Pain Status Research Articles

Clinical Outcomes at One-year Follow-up for Patients With Surgical Site Infection After Spinal Fusion.

Retrospective case-control study. To compare health-related quality of life outcomes at one-year follow-up between patients who did and did not develop surgical site infection (SSI) after thoracolumbar spinal fusion. SSI is among the most common healthcare-associated complications. As healthcare systems increasingly emphasize the value of delivered care, there is an increased need to understand the clinical impact of SSIs. A retrospective 3:1 (control:SSI) propensity-matched case-control study was conducted for adult patients who underwent thoracolumbar fusion from March 2014 to January 2020 at a single academic institution. Exclusion criteria included less than 18 years of age, incomplete preoperative and one-year postoperative patient-reported outcome measures, and revision surgery. Continuous and categorical data were compared via independent t tests and χ 2 tests, respectively. Intragroup analysis was performed using paired t tests. Regression analysis for ∆ patient-reported outcome measures (postoperative minus preoperative scores) controlled for demographics. The α was set at 0.05. A total of 140 patients (105 control, 35 SSI) were included in final analysis. The infections group had a higher rate of readmission (100% vs. 0.95%, P <0.001) and revision surgery (28.6% vs. 12.4%, P =0.048). Both groups improved significantly in Physical Component Score (control: P =0.013, SSI: P =0.039), Oswestry Disability Index (control: P <0.001, SSI: P =0.001), Visual Analog Scale (VAS) Back (both, P <0.001), and VAS Leg (control: P <0.001, SSI: P =0.030). Only the control group improved in Mental Component Score ( P <0.001 vs. SSI: P =0.228), but history of a SSI did not affect one-year improvement in ∆MCS-12 ( P =0.455) on regression analysis. VAS Leg improved significantly less in the infection group (-1.87 vs. -3.59, P =0.039), which was not significant after regression analysis (β=1.75, P =0.050). Development of SSI after thoracolumbar fusion resulted in increased revision rates but did not influence patient improvement in one-year pain, functional disability, or physical and mental health status.

Patient-reported Outcomes in Men with Metastatic Castration-resistant Prostate Cancer Harboring DNA Damage Response Alterations Treated with Talazoparib: Results from TALAPRO-1

BackgroundTalazoparib has shown antitumor activity with a manageable safety profile in men with metastatic castration-resistant prostate cancer (mCRPC) and DNA damage response (DDR)/homologous recombination repair (HRR) alterations. ObjectiveTo evaluate patient-reported health-related quality of life (HRQoL) and pain in patients who received talazoparib in the TALAPRO-1 study, with a special interest in patients harboring breast cancer susceptibility gene 1 or 2 (BRCA1/2) mutations. Design, setting, and participantsTALAPRO-1 is a single-arm, phase 2 study in men with mCRPC DDR alterations either directly or indirectly involved in HRR, who previously received one to two taxane-based chemotherapy regimens for advanced prostate cancer and whose mCRPC progressed on one or more novel hormonal agents. Outcome measurements and statistical analysisMen completed the European Quality-of-life Five-dimension Five-level scale (EQ-5D-5L), EQ-5D visual analog scale (VAS), and Brief Pain Inventory—Short Form at predefined time points during the study. The patient-reported outcome (PRO) population included men who completed a baseline and one or more postbaseline assessments before study end. Longitudinal mixed-effect models assuming an unstructured covariance matrix were used to estimate the mean (95% confidence interval [CI]) change from baseline for pain and general health status measurements among all patients and patients with BRCA1/2 mutations. Results and limitationsIn the 97 men in the PRO population treated with talazoparib (BRCA1/2, n = 56), the mean (95% CI) EQ-5D-5L Index improved (all patients, 0.05 [0.01, 0.08]; BRCA1/2 subset, 0.07 [0.03, 0.10]), as did the EQ-5D VAS scores (all patients, 5.42 [2.65, 8.18]; BRCA1/2 subset, 4.74 [1.07, 8.41]). Improvements in the estimated overall change from baseline (95% CI) in the mean worst pain were observed in all patients (–1.08 [–1.52, –0.65]) and the BRCA1/2 subset (–1.15 [–1.67, –0.62]). The probability of not having had experienced deterioration of worst pain by month 12 was 84% for all patients and 83% for the BRCA1/2 subset. ConclusionsIn heavily pretreated men with mCRPC and DDR/HRR alterations, talazoparib was associated with improved HRQoL in all patients and the BRCA1/2 subset. In both patient groups, worst pain improved from baseline and the probability of not experiencing a deterioration in worst pain with talazoparib was high. Patient summaryWe show that talazoparib was associated at least with no change or improvements in health-related quality of life (HRQoL) and pain burden in men with metastatic castration-resistant prostate cancer and DNA damage response/homologous recombination repair gene alterations in the TALAPRO-1 study. These findings in patient-reported HRQoL and pain complement the antitumor activity and tolerability profile of talazoparib.

PELVIC PAIN AND PSYCHO-EMOTIONAL STATUS IN WOMEN WITH OVARIAN ENDOMETRIOMA COMBINED WITH PELVIC INFLAMMATORY DISEASES: TREATMENT OPTIONS CHOICE

The connection between chronic pelvic pain and t he presence in the body of a pathologicalsource of structural and morphological changes in tissue, e.g. in connection with uterine fi broids, endometriosis, chronic infl ammatory processes of the pelvic organsremains a traditional opinion. Endometriosis, which is characterized by a chronicpelvic pain, aff ects about 10% of women of reproductive age, and the problem ofstudying endometrioid cysts demonstrates its relevance by dominating in the structureof genital endometriosis up to 59%. Chronic pelvic pain causes inappropriate coursesof antibacterial therapy and, as a consequence, dysbiosis, the development of ovarianinsuffi ciency syndrome, and the surgical approach does not always show the desiredresults, often worsening the clinical picture and psycho- emotional status of the patient.Purpose – to assess the severity of the pain syndrome and psychological status in patientswith pelvic pain associated with ovarian endometrioma and to seek eff ective therapeuticoptions.Materials and methods. The study included 40 patients with ovarian endometriosiscombined with pelvic infl ammatory disease (main group) and 40 patients with isolatedendometrioma (comparison group). The control group consisted of 30 patients withoutmanifestations of genital endometriosis. Analysis of somatic and gynecologicalanamnesis the objective and gynecological examination, data from adapted Beck’sDepression Inventory and State- Trait Anxiety Inventory, pain assessment according tothe visual- analog scale (VAS), sonographic examination of the pelvic organs, evaluationof magnetic resonance imaging, endoscopic and histological methods of examination hasbeen carried out.Results. Dyspareunia was noted in one third of patients of the main group; dysuricmanifestations, intestinal disorders in every fourth woman, in a third of women –a combination with manifestations of asthenic- neurotic syndrome, the intensity of painwas presented in a third as severe and unbearable. It should be noted that the percentageof secondary infertility increased by 2.6 times, in two thirds of cases there weremenstrual cycle disorders, where manifestations of algodysmenorrhea and abnormaluterine bleeding dominated. The analysis of psychological questionnaires noted equalpercentage of moderate and mild depressive symptoms in the main group, and also, alongwith a decrease in psychological and emotional adaptation, high rates of situational andpersonal anxiety. The proposed therapeutic options included the use of dienogest fi rst ofall in women with mild to moderate pain syndrome, the possibility of the prolonged use atrisk of recurrence and taking into account the smaller percentage of probable side eff ects.Conclusions. The analysis of the obtained data allowed to indicate to more intense painsyndrome, high frequency of menstrual disorders, secondary infertility and manifestationsof nonspecifi c clinical symptoms in patients with endometriomas combined with thepelvic infl ammatory processes. The psycho- emotional state of women is characterizedby high levels of depressive and anxiety disorders, as well as a pronounced intensity ofpain syndrome in one third of cases. At weak and moderate degree of pelvic pain the drugof choice of the therapeutic program is dienogest, the use of which is expedient in theprolonged perspective, in case of the expressed pain intensity syndrome it is expedient togive a preference to the gonadotropin- releasing hormone agonist.

Appraising The Evidence for Conservative versus Surgical Management of Motor Deficits in Degenerative Cervical Radiculopathy.

Systematic review. Understanding the prevalence and outcome of motor deficits in degenerative cervical radiculopathy is important to guide management. We compared motor radiculopathy outcomes after conservative and surgical management, a particular focus being painful vs painless radiculopathy. MEDLINE and EMBASE databases were searched. We stratified each study cohort into 1 of 6 groups, I-VI, based on whether radiculopathy was painful, painless or unspecified, and whether interventions were surgical or non-surgical. Of 10514 initial studies, 44 matched the selection criteria. Whilst 42 (95.5%) provided baseline motor radiculopathy data, only 22 (50.0%) provided follow-up motor outcomes. Mean baseline prevalence of motor deficits was 39.1% (9.2%-73.3%) in conservative cohorts and 60.5% (18.5%-94.1%) in surgical cohorts. Group VI, 'surgically-managed motor radiculopathy with unclear pain status' had the largest number of cohorts. Conversely, no cohorts were found in Group III, 'conservatively-managed painless motor radiculopathy'. Large disparities in data quality made direct comparison of conservative vs operative management difficult. Overall pre-intervention prevalence of motor deficits in degenerative cervical radiculopathy is 56.4%. Many studies fail to report motor outcomes after intervention, meaning statistical evidence to guide optimal management of motor radiculopathy is currently lacking. Our study highlights the need for more evidence, preferably from a prospective long-term study, to allow direct comparisons of motor outcomes after conservative and surgical management.

Function-based tests to determine the return-to-activity state inpatients with non-specific low back pain

Most people with back pain suffer from non-specific low back pain, for which no specific reasons can be found. Two out of three have recurrent pain episodes. To reduce the likelihood of recurrence and long-lasting pain, functional tests are increasingly used to determine the current functional status. This literature study evaluates evidence of functional tests in patients with non-specific low back pain and their validity related to the return-to-activity (RTA) status. The objective of this analysis is to give recommendations for specific activities and to assess the risk of chronification and recurrent pain. PubMed-based literature search. Narrative review focusing on data from the past ten years. A total of twelve studies were included in the analysis. Overall, 33 different tests were identified for which positive statements regarding reliability, validity and relevance for the assessment of the RTA status in non-specific back pain could be made. The tests identified may be able to provide useful information when assessing the RTA status and to recognise yellow and blue flags in patients with non-specific low back pain. The ability to walk, the behaviour when lifting and carrying objects, motor control, muscle strength and mobility play a particular role. The determination of the RTA status in patients with non-specific low back pain should be patient-specific and based on biopsychosocial aspects rather than relying exclusively on movement-related tests. Exact statements regarding the point in time when patients can resume everyday activities and work without an increased risk of recurrence or chronicity do not seem possible with functional tests alone. The major influence of psychological and social factors on disease development, course and prognosis are limiting factors. Movement and strain-related tests can still be used to evaluate activities related to everyday life, to design therapy programs and to give patients confidence.

A phase II study of gemcitabine docetaxel combination in metastatic/unresectable locally advanced relapsed synovial sarcoma.

11554 Background: Synovial sarcoma (SS) is one of the commonest non-Rhabdomyosarcoma Soft Tissue Sarcomas (STS) in Adolescent and Young Adults. It is a chemosensitive, high-grade tumor with a tendency for local and metastatic recurrence. While the frontline therapy is doxorubicin, treatment options in later lines are scarce. Gemcitabine docetaxel combination has demonstrated its role in relapsed STS and promising potential in frontline setting in recent times. The major STS types in previous trials included leiomyosarcomas and pleomorphic sarcomas but in SS, this regimen has not been explored. We conducted this study on gemcitabine and docetaxel combination in relapsed metastatic/locally advanced unresectable SS. Methods: This is a phase II, single-arm study in patients (pts) of metastatic/locally advanced unresectable SS relapsed post atleast one line of treatment aged between 15-75 years, ECOG performance status (PS) 0-2, adequate organ function and measurable disease by RECIST 1.1. Treatment was gemcitabine 900 mg/m2 on days 1 and 8 plus docetaxel 75 mg/m2 on day 8 with G-CSF prophylaxis for maximum 6 cycles. Adverse event (AE) profile was analyzed by CTCAE 5.0, quality of life (QoL) assessed 4-weekly by EORTC QLQ-C30 questionnaire and response assessed by RECIST at 12 weeks. Primary endpoint, 3-month Progression-free survival rate (PFR) was required to be 40%. Results: 22 pts were enrolled between 3/2020 – 9/2021 with median age 32 (range 15-60 years); 13 (59%) patients were male; ECOG PS was 1 in 13 (59%) and 2 in 9. Extremity and lung were the commonest primary and metastatic sites respectively with 20 (90.9%) pts having metastases. 50% pts received the study treatment in 2nd line, 36.3% in 3rd line and the remaining in 4th line. The 3-month PFR was 45.4%, median PFS was 3 months, OS 67% at 7 months follow-up and Overall Response Rate (ORR) was 4.5% (1 PR). There was statistically significant worsening in QoL parameters of cognitive functioning, fatigue, dyspnea, appetite loss, nausea/vomiting at 12 weeks. Progression-free pts had better QoL in cognitive and emotional function, fatigue, pain and global health status. Beyond 12 weeks, 7 out of 10 non-progressors continued the treatment (1 patient each discontinued treatment due to death, change to TKI and enrolment in another trial). The most common AEs were fatigue, nausea/vomiting, mucositis, diarrhea, alopecia, anemia, transaminitis; Grade &gt; 3 AEs (31.8%) included anemia, neutropenia, hyperbilirubinemia, transaminitis, mucositis. There was no febrile neutropenia. Conclusions: This is the first prospective study on gemcitabine docetaxel in patients of SS. The trial met its primary endpoint of 3-month PFR more than 40% which is promising in relapsed population. The improved QoL among progression-free pts is encouraging. Gemcitabine docetaxel regimen exhibits efficacy and safety to be considered for use in relapsed SS. Clinical trial information: CTRI/2020/02/023612.

An investigation of sleep profiles in individuals with idiopathic scoliosis.

ObjectiveSleep behaviors have not been well investigated in individuals with idiopathic scoliosis (IS). This study aimed to investigate sleep quality and daytime sleepiness in individuals with IS and investigate the relationship between sleep parameters and curve magnitude, trunk deformity severity, pain, and emotional status in adolescents with IS.Material and MethodsNinety-one participants between the ages of 10 and 19 years with IS were included. Sleep quality was evaluated using the Pittsburgh sleep quality index (PSQI), and daytime sleepiness was assessed with Epworth sleepiness scale (ESS). Pain was assessed using the short-form McGill pain questionnaire; the presence or severity of depressive feelings was evaluated using the Beck depression scale.ResultsThe majority of the participants (64.8%) had poor sleep quality, while daytime sleepiness was within normal limits in most participants (85.7%).The frequency of participants without pain (52.7%) was similar to participants with pain (47.3%). The prevalence of participants with depressed mood was 35.2%. Participants with poor sleep quality were more likely to have a higher sensorial index (p<0.001), higher total pain scores (p=0.001), and less lumbar axial rotation (p=0.046). Higher pain (r=0.391), depression scores (r=0.234), and lower lumbar axial trunk rotation (r=-0.317) were associated with increased daytime sleepiness.ConclusionWe observed poor sleep quality and an association with pain in patients with IS. Curve magnitude had no adverse effect on sleep quality or daytime sleepiness. Therefore, the sleep profile and its association with pain should be considered during the rehabilitation process in patients with IS.

A feasibility study of EMF(erlotinib+methotrexate+5-fluorouracil) regimen in recurrent head and neck squamous cell carcinoma (HNSCC) and role of circulating tumour cells(CTCs) in assessment of outcomes.

e18038 Background: Head and neck cancer is a huge burden in South East Asia with frequent relapse after curative therapy while the rest presenting in advanced unresectable stages. Financial constraints for targeted and immunotherapy make it inaccessible for the bulk of population. Thus, low-cost but efficacious regimen is highly implicated. We assessed if readily available triplet therapy of EMF, is superior in terms of extending life and maintaining quality of life along with evaluation of CTCs as a predictive biomarker in such patients. Methods: This was a single arm, phase II, investigator initiated interventional study, wherein 35 patients were enrolled. Platinum resistant/refractory patients of HNSCC were treated with combination of erlotinib 150mg daily, methotrexate 40 mg/m2 and 5-fluourouracil 500 mg/m2 (d1, d8) q28 days till progression or unacceptable toxicities. The primary endpoint was overall response rate(ORR) at 3 months; additional endpoints were disease control rate(DCR) at 3 months, overall survival (OS), progression free survival (PFS) safety and patient reported quality of life(QOL). The role of CTCs in gauging the responders and non-responders was monitored using anti Epithelial Cell Adhesion Molecule antibody based enrichment - OncoDiscover Drug Controller General of India (DCGI) approved platform. Results: The ORR and DCR at 3 months was 45.7% and 68.5%, respectively. The median PFS was 5 months (95%CI: 3.9-6 months) and median OS was 9 months (95%CI:7.4 -10.5 months). The 3 and 6 months PFS rates was 86 + 6% and 45 + 9%, respectively, while OS rates at 3 and 6 months were 91+ 5% and 68+ 8%, respectively. Rash, mucositis and fatigue were common adverse events occurring in 23 (65%), 14 (40%) and 9 (25.7%) respectively. The grade 3 events seen were rash in 5 (14.2%) and diarrhea in 2 (5.7%). Clinically significant improvement was seen in domains of role functioning, social functioning, fatigue, pain and global health status, swallowing, dryness of mouth and feeling ill. The mean CTC count at baseline was 0.90 + 1.1 /1.5ml of blood. Responders showed decline in levels from 1.19 + 0.25 to 0.33 + 0.48, while non-responders had increasing trend: 0.29 + 0.48 to 1+ 0.10 at 3 months (p = 0.010); with concordance rates with response being 52.9%. Additionally, CTC clearance at 3 months had numerically better PFS ̃ 6 months (95% CI: 4.72-7.72) and OS of 10 months (95% CI: 2.3-5.65) vs 4 months (95% CI: 2.3-5.65), p = 0.258 and 8 months (95% CI: 4.3-11.6), p = 0.203 in those with persistence of CTCs. Conclusions: The triplet regimen of EMF is a feasible, safe therapeutic option with favourable response rates and improved QOL in patients with platinum resistant/refractory HNSCC. CTCs have a promising futuristic role as a predictive biomarker and can be extrapolated in clinical upfront setting too. Clinical trial information: CTRI/2020/02/023378.

Long-term biopsychosocial issues and health-related quality of life in young adolescents and adults treated for childhood Complex Regional Pain Syndrome, type 1.

Treatment for childhood Complex Regional Pain Syndrome (CRPS) is associated with long-term recovery. The present study aimed to investigate the long-term biopsychosocial status and quality of life in young adolescents and adults after the treatment of childhood CRPS. A 4year follow-up of individuals with childhood-CRPS, type 1 (n=22; age:12years (years) [median] at treatment and 17years at follow-up) was completed. Biopsychosocial status and quality of life were assessed with structured interviews, using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the Strengths and Difficulties Questionnaire (SDQ), the Pediatric Pain Coping Inventory (PPCI), and the Pediatric Quality of Life Inventory (PedsQL). Comparisons were made with normative samples of age-matched controls. CRPS at follow-up was still present in seven out of 22, and non-CRPS pain symptoms were found in 12 out of 22 individuals. Signs of mental health pain-related problems, including phobias and obsessive-compulsive disorder, were observed in ten out of 19 individuals. Mental well-being, social functioning, and quality of life (SDQ and PedsQL) were independent of pain status (p>0.05). Adaptive pain coping strategies were utilized regardless of pain status (PPCI). Social functioning (p<0.01) and the quality of life (p=0.01) were attenuated and statistically significantly poorer than healthy age-matched young adults but better than for fibromyalgia subjects. A subset of individuals treated for childhood-CRPS, type 1 experiences long-term consequences of persistent pain, a decrease in quality of life indicators, and demonstrates significant psychosocial issues. Childhood-CRPS is suggested to be associated with long-term psychosocial consequences and poorer quality of life than found in age-related healthy peers. Subjects treated for childhood CRPS may need a longer clinical follow-up attempting to preclude relapse of CRPS and non-CRPS pain.

Effects of Different Physiotherapy Interventions on Pain and Function in Persons Experiencing Lower Back Pain

Background. Lower back pain is one of the most common reasons people seek help from a physiotherapist. One of the techniques used in rehabilitation is resistance exercises with instability, such as exercises with TRX belts or on unstable planes.&#x0D; The aim. To evaluate the effects of different interventions on pain and functional status in individuals with lower back pain.&#x0D; Methods. The study included 30 subjects (mean age 47.53 ± 5.412) with lower back pain. Subjects in the study group underwent lower back stabilization exercises with TRX straps and in the control group using unstable planes. The tests were performed twice: before and after 15 intervention sessions.&#x0D; Results. Pain intensity after interventions was significantly reduced (p&lt;0.05) in both groups. In the group with exercises with TRX belts, the pain was significantly reduced more (p&lt;0.05) than in the group on unstable planes. Torso muscle endurance after interventions was significantly increased (p&lt;0.05) in both groups. Abdominal and back muscle endurance after interventions increased significantly (p&lt;0.05) in both groups. In the group with exercises with TRX belts, the endurance of the left and right torso muscles and abdominal and back muscles was significantly increased (p&lt;0.05) compared to the group where exercises were performed on unstable planes. The amplitudes of lower back flexion after interventions were significantly increased (p&lt;0.05) in both groups, as were the amplitudes of lower back and left flexion (p&lt;0.05). However, no significant difference was found between groups (p&gt;0.05).&#x0D; Conclusions. After the interventions, the functional condition of both groups improved and the intensity of the experienced pain decreased. Exercise with TRX straps improved the endurance of the lateral torso and abdominal muscles more and reduced pain more than exercises on unstable planes for individuals experiencing lower back pain.&#x0D; Keywords: lower back pain, stabilization exercises, unstable planes, TRX straps.

Neuropathic pain correlates with worsening cognition in people with human immunodeficiency virus.

Neuropathic pain and cognitive impairment are among the HIV-related conditions that have most stubbornly resisted amelioration by virally suppressive antiretroviral therapy. Overlaps between the regional brain substrates and mechanisms of neuropathic pain and cognitive disorders are increasingly recognized, yet no studies have examined the longitudinal relationship between these two disorders. Participants in the prospective, observational CNS HIV AntiRetroviral Therapy Effects Research (CHARTER) cohort underwent standardized clinical evaluations for clinical examination findings of distal sensory polyneuropathy, reporting distal neuropathic pain and neurocognitive performance at study entry (baseline) and an average of 12 years later. Change in neuropathic pain and neuropathy status from baseline to follow-up was by self-report and repeat examination, and change in neurocognitive performance was assessed using a previously published summary regression-based change score. Relationships between incident or worsened neuropathic pain and neurocognitive change were evaluated using uni- and multivariable regressions, including age at baseline and other relevant covariates. Participants were 385 people with HIV, 91 (23.6%) females, mean ± standard deviation (SD) age at baseline 43.5 (7.81) years, ethnicity 44.9% African American, 10.6% Hispanic, 42.6% non-Hispanic white and 1.82% other. Baseline median (interquartile range) nadir CD4 was 175 (34 309) cells/µl and current CD4 was 454 (279 639). Incident or worsened distal neuropathic pain occurred in 98 (25.5%) over the follow-up period. People with HIV with incident or worsened distal neuropathic pain had significantly worsened neurocognitive performance at follow-up compared to those without incident or worsened distal neuropathic pain (summary regression-based change score mean ± SD -0.408 ± 0.700 versus -0.228 ± 0.613; P = 0.0158). This effect remained significant when considering viral suppression on antiretroviral therapy, incident diabetes and other covariates as predictors. Overall neurocognitive change related to neuropathic pain was driven primarily by changes in the domains of executive function and speed of information processing. Those with incident distal neuropathy signs did not have neurocognitive worsening, nor did individuals who used opioid analgesics or other pain-modulating drugs such as amitriptyline. Worsened neurocognitive performance in people with HIV was associated with worsened neuropathic pain but not with changes in physical signs of neuropathy, and this was not attributable to therapies for pain or depression or to differences in viral suppression. This finding implies that incident or worsened pain may signal increased risk for neurocognitive impairment, and deserves more investigation, particularly if better pain management might stabilize or improve neurocognitive performance.

“Comparison of Specific Hip Strengthening Exercises and Conventional Knee Exercises on Pain, Muscle Strength and Function in Sprinters with Patello-Femoral Pain Syndrome”

Objective: The aim of this study is to compare the effects of strengthening exercises of Hip and conventional Knee exercises on pain, muscle strength and functional status in sprinters with Patello femoral pain syndrome Methodology: A randomized controlled trial was performed on 28 sprinters. Participants were selected through non-probability convenient sampling. The study was single blinded and was completed in 6 months. The assessor was unaware of the treatment given to both groups. Group 1 received Conventional knee exercises and weight bearing hip strengthening exercises and Group 2 received traditional knee exercises and strengthening exercises of hip with resistance. All Exercises were performed with 12 reps and 3 sets, 3 times a week for 6 weeks. Numeric Pain Rating Scale (NPRS) for pain, AKPS (anterior knee pain scale) for functional status and make test applied through hand held dynamometer measured strength through contractions of knee muscles. Results: The mean age of individuals in interventional group is 22.79 ±4.28 and the individuals in control group is 24.07 ±4.51. Both groups showed significant improvements in pain, function and muscle strength with p&lt;0.05. There were not any significant changes in both groups with p&gt;0.05. Conclusion: Both interventions are equally effective in reducing pain, improving strength and function in sprinters with PFPS which showed that these interventions can be included in the rehabilitation plan of these athletes. Keywords: Knee pain, Runners, Strengthening exercises, Rehabilitation exercises, strength

Effect of deep and superficial endotracheal suctioning on hemodynamic parameters and pain in neurosurgical intensive care patients

Objective: This study aimed to determine the effects of deep and superficial endotracheal suctioning on hemodynamic parameters and pain level in mechanically ventilated neurosurgical patients. Patients and Methods: This prospective, randomized, controlled experimental study was conducted on 37 patients who underwent deep endotracheal suctioning and 37 patients who underwent superficial endotracheal suctioning using open endotracheal suctioning system. The arterial blood pressure, heart rate, body temperature, respiratory rate, oxygen saturation levels and pain status of the patient were compared before and after endotracheal suctioning at 1 min, 5 min and 30 min. Results: There was no statistically significant difference between the effects of deep and superficial endotracheal suctioning methods (p&amp;gt; 0.05). However, there was less change in systolic and diastolic arterial blood pressure and heart rates in patients who underwent superficial endotracheal suctioning before and 30 min after endotracheal suctioning (p&amp;gt; 0.05). Conclusion: Superficial endotracheal suctioning caused fewer changes in hemodynamic parameters and pain levels of patients compared to deep endotracheal suctioning. For this reason, nurses should first prefer the superficial endotracheal suctioning method during the suctioning practices of neurosurgery patients.

Effects of Stabilization Exercises on Pain and Functional Status in Cervical Radiculopathy

Objective: The objective of this study was to identify the effects of stabilization exercises on pain and functional status in patients of cervical radiculopathy. Methodology: The study was a Quasi experimental trial and was conducted in outpatient department of Ittefaq Hospital Lahore. The patients (n=44), who met the inclusion criteria were divided into 2 groups. Group A (n=22) was treated with stabilization exercises and conventional physical therapy protocol whereas group B (n=22) was given conventional physical therapy protocol only. Patients were evaluated with DASH score and NPRS for functional assessment and pain respectively at baseline and after 3 weeks of treatment in both groups. Data was analyzed on SPSS 21. Results: Mean age of patients in group A (Experimental group) and group B (Conventional group) were 54.22± 4.96 and 51.95±4.21 respectively. Within the group comparison for NPRS and DASH scores were statistically significant with p values &lt;0.05. P values for across the group comparison were 0.40 and &lt;0.05 for DASH and NPRS score respectively. Conclusion: The current study concludes that stabilization exercises along with conventional physical therapy and conventional physical therapy alone, both are effective in improving pain intensity and functional status in patients with cervical radiculopathy. However stabilization exercises are more effective in reducing the pain intensity levels. Keywords: Cervical radiculopathy, Neck pain, Stabilization exercise, Disability

Effect of Qmix 2in1, chlorhexidine gluconate, and ethylenediaminetetraacetic acid on postoperative pain after root canal treatment: A double-blind randomized clinical trial.

Background. This study aimed to investigate the effects of different final irrigation solutions on postoperative pain following root canal treatment. Methods. Eighty-nine nonvital premolar and molar teeth with periapical lesions (PAI: 3‒4) without any clinical symptoms were included. The patients were randomly assigned to three groups according to the final irrigation solutions used: G1: 2 mL of Qmix (n=29), G2: 2 mL of 17% ethylenediaminetetraacetic acid (EDTA) (n=30), and G3: 2 mL of 2% chlorhexidine gluconate (CHX) (n=30). All the patients were prescribed 100 mg of flurbiprofen to use as needed for pain. The patients were asked to rate their pain status according to the verbal rating scale at 12, 24, 48, and 72 hours, and one week. The data were analyzed using Pearson’s chi-squared test, Fisher’s exact test, and chi-squared analysis with Monte Carlo simulation. The significance level was set at P≤0.05. Results. No significant differences were observed in postoperative pain rates at 12, 48, and 72 hours and one week (P>0.05). However, in the Qmix group, a significantly lower pain level was observed at 24 hours with EDTA and CHX (P=0.019). The rate of mild pain in the EDTA group at 72 hours (18.8%) was significantly higher in premolar teeth than in molar teeth (P=0.012). The moderate pain level in the EDTA group at 12 hours was significantly higher in those>60 years of age (P=0.008). Conclusion. The use of Qmix as an irrigation solution resulted in lower postoperative pain levels at 24 hours compared to other solutions. Therefore, Qmix can be considered a proper final irrigation solution in endodontic treatment regarding postoperative pain.

Establishing the Minimal Clinically Important Difference and Substantial Clinical Benefit for the Pain Visual Analog Scale in a Postoperative Hand Surgery Population

Although the pain visual analog scale (VAS-pain) is a ubiquitous patient-reported outcome instrument, it remains unclear how to interpret changes or differences in scores. Therefore, our purpose was to calculate the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the VAS-pain instrument in a nonshoulder hand and upper extremity postoperative population. Adult postoperative patients treated by 1 of 5 fellowship-trained orthopedic hand surgeons at a single tertiary academic medical center were identified. Inclusion required VAS-pain scores at baseline (up to 3 months before surgery) and follow-up (up to 4 months after surgery), in addition to a response to a pain-specific anchor question at follow-up. The MCID estimates were calculated with (1) the 1/2 standard deviation method; and (2) an anchor-based approach. The SCB estimates were calculated with (1) an anchor-based approach; and (2) a receiver operator curve method that maximized the sensitivity and specificity for detecting a "much improved" pain status. There were 667 and 148 total patients included in the MCID and SCB analyses, respectively. The 1/2 standard deviation MCID estimate was 1.6, and the anchor-based estimate was 1.9. The anchor-based SCB estimate was 2.2. The receiver operator curve analysis yielded an SCB estimate of 2.6, with an area under the curve of 0.72, consistent with acceptable discrimination. We propose MCID values in the range of 1.6 to 1.9 and SCB values in the range of 2.2 to 2.6 for the VAS-pain instrument in a nonshoulder hand and upper extremity postoperative population. These MCID and SCB estimates may be useful for powering clinical studies and when interpreting VAS-pain score changes or differences reported in the hand surgery literature. These values are to be applied at a population level, and should not be applied to assess the improvement, or lack thereof, for individual patients.

Prevalence and Clinical Characteristics of Low Back Pain among Operating Room Personnel: A Cross-Sectional Study in South of Iran.

BackgroundLow back pain is one of the most common musculoskeletal disorders and the most common cause of activity restriction in people younger than 45 years. Nurses have a high incidence and prevalence of low back pain in terms of physical and emotional factors among healthcare workers. This study aimed to evaluate the prevalence and clinical characteristics of low back pain.MethodsThis cross-sectional study was performed on 385 operating room personnel of the hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences. The data were collected via a research-made developed questionnaire. The questionnaire consisted of two parts, including the demographic information and prevalence and dimensions of low back pain.ResultsThe results showed that the prevalence of low back pain was 74% among operating room personnel. There was a significant relationship among low back pain, education level, and marital status (p < 0.05).ConclusionHospital managers should reduce the prevalence of this disorder among operating room staff by teaching preventative patient handling techniques via training courses.

0632 Early sleep-disordered breathing in moderate-to-severe traumatic brain injury (TBI) is linked with chronic pain status at long-term follow-up: A TBI Model Systems study

Abstract Introduction Sleep disorders and chronic pain (pain of &amp;gt;3 months duration) are common after traumatic brain injury (TBI). A recently completed multi-center trial found that two-thirds of adults with moderate-to-severe TBI had sleep apnea diagnosed during polysomnography (PSG) completed during inpatient rehabilitation. Although a bidirectional relationship between sleep and pain exists, attention to sleep apnea as a specific diagnosis and its possible role in chronic pain following TBI has not been explored. We hypothesized that PSG-derived respiratory indices shortly following TBI would be worse among those reporting chronic pain at 1- to 2-year follow-up compared to those without chronic pain. Methods Sample (N=66) derived from overlapping cohorts across two separate multicenter studies. Participants with moderate to severe TBI underwent PSG during inpatient rehabilitation and completed a telephone follow-up interview to assess chronic pain status using standardized measures at 1-2 years post-TBI (610-day average). Pairwise comparisons across participants with and without chronic pain were made to determine the magnitude of clinically significant differences on respiratory indices including oxygen desaturation, central and obstructive apneas, and total apnea-hypopnea index (AHI). Results Presence of chronic pain at follow-up was associated with elevated central apnea events (2.6) and oxygen desaturation (19.6) relative to those without chronic pain (0.8 and 7.9, respectively). Important differences were also seen between obstructive and total apnea hypopnea index (AHI) using Centers for Medicaid and Medicare Services scoring criteria, with those in the chronic pain cohort being 6.5 and 8.7 points higher than their non-pain counterparts, respectively. Group differences on obstructive and total AHI were considered minor when using the American Academy of Sleep Medicine scoring criteria, although those with current pain experienced categorically worse sleep apnea (total AHI = 19 versus 12.4). Conclusion This is the first study to find an association between PSG-derived respiratory indices and long-term chronic pain status following moderate-to-severe TBI. Sleep apnea represents an important modifiable factor following injury that may contribute to long-term pain-related outcomes. Given the prominence of chronic pain several years post injury, future studies should investigate the role of sleep apnea and early intervention among those following moderate-to-severe TBI to determine impact on long-term rehabilitation and pain outcomes. Support (If Any) PCORI; CER-1511-33005); VA TBI Model Systems Program of Research; GDIT; NIDILRR 90DPTB0008. Clinicaltrial.gov Registration Number: NCT03033901.

POS0288 A CANADIAN RETROSPECTIVE CHART REVIEW EVALUATING CONCOMITANT METHOTREXATE DE-ESCALATION PATTERNS IN RA PATIENTS TREATED WITH BIOLOGIC OR TARGETED SYNTHETIC DMARDS

POS0288 A CANADIAN RETROSPECTIVE CHART REVIEW EVALUATING CONCOMITANT METHOTREXATE DE-ESCALATION PATTERNS IN RA PATIENTS TREATED WITH BIOLOGIC OR TARGETED SYNTHETIC DMARDS

Effect of an on-site physical therapy on pain, posture, function and composition, and work-related health status in workers in Korea.

The incidence of work-related musculoskeletal disease is increasing despite automated manufacturing processes. To examine the effect of a customized on-site exercise program on pain, posture, body function, body composition, and work-related health status of workers at an auto-parts factory. Fifty-six participants were randomly divided into one of two groups: experimental (EG), which received a customized exercise program that included manual and exercise therapy from physiotherapy at the workplace; and control (CG), which received customized exercise sheets for a self-directed program at home. The program was performed 3 times per week for 12 weeks. Assessments were performed according to numerical rating scale (NRS), Exbody, Selective Functional Movement Assessment (SFMA), InBody, Short-Form-12 version 2 (SF-12v2), and Work Ability Index (WAI), which were evaluated before and after the program. The EG exhibited significant within-group changes in NRS, Exbody, SFMA, SF-12v2, and WAI; the CG exhibited significant within-group changes only in NRS and SFMA (p < 0.05). There were significant between-group differences in NRS, Exbody, SFMA, and WAI (p < 0.05). An on-site program including manual and exercise therapy directed by a physiotherapist among workers at an auto-parts manufacturer was effective in improving pain levels, posture, body function, and work-related health status.