Pain Severity Scores Research Articles

Dry Eye Symptoms and Signs in US Veterans With Gulf War Illness

To examine dry eye (DE) symptoms and signs in individuals with vs without Gulf War illness (GWI). Prospective cross-sectional study. We performed a prospective, cross-sectional study of South Florida veterans who were active duty during the Gulf War era (GWE; 1990-1991) and seen at an eye clinic between October 1, 2020, and March 13, 2021. Veterans were split into 2 groups: those who met Kansas criteria for GWI (cases, n=30) and those who did not (controls, n=41). DE symptoms were assessed via standardized questionnaires whereas DE signs were assessed using a series of ocular surface parameters. Differences between groups were assessed via Mann-Whitney U test. Linear regression analyses were used to examine which GWI symptoms most closely aligned with DE symptoms. Veterans with GWI had higher DE symptoms scores compared to controls (Ocular Surface Disease Index [OSDI] scores: mean 41.20±22.92 vs 27.99±24.03, P=.01). In addition, veterans with GWI had higher eye pain scores compared with controls (average eye pain over past week: 2.63±2.72 vs 1.22±1.50, P=.03), including on neuropathic ocular pain questionnaires (Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 17.33±17.20 vs 9.63±12.64, P=.03). DE signs were mostly similar between the groups. GWI symptoms "nausea or upset stomach" (β=14.58, SE=3.02, P < .001) and "headache" (β=7.90, SE=2.91, P=.011) correlated with higher OSDI scores. Individuals with GWI have more severe DE symptoms and ocular pain scores but similar tear and ocular surface parameters compared to controls without GWI. This finding suggests that mechanisms beyond tear dysfunction drive eye symptoms in GWI.

Does the use of ultrasound guidance during percutaneous Achilles tendon tenotomy improve outcomes of clubfoot management? A randomized controlled trial.

Achilles tenotomy is a crucial aspect in the non-operative management of clubfoot as per Ponseti's casting protocol. Achilles tenotomy is routinely carried out percutaneously in a blind manner without any image guidance. This study aimed to determine the role of ultrasound-guided percutaneous Achilles tenotomy (PAT) in improving outcomes in clubfoot management. There are no previous studies that have explored the role of image guidance in PAT. This prospective, single-center randomized control trial included 50 clubfoot cases (74 feet) planned for PAT at a mean age of 30.2 months. A single experienced senior surgeon performed tenotomies. Patients were randomized to two groups, with the tenotomies performed under ultrasound guidance in one group (test group) and PAT carried out without image guidance in the other (control) group. Outcome measures assessed included rate of complications, immediate postoperative FLACC score for pain severity and Pirani score at a minimum follow-up of 12 months. There were no significant differences in the complication rates between the test and control groups regarding bleeding, nerve injury and incomplete tenotomies. The mean pain FLACC score was significantly higher in the control group (PAT without image guidance) (P = 0.03), suggesting that the child would better tolerate the ultrasound-guided procedure. All patients in both groups had a Pirani score of zero and plantigrade feet at final follow up, with no relapses. Ultrasound-guided PAT does not have any added advantage over PAT with clinical examination without image guidance in terms of long-term outcomes. Level of evidence: Therapeutic level II.

Platelet-rich Plasma for Refractory Coccydynia: A Case Report

Introduction: Coccydynia is a common syndrome characterized by pain localized to the tailbone that radiates into the lower sacrum and perinium. Coccydynia affects female patients more frequently than male patients. It occurs more commonly after direct trauma from fall directly onto the coccyx. The pain is caused commonly by the strain of sacrococcygeal ligament or fracture of the coccyx and less commonly secondary to arthritis. Conservative treatment of coccydynia include simple analgesics and foam donut to prevent irritation to sacrococcygeal ligament. If pain persist, usually ganglion impar block and radiofrequency are alterative options. There are no strong evidence to support coccygectomy.&#x0D; Case Report: A 40-year-old presented with coccygeal pain for more than six months. The patient was seen at the pain clinic in Prince Sultan Military Medical City after failure of conservative and multiple steroid injections followed by radiofrequency therapy. We discussed with the patient a trial of a platelet-rich plasma (PRP) injection into the sacrococcygeal ligament under fluoroscopic guidance with full details endorsed to the patient including the risks and benefits of the procedures and informed consent signed before the injection. Pain severity score was taken before and about one month after each injection. The patient received a total of three PRP injections.&#x0D; Result: The patient reported about 30%, 70%, and 85% pain reduction after the first, second, and third injection, respectively. At six months, the patient continued to experience the same level of reduced pain without the use of regular pain medications.&#x0D; Conclusion: PRP can be considered as an option for the treatment of patients with refractory coccydynia.

Impact of Cannabis Use on Least Pain Scores Among African American and White Patients with Cancer Pain: A Moderation Analysis.

IntroductionBased on many published reports, African American patients with cancer experience higher pain severity scores and lower pain relief than White patients. This disparity results from undertreatment of pain and is compounded by low adherence to prescribed non-opioid and opioid analgesics among African American patients with cancer. While nearly one in four patients use cannabis to manage cancer-related symptoms, less is known about how cannabis use influences pain relief in this patient population.MethodsThis study is based on preliminary data from an ongoing study of longitudinal outcomes of opioid therapy among African American and White patients with cancer. Linear mixed-effects models were utilized to assess the interaction of race and cannabis use on pain relief using “least pain” item scores from the Brief Pain Inventory (BPI) averaged across three time points. Models were adjusted for sociodemographic and clinical variables.ResultsThis analysis included 136 patients (49 African American, 87 White). Overall, 30.1% of the sample reported cannabis use for cancer pain. The mean “least pain” score on BPI was 3.3 (SD=2.42) on a scale of 0–10. African American patients had a mean “least pain” score 1.32±0.48 units higher (indicating lower pain relief) than White patients (p=0.006). Cannabis use did not have a significant main effect (p=0.28). However, cannabis use was a significant moderator of the relationship between race and “least pain” (p=0.03). In the absence of cannabis use, African Americans reported higher “least pain” scores compared to Whites (mean difference=1.631±0.5, p=0.001). However, this disparity was no longer observed in African American patients reporting cannabis use (mean “least pain” difference=0.587±0.59, p=0.32).ConclusionThese findings point to the possible role of cannabis in cancer pain management and its potential to reduce racial disparities. These findings are preliminary and further research into the role of cannabis in cancer pain outcomes is needed.

Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis

ObjectiveSeveral factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported...

The predictive trifecta? Fatigue, pain, and anxiety severity forecast the suffering profile of children with cancer.

Fatigue, pain, and anxiety, symptoms commonly experienced by children with cancer, may predict pediatric symptom suffering profile membership that is amenable to treatment. Three latent profiles (Low, Medium, and High symptom suffering) from 436 pediatric patients undergoing cancer care were assessed for association with three single-item symptoms and socio-demographic variables. Pediatric-PRO-CTCAE fatigue, pain, and anxiety severity scores at baseline were highly and significantly associated with the Medium and High Suffering profiles comprised of PROMIS pediatric symptom and function measures. The likelihood of membership in the Medium Suffering group was 11.37 times higher for patients who experienced fatigue severity than those with did not, while experience of pain severity increased the likelihood of the child's membership in the Medium Suffering profile by 2.59 times and anxiety by 3.67 times. The severity of fatigue increased the likelihood of presence in the High Suffering group by 2.99 times while pain severity increased the likelihood of the child's membership in the High Suffering profile by 6.36 times and anxiety by 16.75 times. Controlling for experience of symptom severity, older patients were more likely to be in the Higher or Medium Suffering profile than in the Low Suffering profile; no other socio-demographic or clinical variables had a significant effect on the latent profile classification. Clinician knowledge of the strong association between fatigue, pain, and anxiety severity and suffering profiles may help focus supportive care to improve the cancer experience for children most at risk from time of diagnosis through treatment.

Intravenous fosphenytoin therapy for rescue of acute trigeminal neuralgia crisis in patients awaiting neurosurgical procedures: A cross-sectional study

Few treatments exist for acute attacks of trigeminal neuralgia. Therefore, this study aimed to investigate the efficacy and safety of an intravenous fosphenytoin therapy protocol in a trigeminal neuralgia crisis. We conducted a single-center, retrospective, observational study of the records of 20 patients with trigeminal neuralgia who received intravenous fosphenytoin therapy (15 mg/mL in normal saline at 50 mg/min for 15 min, total 750 mg) during hospitalization between September 2015 and August 2020. Serum phenytoin concentration was measured 30 min post-infusion. Pain severity was evaluated using a numerical rating scale and was analyzed for statistical significance. The mean age of the patients was 67.5 years (female, 50.0%). The median numerical rating scale score (interquartile range) of pain severity was 2.35 (0–10), 0.65 (0–5), 0.15 (0–1), 2.00 (0–8), and 4.30 (0–10) at 15, 30, and 60 min, and 12 and 24 h, respectively (p < .001); the numerical rating scale score was 10 before treatment. Reduction in pain 24 h following treatment was significant. The mean phenytoin concentration was 12.8 μg/mL 30 min post-treatment. While mild dizziness occurred in four patients, all could walk independently within 60 min. The mean age and weight of patients with mild dizziness were significantly higher and lower, respectively (p < .001), than those of other patients. These results may provide physicians with new insights into the innovative therapeutic option of intravenous fosphenytoin and contribute to advancements in treating acute trigeminal neuralgia crisis.

Anaesthesia in PROstate Biopsy Pain Obstruction Study: A Study Protocol for a Multicentre Randomised Controlled Study Evaluating the Efficacy of Perineal Nerve Block in Controlling Pain in Patients Undergoing Transperineal Prostate Biopsy.

Introduction: Transperineal prostate biopsy is as effective as the transrectal biopsy in detecting prostate cancer and has a lower risk of infection. However, concerning the procedural pain of the transperineal route, a higher level of anaesthesia is needed, which prevents this approach from being widely used. Although several methods of local anaesthesia to relieve pain during transperineal biopsy have been described, few well-designed trials have been conducted to assess the efficacy of local anaesthesia.Methods: This is a prospective, multicentre, randomised controlled study in men suspected of having prostate cancer and planning to undergo transperineal prostate biopsy. The aim of this trial is to determine whether the perineal nerve block and periprostatic block relieve pain to different extents in men undergoing transperineal biopsy. The main inclusion criteria are men aged between 18 and 80 years old, a prostate-specific antigen (PSA) level of 4–20 ng/ml, or/and suspicious rectal examination findings. A sample size of 190 participants, accounting for a 10% loss, is required. All participants will be randomly allocated at a ratio of 1:1 to the perineal nerve block (n = 95) and periprostatic block groups (n = 95). The primary outcome will be the level of the worst pain experienced during the transperineal prostate biopsy procedure, which will be measured by a numerical rating scale (NRS). The key secondary outcomes will include the pain severity score at 1, 6, and 24 h after prostate biopsy.Results: The primary outcome is the level of the worst pain experienced during the prostate biopsy procedure. The main secondary outcomes are as follows: (1) Post-biopsy pain severity score at 1, 6, and 24 h after the prostate biopsy; (2) Changes in blood pressure, heart rate and breathing rate during the biopsy procedure; (3) External manifestations of pain during biopsy; (4) Anaesthesia satisfaction; (5) The detection rate for clinically significant prostate cancer and any prostate cancer.Conclusion: Anaesthesia in PROstate biopsy Pain Obstruction Study (APROPOS) is randomised controlled trial aiming to determine the efficacy of the perineal nerve block in controlling pain in patients undergoing prostate biopsy via the transperineal approach.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04501055.

Application of Quality Control Circle Activity in Improving Effectiveness of Drug Intervention in Lung Cancer Patients with Moderate to Severe Pain.

Lung cancer has the highest incidence and mortality of all malignant tumors in China. Cancer pain dramatically affects patients' comfort level, causing insomnia, anorexia, anxiety, fear, depression, and a decline in the quality of life (QOL). The literature suggests a shortage of adequate cancer pain management for 59.1% of patients in China. The quality control circle (QCC) activity reflects the people-oriented core idea of management. This study aimed to assess the efficacy of QCC in enhancing the effectiveness of drug interventions in lung cancer patients with moderate to severe pain. From January 2019 to July 2019, lung cancer patients with moderate to severe pain were treated with drugs. The total number of drug interventions was 3072. A QCC activity was performed following the ten steps of the plan-docheck- act (PDCA) model. The reasons for the poor effectiveness of drug intervention in lung cancer patients with moderate to severe pain were analyzed. Countermeasures were designed to improve the effectiveness of drug intervention, including setting up a pain college, writing a medication education manual, and formulating operational rules for the administration of narcotic drugs. The effectiveness of drug intervention in lung cancer patients with moderate to severe pain and activity ability scores of QCC members were analyzed statistically before and after QCC activity. The effectiveness of drug intervention was investigated and compared before and after establishing the QCC. After establishing the PDCA model, the effectiveness of drug intervention for moderate to severe pain in lung cancer patients increased from 56.28% to 85.29%. Members had significant improvement in problem-solving ability, responsibility, communication, coordination, self-confidence, team cohesion, enthusiasm, QCC skills, and harmony. QCC activity can significantly improve the efficiency of drug intervention in lung cancer patients with moderate to severe pain and their quality of life.

Assessment of Postoperative Pain and Opioid Consumption Following Laryngeal Surgery: A Pilot Study

Adult voice center patients who had recently undergone laryngeal surgery were included in this retrospective review. Tylenol #3 had been prescribed for all patients for pain management and they had been instructed to take additional over-the-counter acetaminophen as needed. In the senior author's (RTS) practice, patients are asked routinely to report pain severity and analgesic use during postoperative visits. All patients who had this information available were included in the cohort. Opioid medication consumed, over-the-counter medication consumed, and pain level (scale of 0-10 with 10 being most severe) were analyzed over the first week postoperatively. There were 43 patients (19 male, 24 female) included in the retrospective cohort (average age = 46.8 ± 18.6, range = 18-82). Procedures performed included vocal fold mass excision (48.8%), type I thyroplasty (27.9%), laser vaporization of vascular lesions (11.6%), laser stenosis resection (9.3%), and VF medialization injection with abdominal fat harvest (7.0%). Overall, voice surgery patients reported mild to moderate pain (2.1-4.7 out of 10). An average of 13.2 ± 2.8 T3 tablets were prescribed for pain management (range = 10-20), and no patient required more T3 tablets than the number provided. Sixteen patients (37.2%) supplemented or substituted their T3 medication for it with OTC acetaminophen. No patients used non-steroidal anti-inflammatory drugs (NSAIDs) for supplemental pain management. Consumption of both T3 pain medication (r = 0.444) and OTC acetaminophen (r = 0.274) was correlated significantly with postoperative pain severity (P < 0.001). When stratified by type of surgical procedure performed, one-way ANOVA (F = 2.749, P = 0.043) and post-hoc Games-Howell test revealed that the patients who underwent type I thyroplasty reported a significantly higher (P = 0.041) pain severity score than patients who underwent vocal fold mass excision (4.7 versus 2.1, respectively). No significant differences in pain severity existed between other procedures (P > 0.05). There were no significant differences between type of procedure performed for number of T3 tablets prescribed, number of T3 tablets taken, or number of OTC tablets taken (P > 0.05). Younger age was correlated significantly with a higher number of OTC tablets consumed (r = -0.316, P = 0.039). Women consumed more OTC pain medications than men. Most patients in this study reported mild to moderate postoperative pain. Adequate pain management was achieved using less pain medication tablets than the number prescribed. Type I thyroplasty was associated with more severe pain than other surgeries. Women used more OTC pain medications than men with no significant difference in reported pain level.

Initial Psychometric Testing and Validation of the Italian Version of the Canine Brief Pain Inventory in Dogs With Pain Related to Osteoarthritis.

The Canine Brief Pain Inventory (CBPI) is an owner-administered questionnaire, originally developed and validated in English, used to assess canine chronic pain in terms of severity and interference with daily life activities. The aim of the present study was to perform a preliminary validation of an Italian version of the CBPI. Translation was performed and the resulting questionnaire was administered to 45 native Italian speaking owners of dogs suffering from chronic pain due to radiographically confirmed osteoarthritis. Psychometric properties of the Italian CBPI including construct validity, convergent validity and reliability were evaluated. Construct validity was assessed by factor analysis and confirmed a two-factor model (i.e., pain severity and interference factors). The respective scores, that is, the pain severity score (PSS) and pain interference score (PIS), exhibited a substantial negative correlation with overall quality of life score. Pain severity and interference items showed a mean inter-item correlation of 0.90 and 0.80, respectively. For each question, communality ranged from 0.84 to 0.97, highlighting strong internal consistency and suggesting that PSS and PIS can be calculated by averaging the items contained within each factor. Cronbach's α was 0.97 and 0.96 for PSS and PIS, respectively. The present findings confirmed the main psychometric properties of the Italian version of the CBPI, providing clinicians and researchers with a useful metrology instrument to evaluate the severity of chronic pain and its interference with daily life activities in dogs with osteoarthritis owned by Italian speaking people. Further properties of the questionnaire need to be evaluated in future research and larger studies are warranted.

Use of pharmacological and nonpharmacological treatments for chronic noncancer pain among people using opioids: a longitudinal cohort study.

Although multimodal management of chronic noncancer pain (CNCP) is recommended, long-term treatment utilization patterns among people using opioids are not well known. The Pain and Opioids IN Treatment study recruited Australian adults receiving opioids for CNCP for more than 6 weeks from community pharmacies. Pharmacological (opioid and nonopioid analgesics and psychotropic medicines) and nonpharmacological (physical, mental health, and specialized) treatments used in the previous 12 months and 30 days were collected annually over 4 years (2015-2018). Associations were explored between 30-day treatment use and sociodemographic characteristics and pain measures. Overall, 1334 participants completed at least one annual follow-up. The median pain severity (5.0, interquartile range [IQR] 3.8 to 6.3) and pain interference scores (5.7, IQR 3.9-7.3) indicated moderate pain throughout the study period, despite most participants reporting the use of nonopioid pharmacological (12 month: 97.6% and 30 day: 96.8%) and nonpharmacological treatments (12 month: 91.8% and 30 day: 66.1%). Some treatment use was inconsistent with guidelines: ongoing nonsteroidal anti-inflammatory drugs and sedative-hypnotic use were common, whereas fewer people engaged with pain management programs (12 month: 22.3%). Private health insurance was associated with using physical (adjusted odds ratio 1.61, 99.5% confidence intervals 1.15-2.24) and specialized nonpharmacological treatments (adjusted odds ratio 1.47, 99.5% confidence intervals 1.14-1.91). This study demonstrates that many Australians taking opioids long-term for CNCP also use nonopioid pharmacological and nonpharmacological treatments. The use of pharmacological treatments including nonsteroidal anti-inflammatory drugs, psychotropic medicines, and gabapentinoids, outside guidelines, warrants review. Furthermore, despite Australia's universal healthcare scheme subsidising some nonpharmacological treatments, overall use of these treatments was associated with having private health insurance, highlighting a need for more equitable service provision.

Prevalence of Dysmenorrhea and Determinants of Pain Intensity Among University-Age Women.

The study was conducted to determine the prevalence of dysmenorrhea and investigate factors associated with dysmenorrhic pain among university students in Lahore, Pakistan. A cross-sectional study was conducted across various public and private sector universities in Lahore. A self-administered structured questionnaire was used to collect data from 600 randomly selected female university students. The prevalence of dysmenorrhea was 91.5%. Age at menarche (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.10-3.50) was the only significant factor associated with dysmenorrhea. The mean pain severity score among dysmenorrhic students was 5.62 ± 2.28. Most of the participants (65.8%) were experiencing moderate/severe pain. Univariate analysis showed that irregular cycle (OR [95% CI] = 1.62 [1.13-2.33]), age at menarche of ≤14 years (OR [95% CI] = 1.46 [1.05-2.04]), duration of menses of more than 5 days (OR [95% CI] = 1.42 [1.02-1.99]), stress (OR [95% CI] = 2.16 [1.54-3.03]), moderate meat/protein consumption (OR [95% CI] = 1.55 [1.08-2.21]), and medical specialization (OR [95% CI] = 1.72 [1.17-2.52]) were significantly associated with pain severity among dysmenorrhic female students. Multivariate binary logistic regression analysis revealed that medical specialization (OR [95% CI] = 1.83 [1.22-2.73]), age at menarche (OR [95% CI] = 0.603 [0.42-0.86]), regularity of menses (OR [95% CI] = 1.52 [1.04-2.22]), moderate meat/protein consumption (OR [95% CI] = 1.69 [1.16-2.45]), and stress (OR [95% CI] = 1.87 [1.32-2.66]) were independent predictors of moderate/severe dysmenorrhic pain. The study revealed an alarmingly high prevalence of dysmenorrhea among university students. High levels of stress and early menarche were the potent determinants of moderate/severe dysmenorrhea that disturbs quality of life.

Venlafaxine Extended Release in the Treatment of Post Herpetic Neuralgia: A Quasi-Experimental Study

Background: Anti depressant drugs are sometimes used to treat neuropathic pain like Postherpetic Neuralgia (PHN) however, their analgesic efficacy is unclear. Venlafaxine is a reasonably well tolerated anti depressant and is a Serotonin Norepinephrine Reuptake Inhibitor (SNRI) and weak noradrenaline reuptake inhibitor. Although not licensed for the treatment of chronic or neuropathic pain in most countries, it is sometimes used for this indication. The present study evaluated the efficacy, tolerability and Quality of Life (QoL) of venlafaxine use for 12 weeks in patients with PHN.&#x0D; Materials and methods: This quasi-experimental (Pretest-posttest design) was conducted in the department of Neurology, Dhaka Medical College Hospital, from July 2012 to June 2013. Four hundred and fifty two patients were included in the study and Venlafaxine extended release tablet (75 to 150 mg) were administeredfor 12 weeks. Pain severity score, pain interference score and QoL score were assessed by a self-rated questionnaire before treatment and at 12 weeks follow-up.&#x0D; Results: Majority of the patients were male (63.7%) with a mean age of 48.1 years. After 12 weeks of Venlafaxine treatment, 330 (73%) patients reported at least 50% relief in pain, whereas three (0.7%) patients did not report any pain relief. Pain was relieved completely in 32 (7.0%) patients. There was a significant decrease in the mean pain severity score, (5.8±2.0 versus 3.6±2.2) and meanpain interference score (4.5±2.0 versus 3.1±1.9) from baseline to 12 weeks. The mean QoL scale score improved significantly from 5.9±1.6 at baseline to 8.0±1.7 at week 12. Only 2.8% (13/452) patients experienced at least one adverse effect during the study period.&#x0D; Conclusion: Venlafaxine was found to be effective, safe and well tolerated in the patients of PHN for relieving pain and improving QoL. Further double blinded randomize study is needed to validate these findings.&#x0D; JCMCTA 2021 ; 32 (1) : 31-34

Patient satisfaction at the Chronic Pain Management Clinic at Groote Schuur Hospital

Background: Chronic pain is a costly and debilitating ailment with an estimated global prevalence of 20%. The evaluation of patients’ satisfaction with pain management is crucial both to ensure that care provided remains fit for purpose and to identify opportunities for improvement. Groote Schuur Hospital (GSH) has one of the few functional interdisciplinary pain clinics in South Africa with more than 900 patients seen per year. To date, there had been no data informing us about patient satisfaction at the clinic. The aim of our study was to survey patients who are being treated at the Chronic Pain Management Clinic to determine their level of satisfaction with the service. Methods: A descriptive cross-sectional study was conducted with a sample of 67 patients who had been attending the Chronic Pain Management Clinic for more than three months. Data were collected telephonically using the patient demographics form and the internationally validated pain treatment satisfaction scale (PTSS). The data were then analysed using descriptive statistics. Results: The mean age of the 67 participants was 56.5 years (SD 12.9; age range: 18–83). In this sample, 81% of the participants are female while 70% of the participants had not completed 12 years of schooling. Most of the participants were referrals from orthopaedics (48%), followed by referrals from day clinics (13.5%). The median pain severity score was 7.5 (IQR 7–9) a week prior to data collection. The majority of participants (70%) reported that they could ask the staff questions and were provided with adequate support and care. Results indicate that six in every ten patients are satisfied with their pain management at the GSH Chronic Pain Management Clinic. One aspect of care which was less than satisfactory related to patients receiving information about their condition and the treatment thereof. In general, participants would have appreciated more information about their illness or injury (51%), causes and treatments of the pain, as well as side effects of the pain medication (60%). Conclusion: Most participants were either somewhat satisfied or very satisfied with all aspects of care they were asked about. It is clear that patient satisfaction is not only driven by pain relief but can also be enhanced by good patient-provider relationships and shared decision-making. It is, therefore, important to continually train healthcare providers to improve their communication skills.

A prospective, randomized, blinded, placebo-controlled multisite clinical study of bedinvetmab, a canine monoclonal antibody targeting nerve growth factor, in dogs with osteoarthritis

ObjectiveBedinvetmab is a canine monoclonal antibody targeting nerve growth factor. This study evaluated the efficacy and safety of bedinvetmab for alleviation of pain associated with osteoarthritis in dogs. Study designDouble-blind, randomized, multicentre, placebo-controlled study. AnimalsClient-owned dogs (n = 287) with osteoarthritis. MethodsDogs were randomized (1:1) to subcutaneous injection with placebo (saline, n = 146) or bedinvetmab (0.5–1.0 mg kg–1, n = 141) administered monthly. After 3 months, 89 bedinvetmab-treated dogs that responded positively based on owner and veterinarian assessments were administered up to six additional doses of bedinvetmab in a single-armed open-label continuation phase. The primary efficacy end point was treatment success based on the owner-assessed canine brief pain inventory (CBPI) on day 28. Treatment success was defined as ≥ 1 reduction in pain severity score (0–10) and ≥ 2 in pain interference score (0–10). ResultsPercentage treatment success was significantly greater in the bedinvetmab group than in the placebo group from day 7 through all assessed time points (p ≤ 0.0025). On day 28, 43.5% of dogs achieved treatment success with bedinvetmab compared with placebo (16.9%) (p = 0.0017). Treatment success continued through days 56 (50.8%) and 84 (48.2%) in the bedinvetmab group and was < 25% in the placebo group at all time points. Sustained efficacy was demonstrated in the continuation phase. Adverse health events occurred at similar frequencies in both groups. They were considered typical for a population of dogs with osteoarthritis and not related to study treatment. Treatment with bedinvetmab demonstrated a significant effect on all three components of CBPI—pain interference, pain severity, quality of life. Conclusions and clinical relevanceThis study demonstrated the effectiveness and safety of bedinvetmab administered monthly for up to 9 months at 0.5–1.0 mg kg–1 for alleviation of pain associated with canine osteoarthritis.

DEEP Study: Utility of the multidimensional pain inventory in persistent oro-facial pain.

Persistent oro-facial pain (POFP) is disabling, and patients' treatment outcomes are difficult to predict; psychosocial factors play a role. The West Haven-Yale Multidimensional Pain Inventory (MPI) is a self-report measure, which to our knowledge, has not been studied across primary and secondary care in heterogeneous POFP. Assess the MPI's ability to predict clinical outcome in POFP patients across primary and secondary care settings receiving usual care. About 146 patients receiving usual care for POFP were recruited from primary and secondary care medical and dental practices in north-east England. Participants completed the MPI (v3) and Graded Chronic Pain Scale (GCPS) at recruitment, and after 6, 12, 18 and 24months. The Patient Health Questionnaire-4 (PHQ-4) was completed at recruitment, 12, and 24months. 'Good' and 'poor' outcome status was assigned to participants based on their mode dichotomised GCPS score across timepoints. Logistic regression was used with overall GCPS outcome (good/poor) as the dependent variable and MPI subscale scores, demographic variables, and PHQ-4 scores as predictors. 110 participants had a 'good', and 36 had a 'poor' outcome. In the 'poor' outcome group, age, mean income, and life control scores were lower; deprivation, months in pain, PHQ-4, pain severity, interference, and affective distress scores were higher. In the 'good' group, MPI scores improved over time. Interference was the only consistent predictor of 'poor' outcome in the logistic regression model (OR: 1.14-1.98, p<0.05). The MPI interference subscale may help to identify patients with POFP who are likely to have consistent pain-related disability over time; it may therefore be useful clinically to identify patients likely to need early intervention.

Assessment of Opioid Use and Analgesic Requirements After Endoscopic Sinus Surgery

The opioid epidemic has generated interest in optimizing opioid prescribing after common surgeries. Recent studies have shown a broad range of analgesic prescription patterns following endoscopic sinus surgery (ESS). To compare the efficacy of different analgesic regimens after ESS. This multi-institutional, nonblinded randomized clinical trial was conducted at 6 tertiary centers across the US and Canada and included participants who underwent ESS for acute or chronic rhinosinusitis. The study was conducted from March 2019 to March 2020, and the data were analyzed in November to December 2020. All participants received acetaminophen, 650 mg, as the first-line analgesic. From there, patients were randomized to either oxycodone rescue (oxycodone, 5 mg, as second-line therapy) or ibuprofen rescue (ibuprofen, 600 mg, as second-line therapy, with oxycodone, 5 mg, reserved for breakthrough pain). Baseline characteristics and disease severity were collected at enrollment. Medication logs, pain scores, and epistaxis measures were collected until postoperative day 7. The primary outcome was the postoperative visual analog scale score for pain. Brief Pain Inventory Pain Severity and Pain Interference Scores were also collected. A total of 118 patients were randomized (62 [52.5%] oxycodone rescue, 56 [47.5%] ibuprofen rescue; mean [SD] age, 46.7 [16.3] years; 44 women [44.0%]; 83 White [83.0%], 7 Black [7.0%], and 7 Asian individuals [7.0%]). After exclusions for loss to follow-up and noncompliance, 51 remained in the oxycodone rescue group and 49 in the ibuprofen rescue group. The groups had similar demographic characteristics and disease severity. Thirty-two (63%) in the oxycodone rescue group had adequate pain management with acetaminophen only, while 19 (37%) consumed at least 1 oxycodone dose. In the ibuprofen rescue group, 18 (16%) required only acetaminophen, 28 (57%) used only acetaminophen and ibuprofen, and the remaining 13 (26%) consumed 1 or more oxycodone doses. The groups had similar average acetaminophen (9.69 vs 7.96 doses; difference, 1.73; 95% CI, -1.37 to 4.83) and oxycodone (1.89 vs 0.77 doses; difference, 1.13; 95% CI, -0.11 to 2.36) use. Both groups had similar postoperative visual analog scale scores. A subanalysis that compared opioids users with nonusers showed clinically significant lower pain scores in nonusers at multiple postoperative points. In this randomized clinical trial, most patients who underwent ESS could be treated postoperatively using a nonopioid regimen of either acetaminophen alone or acetaminophen and ibuprofen. Ibuprofen as a second-line therapy did not reduce overall narcotic consumption, but the overall narcotic use was low in both groups. ClinicalTrials.gov Identifier: NCT03783702.

The efficacy of TAP block versus ilioinguinal block for post-cesarean section pain management: A systematic review and meta-analysis

BackgroundControversy still exists regarding the analgesic efficacy of transverse abdominis plane (TAP) block versus ilioinguinal or iliohypogastric (IL/IH) nerve block for postoperative pain management following cesarean section. This meta-analysis aimed to perform relatively credible pooled results on the efficacy of the TAP versus IL/IH nerve block for postoperative pain management after cesarean section. MethodsDatabases such as: PubMed/MEDLINE, Google scholar, and google were systematically searched. studies compared the analgesic efficacy of TAP versus IL/IH nerve block for postoperative pain management following cesarean section were included. Data were extracted by three reviewers independently by using Microsoft Excel and then exported to STATA™ 16 version statistical software for analysis. We used a random-effects model meta-analysis and the mean difference of analgesic efficacy with a 95 ​% confidence interval was reported based on Preferred Reporting Items for systematic reviews and meta-analysis (PRISMA). ResultsFive studies with a total of 390 (196 in TAP and 194 in IL/IH) study participants were included in this meta-analysis. No statistically significant difference was observed between the TAP and IL/IH groups in time to first rescue analgesic request, total postoperative analgesic consumption in milligrams of intravenous tramadol equivalence, and post pain severity score at different points of time both rest and movement. ConclusionThis meta-analysis revealed that both approaches have similar postoperative analgesic efficacy following cesarean section. we recommend that the clinician may consider either approach for post-cesarean section pain management.

Emergency department physical therapy: An important tool for emergency physicians.

A collaborative, multidisciplinary approach to medical care has become increasingly common place in modern medicine. Often part of this multidisciplinary team, especially in the inpatient setting, are physical therapists (PT). PT education and training provide useful insight into techniques to improve patients' physical functionality and reduce pain. They often provide patients with the education on how to participate in their own treatment and equip them with the tools for self-care outside of the hospital or clinic setting.