Pain Severity In Patients Research Articles

Ranolazine Versus Allopurinol for Eligible Symptomatic Patients With a History of Angioplasty: Comparative Efficacy Study.

Recurrent angina, which is defined as a return of chest pain or chest discomfort, occurs in many patients undergoing coronary interventions. This study aims to compare the antianginal efficacy of ranolazine versus allopurinol for eligible symptomatic patients with a history of angioplasty. A total of 62 eligible symptomatic patients with a history of angioplasty were randomly allocated into two groups. For group A, 300 mg of allopurinol was administered twice daily, while for group B, 1000 mg of ranolazine daily was prescribed for a duration of 4 weeks. An initial screening visit was done for all participants where patients' medical history was recorded and a physical examination was given; electrocardiography, blood pressure, and heart rate measurements were done as well. The patients were also given a blood and exercise test. At the end of the medication period, participants were revisited, and the tests were done again. All the required data were collected via a researcher-made form, and data analysis was conducted using SPSS. The study was approved by a formal ethics committee. The mean age of participants in the two groups (A and B) was 57.36 (SD 8.36) and 60.27 (SD 9.17) years, respectively. Among the 62 patients, 34 (59%) were men, while 28 (41%) were women. Creatinine, fasting blood sugar, C-reactive protein, N-terminal prohormone of brain natriuretic protein, uric acid, white blood cell, and hemoglobin levels of participants were not significantly different between groups (P>.05). Both allopurinol and ranolazine increased the total exercise time and decreased the ST depression of the patients. Additionally, they both improved the chest pain severity and Duke Treadmill Score of patients. At the same time, ranolazine had a statistically greater effect on ST depression reduction (mean 2.64, SD 0.74 vs mean 1.57, SD 0.49), while allopurinol showed better efficacy in reducing chest pain severity (mean 1.86, SD 0.37 vs mean 0.59, SD 0.21) and the Duke Treadmill Score (mean -14.77, SD 3.65 vs mean -6.88, SD 1.93). Based on the results, the antianginal efficacy of allopurinol and ranolazine was approved but with different effects on ST depression, chest pain severity, and the Duke Treadmill Score. Therefore, the precise differences in their effects need to be explored further.

Effects of Pamidronate Disodium Combined with Calcium on BMD Values and Severity of Pain in Elderly Patients with Osteoporosis Based on Mobile Terminal Platform for Internet of Things.

Objective To explore the effects of pamidronate disodium combined with calcium on BMD values and the severity of pain in elderly patients with osteoporosis based on the mobile terminal platform for the Internet of Things. Methods The data of 120 patients admitted to our hospital from January 2019 to December 2020 were retrospectively analyzed. According to the patients' condition and medication wills, they were divided into the experimental group (n = 68) and the control group (n = 52). All patients were given chronic disease management based on the mobile terminals for the Internet of Things, and they received the treatment of bisphosphonates and calcium, with the supplement of calcium at a daily dose of 1000 mg. The control group was given alendronate sodium once a week, and the experimental group was given pamidronate disodium by intravenous infusion three times a month, with the treatment cycle as 1 year. The patients' bone mineral density (BMD) values and the pain indexes were compared after treatment. Results There was no statistical difference in general information between the two groups (p > 0.05). The BMD values of the lumbar vertebrae L2-4, total hip, and femur neck at 6 months and 1 year after treatment in the experimental group were significantly higher than those in the control group (p < 0.001). The pain scores at 6 months and 1 year after treatment in the experimental group were significantly lower than those in the control group (p < 0.001). Conclusion The treatment of pamidronate disodium combined with calcium based on the mobile terminal platform for the Internet of Things can reduce the severity of pain in elderly patients with osteoporosis and improve the BMD, which has a generalization value.

The Effect of Preoperative Sublingual Melatonin on Postoperative Pain Severity in Patients Undergoing Colorectal Surgery: A Triple-Blinded Randomized Trial.

Background: Postoperative pain has detrimental physiologic and psychologic effects on patients’ outcomes, such as increased postoperative morbidity, delayed recovery, and reduced patient satisfaction. This study aimed to determine the effect of preoperative sublingual melatonin on pain severity after colorectal surgery. Methods: We performed a randomized, placebo-controlled, triple-blinded study to test the efficacy of 6 mg of sublingual melatonin or placebo 1 hour preoperative on pain severity and sedation of 60 patients after colorectal surgeries. Pain and sedation were assessed by numerical verbal response (NVR) and the Ramsey sedation score, respectively, at the baseline, 1, 2, 6, 12, and 24 hours after surgery. The repeated measures analysis of variance was used to assess group × time interaction, and the Bonferroni adjustment was used for between-group comparisons. Results: A total of 60 patients with a mean ± SD age of 49.35 years were equally randomized to the study groups. There was no significant difference between groups with respect to the baseline characteristics. The mean score of pain severity of patients in the melatonin group was significantly lower compared with the placebo group at 2, 6, 12, and 24 hours after surgery. The total mean pain score for the first 12 hours (mean difference [MD] [SE], 0.41 [0.12]; 95% CI, 0.17-0.65; [P = 0.012]) and the mean score of pain in 24 hours after surgery were significantly lower in the melatonin group in comparison with the placebo group (MD [SE], 0.44 [0.13]; 95% CI, 0.19-0.69; [P = 0.001]). Compared with the placebo group, the percent of patients who were cooperative, aware, and calm was significantly higher in the melatonin group at the baseline (43.3% vs 53.3%) and at 1 (36.7% vs 60%) and 2 hours (33.3% vs 80%). Conclusion: The use of 6 mg preoperative melatonin sublingual tablet in patients with colorectal surgeries could reduce the severity of postoperative pain, patients’ restlessness and anxiety, and increase patients' cooperation and calmness. Therefore, it seems that sublingual melatonin is an effective drug in controlling postoperative pain.

Analysis of Fast-Track Surgery with Pain Care on Postoperative Pain Improvement and Complication Prevention in Perioperative Spine Surgery Patients.

Objective The study aimed to analyze the effect of fast-track surgery with pain care on the improvement of postoperative pain and the prevention of postoperative complications in perioperative spinal surgery patients. Methods A total of 126 patients undergoing spinal surgery from January 2021 to September 2021 were chosen as the study population, and the patients were classified into the regular group, the FTS group, and the combined group by random grouping, with 42 cases in each group. Patients in the regular group used routine perioperative care in spine surgery, patients in the FTS group used the FTS care model, and patients in the combined group combined special pain care on the basis of the FTS group. We compared the numeric rating scale (NRS) and pain severity of patients in the three groups post-op, 30 min, 1 h, 3 h, 6 h, and 24 h after surgery; we compared the time to get out of bed, length of stay, and occurrence of postoperative adverse effects in the three groups, compared the incidence of complications in the three groups, and compared the satisfaction of care in the three groups. Results The NRS scores at 12 h, 24 h, 48 h, and 72 h post-op in the combined group and FTS group were lower than those in the regular group, and the NRS scores at 12 h and 24 h post-op in the combined group were lower than those in the FTS group (all P < 0.05); the post-op bed activity time, post-op hospitalization time, post-op adverse reaction rate, and post-op complication rate in the combined group and FTS group were shorter or lower than those of the regular group. Nursing satisfaction was higher than that of the regular group, the post-op time to bed activity in the combined group was shorter than that of the FTS group, and nursing satisfaction was higher than that of the FTS group (all P < 0.05). Conclusion The use of FTS with pain care interventions helps relieve postoperative pain in perioperative patients in spine surgery, reduce the incidence of post-op adverse effects and complications in patients, accelerate their postoperative recovery, and improve nursing satisfaction.

O087 Potential diagnostic biomarkers for congenital vascular malformations

Abstract Introduction To identify potential diagnostic serum biomarkers, particularly those pertaining to the processes of inflammation and angiogenesis in patients with congenital vascular malformations (CVM). Methods Isolated sera from the peripheral bloods of consented healthy controls (n = 10) and patients diagnosed as having either low-flow (LF) (n = 10) or high-flow (HF) (n = 10) CVMs. Various mediators of inflammation and angiogenesis were analysed in the sera using the Inflammation 20-Plex and Angiogenesis 18-Plex Human ProcartaPlex™ Panels. Analysis was conducted via Kruskall-Wallis test and correlated with lesion volumes and visual analogue scores for pain using the Spearman rank correlation test. Results Compared to healthy controls, the inflammatory mediators E-selectin, IFNa, IFNg, IL1b, IL4, IL12, IL17, MIP1a, MIP1b and TNFa were elevated in the sera of LF CVM patients, whereas only MIP1a was raised in the sera of HF CVM patients. None of the angiogenic mediators were altered in the sera of patients with LF or HF CVMs. Serum IFNa, IFNg, IL4, IL12, TNFa, VEGFA, VEGFD and syndecan correlated positively with pain scores in patients with LF CVMs, whereas only IP10 did in patients with HF CVMs. Serum Ang1 and leptin correlated negatively with lesion volumes in patients with LF or HF CVMs, respectively. Conclusion Serum inflammatory mediators could be used to distinguish LF from HF CVMs and their expression seemed to be associated with pain severity in patients with LF CVMs. The angiogenic mediators Ang1 and leptin were associated with lesion volumes in patients with LF or HF CVMs, respectively. Take-home message Serum inflammatory mediators could be used to distinguish LF from HF CVMs and their expression seemed to be associated with pain severity in patients with LF CVMs. The angiogenic mediators Ang1 and leptin were associated with lesion volumes in patients with LF or HF CVMs, respectively.

Comparison of clinical findings and electromyography results in patients with preliminary diagnosis of carpal tunnel syndrome

ObjectiveTo evaluate the link between EMG findings and clinical status, the Boston questionnaire and the severity of pain in patients with pre-diagnosis of carpal tunnel syndrome. MethodsA total of 85 patients (133 hands) who presented to the Physical Therapy and Rehabilitation outpatient clinic consecutively with complaints of numbness, tingling, pain and weakness in their hands were evaluated for their demographic and clinical features. After the initial evaluation, the diagnosis of CTS was confirmed by EMG. Visual analog scale (VAS), the Boston Questionnaire (Symptom Severity Scale = SSS, Functional Status Scale = FSS) and nerve conduction study results (sensory conduction velocity = SCV, distal motor latency = DML, compound muscle action potential = CMAP) were enrolled. ResultsEighty-five patients (58 female and 27 male) participated in this study yielding 133 hands (73 right hands, 60 right hands) with CTS. The mean age was 48.3 ± 10.41 years. Of all patients, 68.2 % were female and 31.8 % were male. A statistically significant relationship was found between SSS and duration of symptoms, VAS, both right and left SCV, DML and CMAP. A statistically significant relationship was found between FSS and duration of symptoms, VAS and only right SCV, DML and CMAP. ConclusionThe diagnosis of CTS should be evaluated not only as an electrodiagnostic finding, but also the clinical picture of the patients. According to our results, both SSS and FSS had good correlations with VAS and the findings of EMG. Therefore, the Boston Questionnaire can provide a standardized measure of symptom severity and functional status in patients with CTS.

Effectiveness of Mindfulness-based Stress Reduction (MBSR) on Patients With Chronic Pain: A Randomized Clinical Trial

Objectives: This research aims to investigate the effectiveness of mindfulness-based stress reduction (MBSR) on pain intensity, anxiety, depression, and quality of life (QoL) of patients with chronic pain via randomized clinical trials. Methods: The study population consisted of all patients with chronic pain referred to Imam Reza Hospital. Of these patients, 50 cases who met the inclusion criteria and were willing to participate in the study were selected through convenience sampling and randomly assigned to the experimental (n=25) or control groups (n=25). After selecting the patients and randomly assigning them to the two groups, the research questionnaires were completed by the patients before and after the treatment. After obtaining a written consent letter from the research participants, the experimental group received MBSR therapy (8 weekly sessions) while the control group did not receive any intervention. The questionnaires included the numeric pain rating scale (NPRS), the World Health Organization quality of life (WHOQOL) (WHOQOL-BREF), the Beck anxiety inventory (BAI), and the Beck depression inventory-2nd edition (BDI-II). To comply with the ethical principles, after the end of the study, MBSR therapy was administered to the control group as well. The data were analyzed via analysis of variance and multivariate analysis of covariance in the SPSS software, v. 19. Results: The results of the analysis showed that MBSR therapy reduces pain severity, anxiety, and depression in patients with chronic pain (P&lt;0.05). The findings also showed that MBSR therapy improves the QoL of patients with chronic pain (P&lt;0.05). Conclusion: Along with the common medications for chronic pain, MBSR therapy can be used to improve the QoL and reduce the severity of pain, anxiety, and depression in patients with chronic pain.

COMPUTER ELECTROACUPUNCTURE FOR IRRITABLE BOWEL SYNDROME: EFFICACY AND SEARCH FOR EFFICACY PREDICTORS

Non-pharmacological treatment modalities, in particular, a new technique in reflexology – computerized electroacupuncture (CEAP), allow us to increase the efficacy while treating patients with irritable bowel syndrome (IBS). Search for predictors of CEAP efficacy in IBS will optimize the choice of patients for treatment, improving the CEAP efficacy profile. &#x0D; The aim of the study is to evaluate CEAP efficacy in the complex therapy of various clinical IBS forms.&#x0D; Materials and Methods. The study involved 80 IBS patients. Patients of the main group underwent three courses of CEAP in addition to standard pharmacological therapy, patients of the reference group received only pharmacotherapy. At the beginning and at the end of each CEAP course, the severity of pain syndrome (visual analogue scale), stool frequency, stool consistency (Bristol stool scale), and subjective state indicators (Zung Self-Rating Depression Scale, Spielberger-Khanin test) were assessed.&#x0D; A retrospective analysis of the research results was carried out to search for predictors of CEAP efficacy. The impact of such parameters as patient’s gender, age, disease form and severity on treatment outcome was assessed.&#x0D; Results. After the first CEAP, the severity of abdominal pain in patients of the main group decreased from 6.1 mm to 3.9 mm and after the third CEAP to 3.7 mm. After three courses of CEAP, defecation frequency in IBS patients with diarrhea decreased from 4.7 to 1.9 per day, and in IBS patients with constipation increased from 0.26 to 0.77 per day. The proportion of patients with normal stool consistency increased significantly both among patients with constipation and among those with diarrhea to 47.1 and 55.6 %, respectively. &#x0D; Retrospective analysis showed the best treatment results in patients with mild and moderate IBS.

Effect of Topical Sesame Oil on the Severity of Pain in Patients With Limb Trauma: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to investigate the effect of topical use of sesame oil on pain severity in patients with limb trauma. MethodsA placebo-controlled randomized controlled trial was conducted on 120 patients with nonpenetrating upper and lower limb traumas admitted to the trauma emergency department. The patients were allocated to either the sesame oil group or the placebo group using the stratified random sampling technique based on trauma size and age. Depending on the trauma area, sesame or placebo oil were poured on the trauma site and massaged for 5 to 7 minutes. The intervention was repeated twice a day for 3 days at home. Pain severity was measured using the numeric pain scale before intervention on the first day and 30 minutes after each intervention for 3 days, twice a day. Data were analyzed using descriptive and analytical tests including the independent t test, χ2 test, Fisher exact test, Mann-Whitney U test, Friedman test, and multiple linear regression analysis. The significance level was set at 0.05. ResultsThe decreasing trend of pain was significant in both the intervention and placebo groups (P < .001). Comparison of the trend of changes in pain scores between the 2 groups showed that the mean changes of pain severity were higher in the intervention group compared with the placebo group in all assessments. There was a significant difference in the rate of analgesic consumption in the intervention group compared with the placebo group (P < .001). However, there was no significant difference between the 2 groups regarding pain severity. Pain reduction was negatively associated with body mass index (b = –0.091, P = .003), amount of received pain medication (b = –0.001, P = .039), and area of trauma (b = –0.002, P = .039). Pain reduction was greater in male patients than female patients (b = 0.676, P = .015). The effect of sesame oil on pain changes was not significant. No adverse side effects were reported. ConclusionThis study showed that despite less use of analgesics in the intervention group than in the placebo group, sesame oil did not have any statistically significant effects on the severity of limb trauma pain. Further research is needed regarding the effect of topical sesame oil application on pain as a safe and uncomplicated intervention.

Predictors of abdominal pain severity in patients with constipation-prevalent irritable bowel syndrome.

Symptoms of irritable bowel syndrome (IBS) have been associated to altered colonic motility and sensation. Smoking affects pain perception and is a risk factor in the development of post-infectious IBS, but its effect on abdominal pain and colonic transit remains to be elucidated in IBS. Forty patients with IBS-C and 28 with IBS-M were selected based on Rome IV criteria. Colonic transit time was studied and smoking habit was recorded. Presence of mild or severe abdominal pain and the prevalent pain characteristics (diffuse or localized, chronic or acute, with cramps or gradually distending) were recorded. Data were analyzed by univariate and stepwise multiple logistic regression analysis to verify the risk association between pain and all other variables. IBS-C patients had a longer transit time in the right colon and scored more chronic pain than IBS-M patients. When severity of abdominal pain was used as discriminating factor, a significant number of subjects reporting severe pain were males and smokers (16/30 vs. 4/38 and 20/30 vs. 4/38, both ƿ<0.001). Multivariate analysis confirmed that smoking was an independent factor associated with severe abdominal pain (OR 14.3, CI 2-99, p=0.007). Smoking was not associated with colonic transit times and colonic transit was not associated with IBS symptoms' severity (both ƿ=N.S.). Smoking was the only factor independently associated with severe abdominal pain. As smoking does not seem to affect colonic transit time, we suggest that smoking may influence visceral perception and symptoms severity in IBS patients.

Pain and Spiritual Distress at End of Life: A Correlational Study.

Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

Diagnostic value of oxidative stress markers in patients presenting with primary dysmenorrhea to the emergency department.

Primary dysmenorrhea (PD) is a common presentation for emergency departments. This study investigates the diagnostic value of oxidative stress and ischemia markers in patients with PD. The participants were classified into the PD group (patients with PD) and the control group (healthy volunteers). Thiol/Disulfide Homeostasis (TDH) parameters (Ds, Disulfide; NT, Native Thiol; TT, Total Thiol) and serum ischemia modified albumin (IMA) levels of the groups were measured. The Numeric Rating Scale (NRS) was used for pain assessment. Bivariate correlation analysis was performed to test the relationship between NRS and oxidative stress parameters. A P < 0.05 was considered significant. A total of 135 patients (PD group, n = 83; Control group, n = 52) were included in the study. PD group had statistically higher oxidant biomarkers (Ds level, Ds/NT ratio and Ds/TT ratio) and lower antioxidant biomarkers (NT/TT ratio) compared to the control group (p = 0.001; 0.003; 0.002, and 0.002, respectively). Serum IMA level in the PD group was higher than in the control group (P = 0.000). There was a positive correlation between IMA and NRS score (r = 0.342, P < 0.01), but no correlation was found between the other oxidative stress parameters and NRS. PD is characterized by increased oxidative stress and ischemia in the endometrium, which can be detected by TDH parameters and serum IMA. NRS score in PD patients is positively correlated with serum IMA level, which suggests IMA level can be valuable to determine the severity of endometrial ischemia and pain in patients with PD.

Biopsychosocial Evaluations of Pain and Opioid Administration in the Emergency Department in Cancer Patients

This aim of this study was to evaluate the association of medical, surgical, sociodemographic, and psychological factors with pain severity, pain interference, opioid administration and subsequent hospital admission in cancer patients presenting to the ED with pain. Cancer patients presenting to the ED with a complaint of acute pain (> 4/10 NRS) completed validated self-report measures assessing sociodemographic, cancer and medical history, pain (BPI), and psychosocial factors (depression, anxiety, pain catastrophizing, and sleep disturbance). ED pain scores, opioid administration (converted to MME/hour) and inpatient admission were abstracted from the medical record. Univariable analyses were conducted to individually compare predictors with outcomes, and significant predictors were used to build multivariable models for each predictor. Patients (n=175) were 55% female, predominantly white (81%), frequently had metastatic disease (76%), and 42% reported current outpatient opioid use for pain. On multivariable regression analyses, only current outpatient opioid use was independently associated with all pain-related outcomes (severity, interference, and MME/hour). Higher catastrophizing and sleep disturbance were both significantly associated with greater pain severity and interference. History of chronic pain prior to cancer diagnosis, depression, and income were significantly associated only with pain severity, and greater formal education and greater anxiety were associated only with pain interference. No significant associations were observed for hospital admission. Patients' medical, sociodemographic, and psychosocial characteristics were variably associated with worse pain severity and interference, opioid administration in the ED, with multivariable analyses suggesting ongoing outpatient opioid use and psychosocial variables are important predictors of pain outcomes. Our findings suggest that a more person-centered assessment of potential pain modulators may help identify individuals with cancer whose analgesic regimen would benefit from optimization and targeted multimodal and preventive analgesic therapies. Grant support from The National Palliative Care Research Center Kornfeld Scholars Award and a grant from the NIH (NIH/NIGMS: R35 GM128691).

Effects of propolis supplementation on irritable bowel syndrome with constipation (IBS-C) and mixed (IBS-M) stool pattern: A randomized, double-blind clinical trial.

BackgroundRecent evidence indicates that propolis can modulate gastrointestinal (GI) function. This trial aims to assess the efficacy of propolis supplementation on the severity of irritable bowel syndrome (IBS) symptoms.MethodsThis clinical trial was conducted on 56 subjects with IBS diagnosed by Rome IV criteria. Eligible subjects were randomly assigned to receive either 900 mg/day of propolis or matching placebo tablets for 6 weeks. The IBS symptom severity scale (IBS‐SSS) was used to evaluate IBS severity in five clinically applicable items.ResultsAfter adjusting anxiety scores, a significant reduction was observed in the overall score of IBS symptoms (−98.27 ± 105.44), the severity of abdominal pain (−24.75 ± 28.66), and the frequency of abdominal pain (−2.24 ± 3.51) with propolis treatment as compared to placebo (p‐value < .05). Patients in the propolis group were 6.22 times more likely to experience improvement in IBS symptoms than those in the placebo group (95% CI: 1.14–33.9; p‐value: .035). There was no significant change in anthropometric measurements and dietary intakes in both groups (p‐value > .05).ConclusionsOur results showed that propolis supplementation might have a beneficial effect on constipation subtype of IBS (IBS‐C) and mixed subtype of IBS (IBS‐M) severity by reducing the severity and frequency of abdominal pain in patients with irritable bowel syndrome (IBS).

The Effectiveness of Facet Joint Local Corticosteroid Injection in Diagnosis and Treatment of Facet Joint Syndrome

Objectives: To evaluate outcomes of lumbar facet joint injection with local corticosteroid in treatmentof chronic low back pain according to Oswestry disability Index(ODI).Patients and Methods: Interventional prospective study on 23 patients attended the outpatient clinic ofOrthopedic Surgery in Cairo University Hospitalscomplaining of chronic low back pain not responsiveto medical treatment and physiotherapy from September 2018 to august 2019.Results: The mean age of the patients was 41.17 ± 9.74 years and 47.8% were males. Facet jointcorticosteroid injection resulted in significant reduction of pain severity of patients as it ranged 5:10(mean 7.3 ±1.5) pre-injection and improved to 0 :6 (mean 3.6 ± 1.7) 3-month post injection(Pvalue:0.001)while the ODI score ranged 26:80 (mean 47.4 ±15.7) pre-injection and improved to 4:46 (mean 28.8 ±10.4) three months post injection(Pvalue 0.001).Conclusion: intra-articular facet joint injection is crucial in the diagnosis and treatment of facet jointsyndrome.

The effect of Hugo point acupressure massage on respiratory volume and pain intensity due to deep breathing in patients with chest tube after chest surgeries

IntroductionHugo point is the most important pain control point in the body, so the study was performed to determine the effect of Hugo point massage on respiratory volume and the pain intensity after chest tube placement. Materials and methodsThe study was performed as a randomized crossover clinical trial on 61 patients with a chest tube. Patients were placed in every 2 h through the ternary permutation block once under a false point pressure, once under a Hugo point pressure, and once without intervention. Data were collected using a questionnaire of demographic, clinical information, the Numerical Pain Rating Scale, and spirometry. Analysis of variance with repeated measures was used to analyze the data. FindingsThere was no significant difference in the pain intensity before and during the intervention between the three groups. However, after the intervention, the mean pain intensity in the control group was higher than the Hugo and placebo groups (P < 0.001), and the mean pain intensity in the placebo group was higher than in the Hugo group (P < 0.001). There was no significant difference between the three groups in terms of the rate of ascent and retention time of spirometry ball the three times before, during, and after the intervention. ConclusionHugo point massage reduces the pain intensity; however, has no significant effect on their respiratory volume. Hugo point massage is recommended to reduce the severity of pain in patients with chest tube.

Correlations between Age, Pain Intensity, Disability, and Tactile Acuity in Patients with Chronic Low Back Pain.

Objective Chronic low back pain is an overwhelming problem for a wide range of people and leads to tactile acuity deficits. We aimed to investigate the correlations among age, pain severity, disability, and tactile acuity in patients with chronic low back pain by using multiple tactile acuity tests. Methods A total of 58 participants (36.40 ± 14.95 years) with chronic low back pain were recruited, and two-point discrimination, point-to-point test, and two-point estimation were performed on their painful low back areas. The correlations between age, pain intensity, disability, and tactile acuity were characterized with Pearson's correlation coefficients. Subgroup analyses according to the median values of age, pain intensity, and disability were used to compare the intergroup difference in tactile acuity. Results Results illustrated significant negative associations among age, pain intensity, disability, and tactile acuity. Subgroup analyses revealed that patients with below-the-median values of age, pain intensity, and disability had better performance in tactile acuity tests than those with above-the-median values. Conclusion This study indicated that tactile acuity was negatively associated with age, pain intensity, and disability in young patients with chronic low back pain.

Self-Efficacy Is Inversely Associated with Pain Rumination and Pain Severity in Chronic Low Back Pain

BACKGROUND: Chronic low back pain is a major cause of disability, lost wages, and high health care costs. Increased pain rumination and lower resilience have been shown to be associated with increased pain severity. In contrast, higher levels of self-efficacy may benefit patients with chronic low back by reducing pain severity. Objectives: To examine the influence of self-efficacy on the relationship among pain rumination, resilience, and pain severity in patients with chronic low back pain. Methods: A sub-sample of participants from a previous cross-sectional study were evaluated and consisted of men and women (N=19) with chronic low back pain (> 6 months) enrolled from an outpatient pain clinic.

Perioperative management of acute pain by multimodal analgesia after laparoscopic sleeve gastrectomy: A prospective cohort study

BackgroundBariatric surgery has been shown to be the most effective treatment in achieving and maintaining weight loss and reducing obesity-related morbidities. Adequate measurement and control of pain allows for better postoperative outcomes and substantial reduction of complications, especially in subjects with morbid obesity. The aim of this study was to investigate the efficacy of postoperative analgesia via the utilization of a multimodal approach and to determine predictors of postoperative pain severity in patients undergoing laparoscopic sleeve gastrectomy (LSG). MethodsThis is a prospective cohort study designed to evaluate a perioperative multimodal analgesia protocol (i.e. subcutaneous/subfascial and intraperitoneal instillation of Ropivacaine; nonsteroidal anti-inflammatory agents; paracetamol and minimal dose of oral opioids) in subjects undergoing LSG. Evaluation of postoperative analgesia was performed at 1, 4 and 24 h after surgery through employment of chromatic visual analogue scales (VAS). ResultsBetween February and June 2019, a total of 48 consecutive patients affected by morbid obesity (mean BMI 41.83±5.51 kg/m2) underwent LSG. Mean operative time was 106±31.56 min. Only 8 patients (16.6%) required Morphine rescue in order to bring VAS at rest to ≤5. Pearsons’ coefficient showed a negative pCO2 correlation before surgery and both VAS scores measured at rest and during activity at different time points. P/F ratio and pCO2 measured before surgery were strong predictors of VAS >5 at rest and during activity (AUC=0.981 and AUC=0.980, respectively). ConclusionsThe identification of pain predictors could aid in foreseeing those patients requiring supplementary analgesia. Hence, a tailored analgesia protocol could be performed for each patient, improving pain management and perioperative outcomes. A multimodal analgesic protocol appears to represent the gold standard in the treatment of acute postoperative pain, especially in patients with morbid obesity, who require a rapid retrieval of physiologic functions in order to reduce the risk of postoperative complications.

Patient Race, Ethnicity, Language, and Pain Severity in Primary Care: A Retrospective Electronic Health Record Study

BackgroundPatient race, ethnicity, and culture including language are intertwined and may influence patient reporting of pain severity. PurposeTo describe documentation of patient's self-reported pain presence and severity by race, ethnicity, and language, specifically, Spanish, Hmong, Lao, or Khmer requiring an interpreter or English. Design and SampleRetrospective, electronic health record clinical data mining study of 79,195 patient visits with documented pain scores from one primary care clinic. MethodsHurdle regression was used to explore the effect of race, ethnicity, and language on the chances of having any pain (vs. no pain) and pain severity for visits with pain scores ≥1, controlling for age, sex, and documentation of a pain diagnosis. Mann-Whitney tests were used to explore the influence of English vs. non-English language on pain severity within a race or ethnicity category. ResultsPain scores were higher for limited English proficiency, compared with English-speaking, patients within the Asian race or Hispanic/Latino ethnicity category. Older age, female sex, pain diagnosis, Black or African American race, and Spanish or Lao language increased the chance of having any pain. These same factors, plus American Indian or Alaska Native race, contributed to higher pain severity. Asian race, in contrast, decreased the chance of reporting any pain and contributed to lesser pain severity. ConclusionsRace, in addition to a new area of focus, language, impacted both the chances of reporting any pain and pain severity. Additional research is needed on the impact of language barriers on pain severity reporting, documentation, and differences in pain outcomes and disparities.