Pain Intensity Scale Research Articles

Fractional CO2 Laser for Burn Scars: A Comparison of Patient-Reported Outcomes Between Those With and Without Laser Treatment.

Burn reconstruction outcomes are an area of growing investigation. Although there is evidence of measured physical improvements in scar characteristics after laser treatment, there is little information on patient-reported outcomes. The purpose of this study is to compare patient-reported outcomes between burn survivors with and without laser treatment. The study included participants in the Burn Model System National Database at a single center; participants that received outpatient laser treatment for burn scars were compared to a matched group of burn survivors that did not receive laser. The following outcomes were examined: Satisfaction With Life Scale, Mental and Physical Component Summary of the Veterans Rand Survey, and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Scale. Regression analyses examined the associations between laser treatment and each outcome at 12 and 24 months. The study population included 287 adult burn survivors (65 laser group and 222 control group). The significant differences found between the 2 groups included: burn size (laser: 14.9, 13.5 SD, control: 8.9, 11.1 SD; P < .001), insurance type (P = .036), inhalation injury (laser: 17.2%, control: 2.7%; P < .001), and ventilator requirement (laser: 27.7%, control: 13.5%; P = .013). Laser treatment was not associated with any of the outcomes at both follow-up time points. Further research is needed to develop patient-reported outcome measures that are more sensitive to the clinical changes experienced by burn survivors receiving laser treatment.

What is the Effect of Lidocaine Compared to Lidocaine and Clove Oil on Episiotomy Site Anesthesia: Results from a Randomized Clinical Trial

Background: Episiotomy is a commonly performed obstetric procedure that often results in perineal pain for women. Objectives: This study aimed to compare the effects of lidocaine alone and lidocaine combined with clove oil on pain at the episiotomy site. Methods: This randomized clinical trial was conducted at Baharloo Hospital in Tehran, involving 65 nulliparous women who underwent episiotomy. Perineal pain was assessed using the Visual Pain Intensity Scale (VAS) and the McGill Questionnaire. The control group received a 2% lidocaine injection, while the intervention group received a combination of 0.8% clove oil and 2% lidocaine to alleviate pain before the episiotomy. The clove oil was applied topically to the episiotomy site 10 minutes prior to the lidocaine injection. During the episiotomy repair stage, both groups received a 2% lidocaine injection. Pain intensity was measured using the aforementioned tools at 1, 6, and 12 hours after episiotomy repair. Results: There was no statistically significant difference in average pain intensity between the two groups before and 12 hours after the intervention (P &gt; 0.05). However, at 1 and 6 hours after the intervention, the combination of clove oil and lidocaine resulted in significantly lower pain compared to the lidocaine-only group (P &lt; 0.05). Conclusions: Considering the greater effectiveness of lidocaine combined with clove oil in reducing episiotomy site pain intensity and the absence of side effects, this method can be recommended as an adjuvant therapy to reduce pain at the episiotomy site.

Dexketoprofen Trometamol and Tramadol Hydrochloride Fixed-Dose Combination in Moderate to Severe Acute Low Back Pain: A Phase IV, Randomized, Parallel Group, Placebo, Active-Controlled Study (DANTE).

Dexketoprofen/tramadol 25/75 mg (DKP/TRAM) is a fixed-dose combination of a cyclooxygenase inhibitor and opioid receptor agonist. To better understand the efficacy and safety of DKP/TRAM in the treatment of moderate to severe acute lower back pain (LBP) with or without radiculopathy, we carried out a large explorative phase IV international, multicenter, prospective, randomized, double-blind, parallel group, placebo-controlled study (DANTE). A total of 538 patients with or without a history of LBP and experiencing acute LPB of moderate to severe intensity [Numerical Rating Scale-Pain Intensity (NRS-PI) score > 5] were randomized 4:4:1:1 to DKP/TRAM 25/75 mg every 8 h (n = 211), tramadol (TRAM) 100 mg (n = 207), placebo-matched DKP/TRAM (n = 59), or placebo-matched TRAM (n = 61). The proportion of patients achieving the primary endpoint, defined as the time to first achieve NRS-PI score < 4 or pain intensity reduction ≥ 30% from drug intake up to 8 h after the first dose, was higher in the DKP/TRAM arm than in the placebo group, but the difference was not statistically significant (46.1% vs. 42.6%, respectively; hazard ratio 1.11; 95% confidence interval 0.775, 1.595; p = 0.566). DKP/TRAM achieved superiority over TRAM in total pain relief at 4, 6, and 8 h (p < 0.05). Conversely, in relation to the secondary endpoints, a significantly greater reduction in NRS-PI score was seen with DKP/TRAM versus placebo starting from 1 h, and this reduction remained numerically lower throughout 8 h. Summed pain intensity difference values were also significantly lower at 4, 6, and 8 h with DKP/TRAM compared to TRAM (p < 0.05). Overall, DKP/TRAM was well tolerated. Although the primary endpoint was not met, secondary efficacy analyses suggest the superiority of DKP/TRAM over placebo and TRAM alone in terms of total pain relief. DKP/TRAM can be considered to be an effective and safe option for the treatment of moderate to severe acute LBP. EudraCT number: 2019-003656-37; ClinicalTrials.gov Identifier: NCT05170841.

Prevalence and Association of Risk Factors for Plantar Fasciitis Among Nurses in Government Tertiary Care Hospitals of Peshawar

Background: Plantar fasciitis is a common cause of heel discomfort and pain, resulting from inflammation of the plantar fascia, a thickened fibrous aponeurosis extending from the medial calcaneal tuberosity to the metatarsal heads. It affects more than 1 million people worldwide annually, with a lifetime prevalence that may reach 10% of the general population. Despite its widespread impact, the exact incidence remains unknown. Objective: This study aimed to determine the prevalence and associated risk factors of plantar fasciitis among nurses working in government tertiary care hospitals in Peshawar. Methods: A cross-sectional survey was conducted over six months, utilizing a convenient sampling technique. A total of 332 female nurses aged 25 to 50 years with clinical duties exceeding five hours per day participated in the study. Data were collected using the Plantar Fasciitis Pain and Disability Scale and the Visual Analogue Scale (VAS) for pain intensity. Face-to-face interviews and physical assessments were conducted by trained healthcare professionals. Statistical analysis was performed using SPSS version 25.0, with descriptive statistics calculated for quantitative variables and Chi-Square tests used to examine associations between variables. Ethical approval was obtained from the Institutional Review Board, and informed consent was secured from all participants. Results: The mean age of participants was 29.8042 ± 3.67743 years. The mean total score for plantar fasciitis was 31.4096, and the mean VAS score was 1.9458. Pain occurrence per week was reported as 1-2 days by 44.0% of participants, 3-4 days by 46.7%, and 5-7 days by 9.3%. Pain was most commonly worse in the afternoon (35.8%) and interfered with walking occasionally (52.7%). High heel standing was uncomfortable for 54.5% of participants. A significant relationship was found between age and VAS scores (p=0.001), as well as between high heel usage and increased pain levels (p=0.000). Conclusion: The mean score of plantar fasciitis among the nurses was below the threshold indicating significant prevalence. However, a significant association was found between high heel usage and plantar fasciitis, suggesting that footwear choices play a critical role in the development of this condition. Ergonomic interventions promoting supportive footwear and regular breaks are recommended to mitigate the risk of plantar fasciitis among nurses.

The effects of smoking on pain scores, vital signs, and analgesic consumption in patients undergoing tympanomastoidectomy surgery.

In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18-55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke.

Prophylaxis of migraine without aura of liver yang hyperactivity treated with acupuncture at the points selected using the "seven lines of the neck" method: a randomized controlled trial

To observe the clinical effect of prophylaxis on migraine without aura differentiated as liver yang hyperactivity undergoing acupuncture at the points selected using the "seven lines of the neck" method. Fifty-eight patients with migraine without aura of liver yang hyperactivity at remission stage were randomly divided into an observation group (29 cases, 3 cases dropped out) and a control group (29 cases, 4 cases dropped out). In the observation group, acupuncture was delivered at Dazhui (GV 14), Fengfu (GV 16), bilateral Fengchi (GB 20), Gongxue (Extra), etc., selected using the "seven lines of the neck" method. In the control group, conventional acupuncture was applied to ashi point, Sizhukong (TE 23), Shuaigu (GB 8), Taiyang (EX-HN 5) and others on the affected side. The treatment was given once every other day or every two days, 3 interventions weekly, for consecutive 8 weeks. Before treatment, after 4 and 8 weeks of treatment, and after 4 weeks of treatment completion (follow-up visit), the days of migraine episodes, the frequency of migraine episodes, the score of visual analogue scale (VAS) for pain intensity, and the score of migraine specific quality of life questionnaire (MSQ) were observed in the patients of the two groups. Before treatment and after 8 weeks of treatment, the score of TCM syndrome was observed. After 4 and 8 weeks of treatment and after 4 weeks of treatment completion (follow-up visit), the response rates of 50% reduction in the days and the frequency of migraine episodes were calculated in the two groups. After 4 and 8 weeks of treatment and during follow-up visit, the days and the frequency of migraine episodes were decreased (P<0.01) and VAS scores were declined (P<0.01) when compared with those before treatment in the two groups. The days and the frequency of migraine episodes in the observation group were lower during the follow-up visit (P<0.05) and VAS scores were lower after 8 weeks of treatment and during the follow-up visit (P<0.05) when compared with those in the control group. After 4 and 8 weeks of treatment, and during follow-up visit, the scores of "role function-preventive" and "emotional function" of MSQ were increased in comparison with those before treatment in the observation group (P<0.05). After 8 weeks of treatment and during the follow-up visit, the scores of "role function-restrictive" of MSQ were increased in comparison with those before treatment in the observation group (P<0.05), and the scores of "role function-restrictive" "role function-preventive" and "emotional function" were higher when compared with those before treatment in the control group (P<0.05). After 8 weeks of treatment, the scores of TCM syndrome were decreased in comparison with those before treatment in the two groups (P<0.01). In the observation group, the response rate of 50% reduction in the days of migraine episodes after 8 weeks of treatment and that of the frequency of migraine episodes during the follow-up visit were higher than those of the control group (P<0.05). Acupuncture at the points selected using the "seven lines of the neck" method can reduce the days and frequency of migraine episodes and pain intensity, ameliorate the syndrome of TCM and improve the quality of life of the patients with migraine without aura of liver yang hyperactivity.

Relationship between disability and physical activity frequency after cervical spine surgery: A linear mixed model analysis.

There is a paucity of data on physical activity and its effects in patients after cervical spine surgery. This study aimed to examine the association between physical activity and disability in patients after cervical spine surgery while also considering age, sex, pain, and central sensitization (CS)-related symptoms. Participants included individuals with a cervical degenerative condition who had undergone surgery. Neck disability index, physical activity frequency, numerical rating scale for pain intensity, and short form of the CS inventory were recorded more than 1 year postoperatively. The linear mixed model was performed to examine the association between physical activity and disability. The responses of 145 participants were analyzed. The linear mixed model results showed that the stretching and light-intensity exercise frequency (β=-0.14, p= 0.039) was independently associated with disability, adjusted for age, sex, pain, and CS-related symptoms. Conversely, other physical activities, such as walking and muscle strength exercises, were not associated with a disability. The findings emphasize the importance of performing regular physical activity, regardless of pain and CS-related symptoms.

Effect of Hamstring Tightness, Back Pain and Disability on Sleep Quality

Background: Chronic low back pain (CLBP), defined as pain persisting for more than three months, is associated with disability, functional limitations, musculoskeletal issues, and sleep disturbances in many individuals worldwide. Objective: The main objective of this study was to determine the effect of hamstring tightness, pain intensity, and disability on sleep quality in patients with chronic low back pain. Methods: This cross-sectional study included 387 individuals aged 25-55 years, recruited from various orthopedic units. Data were collected using the Roland-Morris Questionnaire (RMQ) for disability, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, the Active Knee Extension (AKE) test for hamstring tightness, and the Numeric Pain Rating Scale (NPRS) for pain intensity. Statistical analysis was conducted using SPSS version 25. Descriptive statistics, including means and standard deviations, were calculated for quantitative variables, while frequencies and percentages were calculated for qualitative variables. Chi-square tests were performed to examine the associations between NPRS, RMQ, AKE scores, and PSQI scores, with a p-value of less than 0.05 considered statistically significant. Results: The mean age of the 387 participants was 41.67 ± 13.38 years; 233 were females (60.2%), and 154 were males (39.8%). The mean RMQ score was 11.45 ± 2.34, the mean PSQI score was 8.58 ± 2.60, and the mean NPRS score was 4.97 ± 1.37. The AKE test was positive in 34.6% of participants. Chi-square tests showed a significant positive association between NPRS and PSQI scores (p = 0.001), and between RMQ and PSQI scores (p = 0.048). However, the association between AKE scores and PSQI scores was not significant (p = 0.400). Conclusion: This study highlights the significant association between pain intensity, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain and disability adversely affect sleep quality, while hamstring tightness does not appear to have a significant impact. These findings underscore the importance of addressing pain and disability to manage sleep disturbances in this patient population.

Effects of mind-regulating acupuncture on pain, negative emotion and sleep quality in patients with postherpetic neuralgia： a randomized controlled pilot trial.

To observe the effect of mind-regulating acupuncture on pain intensity, sleep quality, negative emotion in patients with postherpetic neuralgia (PHN), and evaluate the clinical effect of mind-regulating acupuncture combined with surrounding needling and heavy moxibustion at Ashi points (Extra) in treatment of PHN. The patients with PHN were randomly divided into a control group (35 cases, 2 cases dropped out) and a comprehensive therapy group (35 cases). The patients in the control group were treated with surrounding needling and heavy moxibustion at Ashi points. In the comprehensive therapy group, the mind-regulating acupuncture therapy was delivered besides the treatment as the control group. The treatment was given once daily, one course of treatment was composed of 6 days and 2 courses were required in the 2 groups. Before and after treatment, the pain conditions were assessed using pain rating index (PRI), visual analogue scale (VAS) and present pain intensity (PPI), the negative emotions were assessed using Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD), and the sleep quality with Pittsburgh sleep quality index (PSQI). One week before and one week after treatment, the average sleep time was recorded. The therapeutic effect of 2 groups was evaluated. The effective cases of 2 groups were followed up in 2 months after treatment completion and the recurrence of neuralgia was recorded. There were no statistical differences in the above indicators between the 2 groups before treatment. After 2 courses of treatment, the scores of PRI, VAS, PPI, HAMA, HAMD and PSQI were reduced when compared with those before treatment in the patients of the 2 groups (P<0.05), and the average sleep time was increased (P<0.05). The scores of PRI, VAS, PPI, HAMA, HAMD and PSQI in the comprehensive therapy group, as well as the average sleep time were all improved when compared with those of the control group (P<0.05). The total effective rate in the comprehensive therapy group (34/35, 97.14%) was higher than that of the control group (27/33, 81.82%, P<0.05) and the recurrence rate was lower (［2/34, 5.88%］vs［8/27, 29.63%］, P<0.05). The combination of mind-regulating acupuncture with surrounding needling and heavy moxibustion at Ashi acupoint can effectively relieve PHN. Compared with the traditional surrounding acupuncture in pain area combined with moxibustion at Ashi points, this comprehensive therapy is more effective for ameliorating pain intensity, improving sleep quality and reducing negative emotions. It is also effective for declining the recurrence.

Measurement Error, Minimal Detectable Change, and Minimal Clinically Important Difference of the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale, and Pain Numeric Rating Scale in Patients With Chronic Pain

In both pain research and clinical practice, patient-reported outcome measures are used to assess dimensions of health. Interpreting these instruments requires understanding their measurement error and what magnitude of change has subjective importance for patients. This study estimated the standard error of measurement, 1-year minimal detectable change, and 1-year minimal clinically important difference (MCID) for the Short Form-36 Health Survey physical component summary and mental component summary, the Hospital Anxiety and Depression Scale subscales for anxiety symptoms and depression symptoms, and the numeric rating scale for past-week average pain intensity. MCIDs for these instruments have not previously been estimated in a large sample of chronic pain patients participating in interdisciplinary pain rehabilitation. Data were drawn from the Swedish Quality Registry for Pain Rehabilitation (n = 8,854 patients). MCID was estimated as average change and change difference based on 3 different anchors. MCID estimates were 2.62 to 4.69 for Short Form-36 Health Survey physical component summary, 4.46 to 6.79 for Short Form-36 Health Survey mental component summary, .895 to 1.48 for numeric rating scale, 1.17 to 2.13 for anxiety symptoms in the Hospital Anxiety and Depression Scale, and 1.48 to 2.54 for depression symptoms in the Hospital Anxiety and Depression Scale. The common assumption of an identical standard error of measurement for pre- and post-treatment measurements was not always applicable. When estimating MCID, researchers should select an estimation method and anchor aligned with the study’s context and objectives. PerspectiveThis article presents estimates of MCID and minimal detectable change for several commonly used patient-reported outcome measures among patients with chronic pain. These estimates can help clinicians and researchers to determine when a measured health improvement is subjectively important to the patient and greater than measurement error.

The use of an exoskeleton in the comprehensive rehabilitation of patients with impaired motor activity

Abstract. Purpose of the study: to evaluate the effectiveness of comprehensive rehabilitation of patients with impaired mobility using the E-Helper exoskeleton and a treadmill in a day hospital. Materials and methods. The study involved 42 patients with mobility impairments who underwent the third stage of medical rehabilitation in the day hospital at the Republican Medical and Physical Education Center, Ufa. The study participants were divided into two equal groups, comparable in terms of the main studied indicators. The patients in the control group (CG, n = 21) received a basic complex consisting of therapeutic exercises, mechanotherapy using the FISITEK 2000TS device, magnetic therapy from the ALIMP-1 device, and sessions with a psychologist. The patients of the study group (SG, n = 21) were additionally prescribed exercises on the exoskeleton and a treadmill for 30 minutes daily, 10 procedures per course. To analyze the effectiveness of rehabilitation, we used the modified Rankin scale and the Visual Analogue Scale (VAS) for pain intensity; to assess the patient»s locomotor function, the Hauser Ambulation Index and the EQ-5D quality of life questionnaire were utilized at the start of the study and at the end of the rehabilitation course (after 14 days). Results. It has been found that the use of an exoskeleton in the patients of the study group contributes to a more significant improvement in locomotor function, a decrease in functional dependence on external assistance, and an improvement in the quality of life of patients with impaired mobility compared to the control group.

Effects of focal muscle vibration on cervical pain in Parkinson's disease patients: a pilot study.

Musculoskeletal pain is a common symptom of Parkinson's disease (PD) that is not adequately treated with current dopaminergic drugs. This pilot study sought to investigate the effect of focal muscle vibration (fMV) on a group of Parkinson's disease patients suffering from chronic cervical pain. In addition to conventional physiotherapy, twenty-two patients with idiopathic Parkinson's disease (Hoehn and Yahr stages II-III) received three weeks of bilateral focal musclevibration to the trapezius muscles. The Visual Analogue Scale (VAS), the Short-form McGill, and the Present PainIntensity scales were used to assess pain at baseline (T0), after three weeks of treatment (T1), one week after the last treatment session (T2), and three weeks after T2 (T3). Pain intensity decreased significantly from baseline to T1 across all pain scales (p < 0.0001). Furthermore, the beneficial effect of fMV on cervical pain lasted up to one month after treatment. Our findings show that fMV, in combination with conventional physiotherapy, is effective at reducing pain intensity in PD patients, with results visible even after a month of follow-up.

Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial

ABSTRACT Purpose To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome. Methods Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention). Results After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05). Conclusion Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.

Physician Empathy and Chronic Pain Outcomes

Empathy is an aspect of the patient-physician relationship that may be particularly important in patients with chronic pain. To measure the association of physician empathy with pain, function, and health-related quality of life (HRQOL) among patients with chronic low back pain. This cohort study included adult enrollees from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation national pain research registry. Study dates were from April 1, 2016, to July 25, 2023, with up to 12 months of follow-up. Physician empathy was assessed with the Consultation and Relational Empathy measure and dichotomized to yield very empathic physician and slightly empathic physician groups. Main outcomes were patient-reported pain, function, and HRQOL measured with a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related disability, and the Patient-Reported Outcomes Measurement Information System for HRQOL deficits pertaining to anxiety, depression, fatigue, sleep disturbance, and pain interference. Data were collected at 5 quarterly encounters from registry enrollment through 12 months and analyzed with generalized estimating equations, including multivariable models to measure temporal trends and to adjust for baseline and longitudinal covariates. Among the 1470 patients, the mean (SD) age was 53.1 (13.2) years, and 1093 (74.4%) were female. Patients completed 5943 encounters in which multivariable analyses demonstrated that greater physician empathy was inversely associated with pain intensity (β = -0.014; 95% CI, -0.022 to -0.006; P < .001), back-related disability (β = -0.062; 95% CI, -0.085 to -0.040; P < .001), and HRQOL deficits on each measure (eg, pain interference: β = -0.080; 95% CI, -0.111 to -0.049; P < .001). Correspondingly, compared with the slightly empathic physician group, the very empathic physician group reported lower mean pain intensity (6.3; 95% CI, 6.1-6.5 vs 6.7; 95% CI, 6.5-6.9; P < .001), less mean back-related disability (14.9; 95% CI, 14.2-15.6 vs 16.8; 95% CI, 16.0-17.6; P < .001), and fewer HRQOL deficits on each measure (eg, fatigue: 57.3; 95% CI, 56.1-58.5 vs 60.4; 95% CI, 59.0-61.7; P < .001). All physician empathy group differences were clinically relevant, with Cohen d statistics ranging from 0.21 for pain intensity to 0.30 for back-related disability, fatigue, and pain interference. Physician empathy was associated with more favorable outcomes than non-pharmacological treatments, opioid therapy, and lumbar spine surgery. In this cohort study of adult patients with chronic pain, physician empathy was associated with better outcomes over 12 months. Greater efforts to cultivate and improve physician empathy appear warranted.

Reoperation Following Primary Greater Occipital Nerve Decompression Surgery: Incidence, Risk Factors and Outcomes.

Although nerve decompression surgery is an effective treatment for refractory occipital neuralgia (ON), a proportion of patients experience recurrence of pain and undergo reoperation. This study analyzes the incidence, risk factors, and outcomes of reoperation following primary greater occipital nerve (GON) decompression. 215 patients who underwent 399 primary GON decompressions were prospectively enrolled. Data included patient demographics, past medical and surgical history, reoperation rates, intraoperative findings, surgical technique, and postoperative outcomes in terms of pain frequency (days/month), duration (hours/day), intensity (scale 0-10), and migraine headache index (MHI). Bivariate analyses, univariable and multivariable logistic regression analysis was performed. 27 (6.8%) GON decompressions required reoperation with neurectomy at a median follow-up time of 15.5 months (9.8-40.5). Cervical spine disorders on imaging that did not warrant surgical intervention (OR, 4.88; 95% 1.61-14.79; p<0.01) and radiofrequency ablation (RFA) (OR, 4.20; 95% CI, 1.45-15.2; p<0.05) were significantly associated with higher rates of reoperation. At 12 months postoperatively, patients who underwent reoperation achieved similar mean reductions in pain frequency, duration, intensity and MHI, as compared to patients who underwent only primary decompression (p>0.05). Patients with ON who have a history of cervical spine disorders or RFA should be counseled that primary decompression has a higher risk of reoperation, but outcomes are ultimately comparable.

Psychometric evaluation of the Bengali brief pain inventory in a sample of Bangladeshi cancer patients

Pain is a common complain among oncology patients, and success of its management requires accurate assessment. However, the status of pain treatment in Bangladesh is largely undocumented. The purpose of this study was to evaluate the psychometric properties of the Bengali version of Brief Pain Inventory (BPI-Bengali) in a Bangladeshi sample of cancer patients. BPI-Bengali and the Questionnaire on Stress in Cancer Patients Revised (QSC-R 23) were administered to a convenience sample of 60 adult oncology patients receiving pain treatment. Cronbach alpha coefficients were 0.89 and 0.94 for the severity and interference items respectively. The Pearson correlation coefficients for the test-retest stability were 0.65 (p&lt;0.01) for the pain intensity scale and 0.88 (p&lt;0.01) for the pain interference scale. Exploratory factor analysis (EFA) yielded two components, indicating pain severity and interference clusters by explaining 75% of the variance. The confirmatory factor analysis indicated the model as moderate fit to the data (CFI=0.89, RMSEA=0.16). Convergent validity of the pain severity and interference was demonstrated by significant correlations with stress level (r=0.67, p&lt;0.01), (r=0.66, p&lt;0.01). The findings of this study support the psychometric properties of Bengali BPI among cancer population in terms of validity, reliability and factor structure. Dhaka Univ. J. Biol. Sci. 33(1): 99-108, 2024 (January)

Altered serum cytokines in patients with symptomatic disk herniation and depressive symptoms.

An increasing number of studies have indicated the important role of cytokines in the development of depressive disturbances (DD). In medically ill patients, cytokines can provoked sickness behavior, the signs of which resemble DD. This results in alterations in behavior to limit energy expenditure and redirect it to cope with particular diseases. The aim of our study was to investigate the role of pro-inflammatory IL-6, TNF-α, and IL-1β and anti-inflammatory IL-10 and TGF-β in DD observed in patients suffering from pain caused by disk herniation (DH) qualified for surgery. The intensity of DD assessed by using Beck Depression Inventory, pain intensity, and functional impairment were evaluated in 70 patients with DH who were qualified for surgery. Pro-inflammatory serum levels of TNF-α, IL-1, IL-6, anti-inflammatory TGF-β, and IL-10 were measured. Elevated serum levels of TGF-β, IL-10, and IL-6 were found in the group with moderate and severe depressive symptoms (SD) compared with the groups with mild (MD) or no depressive symptoms (ND). TGF-β levels were negatively correlated with pain intensity, as assessed using the Present Pain Intensity scale in SD. Functional impairment measured using the Oswestry Disability Index was the most advanced in SD group. Results of our study can suggest association between depressive disturbances and anti-inflammatory cytokines TGF-β and IL-10. Functional impairment of SD group is more severe but serum levels of TGF-β and IL-10, which are involved in the healing processes, are increased.

Outcomes of combined treatment of patients with acute lumbodynia

Introduction. Acute dorsalgia is a common reason to seek outpatient medical care in Russia. The clinical picture usually includes muscular-tonic and pain syndromes. The most common form of dorsalgia by localization is acute lumbar pain (lumbodynia).Aim. To evaluate the effectiveness of Spascuprel®, Traumeel S in the complex treatment of patients with acute lumbar pain in real-world clinical practice.Materials and methods. We conducted a non-interventional, prospective, observational study of 110 outpatients aged 26 to 65 years. Patients received a standard on-demand therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, Group 1 received Spascuprel® and Traumeel® C, and Group 2 received centrally acting muscle relaxants. The effectiveness of treatment was assessed using the visual analogue scale (VAS) of pain intensity and the limitations of various activities in daily living were measured using the Roland – Morris questionnaire. Consideration was given to the exacerbation duration, the need for additional intake of NSAIDs, and the number of cases of pain exacerbation within 60 days from the start of participation in the observational study.Results. Under treatment, pain intensity showed statistically significant decreases in VAS scores (from 61.0 to 35.5 scores out of 100 according to VAS by Day 7 and to 19.5 scores by Day 14 of treatment in Group 1, from 61.2 to 41.1 and to 25.8 scores in Group 2, respectively (p &lt; 0.05)). A more rapid decrease was observed in VAS pain intensity score from baseline in Group 1. Over 2-month observation period, group 1 had less exacerbations (p &lt; 0.05) and fewer cases of need for additional intake of NSAIDs (p &lt; 0.05). The frequency and severity of adverse events did not differ between two groups.Conclusion. A more rapid decrease in VAS pain intensity scores and reduction in the need for NSAIDs were noted in the group of patients with acute dorsalgia who used Traumeel® C and Spascuprel® in addition to standard NSAID therapy.

A Novel Therapeutic Approach of 980 nm Photobiomodulation Delivered with Flattop Beam Profile in Management of Recurrent Aphthous Stomatitis in Paediatrics and Adolescents-A Case Series with 3-Month Follow-Up.

Background/Objectives: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal lesions and a very debilitating lesion, especially in paediatric and adolescent patients. The current pharmacotherapy offers a pain relief but not without side effects, and therefore photobiomodulation (PBM) can be an alternative therapy. To the authors' best knowledge, no published study has explored the efficacy of λ 980 nm laser PBM in the management of all RAS subtypes in paediatric and adolescent patients, and therefore, this prospective observational clinical study was conducted to bridge this gap by evaluating λ 980 nm laser PBM efficacy in symptomatic RAS management in paediatric and adolescent patients. The objectives were to evaluate (1) pain intensity alleviation; (2) wound healing rate; (3) wound size closure; (4) a complete resolution; (5) evidence of recurrence; and (6) patients' treatment satisfaction. Methods: The study's variables were assessed at the following timepoints: T0: pre-treatment; T1: immediately after first PBM session; T2: 5 hours (h) post first PBM session (via telephone call); T3: immediately after second PBM session (three days post first PBM session); T4: three-day follow-up (after complete PBM treatments); T5: two-week follow-up; and T6: three-month follow-up. The following PBM dosimetry and treatment protocols were employed: λ 980 nm; 300 mW; 60 s; 18 J; CW; flattop beam profile of 1 cm2 spot size; 18 J/cm2; and twice-a-week irradiation (72 h interval). Results: At T1, significant immediate pain intensity relief was reported. 33.33% recorded "4" and 66.67% reported "5" on the quantitative numeric pain intensity scale (NPIS), and this continued to improve significantly (83.33%) at T2. All the subjects reported "0" on the NPIS at T3, T4, T5 and T6. There was a significant reduction in the lesion surface area (>50% complete healing) at T3 compared to T0. Complete healing (100%) with no evidence of scarring and lesion recurrence observed at T4, T5 and T6. Very good patients' satisfaction was reported at all timepoints. Conclusions: This is the first report demonstrating λ980 nm efficacy in all RAS subtype management in paediatric and adolescent patients with a 3-month follow-up, whereby its PBM dosimetry and treatment protocols were effective from scientific and practical standpoints, and hence multicentre RCTs with large data are warranted to validate its reproducibility and to enrich the knowledge of PBM application in all RAS subtypes.

Frequency of Neck Pain and Associated Disability in Medical Students

Background: Musculoskeletal disorders, particularly neck pain, have been increasingly documented among medical students due to their rigorous academic and clinical training demands. The impact of neck pain can lead to significant disability, affecting academic performance and quality of life. Prior studies have demonstrated varying prevalence across different geographies, indicating a need for further localized research. Objective: This study aimed to assess the prevalence of neck pain and its associated disability using the neck disability index among students of Akhtar Saeed Medical College and to compare these findings with global data. Methods: A cross-sectional descriptive study design was employed, involving 150 students from various medical programs. Data collection was conducted via a structured questionnaire including the Neck Pain Disability Index and the Visual Analog Scale for pain intensity. Ethical approval was obtained in line with the Helsinki Declaration. The sample size was determined statistically, and the collected data were analyzed using SPSS version 24.0. Statistical tests including independent t-tests and Chi-square tests were utilized to discern the significance of associations, with a p-value of less than 0.05 considered statistically significant. Results: Participants had an average age of 22.74±2.04 years, with a gender distribution of 58.7% female and 41.3% male. The mean score for neck pain disability was higher in females (21.33±6.45) compared to males (20.76±5.11), albeit non-significantly (p=0.562). The prevalence of neck pain in our sample (58.7%) was higher than in similar cohorts from Brazil (8.23%), Thailand (22.3%), and China (33.8%), yet comparable to Pakistan (44.8%), Australia (52.8%), and Central Saudi Arabia (54%). Approximately 22.7% of students reported neck pain that interfered with their normal activities. Conclusion: Neck pain was found to be prevalent among the medical student population, with a higher incidence in females. The study underscores the association between neck pain and disability, suggesting the need for preventive measures and interventions within the medical academic setting.