Pain Subscale Research Articles

Course of hand pain over four years in patients with hand osteoarthritis depends on BMI, employment and mental wellbeing: The Hand OSTeoArthritis in Secondary care cohort study.

We aimed to characterize hand osteoarthritis (OA) patients with deteriorating or improving hand pain, and to investigate patients achieving good clinical outcome after four years. We used four year annual Australian/Canadian hand osteoarthritis index (AUSCAN) pain subscale (range 0-20) measurements from the HOSTAS cohort (hand OA patients). Pain changes were categorized as deterioration, stable and improvement using the Minimal Clinical Important Improvement (MCII). Good clinical outcome was categorized using the Patient Acceptable Symptom State (PASS). Associations between baseline characteristics (patient and disease characteristics, coping styles, illness perceptions) and outcomes were investigated using multinomial or binary logistic regression, adjusted for baseline pain, age, sex and BMI. 356 patients (83% female, mean age 60.6 years, mean AUSCAN 9.1) were analyzed. Pain improved for 38%, deteriorated for 30% and remained stable for 32% over four years. Four year pain development followed annual trends. At baseline, 44% of patients reached PASS, 49% at follow-up. Higher BMI, coping through comforting cognitions and illness comprehension were positively associated with pain deterioration. Higher AUSCAN function score, mental wellbeing and illness consequences were negatively associated with pain improvement. Employment (positively) and emotional representations (negatively) were associated with both improvement and deterioration. Higher baseline AUSCAN function, tender joint count and symptoms attributed to hand OA were associated negatively with PASS after four years. The pain course of hand OA patients is variable, not inevitably worsening, and various factors may play a role. Whether modification of these risk factors can influence pain outcomes requires further investigation.

IlluminOss photodynamic bone stabilization system improves pain and function in the treatment of humeral metastatic disease.

The aim of the LightFix Trial was to evaluate the clinical outcomes for one year after the treatment of impending and completed pathological fractures of the humerus using the IlluminOss System (IS), and to analyze the performance of this device. A total of 81 patients with an impending or completed pathological fracture were enrolled in a multicentre, open label single cohort study and treated with IS. Inclusion criteria were visual analogue scale (VAS) Pain Scores > 60 mm/100 mm and Mirels' Score ≥ 8. VAS pain, Musculoskeletal Tumor Society (MSTS) Upper Limb Function, and The European Organization for Research and Treatment of Cancer QoL Group Bone Metastases Module (QLQ-BM22) scores were all normalized to 100, and radiographs were obtained at baseline and at 14, 30, 90, 180, and 360 days postoperatively. The mean VAS pain score decreased significantly from 84 (SD 15) to 50 (SD 29), 38 (SD 30), 31 (SD 29), 31 (SD 29), and 21 (SD 23) between the baseline and follow-up times (p < 0.001). The mean MSTS function scores significantly increased from 27 (SD 19) to 52 (SD 22), 60 (23), 67 (SD 23), 72 (SD 26), and 83 (SD 14) (p < 0.001). The pain and functional subscales of the QLQ-BM22 also significantly improved at most times. A total of 12 devices broke, giving an unadjusted device fracture rate of 15%. Stabilization with the IS decreased pain and improved function with consistent results during the first postoperative year. IS is a new, minimally invasive type of internal fixation. The use of the IS alone may be better for impending rather than completed pathological fractures, and may be better in completed fractures if an added plate or more than the usual number of locking screws is required. Caution is warranted regarding its use alone in patients with a completed pathological fracture due to the rate of breakage of the device.

Bone Marrow Aspirate Concentrate Injections for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials.

Osteoarthritis (OA) poses a significant global burden, with conventional treatments like corticosteroid and hyaluronic acid (HA) injections commonly used. Emerging injectable biologics, including bone marrow aspirate concentrate (BMAC), show promise in OA management. To investigate the clinical efficacy of BMAC injection compared with other injection treatments for knee OA. Systematic review; Level of evidence, 1. A systematic review was conducted using PubMed, Embase, Cochrane Library, and Google Scholar to identify randomized controlled trials with Level 1 evidence that compared the clinical efficacy of BMAC with other injections. The visual analog scale for pain and the Pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) were used as clinical scores representing pain. For functional assessment, the Western Ontario and McMaster Universities Osteoarthritis Index and the International Knee Documentation Committee subjective form were used. For studies comparing BMAC with HA, each clinical score was standardized to pain and function scales based on the minimal clinically important difference (MCID). Eight studies, consisting of a total of 937 patients, were included. Patients treated with BMAC showed a significant improvement in clinical scores compared with baseline, starting at 1 month postinjection. For pain scores at 6-month (P = .033) and 12-month follow-up (P = .011), BMAC demonstrated favorable results over HA, with a statistically significant difference. However, these differences did not exceed the MCID. When BMAC was compared with other injections, no significant differences were observed in the degree of clinical score improvement. No serious adverse events or events significantly associated with BMAC compared with other treatments were reported. BMAC injections demonstrated effectiveness in providing pain relief and functional improvement for patients with knee OA. When BMAC was compared with other intra-articular injection options, distinct differences surpassing the MCID were not evident. Further research is deemed necessary to investigate the role of BMAC in the treatment of knee OA.

Association of smoking with knee osteoarthritis structural defects and symptoms: an individual participant data meta-analysis

Prior meta-analyses have suggested a protective link between smoking and knee osteoarthritis (KOA), but they relied on aggregate data, potentially obscuring the true relationship. To address this limitation, we conducted an Individual Participant Data (IPD) meta-analysis using data from three large cohorts: the Osteoarthritis Initiative (OAI), the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study. Participants from 16 centers in the USA and Netherlands were categorized as current, former, or never smokers. We assessed six outcomes, three related to structural changes over 4–5 years of follow-up, and three related to changes in KOA symptoms over 2–2.5 years, 5 years, and 7–8 years of follow-up. First, the incidence of radiographic KOA was evaluated in 10,072 knees, defined as having a Kellgren-Lawrence grade ≥ 2 (‘radiographic KOA’) at follow-up but not at baseline. Second, the progression of radiographic KOA was evaluated in 5274 knees, defined as an increase in Kellgren–Lawrence grade between baseline and follow-up in knees that had radiographic KOA at baseline. Third, the incidence of symptomatic KOA was evaluated in 12,910 knees, defined as having radiographic KOA in addition to symptoms at follow-up but not at baseline. Fourth, fifth, and sixth, we investigated changes between baseline and all follow-ups in scores for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales of pain, disability, and stiffness (in 2640 knees). There were no differences between smoking groups in any of these six outcomes. Our study, leveraging data from three large cohorts and the advantages of IPD, finds no evidence that smoking offers any protection against KOA, refuting the notion that smoking may benefit joint health.

Effectiveness of Cannabis Oil as an Adjuvant Therapy in Patients with Severe Knee Osteoarthritis: A Randomized, Double-Blind Study

Purpose: The removal of cannabis from Thailand's narcotic drug list presents both opportunities and challenges for medical use. The effectiveness of cannabis oil in treating severe knee osteoarthritis in patients awaiting total knee arthroplasty was evaluated in this study. Methods: Thirty-two patients with severe knee osteoarthritis, unresponsive to conservative treatment, were enrolled and divided into two equal groups. The control and experimental groups received syrup and cannabis oil, respectively, at night for 30 days. Pain and quality of life (QOL) were assessed using the Numeric Rating Scale (NRS), and the Knee Injury and Osteoarthritis Outcome Score (KOOS), respectively. Liver and kidney functions were also assessed. Results: The experimental group showed a significant reduction in NRS scores compared to the control group (p = 0.00015). Significant improvements were observed in KOOS subscales for pain, activities of daily living (ADL), and QOL (p = 0.01). However, the symptoms subscale improvement was not significant (p = 0.14). When comparing the KOOS subscales, no significant differences were observed between the groups (p &gt; 0.05). Liver and kidney function remained stable in both groups. Despite these improvements, the changes did not reach a minimal clinically important difference (MCID), indicating limited clinical perceptibility to the patients. Conclusions: Cannabis oil was associated with significant improvements in pain, ADL, and QOL in severe knee osteoarthritis. Although improvements did not meet MCID thresholds, observed benefits suggest potential for pain management. Larger controlled studies are recommended to confirm its clinical efficacy in pain management.

Internet-based treatment for provoked vulvodynia: factors associated with treatment outcomes

Abstract Introduction Previous research has indicated that internet-based Acceptance and Commitment Therapy (ACT) can reduce pain during intercourse and increase pain acceptance in individuals with provoked vulvodynia, but the factors associated with treatment outcomes remain unknown. Aim This study aimed to investigate factors associated with changes in pain acceptance following an internet treatment based on ACT. Methods This exploratory study used data from the EMBLA study, a multicenter randomized controlled trial that investigated the effects of internet-based ACT for provoked vulvodynia. The examined factors included sociodemographics, medical history, pain and sexual behavior, and psychosocial characteristics. Linear regression analysis was employed to assess the association of these factors with pain acceptance, including interaction effects. Results were adjusted for multiple testing using Bonferroni correction. Outcomes The outcome measure was pain acceptance assessed on the scale Chronic Pain Questionnaire–Revised, which comprises two sub-scales: activity engagement and pain willingness. Results Before adjustment, greater improvement in overall pain acceptance and the subscale activity engagement was seen participants in the intervention group who had a history of physical violence or sexual assault. Increased time spent on the treatment platform per week was also associated with greater improvement in pain acceptance. Participants who reported gastrointestinal problems before the internet-based treatment showed better treatment outcomes in activity engagement. Previous contact with a psychologist or counselor was associated with less improvement in activity engagement. The intervention was less effective on the subscale pain willingness with increased age and for those reporting urinary problems. No associations remained statistically significant after adjustment for multiple testing. Clinical implications Previous exposure to violence and sexual assault, concomitant gastrointestinal or urinary problems, and adherence to treatment should be further investigated in larger studies on factors associated with treatment outcomes after internet treatment based on ACT, especially regarding pain. Strengths and limitations This was a novel and exploratory study and provides information for researchers in future investigations of how individual characteristics may influence treatment outcomes. A range of variables were explored in the models, underscoring the importance of future studies to strengthen the findings. One limitation concerns the sample size, which was fairly small considering the nature of the study. Conclusion After correcting for multiple testing, no factors were found to be statistically associated with changes in pain acceptance after the treatment.

Association of Flat Feet with Knee Moments and Western Ontario and McMaster Universities Arthritis Index in Knee Osteoarthritis

Introduction: Flat feet are prevalent among individuals with medial compartment knee osteoarthritis (KOA), showing a correlation with elevated knee pain and cartilage degeneration. This study investigates the relationship between calcaneal eversion angle (CEA) and medial longitudinal arch angle (MLAA) with knee kinetics and pain. Materials and Methods: This analytical observational study included 30 volunteers with moderate KOA. The Vicon motion analysis system and two synchronized force plates were employed to capture level walking and the static standing position to measure CEA and MLAA. The study assessed the first and second peaks of the knee adduction moment, knee adduction moment impulse, peak knee flexion moment, and the peak knee flexion angle at heel strike (PKFA-HS). The Western Ontario and McMaster Universities arthritis index (WOMAC) pain and physical function were evaluated. Results: A significant positive correlation was found between CEA and the knee pain sub-score (Pearson correlation [PC]=0.446, P=0.011) and WOMAC total score (PC=0.363, P=0.049). Additionally, a significant negative correlation was observed between CEA and peak knee flexion moment/PKFA-HS (PC=-0.418, P=0.022, and PC=-0.479, P=0.001, respectively). The results also indicated a negative significant correlation between MLAA and WOMAC pain sub-score (PC=-0.389, P=0.034). Conclusion: Increased CEA and decreased MLAA are associated with elevated WOMAC pain sub-score and decreased PKFA-HS in individuals with moderate KOA. Addressing flat feet should be considered in KOA management to enhance pain relief and functional outcomes

Quality of Life in Subcutaneous or Transvenous Implantable Cardioverter-Defibrillator Patients: A Secondary Analysis of the PRAETORIAN Trial.

The subcutaneous implantable cardioverter-defibrillator (S-ICD) was developed to overcome the risk of lead-related complications associated with the transvenous implantable cardioverter-defibrillator (TV-ICD). In contrast to the TV-ICD, the S-ICD is a completely extrathoracic device. Subsequently, complications differ between these 2 implantable cardioverter-defibrillators, which might impact patient perceptions of the therapies. This prespecified secondary analysis of the PRAETORIAN trial evaluates differences in quality of life. The PRAETORIAN trial (A Prospective, Randomized Comparison of Subcutaneous and Transvenous Implantable Cardioverter Defibrillator Therapy) randomized patients with an implantable cardioverter-defibrillator indication, without the need for pacing to S-ICD or TV-ICD therapy. Two questionnaires were collected at baseline, discharge, 12 months, and 30 months. The Duke Activity Status Index measures cardiac-specific physical functioning, and the 36-Item Short Form Health Survey measures physical and mental well-being, with the subscales bodily pain and mental health being of interest in this analysis. Mann-Whitney U tests were used to compare study arms, and a mixed model was used to describe the questionnaire outcomes over time. Patients were randomized to S-ICD (n=426) and TV-ICD (n=423). In the S-ICD group, 20% were women versus 19% in the TV-ICD group. The median age was 63 (interquartile range, 54-69) years in the S-ICD group versus 64 (interquartile range, 56-69) years in the TV-ICD group. There were no significant differences in the Duke Activity Status Index and 36-Item Short Form Health Survey subscales for bodily pain and mental health between the groups at any time point. Patients with a shock in the last 90 days had significantly lower scores for social functioning (P=0.008) and role limitations due to emotional problems (P=0.001) than patients without a shock, but this effect did not differ between treatment arms. In a large randomized cohort of patients with an S-ICD or TV-ICD, no difference in overall quality of life was observed. However, implantable cardioverter-defibrillator shocks resulted in a reduction in quality of life, regardless of the device type or appropriateness. URL: https://www.clinicaltrials.gov; Unique identifier: NCT01296022.

Synthetic medial meniscus implant demonstrates high reoperation rates: Patients who retain implant or require implant exchange show improvement in post meniscectomy knee pain and clinical function

PurposeThe purpose of this study was to evaluate the clinical outcomes in the use of a synthetic medial meniscus implant in patients symptomatic after medial meniscectomy and not responsive to other treatment methods. and not responded to non-operative treatment. MethodsThis single-arm, multicenter, prospective study enrolled subjects between ages 30-75 with post-meniscectomy pain. Changes from baseline to 24-months were measured in the pain subscale of the knee injury and osteoarthritis outcome score (KOOS) and in KOOS overall (average of all five subscales) in patients that had received a medial meniscus implant. Success was a 20-point improvement at 24-months, reoperation rates, and implant failures were recorded. VAS, IKDC, and WOMET scores were also measured. ResultsOf the 115 treated patients 3 (2.6%) were either lost to follow-up or missed the 24-month visit, 48 (43%) patients had at least one subsequent surgery, 12 (10.7%) had the implant permanently removed. Of the remaining 100 patients, the mean KOOS pain improved 28.4 points at 24 months (P <0.001), and mean KOOS overall improved 28.3 points (P < 0.001). Seventy-six percent of subjects had mean scores for KOOS pain above the minimal clinically important difference (MCID) threshold, and 72% of subjects met or exceeded this threshold for KOOS overall. There were 29 patients (25.9%) who underwent implant exchange. The 24-month clinical outcomes were similar between subjects who had an implant exchange and patients who did not have any subsequent implant procedure (P < 0.2). ConclusionThe synthetic medial meniscus demonstrates high reoperation and failure rates. Patients who retained the implant or required implant exchange showed significantly improved pain, function, and quality of life at 24-month follow-up in patients symptomatic following partial medial meniscectomy and failed non-operative management. The high reoperation rate is a concern, and further evaluation is needed to determine any contributing factors.

Vascular occlusion for optimising the functional improvement in patients with knee osteoarthritis: a randomised controlled trial.

Knee osteoarthritis (KOA) is a leading cause of global disability with conventional exercise yielding only modest improvements. Here we aimed to investigate the benefits of integrating blood flow restriction (BFR) into traditional exercise programmes to enhance treatment outcomes. The Vascular Occlusion for optimizing the Functional Improvement in patients with Knee Osteoarthritis randomised controlled trial enrolled 120 patients with KOA at Ghent University Hospital, randomly assigning them to either a traditional exercise programme or a BFR-enhanced programme over 24 sessions in 12 weeks. Assessments were conducted at baseline, 6 weeks, 12 weeks and 3 months postintervention using linear mixed models with Dunn-Sidak corrections for multiple comparisons. Primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire at 3 months follow-up with knee strength, Pain Catastrophizing Scale questionnaire and functional tests as secondary outcomes. Analysis followed an intention-to-treat approach (NCT04996680). The BFR group showed greater improvements in KOOS pain subscale (effect size (ES)=0.58; p=0.0009), quadriceps strength (ES=0.81; p<0.0001) and functional tests compared with the control group at 12 weeks. At 3 months follow-up, the BFR group continued to exhibit superior improvements in KOOS pain (ES=0.55; p=0.0008), symptoms (ES=0.59; p=0.0004) and quality of life (QoL) (ES=0.66; p=0.0001) with sustained benefits in secondary outcomes. Drop-out rates were similar in both groups. Incorporating BFR into traditional exercise programmes significantly enhances short-term and long-term outcomes for patients with KOA demonstrating persistent improvements in pain, symptoms, QoL and functional measures compared with conventional exercise alone. These findings suggest that BFR can provide the metabolic stimulus needed to achieve muscle strength and functional gains with lower mechanical loads. Reduced pain and increased strength support a more active lifestyle, potentially maintaining muscle mass, functionality and QoL even beyond the supervised intervention period. NCT04996680.

Heart Failure Symptoms Improve With More Intense Physical Activity.

Little is known about how changes in physical activity (PA) over time may influence symptoms in people with heart failure (HF). A secondary analysis was conducted with data from an RCT of an exercise intervention in patients with ICDs (implantable cardioverter defibrillator) and a HF diagnosis (n = 96). Data were collected at baseline and 2months of PA intervention. Physical activity (PA Steps = mean steps/day; PA Intensity = mean steps/min for most intense 30minutes/day) were measured over 5days at each timepoint. Physical symptoms were measured using the Patient Concerns Assessment, the SF-36 Vitality, and Bodily Pain subscales for fatigue and pain. Psychological symptoms were assessed using the Patient Health Questionnaire-9, and the State-Trait Anxiety Index. Associations between PA and physical and psychological symptoms were analyzed with multivariate regression. Patients (n = 96) were predominately male (83%) and Caucasian (79%), aged 55.8 ± 12.3years, BMI of 29.7 ± 5.1, with heart failure with reduced ejection fraction (HFrEF; 30.9 ± 9.9%). An increase in PA Steps was associated with improvement in anxiety (β = -1.178, p = .048). An increase in PA Intensity was associated with significant reductions in depression (β = -0.127, p = .021), anxiety (β = -0.234, p = .037), and fatigue (β = 0.528, p = .022). Decreases in PA Steps and PA Intensity were not associated with changes in any symptoms. For HF patients with an ICD, more intense PA over 2months was associated with improved psychological symptoms and reduced fatigue. Decreases in PA (total and intensity) were not associated with changes in symptoms. Interventions promoting increasing the intensity of PA over time may be an effective approach to reduce some HF symptoms.

THE EFFECT OF EXERCISES OF DIFFERENT INTENSITY APPLIED AFTER TOTAL KNEE ARTHROPLASTY ON POST-OPERATIVE PAIN: RANDOMIZED CONTROLLED TRIAL

Purpose: This study aimed to investigate the changes in pain following exercise sessions with different intensities in patients who underwent total knee arthroplasty (TKA). Methods: This is a repeated measure and single-blinded randomized controlled study. Thirty-six patients who underwent TKA (age, 64.9 ± 7.42 years) were randomly assigned to either low-intensity exercises (LIEs) group or high-intensity exercises (HIEs) group. Exercise programs lasted for five days during the hospitalization period. Pain intensity was assessed by visual analog scale (VAS) and pressure pain thresholds (PPTs) were measured over quadriceps and biceps brachii and muscles immediately before and after exercise. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale (pain, stiffness, and physical function) scores were recorded at two points in baseline and discharge from the hospital. Results: The pain intensity decreased in patients in both groups after TKA. PPTs increased in both groups at all tested sites following the first, third, and fifth exercise bouts. HIE program had a greater positive effect on the pain intensity after the first exercise session than LIE program on the PPTs ([Formula: see text] &lt; 0.05). HIE program was more effective in order to reduce pain severity immediately after the exercise sessions in patients ([Formula: see text]: 0.5, [Formula: see text] &lt; 0.05). WOMAC scores significantly improved in both groups during the discharge from the hospital ([Formula: see text] = 0.001). Conclusion: Our results found that both LIE and HIE programs performed during hospitalization after TKA declined pain intensity. Particularly notable were the substantial improvements observed in managing post-operative pain, especially following the second exercise session. The HIE program proved more effective in improving stiffness, and enhancing physical function.

Does Early Continuous Passive Motion Improves Effectiveness of Physical Therapy After Arthroscopic Release of Elbow Contracture: A Prospective Randomized Trial.

To investigate the effectiveness of early continuous passive motion combined with physical therapy compared to physical therapy alone as the rehabilitation protocol after the release of elbow contracture. In this randomized controlled trial, 61 patients were randomly assigned to two groups (31 in the early continuous passive motion with physical therapy group vs. 30 in the physical therapy group). The patients received rehabilitation with or without early continuous passive motion for 4 weeks and were followed up for 6 months. The outcome measures were the range of motion and Mayo Elbow Performance Score. The early continuous passive motion with physical therapy group demonstrated statistically significant improvements in range of motion and the Mayo Elbow Performance Score compared with the physical therapy group at 6 weeks, 3 months, and 6 months postoperatively. These differences were not observed in the stability subscale of the Mayo Elbow Performance Score at any of the assessed time points, nor in its pain subscale at 6 months. Compared with physical therapy alone, early continuous passive motion combined with physical therapy enabled a quicker recovery of functional elbow motion and early pain control within the 6-month follow-up after arthroscopic release of elbow contracture.

Contribution of inflammation markers and quantitative sensory testing (QST) indices of central sensitisation to rheumatoid arthritis pain.

Pain, the primary complaint in rheumatoid arthritis (RA), is multifaceted, and may be driven by inflammatory disease activity and central sensitisation. We aimed to ascertain what proportion of RA pain severity is explained by markers of inflammation and quantitative sensory testing (QST) indices of central sensitisation. This was a cross-sectional analysis of data from individuals with clinically active RA. Pain severity was assessed using numerical rating scales and inflammation via 28-joint Disease Activity Score (DAS28) and Ultrasound (Greyscale, Power Doppler). Pain sensitivity was assessed by 'static' (tibialis anterior or brachioradialis pressure pain detection threshold-PPT-TA/PPT-BR) and 'dynamic' (temporal summation-TS, conditioned pain modulation-CPM) QST. Bivariate associations used Spearman's correlation coefficients, and multivariable linear regression models determined relative contributions to pain severity. In bivariate analyses of N = 96 (age 65 ± 10y, 77% females) people with RA, pain severity was significantly associated with inflammation indices (r = 0.20 to 0.55), and CPM (r=-0.26). In multivariable models that included TS, CPM, age, sex, and body mass index, inflammation indices remained significantly associated with pain severity. Multivariable models explained 22 to 27% of pain variance. Heterogeneity was apparent for associations with pain between subscores for pain now, strongest or average over the past 4-weeks. In individuals with clinically active RA, markers of inflammatory disease activity best explain RA pain with only marginal contributions from QST indices of central sensitisation. Although inflammation plays a key role in the experience of RA pain, the greater proportion of pain severity remains unexplained by DAS28 and ultrasound indices of inflammation.

A Comparative Study of the Efficacy of Platelet-Rich Plasma (PRP) vs. Other Conservative Treatments for Lateral Epicondylitis.

Background Lateral epicondylitis, also known as tennis elbow, is a degenerative condition that affects a significant portion of the adult population, particularly those between the ages of 35 and 55. Conventional treatments, including analgesics, physiotherapy, and bracing, often lead to a high recurrence rate. Platelet-rich plasma (PRP) therapy has emerged as a promising alternative, offering regenerative benefits that may enhance tissue healing. This study evaluates the effectiveness of PRP injections compared to traditional conservative therapies in alleviating pain and improving function in individuals with chronic lateral epicondylitis. Methods This prospective observational study was conducted at Father Muller Medical College Hospital from April 2018 to August 2019. A total of 44 patients aged 18-60 years with chronic lateral epicondylitis were randomly assigned to two groups: PRP (n = 22) and conservative treatment (n = 22). The conservative group received a combination of physiotherapy, analgesics, and a counterforce brace. The primary outcome was measured using the Patient-Rated Tennis Elbow Evaluation (PRTEE) score, assessed at baseline, four weeks, eight weeks, three months, and six months. The PRTEE score includes pain and function subscales. Data was analyzed using appropriate statistical methods, and significance was considered at p < 0.05. Results Both groups significantly improved pain and function during the first eight weeks. However, the PRP group demonstrated superior long-term outcomes. At three and six months, the PRP group had significantly lower pain scores (26.00 ± 3.55 and 19.55 ± 3.33, respectively, p < 0.001) compared to the conservative group (32.23 ± 3.75 and 33.64 ± 3.63). Similarly, the PRP group showed better functional improvement at six months (PRTEE function subscale: 20.00 ± 3.19 in PRP vs. 30.73 ± 4.11 in conservative, p < 0.001). No complications were reported in either group. Conclusions PRP injections provide superior long-term pain relief and functional recovery compared to conservative management in patients with chronic lateral epicondylitis. While conservative treatments are effective in the short term, PRP offers a more durable solution with no reported complications. These findings support the use of PRP as a viable alternative for the long-term management of lateral epicondylitis.

Transurethral Intraprostatic Injection of Botulinum Toxin Type A for the Treatment of Category III Chronic Prostatitis: A Randomized Sham Controlled Study

Abstract Background Chronic non-bacterial prostatitis (CNBP) is a common disease associated with pain, urinary and sexual symptoms. Diagnosis and treatment of CNBP is usually difficult and requires multiple approaches and usually with unsatisfactory outcomes. Aim and Objectives to assess the effectiveness of the intraprostatic Botulinum toxin type A (BONT-A) in the treatment of refractory CNBP in a randomized sham-controlled trial. Subject and Methods 70 patients with refractory CNBP were equally randomized into two groups. Patients in treatment group (group 1) received transurethral intraprostatic BONT-A injection, whereas patients in sham group (group 2) received transurethral intraprostatic saline injection. Baseline national institute of health chronic prostatitis symptom index (NIHCPSI) was evaluated before intervention and reassessed after 1, 3 and 6 months following treatment. Result Age, prostate size, duration of symptoms as well as baseline total NIHCPSI were not statistically significantly different between both groups before intervention (30.29 vs. 29.8 for group 1 vs. group 2 respectively, p = 0.583). We found statistically significantly reduction of NIHCPSI total score in group 1 compared to group 2 at all intervals of follow up (27.21 vs. 29.03, p = 0.037, 24.97 vs. 28.59, p &amp;lt; 0.001 and 21.76 vs. 27.27, p &amp;lt; 0.001, at 1, 3 and 6 months respectively). Mean pain subscale scores statistically significantly decreased in group 1 compared to group 2 from baseline (14.77 and 14.06 for group 1 and group 2 respectively, p = 0.127) to 12.52 and 13.79, p = 0.010, 11.53 and. 13.25 p &amp;lt; 0.001 and 10 and 13.33, p &amp;lt; 0.001 after 1, 3 and 6 months respectively. Similarly, mean quality of life score statistically significantly improved in group 1 compared to group 2 from baseline (7.74 and. 8.40 for group 1 and. group 2 respectively, p = 0.038), then after 1, 3 and 6 months (6.09 vs. 7.88, p &amp;lt; 0.001, 5.56 vs. 7.81, p &amp;lt; 0.001 and 4.74 vs. 7.39, p &amp;lt; 0.001 respectively). Mean urinary symptoms scores statistically significantly decreased in group 1 compared to group 2 at all follow up intervals from baseline (7.77 and. 7.34 for group 1 and group 2 respectively, p = 0.136), to 6.15 vs. 7.06, p &amp;lt; 0.001, 5.75 vs. 6.97, p &amp;lt; 0.001, 4.91 vs. 6.58 p &amp;lt; 0.001 after 1, 3 and 6 months respectively. Maximal effect of treatment with BONT-A was at 6 months. Mild dysuria and hematuria were the only two postoperative complications encountered after intervention in both groups. Conclusion Transurethral intraprostatic injection of BONT-A is a safe and effective treatment for refractory CNBP.

Genicular artery embolisation versus sham embolisation for symptomatic osteoarthritis of the knee: a randomised controlled trial

ObjectiveTo determine the efficacy of genicular artery embolisation (GAE) compared with sham GAE for pain reduction in patients with symptomatic mild-to-moderate knee osteoarthritis (KOA).DesignDouble-blind randomised sham-controlled clinical trial conducted from...

Cervical dystonia patients with psychiatric classification: Despite dystonia improvement less improvement in other domains after DBS surgery

BackgroundPatient satisfaction of deep brain stimulation (DBS) for cervical dystonia (CD) is heterogeneous. A high prevalence of psychiatric disorders in patients with CD is well-established. The presence of psychiatric classification in CD may affect the outcomes of DBS treatment. MethodsA cohort of 49 patients with CD and GPi-DBS was retrospectively studied in two centers. Psychiatric history was obtained from patient records. Pre- and post-operative Toronto Western Spasmodic Torticollis Rating Scores (TWSTRS, range 0–85) were compared between patients with and those without psychiatric classification. The TWSTRS disability and pain sub-scores were combined to evaluate non-motor improvement. The severity sub-score was used to assess motor improvement. ResultsTwenty (40.8 %) patients had a psychiatric classification, predominantly major depressive disorder and anxiety disorders. Following DBS treatment, the overall mean (± SD) improvement on the TWSTRS was 38.0 ± 29.2 %. Significantly, patients with a psychiatric classification experienced less improvement in the non-motor domain than the patients without a psychiatric classification (29.1 ± SD 38.2 % [range −41.7 to 96.6 %] vs. 51.9 ± 33.6 % [range −8.6 to 100.0 %]; p = 0.02). ConclusionOur findings indicate that CD patients with psychiatric classifications experience less non-motor improvement following DBS. Psychiatric comorbidities could influence the lacking experience of successful DBS treatment despite good motor outcome. Therefore, it is important to establish these comorbidities in CD patients undergoing DBS with respect to expectation management and treatment if necessary.

Topical Nigella Sativa oil versus diclofenac gel for knee osteoarthritis: A randomized open-labeled active-controlled clinical trial

Osteoarthritis (OA) is the most common cause of pain and disability among older adults. This study aims to compare the effect of topical use of Nigella Sativa (NS) oil and diclofenac gel on pain and function in knee OA (KOA). This randomized clinical trial was performed in a rheumatology clinic. Patients who fulfilled the American College of Rheumatology criteria for OA were selected. The subjects were randomly assigned to apply NS oil or diclofenac gel on the knee joint 4 times a day for 3 weeks. The outcomes, including pain and physical activity, were measured with a visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Of the initial 200 KOA patients who were assessed for eligibility, data from 60 patients (30 in each group) were analyzed. The two groups had no significant difference regarding age, sex, and body mass index. Both interventions showed statistically significant within-group differences in terms of the WOMAC subscales of pain, stiffness, function and VAS of pain (P &lt; 0.001). However, there was no significant difference between the groups. Our findings suggested that topical use of NS oil could be as effective as diclofenac gel in reducing pain and stiffness and improving function in KOA.

Effects of group-based versus individual physical exercise programs for knee osteoarthritis: A systematic review and meta-analysis

Background: Knee osteoarthritis (OA) is the most common joint disease worldwide and is associated with a high rate of disability and poor quality of life. However, little is known about the therapeutic effects of group-based versus individual-based physical exercise protocols. Objective: To investigate the effects of individual versus group-based physical exercises on pain intensity and functional outcomes in people with knee OA. Methods: MEDLINE/PubMed, Cochrane, EMBASE, and PEDro databases were searched from the earliest date available to July 2023. Study quality was evaluated using the PEDro scale. Mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated using a random effect model. Results: Six studies, with 763 patients, met the study criteria. Group-based physical exercises improved pain intensity (VAS 0-100) MD -17.2 (95% CI: -22.2 to -12.3), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale MD -0.54 (95% CI: -1.0 to -0.08), WOMAC function subscale MD -2.1 (95% CI: -4.1 to -0.08) compared to individual modality. No significant difference regarding muscle strength and exercise tolerance was found for participants in the group-based physical exercises compared with individual physical ones. Conclusion: Group-based physical exercise was more successful in reducing pain intensity and functional impairment in patients with knee OA than individual exercise programs. Both group-based and individual physical exercise programs enhanced muscle strength and 6-minute walk distance.