Pain Status Research Articles

Pain in Solid and Clean Fuel Using Households

Household air pollution from solid cooking fuel use influences multiple health outcomes, but its association with body pain remains poorly understood. This was a longitudinal study of 8880 adults who participated in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. Household cooking fuels were extracted from the baseline household questionnaire. Transitions in cooking fuels from 2011 to 2018 were also identified. Body pain status was reported in the three waves of surveys conducted in 2011, 2015, and 2018. The associations between cooking fuel type, fuel transition, and pain site number were examined using generalized estimating equations. Among the 8880 participants, 41.4% (n=3680) primarily used clean fuels for cooking, and 58.6% (n=5200) used solid ones at baseline. Cooking with solid fuels was associated with more pain sites (incidence rate ratio (IRR): 1.14; 95% confidence interval (CI): 1.08 to 1.21), but a slower rate of pain sites increases from 2011 to 2018 (IRR=0.78; 95% CI: 0.71 to 0.86, for 2018×solid fuels). Compared with those who persistently used clean fuels for cooking, the number of pain sites increased by 10% in participants who transiting from using solid to clean fuels (IRR=1.10; 95% CI: 1.04 to 1.18), by 21% in those transiting from cooking with clean to solid fuels (IRR=1.21: 95% CI: 1.08 to 1.35) and by 25% among those persistent using solid fuels for cooking (IRR=1.25; 95% CI: 1.18 to 1.34). Our findings provided new evidence linking using solid fuels for cooking with more pain sites, but a slower rate of pain sites increases. Public health efforts should focus on fuel transition and take measures to help clean fuels spread.

Health utilities in adults with hemophilia A: A retrospective cohort study.

Haemophilia A negatively affects a patient's quality of life. There is a limited amount of health utility data (a measure of health-related quality of life) available for patients with haemophilia A. This information is crucial for cost-effectiveness analysis for haemophilia A treatment. The goal of this project is to elicit the health utilities and factors impacting utility values for haemophilia A patients in Canada. This is a population-based, cross-sectional, retrospective study of health utilities in patients with haemophilia A using Patient Report Outcomes Burdens and Experiences (PROBE) components from the Canadian Bleeding Disorders Registry (CBDR). A review of the mean utilities for three severity states, defined by clotting factor VIII level, was completed. A multiple linear regression analysis was completed to examine the determinants of health utilities including age, treatment type, chronic pain status, number of limited joints, and bleed rate. The average utility values (and standard deviations) for patients with haemophilia A in Canada are.79(.17),.76(.20), and.77(.19) for patients with severe, moderate, and mild haemophilia. The regression showed chronic pain status and the number of additional comorbidities as major significant factors (p-value<.001) in haemophilia A utility. Haemophilia severity was shown to be a major factor with smaller p-value (p-value<.05). Haemophilia A patients have lower utility than the general population. Chronic pain was shown to be a significant, major factor in health-related quality of life. Our study is essential for valuing health outcomes in haemophilia A-related cost-effectiveness analysis.

The effectiveness and safety of lifestyle medicine and integrative therapies in inflammatory arthritis: an umbrella review using a hierarchical evidence gathering approach.

An umbrella review was conducted to provide a comprehensive evaluation of the evidence on lifestyle medicine and integrative therapies for inflammatory arthritis. Five electronic databases were searched for umbrella reviews, meta-analyses, and systematic reviews of randomised controlled trials on acupuncture, diet, exercise, herbal medicine, nutrient supplements, and mind-body therapies for rheumatoid arthritis, spondyloarthritis, and gout published from January 2012 to December 2022. The primary outcomes were functional status and quality of life. Quality assessment was performed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) tool, and the certainty of evidence for our primary outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach where possible. We included 52 reviews. Exercise was beneficial for functional status in both rheumatoid arthritis and spondyloarthritis, with moderate certainty of evidence. Chinese herbal medicine in combination with disease-modifying anti-rheumatic drugs may improve functional status in rheumatoid arthritis (very low certainty evidence). Acupuncture may improve functional status in rheumatoid arthritis and pain in both rheumatoid arthritis and gout; however, the evidence is of very low certainty. Evidence for other therapies was not clinically significant; however, it suggests possible benefits from quercetin and polyunsaturated fatty acids. Yoga may result in a moderate improvement in functional status when used as an adjunct to medication; however, the certainty of evidence is very low. Diet interventions offered inconsistent improvements to functional status in rheumatoid arthritis, spondyloarthritis, and gout with low to very low certainty. Exercise should be prescribed for people with rheumatoid arthritis and spondyloarthritis. More research is needed to confirm or refute evidence for Chinese herbal medicine, acupuncture, yoga, and anti-inflammatory diets.

Effect of clock rhythm on emergence agitation and early postoperative delirium in older adults undergoing thoracoscopic lung cancer surgery: protocol for a prospective, observational, cohort study

IntroductionSurgeries conducted at night can impact patients’ prognosis, and the mechanism may be related to circadian rhythm, which influence normal physiological functions and pathophysiological changes. Melatonin is primarily a circadian hormone with hypnotic and chronobiotic effects, thereby affecting disease outcomes through influencing the expression of inflammatory factors and biochemical metabolism. This study aims to observe the effects of circadian rhythms on emergence agitation and early postoperative delirium of older individuals undergoing thoracoscopic lung cancer surgery and explore the possible regulatory role of melatonin.MethodsThis prospective, observational, cohort study will involve 240 patients. Patients will be routinely divided into three groups based on the time of the surgery: T1 (8:00–14:00), T2 (14:00–20:00) and T3 group (20:00–08:00). The primary outcome will be the incidence of emergence agitation assessed via the Richmond Agitation and Sedation Scale (RASS) in the post-anesthesia care unit (PACU). Secondary outcomes will include the incidence of early postoperative delirium assessed via the Confusion Assessment Method (CAM) on postoperative day 1, pain status assessed via the numerical rating scale (NRS) in the PACU, sleep quality on postoperative day 1 and changes in perioperative plasma melatonin, clock genes and inflammatory factor levels. Postoperative surgical complications, intensive care unit admission and hospital length of stay will also be evaluated.DiscussionThis paper describes a protocol for investigating the effects of circadian rhythms on emergence agitation and early postoperative delirium of older individuals undergoing thoracoscopic lung cancer surgery, as well as exploring the potential regulatory role of melatonin. By elucidating the mechanism by which circadian rhythms impact postoperative recovery, we aim to develop a new approach for achieving rapid recovery during perioperative period.Trial registrationThe study was registered at the Chinese Clinical Trials Registry (ChiCTR2000040252) on November 26, 2020, and refreshed on September 4, 2022.

Pain Characteristics and Progression to Sarcopenia in Chinese Middle-Aged and Older Adults: A 4-Year Longitudinal Study.

It is imperative for public health to identify the factors that contribute to the progression of sarcopenia among middle-aged and older adults. Our study aimed to investigate the association between pain characteristics and the progression to sarcopenia and its subcomponents among middle-aged and older adults in China. We included 5568 participants from the China Health and Retirement Longitudinal Study. All participants completed assessments for pain characteristics and sarcopenia. Pain assessment included pain status (baseline pain, incident pain, and pain persistence) and pain distribution (single-site pain and multisite pain) using a self-report questionnaire. Diagnosis of sarcopenia followed The Asian Working Group for Sarcopenia 2019 consensus. The odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by logical regression analysis. Participants who reported baseline pain, multisite pain, pain persistence, or multisite pain persistence were more likely to progress to sarcopenia than those without pain, with ORs of 1.33 (95% CI: 1.08-1.65), 1.44 (95% CI: 1.15-1.80), 1.63 (95% CI: 1.23-2.14), and 1.59 (95% CI: 1.19-2.11), respectively. Even after adjusting for other covariates such as gender, age, residential area, education level, marital status, smoking, alcohol consumption, comorbidities, and falls, these associations remained significant. Additionally, pain persistence and multisite pain persistence were significantly associated with low grip strength and clinically meaningful Short Physical Performance Battery decline, but not with low muscle mass. Our study showed that pain, especially pain persistence, was closely correlated to the increased risk of progression to sarcopenia in Chinese middle-aged and older adults.

EFFECTIVENESS OF ACUPUNCTURE IN THE TREATMENT OF CHRONIC LOW BACK PAIN (LBP): LITERATURE REVIEW

Chronic Low Back Pain (CLBP) or Low Back Pain (NPB) is pain between the costal and gluteal margins that persists for over three months. LPB is a common disease. Fifty percent of the world's population is estimated to experience LBP by 30, and 70% of the population will experience LBP at some point in their adulthood. There is no gold standard for LBP therapy, so the therapy needed depends on the patient. One of the therapies used is acupuncture therapy. In a randomized clinical trial, acupuncture therapy demonstrated greater effectiveness in reducing pain intensity for patients with chronic LBP compared to administering oral baclofen at a dose of 30 mg/day. Another study in Germany with 1162 research subjects also found that providing acupuncture therapy in the treatment of chronic LBP had more significant efficacy on the patient's pain and functional status than conventional therapy.

Analysis of preoperative and postoperative depression and anxiety in patients with osteochondral lesions of the talus.

This study aims to investigate the psychological status of patients with Hepple V osteochondral lesions of the talus (OLT) and evaluate the effect of autologous osteoperiosteal transplantation (AOPT) on their psychological well-being. Fifty patients with Hepple V OLT who underwent AOPT at the Comprehensive Foot and Ankle Surgery Ward of Xi'an Honghui Hospital from November 2021 to May 2023 were included in this study. The patients were divided into two groups based on the presence or absence of preoperative symptoms of anxiety/depression. Group A comprised patients with preoperative symptoms, while Group B included patients without such symptoms. Preoperative and final follow-up assessments included the Hospital Anxiety and Depression Scale for evaluating anxiety and depression, the visual analogue scale for pain assessment, and the American Orthopaedic Foot and Ankle Society scores for assessing ankle and hindfoot function. Among the 50 Hepple V OLT patients who obtained complete follow-up, twenty-four had preoperative symptoms of anxiety/depression, with an incidence rate of up to 48%. Patients in Groups A and B showed significant improvement in all evaluation indexes after AOPT compared to the preoperative period, but the overall prognosis of Group A was poorer than that of Group B. AOPT can effectively improve patients' pain, functional activities, and psychological status, and there is a significant correlation between patients' preoperative psychological status and prognosis.

Dyslipidemia may impact initial recovery following arthroscopic rotator cuff repair: a retrospective study

BackgroundThe current literature shows that dyslipidemia can lead to a higher incidence of rotator cuff tears (RCTs) and an increased retear rate after repair. We aimed to evaluate the influence of preoperative dyslipidemia on postoperative pain, patient-reported outcomes (PROs), active range of motion (ROM), and structural integrity.MethodsA cohort of 111 patients who underwent arthroscopic RCT repair between January 2021 and July 2022, and whose complete preoperative serum lipid data were available within one week prior to surgery was retrospectively reviewed. Dyslipidemia was defined as the presence of an increase or decrease in at least one blood lipid profile (triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein, or non-high-density lipoprotein). There were 43 patients in the dyslipidemia group and 68 in the ortholiposis group. Patient evaluations, including pain score, PROs, and ROMs, were conducted preoperatively; at 3 and 6 months postoperatively; and at the last follow-up. Structural integrity was assessed by magnetic resonance imaging (MRI) 6 months after surgery if possible, and Sugaya type 4 or 5 was considered a retear. Propensity score matching (PSM) was used to reduce bias.ResultsThe RCT size, surgical technique, preoperative pain status, PROs, and active ROM were comparable between patients with dyslipidemia and those with ortholiposis. Three months after surgery, patients in the dyslipidemia group had worse average PROs (Constant score: P = 0.001; ASES score: P = 0.012; UCLA score: P = 0.015), forward flexion (P = 0.012), and internal rotation (P = 0.001) than patients in the ortholiposis group did. The difference between the two groups persisted after PSM but disappeared at the sixth month after surgery. No significant differences in pain score, PROs, or active ROMs were detected between the dyslipidemia and ortholiposis groups after a mean follow-up of 24 months. Of the 72 patients who underwent MRI, 4 retears (5.6%) were found, and all were in the ortholiposis group. There was no difference in the rate of retears between the two groups (P = 0.291) or with (P = 0.495) PSM.ConclusionsIn conclusion, we found that perioperative dyslipidemia may impact initial recovery within the first 3 months following arthroscopic rotator cuff repair but may have no effect on pain, PROs, or active ROMs at a mean 2-year follow-up or rotator cuff integrity at 6 months postoperatively.Trail registration Retrospectively registered.

Does pain tolerance mediate the effect of physical activity on chronic pain in the general population? The Tromsø Study.

Knowledge is needed regarding mechanisms acting between physical activity (PA) and chronic pain. We investigated whether cold pain tolerance mediates an effect of leisure-time physical activity on the risk of chronic pain 7 to 8 years later using consecutive surveys of the population-based Tromsø Study. We included participants with information on baseline leisure-time PA (LTPA) and the level of cold pressor-assessed cold pain tolerance, who reported chronic pain status at follow-up as any of the following: chronic pain for ≥3 months, widespread chronic pain, moderate-to-severe chronic pain, or widespread moderate-to-severe chronic pain. We included 6834 participants (52% women; mean age, 55 years) in counterfactual mediation analyses. Prevalence decreased with severity, for example, 60% for chronic pain vs 5% for widespread moderate-to-severe chronic pain. People with one level higher LTPA rating (light to moderate or moderate to vigorous) at baseline had lower relative risk (RR) of 4 chronic pain states 7 to 8 years later. Total RR effect of a 1-level LTPA increase was 0.95 (0.91-1.00), that is, -5% decreased risk. Total effect RR for widespread chronic pain was 0.84 (0.73-0.97). Indirect effect for moderate-to-severe chronic pain was statistically significant at RR 0.993 (0.988-0.999); total effect RR was 0.91 (0.83-0.98). Statistically significantly mediated RR for widespread moderate-to-severe chronic pain was 0.988 (0.977-0.999); total effect RR was 0.77 (0.64-0.94). This shows small mediation of the effect of LTPA through pain tolerance on 2 moderate-to-severe chronic pain types. This suggests pain tolerance to be one possible mechanism through which PA modifies the risk of moderate-to-severe chronic pain types with and without widespread pain.

Digging deeper into pain: an ethological behavior assay correlating well-being in mice with human pain experience.

The pressing need for safer, more efficacious analgesics is felt worldwide. Preclinical tests in animal models of painful conditions represent one of the earliest checkpoints novel therapeutics must negotiate before consideration for human use. Traditionally, the pain status of laboratory animals has been inferred from evoked nociceptive assays that measure their responses to noxious stimuli. The disconnect between how pain is tested in laboratory animals and how it is experienced by humans may in part explain the shortcomings of current pain medications and highlights a need for refinement. Here, we survey human patients with chronic pain who assert that everyday aspects of life, such as cleaning and leaving the house, are affected by their ongoing level of pain. Accordingly, we test the impact of painful conditions on an ethological behavior of mice, digging. Stable digging behavior was observed over time in naive mice of both sexes. By contrast, deficits in digging were seen after acute knee inflammation. The analgesia conferred by meloxicam and gabapentin was compared in the monosodium iodoacetate knee osteoarthritis model, with meloxicam more effectively ameliorating digging deficits, in line with human patients finding meloxicam more effective. Finally, in a visceral pain model, the decrease in digging behavior correlated with the extent of disease. Ultimately, we make a case for adopting ethological assays, such as digging, in studies of pain in laboratory animals, which we believe to be more representative of the human experience of pain and thus valuable in assessing clinical potential of novel analgesics in animals.

(051) Urodynamic Profiles of Young Aged Women with Genital Pain Disorder

Abstract Introduction It is not uncommon in young female patients with genital pain disorder, they also complain urethral discomfort or unusual sensitivity, bothering symptoms on their urethra and genital area with LUTS. Although urodynamic studies or pressure flow studies are one of very optional studies of diagnostic steps, pressure flow studies provide detailed information of patient bladder-urethral synergistic function that may contribute proper function of the pelvic floor and related organs. However, studies are limited providing their relationship between urethral functional status and etiology of pain. Objective In this study, we aimed to evaluate female patients pressure flow profiles, urethral pressure profiles (UPP) in particular and to investigate their correlation of clinical symptoms in terms of genital pain disorder in 20’s-30’s aged young female. Methods Data of 30 female patients age between 20–39 years old with genital pain and LUTS for more than 6 months were retrospectively analyzed. Pressure flow study (PFS) with free uroflowmetry, overactive bladder symptom score (OABSS), visual analogue scale (VAS), female sexual function index (FSFI) were retrospectively analyzed according to aged groups of 20’s and 30’s. Data were statistically analyzed using t-test (p&amp;lt;0.05). Results We divided the subject patients into 2 groups; age of 20’s (n=16, 20–28, median 25 years old) and age of 30’s (n=14, 30–39, median 34 years old). Average MUCP of all patients was 104 cmH2O. In the group of aged 20’s, mean MUCP was 98.75 cmH2O, mean VAS was 5.81; in the group of aged 30’s, mean MUCP was 111.07 cmH2O, mean VAS was 5.57, respectively. All of the data showed high pressure of MUCP in PFS, &amp;gt;60 cmH2O. In group of 30’s, all the parameters of PFS showed higher compared with 20’s. Mean OAB symptom scores (OABSS) showed 3.63 (20’s) and 3.07 (30’s) respectively (p&amp;gt;0.05) Conclusions Urethral pressure, PdetQmax and Qmax showed significantly high in young females with genital pain. This study suggests that increased urethral tone or resistance may contribute to urethral/genital pain. Proper evaluation of urethral pressure profile and pelvic floor tone would be helpful to provide optimal management of genital pain disorder. Disclosure No.

Neck Pain, Mental Status, and Associated Factors Among Hospital Secretaries: A Cross-Sectional Study From Turkey.

Neck disorders occur in the presence of various risk factors. Determining the cause-effect relationship is highly important in treating existing health problems. Our study aimed to determine the relationship between neck pain and mental status and the factors affecting them in hospital secretaries. The study was cross-sectional. A total of 427 people who had been working as hospital secretaries at Gazi University Medical Faculty Hospital for at least one year were included in the study. Sociodemographic characteristics, working conditions, psychopathology levels, and the presence of neck pain were questioned. The study was conducted with 354 (82.9%) people. 34.3% of the hospital secretaries had neck pain, and 26.3% required psychiatric evaluation. There was a statistically significant (p<0.001) difference in neck pain according to gender, adjustability of the chair, accessibility of the tools, and the need for psychiatric evaluation. Data was collected during November 2022. Those who did neck exercises during the study period had lower mean scores on the General Health Questionnaire-12 than those who did not, and the difference was statistically significant (p<0.001). According to the General Health Questionnaire-12 scores and the Bournemouth Neck Pain Questionnaire Scale, there is a significant (p<0.001), positive, and moderate (r=0.481) correlation between the frequency of mental problems and neck pain disability levels. The relationship between the need for psychiatric status evaluation and neck pain is striking. A significant proportion of hospital secretaries complain of neck pain, work in non-ergonomic conditions, and need psychiatric evaluation. The study's results underline the necessity of targeted workplace interventions and wellness procedures, highlighting the need to implement ergonomic improvements, promote regular exercise regimes, and provide psychosocial support services to improve the general well-being of hospital secretaries and develop a better working environment.

Parent Anxiety, Depression, Protective Responses, and Parenting Stress in the Context of Parent and Child Chronic Pain: A Daily Diary Study of Parent Variability

Parents with (vs without) chronic pain report poorer psychosocial functioning (eg, worse mental health, parenting difficulties), which has been linked to poorer child outcomes (eg, child pain). However, emerging research suggests that individuals vary in their functioning from day-to-day, particularly those with chronic pain. This study used daily diaries to compare parents with (versus without) chronic pain on variability in their anxiety, mood, protective responses, and parenting stress. We also examined parent chronic pain status as a moderator of the associations between parent variability and youth daily pain and interference. Participants were 76 youth with chronic pain (Mage = 14.26; 71.1% female) and one of their parents (89.5% mothers; n = 38 or 50.0% endorsing chronic pain). Parents and youth completed self-report questionnaires and 7 days of diaries. Parent variability was calculated to reflect the frequency and size of day-to-day changes. Multilevel models revealed that parents with (vs without) chronic pain were significantly more variable in their parenting stress, but not in their anxiety, mood, or protective responses. Contrary to hypotheses, parent variability was not significantly related to youth daily pain intensity or interference and parent chronic pain did not moderate any associations. Instead, mean levels of parent anxiety, protective responses, and parenting stress across the week significantly predicted youth daily pain interference. Findings suggest that while variability was observed among parents (with and without chronic pain) of youth with chronic pain, it did not significantly predict youth’s daily pain-related functioning. Further research is needed to confirm these initial findings. PerspectiveParents with chronic pain have expressed concerns that the variable nature of their pain negatively impacts their children. Our results found that parents (with and without chronic pain) were variable in their anxiety, mood, protective responses, and parenting stress, but this variability did not significantly predict youth’s chronic pain-related functioning.

"IT's too much to do alone": A mixed-methods exploration of patient experiences implementing emergency department management plans for chronic pain.

To explore the experiences of socio-culturally diverse community members attempting to manage their chronic pain and enact evidence-based management plans following an index Emergency Department (ED) visit. A convergent parallel mixed-methods design with qualitative interviews and descriptive analysis was undertaken in two public hospitals in a multicultural region in Sydney, Australia. Consecutive adults were recruited from culturally and linguistically diverse (CALD: n=45) or Australian-born (n=45) backgrounds, who presented to the ED for a chronic neuromusculoskeletal pain condition. Consenting participants were prescribed an individualised chronic pain management plan following examination by a physiotherapist, who collected standardised measures of pain and health literacy. Six months later, participants underwent a structured phone survey regarding their pain status and whether they had actioned management plans. Participants were invited to participate in a semi-structured interview. Six-month data were available for 82 of 90 participants who attended the ED and consented to the baseline assessment (40 CALD and 42 Australian-born). Participants were 52% females, predominately middle-aged (mean age 54.7years), with an overall mean symptom duration of 10years (SD 9.0). At 6months, there were nine representations by six CALD participants and 23 by nine Australian-born participants. Overall, 52% reported unchanged pain, 24% were worse and 23% improved, with similar action plan progress for CALD (58%) and Australian-born (53%) participants. Pain features and health literacy were similar, irrespective of progress with pain management plans. From 41 participants who consented to phone interviews, three themes emerged to explain their progress with recommendations: 'illness model', 'urgency' and 'control orientation'. Patients presenting to the ED with chronic pain might be more likely to action discharge recommendations if primary care providers identify patient-specific and contextual barriers to implementation.

Association Between Musculoskeletal Pain and Frailty Over Time in Older Adults.

There is a high frequency of frailty in patients with musculoskeletal pain. Pain from osteoarthritis and lower back pain may be associated with frailty. However, the future risk of frailty among older adults with pain remains unclear. Thus, the primary objective of this study was to examine the association between musculoskeletal pain and the risk of becoming prefrail and frail in older adults. A secondary analysis was performed using data from baseline and 1-, 2-, 3-, 4-, 6-, and 8-year follow-ups of the Osteoarthritis Initiative (OAI). The OAI recruited participants from 4 clinical sites in the United States, between February 2004 and May 2006. A self-reported questionnaire was used to determine the baseline musculoskeletal pain status in older adults (n = 1780) 65 years and older, including pain in the lower back, hip, knee, and at 2 or more sites. Using the Fried phenotypic criteria, participants were classified as nonfrail, prefrail, and frail at each period over 8 years. After adjusting for age, sex, race, education, marital status, annual income, smoking status, comorbidities, and body mass index, binary logistic regression modeling using generalized estimating equations revealed that in older adults musculoskeletal pain in the lower back and at multiple sites was associated with a slightly but significantly decreased risk of prefrailty over time (adjusted odds ratio [AOR] = 0.98, 95% CI = 0.95-0.99, P = .019; AOR = 0.96, CI = 0.92-0.99, P = .032). The association between musculoskeletal pain and frailty among older adults was not statistically significant (all P > .05). Musculoskeletal pain did not independently significantly increase the risk of prefrailty or frailty over time. It remains possible that when musculoskeletal is combined with other factors, the risk of prefrailty and frailty may be heightened. Further research into the combination of characteristics that best predict prefrailty and frailty, including but not limited to musculoskeletal pain, is warranted.

Comparison of Radiofrequency Ablation and Cyanoacrylate Closure for Large-Diameter Great Saphenous Vein Insufficiency

ObjectiveTo compare radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for large-diameter great saphenous vein insufficiency (GSV) between diameters of 12 and 16 mm. Material-MethodsThis study is a single-centre retrospective study. Subjects who underwent endovenous treatment with RFA (Group A) or CAC (Group B) for GSV insufficiency between June 2015 and June 2021 who were followed up for at least 2 years were included in the study. Subjects who had a 12 to 16 mm target vessel diameter and subjects with grade 3 and grade 4 reflux were included. Subjects’ demographic data (age, sex), body mass indices (BMI), clinical, aetiological, anatomic, pathophysiologic (CEAP) classification, GSV diameter, reflux grade, target vessel length, preoperative venous clinical severity score (VCSS), procedural time, postoperative 1st-day pain scores, postoperative 14th-day patient satisfaction scale and postoperative complications were noted. In follow-up, subjects were evaluated with duplex ultrasonography and VCSS at 1, 6, 12 and 24 months. ResultsIn total, 142 subjects were included (n=71 for both groups). The mean GSV diameter was 13,21±1,00 for Group A and 13,51±0,97 for Group B. The groups did not differ in terms of age, sex, BMI, CEAP classification, GSV diameter, reflux grade, target GSV length, preoperative VCSS, complications, postoperative 24-hour pain status or postoperative 14-day patient satisfaction scale (p>0.05 for all comparisons). The procedure time was significantly shorter in Group B (34,68±4,22 min for Group A vs. 22,59±4,5 min for Group B, p=0,001). In the 1-month and 6-month Duplex ultrasonography of the subjects, partial closure and patency rates in Group B were significantly higher than those in Group A (p=0.003 and p=0.025, respectively). At the 12- and 24-month evaluation, closure rates did not show a statistically significant difference between the groups (p=0.056 and p=0.090, respectively). Preoperative and 1-month VCSS measurements did not show a statistically significant difference between groups (p>0.05 for all comparisons). The 6- and 12-month 24-month VCSS measurements of Group A were significantly higher than those in Group B. (p=0.043, p=0.009 and p=0.002, respectively). ConclusionBoth RFA and CAC were found to be effective in the treatment of large-diameter GSV incompetency. The complication rates were similar between the two techniques. CAC had a shorter procedure time. Although the closure rates in the early postoperative period were better in the RFA group, long-term follow-up demonstrated similar patency rates. The functional results in the long-term follow-up were better in the RFA group.

Comprehensive Spinal Tuberculosis Score: A Clinical Guide for the Management of Thoracolumbar Spinal Tuberculosis.

A newly proposed scoring tool was designed to assist in the clinical management of adult thoracolumbar spinal tuberculosis (TB). To formulate a comprehensive yet simple scoring tool to guide decision-making in the management of adult thoracolumbar spinal TB. Spine surgeons have differing consensus in defining the threshold grade for clinico-radiological parameters when deciding between operative or conservative treatment for adult thoracolumbar spinal TB. Currently, the void in decision-making from the lack of well-defined guidelines is compensated by the surgeon's experience in treating these patients. To the best of our knowledge, no scoring system holistically integrates multiple facets of spinal TB to guide clinical decision-making. The RAND/University of California, Los Angeles appropriateness method was employed among an expert panel of 10 spine surgeons from four apex tertiary care centers. Vital characteristics that independently influenced treatment decisions in spinal TB were identified, and a scoring tool was formulated. Points were assigned for each component based on their severity. The cutoff scores to guide clinical management were determined from the receiver operating characteristic curve based on the retrospective records of 151 patients treated operatively or non-operatively with improved functional outcomes at the 1-year follow-up. The components of the comprehensive spinal TB score (CSTS) are pain, kyphosis angle, vertebral destruction, and neurological status. A score classification of <5.5, 5.5-6.5, and >6.5 was established to guide the patient toward conservative, conservative/ operative, and operative management, respectively. The CSTS was designed to reflect the essential indicators of mechanical stability, neurological stability, and disease process stabilization in spinal TB. The scoring tool is devised to be practical and serve as a common language in the spine community to facilitate discussions and decision-making in thoracolumbar spinal TB. The validity, reliability, and reproducibility of this tool must be assessed through multicenter long-term studies.

Short-term and mid-term evaluation of three types of minimally invasive lumbar fusion surgery for treatment of L4/L5 degenerative spondylolisthesis

This was a single-centre retrospective study. Minimally invasive techniques for transforaminal lumbar interbody fusion (MIS-TLIF), oblique lumbar interbody fusion (OLIF), and percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) have been extensively used for lumbar degenerative diseases. The present study analyses the short-term and mid-term clinical effects of the above three minimally invasive techniques on L4/L5 degenerative spondylolisthesis. In this retrospective study, 98 patients with L4/L5 degenerative spondylolisthesis received MIS-TLIF, 107 received OLIF, and 114 received Endo-TLIF. All patients were followed up for at least one year. We compared patient data, including age, sex, body mass index (BMI), Oswestry disability index (ODI), visual analogue scale of low back pain (VAS-B), visual analogue scale of leg pain (VAS-L), surgical time, blood loss, drainage volume, hospital stay, complications, and neurological status. Moreover, we performed imaging evaluations, including lumbar lordosis angle (LLA), disc height (DH) and intervertebral fusion status. No significant differences were noted in age, sex, BMI, preoperative ODI, preoperative VAS-B, preoperative VAS-L, preoperative LLA, or preoperative DH. Patients who underwent OLIF had significantly decreased blood loss, a lower drainage volume, and a shorter hospital stay than those who underwent MIS-TLIF or Endo-TLIF (P < 0.05). The VAS-B in the OLIF group significantly decreased compared with in the MIS-TLIF and Endo-TLIF groups at 6 and 12 months postoperatively (P < 0.05). The VAS-L in the Endo-TLIF group significantly decreased compared with that in the MIS-TLIF and OLIF groups at 6 months postoperatively (P < 0.05). The ODI in the OLIF group was significantly better than that in the MIS-TLIF and Endo-TLIF groups at 6 months postoperatively (P < 0.05). No statistically significant differences in the incidence of complications and healthcare cost were found among the three groups. Follow-up LLA and DH changes were significantly lower in the OLIF group than in the other groups (P < 0.05). The intervertebral fusion rate was significantly higher in the OLIF group than in the other groups at 6 and 12 months postoperatively (P < 0.05). In conclusion, while MIS-TLIF, OLIF, and Endo-TLIF techniques can effectively treat patients with L4/5 degenerative spondylolisthesis, OLIF has more benefits, including less operative blood loss, a shorter hospital stay, a smaller drainage volume, efficacy for back pain, effective maintenance of lumbar lordosis angle and disc height, and a higher fusion rate. OLIF should be the preferred surgical treatment for patients with L4/5 degenerative spondylolisthesis.

Effects of Home Exercise and Manual Therapy or Supervised Exercise on Nonspecific Chronic Low Back Pain and Disability

In this study, we aimed to evaluate the effects of two therapeutic methods: home-based exercise and manual therapy (MT) or supervised exercise on pain and functional status in individuals with chronic nonspecific low back pain. In total, 60 individuals with LBP were included in this randomized study. All participants were treated for 6 weeks in one of two groups: the manual therapy group or the exercise therapy group. In addition, all participants were asked to perform an exercise program at home independently. Levels of pain, spinal mobility, disability, and abdominal and back muscle endurance were measured before and after 6 weeks of intervention. Results: After MT, disability was reduced by 70% (F = 42.2; p &lt; 0.00; ηp2 = 0.99) and pain was reduced by 78% (F = 4.9; p &lt; 0.00; ηp2 = 0.51). After exercise therapy, disability and pain were reduced by 78% (F = 11.5; p &lt; 0.00; ηp2 = 0.78) and 68% (F = 9.4; p &lt; 0.00; ηp2 = 0.41), respectively. Muscle endurance and lumbar spine mobility values were significantly higher in both groups after 6 weeks of intervention (p &lt; 0.00). After 12 MT interventions, lumbar spine mobility increased by 40% (F = 1.9; p &lt; 0.00; ηp2 = 0.24) and after exercise therapy by 38% (F = 28.4; p &lt; 0.00; ηp2 = 0.82). Abdominal muscle endurance improved by 29% (F = 24.2; p &lt; 0.00; ηp2 = 0.79) after MT and by 34% (F = 57.6; p &lt; 0.00; ηp2 = 0.67) after exercise therapy; back muscle endurance improved by 18% (F = 48.6; p &lt; 0.00; ηp2 = 0.78) after MT and by 20% (F = 14.2; p &lt; 0.00; ηp2 = 0.76) after exercise therapy. After 6 weeks of intervention, there was no statistically significant difference between the pain, disability, and spinal mobility groups (p &gt; 0.05). However, differences between groups in kinesiophobia (p = 0.02), back (p &lt; 0.02) and abdominal (p &lt; 0.03) muscle endurance values were statistically significant. Following the home exercise program and manual therapy, or the home exercise program and supervised exercise, LBP and disability had clinically significant reductions and functional status showed improvement.

Parent-perceived recurrent pain in children: associations with maternal pain, depressiveness, socioeconomic status, and children's behavioural difficulties.

The current study aimed to examine the potential transgenerational associations between maternal pain and depressiveness and childhood pain, and to explore the associations between the children's difficulties and recurrent pain (defined as pain occurring at least once a month in the previous 6 month) in healthy children aged 3-13 years. We collected Data between 2015 and 2019 as part of the LIFE Child study in Germany and investigated associations of maternal pain and depressiveness, child age, sex, pubertal stage, emotional difficulties, conduct difficulties, hyperactivity/inattention, peer group difficulties, and prosocial skills, and family socioeconomic status with the frequency of parent-perceived headache, backache, and stomachache in a sample of 1,850 children (4,819 documented visits) using logistic and ordinal regression analyses. Overall, 10.4%, 24.4%, and 45.2% of parents reported their children had recurrent backache, headache, and stomachache, respectively, with 5.5% of children were reported to experience all three types of pain simultaneously. Higher age, female sex, puberty, emotional difficulties, low family socioeconomic status, as well as higher maternal impairment due to pain and maternal depressiveness were significantly associated with more frequent pain. Our study suggests that maternal pain, maternal depressiveness, and lower family socioeconomic status as well as child's emotional difficulties are significantly associated with a higher frequency of recurrent pain in children perceived by their parents.