatment, one in each patient, were included. All treatment procedures were performed in a single visit by an experienced endodontist. Patients were asked to mark their pain levels on a vertical visual analog scale (VAS) while the relevant tooth was at rest and during function 24 h after the treatment. In addition, patients marked their pain levels after the clinical tests of percussion and chewing. Finally, the pain levels were compared using Pearson's correlation for the reliability of the test methods at a significance level of 95%. ResultsThe postoperative pain levels measured during the clinical tests and functions were significantly higher than the pain levels at rest (P < 0.05). The pain levels after percussion tests were significantly higher than that during the function and chewing tests (P < 0.05). Pain intensity during the function was simulated with a higher correlation when using the chewing strip method rather than the percussion method. ConclusionThe bite test using the chewing strips as a pain intensity assessment can mimic the actual postoperative pain experience, whereas the percussion test fails to provide the accuracy of this pain experience.

Effects of Physical Exercise and Motor Activity on Oxidative Stress and Inflammation in Post-Mastectomy Pain Syndrome.

It is estimated that 10-50% of interventions can generate persistent post-surgical pain. Chronic post-mastectomy pain is a condition persisting for at least three months after surgery. It has been shown that physical activity in the cancer patient allows the improvement of the pain symptom. The aim of this study was to evaluate the effects of physical activity on the intensity and interference of chronic pain in the quality of life of women underwent mastectomy needed for breast cancer removal. The secondary objective was to measure the effects of physical activity on inflammatory and oxidative markers in the same population. A Numeric Rating Scale (NRS) was used to assess pain intensity, and Brief Inventory Pain (BIP) was used for assessing interference of pain in quality of life. Physical activity was measured with the International Physical Activity Questionnaire (IPAQ). Inflammatory mediators such as interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, c-reactive protein (CRP), and biomarkers of oxidative stress malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) were evaluated in the blood of patients. All the evaluations were performed after three and six months after surgery. Results showed that adequate physical activity can diminish intensity and interference of pain and that these effects are associated with a reduction of blood biomarkers of inflammation.

Durable patient-reported outcomes following 60-day percutaneous peripheral nerve stimulation (PNS) of the medial branch nerves

BackgroundChronic low back pain (CLBP) is often associated with clinical evidence of central nervous system sensitization and finding a clear source of nociceptive input can be challenging. Conventional therapies targeting peripheral spinal pain structures can fail to address centrally-mediated, underlying causes of pain. Sixty-day percutaneous peripheral nerve stimulation (PNS) applied to the lumbar medial branch nerves is a non-surgical, non-opioid treatment that may restore the balance of peripheral inputs to the central nervous system and reverse maladaptive changes in central pain processing. As a minimally invasive, non-destructive treatment, percutaneous PNS was designed to be used earlier in the treatment continuum than radiofrequency ablation or permanently-implanted neurostimulation systems. ObjectiveThe objective of this clinical trial was to characterize the durability of responses to medial branch PNS in a prospective multicenter case series study of CLBP patients recalcitrant to multiple non-surgical treatments. DesignProspective, multicenter clinical trial. PopulationAdults with CLBP without radicular leg pain who had previously failed multiple types of conventional treatments. InterventionSixty-day percutaneous PNS applied to the lumbar medial branch nerves. MethodsPercutaneous PNS leads were implanted under image guidance (ultrasound and/or fluoroscopy) and treatment was applied for up to 60 days, after which the leads were removed. Participants were followed through 14 months (12 months after the 2-month PNS treatment). Prospectively-defined endpoints included assessments of pain intensity, disability, pain interference, health-related quality of life, depression, and patient global impression of change. ResultsTreatment of CLBP with 60-day percutaneous PNS treatment produced clinically meaningful improvements in average pain intensity, disability, and/or pain interference for a majority of participants through the entire 14 month follow up period without requiring permanent system implantation. The proportion of participants experiencing clinically meaningful improvement in at least one outcome (pain intensiy, disability, pain interference) with PNS was 91% after 2 months, 79% at 5 months, 73% at 8 months, 75% at 11 months, and 77% at 14 months. There were no serious or unanticipated study-related adverse events. ConclusionThis prospective multicenter clinical trial demonstrates the clinical utility of percutaneous PNS when applied to the medial branch nerves for the treatment of chronic low back pain recalcitrant to non-surgical treatments. Given the minimally invasive nature of percutaneous PNS and the significant benefits experienced by participants, percutaneous PNS provides a safe and effective first-line neuromodulation treatment for patients with CLBP that may obviate the need for neuroablative procedures or permanent neurostimulation system implantation.

Determinants of satisfaction with acute pain therapy during and after childbirth.

An important task in obstetrics is to offer patients adequate pain management after vaginal delivery (VD) and after cesarean section (CS). The aim of the present analysis was to assess pain intensity at the day after childbirth, after 3 and 6 months in women after VD and after CS. Additionally, it was planned to identify determinants of maternal satisfaction with acute pain therapy following VD and CS. This secondary analysis of asingle-center prospective cohort study included 210 parturients. The women gave birth in the University Hospital of Wuerzburg. They completed asurvey before childbirth(P), on the first day (D1), 3and 6months after VD and CS. The survey included questions about the expected pain, the experienced pain, the birth, the pain afterwards and also psychological questionnaires. In addition, information was collected from the patient records. Women with planned CS received spinal anesthesia. Asecondary CS was performed with an epidural, spinal or general anesthesia. Pain therapy on the ward was standardized. The primary outcomes were acute and chronic pain intensity at rest, during movement, determinants of satisfaction with pain therapy and the wish to have received more pain medication during and after VD and CS (D1). A total of 175women completed the survey at all time points and were available for the analysis (drop-out 16.8%). The results confirmed high pain levels at D1 after CS (median pain intensity during movement: 8NRS points, interquartile range, IQR 6-9 points). After VD pain scores were much lower (median pain intensity during movement:4 points, IQR 2-5 points). Of the mothers 7.4% reported pain at rest at all time points after VD or CS but pain intensity was low after3 and 6months (median pain intensity at rest:2 points, IQR 0-3 points), 28% received extended-release opioids after CS and 33% of women (VD and CS) had an epidural. The most important influencing factor for lower satisfaction with pain therapy after CS or VD was inadequate pain relief. Women with VD who had an epidural, were more satisfied during delivery than women without but there was no difference at D1. This study confirmed high acute pain levels following CS and an incidence of chronic pain of around 7% but pain intensity was low and one third received strong opioids after CS. Around 11% of women after primary CS (8% epidural, 3% combined spinal/epidural) and around 55% of women after secondary CS had an epidural, which could be used for pain therapy after birth. Women without an epidural or without opioids may not have had good pain management. The received pain relief appeared to be the most relevant predictor for satisfaction and the wish to have received more pain medication. Mothers having aVD with an epidural catheter were more satisfied with pain therapy during birth than those without. Therefore, abetter multimodal pain management (including opioids, epidural and nonopioids) might provide better pain relief and might improve overall satisfaction with pain treatment following CS. Finally, the received pain relief might be abetter patient-related outcome measure for satisfaction with pain treatment after childbirth than pain intensity alone.

Predictors of treatment-response to caffeine combination products, acetaminophen, acetylsalicylic acid (aspirin), and nonsteroidal anti-inflammatory drugs in acute treatment of episodic migraine.

To identify predictors of acute treatment optimization for migraine with "over-the-counter" (OTC) or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) as well as other widely used OTCs including acetaminophen, caffeine combination products (CCP), and acetylsalicylic acid (ASA, aspirin) among people with episodic migraine and to develop models that predict treatment response to each class of OTCs. Efficacy of acute OTC medications for migraine varies greatly. Identifying predictors of treatment response to particular classes of medication is a step toward evidence-based personalized therapy. For this prediction model development study, we used data from 2224 participants from the American Migraine Prevalence and Prevention (AMPP) study who were aged ≥18 years, met criteria for migraine, had <15 monthly headache days, and reported being on monotherapy for acute migraine attacks with one of the following classes medications: CCP (N=711), acetaminophen (N=643), ASA (N=110), and prescription or OTC NSAIDs (N=760). The primary outcome measures of treatment optimization were adequate 2-h pain freedom (2hPF) and adequate 24-h pain relief (24hPR), which were defined by responses of half the time or more to the relevant items on the Migraine Treatment Optimization Questionnaire-6. The mean (SD) age of the participants was 46.2(13.1)years, 79.4% (1765/2224) were female, 43.7% (972/2224) reported adequate 2hPF, and 46.1% (1025/2224) reported adequate 24hPR. Those taking CCP had better 2hPF and 24PR outcomes. For those taking NSAIDs, better outcomes were associated with lower average pain intensity (2hPF: odds ratio [OR] 0.89, 95% confidence interval [CI] 0.80-0.99; 24PR: OR 0.86, 95% CI 0.77-0.96), cutaneous allodynia (2hPF: OR 0.92, 95% CI 0.89-0.96; 24PR: OR 0.91, 95% CI 0.87-0.95), depressive symptoms (2hPF: OR 0.95, 95% CI 0.92-0.98; 24PR: OR 0.95, 95% CI 0.91-0.99), and Migraine Disability Assessment Scale (MIDAS) grade (2hPF: OR 0.76, 95% CI 0.64-0.90; 24PR: OR 0.79, 95% CI 0.65-0.95). Adequate 2hPF for those taking CCP was associated with male gender (OR 1.83, 95% CI 1.21-2.77), lower average pain intensity (OR 0.80, 95% CI 0.70-0.91), lower cutaneous allodynia (OR 0.94, 95% CI 0.90-0.97), and lower Migraine Symptom Severity Scale Score (MSSS; OR 0.91, 95% CI 0.86-0.97). Adequate 24hPR for those taking CCP was associated with lower average pain intensity (OR 0.85, 95% CI 0.75-0.96), lower cutaneous allodynia (OR 0.92, 95% CI 0.89-0.96), and lower MIDAS grade (OR 0.81, 95% CI 0.68-0.96). Participants who were married (OR 1.51, 95% CI 1.05-2.19), had lower average pain intensity (OR 0.79, 95% CI 0.70-0.89), lower MSSS (OR 0.93, 95% CI 0.88-0.99), less depression (OR 0.96, 95% CI 0.93-0.99), and lower MIDAS grade (OR 0.72, 95% CI 0.59-0.87) had adequate 2hPF after taking acetaminophen. Participants who were married (OR 1.50, 95% CI 1.02-2.21), had lower pain intensity (OR 0.78, 95% CI 0.69-0.88), less depression (OR 0.95, 95% CI 0.91-0.98) and lower MIDAS grade (OR 0.53, 95% CI 0.42-0.67) had higher 24hPR following use of acetaminophen. A lower MSSS was the only factor associated with higher 2hPF and 24PR after using ASA (OR 0.78, 95% CI 0.67-0.92 and OR 0.79, 95% CI 0.67-0.93). Predictive models had modest performance in identifying responders to each class of OTC. A large subgroup of people with migraine had an inadequate response to their usual acute OTC migraine treatment 2- and 24-h after dosing. These findings suggest a need to improve OTC treatment for some and to offer prescription acute medications for others. Predictive models identified several factors associated with better treatment-response in each OTC class. Selecting OTC treatment based on factors predictive of treatment optimization might improve patient outcomes.

Differences in Pain Assessments Between Inpatients and Nurses Leads to Considerable Misestimated Pain

BACKGROUND: Pain assessments are an important aspect of health care quality because the high prevalence of pain in inpatients may contribute to complications. Several studies revealed a gap in the pain intensity evaluated by nurses (PEN) and patients (PEP). The aim of the present study was to analyze the correlation and agreement between pain assessments conducted by nurses and patients, and to determine patients at high risk of misestimated pain. OBJECTIVES: To compare the difference of pain intensity between the questionnaires conducted by additional assessors and electronic records by nursing staff. STUDY DESIGN: A retrospective study. SETTING: A medical center in Taichung, Taiwan. METHODS: We approached 1,034 patients admitted from January 1, 2018 to December 31, 2018 in our hospital. We compared the assessments of pain intensity using questionnaires conducted by additional assessors with those entered into electronic records by nursing staff. Continuous data were reported as the mean (± standard deviation). The analysis of agreement and correlation were performed by kappa statistics or weighted kappa statistics, and correlation (Spearman rank correlation method). RESULTS: Among the 1,034 patients, 307 patients were excluded. Thus, the final analysis included 686 patients. Patients’ median pain intensity was 5 in PEP and 1 in PEN. The patients’ pain intensity was underestimated (PEN &lt; PEP) in 539 patients (78.6%), matched (PEN = PEP) in 126 patients (18.3%), and overestimated (PEN &gt; PEP) in 21 patients (3.1%). The surgical interventions (chi squared = 7.996, and P = 0.018) and pain in the past 24 hours (chi squared = 17.776, and P &lt; 0.001) led to a significant difference. LIMITATIONS: The limitation of the study was the single-center and retrospective design. CONCLUSIONS: The gap in pain assessments between inpatients and nurses is an important issue in daily practice. The underestimations of pain were more common than overestimations (78.6% vs 3.1%). Surgical interventions and persistent pain lasting over 24 hours were high risk factors for underestimation, but patients’ gender, receiving anesthesia, type of anesthesia, and patient-controlled analgesia did not contribute significantly to differences in pain estimation. KEY WORDS: Pain, assessment, correlation, agreement

Features of postoperative pain relief in patients with a low level of consciousness: a prospective randomised study

AIM: To determine the possibility of using analgonociception monitoring (analgesia nociception index, ANI) to assess the need for postoperative analgesia in patients with prolonged impairment of consciousness.&#x0D; MATERIAL AND METHODS: This pilot prospective randomized study enrolled 34 consecutive patients with chronic impairment of consciousness (vegetative state/minimal state of consciousness) who underwent neurosurgical interventions. Randomization was made by the envelope method for the grouping of the patients: study group (SG, n=17), received anesthesia with intravenous paracetamol 1000 mg according to ANI in the postoperative period; control group (CG, n=17), without additional anesthesia in the postoperative period. Patients with arrhythmias were excluded. The groups are comparable in terms of the main clinical parameters (all parameters p 0.05). The ANI (MetroDoloris device, France) was recorded at 1, 4, 8, 12, and 24 h after surgery. The valuation was based on the revised scale for assessing pain in a coma, i.e., Nociception Coma ScaleRevised (NCS-R) [7], after 4, 12, and 24 h.&#x0D; RESULTS: An intragroup comparison of the changes in ANI during postoperative day 1 showed an adequate level of pain relief (60.1 [55.362.5]), whereas in the group without postoperative analgesia with paracetamol, by 4 h after the operation, ANI dropped to the lower limit (46.3 [40.251.9]). In an intergroup comparison in the first 8 h after surgery, ANI was significantly higher than in the group without anesthesia (p=0.04) and had values of 55, which indicates the absence of pronounced vegetative reactions indicating the presence of pain. From 12 oclock, the values are leveled out, not going beyond the limits of indicators of inadequate anesthesia (p=0.69). When assessing nociception on the NCR-R scale during the postoperative day in both groups, a tendency to the appearance of weak autonomic responses was observed (6 [5; 8] in SG and 6 [5; 7] in CS, respectively), which did not differ significantly. The presence of pain 4 h after surgery was confirmed by increased levels of cortisol and salivary alpha-amylase in patients without postoperative analgesia (p=0.03).&#x0D; CONCLUSION: No generally recognized and available evidence-based instrumental methods are available for the assessment of pain intensity in patients with chronic impairment of consciousness. There is no single position of the professional community on the need for postoperative analgesia in such patients. Further studies to evaluate the effectiveness of using the ANI Metro Doloris monitoring system with a significant number of observations will lead to the determination of adequate perioperative analgesia regimens in patients with various forms of prolonged impairment of consciousness.

Memojis Pain Scale: A novel pain assessment tool.

Dental pain exerts a considerable impact on the psychosocial well-being of children; reliable management of pain depends on the ability to assess pain intensity. To validate and compare a new memojis pain assessment scale with the Faces Pain Scale-Revised (FPS-R) and Wong-Baker FACES Pain Rating Scale (WBFPS) in assessing dental pain experienced by children. Two hundred and fifty healthy children aged 5-9 years without any past dental experience and requiring local anaesthesia (LA) administration were recruited. Three different scales [FPS-R, WBFPS and Memojis Pain Scale (MPS)] were applied to assess the children's pain during LA administration. The preferences of each child based on the ease of understanding the faces were recorded. Pearson correlation test was performed to determine the correlation between MPS with WBFPS and MPS with FPS-R. A strong correlation was seen when comparing MPS with WBFPS (r= .966; p< .001) and MPS with FPS-R (r= .969; p< .001), and 81.6% of the children preferred MPS. The Memojis Pain Scale was an effective pain assessment tool. It can be employed as an alternative scale for pain assessment in children.

Whether ambulatory electroencephalogram and visual tracking system could be the new strategy for pain assessment?

The human pain experience is a complex multi-faceted symptom. Effective pain management begins with a comprehensive assessment. However, a plethora of existing assessment tools for pain assessment focus more on self-report of pain intensity but lack of multi-dimensional impersonal assessment. These unidimensional scales, which capture self-reported levels of pain intensity, not only underestimate the complexity of the pain experience, but also lack stability and objectivity in their own assessments of pain intensity. Therefore, we propose a hypothesis that using scientific and technological means, such as visual tracking and surveillance system, ambulatory electroencephalogram and other techniques, combined with psychological assessment pictures and existing scales, to comprehensively evaluate pain may provide a new method for more effective clinical treatment of pain, especially chronic severe pain.

Ultrasound-guided pulsed radiofrequency of cervical nerve root for cervical radicular pain: a prospective randomized controlled trial

Pulsed radiofrequency (PRF) on cervical dorsal root ganglion (DRG) for pain management in cervical radicular pain is mainly performed via a transforaminal approach under fluoroscopic guidance. Ultrasound-guidance periradicular cervical nerve root intervention raises concern about the neuromodulatory effect. This study aims to evaluate the effectiveness and duration of pain relief between PRF treatment and steroid injection on the cervical nerve roots. To evaluate the efficacy of pulsed radiofrequency for cervical radicular pain. A prospective, double-blinded, randomized controlled clinical trial PATIENT SAMPLE: Patients who underwent ultrasound-guided periradicular cervical nerve root PRF or steroid injection from January 2020 to May 2021 at King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand. The primary outcome was the pain score at 3 months postprocedure. The secondary outcomes were the duration of pain relief of at least 50%, pain scores at other time points after pain intervention, the amount of rescue pain medications, procedural time, and complications. Forty-two patients who presented with chronic cervical radicular pain were prospectively randomized into the PRF and steroid groups. Patients in the PRF group received PRF treatment at 42°C for 4 minutes, followed by the injection of 2% lidocaine 1.5 mL and dexamethasone 10 mg to the targeted cervical nerve root. The steroid group received the same injectate. Patients and pain assessors were blinded. The numerical rating scale (NRS) and the Neck Disability Index (NDI) questionnaires were used for pain intensity and neck functional assessment before and after the procedure. Pain reduction was recorded up to a 9-month follow-up. Data analysis was obtained from 20 and 21 patients receiving PRF and steroid treatment, respectively. At 3-month postprocedure, there were 70% of patients in the PRF group reported 50% pain reduction compared with 23.8% of patients in the steroid group (p<.01). Moreover, patients in the PRF group had significantly less pain (NRS 2.8±2.7) compared with patients in the steroid group (NRS 5.5±2.6) (p=.01). The neck disability index demonstrated significant improvement at 3 and 6 months (p<.01) after PRF treatment compared with steroid injection alone. The duration, in which pain relief was at least 50%, was significantly longer in patients who received PRF treatment (6.0±4.1 months) compared with those in the steroid group (2.3±2.1 months) (p<.01). Ultrasound-guided periradicular cervical nerve root PRF exhibited a neuromodulatory effect and was considered effective for patients with cervical radicular pain. It provided a longer duration of pain relief and improvement of neck function for up to 6 months.

The Combined Efficacy of Sacro-Occipital Technique and Electrical Stimulation Therapy in the Treatment of Cumulative Trauma Disorders with Cervicogenic Cephalgia

Background and Aim: Cumulative trauma disorders attributed to poor sustained posture in working or repetitive physical activity. Cervicogenic headaches are assumed to be associated with cervical dysfunction and may include facial pain. Cervicogenic Cephalgia may result from the entire body´s muscle imbalance as well as Temporo-Mandibular Joint (TMJ) disorder. Methods: 31 male and 39 female subjects diagnosed with CTDs with Cervicogenic Cephalgia were recruited and they were randomized into 2 groups. The study group participants underwent Sacro-Occipital Technique and Electrical Stimulation Therapy and control group underwent only the electrical stimulation therapy. Pain intensity assessment, posture and gait evaluation was done before and after intervention. Results: Pain intensity was reduced in the study group compared to control group and the gait and posture was improved in study group participants following intervention which was statistically significant. Conclusion: The symptoms of CTDs with Cervicogenic Cephalgia were improved by the Sacral–Occipital Technique (S.O.T.) and the electrical stimulation therapy that are non-phamacotherapy for normalizing neuromusculoskeletal system. So the overall effective rate is 95.0%.

Study of EEG alpha wave response on the effects of video-guided deep breathing on pain rehabilitation.

Athletes with chronic ankle pain (CAP) are more inclined to suffer from physical and psychological pain depending on the severity of the injuries, which might trigger the powerless feeling on future sports participation. Therefore, an efficient and simple method is useful to integrate into conventional physiotherapy (CP) for maintaining mental wellness. This research aimed to verify the effects and progress of video-guided deep breathing (DB) integrated into CP through study on the changes of alpha waves and pain scale. Alpha waves were recorded using an electroencephalogram (EEG) and a visual analogue scale (VAS) to assess pain intensity before and after the intervention (6weeks). Thirty CAP participants were recruited and randomly assigned to two groups: group A for video-guided DB integration into their CP and group B for CP. The effects of pre and post intervention were analyzed using a paired t-test with statistical significance set at p< 0.05. Profound results from the research have shown that the participants who received both the DB+CP revealed a significant increase in alpha wave (p< 0.05) at occipital region. The significant result reveals an increase in alpha waves in the occipital region after 6weeks and indicates that the video-guided DB with a smartphone application is able to produce a change in CAP participants. This supports the DB integration to the CP for altering the pain perception.

Knowledge related to low back pain and its associated factors in patients with low back pain: A cross-sectional study.

Patients' knowledge about low back pain (LBP) negatively influences LBP prognosis. Studying the extent of patients' knowledge about LBP may help clinicians design effective LBP treatment strategies. To explore the level of LBP knowledge and its associated factors in patients with LBP. A cross-sectional study with a representative sample. Participants with acute or chronic LBP completed a self-administered questionnaire including sociodemographic and clinical characteristics. We used the Low Back Pain Knowledge Questionnaire (LBP_KQ) to assess knowledge, the Fear-Avoidance Beliefs Questionnaire for LBP (FABQ_LBP) to assess fear of movement, the Oswestry Disability Index (ODI) to assess functional disability, Depression Anxiety Stress Scales (DASS 21) to assess mental health status, and the Numeric Pain Rating Scale (NPRS) to assess pain intensity. A total of 271 individuals with LBP completed the study. The mean age of participants was 39.86 (± 11.27), the LBP chronicity median was 18 (IQR = 44) months, and 56.5% of the participants were females. The mean LBP_KQ score was 9.29 (± 3.89)/24. An educational level higher than high school (diploma education (β= 1.202 [95%CI: 5.633 to 11.498], p< 0.001), bachelor or higher education (β= 2.270 [95%CI: 1.107 to 3.433], p< 0.001)), and using pain killers (β= 1.180 [95%CI: 0.140 to 2.221], p= 0.026) were significantly associated with higher LBP_KQ score. While being employed (β=-1.422 [95%CI: -2.462 to -0.382], p= 0.008) and having higher DASS Anxiety score (β=-0.144 [95%CI: -0.240 to -0.048], p= 0.003) were significantly associated with lower LBP_KQ score. Individuals with chronic LBP in Jordan demonstrated relatively low levels of LBP knowledge related to their condition. Rehabilitation personnel, healthcare stakeholders, and policymakers should carefully monitor the level of LBP knowledge and its associated factors.

The efficacy of combined ultrasound and electric field stimulation therapy in the treatment of venous leg ulcers.

Venous leg ulcers are the most common cause of leg ulcers. The aim of this study is to assess the effect of Combined Ultrasound and Electric Field Stimulation therapies (CUSEFS) on wound surface area and pain level in patients with venous leg ulcers, utilizing a novel device (BRH-A2 from BRH Medical, Ltd). This prospective case series study, conducted by the Department of Plastic Surgery at the Yitzhak Shamir Medical Center, Israel, collected data for subjects treated with CUSEFS with the BRH-A2 device, between April 2018 and September 2019. Measurements of wound area and assessment of pain intensity using a 10-point visual analog score were recorded. At the end of the four-week period, average wound area and pain scores were included for analysis. Ten consecutive patients met the inclusion criteria. During the study period, all patients exhibited a reduction in the wound surface area. The final average wound surface area was reduced by 53.52% following the combined treatment. Eight out of the ten patients (80%) reported a reduction in pain, with an average pain level reduction of 64% throughout eight consecutive treatments. CUSEFS therapies with BRH-A2 technology is a promising treatment for venous leg ulcers. In accordance with our preliminary results, this treatment modality can aid in the reduction of wound surface area as well as reducing the pain suffered by patients from these chronic wounds. Larger multicenter studies are needed to further quantify and qualify the beneficial effect of CUSEFS in venous leg ulcers and other chronic wounds. Venous leg ulcers (VLUs) are painful wounds occurring between the knee and ankle joint, that fail to heal for a period of at least two weeks and occur in the presence of venous disease. VLUs, are the most common cause of leg ulcers, affecting approximately 5% of the general population over the age of 65. Numerous non-invasive treatment modalities have been attempted for healing chronic wounds and ulceration, however, in some instances surgery, although invasive, is the preferred option. For many years, ultrasound (US) has been used therapeutically to treat chronic ulcers. US produces biophysical effects that are significantly beneficial to the wound healing process. Electrical stimulation therapy is another treatment option which contributes to wound healing by influencing the electrochemical wound process.Combined Modulated Ultrasound and Electric Field Stimulation (CUSEFS) have been shown to improve the healing of chronic wounds. However, research has focused predominantly on objective measures of healing, while less consideration has been given to researching the subjective discomfort and the negative impact that ulceration places on the patient. The aim of this study was to assess objective and subjective factors by measuring the short-term effect of CUSEFS on the surface area of wound and on pain levels in patients with venous leg ulcers (VLUs). Our study findings demonstrate that the combined treatment was effective in initiating wound healing and reducing levels of pain in chronic, stagnant, recalcitrant venous leg ulcers.

Comments on “Efficacy of diadynamic currents in the treatment of musculoskeletal pain: a systematic review”

Introduction: Diadinamic currents (DDCs) are electrotherapy modalities available for musculoskeletal pain management. The aim of this study is to offer quantitative evidence to supplement the systematic review of DDCs for musculoskeletal pain. Method: A meta-analysis was performed using the studies included in the systematic review titled "Efficacy of Diadynamic Currents in the Treatment of Musculoskeletal Pain". The meta-analysis involved grouping the results related to the primary outcome, which is the assessment of pain intensity, utilizing both the Visual Analog Scale (VAS) and the Numerical Pain Rating Scale (NPRS). Results: The pooled effect demonstrates a reduction in pain levels for both the VAS and the NPRS, with values of -0.83cm (95% CI: -1.9.0.2) and -0.78 points (95% CI: -1.2-0.4), respectively. However, statistically significant differences were only observed for the NPRS. These results align with clinically meaningful differences, particularly in the case of NPRS. Conclusion: While randomized clinical trials report the efficacy of DDCs, the quantitative analysis suggests that the evidence is inconclusive when comparing the two evaluated scales. Furthermore, DDCs appear to be a clinically viable alternative that is equivalent to transcutaneous electrical nerve stimulation (TENS).

Biofeedback EMG alternative therapy for chronic low back pain (the BEAT-pain study).

The aim of this study was to assess the feasibility and potential effectiveness of an 8-week virtual EMG biofeedback intervention for patients with CLBP. Patients with CLBP completed validated baseline and post-intervention assessments of pain intensity and interference (Brief Pain Inventory), back pain-related disability (Oswestry Disability Index), anxiety and depression (Hospital Anxiety and Depression Scale). Participants underwent a series of Quantitative Sensory Testing (QST) procedures assessing responses to mechanical stimuli during two separate visits (baseline and post-intervention). In addition, we assessed, using surface EMG, the muscle tension in the trapezius, latissimus, and low back muscles at each session. Patients were randomized into the EMG biofeedback intervention or usual care group. Factorial analysis of variance including the interaction between treatment group and time was used to analyze the changes in pain intensity (primary outcome), pain interference, disability (secondary outcomes), anxiety, and depression (secondary outcomes). Compared to the treatment as usual comparison group, patients in the EMG biofeedback group reported lower pain intensity after completing the intervention (mean group difference 0.9, 95% CI -1.07, -0.32; p≤0.01). Compared to baseline, participants in the EMG biofeedback group demonstrated statistically significant reductions in pain interference (mean difference 1.3, 95% CI 0.42, 2.1; p≤0.01), disability (mean difference 4.32, 95% CI 1.2, 7.3; p≤0.01), and significant increases in low back pain thresholds (mean difference 0.5, 95% CI -0.87, -0.05; p≤0.01), assessed by QST. However, no significant group by time effects were observed for secondary outcomes: pain interference, disability, and low back pain thresholds. In addition, significant changes were observed in muscle tension for the trapezius, latissimus, and low back muscles in the EMG biofeedback group (p<0.001). Virtual EMG biofeedback shows promise as a potential therapy for reducing pain and disability in individuals with chronic nonspecific low back pain.

Comparing preemptive injection of peri-articular-multimodal drug with oral celexocib for postoperative pain management in total knee arthroplasty: A randomized clinical trial.

Total knee arthroplasty (TKA) is associated with tremendous postoperative pain, and pain relief should concisely be considered. This study aims to compare the efficacy of preemptive periarticular multimodal drug injection versus placebo and oral celecoxib on postoperative pain control after TKA. This study is a randomized clinical trial on 146 patients candidate for TKA who were randomly allocated to three treatment groups, including (1) a cocktail consisting of bupivacaine, morphine, epinephrine, and ketorolac (n = 48), (2) only epinephrine (placebo group) (n = 49), and (3) 400 mg celecoxib orally (control group) (n = 49) using the Random Allocation software. The injections and oral therapy were performed within 15 min before the surgical procedure. The study's primary outcome was the Knee Society Score (KSS) calculated at baseline, within 6 weeks and 6 months postoperatively. Range of motion (ROM) and Visual Analog Scale (VAS) to assess pain intensity as the other primary outcomes were evaluated before the procedure, within 24 h, 48 h, and 6 weeks postoperatively. The three studied groups were similar regarding demographic characteristics, including age (P = 0.33), gender distribution (P = 0.65), and involved knee side (P = 0.94). Baseline comparison of KSS (P = 0.39), VAS (P = 0.24), and ROM (P = 0.37) among the groups revealed insignificant differences. All the studied groups showed a statistically significant trend of improvement in KSS, VAS, and ROM (P < 0.001), while the comparison of the three groups in terms of KSS (P = 0.001), VAS (P < 0.001), and ROM (P < 0.001) revealed remarkable superiority of multimodal injection to the other treatments. Preemptive periarticular multimodal drug injection, including bupivacaine, morphine, epinephrine, and ketorolac, can cause considerable postoperative pain relief and better ROM achievement in comparison to placebo or oral celecoxib.

Effect of Biodex Balance Training on Postural Stability in Patients with Primary Dysmenorrhea

Background: Dysmenorrhea is one of the most common causes of pelvic pain in women, estimates of the prevalence of dysmenorrhea range widely from 16.8 % to 81%, with high rates as 90% have been recorded. It has a negative impact on the quality of life of affected females, leading to activity restrictions. Pelvic stability decreases in women with dysmenorrhea, leading to lumbar pelvic imbalance, resulting in impaired balance control. Purpose: The purpose of this study was to determine the effect of Biodex balance (BBS) training on pain, postural stability and functional activities during dysmenorrhea. Methods: Thirty participants suffering from primary dysmenorrhea with a regular menstrual cycle were randomly assigned to experimental group (n=15) and control group (n=15). The experimental group received sessions in BBS training combined with traditional core stability exercises while the control group received only traditional core stability exercises for 4 weeks (three sessions per week). The BBS was used to assess postural stability and limit of stability, while the Visual analog scale (VAS) was used to assess pain intensity and Patient specific functional scale (PSFS) to assess the ability to perform activities. All measurements were obtained before, during the menstrual cycle, and after receiving the treatment. Results: The mean values of all variables showed no significant difference in the pre, mid menstrual cycle an d post-treatment assessments, p values were insignificant (P&gt;0.05) between the 2 groups except for post-post treatment assessment for limit of stability (p&lt;0.05). However, both groups showed improvement in all variables when comparing pre and post balance assessments. Conclusion: Balance training with BBS has a positive effect on dysmenorrhea patients by improving postural stability, functional activities, and decreasing pain intensity

Effect of Therapeutic Touch on Maternal and Neonatal Outcomes in Primiparous Women: A Systematic Review and Meta-Analysis

Introduction: Childbirth is one of the most wonderful yet painful experiences in a woman’s life. Non pharmacological interventions like Therapeutic Touch (TT) can improve labour experiences in women. Aim: To assess the effect of TT on labour pain intensity, neonatal Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score and admission to neonatal intensive care unit in primiparous women. Materials and Methods: In this review, PubMed-MEDLINE, Google Scholar, Cochrane CENTRAL databases were searched till February 2022, for prospective studies fulfilling inclusion and exclusion criteria. Randomised controlled trials comparing TT and massage therapy with usual intranatal care in primiparous women with singleton foetus and without any risk factors for pregnancy were included in this review. Two independent reviewers extracted data and assessed the quality of the trials. The results were presented in form of forest plots. Results: A total of 13 studies, including 1302 primiparous women, were included in the review for qualitative analysis. Amongst them ten studies involving 621 women included meta-analysis of labour pain intensity. Nine studies were included in the metaanalysis of the active phase of labour and four studies included in the transitional phase and one study in the fourth stage of labour. Eight studies used the Visual Analogue Scale (VAS) to assess pain intensity. Overall, there was a small reduction in pain intensity of primiparous women receiving massage/TT compared to routine care {SMD: -0.96 (95% CI: -1.33, -0.60)}. Significant reduction of pain intensity was found in active {SMD: -0.79 (95% CI: -1.26, -0.32)} and transitional phase of labour {SMD: -1.18 (95% CI: -1.67, -0.69)}. No significant reduction of neonatal admission to the intensive care unit and APGAR score &lt;7 at 5 minutes {RR: 0.71 (95% CI: 0.31, 1.62)} was found. Conclusion: TT has beneficial effect on reduction of Labour pain intensity in primiparous women. But no detectable effect was found for neonatal outcomes.