Numeric Rating Scale Pain Scores Research Articles

The Role of Professional Oral Hygiene in Enhancing Outcomes of Maxillofacial Trauma Surgery.

The oral cavity poses challenges in surgical interventions due to its microbial flora. Maxillofacial trauma surgeries are vulnerable to infections, complicating recovery. Traditional methods, including antibiotic prophylaxis, have limitations, highlighting the need for complementary strategies. This study evaluated the impact of professional oral hygiene protocol on infection rates, mucosal health, and pain levels in maxillofacial trauma patients. A retrospective study analyzed 529 patients treated for maxillofacial trauma at the Maxillo-Facial Surgery Unit of "Azienda Ospedaliera Ospedali Riuniti" in Ancona, Italy, from 2018 to 2023. Patients were divided into two groups: Period 1 (2018-2020, no protocol) and Period 2 (2021-2023, protocol implemented). All patients were in good general health, with no systemic diseases compromising immunity or influencing surgical outcomes. The protocol included supragingival scaling 48 hours preoperatively, chlorhexidine 0.20% three times daily postoperatively, and standardized antibiotic and analgesic regimens. Data included infection rates, modified Beck Oral Assessment Scores and Numerical Rating Scale pain scores. Statistical analyses included independent t-tests and Chi-square tests, with significance set at p < 0.05. Period 2 showed significantly lower infection rates (13.44% vs. 19.48%, p = 0.023), reduced pain scores (mean NRS: 4.6 vs. 5.4, p < 0.01) and improved mucosal health (mean BOAS: 2.91 vs. 3.75, p < 0.001). The professional oral hygiene protocol reduced postoperative complications, improved oral health, and enhanced patient comfort. These findings support the integration of structured oral hygiene measures into standard maxillofacial surgical care to optimize outcomes and quality of life.

Effect of virtual reality intervention on hospitalized patients with acute pain after thoracoscopic surgery: a pilot randomized clinical trial.

The study investigates the effectiveness of immersive virtual reality (VR) as a nonpharmaceutical approach to manage postoperative pain in patients following thoracoscopic surgery. In this single-center, triple-arm pilot randomized controlled trial (RCT), 61 postsurgical patients with a postoperative pain numerical rating scale (NRS) score ≥4 after receiving standard analgesia were included and assigned to either a quantum clinics-VR (QTC-VR) group, a Placebo-VR group, or a control group. The QTC-VR group engaged in a daily 10-minute interactive pain relief 3D-VR program, while the Placebo-VR group watched a daily 10-minute relaxation-based 2D film through VR headsets for three days following surgery. 61 postsurgical patients were randomized and allocated (21 in the QTC-VR group, 20 in the Placebo-VR group, and 20 in the control group) in the final intention-to-treat (ITT) analyses. Compared with patients receiving Placebo-VR intervention, patients reported significantly lower pain scores following the daily QTC-VR intervention on postoperative days 1 (mean difference,-0.889; 95% CI,-1.464 to -0.314; P < 0.001), 2 (mean difference,-0.631; 95% CI,-1.211 to -0.051; P =0.014), and 3 (mean difference,-0.798; 95% CI,-1.345 to -0.251; P < 0.001), respectively. Additionally, patients receiving QTC-VR intervention also reported high satisfaction and tolerable adverse events with their treatment. In conclusion, this pilot RCT demonstrates that QTC-VR might be a promising intervention for pain management post-thoracoscopic surgery, warranting further validation in ongoing phase III trials.

Two-year outcomes using fast-acting sub-perception therapy for spinal cord stimulation: results of a real-world multicenter study in the United States

ABSTRACT Background Fast-acting Sub-perception Therapy (FAST) is a novel spinal cord stimulation (SCS) modality delivering paresthesia-free pain relief. Our study evaluated the longer-term, real-world impact of FAST on chronic pain. Research design and methods As part of a multicenter, real-world, consecutive case series, we retrospectively identified patients who used FAST-SCS and analyzed their data. The numerical rating scale (NRS) was used to evaluate the overall pain. Results Data from 315 patients were analyzed at baseline and their last available follow-up (median 6.8 months after SCS implantation). At the time of the analysis, 12-, 18-, and 24-month data were available for 112, 86, and 50 patients, respectively. At the last follow-up, NRS pain score was reduced by 5.5 ± 2.5 compared to baseline (from 7.8 ± 1.7 to 2.3 ± 2.0; p < 0.0001). Interim long-term analysis showed that results were sustained for up to 2 years, with 64% of patients reporting a minimal overall pain score (NRS ≤2/10). Conclusion This ongoing, real-world, multicenter study showed that FAST-SCS achieved significant paresthesia-free pain relief, while long-term interim analysis suggests that outcomes could be sustained for up to 2 years. Our data provide preliminary insights into the potential utility of this low-frequency sub-perception SCS paradigm using a biphasic active recharge pulse shape. Trial registration ClinicalTrials.gov (CT.gov identifier: NCT01550575).

Comparison of Tibiofemoral and Patellofemoral Mobilization in Improving Pain, Rom and Functional Disability in Patellofemoral Pain Syndrome

Patellofemoral pain syndrome significantly impacts daily activities in adults. Physical therapy, including targeted exercises and both patellofemoral and tibiofemoral mobilization techniques, is a primary treatment approach for managing this condition.This study aimed to compare the effects of tibiofemoral and patellofemoral mobilization on pain, range of motion (ROM), and functional disability in patients with patellofemoral pain syndrome.A randomized controlled trial was conducted on 68 participants (n=34) at the Physiotherapy Department of Doctors Clinic, Samnabad, Lahore. The patients were randomly assigned into two groups: Group A received conventional treatment along with patellofemoral mobilization, while Group B received conventional treatment combined with tibiofemoral mobilization. The study spanned six months, with assessments conducted prior to treatment and weekly thereafter. Numeric Pain Rating Scale (NPRS) for pain, a goniometer for knee range of motion, and the Kujala scoring system for functional status used for assessment. The study results demonstrated significant improvements in NPRS scores, range of motion, and Kujala scores in both groups, with a p-value of 0.000. However, a comparison between the groups confirmed that conventional physiotherapy combined with patellofemoral mobilization yielded superior outcomes in reducing pain, improving range of motion, and enhancing functional status compared to tibiofemoral mobilization, with a p-value of &lt;0.05.The study concluded that patellofemoral mobilization, when combined with conventional physiotherapy, is an effective approach for reducing pain, improving range of motion, and enhancing functional status in individuals with patellofemoral pain syndrome.

Evaluating Treatment Preferences and the Efficacy of Capsaicin 179 mg Patch vs. Pregabalin in a Randomized Trial for Postsurgical Neuropathic Pain in Breast Cancer: CAPTRANE.

Background/Objectives: CAPTRANE evaluated the efficacy and tolerability of high-concentration capsaicin patch (HCCP) vs. oral pregabalin for the treatment of postsurgical neuropathic pain (PSNP) following breast cancer surgery. The study was designed with the aim of demonstrating noninferiority of one HCCP against daily pregabalin. Methods: This was a multicenter, randomized, parallel-arm, open-label study conducted across nine centers in France. The primary endpoint was a change from baseline in the Numeric Pain Rating Scale (NPRS) score after 2 months. Results: Recruitment challenges resulted in the randomization of 140 patients (versus 644 planned); the per-protocol population comprised 107 patients (HCCP: n = 65; pregabalin: n = 42). Baseline characteristics were similar between the two groups. In the per-protocol analysis, the mean (standard deviation) change versus baseline in NPRS score was -1.926 (2.554) with HCCP and -1.634 (2.498) with pregabalin. The prespecified analysis showed that HCCP was not inferior to pregabalin: the lower bound of the 90% confidence interval for the between-arm difference was -0.889 and the upper bound was +0.260 (i.e., below the predefined clinical threshold of +0.4). Patient-reported outcomes showed no statistically significant differences between treatments. The painful area size decreased significantly more with HCCP. Tolerability profiles differed, with HCCP mostly causing application-site reactions. While >50% of patients switched from pregabalin to HCCP, none switched from HCCP to pregabalin. Conclusions: This comparative study in PSNP post breast cancer surgery, evaluating a single treatment of HCCP, shows a noninferior reduction in pain intensity, a superior reduction in painful area size, and a patient preference for HCCP compared with pregabalin. Despite limitations, it contributes valuable initial data for PSNP management in breast cancer care.

Modified versus traditional subcostal anterior quadratus lumborum block for postoperative analgesia after laparoscopic nephrectomy: a randomized-controlled study.

To examine the ramifications of both the modified and traditional subcostal anterior quadratus lumborum block (SQLB) on postoperative analgesia in individuals undergoing laparoscopic nephrectomy. Forty-six individuals slated for elective laparoscopic nephrectomy under general anesthesia were randomly assigned to acquire either traditional or modified SQLB using 20mL of 0.5% ropivacaine. The primary outcome was intravenous morphine-equivalent intake during the first 24h following surgery. Secondary outcomes included sensory block dermatomes, numerical rating scale (NRS) scores, the total number of patient-controlled analgesia (PCA) demands, rescue analgesic use, and complications related to opioids and nerve block. The modified SQLB group had significantly lower morphine-equivalent consumption compared to the traditional SQLB group within the initial 24h after surgery (23.1 ± 4.3 vs. 34.7 ± 6.8mg, P < 0.001). The modified SQLB also resulted in a greater number of dermatome segments of sensory block at 5, 10, and 15min after block (P < 0.05), lower NRS pain scores at rest and during coughing at 6, 24, and 48h (P < 0.001), and reduced usage of rescue analgesics as well as total PCA demands (P < 0.05). No significant differences were observed in the incidence of complications related to opioids or the nerve block procedure between the two groups. Ultrasound-guided modified SQLB confers significantly superior analgesic advantages over the traditional SQLB for patients undergoing laparoscopic nephrectomy, culminating in a marked reduction in postoperative opioid consumption and more efficacious pain management.

Immediate effectiveness of condoliase chemonucleolysis for lumbar disc herniation: a comparative study between patients with difficulty walking because of severe leg pain and those who can walk.

Surgery is often the treatment of choice for lumbar disc herniation (LDH) with severe leg pain. This study aimed to investigate the efficacy of Condoliase chemonucleolysis (CC) in patients who were nonambulatory because of severe leg pain. A total of 58 patients who underwent CC for conservative treatment-resistant LDH were included in this study. Changes in the leg and lower back pain evaluated using the numeric rating scale (NRS) were retrospectively assessed at three time points (1 week, 1 month, and 3 months after treatment). Patients were divided into the ambulatory group (group A) and nonambulatory group (group N) based on their ambulatory status. The clinical and radiological findings including magnetic resonance images were compared between the two groups. Of the 58 patients, 16 (28%) who could not walk independently because of severe leg pain were included in group N. Group N showed significantly higher mean NRS score for leg pain (NRS-LP) before treatment than group A (group N, 7.9; group A, 6.8; p = 0.009). Changes in the mean NRS-LP from pretreatment to 1 week were significantly higher in group N (group N, 5.2; group A, 3.4; p = 0.02). In group N, the mean NRS-LP decreased significantly over time, and 69% of the patients were ambulatory after 1 week, 88% after 1 month, and 94% after 3 months. CC provides early pain relief and can be an immediate treatment option for patients who cannot walk independently because of severe leg pain.

Efficacy and safety of a novel cost-effective suspension arthroplasty technique compared to traditional trapeziectomy with abductor pollicis longus arthroplasty Once Looped Around (OLA)/ Once Looped Inside (OLI) in basal thumb arthritis

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; Trapeziometacarpal (TMC) joint osteoarthritis is a common source of wrist pain, predominantly affecting women aged 45 to 70 years. While traditional surgical options like trapeziectomy with abductor pollicis longus (APL) arthroplasty are effective, their limitations in advanced disease stages have led to the exploration of alternative techniques. This study compares the clinical outcomes of conventional trapeziectomy with APL arthroplasty to a novel personalized suspensory arthroplasty technique.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; A retrospective analysis was conducted on 150 patients with Stage III-IV TMC osteoarthritis who underwent either the conventional APL arthroplasty (n=65) or the novel suspensory arthroplasty (n=85) in the period between 2015 and 2018. Outcomes were assessed using the Numeric Pain Rating Scale (NPRS), Disabilities of the Arm, Shoulder, and Hand (DASH) scores, thumb range of motion, grip strength, and patient satisfaction. Statistical analyses included t-test, &amp;amp;chi;2 test, and repeated measures ANOVA.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; Both surgical groups demonstrated significant pain reduction and functional improvement postoperatively. The novel technique resulted in lower NPRS and DASH scores, greater thumb metacarpophalangeal joint flexion-extension, and higher patient satisfaction compared to the traditional method. The prevalence of complications, particularly flexor carpi radialis (FCR) tendinitis, was also lower with the novel technique. Radiographic assessments indicated stable joint positions postoperatively in both groups.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; The novel personalized suspensory arthroplasty technique offers superior clinical outcomes compared to traditional APL arthroplasty, with enhanced pain management, improved function, and reduced complications. This approach represents a cost-effective and minimally invasive alternative for advanced TMC osteoarthritis, leading to better patient satisfaction and faster recovery.&amp;lt;/p&amp;gt;

Comparison of postoperative analgesia between dezocine plus flurbiprofen axetil and sufentanil in patients with CRC undergoing tumor resection: A prospective, observational study.

Flurbiprofen axetil is a nonsteroidal anti-inflammatory drug used for analgesia. Its combination with dezocine has previously shown a superior postoperative analgesic effect compared with that of opioids. The present study compared the analgesic effect between dezocine plus flurbiprofen axetil (DFA) and sufentanil in patients with colorectal cancer (CRC) following resection of the tumor. The study was performed as a prospective, observational study. It included 107 patients who were treated using a patient-controlled analgesia (PCA) pump following the resection of CRC. Patients in the DFA group were given a loading dose of 5 mg dezocine and 50 mg flurbiprofen axetil, followed by PCA with a combination comprising 30 mg dezocine, 200 mg flurbiprofen axetil and 8 mg ondansetron. Patients in the control group were treated with sufentanil at a loading dose of 5-10 µg followed by PCA with a combination of 100 µg sufentanil and 8 mg ondansetron. The DFA group reported lower pain numerical rating scale scores at 2 h (2.4±1.2 vs. 2.9±1.2) and 12 h (2.0±1.0 vs. 2.5±1.2) and reduced rates of moderate-to-severe pain at 12 h (6.7 vs. 21.0%) compared with those in the control group. In addition, the number of PCA boluses in the DFA group was lower than that in the control group [median (interquartile range), 6.0 (4.5-8.5) vs. 8.5 (5.0-11.0)]. The total satisfaction rate was increased, albeit not significantly, in the DFA group compared with that in the control group (80.0 vs. 62.9%). The levels of tumor necrosis factor-α at 24 and 48 h, and of interleukin-6 at 24 h were decreased in the DFA group compared with those in the control group. The incidences of adverse events did not differ between the groups. These findings indicate that DFA provides more effective analgesia, improves patient satisfaction and reduces the levels of pro-inflammatory cytokines with similar adverse effects compared with those of sufentanil in patients after CRC resection.

Establishing the Patient-Acceptable Symptom State for the Numeric Rating Scale-Pain Score in a Postoperative Non–Shoulder Hand and Upper-Extremity Population

The patient-acceptable symptom state (PASS) is a threshold score on a patient-reported outcome measurement beyond which patients consider themselves "well." Our purpose was to establish the PASS for the numeric rating scale (NRS) for pain in a 1-year postoperative hand surgery population. This retrospective study included adult patients undergoing non-shoulder upper-extremity surgery at a single, tertiary medical center identified over a 9-month period. At 1 year after surgery, NRS pain and responses to a pain-specific anchor question were collected. Patients were dichotomized based on achieving "PASS(+)" or failing to achieve "PASS(-)" an acceptable symptom state based upon their response to a pain-specific anchor question. Threshold values of a PASS(+) state were calculated for the NRS pain score using the following three methods: (1) mean score of PASS(+) patients, (2) Tubach method (75th percentile threshold for PASS(+) patients), and (3) the Youden index (receiver operating curve analysis to maximize sensitivity and specificity). Of 233 included patients, mean age was 54 years (±17), and 58% (n= 136) were women. Mean NRS pain scores differed between PASS(+) and PASS(-) patients (0.7 ± 1.2 vs 3.8 ± 2.7, respectively). PASS(-) patients were more likely to be non-White and have a diagnosed psychiatric comorbidity. Patient-acceptable symptom state estimates ranged from 0.73 to 2.1 for NRS pain, depending on the calculation method (0.73 for the mean score method, 1.0 for the Tubach method, and 2.1 for the Youden index). The area under the curve for the Youden index method was 0.86 consistent with excellent discrimination. We propose the value of 2.1 to represent the PASS threshold for the NRS pain score in this population. This PASS value should be used when interpreting NRS pain score outcomes at a population level. This threshold is expected to yield excellent discrimination for patient satisfaction when applied to a postoperative hand surgery population.

Effects of epidural dexmedetomidine on patient-controlled epidural analgesia after total knee arthroplasty: a single-center, prospective, double-blind, randomized controlled study.

To evaluate the impact of adding epidural dexmedetomidine to low-concentration patient-controlled epidural analgesia (PCEA) on pain control and side effects in total knee arthroplasty (TKA). In this double-blind study, American Society of Anesthesiologists I to II patients undergoing TKA were assigned to receive 0.125% bupivacaine + fentanyl 4 µg/mL (group R) or 0.1% bupivacaine + fentanyl 2 µg/mL with an epidural injection of dexmedetomidine 1 µg/kg (group D). The primary outcomes were the effectiveness of postoperative pain control as assessed by the numeric pain rating scale (NRS) and the incidence of side effects. Secondary outcomes included hemodynamic parameters (systolic and diastolic blood pressure, heart rate), motor block assessment, sensory block duration, analgesia duration, and the need for additional analgesia. Both groups achieved similar pain control as indicated by NRS scores. However, group D experienced lower rates of urinary retention and pruritus, whereas sedation in the recovery room was greater in group D. Group R had significantly higher systolic pressure in the recovery room. group D exhibited significantly lower heart rates at 5 and 10 minutes. Low-concentration PCEA with epidural dexmedetomidine provides similar analgesia after TKA as high-concentration PCEA with fewer side effects.

The efficacy of acupuncture in relieving postoperative pain in patients with low simple anal fistula: Protocol of a prospective, randomised, controlled trial.

Anal fistula surgery often leads to postoperative pain, which can hinder recovery and negatively impact patients' quality of life. This prospective, randomised, controlled trial (RCT) aims to investigate the efficacy of acupuncture in alleviating postoperative pain and reducing the usage of analgesic medications following anal fistula surgery. This single-centre, patient-blinded, assessor-blinded, placebo-controlled randomised controlled trial (RCT) will be conducted at a tertiary referral hospital. A total of 66 patients with low simple anal fistula will be randomised at a 1:1 ratio to receive either acupuncture or sham acupuncture. The primary outcome is the difference in the numerical rating scale (NRS) pain score before and after acupuncture at 6 hours post surgery. The secondary outcomes include postoperative analgesic usage (Day 0 to Day 7), complications (including infection, urinary retention, and bleeding from Day 0 to Day 7, as well as delayed wound healing and recurrence within 3 months post surgery), sleep quality (PSQI from Day 0 to Day 7), psychological state (SDS and SAS on Day 0, Day 1, and Day 7), and overall recovery quality (QoR-15 on Day 1, Day 3, and Day 7). The statistical analysis of this trial will be conducted using SPSS software, validating the normality of data and the homogeneity of variance, and employing t-tests, Mann-Whitney U tests, chi-square tests, and repeated measures ANOVA to analyze baseline data, primary and secondary outcome indicators. This study aims to contribute to the expanding evidence base regarding the role of acupuncture in postoperative pain management. Through a comprehensive assessment of pain relief, analgesic usage, and other recovery-related outcomes, our findings will establish a foundation for standardizing acupuncture protocols specifically tailored for anal fistula surgery patients. The strengths of this trial are rooted in its rigorous randomised controlled trial (RCT) design, comprehensive outcome measures, and focused examination of a clinically significant issue. Ultimately, the findings of this trial have the potential to offer valuable insights into the utility of acupuncture as an adjunctive therapy for postoperative pain management among anal fistula patients, thereby informing future clinical practice and research directions. This study was registered in the China Clinical Trial Registry on June 1, 2024, with registration number: ChiCTR2400085178.

Erector spinae block reduces intraoperative and postoperative opioid consumption in patients undergoing laparoscopic sleeve gastrectomy: A randomized controlled trial

Background: Obese patients are at increased risk of postoperative respiratory complications because of sedatives and opioids. The erector spinae block is a novel regional block that has been used in different surgeries. It offers an easier approach and a better safety profile. This study aimed to assess the role of erector spinae plane block (ESPB) in reducing postoperative pain scores and opioid consumption in patients undergoing sleeve gastrostomies. Methods: Institutional committee approval was obtained for this randomized controlled trial. Inclusion criteria included patients aged between 18 and 65 years with American Society of Anesthesiologists (ASA) scores 1–3 who were scheduled to undergo laparoscopic sleeve gastrectomy under general anesthesia. Simple randomization using sealed opaque envelopes was used to allocate study patients to either of the two groups. The intervention group received erector spinae block using 0.2% ropivacaine just after induction of anesthesia while the control group did not receive a block. Primary outcome variables were pain scores during the first 24 hours after surgery. Results: A total of 60 patients were included in the study. There was no significant difference in the baseline characteristics between two groups. Numerical rating scale (NRS) pain scores in the postoperative period were lower in the ESPB group but there was no statistical significance. Intraoperative remifentanil consumption was statistically lower in the ESPB group compared to the control group (P &lt; 0.01). ESPB also reduced 24-hour opioid consumption (P = 0.002). There was no statistical difference in the incidence of adverse events between the two groups. Conclusion: The use of ESPB in laparoscopic sleeve gastrectomy patients is associated with a significant reduction in intraoperative and 24-hour postoperative opioid consumption. Trial registration ID The trial was registered with Clinicaltrials.gov as trial ID-NCT04368195.

Stepping up recovery: integrating patient reported outcome measures and wearable technology for 90-day rehabilitation following total hip arthroplasty.

There is conflicting data in the literature regarding the clinical utility of wearable devices. This study examined the association between patient reported outcome measures (PROMs) and step and stair flight counts obtained from wearable devices in postoperative total hip arthroplasty (THA) patients. Data was collected from a multicenter prospective longitudinal cohort study from October 2018 to February 2022. A smartphone-based platform with smartwatch was utilized for collection of daily step and stair flight counts. Subjects (N = 1644) completed the Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and numerical rating scale (NRS) pain scores preoperatively and at 1 and 3months postoperatively. Patients who reported living in a multi-level home (N = 931) were included in analysis of stair flight counts. Pearson correlation coefficients were calculated to determine correlations between step and stair flight counts with NRS pain and HOOS JR scores. Step counts demonstrated a weak negative correlation to NRS pain scores at preoperative (r = -0.15, p < 0.0001), 1-month (r = -0.15, p < 0.0001), and 3-months follow-up (r = -0.06, p = 0.05). Step counts demonstrated a weak positive correlation with HOOS JR scores at preoperative (r = 0.16, p < 0.0001), 1-month (r = 0.15, p < 0.0001), and 3-months (r = 0.13, p < 0.0001). Stair flight counts demonstrated a weak negative correlation with NRS pain preoperatively (r = -0.19, p < 0.0001) and at 1-month (r = -0.11, p = 0.003). Stair flight counts positively correlated with HOOS JR scores at preoperative (r = 0.24, p < 0.0001), 1-month (r = 0.15, p < 0.0001), and 3-months (r = 0.09, p = 0.02). The utilization of wearable technology can enhance the evaluation of patient outcomes after THA, primarily due to the observed correlation between data collected from wearables and PROMs. Our study highlights the importance of the use of objective data, in addition to subjective patient reported data, when analyzing postoperative patient progress, which propels forward the field of postoperative THA patient care.

Effect of Caudal Epidural Steroid Injection on Transforaminal Epidural Steroid Injection and Dorsal Root Ganglion Pulsed Radiofrequency in Recurrent Lumbar Disc Herniation.

Background/Objectives: Recurrent lumbar disc herniation (RLDH) refers to a lumbar disc herniation (LDH) that recurs at the same level, location, and side following surgical repair. This study aimed to evaluate the efficacy of transforaminal epidural steroid injection (TESI) and dorsal root ganglion pulsed radiofrequency (DRG PRF) therapy with and without caudal epidural steroid injection (CESI) for the treatment of lumbar radicular pain (LRP) associated with RLDH. Methods: This retrospective cohort study included 57 patients treated for RLDH in a hospital pain clinic between September 2022 and February 2024. A total of 27 patients received TESI and DRG PRF therapy (Group 1) and 30 patients received TESI, DRG PRF, and CESI therapy (Group 2). We evaluated patient age, sex, symptom duration, pain medication use, number of prior LDH operations, presence of stabilization on magnetic resonance imaging (MRI), intervention received, lumbar level and side of the intervention, and Numeric Rating Scale (NRS) pain scores before and at 1, 3, and 6 months post-procedure. Treatment success was defined as an NRS score at least 50% or 4 points lower than the pre-procedure score at post-procedure 6 months. Results: There was no significant difference in NRS scores between the groups during the 6-month follow-up period. Moreover, NRS scores did not differ based on the presence of stabilization on MRI or the use of pain medication (p > 0.05). Conclusions: TESI and DRG PRF therapy were effective in the treatment of LRP associated with RLDH over a 6-month follow-up period, and adding CESI did not increase treatment success.

A Retrospective Study of Ultrasound-guided Hydrodilatation of Glenohumeral Joint Combined with Corticosteroid Injection in Patients with Frozen Shoulder.

Objective The purpose of this study was to establish the efficacy of ultrasound (US)-guided hydrodilatation of the glenohumeral joint, in conjunction with corticosteroid injection, in alleviating pain and improving shoulder joint adhesion among patients with primary frozen shoulder (FS). Background: FS, also known as adhesive capsulitis, is a pathological condition characterized by pain and potential functional impairment. The natural progression of FS involves three distinct stages: freezing, frozen, and thawing. Chronic pain in FS patients can lead to aseptic inflammation, thickening of fibroblasts, and an abundance of type I and III collagen fibers in the vicinity of the glenohumeral joint, ligaments, and tendons. This condition significantly impacts patients' quality of life. Methods A total of 200 FS patients were enrolled in this study. All participants underwent US-guided hydrodilatation of the glenohumeral joint, combined with corticosteroid injection, at our department. Pre- and post-treatment (1 year) ultrasound measurements were recorded for the thickness of the axillary recess capsule (ARC), coracohumeral ligament (CHL), and subacromial bursa. Additionally, the numerical rating scale (NRS) and Constant-Murley score (CMS) were assessed to evaluate pain intensity and shoulder function, respectively. Results Prior to the commencement of treatment, the measurements indicated a thickness of 4.8±2.3 mm for the ARC, 4.2±1.7 mm for the CHL, and 3.9±1.4 mm for the subacromial bursa. Additionally, the preoperative assessment using the NRS scale for pain yielded a score of 6.4±2.0, while the CMS score for the joint function was 35.8±8.5. Following one year of treatment, a notable decrease was observed in the thickness of ARC, CHL, and subacromial bursa. Furthermore, significant improvements were recorded in both the pain NRS score and the CMS score. Conclusion US-guided hydrodilatation of the glenohumeral joint, in combination with corticosteroid injection, may help improve the symptom and function of FS.

Posterior-superior insula repetitive transcranial magnetic stimulation reduces experimental tonic pain and pain-related cortical inhibition in humans.

High frequency repetitive transcranial magnetic stimulation (rTMS) to the posterior-superior insula (PSI) may produce analgesic effects. However, the alterations in cortical activity during PSI-rTMS analgesia remain poorly understood. The present study aimed to determine whether tonic capsaicin-induced pain and cortical inhibition (indexed using TMS-electroencephalography) are modulated by PSI-rTMS. Twenty healthy volunteers (10 females) attended 2 sessions randomized to active or sham rTMS. Experimental pain was induced by capsaicin administered to the forearm for 90 minutes, with pain ratings collected every 5 minutes. Left PSI-rTMS was delivered (10 Hz, 100 pulses per train, 15 trains) ∼50 minutes postcapsaicin administration. Transcranial magnetic stimulation-evoked potentials (TEPs) and thermal sensitivity were assessed at baseline, during capsaicin pain prior to rTMS and after rTMS. Bayesian evidence of reduced pain scores and increased heat pain thresholds were found after active rTMS, with no changes occurring after sham rTMS. Pain (prior to active rTMS) led to an increase in the frontal negative peak ∼45 ms (N45) TEP relative to baseline. After active rTMS, there was a decrease in the N45 peak back to baseline levels. In contrast, after sham rTMS, the N45 peak was increased relative to baseline. We also found that the reduction in pain numerical rating scale scores after active vs sham rTMS was correlated with and partially mediated by decreases in the N45 peak. These findings provide evidence of the analgesic effects of PSI-rTMS and suggest that the TEP N45 peak is a potential marker and mediator of both pain and analgesia. This study demonstrates that high-frequency rTMS targeting the posterior-superior insula reduces capsaicin-induced pain and alters cortical activity, with changes in the N45 TMS-evoked potential peak mediating the analgesic effects.

EFFECTS OF CONCENTRIC EXERCISES WITH AND WITHOUT MULLIGAN WRIST MOBILIZATION ON PAIN, GRIP STRENGTH, RANGE OF MOTION AND FUNCTION AFTER DISTAL RADIUS FRACTURE

Background: Distal radius fractures are among the most common orthopedic injuries, often requiring effective rehabilitation strategies to restore function and mobility. Mulligan’s mobilization with movement (MWM) is widely used in musculoskeletal rehabilitation but requires further investigation to understand its effectiveness in improving outcomes following distal radius fractures. This study aimed to evaluate the effects of adding MWM to a conventional concentric exercise regimen on pain, grip strength, range of motion (ROM), and wrist function in patients with distal radius fractures. Objective: To determine the impact of Mulligan’s mobilization with movement combined with concentric exercises on pain, ROM, grip strength, and wrist function compared to concentric exercises alone in patients with distal radius fractures. Methods: A single-blinded randomized controlled trial was conducted at DHQ Hospital Sheikhupura. Twenty patients with distal radius fractures were randomly divided into two groups: Group A (n=10) received concentric exercises combined with MWM, and Group B (n=10) received concentric exercises alone. Treatment was administered three times a week for one month. Pain, wrist function, grip strength, and ROM were assessed using the Numeric Pain Rating Scale (NPRS), Patient-Rated Wrist Evaluation (PRWE), dynamometer, and goniometer, respectively. Assessments were conducted pre- and post-intervention. Statistical analysis was performed using SPSS, with significance set at p&lt;0.05. Results: Group A showed significantly better improvements in all variables except ulnar deviation. NPRS scores improved from 5.40±1.42 to 1.50±0.52 in Group A compared to 6.50±1.35 to 2.50±1.08 in Group B (p&lt;0.05). PRWE scores decreased from 54.6±9.53 to 30.6±7.18 in Group A and from 63.10±14.75 to 44.40±13.85 in Group B (p&lt;0.05). Grip strength increased from 3.30±0.94 to 11.20±1.39 in Group A versus 2.10±0.73 to 4.20±1.22 in Group B (p&lt;0.05). ROM significantly improved in Group A for flexion, extension, radial deviation, pronation, and supination (p&lt;0.05), while ulnar deviation showed no significant difference between groups (p&gt;0.05). Conclusion: Adding Mulligan’s mobilization with movement to a conventional concentric exercise regimen significantly improved pain reduction, wrist function, grip strength, and most ROM measures compared to concentric exercises alone, except for ulnar deviation. This approach can be an effective rehabilitation strategy for patients with distal radius fractures.

Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study.

The aim of this study was to assess the impact of the external oblique intercostal block (EOIB) on early postoperative pain in patients who underwent laparoscopic cholecystectomy. 120 patients were divided into two groups: the EOIB group (Group E) and the control group (Group C). The assessed variables were mainly intraoperative remifentanil usage, numerical rating scale (NRS) pain scores at 0, 1, 2, 4, 6, 12, and 24 h postoperatively, cumulative fentanyl consumption within 24 h postoperatively and within the first-hour post-anesthesia care unit. Remifentanil consumption during surgery was significantly reduced in Group E compared to Group C. Postoperative fentanyl requirements were also lower in Group E at 1 and 24 h after surgery. Furthermore, Group E demonstrated significantly lower NRS scores at 0, 1, 2, 4, and 6 h postoperatively and a reduced need for rescue analgesia compared to Group C. However, at 12 h post-surgery, Group E's NRS scores were slightly higher than Group C's. The EOIB is associated with reduced pain within the first 24 postoperative hours following laparoscopic cholecystectomy.

Combination of ultrasound-guided pectoral nerve block I and serratus anterior plane block for attenuation of surgical stress response during modified radical mastectomy: A prospective interventional randomized controlled trial

Background: General anesthesia with multimodal analgesia is the standard anesthetic management during modified radical mastectomy. In this study, a combined ultrasound-guided pectoral nerve block (PECS I) and serratus anterior plane (SAP) block were used for surgical stress response attenuation and post-operative analgesia. Aims and Objectives: This study aimed to compare the efficacy of combined PECS I and SAP block to intravenous (IV) multimodal analgesia in attenuating surgical stress response and post-operative analgesia in patients who underwent modified radical mastectomy with axillary clearance. The primary objective was to estimate the intraoperative fentanyl requirement to reduce autonomic response due to surgical stimulus. The intraoperative vitals, post-operative numeric rating scale pain score, post-operative analgesic use in the recovery room, and incidence of post-operative nausea vomiting were the secondary objectives. Materials and Methods: Thirty-six consenting patients were randomized into two groups. After induction of general anesthesia, Group B patients received ultrasound-guided PECS I and SAP block whereas Group C patients received IV analgesics only. Intraoperative fentanyl dosage to keep the systolic blood pressure (SBP) and heart rate (HR) within 20% of baseline were noted in the both groups. Intraoperative vitals, post-operative pain score, analgesic requirement, and incidence of post-operative nausea, and vomiting were also recorded in the both groups. Results: Surgical stress response attenuation was achieved with a lower dosage of fentanyl in Group B compared to Group C (intraoperative fentanyl [mean±SD], 116.11±25.70 μg vs. 134.44±20.07 μg, P=0.023). Compared to Group C, intraoperative reduction in SBP and HR was higher in Group B (SBP reduction [mean±SD], 24.03±12.5 mm of Hg vs. 15.2±13.05 mm of Hg, P=0.045 and HR reduction [mean±SD], 18.61±6.6 beats/min vs. 10.73±10.03 beats/min, P=0.009, respectively). The apparently higher pain scores in the control group were statistically insignificant. Conclusion: A combined PECS I and SAP block attenuates intraoperative autonomic stress response due to the surgical stimulus with significantly less opioid requirement.