Pain Perception In Patients Research Articles

Effects of Motor Imagery and Action Observation Training on Pain Perception in Patients With Chronic Neck Pain

Effects of Motor Imagery and Action Observation Training on Pain Perception in Patients With Chronic Neck Pain

The Effect of Medical Exercise Therapy on Pressure Sensitivity in Patients with Knee Osteoarthritis: A Cohort Pilot Study.

IntroductionWhile continued research into pain and exercise may address the underlying mechanisms, the mechanisms through which exercise may act are still poorly understood. The purpose of this study was to examine the effects of medical exercise therapy on pressure sensitivity in knee osteoarthritis patients, and to assess whether the decreased pain perception after medical exercise therapy can be explained by changes in pressure sensitivity.MethodsWe adopted acohort design in which 16 patients with long term pain were tested before and after 3 months of medical exercise therapy intervention. Pain was detected by visual analogue scale (VAS) and a digital pressure algometer, which also assessed pressure sensitivity. Function (Knee Osteoarthritis Outcome Score, KOOS), anxiety and depression (HAD) and kinesiophobia (Tampa Scale of Kinesiophobia, TSK) were also measured.ResultsThe VAS showed a statistically significant reduction of perceived pain, from 5.19 (SD 2.04) to 4.12 (SD 2.09) from pre- to post-test (p < 0.05). There was no significant change in pressure algometry on either the painful side or the non-painful side.ConclusionAs there were no significant correlations between the reduced pain perception and pressure sensitivity in knee osteoarthritis patients, we suggest that local knee pain does not necessarily alter generalized sensitivity. These findings should be further investigated in a randomized trial in the future.Trial RegistrationClinicaltrials.gov, identifier NCT02905747.

Evidence for an association of gut microbial Clostridia with brain functional connectivity and gastrointestinal sensorimotor function in patients with irritable bowel syndrome, based on tripartite network analysis

Background and aimsEvidence from preclinical and clinical studies suggests that interactions among the brain, gut, and microbiota may affect the pathophysiology of irritable bowel syndrome (IBS). As disruptions in central and peripheral serotonergic signaling pathways have been found in patients with IBS, we explored the hypothesis that the abundance of serotonin-modulating microbes of the order Clostridiales is associated with functional connectivity of somatosensory brain regions and gastrointestinal (GI) sensorimotor function.MethodsWe performed a prospective study of 65 patients with IBS and 21 healthy individuals (controls) recruited from 2011 through 2013 at a secondary/tertiary care outpatient clinic in Sweden. Study participants underwent functional brain imaging, rectal balloon distension, a nutrient and lactulose challenge test, and assessment of oroanal transit time within a month. They also submitted stool samples, which were analyzed by 16S ribosomal RNA gene sequencing. A tripartite network analysis based on graph theory was used to investigate the interactions among bacteria in the order Clostridiales, connectivity of brain regions in the somatosensory network, and GI sensorimotor function.ResultsWe found associations between GI sensorimotor function and gut microbes in stool samples from controls, but not in samples from IBS patients. The largest differences between controls and patients with IBS were observed in the Lachnospiraceae incertae sedis, Clostridium XIVa, and Coprococcus subnetworks. We found connectivity of subcortical (thalamus, caudate, and putamen) and cortical (primary and secondary somatosensory cortices) regions to be involved in mediating interactions among these networks.ConclusionsIn a comparison of patients with IBS and controls, we observed disruptions in the interactions between the brain, gut, and gut microbial metabolites in patients with IBS—these involve mainly subcortical but also cortical regions of brain. These disruptions may contribute to altered perception of pain in patients with IBS and may be mediated by microbial modulation of the gut serotonergic system.

Cystoscopy Real-Time Self-Visualization and Its Impact in Patient's Pain Perception.

To determine if self-visualization of ambulatory cystoscopy provides a decrease in pain perception in male and female patients. A quasi-randomized controlled trial involving patients scheduled for ambulatory cystoscopy from August to November 2017. The indications were: hematuria, bladder cancer surveillance, lower urinary tract symptoms, and incontinence. The patients were quasi-randomized into two groups by scheduled date. Both groups received the same explanation before and during cystoscopy. The variables analyzed were gender, age, Visual Analog Scale (VAS) score, number of previous cystoscopies, and indication and positivity of the test for bladder neoplasia. All patients were analyzed by group and gender separately. The statistical tests used were: Wilcoxon rank-sum, Kruskal-Wallis, Mann-Whitney U test, Pearson correlation, and linear regression. Four hundred four patients were included (318 males and 86 females) and divided into two groups, group A (no self-visualization, n = 239) and group B (self-visualization, n = 165). In males, mean VAS score was 2.6 for group A and 2.5 for group B (p = 0.276); in females, VAS score was 2.78 for group A and 1.64 for group B (p = 0.008). Regarding the remaining variables analyzed, neither positivity of the test for neoplasia (p = 0.14) nor cystoscopy indication (p = 0.597) had any influence. In patients with two or more previous cystoscopies, a reduction in mean VAS score was seen in both genders. In males having their first cystoscopy the mean VAS score was 3.1 and decreased to 2.1 for the third or more (p = 0.001); in females the mean VAS score was 2.89 for the first and 1.56 for the third or more (p = 0.02), although this benefit tended to disappear when the number of previous cystoscopies was taken into account. In male patients, self-visualization of cystoscopy did not impact pain perception, while in female patients, it seemed to provide a benefit. The number of previous cystoscopies had an influence, diminishing the perception of pain, regardless of whether the patient visualized the procedure or not.

(338) Nuclear Factor Kappa Beta Subunit 2 Genotype and Pain in Postmenopausal Women with Early-Stage Breast Cancer Prior Treatment

The nuclear factor kappa beta (NF-kB) transcription factor complex is a regulatory element for genes involved in immune function and inflammation. Inflammatory processes are involved in the development and maintenance of symptom clusters. A polymorphism in subunit 2 of the NF-kB complex (NF-kB2) has been associated with symptom clusters in breast cancer patients. One of the most common symptoms experienced by breast cancer patients is pain. Little is known about the association between NF-kB2 and perception of pain in breast cancer patients. The purpose of this exploratory analysis was to compare pain severity with NFkB2 genotype (rs1056890) in women with early-stage breast cancer prior to adjuvant treatment initiation to gain insight into the mechanisms of pain development. Responses to the Brief Pain Inventory and NFkB2 genotype information were collected from 271 postmenopausal women aged 43 to 75 diagnosed with breast cancer as part of a larger cohort study. Of the 271 women, 257 (94.8%) reported race as being white. Univariate descriptive analysis of data showed 124 women were GG, 112 were AG, and 35 were AA. The overall average pain scores for the women on a 10-point scale with 0 being “no pain” and 10 being “pain as bad as you can imagine” were: 1.37 ±1.93 (AA), 1.89 ±2.37 (AG), 1.76 ±2.34 (GG). But, of the women reporting pain, the overall averages rose to: 3.20±1.66 (AA), 3.79 ±2.02 (AG), 3.82 ±2.00 (GG). Analysis of variance between the three genotypes was nonsignificant. The results of our analysis suggest that although there were no significant differences between NF-kB2 genotype and pain severity, the G genotype was present in those women with more severe pre-therapy pain. These results present a useful baseline for further study of the NF-kB2 genotype in cancer-related pain.

Needle temperature and pain perception in the treatment of rheumatic heart disease

Aim: Patients with rheumatic heart disease (RHD) are committed to lifelong secondary prophylaxis with antibiotics. The study was conducted to evaluate the effect of cold needle to decrease the pain associated with this injection. Material and methods: A randomised crossover single-blinded study was conducted among 100 patients receiving penicillin with room-temperature needle and cold needle (0–2oC) in random order. Pain was evaluated using numerical pain rating scale and bio-physiological measures. Results: There was a significant decrease in subjective pain score when cold needle was used as compared to room-temperature needle (3.37 ±1.75 vs 5.58 ±1.68, P≤0.0001). Conclusion: Cold needle decreased pain perception of patients receiving intramuscular injection of benzathine penicillin. Pain-reducing technique may be useful in improving compliance of patients receiving benzathine penicillin.

Association of COMT gene variability with pain intensity in patients after total hip replacement

Pain is one of the most interdisciplinary clinical symptoms of a disease. The aim of the study was to evaluate the association of COMT gene polymorphism with pain perception in patients after total hip replacement (THR). The study included 195 patients qualified for surgical treatment (THR) due to osteoarthritis. Patients previously undergoing hip replacement subsequently underwent multimodal pain management therapy, in accordance with the recommendations for treating postoperative pain. The intensity of pain was measured three times at pre-defined time intervals: 1.5, 6 and 12 months after hip replacement, using the visual analogue scale. Single nucleotide polymorphism (SNP) in the COMT gene rs4680: A>G (Val158Met), rs6269: A>G (promoter region), rs4633: C>T (His62His) and rs4818: C>G (Leu136Leu) was genotyped. COMT SNP frequency distribution was analysed. For rs6269 and rs4818, the minor allele was the G allele (38.7 and 38.5%, respectively). It was also observed that rs4633 (T) allele frequency (50%) equalled that of the rs4680 (A) allele (50%). We assessed COMT haplotype frequency in the patients studied. The most frequent haplotype was haplotype M (ATCA) (50%), the rarest haplotype was haplotype R (ATGG), with a frequency of 0.3%. The most frequent diplotype was H/M, which was found in 37.95% of the patients. The frequency of other diplotypes was: M/M–24.10%, H/H–15.90% and L/M–13.33%. The study showed a significant association of rs4818 G allele and equivalent COMT H haplotype with lower sensitivity to pain after hip replacement.

Acute effects of manual therapy on respiratory parameters in thoracic outlet syndrome.

This study aims to investigate the acute effects of manual therapy on pain perception and respiratory parameters in patients with thoracic outlet syndrome. The study included 10 patients with thoracic outlet syndrome (1 male, 9 females; mean age 31.3±9.0 years; range, 20 to 43 years). Patients were accepted in a single session of manual therapy involving the cervical spine and thorax. Stretching of scalene, upper trapezius, sternocleidomastoid, rectus abdominis, hip flexor muscles; and mobilization of first rib, cervical and thoracic spine, sacroiliac joints and thorax were applied as manual therapy program. Pain perceptions of upper arm and neck were assessed with visual analog scale. Measurements were performed before and immediately after of a 30-minute session of manual therapy. Pulmonary function testing was performed with a spirometer. Respiratory muscle strength (inspiratory and expiratory muscle strength, maximal inspiratory pressure and maximal expiratory pressure, respectively) was measured. Respiratory muscle endurance was recorded using sustained threshold loading of 35% maximal inspiratory pressure. There were no significant changes in any pulmonary function parameters or maximal expiratory pressure following manual therapy intervention (p>0.05). However, maximal inspiratory pressure and respiratory muscle endurance improved (p<0.05). Pain perceptions of upper arm and neck reduced after treatment (p<0.05). A 30-minute single manual therapy session improved inspiratory muscle strength and respiratory muscle endurance but not pulmonary function and expiratory muscle strength in patients with thoracic outlet syndrome. Manual therapy may facilitate functional breathing and support use of primary respiratory muscles more effectively together with rapid pain reduction. The long-term effects of regular manual therapy on respiratory parameters should be investigated after surgical procedures.

Clinical evaluation of the developed method effectiveness of anesthesia of the zygomaticofacial nerve

The branching of the trigeminal nerve on the face has an individual anatomical variability. The individual variability of innervation of soft tissues of the maxillofacial area should be taken into account during their local anesthesia. During the blockade of the zygomaticofacial nerve in accordance with the well-known technique, only 74 % of the cases of anesthesia in the buccal and zygomatic areas were completely anesthetized.&#x0D; The aim of the study – to give a сlinical evaluation of the effectiveness of the developed method of anesthesia of the zygomaticofacial nerve.&#x0D; Materials and Methods. In the clinical observation 41 stationary stomatological patients with planned surgical interventions on the lateral facial area took part (in the buccal area – 16 patients, in the zygomatic area – 25 patients). In order to detect the individual anatomical features of the facial part of the head in patients, the facial index was determined by the Garson`s formula as the relation between the morphological height of the face and its width multiplied by 100. These patients were applied a developed method of conductive anesthesia of the zygomaticofacial nerve and compared its effectiveness with a known method. Pain sensitivity and perception in patients were studied using subjective and objective methods. Pain sensitivity was determined by injection of a needle (pinprick) into the epidermis. Pain perception during local anesthesia administration was evaluated by the Sounds, Eyes and Motor (SEM) scale.&#x0D; Results and Discussion. Taking into account the results of craniometric studies as well as the individual topographic and anatomical features of zygomaticofacial nerve branching in people with different types of skull structure, the technique of conduction anesthesia of the branches of the zygomaticofacial nerve was developed. During surgical treatment the effectiveness of the local anesthetic developed method was evaluated as good – it was observed in patients a stable anesthesia, without psychosomatic peculiarities as well as local and general complications.&#x0D; Conclusions. Application in clinical conditions of the technique of conductive anesthesia of the zygomaticofacial nerve, developed by us, in combination with the classical method of local anesthesia of the buccal nerve provides painless surgical interventions on the lateral area of the face. For the successful local anesthesia of the zygomatic and buccal regions, it is necessary to take into account the anatomical variability of the branch on the face of the zygomaticofacial nerve in patients with different types of skull structure and face shape.

Psychometric Factors in Quality of Life and Pain Perception in Patients with Chronic Nonspecific Neck Pain

Introduction: Nonspecific neck pain is the most common cause of neck symptoms and usually presents psychosocial aspects that make treatment difficult. Objective: Analyze the association of psychometric factors in quality of life and pain perception in patients with chronic nonspecific neck pain. Methodology: 17 individuals with chronic nonspecific neck pain submitted to an evaluation through validated questionnaires for pain, quality of life, kinesiophobia, catastrophism, anxiety and depression. Results: Correlations with quality of life were observed between pain intensity in the domains of pain (r=-0.73; p= 0.001), general health status (r=-0.74 ; p=0.001) and limitation by social aspects (r=-0.60; p= 0.01); interference and functional capacity (r=-0.50 ; p= 0.04), physical limitations (r=-0.50; p=0.008), pain (r=-0.82; p= 0.001), condition general health (r=-0.65; p= 0.005) and limitation by social aspects (r=-0.57; p= 0.02); this correlation was also seen with catastrophism and limitation by social aspects (r=-0.65; p= 0.004); anxiety with functional capacity (r=-0.60; p=0.01), with pain (r=-0.59; p= 0.01) and social limitation (r=-0.60; p= 0.01). Pain intensity was significant when correlated with catastrophism (r=0.51; p=0.03), anxiety (r=0.55; p=0.02), and pain interference with catastrophism (r=0.70; p=0.002), anxiety (r= 0.49; p=0.05) and with the pain intensity itself (r=0.78; p=0.0003). Conclusion: Individuals who have chronic nonspecific neck pain and present some of the psychometric factors studied, have less quality of life, and more pain interference in their life.

Assessment of Pre-surgical Perception of Pain and Post-Surgical Pain in Patients Undergoing Dental Implant Placement Using Modified VAS Scale: A Clinical Study

Implants are the most preferred choice of treatment options for replacement of missing tooth or teeth for all age groups. Excellent long term survival rates make it a viable option for both simple and complex dental rehabilitations. Involvement of a surgical procedure for implants makes the patient anxious and develops a rejection towards the procedure. Research has shown anxiety to play a role in pain perception prior to surgical procedure. This study analyses the role of pain perception to actual pain experienced by subjects undergoing elective dental implant procedure and the role of age and gender in this assessment using a modified visual analog scale.

Evaluation of the Safety and the Influence of a W Whole Body Cryotherapy on the Level of Pain Perception and Functional Capacity of Patients at Different Age

Introduction: Whole body cryotherapy with kinesitherapy can potentially improve the everyday functioning of patients. The aim of the study was to assess the influence of whole body cryotherapy on the pain perception and functional efficiency of patients with pain syndromes in a different age and to assess the occurrence of adverse effects during treatment. Material and Methods: The study involved 40 patients with pain syndromes aged between 24 and 73 divided into 2 groups: group I (younger) up to 55 years old and group II (older) over 55 years old. The subjects underwent a series of 10 treatments of cryotherapy. The following tests were used to assess functional performance and pain: FTSST (Five Times Sit- to- Stand Test), TUG (Timed Up and Go Test), VAS (Visual Analogue Scale) Modified Pain Questionnaire according to Laitinen. Results: In the group I: the intensity of pain on the VAS scale was reduced after the first treatment (p=0.003); after a series of 10 treatments improvement in pain scales (VAS: p = 0.001, Laitinen Questionnaire: p = 0.002) and functional tests (TUG: p = 0.002, FTSST: p &lt;0.001) was obtained. In the group II: improvement in pain perception at VAS scale after first treatment (p = 0.01) was achieved and after a series of 10 treatments, functional improvement (TUG: p = 0.006, FTSST: p &lt;0.001) and in results in pain scales (VAS: p = 0.04, Laitinen questionnaire: p = 0.05) was obtained. Conclusions: Whole body cryotherapy with kinesitherapy contribute to the reduction of pain after only a single exposure, and after a series of 10 treatments occur to improve performance of functional tests. Cryotherapy may be associated with adverse effects, which are relatively rare, disappear quickly and do not endanger the life or health of patients. The age of patients has no significant effect on the final outcomes of therapy and on the occurrence of adverse effects.

Role of Virtual Reality in Pain Perception of Patients Following the Administration of Local Anesthesia.

Background:Dental anxiety and anxiety-related avoidance of dental care creates significant problems for the patients and dental practitioners. Administration of local anesthesia is one of the procedures which results in increased anxiety level among patients.Aim:The aim of this study was to study the effectiveness of virtual reality (VR) as a distraction tool during the administration of local anesthesia in patients undergoing a dental procedure.Materials and Methods:Fifty patients were randomized into two groups, namely, control group (n = 25) and study group (n = 25). Preoperative, intra-operative, and postoperative pulse rate and oxygen saturation were measured using pulse oximeter for all the patients. Local anesthesia was administered without the use of VR for the control group and with the VR for the study group.Statistical Analysis:The data were evaluated using the Statistical Package for the Social Sciences 20. Student's t-test was used to compare the variables.Results:Statistically significant results were obtained for preoperative and postoperative oxygen saturation, intraoperative pulse rate, and postoperative visual analog scale pain scale.Conclusion:The findings of the current study indicate that immersive VR is an effective distraction tool to alleviate the anxiety of the patient.

Effect of catechol-O-methyltransferase (rs4680) single-nucleotide polymorphism on opioid-induced hyperalgesia in adults with chronic pain.

The catechol-O-methyltransferase Val158Met polymorphism has been associated with alterations in pain perception, but the influence of the polymorphism on pain perception in patients with chronic pain receiving daily opioid therapy has not been previously reported. The primary aim of this study was to investigate the effects of the catechol-O-methyltransferase Val158Met polymorphism on heat pain perception in a cohort of adults receiving daily opioid therapy for chronic pain. Adults with chronic pain consecutively admitted to an outpatient pain rehabilitation program who met inclusion criteria and were receiving daily opioid therapy were recruited for study participation (N = 142). Individuals were genotyped for catechol-O-methyltransferase Val158Met (rs4680), and the polymorphism was analyzed using an additive and codominant genotype models. The distribution of the Val158Met genotypes was 25% for Val/Val, 41% for Val/Met and 34% for Met/Met (Hardy–Weinberg, P > 0.05). A main effect of genotype was observed for heat pain perception (P = 0.028). Under the codominant model of allele effects, exploratory post hoc pairwise comparisons adjusted for morphine equivalent dose and pain catastrophizing demonstrated that individuals with the Val/Met genotype were hyperalgesic compared to individuals with the Val/Val (P = 0.039) and Met/Met (P = 0.023) genotypes. No significant association was observed between heat pain perception and genotype under the additive model of allele effects. Among patients with chronic pain who were receiving daily opioids, the Val/Met genotype was associated with hyperalgesia using a measure of heat pain perception that has been previously indicative of opioid-induced hyperalgesia in other heterogeneous samples of adults with chronic pain. This study contributes to the emerging understanding of how catechol-O-methyltransferase activity affects pain perception in the context of daily opioid use, and these findings may be useful in the design of future trials aimed at investigating the potential efficacy of ß-2 adrenergic receptor antagonism for opioid-induced hyperalgesia.

The prevalence of restless legs syndrome and comorbid condition among patient with type 2 diabetic mellitus visiting primary healthcare.

Aim:The aim of this study was to determine the prevalence of restless legs syndrome (RLS) and Pittsburgh Sleep Quality Index (PSQI) in patients with type 2 diabetes mellitus (T2DM) attending primary healthcare.Subjects and Methods:This is a cross-sectional study and participants were between 25 and 70 years old who visited the diabetes and endocrinology department of Mega Medipol University Teaching Hospital, Istanbul. The diagnosis of RLS was performed according to the International Restless Legs Syndrome Study Group consensus criteria. The RLS and PSQI instruments were conducted on 871 patients with T2DM. Good sleep quality was defined as PSQI score <5. RLS severity was assessed by the Restless Legs Syndrome-6 Scales (RLS-6). The scale development and validation was carried out using Rasch measurement model.Results:The prevalence of RLS was 22.8% including 60.3% of females and 39.7% of males. This study showed significant differences between RLS and no RLS patients with respect to their age (years), body mass index (BMI) (kg/m2), physical activity, smoking habit, sheesha smoking, income, and sleeping quality with PSQI. Also, the analysis presented that statistically significant differences between both RLS and no RLS reported sleep complaints including difficulty falling asleep, inadequate sleep, anytime fatigue, and leg discomfort. There were statistically significant differences between RLS and no RLS patients regarding hypoglycemia, numbness in legs, retinopathy, neuropathy, nephropathy high blood pressure, depression, stroke, anemia, diabetic foot, ulcer, arthritis, respiratory disease, metabolic syndrome, and coronary heart disease. Furthermore, there were statistically significant differences between RLS and no RLS concerning the number of sleeping hours, wake-up time (AM), sleeping time (PM), BMI (kg/m2), HbA1c, vitamin D, calcium, creatinine, fasting blood glucose, low-density lipoprotein, triglyceride, uric acid, and systolic and diastolic blood pressure (mmHg).Conclusion:This study confirms positive relation and high prevalence of RLS among patients with T2DM visiting primary healthcare. The results suggest that physical activity is associated with a better perception of functional capacity and pain in diabetic patients with RLS, and thus a more active lifestyle should be encouraged.

CLINICAL EVALUATION OF THE EFFECTIVENESS OF THE DEVELOPED METHOD OF CONDUCTIVE ANESTHESIA OF THE FACIAL BRANCHES OF GREAT AURICULAR NERVE

The most common method of local anesthesia of maxillofacial region in the modern surgical practice is conductive anesthesia of the peripheral branches of trigeminal nerve. In order to reach the total anesthesia of the lateral facial region it is necessary to block not only auriculo-temporal and buccal nerves, but also facial branches of great auricular nerve taking part in the innervation of parotid-masticatory area and the part of the cheek. Topographic-anatomical investigations of corpses revealed the anatomical variability of the branching of great auricular nerve on the neck and the head. Taking into account the topographic-anatomical aspects of variability of innervation of the lateral facial region, we developed the method of conductive anesthesia of the facial branches of great auricular nerve. To evaluate the clinical effectiveness of the developed method of conductive anesthesia of the facial branches of great auricular nerve taking into account individual anatomical peculiarities of its branching in patients with the different forms of the skull. Clinical observations were conducted on 69 patients of different age (from 18 to 70) and sex (43 males and 26 females). Under the local anesthesia we conducted surgery in the parotid-masticatory region including: disclosure of the abscesses, excision of migrating granulomas or lymph nodes (in the cases of chronic hyperplastic lymphadenitis); excision of the benign tumors of the soft tissues (atheromas, lipomas, fibromas and keratoacanthomas), excision of the salivary fistulas and keloid scars. Depending on the used methods of local anesthesia of the soft tissues of the parotid-masticatory region the patients were divided into two clinical groups. The first group (30 patients) was exposed to conductive anesthesia of great auricular nerve by the method of P. Raj (2002). according to which the blockade of the nerve is conducted ahead the apex of mastoid process of the temporal bone. 39 patients after the signing of the written agreement were exposed to the developed method of conductive anesthesia of the facial branches of great auricular nerve. In order to detect the individual anatomical features of the facial part of the head in patients, the facial index was determined by the Garson`s formula. Pain sensitivity and perception in patients were studied using subjective and objective methods. The data were analysed by means of the Pearson’s chi–square tests. It is revealed that total anesthesia of the soft tissues of the parotid-masticatory region in all cases was reached in patients with euriprosopic face shape (broad-faced) – in 8 patients of the first clinical group and 10 patients of the second. The least effective was the anesthesia of the anterior branch of great auricular nerve conducted according to P. Raj’s method (2002) in patients with leptoprosopic face shape. In patients with leptoprosopic face shape of the second clinical group after administering anesthesia according to the developed method in 9 cases total anesthesia was reached, in 2 cases pain sensitivity in the inferior-anterior quadrant remained (χ2 = 5,70; р < 0,05). Generally, in patients of the first clinical group the method of conducted anesthesia by P. Raj was effective in 19 cases (63,3 %), and the developed method of conductive anesthesia of the facial branches of great auricular nerve – in 36 cases (92,3 %) – χ2 = 8,85, р < 0,01. The results of the research confirm that the developed method of conductive anesthesia of the facial branches of great auricular nerve is more effective in comparison to methods of anesthesia commonly used in today dentistry surgical practice. It allows to reach the total anesthesia of the soft tissues of the parotid-masticatory region in 92,3 % patients with different face shapes.

Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training.

Clinical Scenario: The anterior cruciate ligament is one of the major stabilizing ligaments of the knee joint by preventing anterior translation of the femur in the closed kinetic chain. A ruptured anterior cruciate ligament may require reconstructive surgery for patients who wish to return to physical activity. For the most part, surgeries are successful at repairing the ruptured ligament and restoring ligamentous function; the percentage of athletes that return to a competitive level of physical activity is only 44%, and 24% of patients report a main factor of preventing their return is fear of reinjury and pain. Most physiotherapy and rehabilitation research has focused on the physical treatment and is limited on the psychological aspects of recovery. Imagery has been suggested to be effective at reducing anxiety, tension, and pain, while promoting and encouraging healing after an injury. Imagery is defined as a process of performing a skill in one's mind using the senses (touch, feel, smell, vision, etc) without any overt actions. Clinical Question: In athletes who are first-time anterior cruciate ligament reconstruction patients, does imagery training in combination with standard physical therapy reduce the fear of reinjury and pain perception? Summary of Key Findings: Previous research has primarily looked at the physical treatment aspect, and few studies have focused on the psychological factors affecting recovery. Researchers concluded that fear of reinjury was the unique predictor of return to sport even in a sample of participants that reported very little or almost no pain at all. Imagery as a therapy is an effective intervention in reducing fear of reinjury and confidence building. Furthermore, mental imagery is suggested to assist with a reduction in anxiety, pain, and tension, while promoting healing. Clinical Bottom Line: Based on the strength of recommendation taxonomy, there is a combination of level A and B evidence proposing that imagery, in combination with traditional physical therapy, can be effective at reducing psychological distress such as fear of reinjury and pain perception in first-time anterior cruciate ligament reconstruction patients.

Impact of Depression or Anxiety on Opioid and Benzodiazepine Use in Hospitalized Hematopoietic Stem Cell Transplantation (HSCT) Recipients

INTRODUCTION:Patients undergoing HSCT are reported to have a high prevalence of depression and anxiety. These comorbid mood disorders have been known to be associated with alteration in pain perception in patients without hematological malignancies. Pharmacological compounds such as opioid and benzodiazepines are frequently used to manage patient symptomology including pain and anxiety. Patients undergoing HSCT are a unique population where the impact of depression and anxiety on opioid and benzodiazepine use has not been well studied.METHODS:The study population consisted of patients who underwent HSCT at a single center for a variety of hematological malignancies from 2015-2018. Opioid and benzodiazepine exposure and dosage was defined in a) Patients who were exposed to opioid including those who were previously exposed and those who were exposed during hospitalization for HSCT b) Patients who were neither exposed to opioid previously, nor during the hospitalization for HSCT. Depression and Anxiety was defined as per PHQ-9 and GAD-7 scales prior to hospital admission. Multivariable analysis was performed to identify differences in opioid status, previous benzodiazepine use, transplant type, Karnofsky score, gender, age, race, and marital status with associated Diazepam Equivalent Daily Dosage (DEDD) (Negative Binomial Regression), and Morphine Milligram Equivalent Daily Dosages (MMEDD) (Logistic and Zero Truncated Negative Binomial Regression).RESULTS:A total of 275 patients underwent HSCT including autologous and allogeneic from 2015-2018. Anxious or depressed HSCT recipients had an increased incidence of higher DEDD with an IRR of 1.69 (95% CI: 1.15, 2.49) compared to those who were neither depressed nor anxious (Figure 1). However, patients who reported anxiety and depression did not have a different DEDD than those not anxious nor depressed. In addition, patients who were not naïve to benzodiazepine use prior to admission had an increased incidence of a higher DEDD [IRR of 2.23 (95% CI: 1.61, 3.05)]. Patients undergoing autologous stem cell transplant had a decreased incidence of receiving a higher DEDD [IRR of 0.65 (95% CI: 0.47-0.90)]. African American and other populations had a decreased incidence of receiving a higher DEDD [IRR of 0.40 (95% CI: 0.27, 0.59)]. Patients receiving higher MMEDD had a higher DEDD incidence [IRR of 1.01 (95% CI: 1.01, 1.02)].Patients who were both anxious and depressed had increased odds of receiving an opioid [OR of 3.35 (95% CI: 1.62, 6.94)] compared to patients who were neither depressed nor anxious. However, patients who were either depressed or anxious did not have different odds of receiving an opioid compared to those who were neither depressed nor anxious. Patients undergoing autologous stem cell transplant had reduced odds of receiving an opioid [OR of 0.17 (95% CI: 0.07, 0.40)]. Patients with less than normal Karnofsky performance status (<90 on scale of 1-100) had an increased incidence of receiving a higher MMEDD [IRR of 2.34 (95% CI: 1.07, 5.12)] when modeled by Zero Truncated Negative Binomial Regression.Finally, HSCT recipients who were both anxious and depressed had reduced odds of being naïve to opioids [OR0.31 (95% CI: 0.15, 0.67)] compared to recipients who were neither depressed nor anxious. New opioid users had reduced odds of receiving a greater MMEDD [OR of 0.98 (95% CI: 0.96, 0.99)] when compared to previous users. In addition, autologous stem cell transplant recipients had reduced odds of receiving greater MMEDD compared to allogeneic transplant recipients (OR 0.33, 95% CI: 0.16, 0.66).CONCLUSION:Comorbid depression and /or anxiety impact opioid and benzodiazepine use in patients undergoing HSCT. The presence of these comorbid conditions and their association with increased use of opioids and benzodiazepines can also affect various health related outcomes. Larger studies are needed to fully understand the potential impact of this association on health related outcomes. DisclosuresKharfan-Dabaja:Incyte Corp: Speakers Bureau; Alexion Pharmaceuticals: Speakers Bureau; Seattle Genetics: Speakers Bureau. Ailawadhi:Amgen: Consultancy; Pharmacyclics: Research Funding; Celgene: Consultancy; Janssen: Consultancy; Takeda: Consultancy.

A Prospective, Randomized, Double-Blinded Controlled Trial Comparing Ibuprofen and Acetaminophen Versus Hydrocodone and Acetaminophen for Soft Tissue Hand Procedures

To compare the efficacy of opioid versus nonopioid analgesic regimens after elective, soft tissue hand surgery. We hypothesized that there would be no difference in patient-perceived pain relief between these 2 groups. This prospective, randomized, double-blinded controlled trial included patients undergoing elective soft tissue hand procedures (carpal tunnel release, trigger finger release, first dorsal compartment release, or ganglion cyst excision). Patients were randomized before surgery into 2 treatment groups: acetaminophen/hydrocodone 325/5 mg (AH, opioid group) or acetaminophen/ibuprofen 500/400 mg (AIBU, nonopioid group) and followed for 2 weeks after surgery evaluating daily pain intensity scores-visual analog scale (VAS), medication pain relief (Likert pain relief score), need for rescue opioid prescription at 1 week, and days until pain-free. Sixty patients were randomized, 30 in the AH group and 30 in the AIBU group. There was no difference in the average VAS score. There was improved pain relief in the AIBU group, but the difference did not reach significance. There was no difference in time until pain-free, with a median of 5 days in the AH group and 3 days in the AIBU group. Two patients in each group required rescue opioid medication. Side effects were significantly more common in the AH group (n= 7; 23%) than the AIBU group (n= 1; 3%), but none were severe. We recommend surgeons consider a combination of acetaminophen and ibuprofen as a safe and effective postoperative pain regimen for soft tissue hand surgery procedures. Therapeutic I.

Cryoablation with an 8-mm tip catheter in the treatment of atrioventricular nodal re-entrant tachycardia: results from a randomized controlled trial (CRYOABLATE)

This was a randomized controlled study performed to compare 8 mm-tip catheter cryoablation (CRYO) with radiofrequency ablation (RFA) in treating atrioventricular nodal re-entrant tachycardia (AVNRT). A total of 158 patients (103 women, mean age 48.9 ± 14.1) with symptomatic AVNRT (140 typical; 18 atypical) were randomized to undergo CRYO with an 8 mm-tip catheter (n = 80) or RFA (n = 78). The primary endpoint was a composite of acute procedural failure, inadvertent permanent atrioventricular block (AVB) and recurrence at 12 months. No significant difference was observed between CRYO and RFA groups in primary endpoint (7.5 vs. 11.5%; P = 0.764), 12-month recurrence rate (3.8 vs. 1.3%; P = 0.358), inadvertent permanent AVB (0 vs. 1.3%; P = 0.307), and acute procedural failure (3.7 vs. 9%; P = 0.128). In patients with acute procedure failure, success was achieved in 5 of 7 patients (71.4%) in RFA group and 2 of 3 patients (66.7%) in CRYO group on cross-over. There was no significant difference in procedural duration between CRYO and RFA groups (72.4 ± 41.6 vs. 63.7 ± 29.8 min; P = 0.13), but fluoroscopic duration in CRYO group was significantly shorter (3.4 ± 6.3 vs. 6.7 ± 7.4 min; P = 0.005). Patient pain score (2.7 ± 2.7 vs. 4.6 ± 2.7; P < 0.001) and operator stress score (2.3 ± 1.3 vs. 4.9 ± 2; P < 0.001) were significantly lower in CRYO group. Cryoablation with an 8 mm-tip catheter is shown to be comparable to RFA in treating AVNRT in terms of efficacy and safety. Additional advantages in CRYO include shorter fluoroscopic time, lower patient pain perception, and operator stress level.